August 27, 2015

v.i.Prose: “Consider this Case,” a story by Melissa Yancy

Photo Melissa Yancy

 

Melissa Yancy’s story “Consider this Case” explores the fraught relationship between a gay fetal surgeon and his terminally ill father. It was selected as our Jeffrey E. Smith Editors’ Prize winner in fiction for 2013. Yancy’s work has also appeared in Glimmer Train, One Story, Prairie Schooner, American Literary Review and elsewhere. She lives in Los Angeles and works in the nonprofit world.

Consider this Case

By Melissa Yancy 

This is the one day each year they come to him, enshrouded in blankets and footed rompers, matching sets of pink plaids and blue stars or T-shirts proudly declaring personal interests in trucks or ladybugs. Nowhere else do so many twins and triplets, all under the age of five, congregate en masse. Julian, stationed with a chair and a photographer, looks something like a wasting Santa Claus. He scoops them up—one in each arm if they are small enough—to smile for the camera. The babies rarely cry. They touch his thick eyebrows, his prominent nose. They have to be coaxed to look at the photographer.

The reunion is one of Julian’s favorite days each year. It is the only day he works in the sunlight, one of the few times he allows himself to relax. He spends half his life in the operating room. The lawn between the hospital and the parking garage has been set up with rental tables and a tent, and a food truck stationed in the entry drive serves burgers to the families. Older children, now four and five, race around the perimeter with blades of grass stuck to their sweaty faces, waving their sticky Popsicle fingers—exhibiting their dominion over this place, their right to be.

He first encountered these children as fetuses. The same jokes get told. From him: “I knew you when!” From the parents of the triplet toddlers: “Did you have to save all of them?”

After lunch, the photographer sets up for the annual group photo, positioning Julian in the center of the crowd. She perches high on an A-frame ladder, directing the dozens of children. More tables have to be cleared to fit everyone.

They are nearly in position, ready for the group wave, when the telephone in his pocket vibrates. It is his sister, Liv, calling from London; she never calls just to talk to him. Everyone in his family has this uncanny ability to call at the worst possible moment, usually to deliver bad news.

“It’s Father,” Liv whispers through the phone, as though their father hovers nearby. “It’s time. He can’t be in-de-pen-dent anymore.”

“Why are you whis-per-ing?” Julian mimics. “I can barely hear you.” All around him hips bob, pacifiers are offered. A few toddlers are chased down at the fringe.

“I can feel his anger from across the Atlantic,” she says.

The photographer gesticulates like a conductor. It is time to wave, time to smile.

He misses half of what his sister says, but he knows what she’s asking of him. He tells her to hold, smiles for the camera. Then he excuses himself and squeezes through to the edge of the lawn.

“He only has a couple of months,” his sister says. “It’s not like a permanent situation.”

“Life is not a permanent situation,” Julian says.

Liv is an actress, currently on the West End. Their mother is long dead. Their younger brother Jay is also dead, from an overdose that may or may not have been accidental. Their father is still at home in Virginia, which makes Julian, all the way in Los Angeles, his nearest relative. Julian offers to pay for residential care, but this is not what his sister has in mind.

“He needs to be in hospice,” Julian says.

“You could get a nurse to come to the house every day. And you have the space.”

“He’ll try to redecorate,” he says.

“So what?” she says. “The place could use a woman’s touch.”

 

At the airport, Julian parks the car and goes to wait inside, in the cordoned-off area where they allow it. He can’t remember the last time he has gone to the trouble to do this.

“They don’t let you come to the gate?” is the first thing his father says. “So much for welcomes.”

He is wearing a seersucker blazer and tan slacks and a tie with a print of tiny sailboats. His loafers look brand new. His father looks around at the abundance of flesh, flip-flops and bedazzled sweat suits.

“It’s like the apocalypse,” his father says. “Like everyone was looting, and this was all they could find to wear.”

“It’s the West Coast, Dad.”

“It’s something, all right.”

He has brought only two bags—a matching leather set—and tells Julian that he has sent his other belongings through “the United Parcel Service.” He has a lifelong aversion to acronyms and abbreviations.

Perhaps his father will be impressed by the location of his house, if nothing else, Julian thinks. Some people are taken with Malibu. But the weather hasn’t entirely cooperated. When they arrive at the beach, it is dull and brown outside. Julian’s house, like most of the homes in his neighborhood, is unimpressive from the street, just a simple clapboard square wedged between the highway and the ocean. But when you step through the front door, the highway seems to recede, and the water extends in front, giving the sensation, as the enthusiastic realtor had called it, of “having stepped off the continent.”

But the ocean view from Julian’s living room might as well be of a cinder block wall for all the impact it makes on his father. It’s cold like a Rothko out there.

His father eyes the floating staircase in the modern house. Julian has almost forgotten that his father is truly ill. His hair is white but still thick, with the soft sheen of old age. His posture is erect, too, but the footsteps are smaller, nearly a shuffle. Julian has rearranged things so the space he uses as a downstairs office can serve as his father’s room. He goes to help him unpack, but his father pushes his hand away hard.

At dinner, Julian tries to remember ever having sat alone like this across from his father at a meal. When his siblings were in college, there were times his mother went out to play bridge with her friends. But had they sat together, or retreated into their rooms? Julian only remembers how hollow the house had felt in his mother’s absence. Even though his father selected and arranged most of the décor, he never seemed to inhabit the house in the way Julian’s mother did. Without her, none of them knew how to behave as family members. She’d had to keep reminding them, like children, to share, to set a good example for their siblings, to call on each other’s birthdays.

“I didn’t know you could cook,” his father says. Julian has made penne with sausage and greens and French bread. He remembers his father’s weakness for the tang of fresh bread.

“Mom taught me in high school,” he says. “So I could fend for myself in college.”

They talk of Washington. His father chronicles the current first lady’s fashion in great detail. A glimmer comes into his eye. Her style is classic, he tells Julian, but fresh and bold. He is particularly pleased with a recent mint shell paired with a coral pencil skirt. There have been missteps, too, he reports. He did not care for an ombré evening dress. “It looked like she had been wading in mud,” he says.

He stares at his son, as though he too will feel sufficiently worked up about ombré. Julian does not know what ombré is.

“You know,” his father says, pushing himself back from the table and eyeing the open floor plan, “modernity is all about poverty. Cheap reproduction and delivery to the masses. Like that case study house the Eameses lived in. That house looked like a rabbit’s warren.”

It is not so much Julian’s taste that bothers his father but his disinterest in taste, his failure to take a position. Julian has delegated the furnishing of the house to his friends who care about that sort of thing. He knows his father associates this disinterest with his career, with a predilection for science, when in fact it was cultivated in childhood, a path of least resistance to his father.

“A warren has mounds and tunnels,” Julian says. “It hardly looks like a box.”

“I was speaking metaphorically of the specks of junk everywhere. And the terrible use of textile.”

Julian wants to laugh. But his father is deeply serious about the “terrible use of textile,” whatever that could possibly mean.

“How are you feeling?” Julian asks. He begins to think his sister has tricked him, that his father has years more to live.

“Quite well. Physically, I mean. Aesthetically, I am suffering at the moment.”

 

Despite his father’s protests, Julian takes him to see one of his friends in oncology at the hospital. Walking in through the sliding front doors with his father beside him—when he usually enters from the staff entrance at the rear—he no longer feels ownership over the place. He feels almost out-of-body, as though he’s never worked there at all.

His friend confirms that the lung cancer is stage IV, the kind that, to his father’s great pleasure, will kill him quickly. His father is the sort of man who will gladly choose death over loss of dignity. He is known, in fact, for pronouncing death as a preference to many things: American cheese, West Texas and prime time television, to name a few.

The oncologist prescribes pain medication and says they can get an oxygen tank for the evenings if Julian’s father gets short of breath. The oncologist keeps telling Julian how lucky he is. The cancer is killing his father softly. Julian thinks that’s a strange way to put it. He pictures the cancer kissing his father all over his body, spreading until its lips cover his, until it snuffs out his breath.

 

To get out of the house, Julian agrees to attend a political fundraiser at the home of a wealthy philanthropist. One of his nurses, Terri, has convinced him that a few eligible bachelors will attend. Julian’s nurses, all women, are like a tribe, and he has given himself over to them completely. Most of them have known him since medical school, and even though he is only 43, they treat him like a helpless old man, picking out his car, his furniture, and arranging his kitchen cabinets. For the fundraiser, Terri has picked out his clothes; Julian spends his days in scrubs and is always at a loss when he approaches his closet.

He wears a tapered suit and a skinny tie that strikes him as too feminine. The house where the party is held is indiscriminately ostentatious—a style a realtor might call Mediterranean—and with his cocktail in hand, Julian feels like an extra who has stumbled onto a bad set. He keeps catching glimpses of himself in the large gilded mirrors that fill the home’s foyer. Some of the mirrors high on the wall are strung by wire and angled, giving a birds-eye view of the guests. He sees that he is getting balder on top. He has hair everywhere except his head. Why hasn’t he noticed this before?

Terri introduces him to an architect, a handsome man with the confidence of the newly, rather than perennially, single. Julian feels himself shrink beside him. On the subject of his work, the subject that should give him confidence, he falters. How he describes his profession is always calibrated to the listener: he calls himself a doctor, or an ob-gyn, or a fetal surgeon, depending on the kind of conversation he wants to discourage or engender.

He settles on doctor.

“Is it too cliché to ask you about health care reform?” the architect says. “Normally I wouldn’t talk politics, but I suppose that’s why we’re here.” He smiles. He is one of those men who age well, Julian thinks; he undoubtedly looks better than he did fifteen years ago. His teeth are so tidy and white. Sometimes Julian feels angry at those men.

“I’m for it,” Julian says flatly, “if that’s what you want to know. Although it doesn’t impact my patients. Fetuses. They don’t really have a status.” His patients, in fact, are the mothers, but he spends his days in the womb.

He waits for a reaction. The word “fetus” carries a charge for anyone who is not a physician. And yet he throws it out there like smut.

He sees the architect formulating a question, wondering if he is a quack or an abortion doctor or just being funny.

“I imagine it’s hard to bill and collect,” the architect says. “Fetuses tend to have a weak credit history.”

Julian actually smiles. Why has he been an asshole? “I’m getting another,” Julian says. “Would you like me to bring you anything?”

But the architect shakes his head.

At the end of the night, Julian goes out back to get some air. One of the caterers is smoking a cigarette. He is scrawny and fey, and Julian feels more comfortable out there with him.

“What’s this party about?” the boy asks.

“Politics,” Julian says.

“I got that much. For what?”

Julian is a gay man who saves fetuses and performs medical research on sheep: he is always an abomination to someone. He is accustomed to strange political company.

Julian shrugs. “Our side,” he says.

 

 

He has a new triplet case referred from one of the status hospitals in town. Most of the families seem impossibly young to Julian, but not this one. The mother is an executive in her forties, pregnant with triplets because of in vitro fertilization. “An embarrassment of riches,” she says to Julian, as they sit waiting for the father to arrive. He is a television producer, she explains, and it is difficult for him to get away during the day. When the father arrives and takes a seat, he keeps his cell phone balanced on his knee.

Terri sits beside the family while Julian tells them what is happening. He explains that even though the babies are in their own amniotic sacs, they share the placenta. Two of the babies aren’t sharing the placenta equally because of a problem in the connected blood vessels. One baby is providing too much blood to the other. On the ultrasound, Julian points out the donor and the donee. The donor is dangerously small and can’t urinate enough to make amniotic fluid. The baby could become shrink-wrapped in its own sac. The donee has too much blood, too much urine, and its tiny heart is working far too hard.

“You mean they pee in there?” the father says.

“Well,” Julian says. “As the pregnancy progresses, more of the amniotic fluid is made up of urine.”

The man looks over at his wife. “I guess that makes sense.” “What about the third one?” the mother says, running her hand over her stomach.

“He’s an innocent bystander,” Julian explains. “Off to the side doing his own thing.”

If they do nothing, at least one and maybe both of the twins will die. The parents understand, so they agree to the surgery.

“Three,” the father says. “We’re going to need a bigger house.”

Julian and Jay and Liv had been three, but they came in a trickle instead of a flood: Jay two years after Liv, Julian two years after Jay. His brother had been the reckless one, the one who gleamed—not on stage or in the darkness of an operating room or in Washington but in life, with real people, when intimacy was actually required. Jay’s death had broken their hearts. When Julian thinks of his father as a father and a husband, his mind always goes to Jay’s funeral, which stands like a wall between the father of his childhood and the one he now knows. His father refused at first to attend the service, but his mother wouldn’t allow it; in her usual way, she forced them to behave as a family. But he wouldn’t comfort their mother. He wouldn’t lay a hand on her at all.

At the time, Julian had hated his father for his stoicism, what had felt like a rejection of each of them. It was his sister who had explained, “He’s ashamed, Julian. You don’t see that? His son died from addiction.”

Liv spent her life inhabiting people—not invading the body, the way Julian did but gaining entry in ways that led to different understandings. He was envious of that sometimes.

“Jay was sick,” Julian said. “He can’t treat this like an affront to his manners.”

If their father acknowledged that shame, Liv told him, if he allowed himself to live in it, he would expose himself to deeper shame, shame he would not be able to manage. This was a fragile little carapace, she said.

Carapace, Julian thought. Like a crab, like cancer. He had never thought of it that way: emotion could explode that shell, letting what was soft and rotten inside metastasize throughout the body.

“But what’s he got to be so ashamed of?” Julian said.

Liv only put her hand on his shoulder and shook her head.

 

The surgery does not go easily. Julian cannot insert the scope in the usual place because of the innocent bystander. He will have to work around the third baby.

The surgery begins as it normally does. His nurses stand off to the side of the operating room watching the monitors; they help him find the vascular equator and build the roadmap of large and small veins that he will ablate. But it is cloudy in the uterus, the turbid amniotic fluid like watery milk speckled with mucus. Just finding all the connections takes him twenty minutes. He can often finish a surgery in that amount of time.

He has to pump in Ranger’s solution for visibility, then use the diagnostic scope to get a look at the spot he is going to laser. But when he pulls the scope out and slides the laser into the cannula, the landscape has already gone cloudy again. It feels like he is walking down a dark hall, brushing cobwebs out of his face all the way.

The babies won’t stay where he wants them. When the solution rushes in, one of the babies raises his hand up to feel the water moving against his palm. He closes his fingers to grab onto the scope. Normally, Julian finds this cute. Sometimes he will even point this out to the mother if she is alert enough.

“I need you to scoot over, baby,” he says.

He has to find a rhythm, and the rhythm is fast: he has to add the solution, put the diagnostic scope in, find the next connection, then whip out the scope and get the laser in while he can still see. But he keeps getting lost. He gets a large vein that should have been adjacent to two smaller ones, but the smaller ones are not there.

“How many are left?” he asks Terri.

“Three large, five small,” she says.

“Scope,” he barks. “Scope, scope, scope.”

“How many are left?” He asks it a dozen times. He needs to hear Terri’s voice telling him that he is almost there.

“We’re winning,” he finally says. “Did we get them all?”

“Last one,” Terri says.

It doesn’t feel like the last one. It still feels like new veins are proliferating, swelling with blood when his eyes are closed.

 

When he gets home, the house is empty. He goes to his father’s room, where antique whale-oil lamps and Canton vases now cover the midcentury dresser. At the far end, closest to the bed, his father has set out a series of frames—photos of himself with American presidents and visiting shahs and kings. In the largest photo, he and Pat Nixon stand in the Green Room, one of dozens of rooms they had rescued, in his words, from Mrs. Kennedy’s handiwork. His father spent almost thirty years redecorating the State Department’s diplomatic reception rooms and then curating the White House, but it was only Pat who really let him have his way.

His eyes go to one photograph of his father alone. The photograph is more recent, yet in it he looks more youthful than he does in the older pictures: he wears a yellow-and-green floral blazer with creased cream pants and black-and-brown saddle shoes. He is leaning back against a wall of black-and-white Moroccan tile in what looks like an exotic locale. The photograph looks professional.

“Excuse me.” His father has propped himself in the doorway behind him.

“Where have you been?” Julian says.

“For a walk.”

“On the beach or the highway?”

“I found a little tributary,” his father says, making his way slowly to the corner chair. “Who lives in a place where there’s nowhere to take a walk? Private beaches. Hmmph.”

“Where’s the nurse?”

His father leans back and closes his eyes. “I let her go, I’m afraid. She wasn’t amenable to my shopping trip. She was supposed to be a nurse, not a warden.”

“But she was in my employ,” Julian says.

“Please. It’s a service. They’ll send a new one tomorrow.”

Julian stands there, waiting for his father to open his eyes.

He phones the nurse. “I’m so sorry, doctor,” she says, before he has even begun. “He wanted to go shopping for antique furniture. He said he was going to have a mover come and take your furniture out of the room. He had a list of the furniture he needed to buy. I told him we couldn’t go, not until we spoke to you.”

Once, when Liv was eight and away at summer camp, their father had redecorated her room. She’d wanted a princess room—in the pedestrian pink sense of princess—but she’d returned to find a room that was practically Elizabethan. Julian hasn’t thought of it in years—the big reveal, his sister squealing, dancing through the velvet drapes that hung from the four=poster bed, gesturing as though about to give a monologue. He always thinks of his father as a disinterested figure hovering at the edge of their childhoods. But perhaps it is Julian who wasn’t interested in him.

“You did the right thing, of course,” he says. “You’re not fired. You should come back tomorrow.”’

“They’ve already reassigned me. I think it’s for the best,” she says. “He requested a male nurse.”

 

The architect calls. Julian has so excluded this possibility—they had not exchanged information, for one thing—that he sits there dumbly on the phone, wondering if his father has called an architect to redesign his house.

“It’s Wesley,” he says. “From the fundraiser,” he says. “Do you remember me?”

“Of course,” he says. He didn’t remember even learning the man’s name. He has thought of him only thought of him as the architect. “I didn’t expect to hear from you. How did you find my number?”

“Terri.”

“Oh, yes. I must not sound too resourceful.”

“She also told me you’re more charming than you came across.”

“Is that so?” Julian says. He should just admit to having been intimidated by the architect’s good looks. But he can’t manage it.

“I thought I’d give you the opportunity to redeem yourself,” he says.

 

The architect wants to see Julian’s house, so he invites him over for the date, with the reassurance that his father will keep himself entertained. The housekeeper has just come, but Julian patrols the house for anything to straighten.

His father comes out of the guest room. “I thought you were having company,” he says.

“He should be here soon,” he says.

“Then why do you look like a farmer?”

Julian has put on a thin denim button-down and tucked it into his khakis. He does not look anything like a farmer in these clothes, but he does not feel like himself, either.

“It’s unstudied gay,” he says to his father. His father hates it when he says the word “gay” aloud.

His father comes over and lifts his reading glasses up.

“This look is neither happy nor what I would deem homosexual,” he says. “So it fails both senses of the word. Why don’t you put on a nice striped shirt?”

So Julian does. He looks like a junior professor, but he feels more comfortable. When he comes back, his father has poured himself a drink.

“Let me give you a word of advice, son.” He pauses for effect. “You may live in California now, but nothing about you will ever be unstudied. This house, your clothes, your gait. It is not in your blood.”

The architect arrives, wearing a light blue V-neck sweater, linen shorts and loafers, his salt-and-pepper hair effortlessly combed back with natural wave. Apparently the look is in his blood. Julian feels an unexpected charge, seeing the man on his doorstep like that. Perhaps it’s because he brings so few men home that it makes him feel familiar, as though their relationship has already progressed past awkward beginnings.

When Julian brings him into the kitchen, his father has thankfully disappeared. Julian opens one of his best bottles of white wine—he knows nothing about wine, but one of his tribe has stocked the cooler with the cheap ones on top, ones for entertaining on the bottomand pours them both a glass.

The architect has wandered off and is showing himself around the living room. “Occupational hazard,” he says when Julian brings him the wine. “I tend to help myself around other people’s homes.”

“You probably think you can tell a lot about a person by their house and what’s in it,” Julian says. “But not me. I haven’t picked any of this.”

“What could be more telling than that?” he says.

They sit on the couch that faces the ocean. It is dark already, and Julian has left just one lamp on in the living room. He apologizes for his behavior at the party. “I can’t imagine what would have made you call. Was it my incredible charm, my sense of style? It must have been my body.”

The architect just smiles. Julian can smell ginger and amber on his skin. It makes him want to lean in.

His father comes out—for a glass of water, he claims—and the architect gets up to greet him. A consequence of being well-bred.

His father picks up the bottle of wine. “And what are we having, Wesley?”

Wesley falls for it all. He offers to pour. He insists that Julian’s father join them for a drink, and suddenly Wesley and Julian are not knee-to-knee on the couch but outside on the deck chairs because his father thinks they need some ocean air. Julian goes to fetch blankets for them, and when he returns, his father and Wesley are laughing like old friends. He stands in the living room for a moment, watching. His father leans in, the way he does when he approves, when he wants to know more.

“Your father was just telling me about his career,” Wesley says. “About a certain naughty first lady who kept gilding the silver fixtures.”

“I thought an architect could appreciate my stories,” his father says.

“I think most people would,” Wesley says. “Everyone is fascinated by first families.”

“And did you share your thoughts on architecture?” Julian asks his father. “The modernism-poverty-communism speech?”

The architect frowns: Julian is being mean again. So Julian wraps his father in the cashmere blanket and prepares himself to endure.

He knows the stories. His father’s favorite is how he swindled collectors by asking to borrow their favorite pieces of art and furniture to have them reproduced, only to place the originals in the White House and slyly suggest that this was the more fitting home. Some of them—either too stunned to protest or flattered to see their belongings take residence in the White House—had agreed to give the originals up.

Wesley looks charmed. He asks about the first ladies, the marriages, the changes in what constituted formal entertaining. His father could have rivaled Emily Post in the area of social graces; it was the intimacy of domestic life behind closed doors that seemed to paralyze him.

“This is fascinating,” Wesley says.

“You really think so?” his father says. “That’s nice of you to say. I didn’t suppose we would be discussing all this this evening.”

“Nor did I,” Julian says.

“Could you top me off?” his father asks Wesley.

“I’ll get it,” Julian says, but Wesley is already up, leaning over his father.

“Wherever did you meet my son?” he asks now. “Do you run in the same circles?” He says this as though that couldn’t possibly be the case.

“It was at a political event. Although he didn’t seem interested in the politics. Or in me.”

“Oh, never mind that,” Julian’s father says. “See his face right now? That’s interested. That’s what a surgeon looks like skydiving.”

The wind is coming through Julian’s blanket and reaching his toes. He has been hiding them not just for warmth but out of vanity, too. He almost has more hair on his toes than on his head.

“Dad, aren’t you cold?” Julian says.

“Who cares? I’m dying. I should enjoy it. Maybe I’ll never feel wind like this again.”

“How about we not accelerate death?” Julian says. “The wind will still be here tomorrow.”

It is a long good-bye. His father shakes Wesley’s hand in both of his, grasping onto him like a railing. Wesley kisses his father’s cheek.

It is a chore to get his father back into his room. He wants water from the kitchen, then a magazine from upstairs. With his father in bed, they move back into the house, onto the long gray sectional again. But Julian can’t completely relax. This is what it must be like to have small children. Even once they are in bed, the parent is still spring-loaded, ready to go into action.

“Is he very ill?” Wesley asks. “He looks so healthy.”

“Either that or my sister lied to me,” Julian says.

“It must be interesting to have a father who’s gay,” Wesley says. “I’ve always kind of wondered what that would be like. How it might have made me different.”

“He is not gay,” Julian says.

“Oh. But—” Wesley sits back against the couch with a strange smile on his face.

“What?”

“I misunderstood. I completely misunderstood.”

“He’s Southern,” Julian says. “He’s deeply Southern.”

 

His father has no complaints about his new nurse, although Julian comes home every day in fear of a home remodel. But his father no longer has the energy to coordinate an attack. His health is diminishing in a quiet, almost invisible way not noticeable day-to-day; yet it’s markedly worse than when he arrived.

The nurse gives Julian thorough reports, even sharing news from Liv, who calls a few afternoons a week, just after her evening show is over. Julian supposes the time zone is to blame, but she never calls when Julian is home.

Julian tries to sit with his father, but he rarely looks up from his biographies. “What does he do all day when I’m gone?” Julian asks the nurse.

“Reads. And asks me to talk to him. He seems to think my life is a telenovela. He wants to know all about the romance.”

At work, Julian has a breakthrough. For a year, he and his collaborators in engineering and cardiology have been trying to implant a fetal pacemaker onto the tiny heart of a sheep fetus, spending long afternoons at the research barrack at the edge of the medical center. They’ve been working with a small intramural grant from the hospital’s research institute, an award that covers the cost of the sheep and the anesthesiologist’s time, and not much else. The team uses sheep because of the ewe’s paper-thin uterus, the way it lights up like a zeppelin, all the ramuscles and arcades easy to trace. Today, for the first time, the prototype of the pacemaker has stayed put. It is the kind of career news a person wants to share, however difficult it is to explain. He drives home thinking of telling his father, how he could relay its significance, if he wanted to.

But when he arrives, the architect, the nurse and his father are all having drinks in his living room.

“Join us,” his father says. “We were just getting started.”

Wesley turns to Julian apologetically. “I was down the street visiting a client. I thought I would stop in.”

“Stop looking so scandalized,” his father says. “We were just swapping stories of Rio.”

“You’ve never been to Rio,” Julian says.

The nurse gets up and comes to him, wrapping an arm around Julian’s shoulder and pulling him into the kitchen. Julian flinches at his touch.

“It’s happening,” the nurse says.

“He’s never been to Rio,” Julian repeats.

“Listen to me,” the nurse says. “It’ll be fast, now.”

“Should he be drinking?”

“The drink is weak. A little is fine. It’ll help the pain.”

“He’s in pain?”

“Why don’t you join them?” the nurse says.

But when the nurse heads home, Wesley gets up, too. It is only later that Julian realizes this is because his father wants a moment with him. He wants to show him the outfit he’d like to be buried in. “I already showed it to them. Both approved.”

“Dad.”

“It’s happening soon enough. And you think I’m going to let you pick it out?” he says. “You’ll dress me like it’s my first dance.”

He follows his father to the bedroom, where he rolls open the left hand side of the closet. On a wooden hanger is a cream-colored evening suit. His father lifts the hanger off the rod and pulls it out, gently running his hands along the back of the suit to show it to Julian. Next, he holds up a light teal dress shirt with French cuffs.

“When have you ever worn that?” Julian asks.

“If you can’t be yourself when you’re dead, when can you be?”

His father maneuvers past the bed to the dresser. From the top drawer, he pulls out a pocket square, then sits down on the bed.

“This is the most important piece,” he says, fingering the cloth. “Come look at this.”

Julian sits down on the bed beside him. His father holds a small printed square of teal, cream and coral. He is staring at it as though looking at a photograph.

“This is a medallion print,” he says. “That’s a man’s word for flower. They didn’t used to use the word flower for anything for men.”

The medallions are lined up in neat military rows, rimmed by a teal border. He holds it up to Julian. “See this? These are hand-rolled edges, not machine finished. See how plump they make it? This is what you’re looking for.”

He lays the square out across his knee, and Julian sees how slim his father’s leg has become. “I haven’t taught you these things,” he says. He folds the square neatly. Julian rises and opens the top drawer for him. “Perhaps the architect can attend to these things when I’m gone,” his father says.

 

 

Julian is washing up from supper when he hears his father cry out. He almost doesn’t recognize the sound at first—it is high and muffled, like a cat’s scream. He runs to the bedroom and, finding it empty, realizes his father must be in the bathroom. The door is locked.

“Can you unlock the door?” he asks.

His father moans. “Leave me be,” he says. His voice is coming from a low point; it sounds as though he’s on the floor.

“Did you fall? Can you reach the lock?”

“I must have eaten something that disagreed with me,” he says. Despite his father’s best efforts, Julian can hear the high pitch of pain. “Call the nurse,” his father says.

“He’s gone home. I’m here now.”

“He’ll come back if you ask.”

“I’m a physician, Dad.” Julian presses his ear to the door.

“I don’t have a uterus,” his father says.

“Jesus Christ, Dad.” Julian bangs on the door with the side of his fist. “Can you reach the lock? Let me in.” He listens through the door but hears nothing. “I’m a doctor,” he says.

The hole on the outside of the doorknob is very small, so Julian gets an ice pick from the kitchen, comes back and drops to his knees to get a better view of the outside of the privacy lock. He threads the ice pick in and feels around for the groove, but the pick won’t catch. He tries a few different angles with no luck. He could get a paperclip, but it would be no better. He is a surgeon, and he cannot unlock a privacy door. He jams the ice pick in lazily, like a child without a strategy. He needs a tiny screwdriver, the kind used for eyeglasses. His father might have one in the dresser. He is about to go searching for it when the lock clicks.

Julian opens the door and stands there with the ice pick still in hand. His father is wet, prone on the floor between the shower and the toilet; there is a smear of feces across the floor in front of him, and Julian cannot quite piece together the order of events. Without his clothes on, his father looks more than naked—he is a sea creature yanked from its shell.

The intensity of residency is meant for moments like this; it leaves a muscle memory that is more like a scar. Although the son wants to scoop his father up, the doctor knows better. He assesses him first, and only when he finds nothing broken, no signs of internal injury, does he carefully lift him up and set him down in the shower chair, where he can wipe off the feces with a warm rag. The son doesn’t really see his father—only the doctor does. It is not until later, after he has dried his father and put him in his proper pajama set and gone to sleep out on the couch so that he can come to him in the night, that he closes his eyes and finally sees his drooping breasts, the last tuft of hair sprouting proudly on his concave chest, his skin so opaque it’s a roadmap, a surgeon’s dream.

 

 

He cancels all his work except for surgeries. Those cannot wait. The next closest fetal surgeon is in San Francisco, and, like Julian, he is always at capacity.

At home, his father sleeps most of the days. He calls Liv, and she arranges to come to Los Angeles for a three-day trip in two weeks. Julian wanders and waits. He edits a journal article he has been putting off. He cleans his home office. He works in a hospital, yet he knows nothing about illness, not really.

One morning, his father wants to take his tea in the living room and watch the morning light on the water. There is no fog, and the ocean looks lit from within. Julian sits with him. They are both wearing robes and slippers as if it is Christmas morning. His parents always wore matching robes, which, as a child, Julian interpreted as a symbol of deep love. It is hard to clearly remember his parents on a holiday morning; the memory of his own anticipation is stronger. He remembers running downstairs without using the bathroom, trying hard not to pee on the floor by the Christmas tree. He can see the extravagance of the house, perfectly decorated with old-fashioned ornaments his father liked: lace snowflakes, golden orbs, wooden Santas carrying trees. He can see his father leaning forward in his high-backed chair that he positioned near the tree, while his mother sat with her legs tucked up beneath her on the end of the couch.

“I can’t complain about this view,” his father says. “Although it could get lonely looking out at this.”

“It does,” Julian admits.

“Trees make me feel insulated,” his father says. “You and your sister always had a higher tolerance for loneliness. In different ways. She’s surrounded by people, of course. But there’s no lonelier life. Jay was always more like me. Looking for something to fill it.”

His father never speaks of Jay and certainly not in relation to himself. “I hadn’t thought of it that way,” Julian says carefully. “As you two being alike.”

“Unfortunately for Jay, I’m afraid so,” he says. “But you—the work you do. I don’t know what kind of person one has to be to do that. It frightens me. I thought it was crazy enough when you decided to study gynecology.”

Julian tells his father about the pacemaker, about the federal funding he could get. He does not fill in the gaps or explain that he researches on sheep. He tells him instead what it could mean for the babies.

“The lengths a person will go to to bring a child into this world,” his father says. “It’s the only thing that still astonishes me. People are so predictable in other matters. But not this.” He is looking out at the water, the rim of the cup grazing his lips. Julian feels he has stepped into a private moment that perhaps he shouldn’t be witnessing.

“Look at me, for example,” his father says. “Consider this case.”

“Yes?” Julian asks.

His father turns to face him. “Look at me,” he says.

Julian is looking. His father is a shrunken man, skin now barely hiding what lies beneath. And yet somehow he still looks royal.

Julian has always believed he and his siblings were a nuisance or a social obligation to be fulfilled. He has been telling himself a particular story for so long—has had, in physician terms, a cognitive disposition to respond, the kind of bias that leads to errors in diagnosis. As a boy, he could identify the symptom: a coldness that swept over their home. But the only cause he could attach to it was his father’s preoccupation with his work. He had understood the work to be the cause, but what if it had been the compensation, instead?

“It’s been worth it,” his father says. “You and your sister and Jay. I know that you’re more than a doctor. I’ve understood that all along. But that’s exactly what I’m afraid of. When all I want for you is a great love. That’s all I want for your sister, too. That’s what I wanted for all of you. And yet I suspect I did the thing that has made that impossible for you.”

In medical school, Julian thinks, they would call his blindness “anchoring”: the tendency to lock on to salient features in a patient’s initial presentation and fail to adjust in the light of later, contradictory information. Julian reenvisions his father’s life now—a life, as he’s always understood it, of sacrifice—but with different bargains than Julian has previously understood.

He says to his father what he says with great intention to every patient he encounters: “It is not your fault.”

 

 

Terri briefs him when he arrives. They have done an ultrasound, and they are missing one heartbeat. This mother is at the follow-up visit alone; the father was unable to get away from the studio that day.

Sometimes the nurses are wrong. Sometimes a shift of position changes the scene. But not this time.

“We are missing a heartbeat,” he tells the mother.

She does not need to ask him what that means. He takes her hand and watches her face. She blinks slowly, her eyes rimmed with laugh lines he doesn’t see in most of his patients.

“We have to run some tests,” he said, “but it appears the ablation was successful. But the donor’s bladder is still very small. It would indicate that the kidney failure was already too advanced.”

“Will I have to deliver now?” she says.

“No, the vessels are severed, so the donee is safe,” he says. This is, technically speaking, good news. But he has always found this the hardest news to share. “Eight more weeks,” he says. He squeezes her hand. “You can do this.”

He is lucky. Days with bad news are fewer and farther between. He is not entitled to ask why this woman must now live for two months with a dead baby inside her. If things happen for a reason, he has not figured that reason out yet.

What makes him saddest about his work is not those he disappoints but the shame his patients feel. Some of them are young and superstitious; others have gone to great lengths to get pregnant, but no matter the level of education or circumstances, they feel a deep responsibility. This is why he has learned to absolve them out loud. They need to hear it said explicitly, more than once, and by him. It is not the same when they hear it from someone else.

He thinks of his patient in the months ahead, of the baby shower, of strangers touching her belly in the supermarket, of the innocent questions people ask. Of how some people can bear hidden knowledge inside them, buried under skin and muscle, half-formed, something they will never betray.

 

 

The nurse warns Julian that there may be a little burst of energy near the end. The light doesn’t just dim; the switch has to be turned off—and that takes a final push of spirit. Julian remembers this phenomenon mentioned briefly in medical school, but he is skeptical, as there is no real switch, no physiological need for this burst. But there may be evolutionary reasons, he thinks: the energy to pass on one final piece of survival knowledge: Watch out for bears near the far ridge of the mountain!—that comes straight from the cavemen days.

So when he finds his father making breakfast one Saturday morning, he has forgotten. He is so surprised to see him there that he just smiles. Only the night before, his father seemed half-conscious. He wasn’t eating or drinking and wouldn’t tell Julian the last time he had had a bowel movement. Julian sat at his bedside like a doctor on a house call, taking his temperature, listening to his heartbeat. The beat was irregular, his father’s eyes glazed.

Now his father is in the kitchen making chocolate pancakes and scrambled eggs. The house is filled with the sharp sourness of real buttermilk. “I can’t stop thinking of chocolate,” his father smiles. “I had to have some.”

Before the pancakes are ready, Julian is called in to work. There’s an urgent case from Arizona. It is his father’s nurse’s day off. He would call Terri, but she is at work, of course, waiting patiently for him with the couple.

He calls the only person he can think of: the architect. He considers for a moment what favors of this kind usually mean, how advanced a relationship must be to call one in. But
Wesley doesn’t hesitate. Julian wonders if it is his father’s illness or his father himself or something about Wesley that has allowed them to bypass so many preliminaries and what, if anything, this portends for their relationship.

When Wesley arrives, he is a weekend-morning beauty, hair tousled, tan feet in flip-flops. His father delights at the sight of him, smoothes his own hair back with a quick gesture.

“I hope you haven’t eaten breakfast,” Julian’s father says. He pulls another mug out of the cabinet and places it next to the coffee maker.

“I can’t thank you enough for coming,” Julian whispers to Wesley. He wants to hug him but settles for squeezing his elbow instead. “This is a real gift.”

Wesley goes to the kitchen, helps carry the plates and the mugs to the dining room. He goes back for the syrup and the juice, then pulls out a chair for Julian’s father, who sits at the head of the table. His father’s hands just graze the beam of morning light that slices across the dining table. It will only take a couple of hours. Julian quietly backs out of the room, leaving the two to their breakfast, smiling over their mugs like old mates.

 

 

 

 

 

 

 

 

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