Things Fall Down Read online

  “That could be good for her,” Sarah agreed, then glanced at her watch. “Well, I better get back in there before they burn the place to the ground.” She dropped her butt into a grating and brushed a little ash from her blouse. “And hey,” she said soothingly, patting Karen on the shoulder, “don’t try to carry the weight of the world on your shoulders. Kids are resilient. She’ll bounce back eventually.”

  “You think so?”

  Sarah shrugged, a mischievous grin playing on her lips. “Who knows? It’s just something they tell us to say in training. I don’t even have kids. Emily’s tough, though, and we can handle everything she throws at us while she’s adjusting. You don’t have to worry about her for a second while she’s here, OK?”

  Karen could feel the tears waiting to burst forth as she hugged Sarah goodbye, and she climbed quickly back into the Subaru before her emotions slipped out. She hated feeling like this, but not as much as she hated letting others see her like this. Before the divorce she’d never been a weepy type. She’d always prided herself on being the rock of the family, on keeping her head when the pressure was on, but these days all it took was a sad toilet paper commercial to shatter her into a million pieces.

  A sob finally escaped her lips as she pulled out of the parking lot and headed east, in the direction of her office on the outskirts of San Francisco, and once the first had come she knew plenty more would follow.

  It killed her that Emily wasn’t old enough to understand what was really going on. She was mature for her age, but how can a seven year old understand the realities of PTSD? Of addiction? Of watching her dad, her hero, cry out in terror in his sleep? How could she understand why he woke up in a cold sweat in the middle of the night, and then turned to drink and pills to make it through the day? No seven year old could really understand what was happening to him, and it was a cruel and uncaring world that would ask her to try.

  As Karen pulled onto the slip road and joined the highway an unwanted memory rushed back to her, of the morning she’d told Emily that daddy wouldn’t be living with them any more. It was just after the board had revoked Jack’s license and he’d been fired from the hospital, back when they were threatening lawsuits and it had all become just too much to handle. She’d sat Emily down the morning after Jack had left for the hotel and tried to explain it in terms she might understand, and Emily's response never failed to destroy her whenever she remembered it.

  She wasn’t mad. She didn’t stamp her feet and demand that daddy come home. She’d just looked up at her mom with those big, confused brown eyes and sniffed away a tear, her lower lip trembling.

  “But if daddy’s sick, shouldn’t we help him get better?”

  Karen had to pull over as the tears began to flow, clouding her view of the road ahead. Someone following behind honked their horn long and loud as she changed lanes without her blinker, and she almost scraped against the crash barrier beyond the shoulder before stamping on the brakes and killing the engine, still sobbing.

  If daddy’s sick, shouldn’t we help him get better?

  Emily had really stabbed her through the heart with that one. She hadn’t meant to hurt her, of course. She wouldn’t even know how to hurt her mom intentionally, but that innocent question had kept Karen awake at night for the last six months. She’d played it over and over in her head a thousand times, and then a thousand more, and even now she didn’t know the answer.

  All she knew was that she’d watched, helpless and alone, for almost a year as Jack left them without ever leaving. She’d watched him vanish down the rabbit hole just when she and Emily needed him more than ever. She’d watched him numb himself with alcohol, and when the pain found a way to sneak past the booze she’d watched him turn to the pills. The hidden stashes. The late night shouting matches staring into glazed, medicated eyes, seeing nothing in them but her own reflection. The furious denials and injured pride, followed always by the tearful admissions and empty promises that neither of them ever really believed.

  She didn’t know if it was even possible to drag Jack back into the daylight once he’d slipped so far into the darkness. All she knew was that she couldn’t let Emily watch her daddy kill himself by inches. Not after they’d been through so much already.

  Could Karen have done more? Had she made matters worse by throwing him out? Had she only replaced one pain in Emily’s life with another, maybe even worse pain? Even now, now the papers were signed and the world expected her to move on, she still had no idea.

  She took a deep, shuddering breath and dabbed at her eyes, then leaned over to reach for the old pack of cigarettes she knew were stashed at the bottom of the glove compartment. As she awkwardly buried her arm deep in the mess of receipts, candy wrappers and scratched sunglasses her elbow hit the radio, switching the station from easy listening back to one of the presets Jack had programmed when they’d first bought the car.

  It was one of his talk radio stations, the kind that filled the time between jingles for discount mattress stores by encouraging crazy people who’d forgotten to take their meds to call in and ramble on every subject under the sun.

  … all sounds a little too crazy even for me, caller. Sorry, I’m not trying to be mean, I’m just bein’ honest here. That’s all a bit, y’know, whackadoodle, know what I’m sayin’?

  Caller: Karl, I assure you I’m not one of your usual paranoid lunatics. I’m telling you the God’s honest truth here. The Navy’s already been dispatched to one of the freighters, and we’re tracking six more on the west coast alone. I can see them on my console right now. I can hear the radio chatter on the military channels. This is real. It’s happening, and everyone needs to get out of the cities before it’s too late.

  Host: OK, OK, so you’re telling me that we have… what, seven? Seven ships off the west coast and Lord knows how many more around the rest of the country, each of them carrying nuclear missiles and… did you say launch platforms, did I hear that right? OK, so we got a ton of nukes and a ton of launchers just waiting to fire, and you say this is all going down today? If that’s true then why are we hearing it from some guy at the Coast Guard and not, say, the White House? The Pentagon? Why has the Emergency Alert System not been activated? Why have there been no evacuation orders in the cities? Come on, help me out here, cause this is all sounding a little too far-fetched even for this show, and last week we had a guy who claimed that blue whales are really camouflaged Russian subs.

  Caller: Look, I know it sounds crazy, but I don’t know what to tell you. I’m just—

  Host: And why haven’t you reported this to the authorities? Far be it from me to denigrate the good name of this station, but if I knew of some vast plot to launch a nuclear attack on the US this afternoon there are about two hundred calls I’d make before I tried to scare the pants off the listeners of WKLB, the Station for the Nation, know what I’m saying?

  Caller: I have been making calls! I’ve called the FBI office in Bakersfield, my own superiors at the Coast Guard... I even tried to call the White House switchboard directly, but nobody wants to listen! Look, I don’t expect you to believe me, Karl, but if you’re listening to this right now I’m begging you to get out of the cities. Just get the hell out, and stay out until it’s safe to return. I’m not kidding around here. I’m completely fu—

  A long beep sounded, and when it was over the voice of the host returned.

  Host (laughing): Whoa, there. Yeesh. Thanks to Sally for her lightning fast reactions on the bleep button. She really is the fastest gun in the west. As you know we have a one strike and you’re out profanity rule here at WKLB, the Station for the Nation, and dropping the F bomb wins you a one way ticket to a lonely dial tone.

  OK, up next we have a young gentleman who believes that Hitler is alive and well and – get this – living in a retirement home in Topeka, of all places, at the ripe old age of 130. How about that? I guess vegetarianism really does pay off, am I right, listeners? We have old man Hitler and much more coming up right after
these messages…

  Karen shook her head, flipping back to her easy listening station with one hand and she lit her cigarette with the other. Jack had always loved these call-in shows. He’d claimed to listen to them just for laughs, but they’d always given Karen the creeps. She thought it was cruel to exploit the lonely, isolated and mentally ill for entertainment.

  Ever since they’d first started dating the radio been the focus of the endless minor battles that come part and parcel with every relationship, and these awful shows often played a featured role in the fights. She always wanted to listen to James Taylor and Sam Cooke play something soft and slow, and Jack always wanted to hear a rant about secret CIA black sites from some sad, unbalanced old man whose kids hadn’t visited him for five years. He never seemed to understand that these poor people were just crying out for a little attention, a little human contact. They just wanted someone to acknowledge their existence, even if that came in the form of ridicule. It wasn't right to laugh at them.

  She dabbed at her eyes with a tissue, thankful for the accidental station switch. That reminder of one of the thousand little gripes she had with her ex-husband had distracted her from her sadness, if only for a moment.

  A moment was enough, though. Enough to end the tears and give her the chance to bring herself under control. Now she just felt a little silly for losing her composure out where people might see her. Hell, the ink on the divorce papers was three months dry. The time for tears had long since passed, and allowing herself to become a slave to her emotions was doing her no favors, nor Emily. She knew that. Time to move on, Karen.

  She stubbed her cigarette out in the ashtray and pulled down the sun visor to check herself in the vanity mirror. No streaky mascara or ugly panda eyes. There was a little redness around her nose, but nothing she couldn’t pass off as hay fever if anyone at the office got curious. Nobody would know she’d been crying.

  She took a deep breath through her nose and let it out slowly through pursed lips, gathering herself, then she turned the key, flipped the visor from the window, took hold of the wheel and began to pull back out into the highway.

  She never saw the truck. Didn’t even catch the movement in her mirror, and the semi driver didn’t have time to so much as touch the brakes before he rammed full speed into the trunk of the Subaru, clipping the edge and shunting the car off its wheels. By the time he knew what was happening the mangled car was already flipping over the crash barrier, upside down.

  For Karen, everything went black.

  ΅

  CHAPTER THREE

  GOD DAMNED MAUI?

  “AND YOU'RE SAYING it has fewer adverse side effects than Butropril?”

  Jack smiled. “Significantly fewer. In trials less than 2% of subjects reported dizziness, fatigue, dry mouth or gastrointestinal issues, and yet the efficacy was comparable to Butropril, which as you know has a 10% reported rate of one or more side effects. You can check the data yourself, it’s all there in the pack.”

  Jack reached for his glass of Chablis as his lunch guest flipped the glossy pages, peering through reading glasses at glossy stock photos of smiling patients and colorful charts and graphs, but as Jack watched him over the edge of his glass the first cracks of doubt were beginning to appear in his confident facade. His guest looked a little bored, blowing out his cheeks as he skimmed the papers. Jack decided to go in for the kill.

  “Let me ask you this, Frank,” he said, clutching his glass as he leaned forward. “How many of your patients are currently on ACE inhibitors?”

  Frank sniffed distractedly, nudging his reading glasses up the bridge of his nose with a finger. “Right now? I’d have to check our records to be certain, but I’d say it’s probably somewhere in the region of 30%. Maybe three hundred residents across our seven facilities.”

  “Three hundred. Wow.” Jack took another gulp of wine. He was getting into the swing of things now. “That’s three hundred patients whose quality of life you could measurably improve right now, right this minute, simply by switching them from Butropril to Sentrax. And considering the rate of patient turnover in your sector you’re looking at thousands more over the next decade alone. Just think about that for a minute. That’s why you got into this business, right? To help make those golden years really count?” Another gulp of wine. “You could help a lot of people with this decision, Frank. You could really make a difference. So, what do you say?” He thrust his hand across the table. “Are we in business?”

  Jack’s smile began to fade as Frank set down the papers and removed his glasses, ignoring the proffered hand. He could already see what was coming.

  “Look, Jack… I like you. You seem like a stand up guy. You made a heck of a pitch and this was a damned good steak, so I’m gonna level with you.” Frank was already mentally walking out the door. Jack had met enough of these guys to know what he was about to say. Hell, he’d been one of these guys just a couple of years ago.

  “Merck sent me to the Butropril conference in Maui last month. The Four Seasons. Beautiful resort. All expenses paid, and the golf was… well, it was fantastic. I'd swear they cut those greens with a razor.” He held up his hands. “Now don’t get me wrong, Baxter’s a great outfit. You guys are… you know, you guys are scrappy. I respect the hell out of you, and I’m sure you put out a great product, but at the end of the day Baxter isn’t flying me to Maui on their dime. You guys just don’t play at the same level as Merck.” He stood from the table and began to button his suit jacket. “I’m sorry, Jack, I’m just trying to be straight with you. I can’t afford to kill the goose that lays the golden egg just for… what, an 8% reduction in adverse effects?”

  Jack pushed back his chair and stood. “Frank, think about what you’re passing up here. We’re talking about a significant increase in quality of—”

  Frank held up a hand to silence him. “Yeah, yeah, I know, fewer upset stomachs. Maybe a little less work for my nurses and the cleaning staff, but Jack…” He tucked his glasses into his breast pocket. “It ain’t Maui.” He pulled back his sleeve without even pretending to glance at his watch. “Look, I gotta get back to the office. Thanks for the steak, thanks for the wine, and if you guys ever want to talk about upping the incentives you know where to find me. Take care, Jack.”

  With that Frank strode towards the door without another word, leaving Jack sitting alone at the table with half a bottle of wine, a $200 check, and the information pack he hadn’t even had the good grace to take with him. Jack stared at his glass, reeling from how quickly his pitch had been shut down.

  Maui?

  God damned Maui?

  He couldn’t believe it had ended that way. Jack would be the first to admit he was no saint. He knew he’d been swayed by the generous perks offered by pharma reps back when he’d been practicing, but he’d never heard of a doctor passing up the opportunity for an objectively better treatment just so he could get a few nights in the Four Seasons and a round of golf.

  Hell, Frank Whittaker was on the board of the largest retirement home consortium in Washington state. The man must be clearing at least three hundred grand a year, plus bonuses, stock options, and all the other incentives they throw at doctors to entice them into a career of watching wealthy old people gradually wither away in magnolia painted cells. How could he be willing to leave hundreds of his patients in chronic pain, stuck with medication that gave them constant stomach cramps and vertigo, in return for a vacation that would have cost him no more than a week’s salary? He could pay for that trip out of his damned swear jar, and he’d screwed over his patients just so he could get it for free.

  What kind of person does something like that?

  Jack already knew the answer. Doctors did things like that. Doctors did it all the time.

  Not at first, of course. Not when the diploma was fresh on the wall and they still had dreams of saving the world. Back in the early days they’d happily tear out one of their own kidneys and sew it into a patient if it would give them anothe
r hour of life. No, they only got jaded much later on, once they’d sutured a thousand wounds and set a thousand bones, when the dreams had long since faded. That’s when it all went to hell. That’s when their attitude shifted from ‘what can I do for you?’ to ‘what can you do for me?’

  Jack sighed and finished his wine, slumping back in his chair and loosening his tie as he slapped the company credit card on top of the obscene check. A passing waiter silently whipped it away before Jack had even noticed him. Always the sign of a good restaurant, when the customers didn’t even see the money draining from their accounts.

  Oh well, he told himself, trying to be philosophical about his failure. At least he didn’t have to pay for the damned meal out of his own pocket. He couldn’t, not these days. Not after Karen took the house. Not after he was forced to rent a shoe box at San Francisco real estate prices just so he could be close to Emily. He couldn’t even afford the bread sticks at a place like this once the taxes, rent and alimony had been violently vacuumed out of his pay check.

  He pulled his phone from his jacket pocket, tracing an intricate pattern on the screen to unlock it. The screen flashed red. Wrong pattern. The wine was hitting him already, sitting uncomfortably atop his vodka eye opener. He tried again more slowly, concentrating, and this time the line turned green, the screen unlocked and his notifications appeared.

  Nine missed calls. One message.

  Nine? Seriously? I only checked it forty minutes ago.

  He frowned at the phone, confused. All nine of the calls were from Cesar Ramos, an old friend and the chief radiologist at Saint Francis Memorial back home. They hadn’t spoken in… what, a year? Eighteen months? What could possibly be so urgent that he’d call nine times in a half hour? He clicked the message icon.

  Jack, please call ASAP. Karen’s hurt.

  Jack was out of his seat and halfway to the door by the time he’d hit redial, grabbing his credit card from the baffled waiter as he weaved between the tables. The phone had barely started ringing before it was picked up on the other end.