GIDEON CREW SAT in the fourteenth-floor waiting room of Lewis Conrad, MD, restlessly drumming the tips of his left fingers against the back of his right wrist, waiting to find out whether he would live or die. An oversize envelope he’d brought with him, currently empty, lay beside his chair. Despite Dr. Conrad being one of the more expensive neurosurgeons in New York City, the magazines in his well-appointed waiting room had a greasy, well-thumbed look that deterred Gideon from touching them. Besides, they were of a subject matter—People, Entertainment Weekly, Us—that held little interest. Why couldn’t a doctor’s waiting room have copies of Harper’s or The New Criterion, or even a damn National Geographic?
A door on the far side of the waiting room opened silently; a nurse with a file in one hand poked her head out, and hope flared within Gideon’s breast.
“Ada Kraus?” the nurse said. An elderly woman rose to her feet with difficulty, walked slowly across the waiting room, and disappeared into the hallway beyond the open door, which immediately closed again.
As Gideon settled back into his chair, he realized it wasn’t restlessness, exactly, that afflicted him. It was a feeling of unsettledness that had kept him in New York City ever since the completion of his last mission for his employer, Effective Engineering Solutions. Normally he would have made a beeline for his cabin in the Jemez Mountains of New Mexico, gotten out his fly rod, and gone fishing.
It was so strange. His boss, Eli Glinn, had vanished with no word. The company’s offices in the old Meatpacking District of Lower Manhattan remained open, but the place seemed to be slowly winding down. Two weeks ago, his automatic salary payment had stopped, with no warning, and last week EES ceased paying for his expensive suite in the Gansevoort Hotel, around the corner from EES headquarters. Even so, Gideon had not left New York. He’d stayed on for over two months as his arm healed from the last mission, wandering the streets, visiting museums, reading novels while lounging at the hotel, and drinking far too much in the many hip bars that dotted the Meatpacking District. Finally, he admitted to himself why he’d been hanging around the city: there was something he had to know. The problem was, it was also the last thing he wanted to know. But in the end his need to know had overcome his fear of knowing, and he had made an appointment with Dr. Conrad. And so two days ago, he had been given a cranial MRI and now he was cooling his heels in the doctor’s waiting room, awaiting the results.
No: it wasn’t restlessness. It was a powerful combination of hope and fear pulling him in different directions: hope that something might have happened to him during the past ten months that fixed his condition, known as AVM; and fear that it had gotten worse.
And here he was, waiting, hoping, and fearing, all tangled up in his head like the AVM itself.
The door opened again; the nurse stuck out her head. “Gideon Crew?”
Gideon picked up the empty envelope, rose from his chair, and followed the nurse down the corridor and into a well-appointed doctor’s consultation room. To his surprise, the doctor was already seated behind a desk. On one side of his desk were the beat-up medical records and MRIs that Gideon had been carrying around with him in the envelope for the better part of a year. On the other side was a fresh set of pictures and scans—the ones taken two days before.
Dr. Conrad was about sixty, with a mild expression, gray eyes, and a sheaf of salt-and-pepper hair. He gazed kindly at Gideon through a pair of black-rimmed glasses. “Hello, Gideon,” he said. “May I use your first name?”
“Of course.”
“Please sit down.”
Gideon sat.
There was a moment of silence while the doctor cleared his throat, then looked briefly from the old MRIs to the new. “I take it that you are already apprised of your condition?”
“Yes. It’s known as a vein of Galen malformation. It’s an abnormal knot of arteries and veins deep in my brain, in an area known as the Circle of Willis. It’s usually congenital, and in my case inoperable. Because the arteriovenous walls are steadily weakening, the AVM is expanding in size and will eventually hemorrhage—which will be instantly fatal.”
There was a brief, uncomfortable silence.
“That’s as good a summary as I could have made.” Dr. Conrad propped his palms on the edge of his desk and interlaced his fingers. “When you first learned of your AVM,” he asked, “did the doctor give you a prognosis on how long you might expect to live?”
“Yes.”
“And how long was that?”
“About a year.”
“When was that?”
“Almost ten months ago.”
“I see.” The doctor shuffled through the images on his desk, cleared his throat again. “I’m very sorry to have to tell you, Gideon, but from these tests and everything else I’ve seen, the original prognosis was correct.”
Although he had half expected this—indeed, he’d had no real reason to suppose it would be different—for a moment, Gideon found he couldn’t speak. “You mean…I’ve only got two more months to live?”
“Comparing your original MRIs with the ones we just did, the progress of your AVM has been textbook, unfortunately. So yes, I would say that is a likely time frame—give or take a few weeks.”
“There aren’t any new treatments or surgical options?”
“As you probably have learned, most brain AVMs can be treated with surgery, radiation, or embolization, but the location of your AVM and its size make it impossible to be treated with those methods. Anything we did, either surgical or radiological, would almost certainly cause severe brain damage, if you survived at all.”
Gideon leaned back in his chair. All the anxiety and uncertainty that had been hovering around him the last several weeks now settled down like a deadweight. He could hardly breathe.
Dr. Conrad leaned forward. “It’s tough, son. There’s nothing I can say to make it otherwise. It may not help to hear this, but: you know how much time is allotted you. Most of us don’t have that luxury.”
“Luxury,” Gideon groaned. “Two months, a luxury. Please.”
“When Warren Zevon, the rock star, knew he was dying of cancer, someone asked him how he was coping with that knowledge. His reply? Enjoy every sandwich. My advice to you is similar: don’t become miserable and paralyzed with grief and fear. Instead, do something worthwhile and engaging with the time you have left.”
Gideon said nothing; he merely shook his head. He felt sick. Two months. But why did he expect anything different?
“You’re strong and mobile, and will remain so…until the end. That’s the nature of AVM. So I’ll tell you what I tell my other patients facing the same situation: live every minute the best way you can.”
A long moment passed while Gideon sat in the chair, motionless. Dr. Conrad smiled at him from across the desk with the same kindly expression. When he started gathering together the various reports and scans, Gideon realized the conference was at an end. He stood up.
“Thank you,” he said.
The neurosurgeon stood as well, handed him the paperwork, then shook his hand. “God bless you, Gideon. And remember what I said.”