"Can I see her?"
"She's in the ICU. I'll have someone take you."
The ICU was quiet in the way hospitals are quiet—machines humming, monitors beeping, lives held in suspension. Serafina stood at the window and looked through the glass at her sister.
Aria lay motionless on the bed, the breathing tube taped to her mouth, her chest rising and falling in the mechanical rhythm of the ventilator. She looked smaller than she should have. Younger. The swelling at her throat was hidden now beneath hospital gown and monitors, but Serafina could still see it in her mind—the mass that had grown while everyone was watching, waiting, trusting that the system would work in time.
She pressed her hand to the glass.
"I'm here," she said, though Aria couldn't hear her. "I'm not going anywhere."
An hour later,Serafina sat on a concrete bench outside the hospital with her phone pressed to her ear.
She knew this call. She'd made versions of it half a dozen times already—the hold music, the transfers, the representatives who sounded sympathetic and delivered nothing. She knew the script. She made herself go through it anyway.
"Thank you for holding, Ms. Montecristo. I see here that the surgery has been reclassified as emergent?"
"Yes. This morning. Her airway was closing. They had to intubate."
"I understand. That does change the coverage calculation." A pause. Typing. "Emergency surgery is covered at sixty percent after deductible when performed by an in-network provider."
"Dr. Rao is out-of-network."
"Yes, I see that. The facility is in-network, but the surgeon's fees are billed separately under the out-of-network schedule."
"Which means what, exactly?"
More typing. "Surgeon's fees would be covered at forty percent of the allowed amount, which may differ from the billed amount. The difference would be the patient's responsibility."
Serafina closed her eyes. "What about the ICU?"
"ICU is covered under the emergency admission, but there are limits. Let me see..." Another pause. "Coverage is capped at seventy-two hours for the current diagnostic code. After that, additional review would be required to determine medical necessity."
"And if it's denied?"
"Then those charges would be the patient's responsibility." The voice remained pleasant, practiced. "I know this is difficult. Do you have any other questions about the policy?"
Serafina had one question. "What's the bottom line? Total out-of-pocket."
Silence. More typing. "I can only provide estimates, but based on the surgical quote and current ICU charges... the policy would cover approximately forty to fifty thousand. That's pending review. The remaining balance would be..." A pause that meant the number was bad. "Approximately one hundred forty thousand, plus any additional ICU days beyond the covered period."
One hundred forty thousand dollars. The surgery would happen—they couldn't refuse an emergency. But the debt would follow Aria out of this hospital and into the rest of her life.
Just like it had followed their mother into the grave.
"Thank you," Serafina said. "You've been very helpful."
She hung up and sat there for a while. The sun was bright and warm on her face. It didn't help.
Angelo arrivedin the late morning.
Serafina saw him come through the sliding doors of the hospital entrance—rumpled shirt, stubbled jaw, paper coffee cup in hand that he'd probably been refilling at gas stations since three in the morning. He walked the way he always walked, solid and deliberate, like a man who'd spent his life carrying heavy things and never complained about it.
He spotted her in the waiting area and crossed to her without hesitation.
"Sera."
She stood, and he pulled her into a hug—brief and hard, the kind that said everything without words. He smelled like coffee and highway and the familiar aftershave he'd worn for as long as she could remember.
