“In the meantime, I want to start you on two medications. The first is an ACE inhibitor. It’s a blood pressure medication, but in this context, it works to reduce pressure inside the kidneys and prevent further injury. The second is a course of corticosteroids.”
The word lands like a physical blow.Corticosteroids.Prednisone. The devil’s Tic Tacs. A wave of nausea, sharp and acidic, rises in my throat. I remember the last time. The six months of high-dose steroids that felt like a chemical lobotomy.I didn’t feel sad; I felt nothing. A profound, terrifying emptiness, a gray void where my personality used to be. I would sit and stare at a wall for an hour, unable to muster the energy or inclination to move, to speak, to feel. My face swelled up into a puffy, unrecognizable moon. I was a ghost in my own life. I can’t go back there. I can’t.
“No,” I whisper, the word escaping before I can stop it. “Not the steroids. Please.”
Dr. Sharma’s expression softens with sympathy. “I know you had a difficult experience with them before, Maya. But your body changes, and your reaction might be different this time on a different dosage. They are the most effective tool we have for rapidly reducing this kind of inflammation.”
My vision starts to tunnel. The edges of the room blur. All I can see is that gray, empty feeling waiting to swallow me whole. It’s worse than the joint pain, worse than the fatigue. It’s the loss of myself.
It’s Flick’s voice that pulls me back. “Is there any other option? Anything else she can try first while waiting for the biopsy?” she asks. Her tone is respectful but unyielding. In this moment, she’s not just my friend; she’s my advocate.
The image of my ex, Sam, flashes in my mind, sharp and unwelcome. If he were sitting here, he would be nodding along with the doctor, patting my knee and telling me to listen to the expert. He would have seen the steroids as the fastest route back to stability, the quickest way to get my body ready for the family he was so desperate to start.“If you get pregnant, it will be safer for the baby if the lupus is under control,”he’d said once, completely bulldozing my fears about what the drugs did to my mind. My mental health was an inconvenient variable in his life plan. He would have ignored the terror in my eyes and agreed to the prescription, for my own good. Forhisown good. To start the family he wanted.
“What about the hydroxychloroquine?” Flick suggests, remembering what I’ve told her about the early days of my diagnosis. “And maybe a stronger anti-inflammatory. At least until the test results are back and you know exactly what’s going on.”
Dr. Sharma looks at me, really looks at me, seeing the silent, desperate plea in my eyes. I’m trying so hard not to cry, swallowing against the lump in my throat until it feels like I’m choking on glass.
She lets out a slow breath. “Alright,” she says, finally. “Let’s try that. We’ll restart the hydroxychloroquine and I’ll prescribe a course of naproxen. But, Maya, you must monitor your symptoms closely. Any increase in swelling, any shortness of breath, any significant pain, you call me immediately. And we are still doing the biopsy in two weeks. If it shows significant inflammation, we will have to have a serious conversation about the corticosteroids again. Agreed?”
I can only nod, a wave of relief so profound it makes me dizzy. I feel boneless, exhausted. The rest of the appointment passes in a blur. Scheduling, prescriptions sent to the pharmacy, instructions I know I won’t remember. All I know is that Flick’s hand is still holding mine. When we finally walk out of the office and into the too-bright hallway, I feel hollowed out, a fragile shell. Flick steers me toward the elevators.
“Here,” she says, digging into her tote bag and pulling out a brown paper bag. “Noah dropped this off this morning at Knit Happens. He made a special batch just for you. Pumpkin and dried cranberry with a cinnamon nutmeg drizzle.”
She opens the bag, and the warm, sweet, spicy scent of the sourdough bread wafts out. Normally, it would be my favorite smell in the world, a scent of comfort and care. But right now, my stomach churns in protest. The smell is thick, cloying, unbearable.
“I can’t,” I say, my voice raspy. I turn my head away. “Thank you. But I can’t eat.”
“Okay,” she says, instantly closing the bag. “Later, then.”
She doesn’t push. She just guides me into the elevator, through the lobby, and out into the glaring afternoon sun. The world feels loud and sharp, an assault on my senses. I feel like I’m moving through water, every step a monumental effort. Flick leads me to her car, opens the passenger door, and waits for me to buckle myself in.
I lean my head against the cool glass of the window, grateful beyond words that I don’t have to drive, that I don’t have to think, that for this short car ride home, I can just fall apart in silence, with one of my best friends at the wheel.
Chapter Eighteen
Maya
Three days. It takes me three full days to stop the panicked spiral. Three days of reading dense medical articles online about lupus nephritis, of scrolling through patient forums until my vision blurs, of staring at the ceiling at two in the morning, my mind a slideshow of worst-case scenarios. I research GFR numbers, biopsy procedures, and the long-term side effects of every potential medication. By the time my planning period rolls around on Monday, the terror has receded, leaving behind a brittle, functional calm. I finally feel like I can speak about it without my voice cracking, so I decide it’s time to call my family.
Instead of staying in the trailer, where Zachary’s low, enthusiastic murmur about plant tropisms seeps through the thin partition, I grab my keys and walk out to my car. The faculty parking lot is mostly empty, a quiet island in the middle of a bustling school day. Inside my compact Honda, the world goes quiet. The distant shouts from the playground are muffled, the afternoon sun warm through the windshield. I clutch my phone, my thumb hovering over my mom’s contact photo.
I don’t usually call her with this kind of news. My health is my own private battle, a landscape too treacherous and complicated to explain to someone who thinks a green smoothie can cure chronic illness. But some foolish, stubborn little girl inside me is still hoping for a mom. For a soft voice to tell me it will be okay, that I’m strong, that she’s there for me. For simple, uncomplicated reassurance. Taking a deep breath, I press the call button.
She answers on the second ring, her voice bright and airy. “Maya, darling! I was just thinking about you. I saw the most exquisite cerulean pigment at the art supply shop, it would be divine for one of your skyscapes.”
“Hi, Mom,” I say, trying to steer the conversation before it sails off into the ether of oil paints and canvases. “Is now an okay time to talk? I have some news.”
“Of course, sweetie. Is everything alright?” There’s a faint shift in her tone, a performative dip into concern.
I close my eyes and just say it, laying out the facts as clinically as I did for myself over the weekend. “I had a check-up with my rheumatologist. My recent bloodwork showed that my kidney function is down. She thinks the lupus is causing some inflammation, so I have to go for a biopsy in a couple of weeks to see what’s going on.”
There’s a sharp intake of breath on the other end of the line. I wait. This is the moment. The moment for reassurance, for a steadying word.
“Oh, Maya,” she breathes, her voice thick with sudden, theatrical emotion. “It’s my fault. It’s my genes. I’ve given you this awful, broken immune system. I knew it. That whole side of the family is a genetic mess. Your great-aunt Susan had a goiter, you know.”
My stomach plummets. Just like that, my medical crisis has become a referendum on her ancestry. My illness is a reflectionon her. I grip the steering wheel, my knuckles turning white. “Mom, it’s not anyone’s fault. It’s just what it is.”
“No, no, I insist,” she says, completely ignoring me. “And I will fix it. Listen to me. Don’t let them pump you full of those horrible drugs. Forget the biopsy. We’ll skip all that. I’ll give you one of mine.”
