Chapter 1 1

The heat outside JFK Terminal 4 hit Ivana Becker like a physical blow. It was a wet, heavy blanket of ninety-degree humidity that smelled of exhaust fumes and stale asphalt. She gripped the handle of her suitcase, the plastic warm and sticky against her palm.

One wheel was broken. It dragged across the concrete with a rhythmic, scraping sound that set her teeth on edge.

She checked the ride-share app on her cracked phone screen. The estimated fare to Brooklyn was seventy-eight dollars.

She closed the app. Her thumb hovered over the screen for a second, trembling slightly, before she shoved the phone into the pocket of her oversized gray hoodie.

Seventy-eight dollars was two weeks of formula for Cohen. It was a co-pay for her mother's medication. It was not something she could spend on a car ride, no matter how much her lower back throbbed from the nine-hour flight in economy.

She turned toward the AirTrain.

The subway ride was a blur of noise and bodies. The air inside the car was thick with the scent of pepperoni pizza and unwashed fabric. Ivana clutched her canvas tote bag against her chest. Inside was a folder of medical records that felt heavier than lead.

Her phone buzzed against her hip. The screen lit up with the name Dr. Evans.

Her stomach dropped. It felt like the floor of the subway car had suddenly vanished. She answered, pressing the phone hard against her ear to hear over the screech of the brakes.

"I'm almost there," she said. Her voice sounded rusty, unused.

"You need to hurry, Ms. Becker," the doctor said. His voice was professional, clipped, but she could hear the underlying urgency. "Her creatinine levels spiked an hour ago. We are looking at systemic failure if we don't start the new dialysis protocol immediately."

"I'm coming. I'm twenty minutes away."

She hung up. A wave of nausea rolled through her. She leaned her head back against the metal pole, closing her eyes.

Don't throw up. Not here. Not now.

She got off at the Winthrop Street station. The neighborhood hadn't changed much in four years, but she had. The pavement seemed harder under her thin-soled sneakers. The sun seemed brighter, harsher.

St. Mary's Hospital loomed ahead, a block of beige brick that looked more like a prison than a place of healing. It was a far cry from the private clinics she had once known, but it was the only place that would take a patient with gaps in their insurance history.

Inside, the air conditioning was set to arctic. The sweat on her back turned instantly cold, making her shiver. She walked past the reception desk. The nurse didn't even look up from her computer.

Ivana knew the way. Fourth floor. Nephrology.

The elevator smelled of bleach and old coffee. When the doors opened, she stepped into the hallway and saw room 412 through the glass partition.

Her mother, Elena, looked small in the hospital bed. Her skin was the color of parchment paper, almost translucent. Tubes snaked out from under the sheets, tethering her to beeping machines.

Ivana pushed the door open. The sound of the heart monitor was the only rhythm in the room. She walked to the bedside and took Elena's hand. It was cold.

Dr. Evans walked in a moment later. He was holding a clipboard. He didn't smile.

"We need to talk about the billing," he said.

Ivana felt the blood drain from her face. "Can we do the treatment first? Please. She is in pain."

"The hospital administration has flagged the account, Ivana. The new protocol involves a proprietary filtration agent. It is not covered by standard Medicaid. The total cost for the full cycle is fifty thousand dollars."

The number hung in the air. Fifty thousand.

Ivana looked at her mother's sleeping face. "Can I do a payment plan?"

"Not for this specific treatment," Dr. Evans said, his voice softening slightly. "However, if you can put down a deposit of five thousand dollars within twenty-four hours, I can override the system to start the first session. But I can't do it with zero."

Dr. Evans looked sympathetic, but his sympathy didn't pay bills. He left her with the invoice.

Ivana stared at the paper. The numbers blurred. She opened her banking app. The balance was three hundred and forty-two dollars.

Panic, cold and sharp, clawed at her throat. She had to do something. Maybe the billing department made a mistake. Maybe there was a charity waiver she hadn't signed.

She left the room, her legs feeling like jelly. She needed to go to the financial aid office on the first floor.

She walked down the corridor, her head down, counting the tiles on the floor to keep herself from hyperventilating.

One, two, three. Breathe. Four, five, six.

Click. Click. Click.

The sound of high heels on linoleum cut through the hospital hum. It was a sharp, authoritative sound.

Ivana froze. She knew that cadence.

A laugh followed. High-pitched, performative.

Ivana pressed herself against the wall, trying to make herself invisible. She pulled the hood of her sweatshirt up.

Please, no. Not today.

But the universe was not in the business of granting her mercy.

Around the corner came two women. One was Marnie, holding a tray of Starbucks cups. The other was Aleta Cortez.

Aleta was wearing a Chanel tweed suit that probably cost more than Elena's entire treatment. Her hair was a glossy waterfall of dark silk. She looked like she had just stepped out of a magazine shoot, completely out of place in the dingy hospital hallway. She was wearing a visitor badge labeled "Sharpe Foundation - Charity Oversight Board," explaining her unfortunate presence in this crumbling facility.

Ivana tried to turn, to retreat back into the room, but the wheel of her suitcase caught on the edge of a floor mat.

The suitcase tipped over with a loud crash.

Aleta stopped. Her head snapped toward the noise. Her eyes, lined with perfect precision, narrowed.

Then, they widened. A slow, cruel smile spread across her face.

"Oh my god," Aleta said. Her voice echoed in the corridor. "Look what the cat dragged in. Or should I say, what the garbage truck dropped off."

Ivana felt her heart hammer against her ribs. She gripped the handle of her fallen suitcase.