Time warped on me. Thursday and Friday passed like a blur, but each second sitting in Dr. Katz's waiting room seemed like it wouldn't pass. My heart pounded faster as I stared at the clock, willing it to move faster.
The small lobby squeezed in tighter with Brody sitting next to me. He read through a sports magazine with his legs extended and feet crossed. We weren't touching, but his presence was suffocating. The hot air and low ceilings were suffocating. Dad's huffed breathing and glancing over my head every minute were suffocating. Morgan giggling over her phone at Brody was...annoying.
"Paige Hart?" A nurse smiled over my chart.
The weight of Brody's gaze made my backside—all of the back of me, not my butt—tingle. Mom came with me, but he remained sitting with Dad, who'd reminded repeatedly of how he wasn't allowed back in the examination room until the end.
Poor Brody. This would be my most embarrassing appointment ever. With my cheeks burning, I answered the usual screening questions—no changes, my psoriasis still sucked—and Dr. Katz examined my elbows, back, and behind my knees and ears.
"They were looking marginally better a couple of appointments ago," he hummed, releasing my right ear. "The beach did wonders, Paige. It's regressed."
Brody deserved all the beach credit. Behind Dr. Katz's white coat-covered shoulder, Mom smiled. "Guess you'll have to make more trips to the beach."
I was less worried about her liking Brody than Dad. He wouldn't like anyone Morgan or I dated and took the longest to warm up to Nate being just my friend. What would Dad ask him in private? Hopefully nothing embarrassing.
"How do you feel about more sun exposure?" Dr. Katz asked.
"Great." I huffed. "More awkward staring."
Sympathy filled his kind eyes. "I know it's hard to look different, especially at your age. But the sun and salt water are good for your skin, reducing the dryness and inflammation, so if you'd like to reduce these—" he rubbed his thumb over the white scales on my right elbow. "—sun and cold saltwater are helping."
Other than fewer flakes, I hadn't noticed much of a difference. It still itched, but I wouldn't know if a more consistent approach worked unless I tried. With a sigh, I slid off the table to the sound of more rustling plastic.
"Now, what's this about a young man having some questions?"
A constricting sensation choked my throat, and I curled my hands to close my front-open robe.
"After her laser." Mom stepped between me and the doctor, waving me to where the nurse would do the laser. "Are there any new treatment options, Dr. Katz?"
His answer, "Nothing besides the biologics," muffled behind me. I squirmed more than usual under the pricks and burns from the laser, rolling onto my stomach and clenching my teeth when the nurse passed over my lower back.
Fortunately, she finished and walked me to Dr. Katz's office, where Brody sat on the worn leather sofa between Mom and Dad. He stood with a smile, his eyes asking if I wanted to sit. I returned it with a shaky one and shook my head. My lower back was already pulsing, so I closed the door and leaned my shoulder against it.
Brody's gaze lowered down the side of my neck, another throbbing spot. His eyes filled with sympathy, and he rubbed the back of his neck. "Does it hurt?"
I nodded, directing my gaze to Dr. Katz sitting behind his desk. His hands clasped over an open folder, probably my medical chart, and he raised his gray eyebrows. "Do I have your permission to discuss your condition, Paige?"
"Yes," I answered, stilling when Brody took my hand. His thumb rubbed an arch between my index finger and thumb, keeping his eyes forward on Dr. Katz. Was he comforting me?
"Paige has a noncontagious, autoimmune condition called psoriasis. Her skin grows very rapidly, causing a build-up of cells. They accumulate into the pink, scaly patches you see."
"But it's not a skin condition," he stated with enough hesitation to make it a question.
"No." Dr. Katz's shook his head. "It's an immune system problem, down to her blood cells, and the skin reaction is a symptom. There's no cure for cases like Paige, only management and relief from the symptoms."
"Which are?"
I blinked at him because I had explained them, but Brody stared at my doctor.
"From the mildest dry skin to extreme inflammation and pain." Dr. Katz frowned. "Paige is about three-quarters of the way through the spectrum of severity, but she's younger, so her condition could worsen as she ages into her twenties."
Fantastic. I ducked my head, inadvertently tugging on Brody's hand. He squeezed it, stroking it with his thumb. Thankfully, he didn't ask about it worsening because I never liked hearing what I had to look forward to.
"Why are they purple?" he asked.
"Paige receives weekly treatments from our XTRAC laser." Dr. Katz gave me a sympathetic smile and handed a stack of pamphlets to my dad. He handed them to Brody, which I recognized as the same ones when we asked similar questions three years ago. "It's concentrated UV light on the localized areas."
"What do the laser treatments do?"
"They can help manage mild to moderate cases, slowing the growth and reducing the inflammation and itching by allowing the skin to heal. There's no risk to the healthy skin around the affected areas, and heals faster than natural sunlight. We can also target harder-to-treat areas like elbows, knees, and the area behind ears."
All of those possibilities sounded so nice. Unfortunately, the laser didn't do any of them for me.
"What are the other treatment options?"
Brody's heart was in the right place of concern, but my shoulders sank under the question Mom asked during every appointment. Her and Dad's late-night worrying and crunching impossible numbers when they thought I was asleep never ended. Quarterly injections at nine thousand dollars each, none of which insurance covered because our insurance considered them experimental was as likely as the sun burning off my dry patches.
"Beyond over-the-counter medications, prescription creams, Vitamin D laser treatments, and anti-inflammatory medications, there are new options in biologics." Dr. Katz's sympathy shifted to my parents.
"What's that?"
"To answer, I need to go through the immunology process." Dr. Katz leaned back and scribbled two parallel lines on his notepad, then dotted them with X's. "The body's bones make white blood cells to fight off infections, keeping us healthy. T-cells are a component in the white blood cells contributing to those processes. Part of those T-cells include a messenger chemical in the immune system called a tumor necrosis factor, or TNF. TNF binds to the proteins that cause inflammation. When TNF is suppressed in psoriasis patients through administration of a biologic, there's less inflammation and even absence of symptoms."
I exhaled slowly. No matter the number of times Dr. Katz explained my condition and drew this same picture, I didn't understand beyond shitty genetics. While the biologics sounded like the perfect solution, their hefty, non-insurance-covered price tag made them like I walked into a jewelry store with pennies in my pocket and wanted the most expensive diamond.
"There's also a family of biologics aimed at targeting special proteins called interleukins, or ILs. In particular, the TNF works because of the IL-twelve protein, which works from IL-seventeen through communicating with IL-twenty-three. So, IL-twenty-three needs to be treated since they're all connected." He paused and threaded his fingers together into a web of crisscrossed digits.
"If we disrupt their communications—" He unwound his fingers. "—the interleukins lose their effect. Biologics are medicines made from lab-produced proteins or antibodies and injected into the skin or bloodstream. Once inside the body, it causes this disruption process, blocking part of the immune system that adds to psoriasis."
Brody frowned, a line creasing between his eyebrows. The explanation was confusing, and he probably wished he hadn't come.
Dr. Katz sighed. "There are drawbacks, of course... Biologics are expensive. The cheapest single treatment I could arrange for is nine thousand."
"How long does it last?" Brody pressed.
"Three to nine months, depending on how she reacts. And while IL-twelve is the one we want to suppress, IL-twenty-three does some pretty important stuff, protecting against cancer or viruses. Those risks are minimal, especially given Paige's age, but haven't been effectively studied in long-term clinical trials yet."
"Are there any financial assistance options?"
"Brody," I whispered, shaking my head. He was asking Mom's questions, and while part of me glowed in appreciation for him being so thorough, the conversation crossed the border of being sensitive and depressing. Mom and Dad smiled, but being reminded of their limited finances couldn't feel good. "It's—"
"Absolutely." Dr. Katz nodded. "With grants, the lowest out-of-pocket expenses we could secure is five thousand."
Was that all? Unable to look at Mom and Dad's disappointment, I scoffed and crossed my arms. Five thousand for six months was the most expensive potential short-term fix I'd ever heard of.
"It's possible I could add you to a clinical trial, Paige." Dr. Katz's smile was sympathetic. "But we've been passed on the waitlist before, and I couldn't guarantee you wouldn't get the placebo arm. It's a common, silently discussed condition. More than eight million people are estimated to have it, although with varying levels of severity."
Heat burned in my cheeks, and I looked down at my shoes. Being stuck in a corner didn't feel good, especially pinned in with my family.
"Sorry," the guilt in Brody's voice made me squeeze his hand. He shouldn't have to feel sorry for our shitty situation. His asking with judgment-free curiosity stirred a funny feeling in me, but it drowned under the painful reminders.
No one should feel trapped and optionless. Just another reason I wanted to be a doctor. Not a Dr. Katz, treating symptoms to be livable, but to alleviate and remove the problem entirely.
We thanked Dr. Katz, and I was about to tell my parents I would ride with Brody when Morgan huffed from where she slumped in her lobby seat. "About time! I'm so hungry."
"Same," Brody said, but he wore his somber look on the way out to his truck. I rubbed his hand but with my opposite hand's fingers, which continued until we sat inside. His truck smelled...like the inside of his gym bag, sweaty and stinky, but he didn't have practice today. I wrinkled my nose and clasped my hands in my lap.
He looked at my parents getting into their cars with guilty eyes. "Paige, I didn't mean to—"
"Nope." I shook my head and fought the urge to hold his hand again. "All you did anything was ask innocent questions."
He turned on his truck and followed Dad home while Mom and Morgan took my car. "Did I piss off your parents"
"Nah. We're just butthurt that we can't change the fact it's too much money."
I didn't mean to sound so bitter. We fell silent for the ride home. It wasn't an uncomfortable silence, but I was tired. My shoulders slumped, and we still needed to get through dinner.
Making dinner gave us enough of a diversion conversation, and Brody stepped into the kitchen chaos, setting the table and pouring drinks. Mom cooked the teriyaki pork chops she'd marinated overnight, Dad and Morgan washed our lunch dishes, and I chopped mushrooms, broccoli, and carrots to steam until my hands quit. I stopped to rub my wrists, eyeing the last pile of carrots. Brody stepped in and took the knife from my hand.
The warmth of his breath rushed over my ear, his fingers gliding over mine, and a weird urge to lean into him made me sway. "I'll finish."
He and I sat on one side of the table, with Dad at the head, Mom next to him across from Brody, and Morgan across from me. My sister wasted no time, blinking at Brody as if he was an alien. "Why are you dating my sister?"
"Morgan!" I glared at her. "Brody, you don't need to answer her."
"What? I'm not sweeping the truth aside. You have a weird condition."
Easy to say for someone whose issue was solved with insulin shots. Her bratty streak was so irritating, and I couldn't wait for her to become a normal human again.
"Paige's condition isn't who she is," Brody's quiet tone drew the table's eyes to him.
Mom nodded and passed him the pork chops plate. "Well said, Brody."
I blinked at him taking three pork chops, taking one myself.
Dad coughed. "Brody, what are your intentions with Paige?"
Here we go. I sighed and clenched my stomach. Nate said my family's questioning was one of the most uncomfortable moments of his life, but Brody looked unaffected. Mid-bite, he only shrugged. "Uhh, get to know her better. Thank you for letting me ask the doctor questions. I think..."
We all leaned in closer, and he swallowed. "I think she's really special."
My heart wasn't prepared for his answer, stalling for a beat and then plunging with a tugging sensation. Special? I wasn't—
Morgan coughed, then covered it by sipping her water. "Special, sure."
"Yeah." Brody's gaze on me made me blush, and my heart did a funny flip when he covered his hand over mine resting on the table. "She was nice to me when I was a stranger adjusting to a new school. I probably would've burned my Home Ec kitchen down if it weren't for her and been...a lot lonelier."
Could my face burn any hotter? Probably not. My heart felt like it would burst from all the pressure in my chest. I stared at his hot, sweaty hand atop mine. Sure, my parents believed we were dating, but he didn't have to lay on the affection. "You're doing fine in Home Ec."
He was probably one of the top grades in class. For once, Morgan was quiet, staring at Brody's hand on mine. So were Mom and Dad. Why were they being so creepy?
Mom blinked. "Why are you in Home Ec?"
"My mom can't cook, and I wanted to learn." Brody gave me a small smile. "Paige is—"
"The helper." Morgan stabbed her plate and rolled her eyes, making me kick her shin under the table. "Oww! Mom, Paige kicked me."
"Paige," she warned. "Brody, promise my children know manners."
"It's cool." Brody looked at Morgan, who was rubbing her shin under the table. "I'm the younger sibling too. My older brother did way worse things."
She gave him a skeptical frown. "Like what?"
"One time, he shaved my eyebrows off. Another time, he..." Brody paused and cleared his throat. "Picked on me a lot. But, if I trust anyone to have my back, it's him."
His voice lowered, and I flicked my thumb up to rub the side of his hand. He was super quiet after his Seattle visit, missing his brother.
"He's right." Dad pointed his fork between me and Morgan, although his look at me wasn't happy. "When Mom and I are gone, you two will only have each other. So, you'd better learn to get along better."
I rolled my eyes at his morbid words. Awkward. So awkward, but we all focused our attention on our plates. My parents didn't stop the barrage of questions—where Brody wanted to go to college, what he wanted to major in, what his backup was if sports didn't pan out, on and on. Brody didn't seem to mind, answering every question with ease until they asked about his dad. He stiffened and said his relationship wasn't good. We fell silent, but they must have appreciated his honesty because they were okay with me showing Brody my room while they cleaned up dinner.
"Wow." Brody scanned my room, not that it was much to look at. Our house was small but cozy, with dated but comfortable furniture, and my room was no different. He had to bend his head down because the stars I attached to the cords from my ceiling fan brushed his forehead.
He took up a lot of space in it my room, making it feel smaller. I hadn't noticed how big he was because he slumped, but I cleaned every inch of my room so no incriminating dirty laundry or rogue underwear snuck out to embarrass me. My Homecoming dress was also hidden in the back of my closet, not that I expected Brody to go through my clothes. Especially with—
"No funny business!" Morgan yelled from her adjacent room, where Dad sent her to pretend she was doing something.
He also insisted I kept the door open, so I wasn't sure what he worried would happen. My bed was twin-sized and half-covered by one particular addition.
"Brody." Brody grinned at the stuffed bear reclining on my bed, with his giant purple-padded paws sprawled over the edge. "You sleep with him?"
"He, umm..." Wow, this was embarrassing. I cupped my warm cheeks. "I do. He keeps me from knocking my elbow into the wall."
He exhaled through his nose. "Makes sense."
Brody stopped at my small vanity area, taking in the creams I'd organized and wiped down. "What are the restrictions on stuff like this you can use?"
"It's embarrassing." Something about him towering over my daily routine necessities, where I tried my best to cover my skin, made me self-conscious. He didn't project an ounce of judgment at the twenty bottles lined up, only genuine curiosity, but reminding myself why I needed them made me uncomfortable.
"Shouldn't be," was his odd, blunt reply. "What are they?"
"Creams without isopropyl alcohol, methanol, and ethanol, anything that dries my skin—what are you doing?" I stopped when Brody typed into his phone.
"Taking notes," he mumbled. "Keep going."
"Umm..." I fought the urge to scratch behind my ears. "Petroleum jelly or shea butter are good. Unscented lotions with ceramides after cold showers with sulfate-free shampoo."
"Cold showers?" His eyes lifted over his screen, wrinkling his forehead. "What about swimming, the ocean?"
"Not for prolonged periods, but Dr. Katz recommends once a week for fifteen minutes of sun exposure."
"We're going back." He set aside his phone.
I hated the ugly emotions twisting my stomach and putting an ache in my chest. Nate's rejection because of my lack of confidence hurt, and I wasn't above admitting, sometimes, I was insecure. How could I not? People stared at me like I was a freak, and with the laser-treated purple version reflecting, I couldn't blame them,
"I don't know, Brody," I said. "I don't want...to be stared at because I'm in a bathing suit."
Stepping closer, Brody's gaze dropped to the rolled-up hem of my shirt. His fingers curled around his phone. "Is it...still hurting?"
"No, more like it's ugly," I whispered, hugging my stomach.
He gave me a look like his thoughts got trapped in his mouth. Good thing he didn't say the darker version wasn't ugly, because I wouldn't have believed him. His eyes darted between mine, and his hands tightened. "You should try the experimental option. Biologics."
"Right." I rolled my eyes. Had he missed the part where Mom cringed and Dad looked guilty about the cost? We weren't poor but didn't have excess money. My entrance into Stanford was dependent on a scholarship for a reason. "Do you have an extra nine thousand dollars lying around?"
"No." His frown softened into a smile—not a pleasant one, more a 'you won't like this suggestion smile.' It was the same look Violet wore before she suggested Brody and I should pretend to date. "But I know where we can get five."
What? Where—oh no. No. Ten thousand times no. He couldn't mean what I thought. No.
I shook my head, but he clamped his hands around the sides of my head to stop it. "Yes."