Saint Therese of Lisieux chapel occupies a choice lot in Santa Monica, just blocks from the ocean. Most of the members walk there for services from the surrounding neighborhoods but a few make the drive from other parts of Los Angeles: Westwood, Pacific Palisades, Mar Vista. One family makes the drive all the way from Signal Hill because the father went there as a child and he wants his family to experience the same community. In many ways, the white, painted brick building is out of place among the new-money McMansions with their luxury sedans and oversized SUVs in the driveways, contrasting with Saint Therese of Lisieux’s small green lawn and rose bush hedges. Inside, the mahogany pews were time-worn but sturdy. The chancel is draped with red, plush carpet and adorned with a brassy cross, an oversized, white leather bible, and a modest pulpit. A beautiful wooden table that one of the parishioners had made sits at the center as the altar.
Sunday morning services had just ended, and most of the congregants had moved on to the community hall for the monthly potluck. Maura was in line for the buffet when she noticed she was missing an earring and returned to her pew to look for it. She found it where she sat during the service. As she pushed the post into her piercing, she saw Pastor Stone on the other side of the sanctuary chatting with a congregant. Although she couldn’t hear what they were saying, she could tell from their gestures and body language that the two were comfortable in each other’s presence, relaxed in a way that bespoke a mutual trust. Pastor Stone waved her over and she hesitated at first, not wanting to intrude on whatever conversation they were having.
“Maura, this is António,” Pastor Stone said. Pastor Stone had mentioned an António in the call for prayers during the service. She thought this must be him and almost asked but decided better.
“Maura’s a runner, too,” Pastor Stone told António as she made her way over, before leaving the two of them to join the potluck.
“Do you run?” Maura asked.
“Well, not so much anymore. I used to run a lot,” António said. “It’s more of a goal now.”
“I’m an out-of-shape distancer,” Maura said. “10Ks were my specialty.”
António smiled. “Mine, too, once upon a time. Coming to the potluck?” he asked.
“Yes, I thought I’d check it out,” she said. “You?”
“No choice for me. My husband is the co-chair of the social committee.”
“Even if you’re conscripted you must smell how good it’s going to be,” Maura said. The mingled aromas from the different ethnic culinary traditions of the churchgoers wafted from the community hall into the sanctuary.
The two of them entered the community hall where António’s twins—little Alberta and Sergio—ran to him, their jet black, curly mops bouncing with each step until they reached him. They clung to their father as young children do. Church members sat at round tables with paper plates loaded with food or waited in the buffet line. This was Maura’s third week at Saint Therese of Lisieux and her first social occasion. She had just finished her medical residency and moved to Santa Monica from Boston to start her practice. António introduced Maura to the Del Villar family and when she was engaged in conversation with them, he and the twins made their way to his husband Erich’s side. Erich gave him a peck on the cheek.
“How’s António?” Bart Del Villar asked Maura.
“How’s António?” Maura repeated, turning to look at him just in time to see him sneak a bit of food from Erich’s plate. “Fine, I guess. We just met.”
“Oh,” Bart said, brow furrowing with concern. “You don’t know?”
Maura listened patiently as Bart explained António’s diagnosis. Even after she worked into the conversation that she was a medical doctor, he went on about how this type of pancreatic cancer isn’t the one that kills you right away.
“It sounds like neuroendocrine cancer of the pancreas,” she said.
Bart paused his explanation for only a moment before continuing. “There’s two kinds,” he said. “One is fatal pretty quick.”
“Adenocarcinoma,” Maura said, nodding.
“You can live a long time with what he has. There’s no cure but you can still live a long time. António’s been living on our prayers for three years now.” Maura smiled patiently.
Maura chose to join Saint Therese of Lisieux on the recommendation of her stepmother, a minister who knew Pastor Stone from Divinity School.
“If I know you at all, Maura, you want a pastor who makes you feel like part of a team, part of a gentle, truth-telling, don’t-rest-till-the-job’s-done team. You and Pastor Stone are cut from the same cloth that way.” Maura entered the church into the search engine on her smartphone and started clicking through the links. She found a video of Pastor Stone giving an address at the opening of a community shelter for immigrant families.
“You can’t separate the church from the world. We have to dive right in. And the world is messy and suffering and made up of real people and real struggles and their feelings, their pain, and their concerns. We make the biggest difference when we meet them in that messiness and get our own hands dirty from work.”
That’s just how medicine should be, Maura thought. Right there, hands dirty, in the midst of it all. She looked the church up her second week in California.
Three years before the potluck, António won a ten-kilometer trail run that followed the Coastal Trail up in San Francisco. He set his personal record and, to his surprise, beat out athletes twenty years his junior. Everything had aligned to suit him just right. The air temperature was cool, and a light fog caressed the hillsides. The night before, Erich prepared his specialty dinner at their short-term apartment rental in Noe Valley: chicken carbonara complete with homemade pasta. Even Alberta and Sergio graced him with the favor of sleeping straight through the night so that he was fresh when the alarm went off.
He positioned himself toward the front of the pack for the start. When the gun went off, he found himself in the lead group. He felt strong. His heart pumped fast but without labor. Charge like a racehorse, he thought to himself. It was a mantra he used during races, ever since high school when his coach used that phrase to motivate the distance runners. Coach Dahlgren was her name, and she would have the team watch videos of cheetahs and horses to study their rhythms, their movements, and to highlight the differences between sprinting and endurance running. She would keep the team together in the off-season by showing films at her house or reading books together—always with a running theme or with characters who were runners. At the start of each season, she would give a lecture on the history of running, oftentimes starting with the Greek legend of Pheidippides, the runner from Marathon, who brought news of their victory in battle. Charge like a racehorse. His breathing was effortless.
He loved that trail, skirting the bluffs as it did, majestic views of the convergence of waters between the San Francisco Bay and the Pacific Ocean, swirling below in dark green and beige waves, capped with white foam and shore breaks. He used to run the trail when he and Erich lived in San Francisco for graduate school. Even when running a race, the beauty of it wasn’t lost on him. He never felt more part of a place than when running that trail on swift legs. At a couple points in the trail there was nothing but a few hedges between him and a sheer hundred-foot drop to the salty, rocky coastline and it struck him how special to have such natural beauty tucked along the outskirts of urban San Francisco.
As António approached the finish line, he knew he must have pulled away from the others, but he began to doubt his own senses. There must have been another breakaway athlete he hadn’t noticed. He was probably racing for second or third, he told himself. But when he saw Erich at the finish line, giddy, holding the twins in his arms, “It’s you! It’s you! Go!” he found a reserve in him that he unloaded.
He crossed the finish line and scanned the crowd for the winner, still not quite allowing himself the victory. Twenty-three seconds later, the wiry second-place runner charged down the finisher’s chute, slapped him on the shoulder, and huffed out his congratulations.
Five months after that win, António awoke in the middle of the night to excruciating pain. Moments later, he was vomiting blood.
“Babe,” he could barely choke out. “Help.”
“Don’t forget your backpacks,” António reminded the twins. They had little matching backpacks with their names embroidered in white block letters, in which they carried lunches, light sweaters, and small water bottles. Alberta picked up Sergio’s and helped him put it on and he, then, returned the favor. Walking Alberta and Sergio to preschool had become one of António and Erich’s favorite rituals. They attended the Bright Mornings daycare at Saint Therese of Lisieux. What by rights should only be a fifteen-minute walk could often expand to fill nearly an hour. The palm tree-lined street was alive with squirrels and monarch butterflies, snails, and people walking their dogs and any number of distractions to capture their attention.
Before the diagnosis, António and Erich traded turns walking them to and from preschool and, though the dallying kids were heartwarming even then, now the couple walked them together, savoring their authentic curiosity and wonder, savoring the moments together. Alberta stopped and smelled a Bird of Paradise bloom, its burst of orange radiant in the morning sun. Sergio joined her.
“There’s a group from Saint Therese’s planning to do the Coastal Trail run in October up in San Francisco,” António said. Erich turned to look him in the eyes, concern seeping from his expression.
“What about the pain?” he asked.
“It’s been manageable, almost like normal. And besides, I’d rather run in a little pain than not run at all,” António said. António had been managing pain since the first surgery to remove tumors—and his spleen and a fifth of his pancreas—in the initial weeks after the diagnosis.
“Wait, isn’t that a 10K?” Erich asked.
“I won’t run the whole thing. Probably just run every other mile.”
“It’s so hilly. You haven’t run more than two miles since you got sick.”
“Babe, I want to do this. And I want you to be supportive. The race is before my next round of therapy and we both know I won’t be running much after that. If I have to walk the whole thing, then I’ll walk the whole thing. But I have to do this.”
Alberta crouched to pick a fragrant, purple flower growing next to the Bird of Paradise and handed it to Sergio. He smelled it and then rubbed his nose, the pollen from the bloom tickling him. Sergio, with help from Alberta, put the flower in place behind his ear as Erich snapped pictures on his smartphone. Without another word, the twins continued walking.
“Okay,” Erich said, taking António’s hand into his. “Let’s go to San Francisco.”
“António this is Tricia from Human Resources. Sorry to leave this for you in a voicemail, but your sick and vacation accruals have zeroed-out and I need to know what your plan is for the upcoming leave you’ve scheduled. You can request an unpaid leave or wait another two months for your balances to bounce back but it’s against policy for leave accruals to go into deficit. Again, this is Tricia from HR. Give me a call to discuss your options.”
António hung up the phone without saving the message. His eyes turned to his computer monitor, the browser was open to his savings account. The reserve that he and Erich had always thought ample seemed suddenly inadequate. He opened another browser and went to the web page for the trail run in San Francisco and willed his thoughts to take him there.
Maura stooped down to tighten the laces on her running shoes on the lawn at the terminus of San Vicente Avenue at Ocean Avenue in Santa Monica. The bluffs overlooked Santa Monica Bay with spectacular views. On a clear day, you could see all the way to Malibu to the north and Santa Catalina Island to the south. António had invited her to join the running club on this his return to formal training. She was a few minutes early and so spent the time stretching and taking in the views.
António called to her as he approached, flanked by Bart Del Villar and other runners she recognized from Saint Therese of Lisieux. As more runners gathered, they broke into groups based on pace and distance goals. “My goal is three slow miles,” António said. “But I’ll settle for two.” Maura offered to run with him for her warm-up.
He shuffles his feet, moving slowly, more like a trot than the athletic gait he had before his diagnosis.
“Don’t laugh,” António said.
“At what?” Maura asked.
“My run gait. I used to be a racehorse. Now I’m more of a waddling pigeon,” he said, jutting his head back and forth for effect. They shared a polite laugh. A few moments later, António asked Maura what she knew about medical insurance. “My doctors found some new spots on my liver but insurance won’t cover the procedure. It’s not even experimental, just another round of RFA.” António was so accustomed to explaining the common form of cancer treatment that he had to stop himself to avoid patronizing Maura.
“Have your doctors filed letters of support?”
“They will. They have before but it’s like this all the time now. Every procedure. Everything. Insurance turns it down, we appeal and so far, we’ve been able to win. All I have is time, Maura. I’m not going to beat this, just delay it. It’s like they won’t even give me that.”
“You have to keep appealing. Just keep at it. They’ll approve it but you can’t let them wear you down.”
António winced and slowed to a walk.
“What is it?” Maura asked, taking him by the wrist.
António grimaced before taking a deep breath. “Not a word to Erich,” he said.
“Pain getting worse?”
“It never really got better,” he admitted, slowly working his pace back to a trot. They ran the next mile in silence until António mentioned the trail run in San Francisco, inviting her along. “A few of us from Saint Therese’s are going. We’re all booking rooms in the Hotel Nikko. You should come. It’ll be fun.”
The health insurance company spat out letters in the ugliest font. Skinny lettering, anemic. Designed, no doubt, to get as much mileage from the printers as possible. The paper was thin and scratchy and cheap. There was no letterhead, all contact information was printed in the same ugly font. There was no signatory so there was no signature, no person to claim responsibility or even to see the letter, until, that is, it was opened by its recipient.
In some ways, it’s a stretch to even call them letters—no salutation, numbers for everything—the procedure, the diagnosis, the patient, the primary care physician, the oncologist, all numbered.
The reason for the denial was also preceded by a reference code: It is determined that the treatment you requested is not medically necessary for your condition.
António had to stifle a laugh at the bravado of the lie. What could be more necessary? He took out a pen and drew a single blue line through the reason and, imitating the ugly font as best he could, scrawled “It is determined that this treatment will cost tens of thousands of dollars and may only extend your life by a few months.”
He put the letter back into its envelope and stuck it into the thick, weathered accordion file they were using to track all the insurance decisions, notifications, changes in coverage, etc. This latest notice brought the number of denials up to nine, though the eight prior had been approved on appeal. When he was first diagnosed, he knew he had to fight the ongoing mutiny in his body, the mutiny of murderous cells, but he didn’t think he’d have to fight the people he had been paying to have his back exactly for this reason. That happened all the time, he knew, but not to him. He never thought this would be him, that he would be the one to lose. He put the accordion file away and tried his best to put the thought from his mind. Erich would be home soon with the kids. He turned on a classic rock playlist and pushed the denial of coverage from his thoughts.
The pastor’s office at Saint Therese of Lisieux brought the white-painted bricks so prominent on the outside of the building into its interior, framing the large windows which flooded the room in natural light. A skylight added some thirty years after the church was built, showed nothing but blue skies above. The furniture was mid-century modern and built-in bookshelves filled with biblical commentaries, theology books, and fiction—all of Pastor Stone’s expansive collection—lined the walls. Three diplomas in simple wooden frames were hung in a column, one above the other, displaying Pastor Stone’s credentials. A BA in economics from Yale College, cum laude, a Master of Divinity from Duke Divinity School, and a doctorate in pastoral counseling from Garret Evangelical Theological Seminary. The office was tidy and inviting.
“There’s a weightiness in my chest,” António said. “Like I’m waterlogged, and nothing can shake it…. It saturates me with heaviness.”
He was seated in a recliner and spoke slowly, each word a burden. “Like a dark fog is closing in from all directions. It gets into my thinking, too and I can’t shake it off. It’s there when I’m happy or when I’m sad. It’s there when I’m afraid, especially then. Especially when I’m afraid. I fill my day with the things that make me happy: Erich and the twins, the church, running, my garden, but it’s still there, dogging me. It knows I’m dying.
“I signed up for the run in San Francisco to change the subject but none of it changes the fact that I’m living with dying every single day and the day will come when it all catches up to me, when there are no more surgeries or RFAs or experimental therapies. And when that happens, I won’t have a choice but to leave my children, my husband.” António paused, but Pastor Stone sat silently and waited for him to continue.
“At night, I always dream but I can never remember what about. I just remember the restlessness. But last night, I remembered everything. My mother and father were there and we were in our old place in Culver City, when I was just a boy. They were young and strong, from before, from before they died in the car wreck. Everything was warm and light. Their eyes sparkled with life. The weightiness was gone from my chest, the fog lifted. They didn’t say anything, but they didn’t have to. It was like without speaking they were telling me they’re waiting for me, and that everything would be okay, that Erich and the twins, they’d somehow be okay. And this morning, when I woke up, for a split moment that’s how I felt before I realized it was a dream. For just one moment I felt no weight, no fog. Just a slice of clarity before it all came flooding back in.”
António had been looking down at the hardwood floor while he spoke. When he finished, he looked up.
“Have you shared any of this with Erich?” Pastor Stone asked.
“How could I? He’s already carrying so much. After he buries me, he’ll be a single father. I can only imagine what he’s going through.” António paused. “After your sermon last Sunday, we were able to have such a great conversation with Alberta and Sergio. I felt like they really got what you said about the lilies of the field and God’s faithfulness, and that it is more about how you live than what you believe. They got that. That’s what parenting is supposed to be about, teaching them how to be good in this world. Not this. Not copays and pain management and finances and debt. You want your lesson to be swept away like it never happened? Bring up cancer. Bring up dying. It sweeps it all away.”
“I think Erich would surprise you, Alberta and Sergio, too, if you were to talk with them.”
The two sat without speaking for the next few moments. “António, will you pray with me?” Pastor Stone said, taking António gently by the hands. António sighed and nodded.
“Race day,” Erich whispered as the crescendo of his smartphone chimes pulled him out of his slumber. He rolled over and kissed António softly on his closed eyes. “You sure you don’t want me to come with you?”
“Take the twins to Alcatraz. It’ll be way more fun than watching me take seventy-five minutes to run a 10K,” António said. “I’ll be lucky if I make the cut-off time.”
“In that case, I can sleep for another hour,” Erich said. António sat up in bed as Erich rolled over onto his side to fall back asleep.
António kissed him on his forehead.
“Walk it, if you have to, babe,” Erich said.
António sat for a moment, watching sleep return to his husband. The twins slept soundly in the queen size bed next to theirs. He walked over and watched them sleeping, an indulgence he had been giving himself ever since they were infants. Watching them sleep was like watching them at absolute peace.
He kissed them. “Daddy loves you,” he whispered.
The crowd of about seventy runners gathered on Crissy Field about a mile from the Golden Gate Bridge—stretching, warming up, chatting. Bart Del Villar and a couple of other runners from Saint Therese of Lisieux waved and called to António, who waved back but didn’t stop to chat. The breeze off the Bay was salty and fresh. Full-bodied, cumulus clouds raced across the deep blue sky with the sun casting golden rays between them. Maura was taking in the views. She had never been to San Francisco and a trail run under the Golden Gate Bridge, traversing the coast, was a spectacular way to encounter the city for the first time. António made his way over to Maura.
“I’m glad you made it,” he said.
“It’s breathtaking. I can already see why you love running here,” she said. “How are you feeling?”
“I think I’ll be walking more than running,” he said.
The race director signaled for everyone to gather by the start line. She held up a poster-size map of the run and explained the course: a point-to-point race, ending at the Land’s End Lookout. “Be careful here and here,” she said, pointing at the map. “The trail traces the cliffs there, so keep your eyes on the trail.”
The athletes lined up for the run and António found a place at the very back. Maura stood beside him.
“Please don’t wait for me,” he said. “I’ll take forever.”
“But at least you know the course,” Maura said with a wink.
When the gun went off, António remembered the way his body used to move, how the last time he ran this race, his relaxed run gait was smooth, quick, rhythmic, and athletic. Charge like a racehorse. It was like a planted memory from someone else’s life, so foreign and out of touch with who he was at that moment. So familiar, yet so strange to be at the very back of the pack, next to an elderly man, an overweight teen, and Maura, who should be somewhere closer to the front. His feet shuffled as he tried to find his cadence.
“Go, Maura. Don’t wait for me,” he insisted after a little while. Before long, António was at the very back of the pack, trotting his slow pace.
António approached the second set of bluffs on the run alone. The edge was just as he remembered—a narrow trail, lined by modest hedges of lush clover and soft fans of lady ferns all bordered by a straight drop over a hundred feet to the rocky shoreline below. A small flotilla of surfers paddled along the coast, making their way from one shore break around the rocky bend to another a little further south. They looked like shadowy silhouettes the way the sun cast them in a shimmering arc of white gold. On the other side of the Bay, the Marin Headlands glowed a bright beige in the sun. Sailboats stippled the ocean.
For the briefest moment, absolute fear welled up in António and threatened to engulf him. An existential upwelling of all his hopes and dreams that he thought he had made his peace with pushed forth and would have forced a scream from him, an angst-laden howl but he clenched his fists and pushed it down, and turned his thoughts to Erich, Alberta, and Sergio, by now on a ferry en route to Alcatraz Island. He stood on the edge and felt the breeze on his skin, smelled its salt.
“António.” It was Maura. He turned and looked at her. Their eyes locked for a long moment.
“It was an accident. They’ll be taken care of—my life insurance will cover everything but only if it’s an accident.”
“Not like this,” Maura said. “Let me help you.”
António smiled. He knew she meant it. She probably even believed that she could.
“I’m sorry you came back. But, Jesus, Maura, now you know. I got disoriented and fell. You know that. You see that.”
“I was running, got dizzy, disoriented, and fell.”
“António,” she said, gingerly stepping forward.
António shook his head no, turned and fixed his eyes far off into the distance, far out over the Pacific, and, in an instant, charged forward off the trail, pushing everything he had—every memory, every joy and fear, every victory and defeat, every love—into his legs which opened with a strong, athletic gait for just three loping steps before he disappeared from view.
Maura held her face in her slender, trembling hands, her hair still pulled back tightly into a ponytail, her skin salty from dried sweat. Some hikers came along and took her to a wooden bench a little way up the path and sat with her. One of them called for help. She couldn’t stop shaking. That scene, that terrible scene. António’s charging leap—no noise, no calling for help, just a shake of his head and a silent charge forward—played over and over in her mind.
She lifted her face to see a police officer walking the trail toward her. There was a ringing in her ears and yet the hum of bees collecting pollen off wildflowers nearby somehow got through the ringing. One of the hikers started talking to the officer, but Maura heard only the ringing in her ears and the humming wings of the bees.
He was disoriented and fell.
Maura knelt in the grass by the rose bushes at Saint Therese of Lisieux. Her hands were fitted with oversized gardening gloves but, in a moment of frustration, she cast them off as the extra fabric kept hampering her weeding. She didn’t have any tools, so she developed a gentle push, pull, shake technique to uproot the weeds from the damp, dark soil, piling the limp greens on the ground next to her. Soil collected under her fingernails. Kids, including the twins, chased each other on the lawn behind her. Other congregants attended to different tasks and chores. It was the annual church beautification day. Pastor Stone walked across the lawn behind her, carrying a wooden tray with a pitcher of hand-squeezed lemonade and paper cups.
“Hello Maura,” Pastor Stone said. Maura didn’t look up, didn’t answer.
“Hello, Pastor.” It was Erich.
Erich helped himself to a cup and poured the lemonade, filling the cup to the brim.
“Alberta and Sergio are having fun,” Pastor Stone said as the kids raced by them.
“They do a little better with each passing week,” Erich said, responding to the question behind the pastor’s statement. “We all do,” Erich said before walking into the church. Pastor Stone set the lemonade tray down and knelt next to Maura.
“Do you need a hand?” Pastor Stone asked.
“I’m just about done with this section,” Maura answered, shuffling her weight, preparing to stand.
“Before you go,” Pastor Stone put a hand on her shoulder. “Please, let me get something off my chest.” Maura turned and looked expressionless at the pastor. “What you saw in San Francisco, António’s accident… When you see something like that, you take it in and it can do something to you. It’s a burden and a scar. You don’t have to talk to me, but I’m worried that you’re not talking to anyone at all. You saw a horrible accident and you’ve had to tell it over and over, to the police, to the insurance company. But I’m concerned nobody stopped to ask about you in all of this. So, I’m asking, Maura. And if you ever need a friend, I want you to know that I’m here.”
Maura managed a meager smile through the weight of all she carried. Her eyes took in a pair of bees hovering over a rose bloom. She nodded at Pastor Stone and, standing, took the pulled weeds into her dirt-covered hands, walked to the compost bin and tossed them in.