10

DIAGNOSIS

TO JOHN ARTHUR, the worst part of nearly dying over Mother’s Day weekend in 1995 was the embarrassment of it. The asthma attack had left him feeling feeble and exposed, like the beanpole of a boy who hid in a tree when he couldn’t finish a physical fitness test at school. Years later, he could still hear the laughter as he darted off the running track, louder with the passage of time and the embellishment of memory, and he never wanted to feel that way again.

Once, while driving through town with his aunt Paulette, John had confided, “I always hated phys ed. I was the target of dodgeballs.”

Paulette shot back, “But look what you’ve become. You’re better than any of them.”

And she meant it. John wasn’t in love with his consulting job in technology, but his job had fueled his passions. He had grown into something of a local tastemaker and filled his life with whimsical, interesting things, fabric and furniture, clothing and paintings. Saturdays with John were grand adventures, a long brunch, a lazy walk, a hunt through the dusty aisles of an antique shop, where John, from the corners of his mouth, would issue a running, witty commentary on his interesting finds and the god-awful items that he rejected.

Lonely people moved him, perhaps because they reminded John of how different he felt as a boy, and more than once he touched his friends by inviting strangers sitting alone at bars to join them for drinks or dinner. Year after year, John brought new people into his social fold. He never shared particularly personal stories about himself, but he was a perceptive listener who could critique without judging, and friends often left his company feeling understood—deconstructed and put back together again.

Once, just before Christmas, Jim watched John slip into a quiet conversation with a clerk at a craft store in Columbus, where they bought a German nativity set made of hand-carved wood. When they returned the next year to buy more pieces, Jim watched the clerk’s face soften when John recognized her and picked up the conversation where they had left off twelve months earlier. Such a beautiful thing, Jim thought, to take the time to connect with strangers.

Still, the smallest thing could fluster John, a glance from a coworker, a comment from a store clerk. On the last night of a trip to Paris in 1999, Jim stumbled as he tried to ask a waiter in French for a glass of red wine.

Je voudrais . . . de vin rouge?

“Oh hell,” Jim said as the waiter stood rather impatiently at the head of the table. “How do you say bottle?”

“Bottle,” the waiter said in perfect English, and promptly walked away.

John sank low in his seat, mortified. “Go outside,” he told Jim. “You’re embarrassing me.”

Jim knew that John’s heightened sensitivity was a vestige from childhood, when he was mocked by other children and berated by his father. Jim also knew that silliness could help defuse it, and so he walked out to the street and made funny faces through the brasserie’s glass windows until the beginnings of a smile crept across John’s face.

Early on, John decided that scenes of all distasteful varieties could be avoided with proper behavior, so he coached his friends to properly spoon soup (from the front of the bowl to the back) or match socks (never white) with slacks. He was a practiced host at lavish parties thrown in their cottage and later in an eight-thousand-square-foot house on a hillside overlooking Cincinnati’s Mill Creek Valley, with a twenty-eight-mile stream running through the heart of the city and into the Ohio River just west of downtown. John and Jim filled each room of “the Big House” with paintings by local artists, and Jim found himself wondering whether John could have forged a successful career in interior design. He had been accepted into a program in Chicago when he was a senior in high school, but his father had refused to pay for it.

John even threw a party in the Big House in 2007 after his mother Marilyn died of lung cancer six months after she started coughing. Curtis had traveled with his mother on trips around the world, to Poland to study the activities of beavers, to Brazil to volunteer in an orphanage. In the final days of Marilyn’s life, Curtis brought his laptop to the hospital and later to the hospice to sit with his mother and was the last person to see her before she died. But John could barely bring himself to go.

Mourning his sixty-four-year-old mother in public would have seemed almost obscene, so he and Curtis served a menu of Marilyn’s favorite drinks at a party celebrating her life, including white wine “à la Marilyn,” poured from a box and chilled with ice cubes, and put a blonde wig and some jewelry on a dress form that John found stashed in the basement.

“How are you doing?” Jim asked before the party, brushing his hand along John’s cheekbone. John had cried once, just briefly, after the hospice nurse called with news of his mother’s death. Jim had held him tightly, but he knew there would be no drama, no bucket lists, no urgent declarations of love or anger or grief. It was completely unfamiliar to Jim, who leaned toward sentiment, but after more than fourteen years with John, he had learned not to push his partner.

“I’m having a hard time, Boo,” John said simply, then quit his job in project management and, over the objections of Curtis and Jim, bought a burned-out seven-unit apartment building in a desolate stretch north of downtown that he vowed to renovate for the good of Greater Cincinnati.

In 2001, when Cincinnati police shot and killed an unarmed nineteen-year-old African American man, prompting four nights of rioting, John decided to take part in a series of neighborhood discussions about race. He wasn’t particularly political and would never think of himself as an activist, but he hated the idea that black people felt targeted and vulnerable, shunned by their own community. If he could help people sit down together and hear each other, he wanted to do it.

But redeveloping and renting out an apartment building would take years of hard work, and Jim feared that the complicated project would never get done. Curtis was so worried that he signed on as John’s business partner to oversee the costs.

It came as no surprise to John’s friends when he shrugged off a strange sensation in his left foot in the winter of 2011, a tingling that at first was more annoyance than disability. Meb Wolfe, who had married eleven years earlier, heard about it from her husband while she was away on a business trip. “John’s having trouble with his leg,” he said during a late-night call. “Something is definitely not right.”

Katherine Jurs, a city planner who had met John in the early 1990s, got a text from Jim: John had a rough time getting home. I’m really worried.

Jurs thought about her longtime friends, who had opened their home year after year to fund-raisers she hosted for the Leukemia & Lymphoma Society.

Jurs responded: He needs to go and get checked out.

Jim: What could it be?

Jurs: A pinched nerve? It might not be as bad as you think.

At a Cincinnati bar one night, Jim watched quietly as John limped toward the bathroom. Their friend Jennifer Stowe, who had traveled with John and Jim to Paris, wondered whether John had suffered a mild stroke. “Look at him when he walks,” Jim said, shaken.

“What’s going on?”

“He’s got to go to the doctor,” Jim said. “He’s tripped a few times, too.”

It started with a strange sound, a soft and steady thump-thump-thump in the hallways of their condominium, which they had bought in 2008 after they’d decided it was time to sell the Big House and live a simpler life. John’s left leg was slapping against the ground, as if bound by a heavy weight. Thump-thump-thump. The sound was deafening.

Then John had trouble swinging his legs out of their Volkswagen hatchback. He pointed to his shoes, brown leather lace-ups. “Too heavy,” he told Jim with a shrug. They traded their hatchback for an SUV and chalked it up to benign aggravation, life in their forties.

But as the slapping grew louder, Jim trolled the Internet late into the night, reading about pinched nerves and lead poisoning and muscular dystrophy. One was worse than the other, but nothing was as frightening as a disease called ALS, a fatal neurological disorder that attacks the nerve cells in the brain and spinal cord.

In May, John went to the doctor. He started taking antibiotics for Lyme disease. He had blood infusions when traces of heavy metals were found in his body. He got acupuncture for a possible pinched nerve. Still, there was no firm diagnosis.

Jim knew that ruling out diseases like muscular dystrophy should have brought some comfort. But he also knew that an ALS diagnosis is more of a process of elimination, coming only after neurological exams and blood tests eliminate other conditions and disorders.

John had an MRI and spinal tap. The electrical activity in his skeletal muscles was tested. Still, by late May 2011, there was no diagnosis. Only questions.

Jim paced the kitchen, the bedroom, the living room, frowning at the white brick walls. He passed their painting of Tunisian kilns and the marble-topped coffee table that had once belonged to John’s grandmother. He looked at the clock. He answered an e-mail from work. He waited. Please. Let it be okay.

Any moment now, John would come home from the neurologist with a final diagnosis, something that explained the heaviness in his left foot, which lately had been creeping higher, into his calf and thigh. One doctor had mentioned the possibility of ALS, which most often starts with weakening in a single limb, but other diseases could produce the same symptoms, and John wanted a second opinion. Hours earlier, he had dressed for the appointment, choosing a gray T-shirt with a picture of a drinking glass that said HALF FULL. Jim watched from the doorway.

“Let me come with you.”

John paused and turned to Jim. “I need to go alone.”

Jim fought the urge to grip John by the arms and beg him to change his mind. But John was about to find out whether he would live or die, and Jim couldn’t think of a more personal moment. John would process the news on his own quiet terms, without emotion or drama.

Jim walked John to the door and said, “I love you,” then sank down on a kitchen stool to wait. He looked around their condominium, on the second floor of a converted glass factory in a neighborhood of buildings from the mid-1800s. Their unit had been raw industrial space, but John and Jim renovated every room, adding white bookshelves and a backsplash by the kitchen sink of collectible pottery in orange, blue, and green. A painting of John and Jim from the 1990s hung on the wall in the living room.

Sitting in the kitchen, Jim thought about John’s near-fatal asthma attack years earlier and promised himself that he wouldn’t panic. The day before, Jim had sent an e-mail to his sister-in-law: We have our fingers crossed. He’s been feeling better.

Jim brewed coffee and looked at the clock again.

When John walked in late that afternoon, he bent down to leave his leather shoes by the bench in the foyer, a sight so familiar and mundane that for a split second Jim felt himself relax. But John’s cheeks were wet and his shoulders were slumped. Jim leapt from his stool in the kitchen, and under the foyer’s stained-glass window, he gripped John by the arms. Please. Let it be okay.

There is never a good way to talk about dying, so John opted for simplicity. “Yeah,” he said, the words a soft tremble. “It’s ALS.”

Jim wanted to scream. He wanted to vomit. How much time did John have? How quickly would his body fail him? John rarely cried, but his shoulders were heaving as he clung to Jim. “We’ll do what we can, okay?” Jim said.

He took John’s hand and they walked slowly down the stairs to the media room. The thump-thump-thump from John’s heavy left foot seemed to reverberate off every wall in the house, and Jim silently cursed the disease that was crippling his partner. John leaned back into the couch, his face blotchy and streaked with tears. Outside, couples strolled the riverfront, relishing a first taste of summer. Soon, local storefronts would boast vibrant bundles of gladiolas and pansies. Jim felt disconnected and afraid, and he edged closer to John.

A veteran neurologist at the University of Cincinnati had made the diagnosis.

Back in medical school at the University of Illinois in the late 1970s, there was no question that John Quinlan would study the brain. He had been diagnosed with muscular dystrophy at fifteen, when he was playing on the high school football team, and decided he couldn’t become a surgeon because he lacked the strength in his hands. By the time he was a neurology resident in the 1980s, he was navigating around the hospital on a power scooter. He took his last step in 2005.

Over the years, as his own body failed him, he diagnosed dozens of people with ALS, watching the muscles of their arms and legs waste away, leaving nothing but the contours of bone. A terrible disease, the doctor had said more than once, as patients who were once standing over his power wheelchair, looking healthy and strong, quickly lapsed into chairs of their own.

A slight man with a thick white beard and mustache, the doctor had decided that finding a cure for ALS must be like repairing a model of a miniature ship while it was inside a glass bottle. ALS not only affected the body, but the cells inside the body. It helped explain why the disease, after decades of research, had no known cure.

When Dr. Quinlan rolled into the exam room in his power wheelchair, notebook paper balanced in his lap, John was perched on the edge of the exam table. The doctor started asking John a series of questions. He wrote, “progressive weakness in left foot and left hand,” “developed foot slap,” “three falls,” “can’t hold a cup or clip fingernails.”

Dr. Quinlan had seen the same symptoms in other ALS patients, but he still couldn’t be certain. “Can you hold out your arm?” he asked John. “Don’t let me knock it down.”

John had trouble keeping his arm in the air.

The doctor scanned the results of John’s medical tests, hoping to find another explanation for the muscle weakness. But he turned to John, and said, “I’m worried about this being ALS.” Dr. Quinlan spoke slowly and carefully, knowing that patients often don’t hear anything else after the shock of the initial diagnosis.

“I thought so,” John said.

“What’s your understanding of this disease?”

Most people diagnosed with ALS live for three to five years, but Dr. Quinlan had made it a habit of describing his own experience as a doctor: his longest-surviving ALS patient had lived for seventeen years, the shortest just nine months. There would be progressive muscle weakness, cramps, twitches, and slurred speech. Eventually, when John’s breathing muscles weakened, he would need a ventilator. John had already decided he would never want a machine to help him eat or breathe.

“You’ve got a lot of living to do,” Dr. Quinlan said. “Let’s look at all the things that are important to you and the things that you want to do now.”

That first weekend after the diagnosis, John and Jim let themselves sink into the comfort of a routine carved over years. It seemed there was safety inside their white brick walls, with John lounging in his corner of their favorite corduroy couch, long legs tucked beneath him. Jim couldn’t bring himself to think about doctors and disease, not yet, not this soon, so he ironed shirts and scanned the Cincinnati Enquirer long into Sunday.

Then Monday came, swift and unwelcome. Jim knew that John considered the ALS diagnosis something of an embarrassment, as if he were responsible for the dying nerve cells in his brain. So that afternoon, Jim started making calls and sending e-mails to their family and friends, one after the next, feeling the contours of his life blur and fade every time he described the disease and their harsh new world.

He phoned Meb Wolfe, his older brothers, his sister Ann in Sandusky. He sent out an e-mail, struggling to find the words: I wish I had better news to share.

Paulette Roberts called from Portland, where she was vacationing along the Columbia River. Jim winced when he saw her cell-phone number on his caller ID. “What’s happening?” Her voice was urgent.

Jim hesitated before whispering the words he had come to detest. “Tootie, it’s ALS.”

There was silence, and then, “Oh Jim.”

“I’m so sorry for telling you like this,” Jim said, batting away fresh tears.

“No. No. You had to tell me.”

“I’m sorry.”

“There’s no way you could have told me any better.”

Paulette hung up, pulled the car to the side of the road alongside the river, and turned to her husband. “My God,” she sobbed. “John’s going to lose everything.”

In the end, John decided to tell his brother, Curtis, but he did it the only way he knew how. Over an online bridge game, John e-mailed: I have some news—ALS.

Curtis, who was working in Saudi Arabia, e-mailed back: Do you want me to move home?

John e-mailed: It’s okay.

Then, because there was a hand to play, John and Curtis finished their bridge game. Curtis went to work the next day and told his boss, “I just want you to know that I’m going to be funky for a while.” Then he sat down at his desk and cried. Weeks later, he would transfer to Toronto to be closer to John.

John also called his father.

“ALS?” said Chester, who had been diagnosed with dementia. “That’s Lou Gehrig’s disease, isn’t it?”

“Yeah, it is.”

“Well,” Chester told his son, “sometimes you’ve just got to play the hand that life deals you.”

The first thing to go was their two-story condominium in the old glass factory. John and Jim had figured they would spend years here, in cozy corners filled with oriental rugs and antique furniture, perfect for a couple edging toward fifty. But John would need hallways wide enough for a wheelchair and windows big enough to let in the sun when he was no longer able to walk outside. In September 2011, they found a new condominium with an elevator in a bustling stretch of downtown not far from Cincinnati’s famed Fountain Square, with its towering bronze statue, the Genius of Water, commissioned from Munich by a local hardware magnate in 1871.

They had bought three homes together over twenty years, but this time, Jim signed the deed alone. He tried not to cringe when John said firmly, “My name is not going to be on it.”

That first winter brought a whirlwind of loss.

Left foot. Left leg. Left hand. John started wearing a leg brace and a metal plate in his shoe to control what doctors called “foot drop.” He started walking with a cane, and when he complained, “I feel like everyone’s looking at me, Boo,” Jim encouraged him to buy one made of walnut with an arched, old-fashioned handle, something of a fashion accessory.

Years earlier, John had discovered a full-length men’s mink coat while he was trolling a yard sale. He shrugged it on and said, “I like the way it feels.” His friend, Adrienne Cowden, shook her head of brown curls and laughed. But John bought the coat and wore it when it was cold, and Cowden, a local pastry chef and historic preservation expert, realized that her sensitive friend could withstand stares from strangers as long as he could dictate when and how they happened. It was the stares he couldn’t control that frightened him.

Left shoulder. Left arm. Left fingers. Jim started coaxing John’s twitching arms into a dress shirt every morning before work. When John could no longer clasp the buttons, Jim took him to a tailor and had shirts made with Velcro instead of buttons.

Once, in those early months, on a trip to North Carolina’s Outer Banks, it seemed the disease had taken a merciful turn. From a deck overlooking the Atlantic Ocean, John sipped beers as the chilly salt air whipped at his face. The sun was bliss, and for a perfect few days, the spasms and twitching disappeared.

But in the early, gray months of 2012, John’s right foot started to drop and he traded the cane for a walker. There was no way to know what ALS would take next and there was no way to fight, no treatment to test. The human brain has a hundred billion nerve cells, which communicate with the muscles and glands through signals that can travel more than two hundred miles per hour, orchestrating even the tiniest of movements across the body. ALS kills the largest of the body’s nerve cells, the upper and lower motor neurons, and science has never been able to say why.

Though descriptions of the disease date back to 1824, when a Scottish neurologist named Sir Charles Bell started studying the nerves in the spinal cord, research has been slow and interest from major drug companies sporadic. As neurological disorders go, ALS is relatively rare, with about 5,600 new cases a year in the United States, prompting the federal government to dub it an “orphan” disease.

When John was diagnosed, only one drug for it was on the market, approved for use back in 1995, but it prolonged survival by only a handful of months. Another drug was in clinical trial and appeared to slow the progression of the disease, a breakthrough treatment carefully watched by researchers, doctors, and ALS groups, but within two years, the trial would end with poor results, devastating the ALS community. Though there was growing interest among researchers and drug companies globally and advancements in quality-of-life treatments, it typically takes $2 billion and fifteen years of research to get a single drug to trial, and there was nothing nearly as promising on the horizon.

John had the fillings in his teeth replaced when he heard that metal might hasten the progression of the disease. He bought exotic mineral supplements and stopped eating gluten. But it seemed to Jim as if the disease was progressing far faster than he had imagined, and on the darkest days, when John struggled to hold a fork or brush his hair, Jim would sneak into an empty room, bury his face in his hands, and cry. Time had been tilted on its side, and Jim never knew when a new day might be the last with an arm that moved freely or a leg that could bend without pain. He lay awake long into the night.

John began to have trouble standing upright in public bathrooms and went to see Dr. Quinlan. The doctor pointed to a camera case that was dangling from the side of his wheelchair. Inside were wet wipes and a plastic container that could be used when urinating from a seated position. In April, John went back to Dr. Quinlan again, this time to learn about lifting systems that would help him into the car. Very soon, the doctor decided, John would no longer be able to walk.

For the most part, John rarely talked about the disease. When the New York Times cited the revitalization of Cincinnati’s riverfront, John wrote on Facebook: “So happy and proud to live here.”

John was working as a project manager, and Jim had taken a job with the same consulting company so he could be near John during the day. But typing had become a one-handed slog across the keyboard, and over dinner on a warm July evening, Jim asked carefully, “Do you need to think about going out on disability?”

“I really don’t want to.” ALS can severely affect the vocal cords, but John’s speech, more than a year after the diagnosis, was still clear. “I feel like I need to keep working.”

“Why?” Jim pressed. “You don’t need the stress.”

“I want to stay.”

“You don’t need to put yourself through this,” Jim said. “Everyone will understand.”

That week, Jim filled out the disability paperwork since John could no longer grip a pen. Jim could have taken a leave of absence from his own job, but as an unmarried man, he wouldn’t have qualified for family medical leave. The idea seemed almost preposterous to Jim, who was regularly helping John use the toilet.

Years earlier, they had talked about marriage, particularly after Paulette Roberts called on John’s forty-second birthday in 2007. “You can call me ‘reverend’ now. I got ordained,” she said.

John laughed. “Do you mind if I ask . . . why?”

“Well, so I can marry you and Jim.”

“One of these days, if we ever decide to get married, we’ll have you marry us,” John quipped. “But right now, we can’t get married in Ohio.”

Even if John and Jim traveled to a state that allowed gay couples to marry, the federal government only offered the rights and protections of marriage—more than a thousand benefits that covered everything from family leave to health insurance—to heterosexual couples. John and Jim thought, Why bother?

Many of their friends had consuming careers, but John and Jim considered their relationship the focal point of their world. And they already felt married. They were in love and committed for the long haul. They had bought houses, planned trips, saved for retirement. They had talked about adopting a child, but dropped the idea when they learned that Ohio didn’t recognize two fathers. They hosted foreign exchange students instead, a boy from Sweden and another from Finland, with John issuing three rules: no drugs, no pregnancies, no riding in cars with friends who had been drinking. John and Jim took the boys on vacations and hosted dinner parties before their proms, creating a makeshift multinational family that remained intact long after the boys returned home a year later.

John and Jim weren’t thinking about disease and death during those years, or the practical, critical benefits of marriage that are needed in times of crisis.

In the fall of 2012, John traded a walker for a manual wheelchair, which Jim hoisted into the back of their SUV on outings to dinners and concerts. John used the wheelchair in an ALS walk and helped raise more than $22,000 through a team that Jim dubbed “Half Full.” Writing was slow and difficult, but when Cincinnati was cited as a leader in clean water technology in October, John posted on Facebook: “Another reason I love Cincinnati and why others should call Cincinnati home.”

During a visit with Dr. Quinlan that month, John described his new life, navigated at just twenty-one inches off the ground. “Very upbeat despite severe disabilities,” the doctor noted, adding, “Absolute need for a power wheelchair.”

Jim started lifting John into bed, onto the couch, into the car. He had grab bars installed in the shower, and when John could no longer stand on his own, Jim went out and bought a shower seat. Eventually, Jim stripped down and got into the shower himself to hold John steady. The last limb to go was John’s right arm, and with it came a power wheelchair that Curtis quickly dubbed the “urban assault vehicle” in a halfhearted attempt to make John laugh. John hated the chair’s bulk and the embarrassing hum it would make, and he told Jim just before Christmas in 2012, “I don’t want to go out in that thing. I feel like a spectacle.”

Then John had to trade the wheelchair for a bed, and it seemed the only thing left to do was wait.

One of the cruelest ironies of ALS is that its victims lose their muscles and motor skills, but not their ability to feel pain. In John’s case, it often shot down his legs, hot and unrelenting, and Jim spent hours hunched by John’s bedside, shifting his position to relieve pressure. Jim brought in a hospital bed, set it up in the center of the bedroom, and moved himself to the guest room across the hall.

Paulette came by to visit and sucked in her breath when she saw her nephew, huddled under an electric blanket. “You know I’m going to die, Aunt Toot,” John said when Jim was out of earshot. “It’s going to be months, not years. I just want to tell you it’s coming.”

Paulette thought of the skinny, sensitive boy who would crawl into her lap for songs or stories as she looked at the man in the hospital bed. She kissed John on the forehead, careful not to press too hard. “It’s okay, sweetheart,” she said. “I know.”

To Jim, the call to hospice seemed almost surreal, even after months of living with the menace of a deadly disease. But nearly every limb on John’s body had lost function and his speech had started to go. Jim felt as if he was shifting between two extremes, numbness and absolute misery, when he e-mailed friends in March 2013 to say that John could no longer answer calls on his cell phone.

He wrote to his sister, Ann: This f’ing disease.

Martha Epling, a family friend, had started working at a local hospice three years before she lost her seventy-four-year-old husband to pulmonary disease. With soft white hair and red glasses, she reminded Jim of what it might have been like to talk to his own mother.

“You need help,” Epling said, studying Jim over a coffee mug in a downtown café that spring.

Jim had been staying up at night, worried that John would need the bedpan changed or his position shifted in bed. “I have to do it myself, Martha.”

“No, you don’t.” There were nurses, social workers, physical therapists. “You don’t have to be his total entertainment. You don’t have to do all of the physical stuff.”

She went to see John a few days later while Jim was at the grocery store. “Will I be comfortable with strange women giving me a bath?” John asked her, trying to smile. Then he said, “I need to do this. I need to do this for Jim.”

With nurses coming twice a week, Jim decided to continue their tradition of turning Friday nights into something of a celebration. He invited friends to sit by John’s bedside with wine and Manhattan cocktails. One night, their old friend Meb Wolfe stopped by for a visit.

“I hope you don’t mind us just hanging around,” she said, huddled over John, who had a bowl of guacamole balanced in his lap. The tortilla chips were large, and John could still manage to draw one into his mouth.

“No. This is great,” John said, glancing around the room. “This is my world now.”

Wolfe couldn’t think of a single thing to say. She looked at her friend, trying to drink a splash of bourbon from a cup with a straw, and thought, I can’t believe we’re even having this conversation.

By May, John’s arms stopped moving altogether. His neck started to ache, even after a drink of water. Jim wanted to stroke his hand, rub his head, run a finger along his cheekbone, brief moments of intimacy that made Jim feel as if he was still connected to his partner. But the disease took that away, too. Jim was profoundly sad and too tired to think clearly. When their traveling companion, Jennifer Stowe, came by, John gestured toward Jim and whispered, “Please. Get Jim out of the house.”

Jim didn’t want to leave, but he agreed to step out to a neighborhood pub with Stowe. She studied Jim, who had grown a beard and gained twenty pounds. Jim had stopped cooking because John couldn’t eat, and he often stole downstairs to a donut shop on the ground floor of their building. Over tacos, Jim yawned. “I’m sorry I’m not much fun. I just spent most of the day crying.”

“I don’t know how you can’t,” Stowe replied, thinking about the twenty-eight-year-old John Arthur who had nicknamed her “Fire” when he discovered that her Ford Mustang had gone up in flames in college after a botched oil change. All through the years, on trips to London, Paris, and the North Carolina Outer Banks, the nickname stuck.

Stowe leaned over the table and kissed Jim’s cheek, but the gesture seemed entirely inadequate.

“I feel awful,” Jim said. “Am I doing enough?”

“You’re doing plenty. You’re there. You’re there every day and you see it.”

“It’s just that you can’t do anything about it,” Jim said slowly. “You just have to sit and watch.”