Chapter 21 — What Happens Now?

_November 9, 1983, Chicago, Illinois_

{psc} "Got a minute?" John Peters, the lead equities analyst, asked on Wednesday morning.

"Sure, what's up?"

"On Monday, the FDA is going to approve a new drug, cyclosporin, for Sandoz GmbH."

I knew about cyclosporin, as it had been mentioned during our trip to Mayo Clinic, as a drug Keiko would receive to prevent her immune system from trying to attack the transplanted marrow cells. They'd said it was undergoing trials and awaiting FDA approval but had made the point that the information they'd provided was confidential.

I had looked into the drug to see if I could find any public sources, but nothing was available except to say that it was an experimental drug and that it was pending FDA approval. That might or might not have been enough to make the trade, but it was highly speculative, so I hadn't made any additional trades over and above the basket of pharmaceutical stocks in the Cincinnatus Fund.

"We can't act on inside information; what's your source?"

"My cousin who's a K Street lobbyist."

"For the pharmaceutical industry?"

"Yes."

"I don't think it'll fly. Run it by Kendall Roy in Compliance. If he says it's kosher, put it in your report."

"Compliance is way too conservative," John countered.

"Only Mr. Spurgeon can change the guidelines. Run it by Compliance and see what they say."

"OK," John agreed.

I made a note of the conversation in my log, which was required by Compliance when there was any risk of a violation of any regulations. About twenty minutes later, Kendall Roy called and asked me to come to his office.

"John Peters?" I asked.

"Yes. Make sure you document the conversation in your log."

"Already done. I noted that he felt you were too conservative in your rulings."

"He said that?" Mr. Roy asked.

I nodded, "He did. I reminded him that Mr. Spurgeon set the guidelines, and he's the only one who can change them."

"And your thoughts?"

"Spurgeon Capital's reputation and all our jobs depend on not violating any regulations. Given our track record, both in terms of compliance and profits, I'd say Mr. Spurgeon has it exactly right. There's no need to push the envelope and take on reputational risk."

"Good answer. And your analysis is correct — a lobbyist working with a pharmaceutical company who has access to the FDA is absolutely an insider for purposes of SEC regulations. Not to mention, whoever leaked that information very likely committed a felony. Of course, the SEC can only bring civil enforcement actions, but they could refer this misconduct to the US Attorney."

"I'm curious about the internal process. None of my trades has ever been flagged by Compliance."

"I can't divulge the criteria, but when the executing traders process your orders, a set of rules is applied by the computer, and the order is either flagged or approved. If it's flagged, someone from our department reviews the trade and, if necessary, asks for backup."

I nodded, "That makes sense. How often are those rules updated?"

"As necessary. I think you can work out for yourself the basic criteria. I suspect you understand why the exact criteria are closely held."

"Because it would be fairly easy to game the system if I knew the exact rules."

"Exactly right. Anyone who has studied the regulations could easily skirt them, as we've seen with individuals trading in unmonitored accounts. But you also know how they're caught."

"The SEC will look at every trade in Sandoz GmbH for some period before the announcement and flag anything that seems suspicious. A retail investor buying a hundred shares won't attract scrutiny, but an institution buying a million shares will. Similar for shorts before major bad news."

"Yes, and that's why we are required to file our large trader reports at the end of every trading day, including off-market trades. And why publicly traded companies are required to file reports of trades by insiders. Anyway, that's all, and I'm sure you understand that now that we're aware, any trades in Sandoz will be flagged and likely blocked."

"I assumed that would be the case. Thanks."

I left his office and as I was getting into the elevator, I realized that ANY trade in any pharmaceutical company would be scrutinized, as a newly approved drug could affect the stocks of competitors. I didn't think I needed to change my allocation in that sector as, in the long run, it would be highly lucrative.

"Trouble?" Tony asked when I reached my desk.

"No. Just confirming we aren't able to trade on some information that found its way to us."

"Is everything cool with Enderlee's BS?"

"Yes. The IRS examiner is still working, but my CPA and tax attorney are confident I'm clean, though with the complexities of the tax code, you never know."

"How is the space next door?"

"Getting there. Our target move date is December 3rd. With Thanksgiving, Jack Nelson decided to schedule it for that date because we're not sure we'll have the occupancy permit by the end of next week."

"You're out all next week, right?"

"Yes. We should probably sit down and coordinate our time off for next year because you'll need to cover for me during my sensitive leave."

"Any idea when you'll want to take it?"

"That's a very good question," I replied. "Let's talk about it when I'm back on the 21st."

"Sounds good.

_November 12, 1983, Chicago, Illinois_

On Saturday morning, I took Keiko to Rush-Presbyterian so she could have her transfusion, as well as have blood drawn for testing. Her temperature had, finally, dropped below 99.5°F, which Doctor Morrison said was a good sign, though her white count would determine if the infection had been resolved by the antibiotic cocktail. He wrote a prescription for oral antibiotics that he instructed Keiko to take prophylactically.

"Have you thought about what's next?" I inquired after we got into the car just after 11:00am.

"You mean if my white count is down?"

"Yes."

"Do you want me to try another round of chemo?" Keiko asked.

That was a tricky question to answer, as without a marrow donor, nothing would prevent Keiko from dying. Was the suffering she'd undergo with chemo worth the extra month or two? And would the chemo weaken her system to allow the infection to return or a new one to develop? I wasn't one to give up, but I also didn't want Keiko to suffer needlessly.

"I think it all depends on whether you believe we'll find a marrow donor and if you'll be healthy enough to undergo the procedure."

"You're the analytical one," Keiko said. "What do you think the chances are of finding a compatible donor?"

I took a deep breath and let it out, then answered.

"Not very good," I admitted. "The National Bone Marrow Donor Registry created four years ago consists mostly of Caucasians. And you know the challenges we've had with testing in Japan. Whatever decision you make, I'll support. The last thing I want you to do is suffer needlessly. That said, let's see the results of the tests, then decide. For now, let's focus on our trip to Wisconsin starting Monday morning. I probably should have waited to ask until after."

"No, it's OK. It's always on my mind, and I really do want to know what you think."

"Is there anything you want to do next week besides what you already requested?"

"What?" Keiko asked with a smile. "We can't make love non-stop the entire time?"

"Food? Water?" I asked.

"Practical as always! But no, just time together because I fear we won't have very long."

I suspected she was right, as even another round of chemo wasn't a guarantee of more time and could hasten the end rather than prolong it.

"Whatever you want, Keiko. I mean that."

When we arrived home, we ate lunch, then Keiko went upstairs for a nap, and Bianca and I went out to do our usual Saturday tasks — grocery shopping and the dry cleaners.

"No updates, right?" Bianca asked.

"Correct. We'll receive the blood test results next week, though unless there is some emergency need, they won't call us. Keiko will call on Friday."

"You'll be home on Friday, right?"

"Yes. We'll be gone from Monday afternoon through Thursday afternoon. You know from our staff meeting on Monday that Tony is covering for me. I haven't asked in a week or so — how are you feeling?"

"Other than my clothes not fitting properly, pretty good. I plan to talk to Mrs. Peterson on Monday about maternity leave."

"Have you done your research into a nanny?"

"Yes. I spoke to two companies, and they agreed that early March is the right time. We discussed our situation, and they said we could interview as many candidates as we needed to find the right one. I think someone around our age, because that way she'll fit in with other moms of very young kids. They have playgroups and that kind of thing when the kid gets older."

"In that regard, whatever you think is best. Obviously, I'll want to have a say, but I'm happy if you set the criteria."

"I meant to ask earlier, but what about class next week?"

"I'm only missing Tuesday, and I explained the situation to the professor, so he's cutting me a lot of slack. Of course, I have a 101% in the class, so it's not like I'm struggling."

"Extra credit?"

"Yes. I do every extra credit problem or assignment. I've missed a few points in quizzes and homework, but the extra credit covers that and then some. Basically, it's a way for him to give students who are poor test takers a chance at a better grade."

"Back to the nanny, the usual schedule is for twelve hours a day, weekdays. I think 7:30am to 5:30pm is about right. Also, my grandma is willing to help. She didn't freak out when I explained about the baby."

"And your parents?"

"Aren't talking to me, but my grandmother is positive that will change as soon as the baby is born. They're upset about me having a baby out of wedlock and having Juliette as my girlfriend. You can guess which of those is a bigger problem."

"Actually, I can't, given they're Catholic. Both are fairly big no-no's for Catholics!"

Bianca laughed, "So true, but you know it's Juliette."

"Of course, because it's anyone's business other than yours who you sleep with. Or if you decide to have a baby without getting married. Honestly, the ideas put forth in the 60s were spot on, but reactionary forces have done their damndest to turn back the clock."

"It's those idiots Jerry Falwell and Pat Robertson and their followers who helped elect Reagan. Granted, we both preferred Reagan to Carter, but sadly, that empowered the Evangelicals. Fortunately, Reagan is only paying lip service to banning abortion."

"Wouldn't that require amending the Constitution?" I asked. "The Supreme Court made it clear that it's a right, at least during the first trimester."

"Oh, I agree, but those whack jobs would do that in a heartbeat! And that disease that mostly infects the gay community — AIDS — is providing them ammunition."

"That's a scary one," I replied, "but reports say it's only found in the gay community and in IV drug users."

"The thing is, and perhaps you haven't considered it, that men can be bisexual as well as women."

"You're right; I hadn't considered that. We need to look out for any mention of AIDS treatment or cure research by any pharmaceutical company."

"I don't mean this as a jab, but pretty much your first thought about everything is how you can use it to your advantage."

"Not quite everything."

"Sorry, I didn't mean to imply anything about Keiko, me, the baby, or your friends. Sometimes, you can be a bit too literal."

"I don't deny that, but it serves me well at work and, honestly, in my private life. Do you think anyone has any misconceptions about me?"

"No," Bianca replied. "I see you with Keiko, and it's obvious you love her. And you truly care for your friends."

"Have you thought about the future?"

"Keiko basically asked the same thing, and I'm going to give you the same answer — cry."

_November 13, 1983, Chicago, Illinois_

On Sunday, Violet and I went to Chicago Stadium to see the Hawks play the Edmonton Oilers. The game was a sellout, with standing-room tickets sold to pack the arena to capacity. The Hawks were suffering through a five-game losing streak, and having to play Wayne Gretzky, Grant Fuhr, Jari Kurri, Glenn Anderson, and Paul Coffey did not bode well.

"Will you join us for Thanksgiving?" I asked Violet as we walked towards the stadium.

"Of course! Thank you!"

"You can show up anytime during the day; just take the L. I'll drive you home."

"Perfect!" she agreed.

We handed our tickets to the ticket-taker at the gate and entered the stadium.

"How bad do you think this will be for the Hawks?" Violet asked as we made our way to the concession stand.

"They lost 6–1 to the Whalers yesterday, so I don't hold out a lot of hope."

"Do you know who's starting in goal? Esposito or Bannerman?"

"Bannerman has given up thirty-five goals in five games, so I hope they start Esposito, even though he's at the end of his career. I mean, how much worse could it get?"

"Don't ask!" Violet exclaimed.

We got hot dogs, nachos, and drinks, then headed for our seats, sitting down just as the teams left the ice after warmups. A few minutes later, they returned for the US and Canadian Anthems, then the starters took their spots. I saw Tony Esposito skate to the net and was happy.

"Maybe we'll see some of the old Esposito magic," Violet said hopefully. "And goals by Savard and Larmer."

"We can hope!"

The puck dropped, and just thirty-one seconds in, the Hawks went on a powerplay on a tripping penalty called on Pat Hughes. Sadly, the Hawks couldn't score, and just four minutes later, Troy Murray of the Hawks was called for charging. Edmonton took immediate advantage, with Willy Lindström scoring at twenty-six seconds into the man advantage to take a 1–0 lead.

"Well, crap!" Violet exclaimed. "We needed a goal on our powerplay!"

"Esposito has made some great saves, so let's see if he can hold them."

He did, but the Hawks couldn't score on Grant Fuhr, and the period ended 1–0 in favor of the Oilers, but Lee Fogolin of the Oilers had been called for interference, meaning the Hawks would start the second period on the powerplay. They took full advantage, and just over a minute in, Denis Savard scored the tying goal. Ten minutes later, the Hawks went ahead 2–1 on a Bill Garner goal.

"That's more like it!" Violet exclaimed happily.

Her joy was short-lived, as Ken Yaremchuk of the Hawks was called for hooking, and just fifteen seconds into the powerplay, the Oilers tied the game on a Jari Kurri goal. Less than four minutes later, Violet and I jumped to our feet with the rest of the crowd when Rick Patterson put the Hawks ahead.

From there on, the Hawks never lost the lead, scoring twice in the third period, including an empty net, while the Oilers only scored one, resulting in a Hawks 5–3 win to snap their losing streak.

"Esposito looks beat," Violet said, pointing to him sitting on the bench, trying to catch his breath following the game.

"He gave it his all and made some great saves," I observed.

It took a long time to get out of the stadium and longer than usual to get out of the parking lot because of the size of the crowd.

"You're gone until Thursday, right?" Violet asked when I pulled up in front of her house."

"Yes. I'll be in class on Thursday, and we can have our usual homework session."

"Did you sign up for your class for next semester like you planned?"

"Yes. International finance, on Saturday mornings. I'm sorry about that, but given the circumstances, I felt one day a week was a better choice."

"I totally understand. Could we have lunch on Saturdays?"

"I think so, but let's see what happens."

"She's going to die soon, isn't she?" Violet asked quietly.

"Nobody can say how long," I replied. "and the research I've done doesn't shed much light. We'll know a bit more when we see the test results on Friday."

"If there's anything I can do for you, anything at all, I want you to ask."

I nodded, "I will. I appreciate the offer."

"You know how much I care for you."

"And I care for you, too."

We got out of the car, I walked Violet to the door, she gave me a quick hug, and then went into the house. Once she'd closed the door, I headed back to my car for the drive home.

_November 14, 1983, The American Club, Kohler, Wisconsin_

"This is amazing!" Keiko exclaimed once the bellboy had left the Presidential Suite.

The transfusion had, as we had hoped, increased Keiko's energy, and if the past was any indication, she'd have about a week before the effects began to wear off.

"What would you like to do?" I asked as she walked through the suite.

"How about a bubble bath?" she asked. "And then spend the afternoon cuddling and making love?"

"That sounds like a grand idea!" I agreed.

I turned on the stereo, tuned to a jazz station, and ten minutes later we were soaking in a tub full of warm water and bubbles. We sat quietly, with Keiko reclining against me until the water cooled. We got out, I opened the drain, then Keiko and I showered in the large stall shower. When we finished, we dried off, and I carried her to the king-size bed, and we made love, then cuddled.

That was the pattern for the afternoon, and for dinner, we drove into Sheboygan and ate dinner at a family-style restaurant. We found a local ice cream shop for dessert, then returned to the American Club.

"Is there something you'd like to do tomorrow?" I asked Keiko, handing her a list of local attractions I'd found on the desk in our room.

"How about the carriage ride?" Keiko asked. "It says they have lots of blankets and can pick us up here."

She handed me the list and I went to the phone and dialed the number for Bulitz Farm and arranged for the carriage ride during the afternoon.

"All set for tomorrow afternoon," I confirmed. "For Wednesday, I'd like to visit the John Michael Kohler Arts Center in Sheboygan."

"Deanna really has you hooked on art! Did you have any exposure growing up?"

"Not beyond seventh-grade art class. It's something that fascinates me."

"If the weather is nice enough on Thursday morning, could we go to the lake and see the lighthouse?"

"That sounds good. If we time it properly, we can do that, then head directly home from there."

We got into bed, made love, then cuddled close and fell asleep.

_November 17, 1983, The American Club, Kohler, Wisconsin_

"Thank you for bringing me here," Keiko said as we packed our things on Thursday morning after breakfast.

"You're welcome," I replied. "You know I'll do anything in my power for you."

"I love you, Jonathan," Keiko said, stepping into my arms.

I love you, too, Keiko-chan," I replied, hugging her tightly.

"Will you promise me something?" she asked.

"What?"

"That after you mourn, you'll find someone with whom you can share your life."

"I'll have my son or daughter," I said.

"Yes, of course, but you should have someone special."

"Keiko-chan, I can't promise how I'll feel or how I'll respond."

"I know, but please don't think it diminishes what we had together."

"Nothing could ever do that," I countered. "Will you accept my promise to do what's in my best interests and listen to advice from Bianca and Jack?"

"Yes, I'm just concerned for you."

"I promise to get help if I need it, but I will never, ever, stop loving you."

We stood, hugging, for several minutes, then left the room. We checked out, got into my car, and headed for Lake Michigan. At the lake, we found a parking spot and walked to the end of the jetty and saw that it was possible to walk out to the lighthouse itself. As we came closer, I noticed the light was missing. When we walked back to the sidewalk, I saw a sign and walked over to read it. It noted that the lighthouse had been deactivated, the light removed, and what remained was the tower itself.

We took a short walk along the lake, but given Keiko's health, we stopped and returned to the car, then headed home to Chicago so I could make it to my statistics class.

_November 18, 1983, Chicago, Illinois_

On Friday morning, Keiko called for the results of her tests. Her white count was still elevated, indicating she had some kind of infection, and more worryingly but not unexpectedly, her blast count was 19%, up significantly. Unfortunately, with a high white count, another round of chemo was out of the question, and that meant we were in the final stages. Keiko sat in my lap and cried softly, and I contemplated a future without her, which might begin very soon.

I knew, from my research and from our conversations with Doctor Morrison, that at some point in the near future, Keiko would become too weak to climb the stairs and then be basically bedridden. At some point, she'd require a catheter and the nurse would make multiple visits each day, and then, eventually, Keiko would likely need some kind of painkillers before finally succumbing to her disease.

The biggest challenge would be near the end when she'd need continuous care, something I would need to work out, most likely a combination of nursing, her grandparents, her parents, and me. Those arrangements would likely need to be made soon as if her blast count continued to rise at the same rate, she might not even make it to Christmas, which was just over five weeks away.

Keiko and I cuddled in one of the Papasan chairs until lunch, getting up only to visit the bathroom. After lunch, we took a brief walk on the cool mid-November day. With the temperature around 55°F, we could walk for about twenty minutes before Keiko became fatigued, and when we returned to the house, I lay down in bed with her and cuddled her while she napped.

We got out of bed just after Deanna and CeCi arrived home from class and had tea with them. Juliette arrived home a short time later and joined us. Keiko and I spent the rest of the time before dinner in the Japanese room, then, when our friends had gone out, had Chinese food delivered. After we ate, we watched TV, then headed up to bed.

_November 19, 1983, Chicago, Illinois_

"You were very subdued last night," Bianca observed on Saturday when we left to run our usual errands. "How bad?"

"It couldn't be much worse," I replied. "Her blast count is rising quickly, and her white count indicates she has some kind of infection that the IV antibiotics kept in check but didn't resolve, so chemo isn't possible."

"How long?"

"Weeks," I replied with a hitch in my voice, feeling tears well up in my eyes.

"Shit," Bianca said softly. "I'm sorry. What can I do for you?"

"The same as you've always done — be my friend and confidante."

"I hate to ask, but what happens?"

"The short version is organ failure due to the good blood cells being overwhelmed by the bad ones. There's no way to predict exactly, but she'll become weaker, and her body will begin to shut down. I'd say sometime in the next two weeks, she'll likely be too weak to climb the stairs, and sometime before Christmas, she'll basically be confined to her bed, most likely with a catheter. At some point, IV painkillers, and then, the end."

"Won't someone need to be with her full-time?"

"Yes. I'll work that out between Horizon Hospice, her family, and myself. When it's close, I'll stay with her until the end."

"You're going to need someone to help you."

"I know. I'm sure Deanna will help, and she has a completely flexible schedule."

"I want to help, too."

"I appreciate that, but you need to take care of yourself and our baby."

"I won't do anything that would put either the baby or me at risk," Bianca said. "But I do want to help. I'm sure the others will as well. Has she told her family?"

"We're going to her grandparents' house for dinner tomorrow, and she'll tell them then. I'll work things out with her grandfather and dad."

"Are we putting up a Christmas tree?" Bianca asked.

"Yes. I'm happy to celebrate the solstice with evergreens and lights!"

Bianca laughed, "Cute, but I was concerned about Keiko."

"I think she'd be very upset if we didn't follow that tradition. As much as she doesn't go in for the religious aspects of Japanese culture, she follows the forms, similar to the way I do for the forms of American culture."

"Real or artificial?"

"I think we have to go with artificial, given Keiko's situation. Who knows how she'd react to bringing a live tree of that size into the house. We have time, so why don't we go to Venture and see what they have in the way of artificial trees. We can get lights, ornaments, and other decorations as well."

"That sounds like a good plan," Bianca agreed. "Fortunately, you have a car with a huge trunk because we're going to need a tree that's at least six feet. What about lights for outside the house?"

"I've never done that, but I'm open to hanging them if you want."

"I do. We should do that before grocery shopping."

"Obviously!" I agreed, making a turn to head to Venture rather than Jewel.

We ended up buying a seven-foot artificial spruce, several boxes of ornaments, and strings of lights for both the tree and the house. We fit everything into the car, and there was still plenty of room for groceries, so we went to Jewel, where we bought our usual groceries, and what we would need for Thanksgiving. After Jewel, we stopped at the dry cleaners to pick up my suits and shirts, though we had nothing to drop off because I hadn't been to work during the week.

At home, Bianca carried in the groceries while I brought in the tree, lights, and ornaments, stashing everything in the basement until we'd need it, most likely the Saturday following Thanksgiving. I helped Bianca put away the groceries, then went to the Japanese room to wait for Keiko to wake up from her nap. When she did, I let her know about the Christmas decorations.

"I was going to ask," she said. "I'm glad you're doing that."

"Is there anything special you want to do for Christmas? I'm sure it isn't celebrated in Japan."

Keiko laughed, "You would be wrong! It's not a national holiday, but Japanese often decorate and celebrate, and you can see «サンタさん» (_Santa-san_) in many places!"

"'Santa-san'? Seriously?"

"Seriously! And since the early 70s, it's very popular to eat Kentucky Fried Chicken on Christmas Eve!"

"No way!"

"Yes!" Keiko said mirthfully. "It's called «クリスマスはケンタッキー» (_Kurisumasu wa kentakkī_), literally, 'Kentucky for Christmas'. It started as a promotion by Kentucky Fried Chicken, and it became VERY popular."

"Is that something your family does?" I asked.

"No, because everyone was here by then. My mom came over in 1962, and of course, my grandparents were here before World War II. I know about it from our relatives in Japan. We should just do the usual American things."

"I think because we're having turkey for Thanksgiving, we'll have ham at Christmas. Would you be OK with inviting Violet to Christmas as well?"

"Yes, of course! She has nobody else to be with. Are you planning to see your mom?"

"We haven't discussed it. I'll ask when I talk to her tomorrow. She's having Thanksgiving with her friend who took her in as a teenager, and she's taking a date."

"That's good, right?"

"If she's happy, I'm happy. I don't know anything about him except he's divorced and a judge of the Clermont County Court of Common Pleas."

"What about Bev?"

"I'm positive she and Glen want Christmas with Heather," I replied.

"Did she ever speak to her parents?"

"No."

"Did they ever set a wedding date?"

"Not one of which I'm aware," I said. "I actually haven't spoken to her in about a month because I've been so busy with you and with work. I'll call her this week and see about having lunch next week. Before I forget, we should talk about the Spurgeon Christmas party."

"I saw it on the calendar," Keiko replied. "If what we think is true, I don't think I'm going to be able to make it. Do you want to take someone?"

"No. I'll go without a date; I really don't want people to talk. They're already going to because of Bianca, but that can't really be helped."

"I don't think I'll live long enough to see your baby," Keiko said as tears began rolling down her cheeks.

I took her in my arms and held her, but there was literally nothing I could say to make her feel better.

_November 20, 1983, Chicago, Illinois_

"Did you want to come to visit at Christmas?" I asked my mom when I spoke to her early on Sunday afternoon. "I could plan something with your sister and Alec, too."

"I'd like that. If it's OK with you, I'll drive up on Friday. Do I need to make reservations?"

"No. I checked with Violet right before I called you, and she's happy to have you stay with her. She'll be joining us for Christmas Eve and Christmas Day."

"OK. How is Keiko?"

"It's not good; not good at all."

"I'm so sorry, Jonathan. Is there anything else they can do? Anything at all?"

"No."

"How long?" Mom asked.

"Weeks," I replied. "She might not make it to Christmas, and if she does, she might well be confined to bed."

"I don't know what to say."

"Me neither, because there is nothing to say."

"Does everyone know?"

"Only Bianca, Violet, and you so far," I replied. "We're having dinner with her parents and grandparents tonight, and she'll tell them. Once we've told them, we'll tell a few select others, mainly our housemates and my boss."

"There's truly nothing that can be done?"

"Truly."

"I'll see you at Christmas, but please call and keep me updated."

"I will. Thanks, Mom."

"You're welcome. I love you, Jonathan. Give my best to Keiko, please."

"I will. I love you, too, Mom."

We said 'goodbye' and I ended the call, then went to the Japanese room to sit with Keiko. I let her know what my mom had said, and then she went up to nap before our dinner with her family. She slept for about two hours, and then we headed to her grandparents' house. They greeted us, and Atsuko served us green tea, which we sipped while we waited for Keiko's parents, who arrived about fifteen minutes after us.

"You should say it," Keiko said quietly.

I nodded, took a deep breath, and let it out slowly.

 "I have something to share with you," I said. "Keiko received test results on Friday, which showed a significant increase in blast cells. That, combined with a high white count, which indicates an infection, means chemotherapy is no longer an option."

Ichirō's face turned grim, "Please be direct, Jonathan-san."

"There are no further treatments available; Keiko is going to die."

Both Atsuko and Hanako gasped, and Itsurō looked as grim as Ichirō. Keiko began crying, and I helped her into my lap and held her while she sobbed.

"Is there no one else we can consult?" Itsurō asked.

"Both Doctor Morrison and I have been in touch with the doctors at Mayo Clinic, and Doctor Morrison also consulted with an oncologist at Johns Hopkins. None of them offered any possible treatments, not even experimental ones."

"But if they find a marrow donor…" Itsurō began.

"Would not help," I said. "The process completely wipes out the immune system, and the infection Keiko has would rapidly spread out of control and could not be controlled. According to the protocols, she's not healthy enough to have the procedure, which might even hasten the end."

"What happens now?" Ichirō asked.

"We care for her at our house," I said. "Horizon Hospice will arrange for additional nursing visits, but sometime in the next month or so, Keiko will need round-the-clock help. I've already discussed it with one of my housemates, and I'm hoping Atsuko will continue to help during the day. Obviously, we welcome any help any of you could provide."

"Jonathan," Ichirō said, "after dinner, I would like to speak privately with you. Itsurō, you should join us."

I nodded, confident I knew what he wanted to discuss. When Keiko stopped sobbing, Atsuko invited us to dinner, and I was happy to see that Keiko had a decent appetite, though I knew that wouldn't last. Once we'd eaten, " Ichirō, Itsurō, and I went to a small room with a low table and cushions. We sat down, and Atsuko brought tea, cakes, a pipe, and tobacco.

"Jonathan, it's traditional for Japanese men to smoke ceremonially," Ichirō said. "I will understand if you don't inhale, but please, at least, puff outward."

I nodded, and he lit the pipe, puffing twice, then inhaling. He passed the pipe to me, and despite my complete aversion to smoking, I copied him, managing not to choke or cough, then passed the pipe to Itsurō. He did the same and returned it to Ichirō, who set it aside.

"Have you and Keiko discussed her wishes?" he asked.

I nodded, "She would like a traditional Buddhist ceremony to honor her parents and grandparents, and I concur. She requested cremation and agreed that if her mother would prefer the traditional forty-nine days, that would be fine. She also asked that both our names be engraved on the stone at your crypt, and when the time comes, it's my wish to be with her."

"Do you have any idea how long it will be?" Itsurō asked.

"Weeks," I said. "At the outside, mid-February, but most likely sooner, even as soon as mid-December."

"With your permission, I will speak to the Buddhist monk, Kaito, and make the necessary arrangements. I will cover the honorarium."

"Keiko asked that any gifts be given to the Leukemia Society of America."

"Normally, gifts would be given to you, which is the Japanese tradition. You may make the donation as you wish. For non-Japanese, I think you can simply inform them of your wishes."

"I want to honor your family traditions," I said.

"We're grateful," Ichirō said. "Besides what my wife and daughter-in-law will do, is there anything we can do to help?"

"Making the arrangements is a big help, but otherwise, visit Keiko. She's likely to not be able to walk and be bedridden by Christmas, if not sooner. I'm sure visits will help her. Eventually, she'll need a catheter for urine and likely IV painkillers to keep her comfortable at the end."

"And you can take proper care of her at home?" Itsurō asked.

"We can. Between what is covered by health insurance and my income, there are no problems. And remember, Keiko does not wish to die in a hospital connected to machines. She'll accept the catheter, the IV, and oxygen, but that's it. All of you should be there at the end, if at all possible. And we'll accommodate you any time, day or night, between now and then."

"You truly exemplify the traits of the Kanji we chose to represent your name," Ichirō said. "Courage and protection."

"Thank you."

"Those will appear on the engraved stone, and later, when the time comes, your name in Latin characters may be added on a small plaque."

"Thank you," I replied.

"I will be in touch soon," Ichirō said. "Once I speak with the monk."

I nodded, we stood, I bowed, and Ichirō and Itsurō returned the bow, then we returned to the living room where the women were waiting.