"Do you have the pen?" Ruthie asked. "The long one?"
The long one was the long-acting insulin, the kind you gave once a day with a pen and that lasted twenty-four hours, so that if the pump ever broke you could cover the basal with a shot. Her mother kept a box of them in the butter compartment of the refrigerator. Ruthie had seen them there for years, next to the vials of the fast insulin, a white box with a purple stripe.
Her mother was already opening the refrigerator. She stood there with the door open and the cold coming out and looked at the butter compartment, and Ruthie saw her remember.
"I used the last one in August," her mother said. "When the tubing kinked at Grandma's. And then the insurance wanted a new prior authorization, and Dr. Feldman's office sent it, and they lost it, and I meant to call, and then Teddy had the—" She stopped. She shut the refrigerator. "I meant to call."
Ruthie knew what Teddy had had in August. Teddy had had a mucus plug at three in the morning that turned his lips the color of a bruise and made the ventilator scream its high-low-high until her mother, kneeling on the living room carpet, changed the trach tube in eleven seconds flat with the spare from the go-bag while the night nurse held his head and Ruthie stood in the doorway with the suction catheter in its paper sleeve in her hand, ready, because that was her job. Teddy had spent four days at Akron Children's after that. Her mother had slept in a vinyl chair. Nobody had called the insurance company about a pen.
"You still have the fast kind," Ruthie said. "You can do shots."
"I can do shots." Her mother was already pulling a vial and a syringe from the drawer under the toaster. "I can do shots every couple of hours. That'll hold. It's the night that's the problem. I can't do shots every two hours all night and also do Teddy all night."
"Vonda's coming at seven."
Vonda Pyle was the night nurse. She came five nights a week from seven at night until seven in the morning and sat in the recliner next to Teddy's crib with her knitting and her water bottle the size of a fire extinguisher, and she watched the numbers on his monitors so that Ruthie's mother could sleep. Vonda was sixty-one and had a voice like a crow and hands so gentle that Teddy did not wake up when she suctioned him. Ruthie loved Vonda in a way she would not have known how to say out loud. The nights Vonda came were the nights her mother slept.
Her mother drew up the insulin, pinched a fold of skin on her stomach, and gave herself the shot without looking. She capped the syringe and dropped it into the red sharps box on top of the refrigerator. Then she picked up her phone and called Dr. Feldman's office, which was closed, and listened to the recording, and pressed the number for the on-call doctor, and left a message with the answering service in her calm phone voice, the one she used for insurance companies and the electric company and the people at the medical supply company who kept sending the wrong size of trach ties. Then she called the pump company, and was on hold for twenty-two minutes, during which she fed Teddy through his G-tube and wrote on the whiteboard on the refrigerator 4:40 — 6 units Humalog — BG 247 — pump dead, in her small square handwriting. When the pump company finally picked up, she read them the serial number off the back of the pump, and answered questions, and said, "Yes, I understand, tomorrow by ten-thirty," and thanked them, and hung up, and stood with her forehead against the cabinet for a second.
"They're overnighting a new one," she said. "It'll be here in the morning."
"That's good."