She said to the woman from benefits: “How many people on this plan are taking a tier-three specialty drug for a dependent child?”

The woman did not know.

She found out in nine days.

The answer was thirty-one.

And in the following plan year, Bramhall Industrial moved pediatric specialty biologics to a flat copay tier, which cost the company about four hundred thousand dollars a year and which helped thirty-one families, twenty-nine of whom have no idea why it happened.

So that is the honest ledger of that morning, and I want it set down before anything else, because the rest of this account is going to be extremely hard on Vivienne Bramhall and it should not be the only thing on the page.

She ran my credit at four in the morning and put a price on me.