“The business office asked me to bring this up when I started my shift,” she said quietly.

“It came down from patient financial services twenty minutes ago.”

I ran my fingernail along the metal edge of my wristwatch and took the envelope.

Inside was one printed page carrying the gray watermark of St.

Jude Children’s Hospital.

The bold black heading at the top asked for immediate secondary guarantor confirmation before noon.

“Did something come back wrong with our insurance?” I asked.

“The note on the computer just says administrative review,” Ruth said, picking up a blue dry-erase marker to update the whiteboard.