by Harry Kraus
“A couple reasons really. Number one, I’ve met a great guy, and he wants children. He’s seen what my father and grandfather have been through with kidney failure and dialysis. He wants to know if our children will be at risk.”
“Seems reasonable. I can order an ultrasound of your kidneys. If you don’t have any cysts on your kidneys by this age, we can confidently say that you’ve escaped the disease.”
The patient looked down. “I’m an only child. My father has always been active. He retired early just so he could sail and snow ski. I think he’s felt some guilt for most of his life for passing on an inherited disease to me.”
Claire lifted her pen. “Your father has polycystic kidneys. Is he on dialysis?”
“Just started four months ago. It’s killing him. His whole life revolves around his Monday, Wednesday, Friday dialysis schedule. He can’t do the things he loves.”
“Why does he feel guilt about you? You haven’t been tested, correct?”
“I guess he just figures I’ve got it. His father had it. He was an only child and he got it. Now I’m his only daughter, so I think he just thinks it has to be.”
“But polycystic kidney disease is autosomal dominant. That means if your father has it, you have a fifty-percent chance of inheriting it. But it also means you have a fifty-percent chance of being disease-free.”
“I’ve never wanted to know before. I always had the same assumption that my father has.” She looked up and met Claire’s gaze. “I didn’t want to know the news if the news was bad. If I can’t change the future, I was afraid to know.” She hesitated. “You have no idea what it’s like living with those kind of odds. A flip of a coin. Heads, I end up on dialysis. Tails, I don’t. That’s a mental torture I’ve lived with ever since I watched my grandfather struggle.”
You have no idea how much I understand. Claire looked at her watch. There wasn’t time to explain if she was going to be fair to the other patients. “Are you being pressured to get tested by your fiancé?”
“No. I think it’s only reasonable for him to want to know. He loves me. It’s not like we won’t be married or something if I’ve got it. But children, well, that’s something we’ll have to decide about if I’ve got it.”
“You can still bear children who can have productive lives even if they develop kidney failure. It’s usually not until late in life. You’ve obviously lived a long time with the threat hanging over your head. How will it change your life if you find out you’ve got the disease for sure? Will you still have kids?”
“Probably. They could still be negative. It’s only fifty-fifty.”
“So if getting tested won’t change what you do, why get it?” Claire paused. “I’m only challenging you to see if you’ve thought through all the angles.”
Stephanie smiled. She was Harley Davidson-calendar pretty, something that would likely change if her skin aged and bronzed with kidney failure. “If it was only about me, I wouldn’t have the test. I’ve learned to deal with the pressure. And it’s not really about my fiancé, although he’d like to know. It’s about my father.”
“You want to relieve his guilt?”
“No. I want to donate him a kidney.”
The thought hadn’t occurred to Claire. “Oh, of course.” It made wonderful sense. A live donor, if an appropriate match, would be the most successful transplant option, and a daughter would have the greatest chance of being a close match. Claire hadn’t stopped to focus beyond her patient. She nodded her head with admiration for her young patient. “Then maybe your father could get back to his active life.” She paused, then proceeded with an exam, adjusted the patient’s blood-pressure medication, and scheduled her for an ultrasound of the kidneys. “If the ultrasound shows no cysts, I’ll send you over to the transplant coordinator at Brighton University to see if your tissue type is a match for your father.”
Claire walked out of the room struck with the patient’s statement. If it was only about me, I wouldn’t have the test.
But it isn’t always just about us, is it, Stephanie?
After work, on the way to Brighton, Claire checked with Dr. Branum for an update on Brittany Lewis. The surgery was described as a “chip shot.” “This was an intern gallbladder, Claire,” he said, “you’d have loved it.”
His comment had hit the mark. She would have loved it. But somehow, her heart warmed knowing she was the one who’d been able to assist Brittany through her fears and get her to do the right thing. Claire smiled and muttered, “I’m sure. Maybe I’ll stop by and see her tonight.”
“Don’t stop tonight. I’m going to keep her in the hospital on observation. The poor girl’s only nineteen and she’s on her own. I’d send her out if she wouldn’t be alone.”
“She’s nineteen, but she’s tough.” This valley seems to grow ’em that way. “Tell her I’ll see her in the office next week.”
Branum laughed. “Perfect. I cut ’em. You watch ’em.”
Claire said good-bye and laid the phone on the seat beside her. Route Two over North Mountain wasn’t exactly a one-hand steering job.
An hour later, she pulled up to the women’s shelter. Lena seemed glad to see a familiar face. Cathy Rivera let them use the library room. There was a two-seat couch with two other upholstered chairs, and shelves lined with books. Claire could have been happy here alone for hours. Cathy gestured to the furniture. “Make yourselves at home.” She shrugged and smiled. “Hey, it was donated. I never say ‘no.’”
Claire understood when she looked at the chairs. She studied Lena for a moment. “Maroon vinyl or orange flowers?”
Lena sat on the orange one. Claire knelt beside her and put a small rubber tourniquet around Lena’s arm. Claire then swabbed the inside of her patient’s elbow and made quick work of drawing a blood sample for a pregnancy test. “I’ll drop it by the university lab on my way out. I’ll call you with the results tomorrow.”
Claire took a deep breath. Where should she start? She leaned back and tried to appear relaxed. “I’ve brought you some prenatal vitamins. I want you to take one a day.”
Lena shook her head. “I’m not keepin’ this baby.”
“Give this some time, Lena. An abortion isn’t something a clinic will want to do in the first few weeks of pregnancy anyway. Give it some time and think about what I said last night. And take the vitamins for your own health. They certainly won’t hurt you.” She held up her hands. “And they’re free.”
Lena nodded quietly.
“Will you talk to me, Lena?” She hesitated. “Sometimes it helps if you have someone . . . a friend, a mother . . . even a doctor to talk things out with.”
Lena stared at the floor.
“Do you have anyone you can talk to? Anyone supporting you?”
She spoke quietly. “Billy Ray. That’s all.”
“Will you talk to me? It won’t be easy, but I think it will relieve your sorrow if you share it with me.”
Lena nodded. “I guess.”
“I want you to tell me about Billy Ray. What happened yesterday before you called?”
“It was supposed to be a celebration,” she began. “I’d fixed a special dinner.” Lena paused and stared out the window.
“A celebration? An anniversary?”
Lena shook her head. “I wanted to tell him about the pregnancy. To surprise him with the news.” She sniffed. “I wanted it to be so special. We were going to celebrate his not drinkin’ for the last three weeks, so I used that as an excuse to make a nice dinner. Then after we ate, I told him he was going to be a father.”
Claire waited without speaking.
“That’s when he exploded. He accused me of cheatin’ on him. I couldn’t talk to him. He just went crazy.”
“How did you stop him?”
She put her hand to her mouth and began to cry. Through her sobs, she continued. “I thought I was going to die. He’d knocked over the table. He knocked me down and held me by the hair. When he jerked me up, I stabbed him in
the arm with a piece of broken glass.”
“So he left you alone?”
She shook her head. “I think it just scared him. It gave me a chance to get away. When he grabbed his arm, I ran.”
“Good for you.”
“I grabbed a butcher knife. That’s when he left.” She smiled through her tears. “Maybe he was afraid.”
You’re my hero, Lena.
They sat quietly for a minute before Lena added, “It’s the first time he hit me when he wasn’t drinkin’.”
“He was mad about the baby?”
“I guess.”
“He didn’t want kids?”
“We’d been trying for a while. I’d been off my pills for six months. Billy Ray hasn’t always been a bad guy. He’s just bad when he drinks, mostly. I thought if we’d have a baby, he’d settle down. Stay home more.” She looked up. “He’d usually drink when he went out with friends.”
“Why would he accuse you of cheating on him?”
“I don’t know. I’ve always been faithful to Billy Ray. I know I’m not perfect, but I wasn’t cheatin’ on him or nothing like that. He’s always been a jealous type, though. He never liked it if I talked to other guys. I think if I was cheating, he’d kill me and whoever I was with.” She paused. “But I’d never do that.” She looked at the floor. “I always planned to have a family with Billy Ray. I just figured he’d settle down if we had a family together.”
Wishful thinking. “Did you ever fight back?”
Lena’s gaze hardened. “Once.”
“Will you tell me about it?”
“I remember it because it was the first time I thought I was really going to die. Billy Ray came home drunk after bowling with his friends. He hit me and held my face into the pillow. I couldn’t breathe, but he let me up just enough to gasp for air.” Lena’s face flattened. “Then we had sex.” She continued without emotion like she was reporting events that happened to someone else. “It was the day after I’d come in to see you. My ankle hurt so bad, I couldn’t have run from him if I’d had the chance.”
“He forced himself on you?”
She nodded and wiped her eyes. Her nose wrinkled like she smelled something unpleasant. “I was pretty torn up down there. I bled for a week even though I wasn’t on my period.” She hesitated before the memory seemed to flood to the surface. She lifted her top lip in a snarl to reveal a small chip in her front incisor. “That’s when I decided I’d had enough. I decided to kill him. I lay awake most of the night planning how I’d do it. The next morning, when he was passed out on the couch, I put a shotgun to his head and pulled the trigger, but I’d forgotten to load the gun.”
Claire put a hand over her mouth. “What happened?”
“I scared him to death. He begged for forgiveness like he always did.” She shrugged. “But this time he stopped drinking. And I thought that meant that he wouldn’t hit me anymore. But that time was weird.”
“Why’s that?”
“Sex for Billy Ray had always been his way of proving to me or to himself that we were okay together. It was his way of making up. He’d never used it to hurt me before.”
“Rape isn’t usually about sex. It’s a power thing.”
Claire let the comment hang for a moment, hoping it would jar Lena with some insight. “I want to ask you about one more thing. When you talked to Ms. Rivera, she wasn’t sure about something. She had the idea that you were talking about two different men in your life.”
Lena stared quietly at the floor, shaking her head. “I’ve never cheated on Billy Ray.”
“I believe you.”
“She thinks I’m crazy, doesn’t she?”
“No, Lena.” Claire hesitated. “Why would she think that?”
Lena stood up. “Look, maybe this wasn’t such a good idea.”
“Sharing your problems is a good idea. Sometimes it helps us see the reasons we do what we do, and keeps us from repeating our mistakes.”
Lena paced slowly around the little library room. When she paused at the door, Claire was sure she was going to bolt.
“Lena, you’re an intelligent woman. You’ve got so much going for you. You’re young, attractive, and you’ve got your health. But more than that, the things you’ve told me show how much insight you already have.” Claire threw up her hands. “You’ve been so open with me. That’s a great start to winning over this problem and getting a life back. Why wouldn’t you talk to the other women? Why wouldn’t you talk to Cathy?”
The teenager stayed quiet.
“Why do you talk to me?”
Lena’s hand went to her eye, where she touched a scar hidden in her eyebrow, and then she headed back to the door. As she moved, Claire noticed a slight limp, something she hadn’t seen when they’d walked to the room. Lena pulled open the door and stepped into the hall. Before she disappeared, her eyes met Claire’s. “You’ve seen what Billy Ray does. It’s stupid to pretend with you.”
Chapter Fourteen
John Cerelli was a patient man. But twelve nights, two tickbites, and more briar scratches than he could count had broken his will to return to Lena’s place to risk life or limb from the monster dog or the gun-totin’ Billy Ray. The engagement ring was gone forever, and John would have to face facts.
John pulled into the parking lot behind the clinic and lifted a cool sausage and mushroom pizza from the passenger seat. He popped the trunk and shoved aside the night-vision goggles and the metal detector with disgust, and hoisted a cardboard box of medical supplies into his arms. He closed the trunk with his elbow. On the top of the supplies, he balanced the pizza box.
He used his own key to the back door. “Claire?”
“In here.”
He found Claire at her desk. He set the box of supplies on the floor and plopped the pizza on the desk on top of her patient charts.
“Hey!”
He met her stare. She broke away and hung her head. “John.” She shook her head. “I’m sorry. I completely forgot.”
“I noticed.”
“Did you wait long?”
“Thirty minutes.”
“You should have called.”
“I tried. I got voice mail.”
“Ugh. My phone’s in the car.” She closed the large medical textbook. “I’m sorry.”
He shrugged. “I went by your place. When I didn’t find you, I thought I’d look here.”
“Good guess.”
“Claire, it doesn’t take a college degree to know where to find you. What’s going on?”
She let his comments fall. “Work, John. Sick people. I’m a doctor.”
“No one has to work twenty-four/seven.”
“I’m seeing new stuff around here. It may be common to some people, but my internship was surgery, remember? I’ve got a little catching up to do.”
“Why did you come home, Claire?”
She looked up and lifted the top of the pizza box. “You ate?”
John nodded. He couldn’t quite resist holding up his hurt for her to admire. “Alone. At our favorite pizza place.” He added one more twist of an emotional knife. “I asked Tony to put the cheese on the top of the pepperonis just like you like it.”
“I said I was sorry, John.” She dropped the lid. “I’ll eat later.”
“Answer the question.”
She leaned back and glared at him.
He decided to rephrase it. “Did you come back for this? To work day and night?”
“These people need me.”
“Remember why you came back, Claire.”
“I don’t need this.”
He whispered under his breath. “You need it. You just don’t see it.”
“You’re just angry because I stood you up, is that it?”
“It’s not about our date. It’s about what you’re doing.”
She sighed. “I’m working, John. I’m not sure I see the catastrophe here.” She held up her hands. “What do you want me to say?”
“I want you
to see why you’re doing this to yourself.”
“This is a demanding job. My patients need me.”
“Give me a break. This isn’t about your patients. It’s about you. You keep yourself so busy so you won’t have to face life, Claire. Your life. You just walk around pretending your life is normal.”
“Oh, now you’re my psychiatrist. Since when did you—”
“I’m no psychiatrist.” He took a step toward her. “I’m just a man who loves you.”
She looked away. “You have a funny way of showing it.”
“Why did you come home, Claire? Tell me what you want.”
Claire took a deep breath. “You know why I came home.”
“You left a life you loved, Claire. Surgery. High risk. High glamour. You loved it. Tell me why you left.” He sat on the corner of her desk. “I just don’t want you to lose sight of what you wanted.”
Claire appeared to be studying her hands. She had long, fluent fingers. After a minute, she spoke slowly, “I came home to recapture life. I wanted to connect with a father I’d lost. I wanted to find the faith that I’d lost.” Her eyes met his. “And I wanted to find love again.”
John stayed quiet and kept her gaze until she broke away.
“I knew my mom needed help. I had to come. It was the right thing. For once I wanted to do something that wasn’t for me.”
“Claire, you changed locations, but you’re still running away from HD.”
She stood up. “I just want a normal life! I want a meaningful job, a man, maybe a family. I don’t want to think about HD.”
“You can’t just walk around pretending it doesn’t exist. That’s a fantasy world.”
“How can I pretend it doesn’t exist? Every time I go home, I see it. I can’t escape it.”
“Deal with it, Claire. Get your test results and get on with life. Then you’ll know what you’re up against.”
“Is that what this is about? You can’t live with the uncertainty. You want to know if I’ve got the HD gene so you will know if a relationship is worth pursuing.”
“My desire to be with you has nothing to do with whether you will get HD.”
“You can’t say that. Look at Wally. I asked my mom straight out. Would she have chosen this man if she’d have known he’d get HD? No. That’s an honest answer, John.”