Over the loudspeaker came a female voice: “Dr. Chideya to exam room four. Dr. Chideya, room four.”
Joely shifted her weight, wrinkling the sheet beneath her. “So I’m not crazy.” She almost sounded relieved.
Studying the chart, Dr. Martin adjusted his glasses. “Lupus is very difficult to diagnose. Considering the family medical history you provided, your mother probably had lupus as well.”
Goose bumps popped up on Kate’s arms as she remembered her mother shuffling down the hall with her walker, crying with every step. Kate had been so young at the time, she only knew something was wrong with her mother that numerous surgeries and medications failed to fix. Kate had begged God to let her share just some of her mother’s pain. But of course He didn’t.
Now Joely was cursed too. And the curse had a name—lupus.
Joely swallowed. “Am I going to die?”
Dr. Martin delivered the details matter-of-factly. “There is no cure, but most of the time, lupus can be managed.” He went over some of the medical facts, which Kate struggled to absorb.
“Right now the lupus is attacking your kidneys,” he continued. “We need to address that, so you don’t end up on dialysis.”
Overwhelmed, Kate tried to take it all in. No cure. Can be managed. Dialysis.
“What can we do?” Joely asked, with a catch in her voice.
Dr. Martin wrote some notes on Joely’s chart. “I’ll give you a prescription for steroids, which will reduce the swelling in your joints. You should feel better within a few days.”
Joely released a huge sigh. “That sounds good.”
Kate had the uneasy feeling that Dr. Martin hadn’t revealed all of the fine print yet. You didn’t get diagnosed with a life-threatening disease and go home with a simple prescription.
A baby’s cry echoed down the corridor. Kate’s neck muscles clenched.
Dr. Martin removed his glasses and tucked them in his shirt pocket. “Do you have any children?”
Joely shook her head. “Not yet.”
“Cyclophosphamide is the best treatment to slow or stop aggressive lupus.” He paused. “I’m sorry to tell you this. . .but it causes infertility.”
Joely’s eyes widened. “Infertility?”
“I’m afraid so.”
Sweat droplets formed above Joely’s lip. “No. This can’t be happening.” She stared into the mid-distance. The baby continued wailing.
A tear trickled down Joely’s cheek. “I thought I still had plenty of time.” Her voice sounded small and fragile.
Kate bit her lip to hold back her own tears. The last thing Joely needed was to see her lose it. She pulled Joely’s head to her chest and stroked her curly hair. She brushed and brushed just like when they were children and Joely woke up from a nightmare about their dad’s car accident. Now Kate felt her sister’s shoulders jerk. Joely began to sob.
Dr. Martin handed her a tissue.
Kate felt her eyes water. Stop it. She started to rock Joely. “It’s OK. It’s OK,” she whispered. She heard a gurney wheeling past the room and tense voices following it.
After a long while, Joely looked up. She wiped at her eyes. “Tell me about dialysis. You said if I didn’t do the treatment that I would need dialysis.”
“Don’t be ridiculous,” Kate said, thinking of her mom’s excruciating demise. “We need to treat this before it gets worse.”
“What are my other options?” Joely asked Dr. Martin with steel in her voice.
He squared his shoulders. “There are none. This is the treatment I recommend. With dialysis you would depend upon a machine until you could get a kidney transplant. It’s only used as a last resort.”
“Be reasonable,” Kate said to Joely.
Joely blinked her dewy eyes. “How could giving up my future babies be reasonable?”
Dr. Martin flipped through Joely’s file until his index finger pointed at something he must have found relevant. “There is a chance your ovaries could recover after the cyclophosphamide treatment. I’ve heard of it happening for women younger than you—in their twenties.” He shook his head. “But at age thirty-two, it’s hard to say. You should consider other options if you want children.”
Joely wadded up the tissue and squeezed it in her fist. “Other options? Like what—adoption?”
He nodded.
Joely started ripping apart the tissue. “What about freezing my eggs?”
Dr. Martin put down the chart. “You could, but there isn’t time to go on drugs to stimulate egg production. Unfortunately, the harvesting procedure costs thousands of dollars and insurance won’t pay for it.” He softened his voice. “I know this is hard to hear, but even then, the odds of a woman with lupus carrying a baby to term are only fifty-fifty.”
Joely crossed her arms and looked at Dr. Martin. “Maybe you’re wrong. You said yourself lupus is difficult to diagnose.”
Dr. Martin pursed his lips. “I’m confident of this diagnosis. Now, the treatment involves an injection once a month. I can arrange for you to start tomorrow.”
Joely shook her head. “I won’t do it.”
# # #
That evening Joely lay on her well-worn leather couch, a navy afghan across her legs. She stared at the blank tv screen. “I was pregnant once.”
The remote control slipped from Kate’s hand. She’d been ready to ask if Joely would welcome the distraction. “You were? When?” Crossing the room, she sat on the worn carpet, near Joely’s pale face.
Joely continued to look past her. “I was sixteen. Junior year.” Her chest rose and fell with her breath.
“Why didn’t you tell me?”
Joely turned her sharp gaze toward Kate. “Because you left. I needed you, but you weren’t there.”
“I didn’t abandon you. I went to college.” Kate remembered calling Joely from her dorm, bubbling with excitement about having a room with a view of the courtyard and a closet she didn’t have to share. Hearing the flatness of Joely’s voice at first made Kate think their guardian, Aunt Suzy, had done something cruel, but Joely denied it. When Kate asked repeatedly what was wrong, Joely replied, “Nothing.” As the one-sided conversation continued, Kate determined that Joely resented her simply for leaving.
So Kate shut up about her adventure and inquired about Joely’s life. Her sister offered few details, her silence shredding Kate’s heart. Kate kept calling several times a week, despite her growing phone bill, trying to reconnect with her sister. After a while, Kate grew to resent how their quiet feud cast a shadow over her freshman year.
Joely scowled at Kate. “You left me alone in that house. You finished your high school credits early even, so you could get out of there.”
Kate couldn’t deny that. Escaping Aunt Suzy’s lair had been her incentive for graduating a semester early. But she couldn’t save Joely. She could only save herself. At least that’s the story she’d told herself.
A strand of her brunette hair hovered near Joely’s eye. Kate brushed it back with her fingers. “Who was the father?”
“Ray.”
Kate pictured Ray, the blond boy next door with big ears and an even bigger smile. Joely had been crushing on him since sixth grade and finally in tenth grade, he’d grown his hair long enough to camouflage his ears, decided he was cute, and asked Joely out. They’d been stuck together like glue from their first kiss.
“We’d been dating for so long and I thought I was in love. . . .Anyway, the condom broke.” Joely sighed. “A few weeks later I realized I was pregnant.”
Shaking her head, Kate hated to hear what came next. If her sister had had an abortion, she definitely regretted it more now than ever. “What did you do?”
“Well, he wasn’t too excited about having a kid. He’d been accepted to Michigan State the next fall. He offered to pay for an abortion.” Joely’s face scrunched up.
Kate held her breath. So, this was why Joely had broken up with Ray and never spoke of him again.
Joely blinked back
her tears. “I was just a kid. It wasn’t like I could get a great job and provide much of a home.”
“Of course not. I wish you would’ve told me.”
Joely shrugged. “Shutting you out was my way of punishing you, I think.”
Kate curved her hand over the top of Joely’s. “Whatever you did, you did what was right for you at the time.”
Joely’s lips squeezed together. “That’s what they said at Planned Parenthood, too.”
Kate felt a sharp pain in her chest. Joely had unknowingly squandered her one chance at motherhood.
“I kept thinking it wasn’t a good time, but there was no way I could ever get an abortion. And then. . . I started bleeding. I called Planned Parenthood and told them about the terrible pain. They said I was probably having a miscarriage. I bawled to them about how it was my fault for not being more excited. It felt like it was God’s way of punishing me.”
Kate started stroking Joely’s hair. “No, no. Your body just wasn’t ready. The baby wasn’t ready. It’s not your fault.”
Tears dripped down Joely’s face, rolling across her nose, falling onto the couch. “I told myself someday I’d be married and have a house and I’d make up for it by being such a great mom.” She sniffled. “But now. . . .”
Without hesitating, Kate reached her arm around Joely’s back. For years, Kate thought she knew why Joely wanted to be a mom so badly, but she’d been wrong. How was it possible that she’d prided herself on being so close to her sister, and yet all along Joely had been burdened with this dark secret?
What kind of big sister was she? When Joely had needed her most, Kate had failed her.
Never again.
# # #
Twelve hours later, Joely and Kate sat cross-legged in the lobby of the rheumatologist who had confirmed Dr. Martin’s diagnosis. A TV mounted on the wall had the sound turned down so low that Kate couldn’t hear it. Not that she wanted to.
A stooped man with a cane passed in front of them and sat down. An elderly woman carrying the Chicago Tribune took the seat next to him. She pulled out the crossword section and handed him the rest of the newspaper.
Joely nibbled her bottom lip. Even though she and Kate didn’t look much alike, people always claimed that they could tell the women were sisters. Friends told them their mannerisms were exactly the same, the most obvious of which were that when excited, they talked with their hands and when stressed, they chewed on things—thumb nails, the ends of pencils or their lower lip.
Joely’s normally radiant face still hadn’t regained its color, causing Kate to worry. She hoped to ease the tension with small talk. “Boy, traffic was heavy. Is it always like that?” Silence.
“I hope it doesn’t rain. It’s not supposed to, is it?” More silence.
“Did you hear about that new reality show?” Still no reply.
Eventually Kate gave up and looked around at the faces of strangers silently worrying, hoping and praying. A middle-aged woman gulped coffee, a balding man with a briefcase tapped his foot, a young couple held hands and watched their little boy play with Legos.
In the corner Kate saw a rack of aqua-colored brochures starting with the word “when”: When a Parent has Osteoporosis, When a Spouse has Fibromyalgia, When You have an Autoimmune Disease. Where was the one titled “When your Baby Sister is Screwed”?
Kate pressed on her temples. She hated this. She would do anything to take Joely’s place. Joely had her whole life ahead of her. She deserved to fall in love, get married and have the children of which she’d always dreamed.
“Joely Shupe,” a voice called. Joely and Kate looked up to see a stocky woman dressed in salmon-colored scrubs holding a door open. Kate stood, but Joely remained seated.
“Come on,” Kate said.
Joely picked at her cuticles. “I don’t know. . . .”
“We talked about this. If you don’t do the treatment, your kidneys will shut down.”
Joely hesitated.
Someone turned up the volume on the TV. Kate heard a reporter talking about a missing child. “Shauna Kay Leyner was last seen wearing a pink sweatshirt and blue jeans. She is four years old and believed to be in danger.” Kate shot a dirty look toward the middle-aged woman who lingered near the TV volume button.
Joely stared at the on-screen photograph of an African-American girl with dreadlocks. “Where was her mother?” she asked, her voice rapidly rising in pitch. “Why wasn’t she watching her daughter? She doesn’t deserve to have children.” Tears shimmered in her eyes.
The Chicago Tribune couple turned toward them with horrified expressions. Kate sat down and took Joely’s hand. She spoke so no one else could hear. “It’s not fair. It isn’t. But if you don’t do this, you could die.”
Joely took a deep breath and wiped at her eyes with the back of her free hand. Kate stood, never letting go of her sister’s fingers. Joely allowed herself to be pulled up. They walked until they were face-to-face with the nurse and her clipboard.
The nurse looked at Kate. “You need to wait here.”
Kate felt as if she had been knocked down. She wanted to be there for Joely. She had to be there as they injected the necessary poison into her sister’s veins, a drug that would simultaneously save and destroy her life. “Can’t I just go and hold her hand? I promise I won’t be in the way.”
“Let me get her situated first. Then someone will come get you.”
Kate studied the nurse’s face. “Are you sure?” What if they forgot?
The woman wouldn’t yield.
Kate rose up a bit on her toes, wrapped her arms around Joely’s shoulders and squeezed. They hugged each other all of the time—as part of their greeting when they first saw each other, to celebrate whenever Joely landed a new client, and as they reluctantly said goodbye after a day at an art museum. But this hug was different, laden with disappointment and despair.
“Ow!” Joely flinched.
Kate immediately let go. “Did I hurt you? I’m sorry.”
“My shoulders are really sore today.” She rubbed the top of her arm just as she had in the thrift store. Back when Kate thought she was faking.
Remorse surged through her. She made a mental note to give only gentle hugs from then on. After today nothing would ever be the same.
Joely’s face took on an even more serious expression. “Kate?”
“What is it?”
She didn’t speak, but her blood-shot eyes seemed to beg for something. “Don’t make the mistake I did. . .thinking you have lots of time. . . .” Her tiny voice trailed off.
Guilt washed over Kate. If she had kept her mouth shut all of those years ago, Joely would be married and the proud mother of Anna Jo and Thomas by now. Kate should’ve stayed out of it.
“Everything’s going to be fine,” Kate reassured her. A yellow Lego tumbled toward her foot, chased by a toddler in bib overalls. He snatched up the tiny cube and ran back toward his parents.
The corners of Joely’s mouth drooped as she watched the little boy building a colorful tower. He had dark, curly hair—the kind that girls envied, the kind that looked especially adorable on small children. The same kind that Joely had.
The heavyset nurse shifted her weight.
Kate grimaced. Joely was about to be robbed of her ability to create life. Something she’d longed to do ever since she’d become an orphan.
What could Kate say to make her feel better? It was her job as the big sister to comfort her. To fix things. Only this couldn’t be fixed.
The nurse cleared her throat. “Ready?”
Joely bowed her head, but didn’t take a step. “I’m not sure. . .”
Kate nodded. “You’re stronger than you think.”
Joely tugged on a hangnail. “Kate?”
“What is it?”
“If I’m going to do this, you and Mitch need to have a baby.” She said it as if it were a simple suggestion like “You should get the yellow sweater” or “You should order the onion rings.”<
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Kate’s forehead tightened. “What?”
“I know you were thinking about not having a family. . .but trust me, you’ll regret it.”
“What are you talking about?”
“Promise me you’ll have a baby.”
“Everything’s going to be fine,” Kate reassured her, anxious to end the uncomfortable moment.
The nurse studied her clipboard.
Inspiration struck Kate. “If you want a baby, why don’t you adopt?”
“No one’s going to give me a baby. A single woman with lupus.”
She was probably right. Kate started to ask, “What if. . .?” but choked on the words. They were out of options.
But still—Joely, her flesh and blood, should’ve understood how unreasonable this request was. Kate had not made the decision to remain childless lightly. She saw and felt things differently than her sister did. More pessimistically—more realistically.
“Quit being such a wuss, sis. You only live once.”
Kate bit her lip, her heart hammering against her ribs. You only live once, she repeated to herself. And in our family, not for very long. Thoughts ricocheted inside her brain: Joely isn’t thinking straight—I can’t be somebody’s mother—she’s asking too much.
Joely’s hope-filled eyes locked on Kate’s. “Promise me.”
Time pressed down on Kate like a vise while she searched for the right words. How could she put it gently, so she wouldn’t upset Joely?
The nurse opened the door wider and looked at them. “It’s time.”
Joely stood frozen, staring at the curly-haired toddler.
She wasn’t going to go with the nurse; Kate could tell.
Kate shook her head and took a deep breath.
Her mouth opened.
And she surprised them both with her reply.
CHAPTER THREE
When Kate walked into her house, it smelled funny. Bad. Like fumes.
“I’m up here,” Mitch’s baritone voice called.
As she climbed the stairs, the unpleasant, yet familiar, odor grew in intensity. She heard Mitch singing a Dave Matthews song, ironically called “So Much to Say.” Kate stumbled on one of the steps, catching herself with the handrail.
A Sister's Promise (Promises) Page 2