by Jodi Picoult
Kate’s lips are slick as cherries. I pick her up in my arms. She’s nothing but bones, poking sharp through the skin of her T-shirt.
“When Anna ran off, Kate wouldn’t let me into her room,” my mother says, hurrying beside me. “I gave her a little while to calm down. And then I heard her coughing. I had to get in there.”
So you kicked it down, I think, and it doesn’t surprise me. We reach the car, and she opens the door so that I can slide Kate inside. I pull out of the driveway and speed even faster than normal through town, onto the highway, toward the hospital.
Today, when my parents were at court with Anna, Kate and I watched TV. She wanted to put on her soap and I told her fuck off and put on the scrambled Playboy channel instead. Now, as I run through red lights, I’m wishing that I’d let her watch that retarded soap. I’m trying not to look at her little white coin of a face in the rearview mirror. You’d think, with all the time I’ve had to get used to it, that moments like this wouldn’t come as such a shock. The question we cannot ask pushes through my veins with each beat: Is this it? Is this it? Is this it?
The minute we hit the ER driveway, my mother’s out of the car, hurrying me to get Kate. We are quite a picture walking through the automatic doors, me with Kate bleeding in my arms, and my mother grabbing the first nurse who walks by. “She needs platelets,” my mother orders.
They take her away from me, and for a few moments, even after the ER team and my mother have disappeared with Kate behind closed curtains, I stand with my arms buoyed, trying to get used to the fact that there’s no longer anything in them.
• • •
Dr. Chance, the oncologist I know, and Dr. Nguyen, some expert I don’t, tell us what we’ve already figured out: these are the death throes of end-stage kidney disease. My mother stands next to the bed, her hand tight around Kate’s IV pole. “Can you still do a transplant?” she asks, as if Anna never started her lawsuit, as if it means absolutely nothing.
“Kate’s in a pretty grave clinical state,” Dr. Chance tells her. “I told you before I didn’t know if she was strong enough to survive that level of surgery; the odds are even slighter now.”
“But if there was a donor,” she says, “would you do it?”
“Wait.” You’d think my throat had just been paved with straw. “Would mine work?”
Dr. Chance shakes his head. “A kidney donor doesn’t have to be a perfect match, in an ordinary case. But your sister isn’t an ordinary case.”
When the doctors leave, I can feel my mother staring at me. “Jesse,” she says.
“It wasn’t like I was volunteering. I just wanted to, you know, know.” But inside, I’m burning just as hot as I was when that fire caught at the warehouse. What made me believe I might be worth something, even now? What made me think I could save my sister, when I can’t even save myself?
Kate’s eyes open, so that she’s staring right at me. She licks her lips—they’re still caked with blood—and it makes her look like a vampire. The undead. If only.
I lean closer, because she doesn’t have enough in her right now to make the words creep across the air between us. Tell, she mouths, so that my mother won’t look up.
I answer, just as silent. Tell? I want to make sure I’ve got it right.
Tell Anna.
But the door to the room bursts open and my father fills the room with smoke. His hair and clothes and skin reek of it, so much so that I look up, expecting the sprinklers to go off. “What happened?” he asks, going right to the bed.
I slip out of the room, because nobody needs me there anymore. In the elevator, in front of the NO SMOKING sign, I light a cigarette.
Tell Anna what?
SARA
1990–1991
BY PURE CHANCE, or maybe karmic distribution, all three clients at the hair salon are pregnant. We sit under the dryers, hands folded over our bellies like a row of Buddhas. “My top choices are Freedom, Low, and Jack,” says the girl next to me, who is getting her hair dyed pink.
“What if it’s not a boy?” asks the woman sitting on my other side.
“Oh, those are meant to be for either.”
I hide a smile. “I vote for Jack.”
The girl squints, looking out the window at the rotten weather. “Sleet is nice,” she says absently, and then tries it on for size. “Sleet, pick up your toys. Sleet, honey, come on, or we’re gonna be late for the Uncle Tupelo concert.” She digs a piece of paper and a pencil stub out of her maternity overalls and scribbles down the name.
The woman on my left grins at me. “Is this your first?”
“My third.”
“Mine too. I have two boys. I’m keeping my fingers crossed.”
“I have a boy and a girl,” I tell her. “Five and three.”
“Do you know what you’re having this time?”
I know everything about this baby, from her sex to the very placement of her chromosomes, including the ones that make her a perfect match for Kate. I know exactly what I am having: a miracle. “It’s a girl,” I answer.
“Ooh, I’m so jealous! My husband and I, we didn’t find out at the ultrasound. I thought if I heard it was another boy, I might never finish out the last five months.” She shuts off her hair dryer and pushes it back. “You have any names picked?”
It strikes me that I don’t. Although I am nine months pregnant, although I have had plenty of time to dream, I have not really considered the specifics of this child. I have thought of this daughter only in terms of what she will be able to do for the daughter I already have. I haven’t admitted this even to Brian, who lies at night with his head on my considerable belly, waiting for the twitches that herald—he thinks—the first female placekicker for the Patriots. Then again, my dreams for her are no less exalted; I plan for her to save her sister’s life.
“We’re waiting,” I tell the woman.
Sometimes I think it is all we ever do.
• • •
There was a moment, after Kate’s three months of chemotherapy last year, that I was stupid enough to believe we had beaten the odds. Dr. Chance said that she seemed to be in remission, and that we would just keep an eye on what came next. And for a little while, my life even got back to normal: chauffeuring Jesse to soccer practice and helping out in Kate’s preschool class and even taking a hot bath to relax.
And yet, there was a part of me that knew the other shoe was bound to drop. This part scoured Kate’s pillow every morning, even after her hair started to grow back with its frizzy, burned ends, just in case it started falling out again. This part went to the geneticist recommended by Dr. Chance. Engineered an embryo given the thumbs-up by scientists to be a perfect match for Kate. Took the hormones for IVF and conceived that embryo, just in case.
It was during a routine bone marrow aspiration that we learned Kate was in molecular relapse. On the outside, she looked like any other three-year-old girl. On the inside, the cancer had surged through her system again, steamrolling the progress that had been made with chemo.
Now, in the backseat with Jesse, Kate’s kicking her feet and playing with a toy phone. Jesse sits next to her, staring out the window. “Mom? Do buses ever fall on people?”
“Like out of trees?”
“No. Like . . . just over.” He makes a flipping motion with his hand.
“Only if the weather’s really bad, or if the driver’s going too fast.”
He nods, accepting my explanation for his safety in this universe. Then: “Mom? Do you have a favorite number?”
“Thirty-one,” I tell him. This is my due date. “How about you?”
“Nine. Because it can be a number, or how old you are, or a six standing on its head.” He pauses only long enough to take a breath. “Mom? Do we have special scissors to cut meat?”
“We do.” I take a right and drive past a cemetery, headstones canted forward and back like a set of yellowed teeth.
“Mom?” Jesse asks, “is that where Kate will go?”
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The question, just as innocent as any of the others Jesse would ask, makes my legs go weak. I pull the car over and put on my hazard lights. Then I unbuckle my seat belt and turn around. “No, Jess,” I tell him. “She’s staying with us.”
• • •
“Mr. and Mrs. Fitzgerald?” the producer says. “This is where we’ll put you.”
We sit down on the set at the TV studio. We’ve been invited here because of our baby’s unorthodox conception. Somehow, in an effort to keep Kate healthy, we’ve unwittingly become the poster children for scientific debate.
Brian reaches for my hand as we are approached by Nadya Carter, the reporter for the newsmagazine. “We’re just about ready. I’ve already taped an intro about Kate. All I’m going to do is ask you a few questions, and we’ll be finished before you know it.”
Just before the camera starts rolling, Brian wipes his cheeks on the sleeve of his shirt. The makeup artist, standing behind the lights, moans. “Well, for God’s sake,” he whispers to me. “I’m not going on national TV wearing blush.”
The camera comes to life with far less ceremony than I’ve expected, just a little hum that runs up my arms and legs.
“Mr. Fitzgerald,” Nadya says, “can you explain to us why you chose to visit a geneticist in the first place?”
Brian looks at me. “Our three-year-old daughter has a very aggressive form of leukemia. Her oncologist suggested we find a bone marrow donor—but our oldest son wasn’t a genetic match. There’s a national registry, but by the time the right donor comes along for Kate, she might not . . . be around. So we thought it might be a good idea to see if another sibling of Kate’s matched up.”
“A sibling,” Nadya says, “who doesn’t exist.”
“Not yet,” Brian replies.
“What made you turn to a geneticist?”
“Time constraints,” I say bluntly. “We couldn’t keep having babies year after year until one was a match for Kate. The doctor was able to screen several embryos to see which one, if any, would be the ideal donor for Kate. We were lucky enough to have one out of four—and it was implanted through IVF.”
Nadya looks down at her notes. “You’ve received hate mail, haven’t you?”
Brian nods. “People seem to think that we’re trying to make a designer baby.”
“Aren’t you?”
“We didn’t ask for a baby with blue eyes, or one that would grow to be six feet tall, or one that would have an IQ of two hundred. Sure, we asked for specific characteristics—but they’re not anything anyone would ever consider to be model human traits. They’re just Kate’s traits. We don’t want a superbaby; we just want to save our daughter’s life.”
I squeeze Brian’s hand. God, I love him.
“Mrs. Fitzgerald, what will you tell this baby when she grows up?” Nadya asks.
“With any luck,” I say, “I’ll be able to tell her to stop bugging her sister.”
• • •
I go into labor on New Year’s Eve. The nurse taking care of me tries to distract me from my contractions by talking about the signs of the sun. “This one, she’s gonna be a Capricorn,” Emelda says as she rubs my shoulders.
“Is that good?”
“Oh, Capricorns, they get the job done.”
Inhale, exhale. “Good . . . to . . . know,” I tell her.
There are two other babies being born. One woman, Emelda says, has her legs crossed. She’s trying to make it to 1991. The New Year’s Baby is entitled to packs of free diapers and a $100 savings bond from Citizens Bank for that distant college education.
When Emelda goes out to the nurse’s desk, leaving us alone, Brian reaches for my hand. “You okay?”
I grimace my way through another contraction. “I’d be better if this was over.”
He smiles at me. To a paramedic/firefighter, a routine hospital delivery is something to shrug at. If my water had broken during a train wreck, or if I was laboring in the back of a taxi—
“I know what you’re thinking,” he interrupts, although I haven’t said a word out loud, “and you’re wrong.” He lifts my hand, kisses the knuckles.
Suddenly an anchor unspools inside me. The chain, thick as a fist, twists in my abdomen. “Brian,” I gasp, “get the doctor.”
My OB comes in and holds his hand between my legs. He glances up at the clock. “If you can hold on a minute, this kid’s gonna be born famous,” he says, but I shake my head.
“Get it out,” I tell him. “Now.”
The doctor looks at Brian. “Tax deduction?” he guesses.
I am thinking of saving, but it has nothing to do with the IRS. The baby’s head slips through the seal of my skin. The doctor’s hand holds her, slides that gorgeous cord free of her neck, delivers her shoulder by shoulder.
I struggle to my elbows to watch what is going on below. “The umbilical cord,” I remind him. “Be careful.” He cuts it, beautiful blood, and hurries it out of the room to a place where it will be cryogenically preserved until Kate is ready for it.
• • •
Day Zero of Kate’s pre-transplant regimen starts the morning after Anna is born. I come down from the maternity ward and meet Kate in Radiology. We are both wearing yellow isolation gowns, and this makes her laugh. “Mommy,” she says, “we match.”
She has been given a pediatric cocktail for sedation, and under any other circumstance, this would be funny. Kate can’t find her own feet. Every time she stands up, she collapses. It strikes me that this is how Kate will look when she gets drunk on peach schnapps for the first time in high school or college; and then I quickly remind myself that Kate might never be that old.
When the therapist comes to take her into the RT suite, Kate latches on to my leg. “Honey,” Brian says, “it’s gonna be fine.”
She shakes her head and burrows closer. When I crouch down, she throws herself into my arms. “I won’t take my eyes off you,” I promise.
The room is large, with jungle murals painted on the walls. The linear accelerators are built into the ceiling and a pit below the treatment table, which is little more than a canvas cot covered with a sheet. The radiation therapist places thick lead pieces shaped like beans onto Kate’s chest and tells her not to move. She promises that when it’s all over, Kate can have a sticker.
I stare at Kate through the protective glass wall. Gamma rays, leukemia, parenthood. It is the things you cannot see coming that are strong enough to kill you.
• • •
There is a Murphy’s Law to oncology, one which is not written anywhere but held in widespread belief: if you don’t get sick, you won’t get well. Therefore, if your chemo makes you violently ill, if radiation sears your skin—it’s all good. On the other hand, if you sail through therapy quickly with only negligible nausea or pain, chances are the drugs have somehow been excreted by your body and aren’t doing their job.
By this criterion, Kate should surely be cured by now. Unlike last year’s chemo, this course of treatment has taken a little girl who didn’t even have a runny nose and has turned her into a physical wreck. Three days of radiation has caused constant diarrhea, and put her back into a diaper. At first, this embarrassed her; now she is so sick she doesn’t care. The following five days of chemo have lined her throat with mucus, which keeps her clutching at a suction tube as if it is a life preserver. When she is awake, all she does is cry.
Since Day Six, when Kate’s white blood cell and neutrophil counts began to plummet, she has been in reverse isolation. Any germ in the world might kill her now; for this reason, the world is made to keep its distance. Visitors to her room are restricted, and those who are allowed in look like spacemen, gowned and masked. Kate has to read picture books while wearing rubber gloves. No plants or flowers are permitted, because they carry bacteria that could kill her. Any toy given to her must be scrubbed down with antiseptic solution first. She sleeps with her teddy bear, sealed in a Ziploc bag, which rustles all night and sometimes wakes her up.<
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Brian and I sit outside the anteroom, waiting. While Kate sleeps, I practice giving injections to an orange. After the transplant Kate will need growth factor shots, and the chore will fall to me. I prick the syringe under the thick skin of the fruit, until I feel the soft give of tissue underneath. The drug I will be giving is subcutaneous, injected just under the skin. I need to make sure the angle is right and that I am giving the proper amount of pressure. The speed with which you push the needle down can cause more or less pain. The orange, of course, doesn’t cry when I make a mistake. But the nurses still tell me that injecting Kate won’t feel much different.
Brian picks up a second orange and begins to peel it. “Put that down!”
“I’m hungry.” He nods at the fruit in my hands. “And you’ve already got a patient.”
“For all you know that was someone else’s. God knows what it’s doped up with.”
Suddenly Dr. Chance turns the corner and approaches us. Donna, an oncology nurse, walks behind him, brandishing an IV bag filled with crimson liquid. “Drum roll,” she says.
I put down my orange, follow them into the anteroom, and suit up so that I can come within ten feet of my daughter. Within minutes Donna attaches the bag to a pole, and connects the drip to Kate’s central line. It is so anticlimactic that Kate doesn’t even wake up. I stand on one side, as Brian goes to the other. I hold my breath. I stare down at Kate’s hips, the iliac crest, where bone marrow is made. Through some miracle, these stem cells of Anna’s will go into Kate’s bloodstream in her chest, but will find their way to the right spot.
“Well,” Dr. Chance says, and we all watch the cord blood slowly slide through the tubing, a Crazy Straw of possibility.
JULIA
AFTER TWO HOURS OF LIVING with my sister again, I’m finding it hard to believe we ever comfortably shared a womb. Isobel has already organized my CDs by year of release, swept under the couch, and tossed out half the food in my refrigerator. “Dates are our friend, Julia.” She sighs. “You have yogurt in here from when Democrats ruled the White House.”