by Jodi Picoult
He wiped up in front of me with a dishrag. “Any judge would toss that case out on its ass.”
“You’d be surprised.”
Seven spread the rag out on the brass bar to dry. “Sounds like a misdemeanor, if you ask me.”
I rested my cheek on the cool, damp wood. “No way,” I said. “Once you’re in, it’s for life.”
• • •
Brian and Sara take Anna down to the cafeteria. It leaves me alone with Kate, who is eminently curious. I imagine that the number of times her mother has willingly left her side is something she can count on two hands. I explain that I’m helping the family make some decisions about her health care.
“Ethics committee?” Kate guesses. “Or are you from the hospital’s legal department? You look like a lawyer.”
“What does a lawyer look like?”
“Kind of like a doctor, when he doesn’t want to tell you what your labs say.”
I pull up a chair. “Well, I’m glad to hear you’re doing better today.”
“Yeah. Apparently yesterday I was pretty out of it,” Kate says. “Doped up enough to make Ozzy and Sharon look like Ozzie and Harriet.”
“Do you know where you stand, medically, right now?”
Kate nods. “After my BMT, I got graft-versus-host disease—which is sort of good, because it kicks the leukemia’s butt, but it also does some funky stuff to your skin and organs. The doctors gave me steroids and cyclosporine to control it, and that worked, but it also managed to break down my kidneys, which is the emergency flavor of the month. That’s pretty much the way it goes—fix one leak in the dike just in time to watch another one start spouting. Something is always falling apart in me.”
She says this matter-of-factly, as if I’ve grilled her about the weather or what’s on the hospital menu. I could ask her if she has talked to the nephrologists about a kidney transplant, if she has any particular feelings about undergoing so many different, painful treatments. But this is exactly what Kate is expecting me to ask, which is probably why the question that comes out of my mouth is completely different. “What do you want to be when you grow up?”
“No one ever asks me that.” She eyes me carefully. “What makes you think I’m going to grow up?”
“What makes you think that you’re not? Isn’t that why you’re doing all this?”
Just when I think she isn’t going to answer me, she speaks. “I always wanted to be a ballerina.” Her arm goes up, a weak arabesque. “You know what ballerinas have?”
Eating disorders, I think.
“Absolute control. When it comes to their bodies, they know exactly what’s going to happen, and when.” Kate shrugs, coming back to this moment, this hospital room. “Anyway,” she says.
“Tell me about your brother.”
Kate starts to laugh. “You haven’t had the pleasure of meeting him yet, I guess.”
“Not yet.”
“You can pretty much form an opinion about Jesse in the first thirty seconds you spend with him. He gets into a lot of bad stuff he shouldn’t.”
“You mean drugs, alcohol?”
“Keep going,” Kate says.
“Has that been hard for your family to deal with?”
“Well, yeah. But I don’t really think it’s something he does on purpose. It’s the way he gets noticed, you know? I mean, imagine what it would be like if you were a squirrel living in the elephant cage at the zoo. Does anyone ever go there and say, Hey, check out that squirrel? No, because there’s something so much bigger you notice first.” Kate runs her fingers up and down one of the tubes sprouting out of her chest. “Sometimes it’s shoplifting, and sometimes it’s getting drunk. Last year, it was an anthrax hoax. That’s the kind of stuff Jesse does.”
“And Anna?”
Kate starts to pleat the blanket in folds on her lap. “There was one year when every single holiday, and I mean even like Memorial Day, I was in the hospital. It wasn’t anything planned, of course, but that’s the way it happened. We had a tree in my room for Christmas, and an Easter egg hunt in the cafeteria, and we trick-or-treated on the orthopedic ward. Anna was around six years old, and she threw a total fit because she couldn’t bring sparklers into the hospital on the Fourth of July—all the oxygen tents.” Kate looks up at me. “She ran away. Not far, or anything—I think she got to the lobby before someone nabbed her. She was going to find herself another family, she told me. Like I said, she was only six, and no one really took it seriously. But I used to wonder what it would be like to be normal. So I totally understood why she’d wonder about it, too.”
“When you’re not sick, do you and Anna get along pretty well?”
“We’re like any pair of sisters, I guess. We fight over who gets to put on whose CDs; we talk about cute guys; we steal each other’s good nail polish. She gets into my stuff and I yell; I get into her stuff and she cries down the house. Sometimes she’s great. And other times I wish she’d never been born.”
That sounds so patently familiar that I grin. “I have a twin sister. Every time I used to say that, my mother would ask me if I could really, truly picture being an only child.”
“Could you?”
I laugh. “Oh . . . there were definitely times I could imagine life without her.”
Kate doesn’t crack a smile. “See,” she says, “my sister’s the one who’s always had to imagine life without me.”
SARA
1996
AT EIGHT, KATE IS A LONG TANGLE of arms and legs, sometimes resembling a creature made of sunlight and pipe cleaners more than she does a little girl. I stick my head into her room for the third time that morning, to find her in yet a different outfit. This one is a dress, white with red cherries printed across it. “You’re going to be late for your own birthday party,” I tell her.
Thrashing her way out of the halter top, Kate strips off the dress. “I look like an ice cream sundae.”
“There are worse things,” I point out.
“If you were me, would you wear the pink skirt or the striped one?”
I look at them both, puddles on the floor. “The pink one.”
“You don’t like the stripes?”
“Then wear that one.”
“I’m going to wear the cherries,” she decides, and she turns around to grab it. On the back of her thigh is a bruise the size of a half-dollar, a cherry that has stained its way through the fabric.
“Kate,” I ask, “what’s that?”
Twisting around, she looks at the spot where I point. “I guess I banged it.”
For five years, Kate has been in remission. At first, when the cord blood transplant seemed to be working, I kept waiting for someone to tell me this was all a mistake. When Kate complained that her feet hurt, I rushed her to Dr. Chance, certain this was the bony pain of recurrence, only to find out that she’d outgrown her sneakers. When she fell down, instead of kissing her scrapes, I’d ask her if her platelets were good.
A bruise is created when there is bleeding in tissues beneath the skin, usually—but not always—the result of a trauma.
It has been five whole years, did I mention that?
Anna sticks her head into the room. “Daddy says the first car just pulled up and if Kate wants to come down wearing a flour sack he doesn’t care. What’s a flour sack?”
Kate finishes hiking the sundress over her head, then pulls up the hem and rubs the bruise. “Huh,” she says.
Downstairs, there are twenty-five second-graders, a cake in the shape of a unicorn, and a local college kid hired to make swords and bears and crowns out of balloons. Kate opens her presents—necklaces made of glittery beads, craft kits, Barbie paraphernalia. She saves the biggest box for last—the one Brian and I have gotten her. Inside a glass bowl swims a fantail goldfish.
Kate has wanted a pet forever. But Brian is allergic to cats, and dogs require a lot of attention, which led us to this. Kate could not be happier. She carries him around for the rest of the party. She names him
Hercules.
After the party, when we are cleaning up, I find myself staring at the goldfish. Bright as a penny, he swims in circles, happy to be going nowhere.
• • •
It takes only thirty seconds to realize that you will be canceling all your plans, erasing whatever you had been cocky enough to schedule on your calendar. It takes sixty seconds to understand that even if you’d been fooled into thinking so, you do not have an ordinary life.
A routine bone marrow aspiration—one we’d scheduled long before I ever saw that bruise—has come back with some abnormal promyelocytes floating around. Then a polymerase chain reaction test—one that allows the study of DNA—showed that in Kate, the 15 and 17 chromosomes were translocated.
All of this means that Kate is in molecular relapse now, and clinical symptoms can’t be that far behind. Maybe she won’t present with blasts for a month. Maybe we won’t find blood in her urine or stools for a year. But inevitably, it will happen.
They say that word, relapse, like they might say birthday or tax deadline, something that happens so routinely it has become part of your internal calendar, whether you want it to or not.
Dr. Chance has explained that this is one of the great debates for oncologists—do you fix a wheel that isn’t broken, or do you wait until the cart collapses? He recommends that we put Kate on ALL-TRANS Retinoic Acid. It comes in a pill half the size of my thumb, and was basically stolen from ancient Chinese medics who’d been using it for years. Unlike chemotherapies, which go in and kill everything in their path, ATRA heads right for chromosome 17. Since the translocation of chromosomes 15 and 17 is in part what keeps promyelocyte maturation from happening correctly, ATRA helps uncoil the genes that have bound themselves together . . . and stops the abnormalities from going further.
Dr. Chance says the ATRA may put Kate back into remission.
Then again, she might develop a resistance to it.
“Mom?” Jesse comes into the living room, where I am sitting on the couch. I’ve been there for hours now. I can’t seem to make myself get up and do any of the things I am supposed to, because what is the point of packing school lunches or hemming a pair of pants or even paying the heating bill?
“Mom,” Jesse says again. “You didn’t forget, did you?”
I look at him as if he is speaking Greek. “What?”
“You said you’d take me to buy new cleats after we go to the orthodontist. You promised.”
Yes, I did. Because soccer starts two days from now, and Jesse’s outgrown his old pair. But now I do not know if I can drag myself to the orthodontist’s, where the receptionist will smile at Kate and tell me, like she always does, how beautiful my children are. And there is something about the thought of going to Sports Authority that seems downright obscene.
“I’m canceling the orthodontist appointment,” I say.
“Cool!” He smiles, his silver mouth glinting. “Can we just go get the cleats?”
“Now is not a good time.”
“But—”
“Jesse. Let. It. Go.”
“I can’t play if I don’t get new shoes. And you’re not even doing anything. You’re just sitting here.”
“Your sister,” I say evenly, “is incredibly sick. I’m sorry if that interferes with your dentist’s appointment or your plan to go buy a pair of cleats. But those don’t rate quite as high in the grand scheme of things right now. I’d think that since you’re ten, you might be able to grow up enough to realize that the whole world doesn’t always revolve around you.”
Jesse looks out the window, where Kate straddles the arm of an oak tree, coaching Anna in how to climb up. “Yeah, right, she’s sick,” he says. “Why don’t you grow up? Why don’t you figure out that the world doesn’t revolve around her?”
For the first time in my life I begin to understand how a parent might hit a child—it’s because you can look into their eyes and see a reflection of yourself that you wish you hadn’t. Jesse runs upstairs to slam the door to his bedroom.
I close my eyes, take a few deep breaths. And it strikes me: not everyone dies of old age. People get run over by cars. People crash in airplanes. People choke on peanuts. There are no guarantees about anything, least of all one’s future.
With a sigh I walk upstairs, knock on my son’s door. He has just recently discovered music; it throbs through the thin line of light at the base of the door. As Jesse turns down the stereo the notes flatten abruptly. “What.”
“I’d like to talk to you. I’d like to apologize.”
There is a scuffle on the other side of the door, and then it swings open. Blood covers Jesse’s mouth, a vampire’s lipstick; bits of wire stick out like a seamstress’s pins. I notice the fork he is holding, and realize this is what he has used to pull off his braces. “Now you never have to take me anywhere,” he says.
• • •
Two weeks go by with Kate on ATRA. “Did you know,” Jesse says one day, while I am getting her pill ready, “a giant tortoise can live for 177 years?” He is on a Ripley’s Believe It or Not kick. “An Arctic clam can live for 220 years.”
Anna sits at the counter, eating peanut butter with a spoon. “What’s an Arctic clam?”
“Who cares?” Jesse says. “A parrot can live for eighty years. A cat can live for thirty.”
“How about Hercules?” Kate asks.
“It says in my book that with good care, a goldfish can live for seven years.”
Jesse watches Kate put the pill on her tongue, take a swig of water to swallow it. “If you were Hercules,” he says, “you’d already be dead.”
• • •
Brian and I slide into our respective chairs in Dr. Chance’s office. Five years have passed, but the seats fit like an old baseball glove. Even the photographs on the oncologist’s desk have not changed—his wife is wearing the same broad-brimmed hat on a rocky Newport jetty; his son is frozen at age six, holding a speckled trout—contributing to the feeling that in spite of what I believed, we never really left here.
The ATRA worked. For a month, Kate reverted to molecular remission. And then a CBC turned up more promyelocytes in her blood.
“We can keep pulsing her with ATRA,” Dr. Chance says, “but I think that its failure already tells us she’s maxed out that course.”
“What about a bone marrow transplant?”
“That’s a risky call—particularly for a child who still isn’t showing symptoms of a full-blown clinical relapse.” Dr. Chance looks at us. “There’s something else we can try first. It’s called a donor lymphocyte infusion—a DLI. Sometimes a transfusion of white blood cells from a matched donor can help the original clone of cord blood cells fight the leukemia cells. Think of them as a relief army, supporting the front line.”
“Will it put her into remission?” Brian asks.
Dr. Chance shakes his head. “It’s a stop-gap measure—Kate will, in all probability, have a full-fledged relapse—but it buys time to build up her defenses before we have to rush into a more aggressive treatment.”
“And how long will it take to get the lymphocytes here?” I ask.
Dr. Chance turns to me. “That depends. How soon can you bring in Anna?”
• • •
When the elevator doors open there is only one other person inside it, a homeless man with electric blue sunglasses and six plastic grocery bags filled with rags. “Close the doors, dammit,” he yells as soon as we step inside. “Can’t you see I’m blind?”
I push the button for the lobby. “I can take Anna in after school. Kindergarten gets out at noon tomorrow.”
“Don’t touch my bag,” the homeless man growls.
“I didn’t,” I answer, distant and polite.
“I don’t think you should,” Brian says.
“I’m nowhere near him!”
“Sara, I meant the DLI. I don’t think you should take Anna in to donate blood.”
For no reason at all, the elevator stops on the eleventh flo
or, then closes again.
The homeless man begins to rummage in his plastic bags. “When we had Anna,” I remind Brian, “we knew that she was going to be a donor for Kate.”
“Once. And she doesn’t have any memory of us doing that to her.”
I wait until he looks at me. “Would you give blood for Kate?”
“Jesus, Sara, what kind of question—”
“I would, too. I’d give her half my heart, for God’s sake, if it helped. You do whatever you have to, when it comes to people you love, right?” Brian ducks his head, nods. “What makes you think that Anna would feel any different?”
The elevator doors open, but Brian and I remain inside, staring at each other. From the back, the homeless man shoves between us, his bounty rustling in his arms. “Stop yelling,” he shouts, though we stand in utter silence. “Can’t you tell that I’m deaf?”
• • •
To Anna, it is a holiday. Her mother and father are spending time with her, alone. She gets to hold both of our hands the whole way across the parking lot. So what if we’re going to a hospital?
I have explained to her that Kate isn’t feeling good, and that the doctors need to take something from Anna and give it to Kate to make her feel better. I figured that was more than enough information.
We wait in the examination room, coloring line drawings of pterodactyls and T-Rexes. “Today at snack Ethan said that the dinosaurs all died because they got a cold,” Anna says, “but no one believed him.”
Brian grins. “Why do you think they died?”
“Because, duh, they were a million years old.” She looks up at him. “Did they have birthday parties back then?”
The door opens, and the hematologist comes in. “Hello, gang. Mom, you want to hold her on your lap?”
So I crawl onto the table and settle Anna in my arms. Brian gets stationed behind us, so that he can grab Anna’s shoulder and elbow and keep it immobilized. “You ready?” the doctor asks Anna, who is still smiling.
And then she holds up a syringe.