A Life Everlasting

by Sarah Gray

  DEDICATION

  For everyone who has ever donated their body for the benefit of others, and for their families.

  For the trusted stewards of these precious gifts. For the researchers who help those they will never meet.

  And for Thomas.

  EPIGRAPH

  The child we had, but never had,

  And yet we’ll have forever.

  —FROM “TO THE CHILD IN MY HEART”

  (AUTHOR UNKNOWN)

  CONTENTS

  Dedication

  Epigraph

  Prologue

  Chapter One: It Wasn’t Supposed to Happen Like This

  Chapter Two: Sophie’s Choice, Backward at 100 mph

  Chapter Three: Better Than Nothing

  Chapter Four: Hello, Good-Bye

  Chapter Five: Thomas’s Ride

  Eli’s Story

  Chapter Six: Transplant Envy

  Chapter Seven: An Accidental Quest Begins—Schepens Eye Institute

  Chapter Eight: The Quest Continues—Duke

  Chapter Nine: The Quest Continues—Cytonet

  Chapter Ten: Out of My Comfort Zone

  Amalya’s Story: Mortui vivos docent

  Chapter Eleven: The Dance

  Sue’s Story

  Chapter Twelve: The Quest Isn’t Over Yet—The University of Pennsylvania

  Chapter Thirteen: Who Was Afraid and Why

  Chapter Fourteen: From Donation to Discovery

  Mara’s Story: A Sword and a Shield

  Epilogue: Dreamworld

  Abbreviations and Acronyms

  Resources

  Acknowledgments

  About the Author

  Copyright

  About the Publisher

  PROLOGUE

  I decided to give it one last shot. If I was willing to make one of the weirdest calls of my life, maybe something would happen.

  I paced the skywalk of the Hynes Convention Center as I imagined how the call might go: I would explain the whole story, and they would tell me it violated some confidentiality thing. Or that it wasn’t allowed. Or it wasn’t within policy. But I thought, I have a personal connection to this place. I gave them something they needed. I’m sure they have wondered, at some point, where the donations came from. I’m just going to call. I will feel awkward. Maybe they’ll feel awkward, too. If I could just get past the part of talking about the death of a child to a complete stranger over the phone, something powerful might happen. I have to at least try.

  My heart raced as I clicked “Dial,” and I gripped the phone hard.

  Here goes. I am doing this.

  “Hello,” a woman’s voice said.

  Adrenaline shot through me. I tried to play it cool: Shucks, I’m just a regular old girl next door looking for her deceased child’s cornea researcher. Just like everybody else.

  “Hi, my name is Sarah Gray. I have a kind of unusual request.”

  CHAPTER ONE

  It Wasn’t Supposed to Happen Like This

  2009

  I found out I’m pregnant on August 9, right after our vacation to Scotland and Italy. Found out it’s twins on September 4. What a shock! We have ultrasound photos and look forward to getting more in 2 weeks. Praying everything is OK.

  —Sarah’s journal

  Oh—and there is another heartbeat,” he said.

  Dr. John Maddox, my OB-GYN, pointed at a flickering white blob on the plasma screen mounted on the wall.

  “Ha, ha. Very funny.”

  “It’s twins,” he said, ignoring me. “See here?”

  I looked at the screen at what appeared to be two pixelated white kidney beans. Ross and I gave each other a look. I smiled. Ross looked worried.

  We had been trying to have a baby for two years, and at thirty-five years old I had been starting to worry it would never happen. We were thrilled to see the positive home pregnancy test I’d taken a couple of weeks earlier, but we never expected twins. We didn’t think of ourselves as twins people, whatever that means. “Can you tell if they are fraternal or identical?”

  Was this really happening?

  “Identical.”

  I looked over at Ross. His expression seemed to say, This is more than I bargained for.

  “Can you tell the sex?” I asked.

  “It’s too early now,” Dr. Maddox said, “but we will be able to tell in another four weeks.”

  The doctor looked at my chart for a few moments.

  “Since you’re over thirty-five, you might be interested in getting a first-trimester screening—it’s up to you.” He scribbled something down on his prescription pad, tore it off, and handed it to me. It was a referral to the Genetics & IVF Institute in Fairfax, Virginia. “You can schedule it in the next three or four weeks. They check for genetic defects.” Apparently, I was officially an MOAA—a mother of advanced age. (I couldn’t help but think of the ROUS—the rodents of unusual size from The Princess Bride.)

  As we left the office, Ross and I stopped and turned to each other. At eight weeks, it was too early to make any general announcements to family and friends, but we agreed to share this exciting development with the two people who would be the most thrilled: “We’ve gotta call our moms.”

  On the way to the car I had a pregnancy craving, so we stopped by a nearby Wendy’s for some chicken nuggets and an M&M Twisted Frosty while we called our mothers.

  “How are we going to afford this?” Ross asked a bit later, when the excitement had died down. We already knew we’d have to struggle to afford one child, let alone two. “And where are we going to put two cribs?” We lived in a two-bedroom, one-bathroom condo in Northwest Washington, DC. What could have been a cozy home for a family of three suddenly seemed too small for a family of four. It was a second-floor walk-up—no elevator—so we were going to be carrying two children, plus a twin stroller, up and down the stairs every time we went out. It was often difficult to find a parking spot on our street, too, so we regularly ended up parking several blocks away.

  Nevertheless, we spent the next few weeks getting used to the idea. We called a real-estate agent to talk about putting our place on the market and looking for a bigger house out in the suburbs.

  And we decided to have the first-trimester screening. If more information was available, we would rather know it than not.

  “What would we do if there is problem?” Ross asked one evening as he sat at the computer.

  The last thing either of us wanted to do was terminate the pregnancy that we had been so longing for. It was too stressful to think about; and anyway, it was hypothetical. Why give ourselves heartache over a choice we might never need to make?

  “I don’t know,” I said. “Let’s cross that bridge when we come to it. And hopefully, we will never come to it.”

  Ross agreed.

  We scoured the web in the days before the screening to bone up on the terms we might hear. We wanted to be able to ask the right questions during our appointment. We learned that the ultrasound technician would look for the presence of the fetal nasal bone and measure the nuchal translucency—the size of the clear space in the tissue at the back of a baby’s neck. We knew that a measurement of 2.5 millimeters or more in the nuchal fold could indicate Down syndrome. Since I was a thirty-five-year-old MOAA, I had a higher risk of having a child with Down syndrome. It’s the most common birth defect in the United States, appearing in approximately one in seven hundred births every year. If we were going to hear any bad news at this appointment, I thought it would be that both twins had Down syndrome, since they were identical.

  On the day of the test, per the doctor’s request I arrived with a full bladder, which helps push everything into the right place and makes the babies easier to see on the sonogram.


  During the sonogram, we could see everything the tech was looking at on a plasma screen mounted on the wall. I recognized the babies’ noses, cheeks, arms, legs, and toes. The tech hit the print button a few times, and curling white paper hummed out of the machine. After one first-trimester miscarriage, two years of trying to conceive, and buying numerous adorable baby gifts for friends, finally it was our turn. I had been looking forward to this moment my entire life.

  “So does everything look okay?” I asked.

  “I’m not allowed to interpret results,” the tech said. “The doctor will do that when he comes in. Try to empty your bladder halfway. The restroom is the first door to the left—and when you come back, the doctor will see you.”

  When she left the room, Ross whispered, “I saw her do the nuchal fold test. The measurement was normal.” According to Ross’s Internet expertise, we were in the clear.

  “I counted the fingers on Baby B,” I confided. “Five fingers on the hand I saw.”

  It was hard to guess how much pee was half the pee in my bladder, but I did my best. After I came back from the bathroom, a gray-haired man in a white coat opened the door and introduced himself as Dr. Stern.

  Dr. Stern sat on the stool in front of the sonogram machine and pushed the wand across my belly for about five minutes from a variety of angles. He didn’t seem to be getting the angle he needed. He looked concerned.

  Then, he put down the wand.

  He said, “I’m sorry to tell you that Baby A has a lethal birth defect.”

  Wait.

  What?

  Did he just say that?

  It felt like the floor had dropped out of the room. The babies we had seen on the screen looked fine: legs kicking, round little butts, cute button noses. The nuchal fold was fine.

  “It’s called ‘acrania,’ which means the baby’s skull was not fully formed in the early stages of development.”

  “How do you know that? What do you see?” I asked.

  “See how Baby B’s skull is round?” Dr. Stern pointed at the frozen image on the screen. “This skull developed properly. Now, look at Baby A’s skull. See these bumps? That is exposed brain matter. That shows us that the skull did not close. Also, see how Baby A’s amniotic sac is cloudy? The brain matter has disintegrated into the fluid. Baby B’s amniotic fluid is clear.”

  Dr. Stern paused.

  “Do you have any questions for me?”

  I took a deep breath and collected myself. “What causes this?” I asked, my mind racing to all the things I might have done that could cause birth defects.

  When I first stopped taking birth-control pills a couple of years earlier, I had expected and hoped to get pregnant quickly. I was diligent about following medical recommendations, common wisdom, and even old wives’ tales about what to do for a healthy pregnancy. I took prenatal vitamins, cut back on alcohol, switched to decaffeinated coffee, and avoided hot tubs, sushi, soft cheese, and lunch meat.

  Eventually, however, after months of negative pregnancy tests, I slowly reincorporated caffeinated coffee and wine into my routine.

  Then I remembered our vacation in Scotland and Italy two months earlier. In Scotland, I had been caught in a cold downpour without an umbrella and was chilled to the bone, so I took advantage of the hotel’s hot tub and sauna to warm up. I knew that hot tubs often had warning signs for pregnant women, so even though I didn’t know at the time that I was pregnant, I was careful not to stay in either very long—maybe five minutes in the bath-temperature hot tub and another ten minutes in the sauna.

  I’d compounded the situation in Italy when we toured Pompeii on a hot, dry August day. The temperature hit well into the nineties, and because of the devastating eruption of Mount Vesuvius in AD 79, the site harbors little in the way of shade trees. Walking around the temples of Apollo and Jupiter, the Forum, and the House of the Faun, I was desperate enough that I drank out of the dilapidated brass water fountains; the water was hot. Maybe I was overheated that day?

  Later on in the trip, we took a ferry from Naples to the island of Ischia and visited the Negombo thermal spa resort. There were signs about not entering the spa if you were pregnant. For two years, I had been in a state of possibly being pregnant. Most of the time, I wasn’t. I decided to go in the cool and warm thermal pools but only dip my feet in the hot ones.

  Now I wondered, was it the heat?

  Or could it be alcohol? There was the champagne at Ross’s sister’s wedding. And there was the pub crawl with friends in Edinburgh. We won third place in a pub quiz, and the prize was a round of neon-colored test-tube shots. In Italy, we had enjoyed the local wine and drunk the limoncello we made from the lemons in my friend’s yard.

  “It’s a neural tube defect,” Dr. Stern said. “Low levels of folic acid in the diet can be a cause.”

  Folic-acid deficiency? That’s for rookies. Everyone knows to take folic acid. Doctors had been recommending it as a standard supplement since 1992. Even breakfast cereals and bread are fortified with folic acid. Folic acid I definitely did right. But even if I had been folic-acid deficient . . . why did only one twin have acrania? “I have been taking a prenatal vitamin almost every day for about two years now,” I said. “And I eat food that probably has even more folic acid in it. Could it be something else?”

  Dr. Stern looked uncomfortable, as though he had already exhausted his knowledge of this topic.

  “Are either of you from Belfast? There has been a higher concentration of incidences there.”

  My mind was reeling. I had not read this on Babycenter. com. What did being from Belfast have to do with it? I had never been to Belfast, but I imagined the citizens as 100 percent having brains.

  My cell phone rang in my purse. I fumbled to turn it off without taking it out.

  “I have Irish ancestors, but none from Belfast. And that was two hundred years ago. Ross was born in Scotland—”

  “Scotland is not Ireland!” Ross interrupted, indignant.

  “I used a sauna before I knew I was pregnant. Or could it be something I ate or drank? Like sushi or wine?”

  I pictured myself on a bus poster with a serious face and the words I ate a rainbow roll and it killed my baby. Don’t take chances.

  “There have not been a lot of studies, and the ones that I have read are not conclusive.”

  We were obviously asking for information that he didn’t have. I felt sorry for Dr. Stern: he had to tell us the news with barely any knowledge of the cause.

  “Have you ever seen a baby like this before? How often do you see this? Like, once a year?”

  “Yes, about once a year.”

  Okay, so this is pretty rare.

  “What do the babies look like?”

  He looked at the wall a moment before answering. He took a deep breath.

  “The skull stops near the eyebrows.” He lifted his hand to his brow line, in a kind of salute. “The brain is exposed at the top.” He paused and lowered his voice. “Sometimes it looks like the baby is wearing a mask.”

  I thought I knew about all the basic birth defects. This one sounded too bizarre and terrible to be true. How would we feel when we saw this baby? Would we be scared?

  “Is Baby B okay?” I asked.

  “Baby B appears to be fine. I don’t see anything of any concern at this point, although things could change. But the nuchal fold looks good, so I’m not concerned about Down syndrome.”

  Ross and I nodded.

  “Is there anything we can do?” I asked.

  “You have a few options. You can terminate this pregnancy and try again. Or you could carry both twins to term. Baby B would be born healthy, and Baby A will be stillborn or die within a few minutes or hours.”

  “What will be the actual cause of death?”

  “The part of the brain that regulates heartbeat and body temperature is missing. So the trauma of being born can cause the heart to stop. Right now, your heartbeat is keeping both babies alive. Once the umbilical cord is
cut, Baby A will begin to die.”

  Giving birth to one healthy baby and one dead baby seemed like a sick joke.

  What kind of God takes away a child’s brain? What kind of sicko makes a mother gestate a baby for nine months only to have the baby die at the moment of birth? Who came up with this? And are they ashamed of themselves?

  And why me? Why my child? Is it something I did? Don’t I follow the rules? God, if you are trying to teach me a lesson, and you are merciful and forgiving like I thought you were, why didn’t you just send me a message in a dream? There are so many other ways of communicating. Killing a baby is not fighting fair. Take this up with me, not them.

  “Should we look into selective termination?” I asked.

  I remembered the phrase from watching the TLC reality show John & Kate Plus 8. John and Kate already had twins when they decided to try for another child. A round of in vitro fertilization (IVF) produced not one more, not two, but seven embryos (though one eventually disappeared). Before the treatment, the couple had expressly hoped for just one more child but had also stated that they would not selectively terminate; the procedure is used if there is a defect or to protect the health of the other babies and the mom. And the phrase, though horribly clinical, had stuck in my head, especially when their family of four had become a famous family of ten.

  “You won’t be able to do that, because these are identical twins and they share a placenta. What happens to one will affect the other.” Dr. Stern went on to explain that my babies were mono-di, or monochorionic diamniotic, twins, which meant that each had its own amniotic sac, but they shared a placenta.

  Mono-di twins begin as a single sperm and a single egg. Together these form a zygote, which splits into two somewhere between four and eight days later and creates what we know as identical twins. I sometimes think about those four to eight days. When exactly did the split happen? What was I doing when it did?

  And then all of a sudden those what-ifs receded and I realized how lucky I was that we would possibly still have one healthy child. It was all we had hoped for in the first place. I had gone into this exam assuming that if we had a child with a birth defect, we would be faced with the choice we didn’t want in the first place—the choice to terminate. But because that child had a healthy identical twin, we would not even have that terrible option.