Saving Jane Doe

by Carolyn Purcell

  Jessie pulled her legs up and turned to bring her bare feet back into the bedroom. Slowly, she jumped off the window ledge and took a step into the room. I slipped behind her and closed the window while she stood shivering. Uncle Henry took her into his arms, holding her as he had held me when I was a child and something hurt me.

  “Get a blanket, Cara. She’s freezing.”

  I stripped a blanket from her bed and wrapped it around her shoulders. Uncle Henry led Jessie downstairs to the library to sit by the fire.

  I said, “I think I should call Dr. Whyte.”

  Jessie shook her head. “He can’t get my life back for me.”

  “No, but he might give you some medicine to help you sleep and eat. That would help you deal with it. Don’t you want to be able to enjoy Grace when she comes?”

  “I’m not sure I should have Grace come anymore.”

  “Jessie, don’t say that.”

  “I thought I was depressed after the stillborn babies. I should have been grateful for the ones I had. Now I’ve even lost them.”

  “You haven’t lost them. Your relationship with them has changed, yes, but they are still your children, and they need you.” I looked at Uncle Henry for help.

  “You still have things to be grateful for,” he said.

  “Like what?” Jessie snapped. For the first time, she seemed irritated with Uncle Henry.

  “Well, one or all of your children might get sick or die. Would that be worse than this?”

  “I’m sorry.” She hung her head. “You’re right. That would be worse. I wouldn’t be in this mess if I’d been grateful for what I had before. Cara, would you call Dr. Whyte?”

  “Uncle Henry, if you will stay here with Jessie, I’ll call him now.” I left the room to make the call. Miraculously, I was able to speak with Dr. Whyte after evening rounds. He was concerned when he heard about the resolution of Jessie’s amnesia and her suicide attempt.

  “Dr. Whyte wants to admit you to the hospital.”

  “When?”

  “Tonight.”

  “All right.” Jessie stood and walked toward the stairs. “I’ll pack a few things. At least I won’t have to get my clothes from the psych closet.”

  Dr. Whyte saw Jessie in the ER and admitted her to Psychiatry. He was not at all surprised by her depression and started an antidepressant as soon as she got to her room. He wanted her to take the medicine for at least six months. Dr. Whyte did not consider shock treatments, which were a common treatment for depression at the time. He felt she had already had shock enough. Uncle Henry and I stayed with her until bedtime.

  “I think we need to study the Psalms,” Uncle Henry said, opening his Bible. “King David knew something about sorrow for making a mess of his life. The good thing is that God can bring good from the mess.”

  “I don’t see how that will happen.”

  “That’s the problem,” he said. “You don’t see, but someday you will. Do you remember the story of Joseph, the one with the coat of many colors that shows up in children’s Bible storybooks? Next to Jesus, Joseph is my favorite person in the Bible. He was arrogant and favored by his father. His brothers were jealous and sold him into slavery. Then his owner’s wife accused him of adultery, and even though he was innocent, they threw him into prison. Through all of this, he was faithful to God, who helped him rise to a position of power. In the end, he forgave his brothers and told them that what they did for evil, God used for good. You see, he saved his whole family because of the position he was in when a famine came. Someday, Jessie, your children will need you in a way you can provide now that you might not have been able to provide before.”

  “I can’t imagine that.”

  “I know you can’t, but God will redeem this.” Even Uncle Henry was surprised at how soon we would see evidence of his prediction.

  Uncle Henry visited every day. He brought his Bible, and the two of them studied the Psalms. Whether from the Bible study, Uncle Henry’s wise counsel, professional counsel, or the medication, by the time Grace was due to come again, Jessie was sleeping better and eating some. Dr. Whyte agreed to release her on Thursday so she could pick Grace up on Friday.

  CHAPTER 4

  On Friday morning, Jessie cooked spaghetti sauce and meatballs for dinner, knowing it was one of Grace’s favorites. After lunch she took Uncle Henry’s car for the ninety-minute drive to pick up Grace. Before Jessie was back with Grace, Uncle Henry had built a roaring fire in his library. He wore a blue sweater, just the shade of his eyes. His full head of white hair was worn a little longer, and he looked ten years younger than usual. He seemed as excited as Jessie to have Grace visit.

  I arrived shortly after Jessie and Grace got home. The three of us talked and finished dinner. Grace washed salad greens; Jessie cooked the pasta, and I mixed a box of brownies and baked them while we ate. Grace wore green corduroy pants and a sweater of the same shade. Having just had my color palette done, I wondered if Grace was a “winter” like me. I couldn’t wear that shade of green, and Grace shouldn’t either. Her face looked a pale yellowish-green color, not unlike the sweater, and she had dark circles under her eyes. She seemed energetic enough, but it crossed my mind that she might be sick.

  After dinner, Grace joined in our Scrabble game. As she sat by the fire, her cheeks pinked up a bit, so I didn’t think more about her color until I got home and tried to catch up on my journal reading. I kept seeing that pale green face. When I awoke on Saturday morning, I had this nagging suspicion that something was wrong. I hadn’t planned to see them over the weekend but decided I needed to act on this concern. Even as a medical student, I had learned to pay attention to that intuition.

  When I arrived at Uncle Henry’s, Jessie opened the door and looked somewhat surprised. “I brought Spaulding’s,” I said.

  “Cara, what are you really doing here? You hadn’t planned to come today.”

  “Grace can’t come to Lexington without having the city’s best donut.” I smiled at the little girl, who had joined her mother at the front door.

  “And?” Jessie asked.

  “Where’s Uncle Henry?”

  “In the library,” Grace said. “Can I take him a donut?”

  “Yes, Grace. That would be nice.”

  “Okay, Cara. What is it?” Jessie said after Grace had scampered off.

  “I want you to take Grace to the doctor.”

  “What? This is only my second weekend with her? Why should I do that?”

  “I’m concerned because she is so pale.”

  “She has always been fair.”

  “It looks like more than fair skin to me. Will you let me do a little exam when she comes back? I’ll just look at her eyes and feel her neck.” When I saw her hesitation, I said, “Jessie, please.”

  “What are you looking for?”

  “Her eyes will tell me if she is just fair or if she’s anemic. I would be checking her neck for enlarged lymph nodes.”

  “Okay.”

  When Grace returned from the library, Jessie asked her to let me check her neck and eyes. Her conjunctivae were nearly as pale as her skin. She had several small soft lymph nodes at the back of her neck.

  “Jessie, I think Grace is anemic, and she has some enlarged lymph nodes.”

  “What does that mean?”

  “I’m not sure. It could be a number of things.”

  “What do you want to do?”

  “The pediatric clinic is open on Saturday morning. They could do a complete blood count, an exam, maybe some viral tests. They need to check her liver and spleen. It shouldn’t take long. If I am wrong you’ll still have most of the day.”

  “Grace, have you been to the doctor at home?” Jessie asked.

  The little girl shook her head. “No. Am I sick?”

  “Dr. Cara thinks you might be. We would like you to see a children’s doctor.”

  “Will you be with me?”

  “Yes, honey.”

  Fortunately, the clinic was
not very busy and we got in right away. She saw Dr. Greeley, the chief of Pediatrics. After the exam and blood work, he reported.

  “Grace’s hemoglobin is very low, indicating that she is anemic as Dr. Land suspected. The red cells are very small, suggesting that this might be an iron-deficiency anemia. Her white cell count is slightly elevated. Her mono test is negative. My concern is that she has some atypical lymphocytes on her blood smear. I think we need to admit her to the hospital and do a few more tests.”

  Jessie’s face blanched. “Admit her? What do you think is wrong?”

  “I’m not sure at this point.”

  “Well, what do you think?”

  “I think we need to rule out leukemia.”

  Jessie hugged Grace, who was sitting on her lap. “I will have to call her father. We are divorced, and he has custody.”

  Jessie called George and explained the situation. At first he tried to deny that there was anything wrong, accusing Jessie of trying to keep Grace with her.

  “You speak to the doctor,” she said as she handed the phone to Dr. Greeley.

  When Dr. Greeley finished, George agreed to admission and said he would be there by afternoon. Grace was admitted to room 413, and Dr. Greeley consulted the pediatric hematologists.

  Jessie and George both spent the rest of the weekend in Grace’s room. Uncle Henry came to visit and invited George to change and shower or stay at his house for as long as Grace was sick. The next day, George accepted the shower. The only test completed before Monday was a spinal tap. Jessie held Grace during the procedure, and while her lip quivered, she did not cry. For a bone marrow biopsy and a lymph node biopsy, which were done on Monday, they sedated Grace and gave her a local anesthetic. By Thursday, when all the test results were back, George, who had gone home on Sunday evening for work, came back to the hospital. I was visiting when the pediatric hematologist, Dr. Greta Campbell, came to report. George frowned when Jessie asked that I be allowed to stay and hear the results, but no one disagreed.

  “The good news is that the spinal tap results were completely normal and the lymph node biopsy showed benign reactive changes as children often have. Unfortunately, the bone marrow biopsy indicates that Grace has acute lymphocytic leukemia.” Dr. Campbell paused to give them time to process this diagnosis. “This is an ominous diagnosis,” she continued, “but there are some extremely good prognostic factors in Grace’s case. One is that the anemia is from iron-deficiency, not from the leukemia, or at least not totally. While there are tumor cells in the bone marrow, they are not completely replacing the bone marrow. The other good prognostic factors in addition to the normal spinal fluid are the relatively low white count and the normal liver and spleen. This appears to be an early diagnosis, and we find the earlier the diagnosis, the better the response to treatment. You should be very glad that Grace’s anemia was checked.”

  “What is the treatment?” George asked.

  “She will get chemotherapy for at least six months. Hopefully, that will induce a remission. The length of the remission is variable. There are cases where it has been as many as seventeen years, but honestly, those are extremely rare.”

  “How long will she need to stay in the hospital?” Jessie asked.

  “She will be in and out the whole time, probably more in than out. Before we start the chemotherapy, we need to give her a blood transfusion. You might want to donate some blood for her.”

  “I can’t. I have antibodies,” Jessie said.

  “She has my same type,” George said. “I can give.”

  “That would be good. She may have to be transfused more than once, and some people consider family-designated blood donations safer.”

  “Her brother and sister are the same type too,” Jessie added. “How old do you have to be to give blood?”

  “I’m not sure. We can check with the blood bank. How do you know so much about their blood types?”

  “I had Rh disease.” Jessie frowned and looked past the doctor as if she could see the lost babies. That evening George gave blood for Grace. While at the blood bank, he learned that the minimum age for donating blood is sixteen with parental permission. Thus even Jeff was still too young.

  When George got back to Grace’s room, I was about to leave. To my surprise, he said, “Dr. Land, I guess you are responsible for Grace’s early diagnosis. Thank you.”

  “You’re welcome, George, but please call me Cara. I am your friend here, not Grace’s doctor.”

  “George, I’ve been thinking,” Jessie said. “When Grace gets out of the hospital, would you let her stay with me? She will need to be in and out getting tests and chemotherapy. It will be easier on her not to have to make the trip back and forth from Washington.”

  “That might be best,” he said. “The trips would be hard, and I have to work.”

  “Mr. Henry said you could stay at the house when you want to come and see her.”

  “He seems like a good man.”

  “He is.”

  “I guess we could try that arrangement for a while. She can’t go to school anyway.”

  Jessie took incompletes in her classes and dropped out of school for the rest of the semester. George came every weekend to visit, and Jessie used that time to take care of Uncle Henry’s home and cook his meals. During the week she stayed at the hospital. Grace had chemotherapy for six months. She was often sick, her little arms and legs covered with bruises. Her lips and gums bled. She had to be transfused several times, and her veins collapsed. Still, it was Grace who cheered everyone else. She found joy in the smallest things. When she could be out of the hospital, she spent hours in the library with Uncle Henry, who read to her. They plotted what they were going to do when she got well. They watched out the window as Jessie got a start on the spring garden. Uncle Henry held her in his lap and prayed for her.

  On one occasion Jeff and Ellen came with George so they could see their sister in the hospital, but they did not stay with Jessie. Grace was overjoyed to see them, and while they were warm and loving with her, they were very cold with Jessie. This was only the second time she had seen Jeff. George seemed so grateful for help with Grace that some of his anger toward Jessie dissipated.

  By the end of summer Grace was finished with her treatment and in remission. While her spinal test was negative, Dr. Campbell knew that the central nervous system was often the site of residual tumor that could end a remission. She asked permission for a course of chemotherapy applied into the spinal canal. This was not standard of care at the time, but something that was being considered and has since proved useful. George and Jessie agreed, and with that Grace’s treatments came to an end.

  In the meantime, I graduated from medical school on June 10, 1973. Uncle Henry came and took pictures. After we celebrated with dinner at the Coach House Restaurant, we went to the hospital to see Jessie and Grace. Since I was undecided about what specialty I wanted to pursue, I stayed in Lexington for a rotating internship, which I started on July 1 in the emergency room. I scheduled enough Internal Medicine and Pediatrics in my internship that the year would count toward either residency. In the end, I chose neither. I decided that Obstetrics and Gynecology was the perfect specialty, a combination of medicine and surgery, and endocrinology was my favorite part of medicine.

  Come fall, Grace did not want to go home, and Jessie didn’t make her. She argued that if Jeff and Ellen didn’t have to visit her because they didn’t want to, then Grace should be able to stay with her because she wanted to. In the end, Grace and Jessie won that battle. Jessie enrolled her in elementary school in Lexington, and Grace went the other way for visits every other weekend.

  Jessie confided, “I think if we knew the truth, Mary wanted Grace to stay with me. George didn’t want to fight both of us. Mary is afraid Grace will get sick again. Jeff and Ellen are old enough to take care of themselves, and Mary has a new baby. At least Mary is Rh-positive, and she had a healthy baby girl.”

  While Jeff and Ellen’s attitudes t
oward Jessie may have helped her get Grace, they did not help Jessie’s longing to be with them. Every other weekend she called to see if they would come for a visit. Basketball, football, baseball, and track all kept Jeff busy. Ellen was in cheerleading, the band, and 4-H. Finally, Jessie gave up hoping they would come to her and started asking if she could come and just take them to dinner. They did not agree to that either.

  Most of what she knew about her two older children, Jessie learned from Grace and from their local newspaper. The Daily Independent arrived a day late, but she read every word looking for information about the children and their school events. When she took Grace for her weekends with her father, Jessie often stayed to watch a ballgame or listen to the band, but she rarely talked to them.

  Grace, Jessie, Uncle Henry, and I spent that Thanksgiving Day together. After the prayer, Uncle Henry announced the opening of the eating season, and this time Grace laughed. Jessie and I just smiled. Most of our gratitude was for Grace. She seemed happy in her new school, and she did well. Her leukemia was still in remission, at least for the time being. Jessie was back in school and doing well. We were all learning to appreciate each day. Grace reminded us of that. The next day Grace went to spend the rest of Thanksgiving weekend with her father.

  On December 1, Grace joined Uncle Henry and Jessie for their annual study of Luke. Uncle Henry told me one Friday evening after she had gone to bed that Grace’s comments and questions were exceptional. “She adds a fresh perspective that makes this the best study I have ever done.”

  That Christmas Jessie had one of her children with her for the first time since she left home, and Uncle Henry had a child in the house for the first time ever. When I was Grace’s age, I still lived with my parents. Grace stimulated a whirlwind of activity, decorating, baking, and even bell-ringing. Uncle Henry had been on The Salvation Army Advisory Board for years, and the board had a day to stand at a kettle and ring the bell to raise money. Uncle Henry had thought himself too old to do it until he thought it would be a good experience for Grace. In deference to his age, he was allowed to take a stool to sit during his hour of ringing. Grace loved it, and they attracted a crowd of givers when she and Uncle Henry sang Christmas carols. They had the largest kettle collection of the season, but probably because Uncle Henry slipped in a five-hundred-dollar check. As soon as they finished, Grace made plans to do it again the next year.