by Austin Boyd
“Heard you needed some help,” Granny Apple said a minute later when Laura Ann met the truck in the lot. She gathered Laura Ann in the wiry grip of thin arms. “Any word?” she asked as she pulled away.
“More tests,” Laura Ann said. “The doctors promised some answers, but I’ve been here what—four hours?”
Ian squeezed her hand. “It takes time. She’s in good hands. Her doctor’s the best obstetrician in the valley.”
“All the same, I’d like to find out more about her. And the baby.”
At that last word, Granny Apple’s brow scrunched down a bit, her grey eyes peering deep into Laura Ann’s words with a keen insight. Laura Ann spoke the word like a mother would, a nuance Ian might have missed, but one that scarce escaped Granny Apple. Her friend could read an entire story into those two syllables.
Baby.
Granny Apple touched her on the arm just above the elbow, and then smiled. “Let’s go get some news.” Together they headed back into the waiting room.
While Ian went to the desk to get news and borrow a wrap
for Laura Ann, she sat with Granny Apple as far as possible from the incessant drone of television.
“She’s the woman I saw in your truck the day of the flood?” Granny Apple asked, probing around the edges of Laura Ann’s story. She prodded gently, but with a sure stick.
Laura Ann nodded. “Her name is Sophia McQuistion. She’s from Pittsburgh.” She hesitated, fearful that her mentor would eventually pry the story free — but determined that she would not. “Sophia couldn’t leave because of the crossing.”
Granny Apple laid a hand on Laura Ann’s and squeezed it. “She must be a dear friend,” she said with emphasis, squeezing a second time. “You’re going to need a little help if you’ll be staying up here a spell.”
Laura Ann turned to face her, greeted by an accepting smile and a knowing nod. A woman with the gift of helps. “I came with Ian to let you know that we’ll take care of the farm. If it don’t rain, water will be low enough in another couple of days to wade across at the old causeway. I’ll wander over and check on things every day.” Decked out in white button-up shirt, white jeans, and white cotton shoes, she reminded Laura Ann of an angel with wrinkles. She patted her on the knee. “Ian went to the farm, by the way. Got some of your things. Just in case.”
“Thank you. I don’t know how long this will take.”
“Yes, you do.” Her visage darkened. “From what Ian told me, this sounds real serious. Sophia needs to rest and hold that little bun in her oven. She’s what … seven months?”
Laura Ann nodded.
“It’s too early. We need her to get to thirty-one weeks. More is better. And it’s too early to be fighting toxemia. Later in her pregnancy, perhaps, but not now.”
Granny Apple knew mothers. A midwife in her early years, she’d counseled many young women on the brink of motherhood. Some guessed she’d delivered two hundred babies in her day. Others said twice that many. Every family on the Middle
Island Creek had at least one relative who met their first day arriving in her hands.
“I — I don’t know how I can stay here that long,” Laura Ann objected. “The bank …”
Granny Apple squeezed again. “Don’t worry about the money, child. Ian and I have a plan.”
“A plan?” Laura Ann stammered.
Granny Apple nodded in silence. A smile played at the corner of her lips. “I’ll let Ian tell you about it.” “I don’t know how to thank you — “
“Don’t have to. Just get your friend well and come back home. In the meantime, you’ll need a place to stay. How about your cousin? Stefany.”
Mental images of Stefany on the television came to mind. Eight years older and working in a career wildly divergent from Laura Ann’s, her third cousin lived in another world. Flashy red hair, a professional wardrobe, and an apartment in the city. Worlds away from the farm and their little valley.
“Ian got ahold of her. She left us a key. She’s out of town reporting on the flood and not in her apartment much. Said it would be a big favor to have someone come and house-sit.”
Granny Apple stood, pulling at Laura Ann’s hands. “Ian told me that Sophia doesn’t have any kin. You need to be here for her, Laura Ann … and for her baby.” Her voice lowered in a special way like a momma’s would, a tone that sang of her deep empathy for the maternal bond.
“Stay here for all your sakes, child. We’ll care for things. As long as it takes.”
“This is Dr. Murphy,” Ian said, introducing a middle-aged man in green surgical scrubs when he entered the waiting area. Laura Ann’s eyes went immediately to the tiny splatters of red that
stained the front of his operating outfit. Tufts of brown and grey poked out from under a tight cotton cap, and a wrinkled mask hung about his neck. He wore green pull-on shoe-covers, like he’d just emerged an operation.
“My pleasure. Ms. McQuistion mentioned that you’re sisters?” he said, extending a hand. His eyes wandered up and down Laura Ann, the keen eye of a physician on the hunt for trouble. Her lie had found her out.
Ian cocked his head, an eyebrow raised. Laura Ann looked from the doctor to Granny Apple, expecting more inquisitive looks. Yet, with the knowing gaze of a woman who’d already heard every story a troubled girl could invent, she smiled, a wrinkled explosion of warm comfort. Granny Apple nodded, as if to say, “Go on. It will be fine.”
“We’re like sisters,” Laura Ann protested, taking the doctor’s grip in hers. She shook hard, determined to show strength.
Dr. Murphy shrugged. “That’s funny. She was quite adamant about the family part. Anyway, I’m sorry to have been tied up in surgery. After I met with Ms. McQuistion, I was called away on emergency. Just now catching up.”
“How is she? Do you know what’s wrong?” Laura Ann asked. The doctor launched into an explanation that she understood most of, but not all. Ian nodded as he listened, his frown deepening with each successive bit of news. At the words heart disease Laura Ann’s own heart skipped a beat.
“Her heart damage is severe. It’s a grave condition for any pregnant mother. Maternal mortality is high in these cases, usually around five to eight percent.”
Laura Ann watched Ian while she listened to the doctor. The color washed from Ian’s face with that last comment. Confirmation of the doctor’s message.
“I work with many mothers like Ms. McQuistion. We’ll watch her closely. She has a mild impairment of exercise tolerance, which is why she ‘fell out,’ as she said, when walking or climbing stairs. Her history of chlamydia, combined with severe hypertension — high blood pressure — makes a premature birth and postpartum hemorrhage very likely.”
Granny Apple’s eyes were affixed on the doctor, dissecting every word. Her own frown deepened with the words about premature birth. Like two bellwethers, Ian and Granny gave image to the criticality of Dr. Murphy’s words. Laura Ann missed some of his prognosis, but caught the next words.
“… valvular lesions, mitral stenosis, and insufficiency. Her heart cannot pump enough blood for the two of them. We spoke at length about this. Ms. McQuistion was concerned about why her heart murmur hadn’t been noticed in visits to her obstetrician. I explained that it’s not unusual to have a murmur, and then lose it, during the course of the pregnancy. Shortness of breath is also not uncommon. A third of women with heart disease won’t discover it until they’re nearing term in a pregnancy. That’s what’s happened here.”
Words came and went, Laura Ann caught in a whirlwind of emotions, surrounded by the conversations that flowed between Ian, the doctor, and Granny Apple. Premature birth. Danger to the mother.
Morbidity. A word she’d heard all too often in consultations with Daddy’s oncologist.
“Yes. A caesarean section may be justified,” Dr. Murphy said to Granny Apple in response to her question. “Where there is significant heart disease — and where a long or difficult labor is expected — we’ll do a caesarean
to lessen the risk to the baby and the mother.”
“When?” Laura blurted the word, her only foothold in the technical discourse between the doctor and her close friends. “What about the baby?”
The doctor tilted his head a bit and seemed to shrug. “She’s very much preterm. A premature birth at this point is probably out of the question. Lung problems, low birth weight. But
my main concern is with the mother, of course. Her well-being comes first,” he said, then added, “before the fetus.”
Fetus?
Laura Ann heard the rushing whoosh of blood in her ears, the pounding of her heart thrumming inside her head. She’d spent enough time in hospitals, and read enough articles in the paper, to decipher the unspoken message in his last word.
“I beg your pardon?” Laura Ann exclaimed, clenching her fists. The doctor clipped his next words.
“Women with her extent of heart disease, complicated by extreme hypertension, run a high risk of delivering a defective child born with a heart malfunction or other significant abnormality. One in ten mothers like her will die if not delivered soon. If I can save the life of one of them — the mother or the child — I am committed to save the mother first.”
“Surely there’s some hope,” Ian blurted out. “What hope for the baby?”
“I’m sorry, sir. I’m a pragmatist.” Dr. Murphy took a deep breath, forming his words. “In cases like this one, where the heart disease and complications are so severe, there is some hope for the mother. But for both?” He shook his head, his eyes cast down. “The chances are very slim.”
The doctor left, and Laura Ann turned to Ian. “Let the baby die?” she cried out.
“That’s not what the doctor said,” Ian insisted. “He’s trying to save Sophia’s life.”
“It is what he said. He told us the baby might have some kind of birth defect and there’s little hope for him.”
“That might be what you heard, Laura Ann, but I’m sure it’s not what he meant.”
“Now you’re talking like an EMT, Ian. Why are we debating saving one or the other? What happened to saving both of them?”
“What Dr. Murphy said was that if we can save only one life — then it should be your friend. But remember, that’s her decision.” He withdrew his hand. “Not our decision — and not yours.”
“Ian,” Granny Apple said, laying a hand on his shoulder. “Could you leave us alone for a while?”
He sighed and nodded. “Maybe you can explain it better.” He spun and left the room.
Granny Apple extended a hand to Laura Ann. “Let’s talk.” Her hands resembled twigs with skin, but her grip was one of enormous strength, a sure hold that said “I understand.” “This baby has a special meaning to you, doesn’t it?”
Granny Apple’s question was neither condemning nor inquisitive. More like a statement. No judgment, no precondition. A simple matter of fact.
Laura Ann nodded, unable to speak.
“I’ve never met Sophia. She must be a strong woman to do what she did.”
Laura Ann nodded again, eyes wide in amazement. Does she know?
“You sold something precious, Laura Ann. Now you’re connected to her in a special way. To her—and to the child.”
Laura Ann bent over, her face cradled in her hands, determined not to cry. She moved her head up and down, not much, but a sure gesture in the arms of her mentor. She dared not look up, too ashamed to put a word to what she’d done. Her sin had found her out.
“Do you remember what I said to you the morning of the flood?”
She moved her head up and down again.
“Secrets don’t become you.” Granny Apple drew in a deep wheezing breath, sighing out the weight of some unspoken disappointment. “Preacher would agree with me on this one. And
Lord knows, he and I don’t agree on much.” She sighed again, a long exhale of exasperation.
“Did you know her beforehand?”
Laura Ann shook her head.
“And that’s how you paid for the farm all those months? Kept the property in your family, covered most of Angus’s medical treatments, and still managed to put food on the table?” She cradled Laura Ann in a tight grip.
“I never could have done that,” she said with a lilt in her voice. “I’m way too old.”
Laura Ann let go a little chuckle.
“How many times?” she asked, stroking Laura Ann’s hair like Momma used to do.
“Four,” Laura Ann replied, forcing the words while shutting out memories of the excruciating pain. “It was horrible.”
Granny Apple held her for a long time, fingers running through her hair. Laura Ann ached for words of comfort, but knew her friend would share words of wisdom. Words that sprang from tough love.
“You bought your dad some time. Some dignity too. And — probably brought a gift of life to many women in the process.” She paused. “But for all the good you did for them, I can’t say it’s something I would have done. Or recommended.” She held Laura Ann tight. “I know those are hard words. But something permanent’s been done here — a decision you can’t undo.”
Laura Ann looked up, her heart in her throat.
“You’ve got a decision to make, child. Whether to move on and accept that you can’t control the outcome of your actions — or to try to hang on to something you shouldn’t. Even though it sprang from your body, the baby in that woman is not yours. And her health is not yours to decide. I want a happy outcome for both of them.” Granny Apple shivered. “But that might not be possible.”
Laura Ann buried her head in Granny Apple’s shoulder. Her white shirt was smooth, a gentle cotton that matched her wise heart. The fragrance of cinnamon and spice, possibly a pie she’d been baking when Ian came for her, embedded itself in the fabric.
“Pray for wisdom, child. These are trying times.”
CHAPTER 20
JUNE 30
Sophia’s skin took on a pale cast under the purple-white glare of fluorescent lights, the room’s shades drawn closed against the bright rays of sunrise. Dressed only in a faded gown, slit ingloriously down the back, she lay in the bed, connected to a maze of tubes, monitors, and a drip application of intravenous fluid. Above her sat a digital monitor, reporting her blood pressure, respiration, and heart rate. An inflatable cuff, pumped up every few minutes by the computer, lay strapped about her left arm. Another line ran to her right index finger, a red light glowing where it measured her oxygen uptake. The impeccably dressed Hispanic woman in heels who’d first landed on a rock driveway at The Jug could be found no more, yet her eyes, those brown spheres of warmth that sparkled at their reuniting, drew Laura Ann toward her. Sophia beckoned her sit beside her.
Dr. Murphy tarried at the foot of the bed, her room his first stop on morning rounds.
“I understand your reluctance, but we have to act soon, Ms. McQuistion.” The doctor looked down, his stylus ticking off some unseen checklist on a digital chart. “I’ll do my best to support your wishes, whichever path you choose. But you must understand, you’re in a tough spot here. We’ll do everything we can for you and your child. But it’s time to face some brutal realities. There’s a chance we’ll have to take the baby before term, in order to save you. And there’s a chance — a significant probability — that a baby delivered that early won’t survive.”
He looked up at last, adding, “But I assure you. We’ll make every effort to save your child.”
He watched Sophia for a brief moment, and then continued.
“The medication we’re using is targeted at reducing the swelling around your heart, damage due to your rheumatic fever. If we were only dealing with the heart disease, yours would be a fairly straightforward treatment.” The faintest of shrugs accompanied his next words. “That’s serious, but manageable. However, your pregnancy significantly complicates matters.”
The doctor looked up and made direct eye contact. Like two card players putting their best hands on the table, Sophia and Dr. Mu
rphy locked eyes, each with their cards face up. “Should you slip into an early labor, Ms. McQuistion — one that is instigated by your prior infection from chlamydia, or by the preeclampsia slipping out of our control — then you risk complications such as atrial fibrillation. The upper chambers of your damaged heart will begin to contract at an excessively high rate, in an irregular way. Blood flow will slow dramatically, and, in the worst case, you will experience heart failure.”
He bit his lip, his jaw clenched, but never took his eyes off her. “At that point, we might save the baby with an emergency caesarean. But—it would be difficult to save you both.”
Sophia smiled. It was a forced raising of the corner of her lips, testament to some incredible inner strength that defied understanding. A woman who’d overcome so much to reach this day would not be deterred. She reached out to Laura Ann at the bedside and took her hand, then responded to the doctor’s challenge.
“Thank you for your candor, Dr. Murphy. I understand the prognosis.” She gripped Laura Ann’s hand in a tight embrace and spoke with renewed vigor. “I overcame terrible odds fifteen years ago, odds that I’d wind up on the streets despite my upbringing. A medical crisis — the chlamydia — pushed me out of a destructive lifestyle and saved my life. Infertility, my second crisis, brought me to West Virginia.”
Like a woman climbing a long set of stairs under an immense load, Sophia stopped, gathering her breath to tackle the next flight. “The probability I’d make it through those crises, each offering a very small chance for success, says that I’ve already beaten tough odds to arrive here in your excellent care. I’m a fighter, Dr. Murphy. I overcame poverty, prostitution, language barriers, racism, and infertility. I’m not afraid to tackle this.”
He shrugged, looked down at the tablet for a moment, and then lowered the tiny device and its stylus into a pocket of his physician’s coat.
“I admire your pluck. I’m here to serve your medical needs — whichever direction you decide to go. But I do not consider it prudent to continue a pregnancy as high risk as yours.”
“No pregnancy is without risk — or liability.”