by Victor Koman
Evelyn only heard telephone static for long seconds.
"What about the baby's mother and father?" Valerie asked.
"The father's unavailable, and the mother's blood type is incompatible. And there are no siblings or other close rela-tives. We exhausted those avenues before we searched the computer files for a close HLA match."
"I really don't know," Valerie said. "I've never given blood before. With all this talk about AIDS and all, I-"
"You can't get anything from giving blood." Fletcher paused, her mind racing through logical arguments until she hit upon one. "Valerie-have you had any feelings of guilt about termi-nating your pregnancy?"
After a moment of quiet, the voice on the other end said, "Yes."
"You might be able to assuage some of those feelings by giv-ing the gift of life to another child." Silence crisscrossed the wires for long moments. Evelyn knew that if she said nothing more, Valerie would have to make the next move to break the awkward hiatus.
After a pause that almost seemed itself to be a battle, Valerie's soft voice said, "All right. What should I do?"
"
Mark Landry gazed at the blonde entering the lab and thought, What a babe! Wearing a maroon cashmere sweater dress and matching high heels, she looked to be in her mid-twenties. That was all right. He liked older women. His fin-gers tapped at the counter.
Valerie approached the skinny laboratory technologist-he was the only one in the lab whose life at the moment appeared to be untainted by physical labor. She handed him a slip of paper.
"Here for a blood test and a pint, eh? Sit up here, Ms. Dalton. This won't take long." She sat on the cot. There were three other people in the room, all hooked up to blood bags. She found it remarkably difficult to look at the people or the apparatus. She kept her eyes focused on the young man.
He was a lanky, freckled surf blond possessing an eager, admiring wolf gaze. She was flattered, but since she was in a situation that involved pain and bleeding, she wished for the entire episode to conclude swiftly.
He recorded her blood pressure, taking longer than normal to fit the cuff on her smooth, tanned arm. He gazed at her eyes-grey in the fluorescent light of the lab-while attempt-ing to make conversation.
"My name's Mark." He glanced at the paperwork. "Uh, is this for donation or autologous storage?"
"Autologous storage?"
"You know-setting blood aside before an operation so you only get your own. Safer, these days."
"No, it's for a baby here. It's-"
"Oh, right," he said, removing the pressure cuff and substi-tuting a stretch of elastic. "Directed donation for the Chandler girl. Her mother was in the center's fertility program. Just born three days ago and already in trouble." He donned a double pair of clear plastic gloves. "I'm going to take a drop of blood from your ear lobe."
"Is she sick because of the fertility program?" She stared at the needle Landry removed from a sealed package, then at the syringe he produced. She took a deep breath, focusing again on the man's angular, boyish face.
Landry dabbed antiseptic on her right ear lobe, then stuck her with a disposable needle in a brisk, practiced motion. Draw-ing off a crimson droplet into a slender tube, he held the blood over a cylinder filled with blue liquid. The droplet fell, hit the surface, and sank to join a pile of blackish globules at the bot-tom.
"Congratulations. You're not anemic." He slid a sample vial up the hollow back of the syringe.
"Anyway she got a little ear infection, and they gave her antibiotics. Most kids have no prob-lem, but every once in a while you get one that's sensitive and gets bone-marrow suppression. Transfusions can help. Bone-marrow transplants-Okay, make a fist."
"What?"
"Make a fist and squeeze a few times. I need to find a vein. Anyway-" His thumb felt around the crook of her right arm. "Bone-marrow transplants will probably do the trick. Here we go." Valerie flinched at the sharp jab of the needle. She felt a flutter in her stomach. Landry pushed the sample vial against the back of the needle until it penetrated the rubber stopper.
"Whoa-careful. Let me get it in there." He poked around gently until the dark red liquid pulsed suddenly into the tube. Taping the needle to her arm, he let the vial fill up, removed it, and quickly attached the long, thin plastic tube from the blood bag.
Valerie gazed at the bag. From the squarish periphery of the large central bag extended several smaller bags connected by tubes. It looked like a squashed octopus. "What are all those things hanging there?"
Landry smiled. "This is what we use for baby transfusions. We fill up the big bag. Then, whenever we need the small amount a baby requires, we can squeeze some into a satellite bag, pinch it off, and use it. That way we don't have to enter the main bag. The blood stays usable longer that way." During all this, he took the opportunity to scan the sheet she had given him.
"I see you visited Dr. Fletcher a few months back."
Valerie frowned. "Yes."
"Were you also involved in the fertility program?"
Valerie stiffened, almost popping the needle out of place. "You mean Dr. Fletcher's involved in fertility programs, too?"
A sinking feeling of embarrassment overcame the young technologist. His brown eyes glanced down at her arm. "I'm sorry. I didn't know that you'd been... I mean, some people think it's strange for her to be working both sides of the street..." That's not right. "I mean, I can understand her trying to maximize women's choices, no matter what they..." He taped the tubes to her arm, squeezed the blood bag a few times to distribute the anticoagulant, and let it hang below the cot.
"There," he said with relief, grasping the sample vial in his suddenly sweaty hand. "Just lie down, relax, and squeeze this every few seconds." He handed her a rubber cylinder. "I'll be back in a few minutes."
He made for the water cooler at the far end of the room and took a stiff drink of Sparkletts. A candy striper noticed his flus-tered expression and wandered over to him.
"What's up, Mark?"
"Nothing," he said quietly. "I just have all the bedside man-ner of a meat packer." He handed the blood sample to the technologist behind the counter, then quickly returned to Valerie's side.
Valerie squeezed and released, squeezed and released. It was the queasiest feeling to know that each contraction sent an extra squirt of blood into the bag. The plastic tube lay draped across her arm. It felt warm and sickening, like a snake that had slithered out of the desert sun to rest on her flesh. A wave of unease bordering on nausea washed over her when she dared to glance at where the tube of dark red blood disap-peared under white adhesive tape at the inside of her elbow.
Some people did this every six weeks. Her boss, Mr. Sewell, was a member of the Rare Blood Club and kept arranging bloodmobile visits for the office. She never donated. Now she knew why. Squeeze. Release. Squeeze. Release.
She reminded herself that this was for a little baby whose life was in far greater peril than hers. She thought about how strange it was that blood-something spilled so easily from cuts, in fights, in wars-could, if gathered carefully, be so valu-able to another.
Squeeze. Release. It really wasn't all that difficult.
After what seemed to be hours of uncomfortable silence, Landry said, "There we go, that's enough." He pressed the bag a couple of times, causing the tube along her arm to creep warmly across her flesh. It made her shudder.
"Do I keep squeezing?" she asked.
He shook his head, busying himself with removing the needle, putting a piece of cotton over the puncture, and fold-ing her arm back. "Don't sit up. Just hold it like this and press," he said. He took the bag over to the sealing unit, and stamped the blood-filled tubing at regular intervals to create almost a dozen sample blisters. He labeled the bag with stickers that read Directed Donation Baby Girl Renata Chandler, adhering a similar tear-away portion of the bar-coded sticker to Valerie's file. That done, he brought a cup of orange juice and two choco-late chip cookies to her.
"Here's the p
ayoff."
Valerie accepted them with a grateful smile.
"Just relax," he told her. "I have to deliver the lab results to Dr. Fletcher." He gazed at her with a troubled expression, then rose and walked away.
Valerie wondered if something was wrong.
"
Landry found Dr. Fletcher in the infant intensive care unit. It looked like any other ICU except that the tubes and wires from all the equipment streamed into a clear bassinet not much larger than a bread box.
Evelyn stood beside the instruments, watching the beat of Renata's heart.
"When did you transfer to pediatrics, Doc?"
Fletcher looked up at the intruder. "Mark, did you get the printout?"
"She's still O positive," he said deadpan. "HLA and serolo-gies will take until six o'clock and Debbie said you'll be lucky to get them that fast." He handed her a manila folder. She opened it up to scan the contents. He took the opportunity to check out the baby.
Renata lay inside the germ-free chamber, hooked to an IV. Aside from her waxy pallor, she looked perfectly healthy. Un-der the warm glow of the heat lamp, her sparse hair shone blond with the softest of golden-bronze highlights. She lay on her back, quietly staring up at a bunny and duckie mobile hang-ing from inside the top of the box.
Fletcher seemed to study the results with cursory attention. "This will do very well," she said.
"Question," said Landry. "How did you know to bring her in when her tests before and after the abortion didn't include the HLA typing?"
Fletcher closed the folder and looked down at Landry from her half-inch advantage. "Dalton's O
positive and so is the baby. I had her frozen sample retested, but the HLA results were ambiguous. Since Renata has a rare HLA, I grasped at straws. If we're lucky, Mark, my `woman doctor's intuition' will pan out, and this baby'll have a better chance." She clapped him on the shoulder. "And isn't that what medicine's all about?"
"Aren't marrow donors supposed to be close relatives? Mr. and Mrs. Chandler both seem fit." What a snoop. "Do you have access to their medical histo-ries?" Landry shook his head.
"Then you couldn't be aware of the mismatched ABO and Lewis factors and Mr. Chandler's history of hepatitis B, could you?"
Landry shook his head again.
"Would it be safe to assume that a closely matched stranger's marrow might, under such circumstances, be preferable to the parents'?"
"Well, yes, but why did you go straight to this woman in-stead of going through the marrow registry program?"
"I told you," Fletcher said. "Her HLA is rare."
"But-"
"Look, scut puppy." She was tired, worried, and irritated. "You stick the patients, and I'll do the doctoring. Okay?"
Landry said nothing. Turning, he walked out of the infant ICU, leaving Dr. Fletcher behind in her anger.
He made straight for the file room and its computer.
"Is this thing logged on?" he asked.
The busy record keeper nodded without lifting his gaze from a stack of forms. Landry started tapping away, pleased to know that he was accessing the files with someone else's security code. Though everyone did it, he felt he had extra reasons to be secretive. The screen offered up the files on Karen and Renata Chan-dler. He scrolled through them quickly, noting within instants that their Rh factors were identical. As Dr. Fletcher indicated, though, their ABOs were indeed mismatched. The mother had AB blood, the baby had type O. A transfusion or marrow trans-plant from mother to daughter would be fatal. Renata's own blood would hemolyze-clump up and kill her.
No mention existed of the father in either file, so the hepati-tis B comment couldn't... Landry looked back at the blood groups. Something was wrong. Mother AB, daughter O. That can't be, he thought. Can it? If the mother was AB, the daughter would have to be A, B, or AB. She could never be O. Ever.
When the realization struck him, he laughed. Of course! She was in the fertility program. She got someone else's egg. Landry shook his head. What a jerk. Valerie Dalton must have been the egg donor. That's why Fletcher brought her in. Nothing super unusual in that.
Except, he realized, that Valerie Dalton was unaware of Fletcher's involvement in the fertility program. She was only familiar with the Fletcher that performed abortions.
A sickening sensation churned inside Landry's stomach.
Calling up Dalton's file, he noted with relief that the date of her abortion was March third. Scrolling back to Karen's file, he saw that her fertility operation took place January seven-teenth. Maybe I'm wrong. I have to be wrong. Or maybe...
He printed out copies of the screen pages, then darted over to Reproductive Endocrinology, fifty feet down the hallway.
The receptionist listened to his request. "Well, hon," she said in her raspy voice. "I don't know what good seeing the old appointment books will do. We don't keep patients' addresses there."
"No," Landry said, thinking as swiftly as possible. "But you do keep phone numbers. Just let me look at the month of March. I can find the patient's name if I can correlate the time of the operation to the time of the transfusion."
"I don't know-"
"Look, Mrs. Welsch, if the transfusion you'd received half a year ago had turned out to have HIV in it, you'd want someone to track you down and tell you, wouldn't you?"
"Why, so I can worry myself to death?" She pushed away on her swivel high chair to the shelves behind the counter. A half rotation brought her face to spine with the appointment book back files. She removed a thick blue canvas-covered binder.
"Here's the first half of the year, hon. Bring it back when you're done." He thanked her and carried the binder off to the break room. Too crowded. He found an examination room that wasn't in use and closed the door. Placing the binder on the couch, he opened it to January seventeenth. Karen Chandler had a one o'clock appointment. No Valerie Dalton. Then he checked March third. No Karen Chandler, but a six-thirty appointment for Valerie Dalton. He sighed and stared at the page. It was a stupid theory, any-He stared at an entry next to Dalton's. Reaching overhead, he pulled down the lamp and switched it on. The intense white glare brought out every detail of the page. The entry next to Dalton's had been written over an erasure.
Landry angled the lamp to bring out surface details. It looked as if the name Chandler had been there once. He reached into his breast-pocket pen protector. Taking the edge of a pencil to the entry, he lightly rubbed all over until only the grooves made by the original entry showed as white traces against a grey background.
He gazed at the tracing, barely able to make out a captial K, a small e and n, and the last name Chandler. He frowned for a moment, almost not wanting to believe. Then he went back to January seventeenth. Karen Chandler's appointment had been written in over an erasure of another woman's name.
Appointment changes were common, Landry reminded him-self. That's why entries are written in pencil. The sick feeling, though, would not go away. "
Valerie noted the young man's troubled expression as he returned to check her progress. She sat up with his help and had another glass of orange juice.
"If you had it to do over again," he suddenly asked, "would you have gone through with your abortion?"
Valerie turned to stare at him in shock. "I don't think that's any of your concern. How dare you ask-"
"What if some way existed," he said quickly, his words tum-bling out in a rapid, anxious whisper,
"for you to have ended your pregnancy without harming the fetus? What if your baby were ali-" The door to the blood room swung open. Dr. Fletcher strode in and scanned the room to see Landry crouched next to Valerie Dalton. He shut up the instant he saw her. Rising up unsteadily, he resumed his work.
Valerie said nothing to the technologist. Her confused eyes watched Fletcher's approach.
"Have them get the blood over to infant ICU," she told Landry, then turned to gaze down upon Valerie. "I want you to know how much we appreciate your doing this to help a little stranger. I hope that we can
count on you for subsequent do-nations."
With the doctor's aid, Valerie slid her legs off the cot and sat up straighter, her left hand still applying pressure to the crook of her right arm. "How often will I have to do this?" Fletcher sat next to her on the padded table. "There's no way of knowing. Transfusions are adequate in providing sup-portive care. Sometimes it's all that's needed to help the bone-marrow to recover and start producing blood cells again. There's a surer way, though."
"What's that?" Valerie stared at the floor, unable to look at the doctor.
"A bone-marrow transplant will give the baby what she needs directly. Recovery is almost immediate and generally perma-nent in most such procedures."
"What do you mean by a transplant?" Valerie asked. She noticed that the floor below had two dark brown spots on the green linoleum. Her blood? Or some stranger's before her?
"It's not the same as an organ transplant. We don't do any surgery. It's almost like a blood transfusion except that we put the needle into your hip or sternum where we can aspirate some bone-marrow. Then we inject it in the baby just like a blood transfusion. The cell colonies swim around in her blood-stream and instinctively head right for her bones. There they set up shop and start manufacturing new cells. And then she can lead a full and healthy life." The doctor put a friendly arm around her patient. "And-if your tissue types match-you could be the one who saves her."
"Does it hurt?"
"I'd be lying if I said it didn't. But dying hurts a lot more. And not just baby Renata. Her parents have been trying to have a baby for years and she's their first. Remember what I said about... well, you know. What I said last night."
Valerie looked up into Dr. Fletcher's sympathetic eyes. "I'd like to see her." Fletcher's eyes became guarded, her entire expression stiff-ening imperceptibly. "That isn't really possible. She's in Inten-sive Care."
Landry, gathering up his equipment slowly in order to eaves-drop, said, "She can look through the observation window." He watched the doctor for her reaction, trying to maintain an innocent, helpful expression.
She shot him a troubled glance, then coolly agreed.
