by Jodi Picoult
• • •
To save Kate’s life, part of her has to die. That’s the purpose of chemotherapy—to wipe out all the leukemic cells. To this end, a central line has been placed beneath Kate’s collarbone, a three-pronged port that will be the entry point for multiple medication administrations, IV fluids, and blood draws. I look at the tubes sprouting from her thin chest and think of science fiction movies.
She has already had a baseline EKG, to make sure her heart can withstand chemo. She’s had dexamethasone ophthalmic drops, because one of the drugs causes conjunctivitis. She’s had blood drawn from her central line, to test for renal and liver function.
The nurse hangs the infusion bags on the IV pole and smoothes Kate’s hair. “Will she feel it?” I ask.
“Nope. Hey, Kate, look here.” She points to the bag of Daunorubicin, covered with a dark bag to protect it from light. Spotting it are brightly colored stickers she’s helped Kate make while we were waiting. I saw one teenager with a Post-it note on his: Jesus saves. Chemo scores.
This is what starts coursing through her veins: the Daunorubicin, 50 mg in 25 ccs of D5W; Cytarabine, 46 mg in a D5W infusion, a continuous twenty-four-hour IV; Allopurinol, 92 mg IV. Or in other words, poison. I imagine a great battle going on inside her. I picture shining armies, casualties that evaporate through her pores.
They tell us Kate will most likely get sick within a few days, but it takes only two hours before she starts throwing up. Brian pushes the call button, and a nurse comes into the room. “We’ll get her some Reglan,” she says, and she disappears.
When Kate isn’t vomiting, she’s crying. I sit on the edge of the bed, holding her half on my lap. The nurses do not have time to nurse. Short-staffed, they administer antiemetics in the IV; they stay for a few moments to see how Kate responds—but inevitably they are called elsewhere to another emergency and the rest falls to us. Brian, who has to leave the room if one of our children gets a stomach virus, is a model of efficiency: wiping her forehead, holding her thin shoulders, dabbing tissues around her mouth. “You can get through this,” he murmurs to her each time she spits up, but he may only be talking to himself.
And I, too, am surprising myself. With grim resolve I make a ballet out of rinsing the emesis basin and bringing it back. If you focus on sandbagging the beachhead, you can ignore the tsunami that’s approaching.
Try it any other way, and you’ll go crazy.
• • •
Brian brings Jesse to the hospital for his blood test: a simple finger stick. He needs to be restrained by Brian and two male residents; he screams down the hospital. I stand back, and cross my arms, and inadvertently think of Kate, who stopped crying over procedures two days ago.
Some doctor will look at this sample of blood, and will be able to analyze six proteins, floating invisibly. If these six proteins are the same as Kate’s, then Jesse will be an HLA match—a potential donor for bone marrow for his sister. How bad can the odds be, I think, to match six times over?
As bad as getting leukemia in the first place.
The phlebotomist goes off with her blood sample, and Brian and the doctors release Jesse. He bolts off the table into my arms. “Mommy, they stuck me.” He holds up his finger, festooned with a Rugrats Band-Aid. His damp, bright face is hot against my skin.
I hold him close. I say all the right things. But it is so, so hard to make myself feel sorry for him.
• • •
“Unfortunately,” Dr. Chance says, “your son isn’t a match.”
My eyes focus on the houseplant, which still sits withered and brown on the sill. Someone ought to get rid of that thing. Someone ought to replace it with orchids, with birds-of-paradise, and other unlikely blooms.
“It’s possible that an unrelated donor will crop up on the national marrow registry.”
Brian leans forward, stiff and tense. “But you said a transplant from an unrelated donor was dangerous.”
“Yes, I did,” Dr. Chance says. “But sometimes it’s all we’ve got.”
I glance up. “What if you can’t find a match in the registry?”
“Well.” The oncologist rubs his forehead. “Then we try to keep her going until research catches up to her.”
He is talking about my little girl as if she were some kind of machine: a car with a faulty carburetor, a plane whose landing gear is stuck. Rather than face this, I turn away just in time to see one of the misbegotten leaves on the plant make its suicide plunge to the carpet. Without an explanation I get to my feet and pick up the planter. I walk out of Dr. Chance’s office, past the receptionist and the other shell-shocked parents waiting with their sick children. At the first trash receptacle I find, I dump the plant and all its desiccated soil. I stare at the terra-cotta pot in my hand, and I am just thinking about smashing it down on the tile floor when I hear a voice behind me.
“Sara,” Dr. Chance says. “You all right?”
I turn around slowly, tears springing to my eyes. “I’m fine. I’m healthy. I’m going to live a long, long life.”
Handing him the planter, I apologize. He nods, and offers me a handkerchief from his own pocket.
“I thought it might be Jesse who could save her. I wanted it to be Jesse.”
“We all did,” Dr. Chance answers. “Listen. Twenty years ago, the survival rate was even smaller. And I’ve known lots of families where one sibling isn’t a match, but another sibling turns out to be just right.”
• • •
We only have those two, I start to say, and then I realize that Dr. Chance is talking about a family I haven’t yet had, of children I never intended. I turn to him, a question on my lips.
“Brian will wonder where we’ve gone.” He starts to walk toward his office, holding up the pot. “What plants,” he asks conversationally, “would I be least likely to kill?”
• • •
It is so easy to presume that while your own world has ground to an absolute halt, so has everyone else’s. But the trash collector has taken our garbage and left the cans in the road, just like always. There is a bill from the oil truck tucked into the front door. Neatly stacked on the counter is a week’s worth of mail. Amazingly, life has gone on.
Kate is released from the hospital a full week after her admission for induction chemotherapy. The central line still snaking from her chest bells out her blouse. The nurses give me a pep talk for encouragement, and a long list of instructions to follow: when to and when not to call the emergency room, when we are expected back for more chemotherapy, how to be careful during Kate’s period of immunosuppression.
At six the next morning, the door to our bedroom opens. Kate tiptoes toward the bed, although Brian and I have come awake in an instant. “What is it, honey?” Brian asks.
She doesn’t speak, just lifts her hand to her head and threads her fingers through her hair. It comes out in a thick clump, drifts down to the carpet like a small blizzard.
• • •
“All done,” Kate announces a few nights later at dinner. Her plate is still full; she hasn’t touched her beans or her meat loaf. She dances off to the living room to play.
“Me too.” Jesse pushes back from the table. “Can I be excused?”
Brian spears another mouthful with his fork. “Not until you finish everything green.”
“I hate beans.”
“They’re not too crazy about you, either.”
Jesse looks at Kate’s plate. “She gets to be finished. That’s not fair.”
Brian sets his fork down on the side of his plate. “Fair?” he answers, his voice too quiet. “You want to be fair? All right, Jess. The next time Kate has a bone marrow aspiration, we’ll let you get one, too. When we flush her central line, we’ll make sure you go through something equally as painful. And next time she gets chemo, we’ll—”
“Brian!” I interrupt.
He stops as abruptly as he’s started, and passes a shaking hand over his eyes. Then his gaze lands on Jesse, who
has taken refuge under my arm. “I . . . I’m sorry, Jess. I don’t . . .” But whatever he is about to say vanishes, as Brian walks out of the kitchen.
For a long moment we sit in silence. Then Jesse turns to me. “Is Daddy sick, too?”
I think hard before I answer. “We’re all going to be fine,” I reply.
• • •
On the one-week anniversary of our return home, we are awakened in the middle of the night by a crash. Brian and I race each other to Kate’s room. She lies in bed, shaking so hard that she’s knocked a lamp off her nightstand. “She’s burning up,” I tell Brian, when I lay my hand against her forehead.
I have wondered how I will decide whether or not to call the doctor, should Kate develop any strange symptoms. I look at her now and cannot believe I would ever be so stupid to believe that I wouldn’t know, immediately, what Sick looks like. “We’re going to the ER,” I announce, although Brian is already wrapping Kate’s blankets around her and lifting her out of her crib. We bustle her to the car and start the engine and then remember that we cannot leave Jesse home alone.
“You go with her,” Brian answers, reading my mind. “I’ll stay here.” But he doesn’t take his eyes off Kate.
Minutes later, we are speeding toward the hospital, Jesse in the backseat next to his sister, asking why we need to get up, when the sun hasn’t.
In the ER, Jesse sleeps on a nest of our coats. Brian and I watch the doctors hover over Kate’s feverish body, bees over a field of flowers, drawing what they can from her. She is pan-cultured and given a spinal tap to try to isolate the cause of the infection and rule out meningitis. A radiologist brings in a portable X-ray machine to take a film of her chest, to see if this infection lives in her lungs.
Afterward, he places the chest film on the light panel outside the door. Kate’s ribs seem as thin as matchsticks, and there is a large gray blot just off center. My knees go weak, and I find myself grabbing on to Brian’s arm. “It’s a tumor. The cancer’s metastasized.”
The doctor puts his hand on my shoulder. “Mrs. Fitzgerald,” he says, “that’s Kate’s heart.”
• • •
Pancytopenia is a fancy word that means there is nothing in Kate’s body protecting her against infection. It means, Dr. Chance says, that the chemo worked—that a great majority of white blood cells in Kate’s body have been wiped out. It also means that nadir sepsis—a post-chemo infection—is not a likelihood, but a given.
She is dosed with Tylenol to reduce her fever. She has blood, urine and respiratory secretion cultures taken, so that the appropriate antibiotics can be administered. It takes six hours before she is free of the rigors—a round of violent shaking so fierce that she is in danger of shimmying off the bed.
The nurse—a woman who braided Kate’s hair in silky cornrows one afternoon a few weeks back, to make her smile—takes Kate’s temperature and then turns to me. “Sara,” she says gently, “you can breathe now.”
Kate’s face looks as tiny and white as those distant moons that Brian likes to spot in his telescope—still, remote, cold. She looks like a corpse . . . and even worse, this is a relief, compared to watching her suffer.
“Hey.” Brian touches the crown of my head. He juggles Jesse in his other arm. It is nearly noon, and we are all still in pajamas; we never thought to take a change of clothes. “I’m gonna take him down to the cafeteria; get some lunch. You want something?”
I shake my head. Scooting my chair closer to Kate’s bed, I smooth the covers over her legs. I take her hand, and measure it against my own.
Her eyes slit open. For a moment she struggles, unsure of where she is. “Kate,” I whisper. “I’m right here.” As she turns her head and focuses on me, I lift her palm to my mouth, press a kiss in its center. “You are so brave,” I tell her, and then I smile. “When I grow up, I want to be just like you.”
To my surprise, Kate shakes her head hard. Her voice is a feather, a thread. “No Mommy,” she says. “You’d be sick.”
• • •
In my first dream, the IV fluid is dripping too quickly into Kate’s central line. The saline pumps her up from the inside out, a balloon to be inflated. I try to pull the infusion, but it’s held fast in the central line. As I watch, Kate’s features smooth, blur, obliterate, until her face is a white oval that could be anyone at all.
In my second dream, I am in a maternity ward, giving birth. My body tunnels in, my heart pulses low in my belly. There is a rush of pressure, and then the baby arrives in a lightning rush and flow. “It’s a girl,” the nurse beams, and she hands me the newborn.
I pull the pink blanket from her face, then stop. “This isn’t Kate,” I say.
“Of course not,” the nurse agrees. “But she’s still yours.”
• • •
The angel that arrives is wearing Armani and barking into a cell phone as she enters the hospital room. “Sell it,” my sister orders. “I don’t care if you have to set up a lemonade stand in Fanueil Hall and give the shares away, Peter. I said sell.” She pushes a button and holds out her arms to me. “Hey,” Zanne soothes when I burst into tears. “Did you really think I’d listen to you when you told me not to come?”
“But—”
“Faxes. Phones. I can work from your home. Who else is going to watch Jesse?”
Brian and I look at each other; we haven’t thought that far. In response, Brian stands up, hugs Zanne awkwardly. Jesse runs toward her at full tilt. “Who’s that kid you adopted, Sara . . . because Jesse can’t possibly be that big . . .” She disengages Jesse from her knees and leans down over the hospital bed, where Kate is sleeping. “I bet you don’t remember me,” Zanne says, her eyes bright. “But I remember you.”
It comes so easy—letting her take charge. Zanne gets Jesse involved in a game of tic-tac-toe and bullies a Chinese restaurant that doesn’t deliver into bringing up lunch. I sit beside Kate, basking in my sister’s competence. I let myself pretend she can fix the things I can’t.
• • •
After Zanne takes Jesse home for the night, Brian and I become bookends in the dark, bracketing Kate. “Brian,” I whisper. “I’ve been thinking.”
He shifts in his seat. “What about?”
I lean forward, so that I catch his eye. “Having a baby.”
Brian’s eyes narrow. “Jesus, Sara.” He gets to his feet, turns his back to me. “Jesus.”
I stand up, too. “It’s not what you think.”
When he faces me, pain draws every line of his features tight. “We can’t just replace Kate if she dies,” he says.
In the hospital bed, Kate shifts, rustling the sheets. I force myself to imagine her at age four, wearing a Halloween costume; age twelve, trying out lip gloss; age twenty, dancing around a dorm room. “I know. So we have to make sure that she doesn’t.”
WEDNESDAY
I will read ashes for you, if you ask me.
I will look in the fire and tell you from the gray lashes
And out of the red and black tongues and stripes,
I will tell how fire comes
And how fire runs as far as the sea.
—CARL SANDBURG, “Fire Pages”
CAMPBELL
WE ARE ALL, I SUPPOSE, beholden to our parents—the question is, how much? This is what runs through my mind while my mother jabbers on about my father’s latest affair. Not for the first time, I wish for siblings—if only so that I would receive sunrise phone calls like this only once or twice a week, instead of seven.
“Mother,” I interrupt, “I doubt that she’s actually sixteen.”
“You underestimate your father, Campbell.”
Maybe, but I also know that he’s a federal judge. He may leer after schoolgirls, but he’d never do anything illegal. “Mom, I’m late for court. I’ll check back in with you later,” I say, and I hang up before she can protest.
I am not going to court, but still. Taking a deep breath, I shake my head and find Judge staring at me. “R
eason number 106 why dogs are smarter than humans,” I say. “Once you leave the litter, you sever contact with your mothers.”
I walk into the kitchen as I am knotting my tie. My apartment, it is a work of art. Sleek and minimalist, but what is there is the best that money can buy—a one-of-a-kind black leather couch; a flat screen television hanging on the wall; a locked glass case filled with signed first editions from authors like Hemingway and Hawthorne. My coffeemaker comes imported from Italy; my refrigerator is sub-zero. I open it and find a single onion, a bottle of ketchup, and three rolls of black-and-white film.
This, too, is no surprise—I rarely eat at home. Judge is so used to restaurant food he wouldn’t recognize kibble if it slid its way down his throat. “What do you think?” I ask him. “Rosie’s sound good?”
He barks as I fasten his service-dog harness. Judge and I have been together for seven years. I bought him from a breeder of police dogs, but he was specially trained with me in mind. As for his name, well, what attorney wouldn’t want to be able to put a Judge in a crate every now and then?
Rosie’s is what Starbucks wishes it was: eclectic and funky, crammed with patrons who at any time might be reading Russian lit in its original tongue or balancing a company’s budget on a laptop or writing a screenplay while mainlining caffeine. Judge and I usually walk there and sit at our usual table, in the back. We order a double espresso and two chocolate croissants, and we flirt shamelessly with Ophelia, the twenty-year-old waitress. But today, when we walk inside, Ophelia is nowhere to be found and there is a woman sitting at our table, feeding a toddler in a stroller a bagel. This throws me for such a loop that Judge needs to tug me to the only spot that’s free, a stool at the counter that looks out on the street.
Seven-thirty A.M., and already this day is a bust.
A heroin-thin boy with enough rings in his eyebrows to resemble a shower curtain rod approaches with a pad. He sees Judge at my feet. “Sorry, dude. No dogs allowed.”
“This is a service dog,” I explain. “Where’s Ophelia?”
