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charlotte
A notepad filled with Felipe Otero’s small, even script lay on the desk in Raney’s ICU. Her numbers. Felipe must have gotten here early—it was his habit to handwrite each patient’s information, though he could as easily print it from the computer. He said it helped him organize his thoughts. Once, Charlotte had found a list of personal goals inadvertently tucked beneath the medical lists: “Try to go to bed at the same time, clean one bathroom every Saturday morning, read one book in common each month, count to ten . . .” After skimming it, she’d been embarrassed to realize it referred to his struggling marriage. She’d found it months before she knew Felipe and his wife were separating, and she remembered thinking she could have written the same list for her own relationship with Eric. Well, were any human relationships so very unique?
The numbers Felipe had written today were remarkably good—they must be Raney’s post-dialysis blood work—another miracle of modern medicine doing its superior, computer-calculated job. But it was the ventilator readings that got Charlotte’s attention. Raney’s pulmonary pressures were out of the danger zone. Her respiratory gases were normalizing.
She knew. It was time. They would stop her sedation and check her reflexes, then take her off the ventilator and see if she had enough brain-stem function to breathe.
She saw Felipe coming down the hall. He broke into a smile, so genuinely pleased to see her it made her particularly glad that today, of all days, she would not have to make every medical decision alone. “You saw her creatinine?” he asked.
“Looks good. They didn’t land her potassium quite as perfectly as usual. Still a bit high.” It was another joke they had, comparing dialysis to technical marvels such as Mars landings or the Chunnel.
“She wasn’t dialyzed today. Those are her own kidneys back at work. She’s getting an MRI this morning—it’s been a while,” Felipe said.
All her lab values were normalizing, in fact. The antibiotics had battled the most malevolent bacteria to a standstill. The last residual hepatic toxins appeared to be out of her system. The inflammation in her lungs had subsided. It was all good news. Heartening. Charlotte began to hope, to pray, that the healing of Raney’s body foretold a healing of her brain, but when she looked at Raney’s MRI and saw the shrunken folds, too small for the encasing skull, like a child’s hand inside a woman’s glove, Charlotte knew how permanent the damage was.
She stood with her hands in her deep lab coat pockets, looking at her patient. Her patient. A gifted artist, an orphan, a widow, a wife. Her lover’s ex-lover, the mother of a boy she felt committed to, rationally or not. How odd to know someone’s history, body, home, child—and never have heard her voice, never have seen her open her eyes.
Felipe stood quietly behind her for a moment. “I can write the orders.” Charlotte nodded. “Are you okay?” he asked.
She lifted one shoulder. “At least we’ll have an answer, even if it’s not an easy one. At least Christina Herrand isn’t here to share the moment with us,” and with that comment she managed a small, disingenuous laugh.
They stood together at Raney’s bedside. Charlotte lifted Raney’s eyelid and brushed a clean Q-tip softly across her cornea. In the first spontaneous movement she had made in almost three weeks, Raney reflexively blinked—a sign that despite all she had suffered, the most elementary animal functions had survived. She turned to Felipe, not caring if he saw how deeply affected she was. “Tell me. If you were twelve, would you rather learn your mother had died, or see her live in an endless coma—almost as unreachable. Would you rather visit a grave marker or . . .” she gestured toward Raney but her hands ended up covering her face. Felipe put his arms around her and she completely gave in to him, unconcerned that anyone might walk through the open door. “I know better, after all these years. I know better!”
“Charlotte, Charlotte. You’re better at this job because you care. Because you let yourself care.” He rocked her quietly, waited until she was ready to let him go. “There’s still a chance, you know. It happens.”
“Yeah. But it won’t. Not for her. We’ve both seen her brain scan.”
“You did the job you set out to do, as well as any doctor I’ve ever known. No one can heal a broken mind, Charlotte. None of us.”
—
By the next day they were ready to see if Raney could breathe without a machine. At the moment they disconnected her ventilator, Charlotte inhaled deeply and froze. For three, four, five, six minutes she watched Raney’s still chest until she saw the faintest expansion, a butterfly wing of breath. And when it became apparent over the next few hours that Raney’s lungs had indeed healed enough to sustain her, Charlotte exchanged the respiratory therapist’s high five. Then she walked down the hall to the conference room and scooted a chair against the door, stood beside the window looking over the tarred and graveled roof of the hospital, and cried.
Her job was largely done now. Raney would be transferred to a chronic care facility and her ICU cubicle would soon house some other person on the cusp of life. With Charlotte as the lead doctor, they had cured Raney’s body—or at least helped it cure itself. Her liver made proteins again; her heart beat with steady, sustainable pressure; her stomach absorbed the nutrients her tissues demanded; and now her lungs expanded and contracted with suppleness, gathering oxygen from invisible air. In the end even the root of Renee’s brain had rallied to its job, pulsing the rhythm of circling blood and flowing breath—like a power station left behind after the apocalypse, still churning electrons with no one to flick the light switch. How brilliant a body was, Charlotte thought. More than a century after Thomas Edison and nobody had built anything close to such a marvel out of metal and wires.
—
When Eric came to her house later that evening Charlotte was on the porch watching the evening settle, every solid shape backlit. She barely turned when he bent to kiss her. “What is it?” he asked. “Jake? Is he all right?”
She was surprised by his question—to know that Jake was so much on Eric’s mind even when the two of them seemed fatally split over how to help him. “Raney,” she answered. “We took her off the ventilator today. She’s breathing on her own.”
“She is? Do you think there’s a chance she’ll wake up?”
Charlotte shook her head. “I don’t think she’ll ever talk. Move. Communicate in any meaningful way.”
“How long could it go on like that?”
“Until some new problem happens—some caregiver forgets to wash his hands, forgets her blood thinners, doesn’t watch out for bedsores . . . Ask Sunny von Bülow. Is it what you’d want?” She looked at him closely for the first time since he’d come in. “No. Me neither. And I’m the one that put her there.”
“He’s trapped now, isn’t he?”
He was talking about Jake again, she realized. “I don’t know. Maybe they’ll let him stay with Louise—or find another home for him.”
“Charlotte, if he has NF . . . If he needs an operation . . . Whatever he needs . . . I want to pay for it.”
She laced her fingers through his. So much he couldn’t change about himself, wasn’t there? It was true for her, too, of course. Everyone. But harder, probably, when you had skated so close to death so many times. It must be its own sort of prison. It made her both love him more and broke her heart, to see him stretch so far for this one small step, offering his money if he couldn’t give his soul. So generous, but not generous enough. Not for her, at least. She understood now why the paternity test had meant so much to her. Some irrational corner of her love had believed that maybe, conceivably, if Eric knew his genes were already inextricably embedded in this child, maybe he would take a risk with the rest of himself too. With her. With another child. But as Felipe said, no one can heal a broken mind. Not even one you love. “We’ll both pay, okay?” she said. This at least, they could do together.
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—
As pediatricians, Pamela and Will were the obvious ones to turn to first—Will was on staff at Seattle Children’s and would not only be able to recommend the best pediatric orthopedist, he’d get the appointments back-to-back tomorrow if they asked him.
“Jeez, it’s as nepotistic as Hollywood,” Eric said.
“Only at the front door,” Charlotte countered. “Everyone’s equal after they get in.” One boon of academic medicine over private practice, she knew, was the wall between the patient and their payment. No one outside the billing office would care if Jake had insurance. If anything, the extraordinary nature of Jake’s diagnosis would have specialists clamoring.
They invited Pamela and Will for dinner, but they already had plans and said they’d come by on their way home. Dessert, then. So Charlotte and Eric ate dinner alone. He stood next to her in the kitchen, chopping tomatoes for spaghetti. “Are you going to tell them everything?” he asked.
“About Jake? As much as we have to. They’ll need to see him—Will, at least—and I’m not sure how to make that happen.”
Eric was quiet for a while after that, brushing off her offer to help him cook. She took the knife out of his hand and touched his face. “There’s no need to tell them about your disease, Eric. Or the paternity question. The urgent problem is his back—the scoliosis. They’ll test Jake for neurofibromatosis and everything else as part of his workup.” Despite how much she’d educated herself about NF since they’d fallen in love, Charlotte had told none of her medical family about Eric’s brain tumors. They couldn’t see the scars hidden by his hair like a secret tattoo. She’d tried to respect his privacy—it was his decision to tell them if he chose. And what sane person could sit through all those family dinner discussions and feel remotely inclined to become the next intriguing topic for dissection? But for the first time it occurred to Charlotte that the real reason she hadn’t told her family was that they might ask the questions she couldn’t face herself.
—
It was after ten when the doorbell rang. Charlotte had fallen asleep on the couch. “Sorry we’re so late,” Pamela said. “We have to make it quick—the sitter charges twelve dollars an hour. I remember being happy with seventy-five cents.”
Charlotte put some cartons of ice cream on the table and began the story at the safest place she knew. “You remember my patient—my Jane Doe. They were able to identify her by the scar on her arm.” Pamela started to break in, but Charlotte said, “I shouldn’t be telling you any of this. The story’s complicated because the husband’s been under investigation. And . . .” She struggled to find the right bridge to their discovery of Jake at the trailer in Queets. “My patient has a child, a son, and I met him. He’s complaining of back pain. I think he has scoliosis and he’s not getting any medical care. I’m hoping you can help.” There it was. The critical one percent of the surreal story that she hoped might win Jake the golden ticket to see the top specialists in Seattle.
Will was watching her intently—he’d been able to see through her B.S. since they were squabbling preschoolers. “This is the child you were asking me about the other day?” Charlotte nodded. “I’d be happy to help—Children’s has some great spine people.” He paused a minute, considering her face closely enough to make her flush. “You hadn’t told me it was a boy. You’re sure he’s having back pain?”
“He told me he was. He said his mother was trying to get him to a doctor, but the stepfather wouldn’t let her.”
“Will his mother recover enough to take care of him?”
Charlotte shook her head. “No. I don’t think so.”
“So, it won’t be easy to get him seen,” Will said. “It could take a court order if his stepfather refuses.”
“It could take time,” Charlotte answered. “He’s in a temporary foster home right now.”
Will nodded, pursing his lips the way he did when he was getting worried and trying to hide it. “Because, the thing is, scoliosis is more common in girls. And typically it doesn’t hurt, it’s so gradual. Both of those mean you have to think about something more serious. A growth on the spinal cord. Something that shouldn’t wait.”
Eric had been sitting at the far corner of the table ignoring the ice cream, slowly spinning his empty wineglass while they talked, sinking further into the shadows outside the chandelier’s light until he was a mere observer to their “familial medical grand rounds,” as he’d often called the Reese dinner table conversations. So they all turned when Eric cleared his throat and said flatly, “Charlotte thinks Jake could have neurofibromatosis.”
“So it is more serious,” Will said. He looked at Charlotte again and she felt transparent, as if he were counting the cogs spinning in her brain. She had never been a good liar. “Why do you think he has NF?” Will asked her.
She started to tell him about the freckles under Jake’s arm, hoping that would be enough. But it was Eric who answered again. “Because I have it. And Charlotte thought, we thought, for a while, that Jake might have inherited it from me.” Pamela’s mouth dropped open and Charlotte felt a quickening in her chest, for a moment wishing she had never invited her brother and his wife into this private crisis.
Eric drew his chair closer to Charlotte before he began his own story. “I identified Raney’s scar. She was a friend of mine, when I was growing up. We hadn’t seen each other in more than ten years.” He seemed to purge himself through the retelling, moving back and forth in time until, at the end of half an hour, Pamela and Will knew almost everything. Even the extinguished possibility that Jake might have been the product of Eric’s single coital episode with Raney—how Eric and Charlotte had both been persuaded by the remarkable resemblance Jake bore to Eric: the shape of his nose, the jagged lay of his hair, even the single blue eye. The only thing Eric didn’t tell them was how devastated Charlotte had been when the paternity test did not show a match.
“Those mail-order paternity tests can be wrong. Maybe you should do a blood test,” Pamela said.
Charlotte answered, “They’re not wrong very often. And how could we get a blood sample from him? Besides, the whole idea was crazy. Raney’s first husband, Jake’s father, was Filipino and Jake has his skin color. And at least one of his brown eyes!” Charlotte laughed telling this part, needing some thin element of humor.
“He really has two different eye colors? Like my cat—Effie. Maybe he’s a chimera.”
“A chimera? You mean as in the mythical beast?” Charlotte said.
“Well, no. I was joking. But the other kind—the nonmythical kind—is a genetic glitch. Twins that fuse together. If it happens early enough, before the cells differentiate, they can grow into a completely normal-looking person. Only the person has two different cell lines, one from each fertilized egg. Kidney from one twin, liver from another . . .”
“You’re kidding. That exists?” Charlotte said.
“For sure in animals. Marmosets. Tortoiseshell cats—that’s how I know about it. Calicoes and tortoiseshells are almost always female, but one in a few thousand is a male, like Effie, and those can be a chimera.”
“But not in people . . .” Charlotte said.
Will said, “I’ve read about it. It happens in people. Rarely. Or maybe not so rarely—no one’s testing for it, so who knows? They’d look normal, or something as subtle as different-colored eyes.” He smiled, but when he looked at her, Charlotte caught a hint of something sad crossing his face, as if he’d begun to appreciate how Jake’s story related to his sister’s romantic relationship. He shifted the conversation to the topic at hand. “Listen, I’ll get the boy into our spine clinic if you can work on getting the permission from the foster home or his stepfather. Maybe our social workers can help. You’ll call me?”
—
After Will and Pamela left, Eric seemed sober, depleted. He said he wanted to go to his apartment. He had more work to do on
his last chapter, and anyway, it was office hours in Sweden, where his genetics resource lived. Charlotte could tell he was upset. Pamela and Will had been circumspect about Eric’s medical history but still, it was out there now. So this would be their own last chapter, then. Everything finally out in the open just before they separated. She tossed with an unsettled mind, half-dreaming of being asleep and waking in disappointment that the dream was only a dream. She startled in jagged alarm when she heard Eric’s key in the lock. It was just after two in the morning, 9:00 a.m. in Stockholm.
He looked so somber it worried her; her first thought, as always, was that his headaches were back, a tingling in his arm or blurring of his vision that might warn his tumor was recurring. “Eric? What is it? Are you sick?”
“I’m fine. Stop worrying about my head.” He pulled away, agitated. “Do you remember what Pamela was talking about. Jake’s eyes?” She didn’t answer, not following him. “Will is right. They aren’t freaks or myths.”
“What? Who’s not a myth?”
And then she heard why Eric had been so quiet at the end of the evening, why he had left so abruptly. He told her about the chapter he’d been working on, and the quirky path of research it had turned up: a kidney transplant patient whose blood was matched against her three sons, hoping one might be a donor. The DNA tests “proved” two of her boys could not be her children. But when they tested cells from different parts of the mother’s body they found genetic prints from two different individuals. Different parts of her had arisen from different fertilized eggs. Twins fused into one person. “The woman was a chimera. I called Fikkers, the geneticist in Sweden. He’s seen it—people who have two different blood types. Different tissues with unique cell lines. Hermaphrodites sometimes—he even talked about people with different eye colors, like Jake.”
Gemini: A Novel Page 33
