“Who wouldn’t be? She’s so precious.”
“Ja, I feel it, too. The love for a child is a powerful thing.”
“I know I said I wouldn’t get too attached to her, but it’s already too late.” Hannah was firmly embedded in her heart. Giving her up was going to hurt terribly.
Ada came and wrapped one arm around Miriam. “She has crept into my heart, too.”
“I think we made a mistake trying to keep her until her mother came back. All we did was set ourselves up for a big heartache.”
“Heartaches are part of life, child. God brought this baby to us for a reason. We can only pray that He shows us His will.”
Miriam’s cell phone rang. She stepped outside on the porch to answer it to avoid her mother’s disapproving glare. It was Dr. Zook on the other end.
“Miriam, I need you to bring Hannah into the office today.”
A knot of worry formed in Miriam’s stomach. “Why?”
“We need to repeat some of her blood tests. I’m afraid her MSUD screen has come back positive.”
“MSUD? Hannah has Maple syrup urine disease?” Miriam sank onto the porch steps. Bella came from beneath the porch and sat beside her.
Dr. Zook said, “Let me stress that this may be a false positive. We need to double-check before we assume the worst.”
“How often do you have a false positive?”
He hesitated, then said, “Not often but it does happen. I’m sorry to worry you but there is treatment now for this disorder if the test is correct.”
“Treatment, but no cure.”
“I’m afraid not. We’ll repeat the test to be doubly sure, but in the meantime, you’re need to make a formula change right away. We have cans of a special powdered formula that you can start using today.”
“I’ll be there as soon as I can.” Miriam closed her phone and stared at nothing. Her beautiful little baby might have a genetic disorder that in worst-case scenarios could lead to mental retardation and complete paralysis of her body, even death. The unfairness of it overwhelmed her.
Wasn’t it enough that Hannah’s mother had given her away? Why did God laid this burden on a helpless child? She wrapped her arms around Bella and burst into tears.
An hour later, she helped her mother out of the car and lifted Hannah from her car seat. As they approached the front door of the clinic, Nick’s SUV spewed gravel as he turned into the parking lot and pulled up beside them.
He jumped out of his vehicle and slammed the door. His hair was still damp and he had one missed button on the front of the shirt. “Dr. Zook just called me. I could tell from his voice that this is serious, but how serious?”
“That’s what we have to find out. There are variations of the disease. Some types are not as serious as others.”
“Do we know what type she has?”
“They aren’t sure she has it. That’s why she needs further testing.”
He pulled the clinic door open so that she could go in. Wilma rose from behind the desk and came forward to meet them. “Dr. White and Dr. Zook are waiting for you in Dr. White’s office. I’ll show you the way.”
Miriam followed her down the hallway with growing dread. She prayed as she had never prayed before.
Please let this be a false alarm, Lord.
When Wilma held open a door, Miriam froze, unable to move forward. She felt a comforting hand on her shoulder and turned to look at her mother but it was Nick who stood beside her. He said softly, “We can bear all things with God’s help. He is with us always.”
She nodded, drew a deep breath then walked in.
Dr. White was seated at his desk, his head of snow-white hair bent over a book laid open on his desk. Dr. Zook stood beside him. As soon as he saw Nick was with them, he said, “I’m glad you could all make it. Miriam and Ada, please have a seat. I’ll get another chair for you, Nick.”
He shook his head. “I’d rather stand.”
Dr. White closed his book and laced his fingers together. “I’m sure hearing that Hannah may have MSUD is very disturbing news.”
Nick said, “You’re going have to use plain English, Doc. I don’t know what your medical terms mean. I’m sure Ada doesn’t, either.”
“My apologies, Sheriff. MSUD, or maple syrup urine disease, is an inherited disorder. It’s a rare disorder in the general population, only about one in every 185,000 births worldwide. Unfortunately, in the Amish and Old Order Mennonite communities the incidence is much higher. Almost 1 in every 380 Amish children will have some form of this disease.”
“What type does Hannah have?” Nick asked.
“Let me stress that we aren’t sure she does have it. However, in the most severe cases, a child’s body is unable to properly process certain protein building blocks called amino acids. The three essential amino acids a child can’t break down are leucine, isoleucine and valine. They are often referred to as the branched-chain amino acids or BCAA’s. The condition actually gets its name from the distinctive sweet odor of affected infants’ urine.”
“I haven’t noticed that,” Miriam said quickly, hoping to prove their diagnosis was wrong.
Dr. Zook said, “Not all babies will show that symptom until they are in crisis. It used to be that babies with this condition showed poor feeding, frequent vomiting, a lack of energy and finally developmental delays before anyone knew what was wrong with them. Fortunately, in recent years all babies in the state of Ohio began being tested for this condition because if untreated, maple syrup urine disease can lead to seizures, coma, paralysis and death.”
Nick looked from Dr. Zook to Dr. White. “If left untreated. That means there is treatment available, right?”
“Yes.” Dr. White extended a pamphlet toward Nick and Miriam. “Treatment of MSUD involves a carefully controlled diet that strictly limits dietary protein in order to prevent the accumulation of BCAAs in the blood. The cornerstone of this diet is a special formula that does not contain any leucine, isoleucine or valine but is otherwise nutritionally complete. It contains all the necessary vitamins, minerals, calories and the other amino acids needed for normal growth.”
“How soon do we start it?” Miriam asked. This shouldn’t be happening. It wasn’t fair, but then how often was life really fair? Without Hannah’s family in the picture it would be up to Miriam to give the baby the best possible start in life.
Dr. Zook gave her a sympathetic smile. “Initially, Hannah will need the MSUD formula to be supplemented with carefully controlled amounts of the protein-
based baby formula she is on now until we know for certain that the test is correct. It if is, I’m afraid Hannah is going to become a frequent flyer here. She will need frequent monitoring of her blood levels.”
“Will she grow out of this?” Nick asked. He was grasping at straws. Miriam knew better.
Dr. White shook his head. “No. Lifelong therapy is essential. Typically, the MSUD diet excludes high protein foods such as meat, nuts, eggs and most dairy products.”
Dr. Zook said, “Children can gradually learn to accept the responsibility for controlling their diets, however, there is no age at which diet treatment can be stopped.”
Ada had remained silent until now. “What does this mean for her mother and father?”
Dr. Zook and Dr. White exchanged glances. Miriam said, “If the test is correct, it means they both carry the MSUD gene. If they have more children together, there is a strong possibility that those children will have the same disease.”
A strange look came over Ada’s face. “It is Gottes wille if their children are sick or if they are healthy. Perhaps that is why He brought the child to you, Miriam. So that your knowledge can help her.”
It was the first time her mother had even come close to admitting that Miriam’s education was a good thing.
Dr. White sat back in his chair. “What is really important is that we make sure we have correct test results. Let’s not panic until we know for sure she has this thing. In the meanti
me, we don’t allow Hannah to develop a BBCA crisis. High fever, vomiting or diarrhea, not eating, these can all trigger an elevated level of BBCA in her blood, and that can lead to brain damage. She is going to require close medical supervision.”
Nick asked, “Should she be hospitalized now? What kind of further testing does she need?”
Dr. White rose to his feet and came around the desk. He perched on the corner and reached for Hannah. Miriam handed the baby over to him. He lifted her to his shoulder and bounced her gently. Looking a Nick, he said, “You are wondering if you made a mistake by allowing Amber and these women to talk you into keeping the baby out of child care services.”
“Did I?”
“I don’t believe so. There’s no reason to hospitalize Hannah at this point. We can draw the additional blood we need for testing here.”
Miriam saw the tension ease in Nick’s shoulders. Dr. White continued, “No one has more respect for the Amish than I do, Sheriff. They welcome and lovingly accept children with any kind of disability as a gift from God. Fewer and fewer people in the general population feel the same way. If her mother doesn’t return for her, I would hope that she can be adopted by an Amish couple here in this community.”
Miriam stood and took the baby from Dr. White. “How can I get the formula that Hannah needs?”
Dr. Zook smiled at her. “We have some that we can give you. I will also give you the number of our formula supplier so that you can order all you need.”
“Thank you.”
Dr. Zook moved to open the door. “If you’ll come with me, we can draw her blood. We should have the final test results back in about twenty-four to forty-eight hours. Hopefully, all this worry will be for nothing.”
* * *
Nick stayed behind as the women left. Folding his arm over his chest, he spoke to Dr. White. “I wish I could compel you to reveal all you know about Hannah’s mother.”
“Sheriff, I wish I had something to reveal. Sadly, I don’t know any more than you do.”
“But you have seen this disorder in families around Hope Springs.”
“I have. Too many times, as a matter of fact.”
“I don’t suppose you could give me a list of those families’ names. I don’t mind looking for a needle in haystack, but if I could have a smaller haystack to search, that would be better.”
Dr. White chuckled. “I can imagine it would. I’m sorry I can’t be more help. The baby is in good hands now, and that is what’s important. I hear that you’ve been checking buggies all over the county.”
“The buggy that left Hannah at Miriam’s had a crack in the left rear wheel in the shape of a long Z. It’s all we have to go on. I must have looked at over a hundred buggies, and I haven’t been able to locate it.”
“Levi Beachy is here waiting to get stitches taken out of his hand. He’s the local buggy maker. It’s possible he might know who owns a rig with a wheel like that. I’ll tell him you’d like to speak to him.”
“Thanks, Doc.”
Nick left the office and saw Miriam waiting outside by the car. She looked tearful and worried. All he wanted was to hold her close and reassure her.
No, he wanted much more than that. He wanted to tell her that he loved the color of her hair. That he loved the way her eyes sparkled when she was happy. That he wanted to spend the rest of his life making her eyes sparkle.
A dozen ways to tell her how much he cared about her ran through his mind. None of them seemed like the right thing to say at the moment. Soon, he would find a way to tell her how he felt and pray that she might return his affection. Soon, but not now.
He didn’t see Hannah or Ada as he left the clinic and stopped beside Miriam.
“At least it’s a treatable disease,” she said before he could say anything.
“That’s right and she may not even have it. Where is your mother?”
“She’s changing Hannah. I needed some fresh air.” She pressed a hand to her mouth. Her eyes filled with unshed tears. “I’m so scared for her, Nick. Any illness she gets could result in permanent brain damage. A bad cold, the flu...”
Nick wrapped his arms around her and pulled her close. He pressed a kiss to her forehead. “I know you’re scared. I’m scared, too.”
Her arms crept around his shoulders. To his surprise, she returned his hug. “How is a teenage Amish mother going to handle this if I’m terrified and I’m a critical care nurse?”
“Maybe we should stop looking for her.” Nick held his breath as he waited for Miriam’s reply.
Softly, she said, “I’ve thought of that. Hannah is so easy to love. The longer she stays with me the harder it’s going to be to give her up. Now that I know she may be sick, I can’t bear to let her go.”
Nick stepped back and held Miriam at arm’s length. “There may be a way for you to keep her. Have you heard of being a treatment foster parent?”
“Of course I’ve heard of it. They are foster parents that provide medical care to children with emotional or serious medical problems.”
“Right. There is an agency called The Children’s Haven, Incorporated. They cover foster children in Ohio and Indiana. I might be wrong, but I would think a registered nurse, who’s already a foster parent in Ohio, would have an easy time becoming one for them. If I were you, I’d start making phone calls.”
“How do you know about this?”
“It’s called the internet. Ten minutes with a search engine was all it took.”
“And when did you do this search?”
“Last Monday after I left your place.
“We didn’t know about Hannah’s condition then.”
“I’ve watched you with her. You looked at her the way other mothers look at their babies. I can see that you love her, even when she’s throwing up on you. Since I knew you were already a foster parent, I wanted to see if there was a way for you to keep her. It seemed worth a shot to do some research.”
“I’m stunned.”
“The Children’s Haven was one of the sites I ran across. Now that she may have this disorder, it makes me believe that God intends for you to take care of her.”
* * *
Nick’s revelation was a stunning one. Miriam wanted to believe she might be more than a temporary part of God’s plan for Hannah. “Do you really think so, Nick?”
“He had some reason to lead Hannah’s mother to your house.”
The clinic door opened and a young Amish man came out. He wore dark trousers and a pale blue shirt and sported a straw hat on his head of curly brown hair. He was clean shaven. Only married Amish men wore beards. He had a thick dressing around his left hand.
He stopped in front of Nick, but wouldn’t meet his eyes. It took him a moment to speak. “I’m Levi Beachy. The doctor said...ya wanted to know about a buggy with a broken rim.”
Miriam and Nick exchanged a quick glance. Nick said, “Yes.”
“It was my buggy. I replaced the wheel rim two days ago.” His face grew beet-red as he spoke.
“Did you visit Miriam Kauffman’s farm a week ago on Thursday night?”
“Nee, I did not.” The man looked up at last. Miriam realized he was painfully shy. He took a step back and tried to hurry away, but Nick called out, “Do you have twin brothers about sixteen years old?”
He stopped, but he didn’t meet Nick’s gaze. “I do.”
“Could they have taken your buggy without you knowing it?”
“What night did you say that was?”
“It would have been a Thursday night.”
Levi rubbed the back of his neck. “My best mare came up lame on Friday morning for no reason. I mentioned it to the boys, they didn’t say anything, but I did wonder if they’d taken her out and driven her hard. I don’t like to pry.”
Nick said, “I need to talk to those boys.”
“They’re at home.” Levi nodded to the Sheriff and walked away down the street.
Miriam said, “I should come with you.”
/> “I can handle it.”
She said, “I know you can handle it. I also know that I am less intimidating than you are. They might be more willing to confide in me.”
He considered it for a moment and said, “All right, we’ll go out there together, but let’s take Hannah and your mother home first.”
“What shall we tell Mom?”
“The truth. That we’re checking a lead, but it could be a wild-goose chase.”
Miriam agreed. After taking her mother and the baby back to the farm, Miriam climbed into Nick’s SUV for the trip back.
“I had a feeling those two boys knew more than they were saying.” Nick sped up to pass a wagon pulled by two large draft horses.
“When did you talk to them?”
“The day of the market, I saw them following you and I asked them what their interest was. They said they wanted to find out how much you would charge to drive them to Cincinnati. I don’t think either one of them is the father. You should’ve seen their faces when I asked them point-blank if they were.”
Miriam said, “I believe the buggy shop is on the east side of town.”
“I know where it is. It used to belong to Sarah Wyse’s husband before he died.”
A few minutes later, they pulled into a lot with buggies ringing the perimeter. They were in all stages of construction and repair.
Miriam saw a young woman sweeping the front steps of the office. She stopped work, and waited until Nick and Miriam approached. “Good day. I’m Grace Beachy, how may I help you?”
Nick said, “You can tell us how to find Atlee and Moses.”
“My brothers are chopping wood behind house. Shall I get them for you?”
Nick shook his head. “I’ll find them.”
Miriam remained silent and followed his lead. Behind the small house, the twins were splitting logs at such a rapid pace than Miriam knew it had to be a contest.
One of them, she couldn’t tell them apart, caught sight of her and stopped swinging. A wary look crossed his face. He spoke to his brother who instantly stopped working as well.
Nick surveyed them closely. “Afternoon. Which one of you is winning?”
A Home for Hannah Page 11
