"No," said Dr. Malalai. "Usually this disease doesn't rear its head until after the first six months or so. This situation is highly unusual, and the fact is there's definite, immediate risk to Ruthie, so we'll take precautions. But we're going to remain optimistic."
Alyssa threw out almost everything but the word "precautions." "Precautions" was a word doctors used when the likelihood of impending awfulness was high.
The pain in her body was suddenly replaced by a numbing cold.
"What kind of precautions?" she said.
Dr. Malalai took his hand off Blake's shoulder. He pulled off his glasses and began cleaning them with his shirt. "Ruthie suffered a vaso-occlusive crisis – that's what caused her so much pain – and that may recur, I'm afraid."
"What does that mean? And what do we do about it?" asked Blake. Alyssa felt something fumbling around in her blankets and realized it was him, his hand looking for hers in the bed. They'd been married long enough that she suspected it was an automatic motion: muscle memory carrying them together in times of crisis.
"It means the cells, sticky and stiffened, have become stuck in the blood vessels. Like a stopped-up pipe in your kitchen or bathroom. That is what causes the tremendous pain that Ruthie experienced. As to what you do about it…." He stopped cleaning his glasses. He didn't return them to his face, but his fingers stopped their circular motions, his body froze from the neck down. "Mostly you watch. Keep her hydrated. If she screams like that again, bring her to the ER immediately. Keep her from getting too cold and be on the lookout for fevers. Infection is a huge danger for her."
Blake asked the big question. Alyssa was glad, because she didn't know if she would have been able to. "Can we cure it?"
Malalai put his glasses back on, and Alyssa sensed it had nothing to do with his vision. He was trying to hide what was on his face, the look in his eyes. "No," he said once his glasses were in place. "But we'll give you the information you need to keep watch and properly respond. Even without a cure, medical science has come up with some excellent aids and controls. We're going to refer you to several specialists who will likely put Ruthie on a medication regimen to help with the disorder. And before you leave we'll give you some information packets, and even some clothing that changes color if her core temperature rises or drops too much."
Malalai grinned widely. But the grin barely turned up at all at the ends – nearly a straight line that seemed less to brighten his face than to slash it violently in half.
"So that's it?" said Alyssa. The anger that had fallen away from her before now climbed back into her heart. "We get some pamphlets, a referral, and a temperature-sensitive onesie?"
Blake's hand finally found and clenched over hers. He probably meant to comfort her, to calm her. But his palm was awash in sweat. His own rage and terror and pain could not hide, not from her.
Malalai just stared at them, that violent cut of a grin fixed on his face. Not saying anything, and the silence itself saying everything there was to say.
Alyssa's anger fell away again.
She felt pain once more. Not the pain of the birth. Not the pain in bones and joints and muscles. Not the pain of a womb newly empty, not the pain of her perineal tear.
Ruthie had screamed so loudly, had been in so much agony. And that agony had instantly become Alyssa's. Holding the baby, she had also held her own heart, her own soul.
The baby was hers to hold. Hers to keep. Hers to protect.
She had already begun to fail.
And the failure, more than anything, was what caused Alyssa's pain.
FIRST STEPS
They brought the baby home.
The home itself was newish and niceish. Two stories, five bedrooms, two-and-a-half baths. The first floor had a kitchen/dining area, a living room, one bedroom, and the half-bathroom. The second floor had the other four bedrooms, two bathrooms, and a closet that hid the washer and dryer hook-ups.
It was the kind of place that a growing family could not only settle down in, but could continue to settle into over the years.
Many homes are designed with "curb appeal" as the first and last goal. These are the kind designed to sell. The kind where the builder/developer puts in just enough work to get out with the maximum profit after spending the minimum money. These are the houses that look lovely, but inexplicably fall apart three months after the "no hassle, wall-to-wall" warranty period ends.
This house, on the other hand, had been built with something else in mind. Profit, yes – whoever built it likely didn't do so with the goal of losing money. But this building also had the feel of a place that intended to stick around. To grow old with its owners, see them into the ground, and then allow a new family to settle down in and settle into.
The feeling of a place that perhaps had been built on the shoulders of other buildings. Older buildings. Buildings and homes long gone but never quite forgotten.
This house was a place that seemed built with a solid roof, and that roof seemed to be built on sturdy walls, and those walls gave the impression of resting on a sure foundation.
Blake didn't notice any of that. He just got out of the car and helped Alyssa out of the backseat. She leaned against the side of the junker sedan. She grimaced. Still in pain, body and heart.
Mal got out the other side. He went to his mother. He put her arm over his shoulders and she smiled and thanked him as though the gesture meant actual support. And perhaps it did, though it was of a mental or emotional nature, certainly not a physical one.
Blake looked at Alyssa. He mouthed, "Okay?" and she nodded.
He got Ruthie from her car seat in the center of the backseat. It was the newest model, with a five-star rating on Amazon, Consumer Reports, and Parents.com. It was far too expensive, but Alyssa demanded it and Blake gave in with no fight. How much was a child worth to them?
Ruthie was asleep, and slept on as he picked her up. A pink fleece blanket lay lightly across her, and he balanced both infant and blanket over his folded arms, the movements flying across the years that separated this baby from the baby that Mal had been, once-upon-a-time, so long ago, so very recently.
Blake carried her to the door while Mal "helped" Alyssa. This was what they had agreed on.
When they married, Blake carried his new wife over the threshold of their home – a tiny apartment in a part of town that was so questionable he got nervous when she went to get the mail.
When Mal was born, he asked Alyssa if it would be all right if he carried the boy across the threshold, as he had done with her. She consented. He carried the swaddled baby across the dividing line between the outside world, so frightening, so terrible, so dreary, and the place that would be their boy's home: a townhouse that was across the street from a Nissan dealership, a place where the baby woke up every hour or two because the salesmen honked the horn of every car they sold.
And now Blake would carry his new daughter across the threshold of this house. He would carry his new, sickly child through the doorway, into a place that the family wished could provide her safety, but knew never would.
He carried her into the house that seemed secure.
That seemed solid.
That seemed safe.
He disappeared into the house.
Mal brought his mother up the walk. Alyssa walked so slowly it seemed the new baby might enjoy her first birthday before mother and brother made it inside to see it. And that made Alyssa sad, because what if Ruthie never made it that far?
Mal just focused on his mother. His mommy. He understood she was hurting, though the scope of her hurt was beyond his understanding.
They, too, walked into the house.
All of them were smiling as they stepped onto the porch.
All of them, for some unknown reason, stopped smiling as they stepped inside.
The house did not comfort.
There was no safety here. Not for Ruthie.
And, though none of them said anything, all of them felt – for just an instan
t – that there was no safety here for any of them.
Not in this house that only seemed safe.
A MOTHER'S HANDS
Blake was waiting for Alyssa in the grand foyer of the house.
Of course, it was nothing of the kind – the space was about ten feet by five feet, with a large door leading to the living room on the right, the stairs straight ahead, and a hall beside them that led down to Mal's room and the kitchen. It was barely an "entryway," let alone a "grand foyer."
But when they had bought the house, Blake went through the place, renaming everything. The living room became the "sitting parlor," the kitchen became the "serving area," their room "the servant's quarters," and several other names Alyssa didn't remember. All of them had been one-off jokes – little bits of Blake-humor that faded as fast as they appeared.
For some reason, though, "grand foyer" stuck. The entrance was always called that, or G.F. for short.
Blake was looking around the G.F., holding Ruthie. She was still sleeping, which was a blessing. Alyssa was terrified that the little girl would wake up and need feeding. Alyssa's milk hadn't fully come in yet, and if her experience with Mal was any indicator she was going to let down slowly each time. Which meant a cranky, crying baby.
Only when Ruthie cried, it could mean the precursor to something quite different and more serious than just an empty belly. And Alyssa didn't know if she was going to be able to handle that tension for months or a year or more, depending on how long her milk held out and Ruthie kept breastfeeding.
"What now?" asked Blake.
Alyssa knew he wasn't really asking the obvious. His question was deeper, going to the care of Ruthie, of Mal, of her –
(and the bills and the business failing and the bank account, don’t forget all that)
– and all the other responsibilities she knew he struggled under right now.
"Let's put her in the crib and see how she does," she said.
Blake looked at her sharply, as though he'd suddenly forgotten she – and Mal, who was still parked under her arm – even existed.
He smiled sheepishly. "Yeah, that'd be a good idea, huh."
Alyssa looked at Mal. "Honey, would you get my bag out of the back of the car?"
"Do you need anything after that?"
"Yes. You are under orders to watch at least a half hour of cartoons. Or else."
Mal threw her a solemn salute, then grinned his slightly buck-toothed grin before spinning on his heel (and almost careening into the wall). He went through the front door. He was singing the theme song to Phineas and Ferb as he left.
Blake took Mal's spot under her arm. He moved so slowly and tenderly it made her want to cry. She knew that was partly the hormones that were trying to decide whether to cling for dear life or flee out of her big toe in a single chunk.
But it was also that Blake was straight-up, truly sweet.
And damn cute.
"Can you make it up to the room? Or do you need me to carry you?"
She chuckled. Even that hurt. "How you going to do that, Romeo? Just throw me over one shoulder and Ruthie over the other?"
He looked so genuinely wounded by the suggestion she laughed – and winced – again.
"No. You carry her, and I carry you. A twofer."
She shook her head. "I'll take my chances walking."
Each step hurt. Halfway up the stairs she was berating herself for trying this. But then she asked herself what she was going to do – stay upstairs, stay downstairs? Stay confined to one spot in the house while her family proceeded with life?
No. Undoubtedly the doctors would say to do exactly that, but doctors always told you what to do without any kind of perception of how it might impact real life. And her real life was this: she was a mother. She was a wife. She had to move. She had to be a part of what was going on.
She would survive.
And in the middle of those thoughts, she realized she had stepped over the top stair.
"Made it," said Blake. "You okay? You want to rest?"
She almost laughed – a courtesy laugh, to be sure – until she saw the worry in his eyes. He wasn't joking, he was truly concerned about her ability to hobble the last few feet to Ruthie's room.
The worry made her feel like they might make it through all this. He seemed to have forgotten the situation with Ruthie, the bills that were still waiting for them, the problems with the business. He was looking at her like she was the only thing that mattered.
And if he could look at her like that, if she could muster up the same kind of looks for him, well… they could get through anything.
"Let's keep going," she said.
The last few feet hurt less. They stood at the open door to Ruthie's room in only a few moments. "You need me?" he said.
She shook her head. Blake disappeared down the hall, though she had no doubt he was listening for any sudden noises that might signify she had keeled over and needed to be rescued. He was nearby.
But out of sight. Because just as they had agreed he would carry the baby through the front door, so they had also agreed this would be her experience. Her moment alone with the baby.
She carried Ruthie into the baby's room. It was dark. They had put blackout curtains over the window, so even in the middle of the afternoon it would be like walking into a mineshaft were it not for the nightlight beside the door. The light was shaped like a cheerful Strawberry Shortcake, seemingly caught in mid-jump, a happy bit of brightness they thought would be perfect for their little girl's room.
The light was pink. Almost red.
Alyssa took her baby to the crib. A mobile hung from the backboard: red and black and mirrored surfaces – colors that the experts agreed were among the first infants could recognize, among the most stimulating for them. Alyssa touched a button on the side and the mobile began to spin, the toys at the ends of the arms bouncing up and down as it did.
The mobile made a quiet noise as it turned, the sound of a never-ending wave: whrrrrr.
Ruthie cooed.
Alyssa put her daughter down. The baby lay on her back, sucking hard at the green pacifier she had gotten at the hospital.
She was wearing a pink onesie. The hospital had given that to them, too.
Alyssa put her hand gently on the baby's stomach. Ruthie gasped, but didn't wake. Alyssa almost cursed at herself. She didn't want to wake the baby, and knew she shouldn't be doing this. But a sudden terror grabbed her, shook her, wouldn't let her go.
She left her hand on her daughter's stomach.
Then, finally, withdrew it.
Her handprint stayed behind, a darker red on the pink fabric. Relief flowed through her: the onesie was working. It would give them an early warning of Ruthie's temperature changed suddenly, going too low (the onesie would shift to blue) or too high (a red shift).
She leaned down, but stopped herself from kissing the baby. This she would resist. She'd tempted fate enough for one day, and it was a truism that you should let sleeping dogs and babies lie.
"Stay healthy, Ruthie," she whispered. Her voice was so low that she herself could barely hear it, but Ruthie began sucking harder, faster.
The baby moved slightly, and the onesie shifted. Alyssa's handprint shifted as well, altered by several folds that appeared in the fabric.
A chill rippled down the nape of her neck, through her spine, to her buttocks.
The handprint now looked like a skull.
Then Ruthie moved again, and the onesie pulled tight, the folds disappeared. The handprint was just a handprint again.
And then it faded away.
But the skull remained in Alyssa's mind. She felt like she had just seen something important.
Something terrible.
She hobbled out of Ruthie's room.
But left the door open.
As soon as she left the room, she could tell something was wrong. The faint noise of Mal's cartoons wafted up the stairs like comfort food. Sometimes the noise bothered her – too r
aucous, too crazed. But other times it was a reminder that this was home, that this was normal life, that this was the motherhood she had hoped and prayed for her whole life.
Now, neither of those feelings was present. The sounds were crazy as ever, as familiar as ever. But she felt neither irritated nor comforted. They slid off her. Dismissed.
She turned toward the back of the hall. Her room.
She moved slowly, hobbled by injury. And her slow movements made whatever was bothering her seem even worse. Seem more critical.
The skull.
No. Not that. That wasn't real.
She moved to her room. And knew.
Blake was there. He had a drafting table set up where he did work from time to time. But he wasn't working now. At least, not on anything from the business.
Instead, he had a mass of envelopes spread over the slanted surface. The usual colors: red and white. The usual words: "Final Notice," "Urgent" "Open Immediately."
Alyssa limped over to him and to her ears she made more noise than a Clydesdale in clogs dancing on a teak floor. But he still jumped when she put her hands on his shoulders. He always got jittery when he was stressed, and that made him worry about what he might do if he got too jittery (or who he might do it to), and that made him more stressed, which made him more jittery, and on and on and on.
The vicious circle of self-feedback: one of nature's cruelest jokes.
She put her hands on his shoulders, wrapping them around his neck, holding him tight. He touched her hands. It made her shiver.
One of the envelopes on the table was marked "ST. FRANCIS HOSPITAL OBGEN." That almost made her laugh.
"Boy, they didn't waste any time," she said, pointing to it.
"They never do. Doctors may be slow when it comes to talking to you, but they sure know how to get a bill out." He sighed. "And the deductible is going to kill us." He pounded a fist against the table, and the envelopes and letters all took a single leap sideways.
"It'll be okay," said Alyssa. She massaged his neck.
"Will it? Between the business, the house, this…." He gestured at the envelopes, the bills. Then the hand went up to rub his eyes. An exhausted gesture that made him seem strangely old. "We shouldn't have moved here. It was too much."
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