Handle With Care

by Jodi Picoult

  For the filling, mix together the chopped pecans, 2 tablespoons sugar, 2 tablespoons brown sugar, and cinnamon. Set aside.

  Punch down the dough with your fist. Then, on a lightly floured surface, flatten it into a rectangle, about 15 by 10 inches. Spread it with 2 tablespoons of butter, then dust it evenly with the chopped pecan mixture. Beginning at the 10-inch side of the rectangle, roll the dough up tightly and pinch the edge closed. Roll it, stretch it, and mold it until it is cylindrical.

  Cut into eight even slices and place them in a pan, not quite touching. Wrap the pan tightly with foil and refrigerate for at least 12 hours. Dream of them rising, that proof again, evidence that some things grow bigger than we ever expect.

  Heat the oven to 350 degrees F and bake 35 minutes. When golden, remove from the oven. Immediately invert on a platter, and serve warm.

  Marin

  Minutes later

  I

  've always sort of wondered about the term bearing witness. Is it that testifying is such a hardship? Or is it childbirth lingo, the idea that a witness brings forth something new to the trial? That's certainly true, but not in the way you'd imagine. Witness testimony is always flawed. It's better than circumstantial evidence, sure, but people aren't camcorders; they don't record every action and reaction, and the very act of remembering involves choosing words and phrases and images. In other words, every witness who's supposed to be giving a court facts is really just giving them a version of fiction.

  Charlotte O'Keefe, who was on the witness stand now, was not even really capable of bearing witness to her own life, in spite of the fact that she'd lived it. By her own admission, she was biased; by her own admission, she remembered her history only when it was entwined with Willow's.

  I would make a lousy witness, of course. I didn't know where my story started.

  Charlotte had knotted her hands in her lap and sailed through the first three questions: What's your name?

  Where do you live?

  How many children do you have?

  She'd stumbled on the fourth question, though: Are you married?

  Technically, the answer to that was yes. But practically, it had to be spelled out - or Guy Booker would use Charlotte and Sean's separation to his own legal advantage. I had coached Charlotte through the right response, and we had not managed to practice it yet without her bursting into tears. As I waited for her to answer, I found myself holding my breath.

  'Right now I am,' Charlotte said evenly. 'But having a child with so many special needs - it's caused a lot of problems in my marriage. My husband and I are separated right now.' She exhaled, a slow whistle.

  Good girl, I thought.

  'Charlotte, can you tell us about how Willow was conceived?' At the gasp of an elderly juror, I added, 'Not the nuts and bolts . . . more like the decision you made to become a parent.'

  'I was already a parent,' Charlotte said. 'I'd been a single mother for five years. When I met Sean, we both knew we wanted more children - but that didn't seem to be in the cards. We tried to get pregnant for almost two years, and we were just about to start fertility treatments when, well, it just happened.'

  'How did that feel?'

  'We were ecstatic,' Charlotte replied. 'You know how sometimes, your life is so perfect you're afraid for the next moment, because it couldn't possibly be quite as good? That's what it felt like.'

  'How old were you when you became pregnant?'

  'Thirty-eight.' Charlotte smiled a little. 'A geriatric pregnancy, they call it.'

  'Were you concerned about that?'

  'I knew that the odds of having a Down syndrome child were higher once you were over thirty-five.'

  I approached the stand. 'Did you speak to your obstetrician about that?'

  'Yes.'

  'Can you tell the court who your obstetrician was at the time?'

  'Piper Reece,' Charlotte said. 'The defendant.'

  'How did you select the defendant as your ob-gyn?'

  Charlotte looked down at her lap. 'She was my best friend. I trusted her.'

  'What did the defendant do to address your concerns about having a baby with Down syndrome?'

  'She recommended that I do some blood tests - a quad screen, it was called - to see if I had an even greater chance than the norm to have a baby with neural defects, or Down syndrome. Instead of my risk being one in two hundred and seventy, it was one in one hundred and fifty.'

  'What did she recommend?' I asked.

  'Amniocentesis,' Charlotte replied, 'but I knew that carried a risk, too. Since I was scheduled to have a routine ultrasound anyway at eighteen weeks, she said we could read the results of that first, then make a decision about the amnio based on what we saw. It wasn't as accurate as amnio, but there were supposedly certain things that might turn up that would suggest Down syndrome, or rule it out as less likely.'

  'Do you remember that ultrasound?' I asked.

  Charlotte nodded. 'We were so excited to see our baby. And at the same time, I was nervous - because I knew the technician was going to be looking for those Down syndrome markers. I kept watching her, for clues. And at one point she tipped her head and said, "Hmm." But when I asked her what she'd seen, she told me that Dr Reece would read the results.'

  'What did the defendant tell you?'

  'Piper came into the room, and I knew, just from her face, that the baby didn't have Down syndrome. I asked her if she was sure, and she said yes - that the technician had even remarked on how clear the images were. I made her look me in the eye and tell me that everything looked all right - and she said that there was only one measurement that was the slightest bit off, a femur that was in the sixth percentile. Piper said that wasn't something to worry about, since I was short, that by the next ultrasound, that same measurement could be up in the fiftieth percentile.'

  'Were you concerned about the sonogram images being clear?'

  'Why would I be?' Charlotte said. 'Piper didn't seem to be, and I assumed that was the whole point of an ultrasound - to get a good picture.'

  'Did Dr Reece advise having a more detailed follow-up ultrasound?'

  'No.'

  'Did you have any other ultrasounds during your pregnancy?'

  'Yes, when I was twenty-seven weeks pregnant. It wasn't a test as much as a lark - we did it after-hours in her office, to find out the sex of the baby.'

  I faced the jury. 'Do you remember that ultrasound, Charlotte?'

  'Yes,' she said softly. 'I'll never forget it. I was lying on the table, and Piper had the wand on my belly. She was staring at the computer screen. I asked her when I'd get a chance to look, but she didn't answer. I asked her if she was okay.'

  'What was her response?'

  Charlotte's eyes looked across the room and locked with Piper's. 'That she was okay. But that my daughter wasn't.'

  Charlotte

  W

  hat are you talking about? What's the matter?' I'd sat up on my elbows, looking at the screen, trying to make sense of the images as they jostled with my movements.

  Piper pointed to a black line that looked to me like all the other black lines on the screen. 'She's got broken bones, Charlotte. A bunch of them.'

  I shook my head. How could that be? I had not fallen.

  'I'll call Gianna Del Sol. She's the head of maternal-fetal medicine at the hospital; she can explain it in more detail--'

  'Explain what ?' I cried, riding the high wire of panic.

  Piper pulled the transducer away from my belly, so that the screen went clear. 'If it's what I think it is - osteogenesis imperfecta - it's really rare. I've only read about it, during medical school. I've never seen a patient who has it,' she said. 'It affects collagen levels, so that bones break easily.'

  'But the baby,' I said. 'It's going to be okay, right?'

  This was the part where my best friend embraced me and said, Yes, of course, don't be silly. This was the part where Piper told me it was the kind of problem that, ten years from now, we'd laugh about a
t your birthday party. Except Piper didn't say any of that. 'I don't know,' she admitted. 'I honestly don't know.'

  We left my car at Piper's office and drove back to the house to tell Sean. The whole way, I ran a loop of memory in my mind, trying to think back to when these breaks might have happened - at the restaurant, when I'd dropped that stick of butter and bent down to retrieve it? In Amelia's room, when I stumbled over a tangled pair of pajama pants? On the highway when I stopped short, so the seat belt tightened against my belly?

  I sat at the kitchen table while Piper told Sean what she knew - and what she didn't. From time to time, I could feel you inside me, rolling a slow tango. I was afraid to touch my hands to my abdomen, and acknowledge you. For seven months we had been a unit - integrated and inseparable - but right now, you felt alien to me. Sometimes in the shower when I did a self-breast exam I had wondered what I would do if I were diagnosed - chemo, radiation, surgery? - and I had decided that I would want the tumor cut out of me right away, that I couldn't bear sleeping at night and knowing it was growing beneath my skin. You - who had been so precious to me hours ago - suddenly felt that way: unfamiliar, upsetting, other.

  After Piper left, Sean became a man of action. 'We'll find the best doctors,' he vowed. 'We'll do whatever it takes.'

  But what if there was nothing that could be done?

  I watched Sean in his feverish zeal. Me, I was swimming through syrup, viscous and pendulous. I could barely move, much less take charge. You, who had once brought Sean and me so close together, were now the spotlight that illuminated how different we were.

  That night, I couldn't fall asleep. I stared at the ceiling until the red flush from the LED numbers on the clock radio spread like wildfire; I counted backward, from this moment to the one where you were conceived. When Sean got out of bed quietly, I pretended that I was asleep, but that was only because I knew where he was headed: to look up osteogenesis imperfecta on the Internet. I'd thought about doing that, too, but I wasn't as brave as he was. Or maybe I was less naive: unlike him, I believed what we learned could actually be worse than what we already knew.

  Eventually, I did drift off. I dreamed that my water had broken, that I was having contractions. I tried to roll over to tell Sean, but I couldn't. I couldn't move at all. My arms, my legs, my jaw; somehow I knew that I was broken beyond repair. And somehow I knew that whatever had been inside me all these months had liquefied, was soaking into the sheets beneath me, was no longer a baby at all.

  The next day was a whirlwind: from a high-level ultrasound, at which even I could see the breaks, to a meeting with Gianna Del Sol to discuss the findings. She threw out terms that meant nothing at the time: Type II, Type III. Rodding. Macrocephaly. She told us that one other child with OI had been born at this hospital, years earlier, who'd had ten breaks - and who had died within an hour.

  Then she sent us to a geneticist, Dr Bowles. 'So,' he said, getting right down to business - no I'm so sorry you had to hear this news. 'The best-case scenario here,' he said, 'would be a baby that survives the birth, but even if that's the case, a Type III might have cerebral hemorrhage caused by birth trauma or an increased circumference of the head compared to the rest of the body. She will most likely develop severe scoliosis, have surgeries for multiple broken bones, need rodding in her spine, or vertebrae fused together. The shape of her rib cage won't allow her lungs to grow, which can lead to repeated respiratory infections, or even death.'

  Amazingly, this was a whole different run of symptoms from the ones Dr Del Sol had given us already.

  'And of course, we're talking hundreds of broken bones, and realistically a very good chance she'll never walk. Basically,' the geneticist said, 'what you're looking at is a lifetime, however short, of pain.'

  I could feel Sean next to me, coiled like a cobra, ready to take out his own anger and grief on this man, who was talking to us as if it were not you, our daughter, who was the subject but a car whose oil we needed to change.

  Dr Bowles looked at his watch. 'Any questions?'

  'Yes,' I said. 'Why didn't anyone tell us before?'

  I thought of all the blood tests I'd taken, the earlier ultrasound. Surely if my baby was going to be this sick - this hurt for her whole life - something would have shown up earlier?

  'Well,' said the geneticist, 'neither you nor your wife is a genetic carrier of OI, so it wouldn't have been routinely tested for prior to conception, or flagged by the obstetrician as something to keep an eye on. It's good news, actually, that the disease was a spontaneous mutation.'

  My baby is a mutant, I thought. Six eyes. Antennae. Take me to your leader.

  'If you have another child, there's no reason to believe this will happen again,' he said.

  Sean came out of his seat, but I put a hand on his arm to restrain him.

  'How do we know whether the baby will . . .' I couldn't say it. I lowered my eyes, so that he knew what I meant. '. . . at birth, or live longer?'

  'It's very difficult to tell at this point,' Dr Bowles said. 'We'll schedule repeated ultrasounds, of course, but sometimes a parent whose child has a lethal prognosis will end up with a baby that survives, or vice versa.' He hesitated. 'There is another option - several places in this country will terminate a pregnancy for maternal or fetal medical reasons, even this far along.'

  I watched Sean fit his teeth around the word he did not want to say out loud. 'We don't want an abortion.'

  The geneticist nodded.

  'How?' I asked.

  Sean stared at me, horrified. 'Charlotte, do you know about those things? I've seen pictures--'

  'There are many different methods,' Bowles answered, looking directly at me. 'Intact D and E is one, but so is induction after stopping the fetus's heart.'

  'Fetus?' Sean said, exploding. 'That's not a fetus. That's my daughter we're talking about.'

  'If termination isn't an option--'

  'Option? Fuck that. It should never even have been on the table,' Sean said. He reached for me, pulling me to my feet. 'Do you think Stephen Hawking's mother had to listen to this load of bullshit?'

  My heart was hammering and I could not catch my breath. I didn't know where Sean was taking me, and I didn't particularly care. I just knew that I couldn't listen to that doctor for one more moment, talking about your life or lack thereof as if it were a textbook he was reading on the Holocaust, the Inquisition, Darfur: truths that were so awful and graphic that you instead skipped over them, conceding their horror without suffering the details.

  Sean dragged me down the hallway and into an elevator that was just closing. 'I'm sorry,' he said, leaning against the wall. 'I just . . . I couldn't.'

  We were not alone inside. To my right was a woman about ten years older than I was, pushing one of those state-of-the-art wheelchairs with a child sprawled across it. This one was a boy in his teens, thin and angular, his head supported by a brace on the back of the chair. His elbows twisted, so that his arms were flailed outward; his glasses were askew on the bridge of his nose. His mouth was open, and his tongue - thick and jellied - filled the bowl of his mouth. 'Aaaaah,' the boy sang. 'Aaaaah!'

  His mother touched her hand to his cheek. 'Yes, that's right.'

  I wondered if she really understood what he was trying to say. Was there a language of loss? Did everyone who suffered speak a different dialect?

  I found myself staring at the woman's fingers, stroking her son's hair. Did this boy know his mother's touch? Did he smile at her? Would he ever say her name?

  Would you?

  Sean reached for my hand and squeezed it tightly. 'We can do this,' he whispered. 'We can do it together.'

  I didn't speak until the elevator stopped at floor three and the woman pushed her son's wheelchair off into the hallway. The doors sealed shut again, isolating Sean and me in a vacuum. 'Okay,' I said.

  'Tell us about Willow's birth,' Marin said, pulling me back to the present.

  'She was early. Dr Del Sol had scheduled a C-section, but in
stead, I went into labor and everything happened very quickly. When she was born, she was screaming, and they took her away from me to X-ray her, to do tests. It was hours before I saw Willow, and when I did, she was lying on a foam pad in a bassinet, with bandages wrapped around her arms and legs. She had seven healing fractures and four new breaks caused by the birth.'

  'Did anything else happen in the hospital?'

  'Yes, Willow broke a rib, and it pierced her lung. It was . . . it was the most frightening thing I've ever seen in my life. She went blue, and suddenly there were dozens of doctors in the room and they started doing CPR and stuck a needle in between her ribs. They told me her chest cavity had filled with air, which made her heart and trachea shift to the wrong side of her body, and then her heart had stopped beating. They did chest compressions - breaking even more of her ribs - and put in a chest tube to make the organs go back where they belonged. They cut her,' I said. 'While I watched.'

  'Did you talk to the defendant afterward?' Marin asked.

  I nodded. 'Another doctor told me that Willow had been without oxygen for a while, and that we wouldn't know if there would be brain damage. He suggested that I sign a DNR form.'

  'What's that?'

  'It means do not resuscitate. If anything like this happened to Willow again, the doctors wouldn't intervene. They'd let Willow die.' I looked into my lap. 'I asked Piper for advice.'

  'Because she was your physician?'

  'No,' I said. 'Because she was my friend.'

  Piper

  I

  had failed.

  That's what I thought, when I looked down at you, battered and buttressed, a fountain of a chest tube blooming out from beneath your fifth rib on the left side. I had been asked by my best friend to help her conceive, and this was the outcome. After the wrenching question about whether or not you belonged in this world, it seemed that you were giving Charlotte your own answer. Without saying a word, I walked up to Charlotte, who was staring down at you as you slept, as if glancing away for even a moment might give you incentive to code again.