My candle burns at both ends;
It will not last the night;
But ah, my foes, and oh, my friends—
It gives a lovely light!
—EDNA ST. VINCENT MILLAY, "First Fig," A Few Figs from Thistles
I USED TO PRETEND that I was just passing through this family on my way to my real one. It isn't too much of a stretch, really—there's Kate, the spitting image of my dad; and Jesse, the spitting image of my mom; and then there's me, a collection of recessive genes that came out of left field. In the hospital cafeteria, eating rubberized French fries and red Jell-O, I'd glance around from table to table, thinking my bona fide parents might be just a tray away. They'd sob with sheer joy to find me, and whisk me off to our castle in Monaco or Romania and give me a maid that smelled like fresh sheets, and my own Bernese mountain dog, and a private phone line. The thing is, the first person I'd have called to crow over my new fortune would be Kate.
Kate's dialysis sessions run three times a week, for two hours at a time. She has a Mahhukar catheter, which looks just like her central line used to look and protrudes from the same spot on her chest. This gets hooked up to a machine that does the work her kidneys aren't doing. Kate's blood (well, it's my blood if you want to get technical about it) leaves her body through one needle, gets cleaned, and then goes into her body again through a second needle. She says it doesn't hurt. Mostly, it's just boring. Kate usually brings a book or her CD player and headphones. Sometimes we play games. "Go out into the hall and tell me about the first gorgeous guy you find," Kate'll instruct, or, "Sneak up on the janitor who surfs the Net and see whose naked pictures he's downloading." When she is tied to the bed, I am her eyes and her ears.
Today, she is reading Allure magazine. I wonder if she even knows that every V-necked model she comes across she touches at the breastbone, in the same place where she has a catheter and they don't. "Well," my mother announces out of the blue, "this is interesting." She waves a pamphlet she's taken from the bulletin board outside Kate's room: You and Your New Kidney. "Did you know that they don't take out the old kidney? They just transplant the new one into you and hook it up."
"That creeps me out," Kate says. "Imagine the coroner who cuts you open and sees you've got three instead of two."
"I think the point of a transplant is so that the coroner won't be cutting you open anytime soon," my mother replies. This fictional kidney she's discussing resides right now in my own body.
I've read that pamphlet, too.
Kidney donation is considered relatively safe surgery, but if you ask me, the writer must have been comparing it to something like a heart-lung transplant, or some brain tumor removal. In my opinion, safe surgery is the kind where you go into the doctor's office and you're awake the whole time and the procedure is finished in five minutes—like when you have a wart removed or a cavity drilled. On the other hand, when you donate a kidney, you spend the night before the operation fasting and taking laxatives. You're given anesthesia, the risks of which can include stroke, heart attack, and lung problems. The four-hour surgery isn't a walk in the park, either—you have a I in 3,000 chance of dying on the operating table. If you don't, you are hospitalized for four to seven days, although it takes four to six weeks to fully recover. And that doesn't even include the long-term effects: an increased chance of high blood pressure, a risk of complications with pregnancy, a recommendation to refrain from activities where your lone remaining kidney might be damaged.
Then again, when you get a wart removed or a cavity drilled, the only person who benefits in the long run is yourself.
There is a knock on the door, and a familiar face peeks in. Vern Stackhouse is a sheriff, and therefore a member of the same public servant community as my father. He used to come over to our house every now and then to say hi or leave off Christmas presents for us; more recently, he's saved Jesse's butt by bringing him home from a scrape, rather than letting the justice system deal with him. When you're part of the family with the dying daughter, people cut you slack.
Vern's face is like a souffle, caving in at the most unexpected places. He doesn't seem to know whether it's all right for him to enter the room. "Uh," he says. "Hi, Sara."
"Vern!" My mother gets to her feet. "What are you doing at the hospital? Everything all right?"
"Oh yeah, fine. I'm just here on business."
"Serving papers, I suppose."
"Um-hmm." Vern shuffles his feet and stuffs his hand inside his jacket, like Napoleon. "I'm real sorry about this, Sara," he says, and then he holds out a document.
Just like Kate, all the blood leaves my body. I couldn't move if I wanted to.
"What the… Vern, am I being sued?" My mother's voice is far too quiet.
"Look, I don't read them. I just serve them. And your name, it was right there on my list. If, uh, there's anything I…" He doesn't even finish his sentence. With his hat in his hands, he ducks back out the door.
"Mom?" Kate asks. "What's going on?"
"I have no idea." She unfolds the papers. I'm close enough to read them over her shoulder. THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS, it says right across the top, official as can be. FAMILY COURT FOR PROVIDENCE COUNTY. IN RE: ANNA FITZGERALD, A.K.A. JANE DOE.
PETITION FOR MEDICAL EMANCIPATION.
Oh shit, I think. My cheeks are on fire; my heart starts to pound. I feel like I did the time the principal sent home a disciplinary notice because I drew a sketch of Mrs. Toohey and her colossal butt in the margin of my math textbook. No, actually, scratch that—it's a million times worse.
That she gets to make all future medical decisions.
That she not be forced to submit to medical treatment which is not in her best interests or for her benefit.
That she not be required to undergo any more treatment for the benefit of her sister, Kate.
My mother lifts her face to mine. "Anna," she whispers, "what the hell is this?"
It feels like a fist in my gut, now that it's here and happening. I shake my head. What can I possibly tell her?
"Anna!" She takes a step toward me.
Behind her, Kate cries out. "Mom, ow, Mom… something hurts, get the nurse!"
My mother turns halfway. Kate is curled onto her side, her hair spilling over her face. I think that through the fall of it, she's looking at me, but I cannot be sure. "Mommy," she moans, "please."
For a moment, my mother is caught between us, a soap bubble. She looks from Kate to me and back again.
My sister's in pain, and I'm relieved. What does that say about me?
The last thing I see as I run out of the room is my mother pushing the nurse's call button over and over, as if it's the trigger to a bomb.
I can't hide in the cafeteria, or the lobby, or anywhere else that they will expect me to go. So I take the stairs to the sixth floor, the maternity ward. In the lounge, there is only one phone, and it is being used. "Six pounds eleven ounces," the man says, smiling so hard I think his face might splinter. "She's perfect."
Did my parents do this when I came along? Did my father send out smoke signals; did he count my fingers and toes, sure he'd come up with the finest number in the universe? Did my mother kiss the top of my head and refuse to let the nurse take me away to be cleaned up? Or did they simply hand me away, since the real prize had been clamped between my belly and the placenta?
The new father finally hangs up the phone, laughing at absolutely nothing. "Congratulations," I say, when what I really want to tell him is to pick up that baby of his and hold her tight, to set the moon on the edge of her crib and to hang her name up in stars so that she never, ever does to him what I have done to my parents.
I call Jesse collect. Twenty minutes later, he pulls up to the front entrance. By now, Deputy Stackhouse has been notified that I've gone missing; he's waiting at the door when I exit. "Anna, your mom's awfully worried about you. She's paged your dad. He's got the whole hospital being turned inside out."
I take a deep breath. "Then you better go tell her I'm okay," I say, and I jump into the passenger door that Jesse's opened for me.
He peels away from the curb and lights a Merit, although I know for a fact he told my mother he stopped smoking. He cranks up his music, hitting the flat of his hand on the edge of the steering wheel. It isn't until he pulls off the highway at the exit for Upper Darby that he shuts the radio off and slows down. "So. Did she blow a gasket?"
"She paged Dad away from work."
In our family, it is a cardinal sin to page my father away. Since his job is emergencies, what crisis could we possibly have that compares? "Last time she paged Dad," Jesse informs me, "Kate was getting diagnosed."
"Great." I cross my arms. "That makes me feel infinitely better."
Jesse just smiles. He blows a smoke ring. "Sis," he says, "welcome to the Dark Side."
They come in like a hurricane. Kate barely manages to look at me before my father sends her upstairs to our room. My mother whacks her purse down, then her car keys, and then advances on me. "All right," she says, her voice so tight it might snap. "What's going on?"
I clear my throat. "I got a lawyer."
"Evidently." My mother grabs the portable phone and hands it to me. "Now get rid of him."
It takes enormous effort, but I manage to shake my head and the phone into the cushions of the couch.
"Anna, so help me—"
"Sara." My father's voice is an ax. It comes between us, and sends us both spinning. "I think we need to give Anna a chance to explain- We agreed to give her a chance to explain, right?"
I duck my head. "I don't want to do it anymore."
That ignites my mother. "Well, you know Anna, neither do In fact, neither does Kate. But it's not something we have a choice about-'
The thing is, I do have a choice. Which is exactly why I have the one to do this.
My mother stands over me. "You went to a lawyer and made him think this is all about you—and it's not. It's about us. All of us—"
My father's hands curl around her shoulders and squeeze-crouches down in front of me, I smell smoke. He's come from someone else's fire right into the middle of this one, and for this and nothing else. I'm embarrassed. "Anna, honey, we know you think you were something you needed to do—'
"/ don't think that," my mother interrupts.
My father closes his eyes. "Sara. Dammit, shut up." Then he looks at me again. "Can we talk, just us three, without a lawyer having to talk for us?"
What he says makes my eyes fill up. But I knew this was coming—I lift my chin and let the tears go at the same time. "Daddy, I can't—“
"For God's sake, Anna," my mother says. "Do you even realize what the consequences would be?"
My throat closes like the shutter of a camera, so that any air must move through a tunnel as thin as a pin. I'm invisible I think, and realize too late I have spoken out loud.
My mother moves so fast I do not even see it coming. But she slaps my face hard enough to make my head snap backward. She leaves a print that stains me long after it's faded. Just so you know: shame is five-fingered.
Once, when Kate was eight and I was five, we had a fight and decided we no longer wanted to share a room. Given the size of our house, though, and the fact that Jesse lived in the other spare bedroom, we didn't have anywhere else to go. So Kate, being older and wiser, decided to split our space in half. "Which side do you want?" she asked diplomatically. "I'll even let you pick."
Well, I wanted the part with my bed in it. Besides, if you divided the room in two, the half with my bed would also, by default, have the box that held all our Barbie dolls and the shelves where we kept our arts and crafts supplies. Kate went to reach for a marker there, but I stopped her. "That's on my side," I pointed out.
"Then give me one," she demanded, so I handed her the red. She climbed up onto the desk, reaching as high as she could toward the ceiling. "Once we do this," she said, "you stay on your side, and I stay on my side, right?" I nodded, just as committed to keeping up this bargain as she was. After all, I had all the good toys. Kate would be begging me for a visit long before I'd be begging her.
"Swear it?" she asked, and we made a pinky promise.
She drew a jagged line from the ceiling, over the desk, across the tan carpet, and back up over the nightstand up the opposite wall. Then she handed me the marker. "Don't forget," she said. "Only cheats go back on a promise."
I sat on the floor on my side of the room, removing every single Barbie we owned, dressing and undressing them, making a big fuss out of the fact that I had them and Kate didn't. She perched on her bed with her knees drawn up, watching me. She didn't react at all. Until, that is, my mother called us down for lunch.
Then Kate smiled at me, and walked out the door of the bedroom—which was on her side.
I went up to the line she had drawn on the carpet, kicking at it with my toes. I didn't want to be a cheat. But I didn't want to spend the rest of my life in my room, either.
I do not know how long it took my mother to wonder why I wasn't coming to the kitchen for lunch, but when you are five, even a second can last forever. She stood in the doorway, staring at the line of marker on the walls and carpet, and closed her eyes for patience. She walked into our room and picked me up, which was when I started fighting her. "Don't," I cried. "I won't ever get back in!"
A minute later she left, and returned with pot holders, dishtowels, and throw pillows. She placed these at odd distances, all along Kate's side of the room. "Come on," she urged, but I did not move. So she came and sat down beside me on my bed. "It may be Kate's pond," she said, "but these are my lily pads." Standing, she jumped onto a dish-towel, and from there, onto a pillow. She glanced over her shoulder, until I climbed onto the dishtowel. From the dishtowel, to the pillow, to a pot holder Jesse had made in first grade, all the way across Kate's side of the room. Following my mother's footsteps was the surest way out.
I am taking a shower when Kate jimmies the lock and comes into the bathroom. "I want to talk to you," she says.
I poke my head out from the side of the plastic curtain. "When I'm finished," I say, trying to buy time for the conversation I don't really want to have.
"No, now." She sits down on the lid of the toilet and sighs. "Anna… what you're doing—"
"It's already done," I say.
"You can undo it, you know, if you want."
I am grateful for all the steam between us, because I couldn't bear the thought of her being able to see my face right now. "I know," I whisper.
For a long time, Kate is silent. Her mind is running in circles, like a gerbil on a wheel, the same way mine is. Chase every rung of possibility, and you still get absolutely nowhere.
After a while, I peek my head out again. Kate wipes her eyes and looks up at me. "You do realize," she says, "that you're the only friend I've got?"
"That's not true," I immediately reply, but we both know I'm lying.
Kate has spent too much time out of organized school to find a group she fits into. Most of the friends she has made during her long stretch of remission have disappeared—a mutual thing. It turned out to be too hard for an average kid to know how to act around someone on the verge of dying; and it was equally as difficult for Kate to get honestly excited about things like homecoming and SATs, when there was no guarantee she'd be around to experience them. She's got a few acquaintances, sure, but mostly when they come over they look like they're serving out a sentence, and sit on the edge of Kate's bed counting down the minutes until they can leave and thank God this didn't happen to them.
A real friend isn't capable of feeling sorry for you.
"I'm not your friend," I say, yanking the curtain back into place. "I'm your sister." And doing a damn lousy job at that, I think. I push my face into the shower spray, so that she cannot tell I'm crying, too.
Suddenly, the curtain whips aside, leaving me totally bare. "That's what I wanted to talk about," Kate says. "If you don't want to be my sister anymore, that's one thing. But I don't think I could stand to lose you as a friend."
She pulls the curtain back into place, and the steam rises around me. A moment later I hear the door open and close, and the knife-slice of cold air that comes on its heels.
I can't stand the thought of losing her, either.
That night, once Kate falls asleep, I crawl out of my bed and stand beside hers. When I hold my palm up under her nose to see if she's breathing, a mouthful of air presses against my hand. I could push down, now, over that nose and mouth, hold her when she fights. How would that really be any different than what I am already doing?
The sound of footsteps in the hallway has me diving underneath the cave of my covers. I turn onto my side, away from the door, just in case my eyelids are still flickering by the time my parents enter the room. "I can't believe this," my mother whispers. "I just can't believe she's done this."
My father is so quiet that I wonder if maybe I have been mistaken, if maybe he isn't here at all.
"This is Jesse, all over again," my mother adds. "She's doing it for the attention." I can feel her looking down at me, like I'm some kind of creature she's never seen before. "Maybe we need to take her some-where, alone. Go to a movie, or shopping, so she doesn't feel left out. Make her see that she doesn't have to do something crazy to get us to notice her. What do you think?"
My father takes his time answering. "Well," he says quietly, "maybe this isn't crazy."
You know how silence can push in at your eardrums in the dark, make you deaf? That's what happens, so that I almost miss my mother's answer. "For God's sake, Brian… whose side are you on?"
And my father: "Who said there were sides?"
But even I could answer that for him. There are always sides. There is always a winner, and a loser. For every person who gets, there's someone who must give.
A few seconds later, the door closes, and the hall light that has been dancing on the ceiling disappears. Blinking, I roll onto my back—and find my mother still standing beside my bed. "I thought you were gone," I whisper.
She sits down on the foot of my bed and I inch away. But she puts her hand on my calf before I move too far. "What else do you think, Anna?"
My stomach squeezes tight. "I think… I think you must hate me."
Even in the dark, I can see the shine of her eyes. "Oh, Anna," my mother sighs, "how can you not know how much I love you?"
She holds out her arms and I crawl into them, as if I'm small again and I fit there. I press my face hard into her shoulder. What I want, more than anything, is to turn back time a little. To become the kid I used to be, who believed whatever my mother said was one hundred percent true and right without looking hard enough to see the hairline cracks.
My mother holds me tighter. "We'll talk to the judge and explain it. We can fix this," she says. "We can fix everything." And because those words are really all I've ever wanted to hear, I nod.
THERE IS AN UNEXPECTED COMFORT to being at the oncology wing of the hospital, a sense that I am a member of the club. From the kindhearted parking attendant who asks us if it's our first time, to the legions of children with pink emesis basins tucked beneath their arms like teddy bears—these people have all been here before us, and there's safety in numbers.
We take the elevator to the third floor, to the office of Dr. Harrison Chance. His name alone has put me off. Why not Dr. Victor? "He's late," I say to Brian, as I check my watch for the twentieth time. A spider plant languishes, brown, on a windowsill. I hope he is better with people.
To amuse Kate, who is starting to lose it, I inflate a rubber glove and knot it into a coxcomb balloon. On the glove dispenser near the sink is a prominent sign, warning parents not to do this very thing. We bat it back and forth, playing volleyball, until Dr. Chance himself comes in without a single apology for his delay.
"Mr. and Mrs. Fitzgerald." He is tall and rail-thin, with snapping blue eyes magnified by thick glasses, and a tightly set mouth. He catches Kate's makeshift balloon in one hand and frowns at it. "Well, I can see there's already a problem."
Brian and I exchange a glance. Is this coldhearted man the one who will lead us through this war, our general, our white knight? Before we can even backpedal with explanations, Dr. Chance takes a Sharpie marker and draws a face on the latex, complete with a set of wire-rimmed glasses to match his own. "There," he says, and with a smile that changes him, he hands it back to Kate.
I only see my sister Suzanne once or twice a year. She lives less than an hour and several thousand philosophical convictions away.
As far as I can tell, Suzanne gets paid a lot of money to boss people around. Which means, theoretically, that she did her career training with me. Our father died while mowing the lawn on his forty-ninth birthday; our mother never quite sewed herself together in the aftermath. Suzanne, ten years my senior, took up the slack. She made sure I did my homework and filled out law school applications and dreamed big. She was smart and beautiful and always knew what to say at any given moment. She could take any catastrophe and find the logical antidote to cure it, which is what made her such a success at her job. She was just as comfortable in a boardroom as she was jogging along the Charles. She made it all look easy. Who wouldn't want a role model like that?
My first strike was marrying a guy without a college degree. My second and third were getting pregnant. I suppose that when I didn't go on to become the next Gloria Allred, she was justified in counting me a failure. And I suppose that until now, I was justified in thinking that I wasn't one.
Don't get me wrong, she loves her niece and nephew. She sends them carvings from Africa, shells from Bali, chocolates from Switzerland. Jesse wants a glass office like hers when he grows up. "We can't all be Aunt Zanne," I tell him, when what I mean is that I can't be her.
I don't remember which of us stopped returning phone calls first, but it was easier that way. There's nothing worse than silence, strung like heavy beads on too delicate a conversation. So it takes me a full week before I pick up the phone. I dial direct. "Suzanne Crofton's line," a man says.
"Yes." I hesitate. "Is she available?"
"She's in a meeting."
"Please…" I take a deep breath. "Please tell her it's her sister calling."
A moment later that smooth, cool voice falls into my ear. "Sara. It's been a while."
She is the person I ran to when I got my period; the one who helped me knit back together my first broken heart; the hand I would reach for in the middle of the night when I could no longer remember which side our father parted his hair on, or what it sounded like when our mother laughed. No matter what she is now, before all that, she was my built-in best friend. "Zanne?" I say. "How are you?"
Thirty-six hours after Kate is officially diagnosed with APL, Brian and I are given an opportunity to ask questions. Kate messes with glitter glue with a child-life specialist while we meet with a team of doctors, nurses, and psychiatrists. The nurses, I have already learned, are the ones who give us the answers we're desperate for. Unlike the doctors, who fidget like they need to be somewhere else, the nurses patiently answer us as if we are the first set of parents to ever have this kind of meeting with them, instead of the thousandth. "The thing about leukemia," one nurse explains, "is that we haven't even inserted a needle for the first treatment when we're already thinking three treatments down the line. This particular illness carries a pretty poor prognosis, so we need to be thinking ahead to what happens next. What makes APL a little trickier is that it's a chemoresistant disease."
"What's that?" Brian asks.
"Normally, with myelogenous leukemias, as long as the organs hold up, you can potentially reinduce the patient into remission every time there's a relapse. You're exhausting their body, but you know it will respond to treatment over and over. However, with APL, once you've offered a given therapy, you usually can't rely upon it again. And to date, there's only so much we can do."
"Are you saying," Brian swallows. "Are you saying she's going to die?"
"I'm saying there are no guarantees."
"So what do you do?"
A different nurse answers. "Kate will start a week of chemotherapy, in the hopes that we can kill off the diseased cells and put her into remission. She'll most likely have nausea and vomiting, which we'll try to keep to a minimum with antiemetics. She'll lose her hair."
At this, a tiny cry escapes from me. This is such a small thing, and yet it's the banner that will let others know what's wrong with Kate. Only six months ago, she had her first haircut; the gold ringlets curled like coins on the floor of the SuperCuts.
"She may develop diarrhea. There's a very good chance that, with her own immune system laid low, she will get an infection that will require hospitalization. Chemo may cause developmental delays, as well. She'll have a course of consolidation chemotherapy about two weeks after that, and then a few courses of maintenance therapy. The exact number will depend on the results we get from periodic bone marrow aspirations."
"Then what?" Brian asks.
"Then we watch her," Dr. Chance replies. "With APL, you'll want to be vigilant for signs of relapse. She'll have to come into the ER if she has any hemorrhaging, fever, cough, or infection. And as far as further treatment, she'll have some options. The idea is to get Kate's body producing healthy bone marrow. In the unlikely event that we achieve molecular remission with chemo, we can retrieve Kate's own cells and reinstill them-an autologous harvest. If she relapses, we may try to transplant someone else's marrow into Kate to produce blood cells. Does Kate have any siblings?"
"A brother," I say A thought dawns, a horrible one. "Could he have this, too?"
"It's very unlikely. But he may wind up being a match allogeneic transplant. If not, we'll put Kate on the national registry for MUD—a matched, unrelated donor. However, getting a Transplant from a stranger who's a match is much more dangerous than getting one from a relative-the risk of mortality greatly increases."
The information is endless, a series of darts thrown so fast I cannot feel them sting anymore. We are told: Do not think; just give your child up to us, because otherwise she's going to die. For every answer they give us, we have another question.
Will her hair grow back?
Will she ever go to school?
Can she play with friends?
Did this happen because of where we live?
Did this happen because of who we are?
"What will it be like," I hear myself ask, "if she dies?"
Dr. Chance looks at me. "It depends on what she succumbs to," he explains. "If it's infection, she'll be in respiratory distress and on a ventilator. If it's hemorrhage, she'll bleed out after losing consciousness. If it's organ failure, the characteristics will vary depending on the system in distress. Often there's a combination of all of these."
"Will she know what's happening," I ask, when what I really mean is, How will I survive this?
"Mrs. Fitzgerald," he says, as if he has heard my unspoken question, "of the twenty children here today, ten will be dead in a few years. I don't know which group Kate will be in."
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 corn-rows 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."