My Sister's Keeper (22 page)

quiet up here; the boys are downstairs washing the engines and doing their
daily maintenance.

“So.” Alexander takes a sip of his coffee. “Anna tells me
that you've both moved out.”

'Yeah. I sort of figured you might want to ask me about that."

“You do realize that your wife is opposing counsel,” he says
carefully.

I meet his eye. “I suppose by that you mean do I realize that I
shouldn't be sitting here talking to you.”

“That only becomes an issue if your wife is still representing
you.”

“I never asked Sara to represent me.”

Alexander frowns. “I'm not sure she's aware of that.”

“Look, with all due respect, this may seem like an incredibly big deal,
and it is, but we have another incredibly big deal going on at the same time.
Our older daughter's been hospitalized and… well, Sara's fighting on two
fronts.”

“I know. And I'm sorry about Kate, Mr. Fitzgerald,” he says.

“Call me Brian.” I cup my hands around my mug. “And I would
like to speak to you… without Sara around.”

He leans back in the folding chair. “How about right now?”

It's not a good time, but it will never be a good time for this.
“Okay.” I take a deep breath. “I think Anna's right.”

At first I'm not sure Campbell Alexander's even heard me. Then he asks,
“Are you willing to tell that to the judge at a hearing?”

I look down at my coffee. “I think I have to.”

By the time Paulie and I responded to this morning's ambulance call, the
boyfriend already had the girl in a shower. She sat on the bottom, her legs
splayed around the drain, fully dressed. Her hair was matted to the front of
her face, but even if it wasn't, I'd have known that she was unconscious.

Paulie got right inside and started to drag her out. “Her name's
Magda,” the boyfriend said. “She's gonna be okay, right?”

“Is she diabetic?”

“What does that matter?”

For Christ's sake. “Tell me what you were using,” I demanded.

“We were just getting drunk,” the boyfriend said. 'Tequila."

He was no more than seventeen. Old enough to have heard the myth that a
shower will bring someone out of a heroin overdose. “Let me explain this
to you. My buddy and I want to help Magda, to save her life. But if you tell me
that she's got alcohol in her system and it turns out that it's a drug instead,
whatever we give her could backfire and make her even worse. You get
that?”

By then, just outside the shower stall, Paulie had wrestled Magda out of her
shirt. There were tracks up and down her arms. “If it's tequila, then
they've been shooting it up. Coma cocktail?”

I took the Narcan out of the paramedic bag and handed Paulie the equipment
for a microdrip. “So, urn,” the boy said, “you're not going to
tell the cops, are you?”

In one quick move, I grabbed him by the neck of his shirt and pushed him up
against the wall. “Are you that fucking stupid?”

“It's just that my parents will kill me.”

“You didn't seem to care much if you killed yourself. Or her.” I
jerked his head toward the girl, who by then was vomiting all over the floor.
“You think life is something you can throw out like a piece of trash? You
think you OD, and get a second chance?”

I was yelling hard into his face. I felt a hand on my
shoulder—Paulie. “Step down, Cap,” he said under his breath.

Slowly I realized that the kid was trembling in front of me, that he really
had nothing to do with the reason I was yelling. I walked away to clear my
head. Paulie finished up with the patient and then came back to me. “You
know, if it's too much, we can cover for you,” he offered. “The
chief'll give you as much time off as you want.”

“I need to work.” Over his shoulder I could see the girl pinking
up; the boy sobbing into his hands beside her. I looked Paulie in the eye.
“When I'm not here,” I explained, “I have to be there.”

The lawyer and I finish up our coffee. “Second cup?” I offer.

“I'd better not. I have to get back to the office.”

We nod at each other, but there is really nothing left to say. “Don't
worry about Anna,” I add. “I'll make sure she gets whatever she
needs.”

'You might want to check in at home, too,“ Alexander says. ”I just
got your son released on PR bail for stealing a judge's Humvee."

He puts his coffee cup in the sink and leaves me holding this information,
knowing sooner or later, it will force me to my knees.

SARA

No MATTER HOW MANY TIMES you drive to the emergency room, it never becomes
routine. Brian carries our daughter in his arms, blood running down her face.
The triage nurse waves us inside, shepherds the other kids to the bank of
plastic chairs where they can wait. A resident comes into the cubicle, all
business. “What happened?”

“She went over the handlebars of her bike,” I said. “She
landed on concrete. There doesn't seem to be any evidence of concussion, but
there's a scalp lac at the hairline of about an inch and a half.”

The doctor lays her down gently on the table, snaps on gloves, and peers at
her forehead. “Are you a doctor or a nurse?”

I try to smile. “Just used to this.”

It takes eighty-two stitches to sew up the gash. Afterward, with a bright
white patch of gauze taped to her head, and a hefty dose of pediatric Tylenol
swimming through her veins, we walk out to the waiting area, hand in hand.

Jesse asks her how many stitches she needed. Brian tells her she was just as
brave as a firefighter. Kate glances at Anna's fresh bandage. “I like it
better when I get to sit out here,” she says.

It starts when Kate screams in the bathroom. I race upstairs and jimmy the
lock to find my nine-year-old standing in front of a toilet spattered with
blood. Blood runs down her legs, too, and has soaked through her underpants.
This is the calling card for APL—hemorrhage in all sorts of masks and disguises.
Kate's had rectal bleeding before, but she was a toddler; she would not
remember. “It's all right,” I say calmly.

I get a warm washcloth to clean her up, and find a sanitary napkin for her
underwear. I watch her try to position the bulk of the pad between her legs.
This is the moment I would have had with her when she got her period; will she
live long enough for that?

“Mom,” Kate says. “It's back.”

“Clinical relapse.” Dr. Chance takes off his glasses and presses
his thumbs to the corners of his eyes. “I think a bone marrow transplant's
the way to go.”

My mind jumps to a memory of an inflatable Bozo punching bag I had when I
was Anna's age; filled with sand at the bottom, I'd whack it only to have it
pop back up.

“But a few months ago,” Brian says, “you told us they were
dangerous.”

“They are. Fifty percent of patients who receive BMTs are cured. The
other half don't survive the chemo and the radiation leading up to the
transplant. Some are killed by the complications they develop after the
transplant's done.”

Brian looks at me, and then speaks the fear that ripples between us.
“Then why would we even put Kate at risk?”

“Because if you don't,” Dr. Chance explains, “she will
die.”

The first time I call the insurance company, they hang up on me by mistake.
The second time, I wait through Muzak for twenty-two minutes before reaching a
customer service representative. “Can I have your policy number?”

I give her the one all municipal employees get, and Brian's Social Security
number. “How can I help you?”

“I spoke to someone there a week ago,” I explain. “My
daughter has leukemia, and needs a bone marrow transplant. The hospital
explained that our insurance company needs to sign off on coverage.”

A bone marrow transplant costs from $100,000 upward. Needless to say, we
don't have that kind of cash lying around. But just because a doctor has
recommended the transplant doesn't mean that our insurance company will agree.

“That sort of procedure needs a special review—”

“Yes, I know. That's where we were a week ago. I'm calling because I
haven't heard back from you yet.”

She puts me on hold, so that she can look up my file. I hear a subtle click,
and then the tinny voice of a recorded operator. If you'd like to make a
call…

“Shit!” I slam down the phone.

Anna, vigilant, pokes her head around the doorway. “You said a bad
word.”

“I know.” I pick up the receiver and hit the redial button. I wind
my way through the touch-tone menu. Finally, I reach a living person. “I
was just disconnected. Again.”

It takes this rep five more minutes to take down all the same numbers and
names and history I have already given her predecessors. “We actually have
reviewed your daughter's case,” the woman says. “Unfortunately, at
this time, we don't think that procedure is in her best interests.”

I feel heat rush to my face. “Is dying?”

In preparation for the bone marrow harvest, I have to give Anna ongoing
growth factor shots, just like I once gave Kate after her initial cord blood
transplant. The intent is to hyper-pack Anna's marrow, so that when it is time
to withdraw the cells, there will be plenty for Kate.

Anna has been told this, too, but all she knows is that twice a day, her
mother has to give her a shot.

We use EMLA cream, a topical anesthetic. The cream is supposed to keep her
from feeling the prick of the needle, but she still yells. I wonder if it hurts
as much as having your six-year-old stare you in the eye and say she hates you.

“Mrs. Fitzgerald,” the insurance company's customer service
supervisor says, "we appreciate where you're coming from. Truly.”

“Somehow, I find that very hard to believe,“ I say. ”Somehow I
doubt that you have a daughter in a life-or-death situation, and that your
advisory board isn't looking solely at the bottom line cost of a
transplant." I have told myself that I will not lose my temper, and
already thirty seconds into this phone call with the insurance company, I have
ceded the battle.

“AmeriLife will pay ninety percent of what's considered reasonable and
customary for a donor lymphocyte infusion. However, should you still choose to
do a bone marrow transplant, we are willing to cover ten percent of the
costs.”

I take a deep breath. “The doctors on your board who recommended
this—what's their specialty?”

“I don't—”

“It’s not acute promyelocytic leukemia, though, is it? Because even an
oncologist who graduated last in his class from some hack medical school in
Guam could probably tell you that a DLI isn't going to work as a cure. That
three months from now, we'll be having this same discussion again. Plus, if
you'd asked a doctor who had any familiarity with my daughter's particular
disease burden, he'd tell you that repeating a treatment that's already been
tried is highly unlikely to produce results in an APL patient, because they
develop a resistance. Which means that AmeriLife is basically agreeing to throw
money down a toilet, but not to spend it on the one thing that might actually
have a chance of saving my child's life.”

There is a pregnant bubble of silence on the other end of the phone.
“Mrs. Fitzgerald,” the supervisor suggests, “it is my
understanding that if you follow this protocol, the insurance company would
have no problems then paying for the transplant.”

“Except that my daughter might not be alive by then to get it. We
aren't talking about a car, where we can try a used part first and if it
doesn't work, get a new one shipped in. We're talking about a human being. A
human being. Do you automatons there even know what the hell that is?”

This time, I'm expecting the click when I am disconnected.

Zanne shows up the night before we are due to go to the hospital to begin
Kate's preparatory transplant regimen. She lets Jesse help her set up her
portable office, takes a phone call from Australia, and then comes into the
kitchen so that Brian and I can catch her up on daily routines. “Anna's
got gymnastics on Tuesday,” I tell her. “Three o'clock. And I expect
the oil truck to come sometime this week.”

“The trash goes out on Wednesday,” Brian adds.

“Don't walk Jesse into school. Apparently, that's anathema for
sixth-graders.”

She nods and listens and even takes notes, and then says she has a couple of
questions. “The fish…”

“Gets fed twice a day. Jesse can do it, if you remind him.”

“Is there an official bedtime?” Zanne asks.

“Yeah,” I reply. “Do you want me to give you the real one, or
the one you can use if you're going to tack on an extra hour as a special
treat?”

“Anna's eight o'clock,” Brian says. “Jesse's ten. Anything
else?”

“Yes.” Zanne reaches into her pocket and takes out a check made
out to us, for $100,000.

“Suzanne,” I say, stunned. “We can't take that.”

“I know how much it costs. You can't cover it. I can. Let me.”

Brian picks up the check and hands it back to her. “Thank you,” he
says. “But actually, we've got the transplant covered.”

This is news to me. “We do?”

“The guys at the station sent out a call to arms, nationwide, and got a
bunch of donations from other firefighters.” Brian looks at me. “I
just found out today.”

“Really?” Inside me a weight lifts.

He shrugs. “They're my brothers,” he explains.

I turn to Zanne and hug her. “Thank you. For even offering.”

“It's here if you need it,” she answers.

But we don't. We are able to do this, at least.

“Kate!” I call the next morning. “It's time to go!”

Anna is curled on Zanne's lap on the couch. She pulls her thumb out of her
mouth but she doesn't say good-bye.

“Kate!” I yell again. “We're leaving!”

Jesse smirks over his Nintendo controls. “Like you'd really take off
without her.”

“She doesn't know that. Kate!” Sighing, I swing up the
stairs toward her bedroom.

The door is closed. With a soft knock, I push it open, and find Kate in the
final throes of making her bed. The quilt is pulled tight enough to bounce a
dime off its middle; the pillows have been fluffed and centered. Her stuffed
animals, relics at this point, sit on the window seat in gradated succession,
tallest to smallest. Even her shoes have been neatly arranged in her closet,
and the mess on her desk has vanished.

“Okay.” I haven't even asked her to clean up.
“Clearly, I'm in the wrong bedroom.”

She turns. “It's in case I don't come back,” she says.

When I first became a parent I used to lie in bed at night and imagine the
most horrible succession of maladies: the bite of a jellyfish, the taste of a
poisonous berry, the smile of a dangerous stranger, the dive into a shallow
pool. There are so many ways a child can be harmed that it seems nearly
impossible one person alone could succeed at keeping him safe. As my children
got older, the hazards only changed: inhaling glue, playing with matches, small
pink pills sold behind the bleachers of the middle school. You can stay up all
night and still not count all the ways to lose the people you love.

It seems to me, now that this is more than just a hypothetical, that a
parent falls one of two ways when told a child has a fatal disease. Either you
dissolve into a puddle, or you take the blow on the cheek and force yourself to
lift your face again for more. In this, we probably look a lot like the
patients.

Kate is semi-conscious on her bed, her central line tubes blooming like a
fountain from her chest. The chemo has made her throw up thirty-two times, and
has given her mouth sores and such bad mucositis that she sounds like a cystic
fibrosis patient. She turns to me and tries to speak, but coughs up phlegm
instead. “Drown,” she chokes out.

Raising the suction tube she's clutching in her hands, I clear out her mouth
and throat. “I'll do it while you rest,” I promise, and that is how I
come to breathe for her.

An oncology ward is a battlefield, and there are definite hierarchies of
command. The patients, they're the ones doing the tour of duty. The doctors
breeze in and out like conquering heroes, but they need to read your child's
chart to remember where they've left off from the previous visit. It is the
nurses who are the seasoned sergeants—the ones who are there when your baby is
shaking with such a high fever she needs to be bathed in ice, the ones who can
teach you how to flush a central venous catheter, or suggest which patient
floor kitchens might still have Popsicles left to be stolen, or tell you which
dry cleaners know how to remove the stains of blood and chemotherapies from
clothing. The nurses know the name of your daughter’s stuffed walrus and show
her how to make tissue paper flowers to twine around her IV stand. The doctors
may be mapping out the war games, but it is the nurses who make the conflict
bearable.

You get to know them as they know you, because they take the place of
friends you once had in a previous life, the one before diagnosis. Donna’s
daughter, for example, is studying to be a vet. Ludmilla, on the graveyard
shift, wears laminated pictures of Sanibel Island clipped like charms to her
stethoscope, because it’s where she wants to retire. Willie, the male nurse,
has a weakness for chocolate and a wife expecting triplets.

One night during Kate’s induction, which I have been awake for so long that
my body has forgotten how to segue into sleep, I turn on the TV while she
sleeps. I mute it, so that the volume won’t disturb her. Robin Leach is walking
through the palatial home of someone Rich and Famous. There are gold-plated
bidets and hand-carved teak beds, a pool in the shape of a butterfly. There are
ten-car garages and red clay tennis courts and eleven roaming peacocks. It’s a
world I can’t even wrap my head around—a life I would never imagine for myself.

Sort of like this one used to be.

I can't even really remember what it was like to hear a story about a mother
with breast cancer or a baby born with congenital heart problems or any other
medical burden, and to feel myself crack down the middle: half sympathetic,
half grateful that my own family was safe. We have become that story,
for everyone else.

I don't realize I'm crying until Donna kneels down in front of me and takes
the TV remote out of my hand. “Sara,” the nurse says, “can I get
you something?”

I shake my head, embarrassed to have broken down, even more ashamed to be
caught. “I'm fine,” I insist.

“Yeah, and I'm Hillary Clinton,” she says. She reaches for my hand
and tugs me upright, drags me toward the door.

“Kate—”

“—will not even miss you,” Donna finishes.

In the small kitchenette where there is coffee brewing twenty-four hours a
day, she fixes a cup for each of us. “I'm sorry,” I say.

“For what? Not being made of granite?”

I shake my head. “It just doesn't end.” Donna nods, and because
she completely understands, I find myself talking. And talking. And when I have
spilled all my secrets, I take a deep breath and realize that I have been
talking for an hour straight. “Oh my God,” I say. “I can't
believe I've wasted so much of your time.”

“It wasn't a waste,” Donna replies. “And besides, my shift
ended a half hour ago.”

My cheeks flame. “You ought to go. I'm sure you have somewhere else
you'd much rather be.”

But instead of leaving, Donna folds me into her ample arms.
“Honey,” she says, “don't we all?”

The door to the ambulatory operating suite yawns open into a small room
packed with gleaming silver instruments—a mouth gilded with braces. The doctors
and nurses she has met are masked and gowned, only recognizable by their eyes.
Anna tugs at me until I kneel down beside her. “What if I changed my
mind?” she says.

I put my hands on her shoulders. “You don't have to do this if you
don't want to, but I know that Kate is counting on you. And Daddy and me.”

She nods once, then slips her hand into mine. “Don't let go,” she
tells me.

A nurse shepherds her in the right direction, onto the table. “Wait'll
you see what we've got for you, Anna.” She draws a heated blanket over her.

The anesthesiologist wipes a red-tinged gauze pad around an oxygen mask.
“Have you ever gone to sleep in a strawberry field?” They work their
way down Anna's body, applying gelled pads that will be hooked to monitors to
track her heart and her breathing. They administer to her while she's lying on
her back, although I know they will flip her over to draw marrow from her
hipbones.

The anesthesiologist shows Anna the accordion mechanism on his equipment.
“Can you blow up that balloon?” he asks, and places the mask over
Anna's face.

All this time, she doesn't let go of my hand. Finally, her grip slackens.
She fights at the last minute, her body already asleep but straining forward at
the shoulders. One nurse holds Anna down; the other restrains me. “It's just
the way the medicine affects the body,” she explains. “You can give
her a kiss now.”

So I do, through my mask. I whisper a thank-you, too. I walk out of the
swinging door and peel off my paper hat and booties. I watch through the
postage-stamp window as Anna is rolled to her side and an impossibly long
needle is lifted from a sterile tray. Then I go upstairs to wait with Kate.

Brian sticks his head into Kate's room. “Sara,” he says,
exhausted, “Anna's asking for you.”

But I cannot be in two places at one time. I hold the pink erne-sis basin up
to Kate's mouth as she vomits again. Beside me, Donna helps lower Kate back
onto her pillow. “I'm a little busy right now,” I say.

“Anna's asking for you,” Brian repeats, that's all. Donna looks
from him to me. “We'll be fine till you get back,” she promises, and
after a moment, I nod.

Anna is on the pediatric floor, one that doesn't have the hermetically
sealed rooms necessary for protective isolation. I hear her crying before I
even enter the room. “Mommy,” she sobs. “It hurts.” I sit
down on the side of the bed and fold her into my arms. “I know,
sweetie.”

“Can you stay here?”

I shake my head. “Kate's sick. I'm going to have to go back.”

Anna pulls away. “But I'm in the hospital,” she says.
“I'm in the hospital!”

Over her head, I glance at Brian. “What are they giving her for
pain?”

“Very little. The nurse said they don't like to overmedicate
kids.”

“That's ridiculous.” When I stand, Anna whimpers and grabs for me.
“Be right back, honey.”

I accost the first nurse I can find. Unlike the staff in oncology, these RNs
are unfamiliar. “She was given Tylenol an hour ago,” the woman
explains. “I know she's a little uncomfortable—”

“Roxicet. Tylenol with codeine. Naproxen. And if it's not on the
doctor's orders call and ask whether it can be put on there.”

The nurse bristles. “With all due respect, Mrs. Fitzgerald, I do this
every day, and—”

“So do I.”

When I go back to Anna's room, I am carrying a pediatric dose of Roxicet,
which will either relieve her aches or knock her out so that she no longer
feels them. I walk in to find Brian's big hands fumbling a Lilliputian clasp on
the back of a necklace, as he hangs a locket around Anna's neck. “I
thought you deserved your own gift, since you were giving one to your sister,”
he says.

Of course Anna should be honored for donating her bone marrow. Of course she
deserves recognition. But the thought of rewarding someone for their suffering,
frankly, never entered my mind. We've all been doing it for so long.

They both glance up when I come through the doorway. “Look at what
Daddy got me!” Anna says.

I hold out the plastic dosage cup, a poor second-best.

Shortly after ten o'clock, Brian brings Anna to Kate's room. She moves
slowly, like an old woman, leaning on Brian for support. The nurses help her
into a mask and gown and gloves and booties so that she can be allowed in—a
compassionate breach of protocol, as children are not usually allowed to visit
protective isolation.

Dr. Chance stands beside the IV pole, holding up the bag of marrow. I turn
Anna so that she can see it. “That,” I tell her, “is
what you gave us.”

Anna makes a face. “It's gross. You can have it.”

“Sounds like a plan,” Dr. Chance says, and the rich ruby marrow
begins to feed into Kate's central line.

I place Anna on the bed. There is room for both of them, shoulder to
shoulder. “Did it hurt?” Kate asks.

“Kind of.” Anna points to the blood running through the plastic
tubes into the slit in Kate's chest. “Does that?”

“Not really.” She sits up a little. "Hey, Anna?”

“Yeah?"

“I'm glad it came from you.” Kate reaches for Anna's hand and
places it just below the central line's catheter, a spot that falls
precariously near her heart.

Twenty-one days after the bone marrow transplant, Kate's white cell counts
begin to rise, proof of engraftment. To celebrate, Brian insists that he is
taking me out to dinner. He arranges for a private-duty nurse for Kate, makes
reservations at XO Cafe, and even brings me a black dress from my closet. He
forgets pumps, so I wind up wearing my scruffy hiking clogs with it.

The restaurant is nearly full. Almost immediately after we are seated, the
sommelier comes to ask if we want wine. Brian orders a Cabernet Sauvignon.