Authors: Jodi Picoult
“Name?”
“Well, that’s what I’m looking for…”
“I meant your name,” Maisie said.
“Marin Gates.” I swallowed. “It’s the craziest thing,” I said. “I saw a psychic today. I mean, I’m not one of those nutcases who goes to psychics or anything…not that I have a problem with that if it’s something, you know, you like to do every now and then…but anyway, I went to this woman’s house and she told me that someone named Maisie had information about my birth mother.” I forced a laugh. “She couldn’t give me much more detail, but she got that part right, huh?”
“Ms. Gates,” Maisie said flatly, “what can I do for you?”
I bowed my head toward the ground. “I don’t know where to go from here,” I admitted. “I don’t know what to do next.”
“For fifty dollars, I can send you your nonidentifying information in a letter.”
“What’s that?”
“Whatever’s in your file that doesn’t give away names, addresses, phone numbers, birth date—”
“The unimportant stuff,” I said. “Do you think I’ll learn anything from it?”
“Your adoption wasn’t through an agency; it was a private one,” Maisie explained, “so there wouldn’t be much, I imagine. You’d probably find out that you’re white.”
I thought of the adoption decree she’d sent me. “I’m about as sure of that as I am that I’m female.”
“Well, for fifty dollars, I’m happy to confirm it.”
“Yes,” I heard myself say. “I’d like that.”
After I wrote the address where I needed to send my check on the back of my hand, I hung up and watched the children bouncing around like molecules in a heated solution. It was hard for me to imagine ever having a child. It was impossible to imagine giving one up.
“Mommy!” one little girl cried out from the top of a ladder. “Are you watching?”
Last night on the message boards, I had first seen the labels a-mom and b-mom. They weren’t rankings, as I’d first thought—just shorthand for adoptive mom and birth mom. As it turned out, there was a huge controversy over the terminology. Some birth mothers felt the label made them sound like breeders, not mothers, and wanted to be called first mother or natural mother. But by that logic, my mom became the second mother, or the unnatural mother. Was it the act of giving birth that made you a mother? Did you lose that label when you relinquished your child? If people were measured by their deeds, on the one hand, I had a woman who had chosen to give me up; on the other, I had a woman who’d sat up with me at night when I was sick as a child, who’d cried with me over boyfriends, who’d clapped fiercely at my law school graduation. Which acts made you more of a mother?
Both, I realized. Being a parent wasn’t just about bearing a child. It was about bearing witness to its life.
Suddenly, I found myself thinking of Charlotte O’Keefe.
Piper
The patient was about thirty-five weeks into her pregnancy and had just moved to Bankton with her husband. I hadn’t seen her for any routine obstetric visits, but she’d been slotted into my schedule during my lunch break because she was complaining of fever and other symptoms that seemed to me like red flags for infection. According to the nurse who’d done the initial history, the woman had no medical problems.
I pushed open the door with a smile on my face, hoping to calm down what I was sure would be a panicking mother-to-be. “I’m Dr. Reece,” I said, shaking her hand and sitting down. “Sounds like you haven’t been feeling too well.”
“I thought it was the flu, but it wouldn’t go away…”
“It’s always a good idea to get something like that checked out when you’re pregnant anyway,” I said. “The pregnancy’s been normal so far?”
“A breeze.”
“And how long have you been having symptoms?”
“About a week now.”
“Well, I’ll give you a chance to change into a robe, and then we’ll see what’s going on.” I stepped outside and reread her chart while I waited a few moments for her to change.
I loved my job. Most of the time when you were an obstetrician, you were present at one of the most joyous moments of a woman’s life. Of course, there were incidents that were not quite as happy—I’d had my share of having to tell a pregnant woman that there’d been a fetal demise; I’d had surgeries where a placenta accreta led to DIC and the patient never regained consciousness. But I tried not to think about these; I liked to focus
instead on the moment when that baby, slick and wriggling like a minnow in my hands, gasped its way into this world.
I knocked. “All set?”
She was sitting on the examination table, her belly resting on her lap like an offering. “Great,” I said, fitting my stethoscope to my ears. “We’ll start by listening to your chest.” I huffed on the metal disk—as an OB I was particularly sensitive to cold metal objects being placed anywhere on a person—and set it gently against the woman’s back. Her lungs were perfectly clear; no rasping, no rattles. “Sounds fine,” I said. “Now let’s check out your heart.”
I slid aside the neckline of the gown to find a large median sternotomy scar—the vertical kind that goes straight down the chest. “What’s that from?”
“Oh, that’s just my heart transplant.”
I raised my brows. “I thought you told the nurse that you didn’t have any medical problems.”
“I don’t,” the patient said, beaming. “My new heart’s working great.”
Charlotte didn’t start seeing me as a patient until she was trying to get pregnant. Before that, we were still just moms who made fun of our daughters’ skating coaches behind their backs; we’d save seats for each other at school parent nights; occasionally we’d get together with our spouses for dinner at a nice restaurant. But one day, when the girls were playing up in Emma’s room, Charlotte told me that she and Sean had been trying to get pregnant for a year, and nothing had happened.
“I’ve done it all,” she confided. “Ovulation predictors, special diets, Moon Boots—you name it.”
“Have you seen a doctor?” I asked.
“Well,” she said. “I was thinking about seeing you.”
I didn’t take on patients I knew personally. No matter what anyone said, you couldn’t be an objective physician if it was someone you loved lying on your operating table. You could argue that the stakes for an OB were always high—and there’s no question I gave 100 percent every time I walked into a delivery—but the stakes were just that tiny bit higher if the patient was personally connected to you. If you failed, you were not just failing your patient. You were failing your friend.
“I don’t think that’s the greatest idea, Charlotte,” I said. “It’s a tough line to cross.”
“You mean the whole you’ve-got-your-hand-up-my-cervix-now-sohow-can-you-look-me-in-the-eye-when-we-go-shopping part?”
I grinned. “Not that. Seen one uterus, seen them all,” I said. “It’s just that a physician should be able to keep her distance, instead of being personally involved.”
“But that’s exactly why you’re perfect for me,” Charlotte argued. “Another doctor would try to help us conceive but wouldn’t really give a damn. I want someone who cares beyond the point of professional responsibility. I want someone who wants me to have a baby as much as I want to.”
Put that way, how could I deny her? I called Charlotte every morning so that we could dissect the letters to the editor in the local paper. She was the first one I ran to when I was fuming at Rob and needed to vent. I knew what shampoo she used, which side of her car the gas tank was on, how she took her coffee. She was, simply, my best friend. “Okay,” I said.
A smile exploded on her face. “Do we start now?”
I burst out laughing. “No, Charlotte, I’m not going to do a pelvic exam on my living room floor while the girls are playing upstairs.”
Instead, I had her come to the office the following day. As it turned out, there was no medical reason that she and Sean were having trouble getting pregnant. We talked about how eggs decline in quality after women hit their thirties, which meant it might take longer to happen—but could still happen. I got her started on folic acid and on tracking her basal body temperature. I told Sean (in what had to have been his favorite conversation with me to date) that they should have sex more often. For six months, I tracked Charlotte’s menstrual calendar in my own appointment book; I’d call on the twenty-eighth day and ask if she’d started her period—and for six months, she had. “Maybe we should talk about fertility drugs,” I suggested, and the next month, just before her appointment with a specialist, Charlotte got pregnant the old-fashioned way.
Considering how long it took, the pregnancy itself was uneventful. Charlotte’s blood tests and urine cultures always came back clean; her blood pressure was never elevated. She was nauseated round the clock, and she’d call me after throwing up at midnight to ask why the hell it was called morning sickness.
At her eleventh week of pregnancy, we heard the heartbeat for the first time. At the fifteenth, I did a quad screen on her blood to check for neural defects and Down syndrome. Two days later, when her results came in, I
drove to her house during my lunch break. “What’s wrong?” she asked, when she saw me standing at the door.
“Your test results. We have to talk.”
I explained that the quad screen wasn’t foolproof, that the test was designed specifically to have a 5 percent screen positive rate, which means that 5 percent of all women who took the test were going to be told that they had a higher than average risk of having a Down syndrome baby. “Based on your age alone, your risk is one in two hundred and seventy of having a baby with Down,” I said. “But the blood test came back saying that, actually, your risk is higher than average—it’s one in one hundred and fifty.”
Charlotte folded her arms across her chest.
“You’ve got a few options,” I said. “You’re scheduled for an ultrasound in three weeks anyway. We can take a look during that ultrasound and see if anything is a red flag. If it does show something, we can send you for a level two ultrasound. If not, we can reduce your odds again to one in two hundred and fifty, which is nearly average, and assume the test was a false reading. But just remember—the ultrasound isn’t one hundred percent peace of mind. If you want absolute answers, you’ll have to have amniocentesis.”
“I thought that could cause a miscarriage,” Charlotte said.
“It can. But the risk of that is one in two hundred and seventy—right now, less than the chance that the baby has Down syndrome.”
Charlotte rubbed a hand down her face. “So this amniocentesis,” she said. “If it turns out that the baby has…” Her voice trailed off. “Then what?”
I knew Charlotte was Catholic. I also knew, as a practitioner, that it was my responsibility to give everyone all the information I had whenever possible. What they chose to do with it, based on their personal beliefs, was up to them. “Then you can decide whether or not to terminate,” I said evenly.
She looked up at me. “Piper, I worked too hard to have this baby. I’m not going to give it up that easily.”
“You should talk this over with Sean—”
“Let’s do the ultrasound,” Charlotte decided. “Let’s just take it from there.”
For all of these reasons, I remember very clearly the first time we saw you on the screen. Charlotte was lying down on the examination table; Sean was holding her hand. Janine, the ultrasound tech who worked at my practice, was taking the measurements before I went in to read the results myself. We would be looking for hydrocephalus, an endocardial cushion defect or abdominal wall defect, nuchal fold thickening, a short or absent
nasal bone, hydronephrosis, echogenic bowel, shortened humerior femurs—all markers used in the ultrasound diagnosis of Down syndrome. I made sure that the machine we used was one that had only recently arrived, brand-new, the ultimate technology at the time.
Janine came into my office as soon as she finished the scan. “I’m not seeing any of the usual suspects for Down,” she said. “The only abnormality is the femurs—they’re in the sixth percentile.”
We got readings like that all the time—a fraction of a millimeter for a fetus might look much shorter than normal and, at the next sonogram, be perfectly fine. “That could be genetics. Charlotte’s tiny.”
Janine nodded. “Yeah, I’m going to just mark it down as something to keep an eye on.” She paused. “There was something weird, though.”
My head snapped up from the file I was writing in. “What?”
“Check out the pictures of the brain when you’re in there.”
I could feel my heart sink. “The brain?”
“It looks anatomically normal. But it’s just incredibly…clear.” She shook her head. “I’ve never seen anything like it.”
So the ultrasound machine was exceptionally good at its job—I could see why Janine would be over the moon, but I didn’t have time to rhapsodize about the new equipment. “I’m going to tell them the good news,” I said, and I went into the examination room.
Charlotte knew; she knew as soon as she saw my face. “Oh, thank God,” she said, and Sean leaned over to kiss her. Then she reached for my hand. “You’re sure?”
“No. Ultrasound isn’t an exact science. But I’d say the odds of having a normal, healthy baby just increased dramatically.” I glanced at the screen, a frozen image of you sucking your thumb. “Your baby,” I said, “looks perfect.”
In my office, we did not advocate recreational ultrasounds—in layman’s terms, that means ultrasounds beyond those medically necessary. But sometime in Charlotte’s twenty-seventh week, she came to pick me up to go to a movie, and I was still delivering a baby at the hospital. An hour later, I found her in my office with her feet propped on the desk as she read a recent medical journal. “This is fascinating stuff,” she said. “‘Contemporary Management of Gestational Trophoblastic Neoplasia.’ Remind me to take one of these the next time I can’t fall asleep.”
“I’m sorry,” I said. “I didn’t think I’d be this late. She made it to seven centimeters and then stopped dead.”
“It’s no big deal. I didn’t really want to see a movie anyway. The baby’s been dancing on my bladder all afternoon.”
“Future ballerina?”
“Or placekicker, if you believe Sean.” She looked up at me, trying to read my face for clues about the baby’s sex.