Authors: Jodi Picoult
“Then make her. Get up on that witness stand and say that you love her.”
“That’s sort of at odds with saying I’d have terminated the pregnancy, isn’t it?”
“I don’t think they’re mutually exclusive,” I said. “You don’t want to lie on the stand. I don’t want you to lie on the stand. But I certainly don’t want you judging yourself before a jury does.”
“How can’t they? You even did it, Marin. You as much as admitted that, if your mother had been like me, you wouldn’t be here today.”
“My mother was like you,” I confessed. “She didn’t have a choice.” I sat down on a desk across from Charlotte. “Just a few weeks after she gave birth to me, abortion became legal. I don’t know if she would have made the same decision if I’d been conceived nine months later. I don’t know if her life would have been any better. But I do know it would have been different.”
“Different,” Charlotte repeated.
“You told me a year and a half ago that you wanted Willow to have opportunities to do things she might not otherwise be able to do,” I said. “Didn’t you deserve the same?”
I held my breath until Charlotte lifted her face to mine. “How long before we start?” she asked.
The jury, which had looked so disparate on Friday, seemed to be a unified body already first thing Monday morning. Judge Gellar had dyed his hair over the weekend, a deep black Grecian Formula that drew my eyes like a magnet and made him look like an Elvis impersonator—never a good image to associate with a judge you are desperate to impress. When he instructed the four cameras that had been allowed in to report on the trial, I almost expected him to break out in a resounding chorus of “Burning Love.”
The courtroom was full—of media, of disability-rights advocates, of people who just liked to see a good show. Charlotte was trembling beside me, staring down at her lap. “Ms. Gates,” Judge Gellar said. “Whenever you’re ready.”
I squeezed Charlotte’s hand, then stood up to face the jury. “Good morning, ladies and gentlemen,” I said. “I’d like to tell you about a little girl named Willow O’Keefe.”
I walked toward them. “Willow’s six and a half years old,” I said, “and she’s broken sixty-eight bones in her lifetime. The most recent one was Friday night, when her mom got home from jury selection. Willow was running and slipped. She broke her femur and had to have surgery to put a rod inside it. But Willow’s also broken bones when she’s sneezed. When she’s bumped into a table. When she’s rolled over in her sleep. That’s because Willow has osteogenesis imperfecta, an illness you might know as brittle bone syndrome. It means she has been and always will be susceptible to broken bones.”
I held up my right hand. “I broke my arm once in second grade. A girl named Lulu, who was the class bully, thought it would be funny to push me off the jungle gym to see if I could fly. I don’t remember much about that break, except that it hurt like crazy. Every time Willow breaks a bone, it hurts just as much as it would if you or I broke a bone. The difference is that hers break more rapidly, and
more easily. Because of this, from her birth, osteogenesis imperfecta has meant a lifetime of setbacks, rehabilitation, therapy, and surgeries for Willow, a lifetime of pain. And what osteogenesis imperfecta has meant for her mother, Charlotte, is a life interrupted.”
I walked back toward our table. “Charlotte O’Keefe was a successful pastry chef whose strength was an asset. She was used to hauling around fifty-pound bags of flour and punching dough—and now every movement of hers is done with finesse, since even lifting her daughter the wrong way can cause a break. If you ask Charlotte, she’ll tell you how much she loves Willow. She’ll tell you her daughter never lets her down. But she can’t say the same about her obstetrician, Piper Reece—her friend, ladies and gentlemen—who knew that there was a problem with the fetus and failed to disclose it to Charlotte so that she could make decisions every prospective mother has the right to make.”
Facing the jury again, I spread my palms wide. “Make no mistake, ladies and gentlemen, this case is not about feelings. It’s not about whether Charlotte O’Keefe adores her daughter. That’s a given. This case is about facts—facts that Piper Reece knew and dismissed. Facts that weren’t given to a patient by a physician she trusted. No one is blaming Dr. Reece for Willow’s condition; no one is saying she caused the illness. However, Dr. Reece is to blame for not giving the O’Keefes all the information she had. You see, at Charlotte’s eighteen-week ultrasound, there were already signs that the fetus suffered from osteogenesis imperfecta—signs that Dr. Reece ignored,” I said.
“Imagine if you, the jury, came into this courtroom expecting me to give you details about this case, and I did—but I held back one critical piece of information. Now imagine that, weeks after you’d rendered your verdict, you learned about this information. How would that make you feel? Angry? Troubled? Cheated? Maybe you’d even find yourself losing sleep at night, wondering if this information, presented earlier, might have changed your vote,” I said. “If I withheld information during a trial, that would be grounds for appeal. But when a physician withholds information from a patient, that’s malpractice.”
I surveyed the jury. “Now imagine that the information I withheld might affect not just the outcome of the jury trial you sat on…but your whole future.” I walked back to my seat. “That, ladies and gentlemen, is exactly what brings Charlotte O’Keefe here today.”
Charlotte
I could feel Piper staring.
As soon as Marin stood and started talking, she had a direct view of me from across the room, where she sat at a table with her attorney. Her gaze was blazing a hole in my skin; I had to turn away to stop it from burning.
Somewhere behind her was Rob. His eyes were on me, too, like pin-pricks, like lasers. I was the vertex, and they were the rays of the angle. Acute, somewhat less than the whole.
Piper didn’t look like Piper anymore. She was thinner, older. She was wearing something we would have made fun of while we were shopping, an outfit we would have consigned to the Skating Moms crowd.
I wonder if I looked different, too—or if that was even possible, given that, the very moment I’d sued her, I’d become someone she never thought I could be.
Marin slipped into her seat beside me with a sigh. “Off and running,” she whispered as Guy Booker rose and buttoned his suit jacket.
“I wouldn’t doubt that Willow O’Keefe’s had—what was it Ms. Gates said?—sixty-eight broken bones. But Willow also had a mad scientist birthday party in February. She’s got a poster of Hannah Montana hanging over her bed, and she got the highest grade on a districtwide reading test last year. She hates the color orange and the smell of cooked cabbage and asked Santa for a monkey last Christmas. In other words, ladies and gentlemen, in many ways Willow O’Keefe is no different from any other six-and-a-half-year-old girl.”
He walked toward the jury box. “Yes, she is disabled. And yes, she has special needs. But does that mean she doesn’t have a right to be
alive? That her birth was a wrongful one? Because that’s what this case is really about. The tort is called wrongful birth for a reason, and believe me, it’s a tough one to wrap your heads around. But yes indeed, this mother, Charlotte O’Keefe, is saying that she wishes her own child had never been born.”
I felt a shock go through me, as sure as lightning.
“You’re going to hear from Willow’s mother about how much her daughter suffers. But you’ll also hear from her father about how much Willow loves life. And you’ll hear him say how much joy that child’s brought into his life, and just what he thinks about this so-called wrongful birth. That’s right. You’re not misunderstanding me. Charlotte O’Keefe’s own husband disagreed with the lawsuit his wife started and refused to be part of a scheme to milk the deep pockets of a medical insurance company.”
Guy Booker walked toward Piper. “When a couple first find out that they’re pregnant, they immediately hope the child will be healthy. No one wants a child to be born less than perfect. But the truth is, there are no guarantees. The truth is, ladies and gentlemen, that Charlotte O’Keefe is in this for two reasons, and two reasons only: to get some money, and to point the finger at someone other than herself.”
There were times when I was baking that I opened the oven at eye level and was hit by a wave of heat so strong and severe that it temporarily blinded me. Guy Booker’s words had the same effect at that moment. I realized that Marin was right. I could say that I loved you and that I wanted to sue for wrongful birth and not contradict myself. It was a little like telling someone, after she’d seen the color green, to completely forget its existence. I could never erase the mark of your hand holding mine, or your voice in my ear. I couldn’t imagine life without you. If I’d never known you, the tale would be different; it would not be the story of you and me.
I had never allowed myself to think that someone might have been responsible for your illness. We had been told that your disease was a spontaneous mutation, that Sean and I weren’t carriers. We had been told that nothing I might have done differently during my pregnancy would have saved you from breaking in utero. But I was your mother, and I had carried you under the umbrella of my heart. I was the one who had summoned your soul to this world; I was the reason you’d wound up in this broken body. If I hadn’t worked so hard to have a baby, you
wouldn’t have been born. There were countless reasons, as far as I could see, that I was to blame.
Unless it was Piper’s fault. If that was the case, then I was off the hook.
Which meant that Guy Booker was also right.
This lawsuit, which I’d filed because of you, which I’d sworn was all about you, was actually all about me.
Do you remember still the falling stars
that like swift horses through the heavens raced
and suddenly leaped across the hurdles
of our wishes—do you recall? And we
did make so many! For there were countless numbers
of stars: each time we looked above we were
astounded by the swiftness of their daring play,
while in our hearts we felt safe and secure
watching these brilliant bodies disintegrate,
knowing somehow we had survived their fall.
-RAINER MARIA RILKE, “FALLING STARS”
Proof:
the part of a recipe where dough is allowed to rise.
Twice, during the baking of bread, proof is required. Yeast is proofed in water and a small bit of sugar to make sure it’s still active before going any further in the recipe. But proofing also describes a step where the dough doubles in size, the moment when it suddenly grows in dynamic proportion to what you started out with.
What makes the dough rise? The yeast, which converts glucose and other carbohydrates into carbon dioxide gas. Different breads proof differently. Some require only a single proofing; others need many. Between these stages, the baker is told to punch down the dough.
It’s no surprise to me that—in baking, and in life—the cost of growth is always a small act of violence.
SUNDAY MORNING STICKY ROLLS
DOUGH
3¾ cups flour
1/3 cup sugar
1 teaspoon salt
2 packages active dry yeast
1 cup heated milk
1 egg
1/3 cup butter, softened
CARAMEL
¾ cup dark brown sugar
½ cup unsalted butter
¼ cup light corn syrup
¾ cup pecan halves
2 tablespoons butter, softened
FILLING
½ cup pecans, chopped
2 tablespoons sugar
2 tablespoons brown sugar
1 teaspoon cinnamon
You once told me that the best part of a lazy Sunday is to wake up and smell something so delicious you follow your nose downstairs. This is one of those recipes that, like most breads, requires you to be thinking ahead—but then again, when wasn’t I thinking ahead for you?
To make the dough, mix together 2 cups of the flour, 1/3 cup sugar, salt, and yeast in a large bowl. Add the heated milk, egg, and 1/3 cup butter, and beat at low speed for a minute. Add flour if necessary to make the dough easier to shape.
On a lightly floured surface, knead dough for 5 minutes. This, I will add, was your favorite part—you would stand on a chair and throw your weight into it. When finished, put the dough into a greased bowl and flip it over once, so the greased side faces up. Cover and let it proof until it doubles in size, about 1½ hours. It’s ready if you poke it and the mark of your finger is left behind.
Caramel comes next: Stirring constantly, heat ¾ cup brown sugar and ½ cup butter to boiling. Remove from the heat and add the corn syrup. Pour the mixture into a 13 by 9 by 2-inch ungreased pan. Sprinkle pecan halves over the mixture.
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
“What 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 at 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 naïve: 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.”