Authors: Jodi Picoult
“I would have taken more images of the chest—looking for rib fractures. I would have measured all the other long bones to confirm that this was a generalized short-bone condition. And at the very least I’d have referred the case to a center with more experience.”
Marin nodded. “What if I told you that Mrs. O’Keefe’s obstetrician did none of those things?”
“Then,” Dr. Thurber said, “I’d say that physician made a very big mistake.”
“Nothing further,” Marin said, and she slipped into the seat beside me. She immediately let out a heavy sigh.
“What’s the matter?” I whispered. “He’s very good.”
“Did it ever occur to you that you’re not the only one with problems?” Marin snapped.
Guy Booker got up to cross-examine the radiologist. “They say hindsight is twenty-twenty, don’t they, Dr. Thurber?”
“So I’ve heard.”
“How long have you testified as an expert witness?”
“For ten years,” the doctor said.
“I’m guessing you don’t do this for free?”
“No, I’m paid, like all expert witnesses,” Thurber replied.
Booker looked at the jury. “Right. There sure seems to be a lot of money flying around these days, isn’t there?”
“Objection,” Marin said. “Does he really expect the witness to answer his rhetorical questions?”
“Withdrawn. Doctor, isn’t it true that osteogenesis imperfecta is very rare?”
“Yes.”
“So a small-town OB, for example, might go through her entire professional life without ever seeing a case?”
“That’s true,” Thurber answered.
“Isn’t it fair to say that only a specialist would have been looking for OI on an ultrasound?”
“There is the old medical saying about hearing hoofbeats and assum
ing it’s a horse instead of a zebra,” Thurber agreed, “but any trained obstetrician should be able to look at an ultrasound and spot red flags. She might not be able to identify what they signify, but she would know them for their abnormality, and would recognize that the patient’s care needs to be taken to the next level.”
“Is there any condition other than osteogenesis imperfecta that can give you such a clear image of the near field of the brain during an ultrasound?”
“The lethal form of congenital hypophosphatasia, but it’s extremely rare and it still wouldn’t have changed the need for the patient to be referred to a tertiary-care center.”
“Dr. Thurber,” Booker said, “do you ever get a particularly clear image of intracranial contents of the skull…on a healthy baby?”
“Occasionally. If the plane of the ultrasound on a particular image happens by chance to go through one of the normal cranial sutures, instead of bone, the interior of the brain will be shown clearly. However, we take multiple pictures of the brain looking at different intracranial structures, and the sutures are very thin. It would be virtually impossible to see multiple pictures of the brain for multiple projections where the transducer manages to hit a suture every single time. If I saw one image that showed the near field of brain very clearly but the other images did not, I would assume that single image had been taken through a cranial suture. In this case, however, all of the images of the brain show the intracranial contents unusually well.”
“How about that femur length? Have you ever measured a short femur during an eighteen-week ultrasound and then seen a perfectly healthy baby delivered?”
“Yes. Sometimes the technologists’ measurement can be off by a hair because the fetus is moving around or in an odd position. They measure two or three times and take the longest axis, but even being a whisker off at eighteen weeks—we’re talking millimeters—can drop the percentile significantly. Many times when we see a borderline-short femur length, it’s just undermeasured.”
Booker walked toward him. “As useful as ultrasound technology is, it’s not an exact science, is it? Certain images might be clearer than others?”
“The clarity with which we see all structures in the fetus is variable, yes. It depends on many things—the size of the mother, the position of
the fetus. There’s a continuum, really. On any given day we might not be able to see them well, or conversely we might be able to see everything clearly.”
“At an eighteen-week ultrasound, Doctor, can you definitively say that a child is going to have Type III OI?”
“You can tell that there’s something wrong skeletally. You can see indicators—like the ones that were in Charlotte O’Keefe’s file. As the gestational age increases, if you see broken bones, you can generally guess that the fetus has Type III OI.”
“Doctor, if Charlotte O’Keefe had been your patient, and you’d seen the results of her eighteen-week ultrasound, and there were no broken bones, you would have recommended she have follow-up care?”
“Based on the short femur length and demineralized calvarium? Absolutely.”
“And once you saw broken bones on a subsequent ultrasound, would you have done what Piper Reece did: immediately refer Mrs. O’Keefe to a maternal-fetal-medicine practitioner at a tertiary-care center?”
“Yes.”
“But would you have conclusively diagnosed Mrs. O’Keefe’s fetus with OI at eighteen weeks, based solely on that first ultrasound?”
He hesitated. “Well,” Thurber said. “No.”
Amelia
Sometimes I wonder what really constitutes an “emergency.” I mean, every teacher in my school knew about the trial and the fact that both of my parents were not only in it but squaring off against each other. The whole state knew, and maybe even the whole country, thanks to the newspaper and television coverage. Surely even if they thought my mother was insane or moneygrubbing, they felt a smidgen of sympathy for me, being trapped in the middle? And yet, I still got yelled at in math for not paying attention. I had a huge English test tomorrow, vocabulary, on ninety words that I was most likely never going to use in my life.
To that end, I was making flash cards for myself. Hypersensitive, I wrote. Too too too sensitive. But wasn’t that the point? If you were sensitive, weren’t you bound to take things too seriously in the first place?
Trepidation: fear. Use it in a sentence: I have trepidations about taking this stupid test.
“Amelia!”
I heard you calling, but I also knew I didn’t have to answer. After all, my mother—or maybe Marin—was paying that nurse who smelled like mothballs to watch over you. This was the second day she’d been here when I got off the bus, and to tell you the truth, I wasn’t impressed. She was watching General Hospital when she should have been playing with you.
“Amelia!” you yelled, louder this time.
I screeched the chair back from my desk and thundered downstairs. “What?” I demanded. “I’m trying to study.”
Then I saw it: Nurse Ratched had barfed all over the floor.
She was leaning against the wall, her face the color of Silly Putty. “I think I ought to go home…,” she wheezed.
Well, duh. I didn’t want to catch the bubonic plague.
“Do you think you can watch Willow till your mother gets back?” she asked.
As if I hadn’t been doing just that my whole life. “Sure.” I hesitated. “You are going to clean it up, first, right?”
“Amelia!” Willow hissed. “She’s sick!”
“Well, I’m not going to do it,” I whispered, but the nurse was already heading to the kitchen to mop up her mess.
“I still have to study,” I said, after we were left alone. “Let me go up and get my notebook and flash cards.”
“No, I’ll go upstairs instead,” you answered. “I kind of want to lie down.”
So I carried you—you were that light—and settled you on the bed with your crutches next to you. You picked up your latest book to start reading.
Scrutinize: to observe carefully.
Stature: the full height of a human.
I glanced at you over my shoulder. You were the size of a three-year-old, even though you were six and a half now. I wondered how small you’d stay. I thought about how there are kinds of goldfish that get bigger when you put them in large ponds and wondered if that would help: what if, instead of sitting in this bed, in this stupid house, I showed you the whole wide world?
“I could quiz you,” you said.
“Thanks, but I’m not ready yet. Maybe later.”
“Did you know Kermit the Frog is left-handed?” you asked.
“No.”
Dissipated: dissolved, faded away.
Elude: to escape from. I wish.
“Do you know how big a grave is when it’s dug?”
“Willow,” I said, “I’m trying to study here. Could you just shut up?”
“Seven feet, eight inches, by three feet, two inches, by six feet,” you whispered.
“Willow!”
You sat up. “I’m going to the bathroom.”
“Great. Don’t get lost,” I snapped. I watched you carefully lever your
crutches so that you could hop your way off the bed. Usually Mom walked you to the bathroom—or, really, hovered—and then privacy kicked in and you booted her out and closed the door. “Do you need a hand?” I asked.
“Nope, just some collagen,” you said, and I almost cracked a smile.
A moment later, I heard the bathroom door lock. Scrupulous, devout, annihilate. Lethargic, lethal, subside. The world would be a much easier place if, instead of handing over superstuffed syllables all the time, we just said what we really meant. Words got in the way. The things we felt the hardest—like what it was like to have a boy touch you as if you were made of light, or what it meant to be the only person in the room who wasn’t noticed—weren’t sentences; they were knots in the wood of our bodies, places where our blood flowed backward. If you asked me, not that anyone ever did, the only words worth saying were I’m sorry.
I made it through Lesson 13 and Lesson 14—devious, aghast, rustic—and glanced down at my watch. It was only three o’clock. “Wiki,” I said, “what time did Mom say she’d be home—” And then I remembered you weren’t there.
You hadn’t been, for a good fifteen or twenty minutes.
No one had to go to the bathroom that long.
My pulse started racing. Had I been so engrossed in learning the definition of arbitration that I hadn’t heard a telltale fall? I ran to the bathroom door and rattled the knob. “Willow? Are you okay?”
There was no answer.
Sometimes I wonder what really constitutes an emergency.
I lifted up my leg and used my foot to break down the door.
Sean
The soup that came out of the vending machine at the courthouse looked—and tasted—just like the coffee. It was my third cup today, and I still wasn’t quite sure what I was drinking.
I was sitting near the window of my hiding place—my biggest accomplishment on this, the second day of the trial. I had planned to sit in the lobby until Guy Booker needed me—but I hadn’t counted on the press. The ones who hadn’t squeezed into the courtroom figured out who I was quickly enough and swarmed, leaving me to back away muttering No comment.
I’d poked through the maze of the courthouse corridors, trying door-knobs until I found one that opened. I had no idea what this room was used for normally, but it was located almost directly above the courtroom where Charlotte was right now.
I didn’t really believe in ESP or any of that crap, but I hoped she could feel me up here. Even more, I hoped that was a good thing.
Here was my secret: in spite of the fact that I had defected to the other side, in spite of the fact that my marriage had crashed on the rocks, there was a part of me that wondered what would happen if Charlotte won.
With enough money, we could send you to a camp this summer, so that you could meet other kids like you.
With enough money, we could buy a new van, instead of repairing the one that was seven years old with spit and glue.
With enough money, we could pay off our credit card debt and the second mortgage we’d taken out after the health insurance bills escalated.
With enough money, I could take Charlotte away for a night and fall in love with her again.
I truly believed that the cost of success for us shouldn’t be the cost of failure for a good friend. But what if we hadn’t known Piper personally, only professionally? Would I have endorsed a case like that against a different doctor? Was it Piper’s involvement I objected to—or the whole lawsuit?
There were so many things we hadn’t been told:
How it feels when a rib breaks, when I’m doing nothing more than cradling you.
How much it hurts to see the look on your face when you watch your older sister skating.
How even the people in a position to help have to cause pain first: the doctors who reset your bones, the folks who mold your leg braces by letting you play in them and get blisters, so that they know what to fix.
How your bones were not the only things that would break. There would be hairline cracks we would not see for years in my finances, my future, my marriage.
Suddenly I wanted to hear your voice. I took out my cell phone and started to dial, only to hear a loud beep as the battery died. I stared down at the receiver. I could go out to the car and get the charger, but that would mean running the gauntlet again. While I was weighing the costs and the benefits, the door to my sanctuary opened, and a slice of noise from the hallway slipped inside, followed by Piper Reece.
“You’ll have to find your own hiding place,” I said, and she jumped.
“You scared me to death,” Piper said. “How did you know that’s what I was doing?”
“Because it’s why I’m here. Shouldn’t you be in court?”
“We took a recess.”
I hesitated, then figured I had nothing to lose. “How’s it going in there?”
Piper opened her mouth, as if she were going to reply, and then shut it. “I’ll let you get back to your phone call,” she murmured, her hand on the doorknob.
“It’s dead,” I said, and she turned around. “My phone.”
She folded her arms. “Remember when there were no cell phones? When we didn’t have to listen to everyone’s conversations?”
“Some things are better left private,” I said.
Piper met my gaze. “It’s awful in there,” she admitted. “The last witness was an actuary who gave estimates on the out-of-pocket cost for Willow’s care, and the grand total, based on her life expectancy.”
“What did he say?”