Authors: Jodi Picoult
In the cafeteria, Sean poured coffee for both of us while Amelia lifted the tiny boxes of cereal and tried to decide between Cheerios and Cinnamon Toast Crunch. We sat at a table. At this hour of the morning, the large room was filled with residents cramming down bananas and lattes before making rounds. “I have to go to the bathroom,” Amelia said.
“Well, you can’t,” Sean flatly replied.
“If you have something to say, Sean, we can wait till she gets back—”
“Amelia, why don’t you tell your mother why you can’t go to the bathroom?”
She looked down at her empty plastic bowl. “He’s afraid…that I’ll throw up again.”
I stared at Sean quizzically. “Has she got a virus?”
“Try bulimia,” Sean said.
I felt rooted to the chair. Surely I’d heard him wrong. “Amelia’s not bulimic. Don’t you think we’d know if Amelia was bulimic?”
“Yeah. Just like we knew that she’s been cutting herself for a year or so now? Shoplifting all kinds of crazy shit—including razor blades—which is how Willow got her hands on one?”
My jaw dropped. “I don’t understand.”
“Nope,” Sean said, leaning back in his chair. “Neither do I. I can’t figure out why a kid who’s got two parents that love her, and a roof over her head, and a pretty damn good life would hate herself enough to do any of that.”
I faced Amelia. “Is it true?”
She nodded, and I felt a twinge in my heart. Had I been blind? Or had I just been so busy watching you break that I failed to notice my older daughter going to pieces?
“Piper stopped by last night to tell me that Amelia might be having a problem. Apparently, we didn’t see it—but Emma has. Repeatedly.”
Piper. At the name, I felt myself go as still as glass. “She came to the house? And you let her in?”
“For God’s sake, Charlotte—”
“You can’t believe anything Piper says. For all you know, this is part of some ploy to get us to drop the lawsuit.” Distantly I realized that Amelia had confessed to the behavior, but that hardly seemed to matter. All I could see was Piper, standing in my house, pretending to be the perfect mother when I’d screwed up.
“You know, I’m starting to see why Amelia might have done this in the first place,” Sean muttered. “You are completely out of control.”
“Brilliant, there’s your old MO,” I said. “Blame Charlotte, because then none of this is your fault.”
“Did you ever consider that you’re not the only victim in the universe?” Sean said.
“Stop it!”
We both turned at the sound of Amelia’s voice.
She had her hands pressed over her ears, and tears in her eyes. “Just stop it!”
“I’m sorry, baby,” I said, reaching out to her, but she jerked away.
“No you’re not. You’re just glad it wasn’t something else that happened to Willow. That’s all you ever care about,” Amelia accused. “You want to know why I cut? Because it hurts less than all of this.”
“Amelia—”
“Just stop pretending you care about me, okay?”
“I’m not pretending.” Her sleeve had slipped, and I could see the scars tracking up to her elbow like some secret linear code. Last summer, Amelia had insisted on wearing long sleeves, even when it was ninety degrees outside. To be honest, I’d thought it was a sign of modesty. In a world where so many girls her age were hardly wearing anything, I thought it was refreshing that she wanted to be covered up. I hadn’t even begun to think that she might be not shy but truly calculating.
And because I didn’t have the words for this—because I knew at this point Amelia would not want to hear anything I’d want to say—I reached for her wrist again. This time, she let me take it. I thought of all the times, as a child, she had fallen off her bike and run crying into the house; of the times I’d lifted her onto the counter to clean gravel out of a scraped knee and to set it healing with a brush of my lips and a Band-Aid; of how once she stood by me as I wrapped your leg in a makeshift magazine splint, wringing her hands and urging me to kiss it and make it better. Now, I drew her arm closer, and pushed up the sleeve, and pressed my lips to the fine white lines that marched up her arm like the marks on a measuring cup, yet one more attempt to count the ways I’d failed.
Piper
The next day, Amelia came to the courthouse. I saw her walking with Sean down the corridor to the room that he’d hidden in before. I wondered if you were still in the hospital, if—given the situation—that might not be a blessing.
I knew I was the witness the jury had been waiting for—either to vilify or to vindicate. Guy Booker had begun his defense by putting the other two OBs who had bought into my practice on the stand as character references: Yes, I was an excellent physician. No, I’d never been sued before. In fact, I’d been named the New Hampshire Obstetrician of the Year by a regional magazine. Malpractice, they said, was a ridiculous charge.
Then it was my turn. Guy had been asking me questions for three-quarters of an hour: about my training, my role in the community, my family. But when he asked me the first question about Charlotte, I could feel the atmosphere in the room change. “The plaintiff testified that you two were friends,” Guy said. “Is that true?”
“We were best friends,” I said, and very slowly, she lifted her head. “I met her nine years ago. In fact, I was the one who introduced her to her husband.”
“Were you aware of the fact that the O’Keefes were trying to conceive a child?”
“Yes. To be honest, I think I wanted them to get pregnant just as much as they wanted it. After Charlotte asked me to be her doctor, we spent months looking at her ovulation cycle and doing everything short of fertility treatments to enhance conception—which is why it was such a thrill when we found out she was going to have a baby.”
Booker entered some papers into evidence and handed them to me. “Dr. Reece, are you familiar with these pages?”
“Yes, they’re notes I made in Charlotte O’Keefe’s medical file.”
“Do you remember them?”
“Not really. I’ve gone back and reviewed my notes, obviously, to prepare for this trial, but there wasn’t something so extraordinary that I remembered it immediately.”
“What do the notes say?” Booker asked.
I read from the pages. “Femur length measuring short at sixth percentile, within the curve of normality. Near field of fetal brain particularly clear.”
“Did that strike you as unusual?”
“Unusual,” I said, “but not abnormal. It was a new machine, and everything else on the fetus looked great. At eighteen weeks, based on that ultrasound, I fully expected the baby to be born healthy.”
“Were you disturbed by the fact that you could see the intracranial contents so well?”
“No,” I said. “We’re trained to see something that looks wrong, not something that looks too right.”
“Did you ever see something that looked wrong on Charlotte O’Keefe’s sonogram?”
“Yes, when we did one at twenty-seven weeks.” I glanced at Charlotte and remembered that moment when I first looked at the screen and tried to make the image into something it wasn’t, the sinking feeling in my stomach when I realized that I would have to be the one to tell her. “There were healing fractures of the femur and tibia, as well as several beaded ribs.”
“What did you do?”
“I told her that she needed to see another doctor, someone in maternal-fetal medicine who was better equipped to deal with a high-risk pregnancy.”
“Was that twenty-seven-week ultrasound the first indication you had that there might be something wrong with the plaintiff’s baby?”
“Yes.”
“Dr. Reece, have you had other patients who were diagnosed with abnormal fetuses in utero?”
“Several,” I said.
“Have you ever advised a couple to terminate the pregnancy?”
“I’ve presented that option to numerous families when malformations
are diagnosed that aren’t compatible with life.”
Once, I had a case where a thirty-two-week fetus had hydrocephaly—so much fluid on the brain that I knew the baby couldn’t be born vaginally, much less survive. The only way to deliver would have been C-section, but the fetal head was so large that the incision would have destroyed the mother’s uterus. She was young, it was her first pregnancy. I offered her the options, and eventually we drained the fluid from the head by piercing it with a needle, causing a cranial hemorrhage. The baby was then delivered vaginally, and died within minutes. I remembered showing up at Charlotte’s house that night with a bottle of wine, and telling her I had to drink the day away. I’d slept on her couch afterward, and had awakened to find her standing over me with a steaming mug of coffee and two Tylenol for my throbbing head. “Poor Piper,” she had said. “You can’t save them all.”
Two years later, that same couple came back to me when they were having another baby—who was born, thank goodness, perfectly healthy.
“Why didn’t you counsel termination for the O’Keefes?” Guy Booker asked.
“There was no definitive reason to believe the baby would be born impaired,” I said, “but even beyond that, I never thought termination would be an option for Charlotte.”
“Why not?”
I looked up at Charlotte. Forgive me, I thought.
“For the same reason she didn’t agree to amniocentesis when we thought there was a risk of Down syndrome,” I said. “She’d already told me she wanted this baby, no matter what.”
Charlotte
It was hard to sit here and listen to Piper giving a chronicle of our friendship. I imagine it had been just as hard for her when I had been the witness. “Were you close to the plaintiff after she gave birth?” Guy Booker asked.
“Yes. We’d see each other once or twice a week, and we talked every day. Our kids would play together.”
“What sorts of things did you do together?”
God, what had we done? It didn’t really matter. Piper had been the kind of friend with whom I didn’t have to fill in the spaces with random conversation. It was okay to just be with her. She knew that sometimes I needed that—to not have to take care of anyone or anything, to simply exist in my own space, adjacent to hers. Once, I remembered, we told Sean and Rob that Piper had a conference in Boston at the Westin Copley Place, and that I was going along to talk about having a baby with OI. In reality, there had been no conference. We checked in to the Westin and ordered room service and watched three sappy movies in a row, until we could not keep our eyes open.
Piper had paid. She always paid—treating me to lunch out, or coffee, or drinks at Maxie’s Pad. When I tried to go dutch, she’d make me put my wallet away. I’m lucky enough to be able to afford it, she said, and we both knew that I wasn’t.
“Did the plaintiff ever have a conversation with you where she blamed you for her daughter’s birth?”
“No,” Piper said. “In fact, the week before I was served, we went shopping together.”
Piper and I had tried on the same red blouse in between Emma’s and
Amelia’s buying fits, and to my shock, it had looked fantastic on both of us. Let’s both get one, Piper had said. We can wear them home and see if our husbands can tell us apart.
“Dr. Reece,” Booker asked, “how has this lawsuit affected your life?”
She sat up a little straighter in the chair. It wasn’t very comfortable; it hurt your back, made you wish you were somewhere else. “I’ve never been sued before,” Piper said. “This was the first time. It’s made me doubt myself, even though I know I didn’t do anything wrong. I haven’t practiced since. Every time I try to get back on that horse…well, it starts moving away from me. I suppose I understand that, even if you’re a good physician, bad things sometimes happen. Bad things that nobody wishes for, and that nobody can explain.” She looked directly at me, so intently that a shiver went down my spine. “I miss being a doctor,” Piper said, “but nowhere near as much as I miss my best friend.”
“Marin,” I whispered suddenly, and my lawyer bent her head toward mine. “Don’t.”
“Don’t what?”
“Don’t…just don’t make it worse for her.”
Marin raised her eyebrow. “You have got to be kidding,” she murmured.
“Your witness,” Booker said, and she rose to her feet.
“Isn’t it a violation of medical ethics to treat someone you know well on a personal level?” Marin asked.
“Not in a small town like Bankton,” Piper said. “If that was the case, I wouldn’t have any patients. As soon as I realized there was a complication, I stepped down.”
“Because you knew you were going to be blamed?”
“No. Because it was the right thing to do.”
Marin shrugged. “If it was the right thing to do, why didn’t you call in a specialist as soon as you saw complications during the eighteen-week ultrasound?”
“There weren’t complications during that ultrasound,” Piper said.
“That’s not what the experts have said. You heard Dr. Thurber say that the standard of care, after an ultrasound reading like Charlotte’s, would have been a follow-up ultrasound, at the very least.”
“That’s Dr. Thurber’s opinion. I respectfully disagree.”
“Hm. I wonder whom a patient would rather listen to: a doctor who’s
established in his field, with numerous awards and citations…or a small-town OB who hasn’t been near a patient in over a year.”
“Objection, Your Honor,” Guy Booker said. “Not only was that not a question but my witness doesn’t need to be vilified.”
“Withdrawn.” Marin walked toward Piper, tapping a pen against her open palm. “You were best friends with Charlotte, right?”
“Yes.”
“What did you talk about?”
Piper smiled a little. “Everything. Anything. Our kids, our pipe dreams. How we sometimes wanted to kill our husbands.”
“But you never bothered to have a conversation about terminating this pregnancy, did you?”
During interrogatories I had told Marin that Piper had not discussed aborting the baby with me. And the way I had remembered it up to this point, that’s exactly the way it was. But memory is like plaster: peel it back and you just might find a completely different picture.
“Actually,” Piper said, “we did.”
Although Piper and I were best friends, we didn’t touch very often. A quick hug sometimes, a pat on the back. But we weren’t like teenage girls, who walk with their arms twined around each other. Which was why it felt so strange to be sitting beside her on a couch, her arm wrapped around me while I cried against her shoulder. She was bony, birdlike, when I would have expected her to be strong and fierce.