Beth tried to cleanse her mind of horrific pictures. “I told him the same thing,” she said. “This morning.”
“So we agree.”
“He’s a grown man,” Beth said.
“She’s a grown woman,” Marie said, and began to cry openly, making no effort to sponge away the tears with her thick serviette. “She is all I have. And she has been through so much. I love her so much.”
Beth said, “So do I, Marie. Not like you do. But I’ve spent at least three days a week with her, for nearly seven months. She’s very dear to me.”
They lined the glasses up, like little chess pieces. After three Mahatmas—or whatever Marie had called them—Beth knew she couldn’t drive home. At Marie’s invitation, she rode back in a cab with her to her apartment for a nap, to be followed by some strong coffee. Beth left a message for Pat that she would be home late, then wondered why she had: Pat never got home before one in the morning. She then called Ben’s cell phone to check on Eliza but she got his voice mail.
Eliza had strained her back the previous night, helping to move a girl whose leg and hand and lip had been reattached after a neighbor’s four young dalmatians attacked her. Eliza had taken the morning off, and Beth didn’t want to risk calling the house in case her daughter-in-law had slept in. The baby wasn’t due for at least a month, although Eliza was so big that the other residents teased Dr. Cappadora for getting her dates mixed up.
Marie directed Beth to Sicily’s newly made bed. On Sicily’s bedside table were photos of her father, her mother, and her much-younger self. There was also an enlargement of a photo Beth had taken: Sicily and Vincent were sitting on his porch swing, arguing elaborately with Beth over something—probably to not take the picture. Sicily’s hands were palms-forward in protest; Vincent had buried his face in her neck. Sicily had seen that photo on the digital camera and asked Beth for a print. Beth lay down on the bed and studied the picture: She had disapproved so strongly of the friendship initially. Throughout the early days, she made no secret of that. On a few occasions, she’d been downright chilly. But by the end of the week, they were just so damned charming together. Seeing Sicily so fully happy … for perhaps the first time since she was a child; seeing Vincent so natural, so unguarded, perhaps for the first time since
he
was a child … The mother in her could no more resist that private little snapshot than the photographer could.
Beth closed her eyes and, instantly, she dozed. When her cell phone, in the pocket of her coat, nudged her ribs, Beth took it out and tucked a pillow in its place.
Sometime later, she woke to a loud chime in a room that was dark except for the lights from the concrete cliffs outside. Breaking the surface of her hard sleep like a swimmer, Beth narrowed her eyes to read the bright little screen. It was from Ben:
GRANDMA: WHERE R U? CHARLES VINCENT CAPPADORA. BABY FINE. MAMA 2!
Eliza’s back pains hadn’t been work-related at all! Nearly giggling into the darkness with excitement, Beth texted back that she was already downtown and would be there within the hour. She also wrote:
WHY DID U WAIT SO LONG? DAD THERE?
A grandson. She and Pat had a grandson! Stella had a baby brother! As she sat up and fumbled for Sicily’s bedside lamp, about to call out to Marie, Beth again caught sight of the photo on Sicily’s bedside shelf.
Sicily and Eliza were in the same hospital.
What
, Beth thought,
have I done?
Reluctantly, Hollis Grigsby entered the staff meeting in one of the hospital’s largest and most comfortable conference rooms. The sky outside the floor-to-ceiling windows, gravid with what could only be snow, and so early, was by then fully dark. Hollis opened the door to the sharp, unmistakable smell of Chinese takeout. Evidently, everyone knew that this would not be one of those nights when people got home in time for the seven o’clock Pilates class at the community center. She sat down and said, “I hope some of that has meat, even if it’s mystery meat. There are a few of us left who haven’t gone over to veg and are taking our chances.”
The joke hit the ground like a manhole cover.
Kelli Buoté pushed a carton down past several others toward Hollis, who was spooning up some sticky rice. As she made a big business of exclaiming over the joy of pork, Hollis inventoried the faces around the table—not every member of the team but every discipline, from surgeons to social services, was represented. The only urgent face missing was that of Dr. Cappadora, who had just given birth to a healthy baby boy, providing this doleful day its one sweet note. No one sneaked in a surreptitious glance at a watch—well, these days, it was often a phone. So this was not only obligatory, it was interesting. It should be, Hollis thought, since it was unprecedented.
At least in Hollis’s opinion, Sicily’s dilemma should not continue to be unprecedented. Restricting face transplants to women who already had their families or were past the age of childbearing was expedient but unfair, particularly as those standards did not apply to men. It had been her hope that someone would work up a study that would definitively establish the counter-indications of the anti-rejection drugs on the developing fetus and what alternative medicines might be substituted, at least in the short run of a pregnancy, when the majority of teratogenic events expressed themselves. Most laypeople said that birth defects “occurred” during the first trimester, and it was true that the developing neurological system was most vulnerable to damaging agents during that time. Yet most birth defects were present at the moment of conception, and many of those—which altogether were a small number—were correctible. With other organ-transplant protocols—kidneys being the most common example—the anti-rejection drugs were rarely suspended. Although Hollis considered her knowledge of gynecology and high-risk obstetrics about on the level with that of a good paramedic, she knew that the likeliest complication was an early delivery, forced by a threatened rejection. Kidneys, however, often came from perfect-match donors—some unrelated; many near relatives—so the theoretical likelihood of rejection was smaller in any case. But the sampling for limb and face transplants was still so small, and the black box so large, they nearly overlapped. Although face transplants had accelerated after the first tentative decade, they were still as exotic as heart transplants were in 1978. To Hollis’s shock, she still met people who believed that a transplanted heart would last “a lifetime” in the chest of a forty-year-old man—not perhaps ten years, maybe a few more. Nothing medical science had yet contrived could make a solid-organ transplant last the way a soft-tissue transplant would. Perhaps it just wasn’t possible.
“If there was something definitive we could tell her, it would be so much easier,” said Sira Barathongon, the chief resident, as if reading Hollis’s mind.
“We have told her, over and over, that we believe there is quite possibly substantial risk to the fetus, of birth defect or early spontaneous abortion, from the protocol we have created for her,” Livingston answered. “I’m betting she will go ahead. She was upset, understandably. The procedure is scheduled. Sicily wanted some time to adjust. But we talked last night after the pregnancy test. She’s invested in her face. She’s come too far. She understands what is at stake. She further knows that she can perhaps harvest ova, for later, when she is in a relationship. We’re not dealing with some peasant girl here. Sicily knows her medicine.”
“But listen to the words you just used,” Polly Guthrie put in. “ ‘Possibly substantial risk.’ You don’t even know what kind. From what I see here …” Polly made an open-accordion gesture that encompassed the stacks in front of each of them, which were the materials given to every potential full- or partial-face-transplant candidate and donor family. “The phrase ‘not proven’ is used more than anything else!”
Hollis said, “But I do believe that the way that Imuran can disrupt the synthesis of DNA and RNA and cell division makes an adverse outcome more than a slight possibility.”
“The British study has been considered invalid for years—”
“Only because there cannot be any sort of definitive data without a sampling, and the population is just too small,” Hollis said.
“And what if Sicily should contract an infection during the pregnancy?” asked Tony Coles, a neurological surgeon in his forties. “We have her medical records that show she had her MMRs as a child, but those aren’t foolproof, any more than our foolproof birth control.”
“With any pregnant woman, we proceed as though she’s immune to rubella,” said Dr. Sara Glass. “But that Sicily is not. Of course, there’d be a nuchal translucency inventory at the first opportunity.”
“Why,” Hollis asked, “are we talking about the potential health of the fetus only? Say that the chance she carries on with this pregnancy is small. Fine. But what if she actually does? Isn’t that why we’re here, to discuss the elephant in the room, the pregnancy that might really go forth? Should it, the equal or greater concern is Sicily’s transplant. A full rejection would destroy her emotionally. And, although I think we could fight off a deadly infection, it could kill her.”
There was a long interval during which everyone tore open their chopsticks and applied themselves to their meals. Their agitated cogitation was nearly audible: None of them had ever seen a full-blown rejection.
Hollis had seen only two. Who was the man with the hand? Arthur … Arthur Wilkie. That was it. The dusky red line of blood poisoning, the high, foul smell. There could be no question of taking off only the hand: They’d had to section the arm above the elbow. “It’s better,” Wilkie had said the next day. “It never felt like me. It never felt like it belonged there.” And Hollis was reminded again how the body indubitably had such a mysterious head.
Finally, Livingston said, “Hollis, you’re right. This is a harrowing possibility. Sicily has done so well. Not a sign of an episode. Nothing. No hand tremors. Headaches, but that was stress. No blood-pressure elevation. No increased hair growth. Nothing. We virtually expect—well, at least the beginnings of—a rejection by this point. I can think only of one other time—”
“Marilla Santiago.”
“With so smooth a course,” Livingston finished, nodding. “That’s what I can’t bear. She might be thinking that since she’s doing so well, why couldn’t she have a child? The irony of her own good luck. It might influence her.”
“Yes, but the very fact of her doing so well, I have to say, makes me bold enough to wonder if we actually have some latitude,” said Hollis.
All of them turned toward the two doctors who represented the medical side of the team, Dr. Elizabeth Ahrens and Dr. Andrea Park. Hollis had never noticed how twinlike these two Asian women were—or was she being racist? Each of them had shoulder-length hair cut in a bob, identical black-rimmed plastic glasses, and immaculate complexions.
On the legal pad between them, they had sketched out possible alternative dosages, which Dr. Park now described. Then Dr. Ahrens told Hollis, “I’m not entirely satisfied here. I’m going to mess with this and get back to you. There’s also something else, some research I need to follow up on, and the guy is in Germany. We need a baseline flight plan if she should choose to go through with this and were to have a serious episode in the fifth or sixth month.”
“And that’s where we’re open to legal exposure,” said Joel Brodsky.
Hollis delicately plucked up a few mouthfuls of what she now assumed was lo mein with chicken and thought before she said anything. Technically, the hospital was not liable for anything Sicily Coyne chose or anything that befell her as a result of the transplant—emotionally or physically. Stacks of forms released the University of Illinois, the University of Illinois Chicago Circle Campus, the University of Illinois Chicago Circle Campus Hospital and Clinics, the University of Illinois Chicago Circle Campus Transplant Clinic, the University of Illinois Chicago Circle Campus Department of Psychology, Dr. Hollis Grigsby … her heirs, their heirs and their assigns, the city of Chicago, the known universe … and, at the end of the day, all of those came to nothing in a situation for which there could have been no planning for this foreseen consequence.
“Here,” Brodsky continued, “it points out that should Sicily Coyne willingly or unwillingly fail to present herself on the assigned day each month for her injection … and should a pregnancy result from that failure …”
“She didn’t, though,” Hollis said. “It was the medicine that failed, not Miss Coyne.”
“But she absolves us of any responsibility for any resulting—” Joel went on.
“I think in fact she does absolve us for any result,” said Hollis. “Not in legal terms but in real terms. As Livingston said, Sicily knows her medicine.”
“So our course here is …” Polly Guthrie said. “To counsel when asked? To advise, as Livingston did initially?”
Hollis shook her head. “Our course is to wait,” she said.
CHAPTER FIFTEEN
W
hen Vincent called, I didn’t recognize the number. It was a Chicago exchange. So I picked up without preparing myself and said crisply, “This is Miss Coyne, Coyne Illustration and Design. Please leave a message. I’ll call back sooner rather than later.” I didn’t try to beep.
“Sicily, it’s Vincent,” he said, as I put my hand over the microphone opening. “I’m glad that you didn’t answer, because I need to get this all out before we talk any more, and that might be hard, especially since we haven’t talked for a while. Which is my fault. What I want to say is how sorry I am. It sucks that you had to find this out alone and make this decision alone. It sucks that something so sweet turned out so painful. Maybe I don’t know how you feel, but I think I might know a version of it. Like, thinking you won something you never imagined you would and then finding out you could lose more than you ever imagined you could lose. I’m here in town. You know Eliza had the baby. You might be too sad to see me—”
“I’m not that sad,” I said.
“What? Who’s there?”
“I said, I’m not that sad. There’s nothing to be sad about yet. I suppose I will be soon, but not yet.”