Handle With Care

  '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

  I

  t 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.

  I had held my hands over the bowl of my belly. 'I don't want her to suffer.'

  Piper sighed. 'I don't want you to suffer.'

  I thought of the conversation Sean and I had had after we left the geneticist's office the day before, after being told you had - at worst - lethal OI and - at best - severe OI. I had found him in the garage, sanding the rails of the cradle he'd been making in anticipation
of your arrival. It's like butter, he said, holding out the narrow piece of wood. Feel it. But to me, it looked like a bone, and I couldn't bring myself to touch it. 'Sean doesn't want to do it,' I said.

  'Sean isn't pregnant.'

  I asked you how an abortion was performed, and I asked you to be honest. I had pictured being on the plane, having flight attendants ask me when I was due, whether it was a boy or a girl, those same flight attendants not making eye contact on the flight home. 'What would you do?' I asked her.

  She hesitated. 'I'd ask myself what scares me the most.'

  That's when I looked up at her, the one question on my lips that I had not been brave enough to ask Sean, or Dr Del Sol, or even myself. 'What if I can't love her?' I whispered.

  Piper smiled at me, then. 'Oh, Charlotte,' she said. 'You already do.'

  Marin

  T

  he defense called Dr Gianna Del Sol to the stand, to establish that there was nothing she would have done differently if she'd been the primary physician to treat Charlotte instead of the referral. But when they called Dr R. Romulus Wyndham, an OB and bioethicist with a list of credentials that took a half hour to run through, I started to worry. Not only was Wyndham smart but he was movie-star pretty, and he had the jury eating out of his hand. 'Some tests that flag abnormality early are false positives,' he said. 'In 2005, for example, a team from Reprogenetics kept growing fifty-five embryos that were diagnosed as abnormal during preimplantation genetic diagnosis. After a few days, they were shocked to find out that forty-eight percent of them - nearly half - were normal. Which means there's evidence that embryos with genetically flawed cells might heal themselves.'

  'Why might that be medically important to a physician like Piper Reece?' Booker asked.

  'Because it's proof that termination decisions made too early might not be prudent.'

  As Booker took his seat, I rose in one smooth motion. 'Dr Wyndham, that study you just cited - how many of those embryos had osteogenesis imperfecta?'

  'I . . . I don't know that any of them did.'

  'What was the nature of the abnormality, then?'

  'I can't say, precisely--'

  'Were they major abnormalities?'

  'Again, I'm not--'

  'Isn't it true, Dr Wyndham, the study could have been showing embryos with very minor abnormalities that corrected themselves?'

  'I suppose so.'

  'There's also a difference between waiting to see what happens to a days-old embryo and a weeks-old fetus, isn't there, in terms of the point when you can safely and legally terminate a pregnancy?'

  'Objection,' Guy Booker said. 'If I can't run a pro-life rally in court, she can't run a pro-choice rally.'

  'Sustained,' the judge said.

  'Isn't it true that if doctors followed your wait-and-see approach and withheld information about fetal conditions, it might make it harder to terminate a pregnancy - logistically, physically, and emotionally?'

  'Objection!' Guy Booker called out again.

  I walked toward the bench. 'Please, Your Honor, this isn't about abortion rights. It's about the standard of care that my client should have received.'

  The judge pursed his lips. 'All right, Ms. Gates. But make your point fast.'

  Wyndham shrugged. 'Any obstetrician knows how hard it is to counsel patients with fetal abnormalities to terminate pregnancies when, in one's medical opinion, the baby won't survive. But it's part of the job.'

  'It might be part of Piper Reece's job,' I said. 'But that doesn't mean she did it.'

  We had a two-hour recess for lunch, because Judge Gellar had to go to the DMV to apply for a motorcycle license. Apparently, according to the clerk of the court, he planned to take a Harley cross-country next summer during his month off the bench. I wondered if that was what had made him dye his hair: black went better with leather.

  Charlotte left the minute court was recessed, so that she could visit you at the hospital. I hadn't seen Sean or Amelia since this morning, so I stepped out onto the janitor's loading dock, a door most reporters didn't know existed.

  It was one of those late September days that felt like the long fingers of winter tugging the hem of New Hampshire - cold, bitter, with a biting wind. And yet, there still seemed to be a big crowd gathered on the front steps, which I could only just make out from where I was standing. A custodian pushed out the door and stood beside me to light up a cigarette. 'What's going on up there?'

  'Freaking circus,' he said. 'That case about the kid with the funky bones.'

  'Yeah, I've heard it's a nightmare,' I muttered, and hugging my arms to stay warm, I picked my way to the edge of the group in front of the courthouse.

  At the top of the stairs was a man I recognized from the news: Lou St. Pierre, the president of the New Hampshire chapter of the American Association of People with Disabilities. As if that wasn't impressive enough, he had a degree from Yale Law, was a Rhodes scholar, and had won a gold medal in the breast stroke at the Paralympics. Now, he traveled both in his customized wheelchair and in a plane that he piloted himself to fly kids around the country for medical treatment. His service dog sat by the side of St. Pierre's wheelchair, unflinching, while twenty reporters jammed microphones close to its nose. 'You know why this lawsuit is so captivating? It's like a train wreck. You can't tear your eyes away, even though you'd rather not admit these kind of torts exist,' he said. 'Plain and simple: this topic is loaded. This is exactly the kind of lawsuit that makes your skin crawl, because we'd all like to believe that we might love any child that comes into our family - instead of admitting that, in reality, we might not be that accepting. Prenatal testing reduces a fetus to one trait: its disability. It's unfortunate that prenatal testing automatically makes the assumption that a parent might not want a child who's disabled, and that it implies it's unacceptable to live life with some sort of physical impairment. I know plenty of parents in the deaf community who would love a child just like them, for example. One person's disability is another person's culture.'

  As if on cue, his service dog barked.

  'Abortion's already a hot-button issue: Is it okay to destroy a potential life? Termination takes that one step further: Is it okay to destroy this potential life?'

  'Mr St. Pierre,' a reporter called out. 'What about the statistics that say raising a disabled child is stressful to a marriage?'

  'Well, I agree. But there are also statistics that say it's equally stressful to raise a child who's a prodigy or an athletic superstar, and you don't see any doctors advising parents to terminate those pregnancies.'

  I wondered who'd called in the cavalry - Guy Booker, no doubt. Since this case was technically a malpractice suit, he wouldn't invite another attorney from outside his practice to cochair Piper's defense, but he made sure to stage this impromptu news conference all the same to stack his odds of winning.

  'Lou,' another reporter asked. 'Are you going to testify?'

  'That's what I'm doing right now in front of all you good people,' St. Pierre preached. 'And I'm going to keep on talking in the hopes that I can convince anyone who's listening never to bring another lawsuit like this to the great state of New Hampshire.'

  Excellent. I'd lost my case because of a guy who wasn't even a valid witness for the defense. I trudged back toward the loading dock door. 'Who's talking?' the custodian said, grinding his cigarette butt underneath his boot. 'That dwarf?'

  'He's a Little Person,' I corrected.

  The custodian stared at me blankly. 'Isn't that what I just said?'

  The door banged shut behind him. I was freezing, but I waited before following him inside: I didn't feel like making small talk with him the whole way up the staircase. He was, in truth, the perfect example of the greased slope Charlotte and I were dancing down. If it was acceptable to want to terminate a fetus that had Down or OI, what about when medical advances made it possible to see your child's potential beauty, or her level of compassion? What about parents who wanted only a boy and learned they
had conceived a girl? Who would be allowed to set the bars for access, and for rejection?

  As much as it pained me to admit it, Lou St. Pierre was right. People were always saying they'd love any baby that came along, but that wasn't necessarily true. Sometimes, it really did come down to the particular child in question. There had to be a reason why blond-haired, blue-eyed babies got plucked out of adoption agencies like ripe peaches but children of color and children with disabilities might linger in foster homes for years. What people said they would do and what people actually did were two very different things.

  Juliet Cooper had stated it clearly: there really were some babies who were better off not being born.

  Like you.

  And me.

  Amelia

  W

  hatever goodwill I thought might rain down on me from basking in my father's attention after he discovered my little secret quickly disappeared when I started to realize that I had created a new hell of my own making. I was not allowed to go to school, which would have been awesome beyond belief if not for the fact that, instead, I had to sit in a courthouse lobby reading the same newspaper over and over. I had envisioned my parents realizing how badly they'd messed up and falling all over each other to take care of me, the way they did for you when you had a break. But instead, they'd just yelled so loud in the hospital cafeteria that all the residents watched us like we were a reality TV show.

  I wasn't even allowed to visit you during the long lunch recess, when Mom went to the hospital. I guess I had become, officially, A Bad Influence.

  So I have to admit I was a little surprised when my mother showed up with a chocolate milk shake for me before court reconvened. I was sitting in this totally airless conference room, where my father had left me while he went over his testimony with some stupid lawyer. How my mother even found me in this building was a mystery, but when she stepped through the door, I was actually happy to see her.

  'How's Willow?' I asked, because (a) I knew she expected it, and (b) I really did want to know.

  'She's doing okay. The doctor says we might be able to take her home tomorrow.'

  'You kind of lucked out on the free babysitting,' I said.