The Midwife's Confession

  Noelle smiled and sat down in Emerson’s desk chair. “I’m glad she thinks so. I like her, too.” She nodded toward the notebook. “What are you working on?”

  “Journal.” He grinned with the tiniest hint of embarrassment as he lifted the notebook from the bed and set it on his thigh. His arms were very tan and dusted with dark hair. “Thought I’d give it a try,” he said. “You know, writing down my deepest, darkest thoughts.”

  She loved the answer. What guy journaled? If she hadn’t already pinned him as a rarity, she did now.

  They talked for a while about UNC and his plans for law school. He told her he’d known Tara since they were kids, although Noelle already knew that. Actually, nothing he told her was new; Tara talked about him all the time. Words passed between them, but they could have been any words at all. They could have been talking about the weather or what they’d had for dinner the night before. It wasn’t the words that were being communicated. Something deeper was going on. Noelle felt it and she knew in all those melting, hungry organs of her body that he felt it, too. The way he held her gaze. The way he couldn’t stop smiling at her no matter what he was saying.

  She offered him one of the granola bars and watched his tanned, perfect fingers slit open the wrapper. He took a bite, then licked a crumb from his lips, his blue eyes back on her. She pictured him in her bed, both of them nude. He was between her legs, slipping inside her. She didn’t even try to erase the image from her mind. If he had not been Tara’s, she would have asked him flat out, “Do you want to make love?” because that was her style. Why mince words? And if he were not Tara’s he would say yes. But he was Tara’s and, deep in her heart, she knew he always would be.

  19

  Anna

  Washington, D.C.

  2010

  There were few things I hated as much as having Haley under general anesthesia. For an hour or two or three, it was as though she was gone. I always tried to reassure myself that at least she was in no pain during the time she was out. Yet the goneness, the unreachableness, still scared me.

  She’d received the transfusion a couple of days before and her red blood count had bounced back nicely, but now the surgeon was moving her port from one side of her sore chest to the other and aspirating her bone marrow at the same time. It was never ending, the torture they put her through. Haley’d been stoic when the surgeon told her his plans for today, but I had the feeling she would have chewed him out if Bryan hadn’t been present. She was on her good behavior around Bryan. I actually preferred her feisty side. I liked when she cussed out her doctors. Holding in her anger and frustration wasn’t a good thing. She wanted her Daddy to think she was a sweet girl, though—which she was most of the time, when she wasn’t loaded up on steroids and fighting for her life.

  I didn’t think Haley totally grasped the implications of this bone marrow aspiration. They’d be looking at her MRD level. Minimum Residual Disease. If it was too high, it would mean the chemo was not doing the job and she’d need a bone marrow transplant. Going down that road terrified me. It would mean more grueling chemotherapy plus full-body radiation to destroy her immune system and all that simply to prepare her for the transplant itself. And of course a donor would have to be found. So if I’d been the praying type, I would have been praying for a very low MRD. Very, very low. Although it had required nearly two full years of treatment, chemo alone had taken care of the cancer when she was a toddler. I was hoping for the same outcome this time.

  I made sure the staff had my cell number, then walked down to the cafeteria for a cup of coffee and to check in with my office. Bryan was on a job interview in Bethesda. He’d offered to cancel it when I told him about the surgery, but I encouraged him to go. I’m used to dealing with her alone, I nearly said, but caught myself. Now wasn’t the time to guilt-trip him.

  I didn’t go straight back to the East Wing, but walked instead to the neonatal intensive care unit. It wasn’t the first time since Haley’s relapse that I’d found myself wandering through the halls of the NICU, even though they now had the babies safely tucked away in private rooms and I wasn’t able to see them as I could years ago. I was actually glad. I wanted those babies to be out of sight.

  My work occasionally took me to hospitals, and I always wound up trying to see the babies. The tiniest babies got to me. All those wires and tubes. Those little rib cages pumping air in and out, every breath looking like an effort. They were so vulnerable. Their dependence on others to protect them always cut into me.

  Why did I do that to myself? Why did I look? Why did I search the features of the babies, looking for one who resembled Lily? I sometimes felt as though I couldn’t leave. I needed to stand guard. The nurses couldn’t watch every baby every minute. Even here in the remodeled NICU at Children’s, I searched for evil intentions in the face of each person I saw. That’s when I knew it was time to walk away. I became the director of the Missing Children’s Bureau in part because of my own pain and my passion, but also because I’d been able to hold on to my sanity. That sanity allowed me to distance myself from my own ordeal so that I could be rational as I kept the bureau functioning. That’s why I had to walk away when I began to imagine someone—one of the nurses? A total stranger?—coming into the nursery, detaching one of those fragile, helpless infants from her tubes and wires and slipping out the door with her.

  I’d opted for a home birth with Haley for that reason alone. I’d never been the home-birth type. I wasn’t one of those women who distrusted the medical system or worried about having an unnecessary C-section because my obstetrician wanted to get out on the golf course. But I knew I wanted to give birth to Haley surrounded by trusted friends, by a midwife whose references I’d grilled for hours and a doula I’d known forever.

  My phone rang as I walked toward the oncology unit and I checked the caller ID. Haley’s surgeon. I stopped walking and pressed the button on my Bluetooth. “How is she?” I asked.

  “She’s in recovery,” he said. “She did great.”

  “I’ll be right there.”

  I called Bryan as I started walking again. “She’s in recovery,” I said. I could hear a woman’s voice in the background. Laughter. Was he at a job interview or what? For a moment, I felt a profound stab of distrust. Then I reminded myself once more that he was back in the area for Haley, not for me. I had to remember that.

  “How’d she do?” he asked.

  “They said great.”

  “I’ll be there in a couple of hours,” he said. “Is that okay?”

  “That’s fine.” I heard the coldness in my voice.

  “Can I bring you anything?”

  “No, I’m good.” I walked faster as I neared the recovery room. “I just want to see her.”

  In the recovery room, I slipped my hand into Haley’s. Her puffy little face was at peace for the moment. I sat down next to the bed and watched for the flutter of eyelids. The twitch of her flaky lips. Any sign that she was coming back to me. She’d had to have general anesthesia three times in the past couple of months and each time I worried she would not come back the same girl, that somehow the anesthesia would alter her. But Haley opened her eyes and I saw my brave daughter in her tired smile.

  “Ta da,” she said.

  I touched her cheek. “It went perfectly,” I said. “Just great.”

  A nurse lowered the blue hospital gown a few inches to check the pink skin around the new port in Haley’s chest. “How’s your pain on a scale of one to—”

  “Three,” Haley said before the nurse could finish the question.

  “Three in Haley world is about a six in typical people world,” the nurse said. She knew my daughter. Everyone at the hospital knew her. They called her a “frequent flier,” one of those kids who returned to Children’s again and again.

  “Whatever,” Haley said. She raised her eyes to mine. “Where’s Dad?”

  “On his way.”

  “Good,” she said, and the corners of her mouth curled u
p ever so slightly as she drifted back to sleep.

  I was still sitting with her in her lime-green hospital room an hour later. She’d been awake off and on in the recovery room, but now she slept deeply and I let her. I sat on the sofa that converted to a double bed, doing a little work on my laptop. It was admin stuff, boring but necessary. Every few minutes, I’d stop and look at Haley’s face, her too-pale, too-rounded cheeks and the remnants of a rash on her neck from one of her medications. I’d tucked Fred into her arms, and his big brown plastic eyes stared into space. After a while, a nurse walked into the room. He was African-American, skinny as a toothpick and bespectacled, and I recognized him right away.

  “Tom!”

  “Hey, Ms. Knightly,” he said. “You remember me?”

  “I do!” I stood and gave him a hug. Ten years earlier, Tom had been one of Haley’s nurses, a favorite of both of ours. He looked exactly the same. “I don’t believe you’re still here!” I said.

  “Where am I going to go?” He laughed. “I’ve actually been out for the past few months taking care of some family business—” he rolled his eyes “—and when I came in this morning and saw Haley Hope Knightly on the board…” He shook his head. “I’m sorry she has to go through this again.”

  “Me, too,” I said. I remembered him slipping one time long ago, talking about how he often saw kids come back to the oncology unit years after remission. Strange, the things you remembered. The things that could haunt you. He’d caught himself; I remembered that, too. He’d backpedaled, telling me that most kids did just fine and that he was sure Haley would be one of them.

  I watched as he took Haley’s vital signs and adjusted one of the bags hanging from the IV pole. Then his gaze lit on the framed photograph of Haley and my nieces where it sat on the nightstand. He let out a whoop and picked it up.

  “The cousins!” he said. “Look at them! All grown up.”

  “You remember them?” I asked, surprised.

  “How could I forget them? They’d come barrelin’ into the room like a flock of geese, chattering up a storm, looking more like quintuplets than sisters.”

  “Quadruplets,” I corrected. “There were only four of them. Just seemed like more than that. One set of twins and another two just a couple of years apart.”

  “I have to tell you, I hated the days they visited.” He laughed. “They’d come in all chaotic with their little-girl germs.”

  “Haley loved it, though,” I said.

  Tom pointed to the girl in the center of the photograph. “And this here in the middle is our Miss Haley.” The picture had been taken in the Outer Banks last summer. The redbrick Corolla lighthouse stood in the distance behind the girls who were posing like little vamps in their bathing suits. Madison and Mandy stood on the left. Megan and Melanie on the right. Each of them wore her hair in a dark ponytail slung over her shoulder. Haley stood out from her cousins with her lighter brown hair. Her lighter eyes. She’d been giggling so hard it had been a challenge to get her to hold still long enough for me to take the picture. Haley looked so incredibly healthy in the picture. No sign of the disease that had been planting its seeds in her body at that very moment. She’d insisted on bringing the picture to the hospital with her each time she came. I hadn’t wanted her to. What was it like for her to see that vibrant former version of herself every day?

  “I hear her daddy’s with y’all this time,” Tom said. He’d set down the picture and was writing something in Haley’s chart.

  All sorts of responses ran through my mind, but I decided to be charitable. “He is,” I said. “He was living in California, but he moved back here as soon as I told him Haley’d relapsed.”

  “I remember the last time, how it was just you and her.” He finished writing and looked across Haley’s bed at me. “I don’t remember every single patient but I remember you and Haley real well, because even though she was just a kid, she was like a little adult. She took care of you as much as you took care of her.”

  It might have seemed a weird thing to say except that it was so true. Haley always seemed to sense that there was something broken inside of me, even when I hid that broken ness from the rest of the world. She knew. When she got older and I told her about Lily, she finally understood. She seemed to feel the loss herself.

  “You were a drug rep back then, right?” Tom asked.

  “Uh-huh.” I closed my laptop. “I quit when Haley got sick.” My job had already been on the skids because I refused to travel once Haley was born and travel had been a major part of my work. All those trips to Wilmington. I’d once liked that city. Now I loathed it. “Bryan had just gotten out of the military and was working for IBM.”

  “I don’t remember him at all,” Tom said.

  “Well, he left right after she got sick. He couldn’t handle Haley’s illness.” On top of everything else, I thought.

  “How long were you married?” Tom asked. I saw the ring on his finger. I couldn’t remember if he’d been married the last time or not.

  “Six years.” In my mind I divided those years into three segments. There’d been two wonderful years when it was just the two of us. We lived on base at Fort Belvoir and I’d loved my job doing pharmacology sales. We’d been young, so much younger than we were now. Our relationship had an energy and a heat I could barely remember.

  Then everything went south. Bryan was stationed in Somalia where he’d nearly gotten killed, Lily was born and I had a stroke and nearly died myself. A complete and utter nightmare. Bryan and I settled into a tense, suddenly loveless marriage and he went overseas again, happily I thought. I got pregnant with Haley unintentionally and against doctor’s orders on one of Bryan’s leaves, proof that birth control pills were not one hundred percent effective. Proof you could still make love when you felt dead inside. My pregnancy had all my health care workers in a tizzy, but my blood pressure behaved itself and I felt good and full of hope. For a year after Haley was born, there was a cautious joy in our house. Bryan left the military and took the job with IBM so he could stay closer to home. I remembered thinking he was guarding us, making up for not protecting us well enough the first time around. Our happiness was fragile and we were only beginning to trust it when Haley’s fevers began. Bryan’s retreat was so fast I didn’t see it coming. One minute he was there, the next he was gone. How he could leave Haley and me, cutting himself off from his child, was as unbelievable to me as it was unforgivable.

  “He’s back now, though,” Tom said, “just when she needs him.”

  I nodded. “You’re right,” I said, swallowing my anger. I would have to find a way to put the past aside.

  I was back on my laptop twenty minutes later when Bryan walked into the room. He barely looked at me before heading straight to Haley’s bed. “How’s she doing?” He lightly touched her arm as he peered down at her face.

  “She was asking for you when she first woke up,” I said.

  “Really?” His glasses caught the sunlight from the big windows near Haley’s bed.

  I couldn’t help it. I was touched by the emotion his voice carried in that one word. “Yeah,” I said. “So how did the interview go?”

  He shrugged. “All right, I guess. Time will tell.”

  I remembered the laughter in the background. I didn’t know why that bugged me so much. I’d been sitting with our unconscious daughter while he was laughing with some woman. So? I wasn’t sure exactly what I wanted from him.

  “When will they know her MRD level?” he asked.

  “Probably not for a day or so.”

  “You want to take a break? I can stay with her for a while?”

  I looked at my sleeping daughter. If she’d been awake, I might have taken him up on the offer, but I couldn’t leave her when she looked so drained and weak. I’d let another defenseless child of mine out of my sight. I would never do it again.

  The following evening, Jeff Jackson called with the results from Haley’s bone marrow aspiration. “The chemo’s not doi
ng the job,” he said. “I’m sorry.”

  “Shit.” I was in the cafeteria at Children’s catching up on email while Bryan stayed with Haley in her room. They’d been playing Bananagrams when I left them. I hadn’t expected the news so soon, and it was news I didn’t want to hear. “So we have to go forward with a transplant now?” I asked.

  “We’ll start her on a maintenance level of chemo to hold her steady while we look for a donor. Her MRD’s higher than I’d like to see and we’ll have to move quickly to find a good match. I’ll have you meet with Doug Davis tomorrow. He’s head of the transplant team. He’ll fill you in on what it entails.”

  “Will he test Bryan and me to see if we’re matches?” I asked. “Can we be tested right away?”

  “I’ll let Doug go over all of that with you.”

  “So—” I looked at my laptop screen without really seeing it “—is this ultimately good news or bad?”

  “Neither,” he said. “It just is what it is.”

  I loathed that expression. Imagine if I said it to the family of a missing child. Well, it just is what it is.

  “I want a better answer than that,” I said.

  He hesitated. “I wish it were more positive news,” he said finally. It was the best he could do. The most I could ask of him.

  “All right.” I let him off the hook. I was alone in this. Then I thought of Bryan in the oncology unit, sitting with Haley. I thought of Haley’s new fondness for him. The affection in her voice when she talked about him. How attached she’d become to the very word Dad. I remembered Bryan from the day before when he’d shown up in Haley’s room after the surgery, how he walked directly to her bed. Touched her arm. And I thought maybe, just maybe, I wasn’t alone, after all.