Chapter 4 Sarah 1990

The bruise, the size and shape of a clover, was located on Kate's shoulder blade.Jessie found out while the two kids were soaking in the tub. "Mom," he asked, "does that mean she's lucky?" I tried to rub it off at first, thinking it was her mess, but couldn't.I closely examine two-year-old Kate, who stares up at me with wide-open china blue eyes.I asked her, "Does it hurt?" She shook her head. Somewhere in the hallway behind me, Brian was telling me how his day was going.He smelled faintly of smoke. "The guy bought an expensive box of cigars," he said, "and put fifteen thousand dollars in fire insurance on it. It wasn't long before the insurance company got a claim, and the guy said all the cigars were in a series of small fires." Burned out in the fire."

"Did he take it off?" I asked, washing the suds off Jesse's head. Brian leaned against the door and said, "That's right! When the judge ruled that the insurance company accepted the cigar fire insurance, it didn't specify which kind of cigars were burned." "Hey Kate, does this hurt?" Jess pressed his thumbs hard against his sister's bruised shoulder blades. Kate whimpered and staggered into the water, splashing water from the tub on me.I lifted her out of the water and she was as slippery as a fish.Then, I went over her to catch Jesse.Two buff heads bent down to meet, they are a pair of well-matched brother and sister.Jesse looks more like me--thin, dark, sensible.Brian said from the outside we could tell that our family was complete - we had our own counterparts. "Climb out of the tub yourself now." I said to Jesse.

He stood up, and the four-year-old boy thought he was standing in the waterway.As he sailed to the edge of the tub he fell, slamming his knees and burst into tears. I wrapped Jesse in a towel and talked to my husband while reassuring him.This language belongs to married life, like Morse code for telegraphing, filling baths, dinners, and bedtime stories. "Who subpoenaed you?" I asked Brian. "Defendant?" "Plaintiff's lawyer. The insurance company paid him the insurance money and then called the police and arrested him because he committed 24 arson cases. I'm the expert they called in to consult."

Brian was a professional firefighter who could walk into a darkened building and find out where a fire started with a charred cigarette butt or an exposed electrical wire.The source of every catastrophe leaves clues, you just have to know what to look for. "The judge dismissed the lawsuit, didn't he?" "The judge sentenced the defendant to twenty-four years in prison, to be served consecutively," Bryan said.He put Kate on the floor and pulled the pajamas over her head. In my previous life, I was a civil lawyer.I really believed at one point that I wanted to be a lawyer - but that was before I had a crushed handful of violets handed to me by a toddler, before I learned that a child's smile is like a tattoo, an art that cannot be erased .

That drove my sister Susan crazy.She's a financial whiz with a high position at the Bank of Boston, and she thinks I'm wasting my intelligence.However, I think it depends on what work means to you, and I think I'm better off being a mother than a lawyer.I sometimes wonder if it's just me or other women too?Did they figure out where their place was because they had nowhere else to go? I dried Jesse off and looked up to see Brian staring at me. "Will you miss your law career, Sarah?" he asked quietly.I wrapped my son in a towel and kissed the top of his head, "like missing my root canal."

When I woke up the next morning, Brian had left for work.He will be on duty for two days and two nights, and then he will be off for four days, so the cycle is cyclical.I glanced at the clock and saw that it was past nine o'clock.I'm rather surprised my kids didn't wake me up.I put on my pajamas and went downstairs to find Jesse sitting on the floor playing with blocks. "I had breakfast," he said, "and I made you breakfast." Yeah, breakfast cereal soaked in milk spilled all over the kitchen table.Beneath the locker, on a precarious chair that threatened to tip over at any moment, was a box of cornflakes.Milk can be traced from the refrigerator all the way to the bowl on the table. "Where's Kate?"

"Sleep," Jessie said, "I push her and she won't wake up." My child usually has an accurate biological clock.Kate sleeping up so late reminds me of her recent stuffy nose.Maybe she had a cold and looked so tired last night.I went upstairs and called out to her.In her room, she rolls over to me, her newly awakened eyes focused on my face. "It's time to get up." I opened the blinds, let the sun shine on her blanket, and sat her up, stroking her back. "Let's get you dressed." I pulled her pajamas over her head and took them off. Along her spine, a dark mark like a string of small blue jewels was actually a bruise.

"She's anemic, isn't she?" I asked the pediatrician. "Children that age don't get mononucleosis, do they?" Dr. Weney lifted his stethoscope away from Kate's small chest, and pulled her pink dress back. "It could be a viral infection. I'm going to take a little blood from her for testing." Jessie, who was patiently playing with his headless toy soldier Joy, perked up at the news, "Kate, do you know how they draw blood?" "With crayons?" "Use a needle. Use a big, long needle, like a needle..." "Jessie!" I warned.

"A shot?" Kate screamed. "It hurts?" My daughter, she trusts me to tell her when it's safe to cross the street without getting hit by a car.She trusts me to protect her from scary things, big dogs or darkness or the explosion of firecrackers, and she gazes at me expectantly. "Just tiny needles." I assured her. The pediatric nurse came in with a tray of syringes, vials, rubber tourniquets, and Kate started crying.I took a deep breath, "Kate, look at me." Her cries faded to sobs. "Just like a pinch." "Liar." Jesse murmured. Kate relaxes, but only a little.The nurse helped her to lie on the examination table and asked me to hold her by the shoulders.I watched as the needle dug into the white skin of her arm.I heard a sudden cry -- but no blood flowed into the needle.

"I'm sorry, baby," the nurse said, "we have to do it again." She withdrew the needle and pricked again.This time Kate cried louder. Kate struggled with both the first and second needle sticks.By the third time, she was limp and had no strength left.I don't know if I want her to struggle or if I want her to submit. We are awaiting the results of the blood draw.Jessie was lying on the carpet in the waiting room, wondering if he would be infected with the various germs left by all the sick children who came here.I just wish the pediatrician would come out and tell me I could take her home for orange juice and wave the prescription pad in front of me like a magic wand to get me some antibiotics.

We waited an hour before Dr. Winey called us into his office. "There's something wrong with Kate's test," he said. "Her white blood cell count is lower than normal." "What does that mean?" At that moment, I cursed myself for going to law school instead of med school.I tried to figure out what the white blood cells do. "She may be immunocompromised in some way, or maybe it's just a lab error." He stroked Kate's hair, "I thought, just to be on the safe side, I'd refer you to a hematologist at a major hospital for another test. " I thought: You must be joking.But I didn't say it, I watched my hand move, it seemed to have an independent consciousness, and it took the note from Dr. Weney.The note was not the prescription pad I had hoped for, with only one name on it: Elena Farquéd, God Bless Hospital, Department of Hematology/Oncology. "Oncology." I shook my head. "Isn't a tumor just cancer?" I waited for Dr. Winey to assure me that it was just the unit that this doctor served, and I waited for him to explain to me that the blood tests and the cancer ward just shared one unit. Location, nothing. But he didn't say it. The dispatcher at the fire department told me that Brian was on duty.He left the ambulance twenty minutes ago.I hesitated, looking down at Kate, who was slumped in a plastic chair in the hospital waiting room.ambulance mission. I think our lives come to some crossroads where we have to make very big decisions before we understand the issues.It's like glancing at the headlines in the newspaper while waiting at a red light, so you don't see a car crossing the line and cause a car accident.Or you walk into a coffee shop on a whim, and you meet the man you later married, looking for change in his pocket at the counter.Or this: after you've told yourself that it doesn't matter, and after hours of convincing yourself, you tell your husband to come see you. "Call him on the radio," I said, "and tell him we're in the hospital." I take some comfort in having Brian by my side.It was as if we were now a team of guards standing guard, as if we were defense attorneys for the accused on the same front.We've been at God Bless Hospital for three hours, and with each passing minute it's getting harder and harder for me to deceive myself that Dr. Winey was wrong.Jesse fell asleep in the plastic chair.Kate had another blood draw that left her wailing in agony, and also had a chest x-ray because I mentioned she had a cold. "Five months," Brian answered cautiously to the resident sitting in front of him, holding a splint for notes.Then he looked at me and asked, "Did she roll over at five months?" "Supposedly." The doctor has asked us a lot of questions, from what we were wearing the night we were pregnant with Kate to when she started using her own spoon. "Her first words?" he asked. Brian smiled, "Fuck." "What time do I want to ask?" "Oh." He frowned. "I think it was when she was almost a year old." "Excuse me," I said, "could you please tell me the importance of these questions?" "Mrs. Fitzgerald, these are just medical records. We want to know everything we can about your daughter so we can understand what's wrong with her." "Mr. and Mrs. Fitzgerald?" A young lady in a white robe came over. "I am the doctor who draws blood from the veins. Dr. Farquad asked me to do a coagulation test for Kate." Kate heard her name being said, sat up in my lap, and blinked.She glanced at the white robe, and quietly hid her arms in the clothes. "Can you prick her finger?" "No, it's really the easiest way." It occurred to me that when I was pregnant with Kate, she hiccupped.At one point it lasted several hours and gave me stomach cramps.Every time she moved in my stomach, even if it was just a slight squirm, it forced me to do things beyond my control. "Do you think," I said calmly, "that's the answer I want to hear? Would you be happy when you go to the cafeteria and order a cup of coffee and they give you a Coke because it's the easiest way? You want to pay by credit card, but the clerk tells you that it's too troublesome and asks you to prepare cash, will you be happy?" "Sarah..." Brian's voice was like a distant wind. "You think, I'm sitting here holding my baby and I don't know what the hell is going on or why I'm doing so many tests, do you think I don't want the easy way? You think this frightened Boy, don't you want this to be over quickly and simply? Since when did healthcare workers choose the easiest way to treat patients?" "Sarah." Brian's hand was on my shoulder, and I realized I was shaking so badly. The next moment, the woman walked away in a huff, her clogs clicking on the tiled floor.As soon as she walked away, I was downcast. "Sarah," Brian said, "what's wrong with you?" "What happened to me? I don't know, Brian, because no one came to tell us what the hell happened..." He threw his arms around me, and Kate was panting between us. "Shh." He whispered.He told me that nothing will happen, don't worry too much.For the first time in my life I didn't believe him. Dr. Farquaid, who had not been seen for several hours, suddenly appeared. "I heard there was something wrong with the coagulation test." She pulled up a chair and sat across from us. "Kate has abnormal numbers on various blood counts. Her white blood count is low - one point three, Her hemoglobin was 7.5, her hematocrit was 18.4, her platelets were 81,000, and her neutrophils were 0.6, numbers that sometimes point to an autoimmune disease. But Kate also showed 12 percent promyelocytes, 5 percent blasts, which point to leukemia symptoms." "Leukemia?" I was dumbfounded.The noun rolled out of my mouth like a slippery boiled egg. Dr. Farquad nodded, "It's blood cancer." Brian stared at her without moving his eyes, "What do you mean?" "Imagine the bone marrow as a childcare center for cells. A healthy body makes blood cells that live in the bone marrow until they're mature enough to go out to fight disease, or clot, carry oxygen, do what they're supposed to do. People with leukemia People are like the door to a childcare center that opens too early. Immature blood cells stop circulating and cannot do the work they are supposed to do. It is not surprising to find promyelocytes, or immature white blood cells, on your complete blood count. But when we examined Kate's promyelocytes under the microscope, they were deformed." She took turns looking at the couple, "I'll take Kate's bone marrow to be sure, but it looks like Kate has acute promyelocytes Leukemia." My tongue is stuck under the weight of the question.After a while, Brian let out an unnatural sound from his throat, "Will she...will she die?" I want to shake Dr. Farquad.I want to tell her that if she can take back what she just said, I will draw Kate's blood for a coagulation test myself. "Acute promyelocytic leukemia, APL, is a rare subgroup of myeloid leukemia. Only 1,200 people a year are diagnosed with the disease. Patients with APL who are treated as soon as they are detected have a survival rate of about Twenty to thirty percent." I push that number out of my head and just remember what I want to hear. "It's curable," I said. "Yes. With aggressive treatment, people with myeloid leukemia survive from nine months to three years." Last week, I stood at the door of Kate's room and saw her sleeping clutching a soft blanket, which she was used to, and which gave her a familiar sense of security, and which she could hardly go to bed without.That's when I whispered to Brian: You mark my words, she will never give up that blanket, I will sew it into the lining of her wedding dress. "Bone marrow must be drawn. We will give her a small amount of general anesthetic and keep her quiet. We will also draw her blood while she sleeps for coagulation tests." The doctor leaned forward sympathetically, "You know, every day There are miracles of children overcoming the disease." "Okay," said Brian, clasping his hands as if about to play a game of football. "Okay!" Kate's head moved away from my shirt.Her cheeks were flushed, and her expression was alert. This is a misunderstanding.The doctor examines someone else's unfortunate glass tube of blood.Look at my child, with her glossy curls flowing and her smile flying like a butterfly - it's definitely not a face that's due to die! I have known her for only two years.But if each memory, each moment, is laid out end to end—they stretch forever. Lying in bed at night, Brian was in the shape of an obelisk in the gloom.We hadn't spoken for hours, but I knew he was as lucid as I was. This happened between us last week after I yelled at Jesse, it happened yesterday, and it happened not too long ago.This happened because, at the grocery store, I didn't get the M&Ms that Kate asked for.This happens because, for a moment or two, I wonder what my life would be like without the kids.This happens because, I don't know how far I can take it. "Do you think we did it to her?" Brian asked. "Did we kill her?" I turned to him, "How did we kill her?" "Maybe it's our genes or something." I didn't answer. "Tianyou Hospital doesn't know anything." He said dissatisfiedly, "Do you remember the incident when the captain's son broke his left hand, and they put a cast on his right hand?" I look back at the ceiling. "You should know," I said louder than I expected, "I'm not letting Kate die." All around me came horrible sounds—the wail of a wounded animal, a gasp before drowning.Then Brian buried his face in my shoulders, whimpering against my skin.He reached out and hugged me, and kept holding me tight, as if he would lose his balance otherwise. "I'm not letting Kate die!" I repeat, sounding hopeless even to myself.