My Sister's Keeper (28 page)

Again, there is the sound of a seal being breached, and then Julia surfs
into the courthouse on a crest of shouts and questions. She smoothes back her
hair, gets her bearings, then looks at me and loses them again.

“I'll find her,” I say. Sara bristles. “No, I will.”
Julia looks at each of us. “Find who?”

“Anna is temporarily absent,” I explain. “Absent?” Julia
says. “As in disappeared?”

“Not at all.” This isn't a lie, either. For Anna to have
disappeared, she would have had to appear in the first place.

I realize that I even know where I am headed—at the same moment that Sara
understands it, too. In that moment she lets me take the lead. Julia grabs my
arm as I am walking toward the door. She shoves my car keys into my hand.
“Now you do understand why this isn't going to work?”

I turn to her. “Julia, listen. I want to talk about what's going on
between us, too. But this isn't the right time.”

“I was talking about Anna. Campbell, she's waffling. She
couldn't even show up for her own court date. What does that say to you?”

“That everyone gets scared,” I answer finally, fair warning for
all of us.

The shades to the hospital room are drawn, but that doesn't keep me from
seeing the angel pallor of Kate Fitzgerald's face, the web of blue veins
mapping out the last-chance path of medication running under her skin. Curled
up on the foot of the bed is Anna.

At my command, Judge waits by the door. I crouch down. “Anna, it's time
to go.”

When the door to the hospital room opens, I'm expecting either Sara
Fitzgerald or a doctor with a crash cart. Instead, to my shock, Jesse stands on
the threshold. “Hey,” he says, as if we are old friends.

How did you get here? I almost ask, but realize I don't want to
hear the answer. “We're on our way to the courthouse. Need a lift?” I
ask dryly.

“No thanks. I thought since everyone was going to be there, I'd stay
here.” His eyes do not waver from Kate. “She looks like shit.”

“What do you expect,” Anna answers, awake now. “She's
dying.”

Again, I find myself staring at my client. I should know better than most
that motivations are never what they seem to be, but I still cannot figure her
out. “We need to go.”

In the car, Anna rides shotgun while Judge takes a seat in the back. She
starts telling me about some crazy precedent she found on the internet, where a
guy in Montana in 1876 was legally prohibited from using the water from a river
that originated on his brother's land, even though it meant all his crops would
dry up. “What are you doing?” she asks, when I deliberately miss the
turn to the courthouse.

Instead I pull over next to a park. A girl with a great ass jogs by, holding
on to the leash of one of those froufrou dogs that looks more like a cat.
“We're gonna be late,” Anna says after a moment. “We already
are. Look, Anna. What's going on here?” She gives me one of those patented
teenage looks, as if to say that there's no way she and I descended from the
same evolutionary chain. “We're going to court.”

“That's not what I'm asking. I want to know why we're going to
court.”

“Well, Campbell, I guess you cut the first day of law school, but
that's pretty much what happens when someone files a lawsuit.”

I level my gaze on her, refusing to be bested. “Anna, why are we going
to court?”

She doesn't blink. “Why do you have a service dog?” I rap my
fingers on the steering wheel and look out over the park. A mother pushes a
stroller now, across the same spot where the jogger was, oblivious to the kid
who's trying his best to crawl out. A titter of birds explodes from a tree.
“I don't talk about this with anyone,” I say.

“I'm not just anyone.”

I take a deep breath. “A long time ago I got sick and wound up with an
ear infection. But for whatever reason, the medicine didn't work and I got
nerve damage. I'm totally deaf in my left ear. Which isn't such a big deal, in
the long run, but there are certain lifestyle issues I couldn't handle. Like
hearing a car approach, you know, but not being able to tell what direction
it's coming from. Or having someone behind me at the grocery store who wants to
pass by me in the aisle, but I don't hear her ask. I got trained with Judge so
that in those circumstances, he could be my ears.” I hesitate. “I
don't like people feeling sorry for me. Hence, the big secret.”

Anna stares at me carefully. “I came to your office because just for
once, I wanted it to be about me instead of Kate.”

But this selfish confession saws out of her sideways; it just doesn't fit.
This lawsuit has never been about Anna wanting her sister to die, but simply
that she wants a chance to live. “You're lying.”
Anna crosses her arms. “Well, you lied first. You hear perfectly
fine.”

“And you're a brat.” I start to laugh. “You remind me of
me.”

“Is that supposed to be a good thing?” Anna says, but she's
smiling. The park is starting to get more crowded. An entire school group walks
the path, toddlers tethered together like sled-dog huskies, pulling two
teachers in their wake. Someone zooms past on a racing bike, wearing the colors
of the U.S. Postal Service. “C'mon. I'll treat you to breakfast.”

“But we're late.”

I shrug. “Who's counting?”

Judge DeSalvo is not a happy man; Anna's little field trip this morning has
cost us an hour and a half. He glares at me when Judge and I hurry into his chambers
for the pretrial conference. “Your Honor, I apologize. We had a veterinary
emergency.”

I feel, rather than see, Sara's mouth drop open. “That's not what
opposing counsel indicated,” the judge says.

I look DeSalvo right in the eye. “Well, it's what happened. Anna was
kind enough to help me by keeping the dog calm while the sliver of glass was
removed from his paw.”

The judge is dubious. But there are laws against handicapped discrimination,
and I'm playing them to the hilt; the last thing I want is for him to blame
Anna for this delay. “Is there any way of resolving this petition without
a hearing?” he asks.

“I'm afraid not.” Anna may not be willing to share her secrets,
which I can only respect, but she knows that she wants to go through with this.

The judge accepts my answer. “Mrs. Fitzgerald, I take it you're still
representing yourself?”

“Yes, Your Honor,” she says.

“All right then.” Judge DeSalvo glances at each of us. “This
is family court, Counselors. In family court, and especially in hearings like
these, I tend to personally relax the rules of evidence because I don't want a
contentious hearing. I'm able to filter out what is admissible and what is not,
and if there's something truly objectionable, I'll listen to the objection, but
I would prefer that we get through this hearing quickly, without worrying about
form.” He looks directly at me. “I want this to be as painless as
possible for everyone involved.”

We move into the courtroom—one that's smaller than the criminal courts, but
intimidating all the same. I swing into the lobby to pick Anna up along the
way. As we cross through the doorway, she stops dead. She glances at the vast
paneled walls, the rows of chairs, the imposing bench. “Campbell,”
she whispers, “I won't have to stand up there and talk, right?”

The fact is, the judge will most likely want to hear what she has to say.
Even if Julia comes out in support of her petition, even if Brian says he will
help Anna, Judge DeSalvo may want her to take the stand. But telling her this
right now is only going to get her all worked up—and that's not any way to
start a hearing.

I think about the conversation in the car, when Anna called me a liar. There
are two reasons to not tell the truth—because lying will get you what you want,
and because lying will keep someone from getting hurt. It's for both of these
reasons that I give Anna this answer. “Well,” I say, “I doubt
it.”

“Judge,” I begin, “I know it's not traditional practice, but
there's something I'd like to say before we start calling witnesses.”

Judge DeSalvo sighs. “Isn't this sort of standing on ceremony exactly
what I asked you not to do?”

“Your Honor, I wouldn't ask if I didn't think it was important.”

“Make it quick,” the judge says.

I stand up and approach the bench. “Your Honor, all of Anna
Fitzgerald's life she has been medically treated for her sister's good, not her
own. No one doubts Sara Fitzgerald's love for all her children, or the
decisions she's made that have prolonged Kate's life. But today we have to
doubt the decisions she's made for this child.”

I turn, and see Julia watching me carefully. And suddenly I remember that
old ethics assignment, and know what I have to say. “You might remember
the recent case of the firefighters in Worcester, Massachusetts, who were
killed in a blaze started by a homeless woman. She knew the fire had started
and she left the building, but she never called 911 because she thought she
might get into trouble. Six men died that night, and yet the State couldn't
hold this woman responsible, because in America—even if the consequences are
tragic—you are not responsible for someone else's safety. You aren't obligated
to help anyone in distress. Not if you're the one who started the fire, not if
you're a passerby to a car wreck, not if you're a perfectly matched
donor.”

I look at Julia again. “We're here today because there's a.
difference in our system of justice between what's legal and what's moral.
Sometimes it's easy to tell them apart. But every now and then, especially when
they rub up against each other, right sometimes looks wrong, and wrong
sometimes looks right.” I walk back to my seat, and stand in front of it.
“We're here today,” I finish, “so that this Court can help us
all see a little more clearly.”

My first witness is opposing counsel. I watch Sara walk to the stand
unsteadily, a sailor getting her sea legs again. She manages to get herself
into the seat and be sworn in without ever breaking her gaze away from Anna.

“Judge, I'd like permission to treat Mrs. Fitzgerald as a hostile
witness.”

The judge frowns. “Mr. Alexander, I truly would hope that both you and
Mrs. Fitzgerald can stand to be civilized, here.”

“Understood, Your Honor.” I walk toward Sara. “Can you state
your name?”

She lifts her chin a fraction. “Sara Crofton Fitzgerald.”

“You are the mother of the minor child Anna Fitzgerald?”

“Yes. And also of Kate and Jesse.”

“Isn't it true that your daughter Kate was diagnosed with acute
promyelocytic leukemia at age two?”

“That's right.”

“At that time did you and your husband decide to conceive a child who
would be genetically programmed to be an organ donor for Kate, so that she
could be cured?”

Sara's face hardens. “Not the words I would choose, but that was the
story behind Anna's conception, yes. We were planning to use Anna's umbilical cord
blood for a transplant.”

“Why didn't you try to find an unrelated donor?”

“It's much more dangerous. The risk of mortality would have been far
higher with someone who wasn't related to Kate.”

“So how old was Anna when she first donated an organ or tissue to her
sister?”

“Kate had the transplant a month after Anna was born.”

I shake my head. “I didn't ask when Kate received it; I asked when Anna
donated it. The cord blood was taken from Anna moments after birth, isn't that
right?”

“Yes,” Sara says, “but Anna wasn't even aware of it.”

“How old was Anna the next time she donated some body part to
Kate?”

Sara winces, just as I have expected. “She was five when she gave donor
lymphocytes.”

“What does that involve?”

“Drawing blood from the crooks of her arms.”

“Did Anna agree to let you put a needle in her arm?”

“She was five years old,” Sara answers.

“Did you ask her if you could put a needle in her arm?”

“I asked her to help her sister.”

“Isn't it true that someone had to physically hold Anna down to get the
needle in her arm?”

Sara looks at Anna, closes her eyes. “Yes.”

“Do you call that voluntary participation, Mrs. Fitzgerald?” From
the corner of my eye I can see Judge DeSalvo's brows draw together. “The
first time you took lymphocytes from Anna, were there any side effects?”

“She had some bruising. Some tenderness.”

“How long was it before you took blood again?”

“A month.”

“Did she have to be held down that time, too?”

“Yes, but—”

“What were her side effects then?”

“The same.” Sara shakes her head. “You don't understand. It
wasn't like I didn't see what was happening to Anna, every time she underwent a
procedure. It doesn't matter which of your children you see in that
situation—every single time, it breaks you apart.”

“And yet, Mrs. Fitzgerald, you managed to get past that
sentiment,” I say, “because you took blood from Anna a third
time.”

“It took that long to get all the lymphocytes,” Sara says.
“It's not an exact procedure.”

“How old was Anna the next time she had to undergo medical treatment
for her sister's well-being?”

"When Kate was nine she got a raging infection and—

“Again, that's not what I asked. I want to know what happened to Anna
when she was six.”

“She donated granulocytes to fight Kate's infection. It's a process a
lot like a lymphocyte donation.”

“Another needle stick?”

“That's right.”

“Did you ask her if she was willing to donate the granulocytes?”

Sara doesn't answer. “Mrs. Fitzgerald,” the judge prompts.

She turns toward her daughter, pleading. “Anna, you know we never did
any of these things to hurt you. It hurt all of us. If you got the
bruises on the outside, then we got them on the inside.”

“Mrs. Fitzgerald,” I step between her and Anna. “Did you
ask her?”

“Please don't do this,” Sara says. “We all know the history.
I'll stipulate to whatever it is you're trying to do in the process of
crucifying me. I'd rather just get this part over with.”

“Because it's hard to hear it hashed out again, isn't it?” I know
I'm walking a fine line, but behind me there is Anna, and I want her to know
that someone here is willing to go the distance for her. “Added up like
this, it doesn't seem quite so innocuous, does it?”

“Mr. Alexander, what is the point of this?” Judge DeSalvo
says. “I am well aware of the number of procedures Anna's undergone.”

“Because we have Kate's medical history, Your Honor, not Anna's.”

Judge DeSalvo looks between us. “Be brief, Counselor.”

I turn to Sara. “Bone marrow,” she says woodenly, before I can ask
the question. “She was put under general anesthesia because she was so
young, and needles were put into the crests of her hips to draw out the
marrow.”

“Was it one needle stick, like the other procedures?”

“No,” Sara says quietly. “It was about fifteen.”

“Into the bone?”

“Yes.”

“What were the side effects for Anna this time around?”

“She had some pain, and was given some analgesics.”

“So this time, Anna had to be hospitalized overnight… and she needed
medication herself?”

Sara takes a minute to compose herself. “I was told that donating
marrow isn't considered a particularly invasive procedure for a donor. Maybe I
was just waiting to hear those words; maybe I needed to hear them at that time.
And maybe I was not thinking as much of Anna as I should have been, because I
was so focused on Kate. But I know beyond a doubt that—like everyone else in
our family—Anna wanted nothing more than for her sister to be cured.”

“Well, sure,” I reply, “so that you'd stop sticking needles
in her.”

“Enough, Mr. Alexander,” Judge DeSalvo interjects.

“Wait,” Sara interrupts. “I have something to say.” She
turns tom e. "You think you can lay it all out in words, black-and-white,
as if it's that easy. But you only represent one of my daughters, Mr.

Alexander, and only in this courtroom. I represent both of them equally,
everywhere, every place. I love both of them equally, everywhere,
every place."

“But you admitted that you've always considered Kate's health, not
Anna's, in making these choices,” I point out. “So how can you claim
to love both of them equally? How can you say that you haven't been favoring
one child in your decisions?”

“Aren't you asking me to do that very thing?” Sara asks.
“Only this time, to favor the other child?”

ANNA

WHEN YOU ARE. A KID you have your own language, and unlike French or Spanish
or whatever you start learning in fourth grade, this one you're born with, and
eventually lose. Everyone under the age of seven is fluent in Ifspeak;
go hang around with someone under three feet tall and you'll see. What if a
giant funnelweb spider crawled out of that hole over your head and bit you on
the neck? What if the only antidote for venom was locked up in a vault on the
top of a mountain? What if you lived through the bite, but could only move your
eyelids and blink out an alphabet? It doesn't really matter how far you go; the
point is that it's a world of possibility. Kids think with their brains cracked
wide open; becoming an adult, I've decided, is only a slow sewing shut.

During the first recess, Campbell takes me to a conference room for privacy
and buys me a Coke that isn't cold. “So,” he says. “What do you
think so far?”

Being in the courtroom is weird. It's like I've turned into a ghost—I can
watch what's going on, but even if I felt like speaking no one would be able to
hear me. Add to that the very bizarre way I have to listen to everyone talk
about my life as if they can't see me sitting right there, and you've landed in
my surreal little corner of earth.

Campbell pops open his 7 UP and sits down across from me. He pours a little
into a paper cup for Judge, and then takes a good long drink.
“Comments?” he says. “Questions? Unadulterated praise for my
skillful litigation?”

 I shrug. “It's not like I
expected.”

“What do you mean?”

“I guess I figured when it started, I'd know for sure that I was doing
the right thing. But when my mom was up there, and you were asking her all
those questions…” I glance up at him. “That part about it not being
simple. She's right.”

What if I was the one who was sick? What if Kate had been asked to do
what I've done? What if one of these days, some marrow or blood or whatever
actually worked, and that was the end? What if I could look back on all this
one day and feel good about what I did, instead of feeling guilty? What if the
judge doesn't think I'm right?

What if he does?

I can't answer a single one of these, which is how I know that whether I'm
ready or not, I'm growing up.

“Anna.” Campbell gets up and comes around to my side of the table.
“Now is not the time to start changing your mind.”

“I'm not changing my mind.” I roll the can between my palms.
“I think I'm just saying that even if we win, we don't.”

When I was twelve I started baby-sitting for twins who live down the street.
They're only six, and they don't like the dark, so I usually wind up sitting
between them on a stool that's shaped like the stubby foot of an elephant,
toenails and all. It never fails to amaze me how quickly a kid can shut off an
energy switch—they'll be climbing the curtains and bam, five minutes later,
they're conked out. Was I ever like that? I can't remember, and it makes me feel
ancient.

Every now and then one of the twins will fall asleep before the other one.
“Anna,” his brother will say, “how many years till I can
drive?”

“Ten,” I tell him.

“How many years till you can drive?”

“Three.”

Then the talk will split off like the spokes of a spiderweb—what kind of car
will I buy; what will I be when I grow up; does it suck to get homework every
night in middle school. It's totally a ploy to stay up a little bit later.
Sometimes I fall for it, mostly I just make him go to sleep. See, I get a round
hollow spot in my belly knowing I could tell him what's coming, but also
knowing it would come out sounding like a warning.

The second witness Campbell calls is Dr. Bergen, the head of the medical
ethics committee at Providence Hospital. He has salt-and-pepper hair and a face
dented in like a potato. He is smaller than you'd expect, too, given the fact
that it takes him just short of a millennium to recite his credentials.

“Dr. Bergen,” Campbell starts, “what's an ethics
committee?”

“A diverse group of doctors, RNs, clergy, ethicists, and scientists,
who are assigned to review individual cases to protect patients' rights. In
Western Bioethics, there are six principles we try to follow.” He ticks
them off on his fingers. “Autonomy, or the idea that any patient over age
eighteen has the right to refuse treatment; veracity, which is basically
informed consent; fidelity—that is, a health-care provider fulfilling his
duties; beneficence, or doing what's in the best interests of the patient; nonmaleficence—when
you can no longer do good, you shouldn't do harm… like performing major surgery
on a terminal patient who's 102 years old; and finally, justice—that no patient
should be discriminated against in receiving treatment.”

“What does an ethics committee do?”

“Generally, we're called to convene when there's a discrepancy about
patient care. For example, if a physician feels it's in the patient's best
interests to go on with extraordinary measures, and the family doesn't—or vice
versa.”

“So you don't see every case that passes through a hospital?”

“No. Only when there are complaints, or if the attending physician asks
for a consultation. We review the situation and make recommendations.”

“Not decisions?”

“No,” Dr. Bergen says.

“What if the patient complaining is a minor?” Campbell asks.

“Consent isn't necessary until age thirteen. We rely on parents to make
informed choices for their children until that point.”

“What if they can't?”

He blinks. “You mean if they're not physically present?”

“No. I mean if there's another agenda they're adhering to, that in some
way keeps them from making choices in the best interests of that child?”

My mother stands up. “Objection,” she says. “He's
speculating.”

“Sustained,” Judge DeSalvo replies.

Without missing a beat, Campbell turns back to his witness. “Do parents
control their children's health-care decisions until age eighteen?”

Well, I could answer that. Parents control everything, unless you're like
Jesse and you do enough to upset them that they'd rather ignore you than
pretend you actually exist.

“Legally,” Dr. Bergen says. “However, once a child reaches
adolescence, although they can't give formal consent, they have to agree to any
hospital procedure—even if their parents have already signed off on it.”

This rule, if you ask me, is like the law against jaywalking. Everyone knows
you're not supposed to do it, but that doesn't actually stop you.

Dr. Bergen is still talking. “In the rare instance where a parent and
an adolescent patient disagree, the ethics committee weighs several factors:
whether the procedure is in the adolescent's best interests, the risk/benefit
scenario, the age and maturity of the adolescent, and the argument he or she
presents.”

“Has the ethics committee at Providence Hospital ever met regarding the
care of Kate Fitzgerald?” Campbell asks.

“On two occasions,” Dr. Bergen says. “The first involved
allowing her to enter a trial for peripheral blood stem cell transplant in
2002, when her bone marrow transplant and several other options had failed. The
second, more recently, involved whether or not it would be in her best
interests to receive a donor kidney.”

“What was the outcome, Dr. Bergen?”

“We recommended that Kate Fitzgerald receive a peripheral blood stem
cell transplant. As for the kidney, our group was split on that decision.”

“Can you explain?”

“Several of us felt that, at this point, the patient's health care had
deteriorated to a point where major invasive transplant surgery was going to do
more harm than good. Others believed that without a transplant, she would still
die, and therefore the benefits outweighed the risk.”

“If your team was split, then who gets to decide what will ultimately
happen?”

“In Kate's case, because she is still a minor, her parents.”

“During either of the times that your committee met regarding Kate's
medical treatment, did you discuss the risks and benefits to the donor?”