My Sister's Keeper (4 page)

It is an hour before Dr. Wayne summons us to his office again. “Kate's
tests were a little problematic,” he says. “Specifically, her white
cell count. It's much lower than normal.”

“What does that mean?” In that moment, I curse myself for going to
law school, and not med school. I try to remember what white cells even do.

“She may have some sort of autoimmune deficiency. Or it might just be a
lab error.” He touches Kate's hair. “I think, just to be safe, I'm
going to send you up to a hematologist at the hospital, to repeat the
test.”

I am thinking: You must be kidding. But instead, I watch my hand
move of its own accord to take the piece of paper Dr. Wayne offers. Not a
prescription, as I'd hoped, but a name. Ileana Farquad, Providence
Hospital, HematologyI Oncology.

“Oncology.” I shake my head. “But that's cancer.” I wait
for Dr. Wayne to assure me it's only part of the physician's title, to explain
that the blood lab and the cancer ward simply share a physical location, and
nothing more.

He doesn't.

The dispatcher at the fire station tells me that Brian is on a medical call.
He left with the rescue truck twenty minutes ago. I hesitate, and look down at
Kate, who's slumped in one of the plastic seats in the hospital waiting room. A
medical call.

I think there are crossroads in our lives when we make grand, sweeping
decisions without even realizing it. Like scanning the newspaper headline at a
red light, and therefore missing the rogue van that jumps the line of traffic
and causes an accident. Entering a coffee shop on a whim and meeting the man
you will marry one day, while he's digging for change at the counter. Or this
one: instructing your husband to meet you, when for hours you have been
convincing yourself this is nothing important at all. “Radio him,” I
say. “Tell him we're at the hospital.”

There is a comfort to having Brian beside me, as if we are now a pair of
sentries, a double line of defense. We have been at Providence Hospital for
three hours, and with every passing minute it gets more difficult to deceive
myself into believing that Dr. Wayne made a mistake. Jesse is asleep in a
plastic chair. Kate has undergone another traumatic blood draw, and a chest X
ray, because I mentioned that she has a cold.

“Five months,” Brian says carefully to the resident sitting in
front of him with a clipboard. Then he looks at me. “Isn't that when she
rolled over?”

“I think so.” By now the doctor has asked us everything from what
we were wearing the night Kate was conceived to when she first mastered holding
a spoon. “Her first word?” he asks. Brian smiles. “Dada.”

“I meant when.”

“Oh.” He frowns. “I think she was just shy of one.”

“Excuse me,” I say. “Can you tell me why any of this is
important?”

“It's just a medical history, Mrs. Fitzgerald. We want to know
everything we can about your daughter, so that we can understand what's wrong
with her.”

“Mr. and Mrs. Fitzgerald?” A young woman approaches, wearing a lab
coat. “I'm a phlebotomist. Dr. Farquad wants me to do a coag panel on
Kate.”

At the sound of her name, Kate blinks up from my lap. She takes one look at
the white coat and slides her arms inside the sleeves of her own shirt.

“Can't you do a finger stick?”

“No, this is really the easiest way.”

Suddenly I remember how, when I was pregnant with Kate, she would get the
hiccups. For hours at a time, my stomach would twitch. Every move she made,
even ones that small, forced me to do something I could not control.

“Do you think,” I say quietly, “that's what I want to hear?
When you go down to the cafeteria and ask for coffee, would you like it if
someone gave you Coke, because it's easier to reach? When you go to pay by
credit card, would you like it if you were told that's too much hassle, so
you'd better break out your cash?”

“Sara.” Brian's voice is a distant wind.

“Do you think that it's easy for me to be sitting here with my child
and not have any idea what's going on or why you're doing all these tests? Do
you think it's easy for her? Since when does anyone get the option to
do what's easiest?”

“Sara.” It is only when Brian's hand falls onto my
shoulder that I realize how hard I am shaking.

One more moment, and then the woman storms away, her clogs striking the tile
floor. The minute she is out of sight I wilt. “Sara,” Brian says.
“What's the matter with you?”

“What's the matter with me? I don't know, Brian, because no
one is coming to tell us what's wrong with—”

He wraps me in his arms, Kate caught between us like a gasp.
“Ssh,” he says. He tells me it's going to be all right, and for the
first time in my life I don't believe him.

Suddenly Dr. Farquad, whom we have not seen for hours, comes into the room.
“I hear there was a little problem with the coagulopathy panel.” She
pulls up a chair in front of us. "Kate's complete blood count had some
abnormal results. Her white blood count is very low—1.3. Her hemoglobin is 7.5,
her hematocrit is 18.4, her platelets are 81,000, and her neutrophils are 0.6.

Numbers like that sometimes indicate an autoimmune disease. But Kate's also
presenting with twelve percent promyelocytes, and five percent blasts, and that
suggests a leukemic syndrome."

“Leukemic,” I repeat. The word is runny, slippery, like the white
of an egg.

Dr. Farquad nods. “Leukemia is a blood cancer.” Brian only stares
at her, his eyes fixed. “What does that mean?”

“Think of bone marrow as a childcare center for developing cells.
Healthy bodies make blood cells that stay in the marrow until they're mature
enough to go out and fight disease or clot or carry oxygen or whatever it is
that they're supposed to do. In a person with leukemia, the childcare-center
doors are opened too early. Immature blood cells wind up circulating, unable to
do their job. It's not always odd to see promyelocytes in a CBC, but when we
checked Kate's under a microscope, we could see abnormalities.” She looks
in turn at each of us. “I'll need to do a bone marrow aspiration to
confirm this, but it seems that Kate has acute promyelocytic leukemia.”

My tongue is pinned by the weight of the question that, a moment later,
Brian forces out of his own throat: “Is she… is she going to die?”

I want to shake Dr. Farquad. I want to tell her I will draw the blood for
the coag panel myself from Kate's arms if it means she will take back what she
said. “APL is a very rare subgroup of myeloid leukemia. Only about twelve
hundred people a year are diagnosed with it. The rate of survival for APL
patients is twenty to thirty percent, if treatment starts immediately.”

I push the numbers out of my head and instead sink my teeth into the rest of
her sentence. “There's a treatment,” I repeat.

“Yes. With aggressive treatment, myeloid leukemias carry a survival
prognosis of nine months to three years.”

Last week, I had stood in the doorway of Kate's bedroom, watching her clutch
a satin security blanket in her sleep, a shred of fabric she was rarely
without. You mark my words, I had whispered to Brian. She'll never
give that up. I'm going to have to sew it into the lining of her wedding dress.

“We'll need to do that bone marrow aspiration. We'll sedate her with a
light general anesthetic. And we can draw the coag panel while she's
asleep.” The doctor leans forward, sympathetic. “You need to know
that kids beat the odds. Every single day.”

“Okay,” Brian says. He claps his hands together, as if he is
gearing up for a football game. “Okay.”

Kate pulls her head away from my shirt. Her cheeks are flushed, her
expression wary.

This is a mistake. This is someone else's unfortunate vial of blood that the
doctor has analyzed. Look at my child, at the shine of her flyaway curls and
the butterfly flight of her smile—this is not the face of someone dying by
degrees.

I have only known her for two years. But if you took every memory, every
moment, if you stretched them end to end—they'd reach forever.

They roll up a sheet and tuck it under Kate's belly. They tape her down to
the examination table, two long strips. One nurse strokes Kate's hand, even
after the anesthesia has kicked in and she's asleep. Her lower back is bared
for the long needle that will go into her iliac crest to extract marrow.

When they gently turn Kate's face to the other side, the tissue paper
beneath her cheek is damp. I learn from my own daughter that you don't have to
be awake to cry.

Driving home, I am struck by the sudden thought that the world is
inflatable—trees and grass and houses ready to collapse with the single prick
of a pin. I have the sense that if I veer the car to the left, smash through
the picket fence and the Little Tykes playground, it will bounce us back like a
rubber bumper.

We pass a truck. Batchelder Casket Company, it reads on the side. Drive
Safely. Isn't that a conflict of interest?

Kate sits in her car seat, eating animal crackers. “Play,” she
commands.

In the rearview mirror, her face is luminous. Objects are closer than
they appear. I watch her hold up the first cracker. “What does the
tiger say?” I manage.

“Rrrroar.” She bites off its head, then waves another
cracker.

“What does the elephant say?”

Kate giggles, then trumpets through her nose.

I wonder if it will happen in her sleep. Or if she will cry. If there will
be some kind nurse who gives her something for the pain. I envision my child
dying, while she is happy and laughing two feet behind me.

“Giraffe say?” Kate asks. “Giraffe?”

Her voice, it's so full of the future. “Giraffes don't say
anything,” I answer.

“Why?”

“Because that's how they're born,” I tell her, and then my throat
swells shut.

The phone rings just as I come in from the neighbor's house, having arranged
for her to take care of Jesse while we take care of Kate. We have no protocol
for this situation. Our only baby-sitters are still in high school; all four
grandparents are deceased; we've never dealt with day care providers—taking
care of the children is my job. By the time I come into the kitchen, Brian is
well into conversation with the caller. The phone cord is wrapped around his
knees, an umbilicus. “Yeah,” he says, “hard to believe. I
haven't made it into a single game this season… no point, now that they've
traded him.” His eyes meet mine as I put on the kettle for tea. “Oh,
Sara's great. And the kids, uh-huh, they're fine. Right. You give my best to
Lucy. Thanks for calling, Don.” He hangs up. “Don Thurman,” he
explains. “From the fire academy, remember? Nice guy.”

As he stares at me, the genial smile sloughs off his face. The teakettle
starts to whistle, but neither of us makes a motion to move it off the burner.
I look at Brian, cross my arms.

“I couldn't,” he says quietly. “Sara, I just couldn't.”

In bed that night, Brian is an obelisk, another shape breaking the darkness.
Although we have not spoken for hours, I know that he is every bit as awake as
I am.

This is happening to us because I yelled at Jesse last week, yesterday,
moments ago. This is happening because I didn't buy Kate the M&Ms she
wanted at the grocery store. This is happening because once, for a split
second, I wondered what my life would have been like if I'd never had children.
This is happening because I did not realize how good I have it.

“Do you think we did it to her?” Brian asks.

“Did it to her?” I turn to him. “How?”

“Like, our genes. You know.”

I don't respond.

“Providence Hospital doesn't know anything,” he says fiercely.
“Do you remember when the chief's son broke his left arm, and they put a
cast on the right one?”

I stare at the ceiling again. “Just so you know,” I say, more
loudly than I've intended, “I'm not going to let Kate die.”

There is an awful sound beside me—an animal wounded, a drowning gasp. Then
Brian presses his face against my shoulder, sobs into my skin. He wraps his
arms around me and holds on as if he's losing his balance. “I'm not,”
I repeat, but even to myself, it sounds like I am trying too hard.

BRIAN

FOR EVERY NINETEEN DEGREES HOTTER a fire burns, it doubles in size.

This is what I am thinking while I watch sparks shoot out of the incinerator
chimney, a thousand new stars. The dean of Brown University's medical school
wrings his hands beside me. In my heavy coat, I am sweating.

We've brought an engine, a ladder, and a rescue truck. We have assessed all
four sides of the building. We've confirmed that no one is inside. Well, except
for the body that got stuck in the incinerator, and caused this.

“He was a large man,” the dean says. 'This is what we always do
with the subjects when the anatomy classes are through."

“Hey, Cap,” Paulie yells. Today, he is my main pump operator.
“Red's got the hydrant dressed. You want me to charge a line?”

I am not certain, yet, that I will take a hose up. This furnace was designed
to consume remains at 1,600 degrees Fahrenheit. There is fire above and below
the body.

“Well?” the dean says. “Aren't you going to do
something?” It is the biggest mistake rookies make: the assumption that
fighting a fire means rushing in with a stream of water. Sometimes, that makes
it worse. In this case, it would spread biohazardous waste all over the place.
I'm thinking we need to keep the furnace closed, and make sure the fire doesn't
get out of the chimney. A fire can't burn forever. Eventually, it consumes
itself.

“Yes,” I tell him. “I'm going to wait and see.”

When I work the night shift, I eat dinner twice. The first meal is early, an
accommodation made by my family so that we can all sit around a table together.
Tonight, Sara makes a roast beef. It sits on the table like a sleeping infant
as she calls us for supper.

Kate is the first to slip into her seat. “Hey baby,” I say,
squeezing her hand. When she smiles at me, it doesn't reach her eyes.
“What have you been up to?”

She pushes her beans around her plate. “Saving Third World countries,
splitting a few atoms, and finishing up the Great American Novel. In between
dialysis, of course.”

“Of course.”

Sara turns around, brandishing a knife. “Whatever I did,” I say,
shrinking away, “I'm sorry.”

She ignores me. “Carve the roast, will you?”

I take the carving utensils and slice into the roast beef just as Jesse
sloughs into the kitchen. We allow him to live over the garage, but he is
required to eat with us; it's part of the bargain. His eyes are devil-red; his
clothes are ringed with sweet smoke. “Look at that,” Sara-sighs, but
when I turn, she is staring at the roast. “It's too rare.” She picks
the pan up with her bare hands, as if her skin is coated with asbestos. She
sticks the beef back into the oven.

Jesse reaches for a bowl of mashed potatoes and begins to heap them onto his
plate. More, and more, and more again.

“You reek,” Kate says, waving her hand in front of her face.

Jesse ignores her, taking a bite of his potatoes. I wonder what it says
about me, that I am actually thrilled I can identify pot running through his
system, as opposed to some of the others-Ecstasy, heroin, and God knows what
else—which leave less of a trace.

“Not all of us enjoy Eau de Stoned,” Kate mutters.

“Not all of us can get our drugs through a portacath,” Jesse
answers.

Sara holds up her hands. “Please. Could we just… not?”

“Where's Anna?” Kate asks.

“Wasn't she in your room?”

“Not since this morning.”

Sara sticks her head through the kitchen door. “Anna! Dinner!”

“Look at what I bought today,” Kate says, plucking at her T-shirt.
It is a psychedelic tie-dye, with a crab on the front, and the word
Cancer. “Get it?”

“You're a Leo.” Sara looks like she is on the verge of tears.

“How's that roast coming?” I ask, to distract her.

Just then, Anna enters the kitchen. She throws herself into her chair and
ducks her head. “Where have you been?” Kate says.

“Around.” Anna looks down at her plate, but makes no effort to
serve herself.

This is not Anna. I am used to struggling with Jesse, to lightening Kate's
load; but Anna is our family's constant. Anna comes in with a smile. Anna tells
us about the robin she found with a broken wing and a blush on its cheek; or
about the mother she saw at Wal-Mart with not one but two sets of twins. Anna
gives us a backbeat, and seeing her sitting there unresponsive makes me realize
that silence has a sound.

“Something happen today?” I ask.

She looks up at Kate, assuming the question has been put to her sister, and
then startles when she realizes I am talking to her. “No.”

“You feel okay?”

Again, Anna does a double take; this is a question we usually reserve for
Kate.

“Fine.”

“Because you're, you know, not eating.”

Anna looks down on her plate, notices that it's empty, and then heaps it
high with food. She shovels green beans into her mouth, two forkfuls.

Out of the blue I remember when the kids were little, crammed into the back
of the car like cigars wedged in a box, and I would sing to them. Anna anna
bo banna, banana fanna fo fanna, me my mo manna… Anna. (“Chuck,”
Jesse would yell out. “Do Chuck!”)

“Hey.” Kate points to Anna's neck. “Your locket's
missing.”

It's the one I gave her, years ago. Anna's hand comes up to her collarbone.
“Did you lose it?” I ask.

She shrugs. “Maybe I'm just not in the mood to wear it.”

She's never taken it off, far as I know. Sara pulls the roast out of the
oven and sets it on the table. As she picks up the knife to carve, she looks
over at Kate. “Speaking of things we're not in the mood to wear,” she
says, “go put on another shirt.”

“Why?”

“Because I said so.”

'That's not a reason."

Sara spears the roast with the knife. “Because I find it offensive at
the dinner table.”

“It's not any more offensive than Jesse's metalhead shirts. What's the
one you had on yesterday? Alabama Thunder Pussy?”

Jesse rolls his eyes toward her. It's an expression I've seen before: the
horse in a spaghetti Western, gone lame, the moment before it's shot for mercy.

Sara saws through the meat. Pink before, now it is an overcooked log.
“Now look,” she says. “It's ruined.”

“It's fine.” I take the one piece she has managed to dissect from
the rest and cut a smaller bite. I might as well be chewing leather.
“Delicious. I'm just gonna run down to the station and get a blowtorch so
that we can serve everyone else.”

Sara blinks, and then a laugh bubbles out of her. Kate giggles. Even Jesse
cracks a smile.

This is when I realize that Anna has already left the table, and more
importantly, that nobody noticed.

Back at the station, the four of us sit upstairs in the kitchen. Red's got
some kind of sauce going on the stove; Paulie reads the ProJo, and
Caesar's writing a letter to this week's object of lust. Watching him, Red
shakes his head. “You ought to just keep that filed on disk and print
multiple copies at a time.”

Caesar's just a nickname. Paulie coined it years ago, because he's always
roamin'. “Well, this one's different,” Caesar says.

“Yeah. She's lasted two whole days.” Red pours the pasta
into the colander in the sink, steam rising up around his face. “Fitz,
give the boy some pointers, will you?”

“Why me?”

Paulie glances up over the rim of the paper. “Default,” he says,
and it's true. Paulie's wife left him two years ago for a cellist who'd swung
through Providence on a symphony tour; Red's such a confirmed bachelor he
wouldn't know what a lady was if she came up and bit him. On the other hand,
Sara and I have been married twenty years.

Red sets a plate down in front of me as I start to talk. “A
woman,” I say, “isn't all that different from a bonfire.”

Paulie tosses down the paper and hoots. “Here we go: the Tao of Captain
Fitzgerald.”

I ignore him. “A fire's a beautiful thing, right? Something you can't
take your eyes off, when it's burning. If you can keep it contained, it'll
throw light and heat for you. Its only when it gets out of control that you
have to go on the offensive.”

“What Cap is trying to tell you,” Paulie says, “is that you
need to keep your date away from crosswinds. Hey, Red, you got any
Parmesan?”

We sit down to my second dinner, which usually means that the bells will
ring within minutes. Firefighting is a world of Murphy's Law; it is when you
can least afford a crisis that one crops up.

“Hey, Fitz, do you remember the last dead guy who got stuck?”
Paulie asks. “Back when we were vollies?”

God, yes. A fellow who weighed five hundred pounds if he weighed an ounce,
who'd died of heart failure in his bed. The fire department had been called in
on that one by the funeral home, which couldn't get the body downstairs.
“Ropes and pulleys,” I recall out loud.

“And he was supposed to be cremated, but he was too big…” Paulie
grins. “Swear to God, as my mother's up in Heaven, they had to take him to
a vet instead.”

Caesar blinks up at him. “What for?”

“How do you think they get rid of a dead horse, Einstein?”

Putting two and two together, Caesar's eyes widen. “No kidding,”
he says, and on second thought, pushes away Red's pasta Bolognese.

“Who do you think they'll ask to clean out the med school
chimney?” Red says.

“The poor OSHA bastards,” Paulie answers.

'Ten bucks says they call here and tell us it's our job."

“There won't be any call,” I say, “because there won't be
anything left to clean out. That fire was burning too hot.”

“Well, at least we know this one wasn't arson,” Paulie mutters.

In the past month, we have had a rash of fires set intentionally. You can
always tell—there will be splash patterns of flammable liquid, or multiple
points of origin, or smoke that burns black, or an unusual concentration of
fire in one spot. Whoever is doing this is smart, too—at several structures the
combustibles have been put beneath stairs, to cut off our access to the flames.
Arson fires are dangerous because they don't follow the science we use to
combat them. Arson fires are the structures most likely to collapse around you
while you're inside fighting them.

Caesar snorts. “Maybe it was. Maybe the fat guy was really a suicide
arsonist. He crawled up into the chimney and lit himself on fire.”

“Maybe he was just desperate to lose weight,” Paulie adds, and the
other guys crack up.

“Enough,” I say.

“Aw, Fitz, you gotta admit it's pretty funny-”

“Not to that man's parents. Not to his family.”

There is that uncomfortable silence as the other men grasp at words. Finally
Paulie, who has known me the longest, speaks. “Something going on with
Kate again, Fitz?”

There is always something going on with my eldest daughter; the problem is,
it never seems to end. I push away from the table and set my plate in the sink.
“I'm going up to the roof.”

We all have our hobbies-Caesar's got his girls, Paulie his bagpipes, Red his
cooking, and me, I have my telescope. I mounted it years ago to the roof of the
fire station, where I can get the best view of the night sky.

If I weren't a fireman, I'd be an astronomer. It takes too much math for my
brain, I know that, but there's always been something about charting the stars
that appeals to me. On a really dark night, you can see between 1,000 and 1,500
stars, and there are millions more that haven't been discovered. It is so easy
to think that the world revolves around you, but all you have to do is stare up
at the sky to realize it isn't that way at all.

Anna's real name is Andromeda. It's on her birth certificate, honest to God.
The constellation she's named after tells the story of a princess, who was
shackled to a rock as a sacrifice to a sea monster-punishment for her mother
Casseopeia, who had bragged to Poseidon about her own beauty. Perseus, flying
by, fell in love with Andromeda and saved her. In the sky, she's pictured with
her arms outstretched and her hands chained.

The way I saw it, the story had a happy ending. Who wouldn't want that for a
child?

When Kate was born, I used to imagine how beautiful she would be on her
wedding day. Then she was diagnosed with APL, and instead, I'd imagine her
walking across a stage to get her high school diploma. When she relapsed, all
this went out the window: I pictured her making it to her fifth birthday party.
Nowadays, I don't have expectations, and this way she beats them all.