My Sister's Keeper: A Novel Read online

  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 li