The Jodi Picoult Collection #4 Read online

  “I thought that could cause a miscarriage,” Charlotte said.

  “It can. But the risk of that is one in two hundred and seventy—right now, less than the chance that the baby has Down syndrome.”

  Charlotte rubbed a hand down her face. “So this amniocentesis,” she said. “If it turns out that the baby has . . .” Her voice trailed off. “Then what?”

  I knew Charlotte was Catholic. I also knew, as a practitioner, that it was my responsibility to give everyone all the information I had whenever possible. What they chose to do with it, based on their personal beliefs, was up to them. “Then you can decide whether or not to terminate,” I said evenly.

  She looked up at me. “Piper, I worked too hard to have this baby. I’m not going to give it up that easily.”

  “You should talk this over with Sean—”

  “Let’s do the ultrasound,” Charlotte decided. “Let’s just take it from there.”

  For all of these reasons, I remember very clearly the first time we saw you on the screen. Charlotte was lying down on the examination table; Sean was holding her hand. Janine, the ultrasound tech who worked at my practice, was taking the measurements before I went in to read the results myself. We would be looking for hydrocephalus, an endocardial cushion defect or abdominal wall defect, nuchal fold thickening, a short or absent nasal bone, hydronephrosis, echogenic bowel, shortened humeri or femurs—all markers used in the ultrasound diagnosis of Down syndrome. I made sure that the machine we used was one that had only recently arrived, brand-new, the ultimate technology at the time.

  Janine came into my office as soon as she finished the scan. “I’m not seeing any of the usual suspects for Down,” she said. “The only abnormality is the femurs—they’re in the sixth percentile.”

  We got readings like that all the time—a fraction of a millimeter for a fetus might look much shorter than normal and, at the next sonogram, be perfectly fine. “That could be genetics. Charlotte’s tiny.”

  Janine nodded. “Yeah, I’m going to just mark it down as something to keep an eye on.” She paused. “There was something weird, though.”

  My head snapped up from the file I was writing in. “What?”

  “Check out the pictures of the brain when you’re in there.”

  I could feel my heart sink. “The brain?”

  “It looks anatomically normal. But it’s just incredibly . . . clear.” She shook her head. “I’ve never seen anything like it.”

  So the ultrasound machine was exceptionally good at its job—I could see why Janine would be over the moon, but I didn’t have time to rhapsodize about the new equipment. “I’m going to tell them the good news,” I said, and I went into the examination room.

  Charlotte knew; she knew as soon as she saw my face. “Oh, thank God,” she said, and Sean leaned over to kiss her. Then she reached for my hand. “You’re sure?”

  “No. Ultrasound isn’t an exact science. But I’d say the odds of having a normal, healthy baby just increased dramatically.” I glanced at the screen, a frozen image of you sucking your thumb. “Your baby,” I said, “looks perfect.”

  • • •

  In my office, we did not advocate recreational ultrasounds—in layman’s terms, that means ultrasounds beyond those medically necessary. But sometime in Charlotte’s twenty-seventh week, she came to pick me up to go to a movie, and I was still delivering a baby at the hospital. An hour later, I found her in my office with her feet propped on the desk as she read a recent medical journal. “This is fascinating stuff,” she said. “ ‘Contemporary Management of Gestational Trophoblastic Neoplasia.’ Remind me to take one of these the next time I can’t fall asleep.”

  “I’m sorry,” I said. “I didn’t think I’d be this late. She made it to seven centimeters and then stopped dead.”

  “It’s no big deal. I didn’t really want to see a movie anyway. The baby’s been dancing on my bladder all afternoon.”

  “Future ballerina?”

  “Or placekicker, if you believe Sean.” She looked up at me, trying to read my face for clues about the baby’s sex.

  Sean and Charlotte had chosen not to find out in advance. When parents told us that, we wrote it in their files. It had taken a Herculean effort for me to not peek during the ultrasound, so that I wouldn’t inadvertently give away the secret.

  It was seven o’clock; the receptionist had gone home for the day; the patients were all gone. Charlotte had been allowed to wait for me only because everyone knew we were friends. “We wouldn’t have to tell him that we know,” I said.

  “Know what?”

  “The baby’s sex. Just because we missed the movie doesn’t mean we can’t catch another one . . .”

  Charlotte’s eyes widened. “You mean an ultrasound?”

  “Why not?” I shrugged.

  “Is it safe?”

  “Absolutely.” I grinned at her. “Come on, Charlotte. What have you got to lose?”

  Five minutes later, we were in Janine’s ultrasound suite. Charlotte had hiked her shirt up beneath her bra, and her pants were pushed down low on her abdomen. I squirted gel onto her belly, and she squealed. “Sorry,” I said. “Cold.” Then I picked up the transducer and moved it over her skin.

  The picture of you rose on the screen like a mermaid coming up to the water’s surface: black one moment, and then slowly solidifying into an image we could recognize. There was a head, a spine, your tiny hand.

  I swept the transducer to a point between your legs. Instead of the crossed bones of a fetus cramped inside the womb, your soles touched each other, your legs practically forming a circle. The first break I saw was the femur. It was angulated, bent acutely, instead of being straight. On the tibia I could see a line of black, a new fracture.

  “So?” Charlotte said happily, craning her neck to see the screen. “When do I get to see the family jewels?”

  I swallowed, moving the transducer up to see the barrel of your chest and the beaded ribs. There were five healing fractures here.

  The room started spinning around me. Still holding the transducer, I leaned forward, settling my head between my knees. “Piper?” Charlotte said, coming up on her elbows.

  I had learned about osteogenesis imperfecta in medical school, but I had never actually seen a case. What I remembered about it were pictures of fetuses with in vitro fractures like yours. Fetuses that died at birth or shortly after.

  “Piper?” Charlotte repeated. “Are you okay?”

  Pulling myself upright, I drew in a deep breath. “Yes,” I said, my voice breaking. “But Charlotte . . . your daughter’s not.”

  Sean

  The very first time I heard the words osteogenesis imperfecta was after Piper drove Charlotte home, hysterical, from that off-the-cuff ultrasound in Piper’s office. With Charlotte sobbing in my arms, I tried to make sense of the words Piper was lobbing at me like missiles: collagen deficiency, bones angulated and thickened, beaded ribs. She had already called a colleague, Dr. Del Sol, who was a high-risk maternal-fetal-medicine physician at the hospital. We had an appointment for another ultrasound at 7:30 a.m.

  I had just come home from work—a construction detail that had been hellish because it had rained the entire afternoon and evening. My hair was still damp from the shower, my shirt sticking to the damp skin of my back. Amelia was upstairs watching TV in our bedroom, and I had been holding a container of ice cream, eating right out of it with a spoon, when Piper and Charlotte came into the house. “Damn,” I said. “You caught me right in the act.” Then I realized that Charlotte was crying.

  It never failed to amaze me how the most ordinary day could be catapulted into the extraordinary in the blink of an eye. Take the mother who was handing a toy to her toddler in the backseat one moment, and in a massive motor vehicle accident the next. Or the frat boy who was chugging a beer on the porch as we drove up to arrest him for sexually assaulting another student. The wife who opened the door to find a police officer bearing the news of her