Jodi Picoult: Handle with Care

Now I wonder: Is that when those seven breaks happened? When I kept someone else from getting hurt, did I hurt you ?

I gave birth shortly after three, but I didn’t see you again until it was eight p.m. Every half hour, Sean left to get an update: She’s being X-rayed. They’re drawing blood. They think her ankle might be broken, too. And then, at six o’clock, he brought the best news of all: Type III, he said. She’s got seven healing fractures and four new ones, but she’s breathing fine. I lay in the hospital bed, smiling uncontrollably, certain that I was the only mother in the birthing center who had ever been delighted with news like this.

For two months now, we had known that you’d be born with OI-osteogenesis imperfecta, two letters of the alphabet that would become second nature. It was a collagen defect that caused bones so brittle they might break with a stumble, a twist, a sneeze. There were several types-but only two presented with fractures in utero, like we’d seen on my ultrasound. And yet the radiologist could still not conclusively say whether you had Type II, which was fatal at birth, or Type III, which was severe and progressively deforming. Now I knew that you might have hundreds more breaks over the years, but it hardly mattered: you would have a lifetime in which to sustain them.

When the storm let up, Sean went home to get your sister, so that she could meet you. I watched the Doppler weather scan track the blizzard as it moved south, turning into an icy rain that would paralyze the Washington, D.C., airports for three days. There was a knock at my door, and I struggled to sit up a bit, even though doing so sent fire through my new stitches. “Hey,” Piper said, coming into the room and sitting on the edge of my bed. “I heard the news.”

“I know,” I said. “We’re so lucky.”

There was only the tiniest hesitation before she smiled and nodded. “She’s on her way down now,” Piper said, and just then, a nurse pushed a bassinet into the room.

“Here’s Mommy,” she trilled.

You were fast asleep on your back, on the undulating foam egg crate with which they had lined the little plastic bed. There were bandages wrapped around your tiny arms and legs, your left ankle.

As you got older, it would be easier to tell that you had OI-people who knew what to look for would see it in the bowing of your arms and legs, in the triangular peak of your face and the fact that you would never grow much beyond three feet tall-but right then, even with your bandages, you looked flawless. Your skin was the color of the palest peach, your mouth a tiny raspberry. Your hair was flyaway, golden, your eyelashes as long as my pinkie fingernail. I reached out to touch you and-remembering-drew my hand away.

I had been so busy wishing for your survival that I hadn’t given much thought to the challenges it would present. I had a beautiful baby girl, who was as fragile as a soap bubble. As your mother, I was supposed to protect you. But what if I tried and only wound up doing harm?

Piper and the nurse exchanged a glance. “You want to hold her, don’t you?” she said, and she slid her arm as a brace beneath the foam liner while the nurse raised the edges into parabolic wings that would support your arms. Slowly, they placed the foam into the crook of my elbow.

Hey, I whispered, cradling you closer. My hand, trapped beneath you, felt the rough edge of the foam pad. I wondered how long it would be before I could carry the damp weight of you, feel your skin against mine. I thought of all the times Amelia had cried as a newborn; how I’d nurse her in bed and fall asleep with her in my embrace, always worried that I might roll over and hurt her. But with you, even lifting you out of the crib could be a danger. Even rubbing your back.

I looked up at Piper. “Maybe you should take her…”

She sank down beside me and traced a finger over the rising moon of your scalp. “Charlotte,” Piper said, “she won’t break.”

We both knew that was a lie, but before I could call her on it, Amelia streaked into the room, snow on her mittens and woolen hat. “She’s here, she’s here,” your sister sang. The day I had told her you were coming, she asked if it could be in time for lunch. When I told her she’d have to wait about five months, she decided that was too long. Instead, she pretended that you had already arrived, carrying around her favorite doll and calling her Sissy. Sometimes, when Amelia got bored or distracted, she would drop the doll on its head, and your father would laugh. Good thing that’s the practice version, he’d say.

Sean filled the doorway just as Amelia climbed onto the bed, into Piper’s lap, to pass judgment. “She’s too small to skate with me,” Amelia said. “And how come she’s dressed like a mummy?”

“Those are ribbons,” I said. “Gift wrapping.”

It was the first time I lied to protect you, and as if you knew, you chose that moment to wake up. You didn’t cry, you didn’t squirm. “What happened to her eyes?” Amelia gasped, as we all looked at the calling card for your disease: the whites of your sclera, which instead flashed a brilliant, electric blue.

In the middle of the night, the graveyard shift of nurses came on duty. You and I were fast asleep when the woman came into the room. I swam into consciousness, focusing on her uniform, her ID tag, her frizzy red hair. “Wait,” I said, as she reached for your swaddled blanket. “Be careful.”

She smiled indulgently. “Relax, Mom. I’ve only checked a diaper ten thousand times.”

But this was before I had learned to be your voice, and as she un-tucked the fold of the swaddling, she pulled too fast. You rolled to your side and started to shriek-not the whimper you’d made earlier, when you were hungry, but the shrill whistle I’d heard when you were born. “You hurt her!”

“She just doesn’t like getting up in the middle of the night-”

I could not imagine anything worse than your cries, but then your skin turned as blue as your eyes, and your breath became a string of gasps. The nurse leaned over with her stethoscope. “What’s the matter? What’s wrong with her?” I demanded.

She frowned as she listened to your chest, and then suddenly you went limp. The nurse pressed a button behind my bed. “Code Blue,” I heard, and the tiny room was suddenly packed with people, even though it was still the middle of the night. Words flew like missiles: hypoxemic…arterial blood gas…SO 2 of forty-six percent…administering FIO 2 .

“I’m starting chest compressions,” someone said.

“This one’s got OI.”

“Better to live with some fractures than die without them.”

“We need a portable chest film stat -”

“There were no breath sounds on the left side when this started-”

“No point waiting for the X-ray. There could be a tension pneumothorax-”

Between the shifting columns of their bodies, I saw the wink of a needle sinking between your ribs, and then moments later a scalpel cutting below it, the bead of blood, the clamp, the length of tubing that was fed into your chest. I watched them sew the tube into place, where it snaked out of your side.

By the time Sean arrived, wild-eyed and frantic, you had been moved to the NICU. “They cut her,” I sobbed, the only words I could manage to find, and when he pulled me into his arms, I finally let go of all the tears I’d been too terrified to cry.

“Mr. and Mrs. O’Keefe? I’m Dr. Rhodes.” A man who looked young enough to be in high school poked his head into the room, and Sean’s hand grabbed mine tightly.

“Is Willow all right?” Sean asked.

“Can we see her?”