Jodi Picoult - Handle with Care

I grinned. “Not that. Seen one uterus, seen them all,” I said. “It’s just that a physician should be able to keep her distance, instead of being personally involved.”

“But that’s exactly why you’re perfect for me,” Charlotte argued. “Another doctor would try to help us conceive but wouldn’t really give a damn. I want someone who cares beyond the point of professional responsibility. I want someone who wants me to have a baby as much as I want to.”

Put that way, how could I deny her? I called Charlotte every morning so that we could dissect the letters to the editor in the local paper. She was the first one I ran to when I was fuming at Rob and needed to vent. I knew what shampoo she used, which side of her car the gas tank was on, how she took her coffee. She was, simply, my best friend. “Okay,” I said.

A smile exploded on her face. “Do we start now?”

I burst out laughing. “No, Charlotte, I’m not going to do a pelvic exam on my living room floor while the girls are playing upstairs.”

Instead, I had her come to the office the following day. As it turned out, there was no medical reason that she and Sean were having trouble getting pregnant. We talked about how eggs decline in quality after women hit their thirties, which meant it might take longer to happen-but could still happen. I got her started on folic acid and on tracking her basal body temperature. I told Sean (in what had to have been his favorite conversation with me to date) that they should have sex more often. For six months, I tracked Charlotte’s menstrual calendar in my own appointment book; I’d call on the twenty-eighth day and ask if she’d started her period-and for six months, she had. “Maybe we should talk about fertility drugs,” I suggested, and the next month, just before her appointment with a specialist, Charlotte got pregnant the old-fashioned way.

Considering how long it took, the pregnancy itself was uneventful. Charlotte’s blood tests and urine cultures always came back clean; her blood pressure was never elevated. She was nauseated round the clock, and she’d call me after throwing up at midnight to ask why the hell it was called morning sickness.

At her eleventh week of pregnancy, we heard the heartbeat for the first time. At the fifteenth, I did a quad screen on her blood to check for neural defects and Down syndrome. Two days later, when her results came in, I drove to her house during my lunch break. “What’s wrong?” she asked, when she saw me standing at the door.

“Your test results. We have to talk.”

I explained that the quad screen wasn’t foolproof, that the test was designed specifically to have a 5 percent screen positive rate, which means that 5 percent of all women who took the test were going to be told that they had a higher than average risk of having a Down syndrome baby. “Based on your age alone, your risk is one in two hundred and seventy of having a baby with Down,” I said. “But the blood test came back saying that, actually, your risk is higher than average-it’s one in one hundred and fifty.”

Charlotte folded her arms across her chest.

“You’ve got a few options,” I said. “You’re scheduled for an ultrasound in three weeks anyway. We can take a look during that ultrasound and see if anything is a red flag. If it does show something, we can send you for a level two ultrasound. If not, we can reduce your odds again to one in two hundred and fifty, which is nearly average, and assume the test was a false reading. But just remember-the ultrasound isn’t one hundred percent peace of mind. If you want absolute answers, you’ll have to have amniocentesis.”

“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 humerior 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.