Jodi Picoult - Handle with Care

Not to be confused, I thought to myself, with our personal history.

HEIGHT: 5'2''

WEIGHT: 145

Patient has been trying unsuccessfully to conceive for a year.

I flipped the page-lab results that confirmed pregnancy; the blood tests for HIV, syphilis, hep B, anemia; urinalysis that screened for bacteria, sugar protein. All had been normal, until the quad screen, and the elevated risk for Down syndrome.

The eighteen-week ultrasound had been part of routine pregnancy care, but I’d also been looking to confirm Down syndrome. Had I been so focused on that one task I never thought to look for any other anomalies? Or had they simply not been there?

I pored over the ultrasound report, scrutinized the pictures for any inkling of a break that I might have missed. I stared at the spine, at the heart, at the ribs, at the long bones. A fetus with OI might have had breaks at that point in time, but the collagen defect in the bones would have made them even more difficult to see. You couldn’t really fault a physician for not red-flagging something that appeared, for all intents and purposes, normal.

The last image on the ultrasound report was of the fetal skull.

I flattened my hands on either side of the page, pinning down a picture of the brain that was sharp and focused.

Crystal clear.

Not because of the quality of our new equipment, as I’d assumed at the time, but because of a demineralized calvarium, a skull that had not ossified correctly.

As physicians, we’re taught to look for things that are abnormal-not things that are too perfect.

Had I known back then, long before I knew you and your illness, that a demineralized calvarium was a hallmark of OI? Should I have known? Had I pushed down gently on Charlotte’s belly, to see if the fetal skull gave way to the pressure? I couldn’t remember. I couldn’t remember anything, except telling her that her baby didn’t seem to have Down syndrome.

I couldn’t remember if I’d taken measures that I could point to, now, that could be used to prove this wasn’t my fault.

I reached into my pocketbook and took out my wallet. Buried in the very bottom, among the gum wrappers and the pens from pharma companies, was a rubber-banded stack of business cards I had accumulated. I shuffled through them until I found the one I was looking for. Picking up Rob’s phone, I dialed the law firm’s number.

“Booker, Hood and Coates,” the receptionist said.

“I’m one of your medical malpractice clients,” I replied. “And I think I need your help.”

That night, I could not sleep. I went into the bathroom and stared at myself in the mirror, trying to see if I already looked different than I had when the day had begun. Could you see doubt written on a face? Did it settle in the fine lines around the eyes, the bracket of the mouth?

Rob and I had decided not to tell Emma what had happened, at least not until there was something concrete to tell. It occurred to me that Amelia might mention something now that school had started up again-but then, maybe Amelia didn’t know what her parents were doing, either.

I sat down on the toilet seat and looked at the moon. Full, orange, it seemed to be balanced on the windowsill. The light spilled into the bathroom and across the tile floor, pooling in the bowl of the tub. It wouldn’t be long before dawn, and then I would be expected to go to work and take care of patients who were pregnant or trying to become pregnant, when I could no longer be sure of my own judgment.

The few times I’d been so upset that I couldn’t sleep-like after my father died, and when my office manager stole several thousand dollars from the practice-I’d called Charlotte. Although I was the one who was used to being phoned in the middle of the night for an emergency, she hadn’t complained. She’d acted as if she’d been expecting me to call, and even though I knew she had a thousand things to do the next day with Willow or Amelia, she’d stay up with me for hours, talking about everything and nothing, until my mind stopped racing long enough for me to relax.

I was licking my wounds, and I wanted to call my best friend. Except this time, she was the one who’d caused them.

A daddy longlegs was crawling up the wall. It left me almost breathless. Everything I knew about physics and gravity told me that it should be tumbling to the ground. The closer it got to the ceiling, the more I was riveted. It tucked two legs around the curl at the top of the wallpaper, where the strip had begun peeling off.

I’d asked Rob to fix it a thousand times; he’d ignored me. But now that I was looking at it-really looking-I realized I didn’t like this wallpaper at all. What we needed was a fresh start. A good, new coat of paint.

I stood on the lip of the tub, reached up with my right hand, and in one swift pull, tore away a long tongue of wallpaper.

Most of the strip, though, was still affixed to the wall.

What did I know about removing wallpaper?

What did I know about anything?

I needed a steamer. But at three in the morning, I wasn’t going to get one, so I turned on the hot-water faucets in the bath and the sink, letting steam cloud the room. I tried to curl my fingernails under the edges, to scrape the strip free.

There was a sudden rush of cold air. “What the hell are you doing?” Rob asked, bleary, standing in the doorway.

“Stripping the wallpaper.”

“In the middle of the night? Piper,” he sighed.

“I couldn’t sleep.”

He turned off the taps. “You have to try.” Rob led me by the hand back to bed, where I lay down and drew the covers over me. I curled onto my side, and he fitted his arm around my waist.

“I could redo the bathroom,” I whispered when his even breathing told me he was asleep again.

Charlotte and I had spent one day last summer reading every kitchen and bath makeover magazine in the Barnes & Noble racks. Maybe you should go minimalist, Charlotte had suggested, and then, turning the page, French provincial?

Get an air tub, she’d suggested. A TOTO toilet. A heated towel rack.

I’d laughed. A second mortgage?

When I met with Guy Booker at the law firm, would he take inventory of this house? Of our mutual funds and retirement accounts and Emma’s college savings and all the other assets that could be taken away in a settlement?

Tomorrow, I decided, I would get one of those steamers. And whatever other tools I needed to strip wallpaper. I would fix it all myself.

“I think I dropped the ball,” I admitted as I sat across from Guy Booker at a gleaming, imposing conference table.

My lawyer reminded me of Cary Grant-white hair with a raven’s wing of color at the temples, tailored suit, even that little divot in his chin. “Why don’t you let me be the judge of that?” he said.

He had told me that we had twenty days to file an answer to the complaint I’d been served-a formal pleading for the court. “You say that osteogenesis imperfecta can be diagnosed by a woman’s twentieth week of pregnancy?” he asked.

“Yes-the lethal kind, anyway, by ultrasound.”

“Yet the patient’s daughter survived.”

“Right,” I said. Thank God.

I liked that he was referring to Charlotte as “the patient.” It made it feel more clinical. It was one step farther away.

“So she’s got the severe type-Type III.”

“Yes.”

He flipped through the file again. “The femur was in the sixth percentile?”

“Right. That’s documented.”

“But it’s not a definitive marker for OI.”

“It can mean all sorts of things. Down syndrome, skeletal dysplasia…or a short parent, or the fact that we took a bad measurement. A lot of fetuses with standard deviations like Willow’s at eighteen weeks go on to be perfectly healthy. It’s not until a later ultrasound, when that number falls off the charts, that we know we’re dealing with some abnormality.”