Jodi Picoult - Handle with Care

“Yes,” Dr. Rosenblad said. “Kids with OI often have anxiety issues, because of the worry and avoidance behavior they exhibit to keep from suffering a break. They sometimes develop post-traumatic stress disorder after particularly severe fractures. In addition, Willow’s already started to notice she’s different from other kids and limited because of her OI. As kids with OI grow up, they want to be independent-but they can’t be as functionally independent as able-bodied teens. The struggle can cause kids with OI to become introverted, depressed, perhaps even suicidal.”

When I turned around, I saw Charlotte. Her face was buried in her hands.

Maybe a mother wasn’t what she seemed to be on the surface. Maybe Charlotte had sued Piper Reece because she loved Willow too much to let her go. Maybe my birth mother let me go because she knew she couldn’t love me.

“In the six years you’ve treated Willow, have you gotten to know Charlotte O’Keefe?”

“Yes,” the doctor replied. “Charlotte’s incredibly attuned to her daughter. She’s almost got a sixth sense when it comes to Willow’s level of discomfort, and for making sure steps are taken before it gets out of hand.” He glanced at the jury. “Remember Shirley MacLaine in Terms of Endearment ? That’s Charlotte. Sometimes she’s so stubborn I want to sock her-but that’s because I’m the one she’s standing up to.”

I sat back down, opening the questioning to Guy Booker. “You’ve been treating this child since she was six months old, correct?”

“Yes. I was working at Shriners in Omaha at the time, and Willow was part of our pamidronate trials there. When I moved to Children’s in Boston, it made more sense to treat her closer to home.”

“Now how often do you see her, Dr. Rosenblad?”

“Twice a year, unless there’s a break in between. And let’s just say I’ve never seen Willow only twice a year.”

“How long have you been using pamidronate to treat children with OI?”

“Since the early nineties.”

“And you said that, prior to the advent of pamidronate for OI, these children had a much more limited life in terms of mobility, correct?”

“Absolutely.”

“So would you say that the medical technology in your field has increased Willow’s health potential?”

“Dramatically,” Dr. Rosenblad said. “She’s able to do things now that kids with OI couldn’t do fifteen years ago.”

“So if this trial were taking place fifteen years ago, the picture you’d be painting for us of Willow’s life might be even more grim, wouldn’t you agree?”

Dr. Rosenblad nodded. “That’s correct.”

“Given that we live in America, where medical research is blooming in laboratories and hospitals like yours on a daily basis, isn’t it likely that Willow might see even more medical advances in her lifetime?”

“Objection,” I said. “Speculative.”

“He’s an expert in his field, Judge,” Booker countered.

“He can give his opinion,” Judge Gellar said, “based on his knowledge as to what medical research is currently being done.”

“It’s possible,” Dr. Rosenblad replied. “But like I also pointed out, the wonder drugs that we thought bisphosphonates were might, over the long term, reveal some other problems we hadn’t counted on for OI patients. We just don’t know yet.”

“Conceivably, however, Willow could grow to adulthood?” Booker asked.

“Absolutely.”

“Could she fall in love?”

“Of course.”

“Could she have a baby?”

“Possibly.”

“Could she work outside the home?”

“Yes.”

“Could she live independently of her parents?”

“Maybe,” Dr. Rosenblad said.

Guy Booker spread his hands across the railing of the jury box. “Doctor, you treat illness, don’t you?”

“Sure.”

“Would you ever treat a broken finger by amputating the arm?”

“That would be a bit extreme.”

“Isn’t it extreme to treat OI then by preventing the patient from being born?”

“Objection,” I called out.

“Sustained.” The judge glared at Guy Booker. “I won’t have my courtroom turned into a pro-life rally, Counselor.”

“I’ll rephrase. Have you ever encountered a parent whose child is diagnosed with OI in utero who chooses to terminate the pregnancy?”

Rosenblad nodded. “Yes, often in cases where you’re talking about the lethal form of OI, Type II.”

“What about the severe form?”

“Objection,” I said. “What does this have to do with the plaintiff?”

“I want to hear this,” Judge Gellar said. “You may answer the question, Doctor.”

Rosenblad stepped through the minefield of his response. “Terminating a wanted pregnancy is no one’s first choice,” he said, “but when faced with a fetus who will become a severely disabled child, different families have different levels of tolerance. Some families know they’ll be able to provide enough support for a child with disabilities, some are smart enough to know, in advance, they won’t.”

“Doctor,” Booker said, “would you call Willow O’Keefe’s birth a wrongful one?”

I felt something at my side and realized that Charlotte was trembling.

“I am not in a position to make that decision,” Rosenblad said. “I’m just the physician.”

“My point exactly,” Booker answered.

I had not seen my ultrasound technician Janine Weissbach since she left my practice four years ago and went to work at a hospital in Chicago. Her hair, which had been blond, was now a sleek chestnut, and there were fine lines bracketing her mouth. I wondered if I looked the same to her, or if betrayal had aged me beyond recognition.

Janine had been allergic to nuts, and once there had been a minor war between her and a nurse on staff who’d brewed hazelnut coffee. Janine broke out in hives just from the smell that permeated our little lounge; the nurse swore she didn’t realize that liquefied nuts counted when it came to allergy; Janine asked how she’d ever passed her nursing exam. In fact, the brouhaha had been the biggest upset in my practice…until, of course, this.

“How is it that you came to know the plaintiff in this case?” Charlotte’s lawyer asked.

Janine leaned closer to the microphone on the witness stand. She used to sing karaoke, I remembered, at a local nightclub. She had referred to herself as pathologically single. Now, though, she wore a wedding band.

People changed. Even the people you thought you knew as well as you knew yourself.

“She was a patient at the office where I was working,” Janine said. “Piper Reece’s ob-gyn practice.”

“You’re employed by the defendant?”

“I was for three years, but now I work at Northwestern Memorial Hospital.”

The lawyer was staring off at a wall, as if she wasn’t even listening. “Ms. Gates,” the judge prompted.

“Sorry,” she said, snapping to attention. “You’re employed by the defendant?”

“You just asked me that.”

“Right. Um, can you tell us the circumstances under which you met Charlotte O’Keefe?”

“She came in for an eighteen-week ultrasound.”

“Who else was there?”

“Her husband,” Janine said.

“Was the defendant there?”

For the first time, Janine met my eye. “Not at first. The way we did it, I’d perform the ultrasound and discuss it with her; and she’d read the results and talk to the patient.”

“What happened during Charlotte O’Keefe’s ultrasound, Ms. Weissbach?”

“Piper had told me to be on the lookout for anything that might signify Down syndrome. The patient’s quad screen had shown a slightly elevated risk. I was excited to be working with a new machine-it had only just arrived, and was state of the art. I got Mrs. O’Keefe settled on the table, put some gel onto her abdomen, and then moved the transducer around to get several clear views of the fetus.”