Jodi Picoult - Handle with Care

“What did you see?” the lawyer asked.

“The femurs were measuring on the small side, which can sometimes be a flag for Down syndrome, but none of the other indicators were present.”

“Anything else?”

“Yes,” Janine said. “Some of the images were incredibly clear. Particularly the one of the fetal brain.”

“Did you mention these findings to the defendant?”

“Yes. She said that the femur wasn’t off the charts, that it could simply be because the mother was short,” Janine answered.

“What about the clarity of the images? Did the defendant have anything to say about that?”

“No,” Janine said. “She didn’t.”

The night I’d driven Charlotte home from her twenty-seven-week ultrasound, the one with all the broken bones visible, I’d stopped being her friend and started being a doctor. I sat at the kitchen table and used medical terminology, which almost acted like a sedative itself: the pain in Char lotte’s and Sean’s eyes dulled as I heaped them with information they could not understand. I talked to them about the physician I’d already called for a consultation.

At one point, Amelia had flitted into the kitchen. Charlotte hastily wiped her eyes. “Hey, sweetie,” she said.

“I came to say good night to the baby,” Amelia said, and she ran up to Charlotte where she sat and wrapped her arms as best as she could around her mother’s belly.

Charlotte made a tiny sound, a mewling. “Not so tight,” she managed, and I knew what she was thinking: had this eager love broken some of your bones?

“But I want her to come out,” Amelia said. “I’m sick of waiting.”

Charlotte stood up. “I think I might go lie down, too.” She held out her hand for Amelia, and they walked out of the kitchen.

Sean sank into the seat she’d vacated. “It’s me, right?” He looked up at me, haunted. “I’m the reason the baby’s like this.”

“No-”

“Charlotte had one kid who was perfectly fine,” he said. “Do the math.”

“This is probably a spontaneous mutation. There’s nothing you could have done to prevent it.” I couldn’t have prevented it, either. But that didn’t keep me from feeling guilty, just like Sean. “You have to take care of her, because she can’t fall apart right now. Don’t let her look this up on the Internet before you see the doctor tomorrow; don’t tell her you’re worried.”

“I can’t lie,” Sean said.

“Well, you will, if you love her.”

Now, all these years later, I wondered why I could not forgive Charlotte for following this very same advice.

I didn’t like Guy Booker, but then again, when you choose malpractice insurance providers, you’re not going for the folks you want to have over for Christmas dinner. He was good at making someone squirm on the witness stand, like an insect being pinned by a collector who wanted to scrutinize it more closely. “Ms. Weissbach,” Booker said, standing up to do his cross-examination, “have you ever seen another fetus that had a similar finding in the measurement of the femur?”

“Of course.”

“Do you happen to know the outcome?”

Charlotte’s lawyer stood up. “Objection, Your Honor. The witness is just a technologist, not a physician.”

“She sees this every day,” Booker countered. “She’s specially trained to read sonograms.”

“Sustained.”

“Well,” Janine said, miffed. “For your information, it’s not so easy to read the results of an ultrasound. I may just be a technologist, but I’m also supposed to point out things that might be problematic.” She jerked her chin toward me. “Piper Reece was my boss. I was just doing my job.”

She did not say anything more, but I could hear it all the same: Unlike you.

Something was wrong with my lawyer. She was fidgeting; she kept missing questions and forgetting answers. It got me wondering: Was doubt contagious? Had Marin sat next to me all day while I fought the urge to stand up and put an end to all this, and then awakened this morning with the same gut instincts?

She had called in a witness I did not know-Dr. Thurber, who was British but had become the head of radiology at Lucile Packard Children’s Hospital at Stanford before moving to Shriners in Omaha and applying his knowledge as a radiologist to OI kids. According to the endless list of credentials Marin had led him through, Dr. Thurber had read thousands of ultrasounds during his career, had lectured throughout the world, and donated two weeks of his vacation every year to provide care to expectant mothers in impoverished countries.

Basically, he was a saint. A really smart one.

“Dr. Thurber,” Marin said, “for those of us who aren’t familiar with ultrasounds, can you explain the technology?”

“It’s a diagnostic tool, in terms of obstetrics,” the radiologist said. “The equipment is a real-time scanner. Sound waves get emitted from a transducer, which is placed against the mother’s abdomen and moved around to reflect the contents of the uterus. The image gets projected onto a monitor-a sonogram.”

“What are ultrasounds used for?”

“To diagnose and confirm pregnancy, to assess fetal heartbeat and fetal malformations, to measure the fetus in order to assess the gestational age and growth, to see the location of the placenta, to determine the amount of amniotic fluid-among other things.”

“When are ultrasounds traditionally performed during pregnancy?” Marin asked.

“There’s no hard-and-fast rule, but sometimes scans can be done at about seven weeks to confirm pregnancy and rule out ectopic or molar pregnancies. Most women have at least one ultrasound performed between eighteen and twenty weeks.”

“What happens during that ultrasound?”

“By then, the fetus is large enough to check out the anatomy and to look for congenital malformations,” Dr. Thurber said. “Certain bones will be measured, to make sure the baby is the right size based on the date of conception. They’ll make sure organs are in the right place, and that the spine’s intact. Basically, it’s a confirmation that everything’s where it’s supposed to be. And of course, you get to go home with a picture that stays taped to your fridge for the next six months.”

There were a few laughs on the jury. Had I had a picture of you, from your ultrasound? I couldn’t remember. When I think back to that day, I only feel this great tidal wash of relief, from the moment Piper told me you were healthy.

“Dr. Thurber,” Marin asked, “did you have an opportunity to review the eighteen-week ultrasound that was performed on Charlotte O’Keefe?”

“I did.”

“And what did you see?”

He glanced at the jury. “Based on the ultrasound, there was definite cause for concern. Normally when you do an ultrasound, you’re looking at the brain through the skull, so it’s usually a little fuzzy, a little bit muddy and gray, because of reverberation artifacts from the side of the skull that the ultrasound beam first hits. In Mrs. O’Keefe’s sonogram, however, the intracranial contents were crystal clear-even that near field of the cerebral hemisphere, which is normally obscured. This suggests a demineralized calvarium. There are several conditions in which the skull presents undermineralized, including skeletal dysplasia, and OI. One then has the obligation to look at the long bones, and in fact femur length is a part of every obstetric ultrasound. In Mrs. O’Keefe’s case, the femur was also measuring a bit short. The combination of the short femur and the demineralized skull is strongly suggestive of osteogenesis imperfecta.” He let the words hang in the courtroom. “In fact, had the technologist pushed down on Mrs. O’Keefe’s belly as she was doing the ultrasound, she would have been able to watch the screen and see the skull of the fetus being squashed out of shape.”