After the Fall (12 page)

SARAH
•

Kate can be flighty, but she’s not dishonest. Or so I’d thought. I’d assumed even the flightiness had gone by the time she’d been married to Cary for a year or two. I remember commenting on it to Rick, when they’d been over for one of Alice’s birthdays, how she seemed so relaxed, settled, as if she’d finally grown into her skin. Kate’s my closest friend and one of the most generous people you could ever meet, but for years she lived her life as if she were learning to windsurf: overbalancing, overcorrecting, swept off course by the slightest current. But then again, maybe that was just youth; maybe we were all like that in college.

I knew about that first kiss, but I hadn’t thought it was serious. She dropped around for coffee about a week after it happened, acting as if the whole thing were a big joke while scrutinizing my face for any hint of disapproval. It sounded innocent enough, though I doubt I got the whole story. The baby was distracting me anyway, and I was trying to shoo Alice out of the room in case she heard something she shouldn’t.

“I can’t believe I kissed him.” She giggled. “I must have had too much to drink.”

“What about Cary?” I asked, gently breaking Patrick’s suction on my right breast and raising him to my shoulder to be burped. Warm milk seeped slowly from the nipple he’d vacated, like an old tap that can’t be fully turned off. The light in Kate’s face was dimmed, and in contrast to her breathless confession five minutes earlier the words were careful and flat.

“Cary’s okay with it. He knows it didn’t mean anything.”

“And did it?”

“Of course not! I told you, it was just for fun. Maybe you had to be there.”

I think she expected me to see it as she did, a great big joke, an adventure, the sort of thing we had shrieked over in our student days. Except we weren’t students anymore, and all I could think of was how silly she’d been, how selfish, how I might even have felt ashamed of her had I been there. Kate changed the subject. I’d disappointed her with my worries about Cary and my moral high ground and my tired leaking breasts.

Now this. I’d seen the blond man sidling toward our table at the trivia night, lurking in the shadows as if his impossible looks weren’t sucking attention from every female eye in the room like iron filings to a magnet. I saw him follow Kate out and guessed who he was. The situation almost gave me heart failure, but by a stroke of luck Cary stayed backstage and seemed none the wiser when he finally returned.

In a hushed half minute while Cary got the drinks at the pub Kate admitted that she had been with Luke during her lengthy absence. I could only begin to imagine in what sense.

“Do you think she slept with him?” asked Rick, as we undressed for bed later that night.

“I wouldn’t think so. She was only gone for half an hour.”

“Heck, they could have done it twice in that time!” He laughed, making a grab for my uncovered body. The speculation was turning him on.

“But where? In the gardens, or one of their cars? How uncomfortable! Plus just getting out to the parking lot and back would have taken ten minutes alone, never mind undressing and … the rest.”

“Undressing and having sex, you prude,” Rick teased, his hands on my bra. “Not everyone restricts it solely to bed.”

He kissed my neck and I started relaxing against him, glad that I at least would be confining any congress to between my own sheets. Then Patrick began howling and the moment was lost.

Now Kate was on the other end of the phone evading my questions.

“We just went outside for a cigarette, nothing more. I didn’t want you to tell Cary because you know how much he hates me smoking.”

“I thought you’d given it up?” I didn’t believe her anyway—why would she kiss this guy in full view of an entire wedding reception, then when she was alone with him somewhere dark do nothing more than light up?

“I have, except occasionally,” she replied. “I could stop if I wanted to.”

“What are we talking about again?” I asked.

“Very funny,” Kate said, in a tone that implied it was anything but.

I tried another tack. “Look, you don’t have to tell me anything. Just be careful. These things have a way of getting out of control.”

“Nothing’s going to get out of control,” she said, finally dropping her guard. “It’s just fun, you know?”

I couldn’t help myself. “But what about Cary?” I asked, repeating my question of a month or so before.

“Cary’s fine. I love Cary. I’ll always be married to him. This is just a side dish or something, a trip down memory lane.”

“A what? Did you used to go out with this guy?”

“No, of course not. I just meant the excitement, that feeling you get when you realize you’re connecting with someone.”

“Doesn’t Cary excite you anymore?”

“I knew you’d think that. Yes, he does, and the sex is still good, to save you from asking. It’s just not really … new.” She sighed, stuck for words. “Doesn’t the grass ever look greener to you? Don’t you wonder what it would be like to be with someone else, to start again?”

“I’m too tired to even notice the grass most days,” I replied truthfully. “Anyway, who’d want me, with two children and stretch marks? Rick sees me in my tracksuit every day and still loves me. That’s what those vows we made are all about.”

“I know, I know.” Kate sighed. “It’s just that sometimes it isn’t …”

“Enough?”

“No!” she protested. “I was going to say
spectacular.”

“Well, nothing is. Get used to it. I would have thought you got all the spectacular you wanted with Jake, but you didn’t marry him.”

“You’re right; I’m wrong.” She sounded contrite, but I knew she didn’t mean it. If we’d been talking face-to-face we would have looked at each other and burst into laughter, or tears. Instead there was silence on the phone, awkward and strained.

“Just be careful, won’t you?” I pleaded, longing to hug her or shake her, or both. “Use condoms. Don’t get pregnant.”

“Oh, God,” she groaned. “That’s something else I have to tell you.”

CRESSIDA
•

On the Monday morning after the trivia night Emma was readmitted. She’d been my first patient after I started the pediatric oncology fellowship, and I remembered her well—a quiet child who had blond hair like mine, missing front teeth and ALL, or acute lymphoblastic leukemia, a type of cancer where for some reason the body makes too many of the infection-fighting white blood cells. These don’t mature properly, but collect and crowd out the other cells. Emma’s mother had first become worried when her daughter fell half a foot from the monkey bars and was bruised for weeks. Then other bruises started appearing with no apparent cause, lingering on the girl’s pale skin like tattoos. The night Emma had a bloody nose that would not stop, her parents finally brought her to the hospital. They hadn’t wanted to make a fuss or sound paranoid, they said. Maybe she was just accident-prone. Children were always hurting themselves, weren’t they?

It was the first time I’d had to give a diagnosis like that. I was … what? Twenty-five? Twenty-six? Too young to be reassuring, or even empathetic. I’d told anxious mothers that their sons had fractured an arm or leg, had tonsils that had to come out or an ear infection that needed treatment. But this was something else altogether, the major league of bad-news breaking.

“Just be as natural as you can,” my supervisor advised me. “They won’t be able to take much in, so have some information sheets ready to hand out, the phone number for the Leukemia Foundation. Don’t linger on the prognosis—talk about treatment, remission rates, survival after five years. Be sympathetic. Do it somewhere quiet. And take tissues.”

So I told Emma’s parents what I knew, watching their faces collapse, their postures deflate, clenching my nails into my palm every time I felt tears threaten. “ALL is treatable,” I informed them. “Chemotherapy to send it into remission, then later maybe a bone-marrow transplant, if it’s necessary and if we can find a matching donor.” Throughout the fraught half hour Emma lay in her father’s arms, listless, too quiet. Her red blood cells had been overrun by the lymphocytes, trampled like hapless spectators at a soccer match. She was only six. She should have been tearing around the ward, making the nurses frown and shush, not this limp puddle in her father’s lap.

About half the children who develop ALL survive it, at least for the following few years. Eighty percent if you believe some studies, though I don’t. Chemotherapy puts almost all in remission; radiotherapy comes next to prevent any remaining rogue cells from starting the process over. Nonetheless, I had a bad feeling about Emma. It was the first time I’d experienced such a thing and I didn’t recognize the sensation, but the minute I’d first reviewed her history I’d felt something lodge in my throat, as if I’d swallowed a moth. I coughed and it was gone, but an unnerving furred sensation remained. I know that taste now.

Emma stayed with us for almost six months, going home once or twice but always needing to be readmitted within the week. As predicted, the chemotherapy worked, but at a cost. It devastated her little system, weakening her defenses to all the other bugs that thrive in hospitals … first a chest infection, then blood in her urine. One morning we heard a scream from Emma’s room and rushed in to find her mother shaking and sobbing. The girl’s hair had literally fallen out overnight, lying in golden clots like spilled coins all over her pillow. I gathered it up and tried to give it to the woman, but she wouldn’t touch it. “She’s dying, isn’t she?” she hissed at me as she pushed the locks away.
Yes
, I thought, glancing at my patient. She was barely conscious, nothing but bone wrapped loosely in a tent of skin, eyes sunken and rarely open. “No,” I said, slipping into doctor-speak. “Hair loss is a side effect of radiotherapy. She’s doing fine.”

I didn’t think of it as lying; it was what we had been taught to say. And as it turned out, Emma didn’t die. She crashed once while I was off duty but was revived, the wasted frame forced back into life by a massive jolt of electricity. After that, to our great surprise, she made slow but steady progress, the white-cell count dropping as her hair grew back. I plaited the strands I’d salvaged into a skimpy ponytail, which a staff nurse suggested I attach to a cap for Emma to wear until her own head sported more than pale fuzz. She smiled broadly when I gave it to her and I could suddenly see that her new front teeth were coming in. That surprised me—I don’t know why. She’d been so sick, and yet through it all her body had kept making these teeth, relentlessly preparing for her adult life. Where had the energy come from, when she’d needed all of her resources just to get well? The sheer persistence of those teeth staggered me. Was it just physiology, I wondered, or can cells hope like the rest of us?

I hadn’t yet met Luke at the time, though I told him about Emma later. I don’t think he understood, and I couldn’t fully explain. He just saw biology and luck; I saw a little girl whose body had never given up, who was eventually declared cured and discharged for good. A success, when there were so many failures.

LUKE
•

Kate makes love with her eyes open, blue-green orbs like miniature globes swimming before me as I touch her and hear her call out. Only when we kiss, I think, does she close them, and then only because there is nothing to see. The rest of the time she is alert, aware, unwilling to miss a thing. Her whole body hums, alive in the moment. She watches me reach for her, watches the effect her own caresses have on me. When I enter her, her pupils dilate, swelling and spilling over the irises like an eclipse, a shout louder, more joyful than any that might leave her lips.

Cress closes her eyes; she sighs and murmurs.
Look
, I want to plead when we lie together,
show me that you want me; make me want you. Just look!
There is nothing more erotic, I want to tell her, than watching your partner respond, her eyes clouded by desire or surrender, yet never leaving yours. But how would I suddenly know this? And would I want to replicate it anyway?

CRESSIDA
•

I’d headed to the ward round that morning hoping it would be quick, that there’d be some chat about the trivia night, a few case reviews and we’d all be on our way. A short round would give me a chance to catch up on the discharge summaries threatening to engulf my desk. Instead, I found that Emma was back. One of the nurses filled me in. She’d been admitted late the previous night, once again covered in bruises, so sick she could barely open her eyes. It seemed the leukemia had returned.

“Damn,” muttered the consultant, flicking through the thick file. “It doesn’t look good. And she was doing so well too. Anyone remember her from her last admission?”

“I do,” I called out.

“Your caseload’s already heavy enough, Cressida,” he replied without even looking up. “Someone else had better take this one. Gabrielle? Grant?”

The two doctors in question studied the floor, neither keen to volunteer. We were all too busy.

“I can do it,” I pleaded across their hesitation. “She was my first patient in the unit. I know the family. I want to help.”

The consultant finally lifted his eyes from the history, weary behind smudged glasses. “It’s not going to be pretty. Are you sure you want the case?”

I nodded and he handed me the file. “The WBC count is twenty-one thousand. We’ll do chemotherapy, then think about a bone-marrow transplant. Better talk to the parents and get them tested. Any siblings?”

I’d answered in the negative, though I turned out to be wrong. When I went to reintroduce myself to Emma’s parents they were cradling a small blond child, unmistakably Emma’s sister. The likeness was so uncanny that for a moment I was confused, thinking it was the girl herself, only three years younger rather than older. The father recognized me, and held out his hand.

“I was hoping never to see you again,” he said bluntly. “What are her chances?”

“Good,” I reassured them. “When relapse occurs over a year after discontinuing the initial therapy there’s a thirty to forty percent chance of long-term survival.”

“That’s good?” asked Emma’s father. “Less than fifty-fifty?”

“It’s less than ten percent with relapse in the first year,” I replied. Emma’s mother began crying soundlessly as I outlined the treatment plan.

Over the next two months chemotherapy brought Emma into a second remission. Her best chance now was via a bone-marrow transplant, provided a suitable donor could be found. We took blood from her parents to test their compatibility; then I placed the tourniquet around Emma’s little sister Shura’s chubby arm. Veins swelled beneath the skin like fat pink worms.

“It seems cruel, doesn’t it?” I said conversationally, preparing the tubes I would need to catch Shura’s blood. “It’s going to hurt, and she has no idea why.”

“She doesn’t need to know,” replied her mother, lips set. “Besides, it’s nothing compared to what Emma’s gone through, and to the benefit it might bring.”

She was right, of course, but her tone made me uneasy as I slid the needle in.

“You know that siblings don’t always match, don’t you?” I asked, slowly drawing up the plunger. Shura flinched as the red liquid rose in the cylinder.

“Yes, but Emma and Shura will. They have to,” the woman responded with determination. It suddenly occurred to me that for a two-and-a-half-year-old Shura didn’t speak much.

“Good girl,” I told the toddler, withdrawing the needle and hunting in my pockets for a toy. “You were very brave. Would you like to play with this monkey?”

The child reached for the animal, but her mother pushed her hands away. “It might have germs, and we need you to be healthy for Emma,” she said, heedless of her daughter’s disappointment. “When will we get the results?”

The day the results were due I felt nervous, scared. Trying to hurry breakfast that morning I dropped my coffee cup, then cut a finger as I picked up the pieces. Luke heard me yelp and rushed in from the bathroom, where he had been shaving. As he helped me to my feet I burst into tears.

“Does it hurt that much? What’s the matter?” he asked, turning the injured digit over for inspection.

“It’s not that,” I sobbed. “I’m worried about a patient—Emma, the one I told you about. We’ll find out today if we can do her bone-marrow transplant. It’s been worrying me all night—I hardly slept.”

It was true. I’d tossed and turned while Luke slumbered on beside me. These days he was sleeping more deeply than ever. What a luxury to have nothing to keep you awake, no issues more bothersome than the latest sales figures for toilet paper.

“Oh, Cress,” said Luke, kissing my finger and drawing me into his arms. “You care too much about those people. About everything. You’ve got to let go, my love. I know it’s sad, but you can’t let it consume you.”

He was right, of course, but how do you stop caring? Emotions can’t be turned on and off like tap water.