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And One to Grow On
This is the story of a family in crisis. Written by a family practice physician and a commercial fiction writer, And One to Grow On deals with the emotional upheavals of a family suddenly thrust into the world of medicine because of their daughter's illness.
Megan Malone is seven years old. Her mother, a labor and delivery nurse, thinks of her as Little Miss Song and Dance. Her father, a high school teacher, thinks of her, secretly, as his rare treasure. Her brother Sam, who's ten, doesn't think about her much at all. Then Megan is diagnosed with leukemia.
Drawn into the world of hospitals, doctors, chemotherapy and conflicting medical opinions, the Malones are not always certain who has their child's best interests at heart. Their marriage suffers, with each partner seeking escape from the unbearable strain. And Megan learns her own lessons from a dying hospital friend.
Written by David R. Pepper, M.D., a family practice doctor in Fresno, California, and Elizabeth Neff Walker, author of more than two dozen popular fiction novels, this is a powerful and touching tale of life, hope and the conflicts inherent in modern medicine.
Sara Jane was covering Delivery Room 2, hovering over a thirty-four-week pregnant woman with a placenta previa. The patient was bleeding like a stuck pig.
Though the OB doctor had promised to be there instantly, the situation was becoming desperate and Sara Jane again pressed the call button for reinforcements. This was going to be a real emergency caesarian by the time someone arrived. With her usual calm, Sara Jane spoke reassuringly to the patient as she started an I.V. line in the woman's arm.
Being an OB nurse at Hillside Community infrequently offered such a dramatic scenario for her. Usually there were plenty of experienced people crawling around to assist in a risky birth, but today was a holiday, President's Day, and the OB department was especially short-handed. Sara Jane breathed a sigh of relief as blood squirted into the catheter, indicating she'd hit the right spot.
Dr. Gold burst through the door just as she was hanging the bag of solution. The patient, Mrs. Fellows, moaned. There was a growing pool of blood on the linoleum floor beyond the delivery table. "Damn," Dr. Gold muttered.
"Sara Jane, we're going to need more help. Get another nurse in here stat. Call pediatrics and tell them we're doing a crash c-section on a 34-weeker and I need someone up here now. Get me the anesthesiologist on call and tell the clerk I need two units of blood up here stat. Make it O negative if she's not already typed and crossed." He turned to the patient, but called over his shoulder, "And get a consent form for a c-section."
Sara Jane's rubber-soled shoes squeaked loudly as she raced up the corridor to the nurses' station. The clerk, phone in hand, took one look at her bloody scrub gown, her disheveled brown hair, and winced. "God, you're a mess." Then, extending the receiver to her, "Urgent call for you, Sara Jane."
"Get a number. We have a patient who could bleed out in there."
The clerk, Rosemarie, was a relative newcomer to the floor. "But she said it's urgent, Sara Jane."
"So is this. Five minutes. I'll get back to whoever it is in five minutes. We have to get this under control first, okay?"
While relaying Dr. Gold's orders, Sara Jane swung around and grabbed a nurse as she came out of the patient room across from the nurses' station. "Glenda, Delivery 2, stat, for a crash section."
By the time she returned to the delivery room the monitor showed the baby taching along upwards of 160. The mom's heart rate clocked over 100, and her face was covered with a nitrous oxide mask.
The necessary staff had materialized, becoming an efficient team in which Sara Jane took her part. Bright lights shone down on green drapes, the rusty brown of the woman's betadyne-scrubbed belly, and the trail of red blood that followed the surgeon's knife. The gleaming blade worked down through skin, fascia and uterus until at last a baby erupted from center stage.
Within ten minutes a healthy four and a half pound boy was having his mouth suctioned. But Mrs. Fellows was pale, tachycardic and shocky. Sara Jane estimated that she had lost more than 1000 cc's of blood, and she was still hemorrhaging.
Dr. Gold, a frown wrinkling the brow above his mask, ordered ten units of pitocin I.V. to make the flaccid uterus contract and stop the bleeding. He pressed a gloved hand inside the uterus to clamp down on the placental site.
Don't bleed out, Sara Jane silently begged the woman. This little guy is going to need a mom.
And gradually the bleeding ceased. There was an audible sigh of relief in the delivery room.
So it was thirty minutes before Sara Jane returned to the nurses' station, still disheveled but coming down from an adrenaline high. "You have that phone number for me, Rosemarie?" she asked, reaching out a hand.
"No number," the clerk told her. "She says you know it. Your daughter's babysitter. She says your daughter's sick."
Megan had not been completely well for the last few weeks. The seven year old had had night fevers which Sara Jane assumed to be some version of the flu which was working its way through western Pennsylvania. This one seemed to last longer than most, and was not always discernible during the days, only disrupting sleep at night in some of its victims.
Though her daughter had continued going to school, she was looking more peaked in the last week. If Sara Jane hadn't had to work this shift to repay a colleague, she would most certainly have preferred to be at home with her daughter. Her husband Frank had taken their ten-year-old son to an ice hockey tournament. Sara Jane glanced at her watch. Two o'clock. Still two hours to go before her shift ended.
Feeling a twinge of trepidation, she dialed her friend Letty's number. Megan preferred staying there because Letty's daughter was her best friend, and Sara Jane approved because Letty was both maternal and practical. She didn't fall into a panic at every little sneeze and flushed face. The phone rang three times before it was picked up, and then it was Hillary, her daughter's seven-year-old friend.
"Hillary, it's Sara Jane. Are you having a good time with Megan?"
"Megan's sick," Hillary said. "Her head hurts and her legs hurt and her arms hurt. She can't play at all."
"Poor Megan. I hope she doesn't have anything you could catch."
"Mom put her in the spare bedroom and I'm not allowed to bother her," Hillary said.
Less sanguine than she was attempting to sound, Sara Jane asked, "Can your mom come to the phone?"
"I guess. I'll see."
Sara Jane could hear the child calling in the background, getting farther and farther from the phone. There was a very long wait before Letty picked up an upstairs extension. "Sara Jane? Sorry to have to call you at work, but Megan really does seem to be worse. She's got a headache and she's complaining of hurting all over. She's crying and saying she wants you to come. I tried your house but there was no answer. Will Frank be home soon?"
Glancing once again at her watch, Sara Jane calculated how soon her husband could possibly return from the tournament. "I doubt he'll get back before five." Sara Jane rubbed her forehead in an agony of indecision. They were short-handed at the hospital as it was, and she was covering a shift by working that day, but her daughter needed her. If this was a case of the flu there was little she could do to ease her daughter's symptoms that Letty couldn't, but Megan was asking for her, needing her own mother when she felt so rotten.
"I'll arrange for someone to cover," she finally said into the receiver. "Tell Megan I'll be there soon."
"Thanks, Sara Jane. She'll really appreciate it."
Poor kid, Sara Jane thought as she stripped off her scrub gown. Little Miss Song-and-Dance wasn't accustomed to being sick. In fact, neither of her kids had had many of the usual childhood illnesses. No ear infections, few colds, only the occasional scrape or sunburn. They'd been really lucky, she thought, superstitiously tapping her knuckles on the wooden counter. She'd give Dr. Topping a call when she got Megan home, just to be on the safe side.
Frank Malone was surprised to find his wife cooking dinner when he came into the kitchen behind their son Sam. On days when Sara Jane worked, and he didn't, they had an arrangement that he would do the cooking. When they both worked, they both cooked. Frank knew his wife well enough, after twelve years of marriage, to discern the troubled frown she couldn't entirely banish as she hugged Sam and asked about his day.
Sam detailed their exploits in his too-serious-for-a-ten- year-old voice. Though it was easy enough to tell he had enjoyed himself, he was not given to his sister's light-heartedness. With his sandy hair and freckled face, and the lopsided grin he infrequently flashed, he looked more mischievous than he really was. Sam seldom got into trouble.
As Sam talked, Frank caught Sara Jane's eyes over the boy's head. She seemed to indicate by a slight shake of her head that she didn't wish him to question her while Sam was there. They were probably too protective of Sam, he thought. Maybe the boy wouldn't take everything so seriously if they didn't smooth the way for him. Frank wasn't above wishing that his son was a little more aggressive, a little more rough and ready. The boy took after him too much, his head frequently stuck in a book, his sharp ten-year-old mind questioning subjects beyond his years.
Perhaps if their personalities had been reversed, his children would be more prepared for life in the nineties. But who could want Megan to be other than the delightful charmer she was, and Frank knew that in the long run he would infinitely prefer a serious-minded son to a jock.
Megan took after Sara Jane. They both had short, curly brown hair, and eyes the color of sapphires. But the greatest similarity, Frank realized as he watched his wife stir the spaghetti sauce while she listened to Sam, was that irrepressible joy in living they shared. He was far from sure how Sara Jane had fallen in love with him, her opposite in many ways. At the time he'd thought she sought a balancing influence to her headlong rush into life—her total immersion in nursing, her fun-loving excesses when she partied, her incredible energy level that kept her from sitting still.
When Sam had finished his account, he said he'd go find Megan. Sara Jane shook her head. "She's asleep now, Sam. She's not feeling well. Better find something to do in your room. Dinner will be ready in a few minutes."
The announcement of Megan's illness surprised Frank. When Sam had disappeared from the kitchen, he pursed his lips, frowning. "Sick, Sara Jane? What's the matter with her?"
Sara Jane's shoulders twitched in a restless shrug. "I don't know. Letty asked me to come pick her up early. I called Dr. Topping and he said it was probably flu." Her thick eyebrows drew down over worried eyes. "He said we should watch her overnight, and bring her in if she's worse in the morning."
Frank remained in the doorway, one hand pressed against the frame. "You don't sound convinced that it's flu. What else could it be?"
Sara Jane turned the water down on the boiling pot at the back of the stove. "Her head hurts and her body aches all over. That sounds like flu. But she doesn't have any congestion, and she's had those fevers. And she looks sick. I wasn't surprised that Letty called me, when I saw Megan lying there in bed like all the stuffing had come out of her. It worries me, Frank."
He pushed himself away from the door frame and moved across the brightly lit kitchen to hug her. When he'd first met Sara Jane, such demonstrations of affection were not in his repertoire. But you couldn't be with Sara Jane long and not be converted to her own touchy-feely type of interaction. She kissed people, she hugged people, she touched even strangers' hands and arms as she talked to them. Her whole family was like that—a great clan of touchers.
"Hey, I'm sure it's nothing to worry about, sweetie. The kid's hardly been sick a day in her life. It's not like she's prone to come down with every little thing."
He was alarmed to see moisture pool in his wife's eyes, quickly blinked away. She pressed tightly against his chest and muttered, "I wish I remembered more about kids' sicknesses. I've been an OB nurse so long it's kind of disappeared from my mind."
"Hey, hey, you're getting way ahead of yourself. It's probably the flu, remember?"
He could feel her shiver under his hands. But she stepped back and smiled. "You're right. I'm making too big a deal of it. You'd think there hadn't been enough drama in my day. We almost had a patient bleed out on us just before I left."
"That's what's got you rattled," he said, kissing her forehead. "Can I help with dinner?"
"Sure. Why don't you make the salad and set the table?"
At eleven Sara Jane checked on her daughter for the last time before going to bed. Megan slept, a restless, whimpering sleep, which unnerved Sara Jane. Though she didn't want to wake Megan to take her temperature, she could tell from the heat of the child's forehead that the Tylenol she'd given earlier hadn't brought it down to normal.
Standing in the doorway after she had adjusted the blankets, Sara Jane tugged tightly on the terry cloth belt of her robe. Megan looked so vulnerable lying in the white four-poster bed her grandparents had given her for her sixth birthday. Frank's parents were wealthier than her own, and lavished gifts on both children, their only grandchildren. Sara Jane had finally begged them to slow down. She didn't want her children spoiled.
In a different way Sara Jane's parents attempted to spoil them, too. They didn't offer the expensive trips to Disney World, or tickets to the children's symphony. No, the Stennises had their own way to delight a ten year old boy or a seven year old girl. Her mother knitted bright, adorable sweaters that somehow never were the wrong thing for very opinionated youthful clothing wearers. Her father took them strawberry-picking and fishing, to visit the Pittsburgh zoo or ride ponies on a farm.
Both sets of grandparents lavished love as well as treats on Sam and Megan. They were lucky kids.
Looking around her daughter's room, Sara Jane could pick out the favorite books they'd given, the stuffed teddy bears presented for Christmas and birthdays, and the imaginative, brightly colored toys clustered under Megan's miniature desk.
It had been Sara Jane and Frank, though, who had painted and wallpapered the yellow and white room with its bold green carpet like grass under foot. There was a border of red tulips above the floorboard, and a pattern of purple wisteria on a trellis. When the sun shone in, Megan's room felt like a spring day.
Megan, practically from the day she took her first step, had danced. Laughing and singing and skipping around the bright room, she made her parents laugh, enchanted her grandparents. Soon, Sara Jane assured herself, Megan would feel better. She'd be up and bouncing off the walls the way she always did.
This was just a particularly nasty flu. Dr. Topping said there was plenty of it going around at the grammar schools. He'd seen three cases today alone. And their family practitioner was not above making house calls. If Sara Jane felt Megan needed to be seen that night, Dr. Topping would come.
With a sigh Sara Jane drew the door closed far enough that the hall light wouldn't shine in, but she would be able to hear any sound from her bedroom next door. Their house was compact, with three small bedrooms on the second floor. Sometimes the four of them seemed right on top of each other, the spaces were so constricted. But an older, smaller house was what they could afford, and Sara Jane had had the energy and imagination to decorate it inside to capture the illusion of space and light. Outside it still looked like all the other weathered red brick houses on their street.
Sara Jane blew a kiss to her daughter and slipped into her bedroom where Frank was already lying in bed, propped against the headboard, reading a biography of Lincoln. When he looked up, she could tell he hadn't been concentrating on his book. "How is she?" he asked, placing a bookmark in the biography and setting it on the nightstand.
"Maybe a little less restless, but still feverish." Sara Jane slipped out of her bathrobe and tossed it over the back of the old oak rocking chair she'd used when nursing each of her children. "I left her door open so we can hear her if she needs us."
Frank nodded and watched as she sat down on her side of the bed. "I can stay home with her tomorrow if she's not well enough to go to school. I haven't taken any sick days all year."
Sara Jane would have preferred to be the one to stay home, but it probably made more sense for Frank to do it. She squirted a dab of lotion on her hand and worked it into her winter-dried skin. "Okay. But you have to promise to call me if she gets worse."
"I will." Frank stroked her arm under the flannel nightgown. "Relax, honey. It's just the flu. You're all tense."
"I can't help it. She's never sick."
"I know." Frank plumped her pillow and lifted the corner of the covers. "Come on, get in. Let me hold you."
"Not tonight," she protested.
"Yes, tonight," he said patiently. "It always comforts you."
She needed the comfort of their bodies pressed together, the solace of his flesh on hers. But they seldom managed to merely lie companionably in each other's arms. "I left the door open so we could hear her."
"Good. She's asleep now, isn't she?"
"Yes." Torn, Sara Jane slid under the covers. Frank stroked her arm as she lay rigid at the edge of the bed. This did not seem the appropriate time to indulge in lovemaking. She remained where she was, trying to ignore the soothing effect of his hand's slow rhythm on her forearm. His hands were always warm. It was one of the first things she'd noticed about him when they met a dozen years ago.
Frank had been shoveling snow from his aunt's walk on a freezing winter day. His aunt had moved into a house down the street from her parents, a house Sara Jane knew well because one of her best friends had lived there when she was growing up. Because she now lived in an apartment of her own, nearer to the hospital, it was the first time she had seen the young man.
From the window of the Stennis living room, she had watched him work efficiently down the concrete path to the sidewalk. Despite the cold, he wore no hat. His dark hair curled down over his ears, but she could see that the lobes were pink with the cold. He grinned when his young cousin caught him squarely in the chest with a snowball, but before the boy knew what had hit him, Frank had tackled him into a snowbank. They rolled on the ground, trying to rub snow on each other's faces, laughing uproariously the whole time.
Sara Jane knew she had to meet him.
Without a moment's hesitation, she had grabbed her coat and hat from the closet and charged out the front door, allowing it to bang shut behind her. No stranger to her own impulses, she was not surprised when she found herself halfway to the wrestling duo without a pair of gloves. Regardless, she scooped up a handful of snow and lobbed it accurately at the man, calling, "Bully! Pick on someone your own size."
Startled, he had turned to see where this new attack was coming from, and the boy managed to slip a handful of snow down the collar of his navy loden coat. With a gleeful cry, the boy sped off in the direction of the garage, never looking back. Frank, uncertain as to whether she really thought he had been hurting the child, scrambled quickly to his feet. "We were just playing," he explained, dusting the snow off his brown corduroy pants. "He's my cousin."
"Oh, sure," she said, pretending not to believe him. "And you're such a big guy. Poor little kid must have been terrified."
Apparently he had seen the gleam of amusement in her eyes, because he smiled and cocked his head at her. "Is this how you spend your Sundays, rescuing little boys from their wicked cousins?"
"Most Sundays, though occasionally I have to work."
He narrowed curious brown eyes at her. "What do you do?"
"I'm an nurse, an obstetrical nurse."
"So you do rescue little kids," he teased.
Sara Jane had loved the way he said it, so warmly approving, so casually familiar. He pulled off a soggy brown leather glove and offered her his hand. "Frank Malone," he said.
She allowed him to clasp her hand in his surprisingly warm one, experiencing a sense of expectation. "Sara Jane Stennis. My folks live over there." She pointed to the house with her left hand, because he hadn't let go of her right one. "My best friend used to live here."
"Really? That makes us practically related, doesn't it?"
"I hope not," she said, grinning, as she extracted her hand from his grip. "How about a cup of cocoa?"
It had been as simple as that. He had immediately seemed different than every other man she'd known. And Sara Jane was an outgoing, high-spirited woman at twenty-one. She had dated her share of men, and been intimate with a few. Somehow Frank's touch alone had filled her with anticipation. And it still did.
He had slid the long flannel nightgown above her hips and now drew her against himself. Sara Jane realized that she no longer had any objections. It was usually like that with Frank, even after twelve years, as though he possessed some magic in his touch. She leaned away from him to pull the nightgown over her head and toss it to the floor. For long minutes they shared the pleasure of exploring each other's bodies. Sara Jane felt her anxieties recede far to the back of her mind.
Their joining was slow and powerful. All the coiled tensions of her body exploded in profound release. Frank shuddered and held her tight, whispering, "I love you, Sara Jane."
She traced the line of his jaw with her index finger. "And I love you, Frank. We're very lucky." Before long her hold on him loosened as she fell into a deep, dreamless sleep.
An hour later the quiet of the small red brick house was shattered by a child's haunting cry.