Which disaster had precipitated this? My eyes scanned to the top of the page again, reading the plaintiffs’ names, which I’d somehow missed the first time around.
SEAN AND CHARLOTTE O’KEEFE v. PIPER REECE.
Suddenly I couldn’t see. The space between my eyes and the paper was washed red, like the blood that was pounding so loudly in my ears that I did not hear a nurse ask if I was all right. I staggered down the hall to the first door I could find-into a supply closet filled with gauze and linens.
My best friend was suing me for medical malpractice.
For wrongful birth.
For not telling her earlier about your disease, so that she would have had the chance to abort the child she’d begged me to help her conceive.
I sank down onto the floor and cradled my head in my hands. One week ago, we’d driven down to Target with the girls. I’d treated her to lunch at an Italian bistro. Charlotte had tried on a pair of black pants and we’d laughed about low-rise waistbands and how there should be support thongs for women over forty. We’d bought Emma and Amelia matching pajamas.
We’d spent seven hours together in close quarters, and not once had she managed to mention that she was in the process of suing me.
I pulled my cell phone out of the clip at my waist and speed-dialed her-number 3, outranked only by Home and Rob’s office. “Hello?” Charlotte answered.
It took me a moment to find my voice. “What is this?”
“Piper?”
“How could you? Everything was fine for five years, and all of a sudden out of nowhere you slap a lawsuit on me?”
“I really don’t think we should be talking on the phone-”
“For God’s sake, Charlotte. Do I deserve this? What did I ever do to you?”
There was a beat of silence. “It’s what you didn’t do,” Charlotte said, and the line went dead.
Charlotte’s medical records were back at my office, a ten-minute drive from the hospital birthing pavilion. As I entered, my receptionist glanced up. “I thought you were at a delivery,” she said.
“It’s over.” I walked past her, into the records room, and pulled Charlotte’s file, then headed back outside to my car.
I sat in the driver’s seat with the file in my lap. Don’t think of this as Charlotte, I told myself. This is just any other patient. But when I tried to bring myself to open the manila folder with the bright tabs on the edge, I couldn’t do it.
I drove to Rob’s practice. He was the only orthodontist in Bankton, New Hampshire, and pretty much had a monopoly on the adolescent market there, but he still went out of his way to make the dental experience something kids would enjoy. In one corner of the office was a projection TV, where a generic teen comedy was currently playing. There was a pinball machine and a computer station where patients could play video games. I walked up to his receptionist, Keiko. “Hi, Piper,” she said. “Wow, I don’t think we’ve seen you here in a good six months-”
“I need to see Rob,” I interrupted. “Now.” I grasped the file in my hands more tightly. “Can you tell him I’ll meet him in his office?”
Unlike my office, which was all the colors of the sea and designed to put a woman at ease, in spite of the plaster models of fetal development that dotted the shelves like little Buddhas, Rob’s was luxurious, paneled, masculine. He had an enormous desk, mahogany bookshelves, Ansel Adams prints on the wall. I sat down in his tufted leather chair and spun it around once. I felt small here. Inconsequential.
I did the one thing I’d wanted to do for two hours now: burst into tears.
“Piper?” Rob said as he came in to find me sobbing. “What’s the matter?” He was at my side in a second, smelling of toothpaste and coffee as he folded me into his embrace. “Are you okay?”
“I’m being sued,” I managed. “By Charlotte.”
He drew back. “What?”
“Med mal. For Willow.”
“I don’t get it,” Rob said. “You weren’t even at the delivery.”
“This is about what happened before.” I glanced down at the file, still on the desk. “The diagnosis.”
“But you did diagnose it. You referred her to the hospital when you found out.”
“Apparently, Charlotte thinks I should have been able to tell her earlier-because then she could have had an abortion.”
Rob shook his head. “Okay, that’s ridiculous. They’re die-hard Catholics. Remember that time you and Sean started arguing about Roe v. Wade and he left the restaurant?”
“That doesn’t matter. I have other patients who are Catholic. You counsel termination no matter what, if it’s an option. You don’t make the decision for the couple, based on your own assumptions about them.”
Rob hesitated. “Maybe this is about money.”
“Would you ruin your best friend’s reputation as a doctor just to get a settlement?”
Rob glanced down at the file. “If I know you, you documented every last detail of Charlotte’s pregnancy in there, right?”
“I don’t remember.”
“Well, what does it say in the file?”
“I…can’t open it. You do it, Rob.”
“Sweetheart, if you don’t remember, it’s probably because there’s nothing to remember. This is crazy. Just look through the file, and turn it over to the malpractice carrier. That’s what you have insurance for, right?”
I nodded.
“Do you want me to stay with you?”
I shook my head. “I’m okay,” I said, even though I didn’t believe it. As the door closed behind him, I took a deep breath and opened the manila folder. I started at the very beginning, with Charlotte’s medical history.
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.