"I told you," Fletcher said. "Her HLA is rare."
"But-"
"Look, scut puppy." She was tired, worried, and irritated. "You stick the patients, and I'll do the doctoring. Okay?"
Landry said nothing. Turning, he walked out of the infant ICU, leaving Dr. Fletcher behind in her anger.
He made straight for the file room and its computer.
"Is this thing logged on?" he asked.
The busy record keeper nodded without lifting his gaze from a stack of forms. Landry started tapping away, pleased to know that he was accessing the files with someone else's security code. Though everyone did it, he felt he had extra reasons to be secretive. The screen offered up the files on Karen and Renata Chan-dler. He scrolled through them quickly, noting within instants that their Rh factors were identical. As Dr. Fletcher indicated, though, their ABOs were indeed mismatched. The mother had AB blood, the baby had type O. A transfusion or marrow trans-plant from mother to daughter would be fatal. Renata's own blood would hemolyze-clump up and kill her.
No mention existed of the father in either file, so the hepati-tis B comment couldn't... Landry looked back at the blood groups. Something was wrong. Mother AB, daughter O. That can't be, he thought. Can it? If the mother was AB, the daughter would have to be A, B, or AB. She could never be O. Ever.
When the realization struck him, he laughed. Of course! She was in the fertility program. She got someone else's egg. Landry shook his head. What a jerk. Valerie Dalton must have been the egg donor. That's why Fletcher brought her in. Nothing super unusual in that.
Except, he realized, that Valerie Dalton was unaware of Fletcher's involvement in the fertility program. She was only familiar with the Fletcher that performed abortions.
A sickening sensation churned inside Landry's stomach.
Calling up Dalton's file, he noted with relief that the date of her abortion was March third. Scrolling back to Karen's file, he saw that her fertility operation took place January seven-teenth. Maybe I'm wrong. I have to be wrong. Or maybe...
He printed out copies of the screen pages, then darted over to Reproductive Endocrinology, fifty feet down the hallway.
The receptionist listened to his request. "Well, hon," she said in her raspy voice. "I don't know what good seeing the old appointment books will do. We don't keep patients' addresses there."
"No," Landry said, thinking as swiftly as possible. "But you do keep phone numbers. Just let me look at the month of March. I can find the patient's name if I can correlate the time of the operation to the time of the transfusion."
"I don't know-"
"Look, Mrs. Welsch, if the transfusion you'd received half a year ago had turned out to have HIV in it, you'd want someone to track you down and tell you, wouldn't you?"
"Why, so I can worry myself to death?" She pushed away on her swivel high chair to the shelves behind the counter. A half rotation brought her face to spine with the appointment book back files. She removed a thick blue canvas-covered binder.
"Here's the first half of the year, hon. Bring it back when you're done." He thanked her and carried the binder off to the break room. Too crowded. He found an examination room that wasn't in use and closed the door. Placing the binder on the couch, he opened it to January seventeenth. Karen Chandler had a one o'clock appointment. No Valerie Dalton. Then he checked March third. No Karen Chandler, but a six-thirty appointment for Valerie Dalton. He sighed and stared at the page. It was a stupid theory, any-He stared at an entry next to Dalton's. Reaching overhead, he pulled down the lamp and switched it on. The intense white glare brought out every detail of the page. The entry next to Dalton's had been written over an erasure.
Landry angled the lamp to bring out surface details. It looked as if the name Chandler had been there once. He reached into his breast-pocket pen protector. Taking the edge of a pencil to the entry, he lightly rubbed all over until only the grooves made by the original entry showed as white traces against a grey background.
He gazed at the tracing, barely able to make out a captial K, a small e and n, and the last name Chandler. He frowned for a moment, almost not wanting to believe. Then he went back to January seventeenth. Karen Chandler's appointment had been written in over an erasure of another woman's name.
Appointment changes were common, Landry reminded him-self. That's why entries are written in pencil. The sick feeling, though, would not go away. "
Valerie noted the young man's troubled expression as he returned to check her progress. She sat up with his help and had another glass of orange juice.
"If you had it to do over again," he suddenly asked, "would you have gone through with your abortion?"
Valerie turned to stare at him in shock. "I don't think that's any of your concern. How dare you ask-"
"What if some way existed," he said quickly, his words tum-bling out in a rapid, anxious whisper,
"for you to have ended your pregnancy without harming the fetus? What if your baby were ali-" The door to the blood room swung open. Dr. Fletcher strode in and scanned the room to see Landry crouched next to Valerie Dalton. He shut up the instant he saw her. Rising up unsteadily, he resumed his work.
Valerie said nothing to the technologist. Her confused eyes watched Fletcher's approach.
"Have them get the blood over to infant ICU," she told Landry, then turned to gaze down upon Valerie. "I want you to know how much we appreciate your doing this to help a little stranger. I hope that we can count on you for subsequent do-nations."
With the doctor's aid, Valerie slid her legs off the cot and sat up straighter, her left hand still applying pressure to the crook of her right arm. "How often will I have to do this?" Fletcher sat next to her on the padded table. "There's no way of knowing. Transfusions are adequate in providing sup-portive care. Sometimes it's all that's needed to help the bone-marrow to recover and start producing blood cells again. There's a surer way, though."
"What's that?" Valerie stared at the floor, unable to look at the doctor.
"A bone-marrow transplant will give the baby what she needs directly. Recovery is almost immediate and generally perma-nent in most such procedures."
"What do you mean by a transplant?" Valerie asked. She noticed that the floor below had two dark brown spots on the green linoleum. Her blood? Or some stranger's before her?
"It's not the same as an organ transplant. We don't do any surgery. It's almost like a blood transfusion except that we put the needle into your hip or sternum where we can aspirate some bone-marrow. Then we inject it in the baby just like a blood transfusion. The cell colonies swim around in her blood-stream and instinctively head right for her bones. There they set up shop and start manufacturing new cells. And then she can lead a full and healthy life." The doctor put a friendly arm around her patient. "And-if your tissue types match-you could be the one who saves her."
"Does it hurt?"
"I'd be lying if I said it didn't. But dying hurts a lot more. And not just baby Renata. Her parents have been trying to have a baby for years and she's their first. Remember what I said about... well, you know. What I said last night."
Valerie looked up into Dr. Fletcher's sympathetic eyes. "I'd like to see her." Fletcher's eyes became guarded, her entire expression stiff-ening imperceptibly. "That isn't really possible. She's in Inten-sive Care."
Landry, gathering up his equipment slowly in order to eaves-drop, said, "She can look through the observation window." He watched the doctor for her reaction, trying to maintain an innocent, helpful expression.