LEXIE
Annie freaks out when Sam tries to call an ambulance, and I calm her by suggesting that we could maybe just drive her. Soon we are making our way to the car, headed for Sam’s hospital—and the panic within me gives way to dread. There are closer hospitals, and certainly more suitable options, but he is adamant that she will get the best care with his colleagues. Annie hesitates again when she realizes that Sam works at one of the more upmarket hospitals in the county. Maybe she’s worried about the bill. Well, if she is, that makes two of us.
“Can’t we just wait until morning and go to Lexie’s clinic?” she asks, and I almost wish we could—at least then I could keep her from his workplace.
“You need to be admitted to a proper hospital. My clinic doesn’t have the right facilities.”
“My hospital,” Sam repeats firmly. “It’s the best option.”
Still, I catch his arm after he helps her into his car and pushes the door closed.
“But she won’t have insurance,” I whisper somewhat awkwardly.
“It’s fine, Lexie. She’s family—we’ll take care of it,” is all he says. I spend the thirty-five-minute drive worrying about how this is going to play out. Sam’s parents covered his tuition—but I have hundreds of thousands of dollars of debt between my student loans and the credit cards I used to put Annie through rehab, plus Sam and I did just buy the house, and the bill for Annie’s treatment could be immense. Maybe Sam will get a staff discount, and Medicaid will surely cover some of it...but even so...this is likely a huge financial undertaking.
I’d have covered her bills myself, probably without even thinking twice about it. But Sam is involved now, and it feels wrong for him to pay for Annie’s care. And then there’s the potential for untold drama—the last time I let Annie near my clinic, she was caught breaking in one night raiding the meds cabinet, and I almost lost my job over it.
Annie is in the front seat and I’m in the back, so I can’t actually talk to Sam about my concerns. We will just have to sort it out later, once the emergency passes and we’re sure the baby is fine.
As he drives, Sam calls the obstetrics ward on the Bluetooth car kit and briefs the consultant obstetrician on the situation. I notice the way that he carefully avoids any reference to Annie’s addiction, other than a quiet murmur right toward the end of the call, when he simply says, “There is potential for the infant to suffer NAS.”
I doubt Annie knows what “NAS” stands for, but I know: neonatal abstinence syndrome. It’s a cruel start to life—all of the physical symptoms of opiate withdrawal, crammed and compressed into a tiny newborn’s body. I saw a few cases during the obstetrics rotation of residency. I watched those little babies shake and scream for hours on end, until they’d sweated through their clothing and vomited up every drop of milk in their stomachs. We treat NAS in much the same way that we treat heroin withdrawals—with gradually decreasing doses of opiates—but it’s a very difficult condition to manage. There’s nothing worse in the world than watching a brand-new baby writhe in an agony that could have been avoided.
I’m about to welcome a new niece or nephew who will have one of the worst possible starts to life. There is only one upside to this situation: most NAS babies come through the awful early weeks relatively unscathed. Long-term outcomes are usually good, as long as the baby goes home to a stable environment. I stare at Annie, sitting in the front seat quietly weeping, and wonder if there is any chance of that happening in this case. What kind of upbringing can she offer this baby? And who else is there to support this child? Where is the father? Is my sister’s entire support network me?
When we reach the hospital, Sam parks in his staff parking spot and turns to me.
“I’m going to get Annie a wheelchair. Can you please wait with her?”
When Sam leaves the car, Annie finally speaks.
“I’ve really fucked things up this time, haven’t I?”
“You need to stay calm, Annie.”
“I tried, Lexie, I promise you.”
“Does Mom know about the baby?” I ask. Annie shakes her head. “Can I tell her? Or do you want to? We can call her in the morning.”
“No, I don’t want to worry her—I’ll get clean first, then we can call her... I just need to get my shit together...”
Annie’s voice is starting to wobble, and I realize this isn’t the time to have this conversation, so I let the subject drop. We sit in silence for a while, other than the lingering echoes of her sporadic sobs.
“Sam seems nice,” she says eventually.
“Sam is wonderful.” I look out the window to see him approaching us with the wheelchair. “Wait here a second?”
Before she can respond, I slide out and shut the door behind myself. Sam parks the wheelchair beside Annie’s door and stares at me over the roof of the car.
“Are you okay?” Sam asks me. His eyes are bloodshot and there are already bags hanging beneath them. He won’t be operating today, which means that five or six patients will have to wait for their surgery. Sam is a general surgeon; these were unlikely to be lifesaving or critical surgeries, but it’s still a huge inconvenience. The patients will now have to wait weeks or months for their operations to be rescheduled.
This is what happens whenever Annie reenters my life—things fall to bits, and she’s always oblivious to how the effects flow on and on beyond her. It’s remarkable how one person’s presence can disrupt every little thing that is ordinarily secure. I know it’s too late to go somewhere else, but I can’t hold back my reluctance to proceed.
“We shouldn’t have come here, Sam,” I say quietly, keeping my voice low so that Annie will not overhear us. “We should have gone over to Montgomery Public. You don’t understand what happens when she’s around—she’s chaos personified. It’s just too risky for her to be in your hospital.”
“If she’s here, she’ll be treated well. The nursing staff will give her extra attention, and there’s a high-risk obstetrician I trust implicitly—her name is Eliza Rogers, and I’m going to call her in the morning to ask her to care for Annie personally. Trust me, Lexie, this is for the best. Plus, your clinic is only a few blocks away, and our place is only a twenty-minute drive. She’s going to need us.”
“Annie doesn’t just come into your life and pass through it. She takes prisoners and leaves a trail of destruction.”
“Well, whatever happens—we’ll handle it together, right?” I hesitate again, and Sam raises his eyebrows at me. “Look—we’re just going to have to talk about this later. She needs treatment now.”
He’s right, and I know it. I force my thoughts away as I help Annie into the wheelchair. For better or worse, she’s here now. Sam navigates the wheelchair through a maze of brightly lit hallways, and he’s nearing the ward when I finally glance at my sister. I find her staring at the floor, her jaw set hard. Guilt rises as I wonder if she’d heard my conversation with Sam over the roof of the car.
“Are you okay?” I ask her quietly, and she slowly raises her eyes to me and says, “Have I ever been okay, Lexie?”
I don’t know how to answer, but while I’m fumbling for words, we arrive at the maternity ward. Things begin to move quickly; Annie is sent to give a urine sample and then taken to a private room. A monitoring unit is fitted to her belly, and after several failed attempts by a nurse, the consultant manages to fix an IV into Annie’s arm. No one mentions her collapsed veins or the pockmarked scars along her inner elbow. No one says aloud what I know they are thinking—what I’m thinking, although I hate myself for it.
Filthy drug addict.
We are medical professionals. We know addiction is a disease. We know how hard it is to beat, and how hard it is to access treatment around here. Between meth and narcotics, there’s an epidemic of addiction in this state and there aren’t enough rehab centers. Then there’s her pregnancy, which would disqualify her from treatment at all but a handful of rehab centers in the entire country. Annie represents an impossible mix of circumstances that the rehab industry just isn’t equipped to deal with. I know this, her doctors know it, her nurses know it.
But we aren’t just medical professionals—we are also human beings—and Annie is in a truly terrible state. She’s lying on the bed now, but she’s restless and she’s scratching compulsively around the sores and scabs on her arms and mouth. Every now and again she noisily blows her nose, or dissolves into fits of compulsive sneezing—all symptoms of her body craving the next fix. Even I can’t stop an instinctive feeling of disgust at the sight of her, and an automatic fury on behalf of the baby who’s been dragged along for the chemical ride.
I’m ashamed of that as her sister and as a doctor, but the feeling is as natural as my next breath. I see it in the staff treating her, too. I see it in the way they hesitate for just a second before they touch her, in the silent frowns and narrowed gazes, even in the way their glances flick toward the door again and again as they wait for her to stabilize. I know they want to get out of this room, to move their attention onto more worthy, less uncomfortable patients.
The professional thing to do would be to reserve our judgment. The best we can offer is to judge quietly.
Our training tells us that addiction is a disease, too; a disease with no real cure, a disease that’s difficult to treat. But human nature wants to ignore that training, and to pretend it’s some kind of moral weakness that has brought Annie to where she is now. Maybe we need to believe she’s chosen this life, or that she deserves it somehow, because the alternative is unbearable, unfathomable—even if she is completely blameless, we’re still going to be repulsed by her. And besides which, if she’s a pregnant drug addict because she’s a bad person, then she’s not like us: we’re good people. We could never find ourselves in her position. We are comforted by our sense of smug superiority. It’s a security blanket, a shield.
The IV is finally seated in Annie’s arm. I crane my neck to see what drug has been prescribed, but I can’t make out the label.
“What are you treating her with?”
“You’re Ms. Vidler’s sister?” The consultant frowns at me as he looks up from his chart, and I frown right back at him.
“I am,” I say, then I add, “I’m Dr. Alexis Vidler.”
“Well, doctor or not, I’m not sure you should be in here while we’re stabilizing her.”
“Please, Ron. Let her stay for support?” Sam intervenes, and the consultant sighs but he nods. I open my mouth to ask again about the drugs they have just added to her IV, and Sam shoots me a pointed look and presses his forefinger to his lips. I watch the clear liquid drip through toward her veins—winding its way down into her body.
Would it be nifedipine? Or labetalol? What dose have they got her on? If it’s not high enough, they are just wasting time. What if I don’t speak up and they don’t get the pressure down quickly enough and what if—
“Can you just tell me how you’re planning on treating her?” I blurt, and Sam takes my hand and very gently tugs me toward the door. I plant my feet hard against the vinyl floor and he pulls a little harder. When I resist, he gives me an exasperated look.
“But she’s my sister, Sam,” I protest fiercely.
Tonight is apparently a night for firsts. I met Sam at a physicians networking event, but I’ve never once seen him speak to a patient. I imagine that he would use the kind of tone he uses on me now—supportive, but also firm. He’s never needed to speak to me that way, and I find it both disarming and irritating.
“Exactly. So if you can’t leave them to do their work, you’ll need to wait in the hall.”
I groan in frustration and snatch my arm away from him, then walk to sit in a chair at the corner of the room. Sam follows me and sits beside me, but he doesn’t take my hand.
“Annie,” the consultant says quietly, “are you on a maintenance program?”
Annie scowls at him.
“Do I look like I’m on a maintenance program?”
The doctor’s expression doesn’t change.
“Okay. So can you tell me what your usage is like?”
“My usage?” she repeats, and she laughs bitterly.
“Annie,” I say gently, and she turns her gaze to me. I see the stain on her cheeks; she’s embarrassed to be discussing this with them, and maybe it’s worse because I’m in the room. Well, I’m not going anywhere, so she’s just going to have to get over it. I prompt her gently, “Please, talk to him. It’s really important.”
Annie swallows, and her gaze falls to the shape of her feet, hidden now by the hospital blanket. After a minute, she says unevenly, “At least half a gram a day. My last bump was about eight o’clock last night.”
“Thank you,” the doctor says, and he types into the computer then adds, “I’ll need to consult with a specialist, but I think the best option is going to be split-dosed methadone.”
“I’m not going on a fucking maintenance program,” she snaps, and I sigh and run my hand through my hair. Sam reaches across between the chairs and squeezes my knee gently. I grimace silently at him.
“Given how heavy your use is, it’s going to be a very uncomfortable stay if you don’t agree to something to prevent the withdrawal, Anne,” the consultant says, firmer now. Annie glares at him.
“That’s why it’s not going to be a long stay.”
“Annie,” I interject quietly. “Will you agree to take some methadone just to get you through the next few hours? Until we can get your blood pressure stable?”
Annie’s gaze narrows.
“Can I do that?”
“Of course. You can withdraw your consent for it anytime. But taking it now will ease off the withdrawal symptoms for a while...so the hypertension drugs have some time to work.”
“Fine,” Annie snaps. “Just this once.”
It’s always like this with her. The big battle for her sobriety has been a marathon series of much smaller battles that each needed my careful, attentive management and focus. I’d almost forgotten how difficult she can be. In the seconds after Annie agrees to the maintenance drug, I close my eyes for a moment and try to gather myself. Sam releases my knee, but he slides his arm around my shoulders and pulls me gently against him. I feel the brush of his lips against my hair.
“I’m okay,” I whisper to him.
“I know,” he whispers back.
Sam holds me for a while as we sit and watch the staff work. I glean tiny pieces of information as I eavesdrop; there was some protein in Annie’s urine but not a lot—which may mean she has preeclampsia, and she will need to be very closely monitored. She has, inevitably, failed the narcotics test. Annie responds quickly to the anti-hypertension medication and her blood pressure finally levels out, then starts to drop.
They give her a sonogram with a portable machine right there in front of us, but Annie is becoming drowsy from the medication and is only half-awake to see her child on the screen. I watch the shadow of a smile pass her lips as the first image swims into focus. I move closer to the monitor, and while I’ve seen countless sonography scans in my time, there’s something different about this one. The baby’s body shape appears, and as I identify its form, it’s no longer a fetus. It’s my sister’s baby; my niece or nephew. For all of her faults, Annie already loves it, and in some bizarre way, I already love it, too—just because it’s hers.
The sonographer measures the velocity of the blood passing through the placenta and umbilical cord and then in the baby’s brain. The measurements are all within safe ranges, at least now that Annie’s blood pressure has stabilized. The baby’s femur and humerus lengths suggest that Annie is probably about thirty-five weeks into the pregnancy, but the baby’s belly is much smaller than it should be. This is a typical pattern for a fetus with a growth restriction, but that’s expected given Annie’s addiction and her blood pressure issues.
“Yeah, this little one is going to be tiny,” the sonographer confirms quietly. “But things look okay, considering.”
This is the closest thing to good news that I could have hoped for given the circumstances, and I flash a teary smile toward Sam, who offers an equally weak smile in response. There’s a long road ahead of us—but for now, Annie and the baby are safe. I release a long, heavy breath, and I decide I’ll shift closer to the bed so I can hold Annie’s hand as she sleeps. Sam has other ideas.
“Let’s get a coffee?”
“I can’t leave her,” I say. He offers me a quizzical smile.
“She’s sleeping. Let’s take a minute while things are calm.”
The sonographer is packing up, and the flurry of nurses and doctors is easing. Still, I hesitate—her situation could change in an instant. It’s unlikely, though. She’s on the right meds now, and even if something does change, at least there are monitors fitted so the staff can react.
“Okay,” I say with a sigh, and he rises and gently pulls me to my feet.
* * *
Sam leads the way to a table in the corner of the cafeteria, and we sit opposite one another. Hospital cafeterias are creepy places in the middle of the night. I’ve never been to this one before, but I somehow still miss the swarming mass of staff hastily eating between crises, and the overwhelmed fathers trying to inhale coffee between diaper changes, and the teary relatives grieving bad news. The cafeteria is always a place of extremes, but it’s never more uncomfortable than when it’s empty.
For a while, we sit in silence. I nurse my coffee and stare down into the black liquid while I try to collect my thoughts. There is a swirling mess of ideas and concerns and worries in my mind—and I try to pick one out to speak to Sam about—but then all of a sudden I can think of only thing one thing to say.
“Sorry.”
I blurt out the word—almost pleading with him to accept it, as if this were all my fault—as if an apology could make it all better, if only he says that’s all right. Maybe there is something to my guilt—after all, I have buried my head in the sand for the last two years. I have made a dreadful, unforgivable mistake by not checking on my sister at least every now and again. I should have known how bad things were. I should have known how desperate she was.
“Honey.” Sam raises an eyebrow at me. “None of this is your fault.”
“But this will get worse, you know. It’s never one thing with Annie.”
“Well—at least she’s asking for help now. The baby’s heart rate was all over the place. Another few days and it would have been too late.”
“They’ll have to report her.”
“I know.”
“Do you think she’ll be charged?”
“Well, Annie can’t really handle any stress at the moment...maybe we can convince them to wait a little bit.”
“And then?”
“I don’t know, Lexie. We are really going to have to take this as it comes,” Sam says, and he sighs and says reluctantly, “You shouldn’t have promised her that there would be a way around prosecution.”
“I know.” Here comes the guilt again. I bite at my lip, then I whisper, “I just wanted to make her come in for treatment. She’ll forgive me, won’t she?”
“You probably saved her baby’s life—maybe hers, too. So, if she doesn’t forgive you, that’s on her—not you.” The conversation stalls again, and I stare at my coffee and try not to cry. After a while, Sam reaches across the table and squeezes my forearm. “You haven’t told me much about her, only that you’ve been estranged and that she has an addiction. How long has it been since you spoke to her?”
“About two years. The last time I saw her was a few months before you and I met.”
There is an echoing sadness in Sam’s eyes. “What happened?”
“She moved in with me the year after she finished college. We had some rough years—stints in rehab, ups and downs...you can imagine. But then I started my job at the clinic and I really thought she was doing better. She was in a methadone program, and although she absolutely hated it, things seemed stable. But then one night, she broke into the clinic. They caught her in the meds room.” Tears threaten again, and this time there is no stopping them. I groan and reach for a napkin to wipe my eyes. “It was my fault—I’d let her get into the habit of coming in to visit me at work occasionally. I thought she was just lonely. I should have known she was trying to figure out how to break in. I’d left my security pass on the hall table—and I’d forgotten my PIN code a few times so I’d been stupid enough to set it to the same one we used at home. It just didn’t even occur to me that she’d ever do anything to risk my career.”
“I can’t imagine Oliver took that very well,” Sam says, referring to my boss at the clinic.
“That is the understatement of the century.” I sigh. “He would have been pissed if she’d just broken in—but she didn’t smash a window. She walked in through the front door and right into the meds room because of my carelessness. I got a formal warning, but the worst thing was that Oliver—and the other directors at the clinic—well, they looked at me differently. I should have known better, but I trusted her because she’s my sister. It’s taken a long time to earn back their faith in me.”
“So, after that...you threw her out?” Sam says. His tone is mild, but when I look at him I’m sure I see something dark in his eyes. Judgment? Disapproval? I frown at him.
“I didn’t just ‘throw her out,’” I say defensively. “I’d only ever made things worse in all of my attempts to help her, and it was only when she nearly ruined my life, too, that I finally realized she had to take responsibility. I enrolled her in rehab for the umpteenth time, and when I dropped her off I told her that she wasn’t welcome back at my place until she actually finished the program.”
I tried to keep tabs on her while she was in the rehab clinic, but per her usual pattern, she didn’t last long. Annie was never uglier than when she was detoxing—and never more dangerous than when she was asked to hand control of her life over to someone else.
“I wasn’t criticizing you. I’m just trying to understand so I can help. We’re going to need a plan. Maybe if we can brainstorm what’s gone wrong in the past, we can think of a way to get her some help that actually helps in the future.”
I hear a clear accusation in Sam’s words, but I’m far too tired to tell if it’s really there or I’m just being paranoid. I narrow my eyes and I say sharply, “You’re going to find an answer that I’ve somehow missed all of these years, are you? Well, I’ve tried long-and short-term inpatient programs, at least three outpatient programs, and I even took her off to a luxury program overseas—she lasted a week. We’ve tried Narcotics Anonymous, several secular NA alternatives, a rapid-detox clinic, and she’s been on and off methadone and Suboxone for years. No one can make Annie do anything she doesn’t want to do—in fact, the fastest way to infuriate her is to try to impose rules on her. What rehabilitation program on earth can deal with someone who is so counterdependent that simply setting boundaries with them is enough to see them—”
I’m aware that my voice is rising and the words are starting to run into one other, but it’s only when Sam draws in a sharp breath and pushes his chair back from the table that I realize how hysterical I sound. I break off midword, and Sam raises his hands helplessly. There’s sadness and hurt in his eyes. I’ve been embarrassed about Annie all night, but finally, I’m embarrassed about something that’s entirely within my control.
Sam has been amazing tonight. He doesn’t deserve to bear the brunt of my frustrations.
“Lex, I’m just trying to help. I’m not insinuating that you’ve missed the obvious. We’re both exhausted. We can talk about this tomorrow when we have clear heads. Let’s go back and check in on her, and if her BP is still stable, we can go home for some sleep.”
“I can’t go home.” I shake my head. “I need to stay with her.”
“You have to take care of yourself first, Lexie.”
“Well, I’ve tried that too now, and that approach appears to have been the worst failure of all,” I snap again, and I rise and throw my half-empty coffee cup into the trash. It splashes up the sides of the bin and to the wall beside it, as Sam watches in silence. When I turn to him, I’m not embarrassed anymore, I’m only angry. How can he not see how impossible this situation is? She needs me. “But you should go,” I add curtly. “Get some sleep.”
“I’m not going without you. Come on.”
“No.” The word echoes all around us in the otherwise silent cafeteria, and its edges are hard and fierce—it’s jarring. Sam’s gaze doesn’t waver.
“Everything is going to feel better after some sleep, I promise you.”
“But I’m supposed to look after Annie—I promised Dad, and I’ve let her down, and I’ve let him down—and I just can’t fix it if I’m not here.”
“You haven’t let anyone down, Lex. Your sister is sick, and she has made some bad decisions.” He speaks firmly to me again, and I want to crumble and sink into the comfort of the arms he opens toward me, but I can’t. I step away from him, and the backs of my thighs collide with a chair. Sam sighs and exhales then runs his hands through his hair. We stand there in that frustrated silence until I see his expression soften. “If you don’t want to leave, we can go sleep in one of the residents’ bunk rooms. We’ll let the staff know where to find us if anything goes wrong. We could be back in Maternity in two minutes if she needs us.”
It’s a compromise—a good one and a sensible one. I can see Sam would much rather go home, and I don’t blame him—we won’t sleep well here, and we’re both exhausted. Still, there is no way I’m leaving this hospital until I’m sure Annie and the baby are fine, so Sam’s suggestion is the only way either of us are getting any rest tonight.
I nod. Sam steps back toward me and wraps his arms around my shoulders. I move into his embrace and press my face into his neck.
“You’re a good sister, Lexie. She’s lucky to have you.”
“She’s a mess. You should have known her before. She was amazing.”
“Maybe this is rock bottom. Maybe this baby is the chance she needs to be that person again.”
As we walk back toward Maternity, I try to cling to Sam’s words as if they are a lifeline. I want to believe he’s right, but my hope feels fragile—hollow almost, because we’ve hit so many rocky bottoms before, and Annie always manages to find further depths.