The Migration

It’s just past five when Aunt Irene pulls her Renault into the driveway. Her house—our house—stands at the eastern edge of Osney, a wedge of barely-island just outside Oxford town, circled by the Thames and its offshoot tributaries. The river footpath runs along the side of the house to the southeast, criss-crossing the waterways down to Christ Church Meadow, a popular gathering place for the students from the Colleges.

Kira’s nodded off in the back seat. She only stirs a little when Aunt Irene opens the door and unbuckles her.

“Want me to carry you upstairs?” She’s too big but I ask anyway, backsliding into how it was between us when she was younger. All the medical tests and treatments have made her wary of being touched.

Where the Thames flows past the house, thickset men in fluorescent vests are laying sandbags down in case of another storm. “Hullo, my duck!” one of them says to Kira, his vowels slippery and rolling. She smiles shyly and offers a little wave.

“Will we sound like that one day, Soff?” she murmurs to me as Aunt Irene fiddles with the keys on the step. Kira tries on their accent: “Hulloo, me durrck!”

“Maybe. Would you want that?” Mom’s already got a lilt in her voice I don’t recognize. She’s starting to sound more and more like Aunt Irene, which I guess is how she used to sound before she moved to Toronto before I was born.

Inside we all struggle to find somewhere to dump our things. There are coats and backpacks hung on the knob of the banister or piled with the muddy boots next to the front door. Aunt Irene wasn’t used to having company much before us. So many things are broken in the house: the kitchen clock, half the electrical sockets. The lower right-hand corner of my bedroom window has a thick crack running through it that lets in the cold. “That’s just how it is here,” Mom says if I complain. In Toronto Dad wanted our home to be immaculate. But I like how this place seems to say, “There are more important things to be worrying about.”

Mom appears in the doorway to the kitchen. “How was it?” She looks worn down, but weirdly it makes her seem more glamorous. She has the striking features you see in certain old paintings, cheekbones made for candlelight, her hair a shade darker than mine, chocolate with hints of copper. She’s beautiful in a way that makes it difficult for people to like her, the wrong combination of fragility and hardness. But where Mom is lithe and elegant I take after Aunt Irene: square, compact shoulders and narrow hips.

“Nothing happened.” Kira’s glaring at me. I decide to hold off until she’s out of earshot.

“How was the Centre? Any news, Char?” Aunt Irene asks as she steps out of her mud-splattered boots.

Kira rolls her eyes. She hates people talking about her. “Going upstairs,” she announces and clumps her way up to our bedroom. We share a big room upstairs, a barely insulated extension over the garage that Aunt Irene was using as an office before we arrived. My bed is mounted on an interior balcony I have to climb a ladder to reach while Kira’s is tucked underneath, an old wire-framed twin that looks like it came from a charity shop.

Mom shrugs and makes a sign for us both to come into the kitchen where Kira won’t hear. “Nothing definitive. Not yet anyway. But Dr. Varghese wants to meet with Sophie after we visit Cherwell College tomorrow.” She glances over at me. “Would you mind terribly, Feef? She says it might help for the two of you to get to know each other.”

“Whatever’s best.” I hate visiting hospitals but I know it’ll be easier on Mom if I suck it up.

Aunt Irene offers to work from home the next day so she can watch Kira while Mom drives me around.

“Most of the students in Cherwell College will be ahead of you,” explains one of the teachers, Mr. Coomes, for the umpteenth time in my interview. “You’ll have to work hard if you want to catch up.” He has sharply parted hair, glossy black streaked with white like a badger’s. He reminds me of the men from Dad’s office: that clipped way of speaking, the musky smell of cologne.

I grit my teeth and smile for him. “I know. But I don’t mind the challenge.”

Mom’s quick to say how smart I am, how she doesn’t think I’ll have any difficulty with the reading load. He quirks an eyebrow at me and all I can do is nod while he shows us around. We brush past a group of uniformed girls my age who glance at me without interest. They look identical: red lipstick and too-heavy mascara. Like old-fashioned pin-up models.

“I do hope your sister feels better. Our Centre, I hear, is very good for people with her condition.” Our situation was explained before we arrived, offered as a kind of apology. I’m getting used to it. Before I can respond Mom’s taking the registration forms from him and hurrying me out into the parking lot.

“God, what an ass. I forgot how condescending people can be over here,” she says when we’re back in the car.

“He was all right.” It’s the fourth place we’ve been to but the only one willing to take me at short notice. If I don’t start now I won’t be able to take the exams in the spring and that could mean putting off university for a whole year.

“There are other schools in some of the nearby towns that might have spaces open…”

We head west along the high street, passing Brasenose College and the heavy iron gates of the exam schools. As I watch a gaggle of the older students heading toward the Bodleian Library, I feel a twinge of envy. I want that to be me next year.

Perched at the top of Headington Hill sits the John Radcliffe Hospital, a massive complex of grey brick and glass.

“Last stop, I promise,” says Mom as she leads me toward one of the side entrances. “We won’t be long.” From the parking lot I have a stellar view of Oxford. I can make out the spires of the Colleges in the distance to the southwest. To the north is a load of prefab pop-up wards, and beyond that, the countryside, rolling hills sketched out in yellowy green and brown.

This is the part of the day I’ve been dreading. Mom and Kira have been here once a week since we moved back in December but it’s my first visit. I wouldn’t have come if I had a choice.

The hospital has chipped blue-green walls that make you feel like you’re underwater, slightly rubberized flooring that turns your footsteps noiseless. The same depressing aura as hospitals we’d been to in Toronto. The JI2 Centre’s new wing is an annexation of the old blood donor ward. They haven’t taken down the old signs. There’s something desperate about the whole operation. All the on-duty nurses have the same burnt-out look, as if they’ve been running triple shifts. There are loads of volunteers in dark blue smocks and posters asking for more to help out at all hours.

“I guess I thought it’d be shiny and new. Space-aged.” I try not to let me disappointment show.

“They’re really good with Kira, you’ll see—and they’ve just opened a new set of wards.”

Knowing they’re expanding doesn’t calm the swimmy feeling in my stomach. It just means they haven’t found a solution yet and more kids are getting sick.

We check in at reception and find the office we’re looking for, and a slight, dark-haired woman answers Mom’s knock. Back home I got used to meeting different kinds of doctors: the chummy ones who pretended I was their best friend, the sympathetic ones, and the ones so focused on Kira they barely saw me. I try to size up Dr. Varghese but she doesn’t match any of these. For one, she’s a good six inches shorter than I am and maybe ten years older. So, young for a doctor, and pretty too. She looks me in the eye when she introduces herself. “You must be Sophie. You know you have your mother’s eyes, you and Kira both. But then you must be used to hearing that!”

She offers us seats in her office. The room is spare except for a couple of framed photographs.

“Your mother and I thought it would be a good idea for us to meet properly. I’m your sister’s clinician—her primary carer here at the Centre. I know this must be stressful for you.”

Dr. Varghese smiles. “Let’s start with what you know about your sister’s condition.”

I rap my fingers against my knee. “I know something’s wrong with her immune system. That she gets sleepy more easily and restless sometimes. That if she gets sick then JI2 can make it much worse.”

“That’s the gist of it. It took us a while to identify Juvenile Idiopathic Immunodeficiency Syndrome as a single condition because the first cases presented in different ways, as clusters of seemingly unconnected symptoms. ‘Immunodeficiency’ means the body doesn’t fight diseases and infections the way it’s supposed to, so sometimes blood doesn’t clot properly or the immune system can attack healthy cells. Health problems—even common ones—can be much more dangerous.”

“That’s what ‘idiopathic’ means. It doesn’t seem to be a virus or a bacterium.”

Dr. Varghese sucks in a breath. “Yes, well, that’s true. Over thirty thousand cases have been documented in Britain alone.” Mom’s eyes widen. It’s more than either of us had heard.

“What are the recovery rates?” I’m testing her. No one’s given me a straight answer so far.

“Patients with the condition have a statistically higher rate of mortality within the first four months of diagnosis but—listen, Sophie, the numbers never tell the whole story. They aren’t a prediction. And we’ve made some major breakthroughs in the last few weeks.”

“Like what?” I’ve read dozens of online summaries that all say the same thing: we don’t know what it is. But Dr. Varghese surprises me again. While Mom listens, nodding from time to time, she explains to me that they’ve identified a special hormone in the bloodstream of patients like Kira. “It seems to be manufactured by the thyroid, we think, in addition to thyroxin, which plays an important role in all sorts of body functions, like digestion and brain development and bone growth. The hormone interferes in some of those processes. It can disrupt body temperature, blood pressure and clotting, which is one of the reasons your sister’s immune system is compromised.” When she sees the look on my face she changes tack. “We call it a ‘juvenile’ syndrome because it only seems to affect young people. We suspect it has something to do with the changes the body goes through in puberty.”

“Most of the changes in your body are over by the time you’re seventeen or eighteen but some go on after that. The prefrontal cortex, which handles all sorts of complex processes like reasoning and memory, continues to develop into your early twenties.”

Mom squeezes my hand again but Dr. Varghese’s smile is restrained. “We think so. But with your mother’s help—and yours as well—her condition should be manageable.”

She stands and walks toward a large cabinet and she comes back with a small plastic device that looks like a tuning fork with a screen on it. “This is a HemaPen. It’s based on insulin monitors so it’s noninvasive. We’ll use it to track Kira’s hormone levels.”

She hands it to me. It looks jury-rigged, as if it was pounded out in shop class yesterday. Heavier than I expected. She takes it back and turns it over, lightly flicking a sensor on its base. Then she slides its two prongs around either side of her index finger. “Like this. It should only take a second.” The machine makes a crackling sound and flashes green. “It’ll automatically send the results to us. I want you to keep an eye on your sister and let me know if you spot anything out of the ordinary—even if you don’t think it’s important. You may see something I can’t.”

“Sophie’s amazing with her,” Mom pipes up, nudging me with her elbow. “The best.”

When we get home Aunt Irene is in the kitchen starting on dinner. She doesn’t cook much and with all the flooding it’s been difficult to get fresh ingredients. All signs point to another night of pasta and red sauce.

“Go check on Kira, will you?” Mom hands me the box with the HemaPen inside. “God knows I’m not her favourite person right now.”

I find her asleep in the loft. She’s an inert comma beneath the sheets, head turned away from me.

She twists around, giving me the hairy eyeball when she catches sight of what I’ve got. “Will it hurt?” Not what is it. She knows what it is, or close enough. It bothers me how used to the idea of being tested she’s become.

She presents her palm to me so I can help her, then yanks it away when I press the button. “Ouch!”

She buries her head in the pillow. A minute later the HemaPen begins to crackle softly. “Anything else I should record?” I ask. There’s a logbook on her bedside table to track her symptoms.

“I like saying ‘pudding.’ ” I nudge her foot. “Now you, enough stalling, pudding or no pudding?”

“Fiiine.” She tugs at a lock of long white-blond hair. The strands look frayed at their ends. “Out of breath, um, weakness in the right leg. Tiredness…”

“Hmm.” She’s fading. I write down what she’s said and put the logbook back next to the HemaPen.

I let out a breath, suddenly unsettled by the distance I’ve travelled from Toronto to here. My eyes slide over Aunt Irene’s old shelves, still crammed so tightly with her books they creak whenever I try to prise one out. Reference tomes on the Middle Ages alongside old science fiction paperbacks like The Chrysalids by John Wyndham, which I remember reading in the ninth grade. It’s something at least. I had to leave most of my books at home.

She must have been in here during the afternoon. One book sticks out crookedly and I pull it free, glancing at the title. A Little Book for the Pestilence. It’s old and sweet-smelling like musty vanilla. The glue has weakened and a frail sheet flutters to the ground, the heading inked in a heavy, monastic-looking copperplate. In like wise, as Avicenna says in his fourth book, by the air above the bodies beneath may be infected.

The cryptic words remind me of an old copy of the I Ching that belonged to Jaina’s hippy-dippy mother. She loved crystals, burning sage and incense, ley lines and ouija boards. “Every part of the world touches every other part,” she used to tell us, clad in a long, loose-fitting skirt redolent of sandalwood. When Jaina and I were alone we’d laugh about it but we let her read our fortunes. “The gentle wind roams the earth. The superior person expands her sphere of influence as she expands her awareness,” she would intone.

I turn the page over but behind me Kira stirs on the bed, her voice guttural and indistinct, coming from somewhere deep in her chest. As I slide the page back into the book, the HemaPen stops its processes with a low blip. Numbers in a neutral dark grey scroll across its display panel but I have no idea what they might mean.

After spending most of the day in bed Kira gets up for dinner and won’t settle until I take her along the canal to see the houseboats. They’re as exotic as gypsy caravans, lacquered in deep purple, oxblood, navy, russet, pink and gold. Kira loves the potted plants and lawn chairs laid out on the roofs.

“One day,” she tells me, “I’m gonna live in a boat just like that. What’s the ocean between here and home again?”

Dreamily: “Yeah. I’m going to sail across the Atlantic. You can come too, I guess.”

It’s not until well past ten that she finally nods off. I decide to get a start on the syllabus Mr. Coomes gave me. Aunt Irene has piled some of the books from the list on the corner of my bed. I curl up under the covers and begin working my way through The Yellow Wallpaper by Charlotte Perkins Gilman. It’s a strange partial autobiography of a distraught woman locked in a sick room:

There’s a narcotic flow to the words as the narrator’s world contracts down to a tiny room she can’t escape. I lose myself in the story until the buzz of my tablet interrupts me with a message from Jaina.

There’s a hot itch of worry in my palms, the back of my knees. I dog-ear my page and set the book down.

We used to message daily, but I haven’t been in touch for a while now. The signal’s been on and off since the substation blew during the last storm. There are rolling brownouts to reduce the load until things are repaired. Resources are stretched thin everywhere.

A link hovers at the bottom of the message, but I don’t click on it, not immediately. There are a load of forums devoted to JI2. Some tracking news reports, others spinning off into conjecture and conspiracy theory. Jaina’s been a regular on most of them, ever since Kira got sick. The first time she invited me to one, I lurked for a couple of days, tracking threads about the infection rates in India and China. I finally figured out the users were mostly rubberneckers, chasing disaster. I didn’t much like the idea that Jaina was one of them.

I toy with the idea of putting the tablet away, going back to my homework. I want to see how it ends, what the woman will discover in the strange sickly wallpaper of her room. But I know Jaina will badger me with messages until I give in.

When I click on the link, the page opens to a news video. A shaky mobile camera with a smooth voice-over talking about a kid named Liam Barrett. I can make out a small crowd of people and, beyond them, the expanse of the ocean, grey the colour of wet ash, its surface frothed with whiteheads. Clouds scud the horizon.

The footage must be from one of the other passengers because at first it focuses on a twenty-something girl waving to the camera. Behind her is a freckly kid a year or two older than Kira with a mop of blond curls peeking out from under a fur-lined trapper hat, leaning against the railing of the boat next to his dad. He’s pointing at something in the distance—a pod of dolphins? The camera zooms past him to try to focus on the sleek shapes, diving in and out of the water. Then the angle shifts and a woman is shouting, incoherent. The kid is on the railing, both arms lifted. The shot jerks and blurs, snatches a slice of clouded sky as the boat crashes into a wave and whoever is holding it loses control for a moment. When it refocuses, he’s gone.

A hard cut to the newsroom. The host and her partner have adopted chatty tones, like this is breakfast TV fodder, despite the serious glances they sometimes gives the camera. “Liam Barrett’s father has confirmed that his son was JI2 positive. His body was taken to St. Paul’s Hospital shortly after where the so-called jitterbug video was taken.”

Another link then, with over twelve million hits. This video is clearer, a still point of reference rather than the jerky-cam style on the boat. No audio. It shows a clinical-looking room, bright lights that flare, blanking the image with white. There’s the same kid laid out on a steel table. The curly hair and still, pale face. It takes me a moment to understand. He’s dead, and this is his autopsy.

How could this be posted? Notifications flash at the bottom of the screen, more comments. The views are racking up.

Then I see it: his right leg has begun to hop. It’s barely noticeable at first, the way your leg might twitch if you had a bad spasm. “Shhh…” says a voice. “There it is. It’s happening again.” A blurry hand appears in front of the lens, pointing. A moment later Liam Barrett’s left leg jumps. Then his whole body starts to rock as if he’s having a fit.

I type “JI2” and “lazarus reflex” into my search bar, my hands shaking. The first page in my feed is a Globe and Mail article from an hour ago.

PHAC denies that JI2 is linked to post-mortem tremors

TORONTO – Vancouver’s deputy chief medical health officer said yesterday the province was investigating protocols after an anonymous video taken by a nurse was released of a boy’s body suffering what have been called post-mortem tremors.

Liam Barrett, aged twelve, was diagnosed two months ago with Juvenile Idiopathic Immunodeficiency Syndrome (JI2). His is the fourth confirmed death to be labelled as an accident in recent weeks. The case is being investigated by the Public Health Agency of Canada (PHAC)’s National Microbiology Laboratory in Winnipeg but officials deny there is a link to JI2.

Most doctors attribute the strange phenomenon to the so-called Lazarus reflex, which causes brain-dead patients to briefly raise their arms. Barrett, they believe, may have been improperly confirmed as deceased. The phenomenon is named after the biblical figure Lazarus of Bethany, whom Jesus allegedly raised from the dead in the Gospel of John.

But others have suggested a different explanation.

Dr. Eliseo Gilabert, the coroner who certified Barrett’s death, said: “Liam Barrett was clinically dead, yet his body showed signs of enough cellular energy for certain genes to become active. All we can say is that JI2 seems to be inducing biological processes we still don’t fully understand. It’s time the medical community started talking about this openly.”

I switch off the tablet. I don’t want to see any more videos or hear Jaina’s crazy theories, not when it’s my sister who’s sick. I swing myself down from the bed. Kira is still asleep, hair mussed. I crouch down next to her and touch her shoulder. After a moment she stirs, pushes my hand away. One sleepy eye opens.

“What’s wrong?” she grouses. It’s even colder in here at night. I can see the goosebumps on her exposed arm.

“No, I’m not.” I pinch her, an old reflex from when she was healthy and didn’t bruise so badly. But she squeals, tries to tickle me back though I can keep her arms pinned to the pillow without much effort.

“Soff, don’t!” she says in that voice that always used to mean, yes, keep going. “I’ll kick your butt!” But after a second or two she scowls. “Just stop, okay?” She slumps back and pulls the covers up around her neck.