The best that could be said of Eden’s performance in school was that she rarely missed going. Sadly, her attendance record owed nothing to love of school or the book learning that took place there. Credit ― not the term she would have used ― belonged to her parents, who had taught her long ago that you showed up where you were supposed to be unless you were truly disabled. By the time she was twelve years old, she knew that ordinary colds did not qualify for calling in sick.

What began that Friday in November was no ordinary cold. The headache and sore throat came on during her last class. She hoped that a restful weekend would take care of the worst, and by Monday she’d be back at school, not having missed a day. But it didn’t turn out that way. During the night she vomited. Next morning she had fever of 100 degrees and her throat felt worse. Tylenol did nothing for her.  She spent Saturday and Sunday in bed, drinking hot tea and soup, because swallowing was too painful for anything solid. Clearly she wouldn’t make it to school Monday.

“Shouldn’t she be getting penicillin?” Karen asked her husband.

“Penicillin’s no good for virus infections.”

“You always say that.” It didn’t seem right that nothing should be done for someone as sick as Eden. Other doctors gave antibiotics for sore throats.

“It’s always true,” he said. “Besides, every time you take penicillin you risk having an allergic reaction.”

“I had penicillin when she was born, and I didn’t have a reaction.”

“That’s no reason why she can’t.”

“OK, but that isn’t the only antibiotic.  Why not give her one that doesn’t cause allergies?”

“If she did have strep, penicillin would be the one to give.”

Karen was having trouble with his logic.  “I don’t understand.  First you say she shouldn’t—”

“Look, we’re speculating about strep, then we’re speculating about allergy. That’s not the way to practice medicine.” Always an argument. And his lawyer wife wasn’t done yet.

“You mean she should never get penicillin, no matter how sick? In case she got allergic?”

Alan took a moment to compose himself.  “How sick has nothing to do with it. If she were dying of yellow fever, you could throw the pharmacy at her, so you could say you did something, and it wouldn’t do her a bit of good. Antibiotics don’t touch colds, and that’s what she’s got.”

Karen wanted it straight, for the record. “But suppose she did have strep throat. Then shouldn’t she have penicillin, like you said?”

“Yes, she should. And I’d like to have a dollar for every shot of penicillin given in one year for a sore throat that isn’t strep, just to satisfy overanxious mothers. I could retire in luxury.”

“But suppose it is. Doesn’t that sometimes develop into scarlet fever, or other horrible things?”

“Yes, it does ― sometimes. Rarely. You’re far too worried. . . . OK, tomorrow I’ll get a throat culture. For now, let her gargle with salt water. That’s what we tell all our patients.”

On Monday Eden was no better. Alan brought home a culture kit. “Open wide, say ‘Ah!’ as low as you can,” he instructed her. Her tonsils were large and red, but the telltale marks of strep throat ― white spots and pinpoint hemorrhages ― were lacking. That’s what cultures were for, when you couldn’t be sure from looking. He aimed the swab at one of her tonsils; she drew back and gagged and started to cry. In the end, he didn’t know what he’d swabbed. He took the specimen to the lab Tuesday morning. Finding nobody at the reception desk, he filled out the form, left the specimen, and went about his work. Next day he called for the result.

“Hold on.” Half a minute later the voice returned. “We don’t have a culture with that name.”

“How can you not have it? I left it on the desk. Filled the request slip out myself.”

“Let me check with Marvin, he was at the desk yesterday.”

“There was no one there,” Alan said, already frustrated. “Page me as soon as you know.”

It took twenty minutes. “Laboratory, Marvin speaking. May I help you?”

“My daughter’s throat swab. I left it yesterday. Now they tell me they don’t have it.”

“I’ll have to check. I’ll call you back.”

Alan hung up and cursed. Another half hour went by before his beeper went off again.

“Doctor Avery, this is Angela.”  The supervisor’s intervention meant that the issue was beyond her subordinate’s ability. Alan had already come to that conclusion.  “You figured it out?”

“Name’s Eden, right?” Alan’s relief was short-lived. “Here’s the slip, but there was no specimen with her name,” Angela continued. “It could have been the unlabeled one.”

Alan tried to remember labeling the tube. “I’m sure I labeled it, but even if I didn’t, I left it right on top of the slip, so there couldn’t have been any mistake.”

“I know it’s frustrating, but we’re not allowed to match unlabeled specimens. State regs. I’m terribly sorry. Can you get another one and send it to my attention? I’ll make sure it’s handled right.”

“Thanks.” He realized they were doing their job. State regulations. Everyone hated them. He swallowed his frustration, picked up a new swab, and faced Eden once more.

“Well, Daddy, do I live or die?” She was evidently feeling better. His oversight had cost two days, and he felt even less inclined to go through this exercise again just to allay Karen’s fears of “scarlet fever, or other horrible things.” But he had to be honest with both of them.

“Honey, you’re going to live a long, long time. But I must have forgotten to write your name on the tube, so you’ll have to hold still for another specimen.”

“But I’m getting better. Can’t we pretend you took it?”

“No, we can’t pretend. Mommy’s also going to ask, and I won’t lie to either of you. So please open up. I promise it’ll be the last time.”  She tried, she pulled back, she gagged.  This time he made certain to write her name on the label. Two days later he had the report:  “Normal throat flora. No pathogens identified.” Alan derived no comfort from it.  Ruefully he thought, sick for nine days, getting better, negative culture, and I don’t even know if I swabbed her tonsils or her teeth.

By the following Monday Eden felt well. After a ten-day illness, she might have taken an extra day off to gather her strength, but ice-skating was on the calendar for that evening. Under the circumstances, she thought it best to go back to school. The sore throat was soon forgotten.

Three weeks later she collided with another skater and fell hard, hitting her head on the ice. The impact stunned her. Her friend, Debbie Rabin, watched Eden stagger up.

“I think we should go home,” Debbie said. “You don’t look too great.” Eden did not resist and called Karen to pick them up. By the time they arrived home, she seemed fully recovered.

Next morning her right knee was stiff. Gingerly ― because it hurt ― she removed her pajama bottom. The knee was swollen.  “Mommy,” she called, “my knee hurts, and it’s puffed up.”

Karen looked and called Alan, who was just putting on his coat.

“You really banged yourself up, didn’t you? Do you remember hurting it?” he asked.

“No,” Eden replied. “I felt woozy after I hit my head, but I don’t remember anything about my knee. It seemed OK when I got home. Wasn’t it, Mommy?”

“You didn’t complain about it,” Karen answered. She turned to Alan. “Is it possible to come up like that overnight if it doesn’t hurt at the time?”

“If the knee was all she hurt, she’d have noticed it last night. But like she said, she was stunned, so she wasn’t paying attention to it.”

Karen turned to Eden. “You can’t go to school with that. I’ll call in sick for you.”

For the second time in three weeks, Karen also called the law office to tell them she had to stay home with her child. Great life for a lawyer, she thought, take time off anytime you feel like it.

Twice Eden tried to walk, but all she managed was to hop to the bathroom. Karen witnessed these attempts with mounting anxiety. Finally she could stand it no longer and called Alan.

“Shouldn’t we have her x-rayed? She must have broken something.”

“It could be a bad sprain. If it’s no better in the morning, I’ll have Rick take a look.” Rick Harmon had been Eden’s pediatrician of record since she was born. In practice, Alan was the family doctor. Rick would have preferred Alan, an internist, to leave his daughter’s care to a pediatrician, but Alan didn’t think it took a pediatrician to treat sniffles or keep track of immunizations, and he knew when to call for help. So far so good. But Rick worried about doctors’ children.

That evening Eden’s knee was even tenderer. As Alan reached out to examine it, she shielded it with her hands. He’d barely touched it when she screamed, “Ow! Stop!”  He quickly withdrew his hand, looking puzzled. “Is it that tender? Maybe you did damage something.”

“I’ve never had anything like this. I have to lie on top of the covers because I can’t stand them on my knee. I wish I knew what’s going on. And I don’t feel good at all.” She burst into tears. “This afternoon I had a nosebleed. I don’t even remember hitting it. What’s happening to me?”

“Let’s take your temperature.” After a minute he read the thermometer,. “Hundred one point eight,” he said with exaggerated calm.  “We’ll take you to Doctor Harmon in the morning.”

The next morning brought another surprise. Eden now complained of pain in her left elbow and ankle as well, and again she wouldn’t let her parents near the afflicted joints. Still numb from the preceding day’s experience, she announced the new developments without emotion. Carefully Karen helped her dress. They reached the stairs just in time to catch Alan’s “Damn, damn, DAMN!”

Karen looked at him with alarm but didn’t dare ask what had prompted the outburst. She helped Eden to the car to wait for him. “Shall I come along?”

“You’d better. Rick’s going to want to speak with both of us.”

“Does he know we’re coming?”

“No, but he’ll make room for us. That’s one advantage of not going to him with routine stuff.”

The trip took fifteen minutes, five of them over a cobbled street. By the time they arrived at the hospital, where Rick had his office, Eden was in agony.

“What have we here?” Rick asked as cheerfully as he could, as Eden limped in on Karen’s arm.

“I don’t know what’s going on,” Eden said, trying not to cry. “I fell on the ice, and all kinds of things happen days later. I know I didn’t I hurt myself that bad.”

“Tell me the rest of it.” He frowned as he listened.  “Does she get nosebleeds often?”

“No,” Karen answered definitively. “Only that time the swing hit her in the face. But this one makes no sense. In the middle of the afternoon, lying on her bed. She doesn’t even have a cold.”

Rick examined Eden’s skin from head to toe. “Nothing. Look at her skin from time to time.”

“What do I look for?” Karen asked. “Is she getting scarlet fever?”

“Nothing like that. What you’re looking for is big funny red shapes, like wobbly circles. They come and go. Here in the morning, gone in the afternoon, back someplace else at night. Also check for nodules.”

“You mean swollen glands?” asked Karen. “She did, with the sore throat, three weeks ago.”  Rick turned to Karen with arched eyebrows. “I was coming to the sore throat part. Help her get dressed, and I’ll send in a nurse to get a blood specimen. We’ll also want a throat culture.” Alan stoically kept a straight face.

“And x-rays?” Karen asked.

“Not now. Later maybe.” He turned to Alan, who was standing by the window, staring silently into space. “Come with me.” Rick was a large, overweight man in his late fifties who comfortably filled the Santa Claus outfit in which he made rounds during Christmas season. His iron grip on Alan’s arm made clear his displeasure as he led him into another room, where they could be alone.

“Why in God’s name did you have to drag that poor child all the way out here?”

“Don’t you treat rheumatic fever any more? Would you prefer that I handle it myself?”

“Of course I treat rheumatic fever. Luckily I hardly ever see it anymore. I meant driving her along that bone-rattling Germantown Avenue. You should’ve called. Wait while I send them home.”

Outside, he said to Karen: “What Edie needs right now is bed rest and aspirin.  Give her two adult tablets every four hours till the joints cool off. If her ears start ringing, cut back, but I bet she won’t need that many. I’ll call you in a couple of days.”

To Eden he said: “See you later, princess. Keep your nose clean. No, I take that back. Better leave it alone; we don’t want another bleed.”

Despite her discomfort, Eden smiled at Rick’s pun and said: “I’ll try. Will I be OK?”

“You’ll be fine. Just rest up and take your pills.”

Rick went back into the examining room. Alan was sitting motionless where he had left him.

“I’m sorry I blew up. My emotions got the better of me. But you must be feeling like shit, having this happen in your own family. What’s the story on the sore throat? That just about clinched it for me. I could be wrong, but I’d bet my shirt the skating accident was a red herring.”

“I thought she had a virus. The irony is that Karen got on my back to give her penicillin: Scarlet fever and whatnot, she was fantasizing. I compromised and took a throat culture.” He described the laboratory fiasco. “By the time we got done with that, Eden was getting better, so the whole thing seemed moot.”

“And the culture was negative?”

“So what? I didn’t even get a decent specimen. I was so pissed, I was probably just trying to prove Karen wrong.”

“Now quit the psychoanalysis. You cultured her twice, so how can you say you didn’t try?”

“I didn’t get anywhere near her throat either time. Mouth swabs is what they were. And the first one I didn’t even label. Some shrinks would call that unconscious sabotage. You call it trying?”

“You’re being too hard on yourself.”

“God, I feel so rotten. Here’s my own child getting rheumatic fever because her know-it-all father is too sophisticated to give her penicillin for a strep throat without having it in writing. Just for my information, do you give penicillin without doing a culture?”

“No. Throat cultures are fast and cheap.  We use them all the time. You did the right thing.”

“Except I didn’t get a good specimen ― or label it.  So what’s going to happen now?”

“It’ll run its course.  We can relieve the joints, but if her heart’s going to be involved, there’s nothing we can do to stop it.  I don’t mean to be insensitive. You know the answers anyway. If she gets past the first three weeks without cardiac signs, we can relax a little. But carditis doesn’t have to be severe to damage the valves, as you know.”

“Not encouraging, is it?”

“It could turn out benign. But this is a disease to respect.  It’s better not to have any illusions.  In any case, she’s going to miss weeks, maybe months of school.  Are you going to your office?”

“I ought to, but I don’t know if I’m up to it.”

“You might be even less up to being useful at home. I’ll call Karen and explain that I told you to go about your business. I’ll be over to check Edie two or three times a week till I know where she’s going, and I expect to hear from you if anything happens in between my visits. Is that clear?”

“Thanks. I wish I’d called you when she had the sore throat, instead of being such an asshole.”

“Sometime I’ll tell you about my mother’s heart attack. Believe me, friend, you’re not the only asshole treat-your-own-family doctor in town.”

A few minutes later he called Karen. “Great timing!” she answered, house keys still in her hand. “I just got here.”

“Take your time. Get Edie settled and do whatever else you have to, and call me back.” The message was clear: It was going to be a long conversation, and he didn’t want her running off in the middle of it. She quietly assented and helped Eden to bed. Then she started the coffee maker.  Next she made a ham sandwich.  Finally she went to the bathroom.  Then she ran out of delaying tactics.

Rick wasted no words. “We don’t have proof yet, but Edie may have rheumatic fever. Ordinarily I wait till I’m sure before telling the mother, but I know you too well to hold out on you. I could turn out to be wrong, but a false alarm wouldn’t be any worse than leaving you up in the air.”

“Please, Rick, no apologies. We’re all intelligent people and I respect your judgment. Of course I hope you’re wrong, but if you’re not I’d rather have you level with me. How serious is it?”

“Too soon to tell.  It could turn out benign, despite the pain.  I’ll let Alan explain everything.  Too bad about the sore throat. He told me about the problem with the lab.  I imagine you know that rheumatic fever only happens after a strep throat.”

“I know about scarlet fever, but nobody ever mentioned rheumatic fever.”

“How bad was the sore throat?”

“Pretty bad. Fever over a hundred two, and really sick. Couldn’t swallow. Alan wouldn’t give her penicillin without being sure. She got over it without, so I figured he was right.”

“It was a judgment call.”  Rick kept his opinion of that judgment to himself.  “I wouldn’t have known whether she had strep or a virus. And people do get over strep without penicillin.”

“But if you treat a strep throat, can you prevent rheumatic fever?”  The question made Rick uncomfortable. He did not fancy being caught in the middle of a spousal fight, particularly one with such serious implications.  “Yes, but sore throats are so common, you’d want to be pretty sure.”

The answer met with a brief silence. “What about Alan? Is he on his way home?”

“I took it on myself to send him to work. There’s nothing he can do at home that you can’t, and to have him hanging around all solicitous and useless ― I couldn’t imagine it helping anyone.”

“Maybe he’s not as worried as I am. He knows enough to be objective, and I’m just an overanxious mother.” She forced a laugh to mask the chilling questions welling up in her mind. “I gave Edie her first aspirins, and I don’t hear a thing. I bet she fell asleep.”

“Leave her that way. She won’t feel any pain. Don’t forget, if anything happens before I call you back, get on the phone right away.”

“Thanks a million, Rick. I’m all confused about this, and it’s a comfort to have you to talk to.”

“That’s what I get paid for.”

She smiled as she hung up, knowing he would never charge them a penny.

~~~~~~~~~~

Eden was a child of privilege, the only offspring of a lawyer mother and physician father. Taking the well-oiled routine of her parents’ workdays for granted, she had no idea of the ambition and hard work that paid for her comforts. Ambition and hard work were decidedly not Eden’s forte.

Perhaps her indifference was born of an indifferent self-image. Her appearance was anything but remarkable. A gym coach might have looked with passing interest on her lithe but immature body; her male contemporaries found nothing there to turn their heads. In her round face, crowned by a head of unruly auburn hair, the only notable feature was the abundance of freckles. No one ever called Eden beautiful; plain might have sounded unkind but was certainly more accurate. Her chief asset was an engaging cheerfulness that assured her an abundance of friends.

Her scholastic performance was as indifferent as her appearance. Three months earlier she had settled into sixth grade at the Charles W. Henry School, where she continued her education in the same detached manner as before. She had done well enough to keep up but, in her teachers’ estimation, had absorbed the necessary learning by sheer accident. Their classes were a poor match for Eden’s daydreaming and her fascination with activity outside the windows. Nobody, herself included, had any idea what she wanted to set her brain to.

Her lack of motivation had been the subject of numerous mother-teacher conferences, followed by a lecture, a few days’ improvement, and relapse. Alan was no help.

“I wish you’d talk with her,” Karen had said to him. “I sit down with her, and she promises to keep up. Then a couple of weeks later I get another call. Even Mrs. Lopez called last week.”

“Mrs. Lopez?” Alan did not recognize the name.

Karen swallowed her irritation and answered, yet one more time, “The principal.”

“Will Edie have to repeat the year?”

“It’s only October, but the same old pattern’s developing, and it needs to be stopped.”

“Don’t you think Mrs. Lopez is a bit overanxious? Edie’s barely started fifth grade.”

“Sixth,” Karen corrected him with heroic self-control. She took a deep breath. “No, Mrs. Lopez is not overanxious. On the contrary, I’m thankful she’s so concerned. She also knows that Edie’s bright enough to do better.”

“How about some counseling?”

“How about some paternal involvement?”

It was Alan’s turn to bite his tongue. Karen was right. More and more he had been leaving it to her to deal with school-related matters. One time the telephone had rung as Karen was on top of a stepladder.  As he picked it up, he heard the voice of the principal. She seemed delighted to have caught her student’s father at home. “Is that Doctor Avery? I’m so—”  Before she could announce the purpose of her call he had shouted, “Karen, it’s the principal,” and put down the receiver. As he recalled the incident now, he thought surely she must have given her name and he hadn’t listened.

And now the fifth-sixth-grade gaffe. Yes, he needed to become more involved in his daughter’s education. He resolved to do so. Trouble was, he had resolved similarly in the past. Then his practice demands had got in the way again. An occasional stern lecture was no substitute for the day-in-day-out attention Eden needed. It was easier for Karen, who only worked half days, while he often didn’t get home till nine o’clock. That was no time to deal with his daughter’s study habits.

~~~~~~~~~~

The Rabins lived fifteen minutes by foot from the Averys. Newcomers to Philadelphia four years earlier, they had enrolled their children in the Charles W. Henry elementary school. Three days a week, after school, Eden walked with Debbie over to the Rabins’ on McCallum Street, where they worked together until Karen, on her way home from the office, picked her up. Their assignments might or might not be done, depending on Debbie’s fourteen-year-old brother. Joshua was not one to keep his bountiful wisdom to himself, and when he was in a sharing mood the girls accomplished little.

Joshua also had the teenager’s instinct for shocking his audience. Neither girl would ever forget that summer. His mother had prevailed on him to take out a bag of garbage. As he opened the bin, he stopped cold, first in shock, then in fascination. He replaced the lid, recovered his composure, and seized the opportunity for a little diversion.  “Hey, come out here, you got to see this.”

His tone held such promise that it didn’t occur to the girls to ask what they were being treated to. With a flourish he swept away the lid. Debbie stared, went pale, and vomited right into the bin.

“Did you have to do that?” Eden, with a tougher stomach, demanded.

“What do you mean, ‘have to’?  Would you be puking if you saw a bunch of flies in there?”

“Those ― are ― not ― flies,” she said through clenched teeth.

Debbie’s answer was less restrained. “You louse, you rotten ― ooh ― you WORM!” she screamed, punching him on the chest with both fists.

The hubbub brought Esther Rabin to the door. Following Eden’s eyes to the bin, she looked inside and slammed down the lid. For two seconds she stood still. Then she took a deep breath, surveyed the assemblage, and went for a pail of hot water and ammonia. Her words were few:  “Go get into clean clothes, Debbie.”

Joshua and Eden were alone.  “You don’t think they’re the same as flies?” he asked.

“What’re you talking about? There’s a thousand maggots in there.”

“They turn into flies.”

“I don’t believe it. You’re putting me on.”

“I’m serious.” And his face showed it. “A maggot is a larva. You’re disgusted because that’s how you were brought up. Just tell yourself not to be, and you’ll see how fascinating they are. Real works of art. Those slimy little worms grow wings and turn into flies. . . . Still feel like puking?”

“Are you pulling my leg?” Both the biology lesson and Joshua’s earnestness were new to her.

“I’d never do that. . . . OK, I would. But my word of honor, this is true. Look it up.”

Eden looked skeptical but said nothing. Joshua had another idea.

“Do you know what a caterpillar is?”

“Of course I know what a caterpillar is.”

“Do you know that caterpillars turn into butterflies?”

“That’s different.”

“Here’s more—“

“I’ve heard enough—“

“No, wait a minute. This I have to tell you, then I’ll stop.”

Eden’s expression said this had better be good. She waited for him to speak.

“Did you know that you were a fish before you were born? Gills and all?”

She rolled her eyes and turned to go. As she crossed the threshold, he dropped one more pearl:  “A fish with a freckled face. I love it!”

That evening she checked with her father. Everything Joshua had said was right ― except for the freckles; Alan professed uncertainty about that detail.

Monday and Thursday evenings were for skating. Dinner was at the Averys’ on Wayne Avenue, Esther and Karen taking turns driving the girls to the Wissahickon Ice Skating Club.

“In two years Josh’ll be old enough to drive,” Karen said one day. “The girls will love that.”

“I bet they will,” Esther said, with a suggestive lift of her eyebrows. “Both of them.”

Karen smiled at the hint. Esther continued, “I don’t know that I’d trust him behind the wheel, though. He’s a good boy, but driving and playing practical jokes don’t go together.”

“He could change a lot in two years.” Karen sometimes wondered how a son of hers would have turned out. But she had determined to have no more children after Eden and quickly scotched any regrets. Anyway, Debbie and Josh did just fine as surrogate siblings.