ELEVEN

There were times when Debbie wondered whether, after all those years of indecision, she’d still been too precipitous in marrying Con. But those times were the exception. After all, nine years of shared life was bound to produce occasional conflict, which even her mother would have predicted, and she had to admit that all in all she had made an acceptable match. In moments of doubt she reminded herself that she’d been unlikely to learn more from the safe distance of steady dating. Further, Mom had warned her that no amount of time trying to predict the future would guarantee she made the right decision. The future would have to be lived.

One result of the marriage that she had no doubt about was their two boys, of whom she was truly proud. Not only that, but she found them interesting. They were very different both physically and temperamentally, but both were sociable and took readily to school. Their classmates and teachers were racially diverse, which greatly pleased Debbie. Con knew it was for the best and carefully avoided criticism.

It helped further that both sets of grandparents expressed unbridled enthusiasm about their grandchildren. So much so that, when the boys were six and four years old, Debbie and Con decided to move from Philadelphia to a location closer to New York, so that the elder Flynns would not be at such a disadvantage compared to the Rabins. Although Max objected briefly to the move, Esther felt that its fairness would help cement relations between them and the Flynns. With the Rabins’ blessing and to the Flynns’ delight, Debbie and Con bought a house in Edison, New Jersey, within easy reach of both the commuter train station and the New Jersey Turnpike.

The practical details were easily dealt with. Debbie was able to convince Con that their routine medical care and that of the boys would best be left in the hands of familiar Philadelphia physicians, particularly Richard Harmon, primary caregiver to the Rabins for as long as Debbie could remember. She did not expect that they would need to consult Doctor Harmon often, as the entire family appeared to enjoy the best of health.

Con’s relocation to a new place of work proved even easier. Buick dealerships in New Brunswick as well as Woodbridge were ready to offer a position to an experienced salesman, especially one with a college degree.

❖❖❖❖❖

C.J. — Connor Junior — was big and strong and at the age of eight, like his father a generation earlier, enjoyed playing football. Connor Senior would have liked to see Chris, then six years old, follow in the same tradition. But Chris was more given to daydreaming and asking interminable questions about such arcane topics as the origin of snow and the color of gas flames, and what makes people smile when they’re happy. Con had little patience with a son satisfied to use two good legs for no better purpose than to get from one place to another, even though he had to admit that Chris was a fast runner. Besides, he did not know the answers to many of Chris’s questions. He was determined to add balance to the child’s interests. Though Chris was not built as sturdily as C.J., if he could develop a good throwing arm he might make it as quarterback. One Sunday afternoon in their backyard, while trying to avoid his father’s outstretched arm, Chris twisted his right knee and fell. Con fleetingly remembered his own fall years ago, and noted with relief that there were no cuts or bruises.

“Nice try, son,” Con said. “You’re going to be a great player.” Putting his arm around Chris’s shoulder, he led him inside.

“Who won?” Debbie asked playfully.

“Injury on the field,” Con answered. “A good little future quarterback we got here. Just wait till he’s in high school.”

Debbie sized up her son. “Doesn’t look all that bad.”

“My knee hurts.” Chris had no enthusiasm for the sport and regarded his father’s optimism with more apprehension than pride.

“Let’s put it up on a chair,” Debbie said, helping him. “We’ll put a cold compress on it, so it won’t swell up.”   

But it did. By the time Chris went to bed, he could neither fully bend nor straighten the knee. In the middle of the night, Debbie awoke to the sound of wailing from the boys’ bedroom. She knocked.

“Come in,” C.J. said irritably. “Don’t we have a nursery in this house for babies?”   

“Please, C.J.,” his mother said quietly. “You may have forgotten the way you used to fuss, but I haven’t.”  C.J. threw himself angrily on his other side and lay facing the wall.

“What is it, Chrissie?” she asked.

“ ‘Chrissie.’ ” Debbie heard the whispered echo from the wall behind her.

“My knee!” Chris’s face was contorted with pain and tears were rolling down his cheeks.  He lay flat on his back, arms straight by his side, fists clenched. Debbie picked up his arm and gingerly lifted the sheet. The knee was swollen and tense.

“Let me put an ace bandage on it,” she said, a worried frown on her face. “Maybe it won’t hurt quite as much wrapped.”  She did so with utmost care, and the wrapping did seem to help.  Next she brought him an acetaminophen tablet and water. “In the morning we’ll take you to the doctor. Try to sleep.” With a kiss she departed.

“That was Chris. He must have taken quite a fall,” she reported back to her husband. “His knee’s all swollen. I hope he didn’t break something.”   

“I don’t remember him limping,” Con replied. “He needs to learn to put up with a bit of pain.”   

“You expect too much from that child. He’s only six,” Debbie said. “I’m taking him to the doctor in the morning. C.J. was his usual sympathetic self.”   

“C.J. would have gritted his teeth and let his brother sleep.”   

Debbie didn’t believe that, but she was in no mood for another argument. Why couldn’t Con just let Chris be Chris instead of trying to model him after C.J., who she feared had the makings of a bully?

In the morning Chris’s knee was no better. She wished they’d stayed in Philadelphia, or closer to it.

“We’re in for a little commute,” she told Chris as she got him ready. “I hope it won’t become a habit.” To Con she said, “You’d better come along. There might be decisions to make.”

Con had visions of a quarterback whose stardom was threatened, so he called the showroom and told them he had to take his son to the doctor.

The trip to the doctor’s office, fighting rush hour traffic, took two harrowing hours, and Debbie felt ready to move back to Philadelphia. On finally arriving at the office, she learned that he wouldn’t be back until the afternoon. So she had him paged at Cresheim Valley Hospital. She had given him two children to take care of and stayed with him despite moving out of the city, so she felt entitled to bypass his receptionist, even using the office phone to make the call. Rick sensed an urgency in Debbie’s tone and graciously agreed to interrupt his hospital rounds.

“What brings you all this way, Debbie? That’s no easy trip at this time of day.”   

“It’s Chris. He’s done something to his knee and he’s in agony.”   

“Bring him to the ER. Have me paged when you get there.”   

The trip from Rick’s office took another fifteen minutes. His knee immobilized by the ace bandage, Chris braved the ride without complaint.

C.J. would have had to admire his “baby” brother’s grit.

Rick walked into the examining cubicle in the emergency room. Probably a bad sprain, he thought intuitively on his way there. More likely than a ligament tear or fracture. Common things are common, as he had learned in his training years.

“What have we here?” he asked, placing a hand on Chris’s shoulder.  While Debbie explained, Rick felt Chris’s forehead and frowned. “Nurse!” he called. “Did you take his temperature?”   

“A hundred point eight oral.”    

Rick carefully removed the ace bandage and saw the swelling. He laid his hand on the knee. It felt warm. This was no ordinary sprain. Only a few days earlier he had seen a knee just like it in a seventeen-year-old.  It had turned out to be gonococcal arthritis, a complication of an ill-considered sexual encounter.  But a six-year-old? A Flynn child? Impossible. It would have to be staph. That the knee was infected Rick had no doubt.

“Was twisting all he did?” he asked. “Are you sure nothing penetrated the skin?” He could have answered his own question, because there was no visible break.  

“I don’t think so, but backyard football, you know, anything’s possible.”   

“I’ll have to aspirate,” Rick said. “This could be septic, though I can’t figure how it developed — unless it spread from somewhere else: septicemia. It’s too soon after the injury for that to be the cause.” He looked questioningly at Debbie, but she shook her head. Con merely frowned. Rick turned to Chris.

“Chris, milad, that knee must hurt like the devil, the way it looks.”   

Chris felt vindicated by the doctor’s assessment. Too bad C.J. wasn’t there to be humiliated. “C.J. got mad at me because I woke him up, but I couldn’t help it. It hurt so bad I couldn’t sleep either.”   

“I guess C.J. doesn’t like his dreams disturbed, but he could’ve been nicer about it. Now, I think you have an infection in there, and if we don’t treat it right you could have a stiff knee when you grow up.”   

“I don’t care about football.”   

“But you do care about walking, don’t you?”   

“So what’re you going to do?”   

“First I’m going to spray something on it from a brown bottle, to make it real cold and numb. Then it won’t hurt when I put the needle in — ”   

Chris burst into tears. “I don’t want a needle!”   

Debbie bent down to kiss him on the forehead. “You won’t even feel it, sweetie. Doctor Harmon’s going to make it numb with the spray.” She took both his hands in hers and comforted him as Rick swabbed the knee with Betadine and sprayed ethylene chloride on it. The spray formed a blush of ice on the skin, and before Chris could react to the bewildering sensation Rick’s needle was inside the joint, just next to the kneecap. He had expected pus, but he got a syringe full of blood instead. He aspirated half an ounce, withdrew the needle, and gave the syringe to the nurse. “Cell count, glucose, protein, Gram stain, culture. The usual.”     

Chris looked at him suspiciously. “Did you do it already?”   

“All done. That wasn’t so bad, was it now?”    

“No, it didn’t hurt, just felt cold. I think it’s getting better already. What did you put in there?”   

“Nothing! I just took out some blood and that relieved the pressure. We need to have a special knee doctor look at this. Just relax for a while.” He turned to the parents. “I want to speak with you.” Debbie and Con went out of the cubicle with him.

Out of earshot, Rick said, “I want Doctor Prasad to take a look at him. If Chris tore a ligament, he may need to have it repaired. The knee’s a complicated joint, very vulnerable to twisting injuries. A lot of professional football players end up with their knees ruined. Think about it every time you push him to play. You heard him. He doesn’t even care about football, so he’ll appreciate it if you lay off.”     

Con set his jaw. Who was this beer-bellied doctor to tell him how to raise his son, and make him, Con, out to be a fool? Sometime soon he’d take him to task for it.

Rick hoped Doctor Prasad wasn’t in the operating room, and asked the receptionist to page her. Luckily, she came on the line right away.

“Amaya, I need you to see a six-year-old quarterback who got sacked by his overzealous father. Knee full of blood.” By a supreme effort, Con kept his temper in check. 

“I’ll be right there,” Amaya said. 

She came in, wearing a green scrub suit and cap, from the edges of which a few black curls protruded. Noting her petite stature, earrings, and diamond ring, Con was horrified at the image of her trying to amputate a leg or pound hardware into the pieces of a broken bone. He barely had time to deal with the horror before Rick introduced her. The twinkle in her eye, seeing Con’s expression, showed she was used to this kind of reaction and enjoyed it.

“You’re the child’s father?”   

“Yes.”

“And you must be his mother,” she said, turning to Debbie.   

Debbie did not try to hide her surprise.  Wide-eyed and respectful, she said, “Pleased to meet you, I’m sure.”   

 “I’m Amaya Prasad, orthopedic surgeon.”   

“Surgeon?”

“Orthopedic surgeon. Do you know where the word orthopedic comes from?”   

“Yeah, means bones and stuff,” Con answered promptly. “Everybody knows that.” He didn’t know whether to be offended or charmed by this free-talking woman surgeon. He wondered where she got her degree. Probably from a mail-order house. Certainly not a real American medical school. She talked with an accent.

“Actually it means ‘straight child,’ from the Greek. That’s what my professional forebears did: straighten out deformed children. Luckily your child doesn’t need straightening out, but Doctor Harmon tells me he banged up his knee and made it bleed inside. So let’s take a look.” They went into the examining room.  

Amaya smiled at Chris; he smiled back. “I’m here,” she said, “to help your knee heal up, so you can run all you want. Do you swim?”   

Chris looked puzzled, but he laughed. “Not too good, but I can stay on top of the water.”    

“Good. More swimming and less football. It’s better for your knees.”

Debbie smiled; Con clenched his teeth.   

Amaya gently pressed on the knee from all sides, eyes on his face.  He did not flinch.

“OK,” she said. “No needles. I’m just going to see how well the knee bends.” Chris shrugged. “You don’t even have to do it,” she went on. “I’ll do it. Just think of your favorite dessert or TV show.”   

“‘Batman’ — and chocolate ice cream.”   

“I like your taste!” During this exchange she skillfully put the knee through its range of motion in various directions. She put the leg back down and addressed Rick.

“I can’t put it through the full range because it’s still tense with blood.  But it feels stable. I’d be surprised if there were anything as bad as a torn ligament. Maybe an aberrant blood vessel. Wrap it as tight as he’s comfortable with and keep him off his feet. I’d like to see him again day after tomorrow — unless, of course, it starts to hurt more. What do you think?”   

“Sounds good to me,” Rick answered. “See?” he said, turning to Con, “here’s a surgeon who doesn’t even want to operate!”   

Amaya laughed. “We don’t like to operate unless there’s no other way. But Rick’s a thinking doc, and they love to tease the cutting docs.” She stopped as a new thought struck her.

“Has he ever bled into a joint before?”   

“Not that I can remember,” Debbie said. “Can you, Con?”   

“No. He did bang his elbow on that dresser last year, and it swelled up for a few days. But I didn’t think it was blood.”   

“That’s right,” Debbie said. “It wasn’t this bad.”   

Amaya’s eyes widened ever so slightly. “Any family history of bleeding?” she asked.

“What do you mean, bleeding?” Con was annoyed. “He twisted his knee. What’s the family got to do with it?”   

“Oh, probably nothing,” Amaya tried to reassure him. “Just want to be sure to cover all the bases.”   

“Can’t hurt,” Rick said offhandedly. “We’ll get some coagulation tests. Then we’ll know and we won’t ever have to bring it up again.” He turned to the nurse. “Let’s get a CBC, and make sure it includes a platelet count. And a PT and PTT.”   

“What are all those letters?” Debbie asked.

“Well, there’s complete blood count, CBC. That’s the easy one. But the others are real tongue twisters. First we make up fancy names for things, then we have trouble pronouncing ’em, so we abbreviate. They stand for prothrombin time and partial thromboplastin time.”   

Debbie laughed. “I see. And in English?”   

“Testing for different components of the blood clotting system. Don’t worry about the details. If anything turns up, we’ll tell you everything you need to know.”   

Doctor Prasad gave Debbie her business card. “Have him stay off the knee, wrap it like I said, and use cold packs. Call my office when you get home and get an appointment for the day after tomorrow. And by the way, Mr. Flynn, no football!” He nodded, tight-lipped.   

Between next morning and evening, Debbie felt uneasily that the swelling increased, but Chris didn’t complain. By the second morning she was sure.

“How is it?” she asked.

“It hurts. I had a bad dream.”   

“What, honey?”   

“C.J. jumped on my knee and twisted it.”     

“Oh, he’d never do that,” Debbie said comfortingly, “even if he does get mad about being woken up. Anyway, let’s see what Doctor Prasad says about it. Our appointment’s right after lunch.”   

In the middle of the day the drive was easier. Amaya Prasad entered the reception room shortly after Chris and his mother were announced. Debbie almost fell off her chair; Chris smiled. Doctor Prasad was wearing a pink sari. Her thick black hair was pulled back into a tight bun. She nodded to Debbie and greeted Chris warmly.

“How’s the knee, young man?”   

Debbie let Chris answer. “It hurts again.”   

“ ‘Again.’ You mean it wasn’t hurting for a while?”                         

“Yeah.”   

Amaya looked questioningly at Debbie.

“He didn’t complain at all yesterday,” Debbie said, “but I thought it was swelling some more. Now I’m sure it’s more swollen.”   

Amaya nodded. “OK, Chris. You wait here while I talk with your mom. There are books over there with lots of pictures, and we have paper, pencils, and crayons. Help yourself.”   

Chris limped across the waiting room, and Amaya beckoned Debbie into her office.

“Please sit down, Mrs. Flynn.”   

Debbie was alarmed. “Does he have an infection after all?  Does he have to go to the hospital?”   

“No.” The pause that followed was too short for Debbie to be reassured. “It looks as if Chris might have a bleeding problem.”   

This was even worse. “You mean hemophilia — something like that?”   

“Yes. Those tests we took in the ER the other day, one of them came back positive.”   

Debbie tried to compose herself. “I think I’d rather have my husband here for this.”   

“I understand,” Amaya answered gently, “but we need to deal with it promptly. What’s the chance of getting him to come over?”   

“May I call him from here?”   

“Of course. Go to the receptionist’s desk. . . . No. Better use my phone. You might not want Chris to hear.”   

Con sold used cars at Edison Nissan.  He had done well for himself and the dealership and had no difficulty getting time off to see his son’s doctor. He didn’t approve of foreign imports, especially Japanese, and was determined to switch to a dealer in American cars as soon as there wan as opening that offered acceptable terms. But he didn’t mention this to his boss.

“What’s wrong?  Why the hurry?” he asked Debbie.

“Doctor Prasad said something should be done right away for Chris’s knee, and I didn’t want to be all alone dealing with it. Please come on down. She’ll explain everything to the two of us together. Chris is playing in the waiting room. He’s OK. How long will you need to get here?”   

He frowned.  How to put together “he’s OK” and “something should be done right away”? He’d better get down there. And while he was there, he’d say something to Debbie about finding a doctor with an office that you didn’t have to spend all day to visit. Even more important, an American one.

“I might be able to do it in an hour or so, but it depends on traffic.”   

“Please be careful,” Debbie said. “One casualty’s enough.” She returned to the waiting room while Doctor Prasad attended to other patients. Chris showed her his picture of a dozen oval objects descending on a stick figure. Debbie didn’t need to ask him to explain.

“Is she going to stick a needle in my knee?” he asked.

“No, sweetie. But Daddy’s on his way over. And then Doctor Prasad’s going to tell us what she does want to do.”   

“Can we read something?”   

Con arrived an hour and a half later. Seeing Chris, he put on a happy face.

“Fifteen minutes to find a parking spot. Even Germantown Avenue’s full. I had to drive all the way over to Bethlehem Pike. . . . Hi, tough guy! So,” rubbing his hands, “bring on the doctor!” The receptionist politely directed him to a chair. Ten minutes later they went into the office.

“I started to tell your wife,” Amaya began, silently amused at Con’s reaction to her appearance, “but she wanted you here. I’m glad you could make it. Nothing’s sure till we’ve confirmed it with repeat tests and maybe a special test or two thrown in. But my thinking right now is that Chris has a bleeding disorder. For two reasons. One, he’s bled some more even though the leg was at rest” —  she looked at Con questioningly, as though seeking reassurance that he hadn’t violated her instructions by playing football with Chris — “and that shouldn’t happen if the bleed was traumatic. Second, one of the tests we took Monday, the PTT, was way off; the others were normal. That combination is typical for hemophilia. And I should add that the joints are where hemophiliacs bleed most often, so that fits too.”   

“How can that be?” He looked accusingly at Amaya and raised his voice. Debbie put a restraining hand on his knee.

He didn’t trust this little Indian woman, who was displaying her waist — a slim one, to be sure — in that weird outfit, to know what she was talking about, any more than he trusted her to do competent surgery. And why didn’t she wash that blood off her forehead? Had she looked in the mirror lately? Resentfully he lowered his voice. “OK. How can that be, doctor? Is that better? Doesn’t hemophilia run in families?”   

“It does,” Amaya answered and looked at Debbie. “So think hard. It would have to come from the mother’s side, because fathers can only transmit the gene to their daughters, and they rarely have symptoms.”

He didn’t like to be told that he couldn’t transmit a gene to his son, even a defective one. But then, that might explain Chris’s aversion to the manly game of football. Was it possible that Chris wasn’t really his son? He decided to keep his dawning suspicion to himself for now.   

Amaya took a tome entitled Hematology from a shelf behind her, found the page she was looking for, and buzzed the receptionist. “Make two copies of this page, would you please?” The receptionist was gone less than a minute. Amaya handed one copy each to Debbie and Con.

“Look at this at your leisure. It shows the inheritance pattern for the most common form of hemophilia. If you have questions about it, either Rick or I can help you.  For now, I’d like you, Mrs. Flynn, to think back real hard to your family background.  Was there ever anything like this in a previous generation — an uncle, maybe — or earlier?  Hemophilia can skip generations, you know.”   

“I don’t know much about my ancestors,” Debbie said. “My mother’s grandparents both died in the flu pandemic in 1918. Their daughter, who was my grandmother, was two years old at the time and she was adopted. All I know’s that they — my natural great-grandparents, the ones who died of flu — came over from Germany. I’ve never tried to trace my roots. I probably should.”   

“So that could be a dead end. . . . Oh, I suppose there are ways of finding out,” Amaya continued pensively, “but it doesn’t really matter as far as Chris’s treatment is concerned. We need to do two things: first, stop the bleeding; second, confirm the diagnosis. And that order is deliberate. I don’t want more and more blood in that knee, or bleeding into another joint, while we sit around waiting for lab results.”   

She looked from Debbie to Con and back. Both sat mute. “I know that’s a shock,” she said softly, “and I wish I could give you time to absorb it. But I’d rather give fresh frozen plasma right away. I’ve discussed this with Rick and he agrees.”   

“What’s fresh frozen plasma?” Con asked.

“Chris is missing one of the substances he needs for his blood to clot. It’s called antihemophilic factor, probably Factor VIII. Replacing it has always been a problem because it’s unstable. I won’t bother you with the technical details. To be honest, I have trouble keeping up with all the new developments myself. You’ll need to speak to a hematologist. Let me just say that the scientists and the pharmaceutical companies are working on it. Eventually they’ll find a solution that’s technically feasible and safe. For now, though, the ultimate source is still normal human plasma, and that runs the risk of transmitting things like viruses from donors that aren’t always screened as carefully as we’d like. Many blood donors are paid for their blood, and they aren’t always honest about their history for fear of being rejected.”

“Are you telling us,” Con was half way out of his chair, “that Chris is going to get blood with viruses in it?” Debbie laid a hand on his arm to calm him.

“No, Mr. Flynn. Blood banks in general are very careful about their donors. I just wanted you to know what might happen occasionally, but it’s quite rare.”

“Well, my son’s not getting contaminated blood. Or plasma, or whatever you call it. No way! I’m not going to sit here and watch my son deliberately get jaundice. That’s what ‘viruses’ means, isn’t it?”     

Amaya looked him in the eye. Calmly she said, “You’re well informed, Mr. Flynn. Yes, viral hepatitis is one of the risks, but most people recover from it. And there really is no alternative. If you look at it statistically —”   

“I don’t give two hoots about your statistics. If Chris gets it, then it’s a hundred percent.”   

Amaya stifled an exasperated sigh. She’d heard that argument before, mostly from people who would never think of applying it to their risk of dying in an auto accident. As an isolated statement, it rang true. That’s what made it so hard to rebut. In his present agitated state, Con was not a candidate for a reasoned discussion of relative risk; maybe he never would be. She would have to be more direct.

“Mr. Flynn. If the diagnosis is right, and he’s not treated, he’ll bleed over and over. The more banged up he gets, the greater the risk.” She had already divined Con’s vulnerability. “The end-result is a crippling arthritis.  Enough bleeding into a joint will end up destroying it. Antihemophilic factor can prevent that. Would you be opposed to treating him?”   

 “He’ll be getting someone else’s blood, right? Someone covering up for his contamination so’s he can sell it.” No one could pull the wool over Connor Flynn’s eyes.

“Plasma. Yes,” she answered. “In fact, pooled plasma from many donors.”   

“Like hell he is,” Con said, his tone brooking no dissent. “You’d better find another way.”

Con’s mind wanted to shut it all out. He saw Chris crippled, Chris unable to play football, perpetually on the sidelines, jaundiced, shut in his room with his batteries and those other sissy toys. And this little Indian woman in control. Damn these foreigners, damn these women!

“Just how great are the risks?” Debbie asked.  

“Of treatment, you mean?” Amaya was thankful that Debbie was willing to talk sense.

“Yes.”   

“The biggest risk is hepatitis, like your husband says. Once in a while the donor blood contains something the recipient’s allergic to, but that’s very rare. At least we don’t have to worry about a transfusion reaction. There are no red cells involved.”

Con’s face blanched and both Amaya and Debbie noticed that for an instant he seemed unsteady in his chair. “Are you OK?” Amaya asked.

Con recovered his composure and assured them that he was. But that was only partly true. Over the years — almost fifteen to be exact — he had become less obsessed with Jill. It was as if a curtain had been drawn between him and his memory of her. The words “transfusion reaction” tore away that curtain like a sudden violent gust on a calm day. There she had sat, her baseball cap askew, talking matter-of-factly about her leukemia, resigned to the probability of an untimely death. Just two days later his tears had fallen on her cold, lifeless face.

What had happened to him in those intervening years? Where was the naïve innocence now that had allowed him to fall in love with a dying girl he had never seen outside a transfusion suite? He hoped neither Debbie nor Amaya noticed the moistness in his eyes. He was not prepared to share his most precious memories with people who would not understand.

He tried to steady his voice. “Can you get syphilis?” he asked, as much to divert attention as to obtain information.  

“All blood’s tested for syphilis. No, he won’t get that from a transfusion. Even the risk of hepatitis isn’t all that great. Donors are carefully screened, as I told you, and anybody who’s ever been jaundiced is rejected.”     

“But don’t some people still get it, even with all the testing?” Debbie asked.  

Amaya leaned forward. “Mrs. Flynn — and Mr. Flynn — very few things in medicine are guaranteed. We’re always having to weigh one risk against another. I wish, just like you do, that our treatments were risk-free. As a surgeon, I can tell you that no surgery is absolutely safe, yet we operate because the danger of not operating is greater. So it is with medical treatments. Maybe you should hear this from Rick, but I know he’d say the same thing. I can tell you confidently that if Chris isn’t treated, he’ll face a lifetime of trouble and progressive disability. Proper treatment will prevent most of it, and with relatively low risk —”   

“ ‘Most.’ ‘Relative.’ That’s hedging, and it’s hiding the truth, isn’t it?” Con’s tone was bitter, although he kept the volume down.

What Amaya failed to mention was that the risk of hepatitis was substantial, because there was in those days no way to test blood for the virus, and hemophiliacs, because of repeated transfusions, rarely escaped infection in the long run. Still, the risk of hepatitis, from which most people recovered, was less than the risk of disability from untreated hemophilia, which was irreversible. Despite the technical inaccuracy, she was not deceiving the Flynns.

“I have to be honest,” Amaya said.

After a pause, Debbie asked, “Where does all that hepatitis come from? I don’t know anybody that’s ever had it. Do you, Con?” He shook his head.

Amaya knew the source, and honesty undid her once more. “Most of the pooled plasma comes from paid donors, who are not our most upstanding citizens, else they wouldn’t be selling their blood. We can screen out syphilis, because there’s a simple test, but who knows what else those people carry? They inject themselves with drugs, they’re sexually promiscuous, some of them are homosexual.” She shrugged helplessly. “Of course, they get asked about all those habits at the donor stations, but they lie, because they need the money.”    

Con was on his feet. “Are you telling me, doctor, that you’re giving my son faggot blood?”    

Debbie pulled him back into his chair. “Please, Con, the doctor’s explaining the risks. She’s saying they can’t be sure the homosexuals are being truthful. Which isn’t surprising; they don’t want anybody to know. Just listen to yourself.” She turned to Amaya. “But that’s awful, doctor. Isn’t there a test for homosexuality?”   

Amaya smiled wanly. “We don’t even know if the risk’s any greater for homosexuals than others. Some people say homosexuals are more promiscuous, but you’d never know that working in a VD clinic. That was one of the rotations during my internship, and I can assure you homosexuality wasn’t what brought patients in with syphilis or gonorrhea. The men gave it to the women; the women gave it to the men. Sometimes they brought their partners in, sometimes we sent for them. I’d say at least ninety-five percent were the opposite sex.”   

“Sure,” Con interrupted, “I can just imagine some faggot saying, ‘Oh, I screw guys all the time.’ At least, normal people aren’t afraid to talk about what they do.” He turned his head toward the window and said, without looking at Amaya, “Come on, doctor, how naïve can you be?” Now he knew that his judgment of her was right. He also knew that he was powerless to fight her. To be sure, he could demand a second opinion, which a little voice told him would be the same as the first, and he would be humiliated. But giving in gracefully was not his style.                                                                                 

“We’re just sitting here guessing. You haven’t even proved that he has hemophilia. He’s not getting anything till it’s proved.”   

Doctor Prasad nodded. Con took the gesture as acquiescence. In fact, she was marveling at this façade of paternal concern. Debbie didn’t stop to marvel.

“What happens if we wait out this one time while you make sure?” she asked.

“He could get away with it. But he could bleed again. You’d have to keep him at rest and continue cold packs till the swelling has really gone down. These episodes are self-limited, but they can last. And ― I want to emphasize this ― the damage is cumulative with every episode of bleeding.”   

Debbie knew her husband. He needed this little victory, even at the cost of extra days of immobilization for Chris.

“Let’s wait,” she said to Amaya.

Con looked at Amaya with smug satisfaction.

“OK,” Amaya said, “we’ll repeat the coag tests. I’ll put a rush on them.”     

Debbie sighed. “If he does have it, what about the rest of us?” she asked.

Amaya thought they had covered enough ground. “Maybe we should put that off till we’re sure. If the results are the same, I’ll refer you back to Rick anyway. He can do a better job explaining the details.”   

“Do we come back here for the results?” Debbie asked.

“Either Rick or I’ll call you when they’re in. Technically, as long as we haven’t confirmed hemophilia, we haven’t ruled out injury as the cause. I might still have to operate. But I hope not.”   

Debbie smiled wryly. “I don’t like surgery either. But in this case it seems like the lesser evil.”   

“Whatever it is, I’m sure we can handle it,” Amaya answered with all the sympathy she could muster.

A week later Amaya called the Flynns. The second set of results duplicated the first. Special tests showed Chris’s problem to be, as predicted, a deficiency in Factor VIII. His blood contained less than five percent of normal.

Amaya Prasad’s services were no longer needed. With luck and good management, they might never be. She referred Chris back to Rick Harmon.