{"id":121,"date":"2022-02-08T16:44:36","date_gmt":"2022-02-08T21:44:36","guid":{"rendered":"https:\/\/foxglovesystems.com\/herbheineman\/Stowaway\/?page_id=121"},"modified":"2022-05-09T11:45:01","modified_gmt":"2022-05-09T15:45:01","slug":"eleven","status":"publish","type":"page","link":"https:\/\/herbheineman.com\/Stowaway\/eleven\/","title":{"rendered":"ELEVEN"},"content":{"rendered":"\t\t
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There were times when Debbie wondered whether, after all those years of indecision, she\u2019d 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\u2019d 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<\/em>.<\/p>\n

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<\/em>. 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.<\/p>\n

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\u2019 blessing and to the Flynns\u2019 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.<\/p>\n

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.<\/p>\n

Con\u2019s 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.<\/p>\n

\u2756\u2756\u2756\u2756\u2756<\/p>\n

C.J. \u2014 Connor Junior \u2014 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\u2019re 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\u2019s questions. He was determined to add balance to the child\u2019s 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\u2019s 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.<\/p>\n

\u201cNice try, son,\u201d Con said. \u201cYou\u2019re going to be a great player.\u201d Putting his arm around Chris\u2019s shoulder, he led him inside.<\/p>\n

\u201cWho won?\u201d Debbie asked playfully.<\/p>\n

\u201cInjury on the field,\u201d Con answered. \u201cA good little future quarterback we got here. Just wait till he\u2019s in high school.\u201d<\/p>\n

Debbie sized up her son. \u201cDoesn\u2019t look all that bad.\u201d<\/p>\n

\u201cMy knee hurts.\u201d Chris had no enthusiasm for the sport and regarded his father\u2019s optimism with more apprehension than pride.<\/p>\n

\u201cLet\u2019s put it up on a chair,\u201d Debbie said, helping him. \u201cWe\u2019ll put a cold compress on it, so it won\u2019t swell up.\u201d   <\/p>\n

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\u2019 bedroom. She knocked.<\/p>\n

\u201cCome in,\u201d C.J. said irritably. \u201cDon\u2019t we have a nursery in this house for babies?\u201d   <\/p>\n

\u201cPlease, C.J.,\u201d his mother said quietly. \u201cYou may have forgotten the way you used to fuss, but I haven\u2019t.\u201d  C.J. threw himself angrily on his other side and lay facing the wall.<\/p>\n

\u201cWhat is it, Chrissie?\u201d she asked.<\/p>\n

\u201c \u2018Chrissie.\u2019 \u201d Debbie heard the whispered echo from the wall behind her.<\/p>\n

\u201cMy knee!\u201d Chris\u2019s 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.<\/p>\n

\u201cLet me put an ace bandage on it,\u201d she said, a worried frown on her face. \u201cMaybe it won\u2019t hurt quite as much wrapped.\u201d  She did so with utmost care, and the wrapping did seem to help.  Next she brought him an acetaminophen tablet and water. \u201cIn the morning we\u2019ll take you to the doctor. Try to sleep.\u201d With a kiss she departed.<\/p>\n

\u201cThat was Chris. He must have taken quite a fall,\u201d she reported back to her husband. \u201cHis knee\u2019s all swollen. I hope he didn\u2019t break something.\u201d   <\/p>\n

\u201cI don\u2019t remember him limping,\u201d Con replied. \u201cHe needs to learn to put up with a bit of pain.\u201d   <\/p>\n

\u201cYou expect too much from that child. He\u2019s only six,\u201d Debbie said. \u201cI\u2019m taking him to the doctor in the morning. C.J. was his usual sympathetic self.\u201d   <\/p>\n

\u201cC.J. would have gritted his teeth and let his brother sleep.\u201d   <\/p>\n

Debbie didn\u2019t believe that, but she was in no mood for another argument. Why couldn\u2019t Con just let Chris be Chris instead of trying to model him after C.J., who she feared had the makings of a bully?<\/p>\n

In the morning Chris\u2019s knee was no better. She wished they\u2019d stayed in Philadelphia, or closer to it.<\/p>\n

\u201cWe\u2019re in for a little commute,\u201d she told Chris as she got him ready. \u201cI hope it won\u2019t become a habit.\u201d To Con she said, \u201cYou\u2019d better come along. There might be decisions to make.\u201d<\/p>\n

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.<\/p>\n

The trip to the doctor\u2019s 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\u2019t 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\u2019s tone and graciously agreed to interrupt his hospital rounds.<\/p>\n

\u201cWhat brings you all this way, Debbie? That\u2019s no easy trip at this time of day.\u201d   <\/p>\n

\u201cIt\u2019s Chris. He\u2019s done something to his knee and he\u2019s in agony.\u201d   <\/p>\n

\u201cBring him to the ER. Have me paged when you get there.\u201d   <\/p>\n

The trip from Rick\u2019s office took another fifteen minutes. His knee immobilized by the ace bandage, Chris braved the ride without complaint.<\/p>\n

C.J. would have had to admire his \u201cbaby\u201d brother\u2019s grit.<\/p>\n

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.<\/p>\n

\u201cWhat have we here?\u201d he asked, placing a hand on Chris\u2019s shoulder.  While Debbie explained, Rick felt Chris\u2019s forehead and frowned. \u201cNurse!\u201d he called. \u201cDid you take his temperature?\u201d   <\/p>\n

\u201cA hundred point eight oral.\u201d    <\/p>\n

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.<\/p>\n

\u201cWas twisting all he did?\u201d he asked. \u201cAre you sure nothing penetrated the skin?\u201d He could have answered his own question, because there was no visible break.  <\/p>\n

\u201cI don\u2019t think so, but backyard football, you know, anything\u2019s possible.\u201d   <\/p>\n

\u201cI\u2019ll have to aspirate,\u201d Rick said. \u201cThis could be septic, though I can\u2019t figure how it developed \u2014 unless it spread from somewhere else: septicemia. It\u2019s too soon after the injury for that to be the cause.\u201d He looked questioningly at Debbie, but she shook her head. Con merely frowned. Rick turned to Chris.<\/p>\n

\u201cChris, milad, that knee must hurt like the devil, the way it looks.\u201d   <\/p>\n

Chris felt vindicated by the doctor\u2019s assessment. Too bad C.J. wasn\u2019t there to be humiliated. \u201cC.J. got mad at me because I woke him up, but I couldn\u2019t help it. It hurt so bad I couldn\u2019t sleep either.\u201d   <\/p>\n

\u201cI guess C.J. doesn\u2019t like his dreams disturbed, but he could\u2019ve been nicer about it. Now, I think you have an infection in there, and if we don\u2019t treat it right you could have a stiff knee when you grow up.\u201d   <\/p>\n

\u201cI don\u2019t care about football.\u201d   <\/p>\n

\u201cBut you do care about walking, don\u2019t you?\u201d   <\/p>\n

\u201cSo what\u2019re you going to do?\u201d   <\/p>\n

\u201cFirst I\u2019m going to spray something on it from a brown bottle, to make it real cold and numb. Then it won\u2019t hurt when I put the needle in \u2014 \u201d   <\/p>\n

Chris burst into tears. \u201cI don\u2019t want a needle!\u201d   <\/p>\n

Debbie bent down to kiss him on the forehead. \u201cYou won\u2019t even feel it, sweetie. Doctor Harmon\u2019s going to make it numb with the spray.\u201d 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\u2019s 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. \u201cCell count, glucose, protein, Gram stain, culture. The usual.\u201d     <\/p>\n

Chris looked at him suspiciously. \u201cDid you do it already?\u201d   <\/p>\n

\u201cAll done. That wasn\u2019t so bad, was it now?\u201d    <\/p>\n

\u201cNo, it didn\u2019t hurt, just felt cold. I think it\u2019s getting better already. What did you put in there?\u201d   <\/p>\n

\u201cNothing! 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.\u201d He turned to the parents. \u201cI want to speak with you.\u201d Debbie and Con went out of the cubicle with him.<\/p>\n

Out of earshot, Rick said, \u201cI want Doctor Prasad to take a look at him. If Chris tore a ligament, he may need to have it repaired. The knee\u2019s 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\u2019t even care about football, so he\u2019ll appreciate it if you lay off.\u201d     <\/p>\n

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\u2019d take him to task for it.<\/p>\n

Rick hoped Doctor Prasad wasn\u2019t in the operating room, and asked the receptionist to page her. Luckily, she came on the line right away.<\/p>\n

\u201cAmaya, I need you to see a six-year-old quarterback who got sacked by his overzealous father. Knee full of blood.\u201d By a supreme effort, Con kept his temper in check. <\/p>\n

\u201cI\u2019ll be right there,\u201d Amaya said. <\/p>\n

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\u2019s expression, showed she was used to this kind of reaction and enjoyed it.<\/p>\n

\u201cYou\u2019re the child\u2019s father?\u201d   <\/p>\n

\u201cYes.\u201d<\/p>\n

\u201cAnd you must be his mother,\u201d she said, turning to Debbie.   <\/p>\n

Debbie did not try to hide her surprise.  Wide-eyed and respectful, she said, \u201cPleased to meet you, I\u2019m sure.\u201d   <\/p>\n

 \u201cI\u2019m Amaya Prasad, orthopedic surgeon.\u201d   <\/p>\n

\u201cSurgeon?\u201d<\/p>\n

\u201cOrthopedic surgeon. Do you know where the word orthopedic<\/em> comes from?\u201d   <\/p>\n

\u201cYeah, means bones and stuff,\u201d Con answered promptly. \u201cEverybody knows that.\u201d He didn\u2019t 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.<\/p>\n

\u201cActually it means \u2018straight child,\u2019 from the Greek. That\u2019s what my professional forebears did: straighten out deformed children. Luckily your child doesn\u2019t need straightening out, but Doctor Harmon tells me he banged up his knee and made it bleed inside. So let\u2019s take a look.\u201d They went into the examining room.  <\/p>\n

Amaya smiled at Chris; he smiled back. \u201cI\u2019m here,\u201d she said, \u201cto help your knee heal up, so you can run all you want. Do you swim?\u201d   <\/p>\n

Chris looked puzzled, but he laughed. \u201cNot too good, but I can stay on top of the water.\u201d    <\/p>\n

\u201cGood. More swimming and less football. It\u2019s better for your knees.\u201d<\/p>\n

Debbie smiled; Con clenched his teeth.   <\/p>\n

Amaya gently pressed on the knee from all sides, eyes on his face.  He did not flinch.<\/p>\n

\u201cOK,\u201d she said. \u201cNo needles. I\u2019m just going to see how well the knee bends.\u201d Chris shrugged. \u201cYou don\u2019t even have to do it,\u201d she went on. \u201cI\u2019ll do it. Just think of your favorite dessert or TV show.\u201d   <\/p>\n

\u201c\u2018Batman\u2019 \u2014 and chocolate ice cream.\u201d   <\/p>\n

\u201cI like your taste!\u201d 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.<\/p>\n

\u201cI can\u2019t put it through the full range because it\u2019s still tense with blood.  But it feels stable. I\u2019d be surprised if there were anything as bad as a torn ligament. Maybe an aberrant blood vessel. Wrap it as tight as he\u2019s comfortable with and keep him off his feet. I\u2019d like to see him again day after tomorrow \u2014 unless, of course, it starts to hurt more. What do you think?\u201d   <\/p>\n

\u201cSounds good to me,\u201d Rick answered. \u201cSee?\u201d he said, turning to Con, \u201chere\u2019s a surgeon who doesn\u2019t even want to operate!\u201d   <\/p>\n

Amaya laughed. \u201cWe don\u2019t like to operate unless there\u2019s no other way. But Rick\u2019s a thinking doc, and they love to tease the cutting docs.\u201d She stopped as a new thought struck her.<\/p>\n

\u201cHas he ever bled into a joint before?\u201d   <\/p>\n

\u201cNot that I can remember,\u201d Debbie said. \u201cCan you, Con?\u201d   <\/p>\n

\u201cNo. He did bang his elbow on that dresser last year, and it swelled up for a few days. But I didn\u2019t think it was blood.\u201d   <\/p>\n

\u201cThat\u2019s right,\u201d Debbie said. \u201cIt wasn\u2019t this bad.\u201d   <\/p>\n

Amaya\u2019s eyes widened ever so slightly. \u201cAny family history of bleeding?\u201d she asked.<\/p>\n

\u201cWhat do you mean, bleeding?\u201d Con was annoyed. \u201cHe twisted his knee. What\u2019s the family got to do with it?\u201d   <\/p>\n

\u201cOh, probably nothing,\u201d Amaya tried to reassure him. \u201cJust want to be sure to cover all the bases.\u201d   <\/p>\n

\u201cCan\u2019t hurt,\u201d Rick said offhandedly. \u201cWe\u2019ll get some coagulation tests. Then we\u2019ll know and we won\u2019t ever have to bring it up again.\u201d He turned to the nurse. \u201cLet\u2019s get a CBC, and make sure it includes a platelet count. And a PT and PTT.\u201d   <\/p>\n

\u201cWhat are all those letters?\u201d Debbie asked.<\/p>\n

\u201cWell, there\u2019s complete blood count, CBC. That\u2019s the easy one. But the others are real tongue twisters. First we make up fancy names for things, then we have trouble pronouncing \u2019em, so we abbreviate. They stand for prothrombin time and partial thromboplastin time.\u201d   <\/p>\n

Debbie laughed. \u201cI see. And in English?\u201d   <\/p>\n

\u201cTesting for different components of the blood clotting system. Don\u2019t worry about the details. If anything turns up, we\u2019ll tell you everything you need to know.\u201d   <\/p>\n

Doctor Prasad gave Debbie her business card. \u201cHave 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!\u201d He nodded, tight-lipped.   <\/p>\n

Between next morning and evening, Debbie felt uneasily that the swelling increased, but Chris didn\u2019t complain. By the second morning she was sure.<\/p>\n

\u201cHow is it?\u201d she asked.<\/p>\n

\u201cIt hurts. I had a bad dream.\u201d   <\/p>\n

\u201cWhat, honey?\u201d   <\/p>\n

\u201cC.J. jumped on my knee and twisted it.\u201d     <\/p>\n

\u201cOh, he\u2019d never do that,\u201d Debbie said comfortingly, \u201ceven if he does get mad about being woken up. Anyway, let\u2019s see what Doctor Prasad says about it. Our appointment\u2019s right after lunch.\u201d   <\/p>\n

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.<\/p>\n

\u201cHow\u2019s the knee, young man?\u201d   <\/p>\n

Debbie let Chris answer. \u201cIt hurts again.\u201d   <\/p>\n

\u201c \u2018Again.\u2019 You mean it wasn\u2019t hurting for a while?\u201d                         <\/p>\n

\u201cYeah.\u201d   <\/p>\n

Amaya looked questioningly at Debbie.<\/p>\n

\u201cHe didn\u2019t complain at all yesterday,\u201d Debbie said, \u201cbut I thought it was swelling some more. Now I\u2019m sure it\u2019s more swollen.\u201d   <\/p>\n

Amaya nodded. \u201cOK, 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.\u201d   <\/p>\n

Chris limped across the waiting room, and Amaya beckoned Debbie into her office.<\/p>\n

\u201cPlease sit down, Mrs. Flynn.\u201d   <\/p>\n

Debbie was alarmed. \u201cDoes he have an infection after all?  Does he have to go to the hospital?\u201d   <\/p>\n

\u201cNo.\u201d The pause that followed was too short for Debbie to be reassured. \u201cIt looks as if Chris might have a bleeding problem.\u201d   <\/p>\n

This was even worse. \u201cYou mean hemophilia \u2014 something like that?\u201d   <\/p>\n

\u201cYes. Those tests we took in the ER the other day, one of them came back positive.\u201d   <\/p>\n

Debbie tried to compose herself. \u201cI think I\u2019d rather have my husband here for this.\u201d   <\/p>\n

\u201cI understand,\u201d Amaya answered gently, \u201cbut we need to deal with it promptly. What\u2019s the chance of getting him to come over?\u201d   <\/p>\n

\u201cMay I call him from here?\u201d   <\/p>\n

\u201cOf course. Go to the receptionist\u2019s desk. . . . No. Better use my phone. You might not want Chris to hear.\u201d   <\/p>\n

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\u2019s doctor. He didn\u2019t 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\u2019t mention this to his boss.<\/p>\n

\u201cWhat\u2019s wrong?  Why the hurry?\u201d he asked Debbie.<\/p>\n

\u201cDoctor Prasad said something should be done right away for Chris\u2019s knee, and I didn\u2019t want to be all alone dealing with it. Please come on down. She\u2019ll explain everything to the two of us together. Chris is playing in the waiting room. He\u2019s OK. How long will you need to get here?\u201d   <\/p>\n

He frowned.  How to put together \u201che\u2019s OK\u201d and \u201csomething should be done right away\u201d? He\u2019d better get down there. And while he was there, he\u2019d say something to Debbie about finding a doctor with an office that you didn\u2019t have to spend all day to visit. Even more important, an American one.<\/p>\n

\u201cI might be able to do it in an hour or so, but it depends on traffic.\u201d   <\/p>\n

\u201cPlease be careful,\u201d Debbie said. \u201cOne casualty\u2019s enough.\u201d 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\u2019t need to ask him to explain.<\/p>\n

\u201cIs she going to stick a needle in my knee?\u201d he asked.<\/p>\n

\u201cNo, sweetie. But Daddy\u2019s on his way over. And then Doctor Prasad\u2019s going to tell us what she does want to do.\u201d   <\/p>\n

\u201cCan we read something?\u201d   <\/p>\n

Con arrived an hour and a half later. Seeing Chris, he put on a happy face.<\/p>\n

\u201cFifteen minutes to find a parking spot. Even Germantown Avenue\u2019s full. I had to drive all the way over to Bethlehem Pike. . . . Hi, tough guy! So,\u201d rubbing his hands, \u201cbring on the doctor!\u201d The receptionist politely directed him to a chair. Ten minutes later they went into the office.<\/p>\n

\u201cI started to tell your wife,\u201d Amaya began, silently amused at Con\u2019s reaction to her appearance, \u201cbut she wanted you here. I\u2019m glad you could make it. Nothing\u2019s sure till we\u2019ve 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\u2019s bled some more even though the leg was at rest\u201d \u2014  she looked at Con questioningly, as though seeking reassurance that he hadn\u2019t violated her instructions by playing football with Chris \u2014 \u201cand that shouldn\u2019t 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.\u201d   <\/p>\n

\u201cHow can that be?\u201d He looked accusingly at Amaya and raised his voice. Debbie put a restraining hand on his knee.<\/p>\n

He didn\u2019t trust this little Indian woman, who was displaying her waist \u2014 a slim one, to be sure \u2014 in that weird outfit, to know what she was talking about, any more than he trusted her to do competent surgery. And why didn\u2019t she wash that blood off her forehead? Had she looked in the mirror lately? Resentfully he lowered his voice. \u201cOK. How can that be, doctor?<\/em> Is that better? Doesn\u2019t hemophilia run in families?\u201d   <\/p>\n

\u201cIt does,\u201d Amaya answered and looked at Debbie. \u201cSo think hard. It would have to come from the mother\u2019s side, because fathers can only transmit the gene to their daughters, and they rarely have symptoms.\u201d<\/p>\n

He didn\u2019t like to be told that he couldn\u2019t transmit a gene to his son, even a defective one. But then, that might explain Chris\u2019s aversion to the manly game of football. Was it possible that Chris wasn\u2019t really his son? He decided to keep his dawning suspicion to himself for now.   <\/p>\n

Amaya took a tome entitled Hematology<\/em> from a shelf behind her, found the page she was looking for, and buzzed the receptionist. \u201cMake two copies of this page, would you please?\u201d The receptionist was gone less than a minute. Amaya handed one copy each to Debbie and Con.<\/p>\n

\u201cLook 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\u2019d like you, Mrs. Flynn, to think back real hard to your family background.  Was there ever anything like this in a previous generation \u2014 an uncle, maybe \u2014 or earlier?  Hemophilia can skip generations, you know.\u201d   <\/p>\n

\u201cI don\u2019t know much about my ancestors,\u201d Debbie said. \u201cMy mother\u2019s grandparents both died in the flu pandemic in 1918. Their daughter, who was my<\/em> grandmother, was two years old at the time and she was adopted. All I know\u2019s that they \u2014 my natural great-grandparents, the ones who died of flu \u2014 came over from Germany. I\u2019ve never tried to trace my roots. I probably should.\u201d   <\/p>\n

\u201cSo that could be a dead end. . . . Oh, I suppose there are ways of finding out,\u201d Amaya continued pensively, \u201cbut it doesn\u2019t really matter as far as Chris\u2019s treatment is concerned. We need to do two things: first, stop the bleeding; second, confirm the diagnosis. And that order is deliberate. I don\u2019t want more and more blood in that knee, or bleeding into another joint, while we sit around waiting for lab results.\u201d   <\/p>\n

She looked from Debbie to Con and back. Both sat mute. \u201cI know that\u2019s a shock,\u201d she said softly, \u201cand I wish I could give you time to absorb it. But I\u2019d rather give fresh frozen plasma right away. I\u2019ve discussed this with Rick and he agrees.\u201d   <\/p>\n

\u201cWhat\u2019s fresh frozen plasma?\u201d Con asked.<\/p>\n

\u201cChris is missing one of the substances he needs for his blood to clot. It\u2019s called antihemophilic factor, probably Factor VIII. Replacing it has always been a problem because it\u2019s unstable. I won\u2019t bother you with the technical details. To be honest, I have trouble keeping up with all the new developments myself. You\u2019ll need to speak to a hematologist. Let me just say that the scientists and the pharmaceutical companies are working on it. Eventually they\u2019ll find a solution that\u2019s 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\u2019t always screened as carefully as we\u2019d like. Many blood donors are paid for their blood, and they aren\u2019t always honest about their history for fear of being rejected.\u201d<\/p>\n

\u201cAre you telling us,\u201d Con was half way out of his chair, \u201cthat Chris is going to get blood with viruses in it?\u201d Debbie laid a hand on his arm to calm him.<\/p>\n

\u201cNo, Mr. Flynn. Blood banks in general are very careful about their donors. I just wanted you to know what might happen occasionally, but it\u2019s quite rare.\u201d<\/p>\n

\u201cWell, my son\u2019s not getting contaminated blood. Or plasma, or whatever you call it. No way! I\u2019m not going to sit here and watch my son deliberately get jaundice. That\u2019s what \u2018viruses\u2019 means, isn\u2019t it?\u201d     <\/p>\n

Amaya looked him in the eye. Calmly she said, \u201cYou\u2019re 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 \u2014\u201d   <\/p>\n

\u201cI don\u2019t give two hoots about your statistics. If Chris gets it, then it\u2019s a hundred percent.\u201d   <\/p>\n

Amaya stifled an exasperated sigh. She\u2019d 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\u2019s 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.<\/p>\n

\u201cMr. Flynn. If the diagnosis is right, and he\u2019s not treated, he\u2019ll bleed over and over. The more banged up he gets, the greater the risk.\u201d She had already divined Con\u2019s vulnerability. \u201cThe 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?\u201d   <\/p>\n

 \u201cHe\u2019ll be getting someone else\u2019s blood, right? Someone covering up for his contamination so\u2019s he can sell it.\u201d No one could pull the wool over Connor Flynn\u2019s eyes.<\/p>\n

\u201cPlasma. Yes,\u201d she answered. \u201cIn fact, pooled plasma from many donors.\u201d   <\/p>\n

\u201cLike hell he is,\u201d Con said, his tone brooking no dissent. \u201cYou\u2019d better find another way.\u201d<\/p>\n

Con\u2019s 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!<\/p>\n

\u201cJust how great are the risks?\u201d Debbie asked.  <\/p>\n

\u201cOf treatment, you mean?\u201d Amaya was thankful that Debbie was willing to talk sense.<\/p>\n

\u201cYes.\u201d   <\/p>\n

\u201cThe biggest risk is hepatitis, like your husband says. Once in a while the donor blood contains something the recipient\u2019s allergic to, but that\u2019s very rare. At least we don\u2019t have to worry about a transfusion reaction. There are no red cells involved.\u201d<\/p>\n

Con\u2019s face blanched and both Amaya and Debbie noticed that for an instant he seemed unsteady in his chair. \u201cAre you OK?\u201d Amaya asked.<\/p>\n

Con recovered his composure and assured them that he was. But that was only partly true. Over the years \u2014 almost fifteen to be exact \u2014 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 \u201ctransfusion reaction\u201d 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.<\/p>\n

What had happened to him in those intervening years? Where was the na\u00efve 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.<\/p>\n

He tried to steady his voice. \u201cCan you get syphilis?\u201d he asked, as much to divert attention as to obtain information.  <\/p>\n

\u201cAll blood\u2019s tested for syphilis. No, he won\u2019t get that from a transfusion. Even the risk of hepatitis isn\u2019t all that great. Donors are carefully screened, as I told you, and anybody who\u2019s ever been jaundiced is rejected.\u201d     <\/p>\n

\u201cBut don\u2019t some people still get it, even with all the testing?\u201d Debbie asked.  <\/p>\n

Amaya leaned forward. \u201cMrs. Flynn \u2014 and Mr. Flynn \u2014 very few things in medicine are guaranteed. We\u2019re 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\u2019d say the same thing. I can tell you confidently that if Chris isn\u2019t treated, he\u2019ll face a lifetime of trouble and progressive disability. Proper treatment will prevent most of it, and with relatively low risk \u2014\u201d   <\/p>\n

\u201c \u2018Most.\u2019 \u2018Relative.\u2019 That\u2019s hedging, and it\u2019s hiding the truth, isn\u2019t it?\u201d Con\u2019s tone was bitter, although he kept the volume down.<\/p>\n

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.<\/p>\n

\u201cI have to be honest,\u201d Amaya said.<\/p>\n

After a pause, Debbie asked, \u201cWhere does all that hepatitis come from? I don\u2019t know anybody that\u2019s ever had it. Do you, Con?\u201d He shook his head.<\/p>\n

Amaya knew the source, and honesty undid her once more. \u201cMost of the pooled plasma comes from paid donors, who are not our most upstanding citizens, else they wouldn\u2019t be selling their blood. We can screen out syphilis, because there\u2019s a simple test, but who knows what else those people carry? They inject themselves with drugs, they\u2019re sexually promiscuous, some of them are homosexual.\u201d She shrugged helplessly. \u201cOf course, they get asked about all those habits at the donor stations, but they lie, because they need the money.\u201d    <\/p>\n

Con was on his feet. \u201cAre you telling me, doctor, that you\u2019re giving my son faggot blood?\u201d    <\/p>\n

Debbie pulled him back into his chair. \u201cPlease, Con, the doctor\u2019s explaining the risks. She\u2019s saying they can\u2019t be sure the homosexuals are being truthful. Which isn\u2019t surprising; they don\u2019t want anybody to know. Just listen to yourself<\/em>.\u201d She turned to Amaya. \u201cBut that\u2019s awful, doctor. Isn\u2019t there a test for homosexuality?\u201d   <\/p>\n

Amaya smiled wanly. \u201cWe don\u2019t even know if the risk\u2019s any greater for homosexuals than others. Some people say homosexuals are more promiscuous, but you\u2019d never know that working in a VD clinic. That was one of the rotations during my internship, and I can assure you homosexuality wasn\u2019t 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\u2019d say at least ninety-five percent were the opposite sex.\u201d   <\/p>\n

\u201cSure,\u201d Con interrupted, \u201cI can just imagine some faggot saying, \u2018Oh, I screw guys all the time.\u2019 At least, normal people aren\u2019t afraid to talk about what they do.\u201d He turned his head toward the window and said, without looking at Amaya, \u201cCome on, doctor, how na\u00efve can you be?\u201d 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.                                                                                 <\/p>\n

\u201cWe\u2019re just sitting here guessing. You haven\u2019t even proved that he has hemophilia. He\u2019s not getting anything<\/em> till it\u2019s proved.\u201d   <\/p>\n

Doctor Prasad nodded. Con took the gesture as acquiescence. In fact, she was marveling at this fa\u00e7ade of paternal concern. Debbie didn\u2019t stop to marvel.<\/p>\n

\u201cWhat happens if we wait out this one time while you make sure?\u201d she asked.<\/p>\n

\u201cHe could get away with it. But he could bleed again. You\u2019d 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 \u2015 I want to emphasize this \u2015 the damage is cumulative with every episode of bleeding.\u201d   <\/p>\n

Debbie knew her husband. He needed this little victory, even at the cost of extra days of immobilization for Chris.<\/p>\n

\u201cLet\u2019s wait,\u201d she said to Amaya.<\/p>\n

Con looked at Amaya with smug satisfaction.<\/p>\n

\u201cOK,\u201d Amaya said, \u201cwe\u2019ll repeat the coag tests. I\u2019ll put a rush on them.\u201d     <\/p>\n

Debbie sighed. \u201cIf he does have it, what about the rest of us?\u201d she asked.<\/p>\n

Amaya thought they had covered enough ground. \u201cMaybe we should put that off till we\u2019re sure. If the results are the same, I\u2019ll refer you back to Rick anyway. He can do a better job explaining the details.\u201d   <\/p>\n

\u201cDo we come back here for the results?\u201d Debbie asked.<\/p>\n

\u201cEither Rick or I\u2019ll call you when they\u2019re in. Technically, as long as we haven\u2019t confirmed hemophilia, we haven\u2019t ruled out injury as the cause. I might still have to operate. But I hope not.\u201d   <\/p>\n

Debbie smiled wryly. \u201cI don\u2019t like surgery either. But in this case it seems like the lesser evil.\u201d   <\/p>\n

\u201cWhatever it is, I\u2019m sure we can handle it,\u201d Amaya answered with all the sympathy she could muster.<\/p>\n

A week later Amaya called the Flynns. The second set of results duplicated the first. Special tests showed Chris\u2019s problem to be, as predicted, a deficiency in Factor VIII. His blood contained less than five percent of normal.<\/p>\n

Amaya Prasad\u2019s services were no longer needed. With luck and good management, they might never be. She referred Chris back to Rick Harmon.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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TWELVE >><\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

2001 There were times when Debbie wondered whether, after all those years of indecision, she\u2019d 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 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-121","page","type-page","status-publish","hentry"],"yoast_head":"\nELEVEN - The Stowaway Gene<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/herbheineman.com\/Stowaway\/eleven\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ELEVEN - The Stowaway Gene\" \/>\n<meta property=\"og:description\" content=\"2001 There were times when Debbie wondered whether, after all those years of indecision, she\u2019d still been too precipitous in marrying Con. 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