Jodi Picoult

 

Handle With Care

Synopsis:

When Charlotte and Sean O’Keefe’s daughter, Willow, is born with severe osteogenesis imperfecta, they are devastated – she will suffer hundreds of broken bones as she grows, a lifetime of pain.

As the family struggles to make ends meet to cover Willow’s medical expenses, Charlotte thinks she has found an answer. If she files a wrongful birth lawsuit against her ob/gyn for not telling her in advance that her child would be born severely disabled, the monetary payouts might ensure a lifetime of care for Willow. But it means that Charlotte has to get up in a court of law and say in public that she would have terminated the pregnancy if she’d known about the disability in advance – words that her husband can’t abide, that Willow will hear, and that Charlotte cannot reconcile. And the ob/gyn she’s suing isn’t just her physician – it’s her best friend.

Handle With Care explores the knotty tangle of medical ethics and personal morality. When faced with the reality of a fetus who will be disabled, at which point should an OB counsel termination? Should a parent have the right to make that choice? How disabled is TOO disabled? And as a parent, how far would you go to take care of someone you love? Would you alienate the rest of your family? Would you be willing to lie to your friends, to your spouse, to a court? And perhaps most difficult of all – would you admit to yourself that you might not actually be lying?

One of the Washington Post's
Best Books of 2009

What others are saying about Handle With Care…

“You men out there who think Ms. Picoult is a chick thing need to get with the program. Her books are an everyone thing, and the current offering — about a little girl whose bones are so brittle that they break almost at a puff of wind — is her best since My Sister's Keeper. It's a legal/medical thriller, but at bottom it's a story about the American heart of darkness: a small-town marriage under stress. Picoult writes with unassuming brilliance and never descends into soap opera.”

—Stephen King

“Jodi Picoult crafts yet another fascinating story and again finds a solution to what seems an impossible situation. Her writing is a decadent treat, just like the sweet recipes she infuses throughout the book. ”

—Orlando Sentinel.   Read the full review »

“It’s well written, it’s conscientiously researched and, most important, it presents a character who is a child instead of a disability personified...”Handle With Care” is a great read, with strong characters, an exciting lawsuit to pull you along and really good use of the medical context. Picoult does a terrific job of evoking OI and its peculiarities -- from the likelihood that parents might be accused of child abuse (because of fractures that don’t quite “make sense”) to the incessant push and pull of wanting a child to experience kindergarten friendships, Disney World and ice skating, while worrying constantly that another fragile bone will break.”

—Washington Post

“ Picoult has carved an impressive niche in the topical family drama genre, tackling medical ethics, faith, ;and the law in her sixteenth novel… In her customary fashion, Picoult probes sensitive issues with empathy and compassion.”

—Booklist

“Told through multiple points of view, this suspenseful story explores questions of medical ethics and personal choice, pinpointing the fragile and delicate fault lines that span out from personal tragedy and disability.”

—Kirkus Reviews

“Perennial bestseller Picoult (Change of Heart) delivers another engrossing family drama, spiced with her trademark blend of medicine, law and love. Charlotte and Sean O’Keefe’s daughter, Willow, was born with brittle bone disease, a condition that requires Charlotte to act as full-time caregiver and has strained their emotional and financial limits. Willow’s teenaged half-sister, Amelia, suffers as well, overshadowed by Willow’s needs and lost in her own adolescent turmoil. When Charlotte decides to sue for wrongful birth in order to obtain a settlement to ensure Willow’s future, the already strained family begins to implode. Not only is the defendant Charlotte’s longtime friend, but the case requires Charlotte and Sean to claim that had they known of Willow’s condition, they would have terminated the pregnancy, a statement that strikes at the core of their faith and family. Picoult individualizes the alternating voices of the narrators more believably than she has previously, and weaves in subplots to underscore the themes of hope, regret, identity and family, leading up to her signature closing twists.”

—Publisher’s Weekly

“Handle With care is everything faithful readers would expect from Picoult, handled in her thoughtful, elegiac prose...provocative and complex.”

—BookPage magazine

Picoult, a master of the domestic landscape, creates a dramatic page turner, relentlessly driving home what doctors tell Charlotte at Willow’s birth: “You can’t live a life without impact.” FOUR STARS.

--- PEOPLE magazine.

Book club discussion questions for Handle With Care

  1. Charlotte and Sean are faced with a very difficult decision when presented with the option of suing for “wrongful birth.” How did you feel about the lawsuit? The matter is complicated in many aspects, but especially because of Charlotte’s close friendship with Piper, her ob-gyn. How might the O’Keefes have considered and entered into the lawsuit if they had not had a personal relationship with Piper? Would your own reaction to it have changed?
  2. (38) Charlotte says “I would never have wished for an able-bodied child, because that child would have been someone that wasn’t you.” Do you agree? Discuss.
  3. (46) Sean is angry and wants to get payback for the way he and his family were treated by the authorities in Florida. What is your initial reaction: to do so or forget it? (98) Charlotte asks Sean the perfect question, “How come you were perfectly willing to sue Disney World and half of the public service system in Florida for cash? What’s the difference?” Is there a difference? Discuss the irony of Sean’s feelings initially and then how he changes with the wrongful birth lawsuit. Being played the fool was worth it but getting help for forever wasn’t?
  4. During the filming of a day in Willow’s life, Charlotte purposely asks Willow’s physical therapist to try some exercises that she knows Willow isn’t ready for yet, and Willow begins to cry in pain. Charlotte rushes to her daughter’s side, blaming the physical therapist, and when she asks if they got that on film, Marin feels hatred towards Charlotte for exploiting her daughter. Do you agree with Marin? Charlotte believes she is doing everything out of love for Willow, to win the case that will get her the care she needs, but does this take it too far? Where can we draw the line?
  5. How does Amelia deal with her position in the family…being a preteen, having low self-esteem, being, and the healthy sibling of a very ill child?
  6. All the characters in the book are telling their stories to Willow. Willow doesn’t have a voice until the end of the book. How is that effective to the entire story? Does it seem that the characters can be more honest in their feelings when they’re directed to Willow?
  7. The author inserts recipes throughout the book that highlight certain baking techniques such as tempering, blind baking, and weeping. How do these recipes provide further insight into the story and into Charlotte’s character in particular?
  8. Throughout the story, the question is raised of what it means to be a mother. For Charlotte, it means doing anything in her power to provide the best life for Willow, but at the same time, her other daughter’s suffering goes unnoticed as she develops bulimia and begins cutting herself. For Marin, the question of what it means to be a mother addresses the issues of her adoption. Is a mother someone who gives birth and gives you away, or the woman who raises you? Discuss the different ideas about mothering that the author presents in this book. At what moments do certain characters fail or succeed at being a mother?
  9. The term “wrongful birth” suggests that some people should have never been born. If abortion had been legal when Marin was conceived, she likely would not have been born. Willow’s severe disability could have been cause for abortion. How do we determine what kind of life is worth living? Who has the right say whether or not a pregnancy should be brought to term?
  10. Discuss the roles that honesty and deception play in this novel. How do the characters lie to themselves? To each other? Is it sometimes better not to know the truth?
  11. Charlotte is confident that the potential end of her lawsuit will justify the means, but Sean can’t handle the idea that the “means” may leave Willow thinking she is unloved or unwanted. Clearly they both love their daughter, but express it in drastically different ways. What do each of their approaches say about love? Do Charlotte’s actions speak louder than Sean’s words?
  12. Sean goes to the “other side” of the lawsuit. Do you blame him?
  13. Amelia, understandably, has conflicting emotions concerning Willow. How does Amelia show her compassion? How does she show a lack of such? What are your feelings toward Willow? Toward Amelia? How do you think Amelia’s testimony affects the outcome of the case?
  14. If you choose to stop a loved one’s suffering—either before it began or during the process—was that murder or mercy? (357)
  15. We follow Marin through the search for her birth mother, and what she eventually finds out about the circumstances surrounding her conception are truly devastating. Why do you think she thanks her birth mother for this information? Discuss Marin’s reaction to what she learns.
  16. Why do you think the O’Keefes never cash their $8 million check? How do you feel about what they end up doing with it?
  17. How do you feel about the ending? Why do you think the author chose to write it this way?
  18. Does anyone have the right to decide what kind of life is too limited to be worth living?

Enhance your book club experience – try baking one of Charlotte’s recipes!

a. Crème Patisserie
  • 2 cups whole milk
  • 6 egg yolks at room temperature
  • 5 oz. sugar
  • 1 ½ oz. cornstarch
  • 1 t vanilla

Bring two cups of milk just to a boil in a non-reactive saucepan. In a stainless steel bowl, whisk egg yolks, sugar, and cornstarch. Temper yolk mixture with milk. Put milk and yolk mixture back on the heat, whisking constantly. When mixture starts to thicken, whisk faster until it boils, and then remove from heat. Add vanilla and pour into a stainless steel bowl. Sprinkle with a bit of sugar, and place plastic wrap directly on top of crème. Put in fridge and chill before serving. This can be used as a filling for fruit tarts, Napoleans, cream puffs, éclairs, etc.

b. Chocolate Raspberry Soufflé
  • 1 pint raspberries, pureed and strained
  • 8 eggs separated
  • 4 oz sugar
  • 3 oz all purpose flour
  • 8 oz bittersweet good quality chocolate, chopped
  • 2 oz Chambord liqueur
  • 2T melted butter
  • sugar for dusting ramekins

Heat the raspberry puree to lukewarm in a heavy saucepan. Whisk the egg yolks with 3 oz of sugar in large mixing bowl; whisk in flour and raspberry puree, and return mixture to heavy saucepan.

Cook over medium low heat, stirring constantly, until the custard is thick. Do not allow it to boil. Remove from heat, and stir in chocolate until completely melted. Mix in liqueur. Cover the base mixture with plastic to prevent a skin from forming.

Meanwhile, butter six ramekins and dust with sugar. Preheat the oven to 425.

Whip the egg whites to stiff peaks with the remaining 1 oz. of the sugar. And here is the part where you will see it: the coming together of two very different mixtures, as you fold the egg whites into the chocolate. Neither one will be willing to give up its substance: the darkness of the chocolate will become part of the foam of the egg whites, and vice versa.

Spoon the mixture into the ramekins, just ¼ inch shy of the rim. Bake immediately. The soufflés are done when they are well risen, golden brown on top, with edges that appear dry – about twenty minutes.

c. Sweet Pastry Dough
  • ½ cup + 2T cold unsalted butter cut into small pieces
  • 1 1/3 cup all purpose flour
  • pinch of salt
  • 1T sugar
  • 1 large egg yolk
  • 1 T ice water

In food processor combine flour, salt, sugar and butter. Pulse until coarse. In small bowl whisk egg yolk and ice water. With processor running add yolk mixture to flour and butter until ball forms. Remove dough, wrap in plastic, flatten to a disk and chill for 1 hour.

Roll dough out on lightly floured surface, place in tart pan with removal bottom. Chill dough before baking.

Preheat oven to 375. Remove tart pan from fridge, prick crust all over with a fork, line shell with foil and fill with dried beans. Bake for 17 minutes, remove foil and beans and continue baking for another 6 minutes. Cool completely before filling.

d. Apricot Tart

Sweet Pastry Dough Tart shell-blind baked

  • 2-3 apricots, sliced
  • 2 egg yolks
  • 1 cup heavy cream
  • ¾ cup sugar
  • 1 ½ T flour
  • ¼ cup chopped hazelnuts

Peel apricots, slice and arrange in bottom of blind- baked tart shell

Combine cream, egg yolks, sugar and flour. Pour over apricots, sprinkle with almonds. Bake in preheated 350 degree oven for 35 minutes.

e. Divinity
  • 2 ½ cups sugar
  • pinch of salt
  • ½ cup light corn syrup
  • ½ cup water
  • 3 large egg whites
  • I Teaspoon vanilla
  • 1/2 cup chopped pecans
  • 1/2 cup dried cherries, blueberries, or cranberries

In a two quart saucepan, mix sugar, corn syrup, water and salt. Using a candy thermometer, heat to hardball stage, stirring only until the sugar is dissolved. Meanwhile, beat the eggs white to stiff peaks. When the syrup reaches 260 degrees F, add it gradually to the egg whites while beating at high speed in a mixer. Add vanilla. Continue to beat until the candy takes shape – about five minutes. Stir in the nuts and cherries. Quickly drop the candy from a teaspoon onto waxed paper, finishing each piece with a swirl, and let cool to room temperature.

f. Crème Caramel
Caramel
  • 1 cup sugar
  • 1/3 c water
  • 2 T light corn syrup
  • ¼ t lemon juice
Custard
  • 1 ½ c whole milk
  • 1 ½ c light whipping cream
  • 3 large eggs
  • 2 large egg yolks
  • 2/3 c sugar
  • 1 ½ t vanilla extract
  • Pinch of salt

You can make one large crème caramel, but I like to make individual ones in ramekins. To make the caramel, mix sugar, water, corn syrup and lemon juice in a medium nonreactive saucepan (a light colored one, so you can see the color of the syrup). Simmer over medium-high heat – wiping the sides of the pan with a wet cloth to make sure there are no sugar crystals lurking that might cause crystallization. Cook for about eight minutes, until syrup turns from clear to gold, swirling the pan to make sure browning occurs evenly. Continue to cook for another 4-5 minutes, swirling pan constantly, until large bubbles on the mixture’s surface turn honey-colored. Remove pan immediately from heat and pour a portion of the caramel into each of eight ungreased 5 or 6 oz. ovenproof ramekins. Allow the caramel to cool and harden, about 15 minutes. (These can be covered with plastic wrap and refrigerated for up to two days, but return them to room temperature before you move onto to the next step.)

To make custard, heat milk and cream in a medium saucepan over medium heat, stirring occasionally until a thermometer in the liquid reads 160 degrees. Remove mixture from heat. Meanwhile, whisk eggs, yolks and sugar in a large bowl until just combined. Whisk the warm milk mixture, vanilla, and salt into the egg mixture until just mixed – but not foamy. Strain mixture through a mesh sieve into a large measuring cup and set aside.

Bring two quarts of water to boil. Meanwhile, fold a dish towel to fit the bottom of a large roasting pan. Divide reserved custard mixture between the ramekins and place the filled ramekins on the towel in the pan, making sure they do not touch. Set pan on center rack of a 350 degree oven. Fill pan with boiling water to reach halfway up the ramekins and cover entire pan loosely with aluminum foil, so that steam can escape. Bake 35-40 minutes, until a paring knife inserted halfway between the center and edge of the custards comes out clean.

Transfer custards to wire rack and cool to room temperature. To unmold, slide a paring knife around the outer edge of the custard, hold serving plate over the top of the ramekin, invert, and shake gently to release the custard. Serve immediately.

g. Sunday Morning Sticky Rolls
Dough:
  • 3 ¾ cup flour
  • 1/3 cup sugar
  • 1 t salt
  • 2 packages active dry yeast
  • 1 c heated milk
  • 1/3 c butter, softened
  • 1 egg
Caramel:
  • ¾ c dark brown sugar
  • ½ c unsalted butter
  • ¼ c light corn syrup
  • ¾ c pecan halves
  • 2 T butter, softened
Filling:
  • ½ c pecans, chopped
  • 2 T sugar
  • 2 T brown sugar
  • 1 t cinnamon

To make the dough, mix together 2 cups of the flour, 1/3 cup sugar, salt and yeast in a large bowl. Add the heated milk, the egg, and 1/3 cup butter, and beat at low speed for a minute, pausing frequently to scrape the bowl. Add flour if necessary, to make the dough easier to shape.

On lightly floured surface, turn dough out and knead five minutes, until it is smooth and elastic. This, I will add, was your favorite part – you would stand on a chair and throw your weight into it. When finished, put into greased bowl and turn over once, so greased side faces up. Cover and let proof until double in size, about 1 ½ hours. It’s ready if you poke it and the mark of your finger is left behind.

Caramel comes next: Stirring constantly, heat 3/4 cup brown sugar and ½ cup butter to boiling. Remove from heat and add corn syrup. Pour the mixture into a 13x9x2 inch ungreased pan. Sprinkle with pecan halves.

For the filling, mix together the chopped pecans, the 2 T of sugar and 2 T of brown sugar, and the cinnamon, set aside.

Take your fist and punch down the dough. Then, on a lightly floured surface, flatten it into a rectangle, about 15x10 inches. Spread with 2 T of butter and then dust evenly with the chopped pecan mixture. Beginning at the 10 inch side of the rectangle, roll the dough up tightly and pinch the edge to seal. Roll it, stretch it, mold it until it is even, a cylinder.

Cut the roll into eight quarter-inch slices, and place in pan, not quite touching. Wrap pan tightly with aluminum foil and refrigerate at least 12 hours, overnight. Dream of them rising, that proof again, evidence that some things grow bigger than we ever expect.

Heat oven to 350 degrees and bake 35 minutes, or until golden brown. Immediately invert on a platter and serve warm.

h. Blueberry Peach Buckle
For Topping
  • 1/3 cup unsalted butter, cut into small pieces
  • 1/2 cup light brown sugar
  • 1/4 cup all purpose flour
  • 1 teaspoon cinnamon
  • 1 teaspoon fresh ginger-peeled and grated
Batter
  • 3/4 cup unsalted butter at room temperature
  • 3/4 cup dark brown sugar
  • 1 teaspoon vanilla extract
  • 1/2 teaspoon baking powder
  • 1 ½ c flour
  • Pinch of salt
  • 3 large eggs
  • 2-3 cups wild blueberries (can substitute frozen if fresh are not available)
  • 2 ripe peaches, peeled, pitted and sliced*

Butter and flour 8x8 pan; preheat oven to 350 degrees.

First, make the topping: in a small bowl combine butter, sugar, flour, cinnamon and ginger until it resembles coarse meal, and set aside.

Then, make the batter by sifting together flour, baking powder and salt. Set this aside, too.

In bowl of electric mixer using the paddle attachment, combine butter and sugar until creamy and soft (about 3-4 minutes). Add vanilla. Beat eggs in one at a time. Beat in the flour mixture until just combined. Fold in berries and peaches. Spread batter into prepared pan and crumble topping mixture on top of batter. Bake for 45 minutes or until tester comes out clean, and the top of the buckle is golden.

*The best way to peel peaches is to cut a small cross at the base of each peach, and drop into a pot of boiling water for one minute. Remove with a slotted spoon and immediately place the peach in ice water. Peel the peach – the skin will come right off – and slice into thin wedges or small pieces for the buckle.

i. Lemon Meringue Pie

1 pie shell, blind-baked

Filling:
  • 1 ½ cup granulated sugar
  • 6 T corn starch
  • Pinch of salt
  • 1 1/3 cup cold water
  • 2 T unsalted butter
  • ½ c fresh lemon juice
  • 5 egg yolks
  • 1 T grated lemon zest

Prepare pie shell. Meanwhile, combine sugar, corn starch, salt, and water in a non-reactive saucepan. Mix until there are no lumps and whisk as it gradually comes to a boil. Remove from heat, add butter.

In a separate bowl, whisk egg yolks. Add a small amount of the hot liquid mixture and whisk until smooth. Add egg mixture to saucepan and bring to a boil over medium heat, continuing to whisk as it thickens, approximately two minutes. Remove from heat and stir in lemon juice and zest.
Meringue:
  • 6 large egg whites at room temperature
  • Pinch of cream of tartar
  • Pinch of salt
  • ¾ cup sugar

On low speed beat the egg whites, cream of tartar and salt until combined. Increase speed and whip until they form stiff peaks. Beat in sugar, one tablespoon at a time.

Preheat oven to 350 degrees. Add lemon filling to the prebaked crust and top with meringue. Make sure you spread the meringue all the way to touch the edges of the crust. Bake for 10-15 minutes. Let the pie cool for about two hours, and then refrigerate to prevent weeping.
j. Willow’s Sabayon, with Clouds
Sabayon:
  • 6 egg yolks
  • 1 cup sugar
  • 1/2 cup light rum or Grand Marnier
  • 2 cups heavy cream, whipped

Whisk eggs and sugar over double boiler. Once they are completely mixed, fold in whipped cream. Remove from heat, pass through a sieve, and add rum.

Clouds:
  • 2 cups milk or water
  • 5 egg whites
  • 1/3 cup sugar
  • pinch of salt

Place egg whites and pinch of salt in mixing bowl; on low speed mix whites until smooth.  Gradually increase speed and sprinkle in sugar.  Beat until whites hold a soft peak – this is meringue, the cloud I imagine you resting on nowadays. Meanwhile, simmer water or milk. Take spoonful of meringue and gently drop into simmering liquid. Cook meringue for 2-3 minutes and with slotted spoon, turn over and continue cooking for another 2-3 minutes.  Transfer poached meringue to paper towel. They are fragile.

Spun Sugar:
  • 2 cups granulated sugar
  • 1 teaspoon corn syrup
  • Cooking spray

Spray a baking sheet with cooking spray, wiping any excess off with a paper towel. Place the sugar and corn syrup in a saucepan and cook over low heat. Stir occasionally until sugar is dissolved. Raise heat to high and bring mixture to a boil, until a candy thermometer registers 310 F (hard-crack stage). Remove from heat and cool slightly. Let stand to thicken, about 1 minute.

Dip a fork into the sugar syrup and wave back and forth over the baking sheet to paint long threads of sugar. The syrup will begin hardening almost immediately. With practice you can form the strands into lace, swirls, the letters of your name.

To serve, take some of the sabayon sauce and spoon it in a shallow bowl or large plate and top with 2 poached meringues. Gently place a few threads of spun sugar around the meringue, not on top, or it will deflate.

A conversation with Jodi Picoult about Handle With Care

What led you to OI as the topic for this book? Did the idea of a wrongful birth suit come first or second? Talk about the research required for writing this novel.

The seed for HANDLE WITH CARE began with an article I read about wrongful birth – a mother in New York who had recently won a multi-million dollar settlement sueing her OB/GYN after her son was born with severe chromosomal abnormalities. It was clear from the article that she loved this child dearly – but that in order to give him a better lifestyle, she needed to tell the world she would have aborted the fetus, if given the chance. That moral conundrum got me thinking: what if her child had not been profoundly mentally disabled, but just physically disabled? What if her child could HEAR her in court, saying that she wished he’d never been born?

That led me to osteogenesis imperfecta. Also known as “brittle bone disorder,” it is a genetic bone disease characterized by fragile bones that break easily. It’s caused by a mutation on a gene that affects the body’s production of collagen in bones. It affects 25-50K Americans – the range is large, because mild cases of OI often go undiagnosed. There are eight types of OI, ranging from lethal at birth to mild with few symptoms. A person with severe OI might experience hundreds of fractures and have a reduced life span. Other symptoms include short stature (people with severe OI are approximately three feet tall), hearing loss, curvature of the spine, respiratory failure, and loose joints and muscles. Physically, it’s a very difficult condition – but mentally, people who have OI are one hundred percent normal. Many kids with OI are even brighter than their able-bodied friends, because they do so much reading when they can’t run around after a break.

For research, I tried to walk a brief way in the shoes of a parent whose child has OI, by visiting multiple families with kids who were afflicted by the disorder. The first girl I met with OI had Type I – a milder form – but had suffered nearly fifty breaks in her eight years because her parents wanted her to live as normal a life as possible. Rather than having her walk on her knees or restrict her activities, they allowed her to do what she wanted…knowing that it would lead to broken bones. I remember asking Rachel what it felt like when that happened. “It feels like lightning under my skin,” she said, and I realized then that the pain these kids feel is just what you or I would feel if we broke a bone – it just happens much more frequently for them. From Rachel, I moved on to meetings with kids who had Type III OI – the most severe type you can get that isn’t lethal at birth. I remember the flash in five-year-old Hope’s eyes when the waitress at the restaurant mistook her for a toddler, due to her size; the pain in Jonathan’s mom’s voice when she talked about how she used to think about just leaving him and running away, because she was so afraid she’d be the one to cause another break. During a visit with Matthew, his mom asked me to take him out of his car seat – and I panicked. What if I was the one who snapped a bone this time? This, I realized, was what these parents went through on a daily basis.

The kids I met who have OI were all sweet, bright, engaging, adorable – and much more than the sum of their disabilities. This was best illustrated in the case of a young woman who became my technical advisor for Handle With Care. Kara Sheridan is a paralympian who swam in Athens for Team USA in 2004, who is currently a PhD student in clinical psychology, and is busy planning her wedding. She also has Type III OI. When I asked her what she wished people would know about OI, she said it’s a challenging and painful condition, but it doesn’t mandate a tragic life. The moments she’s cherished the most have come about because of her condition, and are just as important a part of OI as the medical difficulties. She also pointed out that no child has OI alone – it affects families, friends, and loved ones by default.

Many people shy away from a child in a wheelchair – but when you spend time with kids who have OI, you are not struck by how different they are from able-bodied children…you’re struck by how similar they are. They giggle, they flirt, they tease their brothers. They tell knock-knock jokes and whine about long car rides and hate broccoli. But they also know about things regular kids don’t: splints and braces and Pamidronate infusions and spinal rodding. And when you watch them interacting with their parents, you realize that these mothers and fathers are just like the rest of us: willing to do whatever it takes to give their child the best life possible.

Even if that means lying to a judge and jury.

And suddenly, it’s a lot harder to tell whether that’s blatantly wrong…or impossibly right.

The characters in your books are always layered and complex, as are the issues that plague them. How do you create a character like Charlotte that readers can love and hate at the same time?

Well, for me, it’s a lot harder to create a flat character who’s either all villain or all hero. Most of us are a combination, aren’t we? Charlotte’s the best kind of character – one who is doing something that looks unpalatable, but for all the right reasons. In this way she reminds me a bit of Nina Frost from PERFECT MATCH. You want to hate her – but can you really say that if it were you, you wouldn’t at least think about doing the same thing she does? Charlotte’s tragic flaw, in my opinion, is that she is so single-minded in her pursuit of making Willow’s life easier that she neglects the rest of her support system – her friends, and her family.

How did you choose the recipes that appear throughout the book? Do you believe in the significance they hold for Charlotte? Are you a baker yourself?

Before I got married, I was lucky enough to have a roommate who became one of my best friends. Now, Katie works at the Smithsonian organizing special events – but prior to that, she went to culinary school. When I knew that I wanted Charlotte to be a baker, I turned to her and asked for help. Charlotte, as a baker, would believe that the sum of the ingredients is so much more than its parts – this is true for her when it comes to Willow, too, who is so much more than a litany of moments where she broke a bone or had a surgery or was sidelined to recuperate. I do bake (too much, if you ask my husband, who is constantly cursing me for a pan of brownies cooling on the stove that he is compelled to eat) – and often I have been struck by the metaphorical language of baking. I wanted Charlotte’s cookbook to be a collection of these terms, with accompanying recipes. So one day I emailed Katie a list – words like weeping, hardball, blind baking – and asked her to create recipes that might involve each term. I have to admit, that rarely is my fact checking process so delicious…I got to bake, and road test, every recipe in the book.

During the course of the trial, Amelia develops an eating disorder and starts cutting herself. Did you see this as the natural progression for her character? Were these types of behavior in siblings of disabled children something you found to be common while conducting your research?

While doing research with a child psychiatrist about adolescent bulimics I learned that cutting is very common for those girls. Apparently, bulimia involves a lot of self-hatred…and cutting figures into that. Siblings of disabled children aren’t always like Amelia, thank goodness – I’d hope that their families do a better job of including them than the O’Keefes do. For Amelia, having a sibling with a disability is compounded by the fact that she feels she’s failed her sister (in Disneyworld, for example) and that there are very high stakes in that household for being a child who isn’t perfect (which would be Amelia’s interpretation of her mother’s lawsuit).

Having created multiple narrators, is there a character that you connect with most, or that you feel represents your own voice?

I had great sympathy for all of the characters in this book – each of them has a valid point to make, in my opinion. So I’d have to say that at different times, I sided with each one!

Your narrators share their stories as though they are telling them to Willow. Why did you decide to construct the novel this way?

I have always wanted to write a book in the second person narrative voice, but it's tricky and calls for the right kind of story. Because the whole book revolves around Willow, I wanted her to feel present and accounted for - hence the structure. Plus, given the behavior of these characters, they deserved to explain themselves directly to Willow. But I also wanted the reader to feel viscerally what it's like to be at the center of this kind of controversy ~~ and that second person narration also helped foster that sense that the characters are "talking to you".

As the author, do you ever feel as though you’re taking on the role of the jury? How did you decide what the ruling of the wrongful birth suit would be?

I like to think of my reader in the role of the jury, actually. It’s my job as writer to present all sides of the story and then, based on the evidence, leave you to decide what was wrong and what was right. As for a ruling here, it wasn’t as important to me as the final twist of the book – but in order to have that final twist, I had to first have the jury rule a certain way…and that’s all I’m going to say before I give it away!

Why did you decide not to share Willow’s perspective until the end?

Because the reader serves as Willow’s “stand-in” for the book – since the characters are explaining themselves to “you” it makes you part of the action, and therefore part of the judgment of their behavior. And yet after hearing everyone's explanation about the wrongful birth issue, I felt the reader also deserved to hear directly from Willow to see how everything had affected her.

You’ve said before that you know how a book will end before you write the first word. Was this also true for Handle with Care? Do you ever change your mind about an ending as you get deeper into the story?

I do know the ending before I write a single word, and I did here too. I will tell you that I think Handle With Care is the saddest book I’ve written – and coming from me, that’s pretty dire! I never wavered on the ending, however, because there’s a bit of a morality lesson in there as well – it’s a real “Be careful what you wish for” moment.

Handle With Care

An excerpt from Handle With Care:

February 2005

Amelia

My whole life, I’ve never been on a vacation. I’ve never even left New Hampshire, unless you count the time that we flew to Nebraska – and even you have to admit that sitting in a hospital room for three days watching really old Tom and Jerry cartoons while you get your Pamidronate infusion is nothing like going to a beach or SeaWorld or the Grand Canyon. So you can imagine how excited I was when I found out that my family was planning to go to Disneyworld. We would go during February school vacation. We’d stay at a hotel that had a monorail running right through the middle of it.

Mom began to make a list of the rides we would go on. It’s a Small World, and Dumbo’s Flying Circus, Peter Pan’s ride.

“Those are for babies,” I complained.

“Those are the ones that are safe,” she said.

“Space Mountain,” I suggested.

“Pirates of the Caribbean,” she answered.

“Great,” I yelled. “I get to go on the first vacation of my life, and I won’t even have any fun.” Then I stormed off to our room, and even though I wasn’t downstairs anymore, I could pretty much imagine what our parents were saying: There Amelia goes, being difficult again.

It’s funny, when things like this happen (which is, like, always) Mom isn’t the one who tries to iron out the mess. She’s too busy making sure you’re all right, so the task falls to Dad. Ah, see, there’s something else that I’m jealous about: he’s your real Dad, but he’s only my stepfather. I don’t even know my real dad; he and my mother split up before I was even born, and she swears that his absence is the best gift he could ever have given me. But Sean adopted me, and he acts like he loves me just as much as much as he loves you – even though there’s this black, jagged splinter in my mind that constantly reminds me this couldn’t possibly be true.

Meel, he said, when he came into my room (he’s the only one I’d ever let call me that in a million years; it makes me think of the worms that get into flour and ruin it, but not when Dad says it), “I know you’re ready for the big rides. But we’re trying to make sure that Willow has a good time too.”

Because when Willow’s having a good time, we’re all having a good time.

He didn’t have to say it, but I heard it all the same.

“We just want to be a family on vacation,” he said.

I hesitated. “The teacup ride,” I heard myself say.

Dad said he’d go to bat for me, and even though Mom was dead set against it – what if you smacked up against the thick plaster wall of the teacup? – he convinced her that we could whirl around in circles with you wedged between us, so that you wouldn’t get hurt. Then he grinned at me, so proud of himself to have negotiated this deal that I didn’t have the heart to tell him I really couldn’t care less about the teacup ride.

The reason it had popped into my head was because a few years ago, I’d seen a certain commercial for Disneyworld on TV. It showed Tinkerbell floating like a mosquito through the Magic Kingdom over the heads of the insanely cheery visitors. There was one family that had two daughters, the same age as you and me, and they were on the Mad Hatter’s teacup ride. I couldn’t take my eyes off them – the older daughter even had brown hair, like me; and if you squinted the father looked a lot like Dad. The family seemed so happy it made my stomach hurt to watch it. I knew that the people on the commercial probably weren’t even a real family – that the mom and dad were probably two single actors, that they had most likely met their fake daughters that very morning as they arrived on set to shoot the commercial – but I wanted them to be one. I wanted to believe they were laughing, smiling, even as they were spinning out of control.

· · · · · ·

Pick ten strangers and stick them in a room, and ask them which one of us they feel sorrier for – you or me – and we all know who they’ll choose. It’s kind of hard to look past your casts and the funny twitch of your hips when you walk and that part of your right arm that’s supposed to be straight curves in a half-circle. I’m not saying that you’ve had it easy. It’s just that I have it worse, because every time I think my life sucks, I look at you and hate myself even more for thinking my life sucks in the first place.

Here’s a snapshot of what it’s like to be me:

Amelia, don’t jump on the bed, you’ll hurt Willow.

Amelia, how many times have I told you not to leave your socks on the floor, because Willow could trip over them?

Amelia, turn off the TV (although I’ve only watched a half hour, and you’ve been staring at it like a zombie for five hours straight).

I know how selfish this makes me sound, but then again, knowing something’s true doesn’t keep you from feeling it. And I may only be eleven, but believe me - that’s long enough to know that our family isn’t the same as other families; and never will be.

Case in point: what family packs a whole extra suitcase full of Ace bandages and waterproof casts, just in case? What mom spends days researching the hospitals in Orlando? It was the day we were leaving; and as Dad loaded up the car, you and I sat at the kitchen table, playing Rock Paper Scissors. “Shoot,” I said, and we both threw scissors. I should have known better; you always threw scissors. “Shoot,” I said again, and this time I threw rock. “Rock breaks scissors,” I said, bumping my fist on top of your hand.

“Careful,” Mom said, even though she was facing in the opposite direction.

“I win.”

“You always win.”

I laughed at you. “That’s because you always throw scissors.”

“Leonardo da Vinci invented the scissors,” you said. You were, in general, full of information no one else knew or cared about, because you read all the time, or surfed the net, or listened to shows on the History Channel that put me to sleep. It freaked people out, to come across a four year old who knew that toilets flushed in the key of Eb, or that the oldest word in the English language is town, but Mom said that lots of kids with osteogenesis imperfecta were early readers with advanced verbal skills. I figured it was like a muscle: your brain got used more than the rest of your body, which was always breaking down; no wonder you sounded like a little Einstein.

“Do I have everything?” Mom asked, but she was talking to herself. For the bazillionth time she ran through a checklist. “The letter,” she said, and then she turned to me. “Amelia, we need the doctor’s note.”

It was a letter from Dr. Rosenblad, saying the obvious: that you had OI, that you were treated by him at Children’s Hospital. It was in the glove compartment of the van, next to the registration and the owner’s manual from Toyota, plus a torn map of Massachusetts, a Jiffy Lube receipt, and a piece of gum that had lost its wrapper and grown furry. I’d done the inventory once when my mother was paying for gas.

“If it’s in the van, why can’t you just get it when we drive to the airport?”

“Because I’ll forget,” Mom said, as Dad walked in.

“We’re locked and loaded,” he said. “What do you say, Willow? Should we go visit Mickey?”

You gave him a big silly grin, as if Mickey Mouse was real and not just some teenage girl wearing a big plastic head for her summer job. “Mickey Mouse’s birthday is November 18th,” you announced, as he helped you crawl down from the chair.

Mom frowned over her list one last time. “Sean, did you pack the Motrin?” “Two bottles.” “And the camera?”

“Shoot, I left it on the dresser upstairs –“ He turned to me. “Sweetie, can you grab it while I put Willow in the car?”

I nodded and ran upstairs. When I came down, camera in hand, my mother was standing alone in the kitchen turning in a slow circle, as if she didn’t know what to do without Willow by her side. She turned off the lights and locked the front door, and I bounded over to the van. I handed the camera to Dad and buckled myself in beside your car seat, and let myself admit that as dorky as it was to be eleven years old and excited about Disneyworld, I was. I was thinking about sunshine and Disney songs and monorails and not at all about the letter from Dr. Rosenblad.

Which means, in the long run, that everything that happened was my fault. · · · · · · We didn’t even make it to the stupid teacups. We had just gotten through the front gates of the theme park and onto Main Street USA – Cinderella’s Castle in full view – when the perfect storm happened. You said you were hungry and we turned into an old-time ice cream parlor. Dad stood in line holding your hand while Mom brought napkins over to the table where I was sitting. “Look,” I said, pointing out Goofy, pumping the hand of a screaming toddler. At exactly the same moment that Mom let one napkin flutter to the ground and Dad let go of your hand to take out his wallet, you hurried to the window to see what I wanted to show you, and you slipped on the tiny paper square.

We all watched it in slow motion, the way your legs simply gave out from underneath you, so that you sat down hard on your bottom. You looked up at us, and the whites of your eyes flashed blue, the way they always do when you break.

· · · · · ·

It was almost like the people at Disneyworld had been expecting this to happen. No sooner had Mom told the man scooping ice cream that you’d broken your leg than two men from their medical facility came with a stretcher. With Mom giving orders, the way she always does around doctors, they managed to get you onto it. You weren’t crying, but then, you hardly ever did when you broke something. Once, I had broken my pinky playing tetherball at school and I couldn’t stop freaking out when it turned bright red and blew up like a balloon; but you didn’t even cry the time you’d broken your arm right through the skin.

“Doesn’t it hurt?” I whispered, as they lifted up the stretcher so that it suddenly grew wheels.

You were biting your lower lip, and you nodded.

It was Saturday night, and the people coming into the emergency room were much more interesting that the TV program that was playing. There were two kids who looked like they were the right age for college, both bleeding from the same spot on their foreheads and laughing every time they looked at each other. There was an old man wearing sequined pants and holding the right side of his stomach, and a girl who only spoke Spanish and was carrying screaming twin babies.

Suddenly, Mom burst out of the double doors to the right, with a nurse running after her, and another woman in a skinny pinstriped skirt and red high heels. “The letter,” she cried. “Sean, what did you do with it?”

“What letter?” Dad asked, but I already knew what she was talking about.

“Mrs. O’Keefe,” the woman said, “please. Let’s do this somewhere more private.”

She touched Mom’s arm, and – well, the only way I can really describe it is that Mom just folded in half. Dad wrapped himself around her, and the nurse led them to another empty room, a smaller one, with a tattered red couch and a little oval table and fake flowers in a vase. There was a picture on the wall of two pandas, and I stared at it while the woman in the skinny skirt – her name was Donna Roman, and she was from the Department of Children and Families - talked to our parents. “Dr. Rice has some concerns about Willow,” she said. “Apparently, this wasn’t her first break?”

“Willow’s got osteogenesis imperfecta,” Dad said.

“I already told her,” Mom answered. “She didn’t listen.”

“Without a physician’s statement,” the woman said, “we have to look into this further. It’s just protocol, to protect children –“

“I’d like to protect my child,” Mom said, her voice sharp as a razor. “I’d like you to let me get back in there so I can do just that.”

“From what I understand, Dr. Rice is trying to reach your daughter’s physician. But since it’s Saturday night, he’s having trouble making contact. So in the meantime, I’d like to get you to sign releases that will allow us to do a full examination on Willow ---”

“Ms. Roman,” Dad interrupted. “I’m a police officer. You can’t really believe I’d lie to you?”

The woman just blinked at him. “I’ve already spoken to your wife, Mr. O’Keefe, and I’m going to want to speak to you too…but first I’d like to talk to Willow’s sister.”

My mouth opened and closed, but nothing came out of it. Mom was staring at me as if she was trying to do ESP. “You must be Amelia,” the woman said. “Why don’t we take a walk?” She took me to the candy machine at the far end of the emergency room hallway. “What would you like?” she asked. “Me, I’m a chocolate fiend, but maybe you’re more of a potato chip girl?”

She was so much nicer to me when my parents weren’t sitting there – I immediately pointed to a Snickers bar. “I guess this isn’t quite what you’d hoped your vacation would be, huh? Does this happen a lot?”

“Sure,” I said. “Willow breaks bones all the time.”

“Where does it usually happen?”

“At home, mostly.”

“And who’s home when it happens?”

“My parents,” I said. It was a stupid question – one of them was always with you.

“Who was with Willow this time?”

I thought back to the ice cream counter, to Dad, holding your hand. “My father.”

“Was he upset?”

I remembered his tight face as we sped toward the hospital. His fists, balanced on his thighs as we waited for word about Willow’s latest break. “I guess so.”

“Do you think he did this because he was angry at Willow?”

Suddenly, I realized what she thought I’d meant. “My dad wasn’t mad at Willow,” I said. “It was an accident!”

She sighed. “Accidents like that don’t have to happen.”

“You don’t understand –“

By now she was walking back toward the room where my parents were. “Mr. and Mrs. O’Keefe,” Donna Roman said, “we’re putting your children into protective custody.”

Mom threw her arms around me. “Protective custody?”

With a firm hand – and the help of the police officer – Donna tried to peel her away from me. “We’re just keeping the children safe,” she said, “until we can get this all cleared up. Willow will be here overnight.” She started to steer me out of the room, but I grabbed at the door frame.

“Mommy,” I yelled.

“Where are you taking my daughter?”

“Come on, sweetheart,” Donna Roman said, and she pulled at my hands until I had to let go, until I was being dragged out of the hospital kicking and screaming. I did this for five minutes, until I went totally numb. Until I understood why you didn’t cry, even though it hurt: there were kinds of pain you couldn’t speak out loud. · · · · · · I’d heard the words foster home before, in books that I read and television programs I’d watched. I figured that they were for orphans and inner-city kids, kids whose parents were drug dealers -- not girls like me who lived in nice houses and got plenty of Christmas presents and never went to sleep hungry. As it turned out, though, Mrs. Ward, who ran this temporary foster home, could have been an ordinary mom. I guess she had been one, from the photos that plastered every surface, like wallpaper. She met us at the door wearing a red bathrobe and slippers that looked like pink pigs. “You must be Amelia,” she said, and she opened the door a little wider.

I was expecting a posse of kids, but it turned out that I was the only one staying with Mrs. Ward. She took me into the kitchen, which smelled like dishwashing detergent and boiled noodles. She set a glass of milk and a stack of Oreo cookies in front of me. “You’re probably starving,” she said, and even though I was, I shook my head. I didn’t want to take anything from her; it felt like giving in.

My bedroom had a dresser, a small bed, and a comforter with cherries printed all over it. There was a television, and a remote next to the bed. My parents would never let me have a television in my room; my mother said it was the Root of All Evil. I told Mrs. Ward that and she laughed. “Maybe so,” she said, “but then again, sometimes The Simpsons are the best medicine.” She opened a drawer and took out a clean towel and a nightgown that was a couple of sizes too big. I wondered where it had come from. I wondered how long the last girl who’d worn it had slept in this bed.

“I’m right down the hall if you need me,” Mrs. Ward said. “Is there anything else I can get you?”

My mother.

My father.

You.

Home.

“Are my parents…are they in a foster home too?”

She hesitated. “Something like that.”

“I want to see Willow.”

“First thing tomorrow,” Mrs. Ward said.

I lay down, and tried to remember the useless bits of information you’d rattle off before we went to sleep, when I was always telling you to just shut up already: Frogs have to close their eyes to swallow. One pencil can draw a line thirty-five miles long. Cleveland, spelled backward, is DNA level C.

I was still hungry, or empty, I couldn’t tell which. After Mrs. Ward had gone to her own bedroom I tiptoed out of bed. I turned the light on in the hallway and went down to the kitchen. There, I opened up the refrigerator and let the light and cold fall over my bare feet. I stared at lunch meat, sealed into plastic packages; at a jumble of apples and peaches in a bin; at cartons of orange juice and milk lined up like soldiers. When I thought I heard a creak upstairs, I grabbed whatever I could: a loaf of bread, a Tupperware of cooked spaghetti, a handful of those Oreos. I ran back to my room and closed the door, spread my treasure out on the sheets in front of me.

At first, it was just the Oreos. But then my stomach rumbled and I ate all the spaghetti – with my fingers, because I had no fork. I had a piece of bread and another and then another and before I knew it only the plastic wrapper was left. What is wrong with you, I thought, catching my reflection in the mirror. Who eats a whole loaf of bread? The outside of me was disgusting enough – boring brown hair that frizzed with crummy weather; eyes too far apart, that crooked front tooth, enough fat to muffin-top my jean shorts – but the inside of me was even worse. I pictured it as a big black hole, like the kinds we learned about in science last year, that suck everything into their center. A vacuum of nothingness, my teacher had called it.

Everything that had ever been good and kind in me, everything people imagined me to be, had been poisoned by the part of me that had wished, in the darkest crack of the night, that I could have a different life. The real me was the kind of disgusting person who imagined a life where you had never been born. The real me had watched you being loaded into an ambulance and had let myself wish, for a half a second, that I could stay at the theme park. The real me was could eat a whole loaf of bread in ten minutes and still have room for more.

I hated myself.

I could not tell you what made me go into the bathroom that was attached to my room and stick my finger down my throat. Rats can’t throw up, you’d told me once; it popped into my head now. With one hand holding up my hair, I vomited into the toilet, until I was flushed and sweating and empty and relieved to learn that, yes, I could do this one thing right, even if it made me feel even worse than I had before.

Weak and wobbly, I stumbled back to my borrowed bed and reached for the television remote. My eyes felt like sandpaper and my throat ached, but I flipped through the channels. Suddenly that old Disneyworld commercial came on. It felt like a punch in the gut: there was Tinkerbell, there were the happy people; there was the family that could have been us on the teacup ride.

What if my parents never came back?

What if you didn’t get better?

What if I had to stay here forever?

When I started to sob, I stuffed the corner of the pillow deep into my mouth so Mrs. Ward wouldn’t hear. I hit the mute button on the television, and I watched the family at Disneyworld going round in circles.

Sean

It’s funny, isn’t it, how you can be one hundred percent sure of your opinion on something until it happens to you. Like arresting someone – people who aren’t in law enforcement think it’s appalling to know that even with probable cause, mistakes are made. If that’s the case, you unarrest the person, and tell him you were just doing what you had to. Better that than take the risk of letting a criminal walk free, I’ve always said, and to hell with civil libertarians who wouldn’t know a perp if one spit in their faces. This was what I believed, heart and soul, until about an hour ago when I was carted down to the Lake Buena Vista PD on suspicion of child abuse. One look at your x-rays, at the dozens of healing fractures, and the doctors went ballistic and called DCF. Dr. Rosenblad had given us a note years ago that should have served as a Get Out Of Jail Free card – and as far as I know, Charlotte’s always carried it around in the minivan, just in case. But today, with everything we had to remember to pack for the trip, the letter was forgotten, and what we got instead was a police interrogation.

“This is bullshit,” I yelled. I’d been alternating between playing good cop and bad cop, but as it turned out, neither worked when you were up against another officer from an unfamiliar jurisdiction. I hadn’t seen Charlotte since they’d brought us to the station to be questioned – in cases like this, we’d separate the parents so that they had less of a chance to fabricate a story. The problem was, even the truth sounded crazy. A kid slips on a napkin and winds up with compound fractures in both femurs? You don’t need nineteen years on the force, like me, to be suspicious of that one.

“Mr. O’Keefe,” the detective said. “Let’s go through this again.”

“I want to see my wife.”

“That’s not possible right now.”

“I want to make a phone call.”

“You’re not under arrest,” the detective said.

I laughed. “Yeah, right.”

He gestured toward the phone in the middle of the desk. “Dial nine for an outside line,” he said, and he leaned back in his chair and folded his arms, as if to make it clear that he wasn’t giving me any privacy.

“You know the number for the hospital where my daughter’s being kept?”

“You can’t call her.”

“Why not? I’m not under arrest,” I repeated.

“It’s late. No good parent would want to wake his kid up. But then you’re not a good parent, are you, Sean?”

“No good parent would leave his kid alone at a hospital when she’s scared and hurt,” I countered. “I’m not saying another word until I talk to her. Give me that number and I’ll tell you what really happened today.”

He stared at me for a minute, then picked up the phone and dialed. He asked for your room, and talked quietly to a nurse who answered. Then he handed the receiver to me. “You have one minute,” he said.

You were groggy, shaken awake by that nurse. Your voice sounded small enough for me to carry around in my back pocket. “Willow,” I said. “It’s Daddy.”

“Where are you?”

“We’re coming back for you, honey. We’re going to see you tomorrow, first thing.” I cleared my throat. “Tell me something I don’t know, baby.”

It was a game between us. Honestly, I’d never seen a kid absorb information like you. Your body might betray you at every turn, but your brain picked up the slack.

“A nurse told me that a giraffe’s heart weighs twenty-five pounds,” you said. “That’s huge,” I replied. How heavy was my own? “Now, Wills, I want you to

lie down and get a good night’s rest, so that you’re wide awake when I come get you in the morning.”

“You promise?”

I swallowed. “You bet, baby. Sleep tight, okay?” I handed the phone back to the detective.

“How touching,” he said flatly, hanging it up. “All right, I’m listening.”

I rested my elbows on the table between us. “We had just gotten into the park, and there was an ice cream place close to the entry. Willow was hungry, so we decided we’d stop off there. My wife went to get napkins, Amelia sat down at a table, and Willow and I were waiting in line. Her sister saw something through the window, and Willow ran to go look at it, and she fell down and broke her femurs. These three breaks would be her twenty-fifth, twenty-sixth, and twenty-seventh. She’s got a disease called osteogenesis imperfecta, which means her bones are extremely brittle. One in twenty thousand kids are born with it. What the fuck else do you want to know?”

“That’s exactly the statement you gave an hour ago.” The detective threw down his pen. “I thought you were going to tell me what happened.”

“I did,” I said. “I just didn’t tell you what you wanted to hear.”

The detective stood up. “Sean O’Keefe,” he said, “You’re under arrest.” · · · · · · By seven AM on Sunday morning, I was pacing in the waiting room of the police station, a free man, waiting for Charlotte to be released. The desk sergeant who let me out of the lockup shuffled beside me, uncomfortable. “I’m sure you understand,” he said. “Given the circumstances, we were only doing our job.”

My jaw tightened. “Where’s my older daughter?”

“DCF is on their way here with her.”

Suddenly a door opened, and I could see Charlotte – dazed, pale, her brown curls tumbling out of her ponytail elastic. She was blistering the officer escorting her: “If Amelia isn’t back here before I count to ten, I swear I’ll –“

God, I love your mother. She and I think exactly alike, when it counts.

Then she noticed me, and broke off. “Sean!” she cried, and ran into my arms.

She smelled like apples and suntan lotion. She’d made us all put it on before we even left the Orlando airport. To be safe, she’d said.

There was cry from the doorway, and we both looked up in time to see Amelia barreling toward us. “I forgot,” she sobbed. “Mom, I forgot to take the doctor’s note. I’m sorry. I’m so sorry.”

“It’s not anyone’s fault,” I said, pointedly looking at the desk sergeant. “Let’s get out of here.”

The desk sergeant had offered to drive us to the hospital in a cruiser, but I asked him to call us a cab instead. “To the hospital,” I told the driver, and I closed my eyes and leaned my head back against the padded seat.

“Thank God,” your mother said. “Thank God that’s over.”

I didn’t even open my eyes. “It’s not over,” I said. “Someone is going to pay.”

Charlotte

Suffice it to say that the trip home wasn’t a pleasant one. You had been put into a spica cast – surely one of the biggest torture devices ever created by doctors. It was a half shell of plaster that covered you from knee to ribs. You were in a semi-reclined position, because that’s what your bones needed to knit together. The cast kept your legs splayed wide so that the femurs would set correctly. Here’s what we were told: You would wear this cast for several months. Then it would be sliced in half, and you would spend weeks sitting in it like an oyster on the half shell, trying to rebuild your stomach muscles so that you could sit upright again.

The small square cut out of the plaster at your belly would allow your stomach to expand while you ate.

The open gash between your legs was left so you could go to the bathroom.

Here’s what we were not told:

You wouldn’t be able to sit completely upright, or lie completely down.

You couldn’t fly back to New Hampshire.

You couldn’t even lie down in the back of a normal car.

You wouldn’t be able to sit in your wheelchair.

Your clothes wouldn’t fit over the cast.

Because of all these things, we did not leave Florida immediately. We rented a Suburban, with three full bench seats, and settled Amelia in the middle. You had the whole rear bench, and we padded this with blankets we’d bought at Wal*Mart. There we’d also bought men’s t-shirts and boxer shorts – the elastic waists could stretch over the cast and be belted with a hair scrunchie if you pulled the extra fabric to the side, and if you didn’t look too closely, they almost passed for shorts. They were not fashionable, but they covered up your crotch, which was left wide open by the position of the cast.

Then we started the long drive home.

You slept; the painkillers they’d given you at the hospital were still swimming through your blood. Amelia alternated between doing word search puzzles and asking if we were almost home yet. We ate at drive-through restaurants, because you couldn’t sit up at a table. Seven hours into our drive, Amelia shifted in the back seat. “You know how Mrs. Grey always makes us write a short story about the stuff we did over vacation? I’m going to write about you guys trying to figure out how to get Willow onto the toilet to pee.”

“Don’t you dare,” I said.

“Well, if I don’t, my short story’s going to be really short.”

“We could make the rest of the trip fun,” I suggested at one point. “Stop off at Graceland…or Washington D.C …”

“Or we could just drive straight through and be done with it,” Sean said.

I glanced at him. In the dark, a green band of light from the dashboard reflected like a mask around his eyes.

“Could we go to the White House?” Amelia asked, perking up.

I imagined the hothouse of humidity that Washington would be; I pictured us lugging Willow around on our hips as we climbed the steps to the Air and Space Museum. Out the window, the black road was a ribbon that kept unraveling in front of us. “Your father’s right,” I said.

· · · · · ·

People ask all the time how I’m doing; but the truth is, they don’t really want to know. They look at your casts – camouflage or hot pink or neon orange. They watch me unload the car and set up your walker, with its tennis-ball feet, so that we can slowly creep across the sidewalk while behind us, their children swing from monkey bars and play dodge-ball and all the other ordinary things that would cause you to break. They smile at me, because they want to be polite or politically correct; but the whole time they are thinking, Thank God. Thank God it was her, instead of me.

Your father says that I’m not being fair, when I say things like this. That some people, when they ask, really do want to lend a hand. I tell him that if they really wanted to lend a hand, they wouldn’t bring macaroni casseroles – instead they’d offer to take Amelia apple-picking or ice-skating so that she can get out of the house when you can’t; or they’d rake the gutters of the house that are always clogging up after a storm. And if they truly wanted to be saviors, they’d call the insurance company and spend four hours on the phone, so I wouldn’t have to. But Sean says I’m being a martyr.

Sean doesn’t realize that most people who offer their help do it to make themselves feel better, not us. To be honest, I don’t blame them. It’s superstition: if you offer assistance to the family in need…if you throw salt over your shoulder…if you don’t step on the cracks…then maybe you’ll be immune. Maybe you’ll be able to convince yourself that this could never happen to you.

I suppose I used to think that too, but then I’d look at you, sleeping semi-upright in this spica cast, or stifling the urge to scratch the itch underneath the plaster. The last time you broke your leg, you were just as brave. I remember you inched one foot in front of the other, your teeth caught your lower lip in concentration. You forced yourself to learn to walk again after each fall. How could I ask any less of myself?

· · · · · ·

Sean

On my first day back at work, I came into the department to find a doctored WANTED poster on my locker. Written across the photo of my face, in bright red Sharpie marker, was the word APPREHENDED. “Very funny,” I muttered, and I ripped down the flyer and crumpled it int a ball.

“Sean O’Keefe!” said one of the guys, pretending to hold a microphone in his hand as he held it up to another cop. “You’ve just won the Super Bowl. What are you going to do next?”

Two fists, pumped in the air. “I’m going to Disneyworld!”

The rest of the guys cracked up. “Hey, your travel agent called,” one said. “She’s booked your tickets to Gitmo for your next vacation.”

My captain hushed them all up and came to stand in front of me. “Seriously, Sean, you know we’re just pulling your chain. How’s Willow doing?”

“Okay,” I said. “She’s okay.”

“Well, if there’s anything we can do,” the captain said, and he let the rest of his sentence fade like smoke.

I swallowed, pretending that this didn’t bother me; that I was in on the joke, instead of being the laughingstock. “Don’t you guys have something constructive to do? What do you think this is, the Lake Buena Vista PD?”

At that, everyone howled with laughter and dribbled out of the locker room, leaving me alone to dress in my uniform. I smacked my fist into the metal frame of my locker, and it jumped open. A piece of paper fluttered out – my face again, with Mickey Mouse ears superimposed on my head. And on the bottom: It’s a Small World After All.

My ears were hot, my collar too tight. I pulled at it as I navigated the hallways of the department to the dispatch office and yanked a telephone book from a stack kept on a shelf. I looked for the ad until I found the name I was looking for; the one I’d seen on countless late night television commercials: Robert Ramirez, Plaintiff’s Attorney: Because you deserve the best.

I do, I thought. And so does my family.

So I dialed the number. “Yes,” I said. “I’d like to make an appointment.”

· · · · · ·

I was the designated night watchman. After you girls were fast asleep and Charlotte was showered and climbing into bed, it was my job to turn off the lights, lock the doors, do one last pass through the house. With you in your cast, your makeshift bed was the living room couch. I almost turned off the kitchen nightlight before I remembered, and then I came closer and pulled the blanket up to your chin and kissed your forehead.

Upstairs, I checked in on Amelia and then went into our room. Charlotte was standing in the bathroom with a towel wrapped around herself, brushing her teeth. In the mirror, our eyes met. I’ve always wondered whether she sees what I do, when I look at her. Or for that matter, whether she notices the fact that my hair’s gotten thinner on the top. “What do you want,” she said.

“How do you know I want something?”

“Because I’ve been married to you for nine years?”

I followed her into the bedroom. “I need you and Willow to come somewhere with me tomorrow,” I said. “A lawyer’s office.” Charlotte sank onto the mattress. “For what?”

“The way we were treated,” I said. “The arrest. These things, you can’t just let them get away with it. Because then it could happen to someone else.”

She stared at me. “I thought you were the one who wanted to just get home and get on with our lives.” I sat down beside Charlotte, hesitating. “They took my family away. I was in that cell, thinking about you and Amelia and Willow, and all I wanted to do was hurt someone. All I wanted to do was turn into the person they already thought I was.”

Charlotte lifted her gaze to mine. “Who’s they?”

I threaded my fingers through hers. “Well,” I said, “that’s what I hope the lawyer will tell us.”

· · · · · ·

The walls of the law offices of Robert Ramirez were papered in the cancelled settlement checks that he’d won for former clients. I paced with my hands clasped behind my back, leaning in to read a few. Pay to the Order of. $350,000. $1.2 million. $890,000. Amelia was hovering over the coffee machine, a nifty little thing that let you put in a single cup and push a button to get the flavor you wanted. “Mom,” she asked, “can I have some?”

“No,” Charlotte said. She was sitting next to you on the couch, trying to keep your cast from sliding off the stiff leather.

“But they have tea. And cocoa.”

“No means no, Amelia!”

The secretary stood up behind her desk. “Mr. Ramirez is ready to see you now.”

I pulled you onto my hip and we all followed the secretary down the hall to a conference room enclosed by walls of frosted glass. I kept my eyes on Ramirez; I wanted to see his reaction when he saw you. “Mr. O’Keefe,” he said, and he held out a hand.

I shook it. “This is my wife, Charlotte. And my girls, Amelia and Willow.”

“Ladies,” Ramirez said, and then he turned to his secretary. “Briony, why don’t you get the crayons and a couple of coloring books?”

From behind me I heard Amelia snort – I knew she was thinking that this guy didn’t have a clue; that coloring books were for little kids, not ones who were already wearing training bras.

Ramirez gestured toward a woman standing nearby. “I’d like to introduce you to Marin

Gates…she’s an associate here.”

She looked the part. With black hair pulled back in a clip and a navy suit, she could have been pretty, but there was something off about her. Her mouth, I decided. She looked like she’d just spit out something that tasted awful.

“I’ve invited Marin to sit in on this meeting,” Ramirez said. “Please, take a seat.”

Before we could, though, the secretary reappeared with the coloring books. She handed them to Charlotte, black and white pamphlets that said Robert Ramirez, Esquire across the top in block letters. “Oh look,” your mother said, shooting a withering glance in my direction.

“Who knew they made up personal injury coloring books?”

Ramirez grinned. “The Internet is a wondrous place,” he said. “How can we help you, Mr.

O’Keefe?”

“It’s Officer O’Keefe, actually,” I corrected. And I told them. About your OI, and Disneyworld, and the ice cream, and how you fell. I told her about the men in black suits who led us out of the theme park and arranged for the ambulance, as if the sooner they got rid of us the better. I told her about the woman who’d taken Amelia away; about the interrogations that went on for hours at the police station; about the way no one believed me. I told her about the jokes that had been made about me at my own station.

“I want names,” I said. “I want to sue, and I want to do it fast. I want to go after someone at Disneyworld, someone at the hospital, and someone at DCF. I want people’s jobs, and I want money out of this to make up for the hell we went through.”

Robert Ramirez nodded. “The type of case you’re suggesting is very expensive, Officer O’Keefe. I can tell you right away that even though you’re seeking a money judgment, you’re not going to get one.”

I blinked at him. “Those checks in the waiting room…”

“…were for cases where the plaintiff had a valid complaint. From what you’ve described to us, the people who worked at Disneyworld and the hospital and DCF were just doing their jobs. Doctors have a legal obligation to report suspicions of child abuse. Without the letter from your hometown doctor, the police had probable cause to make the arrest in the state of Florida. DCF has an obligation to protect children, particularly when the child in question is too young to give a detailed account of her own health issues. As an officer of the law, I’m sure if you step back and remove the emotion from the facts here, you’ll see that once the health care information was received from New Hampshire, your kids were turned over to you; you and your wife were released…sure, it made you feel awful – but embarrassment isn’t a just cause of action.”

“What about emotional damages?” I blustered. “Do you have any idea what that was like for me? For my kids?”

“I’m sure they were nothing compared to the emotional burden of living day in and day out with a child who has these particular health problems,” Ramirez said, and beside me, Charlotte lifted her gaze to his. The lawyer smiled sympathetically at her. “I mean, it must be quite challenging.” He leaned forward, frowning a little. “I don’t know much about – what’s it called? Osteo…”

“Osteogenesis imperfecta,” Charlotte said softly.

“How many breaks has Willow had?”

“Twenty-seven, including the new ones,” I replied. “How was Willow conceived?”

“Ugh,” Amelia said – until then, I’d forgotten she was with us – “that’s totally gross.” I shook my head at her, a warning.

“We tried in vitro,” Charlotte said. “Three cycles. But it didn’t take. And we’d pretty much given up when I found out I was pregnant.”

“Grosser,” Amelia said.

“Amelia!” I passed you over to your mother, and pulled your sister up by the hand. “You can hang out in the waiting room,” I said under my breath. When I entered the conference room again, Charlotte was still talking. “…but I was thirty-nine years old,” she said. “You know what they write on your charts, when you’re thirty-nine? Geriatric pregnancy. I was worried about having a Down syndrome child – I never had even heard of OI.”

“Did you have amnio?”

“No.”

I remembered it vividly – Piper had wanted Charlotte to have the test so that she could put her mind to rest about Down syndrome. I thought it was an unnecessary risk, since there was a slight chance of miscarriage. The way I saw it, no matter what, we were going to have that baby and love that baby. So what could the amnio results tell us that would make any difference at all?

“OI can’t be flagged with amnio,” Charlotte said.

“So you didn’t know Willow would be born with OI?” Ramirez asked.

“Not until the second ultrasound showed a bunch of broken bones. Look, are we about done here? If you don’t want this case, I’m sure I can find –“

“Well, there was that one weird thing,” Charlotte interrupted. “During the 18 week ultrasound, the tech had to keep repeating the scan, because the picture she was getting of the brain looked too clear.”

“There’s no such thing as too clear,” I said.

Ramirez and his associate exchanged a glance. “And what did your OB say?”

“Nothing.” Charlotte shrugged. “No one even mentioned OI until we did another ultrasound at twenty-six weeks, and saw all the fractures.” Ramirez turned to Marin Gates. “See if it’s ever diagnosed in utero that early,” he ordered, and then he turned to Charlotte. “Would you be willing to release your medical records to us? We’ll have to do some research on whether or not you have a cause of action –“

I reached for you, leaving your mother’s hands free. “I thought you said we didn’t have a lawsuit.”

“You might, Officer O’Keefe,” Robert Ramirez said, looking at you as if he was memorizing your features. “Just not the one you thought.”

Marin As soon as we finished showing the O’Keefes out of the law office, I rounded on my boss. “There is no way I’m doing this,” I said.

“Well,” Bob agreed, “that’s entirely possible. Or, alternately, we might wind up with the biggest wrongful birth payout in New Hampshire. Depends on what her medical records turn up.”

A wrongful birth lawsuit implies that if the mother had known during her pregnancy that her child was going to be significantly impaired, she would have chosen to abort the fetus. It places the onus of responsibility for the child’s subsequent disability on the OB/GYN. From a plaintiff’s standpoint, it’s a medical malpractice suit. For the defense, it becomes a morality question: who has the right to decide what kind of life is too limited to be worth living?

Many states had banned wrongful birth suits. New Hampshire wasn’t one of them. There had been several settlements for the parents of children who’d been born with spina bifida or cystic fibrosis, or in one case, a boy who was profoundly retarded and wheelchair-bound due to a genetic abnormality – even though the illness had never been diagnosed before, much less noticed in utero. In New Hampshire, a parent was responsible for the care of a disabled child their whole life – not just till age eighteen – which was as good a reason as any to seek damages. There was no question Willow O’Keefe was a sad story, with her enormous body cast, but she’d smiled and answered questions when the father left the room and Bob chatted her up. To put it bluntly: she was cute and bright and articulate – and therefore a much tougher hardship case to sell to a jury.

“If Charlotte O’Keefe’s provider didn’t meet the standard of care,” Bob said, shrugging, “then she should be held liable, so this doesn’t happen again.”

I rolled my eyes. “You can’t play the conscience card when you stand to make a few million from the lawsuit, Bob. And it’s a slippery slope – if an OB decides a kid with brittle bones shouldn’t be born, what’s next? A prenatal test for low IQ, so you can scrap the fetus that won’t grow up and get into Harvard?”

He clapped me on the back. “You know, it’s nice to see someone so passionate. Personally, whenever people start talking about curing too many things with science, I’m always glad bioethics wasn’t an issue during the time polio, TB, and yellow fever were running rampant.” We were walking toward our individual offices, but he suddenly stopped and turned to me. “Are you a neo-Nazi?”

“What?”

“I didn’t think so. But if we were asked to defend a client who was a neo-Nazi in a criminal suit, could you do your job – even if you found his beliefs disgusting?”

“Of course,” I said immediately. “But this is totally different.”

Bob shook his head. “That’s the thing, Marin,” he replied. “It really isn’t.”

Piper

“You look like hell,” I said to Charlotte, as I came into the house. “When was the last time you slept?”

“ Gee, Piper, it’s really great to see you too,” she answered tartly.

“ Is Amelia ready?”

“ For what?”

“ Skating?” She smacked her forehead. “I totally forgot. Amelia!” she yelled, and then to me: “We just got home from the lawyer’s.”

“ And did they tell Sean he’s nuts?” Your mother was my best friend in the world, but your father could drive me crazy. He got an idea in his head, and that was the end of that – you couldn’t budge him. The world was utterly black and white for Sean, and I guess I’ve always been the kind of person who prefers a splash of color.

“ I suppose if you forgot about skating, you forgot about the bake sale too…? Charlotte winced. “What did you make?”

“ Brownies. In the shape of skates. From scratch. The rest of the moms already blacklisted me because I missed the spring show for a medical conference. I’m trying to atone.”

“ So you whipped these up when? While you were stitching an episiotomy? After being on call for thirty-six hours?” Charlotte said, as she opened her pantry and rummaged through the shelves, finally grabbing a package of Chips Ahoy and spilling them onto a serving platter.

“ Honestly, Piper, do you always have to be so damn perfect?” With a fork, she was attacking the edges of the cookies.

“ Whoa – who peed in your Cheerios?”

“ Well, what do you expect? You waltz in here and tell me I look like crap, and then you make me feel completely inadequate—“

“ You’re a pastry chef, Charlotte. You could bake circles around --what on earth are you doing?”

“ Making them look homemade,” Charlotte said.

“ Because I’m not a pastry chef, not anymore. Not for a long time. I’m just the skating club’s resident dysfunctional mom.” I moved the platter away. “Charlotte. Are you okay?”

“ Let’s see. I was arrested last weekend; my daughter’s in a full cast; I don’t even have time to take a shower – yup, I’m just fantastic.” She turned to the doorway, and the staircase upstairs. “Amelia! Let’s go!”

“ Emma’s gone selectively deaf, too,” I said. “I swear she ignores me on purpose. Yesterday, I asked her eight times to clear the kitchen counter –“

“ You know what,” Charlotte said wearily.

“ I really don’t care about the problems you’re having with your daughter.” No sooner had my jaw dropped – I had always been Charlotte’s confidante, not her punching bag – she shook her head and apologized.

“I’m sorry. I don’t know what’s wrong with me. I shouldn’t be taking this out on you.”

“ I didn’t even notice,” I lied. Just then the older girls clattered down the stairs.

“ Don’t forget your skates,” Charlotte called, as they skidded past us in a flurry of whispers and giggles. I put my hand on Charlotte’s arm. “You’re not dysfunctional,” I said firmly.

“ You’re the most devoted mother I’ve ever met. You’ve given up your whole life to take care of Willow.” She ducked her head and nodded before looking up at me.

“ Do you remember her first ultrasound?” I thought for a second, and then I grinned. “We saw her sucking her thumb. I didn’t even have to point it out to you and Sean; it was clear as day.”

“ Right,” your mother repeated. “Clear as day.”

Charlotte

What if it was someone’s fault?

The idea was just the germ of a seed, carried home in the hollow beneath my breastbone when we left the law offices. Even when I was lying awake next to Sean, I heard it as a drumbeat in my blood: what if, what if, what if. For four years now I had loved you, hovered over you, held you when you had a break. I had gotten exactly what I so desperately wished for: a beautiful baby. So how could I admit to anyone – much less myself – that you were not only the most wonderful thing that had ever happened to me…you were also the most exhausting, the most overwhelming?

Three weeks after we first went to Robert Ramirez’s law offices, they called to set up another appointment. They wanted to just run something by us. This time, Amelia was in school, but we still had to bring you. And this time, they were ready: beside the coffee machine were juice packs; next to the glossy architectural magazines were a small stack of picture books. When the secretary brought us back to meet the lawyers, we were not led to the conference room. Instead she opened the door to an office that was a hundred different shades of white: from the pickled wood floor to the creamy wall paneling to the pair of pale leather sofas. You craned your neck, taking this all in. Was it supposed to look like Heaven? And if so, what did that make Robert Ramirez?

The lawyer shook Sean’s hand, and mine. “I thought the couch might be more comfortable for Willow,” he said smoothly. “I’m sure you’re wondering why we asked you to come back…my associate’s been doing a great deal of work these past two weeks. Does the name Marcus Cavendish ring a bell?”

Sean and I looked at each other and shook our heads.

“Dr. Cavendish is Scottish. He’s one of the foremost experts on osteogenesis imperfecta in the world. And according to him, it appears that you have a good cause of action of medical malpractice against your obstetrician. You remembered your eighteen-week ultrasound being too clear, isn’t that right, Mrs. O’Keefe? That’s significant evidence that your obstetrician missed. She should have been able to recognize that your baby was suffering from osteogenesis imperfecta back then, long before the next ultrasound, where the broken bones were visible.”

My head was spinning; and Sean looked utterly confused. “Wait a second,” he said. “What kind of lawsuit is this?”

“It’s called wrongful birth,” Ramirez said.

“And what the hell does that mean?”

“A wrongful birth lawsuit entitles the parents to sue for damages incurred from the birth and care of a severely disabled child. The implication is that if your provider had told you earlier on that your baby was going to be impaired, you would have had choices and options as to whether or not to continue with the pregnancy.”

I remembered snapping at Piper: Do you always have to be so damn perfect?

What if the one time she hadn’t been perfect was when it came to you?

I was as rooted to my seat as you were; I couldn’t move; couldn’t breathe. Sean spoke for me: “You’re saying my baby never should have been born?” he accused. “That she was a mistake?”

As he stood up, so did Robert Ramirez. “Officer O’Keefe, I know how unpalatable it sounds. But the term ‘wrongful birth’ is just a legal one. We don’t wish your child wasn’t born – she’s absolutely beautiful. We just think that when a doctor doesn’t meet the standard of care a patient deserves, someone ought to be held responsible.” He took a step forward. “It’s medical malpractice. Think of all the time and money that’s gone into taking care of Willow – and will go into taking care of her in the future. Why should you pay for someone else’s mistake?”

Sean towered over the lawyer, and for a second, I thought he might swat Ramirez out of his way. But instead he jabbed one finger into the lawyer’s chest. “I love my daughter,” Sean said, his voice thick. “I love her.”

At this, you lifted your face. “Well, Daddy,” you said, so simply, “I love you too.”

He pulled you into his arms, but too fast – the grape juice box you were holding tumbled onto the leather and then the floor, a rapidly spreading puddle as dark as blood. “Oh,” I cried, digging in my purse for a tissue to blot the stain. That gorgeous, creamy leather; it would be ruined.

“It’s all right, Mrs. O’Keefe,” Marin murmured, kneeling beside me. “Don’t worry about it.”

“No, no – we made the mess –“

“Charlotte,” Sean said, “let’s get the hell out of here.”

He was already striding down the hall, volcanic, as I mopped up the juice. I realized that both lawyers were staring at me, and I rocked back on my heels. “Um, thank you…for all the time you spent with us,” I faltered.

“Charlotte!” Sean’s voice rang from the waiting room.

“I’m really sorry that we bothered you…” Slowly, I stood and crossed my arms. “I just…there’s one thing…” I looked up at the lawyers and took a deep breath. “What happens if we win?”