Chapter Nine
Four years later
Casey
“I know you’re awake,” I tell her. “Your foot is moving.”
“Bart’s foot is moving.”
“Bart doesn’t have feet. He has stumps. We’ve discussed this.”
“Bart says five more minutes.”
“Bart doesn’t get a vote. Bart is a stuffed elephant. Come on. Meds, then breakfast, then socks.”
“I don’t want socks.”
“You don’t get a choice about socks. Socks are mandatory. Socks are the law.”
Sienna opens one eye. She has Sterling’s gray eyes, which I pretend I stopped noticing two years ago but see every single morning.
She’s four years and five months old. She’s small for her age because she’s been sick, and her hair is auburn like mine but wilder, as though it inherited my color and Sterling’s refusal to cooperate.
She has a central line scar above her collarbone that she shows to anyone who asks and several people who don’t.
She asks questions constantly, doesn’t accept incomplete answers, and is exhausting and magnificent in roughly equal measure.
The meds go in. Cyclosporine, measured and drawn with the precision I bring to everything medical, because Casey Weaver doesn’t make medication errors on the floor and she certainly doesn’t make them on her own daughter.
Sienna takes it without complaint because we’ve been doing this for over a year, and what was terrifying eighteen months ago is now routine.
The apartment is small, warm, and entirely mine.
Two bedrooms, a kitchen with a window that faces the mountains on clear days, a living room with books on every surface and photographs on the wall.
None of the photographs are Sterling. There’s one of my mother, taken the year before she died, holding a casserole at a church picnic in Hickory.
There’s one of Marnie and me at a hospital fundraiser, both of us in scrubs because neither of us owned appropriate clothes.
There’s one of Sienna at three, bruised along both arms from the blood draws, grinning at the camera with Bart in a headlock.
I get dressed. The chain goes on under my shirt. I haven’t looked at it in years. I haven’t taken it off either. It’s stupid, sentimental, or a reminder not to trust easily. Probably all three.
Hettie Sokoll is next door, and we get there by 7:45.
She’s sixty-three, a retired teacher who moved to Asheville from Ohio after her husband died because her daughter lives here and because she’d spent forty years grading papers but wants to spend the next forty looking at mountains.
She watches Sienna when I work. She keeps emergency meds in her kitchen drawer, knows the dosing by heart, and has my cell number, the clinic number, and the hospital number written on a card taped to her refrigerator.
She isn’t family, except she’s, because that’s what happens when people show up often enough and don’t leave.
Hettie is already at her door, coffee in hand, reading glasses pushed up into her gray hair. “How’d you sleep?”
“Fine.”
She looks at me over the glasses. She’s known me long enough to recognize the lie and kind enough to let it go. “I made banana bread. There’s a plate on the table there.”
“You don’t have to keep feeding us.”
“I’m not feeding you. I’m feeding Sienna. You just happen to live in the same apartment.” She takes Sienna’s hand. “Come on, baby girl. Bart and I have plans.”
Four years ago, I drove away from the Hollingsford estate on a November night with a bag and a pregnancy, and I landed in Asheville because Marnie’s cousin had a sublease.
The sublease became a lease, and the lease became a life.
I finished my pregnancy alone. I went through labor without anyone who belonged to me in the room.
Marnie drove from Charlotte and arrived thirty minutes after Sienna did, because Sienna came three weeks early.
I worked night shifts until I couldn’t, switched to days, and moved into case management when a position opened because it paid better and the hours were compatible with a child who needed me there at 7:15 every morning for meds.
I fought insurance companies. I learned to read an EOB like a pro, looking for the number that doesn’t belong. I appealed denials. I negotiated payment plans. I built something with no room in it for anybody except the person I built it for.
The clinic is a ten-minute drive from the apartment.
I work as an RN case manager in pediatric hematology, which means I coordinate care for sick children, navigate insurance companies that would rather not pay for things, and serve as the person parents call when they don’t understand what the doctor said and are too afraid to ask again.
I’m good at it. I’m good at it through stubbornness, competence, and an unwillingness to let a billing department win an argument about a four-year-old’s platelets.
Alec Murphy is in the hallway when I arrive.
He’s tall, sandy-haired, wearing one of his three sweaters, the green one with the hole in the cuff he hasn’t noticed in a year, and his reading glasses are on top of his head, which is where they live sixty percent of the time.
I’ve pointed it out to him twice this week, but the habit remains unchanged.
“Glasses,” I say.
He reaches up, finds them, and grins. “I’d lose my head if it weren’t attached.”
“You’d lose your head if it were attached. You’d just lose it more slowly.”
He laughs. Alec laughs easily, at things that are actually funny, and the sound of it makes the hallway feel warmer.
He’s a pediatric hematologist who talks to four-year-olds as though they’re real people, as they are, and explains conditioning regimens to terrified parents without condescension or false optimism.
He’s very good at his job. He also forgets where he parks, misses his own dentist appointments, and showed up to dinner fifteen minutes late on our first date with an honest apology and spinach in his teeth.
“How’s Sienna this morning?” he asks.
“Negotiating about socks. Standard Wednesday.”
“Bart involved?”
“Bart is always involved. Bart runs my household. I’m just the staff.”
He grins again. “How were last week’s counts?”
“I’m going to find out at ten a.m. The week before, the hemoglobin was 8.2. Platelets at 47. Neutrophils holding at 820.”
He nods slowly. Not great, not crisis. The hemoglobin is low enough that she’s tired all the time but not low enough for another transfusion. The platelets are the concern, trending steadily downward every week from 62 three months ago.
“We’ll keep watching the platelets,” he says. “If they drop below 30, we talk about options.”
“I know.”
“I know you know.” He picks up his coffee. “You memorize every draw, don’t you?”
“I’m a nurse. I memorize everything.”
“You’re a mother. That’s why you memorize everything.”
I like him. We’ve been dating for six weeks. Dinner is Friday. I’m not using him, and I’m not replacing anyone with him. Both of those things are true.
THE CONSULT IS AT TEN via Zoom since the specialist is in Charlotte.
Dr. Nadine Osgood doesn’t perform sympathy, but she embodies competence.
She’s fiftyish, short, built like a guy who played lacrosse in college and never entirely stopped, and she delivers bad news with the same cool efficiency she delivers good news, which means you always know where you stand, even when standing there’s terrible.
Sienna’s counts are falling even from last week.
The immunosuppressive therapy. ATG plus cyclosporine, held for about a year.
It’s losing ground. She’s transfusion-dependent again and will need one soon.
The numbers tell a story I already know.
I’ve been reading Sienna’s labs weekly for eighteen months.
I watched the trajectory flatten, plateau for a while, then start to drop rapidly.
“She needs the transplant,” Osgood says. “The registry has been running four months with no strong match. Haploidentical with a biological parent is the recommended path.”
I’ve been expecting this. I scheduled my own donor workup two weeks ago.
I cleared my calendar. I told Sienna, in four-year-old terms, that Mommy might need to give her some special cells to help her body make blood the right way.
Sienna asked if it would hurt. I told her yes.
She asked if I’d cry. I told her probably. She told me I could borrow Bart.
“I’ve already scheduled my workup,” I tell Osgood. “I can do the preliminary labs this week.”
Osgood nods. Then she says the thing I’ve been pretending I didn’t know she was going to say.
“Standard of care requires evaluating both available biological parents in parallel. We let the HLA data select the better donor.”
“I’m aware of the standard.”
“Then you’re aware that declining to type the father, regardless of your personal history, is a decision that could cost Sienna time she may not have.
” Osgood folds her arms. “The registry has been running four months, Casey. We have no viable unrelated match. A haploidentical parent is the fastest path to transplant, and a parent is automatically a half-match. The only question is which parent is the better one.”
“And I’m telling you it’s me.”
“You might be right. You probably are. I still need both panels to make that case to the transplant committee, and I need them before Sienna’s counts drop below the threshold where conditioning becomes significantly riskier.”
She pauses after saying it. She’s good at giving hard facts to parents who don’t want to hear what she’s saying. She delivers the fact, then steps back and lets it do its work. It’s a technique I recognize because I use it myself.
“How much time are we talking about?” I ask.
“If we start typing now, both parents, I can have the HLA comparison in two to three weeks. Donor workup, another two to three weeks after that. We could move into conditioning in approximately five to six weeks.” She pauses.
“If we wait on the father’s panel because you’d rather not contact him, we add a minimum of six weeks to the timeline, and that six weeks assumes the registry produces a match it hasn’t produced in four months. ”
I sit in my office and do the math I’ve been avoiding.
Sterling’s name, his address, and his attorney.
The four years of deliberate distance I built between his life and mine, between his life and Sienna’s, laid down brick by brick because Sterling threw his pregnant wife out on his mother’s word.
He doesn’t get to know the person who resulted.
My stomach turns over, because I can’t keep him out of our lives any longer. Nausea increases when I imagine saying his name to someone or writing his name on a form connected to my daughter in any way.
It’s opening a door I welded shut four years ago and inviting him back through it, even provisionally, even for blood cells, even for Sienna, makes me want to vomit.
Osgood is right. The ticking clock and dropping labs don’t care about welded doors.
“I’ll authorize my attorney to make contact,” I say. “Contingency typing only. I expect to be the donor.”
Osgood nods again. She doesn’t argue with my expectation. We both know the labs will have final say.
Alec catches me in the hallway afterward. He already knows since he’s been coordinating with Osgood on Sienna’s case from the beginning, and his face tells me he heard about the contingency typing. He could gave told me earlier, but that was Osgood’s job.
“You okay?”
“I’m fine.” My voice sounds brittle. “It’s a formality. They’ll type him, I’ll be the better match, and I’ll never have to think about it again.”
He doesn’t push. He asks if Friday is still on.
I tell him yes. He tells me Sienna’s counts are worth watching but not panicking about.
We’ll schedule her for a transfusion at the end of the week.
He says it in the voice he uses with parents, calibrated by years of delivering bad news to families, honest without being cruel.
It’s a bit early, but I take my lunch break to sit in my car outside the clinic. The mountains are blue-gray above the roofline, and the parking lot is half empty because it’s a Wednesday and most of the clinic’s appointments are in the afternoon.
I pull up my attorney’s number. Her name is Danielle Pratt.
She’s a family lawyer in Asheville who charged me $250 for an initial consult eighteen months ago, after Sienna’s diagnosis, when I was trying to understand what rights Sterling might have if we ever needed his sample for a possible transplant.
She told me plainly that the answer was complicated and depended on whether he came looking.
He never came looking for me. That was its own answer.
I call her. I tell her to send the letter she’s had prepared for months, requesting HLA typing from Sterling Hollingsford as a contingency donor evaluation for his biological daughter, Sienna Weaver, age four.
I say his full name out loud for the first time in years, and my voice doesn’t break, but something behind it does, a small, private fracture that the phone doesn’t carry.
“You’re sure about this?” Danielle asks.
“I’m sure it’s the right thing medically. I’m sure I’d rather cut my own arm off. Both of those things are true at the same time.”
Sympathy laces her tone. “Do you want to add anything personal?”
“No. Just the letter I already approved. His name, the request, the medical context, and the contact information for the transplant center. Nothing else.”
“Casey, once this letter lands, you can’t control what happens next.”
“I know. Sienna matters most.”
She doesn’t push. She’s a good attorney and knows when to stop talking, which is a quality I value more than legal expertise at this point in my life.
I hang up. I sit in the parking lot with the mountains visible over the clinic roof, and I’m certain, completely, professionally, medically certain, that I’ve just gone to a great deal of trouble over a man I’ll never actually have to rely on.
I start the car and call the clinic. “I’m taking the rest of the day off.”
The receptionist, Lynn, doesn’t ask why. She just notes it, and I drive home.
I pick up Sienna from Hettie’s. We read a book about a bear who doesn’t want to hibernate.
Sienna asks me seventeen questions about bears, and I answer all of them.
I heat up leftover soup for dinner, give her the evening meds, and try not to think about the letter my attorney has probably already sent.
I almost make it through the evening without thinking about Sterling Hollingsford. Not quite.