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0800 HOURS: CONSULT
“Oh, I wasn’t expecting anything like this.” Marianna took in the tasteful decor of the postpartum suite as the nurse eased her off the gurney and onto a split-king adjustable bed. “It’s all just so—so welcoming.”
Not to mention upscale. A kitchenette was tucked into a nook to one side of the room, while an entertainment center with flatscreen TV graced the far corner. A picture window set in the exterior wall gave a view of Central Park, snow-dusted fields and bare-limbed trees aglow in early morning light.
“And look, Jon.” She patted the other side of the mattress. “There’s room for you to sleep here with us too. We can spend Persephone’s first night together as a family. How did you ever arrange all this?”
“That’s just it,” he said, sitting down beside her on the bed and looking around at the library stocked with bestsellers and first-run DVDs. “I didn’t. I mean, I booked us a private room, but I had no idea it would come with all these, um, inclusions.”
He turned to where the nurse was just opening the door to leave. “How about it, nurse—is this what we ordered?”
The young woman flushed. “No sir, your reservation was upgraded to this neonatal palliative care unit. It’s just Saint Bartholomew’s way, in situations like this, of trying to make our patients as comfortable as possible.”
“What would really make me comfortable,” Marianna told her, “would be for me to see my baby. I barely got a chance to hold her before they took her away. For tests, they said. Can you tell us what’s going on?”
The nurse wasn’t meeting Marianna’s gaze. “The doctor will be by to see you soon. He’ll explain everything,” she said hastily. Then she slipped out the door and was gone.
Marianna turned to her husband, reached out to grip his hand. “‘Situations like this.’ What do you think she meant by that, Jon? What situation?”
Suddenly, the suite, which had felt so bright and cheery a moment ago, seemed to darken and close in on her. Marianna was having trouble breathing.
Is something wrong with my baby?
Jon took her into his arms, held her tight. “It’s nothing. I’m sure it’s nothing,” he soothed, though his tone belied his words.
There was a knock at the door. Another nurse came in, this one older, more businesslike, sporting carefully coifed gray hair and armed with a clipboard.
Disquieting questions they were, too. Like: “Have you ever been exposed to high levels of radiation?”
Well, she had, of course. She and Jon both, in a place called Antipode Station, set into an undersea mountaintop at the crest of the mid-Atlantic rift. On the other hand, telling the nurse that would be about six kinds of security violation.
Instead, Marianna asked, “What’s all this about? Why can’t I see my daughter?”
“You can. Of course you can. It’s just that there’s something the doctor will have to discuss with you first. Both of you.”
Marianna had been expecting their obstetrician, but when a doctor finally did put in an appearance, it was a stranger. A tubby, balding, ginger-bearded stranger who introduced himself as Malcolm Burke, board certified in neonatal genetics.
Doctor Burke took a seat in the palliative suite’s commodious armchair and crossed his ample legs. He tried and failed to look Marianna in the eye. “Uh, I’m afraid I’ve got some bad news about your daughter. The results of her postnatal gene sequencing are in, and they demonstrate conclusively that . . . ” He paused, as if struggling to recall the child’s name. “ . . . that, uh, Persephone is suffering from a disorder known as triploidy.”
Those last words tumbled out in a rush.
“I’m sorry, doctor,” Marianna said. “I don’t know what that means.”
The doctor sighed. “Where do I begin? You know our genetic material—the DNA, uh, call it a blueprint, if you will, that makes us who and what we are? Well, it comes in the form of tiny structures called chromosomes? And that we humans are diploid organisms, meaning that all of those chromosomes consist of two strands of DNA?”
Marianna nodded, trying to rein in her mounting anxiety.
“Well, then.” Burke waved a pudgy hand. “Those DNA strands are called chromatids. And since, in the human body, the nucleus of every cell contains twenty-three chromosomes, that makes for twenty-three pairs of chromatids, or forty-six in all. With the exception of the human egg and sperm cells, that is—they each have only half that number. That’s how sexual reproduction works, actually. When the two gametes—that is, the mother’s egg cell and the father’s sperm cell—come together, they each contribute one half of the chromatids needed to form the chromosomes for a new individual, a new baby inheriting half its characteristics from each parent.”
Doctor Burke paused. “Sorry, that’s a bit off-topic,” he said, before beginning again. “So twenty-three pairs of chromatids—of DNA strands, that is—in each cell . . . ”
He blinked, swallowed. “Unless,” he went on, “something goes wrong.”
The bottom dropped out of Marianna's stomach. She gripped Jon’s arm with hands gone suddenly cold.
Jon found his voice first. “What are you telling us, doctor? What is triploidy?”
The doctor looked away. “A rare condition. At least it’s rare to see it in a child come to full term like this.”
“Because it usually goes away before then?” Something in Jon’s tone told Marianna that he didn’t believe that was it.
“No, Mr. Knox.” Burke shook his head sadly. “Because the pregnancy almost always ends in a spontaneous miscarriage long before the child can be born.”
“Remember how I was saying that, reproductive cells aside, there are twenty-three pairs of those DNA strands in the nucleus of every cell in a human body? Well, that’s in a normal human body. In your daughter’s case—and, God help me, I don’t know how we could have missed this till now—” The doctor swallowed again. “Persephone has an entire extra set of strands. Not twenty-three pairs, but twenty-three, uh, triples, if you will—sixty-nine chromatids in all, instead of the normal forty-six.”
“And that’s bad, because . . . ?”
“Because adding a third strand of DNA to even just a single one of those twenty-three chromosomes—a condition known as trisomy—is a recipe for genetic disaster. When that happens to chromosome twenty-one, for instance, it results in Down syndrome. And here we’re talking about all twenty-three chromosomes. Triploidy isn’t just bad, Mr. Knox. It’s a death sentence.”
Jon lurched as if someone had punched him in the gut.
Into the silence that followed, her eyes brimming with sudden tears, Marianna said, “You’re telling us our baby has—has died?”
“No, not yet, Ms. Knox, but I’m afraid it’s inevitable. There’s no way to sugarcoat this: triploidy is, simply speaking, incompatible with life. The mortality rate is one hundred percent, without exception. The longest surviving triploid baby on record lived only ten and a half months and seemed to be in constant pain all that time.”
“Persephone is—is suffering?”
“No, strangely enough, other than running a slight fever, she seems to be resting comfortably. And that’s not the only strange thing . . . ”
“What else?” Jon asked tonelessly.
“Well, simply the fact that we were only able to establish this diagnosis postpartum. Nowadays, routine prenatal genetic screening should have detected the syndrome early in the first trimester. Not to mention that there should have been physical abnormalities in the fetus, observable via ultrasound by about the twelfth week of pregnancy—though those abnormalities vary with the specific type of triploidy.”
Doctor Burke must’ve read the incomprehension in their eyes, because he elaborated: “Digynic triploidy is where the extra DNA strands are contributed by the mother; it presents as an abnormally small fetal body size, among other symptoms. The diandric variant, where the extra chromatids come from the father, isn’t as obvious. But it can be more dangerous to the mother, since it can induce preeclampsia and elevate blood pressure to life-threatening levels. In either case, given there’s zero chance of the infant surviving, the recommendation would have been to abort as soon as the condition was confirmed.”
“But none of that happened.”
“No, what’s different here is that, up until the moment of her birth, Persephone’s test results, including the prepartum gene sequencing we conducted shortly after Ms. Knox was admitted, all seemed perfectly normal. But triploidy—any garden-variety triploidy, that is—is present from the moment of conception. There’s no known mechanism by which it could be induced postpartum, after the child is born, that is. And yet that seems to be what’s happening here. Quite frankly, we’re at a loss. Both to that, and—”
“There’s something else?”
Marianna knew that tone: Jon was getting exasperated.
“Well, it’s just that triploidy is usually a global syndrome, affecting all the cells of the body. Which only makes sense when you consider that it’s present in the fertilized egg from the outset and propagates with every cell division of the embryo from there on.”
“And that’s not the case here?”
Burke shook his head. “There is a less severe variant called mosaic triploidy, where only some of the body’s cells are affected. But what we’re seeing isn’t consistent with that diagnosis either.”
“What are you seeing?”
“As far as we can tell, Persephone’s condition seems to have started out localized, like a mosaic. Confined to the central nervous system, in fact—which would be fatal in and of itself. But unlike a stable mosaic, and again—for reasons we don’t understand—it's spreading throughout the rest of her body’s cells. Quite frankly, we don’t know what to make of it. The disorder is progressing in a manner that we’ve never observed before.”
“Can’t you arrest that progress somehow?” Jon asked.
“Not without knowing what’s causing it. I’m sorry, Mr. Knox, but our best guess at this point is, once the effect has run its course, the outcome will be the same.”
“Our daughter is going to die, you’re saying?”
Burke shrank into himself, gave a miserable shrug. “If it’s any consolation . . . ”
“Well, as I said, triploidy is rare, almost vanishingly so. There’s no reason the two of you couldn’t have another baby. A healthy one.”
Marianna, tears streaming down her face now, said, “No, I want this baby.”
For his part, Knox stood there stunned. Over the past nine months he’d had ample opportunity to ponder what kind of a father he’d be—and kept coming up with answers he didn’t like. Truth be told, he was pretty sure he’d suck at it.
Face it, Knox, he’d told himself any number of times. You live in your head too much to shoulder the responsibilities of parenthood.
Though, over the past couple of years of their relationship, Marianna had gone some distance toward engaging him with the world outside his own thoughts. More properly, engaging with her and, through her, the world. Unsettling though it had been at times—especially the occasional brushes with death that Marianna’s day job seemed to entail—he’d found himself unexpectedly liking it. Enough so that he even found himself getting used to married life.
Still, becoming a father was a whole different level of commitment—one he’d doubted he’d ever be ready to take on.
All things considered, he ought to be feeling relief of a sort that he wouldn’t be being called upon to take on that burden as well.
It was something of a surprise to discover that he didn’t feel that way. Not at all.
He discovered that, more than anything, he wanted this baby too.
After a few more desultory remarks and expressions of regret, the doctor stood and walked to the door. Knox shambled over to join him and ask whether they could see Persephone now.
“I’ll have her brought right in,” Burke said, then beat a hasty retreat.
Once they were alone again, Marianna collapsed into his arms. “Oh, Jon,” she sobbed. “What if this is all my fault?”
He held her tight. “How could it be your fault? I don’t understand.”
“What if this is payback for . . . Rusalka? For our exposure to Vurdalak, to that micro black hole’s hard radiation somehow?”
“I don’t see how that could be.” Seeking to reassure her, Knox dredged up a memory from their first assignment together, a memory of a briefing given them by a maverick astrophysicist. “But don’t take my word for it. Jack Adler knows more about black holes than God Almighty, and Jack told us the radiation would dissipate along with the event horizon once the singularity was exposed, remember?”
Knox groped for an answer, found nothing. He was usually good at coming up with answers—for other people. This was too personal, and too devastating.
His daughter, his little girl, not even an hour old, and . . . dying?
Before he could frame a response, the door to the palliative suite swung open on a nurse wheeling in what looked like a bassinet if he disregarded the intravenous drips and multiple monitoring devices built into the frame.
Marianna stood up, still shaky from the long labor, walked to the side of the bassinet, reached in, and cradled Persephone in her arms. The child stirred slightly in her sleep.
“My baby, my baby,” Marianna crooned. “Don’t worry. Your daddy will figure something out.”
Knox just sat there, numbly looking at the little bundle nestled peacefully in his wife’s embrace.
Figure something out? How in the hell was he supposed to do that?
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