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Authors: Austin Boyd

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“Watch out,” he called on the radio, then heaved a light line to her, a rock tied to the end. It clattered to the shore a few feet away.

“Pull it over,” she heard him say in the next transmission, his words partially drowned out by the roar of water that spilled over the log dam a few feet to her right. She grabbed the line and tugged, hauling a heavier rope, and behind it, a cable from the front of his truck's winch. Less than a minute later, a towrope
in hand, he called again. “Hook the rope to your hitch. I'll take a strain.”

Like towing the truck out of a bog after a heavy rain, she whipped the rope and hook about the ball on her hitch, then raised her hand, thumb extended. Ian took up the slack immediately with his cable winch, the rope popping up taut, tugging hard on her vehicle.

Laura Ann returned to check on Sophia in the cab. She wiped the sweat from her friend's brow. “Breathe for James,” she said.

When she turned around, Ian had waded deep into the water, a second rope wrapped about his waist and slung over the towing hawser, with a harness of some sort and two life jackets threaded over one arm. To his left, barely visible in the fog, The Jug Store sat on the crest of the cliff overlooking their rescue, the men inside no doubt unaware of lives that hung in the balance below them.

Ian forded the stream, water over his shoulders as he clung to the tight rope, unable to keep a footing on the rocky bottom, so swift ran the deep brown current. Sixty feet of frothing water drenched him, but he crossed it far faster than she thought possible, working hand over hand along the heavy line. She ran to him at the shore, pulling him close as he waded out of the current, soaked with cool brown.

Ian thrust the harness into her hands. “From my tree stand,” he said, wiping his wet face with a free hand. “Help me get the life jacket on her first. Then the harness.” Together they moved Sophia out of the truck, then dressed her in the flotation and the camouflaged halter. The jacket and harness swallowed her like a child. Ian cinched them as tight as he could, then untied the rope he'd wrapped about his own waist.

Without a word, Laura Ann understood his intention. He threw his waist rope over the cable, hitched a loop about it, then
threaded the bitter end through the belt of her jeans. “Guide yourself along the high line. Gotta pull your way across.” She nodded.

He whipped another hitch in the line a few feet ahead of Laura Ann, and used it to tether her with a carabineer clip to his belt, then gathered Sophia into his arms as easily as lifting a pillow. Sophia draped across one shoulder, he clipped a carabineer from her harness over the high line and stepped into the flood.

Together they waded into the maelstrom. Sophia's only salvation, a ride to the hospital, waited twenty deadly yards away.

When they reached the other side safely, Ian unclipped Laura Ann. “Passenger side. Backseat.” Laura Ann ran for the truck door. He slipped Sophia off his shoulder into his arms, her shivering body cradled tight against his chest, then slid his patient, dripping wet, across the backseat.

Her face pallid and eyes shut, Sophia lay panting in tiny breaths, her arms clutched tight about her chest. No more of the ragged struggling-to-breathe pants; she seemed to be slipping away.

“Might go into shock. You'd better drive,” he said to Laura Ann, unbuckling the harness and jacket and tossing it into the passenger seat. Laura Ann slid the seat forward, giving Ian room to kneel in the back with his patient. Ian handed her a knife. She ran to the front of the truck to slice the high line free of the winch cable and reel in the slack. A few moments later, she stood at Ian's side, passing him the medical pouch he always stored behind the driver's seat.

They said little. Laura Ann didn't hesitate, slamming doors shut once his feet pulled in. Seconds later she had the truck started and in gear. Backing out of the creek bottom with a three-point turn, she raced up the muddy slope, spinning tires until the truck gripped the firm asphalt of Route 18.

She would follow the creek all the way past Middlebourne,
and with it the dense fog. What posed problems for Ian's canoe meant a nightmare for driving, fog lamps no match for the dense mist. Once past The Jug Store, she crept forward at ten, then fifteen miles an hour, feeling for the edges of the roadway. A road that washed away in many places just days ago.

“The truck radio,” Ian barked. She jerked a microphone from its holder and passed it back. Middlebourne lay two miles away down this soupy highway.

“Ten-Thirty-Three. Ten-Thirty-Three,” Ian yelled into the mike. “Unit seven inbound Middlebourne, Route 18, destination Sistersville ER. Request medical assist. Over.”

Laura Ann gunned the engine when a patch of clear road emerged, whizzing past small white houses and the occasional barn. The lifting fog wouldn't last long; the road moved close to the creek again in half a mile. She prayed for people to stay off the highway early on this morning.

“Unit seven, this is base. Copy your ten-thirty-three. Interrogative ten-twenty, over?”

“A mile out of Middlebourne,” he replied.

“Unit seven, base, is the patient in your truck?”

“Ten-four. You ready to copy?”

“Go ahead, seven. We'll relay to Sistersville.”

“White female, early thirties, seven months pregnant. Unconscious. Pulse weak.”

“Got it. Watch those roads, Ian. Lots of fog.”

“Copy. Request an emergency unit meet us en route.”

“Working it. No guarantees.” The voice paused, then added, “Better keep moving.”

Laura Ann slowed for a bank of fog that blanketed the road just before her entrance into town. It wouldn't last long. Past town, she'd cross the river one more time and, Lord willing, the roads would open up. They were fifteen minutes and fifteen miles from the ER on the best of days.

“Ian?” Laura Ann asked.

“Yeah?” He ripped open a blood pressure cuff and strapped it around Sophia's arm.

“How bad is it?” she asked, turning hard right to zip down Main Street. Minutes later she rolled over the last bridge. Ahead lay a dozen miles of twisting blacktop to reach Sistersville.

Ian didn't answer for a long time, his hands busy pumping the blood pressure bulb. At last he spoke up, his voice subdued. “It's serious, Laura Ann. Might be preeclampsia.” He paused to take the numbers. “With this blood pressure, they're both in danger.”

“Be more specific,” she demanded, stomping on the accelerator when the road straightened. “How bad?”

Ian cleared his throat, pumping the blood pressure bulb again. He took a long deep breath, then answered.

“Just pray.”

Vinyl and linoleum. The pervasive odor of plastic overwhelmed her. Alone in the guest area of Sistersville's tiny emergency room, Laura Ann huddled in a green molded chair, forcing back nightmares of too many days in rooms just like this, only a year ago. The beginning of Daddy's quick slide from life.

“She's stable.” Ian dropped into the chair next to her.

Laura Ann grabbed at Ian's arm. Before she could speak, he answered her question. “Sophia's conscious, but it's more complicated than preeclampsia. The doctors improved her blood pressure with medication and they're getting some more tests now.”

His clenched jaw said more than his words. “Preeclampsia is a serious complication, Laura Ann. If her kidney function stabilizes, and they can keep her blood pressure down, she'll come through it fine. Untreated, it leads to serious trouble for her and the baby.”

Her eyes grew wet with more questions.

“Possibly — a premature birth.” He bit his lip, looking away for a moment. “There's an expert in Wheeling. They'll transfer her there soon.”

Laura Ann nodded, crossing her arms against the chill of the room and wet clothes. Like a human blanket, Ian wrapped his arms around her.

Her shivers became his.

C
HAPTER 19

J
UNE 29

“Insurance card and identification,” an attendant said the next morning, with a brief glance to acknowledge Laura Ann's presence. The woman slid a pile of papers into a double-pocketed folder labeled “Wheeling General Hospital” and pushed it under the glass divider in Laura Ann's direction. Her second hospital in as many days. A clear wall separated them, the woman on one side alive in a world of databases and bills. The patient's representative on the other, wading through the pain of life.

“It's not for me. I mean …,” Laura Ann said, handing across Sophia's driver's license and an insurance card she'd fished out of her friend's purse. “Sophia lives in Pittsburgh.”

The administrative assistant nodded, typing in data she gleaned from the cards. “Anyone to sign for her?” she asked a few minutes later. “Any family?”

Family?

Laura Ann froze, unsure how to respond. Her flesh and blood grew inside Sophia, yet no one could know. Sophia was family, but how to describe it?

“We're sisters,” Laura Ann said at last, looking down. Was it a lie? A falsehood would telegraph itself across her face like white
chalk on a black slate. She looked away. More than sisters, they were bound by the same blood shared across the tenuous border of a womb, Laura Ann's DNA circulating inside her friend's body.

Sisters in a strange and yet wonderful way.

“Sign here. And here.” And in another six places, signatures promising money from Sophia, bills that Laura Ann could never pay. Copies of papers just like those she'd signed for Daddy in his first visit to Sistersville's ER, the genesis of the iron shackles that bound her in a seven-year mortgage. Steps on the path that brought her to this very day.

Hours later Laura Ann trembled in the chill of air conditioning. Attendants and nurses scurried about clad in long sleeves, some in sweaters. Outside, the world sweltered.

She shut her eyes against brilliant lights and dog-eared magazines. A soap opera droned on across the room. A motley group of parents and children surrounded her, old and young, heavy and thin, all dressed like they'd quit something mundane to run to the ER with a loved one. People here were dressed for living, not for going out.

Her hands twitched, desperate to be at work, or to cradle a book. She yearned for something to fill the time while Sophia slept. Minutes here melted into hours, bound together by the fabric of whispered prayers. She stood up at last, determined to escape.

“I'm here with Sophia McQuistion,” she said to a nurse at the front desk. “I need to step out for a moment. To knock off the chill. If there's any news …”

The nurse nodded and smiled. “You go on. I'll have someone

come get you. And after you deal with those goose bumps, come see me. I'll get you something warm.”

Sunshine beckoned, beaming through the automatic doors of the exit. Outside, she strode fast to the other side of the parking lot, reveling in the warmth and fresh air, welcoming the clutches of a humid day.

At the end of the lot, a rapid
tat tat da tat
drew her attention. Ian wheeled his truck around the curve of the emergency entrance and tapped on the horn one more time in response to her wave. A special delight on this bitter day, Granny Apple sat in the seat beside him. She'd come!

“Heard you needed some help,” Granny Apple said a minute later when Laura Ann met the truck in the lot. She gathered Laura Ann in the wiry grip of thin arms. “Any word?” she asked as she pulled away.

“More tests,” Laura Ann said. “The doctors promised some answers, but I've been here what—four hours?”

Ian squeezed her hand. “It takes time. She's in good hands. Her doctor's the best obstetrician in the valley.”

“All the same, I'd like to find out more about her. And the baby.”

At that last word, Granny Apple's brow scrunched down a bit, her grey eyes peering deep into Laura Ann's words with a keen insight. Laura Ann spoke the word like a mother would, a nuance Ian might have missed, but one that scarce escaped Granny Apple. Her friend could read an entire story into those two syllables.

Baby.

Granny Apple touched her on the arm just above the elbow, and then smiled. “Let's go get some news.” Together they headed back into the waiting room.

While Ian went to the desk to get news and borrow a wrap

for Laura Ann, she sat with Granny Apple as far as possible from the incessant drone of television.

“She's the woman I saw in your truck the day of the flood?” Granny Apple asked, probing around the edges of Laura Ann's story. She prodded gently, but with a sure stick.

Laura Ann nodded. “Her name is Sophia McQuistion. She's from Pittsburgh.” She hesitated, fearful that her mentor would eventually pry the story free — but determined that she would not. “Sophia couldn't leave because of the crossing.”

Granny Apple laid a hand on Laura Ann's and squeezed it. “She must be a dear friend,” she said with emphasis, squeezing a second time. “You're going to need a little help if you'll be staying up here a spell.”

Laura Ann turned to face her, greeted by an accepting smile and a knowing nod. A woman with the gift of helps. “I came with Ian to let you know that we'll take care of the farm. If it don't rain, water will be low enough in another couple of days to wade across at the old causeway. I'll wander over and check on things every day.” Decked out in white button-up shirt, white jeans, and white cotton shoes, she reminded Laura Ann of an angel with wrinkles. She patted her on the knee. “Ian went to the farm, by the way. Got some of your things. Just in case.”

“Thank you. I don't know how long this will take.”

“Yes, you do.” Her visage darkened. “From what Ian told me, this sounds real serious. Sophia needs to rest and hold that little bun in her oven. She's what … seven months?”

Laura Ann nodded.

“It's too early. We need her to get to thirty-one weeks. More is better. And it's too early to be fighting toxemia. Later in her pregnancy, perhaps, but not now.”

Granny Apple knew mothers. A midwife in her early years, she'd counseled many young women on the brink of motherhood. Some guessed she'd delivered two hundred babies in her day. Others said twice that many. Every family on the Middle

Island Creek had at least one relative who met their first day arriving in her hands.

“I — I don't know how I can stay here that long,” Laura Ann objected. “The bank …”

Granny Apple squeezed again. “Don't worry about the money, child. Ian and I have a plan.”

“A plan?” Laura Ann stammered.

Granny Apple nodded in silence. A smile played at the corner of her lips. “I'll let Ian tell you about it.” “I don't know how to thank you — “

“Don't have to. Just get your friend well and come back home. In the meantime, you'll need a place to stay. How about your cousin? Stefany.”

Mental images of Stefany on the television came to mind. Eight years older and working in a career wildly divergent from Laura Ann's, her third cousin lived in another world. Flashy red hair, a professional wardrobe, and an apartment in the city. Worlds away from the farm and their little valley.

“Ian got ahold of her. She left us a key. She's out of town reporting on the flood and not in her apartment much. Said it would be a big favor to have someone come and house-sit.”

Granny Apple stood, pulling at Laura Ann's hands. “Ian told me that Sophia doesn't have any kin. You need to be here for her, Laura Ann … and for her baby.” Her voice lowered in a special way like a momma's would, a tone that sang of her deep empathy for the maternal bond.

“Stay here for all your sakes, child. We'll care for things. As long as it takes.”

“This is Dr. Murphy,” Ian said, introducing a middle-aged man in green surgical scrubs when he entered the waiting area. Laura Ann's eyes went immediately to the tiny splatters of red that

stained the front of his operating outfit. Tufts of brown and grey poked out from under a tight cotton cap, and a wrinkled mask hung about his neck. He wore green pull-on shoe-covers, like he'd just emerged an operation.

“My pleasure. Ms. McQuistion mentioned that you're sisters?” he said, extending a hand. His eyes wandered up and down Laura Ann, the keen eye of a physician on the hunt for trouble. Her lie had found her out.

Ian cocked his head, an eyebrow raised. Laura Ann looked from the doctor to Granny Apple, expecting more inquisitive looks. Yet, with the knowing gaze of a woman who'd already heard every story a troubled girl could invent, she smiled, a wrinkled explosion of warm comfort. Granny Apple nodded, as if to say, “Go on. It will be fine.”

“We're
like
sisters,” Laura Ann protested, taking the doctor's grip in hers. She shook hard, determined to show strength.

Dr. Murphy shrugged. “That's funny. She was quite adamant about the family part. Anyway, I'm sorry to have been tied up in surgery. After I met with Ms. McQuistion, I was called away on emergency. Just now catching up.”

“How is she? Do you know what's wrong?” Laura Ann asked. The doctor launched into an explanation that she understood most of, but not all. Ian nodded as he listened, his frown deepening with each successive bit of news. At the words
heart disease
Laura Ann's own heart skipped a beat.

“Her heart damage is severe. It's a grave condition for any pregnant mother. Maternal mortality is high in these cases, usually around five to eight percent.”

Laura Ann watched Ian while she listened to the doctor. The color washed from Ian's face with that last comment. Confirmation of the doctor's message.

“I work with many mothers like Ms. McQuistion. We'll watch her closely. She has a mild impairment of exercise tolerance, which is why she ‘fell out,' as she said, when walking or
climbing stairs. Her history of chlamydia, combined with severe hypertension — high blood pressure — makes a premature birth and postpartum hemorrhage very likely.”

Granny Apple's eyes were affixed on the doctor, dissecting every word. Her own frown deepened with the words about premature birth. Like two bellwethers, Ian and Granny gave image to the criticality of Dr. Murphy's words. Laura Ann missed some of his prognosis, but caught the next words.

“… valvular lesions, mitral stenosis, and insufficiency. Her heart cannot pump enough blood for the two of them. We spoke at length about this. Ms. McQuistion was concerned about why her heart murmur hadn't been noticed in visits to her obstetrician. I explained that it's not unusual to have a murmur, and then lose it, during the course of the pregnancy. Shortness of breath is also not uncommon. A third of women with heart disease won't discover it until they're nearing term in a pregnancy. That's what's happened here.”

Words came and went, Laura Ann caught in a whirlwind of emotions, surrounded by the conversations that flowed between Ian, the doctor, and Granny Apple. Premature birth. Danger to the mother.

Morbidity.
A word she'd heard all too often in consultations with Daddy's oncologist.

“Yes. A caesarean section may be justified,” Dr. Murphy said to Granny Apple in response to her question. “Where there is significant heart disease — and where a long or difficult labor is expected — we'll do a caesarean to lessen the risk to the baby and the mother.”

“When?” Laura blurted the word, her only foothold in the technical discourse between the doctor and her close friends. “What about the baby?”

The doctor tilted his head a bit and seemed to shrug. “She's very much preterm. A premature birth at this point is probably out of the question. Lung problems, low birth weight. But

my main concern is with the mother, of course. Her well-being comes first,” he said, then added, “before the fetus.”

Fetus?

Laura Ann heard the rushing
whoosh
of blood in her ears, the pounding of her heart thrumming inside her head. She'd spent enough time in hospitals, and read enough articles in the paper, to decipher the unspoken message in his last word.

“I beg your pardon?” Laura Ann exclaimed, clenching her fists. The doctor clipped his next words.

“Women with her extent of heart disease, complicated by extreme hypertension, run a high risk of delivering a defective child born with a heart malfunction or other significant abnormality. One in ten mothers like her will die if not delivered soon. If I can save the life of one of them — the mother or the child — I am committed to save the mother first.”

“Surely there's some hope,” Ian blurted out. “What hope for the baby?”

“I'm sorry, sir. I'm a pragmatist.” Dr. Murphy took a deep breath, forming his words. “In cases like this one, where the heart disease and complications are so severe, there is
some
hope for the mother. But for
both?”
He shook his head, his eyes cast down. “The chances are very slim.”

The doctor left, and Laura Ann turned to Ian. “Let the baby die?” she cried out.

“That's not what the doctor said,” Ian insisted. “He's trying to save Sophia's life.”

“It
is
what he said. He told us the baby might have some kind of birth defect and there's little hope for him.”

“That might be what you heard, Laura Ann, but I'm sure it's not what he meant.”

“Now you're talking like an EMT, Ian. Why are we debating saving one or the other? What happened to saving both of them?”

“What Dr. Murphy said was that if we can save only one life — then it should be your friend. But remember, that's her decision.” He withdrew his hand. “Not our decision — and not yours.”

“Ian,” Granny Apple said, laying a hand on his shoulder. “Could you leave us alone for a while?”

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