Chapter 34 Shellfish

"Can you fix it like a zipper?" Ruby Galbraith asked. "Like, unzip it and zip it back?"

She sat on the edge of the exam table in my clinic room swinging her sneakers, the left one untied, a paper gown over her T-shirt and jeans because she had flatly refused to take the T-shirt off; it had a cartoon octopus on it, and the octopus was apparently non-negotiable. She was nine and small for nine, with a sharp chin and a brown ponytail and a faint blue tinge at the lips that her mother had stopped seeing, because she saw it every day.

"Sort of," I said. "I unzip you here." I ran a finger down my own breastbone, top to bottom. "Then I fix the door inside, and then I zip you back up. It's more sewing than zipping. I'm extremely good at sewing."

"Do you have a machine?"

"I do it by hand."

She thought that over. "That's worse."

"It's better. Machines make mistakes."

Her mother sat in the chair by the wall with the consent form on her knee, pinning its edges flat against the draft from the air vent. She had read it three times while I watched. On the back of her hand, in ballpoint, she had written *milk, eggs, R's shoes*, and I liked her for that at once.

On the light box behind me Ruby's echo glowed in black and white. Her mitral valve, the door between the two chambers on the left side of her heart, had been born with leaflets that didn't quite meet, and over nine years the leak had widened, until now every squeeze of her heart sent a jet of blood backward through the gap. Her heart had stretched to cope. It did not have much stretch left in it.

"The standard operation," I told her mother, "is to cut the valve out and put in a mechanical one. In a child that means blood thinners every day for the rest of her life, and because she's still growing she would outgrow the valve and need another operation, and probably another after that." I touched the screen. "Her own leaflets are thin, but they aren't hopeless. With the repair I do, I rebuild them, reshape what she has and set a ring round the base to hold it. If it works, she keeps her own valve and it grows with her, and she never needs a blood thinner."

"If it works."

"I've done it on more than a hundred and forty people. Twelve of them were children." I held her eyes. "It's a big operation, and I won't pretend otherwise. But I think it's the right one for Ruby, and I don't think anyone else in Massachusetts can do it."

Mrs. Galbraith looked down at the form, and then across at her daughter's swinging feet.

"Will I be awake?" Ruby asked me.

"No," I said. "I will. That's the deal."

Ruby weighed the deal and found it fair. "Okay. Can I bring a stuffed animal?"

"Into the operating room, no. Into the room before, yes."

"I don't have a good one. Mine's a giraffe and its neck's broken."

"I know someone with a shark," I said, before I had decided to say it. "I'll ask whether he's free on Monday."

Mrs. Galbraith signed. Her pen wobbled on the *G* and she went back over it.

---

I put Ruby down for Monday the eleventh, first case, OR 6, and walked the request to the scheduling desk myself, because I wanted the slot nailed down before the week filled up around it.

Kemp was there, leaning on the counter and initialing a stack of forms for the scheduler. When he saw me coming he straightened and arranged a smile.

"Dr. Fairley. Is that the Galbraith girl?"

"Monday."

"I saw the referral come through." He held out his hand, and I gave him the form, because he was still chief of my department and it needed his signature. He read it and signed with a quick, confident scrawl. "Pediatric. Ambitious."

"She needs it."

"Of course. Of course she does." He passed the form across the counter, then turned back to me and warmed his voice a degree. "Look, you've got a heavy week. Let me take the implant order off your plate. I'll put it through with the supplier myself, make sure the ring's on the shelf with her name on it by Friday. A courtesy. We haven't always seen eye to eye, I know that. Let me do this one thing."

He had offered me nothing before, not so much as the last chair at a meeting. But department chiefs signed off on implants every day of the week, and I had six cases between that afternoon and Monday, and standing at a scheduling desk with a nine-year-old's echo still playing behind my eyes I had no reason to think it was anything worse than a man trying to look gracious after a bad month.

"Thank you," I said. "I'll send you my measurements."

"Send them over. I'll take care of everything."

I sent them from my office twenty minutes later, before the day could bury them, in the same flat format I had used for every implant order since Zurich. *Patient: Galbraith, Ruby. Procedure: Fairley leaflet reconstruction, mitral. Annulus (transthoracic echo): 26 mm. Annuloplasty ring: 26, flexible, pediatric profile.* I had measured it twice off the echo before typing, because I always measure twice, and I copied Rosa, because Rosa liked to know what would be on her back table before anybody else in the building did.

Kemp answered inside a minute. *Received. Leave it with me.*

I closed the email and went to see my last patient of the morning.

---

Family Day at Bramport Harbor Day School began at two in the junior-K room, which had a rug printed with a map of the world, a wall of cubbies with every child's name on a paper fish, and twenty child-sized chairs set out in a semicircle for the grown-ups.

Rhys came.

I had told him on Monday in a two-line email, because the school's note said both parents were welcome and because I had decided that if I was letting him into their lives on my terms, then my terms had to stretch to this sort of thing. I hadn't expected him to come. At one fifty-eight he appeared in the doorway in a dark coat over a dark suit, plainly straight from some room with a long table in it, and stood there taking in the twenty small chairs.

Every parent in the room watched him take them in.

He took the one beside mine and sat. It was red plastic, built for a four-year-old, and he was six foot two, so his knees came up nearly to his chest; he folded his hands on top of them, kept his face perfectly composed, and fixed his eyes on the Atlantic Ocean at his feet, a man at a board meeting where the furniture had simply turned out smaller than advertised.

Across the semicircle sat Simone Dunmore, who had told another mother on the first day of term that she'd heard I tried to kill my husband's grandfather. She looked at him folded onto the red chair, then at me beside him. Then she turned to the window and studied the parking lot for a good while, though nothing in it was moving.

Zoe Frost clapped twice. "Okay, friends! Everybody find your spot!"

The children sat on the map. Pippa took Australia. Felix sat at the edge of the Atlantic, as close to his sister as he could get without being in Australia too.

"Today," said Zoe, "everybody's going to share a thing your family says. It can be something your grown-ups say a lot, or a song, or a joke, or a word only your family knows. Who wants to go first?"

They went round. A boy whose family said *Bless your heart* when they meant the exact opposite. A girl whose grandfather said *Holy mackerel*. Arlo Dunmore, whose family said *Use your inside voice*, which got a laugh from the parents and a long look from his mother. Two sisters sang a short song in Portuguese at top speed, and sat down glowing.

"Felix and Pippa?"

Felix had been sitting with his arms wrapped round his knees. Now he leaned over and put his mouth to Pippa's ear and whispered, and kept whispering, while she listened with her eyes on the ceiling and her lips moving along a half-second behind his.

Then she stood up.

She had Admiral clamped under one arm, a briefcase with fins. She walked out to roughly the middle of the Pacific, turned to face us in our little chairs, and waited with the complete calm of a person who has never in her life suspected that a room might not want to hear from her.

"This is from Grandma Helen," she said. "She's dead. But she told it to Mama, and Mama tells it to us, and Felix says I can do it because I'm louder."

Beside me the red chair creaked as Rhys shifted.

"Why," said Pippa, "won't lobsters share?"

She let it hang. She had Helen's timing; she had been born with it, and I had never had to teach her.

"Because they're *shellfish.*"

The room laughed, a good warm laugh with surprise in it, the sort you get when a four-year-old lands a pun. The Portuguese sisters didn't get it and laughed anyway. Zoe clapped. Arlo Dunmore said "Shell-*fish*" to himself in delight and toppled sideways onto Greenland.

Rhys didn't laugh.

I knew it before I turned my head. I felt it across the six inches between our two small chairs, a drop in the air, a door opened on a winter night. When I did look sideways the color was going out of him, and it went in the order I had watched a hundred times in trauma bays: the lips first, then the skin round the mouth gray-white, then the cheeks and the forehead, until he was the color of the paper fish on the cubbies and the hands on his knees had closed into fists.

He was looking at Pippa as if she had walked up out of the sea.

I made myself look away. I put my eyes on Zoe Frost, on her cardigan, on the name tag pinned to it in the shape of a star, and I kept them there.

Far back in me, a long way down in a place I kept shut, it was dark and bitterly cold and ice was ticking on the roof of an upturned car, and a boy's voice, thick with blood, was saying *Again. Tell it again.*

I realized I was humming. Under my breath, nearly without sound, as I hummed with my hands inside a chest. I let it go on.

Pippa bowed, which nobody had taught her either, and marched back to Australia and sat. Felix put his head on her shoulder.

"Thank you, Pippa! Thank you, Felix! That was a *great* joke," said Zoe, and turned to the next child, and Family Day carried on.

---

It finished at three with juice boxes and goldfish crackers, and the children ran to their cubbies to show off their paper fish. I helped Felix find his rain boots, which he had hung on the wrong hooks on purpose because the right hooks had a scratch on them he didn't care for, while Pippa explained sharks to the Portuguese sisters at a volume meant for the whole corridor. The hallway outside was a crush of small coats and backpacks and parents on phones.

I had Felix's boots in one hand and his jacket in the other when somebody took hold of my sleeve.

Not my arm. My sleeve: two fingers and a thumb on the cuff of my coat, the grip you'd use on the corner of a page you were afraid to turn.

I turned round. Rhys stood among the cubbies and the rain boots and the paper fish, too tall for the hallway, his face still that dreadful paper color, and he was looking at me as he had not managed to in all the time we were married, like a man who has just met a stranger and needs, very badly, to learn her name.

"Where," he said, "did she hear that joke?"