The technician fiddled with the transducer, moved it higher, then to the left. She made a puzzled sound, to which Lily asked a worried, 'Can you not see the sex?'
The woman repositioned the transducer. Susan kept her eyes on the monitor but saw nothing recognizable.
'You sure you want to know?' the woman asked, and when Lily cried an excited yes, she said, 'See this?' She pointed to the screen. Susan squinted. 'If I were to guess, I'd say you have a little boy in here.'
A little boy. Not what Lily wanted. Susan looked at her daughter, and yes, those were tears in the girl's eyes, a brief 'Oh' of disappointment-then a brilliant smile.
'A boy,' she said, testing the word. 'That's okay, that's okay. Mary Kate will die. She wanted a boy until Jess and I bugged her so much she changed her mind. So much for having another generation of girls.'
If the remarks registered with the technician, she didn't comment. She was moving the transducer again, first one way, pressing a little, then another, and all the while her eyes were on the screen. She was looking for something.
'What do you see?' Susan finally asked.
'I'm not sure.'
Lily picked up on Susan's concern. 'Is something wrong?'
'I'm just trying to get another view,' the tech said, but her voice was hesitant.
'You're not sure it's a boy?'
Susan didn't think it was that. Her gut told her that the tech saw something else. 'What is it?' she asked.
Setting the transducer aside, the woman gave them a quick smile. 'It's likely just me. My eye isn't trained well enough. Let me get the radiologist. He'll know.'
As soon as the woman was gone, Lily turned large eyes on Susan. 'She's worried, but how can something be wrong? I mean, I'm young, I'm healthy, I feel great.'
Susan held her hand. 'Everything's probably fine, but the reason they do these sonograms is to detect even the smallest little thing.'
'Like what?'
'You'd know that more than me, sweetie. You're the one who's done all this research.'
'Down syndrome. But there are serious calculations involved, and she wasn't doing any, so maybe she saw something structural, but everything that was supposed to be there was there, wasn't it?'
'Absolutely,' Susan said. 'I'm sure it's nothing.'
'What if it isn't?'
'If it isn't, we'll deal.'
The technician returned with the radiologist, who introduced himself, then said calmly, 'Let's take a look,' and picked up the transducer. Susan studied the monitor, trying to decipher something, but all she could identify was that little heart beating what she thought was a totally normal beat.
Finally, the radiologist pointed at the screen. 'This is the baby's chest. I see the intestines,' he moved the tip of a pencil, 'and the kidneys, but they look to be outside the abdominal cavity.'
Lily's hand started to tremble. Holding it tighter, Susan asked, 'What does that mean?'
He moved the transducer again, but Susan couldn't see anything this time either. When he paused, he didn't look relieved. 'This isn't uncommon. It happens once in about every twenty-five hundred births. We call it a congenital diaphragmatic hernia.'
'Please explain,' Susan said, knowing Lily would ask if she'd been able to speak.
'The diaphragm is a muscle between the abdominal cavity and the chest. It forms at the eight-week point, but occasionally it has a hole. When that happens, organs that would normally be in the abdominal cavity are not.'
'His organs are outside his body?' Lily wailed.
'No. They're inside. They're just in the chest cavity, not the abdomen.'
'What does that mean?'
'It means that there's less room for the lungs to form, so one or both may not fully develop.'
'My baby will die?'
'No. There are different severities of CDH, and even for the most severe, the survival rate is continually getting better. But I don't know for sure that this is CDH. We'll know more in a few weeks.'
'Weeks?' If there was a problem, Susan wanted to
The doctor remained calm. 'The baby's in no immediate danger. Right now, it breathes through the placenta. Typically, we monitor the fetus to confirm its condition and see if it worsens.'
Lily started to cry.
Holding her, Susan said, 'We need to know more. If the baby does have this, how is it treated?'
'Surgery after birth. Depending on the severity as the fetus grows, prenatal surgery is even an option.' He spoke to Lily now. 'Like I said, your baby is in no imminent danger. We'll send the sonogram to your OB.' He checked the file. 'She'll take it from there.'
As soon as they reached the car, Susan called Dr. Brant, who suggested they come in on the way home. Lily was silent, pale, and frightened. The best Susan could do during the drive was to try to reassure her.
'Don't assume the worst, sweetie. The danger of early tests is that they can be wrong. It may be nothing.'
But Dr. Brant was concerned enough after talking with the radiologist to refer Lily to a high-risk obstetrician. The first appointment they could get was for the next morning, which meant a long night of worry. Mary Kate and Jess slept over, and Lily had told enough other friends she was having the sonogram that the phone wasn't quiet for long. When Lily couldn't bear talking about it anymore, the two other girls helped. Lily's sleeping. Everything's great. It's a boy!
Long after the girls turned off the lights, Susan was googling congenital diaphragmatic hernia, reading different accounts, alternately encouraged and discouraged. It was a case of a little information being dangerous, especially once her imagination kicked in. And she didn't know that the baby had this at all.
That was why she didn't call Rick. She had never called when Lily got a rash as a baby, not until the doctor knew what it was. If it turned out to be a heat rash, she didn't call him at all. That was what she wanted this scare to be-like a heat rash, gone by morning.
Jane LaBreia, the new doctor, was younger than Eileen Brant and had trained at Mass General. A small woman with short blond hair and a quiet manner, she was wonderful with Lily, for which Susan loved her. They had an instant rapport.
After examining Lily and studying the sonogram, she said, 'I agree with the diagnosis. What I see in these pictures is consistent with CDH, but there isn't much we can do right now. At week twenty, we'll do a level three ultrasound, which is a more in-depth version of what you had yesterday. If the diagnosis stands, it will tell us whether the baby's condition is getting worse. If we need an even better picture, we'll do an MRI.' Turning to Lily, she explained, 'When a fetus has CDH, we worry first about the lungs being too small to sustain breathing, and second about the heart. Right now, your baby's heart sounds strong and perfectly normal. We want to keep it that way.'
'How do you do that?' Lily asked in a weak voice.
'By monitoring it. If we hear stress and see the CDH worsening, we have choices.'
'What choices?'
'We can do nothing and let nature take its course. Or we can operate.'
Let nature take its course. Susan knew that meant letting the baby die at birth, but of course there was another option. The pregnancy could be terminated now.
Mercifully, Lily had glommed on to the doctor's last option. 'You'd operate before the baby's born?'
'We would. There are new, minimally invasive procedures. The results have been stunning.'
'But there's a risk.'
'Any surgery involves risk, but that's what pediatric specialists are for.'
'My baby could still die.'
'The chances of that are less likely today than they were five years ago. You should have a strong, healthy baby.'
Lily looked like she wanted to believe her but couldn't quite.
'Really,' the doctor insisted gently and said, 'I recommend amniocentesis. The more information we have, the
