1

Lexie

When my landline rings at 2:00 a.m. on a Thursday morning, I know who’s at the other end of the line before I pick it up. Only one person in my life would call at that hour; the same person who wouldn’t hesitate to ask for something after two years of silence, the same person who wouldn’t give a single thought to the fact that I need to be at work by 8:00 a.m.

As I bring the handset to my ear, I brace myself for the one thing that contact with my little sister has brought me in recent years.

Chaos.

“Annie?”

“Lexie,” Annie’s voice breaks on a sob, “you have to help me—I think I’m dying.”

I sit up and push my hair out of my face. My fiancé, Sam, had been asleep on the bed beside me, but he sits up, too. I glance at him and see sleepy confusion cross his face. As a physician, I periodically have late-night calls regarding patient emergencies, but never via the landline. I’ve moved houses twice since I last spoke to Annie, but I’ve always made sure the same number followed me, just in case she wanted or needed to reconnect.

Now, here she is—and just like I always feared, she’s calling me because she’s got an emergency on her hands.

“What’s going on?” I ask.

“My head hurts so much and nothing helps the pain. I’m seeing double and my feet are swollen and…”

They are troubling symptoms, but as Annie speaks I recognize the slur that indicates she is high. Frustration floods me, and I sigh impatiently.

You’re thirty now, Annie. Are you ever going to grow up?

“Go to the hospital,” I say. I feel Sam stiffen on the bed beside me at the hard edge of my tone. He’s never heard me speak like that, and I turn toward him again, an apology in my gaze. It hurts me to be cold with Annie, it even hurts to recognize how only seconds into this phone call I’m already boiling up inside with impatience and frustration toward her. This is my baby sister. This is the same kid I shared a room with for our entire childhood, the same sweet nine-year-old who used to beg me to play “mommies and daddies” with her after our dad died.

But I’ve been dealing with her addiction for years, and even after a two-year break from the drama, the weariness returns as soon as she does. If this was a one-off, I’d probably panic and rush to her aid—but it’s not. I have lost count of Annie’s desperate 2:00 a.m. phone calls. I couldn’t even tally the times she has gotten herself into a hopeless situation and called me to find her a solution.

“Lexie, I can’t,” Annie chokes now. I wait, expecting some long-winded story about not having health insurance or having a warrant out for her arrest or something simpler like not even having a car, or having woken up from a binge to find herself lost. When the silence stretches, I know I need to end the call. I try to push the phone call to its inevitable conclusion as I prompt her, “Well?”

“Lexie, I’m pregnant. I can’t go to the hospital. I just can’t.”

I’ve been a GP for several years—I thought my poker face was pretty good, but I’m not prepared for this. I gasp and feel Sam’s gentle arm snake around my waist. He rests his chin on my shoulder, then presses a soft kiss against my cheek.

My first instinct is to assume Annie is lying. It wouldn’t be the first time, although she generally lies only for some financial or pharmaceutical payoff. The last vestiges of sleep clear from my brain and I quickly consider the situation. There is something different about this scenario. Annie isn’t asking me for money. She is asking for help.

“If you’re pregnant then those symptoms are even more troubling. You need to get to a hospital.”

Annie speaks again, her voice stronger and clearer. She is determined to make me understand, and there’s no way I can ignore her plea.

“If I go to the hospital, I’ll fail the drug test. I just can’t.”

I slide my legs over the edge of the bed, straighten my posture and take a deep breath. I’m immediately resigned to what this call is going to mean. Annie is back—this peaceful period of my life is over.

“Tell me where you are.”

Sam tries to convince me that there are smarter ways to approach this situation than jumping in the car myself.

“Just think about it for a second,” he says quietly. “This is the same sister who nearly got you fired two years ago, right?”

I bristle at his pointed tone, and I’m scowling as I reply,

“She needs me, Sam.”

“She needs medical help. And even if we go there right now, the best we can probably do for her is to call an ambulance anyway. So why don’t we just do that in the first place?”

“Because her situation is complicated and they won’t understand. If I go to her, I can talk sense into her. I know I can.”

There’s a hint of impatience in his eyes as he scans my face in the semidarkness, but then he sighs and throws back the covers on the bed.

“What are you doing?” I frown at him, and he walks briskly toward the wardrobe as he mutters, “I’m not letting you go to some trailer park by yourself at three o’clock in the morning.”

“But you have surgery all day tomorrow, Sam. This isn’t your problem.”

“Lexie, your problems are my problem now. I’ll be fine, and if I’m not, I’ll postpone the surgeries. If you’re going, I’m going, so either call an ambulance and get back into bed or let’s go.”

So I let him come with me, but even as he drives across the city, I feel anxiety grinding in my gut. Sam knows only the basics about Annie’s issues. He’s been supportive and understanding, but at the end of the day, he’s from one of those “old money” northeastern families; the biggest scandal in his entire lineage is his parents’ somewhat amicable divorce. And now, four months after our engagement, here he is looking for an obscure trailer park in the middle of the night, to give medical care to my pregnant, drug-addicted sister.

He hasn’t ever met Mom, and I’m not sure he ever will. I haven’t seen her myself for almost two decades—not since the day of my sixteenth birthday, when I walked out of the strict religious sect she moved Annie and me into after Dad’s death. We speak on the phone from time to time, despite that being against the rules of her community—since Annie and I turned our back on the sect, we’re dead to them. I hate calling her because I usually hang up feeling lonely. A call to Mom back in Illinois is like telephoning another planet. She’s so disconnected from my world, and I have completely rejected hers.

I try to keep an open mind as we drive. I don’t want to think the worst of Annie, but it seems like her situation has gone from bad to worse over the past two years. I think of her every day—but in my thoughts, she has lived a much healthier life than the one I fear I’m about to see. It was the only way I’d been able to deal with throwing her out of my house two years ago. I imagined that she was working somewhere—maybe writing again—maybe she has a nice little apartment, like the one she had in Chicago after she graduated. I pictured her dating and going out with friends and shopping for clothes at little boutiques. Annie always had such a beautiful sense of style, back when she cared about how she looked.

It’s well after 3:00 a.m. when we find the place. It’s an older-style trailer, and even in the semidarkness of the trailer park, there is no denying that Annie is somewhere near rock bottom. The trailer is falling to bits—one side is dented, as if it’s been in some kind of car accident, and there’s black tape holding a panel in place. There is an awning at the front, but the support beneath it is damaged, too, so one corner of the roof leans down toward the ground. Trash cans are stacked against it, each overflowing with waste so that a scattered carpet of filth rests over the ground beneath the awning. There’s a narrow path through that trash right to the front door, and inside the trailer, the soft yellow glow of a light beckons. As soon as the car pulls to a stop beside the awning I reach for the door handle, but before I can open it, Sam takes my other hand in his.

“If things are too messed up in there, we’re calling an ambulance and going home. Okay?”

“She’s harmless, Sam,” I promise him. “Annie is only a danger to herself.”

“I trust you,” he says. “That’s why we’re here. But there’s only so much we are going to be able to do for her without a hospital. If she has preeclampsia, we’ll need to force her to go. Right?”

“I know,” I say on a sigh. “Let’s just play it by ear, okay?”

As we walk toward the trailer, Sam walks so close to me that I can feel his breath on the back of my neck. The door swings slowly open and then Annie is there.

Once upon a time, I was so jealous of her beautiful blond hair and her bright blue eyes, and those delicate, elfin features. The woman who stands before me now is nothing more than a shadow of my beautiful sister. The blond hair is now wiry and thin and hangs around her face in matted tendrils. Her eyes are sunken, her skin sallow; and through her parted lips I see the telltale black marks of rot on the edges of her front teeth. My eyes drift downward, and I take in the jutting ball of her bump—a horrifying contrast to her otherwise skeletal frame.

I’m not seeing my sister—I’m seeing a wasteland after war. If I wasn’t so desperate to help her I might turn away and sob.

“Thanks for coming,” Annie says. Now that I can actually see her, I identify a quality in her voice that had eluded me over the phone. Yes, she is weary. Yes, she is scared. Yes, she is tired…but more than all that, Annie is broken. She has called me because she had exhausted all other options.

I climb up the stairs and duck to step inside Annie’s trailer. I see the unmade bed, the old-style TV, the vinyl-clad table. Every single surface is littered with trash, but there are piles of books haphazardly stacked among the mess. Annie was an English major. She worked for a children’s book publisher and she had some short stories published in magazines. At one stage, she was even working on a book of her own. It’s heartbreaking to see the books in this place—the one throwback to the life she has lost.

“Who is this?” Annie asks, and she nods toward Sam. He is a big man, a broad man, and he looks so cramped in this tiny trailer. He has to bow his head to stand. As I look between Sam and Annie, I can barely believe that both of these people are now technically my family. They couldn’t be more different.

“This is Sam,” I murmur. “He’s my fiancé. He’s a doctor, too.”

“Of course he is.” Annie sinks onto the bed and shoots me a withering look. “Only the best for our Lexie.”

“Do you want help, or not?” Sam says, before I can respond. Rather than feeling pleased for his automatic defense of me, I feel instant and bewildering irritation. Annie is startled by his short tone. Her gaze snaps from my face to his, and then color floods her starkly white cheeks until she looks feverish.

She doesn’t answer Sam—instead, she rubs her belly gently with her palms and she lifts her legs up onto the bed. My gaze zeros in on her monstrously bloated feet; swollen to nearly double their normal size, the skin pitted around her ankles. I was already nervous for Annie—but my heart sinks at the sight of those feet. I scan my eyes over her body and survey her belly.

“How many months?” I ask. It’s difficult to assess how far into the pregnancy she is because her bump is tiny, but then again, so is she. I’m collating a mental catalog of what I know of heroin use in pregnancy, assuming that’s the drug she still favors. If she’s been using for the whole pregnancy, the baby’s growth may have suffered.

“I think I’m due soon,” Annie says. “I haven’t seen a doctor.”

“Not at all?” I wince as the judgmental words leave my mouth to hang in the room between us. Annie’s eyes plead with me to understand—as if I could, as if there is any excuse for what she’s just told me. After a fraught pause, she shakes her head, and a tear drains out of the corner of her eye to run over her weathered cheek. She wraps her arms around her bump protectively, but when she looks at me, her guilt is palpable.

I approach the bed and motion toward Sam, indicating that he should pass me the medical kit he’s carrying. His hand descends upon my shoulder, and he gently steers me toward the cracked vinyl chair that runs alongside the small dining table.

“I’ll assess her,” he says. His tone is gentle, but the words are firm. I shake my head, and Sam’s gaze sharpens. “She’s your sister. You need to let me do this.”

I open my mouth to protest, but Sam isn’t going to back down, so I sigh and sit slowly. At the last minute, the urge to care for Annie myself surges again and I straighten and shake my head.

“She is my sister, Sam,” I say. “That’s why I should be the one to assess her.”

Sam doesn’t budge, and his gaze doesn’t waver.

“You know as well as I do that you’re too close. You can’t possibly make an impartial assessment here—your judgment will be clouded.” Sam’s gaze becomes pleading. “Lexie, please. Let me do this.”

I sit, but as I do, my fingers twitch against my thighs and my foot taps against the floor of the trailer. The urge to take charge is so great that even my body is revolting. I’ve never been good at sitting back when a problem needed solving—particularly not when it came to my family. The only thing that stops me from pushing him aside and reviewing her condition myself is that he’s right—I’m far too close to this situation to remain objective. Besides, this is Sam, the person I trust more than anyone else in the world.

He sits on the bed beside Annie and withdraws a digital blood pressure machine from his pack. After he fixes it to her arm, he offers her a reassuring smile.

“Can you tell us a bit about what’s going on?”

“I started getting headaches last week, but they’re getting worse. Tonight I couldn’t see…everything was doubled and blurry.”

Sam leans over and palpates Annie’s belly, then picks up his stethoscope and listens near her belly button. After a moment or two I see his shoulders relax just a little, and I know he’s found a heartbeat. He continues listening, and I’m desperate to know how stable the rhythm is.

“How long have your feet been like that?” I ask Annie.

“Maybe a week? I’m not sure…” The digital machine beeps several times to indicate a problem. I lean forward and am not surprised to see the numbers flash on the screen: 160/120. Annie and the baby are definitely in trouble. I fumble for my phone—do I call an ambulance? Sam doesn’t seem to be panicking, and perhaps I wouldn’t be either if Annie were a patient who had walked into my office, but right now I’m simply a terrified sister.

“Has the baby been moving, Annie?” Sam asks, as he rises away from her belly.

“I think so…?”

Sam turns to stare at me. Our eyes lock.

“Annie,” I say gently. “We have to get you to a hospital. Now.”

“Lexie, I can’t,” Annie chokes. “My friend failed a drug test last year and they took her baby. Her son went into foster care, and she never got him back. I can’t let that happen to my baby. I just can’t.”

I want to point out the dozens of reasons why she shouldn’t be allowed to bring a baby home to this place at all, especially given her current state of mind. The mess of her life could not be more evident, but those shockingly high numbers on the BP machine are burnt into the forefront of my thoughts. Annie needs urgent medical attention. This is not the time to lecture her about her addiction or her suitability as a parent. This is the time to persuade her, and I have to tread lightly.

But despite this, I know that Annie is probably right about the drug test. If she fails a narcotics test, it’s quite likely she’ll be charged with chemically endangering a child—and that’s a felony in Alabama. I’ve never had it happen to a patient personally, but I’ve heard of several cases in the media.

We’ll cross that bridge when we come to it—the immediate need is to get her to a hospital to push anti-hypertension drugs into her system to bring her blood pressure down. Plus, that baby needs urgent monitoring—proper monitoring, not the very limited heart-rate check we can do here—and if we don’t move fast, there might not even be a baby to save. I don’t want to tell Annie this—in part because I don’t want to stress her further and push her blood pressure even higher. But if explaining the immediate threat to her baby’s health is off the table, I don’t know what I’ll say to convince her. I’m relieved when Sam rescues me.

“Annie, I know this is hard. But your condition is very poor, and the baby is in serious danger. There is only so much Lexie and I can do for you here. We’ll take you to my hospital, and I promise you—you’ll get the very best medical care possible.”

“But I’ll be arrested,” Annie says. She wraps her arms around her belly again and shakes her head. “I can’t. I just can’t.”

“I won’t let that happen,” I promise her. I have no idea if that’s true, but I’m so desperate that I’ll say pretty much anything to get her to the hospital. Annie slowly raises her eyes toward me. There is both fear and hope in her gaze—but suddenly I don’t see her haggard appearance or the pitiful trailer.

I just see my baby sister—the little girl who used to see the world as a place of wonder, a child of limitless creativity and potential. I see her sitting frozen under the tree in our front yard, holding my hand with a death grip as we watched the procession of mourners stream into our house after Dad’s funeral—trusting me to take care of her, just as I’d always promised Dad I would.

I see the child who faced our childhood with courage, the child with a simple optimism and faith that we’d make it through together. I see the girl with an innate sense of fairness who rallied and fought against the rules of our strict childhood home, and then the determined young woman who marched right on out of there when she could take it no longer.

Creativity, passion, courage, optimism—in this moment, I see only the essence of who Annie really is. Suddenly she is not an addict or a potential criminal, not even a somewhat negligent soon-to-be mother—she is simply my Annie, and she is sick, and she needs my support.

Maybe this is the moment when it all turns around.

“You promise it will be okay?” she chokes.

I lean over and I take her hand in mine, and I squeeze it hard. Is this going to haunt me? Perhaps—but I can imagine a worse fate.

“I promise you.”