Chapter One

As the doors of Virginia Commonwealth University Medical Center slid open in front of Alison Reynolds, tension suffused her body. She’d never had a problem with hospitals until her best friend became a regular visitor to them. Now the smell of bleach and nitrile made her skin crawl and her heart ache. Worse yet, she had never been either a patient or a visitor here, and the lack of familiarity made her edgy. She had lived in Richmond most of her adult life, but never had a reason to come into VCU’s hospital. It was the big one. The one where they took gunshots and major accidents. The one where people came to die.

Alison shook the thought from her head. It brought up too many ghosts. She needed to be in a positive frame of mind when she got to Beth’s room. Her best friend had always been able to read her like a book. Whatever mood she arrived with today would immediately show. She needed to be happy. Or at least not scared.

She made for the information desk near the bank of elevators. At most hospitals, an elderly volunteer with a wide smile but little actual information to impart would occupy this space. Instead, she found a harassed-looking, middle-aged African-American woman finishing a phone call. Alison took up a position directly in front of her and waited, scanning the lobby and trying not to tap her nails on the stone countertop.

It was the middle of the day, and there were a fair number of people around. Alison caught her reflection in the tinted glass partition to her left and looked quickly away. She knew she didn’t look her best today, but she wasn’t keen on seeing the evidence. Her sleep had been fitful ever since Beth announced her most recent pregnancy. The bags under her eyes, only barely camouflaged by her simple makeup, were proof. Unfortunately, her best features were round brown eyes and high cheekbones, neither of which she could highlight in her present state. Now all she had to work with were thin lips, a long, arrow-straight nose, and a rounded jaw that at least kept her looking young. She wore her hair long and the thick, dark curls paired with the cheekbones drew a lot of comparisons to Julianna Margulies.

“Thank you for your patience, ma’am. How may I help you today?”

The woman at the information desk looked up at her with a warm smile. Almost as surprising as her kindness was her ability to give Alison detailed directions. More than one hospital in the area had left her frustrated and annoyed at the lack of knowledgeable staff. To find a person who could help her and do so pleasantly was a welcome surprise. She boarded an empty elevator, beginning to hope that this visit would go more smoothly than similar trips in the past.

Her hopes were dashed the minute the doors opened. The directions seemed relatively straightforward downstairs, but it didn’t take long to get herself hopelessly lost. All the hallways looked the same. When she peeked into open doorways, the rooms all looked the same too. She had a room number, but the numbering system did not appear to follow any logical order. Then she turned a corner and the numbers suddenly had letters behind them. She tried to retrace her steps, but found herself in an open lobby she had never seen before.

A high counter ran around a central bank of desks and computers. She assumed that this was the unit nurses station, having seen similar setups before. Unfortunately, it was currently abandoned. The omnipresent beeps and tones announced themselves to a slew of empty chairs. Further along the hall stood a pair of elevators that bore no resemblance to the ones she rode up. People in lab coats milled around in front of them, but, as she started to make her way toward them, an elevator arrived and they all disappeared onto it without noticing her. She sighed in frustration and turned, looking again for someone to help her. Around the corner of the nurses station was a bench against the wall. Someone sat on the bench.

The woman there looked like she might be in her mid to late thirties, but the way she dressed and carried herself were at odds with that age. She was slouched forward over a cell phone, typing away with her elbows on her knees. Her blue jeans were worn and form-fitting, and the sleeves of a black V-neck T-shirt were bunched up around well-toned shoulders, several inches of colorful tattoos visible beneath the left sleeve. She had golden yellow hair cut short on the sides, pulled into gelled spikes on top. It wasn’t quite a mohawk, but it belonged on one of Alison’s students, not an adult. She guessed this woman was a graduate student or perhaps one of the more punky bike messengers popular on this end of town. Her thumbs flew across the screen of her smartphone with a strength and confidence that suggested she worked with her hands a lot. Alison judged that she pretended to be a sculptor or a drummer or something equally unemployable when she wasn’t loitering in hospitals.

Alison turned away, trying to guess a direction based on the room numbers around her. She let out a long, frustrated breath.

“Can I help you find something?”

The voice was low and a little throaty, but with a cadence that exuded confidence. Alison turned. The woman stood, slipping the phone into the back pocket of her jeans with a motion that stretched the fabric of her T-shirt tight across her chest. Alison forced her gaze to the woman’s face. She wore a gleaming smile, showing off impossibly white teeth and shockingly green eyes. Had it not been for her growing annoyance, Alison would have allowed herself a long moment to appreciate the woman in front of her. Today she really didn’t have time.

“No. Thanks.”

The obvious chill of her tone did nothing to dissuade the stranger, who took a step forward, her thumbs hooked in her back pockets. “Are you sure? You look sorta lost.”

“I’m fine.” Alison bit off the words as she pulled out the scrap of paper where she’d scribbled down Beth’s room number. She looked at the hair spiking up a couple of inches over the woman’s head and said, “I think I know where I’m headed.”

She laughed and took a few steps forward, her hand outstretched. “If you let me see the room number, I can point you in the right direction. This place is a bit of a maze. Which unit are you looking for?”

Alison took a step back, her eyes flicking again to the woman’s hair. “Thank you. But again, I don’t need your help.”

Her smile widened. “A blow-drier and a lot of texturizing cream.”

“Excuse me?”

“It’s how I get my hair like this. It’s a lot of work, but I like it, so I put in the time. I assure you I don’t yank out any brain cells when I style it.”

“I’m sure you don’t, and if I were looking for directions to a tattoo parlor or a head shop, you’d be the first person I’d ask. Now, if you’d excuse me?”

The woman laughed, crossing her arms over her chest, but not budging. “That would be a bad idea. I’ve never gotten a tattoo here in Richmond and I haven’t smoked weed since undergrad. I can take a hint though. I was only trying to help, but I can see you’re set on finding your own way. Best of luck.”

She turned away just as a nearby door opened. A young man with a worried look on his face and a white lab coat in his hand hustled out of it.

“Doctor Baker! I’m so sorry! I think I got the stain out, but it’s still a little damp.”

She took the coat from him and slipped her arm through the sleeve. “Not a problem at all. I told you not to worry about it.”

“Oh no! I couldn’t let you walk around with a coffee stain on your coat. Especially when it was my clumsy fault it got there in the first place.” He headed behind the half-wall that separated him from the nurses station. “Should I call Antepartum and let them know you’re on your way?”

Her lab coat back on, the doctor started off down the hall Alison had come in from. “No need. Thanks!”

The young man turned to Alison and asked politely, “Can I help you, ma’am?”

Alison stared after the stranger’s retreating form. Antepartum was Beth’s unit and the annoying woman with the ridiculous hair said she was going there. And she was a doctor, no less. Alison turned back to the nurse. “I…No. Thank you. I know where to go.”

She waited a beat to let the doctor get some distance. She followed quietly and slowly, but she had the sense the woman knew she was there. Alison couldn’t take the thought of her smug smile when she caught Alison following. The very person from whom she’d refused help. Alison slowed to a crawl.

The slower pace gave her time to size up her quarry. Despite the coat’s billowing tails, it was cut well, accentuating the doctor’s broad shoulders and long legs, showing off a slim waist. The coat’s long arms covered the tattoos, and the jeans didn’t appear quite so unprofessional with square-toed black shoes. Most doctors wore business casual if they weren’t in scrubs. On closer inspection, this outfit appeared only slightly more casual than that. Take away the hair and tattoos, and she had the physique of a woman who could talk Alison into almost anything on the third date. Shame it was wasted on such an immature individual.

She turned a quick corner and was suddenly out of sight. Alison cursed for allowing herself to become distracted and hurried to follow. She sped around the corner and nearly slammed into the other woman. She was leaning against the wall, arms crossed, wearing the smirk Alison dreaded.

“I thought I was being followed,” she said good-naturedly.

Alison blushed. She smiled back, but she couldn’t think of anything to say to defend herself.

The doctor laughed and stood straight, holding out her hand. “Jess Baker.”

Alison took her hand and shook it. “Alison Reynolds.”

“Pleased to meet you Alison Reynolds.”

She tried not to notice the way her face heated up as the doctor’s smile widened. “Likewise.”

“Why don’t I show you the way to Antepartum?”

The walk wasn’t particularly long, but it was incredibly uncomfortable for Alison. She couldn’t help mulling over the things she said and the looks she gave to this woman before discovering she was a doctor. Every memory made her cringe. She had not been polite. The quip about the head shop seemed particularly rude in hindsight. She longed for them to arrive at their destination so that she could leave the doctor behind, never to see her again.

Dr. Baker seemed perfectly at ease. Neither smug nor offended, she walked with her hands in her pockets and her eyes straight ahead. They turned into a wide hallway clearly marked with the unit name. How, Alison thought, could she have missed the foot-high, brushed nickel sign earlier? She could only guess it was from being preoccupied with worry.

A man leaning against the doorframe with his back to them blocked the way ahead. He was shouting into his cell phone.

“No. You’re in the wrong place…I don’t know! I’m in Antepartum…This is where Kimberly is…She hasn’t had the baby…I know! Antepartum is for women who are just pregnant and Labor and Delivery is for women who are giving birth…I know it’s confusing, Mom. It’s like Latin or Greek or something, I don’t know…Just stay there, I’ll come get you and bring you here…Yeah, I’m headed there now…Look, it’s not my fault! How was I supposed to know? They should make the names more clear! Okay. Okay. Okay Mom!”

He spun around, banging hard into Alison’s shoulder as he passed without apologizing.

“I told you this place is a maze,” Dr. Baker said with a shrug. “Everyone gets lost in here at least once.”

Just ahead Alison finally saw the right room and decided it was time to make her graceful exit. She stopped, the doctor did as well. Turning with her most winning smile, she held out her hand.

“Well, thank you Doctor…Baker was it? Thank you for helping me navigate the maze. This is my stop.”

“Please call me Jess.” She smiled wide again, shaking Alison’s hand. Motioning toward the door, she continued, “I’m afraid you can’t get rid of me that easily. This is my stop too.”

“You mean you’re…”

“Ali? Is that you?”

It was Beth’s voice, and Alison clung to it like a lifeline.

The room was bright and airy despite the oversized hospital bed and equipment crammed into the small space. Beth looked right at home on the bed, at least a half dozen pillows propped up behind her. Her growing belly was just visible under the blanket.

Alison had met Beth when they were both four years old. Their families were members of the same church, and Alison could remember with perfect clarity the day that a chubby little girl with a pair of puffy pigtails and skin the color of milky hot chocolate plopped down next to her on the carpet in Sunday school and asked her name. She had maybe three tiny teeth still in place and immediately showed them off in a wide grin. Alison smiled back shyly and they had been inseparable ever since.

When Alison’s parents sent her to St. Catherine’s, the all-girls private Catholic school in town, Beth had sweet-talked her parents into sending her as well. When she had gone to University of Richmond, Beth leveraged a basketball scholarship to follow. When Beth chose Boston College for law school, Alison went to Harvard for her master’s degree and they picked an apartment halfway between campuses. Their only separation came when Alison studied in England, but Beth had made the transatlantic trip six times to visit even while studying for the bar and planning a wedding.

Alison all but sprinted to the bed and wrapped her friend in a hug. She tried not to let the worry lines show between her eyebrows when she drew back and perched on the edge of the mattress. She failed. Beth laughed, running her thumb over them to smooth them out.

Alison asked in a mock serious voice, “How’s the Jell-O?”

Beth shook her head. “Lime.”

“Blech! Inexcusable!”

“I know, right!” Beth looked over Alison’s shoulder and asked, “Would it be so hard for you people to stock cherry?”

Dr. Baker stood near the door. “We save the cherry for the visiting heads of state and celebrities.” She took a hesitant step in and continued, “If this is a bad time, I can come back.”

“No, Doctor, please stay. Stephen was just here.” Beth looked around the room as though she had misplaced her keys rather than her husband. “I’m sure he’ll be right back.”

“I’ve told you a thousand times to call me Jess.”

A voice from the hallway said, “Then you only have a thousand more to go before it sinks in.”

Stephen had to duck his head to enter the room. His blond hair was pulled back into a short ponytail that fell just to the collar of his shirt. As he stood to his full height of just over six and a half feet, he reached out to shake the doctor’s hand. “Sorry to keep you waiting, Jess.”

Stephen went straight to his wife’s side and kissed her cheek. He smiled at Alison before retreating behind Beth and fluffing her pillows.

Dr. Baker pulled a rolling stool closer to the bed. “It’s my fault. I had a run-in with a cup of coffee. Literally. Then I had to try and lose a tail.” She smiled at Alison again and continued, “I’m afraid I couldn’t shake her. She followed me here.”

Alison knew the color was rising in her cheeks and forced herself to look nowhere in particular. Stephen saved her. “It’s a good thing you brought her along. All of the decisions in this house go through Ali.”

He laughed when he said it, but his nonchalance immediately chafed Alison’s nerves. Stephen was a wonderful man and a doting husband, but she wished he would take life more seriously. He was a gifted landscaper and could be designing gardens for the governor if he had any ambition whatsoever. Instead, he made just enough money to contribute to the household expenses, and left work early every day to play with their two-year-old daughter.

“Well, then let’s get to it!” Dr. Baker’s entire aspect changed. Her eyes seemed to harden and a more neutral expression replaced the smile. “I’ve spoken to the Blood Bank. They’re putting in an order for the transfusion. It will take a little bit of preparation, and the OR isn’t available until tomorrow morning anyway. I was able to book it for ten o’clock.”

The nonchalance evaporated from Stephen’s voice. “How long will the transfusion take?”

“A couple of hours. Three at the most. After we’re done, there will be some minor testing. Beth, you’ll be under local anesthesia only. I’ll need you to keep me updated on how you’re feeling during and immediately after the procedure. You’re going to take an active part, but don’t worry, I’m going to talk you through everything.”

“Can I be in the room?” Stephen asked.

“Not for this one, Steve. I’m sorry. There will be a lot of movement in and out of the room, so we need to limit the number of bodies. Just as a safety precaution. I was able to get the operating theater, though, so you can watch the whole thing from box seats.”

Beth gripped Alison’s hand like a vise, but her voice was steady as she addressed the doctor. “Tell me again what happens if you miss the vein?”

Jess rolled forward a few inches, her voice smooth as silk. “If we can’t get to the umbilical vein for some reason, we can transfuse into his abdomen. He’ll still get the blood, we just won’t be able to give him as much. We might have to do a second procedure sooner than planned. Either way, he’ll get what he needs.”

All the organs in Alison’s body had turned to cubes of ice. “I’m sorry to interrupt. I know I’m coming late to the party here, but exactly how late am I? What procedure? What blood?”

She looked at Beth and didn’t even try to hide the worry. Her friend answered, “I’m sorry, Ali. It was just too much to tell you over the phone.”

There was a light tap at the door and a stocky woman rolling a cart full of supplies stepped in. “Good afternoon. I’m from the lab. Just here to draw some blood.”

“Yes. Thank you.” Dr. Baker turned to Beth and Stephen. “They have to do a lot of testing before the transfusion, so I’m going to get out of her way.”

Beth let go of Ali’s hand and grabbed the doctor’s. “Dr. Baker.”

“Jess.”

“Jess, would you mind explaining everything to Ali? It’s just so complicated, and she’ll have a lot of questions I know I won’t be able to answer.”

“Of course.” She said to Alison, “Why don’t we step outside and we can talk over in the waiting area?”

Beth eyed the needle being prepared with something akin to terror. She’d always been afraid of needles. Sometimes she even cried when she had blood drawn, or so she said. These days she preferred to lose her dignity not with Alison but only in the presence of her husband, so Alison couldn’t be sure. Stephen gave her a friendly wave and she followed Dr. Baker down the hall.

Waiting area was something of a grand name for the space. It was just an alcove with a couple of faded chairs jammed inside. She sat heavily in one of them, wanting to be back in Beth’s room talking to her instead of a stranger with a fauxhawk.

Dr. Baker sat down facing her. “Where should we start? How much do you know about Beth’s pregnancy issues?”

‘Issues’ was not exactly the word Alison expected from a doctor about her friend’s medical state. Her reply had a snap to it.

“I know she has a healthy daughter, but she’s had three miscarriages in the last two years. I know all of them were caused by her blood attacking the babies’ blood. For some reason Rhogam doesn’t help even though that’s what it is supposed to do. I know she’s been to five different doctors at three other hospitals and the last one told her she should just stop trying. And I know if you tell her that, you should prepare for her to get up and walk out of that room right now.”

Dr. Baker laughed and sat back in her chair. “Well I won’t tell her that. At least not yet.” She looked thoughtful for a moment before continuing, “I guess I should start by telling you why Rhogam isn’t helping her. Rhogam is a drug used for mothers whose Rh blood types don’t match their baby’s. Most people know blood types as their ABO type and their Rh type. For instance, my blood type is A positive. That means my ABO type is A and my Rh type is positive. Positive means Rh is present, negative means it isn’t. Follow me so far?”

Alison nodded.

“Beth is type B negative. Rh is not present in her blood, so her body will see Rh positive blood as foreign.”

“Exactly, so her blood can attack the baby’s because they’re different.”

“Yes it can.” Alison started to interrupt. She knew all of this, but Dr. Baker continued.

“Beth gives the baby blood while he is in the womb, and it sees his different blood. Her blood destroys his. That’s called hemolysis and it creates two big problems. The first is that baby doesn’t have enough blood to deliver oxygen and, second, the stuff inside a red blood cell is toxic if it gets out. When mom’s blood attacks baby’s blood we call it Hemolytic Disease of the Fetus or Newborn, and it can cause a miscarriage.”

Alison finally got her chance to speak. “Right, but that’s not what’s happening here. If it was, Rhogam would stop it.”

“Not necessarily. Rhogam isn’t perfect. It’s a drug. Like any drug, it doesn’t work on everyone. The last couple of doctors Beth went to believed that was the issue. That it wasn’t working because she’s unlucky. They were wrong. The issue here is not from Rh type, it’s from a different blood type. The mechanism is the same, but the culprit is different.”

Dr. Baker sat forward and spoke faster, warming to her explanation. “Most people think we have ABO and Rh and that’s it, but we actually have dozens of other blood groups. Almost everyone will go through life not knowing about them because they don’t usually affect us. The problem for Beth is not that she is Rh negative, but that she is Kell negative.”

“What is Kell?”

“Kell is another blood group. It works pretty much the same way Rh does. When a Kell negative mom has a baby with a Kell positive dad, there is the same danger of mismatched blood types as there is with Rh type.”

Alison tried to wrap her head around the new information. “Stephen is Kell positive?”

“He is. In fact, he’s a very rare type of Kell positive. It’s called the McLeod phenotype and it doesn’t always show up in standard testing.” She sat back again and sighed, sounding defeated. “After her last miscarriage, Beth showed a strong reaction to Kell so they checked Steve. It didn’t show up. I ordered the McLeod testing on a hunch and he has the markers for it.”

“Is that bad for him?”

“Not my area of expertise.” She moved on a little too quickly for Alison’s liking. “It wasn’t good for Ann Boleyn. It’s what got her killed.”

Alison squinted. “That’s not true. Ann Boleyn didn’t die from some blood thing. With all due respect, I’m a professor of history. Ann Boleyn was beheaded by her husband Henry VIII.”

It seemed impossible to wipe the smile off this woman’s face. She didn’t look at all perturbed by Alison correcting her. Instead, she laughed and said, “Very true. He beheaded her because she couldn’t provide him with a male heir. She had a daughter and then a string of miscarriages. He had her beheaded and tried for a son with Jane Seymour. Actually, all of his wives had issues with miscarriages. It’s just that Ann was the only one who got the chop for it. In any case, the evidence suggests he had McLeod and that’s why she kept miscarrying. So, it is what got her killed.”

Alison disliked the semantics of the argument, but the doctor’s knowledge impressed her enough to keep her silent.

“Enough history. What’s important right now is that Beth is going to have a hard time carrying any pregnancy to term. Her body is really good at attacking the Kell positive cells, and it is not something we can shut off. There is no Rhogam-type drug for it, so we have to treat the little guy’s HDFN.”

“And how are you planning to do that?”

“Aggressively.” She was all business again, the neutral expression firmly back in place. “For a start, Beth is on bed rest for the remainder of her pregnancy. It’s a significant period of time, but studies have shown that women on bed rest fare better in these cases. Second, we are going to have to take him early. I was hoping to get him to thirty-two weeks, but that is best-case scenario. Until we can deliver we focus on treatment through intrauterine exchange transfusions.”

The world slipped in a little at the edges as Alison focused on her words. “And what is that?”

“It’s a procedure that exchanges his blood, which Beth’s is attacking, with blood that she won’t attack. The problem, of course, is that he can’t exactly provide us with an IV site while he’s still in the womb. We use ultrasound to locate the umbilical vein, the main vein in the umbilical cord. We pass a needle through Beth’s abdomen, through the placenta and into the umbilical cord. When we hit that we pump in the good blood and hers backs off.”

Alison’s own blood thumped in her ears. It didn’t take medical knowledge to understand all of the ways that could go seriously wrong. The thought was terrifying.

Dr. Baker could see the fear in her eyes. “It sounds scary, I know.”

“It sounds insane!”

“It’s not that bad. And each time it gets easier.”

“Each time?” Alison stood, her anxiety compelling her legs to move. “How often do you have to do this?”

“As often as it takes. As long as the procedure remains safe. Problems can arise if we puncture the placenta too often. We’ll limit it to not more than once every week or two until we can deliver.”

“Once a week!” She walked to the other end of the hall, wrapped her arms around her stomach and walked back. Dr. Baker hadn’t moved. “Will it work?”

“It’s the best chance he’s got.”

“Will it work?”

Dr. Baker stood and faced her, her eyes full of regret. “I can’t answer that question. Not yet. I wish this were a TV show where I could tell you there will be a happy ending. I want their son to live. I want him to meet his sister. To play baseball and go trick-or-treating. Beth wants that too. She is strong and optimistic and, believe it or not, that helps. I can’t give you odds and I can’t give you promises. But if we don’t do this, I can tell you with a great deal of certainty what will happen.”

Tears filled Alison’s eyes and she looked away, gritting her teeth against them. She nodded and Dr. Baker took the hint, walking back to the nurses station. Alison stared at the chair she had been sitting in until her eyes were dry and she felt like she could go back into her best friend’s hospital room without losing her composure. It took a very long time.

Chapter Two

When Alison stepped back through the sliding doors into the sunshine, the streets of Richmond were buzzing with life. It was just after five o’clock. Businessmen and politicians heading home for dinner packed the sidewalks. She slipped into the crowd and immediately wished she hadn’t. She fell in step next to a tall, slim man wearing a three-piece suit and a leather messenger bag strapped across his chest, shouting into his cell phone. The crowd was too thick for her to step away from him, so she was forced, for the second time today, to deal with someone who annoyed her.

The State Capitol was just a block to the left, its emerald lawns and snow-white columns hidden by the façades of commerce, every other nearby building of the high-rise corporate office variety. Richmond’s downtown was a thriving business district and distinct from the other, more residential or cultural areas. The man walking beside Alison, yammering into his cell phone as if everyone else on the street cared what he had to say, was typical of the breed that plagued this part of the city.

Nearly every aspect of his appearance was a mark against him in Alison’s eyes. To start with, his suit fit too well. A well-tailored suit suggested a vanity she found particularly distasteful in men. Then to wear a messenger bag strapped across the chest of a suit he paid so much for was simply ridiculous. The suit cost more than his monthly mortgage payment. The bag was sure to destroy his jacket.

Then there was the massive, chunky watch that dangled loosely on his wrist. He’d spent hundreds of dollars on a watch and didn’t have the extra links taken out of the band. It suggested the casual sloppiness of wealth and privilege. It reminded Alison of her dad, who cared only about how to buy things, not how to maintain them. A car passed close to her, and the gust of wind sent a burst of the man’s cologne toward her. It was a sharp, chemical smell and he wore far too much of it. He let loose an obnoxious laugh at something he’d heard on his phone. The sharp pain that shot through Alison’s jaw was the only reason she stopped clenching her teeth. She hated people who laughed too loud. Mercifully, he turned down the next street and left her in relative peace. She focused on the city rather than the people in an attempt to relax.

The skyline of Richmond, Virginia had changed drastically in the decades that Alison lived here. It had become a lovely, complex mixture of the old and the new. Alison passed the new City Hall, a towering steel and glass structure that exuded modern confidence, and glanced across the busy street at the rugged stone exterior of Old City Hall. The building sat in stark contrast to the towers around it, and yet its dignity was unmistakable. The roughly carved gray stone was a testament to the deep roots of this place, the longevity and solidity that its existence represented mortared together and solid as the day it was first built. Alison loved how Richmond was constantly blending the old and the new, and most of that was due to the college whose hospital she had just left.

Virginia Commonwealth University had garnered some national fame in recent years thanks to the success of its men’s basketball team, but the real impact of the school was written in the skyline. The college had existed in some form or another in the center of this city for almost two hundred years. Since its inception, the medical college earned VCU its highest praise. As Alison turned with the majority of the crowd around her onto 8th Street, she wondered how many of them still called the hospital MCV, or Medical College of Virginia, as she did. The name had changed to VCU Medical Center around the turn of the 21st century, but these were a people famous for their reluctance to release the past. Whatever name people used, the hospital helped provide the funds to revitalize Richmond’s once struggling downtown.

The nineties had not been easy on the city. She’d witnessed it with the eyes of a teenager, and so hadn’t found the names for what happened to her beloved city until later. Recession and suburban flight had hit the downtown businesses hard. They shuttered their doors and jobs dried up. Crime soared and the homicide rate was staggering. Given the environment, most businesses fled to the surrounding counties along with their employees. The men in power suits surrounding her on the sidewalk had probably worked in office parks thirty miles west when they started their careers. Her father had been one of the lucky few who stayed, so Alison got to stay too.

Meanwhile, VCU quietly and cheaply bought up block after block of the decaying city. They ripped down old buildings and replaced them with shiny new classrooms, dorms and art galleries. With each new structure came new jobs, new income, and slowly but surely the recovery crept along. Residents had mixed feelings about the bulldozing, but their city flourished with its new face. Alison’s feelings were mixed too, so many historical places decimated, but her city was beautiful again. A new type of beautiful, but beautiful nonetheless. Love them or hate them for it, VCU had cleaned the place up. Corporations decided Richmond was worth taking a chance on again.

The crowd around her peeled off with each parking deck they passed, and the young began to mix among the old guard. Students from the medical college were leaving classes, heading for the shuttles that would take them to classes or coffee shops on the other side of campus. Alison arrived at a shuttle stop just in time to hop on with them. She scanned the card identifying her as a professor and entitling her to a free ride back to her side of campus. If traffic was fair, she would make it back in time to teach her last class of the day, a graduate seminar that should provide the academic distraction she craved.

VCU split its campus and its focus roughly evenly between medical education facilities downtown and the main campus a few miles west in The Fan and Museum Districts. Alison felt her comfort level rising with each block they traveled. As the shuttle left the medical college behind, it also left the world of wealth and privilege. The students on the medical side of campus tended to be clean-cut, exactly what you would expect from the next generation of doctors, dentists and nurses. The other side of Virginia Commonwealth was predominantly an arts college. Some of the arts were liberal, like the history classes she taught, but most were visual. The students there were more likely to have tattoos on their arms, piercings in their noses and paint stains on their jeans. Still, the campuses mixed freely, and she saw a good number of khakis mixed amongst the artfully ripped T-shirts as the bus slowed and dropped her off outside the Hibbs Building.

At a fresh-looking thirty-five years of age, Alison was young to judge too harshly, but still she had to hold back from rolling her eyes at some of the scene around her. She had never been the type to live too wild a life. She’d grown up on the wealthy side of middle class, and her parents made sure she and her two sisters wanted for nothing. They’d all gone to the best schools and were given every opportunity to succeed. Inevitably, her oldest sister left home in rebellion and her middle sister also resented the perceived interference of their parents. Being the youngest, Alison had the perspective to see her parents’ generosity and felt bound to honor it. The upshot was that though she lived a full, happy life, she’d never had time for wild and crazy. These kids knew nothing else. Half of them still looked hungover as they headed to dinner.

She pushed past a crowd of students leaving Hibbs and heading across the brick paved courtyard to the dining center directly opposite. This group was more her style. She recognized more than one student’s face and guessed they were, if not history majors, probably business or engineering. Something more intellectual and less dirty than artists. She may teach non-majors most of the time, but she was an academic and felt she fit the part. Her wardrobe was heavy on long, flowing skirts, tight-cabled sweaters and cotton blouses. When she branched out to wear slacks, she usually paired them with loafers. She made an effort to stay closer to the modern hippie look than, say, the uptight librarian, and succeeded more days than she failed.

Alison pushed through the door to her classroom just as the first students were arriving. As she settled herself at the teacher’s desk, her phone buzzed. It was a text message from Beth.

 

Stop worrying. Everything is going to be fine. Have a good class! See you tomorrow!

 

At least Beth still had optimism. After living this same nightmare with her best friend so many times, Alison felt like her store was completely empty.

Chapter Three

Stepping into the hallway, Alison pulled the door to Beth’s room shut behind her, careful to hold the handle down until it eased into the frame, pleased to hear only the faintest click. Beth had dropped off to sleep while they were chatting, and Alison didn’t want to wake her. She’d gone through a long afternoon of tests and waiting on tenterhooks. Alison wanted to be sure that she got enough rest.

“How’s our girl?”

Dr. Baker stood at the nurses station, scribbling a note into a green binder.

“I beg your pardon?”

Dr. Baker finished writing with a flourish and clicked her pen. She looked up with a warm smile. “Beth. How is she?”

“Haven’t you seen her today?”

She flipped the lid of the binder shut and dropped it onto the desk behind the counter. “Yes. I’m sure she told you everything went well in the OR this morning. I was with her until around noon when they moved her to the recovery room.”

“So you know how she is.”

She folded her arms and leaned against the counter. “There are things a patient will tell their family that she won’t tell her doctor.”

“We aren’t family.”

“That’s not how Beth and Stephen see it. Didn’t Stephen say that everything in their house goes through you?”

“Stephen is very proud of his little joke.” Alison shifted her bag a little higher on her shoulder. “I’m surprised you remember.”

“I’m a good listener.”

“I’m sure.” She peered down the hall, which was empty and quiet despite all of the occupied rooms. “Beth’s fine.”

“Glad to hear it. How are you?”

“Me? Why do you ask?”

“Because a high risk pregnancy is not an easy thing to deal with.” She pushed off the counter and stood straight as a rail. “It’s hard for mom and baby, but it’s just as hard for the family. It’s common to feel helpless and scared, but also like you’re not allowed to share it. I wanted to make sure you were okay.”

It occurred to Alison that Dr. Baker had seen how upset she was yesterday and must now think she was fragile. Or too involved in her friend’s life. “I’m fine.”

“You and Beth seem very close.”

Too involved, then. “We’ve been friends a long time.”

She was playing with the pen between her long fingers, clicking it open and shut. “It’s good that she has that kind of support. Beth is very special.”

Emotion piled up in Alison’s throat, and she swallowed hard against it. “Yes she is.”

“How did you meet?” She finally held the pen still. “If you don’t mind my asking.”

She did mind. She did not want to talk to this woman. She wanted to be at home on her couch with a very large glass of wine and a very soft pair of pajamas, but she felt the need to advocate for Beth.

“In Sunday school when we were too young to notice any differences between us. When we were old enough to notice, there weren’t any differences anymore.”

“That’s a lovely way of putting it.” She clipped the pen on her breast pocket and stuffed her hands into the pockets of her jeans. “So you’ve been friends ever since?”

“Ever since.”

“That’s rare. I don’t think I can even remember the names of anyone I met so young.”

Alison checked the hall again, it was still empty. “Yes, well, Beth isn’t easy to forget.”

“I can believe that.” Alison was raising her wrist to look at her watch, preparing her escape line, when Dr. Baker said suddenly, “What’s your number?”

“Excuse me?”

She pulled her phone from her lab coat, activating the screen as she spoke. “Your cell phone number. What is it? I have some links to some articles I want to send you.”

Alison pulled her phone from her purse, confusion more than anything else forcing her to comply. She brought up her number from the menu and handed the phone to Dr. Baker.

She handed it back almost immediately, typing furiously as she explained, “They’re just some websites that deal with Kell blood type and HDFN associated with it. I already gave them to Beth and Stephen. I thought you might want to check them out. You seem the sort who needs more information than I gave you yesterday. There’s not much medical jargon in them. I just thought it might help put your mind at ease to know more.”

Alison’s phone buzzed as she dropped it back into her purse. “Thank you.”

“Of course.”

She started down the hall, but stopped and turned. “It was kind of you to think of it.”

“Of course.”

Alison felt like there was more to say, but couldn’t think what, so she continued down the hall and out of the hospital.

Chapter Four

The sun was setting over downtown by the time Alison made it to the hospital the next day. As the sliding glass doors ticked open she was able to see, over the heads of the considerable crowd, the blond monolith that was Stephen. He was on his cell phone, pacing back and forth behind a pair of chairs in the lobby. His usual lazy smile carved a series of radiating lines on his heavily tanned cheeks like ripples from a stone dropped in a pond. Everything about Stephen screamed of the outdoors, from the year-round tan to the aroma of cut grass and sunshine that was as much a permanent part of him as his skin.

An older woman unwittingly stepped into the path of his pacing. She tottered for a moment from the collision, but he reached out and caught her elbow, sending her on her way with a smile to strengthen his silent apology. She smiled back, not the least upset by his carelessness. In fact, she moved with a lighter step than before. That had always been the greatest of Stephen’s gifts. He could charm anyone and everyone he met even for the briefest moment.

Alison could still remember the night she and Beth met him. They had been in Boston for almost a year, but had been so busy with their studies that they rarely left their ice-cold basement apartment. When they both ended up with a Friday night off, they decided to celebrate at the bar on the corner. Its thumping music had been a siren song for weeks. The little place turned out to be everything they wanted it to be. Low lighting, polished wood, reasonable prices and a high bistro table in a corner perfect for people watching. Alison had just broken up with a sweet guy who kissed like a malfunctioning vacuum cleaner and she had no interest in replacing him any time soon. She focused entirely on finding someone for Beth, who had been single for far too long.

Beth’s eyes scanned the crowd over her glass of chardonnay, and Alison noted that they kept going back to one particular table. So fixated on Beth was Stephen that he looked like he’d been punched in the face. Alison watched him for a good five minutes and swore he never blinked; he was staring at Beth so hard he didn’t notice his buddy elbowing him in the ribs.

“Will you go talk to that guy before he passes out? He looks seven feet tall at least. He’ll break something when he falls down.”

“What are you talking about? What guy?”

“The one you can’t keep your eyes off of.” Alison waved at him and he finally seemed to notice her next to Beth. “He’s been drooling into his beer since we walked in.”

He stood up.

“Don’t wave at him! Why did you do that? Now he’s coming over here!”

“Exactly! You’re welcome.”

He didn’t even spare Alison a glance before introducing himself to Beth. Neither of them noticed when she wandered off to the bar a few minutes after he sat down.

The next day when he called to ask Beth out to dinner she accepted, but almost immediately decided to cancel. She came up with a dozen excuses why she couldn’t go out with him and left Alison to say the real reason out loud.

“You aren’t canceling because you don’t like him. You’re canceling because you’re afraid you do like him. You think you’re probably going to fall for this white guy.”

Beth was less than willing to admit the truth, but Alison knew her too well to be fooled. She also knew better than to back down. So she pushed when Beth pulled and waited for her to accept the inevitable. When Beth grabbed the phone to actually cancel the date, Alison yanked the cord from the wall so hard that a little chunk of plaster came loose and rattled to the floor.

“Damn it Beth! You are going to go on that date!”

“Why do you care so much if I go out with this guy?”

“Because he’s perfect for you!” She brandished the frayed end of the phone cord at Beth in a way that would have been funny if the moment hadn’t been so emotionally charged. “Because he’s perfect and you have terrible taste in men. Because it doesn’t matter that he’s white, it matters that he makes you smile. And since you aren’t likely to find another decent guy any time soon, you’re going to go out with this one. You’re going to let yourself fall in love. I wanna dance at your wedding, Beth.”

That hadn’t ended the fight, but Alison had broken the phone so Beth couldn’t cancel the date. That one date was all it took. Alison danced at their wedding a few years later.

Watching him now, still alight with happiness despite the fact that his wife was essentially chained to a hospital bed for the foreseeable future and the baby she was carrying needed constant monitoring, she wondered if she had judged him a little too kindly back then. Alison shook herself, aware that fear and annoyance were erasing her charity.

Stephen turned again and this time he spotted Alison. He waved and ended the call.

“Ali!”

“Hello, Stephen. How’s Beth?”

“Good. I was just heading out to pick Rachel up for dinner.”

She knew from experience that he wasn’t likely to say more about Beth’s condition. He deferred to the doctors when it came to Beth’s health, and Alison had learned that pressing him was a waste of breath. She would have to get her information from the source. Right now, she had other concerns.

“Stephen, there’s something I wanted to talk to you about.”

“Uh-oh.” An exaggerated look of concern almost settled into place before his smile ruined it. “This sounds serious.”

“It is. I want to know more about this blood thing that you have.”

“The McLeod thing.” He waved his hand and the smile lines in his cheeks deepened. “It’s not a big deal.”

“You know, that’s what Beth’s doctor said too. The more I hear it, the less I believe it.” He didn’t offer up any information, so she continued, “I’m not letting it go, Stephen. How dangerous is this?”

“It’s not dangerous, Ali.” Staring into his eyes, she didn’t budge from where she stood. “Okay fine. If I tell you what I know will you let me go pick up my daughter?”

“I’ll consider it.”

“Fair enough,” he said with a deep chuckle. “So it’s a hereditary disorder called McLeod Syndrome. The same thing that gives me the Kell blood type causes it.”

“What does that mean? Is it a mutation or something?”

“I guess so.” He held up his hand at the look she gave him. “I’m not avoiding the question, I just don’t exactly understand. It’s sorta sciencey. There’s a specialist I’m going to see once life goes back to normal. All I really know is it can cause some issues later on.”

“What kind of issues?”

“Anemia, muscle pain, heart problems, and what one of the articles Jess gave me to read charmingly called ‘behavioral changes.’ Bottom line is my heart will give out at about the same time I go crazy.”

“Stephen, that’s not funny.”

“No it isn’t, but there’s nothing I can do about it.”

“Wait, you’re serious?”

“Yep. I might have a mild version of it with no problems at all. I might have a severe case and die five years after I develop symptoms, there’s no way to tell.”

“They can’t tell you how bad it is?”

“Nope. I just have to wait and see. I can drink my milk and eat my spinach, and it’ll still happen. So I’m just not going to worry about it.”

“Stephen…”

“Ali, look…” He sighed, glancing over her shoulder at the sliding glass doors and the sidewalk beyond them. “The articles said symptoms will appear in my fifties. I have twenty years before I have to worry about this thing. I’m not going to drive myself crazy.”

“Have you made an appointment with the specialist?”

“I already have a nagging wife to hassle me about that.”

“Have you made an appointment with the specialist?”

He put a hand heavily on her shoulder. “I promised Beth I’ll make an appointment as soon as she’s out of here with our son.”

Alison bit back the words she wanted to fling at him about his optimism. “Fine. Just know there will be two of us holding you to that.”

He laughed so loud a few people turned to look at him. Using the hand on her shoulder, he pulled her into a bone-crushing hug. The smell of grass and sunshine was there, but the antiseptic smells of the hospital nearly covered them. The mixture made Alison’s stomach turn. She wrapped her arms around his thick waist and held on tight. Part of her hoped that she could squeeze some of that positivity out for herself. But when she headed for the elevator, she didn’t feel any better.