My family Chose My Foster Sister, Then I Died

By the time I was diagnosed with end-stage heart failure, UNOS had finally matched me with a donor heart. My foster sister Isabella had the same condition, but no donor heart had been found for her. My family had heard somewhere that if I signed a voluntary waiver giving up the transplant, the heart would go straight to her. For three straight months, my parents refused to pay a cent toward my care to pressure me into signing. They told anyone who would listen that their own daughter was selfish enough to take away her sister's only chance to live. My older brother Howard came to my room and tossed the waiver onto my bed. "Isabella just got into a top university. She has her whole future ahead of her. "You already have severe drug allergies. Even with that heart, rejection could kill you at any time." Before he could finish, Isabella ran in sobbing, threw herself into his arms, and demanded to know if I had to step over her dead body just to stay alive. Howard patted her back gently. He had once nearly died carrying me out of a fire. Afterward, he cried and swore he would never let me die before he did. Now all he ever did was look at me with those cold blue eyes. My hand shook when I picked up the pen. "All right, Howard. "I'll sign it." Chapter 1 "Done." I threw the pen onto the nightstand. Howard immediately took the waiver from me. He ran his thumb over my signature twice to make sure the ink hadn't smeared, then slid the page into the inside pocket of his suit. My mother took Isabella's arm and led her out. Just before the door closed, Isabella looked back at me with red-rimmed eyes, her fingers clutching my mother's sleeve. Howard buttoned his jacket, and his voice softened. "That's better. Once Isabella recovers, I'll take you to Europe for a change of scenery. My treat." He said something like that the first Christmas after the fire. I was in an isolation room. He held a travel brochure against the glass, pointed to the Swiss mountains, and promised to take me there once I got better. I read that brochure until the corners curled. The trip never happened. Not once. He was at the door when I stopped him. "Do you still remember that Switzerland brochure?" His hand stopped on the handle. "That was a lifetime ago. Why bring it up now?" I looked at the bulge in his jacket. My waiver was in there. So was the promise he had just made me. "Nothing. You owe me enough already. Maybe stop making promises." Isabella called softly for him from the hallway. Howard swallowed hard, then left. My attending physician, Dr. Smith, came in carrying my test results and passed Howard in the doorway. He glanced over his shoulder at Howard, then hurried to my bed and slapped the results down on the table. "Anna, have you lost your mind? You're already in critical condition. Do you know what turning down that transplant means?" I asked, "How long do I have?" "Four weeks at most." Dr. Smith pulled over a chair and sat down, lowering his voice. "If acute heart failure sets in, you may not make it a week. The chances of finding another match are almost zero." "I didn't want to give it up." I closed my eyes. "They were just never going to choose me." Cheers erupted in the hallway. My mother was crying with joy. My father was on the phone with the best rehabilitation center in Los Angeles. Howard stood outside my door, calming Isabella in a low, gentle voice. I heard every bit of it through the door, loud and joyful, as if they were celebrating a new life. I pulled out my phone. A GoFundMe link appeared on the screen: Save Our Angel Isabella. In the photo, Isabella leaned into Howard while my parents kissed her cheeks from either side. The description read: [Our little angel is about to begin a new life. Special thanks to her sister Anna, who has been her rock and given her endless support.] This rock couldn't get her own pain medication refilled. I asked a nurse to message Howard and see if he could cover my medical costs first. All I got was a one-line reply from his assistant. [Mr. Adams is occupied with Isabella's surgery at present. Please make your own arrangements for now.] The fundraiser's donor list showed that he had given Isabella fifty thousand dollars. Not long after, Isabella sent me a photo. She sat in her room in the hospital's private wing, with a specially prepared meal on the table. The cashmere wrap my mother had knitted was draped around her shoulders. [Thank you for letting me have it. I'll take this heart out into the world and see it all for you.] My chest suddenly tightened as I read it, and cold sweat soaked through my gown. Isabella's birth mother, Lucy, had died when she went back into the fire for the medication that kept me alive. At the funeral, my father promised in front of everyone that he would raise Isabella as his own daughter. From then on, whenever they could afford treatment for only one of us, they always stopped my medication. I turned the screen off. Four weeks left. This time, I supposed, I really was going to give Lucy back the life she'd paid for with her own. Chapter 10 The following winter, Howard went to Switzerland. He took very little with him. An old brochure and a leaf from a Shakespeare First Folio in a protective sleeve. It was the leaf I had circled in the auction catalog on my birthday. After the funeral, Howard himself removed it from the climate-controlled frame in Isabella's room. She stood in the doorway with her fingers tucked inside her sleeve. She opened her mouth but didn't dare stop him. His hands shook badly as he slid the leaf into the sleeve. He pressed the seal shut with his head bowed. His voice was so hoarse I could barely make out the words. "This was supposed to be Anna's." I don't need it now. The cable car ticket agent asked him, "How many?" Howard held the brochure against his chest and paused for two seconds. "Two." The agent looked at him but didn't ask why. He tore off two tickets. The car climbed slowly up the mountain. There was nothing but snow outside the glass. Howard sat by the window and put the brochure on the empty seat beside him. More than ten years earlier, he had held that same brochure against the glass of my isolation room, pointed to this very mountain, and told me, "When you're better, I'm taking you there." I never got better. And he never took me there. The wind at the top blew hard. He opened the brochure. All twelve of my notes were still there. He took out a pen and held it over the space after the final line for a long time. He didn't cross anything out or mark any of them paid. Then he put the pen back in his pocket. "Anna." The wind made his eyes red. "Your brother brought you here." He reached for the medal on his wrist. The cold had made the soldered joint in the chain brittle. With a faint snap, the chain broke. The medal dropped into the deep snow. Howard's expression changed. He dropped to his knees and began digging. He wasn't wearing gloves, and all ten fingers quickly reddened from the cold. As the hole deepened, the skin around his nails began to bleed, but he kept his head down and searched through the snow inch by inch. "Don't get lost. "I can't lose anything else." Somebody nearby came over to help. A few minutes later, Howard's fingers found the small medal in the snow. He closed his fist around it, leaving blood from his palm on the gold. He sat down in the snow with his head bowed, his shoulders slowly sagging. The chain had been repaired, but the mended spot was still its weakest point. Afterward, he placed the medal beside the brochure and never had the chain repaired again. Howard bought two tickets for the cable car ride down as well. He sat on one side. The seat beside him stayed empty for the entire ride. The old brochure lay still on the empty seat. The wind flipped it open to the mountain page, revealing the promise he had written as a boy. [When you get out, I'm taking you here.] Twelve years too late, he finally kept that promise. But from the top of the mountain to the bottom, there was no one beside him anymore to grin and remind him, "Howard, that's another one you owe me." Chapter 2 The next morning, two hospital administrators came in and immediately began taking the coats out of my closet. I pushed myself up on the edge of the bed, my arms trembling. "What are you doing?" The supervisor held out a tablet. "I'm sorry, Ms. Adams. Your private nursing care has been canceled, and you need to vacate the suite. We're moving you to a shared room on the seventh floor." I looked at the room transfer confirmation on the screen. My father's name appeared in the requester field. My mother came in with an insulated bag and stopped when she saw them packing. "Why so early? Wasn't the move this afternoon?" She made it sound as though she were asking on my behalf. She came quickly to the bed. "Why are you sitting up? Why do you look like that?" Her fingertip brushed the needle marks on the back of my hand, then pulled away. "Isabella's surgery is tomorrow. She cried all night. She says the regular rooms are too noisy, and she can't sleep." I looked at her. "So you want me to move out?" She didn't answer right away. She opened the insulated bag and took out a bowl. The scent of cream of mushroom soup drifted up. It had been my favorite when I was little. After my first heart surgery, I was in too much pain to eat. My mother blew on every spoonful, fed it to me, and said she would do anything if I would only take one sip. Now she held the spoon to my mouth, her voice still soft. "Have a little. You went all night without eating again, didn't you?" I didn't open my mouth. The spoon tapped the rim of the bowl several times. A flicker of pain crossed her eyes, then disappeared beneath her own distress. "Insurance doesn't cover a private room, and money is tight. Let her have this one. She's never had such a major operation before, and she's truly scared." "I was scared the first time I went into the ICU, too." I sniffled. "You held me all night and wouldn't let go. Do you remember?" Her hand froze in midair, and her eyes reddened. Then my father called. She listened for a few seconds before saying quietly, "I'm talking her into it. Isabella won't have to wait." After she hung up, she held out the spoon again. "Anna, don't put your mother in this position." I raised a hand and pushed it away. Her eyes filled with tears. Finally, she said in a low voice, "Anna, why do you always throw other people's kindness back in their faces? Lucy gave her life for you. She didn't do it so you could turn into this." She had brought up Lucy after all. I twisted the sheet in both fists. "Howard was the one who saved me. Lucy went back for the medication because you told her to. The fire killed her, not me!" Every bit of color went out of her face. A nurse wheeled me up to the seventh floor anyway. As we passed the private wing on the third floor, I saw that the door to Isabella's new room was open. Salmon-pink balloons hung throughout the room, and lead-gray wrapping paper was piled on the table. My father was opening an enormous package. Howard lifted the mounted vellum leaf out of the box. "Look at this, Isa. It's a leaf from Shakespeare's First Folio." He ruffled her hair. "For getting into Stanford." I had circled that same leaf in an auction catalog on my birthday last month. Howard had closed the catalog and said there was no point in a patient buying an antique they couldn't eat or use. Now the vellum was going into an expensive climate-controlled frame. Isabella put a hand over her mouth. "Howard, you're so good to me." Then she looked up, saw me, and grabbed his cuff. "Anna..." Howard turned and filled the doorway. "One look at you, and she thinks you're here to take something from her. Her surgery is tomorrow. Can't you let her have a few peaceful days?" The nurse lifted the transfer sheet. "Mr. Adams, this is the only route to the seventh floor." His gaze swept over the thin blanket covering my legs and the cardboard box, and his expression softened. He crouched and pulled the blanket higher around me. "I'm not throwing you out. There are more nurses on the seventh floor, so you'll be better cared for there. Isa's surgery is tomorrow, and she can't handle any more stress." As I watched him tuck the blanket around me, my throat tightened. "She can't handle any stress, so I get stuck in a drafty shared room?" His hands stopped. "You've always been able to handle more than she can." So in their eyes, the fact that I could endure more was somehow my fault, too. Before the door closed, I saw Isabella hug the vellum to her chest. It didn't matter. I was going to die soon anyway. Whether I fought for the room and the vellum or not, it would all end the same way. Chapter 3 The window in the seventh-floor room didn't seal properly, so gusts of cold air blew in. The patient in the next bed coughed all night. I curled up with one hand over my chest as the pain spread from beneath my breastbone into my back. Cold sweat plastered my gown to my skin. I pressed the call button for the third time that day. The night nurse checked the IV pump and opened the medication log. "Ms. Adams, the strong pain medication you've been paying for out of pocket has run out. "The pharmacy says there's no money left in your backup account to cover a refill, so they can't dispense any more. "The medication your insurance covers won't do much for you at this stage." I called my father with a shaking hand. "Dad, they've stopped my pain medication. There's no money left in the backup account." Silence stretched across the line for a few seconds. He lowered his voice. "Isa needs an anti-rejection drug after surgery. It costs thirty thousand dollars a dose. I moved the money out of your backup account. When the company has more cash, I'll put it back." "I need my pain medication. It hurts to breathe." He sighed. "Anna, how many years have you been taking medication? You always say it hurts, and you always get through it in the end. The pain medication only keeps you comfortable. Isabella needs the drug that keeps her alive!" "Mine keeps me alive, too." "You're not waiting for surgery anymore. You're only on maintenance medication!" His voice hardened. "This family can't keep burning through money like this! Take some over-the-counter painkillers, and don't turn the whole house upside down right before her surgery." I heard Isabella cough on the other end of the line. His voice softened immediately. "Isa? Where does it hurt? Don't be scared. Dad's here." Then he hung up on me. The nurse brought me the over-the-counter painkillers. I managed one sip of water before my stomach seized. I hung over the side of the bed and threw up for a long time, bringing up nothing but bile streaked with blood. Tears streaked my face. The pain kept me awake all night. Before Isabella came into this family, whenever I got this sick, my father, my mother, and my brother were all right there. So late that night, when Howard pushed the door open, I thought he had come to see me. But his gaze went straight to my neck. "Anna, let me borrow the medal." My hand went to my collar. "What for?" It was the St. Christopher medal my grandmother had left me. Whenever I was in the hospital as a child, she would press it into my palm and tell me it protected people who were lost or in danger. I had worn it ever since she died. "No." I closed my fist around it. Howard's tongue pressed against the inside of his cheek. "Isa's surgery is tomorrow. Lend her the medal so she can make it through safely. Anna, Lucy lost her life saving you. Can't you let her daughter have this one blessing?" I looked up at him, the taste of blood still rising in my throat. "She took my transplant. You stopped my medication. You took my room. And now you want the last thing my grandmother left me?" I hunched over on the bed, my shoulders shaking with the effort of each breath. "Howard, what else are you going to take from me?" He saw cold sweat beading along my neck and frowned. "Are you in a lot of pain right now?" I didn't answer. I only gripped the pendant harder. Isabella's tear-choked voice came through his phone. "Howard, did you get it? I really can't sleep." Howard closed his eyes and held my wrist down. "It's a necklace. Don't make me do this." I pulled back as hard as I could. The IV line went taut, and blood welled around the needle in my hand. "No!" He held my wrist down and pried my fingers open one by one. Clenching the medal in his fist, he spoke into the phone. "Isa, don't cry. I've got it. I'll be right there." The chain scraped across my palm as he pulled it away, and the pain nearly finished me. After he hung up, he pressed his lips together and reached out to touch the top of my head, then slowly drew his hand back. "If the over-the-counter painkillers aren't enough, have the nurse give you another dose." He was completely serious. As if that counted as taking care of me. The second the door shut, my heart slipped into an irregular rhythm. My heart rate began to fall from a hundred and ten beats per minute. A red warning light flashed on the monitor as the alarm cut through the dark. As I drifted in and out of consciousness, I heard a nurse's voice crackle over a two-way radio while the family of the patient in the next bed kept complaining about an insurance bill. It seemed I was still alive. But everything that had kept me here had been taken from me, piece by piece. Would I even make it through the next four weeks?