When I first saw Doctor Keep, he was approaching my grandmother in the pediatric cardiology waiting room of Albuquerque’s Good Samaritan. It was March last year, the month when the clouds had let down just enough water for the prickly pear to flower. Grandma’s fingertips were still pink from the magenta salad she’d made by gathering the blossoms off the landscaping outside of Tex Mex restaurants and Motel 6.  
          I’d given Jonah a fresh change and was considering an ice cream sandwich from the vending machine by the restroom when she waved me back over to the blue plastic seating. It was eight-thirty in the morning and we’d been up since five a.m., packing the Econoline and helping my older sister, Rachyel, with her own sons and my younger siblings. The two hours of silence on the interstate from Gallup were nice, and I’d imagined myself alone again while Jonah slept the whole way.
          This appointment had loomed on my horizon for the past six months, sort of like Jonah’s birth before it. I wasn’t sure if I could be a mother at seventeen, or if I’d even have to. The doctors in Gallup couldn’t say how serious Jonah’s heart condition would be. We had to go to Albuquerque to find out.
          The waiting room of wrinkled faces looked up when Doctor Keep extended his hand to me and I couldn’t tell if they were looking at him or at Jonah being in my arms instead of my grandmother’s. Maybe they only watched in anticipation of their own appointments. This wasn’t the maternity wing anymore; people had real problems.   
          Doctor Keep was very tall and thin so that the line of his body from head to foot had several curves to it. In his starched lab coat with his name embroidered on it, he looked like a wolf propped up on its hind legs, Grandma said later. He had a big bump in his nose that I thought was probably bad to grow up with but didn’t matter anymore, and his pants were tan and tailored, their material soft and expensive-looking over tasseled loafers. Nothing like the men I knew would wear.
          In Gallup, men dressed in old and faded black jeans and free t-shirts, or maybe button-downs, so thin after years of washing that the only place you couldn’t see through were the stains. The men, like my uncles and granddad and Rachyel’s ex-husband, were dark with ashy elbows and greasy hair, leaning against the outsides of titty bars and closed restaurants, getting off trains and hoofing it across town with a plastic bag of stuff. Who knew what they were after. They’d soon realize it wasn’t in Gallup and move on like my older sister Amy and both my parents before that. Like I would as soon as I had somewhere to go.        
          When I had sex with Romeo Lopez it was on the couch of his dad’s trailer, three doors down from Grandma’s. When he pulled out, there was half a condom around the base of his dick and the tip was pink with blood. It took me five minutes fishing inside myself on their half-size toilet to pinch the rest of it out. By then Romeo had his pants back on, was squinting at the wrapper between his two fingers. I snatched it from him. “Wrong millennium, Romeo,” I said, and got my sweatshirt on to go.
          Romeo was kind of dumb and kind of smart. I didn’t know it then but believe now that I loved him, if you can measure love by the sheer amount of time you spend thinking about a person. Later, what happened between us stood on its own as the moment when I did what I wanted and got what I got. There’s nothing so tragic about that. 
          When it became obvious to everyone that I was pregnant, Grandma came to me and I told her whose baby it was.
          “We’ll get along better without that Mexican,” she said.
          “Romeo’s family’s from Guatemala, Grandma” I said.  
          “We can get along without him just fine.”
          I knew what was waiting for me in Gallup if I stayed: the same job I’d had since I was fourteen, cashiering at the Luv’s off the interstate. Either that, or fixing hair with Rachyel at Rose’s Beauty Shop. It was a stand-alone pink square building on Aztec Street between the crap art galleries and postcard shops. Rachyel permed hair, answered phones, and swept up. There was a stock of inspirational Christian posters and a few fashion magazines. Those were what I went in for, even after I was pregnant. I’d sit by the dusty window and thumb through the same old issues, stiff and crinkled like they’d been on the back of the toilet too long, while Rachyel permed and relaxed, permed and relaxed, and then blow-dried. I never said anything to Rachyel, but I could tell what made a good actress from reading over and over about the same movies, years after they’d come out. It wasn’t necessarily the best looks or the most training, but an ability to blend into a part, to disappear into whatever the audience wanted you to be. They were no more being themselves in those magazine layouts than they would be in any role on screen. I knew that much.   
          Our older sister, Amy, had got out and we were always waiting for her letters. The last postcard came from South Dakota and sometimes she wrote that I could meet up with her, after she got settled, or for my eighteenth birthday she wrote once, and I wondered if that was for Grandma’s benefit or for mine. We’d always lived in our grandmother’s double-wide, ever since I could remember, and Grandma didn’t seem much changed by Amy—or even by my mother’s moving away. She would always stay right there.
          One night past two a.m. I found her in her recliner, the blue light of the television on her cheeks.
          “Feel okay?” she asked me as I sunk into the couch to her right.
          “Can’t sleep,” I said.
          Grandma had a habit of resting her eyelids, like she was almost asleep, that made me want to speak to her.
          “I can’t even imagine how this is gonna go,” I said, as if I were alone. “Am I supposed to stay here and change diapers all my life? I can’t do that. I want to, I really do. But there’s so much that still seems more important. There was supposed to be so much more time to go.”
          Grandma kept her eyes closed. The airbrakes of semis blasted past on the 40 outside.
          “You’re young,” she said. “Like your mother. You can decide.”
          Doctor Keep’s hands were scrubbed white as paper, and moisturized. They didn’t have any calluses, their wrinkles round and smooth at the knuckles, and his fingers were long and wrapped all the way around Jonah’s torso so that I wondered about the other things he did with them. That’s the thing about hands: you can barely imagine all they‘re useful for—personal, practical—from replacing the toilet roll to heart surgery. And more all of which Doctor Keep washed away before, between, and after every appointment. Like he was just one person’s doctor and not hundreds. Or maybe it was just to get back to himself at the end of the day. Three hours until he’d probably eat a sandwich at his desk, seven until he’d drive home to his two-story pueblo near the petrified forest west of town and look out towards Gallup from the marble countertops of his kitchen. The normal skin began halfway up his forearm, orange and hairy in comparison.
          He lifted Jonah and gave a bounce, Jonah thinking nothing of it. The Doctor was comfortable, too—pleased even. I was the one, it seemed clear to me then—with Jonah’s tan cheeks tilting up at the great man’s massive head—I was the one that cared about this. Whatever the Doctor decided, I would have to live with.
          When I was already huge, I ran into Romeo by the railroad tracks. It was July, after dinner, and the sky streaked pink and orange, the arcs of long passed planes leaving the only bars across it. Two stray dogs paced down the track, running and thirsty, but without any thought that we could help them.
          Romeo took a can out of his shirt, rattled it, and sprayed a big, white rectangle onto the side of a yellow Santa Fe car. When I walked up beside him he pointed to my stomach.
          “You see a doctor about that?”
          “You think I’m an idiot?” 
          “I didn’t say that.” 
          He dropped the white to the gravel and took out a black can, began to write his name.
          “But they said it’s okay?” The train car was blank in front of me, but I stared at it anyway while he ran back over his letters to add dimension, switching to blue for the shadows. Months before, in the lot off the interstate where truckers pulled off to sleep, his lips had first covered mine. There was an inch of warm liquid in the bottom of my forty that I wouldn’t drink but hold all night, and Charlie went to piss while the other kids ran around beside the roar of the headlights and I wondered how many girls Romeo had had to kiss to get that good at it. He was younger than me and I’d only kissed two other boys by then, neither of which had the care or attention that his kiss obviously required. I knew I wouldn’t be the only one to notice, and that was fine with me.
          “Which way do you think these trains are going?” he said, smudging the edges of his letters with a rag from his back pocket. He blended their fill so that they faded from top to bottom. “East or west?”
          “What does that matter?” I said, and kicked at the rocks on the ground. He smiled, biting his tongue with his chin up.
          “I want to make it to Hollywood before you do,” he said.
          “Well.” I shook my head at him. “It’s sure looking that way now, isn’t it?” My face felt twisted and he turned to go. “It’s a boy,” I yelled, just to get back at him. 
          Nurses laughed from the hall outside Doctor Keep’s office, also with their own lives. Doctor Keep opened a file folder with his free hand. He scanned a few lines and looked up at me as if there were nothing written there at all.
          “What brings the two of you in today?” he asked me.
          For a second I worried that I’d say the wrong thing. I had no idea what I was talking about and the Doctor would feel bad for Jonah. It was bad, just too bad, he’d think, that this baby was born to a stupid kid mother from Indian Hills trailer park. Whether Indians ever lived there or not, I’d never know. He looked at me as if it were nothing and waited for me to speak, and for a minute I thought that maybe it could be nothing. Maybe it was nothing at all and he was going to tell me so and make the entire past year and a half disappear. Not only the heart problem, but all of it—Jonah too—and I could leave there and be myself again, the dumb way I used to be and missed so much, dreaming of whatever was to come.
          “Mom?” Dr. Keep asked. It sounded ridiculous. He was still bouncing Jonah.
          “I don’t really know,” I said, and that seemed fine with the doctor, too. He reached into his drawer to take out a stethoscope. Someone else’s baby cried down the hall, its wail knocking against the low ceilings.
          “Someone’s not happy,” Doctor Keep said, and smiled at me as if he knew what it was like not to be able to feed yourself, to be uncomfortable in the seat you were strapped into and to be unable to walk or run away. He knew how all of this felt and he had sympathy for it, was bringing all the compassion and understanding he could to our situation. 
          “Hold him there, just like that,” he said, and hoisted Jonah back toward me where I turned him to sit sideways on my lap.
          Doctor Keep put the ears of his stethoscope in and warmed the pad with his breath, then undid one of Jonah’s overall suspenders and listened underneath his shirt. He leaned in closer, the top of his head tilted toward me so that I saw the roots of his white hair lifting straight up off his pink scalp, distinct as whiskers. It was totally different from the fine black fuzz, half an inch long that pressed to Romeo’s forehead, like a headband, before the rest of it pulled back, solid and shining into a short, soft ponytail. Like a woman’s, you could say, but I never did.
          Once Jonah was born, Romeo had stopped by our trailer. It must not have been hard for him to avoid me after that day on the tracks. I’d stayed close to home, and then been in the hospital for a few weeks while they attempted to sort out Jonah’s heart. For a while the nurses, Grandma, and Rachyel were the only people I saw, and then Jonah came, and everything was different, for me at least.
          Romeo would go about his life like normal. That I’d always understood. He had brothers, and his dad had been sick with colon cancer for the past two years, and was probably too sick to even care who I was, or if he did, to do anything about it. There was nothing to do. Between Rachyel and Grandma, a new baby was more or less routine. Jonah barely even felt like mine the whole time he was inside my stomach—they kept referring to him as Carl. 
          So when Romeo knocked on the screen door, I was mostly happy to talk to someone my own age and whether or not he misinterpreted my enthusiasm, I didn’t care. He had a brown hicky on the right side of his throat and I didn’t care about that either. I was fatter, should have breastfed but hadn’t wanted to, and led him through the living room to where Jonah was down for a nap. Grandma shook her head to show her disapproval.
          In the dim back room we stood side by side and looked down on Jonah asleep. The fan in the window was on to drown out the noise of the TV and Jonah breathed softly, a spit bubble forming between his lips.
          “Woah, that’s him?” Romeo said, and pushed his hands into the pockets of his jeans. His belt gripped just below his hipbone, boxers baggy out the top. It was dark enough that I wouldn’t turn and look at him. “I can’t believe he exists,” Romeo said, and put his hand on my shoulder blade. “I mean, like, that he happened.” 
          Romeo wasn’t very tall with solid brown eyes so dark they seemed black, and soft and sad. His look had none of that piercing effect that people say comes with blue eyes, but a draping warmth that made him seem older than he was. But he would laugh about the stupidest shit and I hated it when he held up his pants from falling down or pinched his tongue between his teeth like an idiot.
          “I know,” I said. “We barely did anything.” He took his hand off my back. I knew that I’d got the worse end of what happened between us and Romeo had to know that too. Or at least that’s what I wanted.
          “But they say something’s wrong with his heart,” I said. “I mean the clinic doesn’t know for sure but they’re sending us to a specialist.”
          Romeo took a step closer, reaching in to move the blanket away from Jonah’s face. His fingertips were sort of square, nails pink and rounded and cut short. The backs of his hands were lacquered in red and gold spray paint. “Doctor’s don’t know shit,” he said.
          “Yeah, I hope it’s nothing.” But this wasn’t entirely true.
          “He looks like me.” Romeo said, and zipped his jacket closed.
          “Oh, is that good for something?” It was a fair enough question but Romeo wouldn’t look at me.
          “Something,” he said, and it occurred to me then that he really didn’t know.

          That day in the trailer felt far away from this fluorescent office. Doctor Keep’s eyes began to look around the room again after his ears stopped listening to Jonah’s heart and he pulled the stethoscope from his ears and draped it around his neck.
          “Your son has a murmur on one side and a pro-lapse on the other. As the blood enters the right side of his heart, some small amount seeps back out before the muscle has a chance to move it into the right atrium. And so, more blood has already entered the heart before the oxygenated blood has been fully expelled. This is what causes the echo and the syncopated rhythm that we hear.”
          Dr. Keep picked up a red and blue painted heart model that I recognized from biology class. Jonah reached out for it with a small, damp hand while Doctor Keep gestured in which directions the blood moved and where the valves weren’t working their best.
          “It’s okay if you don’t understand,” he said. “I have middle-aged surgeons who need me to explain five times.”
          He thinks I’m stupid, I thought, and let Jonah hold onto my thumb. “So what does that mean about Jonah? Will he be just like a regular kid doing his own thing? Or will he, like, have a heart attack if I’m not watching him all the time?” 
          Doctor Keep swiveled his chair to put the model away and I heard my voice pleading with him, pleading to allow me to walk out of that room myself again. I didn’t care what was best for Jonah—I didn’t care if he had a heart problem or not. I pled with Doctor Keep to let me go and not look back, and then I held onto Jonah a little tighter, knowing that I was wrong.
          “Let’s go ahead and have a look. This might be cold.” Doctor Keep lifted Jonah’s shirt up to his chin, squirted some jelly onto the ultrasound and placed it on his small chest. He reached over with the other hand and pulled a monitor on a wheeled cart over from beside the wall, turned it on.
          “That’s it?” I said.
          Jonah’s heart, a lot like the toy model, was wiggling on the screen in blue and white snow.  
          “There it is.” Dr. Keep pointed at the picture. “So you see that Jonah’s heart is working rather well. We see no build-up of fluid. All this tissue, what you see in white, looks normal. The only difference is that the beat is not quite as efficient as we’d like. There’s more of a rolling, galloping rhythm instead of the ideal one-two. But the valves show no plaque, which would typically cause an attack like you asked about. Jonah’s heart is brand-new, nearly perfect.”
          Doctor Keep used a paper towel to remove the extra jelly from the ultrasound.
          “Many children can grow out of a heart murmur as the muscle grows and strengthens. But even if Jonah doesn’t, there’s no reason to think that your son won’t lead a very healthy, happy life.”
          I looked down past Jonah’s eyelashes to the poreless, dewy skin of his cheeks.
          “And we would see symptoms of further weakening before it became serious. Lethargy, discomfort lying down. Be observant, but I don’t think we have anything to worry about as it stands.”
          Jonah whined.
          “So, he can run around and play outside? He doesn’t have to stay home all the time?” I asked.
          Doctor Keep laughed. “We’ll talk before he joins the track team.” He looked down at the file and scribbled a paragraph. “I’d like check-ups every nine months to see how Jonah’s heart is changing—or not changing—as the case may be.” He closed the file and slid it in with the others on the back of the door. That’s where our case would stay for the rest of the afternoon, before a nurse filed it and all the others into a cabinet for the rest of the year during which me and Jonah would have to go and live our lives.
          “Nine months?” I said. There were voices in the hall again and Doctor Keep tucked the pen into the front of his lab coat and opened the door. “Regular check-ups for the next ten years,” he said. “Don’t hesitate to call if you think of questions.” He turned at the doorjamb, his head as high as the ceiling.
          “I guess I’m not going anywhere then,” I said, registering what he’d said.
          Doctor Keep shook my free hand and gave me a comforting smile. “Neither is Jonah,” he said, and left down the hall.
          I lifted my bag over my shoulder and stood with Jonah gripping the neckline of my t-shirt. I was wrong, of course, about this being a one-time thing. Doctor Keep had decided that Jonah’s life could extend a long distance, in nine-month segments, just as unimaginable as the first. I decided, too. The regular world was still out there waiting for me. I walked out to my grandmother and placed Jonah in her arms.

Cecile Berberat is a super8 filmmaker and bookbinder living in Montana. She has both her MFA in fiction and her Masters in Literature from the University of Montana, Missoula and is the 2012 recipient of the Montana Meadowlark Award, judged by the novelist, Richard Ford. She moves to France this autumn to teach writing in Toulouse.  

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