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The Starfish

The Starfish

– Fiction by Scott Graf –

Featured in issue 18 of Dreamers Magazine

Homemade Insanity

“I’m sorry, but we’re going to have to amputate.”

The room was silent. Neither Mr. or Mrs. McAlister said a word. They did not seem upset, only angry. Dr. Jennings shifted uncomfortably in her chair.

Mr. McAlister stood by the window with one hand resting on the sill. Older than his wife, he was a tall and successful looking man who said little. He was rarely seen on the ward and often away for work, sometimes for many weeks at a time. Below him, sitting on the hospital bed, were Mrs. McAlister and their daughter Amy, whose leg it was they were discussing.

Amy sat as she always did in the presence of her parents, silently and with her eyes and hands resting on her lap. She was twelve years old but dressed like she was eighteen. So did her mother. In fact, the two of them were always seen together wearing matching outfits: fashionable, expensive and tastefully provocative clothes worn with a casual chic that made those around them feel dowdy and plain. Prior to Amy’s chemotherapy they had even wore their long brown hair straightened and styled the same way.

‘People mistake us for sisters,’ Mrs. McAlister would often say. It was she who spoke at last.

“Is there nothing else that can be done?” she asked, straightening her daughter’s wig.

“No,” replied Dr. Jennings.

Mr. McAlister shook his head and looked out of the window.

“No other treatment we could try or specialist we could see?” continued Mrs. McAlister. “I’m just not convinced we’ve explored all of our options. We’d be happy to take Amy interstate again or even overseas, wouldn’t we Frank?” Mr. McAlister said nothing.

“Maybe we should get another opinion?” she added.

Dr. Jennings’s face blushed a subtle shade of red and her mouth tightened, just a little. She did not answer immediately, instead releasing a few slow breaths through pursed lips.

Amy McAlister had been admitted to the ward three months before with a large osteosarcoma in her left knee. Chemotherapy had been recommended immediately to try and shrink the tumour before surgery and so save the limb. But its commencement had been delayed by some weeks due to Mrs. McAlister’s concerns, questions and overall reluctance to sign her daughters consent form. Numerous opinions had been sought, both from within the hospital and without and against medical advice Amy had been taken by her parents from the ward to seek the opinions of other pediatric oncologists, all of whom had agreed entirely with Dr. Jennings’s plan.

But by that time the tumour had grown further and the possibility of limb salvage surgery became increasingly remote.

It was felt, if not said, by all that Amy would indeed most likely end up losing her leg.

The subsequent ten weeks of pre-op chemotherapy had been a challenging time for all concerned. Amy bore it bravely and without complaint and became well-liked by the staff. Her mother however had proven difficult. She never left Amy’s side, day or night, and insisted on doing everything for her. She questioned everything, accepting no answers from nurses, demanding to talk to a doctor no matter the time of day it was. Mrs. McAlister had also agitated for a private room for Amy to which the hospital administration had finally agreed, fatigued by her constant entreaties and emails. Here, she slept next to her daughter, in a small cot on the floor between Amy’s hospital bed and the door.

And every day at eight am when Dr. Jennings entered the room on her rounds, she would find them there, sitting together – showered, dressed and immaculate, Amy wearing her wig and Mrs. McAlister a question on her lips, the light of the morning sun behind them.

The pre-op course of chemotherapy was completed but unfortunately without effect. The tumour continued to grow unchecked and lay there every day, as if waiting for Dr. Jennings, arrogantly and mockingly; an ugly misshapen lump beneath the bedsheet where a young woman’s left knee should have been.

Dr. Jennings let out one final long slow breath. “We’ve been through all that before, haven’t we?” she said quietly.

Mrs. McAlister looked away.

“We can’t delay any longer. We must go ahead with the surgery,” said Dr. Jennings.

“Isn’t there any other way we can…?”

“Save the leg?” said Dr. Jennings, more abruptly than she had intended.

Mrs. McAlister closed her eyes and nodded.

“No. The surgeons have all looked at the scans. There’s no other option. And the longer we delay the more risk there is that the cancer will spread.”

Mrs. McAlister would not meet Dr. Jennings’s eyes.

“I’ll give you a little while longer but I’ll be back this afternoon with the consent form,” said Dr. Jennings.

And with that she turned and left, heading off to complete her rounds. Her heavy footsteps echoing down the corridor.

The McAlister’s left the ward a few hours later and were not seen again for two weeks. They returned saying nothing of where they had been or why they had left. Dr. Jennings too said nothing, only bringing the consent form for Amy’s surgery which they signed.

Throughout the time they had been away, Dr. Jennings had received a steady stream of phone calls and letters from colleagues around the country. Experienced clinicians, they had grasped the situation quickly and delicately and professionally given the opinion that they concurred completely with Dr. Jennings’s plan and that the McAlister’s should return home immediately to allow Amy’s treatment to continue.

The night before Amy’s surgery Dr. Jennings returned late to the ward. There had been an academic meeting which had gone on longer than expected and so it was well into the evening by the time she opened the door and stepped into the corridor. The ward was silent and dark apart from the dull blue glow of the nurse’s station and the flicker of light and movement of a television in the room of an older child. Passing by Amy’s room, Dr. Jennings noted that her lamp was on and that she was there alone, sitting up in her bed, her pale bald head hunched over a book. Her wig hung on its stand next to the bed. Dr. Jennings had never before seen Amy without her mother. She stopped at the door.

“Everything ok, Amy?” she asked.

Amy looked up from her book, smiled and nodded.

“Where’s your mother?”

“She just had a call from Dad, he’s away. She’s been trying to get hold of him all day.”

“Oh.” Dr. Jennings stepped into the room.

“I think she’s just gone outside. She said the phone reception’s bad in here or something.”

Dr. Jennings sat down on the end of the bed and looked around. In the quiet stillness of the evening, she noticed for the first time the emptiness of the room. The cards, balloons, flowers and soft toys, all the usual pageantry of childhood illness and hospitalization, were absent. Amy had returned to her book.

“What are you reading?” Dr. Jennings lifted up the front cover to read the title. “Encyclopedia of Ocean Life.”

“I’m reading about starfish,” said Amy.

“Starfish?”

“Yes, did you know that if a starfish loses one if it’s legs, it can just grow a new one?”

Dr. Jennings smiled. “Really?”

“Yeah, as long as its heart, you know the centre bit, remains intact.”

She turned the book around for Dr. Jennings to see and pointed at a picture. Dr. Jennings leaned forward to look.

“It’s called regeneration.”

“How about that,” said Dr. Jennings.

“I don’t suppose that’ll happen to me?” Amy laughed but looked up at Dr. Jennings from beneath her eyelashes.

“Well, I don’t know,” said Dr. Jennings leaning forward and taking the book. “Maybe.” She read a few lines. “Perhaps if you start eating like a starfish it might.” She ran her finger over the text. “It says here they like snails, clams and oysters. I think we’d better start immediately. Shall I call the kitchen?” Dr. Jennings winked.

“Yuck,” cried Amy, sticking out her tongue. She giggled and threw herself back onto her pillow but her laughter was stopped short by a wince and a small cry. She grasped her left leg.

“Does it hurt much?” asked Dr. Jennings. She closed the book and placed it on the bedside table.

“Only if I move suddenly.” Amy rubbed her thigh, keeping her small hand away from her knee.

“How are you feeling about your surgery tomorrow?” asked Dr. Jennings.

“Ok, I guess. I just kinda wanna get it over with. It feels sort of heavy, you know, like its weighing me down. I’m tired of it.”

Dr. Jennings nodded and once again looked around the room.

“Have you had many visitors?” she asked.

“No, not really.”

“What about your friends?”

“I don’t really have any friends.”

Dr. Jennings raised her eyebrows.

Amy quickly continued. “Oh, I mean I have friends at school and stuff but Mum doesn’t like me having people over and Dad’s away a lot for work, so it’s mainly just me and her.”

“I see,” said Dr. Jennings.

“We do everything together,” Amy added.

Dr. Jennings smiled and stood up. “Anyways, you’ve got a big day tomorrow. You’d better get some sleep.”

“Ok Dr. Jennings. But I’ll just wait for my Mum to come back if that’s okay.”

Dr. Jennings paused at the door on her way out and looked back into the room. Amy had once again taken up her book and sat there reading, waiting patiently. A bald little figure huddled by the light of a bedside lamp in a dark and empty room.

Amy was taken to the operating theatre the following morning at nine o’clock. She emerged forty-five minutes later followed by her surgeons who announced the operation a complete success. An above knee amputation had been required but the tumour had been entirely removed. Dr. Jennings was there in recovery when Amy awoke from the anesthetic.

“How do you feel?” she had asked.

“Better,” Amy said.

Dr. Jennings was also there on day two when the physiotherapists first got Amy up and out of bed. Dr. Jennings and Amy’s mother stood side by side at the foot of bed as the sheet was removed to reveal a neat little bandaged stump that pointed and wiggled at them as Amy was assisted to transfer up and across to a walking frame.

“Well done,” Dr. Jennings said.

Amy’s mother had looked away.

The next four weeks of inpatient rehabilitation proceeded well with Amy exceeding everyone’s expectations. Her physiotherapists and occupational therapists were pleased with her progress and felt confident that Amy would be able to manage a prosthetic leg with no difficulty and walk independently once again.

Her mother’s presence however, seemed to diminish during this time. Initially she would attend the daily rehab sessions with Amy, sitting to one side, watching as Amy was put through her paces. But as the days passed, she seemed to spend more and more time on her phone, her painted fingernail tapping and flicking across the screen, looking up occasionally when Amy would call out to her.

After a while, she stopped attending altogether, arriving on the ward only late, once Amy had returned to her room and leaving again after dinner, citing other commitments.

This left Amy freer to begin to socialize with the other children on the ward and Dr. Jennings, as she finished up for the day, started seeing her in the playroom, her crutches beside her, watching television and talking quietly with the others before dinner.

Amy was discharged one month post-op and Dr. Jennings caught sight of her one last time making her way out of the hospital. She was moving slowly along the corridor with a walking frame, flanked on either side by nurses who carried her bags and equipment. Her mother, with hands containing only her phone and keys, walked ahead with quick and impatient steps, stopping occasionally to allow those behind her to catch up. Dr. Jennings noted that mother and daughter no longer dressed the same.


“Amy?”

Dr. Jennings stood by the open door of her clinic room and looked out into the busy waiting room. From amongst the swell of noisy and bustling humanity, a figure rose. It walked towards her with a confident gait, flawless apart from a slight limp that was largely hidden beneath a pair of baggy jeans.

“Hello Dr. Jennings,” said Amy.

Dr. Jennings gasped. “Amy, I almost didn’t recognize you. You’ve cut your hair. I assumed you were going to grow it out again? Come in.”

“No,” replied Amy running her hand over her scalp. “I like it better this way.”

The two of them sat down across from one another at the desk. “So, we’re now twelve months post-op,” said Dr. Jennings. “You look like you’re managing your prosthesis well.”

Amy smiled and nodded. “Yeah, I’ve got the hang of it now.” She swung her left leg back and forth. A faint but audible click could be heard.

“Yes, Jenni tells me they’ve discharged you from rehab.”

“I can do the exercises on my own now.”

Dr. Jennings looked at the computer screen.

“And you’ve started high school this year? How’s that going?” she asked.

“Really good.”

“Made some new friends?”

“Yeah, we’re going to Comic-Con this weekend.”

“Comic-Con?”

“You know, comic book convention. But it’s more than just comics. It’s Star Wars, Dr. Who, gaming, cos-play, anime, all sorts of cool stuff really.” Amy pointed to the colourful characters on her t-shirt. “Oh right,” said Dr. Jennings. She did not recognize any of them.

After completing the physical examination, the two of them sat down once again. Dr. Jennings typed on her keyboard while Amy tied up the laces on her boots.

“Well Amy, everything looks fine and your bloods and scans are all clear.”

“Thanks Dr. Jennings.” Amy stood up.

“I’ll see you again in three months and hey, enjoy your convention. What was it called again… Comi-con?”

“No.” Amy giggled. “Comic-Con.”

Dr. Jennings watched her cross the room and open the door.

“Oh, and Amy?”

Amy paused by the door “Yes?”

“How are you getting home? Is your mum picking you up?”

“No,” she replied. “I took the bus.”


Scott Graf

About the Author – Scott Graf

Scott W. Graf is a medical doctor living and practicing in Adelaide, South Australia. 
In between looking after patients and running a busy practice, he writes short stories and has previously been published in Blood and Thunder and HEAL.


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