As I was imagining baby #4, I got word that pictures of Tom Cruise and Katie Holmes' baby girl had been published. So I went and BAM, there was Jaby #4 staring at me. Okay, not really, but little Suri had such wavy, dark hair and pretty blue eyes that I knew I had to steal the description for Jack and Kate's fourth and last little one. (BTW, here's the picture if you haven't seen it yet: http/img415.imageshack.us/img415/3906/060906mapr01hq7.jpg)

JACK

"Come on, Kate. One more push...yes, as hard as you need to. My hand, Kate, don't give yourself an aneurism, Jesus."

She threw him a frustrated and agonized look before giving a final grunt and collapsing back against the pillow, gasping.

"Sorry," he murmured sheepishly, then grinned at her, checking behind him as the doctors removed the wet and squirming infant, cleaning away the blood and placenta. For a moment, as Jack leaned down by her side, they watched the doctors' movements with their baby. He realized suddenly that the baby wasn't breathing. The room was hushed, and would have been almost eerily silent except for Kate's ragged breathing and the beeping of the monitors. In those first moments, Kate's hand squeezed hard, but all of his energy was focused on the tiny baby that the doctors were working to frantically encourage to breath. Finally, they both let out a collective sigh of relief when the child let out a small whimper, which, seconds later, turned into a full-fledged shriek.

"A boy," a nurse said to them, displaying the still-screaming infant on Kate's chest, another nurse coming to hand Jack a pair of scissors. He leaned forward, but Kate held out a hand to stop him.

"No, let me. You've done it twice already. I couldn't with Lily. Let me..."

He gave up the scissors and watched Kate cut the baby's umbilical cord. The nurse smiled at them before taking the baby off for weighing and a bath.

Jack wiped the sweat from her forehead and then kissed her softly. She turned her forehead to meet his, closing her eyes with a look of bliss on her face, before looking up at him again apologetically.

"Sorry."

"For what?"

"I know you wanted another girl."

He shrugged it off. "My fault. The men in my dad's side of the family tend to have low X-chromosome counts."

"Yeah, but I know you would have preferred another little girl."

"It doesn't matter, he's healthy. Lily's my girl. I think she'd be jealous of a sister."

She leaned her head against his chest, listening to the doctors fussing over their son.

"Just so you know in advance," she said softly, teasing. "I'm done with having your children."

He opened his mouth to reply, but the nurse brought over their tiny bundle and placed him in Kate's waiting arms. She snuggled him and inhaled his fresh baby scent.

"Nine pounds, six ounces." The nurse said with a smile. "You're one brave lady."

Kate glanced up at Jack and the two of them shared a knowing smile. "You have no idea."

Noah Gabriel Alexander Shephard was the name they decided. They had both unanimously agreed on the baby's first name long ago (along with Emily Grace, had he been a girl) but had struggled to decide on a middle name. Kate liked Gabriel, and Jack opted for Alexander. When it became clear that neither would give way to the other, they decided to let him have two. There was a brief discussion about which should be first, but Kate thought it would be cute for them to be in reverse alphabetical order. No use telling her that flipping the whole thing around would have been nicely in order, but he conceded.

Noah was their first real full-term. He'd been a day over his due date, born March 28, 2012. Kate had expressed some grief that all of their children had been born in cold weather. It amused them both, though, that all of the birthdays were two months apart. His and hers: she was born in June, he, two months later, in August. Lily in November, the twins in January, and now Noah in March. Still, after four years of the twins, Noah, who was already a placid, quiet baby, brought them some temporary peace.

He was born with a full head of wavy dark hair, chubby baby cheeks, and dark, stormy eyes that turned brown with time. Their only brown-eyed child. When they brought him home three days later, Lily and the twins crowded around Kate, gazing at their new brother in her arms.

"He's really tiny, Dad." Lily said, hanging from Jack's arm. He lifted her up for a better view. "Like a little doll."

"Can't see, Daddy," Tom said with a whimper, jumping up trying to get a better look. Sam added his own protest, and soon both of them were jumping up and down. Lily ignored them, but Jack found he couldn't.

"Boys!" There was an unrestrained harshness to his voice. They both stopped immediately, looking shamefaced. Kate threw him a scathing look, and bent down to their level to let them look at their new brother.

"Say hello to Noah," she told them.

"He doesn't got freckles like me!" Sam said, wrinkling his nose.

"He might not get them until later, baby."

"He's not a baby anymore, Momma." Lily put in. "They're four. And I'm five, but I'm much bigger. I'm a big girl."

"You are," Jack told her, tickling her stomach so that she giggled. "You're my big girl."

He missed the childish looks of jealousy and envy on his two elder sons' faces. The baby in Kate's arms slept on, happy, content. Healthy.

"JACK!" Her screams jolted him out of his nap. He groaned and checked his watch, running a hand over his face. It was still an hour before he had to go back in for a meeting and he'd hoped to catch a nap beforehand. Obviously, that was not to be. He sat up, looking around, wondering if her scream had been just a dream.

"JACK!" There it was again. He was up immediately, searching for the location of her voice when she called for him again. He ran as fast as his legs would carry him out their bedroom door and down the end of the hall to Noah's room.

Kate was standing next to the crib, one hand over her mouth, looking terrified. The other was touching something–Noah?–in the crib. He moved forward, a questioning look on his face.

"Kate, what–?"

She raised her arm to show him what she was holding. Noah's yellow blanket. The one with the little row of ducklings that Jack had bought only the week before and that their six-week old son was now attached to. She held it up for him to see and what he saw made his knees feel weak.

Blood.

The soft fabric was stained with red. It wasn't a big, bloody mess, but it was blood.

"What happened?" He asked, peering into the crib, expecting to see more blood, and a dead child.

On the contrary, Noah was awake and now smiling at them happily, gurgling up at his parents, ignoring their looks of concern. Jack's eyes caught a stain of red on the part of Noah's white onesie that covered his stomach. With care and his mind racing, Jack unbuttoned the outfit and pulled it back. He breathed a sigh of relief.

"This is normal," He said, putting his free hand on Kate's arm. "Sometimes, babies bleed from the navel. It should go away in a little while. Just an after-effect from the umbilical cord. Nothing too serious."

He went down to the hall to the bathroom and opened the medicine cabinet they always kept stocked in case of emergencies and got a bottle of alcohol, and a strip of gauze. When he returned, Kate looked visibly alarmed.

"What are you doing?" She demanded, hovering over the baby protectively.

"I'm just cleaning it. I've got to put some pressure on it to stop the bleeding." She stepped away, but hovered awkwardly over him as he dabbed the gauze with alcohol and pressed gently on the baby's belly. Noah squealed in protest at the cold (and probably smelly) substance. Kate took one of the baby's hands in her own, wiping away his dark hair from his forehead with the other. Jack tried to be quick about it, increasing the pressure and holding it there for about ten minutes. When he removed the cloth, now stained with red from the blood, it appeared like the meager flow coming from Noah's belly button had now stopped. He took the alcohol back to the bathroom and threw the gauze away, coming back to stand next to Kate.

"He'll be alright now." He told her, putting an arm around her and kissing her forehead. She wasn't convinced.

Noah bled for three days. In the end, Jack finally agreed that this was not normal and they took him to the hospital after they dropped Lily and the twins off at preschool.

He ran tests, drew blood, consulted charts, took samples from Jack and Kate each, hmm-ed and told them to come back the next morning for an official diagnosis.

Those twenty-four hours were the longest either of them had ever lived through. Noah, oblivious to what was going on, smiled and kicked out his legs happily. As a doctor, thousands of possible scenarios ran through Jack's mind, each more ridiculous than the last. Kate spent nearly the whole day with Noah, cuddling him, holding him, feeding him, singing to him. Jack thought it was strangely morbid, with her acting like he was going to die.

"He might," Kate said grimly when he mentioned it. He was terrified.

Hemophilia.

The doctor put it bluntly, but sympathetically. Kate sat stonily in the chair next to him, clutching Noah tightly to her. Jack shut his eyes. This wasn't happening.

They listened vaguely to the doctor's explanation: how serious Noah's condition was, how his blood lacked a clotting factor, how any bump or bruise could cause uncontrollable bleeding and swelling. How Kate had passed the defective gene on to him at conception. How they should bring in Lily for a test, just to see if she'd be a carrier too, when she had children.

Kate cried in his arms that night, more tears than he'd ever known she'd had. The doctor had mentioned that, while not curable, there were effective (but expensive) treatments. Jack assured him that money was not an option when it came to his children's health.

It was a difficult year for them. For the parents of any normal baby, teething is a trying time. For Noah, it was much more painful. By the time he was four months old, his teeth began to come through. His gums were much more swollen than any of the elder three. He cried for hours with the two of them trying to soothe him, sing to him, make him feel better. It broke Jack's heart to watch the tears running down Noah's face. It scared Lily and the twins, who weren't consciously used to a house filled with screaming babies. It terrified Jack and Kate.

As the year went on, their concern increased. At six months, Noah began to crawl, and bruises of all sizes and colors formed on his arms and legs. When he started walking at ten months, and in the process, struggled to stand, and fell, and the swelling began. They watched him constantly, and more than once Jack yelled at the twins to stop being so boisterous around their brother, not to hurt him. He was thankful that Lily had enough sense to sit still with the growing toddler, and keep an eye on Noah when Jack and Kate couldn't. He was proud of her, for all of her going-on-six years.

Despite his condition, Noah grew quickly. He had a beautiful smile, Jack discovered, and he was very affectionate. The twins as babies, and even, admittedly, Lily, had wet kisses that left him wiping off his face discreetly. A kiss from Noah was different: soft, not at all slobbery, a real baby kiss. His first word, in fact, was "Kish." He was such a lovable baby. Lily was a daddy's girl, and the twins were momma's boys, but Noah split their affections. He was so small, so sweet. Jack would stand over his crib and watch him sleeping, touching the fine dark hair, worry etched in his eyes over the son that would never be, could never be normal.

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A/N: Just a prequel to the upcoming events in the next two chapters, which are already pretty much finished. I want to finish this by September 17 for the year anniversary, so after this chapter, there are the two chapters coming up and an epilogue. These next chapters are pretty grim for the Shephard family, so don't hate me in advance for this one and the next one and the first part of the third one. Once I'm done with this, I'll upload the sequel, and FINALLY take a rest. Then I'd like to get to work on my next series, which is an on-island fic. I'll miss this one muchly!