"Mark, come to bed." She set down the lamp on his clinic desk two nights later. "You've been cooped up in the clinic studying your books all day, and it's past midnight."

"Coming," he mumbled and flipped to another page.

She sighed. "You said you were coming for breakfast, lunch, and dinner." Leaning over, she closed the medical textbook.

His head snapped up. "Why'd you do that?! Tanya, I'm in the middle of something!" he barked and opened the book again.

Slapping her hand down over the pages, she met his angry glare. "You've been holed up in here all day today and most of yesterday. What are you even looking for?"

Those blue eyes narrowed on her throat. Then he shot to his feet and started palpating under her jaw down to her collarbone.

"And what are you doing?"

"I've always had a preconceived notion of what I'm looking for when examining Della—and you since Charles was born. I missed the obvious fact that you had worms because I was so convinced it was poverty starvation. You pointed out on Christmas that I need to think like a surgeon, not a father; I'm thinking like a surgeon. Sit on the exam table."

"Not in the middle of the night I'm not. We need to go to sleep—"

But he caught her about the waist and lifted her onto the table.

"If this is your idea of setting the mood, it's not working," she said dryly as he reached for his stethoscope.

"Hush." He unbuttoned the front of her dress and set the bell to her chest. Then he looped it around his neck but started measuring her wrists.

"What on earth do my wrists have to do with anything?"

The man seemed quite absorbed in the measurements he got and then measured her ankles and other areas. "If you were malnourished in childhood, it would be logical to attribute your small frame to nutrition, not heritage. Your grandmother is almost a head taller than you, and she said your mother was about her height. Your father came up to my nose. Your grandfather is slightly taller than I am. Your lineage doesn't explain why you don't even come up to my shoulder, but malnutrition does. If it occurred in childhood and lasted long enough, your growth would've been stunted. A fetus feeds from the mother, so if you were undernourished just enough as a child, you might not have physical symptoms. However, having a fetus feed from a malnourished body might be enough to make the fetus show up with problems." He continued measurements.

Her eyes widened. "So I could've made Della—"

His head snapped up. "I didn't and wouldn't say Della's troubles are because of you!" he barked. "If this is even the cause, it's your moronic father's fault for starving you!"

"But, Charles is fine. Why would Della have problems?"

He wrote down the numbers on a paper and then leaned her back to lie down and started palpating her abdomen. "Because we overfed you with Charles to try to put on weight. If you had any sort of deficiency, such as iodine, overfeeding you could've helped compensate. You ate normal amounts with Della, which your body might've been lacking and therefore taken to use itself before passing them to Della."

Her eyebrows rose. 'It's a strange theory, but I suppose it makes sense. I don't have a goiter, though, so iodine deficiency likely isn't the problem."

"No, it's just an example." He unbuttoned her dress more and handed over one of his laboratory beacons. "See if you have any milk left to give a sample."

Cocking an eyebrow, she gave him a look and took the container. "Moo."

"I don't mean it like that." He patted her shoulder and then got out more tools.

When she handed over the beacon, he set it aside and then held out a hand. "I'll test it in a few minutes. Stand up and bend over."

"What?"

"To check your spine for scoliosis or other potential problems." The man said it like it was the most obvious thing in the world.

When she sighed, he helped slide her dress down to her hips and then ran his hands down the sides of her spine when she leaned down.

"Straighten." He leaned down and palpated the tops of her hips, as if looking for uneven height. "Did you break any bones as a child?"

"No, but the surgeon who took me on as his charity case made me drink milk every time I came. He always wanted to check my legs, I never noticed anything odd."

His head snapped up. "You had rickets?"

She shook her head. "He never referred to it as bowed legs or rickets, and I couldn't tell what he thought looked different. But I did stop having leg pains a few months after I started drinking the milk—he gave me some and then told me to steal it from cows on the sides of the roads."

He straightened and his eyes brightened, as if this was a magical discovery. "The drawer falling on your foot was the only time you've knowingly had a bone broken?"

"Yes. Why?"

"This is bloody brilliant!" He rubbed his hands together like an excited child. "I have a theory that rickets can be inherited, well a proneness to it, anyway." He darted over to the paper with the measurements and wrote down more things. "Did you ever have a lump in your neck as a child that went away on it's own after you saw that physician? Did he ever feed you anything?"

A goiter. There'd been a small lump on the throat that the surgeon had said would go away, but that and the foods high in iodine that he'd given now and then hadn't made a connection until now. Iodine deficiency—another disease of the poor. "A small lump that went away when he started giving me milk and eggs and other foods," she answered quietly and pulled up her dress.

Mark didn't bat an eye—didn't even look up as he wrote, for that matter.

This shouldn't be humiliating. Mark knew when he'd come for her how poor she'd been.

"And you once mentioned tuberculosis, dysentery, influenza, and cholera as a child. Anything else?"

Her gaze dropped to the floor. The threshold of humiliation turned into degradation, but Mark of all people didn't mean it that way. He was just trying to figure out what was wrong with their babe. "He thought smallpox, but it didn't further develop because I'd already caught cowpox when trying to get milk," she said quietly.

He looked up and his eyes widened in horror. Few escaped smallpox, and if they did, it was not without disfigurement.

"There's nothing else." The words came out in a whisper, the degradation of him knowing just how far beneath his station that he'd wed was as complete as it'd ever been. And that poverty may be the reason why his child showed signs of physical and mental disabilities. It was too much to face him a moment longer. Clutching the front of her dress shut, she swept from the room, without the lantern, and into the dark house.

Heavy footsteps followed. "Tanya." Light filled the foyer and a hand wrapped around her arm. "Tanya, wait." He didn't move.

Drawing a deep breath, she slowly turned to meet his gaze that reflected the light of the lantern that he carried in his other hand.

"If I made you feel ashamed, I apologize. I wasn't thinking and was simply asking for facts. I wish you hadn't suffered illness as a child, but it doesn't matter to me what you've had. It's a reflection on the poor conditions your father subjected you to, not anything about you. I've had cholera and dysentery and influenza and several other diseases considered 'poor man illnesses,' and—"

"But you caught them because of treating patients, didn't you? Not as a child because you were living in filth?" She eased her arm free, dreading physical contact right now for some reason.

"The point is I'm not judging you—"

'The point is things like this are going to get out eventually. At some point, Charles and Della are going to realize that I'm not Spanish and it's going to shame them because society will shame them for it. Pickpocketing and stealing cow's milk aren't the worst things I've done for food—"

"Stop." He held up a hand but didn't touch. "Even if you did brothel work for food, which I know you didn't do anything of the sorts," he added when she started to protest, "it doesn't matter to me. You lacked the basic needs as a child, and I don't think anyone should judge a child for trying to survive. I'm proud of you for figuring out how to take care of yourself, not disgusted or whatever it is you think I am. You're my strong Tanya," he said softly and stroked her cheek.

Biting her lip, she looked up at him as he took a step closer. "But you think there's something wrong with me that I caused Della these problems?"

He shook his head. "Not wrong as in it's your fault. But even if none of this is tied to Della, I'm concerned if you have an underlying condition that's so mild thus far that I've missed it. Will you come let me finish checking you, if only to appease my nerves that you aren't unwell?"

She dropped her gaze to the floor. "We need to be checking Della."

"Whose clues about her condition might also come from you. Have you been having symptoms of something?"

Clutching the dress together tighter helped to calm the nerves. "I think perhaps it's only stress about Della and the finances with Christmas that has been making me feel off."

His brow snapped together. "Off how?" The slight, instantaneous panic about cancer couldn't be hidden from his voice.

"Not like that." Nerves twisted the stomach deep inside. "Mark, I've been so tired and I missed my time this month."

He paled.

Another babe wasn't something that he'd see as reason to celebrate, especially after how terribly wrong Della's pregnancy and delivery had gone.

"But I don't think your womb could handle labor after the complications with Della. I had a vasectomy," he breathed, clearly in shock.

She set a hand on his arm. "I think it's just stress. I've missed my time here or there before we wed—"

The man looked on the verge of fainting, so she buttoned her dress and then took his arm to guide him to the clinic. "Check so you don't panic, but I don't think it's a babe. My heart has felt a bit funny a few times, but—"

"What?!" he roared, snapping out of the shock. "You're having heart problems and not saying anything about it?!"

"Shhh! You'll wake the children. It's only been a handful of times for a few seconds and started even before we wed, but it's happened twice in the past week. I've tried looking up if it's tied together—"

"What the hell are you thinking?! Why haven't you told me?!" He slammed the lantern down by the exam table and shot over to the sink to wash his hands.

"Because I thought you'd overreact like this—"

"Goddamn right! You're doing this but not saying a word?! Holy hell!" He stomped over and lifted her skirts. "Lie down right now! Then I'm listening with the stethoscope for five minutes! And you're to get me the next time you feel it beating oddly! Goddammit, woman!"

He stood there in silence minutes later, with the stethoscope pressed to her bare chest, and his head bowed as he listened intently.

"Mark?" She ran a hand through his dark hair. It was so silky and soft, with little flecks of white here and there. He'd look so distinguished with age as his hair whitened. "It's not doing it right now."

"Shhh. I need to hear in case it starts." He moved the bell over a bit. "Does anything in particular trigger it?"

"I don't think so. It's so infrequent that I haven't noticed a pattern. This week it happened when we were doing surgery."

After a slew of more questions over the next ten minutes, he finally set the stethoscope down. "You have to tell me the next time it happens. I don't care what we're in the middle of." Then he picked up a syringe. "I'm going to run bloodwork too."

Once he finished the exam, he held her hand in both of his while she still sat on the table. "I don't want you to be embarrassed. Is there anything that I missed or any illnesses you've had that we didn't discuss?"

The man looked so worried, even after she shook her head, as if he thought about how to phrase something. "If I may ask, how do you know you had cowpox and smallpox? They both usually leave substantial scarring." The back of his forefinger trailed down her cheek, with a soft smile on his lips. "Your face is absolutely perfect."

"Good save," she mumbled and tried to suppress the blush anyways. Turning her left hand sideways, she spread her fingers.

"Truth, not a save," he corrected. His brow furrowed as he looked down at the two spots of deep scarring between her fingers. "Oh, Tanya, do they hurt?" He cradled her hand and glided his finger near the scars.

"No. I forgot they were even there." She shrugged.

"I can't believe it that you escaped so unscathed. That's so incredibly rare." Then he lifted her hand and pressed a kiss to each scar.

Setting Della down the next morning, she picked up a box to put away Christmas ornaments while Mark saw a patient at the clinic.

"These too?" Charles pointed to the strands of popcorn.

"No, we'll feed those..." an odd feeling in the chest, "to the...birds." Heartbeats took off impossibly fast and the room spun.

"Mama?" A small hand touched her shoulder as she sank to the floor.

It was hard to breathe fast enough.

"Mama? Should I get Papa?" Charles tried to hold her up.

With a nod, she gasped, "Heart," and patted her chest.

Charles tore out of the room screaming for Mark at the top of his lungs.

Della burst into tears, confused and frightened.

"It's...alright." She held out a shaking hand but Della stood back and sobbed.

Spots started to monopolize all vision.

Mark tore into the room on his prosthesis and had his medical bag. He dropped to his knees and caught her as vision faded. "Tiger!" his roar cut through the ringing in her ears as he eased her to the floor.

Vision faded but his voice remained in the distance.

"Tanya, cough as hard as you can." His cold stethoscope bell pressed against bare skin.

But it was too hard to breathe, much less cough. Vision cleared just in time to catch his sleeve in a panic.

Grandfather dropped to his knees, cupped the back of her neck to drop her head back, and shoved his fingers down her throat.

A violent gag made Tanya's body buck and then gasp in air, forcing her heart to return to a normal rhythm.

It was hard to stop shaking to give her a cardiac exam. Tiger said something to her.

A hand rested on his back. "Mark? Mark?"

Tearing his eyes from her, it was almost as difficult to look at Tiger and see the fear in his eyes—it made it all seem more real.

"Are you fine here while I tend to the children?"

Turning to look, Charles and Della were huddled in the corner and crying. With a nod, Tiger took the children out.

"Do you feel better? Your color is coming back." Dear god, even his voice shook yet.

She nodded and accepted the aid to sit up as the exam continued, along with a dozen questions.

"It's bad, isn't it? You look doom and gloom." She tried to smile, but the worry in her eyes killed it.

Tilting her head back, another exam to her throat confirmed it. The lumps were so slight that only with hyperextension did they protrude.

Drawing a deep breath to stay calm, he sat beside her against the settee and took her hand. "I want another opinion, but I'm quite certain you have hyperthyroidism developing." She'd need a moment for that terrible diagnosis to settle in.

She looked down at her lap. "There's still no cure, is there? It's just a matter of time until it gets bad enough that I stroke or my heart gives out."

His hand tightened in hers. "We aren't going to sit by and let it worsen. The good news is it explains why you have so much trouble putting on weight, why menses are growing erratic, the heart trouble, and the fatigue. If it was there during pregnancy, it is a clue as to Della's delayed development, so she can be tested. This is good news." Swallowing hard helped hold back tears.

But a sad smile touched her lips when he leaned his forehead to her temple. "You always were a bad liar."

Trading hands to hold, he slipped an arm around her. "Tanya, we will figure this out. There are some specialists who are doing extensive research on this condition. They've done total thyroidectomies and found it causes a host of problems, including mental impairment, so we know not to do that on you. I want to see if they've done hemithyroidectomy—I suspect that removing only half of the gland will still leave enough functioning that you won't have side effects. You aren't having any vision problems at all?"

She shook her head.

He turned her head. "You don't have any exophthalmos, so that's good. I'm going to wire some surgeons, and we'll figure out what to do within a month."

Mark remained holed up in his office for the next two weeks, rarely taking a break to even sleep in bed.

"Tanya!" He burst through the connecting door as she set the table for lunch. The man looked disheveled, exactly like what one would think a mad scientist looked like. A grin split his face. "I have it. Research from five specialists and we all agree to remove half the thyroid." He held up a disorganized pile of papers. "They've done it on a few patients already, and it has good results."

Tiger held out his hand and shuffled through the stack. "This looks good. Are you doing the surgery?"

Mark looked at him crosseyed. "I've never done one, and I'm not trying on my wife. Vocal chord damage can happen if done wrong. A specialist from England can be here in three weeks..."

Their voices faded and she turned to the sink. Mark didn't know that she'd been doing her own research and examining Della. Not enough thyroid caused severe mental impairment and a coma. The only treatment for that was to try eating sheep thyroid. Mark was going mad trying to find a cure—once again—for a wife who had an incurable disease. Looking over at the children climbing into their chairs, an ache deep inside took hold. There was a very real possibility that she wouldn't be around by the time they were grown.

It had been easy to avoid thinking about it and just keeping busy with research and the children and patients. Now it finally slammed like a punch to the gut. Turning, she hurried past the men and ran upstairs to the bedchamber farthest from the kitchen. Closing the door, she sank down against it to the floor and let the sobs of grief finally come.

A knock vibrated the door within moments. It cracked open as much as possible with her leaning against it. "Tanya, scoot over so I can come in," Mark said in a thick voice.

The moment she did, he scooped her up into his lap and bursted into tears himself. "It's going to be alright, my Tanya. After surgery, I'm going to check you every few weeks, and we'll see more doctors if we need to."

"B,but Della has s,signs of..."

"I know, sweetheart. She has signs of being the other way with mild hypothyroidism. I talked to the specialists about her, too, and we're going to put her on a sheep thyroid regimen. She's going to be just fine."

"Is she going to c,catch up?"

He pulled a handkerchief out of his pocket and dabbed at her tears. "She may, but even if not, she's not so far behind most children her age. Della is going to be alright."

Tucking her head under his chin, she rested her cheek on his chest. "Mark?"

Those strong arms wrapped around, so very obviously holding in a way that portrayed how much he wanted to protect her from everything.

"If something happens to me, you can't hole up and push the children away. They'll need you."

"Hush. Don't talk like that," he whispered, his voice cracking as his cheek rested atop of her head.

"But we need to. We've never talked about it, and it's becoming more important that we do." Pressing her lips together, she swallowed down more tears.

His chest shuddered. "I wouldn't push them away because they'd be all I had left of..." The words trailed off, as if he couldn't bear to say it. "If something happens to me, you need to find a man who will be good to you and the children, and you have to tell him about your heritage before marriage to be sure he'd protect you and the children." He held even tighter. "We're going to grow old together, Tanya. We'll be so old that the great-grandchildren will wonder how we're still kicking."

A watery laugh escaped and melted into tears of worry, fear, and grief.


"No, Tanya," he whispered and gently rocked.

"She can't wait. It's hit so suddenly and she's going downhill fast." Mark's distressed voice floated into the bedchamber from the kitchen. It had to be well past midnight. "It's been two weeks since the surgeon said he'd leave, and it'll be two or three more before he gets across the ocean. Her hands are shaking so badly that she can't help with surgeries anymore, she has insomnia, her metabolism is running so fast that she eats everything in sight without gaining a pound, and now she's randomly overheating at any moment of the day. She can't keep up at this rate, and her palpitation episodes are coming more frequently."

"There's no professor from the university who can help do surgery now?" Brigands sounded as worried as Mark.

"None with good survival rates..."

Another random wave of heat swept up from deep inside. The room suddenly became intolerably hot and the nightdress started to grow damp. Throwing off the covers, she swung her legs over the side of the bed and sat up. Next would come the palpitations and the only way to stop them was to cough hard.

Every heartbeat suddenly slammed with such force it hurt. Gasping to catch a breath, it was impossible to get in a hard enough cough.

Mark shot into the bedchamber on his crutches and whipped around the bed. The crutches clattered to the floor as he dropped onto the bed, set a hand on her chest and back, and compressed so hard it almost hurt. Just like every time before, it caused enough of a reaction to instinctively gasp in a huge breath and then fall into a coughing fit. And just like every other time, he became a physician monitoring every vital sign.

Each day became harder and harder to find the energy to drag out of bed, each episode sucking out more energy.

He wiped a cool rag over her wet brow.

"I need to wash." The words came out in a tired pant, but the episode and overheating left the nightdress soaked, just like the two or three times a day that random overheating would desperately cause the need for a bath.

"You're too exhausted. Give me your nightdress and I'll wash you in the basin." He picked up his crutches and went to the vanity to fill the basin with water.

Peeling off the wet clothing, she dropped it on the floor, not even having enough energy to throw it toward the laundry basket. It took leaning two hands on the bed to stay upright from feeling so weak. "Mark?"

He set the basin on the floor and toed it over as he returned on his crutches.

"I don't want to die like this, with you having to clean me and take care of me like an invalid."

His head whipped up and angry tears shimmered in those blue eyes. "You aren't going to die," he snapped. "We promised in sickness and in health. You'll start to get better after surgery."

She simply held his eyes, and the lack of argument spoke volumes in ways that words never could.

His face crumpled, and tears stung to see him fight so hard to not cry, as if refusing to do so could will her body to keep going.

"I want Teresa or Grandmama to do these things—I want you to be my husband, not a surgeon."

He swallowed hard and sat on the bed and picked up the rag. Then he began washing like she hadn't spoken.

"Mark." She caught his hand that wiped her shoulder.

But he wouldn't meet her eyes. "I know you're getting so tired and weak," he whispered and stilled, "but I need you to keep fighting." His voice quivered and a tear slid down his cheek as his eyes raised to meet hers. "We have to do the surgery. I know it will help you get well, and I'm figuring out how to move Heaven and Hell to get you what you need. New York is less than a week's journey from here. If we go there, it's that much less time we have to wait for the surgeon to arrive. If we leave tomorrow, we can take breaks for you to rest over the next two weeks. We—"

Sliding a hand across the bed, she set it on his knee. "It's money we don't have and too long for the children to be left behind."

He quickly finished washing, as if sensing the fatigue of sitting up becoming too much. "I will handle the money. We can take the children and your grandparents along." The man retrieved a fresh nightdress, helped slip it on, and then eased her back into bed.

"Mark—"

The man eased onto the side of the bed and took her hands as he looked down at her. "Please." His face crumpled suddenly, as if the pain was too strong to hide anymore. "I know it won't be easy, but I need you to do this for me." A soft sob escaped him. "I'm watching you slip away, and this is the only thing I know to do. Please, let me take us to New York. I've never done the surgery and there are too many complications for me to even try it alone. Please. I need you to hold on. I'm trying to move Heaven and Hell, but I know we're running out of time." He openly wept and sank to his knees beside the bed, clutching her hand in his. "Please, Tanya. I can't bring help to you any faster, but I can take you to it. The babies and I need you. Please."

"Shhh," she whispered and gave his hand as much of a squeeze as she could muster. "We'll go to New York, but I want the children to come. I don't want them to remember that I left them behind and never came back. But bring Teresa and Brigands or Grandfather and Grandmama in case we don't make it to New York—I don't want the children to watch that."

"We're going to make it to New York," he sniffled and pressed a kiss to her brow.

Grandmama said it was love that kept Mark going. The children couldn't travel far each day and funds ran out faster than expected. Brigands, Teresa, Grandmama, and Grandfather all came, taking turns in pairs to stay behind a day with the children in order to keep making progress to New York. Fatigue took hold only three days into the trip, making it impossible to walk even across a room. Without a word, Mark took to carrying her everywhere. Grandfather promised to look after Mark's leg since she was unable to do it.

Grandfather ran from the postmail carriage nine days later, with panic in his eyes. "He said there are no trains or coaches that go the last five miles. We have no funds to hire horses, either."

Mark's grip on her in his arms tightened and determination set in his eye. "The surgeon's ship docks in an hour."

Teresa wrung her hands. "It'll take at least two days of wages to make enough to take even two of us to New York."

Mark glided down to one knee. "Children, give Mama a kiss. We're going to New York and you'll catch up in a few days."

Grandmama's eyebrows rose. "Just how are you going to get her there today?"

The man looked up. "Walking."

Before she could muster the energy to speak, Grandfather snorted, "Walk five miles on a prosthetic? If your arms don't give out, your leg will."

"If it takes walking through fire to get her well, I'll goddamn walk through fire. Give Mama a kiss, children."

After tearful goodbyes and well wishes and prayers, Mark set off in the afternoon sun on the dirt road with air in his pockets and her in his arms.

She dragged her arms up his shoulders to try to hold on around his neck to help center her weight.

"Save your energy." Fierce determination filled his eyes.

"Mark?" she breathed, the simple act of speaking even requiring so much energy. "Even if we don't get to New York, you already moved Heaven and Hell for me."

His throat convulsed and his lips pressed together. "We're this goddamn close, I sure as shit am not letting you go within the next fifty years."

A weak laugh escaped. "My foul-mouth prince to the rescue."

"Shhh, save your energy," he said softly, keeping up a quick walk.

Nuzzling his chest, it felt so safe despite the fact that all day it felt like she was on fire from the inside out. She glanced down. A slight yellow hue on the hands. "My liver is shutting down." But he of course would've already noticed that.

"I know, sweetheart. Your temperature keeps climbing, too. We're almost there." A slight dampness came through his shirt that had nothing to do with her own high temperature. Either he was panicking or in pain from the prosthesis, but he didn't slow down.

It was the end stage before the heart would give out. Surgery had come too late, but Mark wasn't going to admit it. He had struggled to survive the guilt of Anna's death—he wouldn't make it through being too late for another wife.

"Stay with me, Tanya," he whispered.

Consciousness faded minutes later by the time Mark broke into a run. There had to be at least three three miles to go.