James, who had allowed himself to relax after the boy was born, felt shaky now, and he did not trust himself to do more than nod. Steady. He told himself as the next head crowned. You're anywhere.. he thought, watching from some fine point on the ceiling as his hands worked with method and precision. This is any birth.

The baby was smaller, and arrived easily, sliding so quickly into his gloved hands that he leaned forward. Using his chest to make sure it didn't fall from his arms. "It's a girl," he said, and cradled her like a football, face down, tapping her back until she cried out. Then he turned her over to examine her front. Her blue eyes were cloudy, her hair jet black, but he barely noticed all this. What he was looking at was the unmistakable features, the eyes turned up as if with laughter, the flattened nose. A classic case.

James felt transported back in time. His sister had been born with a heart defect and had grown very slowly, her breath catching and coming in little gasps whenever she tried to run. For many years, until that first trip to the clinic in Morgantown, they had not known what was wrong. Then they knew, and there was nothing they could do. All his mother's attention had gone to her, and yet she died when she was just twelve years old. James was sixteen, already living in town to attend high school, already on his way to Pittsburgh and medical school. To the life he was living now. Still, he remembered the depth and endurance of his mother's grief, the way she walked up the hill to the grave every morning, her arms folded firmly against whatever weather she encountered.

The nurse stood beside him and studied the baby. "I'm so sorry, Doctor," she said, sympathetically.

James held the infant, forgetting what he want to do next. Her tiny hands were perfect, but the gap between her big toes and the others that was there, undoubtedly, like a missing tooth. When he looked deeply into her eyes he saw the spots, tiny as flecks on snow on her irises. He imagined her heart, the size of a plum and very possibly defective. He thought of the nursery, so carefully painted, with it's soft animals and single crib. He thought of his wife, bent over standing on the sidewalk before their brightly veiled home, saying, Our world will never be the same.

The baby's hand brushed against his, and he started. Without violation, he cut the cord and checked her heart, her lungs. All the time he was thinking of the snow, Jeremy'silver car floating in the ditch, the deep quiet of his empty clinic. Later, when he considered this night — and he would think of it often, in the months and years to come; the turning point of his life, the moments around which everything else would always gather — what he would remember was the silence of the room and the snow falling outside. The silence was so deep and encompassing that he felt himself floating to a new height, above this room, and then beyond, where he was one with the snow. This would be what he remembers, that feeling of endless space.

"Alright, clean her up please," he said, releasing the slight weight of the infant into the nurse's arms. "But keep her in the other room. I don't want my wife to know. Not straight away." The nurse nodded. Disappearing into the other room, then to return with James' son to lift him into the baby carrier they'd brought. He was suddenly intent on delivering his wife's placenta, which came out beautifully as James expected. Fraternal twins, male and female, one visibly perfect and the other marked by an extra chromosome in every cell of her body. What were the odds of that?

His son lay in the carrier, his hands waving now and then, fluid and random like the quick motions James would feel him make inside the safety of his wife's womb. He injected her with sedative, then laid his wife down to repair the episiotomy. It was nearly dawn, light gathering faintly in the winter downs. He watched his hands move, thinking how well the stitches were going. And when he had finished, he found the nurse sitting in a rocker in the waiting room, cradling the baby girl in her arms. She met his gaze without speaking.

"There's a place," he said, writing the name and address on the back of a stray envelope. "I'd like you to take her there. When it's light, I mean. I'll issue the birth certificate, and I'll call to say you're coming."

"But your wife.." the nurse spoke, and he heard from a distant place, the surprise and disapproval in her voice. He thought of his sister, pale and thin, trying to catch her breath, and his mother turning to the window to hide her tears. "Don't you see?" he asked, his voice soft. "This poor child will most likely have a serious heart defect. A fatal one. I'm trying to spare us all terrible grief." He spoke with conviction, believing in every word. The nurse sat staring blankly at him, her expression surprised but otherwise unreadable, as he waited for her to say yes. In the state of mind he was in, it didn't occur to him that she'd say anything else. He didn't imagine, as he would later that night, and in many nights to come, the ways in which he was jeopardizing everything. The nurse studied him with her blue unreadable eyes. He returned her gaze, unflinching, and at last she nodded, a movement so slight as to be almost imperceptible.

"The snow," she murmured, looking down.

But by mid-morning the storm had begun to abate, and the distant sounds of plows grated through the still air. He watched from the upstairs window as the nurse knocked the snow from her powder-blue car and drove off into the soft white world. The baby was hidden, asleep in a box lined with blankets on the seat beside her. James watched her turn left onto the street and disappear. Then he went back to sit with his family.

Norah slept, her golden hair splayed across the pillow. Now and then, James dozed. Awake, he gazed into the empty parking lot, watching smoke rise from the chimneys across the street, preparing the words he would say. That it was no one's fault, that their daughter would be in good hands, with others like herself, with ceaseless care. hat it would be best this way for them all.

In the late morning, when the snow had stopped for good, his son cried out in hunger, his wife waking up automatically at the sound. "Where's our baby?" she said, rising up on her elbows, pushing her hair back from over her face. He was holding their son, warm and light, and he sat down beside her, settling the baby down in her arms.

"Hello, you," he said. "Look at our beautiful son. I'm so proud of you." She kissed her son's forehead, undoing her robe to put him to her breast. His son latched on at once, and his wife looked up and smiled. He took her free hand, remembering how hard she'd held onto him, imprinting the bones of fingers onto his flesh. He remembered how much he wanted to protect her. Then and now.

"Is everything alright?" she looked at her husband, the concerned look of worry on her face making him gulp. "Darling. What is it?"

"We had twins," he told her slowly, thinking of the shocks of dark hair, the slippery bodies moving in his hands. Tears starting to rise in his eyes. "One of each."

"Oh," she said. "A little girl too? Phoebe and Joseph. But where is she?"

He thought how her fingers were so slight, like the bones of a little bird.

"Sweetheart," he began. His voice broke, and suddenly the words he had rehearsed so carefully had vanished. He closed his eyes, and when he could speak again, more words came, unplanned.

"Oh my love," he said. "I'm so sorry, our little daughter.. She died when she was born."