The nurse stood beside him and studied the baby.

"I'm sorry, doctor," she said.

He held the infant, forgetting what he ought to do next. Her tiny hands were perfect. But the gap between her big toes and the others, that was there, like a missing tooth, and when he looked deeply at her eyes he saw the Brushfield spots, as tiny and distinct as flecks of snow in the irises. He imagined her heart, the size of a plum and very possibly defective, and he thought of the nursery, so carefully painted, with its soft animals and single crib. He thought of his wife standing on the sidewalk before their brightly veiled home, saying, Our world will never be the same.

The baby's hand brushed his, and he started. Without volition he began to move through the familiar patterns. He cut the cord and checked her heart, her lungs. All the time he was thinking of the snow, the silver car floating into a ditch, the deep quiet of this 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 remembered was the silence in the room and the snow falling steadily outside. The silence was so deep and encompassing that he felt himself floating to a new height, some point above this room and then beyond, where he was one with the snow and where this scene in the room was something unfolding in a different life, a life at which he was a random spectator, like a scene glimpsed through a warmly lit window while walking on a darkened street. That was what he would remember, that feeling of endless space. The doctor in the ditch, and the lights of his own house burning far away.

"All right. 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 right away." The nurse nodded. She disappeared and then came back to lift his son into the baby carrier they'd brought. The doctor was by then intent on delivering the placentas, which came out beautifully, dark and thick, each the size of a small plate. 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 with the quick water motions of the womb. He injected his wife with a sedative, then leaned down to repair the episiotomy. It was nearly dawn, light gathering faintly in the windows. He watched his hands move, thinking how well the stitches were going in, as tiny as her own, as neat and even. She had torn out a whole panel of the quilt because of one mistake, invisible to him.

When the doctor 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, and he remembered the night she had watched him as he slept.

"There's a place," he said, writing the name and address on the back of an 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 said, and he heard, from his 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 a terrible grief."

He spoke with conviction. He believed his own words. The nurse sat staring 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 did not occur to him that she might say anything else. He did not imagine, as he would later that night, and in many nights to come, the ways in which he was jeopardizing everything. Instead, he felt impatient with her slowness and very tired all of a sudden, and the clinic, so familiar, seemed strange around him, as if he were walking in a dream. 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.

(c) 2005, Kim Edwards. Reproduced with the permission of the publisher, Penguin Group.