In The Presence Of My Enemies

Esther had her doubts about that, though she kept quiet about them. Dr. Dambach's work was more specialized than hers; she knew that. But the phones, the patients and parents in the waiting room, the billing, and the medical records often made her feel like a juggler with a stream of plates and knives and balls in the air. If she didn't pay attention every moment, everything would come crashing down.

On the other hand, she'd felt that way ever since she found out what she was. At worst, an office disaster could get her fired. A disaster of a different sort…She resolutely declined to think about that. Staying busy helped drive worry away. Busy she was.

But she was reminded of her heritage when the Kleins brought in little Paul.Something was wrong with him; she could see as much. He seemed listless and unhappy and somehow less well assembled than he should have been. He didn't hold his head up the way a baby his age should have, nor did he act fascinated with his hands and feet like most eight-month-olds. His parents, especially his mother, looked drawn and worried.

They were the last appointment before lunch. Dr. Dambach stayed in the examining room with them for a long time. Paul cried once. He didn't sound quite right, either, though Esther had trouble putting her finger on why. It wasn't astrong cry; that was as close as she could come. Working here, she'd heard plenty of unhappy babies. Paul Klein should have raised a bigger fuss.

At last, the Kleins came out of the examining room, the baby in Maria's arms. "Thank you, Doctor," Richard Klein said. "Maybe this means something important."

"I will have to do more investigating myself before I can say for certain," Dr. Dambach replied. "Make an appointment with Frau Stutzman, please-I'll want to see him again in another two weeks." He sounded brisk and businesslike. The Kleins probably wouldn't know he used that demeanor to mask alarm.

Having worked with him for two years, Esther did. After she'd made the appointment, after the Kleins had left, she turned to the doctor and asked, "What's wrong with him?"

"His muscular development is not as it should be," Dambach said. "He seemed normal up until a couple of months ago, but since then…" He shook his head. "If anything, he has gone backwards, when he should be moving ahead. And I saw something peculiar when I looked in his eyes: a red spot on each retina."

"What does that mean?" Esther asked.

"I'm not sure. I don't believe I've ever seen anything like it before," the pediatrician said. "I don't know if it is connected to the other problem, either. Can you order some food brought here, please? I was going to go out for lunch, but I believe I will stay here and go through my books instead."

"Of course, Doctor," Esther Stutzman said. "Will one of those Italian cheese pies do? The shop is close, and they deliver."

Dambach nodded. "That will be fine. I know the place you mean. They promise to get it where it should go in under half an hour, which is all to the good today."

"I'll take care of it." Esther made the call. The cheese pie arrived twenty-seven minutes later. She'd heard the owner had fired delivery boys for being late, so she was glad this one showed up on time. She paid for it from the cash drawer, then brought it in to Dr. Dambach.

"Just set it on the desk, please," he said without looking up from the medical book he was going through. Only his left hand and his mouth gave the food any notice; the rest of his attention was riveted on the book. Esther thought she could have substituted a coffee cake or plain bread without his knowing the difference.

She was eating her own lunch, ready to go home as soon as the afternoon receptionist came in, when Dambach exclaimed in what might as easily have been dismay as triumph. "What is it, Doctor?" she called.

"I know what Paul Klein has," Dr. Dambach said.

Esther still couldn't tell how he felt about knowing. She asked, "Well, what is it, then?"

He came out of the office, a half forgotten slice of the cheese pie still in his left hand. His face said more than his voice had; he looked thoroughly grim. "It's an obscure syndrome called Tay-Sachs disease, I'm afraid," he answered. "Along with the rest of his condition, the red spots on his retinas nail down the diagnosis."

"I never heard of it," Esther said.

"I wish I hadn't." Now the pediatrician sounded as unhappy as he looked.

"Why?" she asked. "What is it? What does it do?"

"There is an enzyme called Hexosaminidase A. Babies with Tay-Sachs disease are born without the ability to form it. Without it, lipids accumulate abnormally in the cells, and especially in the nerve cells of the brain. The disease destroys brain function a little at a time. I will not speak of symptoms, but eventually the child is blind, mentally retarded, paralyzed, and unresponsive to anything around it."

"Oh, my God! How horrible!" Esther's stomach did a slow lurch. She wished she hadn't eaten. "What can you do? Is there a cure?"