Chapter 1

Kiara watched Malachi playing with the toys in the waiting room. She really hated his playing with communal toys, especially in a place like the doctor’s office, worrying that he would pick up some bug. He was so miserable when he got sick. Who knew how often the doctor’s office sanitized the toys and how many other kids had touched them or put them in their mouths since they had last been cleaned. Of course, at this age, everything went into Malachi’s mouth. Kiara’s mom said that was the way that babies explored the world. You really couldn’t stop them. But she tried to engage him in pushing the cars around the little track instead of picking them up to put them in his mouth.

“He’s so adorable,” said one of the mothers sitting nearby. A polished white woman with a sullen-looking girl sitting in the seat next to her. About six years old, pudgy, and looking miserable. “How old is he?”

“Fourteen months,” Kiara said. She watched the mother’s face as she considered this revelation. That realization that Malachi wasn’t a baby baby, but a toddler.

“He’s so tiny,” the woman said, eyes wide.

“He was premature. He hasn’t caught up yet.”

“Oh,” the woman drew out the word and nodded her understanding.

Kiara wasn’t sure how much longer she would be able to keep using that to explain why Malachi was so much smaller than other babies his age. He was supposed to be caught up by eighteen months or two years old, something like that.

The little girl was eyeing Kiara. “Are you having another baby?”

The mother elbowed her. “Francie, that’s not something we ask people.”

“Why not?” Francie protested. “She has a big tummy!”

“It’s not polite to ask.”

Kiara held her big tummy, looking down at it and feeling for a kick. She was bigger than she had been with Malachi. But she was already past the point that she’d been at when she’d gone into labor with him.

“I am pregnant,” she told Francie and her mother. “I am going to have another baby.”

“They’ll be very close together,” the woman said with disapproval. What business was that of hers? Kiara had often wished that she and Carmel were closer together in age. So that Carmel was her playmate instead of just a bratty little sister. Six years was a big gap when you were little.

“Don’t put that in your mouth, Malachi.” Kiara pulled the toy car away from his mouth and put it on the track, trying to encourage him to push it around. Shouldn’t he be pushing it around, using the toy for what it was made for, instead of just putting things in his mouth?

But Malachi stubbornly raised it up to his mouth again. Kiara picked him up and put him on her lap, then bent back down to find a teething biscuit in the diaper bag. She pulled the car away and offered him the biscuit instead.

“Do you want a cookie? Have a cookie to chew on instead of the nasty car. It’s dirty, Malachi.”

“No!” He fussed and bucked to get away from her, trying to reach the car again and uninterested in the biscuit. Frustrated, Kiara let him slide back down to the floor, screaming his protest at having his toy taken away. Of course, that was when the nurse chose to come out and call for Malachi.

“Malachi Oss?”

Kiara nodded tiredly. She shoved the teething biscuit back into the diaper bag. “We’ll be right behind you.”

She hoped that the nurse would go ahead, leading the way to the first examining room. Kiara already knew where it was and didn’t want the nurse hovering over her as she struggled to pick up the kicking, screaming baby, sling the diaper bag over her shoulder, and stay balanced with her pregnant belly stuck out far in front of her.

“Malachi, shush! You would have had to leave the toys there anyway. It’s time to go see the doctor.”

But, of course, reasoning with him had no effect. Except maybe to make him yell louder in protest. Kiara carried him to the large examining room.

“What’s the matter, little britches?” the nurse asked as she took Malachi from Kiara. She put him down on the examining table and began to remove his clothing. Kiara was expecting him to scream louder at this treatment, but he surprised her by chugging to a stop and watching the nurse wide-eyed as she stripped him down to his diaper. The nurse cooed at him and dangled a toy in front of him to grasp. Before long, Malachi seemed perfectly content, forgetting the car being stolen away from him.

“So, how’s he been doing, Mom?” the nurse asked Kiara without looking at her. “Any concerns?”

Kiara sighed. She stared down at Malachi, his dark skin a stark contrast to the snowy white of the disposable diaper. He looked like a much younger baby. She tried to quantify it. Not as big as the other babies his age. As small as a one-year-old? A nine-month-old? Six-month-old? His eyes sparkled and he babbled as he swatted at the toy the nurse was teasing him with. He was bright, so it wasn’t that he wasn’t developing. He could say a few words—his favorite being “no,” of course—and while he wasn’t walking, he was crawling plenty, or hitching himself around while sitting on his bottom. He liked watching the toddler shows on TV. Not that she let him watch screens all the time. She knew that medical professionals didn’t think that was good for babies’ developing brains. But sometimes, she needed a digital babysitter so that she could make supper for Malachi or catch up on something else important. He was quite active, a “going concern,” as her mother said.

“Just with him being so small,” she told the nurse. “I know the doctor said that he should have put on more weight by now, and he hasn’t. I’ve done everything I can to get more calories in him, but he’s stubborn. He just doesn’t want to eat sometimes, and there’s nothing I can do to make him.”

The nurse nodded. She measured his length, scribbled it down on her clipboard notes, and then transferred him to the basket of the baby scale.

Not the scale for older patients, that he would need to stand on.

The nurse’s eyes were quick as she checked the weight reading and noted it down as well.

“He was heavier than that when I weighed him at home,” Kiara said. “Are you sure that’s right?”

The nurse looked at her. “Of course I am.”

“It’s just that…”

“Weights fluctuate throughout the day and from day to day. It will depend on whether he has had a bowel movement, how much clothing he has on, whether he has eaten anything… but this scale is more accurate than your home scale.”

Kiara thought that was a little presumptuous. The nurse didn’t even know what kind of a scale she had at home. It could be a really high-tech, accurate, atomic thing.

But it wasn’t. It was just a Weight Watchers scale. Kiara would weigh herself, then pick up Malachi, weigh herself again, and figure out his weight by subtracting.

“He hasn’t gained anything since the last appointment,” the nurse noted.

“A few ounces…”

But even if he had gained a few ounces, which was doubtful, that still wasn’t what he needed to gain to be on track.

“He’s on a plateau right now,” the nurse said. “Babies don’t always gain at a regular rate. Sometimes they stay the same for a long time and then go up suddenly. We’ll see what the doctor has to say.”

Kiara nodded. The nurse picked Malachi up and handed him to her. Then while Kiara held him, she pulled out the paper on the examining table and tore off the used portion. Like he’d contaminated it. But Kiara knew that was just the usual protocol. It didn’t mean that they thought that Malachi was dirty.

“Is he up to date on his vaccinations?” the nurse asked, looking back down at her clipboard and continuing with the routine check-up questions.

“No. Because of him being premature. I want to make sure he has a healthy immune system before catching up on all of the jabs.”

“Is he going to daycare?”

“Yes.”

“All kids going to daycare should be fully vaccinated. You’re lucky even to be able to get into a daycare without proof that he’s up to date on his shots.”

Kiara didn’t correct herself and say that Malachi was in a day home rather than a big daycare. A mom who took on a few other kids. She’d never asked about vaccinations. Maybe if the measles was going around, she would but, otherwise, it was just a place to take Malachi for a few hours when Kiara had to work or go out with Jamal. She was wondering about starting a day home herself once the new baby arrived. It would be a way to stay home with them both and still make a little bit of money. But she still hadn’t figured out whether she was going to move in with Jamal once the baby was born. They had talked around the subject, but he hadn’t asked her to move in. She wasn’t sure how she would support herself and the kids if she weren’t living with someone else.

“Miss Oss?”

Kiara came back down to earth. She looked at the nurse. “Sorry, what?”

“Any recent illnesses? Rash, fever, anything else that has concerned you?”

“No. He’s been fine. A couple of colds, but nothing serious. He’s always on the move.”

Malachi was starting to squirm and complain in her arms, no longer entertained by being somewhere new. Kiara kissed him on top of his black, tightly curled hair. “Come on, baby. Don’t fuss.” She looked at the nurse, raising her eyebrows, wondering if they were ready to go to the smaller examining room and talk to the doctor.

The nurse nodded. “This way, then.”

Kiara followed her down the hall to the next room. She was beginning to feel like she shouldn’t have bothered to come. She needed advice, not just observations that Malachi wasn’t gaining weight. She already knew that.

Chapter 2

Kiara hated the stuffy little examining rooms. Small, close rooms, barely big enough for an examining table and doctor’s stool. Walls covered with public health posters. All kinds of advice on taking care of babies and development and dire warnings about missing language milestones. The black instruments affixed to the wall—the blood pressure thing, tips for the ear-scope, the hand sanitizer pump, and other things she didn’t know the purpose of. Sometimes models of body systems or organs. It was all a bit creepy. She was never comfortable there. And Malachi hated having to wait.

“The doctor will be with you shortly,” the nurse promised, and she left, pulling the door behind her.

She had placed Malachi’s clothing on the examining table, but Kiara knew better than to get him dressed yet. They would just want everything off again for the doctor to examine him. Even though the doctor never seemed to actually do anything. How hard was it to look in Malachi’s eyes and ears, and why bother when what she was there about was his weight?

She put Malachi down on the table, keeping one hand on him, and arched her aching back. There was no chair for her to sit on. Even with the little step stool beside the examining table, she didn’t think she could get herself up there on the table with Malachi. Before she’d ever been pregnant, sure. She could have hopped up and down there as easy as anything. She’d been able to do all kinds of things in phys ed at school. But heavily pregnant, there was no way.

Kiara let out another long sigh. Her feet ached. Her back ached. Every joint in her body ached one way or another.

There was a whoosh as the door was pulled open again. It was so sudden and unexpected that it made Kiara jump, jerking her hand away from Malachi and putting both hands up in front of her chest in self-defense.

It was the doctor. Kiara had expected to be waiting for him for another twenty minutes. That was the way it usually worked.

“Miss Oss,” he greeted in a loud, hearty way. She didn’t like how loud he always was. She always wondered if there was another quieter voice in his head that he was trying to drown out.

Malachi looked at the doctor with interest in his dark brown eyes. Did he remember the doctor from the last time? How much did he remember from one visit to another? At least he didn’t automatically start crying when she brought him to the doctor. That was good. He wasn’t too traumatized if he didn’t even cry when he got there.

“How are we today?” Dr. Beamer demanded.

“I’m okay,” Kiara said. She held her belly, trying to ease the cramping that standing up caused.

Dr. Beamer looked around for a chair and didn’t find one. “You could hop up here next to Malachi… well, maybe not. Sorry. We won’t be long here today, I’m sure. So.” He sat down on the wheeled stool and looked from the clipboard he had retrieved from the wall pocket to the computer screen in the corner of the room. “You have some concerns about Malachi not gaining weight.”

Kiara nodded. “You said that he needed to put on more weight… but it doesn’t matter what I do, he just doesn’t. I just… need some more ideas, I guess. Or maybe I’m obsessing over it too much and I need to just relax and wait. I’m not a doctor.” She shrugged. “I don’t know.”

He looked at the numbers on the clipboard and brought up an image of a graph on the computer screen. His lips pressed together in a straight line and he shook his head slightly.

“He is losing percentiles.”

Kiara gave a slight nod. Malachi reached for the black tips for the ear-scope and she grabbed him and pulled him back from it. He flailed and nearly threw himself off of the side of the examining table.

“Whoa, Malachi,” Kiara protested, grabbing him with both hands and trying to settle him in the middle of the examining table. “Be a good boy. Stay here.”

He squirmed, trying to get away from her. “No!” He smacked at her hands. “No, no!”

“It’s okay,” she reassured him, embarrassed. “Just a few more minutes, and then we can go home. Be a good boy.”

He still tried to get away from her to explore.

“Is he still nursing?” Dr. Beamer asked.

“No.”

“Is he on formula?”

“Yeah.”

“Which one?”

Kiara tried to remember the name of the formula she bought and told him what she thought it was. She had gone through several different formulas. Everyone seemed to have an opinion on what was the best kind for Malachi. What would be easiest on his stomach, which would help him to gain weight, which one was good for brain development. She kept looking for the one that would make a difference, but she had a suspicion they were all exactly the same thing and she was wasting her time trying to find the one magical formula that would help him to grow.

“How much does he drink in a day? What else does he eat?”

She did the best she could to describe Malachi’s eating schedule, from his first formula feeding in the early morning to his last one before bed.

“Are you feeding him a vegetarian diet?” the doctor asked, his brow furrowed.

“No. I feed him meat. Just… not a lot of it. He doesn’t really like it, so it’s just a waste of time. And money.”

“Does he drink a lot of juice?”

“No…” Kiara thought about it. “Should he?” Maybe that was another way to get more calories into him without having to fight over food at the table.

“No. You don’t want to be giving him too much milk or juice. It will satiate his appetite without giving him the calories he needs.”

“Okay. Yeah, I don’t give him much juice. Usually just… formula or water.”

“I want you to start cutting down his formula. Focus on solid food. Constantly drinking formula, he probably doesn’t feel like anything else.”

Kiara frowned. She had just walked him through Malachi’s usual eating schedule. Malachi didn’t drink formula constantly, but was only offered it a few times a day. The rest of the time, she was feeding him solid food.

“Umm… okay.”

Malachi was trying to escape Kiara’s hold on him, wanting to play with the doctor’s instruments or to touch the colorful posters on the wall. “Malachi, stop!” Kiara said in exasperation. “Just be still. Be a good boy!” She readjusted him again, trying to get him to sit and then to stay where she had sat him, with one hand on one of his arms and the other on one of his legs.

“What else can I do?” she asked Dr. Beamer. “I’ve tried all of the things that you suggested before. But he isn’t gaining everything. I’m weighing him every day. Trying to get him to eat more is like World War Three. He just won’t do it!”

“Try to make mealtimes a happy time,” the doctor told her, shaking his head. “Making it a battleground is just going to discourage him from eating. No one feels like eating when they are upset and someone is trying to force them. He’ll stop eating, even if he is hungry.” He took off his wire-rimmed glasses and studied her. “Try to feed him more calorie-dense foods. French fries. Full-fat dairy. Avocados. Desserts. It’s not going to spoil him to have some sweets. He needs them.”

Kiara scowled and let go of Malachi with one hand to rub her forehead. It was all completely opposite to the way that she had learned to eat. When they had learned about food groups and meal planning at school, they had always said to limit fat and sugar. Stay away from junk food. Focus on whole plant-based foods. All of those other things led to lifestyle diseases—heart disease, cancer, diabetes. She didn’t want Malachi to get diabetes. Maybe she should take him somewhere else. Were there specialists for babies who didn’t eat enough? It seemed like there were specialists for everything else.

“Do you think there’s something wrong with him? I know he’s just a baby, but babies get diseases too. Maybe he’s not eating because he has a tumor in his stomach or his throat. Or maybe he’s got one of those diseases where he can’t digest what he eats properly.”

“If it were any of those things, we would be able to see other symptoms,” Dr. Beamer assured her. “We’ve done some basic testing and haven’t found anything wrong. If it was something serious, we would be seeing signs of it in other areas. But he’s been healthy, hasn’t he?”

Kiara nodded.

“No unexplained illnesses? Trouble breathing? Diarrhea? Long crying jags? Malaise?”

“What’s malaise?”

“Lethargic. Tired. Doesn’t want to get out of bed and do things.” Dr. Beamer looked at Malachi and put his glasses back on, smiling slightly. “The exact opposite of that.”

Kiara laughed. “No. He’s always my busy little man. Getting into mischief. So you think he’s okay? Even though he isn’t gaining weight?”

“We’ll keep monitoring it. You try those things I suggested. He’ll turn around soon. He won’t keep losing weight if you increase his calorie intake. That’s just not the way it works.”