Vivienne Crouch-Adler turned one on a Tuesday in May. On the Thursday, she had her twelve-month well-visit with Dr. Felipe Soto at a small pediatric practice on East Cesar Chavez Street in Austin.
Her mother, Margaret Crouch, is a journalist for a local weekly. Her father, Aaron Adler, manages the kitchen of a small Mediterranean restaurant on South Lamar. They had arranged, that morning, to both come to the appointment. They had not always done this. Twelve months felt different.
The waiting room had four other families in it. A father with two small boys was reading a board book about a frog. A mother was nursing a four-month-old in a chair by the window. A boy of about three was driving a small red truck on the carpet with the dedicated absorption of a man at work.
Vivienne, in her stroller, watched the boy with the truck. She looked, Margaret thought, like a person planning her next career move.
Dr. Soto called them at 9:18 a.m., eighteen minutes after the scheduled time, which is approximately the practice's median delay. He apologized. He always apologizes. He had been a paediatrician at the same practice for twenty-six years and had, his colleagues said, never once been on time.
The exam room was small and bright and decorated with a peeling decal of the African savanna on the far wall. There was a giraffe missing one leg, the result, Dr. Soto had once explained, of a six-year-old's particularly determined attention in 2017.
He weighed Vivienne on the small scale: twenty pounds, eleven ounces. He measured her length: twenty-nine and three-quarters inches. He measured her head: forty-six centimetres. He plotted each number on the growth chart in the chart on his laptop and turned the laptop so the parents could see.
Vivienne, he said, was in the fiftieth percentile for weight, the sixtieth for length, and the seventy-fifth for head circumference. The numbers, he said, mattered far less than the curve. Her curve, which he traced with a finger across twelve months, was a steady, slightly arching line.
Curves, he said, are what we care about. A baby on the fifth percentile who stays on the fifth percentile is a healthy baby. A baby who falls off her curve is a baby we look at more closely.
He went through the questionnaire. Did Vivienne pull to stand? She did. Did she cruise along furniture? She did, energetically, and had taken her first three independent steps the previous Sunday in the kitchen. Did she wave goodbye? She did, with both hands, like a small dignitary.
Did she have any words? She had two reliable ones, Margaret said: dog, which was the family beagle, Sergeant; and mama, which, Margaret noted with some chagrin, was also currently the family beagle.
Dr. Soto laughed. He said that mama as the dog was, in his experience, a perfectly normal phase. He had seen it many times. The word would, he said, be redirected within a month or two.
He listened to her heart and her lungs. He felt her belly. He checked the soft spot, the anterior fontanelle, which was nearly closed. He looked in her ears with the otoscope and said both eardrums looked clear and pearly.
He turned her over and examined her hips. He counted, gently, her ten toes. He had a way of doing this that made it look ceremonial. The toes were all present.
Then he sat down on the rolling stool and talked to the parents for the longer part of the visit. This was the part Margaret had come to value most, after a year of these appointments. The talking.
He asked about sleep. He asked about feeding. He asked, with care, about how the parents were. He asked whether they were getting enough sleep themselves. He asked if there was anyone helping them.
He asked, last, if there was anything they were worried about that they had not yet said.
Aaron mentioned that Vivienne, in the past two weeks, had been pulling at her right ear. Dr. Soto looked again, briefly, with the otoscope. He said the ear was clear. He said the pulling, at this age, was sometimes related to a tooth coming in, and pointed to the small white edge of a molar visible at the back of the lower gum.
Margaret asked about transitioning off the bottle. Dr. Soto said the recommendation was to be off the bottle by fifteen months, but that there was no urgency. He suggested introducing the open cup at meals and the straw cup between, and letting the bottle become, gradually, only the morning and evening event.
Then came the part the parents had been quietly bracing for. The vaccines.
At twelve months, the standard schedule in the United States includes the first dose of the MMR vaccine, the first dose of the varicella vaccine, the first hepatitis A vaccine, and, depending on the season, the third dose of the influenza vaccine. Dr. Soto's nurse, a woman named Patricia, came in with the syringes on a small tray.
Margaret held Vivienne on her lap and turned her so that her chest was against Margaret's chest. Patricia gave the first shot, quickly, in the upper thigh. Vivienne looked surprised, then offended, then began to cry. The second shot came eight seconds later. The third, ten seconds after that.
By the time Patricia stepped back, Vivienne was crying with her whole body, with the fairness of a person who had been ambushed by people she trusted. Margaret held her. Aaron rubbed her back. Patricia, who had done this thousands of times, did not apologize. She said, you did so well, my brave one, and put three small bandaids on the small thighs.
Vivienne stopped crying within two minutes. She had, by the time they were paying at the front desk, recovered enough to wave at the boy with the truck, who had not, in the intervening half hour, moved.
On the way home, Margaret stopped at a small bakery on East Cesar Chavez and bought, for the second time that week, a slice of Vivienne's birthday cake. They ate it in the car in the parking lot.
Vivienne, in the back seat, ate her piece with both hands. She had cake in her hair before they had finished the parking lot. The morning had gone, on the whole, as well as a twelve-month visit goes. The next appointment was scheduled for fifteen months. They would come back.
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