NITPICKS
He looked up, suddenly remembering the woman and child standing before him.
How likely is it that he would forget she's here? I suggest you write 'looked up at the woman and child…'.
Life changing, but not life endangering
These should be hyphenated (I'm a hyphenation nazi!!! ;>): life-changing, life-endangering.
"How am I supposed to pay you," Helen whispered, conscious of the silence,
Do you need this 'conscious of the silence'?
Also, see below - you mention later that the library is empty. This would be a good place to mention it rather than near the end. Something like 'Helen whispered, though the library was empty'.
The backstory of Helen's looks is much too long IMO, especially since the dialogue goes on after it. Perhaps you could snip non-essentials, like this:
She looked down at what used to be her arms. She had been tall, graceful, elegant once. Her limbs were lithe and long, her body in perfect symmetrical proportion. A - a ballet dancer's figure. And then Maine had come along. Crashed his car into hers to get her name and address and phone number. And then the texts, and the romantic slime, and - after the rejection that would surely come when a fat, greasy, balding middle aged man asked a 23 year old goddess out - after that, - the cajoling and the threats.
And then one bright, sunny morning, the day after she finally rejected his toad-like advances, she woke up to find her arms and her elegant slender fingers gone. Replaced with these. She fought the desire to cry; she had to be strong for Angela.
You don't need the 'fat, greasy, etc.' stuff, I think: 'toad-like' says it all in much less words!
I could give you any number of fetishes.
What do you mean by this?
Helen shuddered. She tried to hide it, but could not. Harold Maine saw it, and smiled again.
I would suggest:
Helen shuddered. Harold Maine smiled again.
"My soul is fine," she answered. "Just fine." The defiance in her voice was unconvincing, but she knew by now that he liked her to have a certain 'resistance' to him. Too much and it angered him and he got cruel; too little and it bored him, and he got cruel.
Why should she bother to please him by being as he liked her to be? She's going to do this later when he threatens Angela, but right now her reaction is rather in opposition to him!
OTOH, the stuff about too much/ too little is useful, perhaps you can put it further down. See below.
This would therefore become:
"My soul is fine," she answered. "Just fine."
Short, harsh and to the point. She still has some fight in her!
"Yes, Mr Maine." She used the formal term now; he would accept that.
This is where you could put the 'too much, too little' stuff!
closed the medical dictionary shut
(difficult to close a book open, don't you think? ;-D)
The noise echoed around the empty library. When it faded into nothing,
If you mention earlier the empty library, you can either leaves this as it is, a a reminder, or delete 'empty'.
He took the eighty six dollars
Hyphenation nazi pops back up… eighty-six dollars ;>
"You can keep the small change," he offered. Helen's daughter ran up, spaded the coins into her hand, and ran off again.
Mmh. Are you sure Angela would be so quick? She's afraid of him… Have Helen turn around and look for her daughter, perhaps? Angela knows her mother cannot pick up anything, that would be the signal for her to come and help.
(and BTW, I wonder how Helen manages in every single everyday task without hands or fingers… And how she explained her sudden thalidomide-impaired limbs to her doctor… But no, don't worry about this too much, I'm just overnitpicking!!!!)
If I could make myself young, good looking and rich
good-looking ;>
Hope this helps!
THANK YOU for the spoiler… I had guessed as much! Get him, Helen, atta girl!