Chapter 10: September 2011

“Hannah, did you write down all the patients for the list yet?”
Hannah startled and looked behind her, seeing the imposing figure of her resident behind her. She breathed a quick sigh of relief after having been surprised, then nodded enthusiastically.
“Sorry I scared you,” said Dr. Scott. “For some reason I just sneak up on people sometimes.” Hannah was not sure how this was possible, as Dr. Scott was at least two inches taller and fifty pounds heavier than Hannah. Her very dark skin also stood out against the bright green scrubs that all of the obstetrics residents wore. She did tend to walk quickly, though, and on the carpeted floors of the Labor & Delivery unit at Franklin Square Hospital her Crocs did not make much noise.
“It’s okay,” said Hannah. “I was totally immersed in this computer system. I think I must be doing something wrong because I have to click through 5 different menus to find the patient’s lab values.”
“Nope, you’ve done everything exactly right,” said Dr. Scott, absentmindedly tugging at her hair rising from her head in thick afro. “They’re a little hard to find at first. You get used to the system.”
“Isn’t that a little counterproductive, to make it like that?”
“Of course it is! But we don’t have time to for me to explain why we have such a terrible computer system. Actually– we do have time– it was the cheapest when they bought it five years ago. Done! Do you have the list written up?”
Hannah again nodded and thrust a piece of paper into Dr. Scott’s hand. On it, Hannah had painstakingly written as many pertinent details about each patient currently laboring on the floor as she could. Dr. Scott stared at the sheet carefully, her eyes darting back and forth along each line as Hannah nervously waited for her to render judgment on her work.
“Good job! There’s a few things you forgot to include but I don’t expect that you should know them. For preeclampsia patients, you should put the hemoglobin and hematocrit on, too.”
“Okay, I didn’t include them because they were normal and didn’t realize–”
“Ah, but with preeclampsia you’re not looking for the normal values. What are you looking for?”
“Uh…” Hannah’s anxiety rose once again, having just relaxed after successfully creating the list for signout.
“C’mon, let’s walk. It’s okay if you don’t know– we’ll look it up after we sign out.” Dr. Scott’s voice trailed off as she quickly began to walk away, almost completely disappearing out of sight before Hannah could realize that she was leaving. Hannah jumped up and followed her, catching up just as she was passing the nurses’ station.
The entire Labor & Delivery floor was an enormous semicircle ringed by labor rooms with two nurses’ stations on the inside of the circle. As they passed by the desk surrounded by computers, she noted that two of the nurses appearing to be in a heated discussion with Dr. Gutierrez, the OB chief resident. She stood no higher than five feet and never raised her voice, but she reminded Hannah very much of Solomon for her ability to instantly change moods and descend with a sweeping fury on anyone who might cross her. In this case, two nurses were gesticulating emphatically with their voices raised while Dr. Gutierrez merely stood with her arms crossed in the center of the work area. Hannah slowed down to try to listen, but Dr. Scott gave her a gentle tug on her scrubs.
“C’mon, we don’t have time to watch the fireworks. We’ll hear all about it in signout.”
“Okay, sorry, Dr. Scott,” said Hannah.
“Please, call me Melanie.”
“Okay. Sorry, Melanie.”
They reached the end of the semicircle, where two hallways forked in front of them. A tiled hallway extended to their left towards the OR and the postpartum rooms lined a carpeted hallway on the right; they went towards the left and continued their frantic pace towards the residents’ room. Hannah felt a much greater sense of urgency on her OB rotation than she had felt during any of her medicine months; even just walking back and forth was a more frantic process.
“So I’ll let you present the delivery that we did today, okay?”
“So what do I say while we’re signing out?” asked Hannah.
“Just briefly describe the delivery—tell us the patient’s G’s and P’s, her problems, when she delivered, and whether or not there were complications.”
“Okay, so like… her chorioamnioitis.”
“Exactly! You can say what her max temperature was, when it was, what antibiotics we gave her, and whether or not we continued them.”
“Okay. Should we have continued them?”
“Well, did we?” asked Melanie with a slight hint of a smile forming at her mouth. Hannah did not enjoy getting pimped with a question answering her questions, but it was certainly better getting a sense of playful rapport with Dr. Scott than the icy, demeaning tone that she received every time Dr. Gutierrez asked her something, as if trying to prove that she knew nothing.
“I… uh… we, um…” Hannah’s mind flashed back to earlier in the afternoon, when they had sat down and written post delivery orders on the computer. They had talked about what chorioamniotis was, how it was treated, and what risks it posed to mother and baby…
“Just say that you don’t know if you don’t know,” blurted Melanie.
“Oh. Okay. I don’t know.”
“See? Easy. Saves everyone time and you’ll be less likely to mislead anyone, especially if it’s a yes/no question about the patient. If you think you know the answer, you can try to answer it and we’ll correct you if you’re wrong. But just standing there looking constipated doesn’t help anyone.”
Hannah giggled, then rejoined immediately. “But Dr. Gutierrez said earlier that if I didn’t know an answer, I should just keep my mouth shut until I do.”
Melanie sighed. “Penny is… hard to work with sometimes if you’re a med student. And she would probably prefer that you say something like ‘I’ll go look it up’ instead of ‘I don’t know,’ because that’s just how she works.”
Hannah nodded slowly, still unsure how she would manage the idiosyncrasies of multiple senior residents over the course of her 6-week rotation. When she was on her first medicine rotation, she had noticed rather quickly that Gwen was, at best, indifferent to her presence. Thus, she spent most of her day with the other residents or students so that she could learn and do more. Gwen was so preoccupied with her load of patients that she never appeared to notice or care and so with minimal contact between them, Hannah ended up enjoying her rotation quite a bit despite the long hours and stressful environment. Now, on Labor & Delivery, the OB team worked much more closely on a smaller number of patients, putting personality clashes into the spotlight more frequently.
“I know it can be hard to deal with people who give you different answers,” said Melanie, as if she had heard Hannah’s thoughts. “But you’ll learn a lot from Dr. Gutierrez as long as you play by her rules. You’ll have to deal with this stuff as long as you’re a doctor.’
They had reached the residents’ room, which Melanie unlocked. Several couches were in one corner, while computers were scattered throughout against the wall. A large flatscreen monitor displayed all of the patients’ fetal monitoring strips, recording the heart rates in thin green lines against a black background grid. Several of the other green-scrubbed residents were already gathered around a table in the center of a room, while some of Hannah’s other medical student colleagues were sitting on the couch.
“Where’s Penelope?” asked one of the residents, leaning back in her chairs..
“Oh, just having it out with one of the nurses,” said Melanie with a shrug. “I’m sure she’ll be here any moment. Let me just make some copies of signout for you and we’ll be ready.”
Melanie scribbled a few more notes on the pages that Hannah had spent the last few hours painstakingly assembled, then handed a copy out to all of the new residents. “And by the way, if you didn’t meet Hannah this morning, she’s on call tonight and she’ll be here until the morning. Today is still her first day, but she’s done really great so far.”
“Great!” said the nighttime senior resident, standing up to shake Hannah’s hand. “I’m Amy Cho. It’s nice to meet you, Hannah.”
Hannah shook her hand, followed by the other residents. “Nice to meet you, too.”
“What do you want to specialize in–” Amy’s question was cut off by an abrupt ringing. Hannah looked to her right to see that Melanie had already put a light blue cordless phone to her ear. Hannah instinctively fingered the one that she had been given to carry—that had not been called all day, of course—but she just wanted to make sure that it was still there.
“Okay, I understand. I’m just getting signout copied.” She hung up. “That’s Penny. She’s on her way now.”
“Fine,” said Amy, taking her seat again. “How did that lady with no prenatal care do? It looks like she already delivered.”
“Oh. My. God. There was so much drama around that today, it was unbelievable.” Melanie’s normally fast speech rose to a fever pitch. “She delivered right after signout in the morning. Fifth baby, y’know, so it just slid out. Then she started getting really cranky about her methadone because she came in last night in the middle of the night and no one had called her clinic to confirm her dose. I left them, like, four messages and no one called me back until noon, when she was already probably starting to withdraw a little and was she was totally freaking out. And then we walked in to check in on her after she got the methadone and she was gone!”
“What do you mean, gone?” asked Amy. Hannah had watched this story unfold, but was still fascinated to hear the details repeated again.
“I mean gone. Like, not in the room gone.”
“Where did she go?”
“Well… she said it was for a ‘smoke break.’” Melanie made dramatic air quotes with her fingers.
Amy just shook her head. “Please tell me she consented for Depo.”
Melanie snorted. “Nope.”
Amy, who until this point had simply listened and shook her head with an appropriate amount of pity, seemed visibly perturbed by this. “What do you mean? Well, are we tying her tubes or something?”
“I asked her about that and she said that she’d think about it. But she knows that she won’t get depo because she’s not sure how she feels about all of those hormones in her body.” Melanie’s tone got higher and more dramatic as he quoted the patient’s concern about hormones. “Bitch, what about that one hundred milligrams of methadone you put in your body every day? Or the cigarettes that you just smoked? You don’t mind putting that shit in your body.”
Hannah’s mouth began to open just before the door did. Dr. Gutierrez walked in. She was short and slim with black hair that fell perfectly straight from her head to her shoulders. She crossed her arms, as she usually did, and scowled.
“Everything okay?” asked Amy.
“No. But we’ll get to it. Let’s just start signout,” said Dr. Gutierrez sternly. She began to take a seat at the table. “Wait. Where’s Julie?”
“She just called before you got in– she was right behind an accident on 695 and traffic is stopped while they are cleaning up. She said that she would be here as soon as possible.”
Hannah watched as Dr. Gutierrez’s jaw muscles clenched. “Okay. Nothing we can do about it.”
Melanie began to present. “Our laboring patient on the floor, Ms. Brown, is a 24 year old G3 P1011 at 39 weeks and 2 days who came in at 11 o’clock this morning complaining of leakage of fluid just prior to arriving. She was only contracting 2 in 10, but baby looked good on the monitor with a rate of 130, moderate variability- category I strip. Her only medical problem is thrombocytopenia, she had a hematology consult and they thought it was ITP. Her platelet count when she came in was 90. She was initially 3 centimeters dilated and fully but she wasn’t progressing when we checked her so we started her on Pit at 4PM and she’s about to get her epidural…”
“No, she’s not,” interrupted Dr. Gutierrez tersely. “So Melanie put the epidural order in but anesthesia calls me and tells me that they don’t feel comfortable putting a needle in someone’s back with a platelet count of 90 and they want a platelet transfusion first.”
“No way,” said Amy. “That’s bullshit.”
“Yeah. So it’s just the nurse anesthetist down here right now and I can’t get to the doc because he got called to the main OR for some big case where something’s going wrong. I don’t know. Anyway, so the CRNA isn’t gonna do it and meanwhile this patient is contracting and having pain and I don’t feel like fighting with him for an hour, so I just put in the order for a platelet transfusion. Of course the blood bank has to give me shit about it, too. But the platelets finally get up here and the CRNA is about to go in and give this poor woman her epidural when the nurse demands to know why we aren’t checking a stat platelet level to see if it did anything. I’m trying to tell her that of course it did something, ‘cause now she has more platelets… and I am not letting this whole thing hold up her procedure any more. And that, ladies, is why I am late.”
“Wow. That’s just…” Amy started to talk, but simply shook her head again. “Whatever. It’s happening now, right?”
“Yes. Thank God the CRNA didn’t hear our conversation or else our lady would still be lying there contracting away without her epidural.”
“When did you check her last?” asked one of the other residents.
“Just before she got the epidural.” Dr. Gutierrez’s eyes glanced upwards towards the screen showing the fetal heart rates. There were three different strips up on the screen, representing one patient on the floor and two upstairs in triage who must have gotten started on the monitor in the time that it took to present the last patient; Hannah had not noticed the two new patients since then. The thin green line of the patient that they had just discussed traced an irregular path across the black grid; the heart rate varied just enough to represent a well-oxygenated baby. Below, thin white lines representing the strength of the patient’s contractions moved in even curves. Except for the platelet issue, everything seemed to be progressing fine to Hannah as she read the strips to herself. She hoped that she might be called upon to read them aloud as Melanie had done with her all day to test her, but then remembered that everyone was eager to get signout over with.
The other two strips looked different. In one the green line was broken up, which usually meant that the ultrasound probe that was strapped to the mother’s belly was positioned improperly. Below, the white lines rose in sharp angles with little space between them. The last strip had a flat, low green line; sometimes this happened when the machine picked up the mother’s heart rate and not the baby’s.
“It looks like they’re having trouble finding baby’s heart rate,” observed Melanie, who had also noticed the new patients. At this point, all four residents were staring intently and Amy had stood up to look more closely at the screen.
Dr. Gutierrez’s phone rang and she quickly pressed it to her ear. “I see it. Call Dr. Frank. I’ll meet you in the OR.”
She paused. The other residents began to chatter among themselves indistinctly.
“Fuck me. That’s real? Amy is coming up.”
She hung up and turned to Amy and Melanie. “So we’ve got to crash the woman in Triage 2 to the OR now because she’s got a giant hematoma on her belly and she’s clearly abrupting. But the baby in Triage 3 is in the middle of a five minute decel and Dr. Theo is out delivering a baby in the parking lot. Go. Now.”
Various profanities emerged from the mouths of everyone as the room exploded in activity. The resident that Hannah had not met followed Dr. Gutierrez out the door and towards the OR, while Amy and Melanie bounded out behind her. Hannah decided to trail them upstairs, following quickly as they sprinted down the long hall. She saw two nurses approaching them just as rapidly. Hannah surmised that they were headed to the OR.
“Oh my god, is it a full moon?” yelled one as they passed.
“I don’t know, I just got here!” exclaimed Amy.
They came to the end of the hallway and rounded the corner, passing the now-empty nurses’ station before reaching the doorway to the stairs. They heard a woman screaming from just out of earshot as the elevator on the other end of the hall opened. The sound disappeared as they rushed up the stairs and the door slammed behind them.
“Oh, Hannah, you’re coming along. Good!” observed Melanie, who must have just noticed as they began to bound up the steps. Hannah just nodded as Melanie turned her head back around so that she could continue to move as fast as she could towards the triage area. Once upstairs, they passed a much more hectic nurses’ station full of indiscernible commotion. Amy was already opening the heavy wooden door to Room 3 by the time that Hannah could even look to see where it was, she was nearly bowled over by another nurse heading in the opposite direction on her way in.
She found herself disoriented and staring towards the station, an apology half-formed on her lips towards the nurse who had not let the brief collision faze her or slow her down in the least. She tried to look around to see which way to go, but was distracted only for a brief second before she felt a firm tug on her scrubs and heard Melanie’s voice curtly say, “In here!” She let herself follow the tug and stumbled into the room.
The sounds came to her first. The patient’s sobs interspersed by shrieks, the snap of latex gloves that Amy was frantically pulling on, the chatter of nurses trying to give the patient directions, and the erratic whoosh and crackle of the blue and pink ultrasound pads that they were trying to adjust on her abdomen. She oriented herself to the small room: Amy was fumbling with the dull brown gloves directly in front of her, a frightened woman stood in the opposite corner, and the patient’s torso was just out of sight, blocked from Hannah’s view by a curtain and the open door. Her legs and the bottom part of her belly were visible, though, and becoming more visible as the nurses pushed her feet together and her knees apart in a frogleg position. Melanie was already peering around the door to see the patient in the corner to Hannah’s right and gently closed the door as Hannah moved in. The two nurses were lifting up the patient’s gown so that Amy could examine her and instructing the patient– in a tone that was neither calm nor relaxed– to calm down and relax.
Before Hannah could even glimpse the patient’s face, she let out another scream and Hannah winced as she looked and saw Amy between the patient’s legs, two fingers extended and ready to plunge between the woman’s legs. Hannah hadn’t had the opportunity to examine any laboring patients and the few vaginal exams that she had done on her gynecology clinic rotation last week had been sufficiently nerve-wracking that she still didn’t feel at ease observing or performing this particular maneuver. Not that she expected to be at ease in this emergent situation.
Amy spoke, putting one gloved hand on the patient’s knee as her other hand reached towards the patient’s . “Listen, honey, my name is Dr. Cho and I know you’re in pain and scared, but your baby does not look good on the monitor. I need to examine you, so please hold still for 10 seconds while I do this.”
The patient thrust her head and neck forward, trying to get a good look at Amy. Hannah, already on edge, gasped quietly as she recognized the woman struggling before her.
“What’s gonna happen to my baby?” asked Tanisha.
“I can’t know if you don’t relax and hold still,” said Amy, her left hand resisting Tanisha’s knee as it rose from the bed, struggling to sit up.
“Okay, just do it.”
Hannah watched as Amy thrust her fingers in. For a few seconds, the clamor in the room died down to just the low, steady lub-dub of the baby’s heartbeat. Hannah had listened to that sound in enough labor rooms in just one day on Labor and Delivery to know that it was too slow, too methodical. The baby inside Tanisha’s large, sweaty abdomen was not getting enough oxygen, and, as Melanie had explained to her in detail earlier today, it was slowing down all of its body systems in a desperate attempt to conserve energy. The fetal heart monitor, imperfect as it was, was all that the team had to assess the well-being of the fetus. Hannah’s own heart rate was quickening in this eerie calm, like the eye of a hurricane.
Amy shook her head. “She’s 6 centimeters, 90%, and minus 1.” Hannah mentally imagined a partially dilated cervix, almost entirely effaced into the tissues surrounding it, with the enormous fetal head just above the pubic bone. Far from where it needed to be– outside where he or she could breathe in oxygen, not inside where the placenta and umbilical cord were, for reasons usually unknown to the medical staff, not functioning appropriately. Hannah tried to remember if Tanisha had told her if the baby would be a boy or girl.
“I have the terbutaline ready, Dr. Cho,” said one of the nurses, uncapping a syringe dramatically and wiping off Tanisha’s arm with an alcohol pad.
“Go ahead and give it. Tell them to get the other OR ready if it doesn’t work.”
“Already done,” said the second nurse.
“Honey, we’re going to give you that shot I told you about, the one that will slow down your contractions,” said the first nurse, plunging the syringe into Tanisha’s arm. She yelped again, not as loud as before. The syringe was withdrawn and she laid her head back, shutting her eyes as tears leaked from them. She grit her teeth, trying to suppress the scream. Hannah was very unsure about what was going on and tried to remember what she had been taught about terbutaline– now a year and a half ago, back when she was in her second year pharmacology class. Her own heart raced faster and faster as she heard the ominous plodding sound of the fetal heart rate.
Melanie moved forward to touch her hand on Tanisha’s stomach, where both nurses already had theirs resting. After a second, she grabbed Hannah’s and moved it over to join them. Hannah was not sure what was happening until her long fingers brushed Tanisha’s skin, and then she realized that Melanie wanted her to appreciate the rock-hard muscle contraction of the uterus. Hannah was surprised by how firm the muscle was; her instinct was to feel even more pity for Tanisha, in the grip of this contraction for the last five minutes.
The sound of the heartbeat continued to thud slowly. As everyone in the room turned their eyes to the screen next to the bed where the rate was being recorded just as downstairs, Hannah’s own heartbeat lifted just slightly along with the green line. A sharp burst of static pierced the quickening pace and Hannah wondered if it could be an arm or leg kicking.
“Okay, I’m gonna put internals in,” said Amy. One of the nurses scurried around Hannah, who tried to move out of the way and found herself backing into the closed door, caught in the curtain. She watched as Amy threaded two catheters in between Tanisha’s legs, then connected them to pads that the nurse strapped to Tanisha’s legs. Hannah had not seen these before, but she surmised that they were the heart rate monitor attached to the baby’s head and the pressure transducer inside the uterus that Melanie had explained to her earlier.
“Are we going to the OR?” asked one of the nurses.
The green line squiggled and bounced across the screen. The rhythm of the heartbeat accelerated.
Amy sighed. “Not for now.”
She stood up and looked Tanisha in the eye even as she pulled off her gloves and gently tugged Tanisha’s gown back down until her thighs were covered. “Your baby looks a lot better now. We’re going to have you move downstairs and keep a very close eye on her.”
Tanisha simply nodded in response, wiping the tears from her eyes.
“Melanie, can you and Hannah finish up her admission and put in her orders? I’m going to find out what’s going on in the OR.”
“Sure,” said Melanie.
Amy slipped past them, followed by one of the nurses. Melanie clapped her hands together with eagerness.
“So! My name is Dr. Scott. I didn’t get the chance to hear everyone’s names,” she burst out. “Let’s start with the star of the show.”
Tanisha gave a short snort of laughter as Melanie gestured towards her. “My name Tanisha.”
“And you?” Melanie turned towards the tall, skinny woman in the corner, who was texting furiously. Her skin was almost as dark as Tanisha’s and she wore an artfully ripped jean jacket over a brashly colored T-shirt.
“Okay, Shawn, and you’re Miss Tanisha’s… sister? Aunt? Friend?”
“Friend,” mumbled Shawn. “Only one with a car at work tonight.”
“I see,” said Melanie. “And this is student doctor Hannah Wells. She’ll be helping me tonight. Hannah, I don’t think you’ve met Jackie.”
The short, stout nurse who had plunged terbutaline into Tanisha’s arm extended her hand to shake. Hannah took it and shook, surprised by Jackie’s firm grip.
“Nice to meet you, Hannah. Welcome to L&D!”
“It’s… uh, good to be here.”
“On call your first night, huh? Draw the unlucky straw?”
“I… have a conference on the weekend, so they let me switch.”
“Good for them!”
“Wasn’t you lookin’ for my uncle?” asked Tanisha. Hannah heard the question, but did not realize that she was being addressed until Tanisha asked again. “Wasn’t that you?”
“Oh! Yes. That was me.”
“Yeah, I thought I recognized you. Sorry I didn’t say nothin’ at first.”
“So you guys know each other, huh?” observed Melanie.
“You could say that,” said Hannah. “Somehow I keep running into family members.”
“Well, you said that you were thinking about specializing in family medicine, right? How perfect!”
“Guess so,” said Hannah with a shrug.
“Okay, enough chitchat,” said Melanie, pulling out her copy of signout and a pen. She began to scribble as she asked questions. “Miss Tanisha, how old are you? I didn’t even get to look before I came rushing in.”
“I’m 25.”
“And this is what number pregnancy for you?”
“Uh… four.”
“Vaginal deliveries, miscarriages, abortions, c-sections?”
“Two vaginal deliveries and one miscarriage.”
“Full term deliveries?”
“Okay, and any other G-Y-N problems or issues?”
“Infections, surgeries, procedures, anything like that?”
“Any other medical problems?”
“Just sickle cell trait.”
“Hmm. Do you know about your partner’s status?”
“Uh… yeah. He’s negative.”
“Okay. Take any medications?”
“Just my prenatal vitamins.”
“Oh good! Glad to hear that. Does this baby have a name?”
“Well… we ain’t too sure yet. It’s a girl, though. That’s what they said on the ultrasound.”
Hannah looked back to the monitoring strip on the screen. The thin green line continue to bounce merrily across the screen, echoing the quickly changing heartbeat that still played loudly over the computer speakers. She then turned to Melanie, who had already whipped out her stethoscope and was listening to Tanisha’s heart and lungs. Hannah dutifully followed behind her, performing the same exam as Melanie.
“Okay, Hannah, can you guess how big this baby is?”
Hannah imitated Melanie’s movements across Tanisha’s belly after removing the pink and blue monitoring pads– first squeezing near the pubic bone to feel the baby’s round head, then pushing inward on either side, first lower and then higher. Hannah remembered a rule from earlier about approximating the size of the baby from how many soda bottles she could imagine holding between her palms, but couldn’t remember any of the details. Her thought process was soundly interrupted by the sensation of a kick in her left hand.
“Oh!” She looked down and saw an unusual bulge in the skin right where her hand had been. It had no distinctive imprint, but from the force that she felt, she surmised that it must be a foot. She turned to Melanie. “Is that okay?”
“Yup, just a foot.”
“My baby be kickin’ like nobody’s business,” observed Tanisha loudly. “I swear, she ain’t been letting me get no sleep!”
“Wow. That’s… crazy.” Hannah let her fingers run against the outline of the foot, starting to ponder what it would feel like to have feet kicking inside of herself. “Just… wow.”
“Okay, how big is this kicker gonna be?” asked Melanie.
“Um… seven pounds?”
Melanie chuckled. “You’re a good guesser. Seven pounds is a safe bet no matter how big the belly is. I’d guess a little closer to eight myself, but it’s all guessing anyway.”
Tanisha put her hand to her forehead. “Please don’t tell me that I’m gonna have an eight pound baby!”
“Well, how big were your other babies?” asked Jackie.
“Oh God, that was way too long ago… Jamie was, like, seven pounds and Jaquan was seven-and-a-half.”
“Well, that’s not too bad. Did you get your sugar test done?” asked Melanie.
“Yeah, they said that somethin’ was abnormal but I never got the three hour test.”
Hannah could see obvious disappointment on Melanie’s face.
“Well, honey, that’s not so good… because if you have gestational diabetes, that can make babies big. Why didn’t you get the test done?”
“Just was too busy with work and the kids to go for the three hour test. Plus you had to be fasting.”
“I see.” Melanie sighed. “Well, I don’t think there’s anything we can do about it now. We’ll go put in all your orders and everything. Do you want to get an epidural?”
“Yes please! The sooner the better! Lord, I can’t take this no more. I went natural by accident on my last baby and I ain’t gonna do that again.”
“All right, we’ll get that set up for you as soon as you get downstairs,” said Melanie.
“Thank you.” Tanisha shook her head, then raised her eyebrows. “That’s soon, right?”
Everyone laughed.
“Oh, yes, don’t worry!” exclaimed Jackie.
Hannah started to follow Melanie out of the room; once again, Melanie was already halfway down the hallway by the time that Hannah realized that they were apart. She finally caught up as they tramped down the stairs together.
“So that was… a little scary,” observed Hannah.
“You’re telling me,” remarked Melanie. “I’m glad that Amy was there. I don’t know what I would have done in that situation. Probably just given the terbutaline since the nurse felt the uterine tachysystole, but only after I finished wetting my pants.”
Hannah giggled. “No kidding.” She felt relieved that she and Melanie felt the same terror during the situation.
“Jackie’s a quick thinker. She must have noticed right away that the uterus wouldn’t stop contracting and drawn it up before we even got in the room.”
Hannah nodded in agreement as Melanie sat down at the computer, handing Tanisha’s chart back as she did. Hannah took the green binder and started flipping through.
“I’ll need you to read me some lab values and stuff, okay? Let’s get these orders done and in so I can leave as soon as Julie gets here.”
“Okay!” said Hannah. She fingered the “Labs” tab in the binder and flipped the section open, revealing several pages of lab reports that appeared to have been faxed and copied several different times before finding their way to this particular binder. There did not appear to be any logic or organization to the layout of the labs; some of the printouts from the lab itself were cluttered with long paragraphs of ordering information and details about particular tests. As Melanie called out for particular labs or other data from a different part of the chart, Hannah grew frustrated very quickly as she tried to find the information.
“Isn’t there an easier way to do this?” she asked aloud as she looked for Tanisha’s sickle cell results.
“Sweetie, try doing this by yourself without a med student to help you flip through the chart.”
Hannah shook her head incredulously. “At least I might be making the process faster. But the data is in some kind of database, right? And that database can’t communicate with yours?”
“They’re trying to make it happen, I guess,” explained Melanie. “But that could take years. I don’t know. I just do what needs to be done for the patient and if they ask me for my opinion about the EMR, I let them know it’s slow, inefficient, and dangerous?”
“But why is it this way when they could have built it better?”
“Who knows? Maybe it’s cheaper this way. Maybe no one could find a way to share the data and protect the patient’s confidential information. Doesn’t do me much good to complain about it.”
Hannah sighed. “I guess so.”
She heard a familiar groan and looked up to see Tanisha coming down the hall, pushed by Jackie and pulled by another nurse that Hannah had not yet met. Tanisha was again writhing in the bed, with Jackie trying to reassure her.
“Tanisha, we’re gonna be in the room right away and then you can get your epidural.”
“Aaaah! I ain’t gonna get no epidural! I gotta push!”
Melanie, previously entranced by the computer screen that had been requiring more of her attention and time than it deserved, sat upright and pushed her chair back. Hannah was startled by her movement, but this time realized much more quickly that she was getting up and moving. As the hospital bed stopped and began to turn in the hallway into an open room, Melanie arrived to help push it in and Hannah was right behind.
“Did you say that you’ve gotta push?” asked Melanie hurriedly.
“Yes, I gotta push!”
“Okay, let me get my gloves on!” cried Melanie. She dashed over to the wooden cabinet on one side of the labor room, which was much larger than the triage room that they had all just been in. The lights above were warmer and softer, as opposed to the harsh fluorescents upstairs. A long green vinyl couch sat against the far wall, which had a window with curtains drawn. They pushed Tanisha’s bed against another wall, which had the accoutrements of most hospital rooms– oxygen valves, light switches, yet another computer monitor, and the electronic fetal monitoring equipment. There was also an infant warmer in the corner closest to them, a thin yellow glow emitting from the heat lamp positioned at the top of the white apparatus.
Jackie scrambled to once again reattach the pink and blue monitors strapped to Tanisha while Melanie put on gloves. The familiar, reassuring heartbeat quickly returned to overpower the rest of the room’s cacophony. Hannah came to Tanisha’s side to hold her hand, as her friend was still entirely unengaged in the entire process.
“Alright, I’m going to check you again,” said Melanie, sitting between Tanisha’s legs and inserting her fingers to check the baby’s position. “Did you say that your last baby came out fast?”
“Real fast.”
Hannah watched as Melanie’s face registered surprise. She then scrunched her eyebrows as she apparently pushed in deeper, trying to make sure that she was correct. Hannah wondered what could be happening down there, but decided to keep her mouth shut. Tanisha clenched her hand firmly, After a few tense seconds, she finally spoke.
“Well, you’re fully dilated and the baby’s head is coming down fast, so if you feel like you need to push, let’s try and see what happens…”
She was not finished with her sentence when Hannah felt the squeeze of Tanisha’s hand get even tighter.
“Whoa! Okay! That’s enough pushing for now! Give us some time to get ready, sweetheart!”
“Do I need to call for some help?” asked Jackie.
“Yes! Please! Call Dr. Franks! And let’s break down the bed.”
The room exploded in a frenzy of activity. Jackie pressed a button somewhere behind the bed to call the secretary, whose voice crackled over the intercom. “What do you need?”
“A baby nurse and Dr. Franks, pronto!”
Hannah kept clutching Tanisha’s hand, watching as Melanie pulled an enormous rolling table from the corner of the room that Hannah hadn’t even had the chance to look at. It was covered with a dark blue sheet, which was whisked away to reveal a neat line of shiny instruments, a wash basin, and several dark green gowns stacked in a pile. Before Hannah could realize what was happening, a green gown was being flung in her direction.
“You wanna catch this baby, Hannah?”
Hannah caught the gown and fumbled with it in her hands for a moment as she stuttered. “Uh… sure!”
“Then get your gloves and hurry.”
Hannah let the gown unfold in front of her and fumbled with the sleeves as she moved over to the cabinet where the gloves were. She opened it and quickly found the size 7 gloves stacked in an orderly row right at eye level. Behind her, Jackie was talking to Tanisha.
“Looks like you’re not going to get your epidural again. Sorry, honey. Is anyone else coming?”
“Shawn, what did Dario say?”
“He say he comin’, he ain’t said when.”
Hannah bit her lip, wondering if there was any reassurance to give to a woman about to give birth in the presence of only an uninterested acquaintance from work. She tore open the white plastic package and unfolded the thin, wax-paper insert. Laid out before her were two dull orange latex gloves, each a mirror image of the other. Not wanting to break sterility, she slid her gown on and tried to maneuver the gloves onto her hands with her fingers still in her sleeves, as she had seen others do at her orientation months ago. She struggled to get the first one on, which slipped and fell back onto the paper before she heard Melanie’s urging behind her to hurry up.
She thrust her arms entirely through the sleeves, snapped the gloves on, and turned around to see that the bottom part of the bed had disappeared. Tanisha’s feet were propped against two wide stirrups and Melanie was sitting on a stool, already gowned and gloved. Bright, white lights had been turned on and they were shining directly at the spot where the guest of honor was expected to arrive. Melanie was frantically waving at Hannah to come closer, trying to direct the chaos of the room as she did.
“Okay, honey, I really need you to hold on as long as you can, I know you want to have this baby but maybe your boyfriend’s on his way and can see it coming!”
Tanisha let out another short scream of pain. Melanie rose from her seat, gesturing for Hannah to replace her on the rolling stool. Hannah took a deep breath as she sat down, staring at the field before her. Melanie had placed a bright blue plastic sheet beneath Tanisha’s bottom; it was attached to a clear plastic bag that at the moment was empty but was ready and waiting to be filled with any number of bodily fluids. With her legs splayed and the bright lights focused in on her vagina, Tanisha’s anatomy was in full view and Hannah was scared to even touch her for fear of making the pain worse. She had a small tuft of pubic hair just above her mons, but she was otherwise free of hair. Her outer labia protruded and the tissue appeared swollen; the brown skin giving way to reddish-black vulva. A slow trickle of blood was draining from the very lowest point of her vagina.
“Go ahead, feel the head,” said Melanie. Hannah, following her instruction, reached her fingers in and immediately appreciated the firm, round mass in Tanisha’s pelvis. It was immediately visible as soon as she gently moved the lips apart; a round head with matted hair pushing every other recognizable anatomic structure out of its way as it emerged.
“Tanisha!” shrieked a familiar voice. Hannah immediately turned her head to the doorway, where the shout had come from. Jessi and Dario stood side by side, panting as they burst into the room. Hannah could sense the shock in Jessi’s face as she looked at Hannah sitting between Tanisha’s legs, but it immediately passed as she turned her attention back to her daughter. She and Dario immediately flanked the bed, each taking one hand.
“Alright, let’s have this baby! Give us…”
Again, Tanisha followed Melanie’s instruction to push before she could even finish her sentence. Hannah watched in awe that quickly turned to fear as the head moved closer towards her, now visible without her hands to spread apart the labia. She felt Melanie take her hands and turn them so that her palms were facing each other, spread apart by about two inches and level with the floor. There was a green towel in Melanie’s left hand; she used it to grip the skin below where the head was starting to emerge.
“You have to protect the perineum,” she explained, squeezing with her thumb and index finger along Tanisha’s skin to keep it from tearing. “But for now, just catch the baby when it comes out. Remember the cardinal movements?”
Hannah wasted no time. “No, I don’t.”
Melanie chuckled. “It’s okay. Just pull down, then up.”
As she spoke, the head began to crown. Hannah’s fingers quivered as the met the child’s skull, but Melanie’s right hand took hers, their fingers nearly intertwined. “Feel for a nuchal cord.” Hannah reached further in, trying to appreciate whether or not there was a cord wrapped around the baby’s neck. She was not sure what she was feeling, everything was warm, slippery, and moving too quickly for her liking. The delivery earlier in the day had been much more drawn out; during that one the nurse had been forced to coach the patient through nearly every push and count with her. Tanisha seemed to have no such difficulty providing the right amount of pressure in the right place to expel the baby.
“Okay, here she is!” announced Melanie.
Indeed, the baby’s head had completely emerged, her neck flush with Tanisha’s skin. An indiscernible scream arose from the head of the bed, where both Dario and Jessi were excitedly relating the news that Melanie had just shared. Hannah’s fingers were still on the smooth scalp, her arms shaking as she tried to anticipate the rest of the baby sliding out and into them. However, the head stayed where it was, the motionless purple face turned to the left and scrunched in silence, as if she were meditating before she opened her eyes.
“One more push!” cried Melanie. Her fingers were firmly wrapped around the baby’s neck and were pulling harder than Hannah thought any child could ever withstand. The head was not bulging out any further, nor was the baby’s countenance changing in the least. Hannah’s heart raced with dread, only exacerbated by Tanisha’s shrieks.
“C’mon, c’mon, c’mon kiddo!”
There was a flurry of other voices behind Hannah. She thought she recognized Amy, but wasn’t sure. Her gaze was fixed on the head in front of her, smooth and dusky. She wondered if this was the shoulder dystocia that she had heard about, where the baby’s shoulders were trapped behind the pubic bone and could not be delivered without maneuvering the legs or breaking the child’s collarbone. Her hands were now only lightly touching the skull, but could still feel the intensity of Melanie’s upward traction.
“There!” Before Hannah could realize what was happening, the shoulder closest to her right hand popped out, followed by the other shoulder. The rest of the body quickly slid into Hannah’s left arm, whereupon she fumbled briefly with the slippery mass of flesh while Melanie quickly suctioned the baby’s nostrils with a bright blue syringe
“Waaaaahhhhh!” cried the infant loudly, shaking its limbs with vigor. “Waaaaahhh!”
Melanie produced a pair of shiny metal scissors as Hannah, still trembling, tightened her grip on the new patient. She held the child’s head in her left hand, the blood-covered legs straddling her elbow. She stabilized the quivering baby with her right hand and finally looked up towards Tanisha, who was straining downwards to see the baby.
“Dad, do you want to cut the cord?” asked Melanie, offering the scissors to Dario.
“Sure,” he said as he took them.
Hannah stood up, awkwardly holding the still-screaming infant out over Tanisha while Melanie fastened clamps along the umbilical cord. Dario snipped gently at first, only tearing the translucent outside tissue a little as he did. He then tried again, this time severing the cord completely with a small spray of dark red blood onto Tanisha’s gown. Jackie had already appeared with a blanket to wrap the baby in and hand her to mom.
“Do you want to go skin to skin?” she asked as she took the infant from Hannah.
“Oh my God, she’s beautiful,” answered Tanisha, taking the bundle and clutching it to her chest. “I don’t mind taking her.”
“You decide on a name yet?’ asked Jessi, reaching over to stroke the baby’s still-moist forehead.
“I think she’s gonna be Olivia,” said Tanisha with as smile.
Hannah looked briefly at her hands, dripping with blood and mucus. A half-formed bowel movement that had emerged from Tanisha along with Olivia hung precipitously from the blue plastic sheet. Blood continued to trickle out of Tanisha’s vagina, dribbling down the cord that stil had a metal clamp dangling from it. She then looked up at Tanisha, Olivia, Jessi, and Dario, each of them embracing in a way that made Hannah tremble again when she stared long enough.


Solomon eased his car into the driveway, flicking his headlights off as he approached the garage door. He turned off the engine and opened his car door, stepping out onto a neatly manicured lawn strewn with riding toys. The grass was still green and healthy-looking despite the cooler weather that had prevailed in the last few days; even in the dark Solomon could appreciate the care that his brother-in-law put into it. He walked along the driveway and up the path to the doorway, where he knocked gently before opening the storm door and putting his hand to the doorknob on the inner door.
A wreath of plastic leaves hung on the dark blue door, its gaudy yellow, red, and brown leaves illuminated harshly by the bright porch light to his left. He hesitated on the doorknob, wondering if perhaps he had come too late altogether and should turn around. After all, he had clinic in the morning. However, he heard a voice from within faintly calling him to come in, so he did.
He stepped into the foyer, which was lit by the warm glow of a vanilla-scented candle perched on a coat rack in front of him. He shed his jacket and hung it up on the rack, revealing a light blue scrub top beneath. His sister came around the corner from the kitchen.
“Glad to see you finally made it.” Her tightly curled hair, accented with lighter brown streaks the further it extended from her head, wiggled with what felt like nagging disappointment to Solomon. He looked down at his worn leather slip-on shoes before looking back up at her.
“I’m sorry, Kendra. There were… complications during the surgery. I won’t bore you with the details, but a very important artery was damaged by my fellow and it took a lot of work to make it right.”
“It’s alright. I understand.” She put her arm on his shoulder, gently squeezing as she did. “Did you eat? I can still warm up the spaghetti.”
“That would be great. I guess it’s pretty cold by now.”
“Mmm… yeah.” She nodded a bit too vigorously before turning and heading into the kitchen.
Solomon took a seat in a wooden chair around the kitchen table, pushing it back along the smooth granite tile floor to face the counter where Kendra was preparing his meal. He watched as she spooned spaghetti and meatballs onto a plate from a tupperware container in the refrigerator, then covered it before placing it in the microwave. The light of the microwave, along with another candle, provided the only illumination in the kitchen and the low hum of the microwave was the only sound for a few more seconds before he spoke.
“So, how is the baby?”
“The baby is fine. Sleeping for now, thank God.”
Solomon smiled. “Not doing so well in the sleep department?”
“I mean, she’s three weeks old, Solomon. She’s just gonna be up every 3 hours for a while.”
“I guess you’re right,” he said. “It’s been a while since I did any pediatrics.”
“She’ll wake up soon enough and you can finally meet her. It’ll be about time soon. We’re trying to get her back to sleep by midnight usually.”
“When are you going back to work?”
“Three more weeks.”
“Is that all they gave you off?”
“I could have taken more, but you know with the mortgage and new school clothes for the kids and Christmas coming up…”
“I hear you.” Solomon nodded gently. “And Rashad has a birthday coming up soon, right?”
“You remembered!” observed Kendra emphatically.
Solomon grumbled low, then sighed. He knew that, at ten o’clock at night after a long day of operating, this was not a fight that he had the time or energy to win, especially since he could not remember a time since residency when he had walked away feeling like he had won it. He decided to keep moving without responding to his sister’s provocation.
“What does he want for his birthday?”
“More Legos, of course.”
Solomon gave a small chuckle. “He doesn’t have enough already?”
“That’s what his father always says,” said Kendra, taking the plate out of the microwave and ceremoniously placing it in front of Solomon along with a shiny fork and knife. He began to cut and eat the meal, savoring the warm sauce and pasta as he ate for the first time since 10AM, when his surgery had started.
“So where is Mark tonight?” asked Solomon.
“Taking the night shift for a little while. Just covering the store until it closes. He was here for dinner and then he’ll get back around the time that McKenzie goes down.”
“I see.”
The silverware clinked noisily against the plate as Solomon wolfed down the spaghetti and meatballs. It was not just good because he was hungry; his sister, he knew, had made this sauce from scratch and let it simmer all afternoon. The meatballs were from a frozen package, but were still tasty after spending plenty of time in the sauce. Half of his serving was gone from the plate before Kendra spoke again.
“Are we gonna get to see that woman of yours again?”
Solomon took another very large bite of spaghetti before looking up, rubbing his temple with a mixture of unease and frustration.
“She’s not mine,” he blurted with a half-full mouth. “I mean, just… the possessive language. Has never worked for me.”
“Sor-ry,” exclaimed Kendra in a low voice. “Are we gonna get to see that woman that you’ve been seeing for a year again?”
“I guess so,” said Solomon. “She’s very busy.”
As soon as the words escaped his mouth, he realized how rote they sounded coming from his mouth. Busyness was an excuse proffered so easily from him that his sister was used to making it for him on most occasions. He turned back to his plate.
“I liked her a lot.”
“I like her a lot,” replied Solomon. “She’s managed to be… instrumental in my research, much to my surprise. There were three patients that were completely lost to follow-up and she helped me hunt them down and bring them in. Not perfect– there’s still one that got away. But she’s given me a new appreciation for primary care doctors.”
“So… she’s useful to you.”
Solomon nodded slowly, trying to figure out if Kendra was just listening or adding adding another accusation.
“And she… doesn’t seem to mind that you still keep her at arm’s length?”
“Fuck if I know,” muttered Solomon, scraping the plate with his fork for the last few strands of pasta. He watched as his sister raised her eyebrows at his language, savoring the reaction. “I can hardly ever read her, and most days she’s so busy reading me that I don’t have time to even try. She’s fucking brilliant is what she is. I’ve met some women in my time who could give me shit back as hard as I could give it. But they’re all just as cynical and jaded as me. She’s one of those genuinely glass-half-full kinda people and it’s just… fascinating.”
Kendra walked over to the table and took Solomon’s plate, then quickly refilled it from the tupperware and put it back in the microwave. “The romance is… breathtaking, Solomon. Moving. You’re a regular Casanova.”
“Your approval is appreciated,” growled Solomon.
“What does she see in you?”
“Passion. Curiosity, I suppose. I don’t think she’s had many men who were patient enough to wait for their chance to psychoanalyze.”
Kendra shrugged. “Well, I guess that makes enough sense to me.”
The whirring of the microwave was broken by whimpers from the dark beyond the hallway. Kendra disappeared for a minute, leaving Solomon alone in the kitchen. He watched the candles behind the sink flicker, then rose and took his plate out of the microwave after it beeped at him. He wondered if he had made the right decision to walk through the door fifteen minutes ago, as he was now very tired and full of more questions than he was used to.
Kendra reappeared with her child, who was still squirming around as she continue to fuss. Her round head was covered in tiny curls; she had her mother and uncle’s dark complexion and had large, round eyes. She was dressed in a soft pink outfit and her feet were twitching slightly in Kendra’s hands. Solomon placed his plate back on the table and walked over to touch one of them.
“McKenzie, this is your Uncle Solomon. He’s a big shot surgeon downtown but he still came all the way up here to Reisterstown to see you. So you had better be on your best behavior and spit up all over him so he knows that you love him.”
Solomon laughed. “It’s a pleasure to meet you, McKenzie.”
Kendra lifted her shirt and put the baby to her breast. McKenzie’s whimpers turned to noisy gulps as she began to eat.
“So, how’d you do it?”
“Do what?”
“I dunno. Fall in love.”
“Do you love Rita?” Solomon thought he could detect a smirk on Kendra’s lips, but it was hard to tell in the candlelight.
“Do you women ever answer a question with an answer instead of another fucking question?”
Kendra scowled.
“Do you ever admit when you don’t know an answer instead of just replying with intimidation and profanity?”
“Sorry.” Solomon hung his head.
“You always say you can’t stand it when your residents B.S. you instead of telling you they don’t know. You could extend the same courtesy to your family.”
“I guess I could.”
“Anyway, since you asked… I don’t know. I just did. It wasn’t easy at first. We went to a lot of counseling the first couple of years. Mark had his own baggage. Just because you grow up in the suburbs with two middle-class parents doesn’t mean that you don’t have some problems relating.”
“Good to know I’m not the only one.”
Kendra rose suddenly. “I forgot to offer you a drink. We have water and… uh, Kool-Aid.”
“Water will be fine, “ said Solomon. He looked down at his plate. “And… a third helping of spaghetti, if you can spare it.”
Kendra laughed. “You still can put it away, can’t you?”
“I can. You don’t have to get up.”
Solomon rose and dumped the remainder of the spaghetti onto his plate, then put it in the microwave. He then opened a wooden cabinet next to the microwave for a glass, but only found plates and bowls. He shut it quickly, then opened another one that only held dry goods and spices. He moved to the other side of the stove and opened the last cabinet, then filled it in the sink.
Kendra was not paying attention to Solomon’s search, but was looking at McKenzie as she fed. The gulps were getting softer and further apart now.
“Dr. Chambliss sure seems to have stirred up some things.”
“Oh?” said Solomon, taking his seat.
“Y’know, just askin’ me all these things you ain’t never taken an interest in before.”
“I’d like to think of myself as always being willing to learn.”
“I guess you wouldn’t have become a surgeon if you wasn’t.”
“Anyway, so you had some help from your foster family, right?”
“Sure. They loved me unconditionally. I did some stupid stuff when I was in high school, but it didn’t stop them from believing in me.”
“I suppose I’ve always thought that the better way to go was not doing anything stupid in high school. But perhaps learning from your mistakes in an environment where you have a little room to fail is helpful.”
Kendra took McKenzie up onto her shoulder and began to pat her back. “Bet you that fellow of yours will never do whatever he did to that artery again.”
Solomon chuckled.
“But… we couldn’t have known, Solomon. I didn’t know anything then. I had to be extracted from our neighborhood, see that there was more to life than what we saw every day. All that rippin’ and runnin’, all that yellin’ and screamin’. You saw it yourself without any prompting; you didn’t need someone to sit you down and tell you over and over that if you didn’t get your act together and stop sneaking out at night and do your homework you weren’t gonna be any better than the good-for-nothin’ parents you was born with.”
Solomon stirred his spaghetti on his plate instead of shoveling it into his mouth. He was almost feeling full.
“I wish I had more to tell you.”
Solomon drained his water glass. “I suppose that’ll have to do for now.”
“You wanna hold her?”
Solomon smiled. “Why not?”
Kendra rose and gingerly placed the child in Solomon’s hands, which he extended as if he were trying to catch a football. She tried and failed to suppress a giggle as he awkwardly tried to situate the infant on his shoulder.
“Guess you don’t handle too many of these, do you?”
“Babies tend to prefer breastmilk to booze, so they need fewer liver transplants.”
Kendra chuckled. “Well, then, I guess that settles it.”
McKenzie let loose a quick, wet belch. Solomon, hearing the noise, moved her away from his shoulder. The tiniest hint of a smile emerged on her face before she spewed curdled, warm milk directly onto his neck and chest, spilling down the front of his scrubs.
“Well, you got me, kid.” Solomon shook his head and laughed. “You got me.”


Jessi nervously sat in the examining room, looking over the unavoidable large poster demonstrating the entirety of a woman’s pelvic region in cross-section again, trying to figure out how the bright yellow bladder managed to balance itself on the soft pink vagina and yet not squash the pale red rectum. And the uterus was all curved up in a way that seemed incompatible with holding a child for 9 months. The pharmaceutical company that had provided the poster had included some product information at the bottom for a drug that cured an infection Jessi hoped she would never get, at least based on the cartoon illustration next to the drug’s name of a labia so red it was angry-looking.
A soft knock at the door preceded its opening. A short-haired Asian woman entered the room, smiling and extending her hand to Jessi, who shook it.
“Hello again, Jessi. It’s been a while.”
“Yeah,” said Jessi, smiling back. “Got admitted the last time I had an appointment with you.”
“Oh no!” exclaimed Dr. Michaels. “I didn’t realize… I’m so sorry. What happened?”
“Leg swelling,” explained Jessi. “They say I got heart failure. Don’t sound so good to me, but they said it’s only a little.”
“Oh, I remember that you already had a little CHF.”
Jessi looked quizzical.
“Congestive heart failure. It just means your heart is not pumping as well as it used to after you had heart attack. A little plumbing issue, as it were.”
“So if it’s just a little plumbing issue, how come they call it ‘failure’?” Jessi snorted with bewilderment.
“Don’t ask me, I didn’t make up the name. But your heart normally pumps about 55 to 60 percent of the blood that comes in. If I remember correctly your heart actually pumps… here, let me look it up on your chart.” She finally sat down at the computer on the opposite end of the room, logging in with a few keystrokes. “Here, why don’t you get off the exam table and sit next to me so we can talk face-to-face? I don’t like having this computer here, but I have to use it to look up your information.”
“Fine with me,” said Jessi, easing herself off the table and over to a chair in the corner next to the computer with only mild difficulty.
“I can’t stand how they’ve set these rooms up,” muttered the doctor. “Let’s take a look at your medications. Did they change any of your medications while you were admitted?”
Jessi nodded. “Yeah… now I’m taking more Lasix, less Lisinopril, and they added some new medication for depression ‘cause they think I’m depressed and I couldn’t sleep.”
“Do you remember what the new medication is called?”
“No,” said Jessi. “It’s a small white pill. They said to stop takin’ my Lexapro. That’s too expensive anyway.”
“Has it helped?”
“I don’t know. I didn’t know I was depressed in the first place.”
“Well, why did they think you were depressed?”
Jessi shrugged. “I dunno. They just said I needed to take this medicine for depression.”
“Okay. Well, if you haven’t been feeling depressed, have you been having difficulty concentrating or sleeping?”
Jessi nodded. “ ‘Cause my work been makin’ me work nights and days alternatin’. Lord have mercy. And my daughter just had her baby, so we been all stressed out over that.”
“Oh, how exciting! Is this your first grandchild?”
“No, she got two little boys. She finally had a girl!”
Dr. Michaels grinned. “That’s wonderful. I’m so excited for you all. Where did she have the baby?”
“Franklin Square. Where I work.”
“Oh, that’s quite a hike!”
“Well, she live over on the East Side… but yeah, it be a long bus ride.”
“Why do you work all the way out there and live here?” asked Dr. Michaels. Her tone was pleasant and inquisitive. Jessi shook her head as she began to answer.
“Oh, honey… I wish it wasn’t like this. But they was the only place I could find a job after I got my MA certification. And I only got 5 years left on payin’ for my momma’s house, so it don’t make much sense to move now.”
“I see.” Dr. Michaels turned back to her computer, clicking a few more buttons . “So if we don’t know what medications you’re on now… and they haven’t sent me your bloodwork… I would really love to change your medication to get your blood pressure a little better controlled because it’s high again, but I can’t do anything without that information from the hospital.”
Jessi rolled her eyes. “Man, I ain’t lettin’ the ambo take me to Bon Secours no more. No, ma’am!”
“Well, we can get the records from them and see what they say. If we can’t, I’m going to have to repeat all the testing that they did.”
“Well, okay then,” said Jessi with a sigh.
“Are you still smoking?” The question was quick and caught Jessi off guard.
“Uh… no. Not really.”
“Not really?” Dr. Michaels raised her thin black eyebrows suspiciously.
“Well… I bought a pack a few days ago and smoked about half, then I threw it away. I just can’t keep it off. Things start stressin’ me out and it’s just too much. I know it’s so bad for me, but I just can’t quit.”
Dr. Michaels nodded sympathetically. “What does smoking do for you?”
“What does it do for me? I dunno. It does a lot to me. It mess up my lungs, my heart, blood vessels… they told me all this last week. You don’t need to repeat it all.”
“No, I want to know what it does for you. Clearly it does something positive in your life, or else you wouldn’t keep doing it.”
“Something positive?” Jessi wondered to herself about what on earth this woman thought she was trying to do.
“Well, for some people it relieves stress, for other people they do it to be social, other people just like having something that gives them an excuse to get out of work.”
“Oh!” remarked Jessi. “Definitely stress relief. It calms me down when everything’s all crazy.”
“Well, are there other things that you can do to relieve stress? Or things you can do to not have as much craziness in your life?”
Jessi pondered for a moment before answering, something she was not used to do at the doctor’s office. “I mean… I don’t know. I think between the baby and my work, there’s not a lot I can control. I may have to throw my brother out the house again. He tryin’ to get his disability check back but this time he insistin’ on bein’ his own payee.”
“I see,” said Dr. Michaels. “Well, some people do deep breathing exercises or pray when they’re stressed, or they find something like to help them relieve stress like chewing on sugar-free gum or squeezing some silly putty.”
“Silly putty?” asked Jessi incredulously.
“I wouldn’t say it if it didn’t help.”
“Hmm.” Jessi tried to convey her continuing suspicion but as her doctor kept clicking, clearly looking for something specific on her computer, she started to think about the suggestions.
“I do pray. A lot,” she said. “And I’ve prayed for the Lord to take this from me, but not so much in the heat of the moment.”
“Well, that’s certainly one thing you could try,” said Dr. Michaels. “So… I finally found the information from when you had your heart attack. it looks like you were only pumping at 35 percent instead of 55 percent after your heart attack.”
“How come I didn’t swell up ‘til just last week then?” asked Jessi.
“Well, sometimes just little variations in diet, infections, or fluid intake can tip the balance. Right now your pump doesn’t work so well, so you have to be careful about how much you take in.”
“That’s what they said,” said Jessi. “Not too much salt, not too much water. At the end of all this you gonna be tellin’ all I can eat is carrots and rice.” She snorted again.
“Oh, the rice might be too many carbs with your diabetes,” said Dr. Michaels thoughtlessly. Jessi watched her quickly try to backtrack mentally, her face screwed up in embarrassment. “I didn’t mean it that way! I just… spoke on instinct. There are lots of good foods that you can eat that are tasty and won’t make things worse.”
“Oh, really?” asked Jessi with suspicion.
Dr. Michaels smiled. “What’s your favorite healthy food, Jessi?”
Jessi had not been prepared for the question. She looked away at the poster, then back at Dr. Michaels.
“Y’know, that’s a good question. Ain’t nobody aksed me that before. Probly greens.”
Dr. Michaels continued to grin. “Okay, and what’s the least healthy thing you like to eat?”
“Oh, Lord. You don’t wanna go there.” Jessi shook her head and chuckled. She thought for a second before slowly giving her answer. “I like…”
Her head went side to side.
“No judgment here,” said Dr. Michaels, her face serene and still.
“I… like to get a big piece o’ fried chicken and dip it in my homemade honey mustard sauce. I eat that three times a week. Probably why I can’t get my diabetes under control. Damn, it’s so good, though. ‘Scuse my language. Oh my God. Can’t believe I just told you that.”
Dr. Michaels chuckled. “No worries, Miss Goodson. I’ve heard crazier answers to that question. Do you think there’s anything that you can do to make that meal healthier?”
Jessi shook her head. “No way.”
“Are you sure?” asked the doctor, her eyebrows raised slightly. Jessi sighed and scratched her head, looking away before she spoke .“Well… I ‘spose I could not use as much mayonnaise in my sauce.”
“Or use fat free mayonnaise,” suggested Dr. Michaels.
Jessi frowned dramatically. “Girl, you ever tried fat free mayonnaise?”
Dr. Michaels smiled again. “It was just a suggestion. I want you to think about what you can do for your health. All I can do is tell you where things are and help you to take control of your own health.”
Jessi shook her head again. “I ain’t had control of my health for a long time.”
“And why do you think that is?”
Jessi laughed. “Man, get me that other doctor back here, the one who look at the screen all day! You ask too many questions. Gimme that insulin that everyone say I need to be on to control my diabetes.”
“Jessi, I don’t think you need insulin. You’re still right at the edge of having your diabetes controlled or not controlled. I’m not going to sit here and tell you what to do or not do, because you know it already. I’m going to help you brainstorm ways to get better. But you have to want to get better.”
“I do want to get better!” protested Jessi.
“Do you want it more than you want to eat your fried chicken with honey mustard?”
Dr. Michaels’ question stunned Jessi. She had felt talked down to before by doctors– judging her for eating what she had been eating since she was a little girl, for smoking to deal with her stress, and back in day for all sort of other habits that she had chosen to mask her pain. But no one had ever asked her if she wanted to be better. Perhaps they had always just assumed that she didn’t.
“I… do,” she said finally. She looked down at the floor. “And you ain’t gonna give me no insulin because you want me to prove it to you.”
“You know just as well as I do that you’re gonna gain more weight on insulin and probably eat worse than you do now.”
She was right. Jessi waited a few seconds before she nodded along and then sighed. She looked up, slightly invigorated.
“Alright, sister, you gonna push me, I’m gonna push back.”
“Good.” Dr. Michaels beamed. “I know you’ve got what it takes, Jessi.”
“Ain’t nobody said that to me since I was in recovery,” said Jessi softly. “All these doctors I seen and all these hospitals I been in.”
Dr. Michaels shook her head. “I know, I know. It’s a lot easier to give you a pill and tell you to lose weight. And I can’t make any promises. Your heart, your kidneys, your lungs– they’ve already taken a hit. But I think we can work together to help you be healthier.”
“I would like that,” said Jessi, smiling.
“I’ll be back in a few minutes,” said Dr. Michaels, rising from her chair. “Let me print you out a copy of the medication list I have, and you can let me know what medications they changed in the hospital so we can have an accurate record in our system.”
Jessi’s eyes followed Dr. Michaels out of the room. As she waited for the door to open again, her eyes revisited the female anatomy poster before moving on to the one next to it. Two smiling black children were running through a grassy field, one clutching a football while the other raised his arms in pursuit. The tagline declared that an hour of day of outdoor play was needed for every kid, every day. She began to wonder about Jamie and Jaquan, who didn’t do much besides play video games. Taking them up to Druid Hill Park was always a lot of work, mostly because if one of them got distracted and ran off somewhere, she had a hard time keeping up.
Jessi’s purse shook at her phone inside vibrated. She pulled it out to see a blurry picture of Jamie and Jaquan hanging off the arms an enormous football player in his dark purple uniform. His clean white teeth beamed at her while the boys’ mouths hung open in a mixture of delight and terror.
how ya doing ma? ray rice came to J&J school today!
Jessie smiled and texted back.
They some lucky boys. 🙂 I’m doin ok. At the doctors.
what they say?? u gonna be okay with ur heart?
Yes. Dr michaels is a nice lady. You know I always feel so guilty when I come to the doctor.
thats cause they tell you what you gotta do to SURVIVE!!!
Jessi gave a gentle snort at her daughter’s prodding.
She don’t lay on the guilt so hard. Not as hard as you anyway. But my fried chicken gonna have to go if I wanna see the boys play for the NFL and the baby go to college.
I been sayin that for years and now you finally gonna do somethin bout it?!
Girl, I been trying. Dont worry. You gonna see things change. I want to get better.


Adam looked at his watch again, as he had nearly every three minutes for the past half hour. Having completed the assigned reading for his classes long ago and finished dinner, he had also read most of the interesting chapters in his Abnormal Psychology textbook and a few of the uninteresting ones. He looked again at the timestamp from Hannah’s text that had said, “Leaving now!” It had been thirty-five minutes exactly, which probably meant that he could start reheating dinner again. He shuffled over to the kitchen from the living room, running his hand along the glazed brick rowhouse wall . The pilot light clicked and then gave a low whoosh as the flame came on beneath the soup that had sat cold on the burner for the past hour.
He heard the heartening sound of a key jiggling in the door and quickly walked back to the living room. A burst of cool air met him, followed by Hannah’s awkward embrace– she had a lunchbox in one hand and a backpack in the other– and the cold sensation of her jacket. She kissed him quickly on the cheek before dropping her bags on the floor, then hugged him tighter.
“I’m sorry I’m late,” she said, pushing the door closed with her left foot as she pulled him closer. “Signout was crazy again.”
“It’s okay,” said Adam. “I just… missed you. That’s all.”
“I know. I missed you too. It’s been a hard day.”
“C’mon, sit down. Let’s eat.”
Hannah kissed him again. “Okay.”
Adam spooned out two servings of peanut soup into bowls and set them on the table while Hannah shed her jacket and sat down. She was still wearing her green scrubs, and as she sat down Adam noticed that a long thread of dark red blood had stained her left pants leg and had even dripped a little onto her shoe. He shuddered, looked first at the floor to make sure that she hadn’t tracked any blood across the house, and then spoke.
“Uh… there’s blood on your pants leg.”
Hannah looked down and gasped. “Oh my God. I’m– I didn’t even realize. It must have been during the delivery. I’m so sorry. Get me a plastic bag, I’ll take off my scrubs. I should have changed when I was still at the hospital– I just wanted to be home with you as soon as I could be.”
“It’s alright,” said Adam, opening a cabinet and grabbing a plastic bag, which he quickly handed to Hannah. She gingerly removed her shoes, inspecting them for more blood as she did. She carefully set them on the floor and then took off her scrubs, placing them in the plastic bag and tying it off.
“I guess I’d better change,” she said, shaking her head with embarassment.
“I don’t mind if you eat in your underwear,” said Adam with a low chortle as he admired her pale, exposed skin.
“So I figured.” Hannah rolled her eyes, crossing her arms over her sports bra as she sat down. “Well, I’m so hungry right now that I could care less.”
“You can change if you want…” started Adam, feeling ashamed that he had ogled her.
Hannah giggled. “No, it’s fine. You keep it warm enough in here that it really doesn’t matter, and I just want to eat and go to sleep. You can undress, too, if you want…”
“Uh, no thanks,” said Adam. “It’s still a little cold in here for me.”
Hannah laughed and started aggressively spooning the soup into her mouth. Adam quickly joined her, devouring the warm red soup. It was just a little creamy and spicy, mixing the peanut and tomato flavors together in his mouth.
“This tastes fantastic,” observed Hannah.
“Yeah, I’m pretty proud of it. You taught me well. A little sad that a white girl had to teach an African how to make his own soup…”
“I’m just glad you were willing to learn.”
“So today was crazy?”
“Yeah. So our friend– I finally found out why she wasn’t on birth control!”
“You mean Tanisha?”
“Shh! I’m not supposed to use names!”
“Sorry,” muttered Adam. “Patient privacy. I guess it’s important. I’ve never known a time when my dad wasn’t aware of the doses I was taking before I was, so it’s a little foreign to me.”
“It makes sense– sort of. I mean, it used to make more sense than it does now. You want to be able to keep your HIV status or the fact that you’re being treated for depression a secret from your boss. But trying to verify this other lady’s methadone dose was just such a hassle, and now trying to communicate with her clinic and Child Protective Services about a previous case was a mess. So of course I had to go open my big mouth and tell the team that I thought we couldn’t just breeze by the social issues on our patients, so I was calling back and forth all morning.”
“What do you mean by ‘breeze by’?” asked Adam.
“Well, they just said that when CPS came to talk to mom, they ‘offered resources’ and mom refused.” Hannah made dramatic air quotes. “She said that there was already a counselor that she saw at her methadone clinic and that was that. And I don’t think they had many resources to offer besides a number for a counselor. But this lady was clearly depressed and when Melanie and I were talking to her this morning, she was crying and talking about how she didn’t know what was going to happen because she doesn’t even know who the father of the baby is or what she’s going to do. All Melanie said was that it was up to the social worker.”
“I thought you said that Melanie was really caring and thoughtful.”
“Well, she is! But I don’t think she feels very comfortable dealing with depression and stuff like that. She is just an intern. I don’t feel very comfortable, either. I guess I’ll learn more about that when I do my psych rotation.”
“So then what happened?”
“Well, I really wanted to make sure that the counselor that the patient sees knew that all of this was going on and that she had an appointment in the next week. Postpartum depression is no joke. But when the counselor finally called back– two hours later– she said that she sees clients at the methadone clinic once a month and that she would see if she can see her any sooner but that she was really busy. It was like nothing I said to her registered.”
“That’s stupid,” said Adam. “If someone needs help, they should be able to rearrange the schedule to fit people in quickly. That’s what Dr. Bode always did for me.”
“Well, Dr. Bode could always scream at his office staff– which is just those two poor ladies up front– to make time. And he could make time at weird hours of the day to squeeze people in. Most bigger places don’t have that kind of flexibility.”
“I guess so.”
“So finally I go back to the patient, who finally tells me that this clinic is what people call a ‘gas n’ go’ so I shouldn’t expect too much out of her counselor, who only checks in with her once a month and asks her how she’s doing but doesn’t really do much else.”
“That’s a bummer,” mumbled Adam. “It’s just a methadone clinic that just hands out the stuff and doesn’t deal with the problem that got someone hooked on drugs in the first place?”
“Yup. God, it makes me mad. They just get paid to hand out methadone. And then when I’m complaining about it later, one of the residents just said it was primary hip adductor failure and that was that. It just made me mad, but I was afraid that if I spoke up again I would only be given more work to do.”
“You’re gonna have to explain…”
Hannah cut him off. “And then there was the whole business about Tanisha’s birth control. It turns out that someone told her that she couldn’t take birth control pills because of her sickle cell trait. There was some kind of theory that it increased the risk of blood clots.”
“And she couldn’t get an IUD, like you have?” inquired Adam.
“They tried. It caused her to bleed constantly. Couldn’t tolerate it. So I went and looked it up and that’s totally not true. Some doctor out there was just giving out bogus advice! And then she had this unwanted pregnancy– the kid is totally cute, but they’re super stressed out because how are they going to afford it– and at least now we could prescribe her birth control.”
“It just seems weird that you keep running into all these people who have all these problems that bring them into the hospital and the hospital fixes the emergency but all the other stuff that brought them into the hospital is still floating out there.”
“Yeah.” Hannah nodded, slurping up the last of her soup. “It’s just… frustrating. And I used to think that access was such a huge deal, that getting everyone covered would make things better. And I’m glad that we got the bill passed and come January, things will be better. But every pregnant patient I’ve seen this past week has insurance and can get better forms of birth control but they’re always full of excuses about why they didn’t get it or don’t want to take it.”
She looked down into her half-empty bowl, then up at Adam. She pulled her hair out of the ponytail that it was in and let if fall gently over her shoulders. They stared at each other in silence for a minute, Adam moving his lips as if to speak several times but then hesitating when a word began to form.
“What is it?” she asked.
“It just… seems like a little bit of your idealistic light is fading.”
Hannah pursed her lips and crossed her arms again. “I don’t know if that’s the case. I feel like I’m still as idealistic as I ever was. I just don’t know where it fits anymore.”
“I guess I can understand that.”
“I mean, I went through this the first few times I went to Ghana. I was even more starry-eyed then, thinking that I would save all of those poor black Africans. It took a few trips before I realized that I could be making things worse by just showing up with good intentions and too much money. It took a few more before I was able to make the right connections and listen long enough to find a better way.”
“Do you think you’ll find a better way?” asked Adam.
“I sure hope so. Dr. Chambliss seems to have a good head on her shoulders. I can’t wait until I get to rotate with her on Family Medicine.”
Adam smiled. “I think you’ll learn a lot from her.”
Hannah rose with her bowl and began to put it in the sink. Adam heard a louder clink! than he expected, followed by her exclamation of “Oh shit!”
“What is it?”
“Afua! She’s in the city for a few days and I told her we’d talk tonight on Skype… shit! It’s gotta be really late there.”
Hannah dashed out of the kitchen and rushed up the stairs, her footsteps resounding decisively on each step. Adam looked down at his half-finished soup and continued to slowly sip at it until his stomach had had enough, then placed his own bowl in the sink. He washed both bowls and put a lid on the pot of soup, then carefully placed it in the refrigerator. Walking back into the living room, he saw the Abnormal Psychology textbook and considered picking it up again, but decided to go upstairs.
Hannah was sitting in the second-floor office, a large blanket wrapped around her. Afua’s grainy and blue-tinted image was visible on the laptop, her voice gently echoing through the room as she spoke.
“…so I would be very careful with what he says. He was storming away from the clinic saying that he was going to find a way to ruin us.”
“I’m so sorry, Afua,” said Hannah. “I guess there wasn’t really a way to verify his background or anything. He seemed like he was really interested in helping people and he said that he wanted to get out of medicine in Nigeria because of all the corruption.”
“There was more to the story.”
“No kidding.” Hannah sighed. She looked back, noticing Adam at that moment. “Oh! Adam is here. Say ‘hi’ to Adam!”
Adam waved and moved closer to the screen, trying to get his head into the camera’s view. He could see himself in a small window on the screen; his head stuck awkwardly in one corner of the frame but Afua’s face brightened when she saw him.
“Adam, it’s so good to see you! Everyone wants to know when you are coming back!”
“Uh, when Hannah comes back, I suppose,” he replied.
“Oh, my, then with her education I guess it will be a while, huh?”
“Yeah,” Adam said slowly, not sure if he should have said something different. “How are things going at the hospital?”
“Oh, you know, it’s been hard without a full-time doctor, but some people from the city are volunteering time and we can still do our vaccination clinics.”
“Oh good.”
Afua yawned. “I should probably get to bed, but maybe we can talk again soon?”
“Sure!” said Hannah. “Will you be able to talk this weekend? That’s when I have the most time…”
“I’ll be back in the village then, but next weekend I can do it.”
“Sounds good. Have a great week and give all my love to the mamas there.”
Afua smiled. “Will do. Greet your father for me, Adam!”
Adam nodded. “Will do.”
The computer gave its usual bubbling chirp to indicate that the conversation was over. Adam turned to Hannah, who was still staring at the screen..
“You know, I just realized that my dad hasn’t called in a few days. I wonder if he went back home and didn’t tell me.”
“He’s usually pestering me to talk by now. I guess I could have called him earlier, but I didn’t know when you’d be home…”
“Dr. Osege was stealing drugs from the hospital.” Hannah kept looking ahead, not turning her head to register Adam’s reaction.
“He what?”
“He was stealing drugs. There weren’t that many– he only got caught when there was a shortage one day. He would order high doses for patients but then take some of the pills for himself. Afua thinks he might have been using them himself. Who knows? He seemed like a great guy. I met him before he got hired by the hospital– he told us he just didn’t want to practice in Nigeria anymore.”
“That’s awful,” remarked Adam. “So… people are just coming in a few days at a time to staff the hospital?”
“Yeah… it was a lot easier when someone was willing to be there 24/7.”
“Damn.” Adam reached his arm around Hannah, taking her shoulder in his hand and pulling her closer to him. Her eyes kept looking forward, but she rested her head in the crook of his neck. Her long hair drifted over his chest and back, tangling in his sweater.
“So what happens next?” he asked.
“Well, they keep looking for a doctor who’s willing to live nearby, at least. The post was funded through the government, so they might make some junior doctors rotate through there. There’s enough need, for sure. It just sucks.”
“I hear you. This whole project is something that you, uh, have a lot invested in.”
“Yeah. I wish… I wish I had more time to go back and forth.”
“You’re not gonna be able to go this year?”
“I’m not really allowed to take any time off besides a week for Christmas. It takes at least 2 days to get out there.”
“Oh. Well, isn’t my dad– I mean, he must know by now, right?”
“She said that she wanted to tell me first. It just happened a few days ago. But people talk. It’s probably gotten to your dad through your uncle. He must be furious. He’s got a personal financial stake in the hospital doing well– if there’s not as much stuff to transport back and forth from Accra, there’s less work for him.”
“I guess I never thought of that way. Surely he’s got some connections with his friends that write that journal?”
Hannah chuckled. “I’m sure he does. They’re probably trying to reach out to every friend they’ve got. Dr. Osege worked hard there. I just…”
There was silence. Adam looked down to see her biting her lip, clearly trying to hold back tears.
“You just…”
“I just wish I could be there.”
“Yeah. Me too.”

Chapter 11 will be released on July 1, 2015.

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Trousseau Syndrome by Matthew Loftus is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.