by Barbara Ebel
With his normal cheery expression, he looked hard at her. “I came to find out what OB/GYN is like.”
“Today was only my first day!”
“You grasp everything in one day. Admit it. Besides, we must discuss our commitment to get a dog together.”
She glanced down at his blonde hair and stylish haircut. “I haven’t forgotten, but I have to tackle a ton of reading.”
Bob frowned and hung his head. “Actually, sooner or later, I need to follow what you’re studying anyway. Can we pore over the material together?”
“Bob, you should be resting.”
“I rested and napped most of the day and was to the point that I yearned for fresh air. I’m only good for an hour or two anyway, and then I’ll go home to bed.”
“Which will be the most for me as well.”
“So there you have it.”
She squinted her eyes at him. “All right, then. What an unpredictable day.” She turned to check if the SUV had left. “I think the female driver just made a pass at me.”
“Why not? You’re a hot chick.”
She tapped her fingers on his head. “A chick without anything in her pantry. Why don’t we go up to the intersection? My OB books are with me; we can grab a bite as we study.”
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The bell above the door tinkled when Annabel and Bob walked into Pete’s Café up the block. Annabel settled her things at a table against the wood-accented wall and they went to the counter.
“Hey, Pete,” she said.
The owner had a slight build and a warm smile. “Welcome back. You two students look like you could use some brain food. My special is a classic Colby Jack grilled cheese sandwich with a salad.”
Annabel nodded. “If we can study over there for an hour.”
“No problem. I love when you clutter up my place.”
“You can skip the sandwich for me,” Bob added. “I’ll take your beer cheese soup instead.”
“Coming right up.”
“Throw in some water too,” Annabel said.
At the table, they sat side-by-side on the bench. She opened a book and went to the index. “I’ve been given an assignment by the chief resident of what to read tonight. Like I can’t pick out what I should be reading myself. For instance, the pharmacology of the certain drugs that kept coming up today, or postpartum hemorrhage, or preeclampsia …”
“Ouch. So what’s the assignment?”
“The physiologic changes of a baby’s first breath.”
“We covered that a little bit last year in class.”
“A tad, but that information is dusty, and look at this.” She grabbed at least one hundred pages between her thumb and index finger, looked at him, and rolled her eyes. “This barely covers the topic.”
“I suppose we must start at the beginning. Like with what is the most essential adaptation in preparation for birth.”
“The adequate development of the fetal lung to support gas exchange.”
“Exactly. I’m impressed with your chief resident’s homework assignment. The transition from a fetus to a newborn has to be the most complex adaptation of a human being’s experience. She must be a sharp cookie and a fine teacher to spring you with this.”
Annabel wondered. Bob had a point. “To tell you the truth, she’s starting out rough, but now that you mention it, I’ll give her the benefit of the doubt.”
She scrolled her finger down to the beginning paragraph. “At least there are charts that break up the physiology into parts.”
Bob honed in closer and scanned the first box, an overview of the neonate’s transition:
“Clearance of fetal lung fluid
Surfactant secretion, and breathing
Transition of fetal to neonatal circulation
Decrease in pulmonary vascular resistance and increased pulmonary blood flow
Endocrine support of the transition”
“Before I went to medical school,” Annabel said, “I assumed the growing fetus’ lungs were filled with amniotic fluid. Fetal lung fluid is different. It is secreted by the airway epithelium; production and maintenance is essential for normal lung growth. And in the last, third trimester of gestation, the lung tissue separates into septa … about four million distal saccules.”
“And if the baby grows up and decides to, he or she starts smoking and destroys some or much of the hard work that Mother Nature did to build the respiratory system for breathing.”
“So true.” Annabel raised her head while Pete balanced both their salads in his hands. The waitress placed down the remaining items.
Bob pushed the textbook further away. “Thanks.”
“You two reading how to use a stethoscope to listen to someone’s lungs?” Pete asked.
“We’re ingesting material a lot more complicated than that,” Annabel said.
“You two can handle it, I’m sure. Need anything else?”
“We’re fine,” Annabel replied, not needing to tell him that they were now separated from their rotation. The Café thinned out as she started with her sandwich. Between bites, she read:
“The cardiovascular response requires striking changes in blood flow, pressures, and pulmonary vasodilation with the removal of the low-pressure placenta. The newborn must also quickly control its energy metabolism and thermoregulation. The primary mediators that prepare the fetus for birth and also support the multi-organ transition are cortisol and catecholamine.”
“Modern medical deliveries have this down to a science,” Bob said. “Helping the neonate transition by suctioning out its mouth, maintaining the temperature of the delivery room, and putting it in a warmer. Of course, all the rest of it, too, like cutting the cord …”
“Where’d you learn all this? I’m the one taking OB, not you.”
“You forget what I tell you. My mother is a nurse. Also, while I was resting today, I watched one of those clips on our list of useful video content.”
“I remember your mom’s career. You just don’t talk about your parents that much. However, it sounds like you learned more than me today.”
“Maybe today, but over the coming days, you’ll learn more from real patients that you’ll never forget.”
“So true. That’s a given. So speaking of real patients, don’t forget that we’re naming the dog we’re getting after one of my prior patients, May Oliver. May if it’s a girl and Oliver if it’s a boy. She was a unique lady and I admired her. I wish she had not battled with and died from lung cancer.” Annabel pictured her sweet expression and close-cropped haircut and thought about their conversations.
“I liked her too. We all did our best to stop her illness. She would have been tickled to know that you are going to use her name for our dog … a pet who will end up being a part of our lives and, I hope, a piece of our hearts.”
“You are making me hungry for one already.”
“How should we do it? Pick a dog out from a breeder’s litter or go to the animal shelter and adopt? What’s your favorite breed and when should we do it?”
She finished chewing a bite while Bob spooned more soup into his mouth. She shook her head.
“We’re in this fifty-fifty. What are your thoughts?”
“I asked you first.”
“You are cognizant that I have a love affair with Chesapeake Bay Retrievers and that my family lost Dakota. Finding a breeder in the region for them may not be easy and then it may take months before puppies are available. Also, our landlords may not appreciate that large of a breed.”
“So let’s consider the diversity available at the animal shelter. They must house a smorgasbord of breeds and mixes, sizes, personalities, and both genders. And more importantly, we would be saving a dog’s life if we adopted from there.”
Annabel picked at her salad. “What if … “
Bob put down his spoon and tilted his head.
“If you are feeling up to it, this week may be our best opportunity to pick up a dog. You could be at home with i
t and I’m also not on night call. Next week, you go back for only one week of internal medicine; maybe pull one night call, and I’ll be on night call only. Like we thought before, between the two of us, one of us would be available to be with May or Oliver quite often.”
A sly smile creeped over Bob’s face. “And we’ll split costs?”
“You’re more strapped financially than me,” she said fiddling with her shoulder-length hair. “But yes, we’ll split the dog’s bills or work something out.”
“How about tomorrow?”
Annabel’s eyes grew big. “Really?”
“Why not? If they close early before you’re off, I’ll ask them to stay open a little later. I’ll pick up the essentials tomorrow. Don’t worry, I’ll make it a short run to the pet store.”
“Why don’t you call them tomorrow about the dogs residing there, so that we have an idea beforehand?”
“I will. I’ll text you what I find out.”
They both chuckled and then Annabel said, “After all, life shouldn’t stop just because we’re in medical school. We should not deprive ourselves of man’s best friend.”
“Precisely.”
After moving plates around, Annabel slid the textbook back over. “We need to cover a lot more ground.”
After the waitress removed their plates, and after an hour, Annabel and Bob adequately covered the subject matter highlighted in the first box they had read. She turned another page. “Cortisol is a big contributing factor,” she said. “Here’s another chart with all of the hormone’s effects. I better understand and remember all of this tonight as well.” She glanced at her wristwatch and Bob yawned.
“I will leave you to it, then,” he said. “I’ll walk you back to your place.”
Bob held her backpack, they said good night to Pete, and nodded at the last remaining table of customers. The street lights lit up the uneven narrow sidewalks as they ambled down to her apartment. The leaves had not burst out of the tree buds yet and the air smacked of soon-to-be warmth and fragrance from new flowers.
“I hope you didn’t overdo being out tonight,” she said before they arrived. She glanced back; she was tall at five-foot-eight, but Bob squared off at six foot. “Are you still taking your antibiotic?”
“I am. A doxycycline twice a day, and the doctor’s office scheduled me for a follow-up appointment in a few days.”
“If you can’t do those dog chores tomorrow, we can always postpone our plan.”
“No way. Don’t stay up too late either.”
“I’ll try not to. By 7 a.m. tomorrow, I’ll be checking on my assigned patients, ready to give my Nurse Ratched reports on them in case she asks. To tell you the truth, I don’t think she cares about what I have to say.” They stopped on the path to the three-story common door. “Sorry. I’m trying not to be critical of her after what you said.”
“Nurse Ratched?”
“Ling Watson, my chief resident.”
Bob maintained a questioning stare.
“You know. The fictional character in One Flew Over the Cuckoo’s Nest.”
“No. I don’t know.”
“Bob Palmer, like Gone with the Wind, which I’m in the process of watching with Dustin. I guess you and I need to watch the movie version of that book. Both movies now seem pertinent to an OB/GYN rotation, particularly this one.”
Bob’s heart skipped a beat and his eyes sparkled. “There’s a first time for everything. We haven’t watched a movie together before. Why don’t we stream the Cuckoo movie after we get our dog?”
“We have a deal. After all, the rate of medical student and physician burnout is at an all-time high. The new mantra and pertinent advice is to separate out time for ourselves. If we are not healthy and happy, how can we pass on effective care to our patients?”
Bob widened his grin and nodded. “I’ll text you tomorrow.”
He twirled around and took off to his car and Annabel entered the ground floor of her house. Besides needing to know the material she’d been assigned to read, she wanted to leave a decent impression tomorrow on Ling Watson and Caleb Gash. As she scrambled up the staircase two steps at a time, she figured her evening would go on later than she would like.
CHAPTER 8
Mary Chandler startled when the door swung open and the night shift nurse entered. She rubbed her eyes. The room had darkened and the RN flicked on the overhead light.
“Hello there,” the nurse said as she bustled over to the white board on the wall. She crossed off the previous nurse’s name, Sherry.
“This is me,” she said as she wrote “Night nurse … Dorothy Clark.” She was a lot younger than Sherry and wore makeup fit for acting in a romance movie. After moving the tray table to the side, she scrutinized Mary’s belly. “Hope that baby doesn’t come soon. You’re not as big as most for your twenty-nine-week gestation. I bet you ate like a bird all along.”
“What’s your excuse for eating that way?”
“Pardon me?”
Mary pulled the crumpled sheet further up on her chest. All she wanted to do was close her eyes again and not talk to some nurse who didn’t look old enough to have experience.
Dorothy went straight to the IV pumps. One liter bag was labelled as Magnesium Sulfate and the other was straight Lactated Ringer’s. The infusion rates were perfect, as ordered, so she traced the tubing to Mary’s hand and made sure the cannula site had not infiltrated and that it was taped down appropriately. She read the last vital signs from the chart and those were adequate as well. Her patient’s oxygen saturation was in the high nineties and an adequate waveform pranced across the pulse oximeter monitor.
“Those residents have a handle on your preeclampsia,” she said. “How are you feeling?”
“Sleepy.”
“I’ll leave you alone and check on you later.”
Happy to see the RN leave, Mary tilted herself more to her side and rubbed her abdomen. “Don’t believe her,” she whispered down to her belly. “You will be big enough and strong enough, and, no matter what, you’ll be my little angel. By the way, your name is Emma or Emmett. That is settled. Certainly if you are a boy, I won’t be naming you after your father.”
She rested her hand and thought back to less than a year ago when she was a senior in high school. Her best friend set her up for a date with her boyfriend Tom’s best friend, Freddie. They double dated, went to a movie, and went to dance afterwards.
Mary had practically swooned over Freddie’s charm and rugged looks. In addition, he was three years older than her, and out in the real world working with subcontractors building a home. Although he still lived with his parents, he made real money, paid for everything on their date, and even owned his own car.
That first night, he rushed to her side of the vehicle, opened the door, and walked her to the front door of her parents’ house. He kissed her, kissed her again, and whispered in her ear, “Can’t wait for next time.”
Of course she’d been kissed and had dabbled in heavy petting before that night, but she was still a virgin.
On the second date, the two couples again double dated. They ate at a restaurant where the guys drank regional beer and the girls splurged on pina colada’s with alcohol-soaked cherries. Over another drink instead of dessert, they all decided to go over to Tom’s apartment. In retrospect, maybe the guys had decided that already.
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When the four young adults landed at Tom’s place, Mary browsed around and salivated to one day have her own place. Before that, however, she hoped that her dates with Freddie continued and he would soon be out of his parents’ house as well.
“How about another drink?” Tom asked the group. He opened the refrigerator and pulled out a six-pack of beer.
“No more for me,” Mary said. “The rum is still swirling around in my head.”
“See you two later, then,” Tom said. “Or not. Just lock the door behind you, Freddie, when you both leave.” He slipped his hand into his girlfriend’s pal
m and led her through the kitchen door and into his bedroom.
Freddie leaned against the counter and opened a beer. “Let’s turn on his television. We don’t have to watch anything if we don’t want.” He tapped her forearm to follow him.
In the living room, Mary noted the bedroom door closed while Freddie turned on the television. There was no couch. Only two slim leather recliners. He grabbed the two throw pillows from each chair and positioned them on the floor. Holding his beer, he lowered himself down and patted the carpet. “What should we put on?”
Mary shrugged her shoulders, but Freddie already switched to a sports channel. A male tennis player smashed his serve and his opponent didn’t stand a chance at a return. “I already know the outcome of this match.” He moved the beer bottle to the coffee table and scooted closer to her. “This was taped earlier in a different time zone.”
Their beginning gentle kisses put Mary in the mood for more. Soon the moistness in her mouth tasted like a combination of pina colada and beer. Freddie began unbuttoning his shirt and soon had it behind him. His hands went under her sweater and he hoisted it over her head. He kissed her neck and rubbed away at her breasts like he was kneading dough. She considered that perhaps she would be better off with her top back on.
Now her thoughts wandered all over the place. He was already undoing the button on his blue jeans and unzipping his fly. She wanted to kiss some more, but he was moving way too fast. After wrestling his pants off, he crumbled them on top of his shoes. He tore off his underwear and tossed them by the flat-screen TV.
Freddie eased Mary flat on the floor and nestled one of the pillows under her head. She glanced at his penis, swollen and hard, but before she could touch it, he began wiggling her out of her casual pants.
“Freddie, I’m a virgin. I’m not on birth control. I don’t think…”
“I know. Don’t worry. I’ll pull out.”
She kept her thighs together. She didn’t know about this. This wasn’t good.