by Tif Marcelo
“Today’s post, actually showing us her bucket list? It gave me all the feels.” Her eyes gleamed. “One day I’m going to do a bucket list, too. You’ll have to send her my best wishes. But I bet it will be another change for you, won’t it? I know I’ve said it time and again, but if you need anything, at all … change, in all ways, is tough.”
“Thank you. I appreciate it, but I’m fine.” Diana smiled and kept her mouth shut despite wanting to commiserate. She could have gone on and on about how the changes in the last six months had rendered her unsteady. With her granny Leora passing away, and her mother moving in to make Diana’s town house her “home base” as she and her best friends conquered this elusive bucket list, on top of Dr. Mendez … it all gave her whiplash. And Millie would have probably empathized—she might’ve given Diana some much needed advice. Night after night of raw emotion, relationship-driven conflict, tragedies, and happily-ever-afters within the context of baby-delivering required nurses to have acute social awareness.
But Diana was the MD on call. Though there wasn’t a hierarchy in the ward, the reality was that nurses looked to physicians for patients’ orders, and sometimes, for the final say. Diana had learned early to compartmentalize, to shove her personal concerns to the rear when she drove into the parking lot of Alexandria Specialty. Narcissism had no business in health care, where her job was to act outwardly, help others, put people first.
Diana clicked on the “log off” button on Madeline’s chart, and it reset her plummeting mood. “I have to head out. I’ll be on my phone. Time to see that Dr. Mendez.”
Millie nodded in understanding, and a wry smile bloomed on her face. “That’s right. And don’t forget the fourth pillar of our mission here at Alexandria Specialty. ‘To provide kind, reliable, and straightforward customer service.’ Even to other doctors.”
* * *
Here was the thing about labor and delivery: it was either feast or famine. Standard procedures dictated that mothers in labor had two methods of entry to the hospital: through the normal prenatal and preregistration process at the labor and delivery ward for those who were patients of providers of Alexandria Specialty, and the ER for all other cases.
Tonight, the ER had been a revolving door of pregnant ladies, but Diana’s current focus was on the man in the white coat at the nurses’ station holding a clipboard.
“Carlo.” Diana stuffed a hand in her pocket and gripped one of her pens to steel herself. She’d successfully avoided him the last week despite them being on call at the same time.
Dr. Carlo Mendez faced her. He was the epitome of perfect proportions; his smoldering look was out of a GQ magazine. When they first met, he was even a model on the side. Not only was his face a true work of art, but his body was, too. At five ten, with a chiseled face, wavy and properly disheveled hair, and a mouth full of perfectly straight white teeth, he had been a sight to behold. He still was, until she remembered that he was a cheating rat.
“Hey.” He used his flirtatious voice, closed the chart, and gestured her to his office. “I passed by the house before work. I was hoping you were going to be there.”
“Nope. I’m here, as you can see. What did you need?”
“I tried to pick up a couple more of my boxes, but Margo wouldn’t let me in.”
Go, Mom. Pride swelled in her chest. Her mother may be flighty, but she had a backbone still.
“You should have called me before showing up. You know my rules.”
He stepped in closer. “Forget the rules, Diana. It’s been six months. Can we end this … cold shoulder? I want to come home. Hasn’t it been tough on you, at all? Haven’t you missed me?”
She clicked the pen in her pocket, hard, just enough to take the edge off. It had gotten better for her, actually. The hurt had transformed itself to something she could work with—realization, with some anger—but she was ready to move on.
“You should have thought of that before sleeping with another woman and keeping me in the dark for a good year about it.”
His face softened. “Diana, please. I made a mistake. At some point you have to forgive me. I’ve forgiven you. Look, it’s not too late. I mean, construction’s going on at our house, for renovations we both drew up, for God’s sake. We can fix this.”
Diana seethed under her breath, though she focused on pasting a saccharine smile on her face. Before they’d broken up—or, before she threw him out of the home they’d purchased together—they’d taken out a home equity line of credit to build a balcony and to renovate the master bath. It wasn’t a wedding ring, but it seemed a commitment enough, coming from him. Or so she thought.
“This is about you removing your items unless you want them trashed or donated to the Salvation Army. This is not about me. This wasn’t my fault.”
“Okay, fine.” He shrugged. “You had no hand in our breakup at all. Even if you pushed me away every step of our relationship. I mean, after five years, it got tiring having to extract any kind of emotion from you.”
“I’m done.” She bolstered her spine straight while attempting to unravel his pretzel of words. He was good at this … this talking. The combination of his radio-worthy voice and his disarming cadence always threw her off her game.
“What do you want from me?” She eyed him. “I can tell there’s more. Out with it; I’ve got a ward full of patients waiting for me.”
“I miss Flossy.”
“Oh, no, no, no.” Forget being civil. Diana’s voice raised an octave higher. “Don’t bring her into this.” Flossy was their Havanese, their one baby, and sadly the collateral damage.
“I want visitation.”
“That’s ridiculous.” She raised an eyebrow, wary of this new turn in the conversation. Their breakup had brought out a different side of Carlo. What had been endearing and loving now presented itself as manipulative and passive-aggressive, like the distance had removed the filter she’d placed on him for all these years.
“I received approval from my landlord, and, I mean, she is mine.”
The hairs on the back of her neck stood. “She is not.”
“I bought her with my credit card, if I remember correctly. I left her with you because I thought it would be easier for transition’s sake, but I miss her. Hell, you didn’t even want her. You wanted to send her back to the breeder.”
“You can’t have her,” Diana said firmly. True, she hadn’t been thrilled when he walked in the door three years ago with Flossy, then named Starla by the Sea. She had been firmly against breeders, but Flossy fit in her hands and had this thing with toilet paper—she’d gone bananas over it, tearing rolls to shreds. Diana had become a mother overnight. The dog filled her heart as she and Carlo’s relationship grew. Being a fur mama had become a part of her.
But before Carlo opened his mouth for what she knew would be a rebuttal, the ER’s double doors opened to admit a woman being pushed in a wheelchair, belly round and high, hands cradling her head. A man, harried, and with a wild look on his face, followed, arms overloaded with jackets and insurance papers from the front desk. A nurse ushered the group into a bay, and the flurry of getting the patient into the bed and taking her vital signs began.
Cecily, the assigned ER nurse, nodded at Diana as she approached. “Francesca Smith. Thirty-six weeks and six days, complaining of a headache, abdominal and back pain for most of the day. No provider listed. Last seen four weeks ago at the Old Town Women’s Center.”
With an eye toward the bay, where they hadn’t drawn the curtains, Diana breathed a momentary sigh of relief. The center was familiar to her—her best friend ran the low-cost clinic and was a lifesaver to so many mothers in the community. No doubt the patient was here because of the education the center provided.
Diana’s initial impressions from the hospital monitors were that Francesca’s heart rate and respirations were normal, but her blood pressure was high. Too high. Diana suspected hypertension, possibly preeclampsia. The next second, she mentally worked through the
algorithm of her diagnosis and the hospital’s status, which was at capacity. “We’ll have to see what we can do for her here. We might need a transfer because the ward is full.”
“I can start transfer paperwork, just in case,” Cecily answered.
Per professional courtesy, Diana waited for the nurses to do an initial assessment, and she followed up with her own, which included an ultrasound.
At the session’s end, she congregated with Cecily at the nurses’ station.
“She’s going to need an overnight for evaluation. I’m not loving the borderline low amniotic fluid. Let’s do the standard preeclampsia protocol, monitoring, labs, fluids, mag sulfate,” Diana said. “We’ve no beds in L and D. Do you have a spare down here?”
The nurse shook her head as she picked up the phone. “We don’t have any beds available for long-term monitoring, and that waiting room is filling up, too. The ICU is packed to the brim as well.”
“Damn.” Diana’s mind went straight to the logistics: the risk of transferring Francesca even ten miles down to the next hospital; then to her ward with its one last serene bed in a coveted, just-opened VIP suite; then to the incoming celebrity patient who had reserved that room.
The patient’s husband caught her eye. The coats were on the floor, the papers forgotten on his seat. He was gripping his wife’s hand. And as he spoke to the nurse at the bedside, the rest of the ER faded, and Diana heard only his voice. “She never gets headaches. Doesn’t get sick, ever,” he said. “Please tell me we’re staying.”
The decision weighed like a balance, tipping left and right. On the left, policy and money; the right, principle and health. In the middle was her conscience, her judgment, her ideals. The spirit of her grandmother hovering above her. Leora Gallagher, the woman Diana had looked up to, the woman she lost just months ago but, just as she had in life, seemed to find a way to insert herself into Diana’s everyday thoughts.
Leora had risked it all once in her life, and for one tiny baby, too.
“What would Leora do?” Diana said to no one in particular.
“Who’s Leora?” Cecily asked.
Diana shook her head, and the action rattled the balance so the factors jostled in her brain. She said the first thing that came to mind. “Forget it. No need to transfer the patient. We do have a bed upstairs: one of the VIP suites. I’ll admit her to that service.”
Cecily’s eyebrows shot up. “You’re sure?”
Diana took a deep breath. Right or wrong, she had to commit. “Yes.”
Technically, this patient arrived before Winter Storm, and technically, per their policy, those rooms were accessible to everyone, as dictated by census, once they were opened. And Diana knew well that not only was it either feast or famine in L & D, but in this business, it was all good and fun until it went to hell in a hand basket. She was making the right decision.
So why did it feel like, in avoiding the heat of this hell, she had jumped right off a cliff?
Chapter Two
Diana’s instincts had been right. While transferring up to the VIP unit for observation, Francesca’s water broke. After over an hour of active labor, the baby went into distress, prompting an emergency delivery by C-section that—while it brought chaos to the ward—ended well. Mom was fine, though still hooked up to an IV medication to bring down her blood pressure; the baby was stable, admitted to the NICU for overnight observation.
Now, Diana perched on Francesca’s hospital bed. The woman was tucked under the covers in a fresh hospital gown with an IV in each arm, eyes hooded from exhaustion, the sedative effect of pain medicine, and the remnants of anesthesia.
“Do you have any questions about your care?” Diana asked both the patient and her husband, Mike, who stood behind his wife.
“I just want to see the baby.” Francesca’s voice was a squeak. In her expression was a trace of fear. For her, the night had gone much too quickly.
“Of course you do. I’ll make sure I check in with the NICU so they can come down and give you an update. And, Dad, you can always go up there, at any time, as long as you have your security band.” She nodded at the bar-coded wristband that matched their baby’s, smiled, and squeezed Francesca’s hand. She wasn’t much of a hugger, but times like this even she needed to be comforted. She had succeeded in admitting Francesca to this VIP room, with Winter Storm conceding the space until a room on the postpartum ward cleared in the morning into which Francesca would move, but the worst wasn’t over. Her boss had yet to wake up and hear the news. “I’ll go now, in fact, and give them a call. Until then, you should rest, okay?”
“Okay. We need to think of a name still.” Francesca’s eyes blinked in slow motion, as if Diana’s permission was a trigger for sleep.
“That’s right, you do. If you’re taking suggestions, Diana is always a winner.” Diana winked, and with a last squeeze of Francesca’s hand, stood and walked to the suite’s entrance with the patient’s husband behind her. As she stepped out, Mike said, “I want to thank you, Dr. Cary.” His skin had gone ashen, face crumpled into the start of belated panic. “I didn’t know what to do.”
“You did the absolutely right thing by bringing her to the ER. You might have saved her life, and your baby’s. Her blood pressure was very high, and your baby needed a little help coming out.”
“This room, though. We can’t afford it. Heck, we couldn’t even afford the regular room. And I heard people in the ER talking. Did we take this room from someone else?”
“No, no, you didn’t.” Diana bit her cheek, stuck on the explanation of who the VIP room sought to serve and whether this was the appropriate time to explain it. “It’s about priorities, and who medically needs the room. Right now, that person is Francesca. In the morning, she will have to transfer rooms because someone else will need this one. But not to worry about that—the nursing staff will keep you updated. And as for insurance purposes, I’ll be sure to let whoever I need to know that it was my decision to put you in this room rather than transfer out, okay? After all, it was medically indicated.” She raised her eyes over his shoulder, to his sleeping wife. Beyond her, the city’s lights twinkled through plate glass. “But for now, you must rest, too. Your baby is going to need you.”
“Okay.” Mike heaved a breath, and a smile shone through. That smile tugged at Diana, a small reward for the decision she had to make. This would be a mess to sort out in a couple of hours, but currently she had a stable patient on her side.
You’re always right, Granny.
But as she stepped through the hallway’s double doors to the nurses’ station—which was now crawling with day nurses congregating with night nurses during the change of shift—her eyes lifted to the only person not wearing the unit-required scrubs. Suddenly, it was as if her foot had been caught in a pothole in the middle of a fast downhill sprint, and the only thing that came to her mind were three words. Granny’s words, too.
Here we go.
* * *
Diana followed her boss, Dr. Aziza Sarris, two floors up, to her sparse office, where Aziza tossed her keys, wallet, and phone on the desk. She had said nothing to Diana on the walk, which was a slight relief. Diana wasn’t one for small talk, and she needed a moment to review her night, for what was likely to be an inquisition.
Aziza gestured to one of her chairs. As Diana sat, Aziza perched on her desk. Behind her was the open expanse of Alexandria, the tops of buildings, and the pink glow of sunrise. Yet, despite the peaceful scene depicted behind her, her pinched expression told a different story.
At sixty, Aziza had not cared for patients in more than a decade, but she still exuded a maternal, yet professional, nature. She wore her hair in a low, loose bun, always with a strand out of place. Despite the late—or early—hour, she wore her standard cardigan with a colorful lanyard around her neck adorned with bling: pins of her years in medical service, her service organizations, and a select few Disney characters.
Diana spotted a framed picture on the wall of t
he current hospital staff OBs: herself, Aziza, Dr. Clay Pritchard, and Dr. Justina Folds. She released a breath, remembering that they were a team, and a special one at that. It had been easy for Diana to join the hospital staff because of Aziza, and frankly because of Clay and Justina, too. They were professionals, respectful, ethical. And they actually liked one another.
Moreover, they each truly cared for patients’ well-being, appreciated new theories in medicine, and were unafraid of testing the waters. But each was equally careful. Pathophysiology was sometimes ruthless, and stories of careless doctors abounded. Much like a wild child in a group of siblings, there seemed to be a reckless doctor in every department, but not in Alexandria Specialty’s OB staff. Four out of four were, hands down, rule followers. For the most part.
“Thanks for staying after a long night, but I feel like we need to get together to discuss some next steps.” Aziza clasped her hands in front of her, shoulders rounding. Like a mother readying her child for her punishment, her voice was steady, firm. Her dark eyes were steadfast and penetrating.
Diana sat up a little straighter in her chair, and her heart beat a steady drum of dread. “Next steps?”
“Yes, Diana. Because what the hell were you thinking?” Aziza’s expression hardened. The wrinkles between her eyebrows deepened.
Diana inhaled through her nose and bolstered herself. Then she recounted the night to Aziza’s unflinching expression.
“I’d do it again,” she told Aziza. “I don’t have any regrets.”
“That’s easy for you to say, Diana, but you postponed a delivery tonight.”
“Winter Storm wasn’t sure she was even in labor, Aziza. Francesca Smith’s case was emergent.”