Nora’s face formed a frown.
Here it comes, Lisa thought. She just can’t help herself.
Lisa could see the battle brewing within her mother-in-law. At the denouement, Nora said, “Maybe you should ask for a second opinion. I know Dr. Russo has a great reputation, but he’s getting on in years. Maybe you could get somebody younger, or from the university.”
“That’s ridiculous,” Phoebe said.
“I wasn’t talking to you,” Nora said, sliding her chair away from Phoebe’s. She turned to face Lisa directly. “I was just making a suggestion for you to consider.”
“Thank you, Mother, but Harvey has Mike’s full confidence, and he has mine, too. Moreover, Harvey teaches at the medical school in San Francisco, and has more real-world experience than any of them.”
“Well,” Nora said, “whatever you think best, Darling.”
“He’s adding his two cents in,” Lisa said, holding her abdomen, and feeling the baby’s movement. “It’s freaky, but he understands what’s going on in my life.”
“The baby looks normal, doesn’t he?” Nora asked.
“As far as Harvey can tell, he has all his parts, and looks perfectly normal.”
After twenty minutes of idle chatter, Nora excused herself. “I’ll see you in a day, or so. Call me if you need anything.”
After Nora left, Phoebe turned to Lisa. “That was an academy award-winning performance.”
“It’s not so bad when you make your mind up in advance that you won’t let her get to you. She’s going to be a part of our lives, and I don’t expect our relationship to be anything but cordial. If cordial is the best we can do, I’ll settle for that.”
“Well,” Phoebe said, “I thought you did well.”
Lisa turned away from Phoebe.
“What is it? Are you okay?”
“With all we’ve been through, from early pregnancy until now, I do worry about the baby’s health. I’ll love him no matter what…”
“No matter what?”
“I smile at the image of Harvey holding the baby,” Lisa said, “and seeing all his fingers, and toes, and to be at ease when I know, at last, that he’s perfect.”
“He is perfect.”
Teresa Russo rolled over in bed to look at the bedside clock. It read three ten a.m. She slid her bottom toward Harvey’s side, but felt nothing. He wasn’t in bed, yet she knew that he hadn’t gone out on call.
She pulled on her robe, and opened the door to the family room and kitchen. Harvey sat at the kitchen table eating an English muffin, sipping a cup of tea, and reading a book.
“I didn’t wake you, did I?” He asked.
“No, I noticed you weren’t in bed. Is everything okay?”
“I couldn’t sleep, and I know how you hate it when I read in bed.”
“You haven’t been sleeping well lately. You were always such a good sleeper.”
“Poor sleep is the curse of the elderly.”
“Elderly? You’re kidding.”
“Lately, I’ve been feeling my age. I’m no kid, anymore.”
“Something’s bothering you, honey. What is it? You never held back before.”
“It’s not one thing; it’s many things. I hate to talk about it. It sounds like I’m complaining, and, I hate people who complain.”
“It’s been a bad year for you. Think about it: Roberta’s arrest, the malpractice fiasco, Mike’s condition, and then all of Lisa’s problems.”
“I still think about Mike, especially when I see Lisa. Some losses are so sudden, and so dramatic, that they remain fixed in your mind, a beat away from the heartache of reliving the devastating moment. I remember Mike’s accident the way I remember that day in Dallas.”
Harvey gathered the cup and saucer, placed them in the sink, and then returned to the table. “Lisa and Mike remind me of us, when we were young.”
“I can’t remember that far back.”
“I can. Those were the days.”
“Maybe so, but for me, honey, these are the best days.”
Teresa hesitated a moment. “Is it the office?”
“Not really. My partners are young and just starting their careers. I’d agree with them about Medi-Cal, if I was beginning a practice today. I started my practice with—don’t laugh—a sense of noble purpose and enough independence to do it my way. Much of that no longer exists for physicians now.”
“Maybe it’s time to cut back.”
“Cut back?”
“You’re the boss. We don’t need the money,” she said, holding his hand. “I don’t think there’s an OB/GYN of your age in the east bay who’s still delivering babies. Why not leave that part of the practice to your partners?”
“For a physician of my advancing age, that makes sense, but it’s the obstetrical part of what I do that keeps me going. From that first delivery in Vietnam until now, I thrill as I help bring babies into the world. I can’t lose that, too.”
“Harvey, sweetheart, you’re not Superman. This isn’t some kind of mid-life crisis. This is stress, and you’re not immune to it.”
He stood, and embraced Teri. “I don’t know what I’d do if I lost you. We’re so much a part of each other’s life that I couldn’t…”
She kissed him. “Let’s think on it. Maybe this isn’t the best time to make a major life decision. Let’s go back to bed.”
Chapter Sixty-Two (Week 33)
Carter Reynolds, with the help of Oliver Schlasser, pulled together all the data on the use of Viagra in the treatment of neurological diseases.
After a surprisingly brief discussion, Brier’s Committee for the Protection of Human Subjects decided to allow its use on Mike Cooper. It had a low risk, after all.
Phoebe stood in the medication room of ICU. She grasped the porcelain pestle, and crushed the iconic blue pill in a mortar. She dissolved the blue powder in water, and instilled it into Mike’s feeding tube. They’d ordered this dose four times a day.
“Maybe I should stand back, Lisa,” Phoebe said after she instilled the first dose.
“I always know what’s on your mind, Phoebe.”
Phoebe lost her smile. She grasped Lisa’s hand, and said, “I know that this is going to work. I just know it.”
Lisa hadn’t realized how active a person she had been until she spent this much time in bed. Exercise had been her Prozac.
“I feel so down,” Lisa said as Phoebe sat by her side one evening near the end of week thirty-three.
“You’re stuck, sweetie. It’s just a few weeks more to get that son of yours into shape for the world.”
“This isn’t an intellectual problem. I understand that my condition’s unstable, and risky to me and the baby, but this depression feels physical, like something’s turned down the thermostat of my happiness. Depression isn’t new to me. After all, I grew up with Sandy and Rudy. This is different. It’s like postpartum depression, except I haven’t given birth.”
Lisa told Harvey about her feelings.
“It’s called antepartum depression,” he responded. “It’s a cousin of the more common postpartum depression. If it gets bad enough, I can prescribe antidepressants.”
“No way,” Lisa said. “No meds, unless I have no choice. The cure is easy, Harvey. Get me to term with a healthy baby.”
Lisa visited Mike twice a day for several hours. She was in the way, she knew, but the nurses never complained.
The Viagra had, after four days, shown no neurological effect on Mike.
Humor can be just what the doctor ordered for the nursing staff’s survival in the face of disease and frustration. The use of Viagra, although novel in Mike Cooper’s situation, had enticed the nurses’ imaginations, especially when they witnessed his reaction to genital care.
Mike was unable to void on his own and had a rubber catheter inserted through his penis, and into his bladder. Although his reaction to touch was predictable, the enormity of Mike’s erections created double or triple takes as passersby not
ed the white-sheet tent covering his groin.
After passing by Mike’s bed for the fifth time in two hours, Phoebe said, “This is the last time I’m saluting that flag.”
Lisa pushed the call button, and when Arlene Fox, her nurse, arrived, she said, “I haven’t had a bowel movement in three days.”
“Is that normal for you?”
“Nothing’s about this pregnancy is normal for me, Arlene, but I’m feeling pressure, like I have to go. Can you give me something for it?”
“Dr. Russo left strict orders: no laxatives. I can give you a stool softener, and help you up for as long as you need, but that’s it.”
“I’ll wait,” said Lisa.
At three in the morning, Lisa had a strong urge to move her bowels. She rang for Arlene again. “Help me up. I have to try.”
“You take it easy, Lisa. Don’t strain. Let me do the work.”
Once up on the commode, Lisa felt short of breath. Her pulse bounded. She pushed, and then relaxed. She tried again, when she felt the cramp begin in her back. Suddenly, the commode flushed with bright red blood, and dark clots.
Lisa must have fainted, because she awoke to find herself back in bed.
“You were out for a second,” Arlene said. “By the time I got the cuff on your arm, the blood pressure was 106/70. It may have been lower when you were sitting up. How do you feel?”
“My back really aches.”
“I’m calling Dr. Russo.”
“Don’t,” said Lisa. “I’m fine.”
“Excuse me, Lisa, but if I don’t call him, and something happens to you, Dr. Russo made it clear that I better seek employment elsewhere.”
Arlene Fox turned to the ward clerk, “Get Dr. Russo, stat.”
After ten minutes, Arlene said, “Where’s Russo? I need him now.”
“I called the on-call room and paged him, but he hasn’t answered,” the ward clerk replied.
“Send someone down to the on-call room—now.”
“Dr. Russo. Wake up.”
Harvey fought his way into consciousness. “What is it?”
“We rang the phone in the on-call room,” said the orderly, “but you didn’t answer. They need you about Lisa Cooke.”
It must have been REM sleep, Harvey thought. Awakening was so painful.
“Lisa,” he grunted. “I’ll be right up.”
“Dr. Russo, Sir?”
“Yes.”
“You’re awake now, Sir?”
“Of course. I’ll be there in a sec.”
Harvey went to the bathroom, and washed up, tossing handfuls of cold water in his face. He looked at the clock, which read three-thirty a.m. He’d slept forty minutes since delivering the last baby, and he felt it. As he put the while lab coat over his scrubs, he shook his head, trying to clear it. His neck and back ached, and he felt his movements in slow motion.
He was headed for the door, when the phone rang. “Dr. Russo, this is Arlene Fox. I have Lisa Cooper tonight. She’s bleeding and cramping.”
“Get the lab up to draw a blood count and clotting studies per protocol. I’m on my way. One other thing, Arlene, stay at her bedside. I want vital signs every ten minutes.”
“I have four other patients, Doctor.”
“Call your charge nurse and get them covered by someone else.”
When Harvey arrived on the ward, he pulled his stethoscope from the lab coat pocket, came to Lisa’s bedside, and listened to her heart and lungs.
Arlene held a white gauze pad over a venipuncture site. “It won’t stop bleeding,” she said with alarm.
Lisa looked like she was sleeping, although she was breathing heavily. When Harvey removed the bed sheet covering her, he gasped at the black and blue marks covering her torso and arms.
“Oh my God,” he shouted. “She has DIC. I want her in ICU, ASAP.”
Harvey turned to Arlene. “DIC, or Disseminated Intravascular Coagulation, is a complication of Lisa’s abruption. Her blood begins to clot in the circulation, and consumes the blood clotting factors needed for control of bleeding. Lisa can bleed from anywhere. Now, it's the skin and venipuncture sites. Later, she could bleed into her brain
“Lisa—Lisa—he shook her.
She groaned, and then whispered, “Harvey, what’s wrong? I can barely see you—what’s happening to me?”
“Her blood pressure is down to 84/50,” shouted Arlene, “And, the baby’s pulse rate is falling.”
“I’m starting an IV. Hang some 5% dextrose and normal saline, and run it slowly. Get 500ml of plasma expander, and run it in right away. We have to get this girl to ICU.”
Chapter Sixty-Three (Week 34)
Harvey and Phoebe trotted beside the gurney as the orderly and Arlene rushed Lisa into Intensive Care. The unit faced west, with the lights of the east bay sparkling in the foreground and San Francisco glowing in the distance.
They slid her off the gurney and into the bed across from the nursing station. Mike’s room was not more than fifty feet away.
While they organized Lisa’s bed, IV lines, and attached the monitors for her heart and for the baby, Phoebe talked to the nursing care coordinator for the night shift, Beth Byrnes. “Can you assign Carla Watts to Lisa tonight? I’ll take her when I come in for my morning shift.”
“Sure, Carla’s great,” Beth said, “but, Phoebe, there’s no way I’m going to assign you to your best friend. I know you mean well, but that’s an awful idea.”
“I guess you’re right. It’s difficult to stand by and watch.”
“Can you work, or maybe you should take the day off to be with your friend?”
“I’ll work,” was her knee-jerk response, but, after giving it more thought, Phoebe said, “No, I think you know me better than I know myself. Get someone to cover for me. My mind’s elsewhere.”
“I’m Carla Watts,” the young nurse said as she approached Lisa. “I’ll be taking care of you this morning.”
“Hi,” whispered Lisa. “I’m so frightened. Where’s Harvey…Dr. Russo?”
“He’s at the nursing station making arrangements.”
“Arrangements for what?”
“He’s asking Dr. Byrnes, the director of the ICU, to consult.”
Carla pulled the sheet back to assess her patient. Black and purple marks covered her skin, and she was still oozing dark red blood from several venipuncture sites. She placed the automated blood pressure cuff on Lisa’s arm, and pushed the start button. The machine vibrated with a throbbing sound as the red LEDs blinked as the readings began. After blinking for twenty seconds, they flashed steadily at 102/60.
“That a better blood pressure than it was downstairs,” Carla said.
Carla removed Lisa’s pad, which was saturated with dark blood, but there were no clots.
“I’m going to put in a bladder catheter, Lisa—doctor’s orders.”
“It’s okay. I understand.”
After ten minutes, Harvey Russo and Jack Byrnes were at Lisa’s bed. “Jack’s going to help us until we get this thing under control,” Harvey said.
“Do I get a twofer?” Lisa said with a smile.
“A to-what?” Jack asked.
“You know, a two for one, since you’re on Mike’s case, too.”
“Why, sure,” Jack said, smiling.
Lisa turned to Harvey, and said, “Tell me about ‘this thing’ that we need to get under control.”
“You know much of this, Lisa, but let’s assume that you’re a regular patient, not a nurse.”
“Okay, Harvey,” Lisa said. “You won’t hurt my feelings.”
“My best guess is that the placental separation has extended. That’s why you’re bleeding, again. When we add to that the bruising and the bleeding from venipuncture sites, it means that some amniotic fluid has entered your circulation, and is consuming your blood clotting factors.”
Harvey held his neck, and pulled his right hand across his face. “I’ve never lied to you, Lisa. This is a dangerous situation. We
could deliver you now, at thirty-four weeks. You know better than I what that could mean for your baby. The last amniocentesis still showed immature lungs, so I’d like to hold off delivery for as long as possible. If we can’t control the bleeding or the clotting problem, or if at any time the baby starts to show distress, then that’s it.”
“After I get a chance to read your chart and examine you,” Jack said, “I’m going to put in a central catheter for IVs, as well as for monitoring your pressures. That will help us to give blood or fluids, and show us how we’re doing.”
Jack draped Lisa’s groin area, and then, with a portable fluoroscope, inserted a long catheter into her heart. As he was placing a dressing over the site, Carla said, “There’s a Nora Cooper outside. She’s demanding to see Lisa.”
Lisa turned to Phoebe, and smiled.
“Oh, no you don’t,” Phoebe said. “Get someone else to face the dragon.”
“You’re not going to give me a hard time now, are you?”
“Okay, but let me get my sword. You’re going to owe me—big.”
When Phoebe entered the waiting room, Nora and her daughters rose.
“What the hell’s going on, Phoebe?” Nora asked. “Why won’t they let me in? What are they keeping from us?”
“Hold onto your shorts, Nora. Give me a chance, and I’ll tell all.”
Phoebe recounted Lisa’s bleeding, its complications, and the plans to try to stabilize her condition for as long as possible before delivering the baby.
“How is the baby?” Lilly asked.
“So far, so good. He shows signs of stress when Lisa’s actively bleeding, but he calms down each time.”
“How long will they wait?” Emma asked.
Phoebe looked at the anxious women, and said, “Until the baby’s lungs are mature enough, or until they have no choice but to deliver him, or risk two deaths.”
Chapter Sixty-Four (Week 34)
ICU sucks! Lisa thought.
Phoebe loved the frantic pace, as did Lisa in the NICU, but now Lisa was on the wrong side of the stethoscope.
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