Local Woman Missing

by Mary Kubica

  Bea shifts her chair in another direction and looks away.

  Dr. Feingold motions for me to slide to the end of the exam table and stick my feet in the stirrups. I do, lying spread eagle on the table before him. Dr. Feingold sets his firm hands on my bare knees. He presses my legs wider, before dropping somewhere that I can’t see. I’m flat on my back. I can’t see what he’s doing. I close my eyes, try and transport myself somewhere far from here. My own gynecologist talks me though the entire exam, as if every time is the first time. A little pressure, she forewarns. Just try and relax for me, Kate. You’ll hear a click...

  But Dr. Feingold doesn’t speak. Before I can process what’s happening, his cold speculum is inside me, blades clicking open, and I gasp, not ready for the pressure of it, for the pain. Dr. Feingold moves fast, shifting the cold metal to get a good look inside me. My eyes fly open and I bite down hard on my lower lip, tasting blood.

  Before I can catch my breath from the sudden plunge of the speculum, it’s out, gone, replaced with his invasive hand and he’s feeling around, groping, another hand applying pressure to the outside of me, to my abdomen. It’s routine for him, automatic, but it’s awful for me, unbearable. Knowing these hands are the hands of a killer makes the heat rush to my face. I think again of Shelby’s body there at the riverbank, dead for days. This man may have stolen a life; he may have left a helpless infant without a mother.

  There’s a sudden ringing in my ears, a blackness spreading from the periphery of my vision so that I think I could pass out. My legs close against my will and Dr. Feingold tells me sharply to open back up, that the more still I sit—as if I’m a four-year-old having a dental cleaning—the quicker he will be done.

  “Everything okay, Kate?” Bea asks as tears prick my eyes and I force them back. I mumble an affirmation. I can’t see her from my vantage point, but I hear the fear and disgust in her voice, same as in mine.

  When he’s done, he pulls his hand abruptly from me and he tells me to sit up. “The blood test,” he says flatly, “will be more definitive.”

  “What does that mean?” I ask, struggling to sit up, clutching the robe together at the chest and lap. Dr. Feingold’s eyes go there, to my hands, which are shaking.

  “It may be too soon to see any changes in the uterus,” he says.

  “So you didn’t see any changes? I’m not pregnant, then?” I ask. “You think I miscarried. Or you think the home pregnancy tests were wrong.” I don’t have to simulate the fear, the shock, the disgust. It’s already there.

  “The nurse will be in to do bloodwork,” he tells me. “I’m not into speculating. I prefer things to be conclusive. Let’s see what we learn from the bloodwork, and figure out where to go from there. You might want to hold off on interviewing doulas until we know more,” he says as he leaves.

  MEREDITH

  11 YEARS BEFORE

  April

  Shelby Tebow goes into labor two weeks early. The call comes in the middle of the night. It’s Jason who calls, from Shelby’s phone. Her contractions are close. I tell him to go to the hospital. I say that I will meet them there.

  I meet Jason for the first time. He’s everything I expected him to be, except that his voice, now that I hear it, is not the same one I heard when I was standing outside their home. That was another man. It calls everything I know about Shelby Tebow into question.

  Shelby gets examined first by a triage nurse to see if she’ll be admitted or sent home. The suggestion of going back home gets Jason provoked, though it’s standard protocol to be examined before being admitted. Jason gets angry with the triage nurse.

  “You need to simmer down, sir,” she tells him. He stands too close, breathing down her neck as she examines Shelby. The nurse tells him to back away and give her room. She examines Shelby, who is five centimeters dilated. Her contractions are less than four minutes apart. Shelby gets admitted. She changes into a hospital gown and takes her place in the bed.

  In time, Dr. Feingold comes. I’ve never had the pleasure of working with Dr. Feingold before. But his reputation precedes him. He’s overweening and uncompromising. He tries to relegate me to the corner of the room. I won’t have it. Shelby is my client as much as she is his.

  He wants to check her progress. He jams his fingers inside her cervix, far less gently than the triage nurse. Shelby recoils on the hospital bed. She presses her knees together. She tries pulling away from him.

  “You need to hold still,” he says. It’s apathetic.

  “You’re hurting me,” she whimpers.

  He makes light of her pain. “This doesn’t hurt,” he says, going on. He wouldn’t know. He’s never had a cervical exam before. Shelby squirms. He tells her to hold still. He says that the more still she holds, the sooner he will be done. It’s denigrating. “All done,” Dr. Feingold says to Shelby as he yanks the latex glove from his hand. “Now that wasn’t so bad, was it?”

  She won’t look at him.

  Dr. Feingold doesn’t use electronic fetal monitoring to continuously monitor the baby’s heart. Instead, he listens with a Doppler device. Many obstetricians do. Electronic fetal monitoring isn’t necessary for everyone, unless they’re high risk. But intermittent auscultation is exactly that—intermittent—and requires diligence on the part of Dr. Feingold and the labor nurse. Tonight the hospital is busy. Many women are in labor, including another of Dr. Feingold’s patients. The nurse says, “Must be a full moon.” There’s no truth in that. It’s only folklore. Changes in barometric pressure can cause women to go into labor, but not full moons. It’s more likely there’s a storm coming than that there’s a full moon.

  Dr. Feingold steps out of the room. Before he leaves, he asks me to step out into the hall with him. He says to me privately as if we’re in cahoots about this, “You’ve got your work cut out for you with this one.” He’s smirking as he asks, “Is this what they mean when they say attention whore?”

  I’m so shocked that at first I don’t speak. I just stare, wide-eyed and slack-jawed.

  “My clients,” I tell him when I catch my breath, “are always looking for OB recommendations. I wouldn’t recommend you to anyone, Doctor.” If I had personal experience with Dr. Feingold before, I would have told Shelby to run in the other direction. I have a growing list of doctors I won’t work with, of hospitals I won’t go to. He’d just been added to my list. He believes his medical degree gives him carte blanche. It doesn’t.

  Once he’s gone, I return to Shelby’s side. She tells me, “I hate him.”

  “Don’t worry about Dr. Feingold,” I say. “Just think of your beautiful baby and the life you’ll share. You’re almost through, Shelby.”

  Within an hour a nurse comes in to check Shelby’s progress. “Already?” I ask when she tells me what she’s here to do. It seems too soon for another cervical check.

  “Dr. Feingold wants to know.” She goes to Shelby. “Let’s have a look-see,” she says. She motions for Shelby to bend her knees and open up. Shelby does as she’s told. She doesn’t know that she can say no. She doesn’t know what I know. There isn’t any good research that says cervical exams are absolutely necessary during labor. They’re also not one hundred percent accurate. One person’s measurements are not the same as the next, and they need not be done every hour.

  “Are you okay, Shelby?” I ask, my hand in the way to prevent the nurse from touching my client without her consent. “Is it okay with you if the nurse checks your cervix? That’s when they see how far dilated you are. That’s what Dr. Feingold did a little while ago when he was here,” I say, because informed consent is important. A person should know what they’re saying yes to.

  Shelby draws backward on the bed. She whimpers. “Is it going to hurt as much as last time?”

  “It might,” I say. “And it might not. It’s your call, Shelby. If you don’t want the nurse to check, she won’t,” I tell her as the
nurse pulls a face. Shelby thinks about it. She decides. She looks to me, and there’s an inappreciable shake of the head. “Not now,” she says. “Not if I don’t have to.”

  “It’s been barely an hour,” I say to the nurse. “It’s too soon for another check.”

  The nurse leaves. She’s not happy with me.

  Shelby asks, “What if she doesn’t come back?”

  This is the problem. Laboring women don’t want to piss anyone off. Because they need them. Which means that sometimes unnecessary things are done to a woman’s body during labor, for the sake of convenience or efficiency. Sometimes I’m as much of a bodyguard as anything else.

  I promise her, “She’ll come back.”

  Shelby doesn’t handle the contractions well. Her threshold for pain isn’t high. I sit with her. I try and help her breathe through them. But she’s too beside herself to breathe. She asks for her epidural. The anesthesiologist is called, but he’s not immediately available. What Shelby wants is immediate relief, but she has to wait.

  “What the fuck is taking so long?” Jason asks. He paces the room. I ask him to calm down. I tell him quietly that he’s not helping anything by getting upset. He needs to be a calming presence, for Shelby’s sake.

  The epidural comes. Jason is asked to leave for the placement of it. This makes him irate. I go with him. In the hall, I try to explain that it’s a sterile procedure, a catheter being inserted directly into Shelby’s epidural space. It’s also a liability. Fathers are notorious for passing out at the sight of needles. It takes longer than expected because Shelby won’t hold still. This sends Jason off the deep end. I have to physically restrain him to keep him from going back into the labor room.

  The epidural slows Shelby’s progression. What was quick is now slow.

  The relief, though, is immediate. She nearly goes numb from the waist down. I sit on the edge of the hospital bed beside her. I push the hair from her eyes. I offer her ice chips and a massage. She declines both, preferring sleep. Sleep is a good idea. She needs her rest.

  As she sleeps, Jason Tebow talks to me. He’s cynical, hostile. He swears a lot. But maybe he’s not the monster my imagination made him out to be. There’s a softer side to him. He’s tender toward Shelby. It’s endearing. I can see that, though he has a temper, he loves her dearly.

  As she sleeps, Jason moves to the edge of the bed. He watches her. He strokes her head. He holds her hand. He tells me, “My father was never around. He left when I was five, got remarried, had another kid. For a few years, I’d get a present at Christmas and on my birthday. After that, nothing.” The look on his face is melancholic. “I’m going to do better for my kid,” he promises.

  “I’m sure you will,” I say. He reaches out, touches Shelby’s abdomen.

  “I’d give my kid the world if I could.”

  I tell him, “I believe you would.”

  “Can I tell you something?” he asks.

  “Of course,” I say.

  “I think Shelby’s going to leave me. I think she’s going to take my kid away with her when she goes.”

  “Why would she do that?” I ask. I shouldn’t have asked. I regret it as soon as I do. It’s none of my business. I shouldn’t let myself get drawn into their marriage.

  “She’s cheating on me,” he says. “I know she is.” I know this, too. At least I think I do. There was a man in their home the day I stopped by. He stood at the top of the stairs, beckoning for Shelby to come. Shelby was desperate for me to leave. It wasn’t so that Jason wouldn’t see me and get upset. It was so that she could get back to her man. This makes me see Shelby in a different light. Their marriage is far from perfect. But it’s not all on Jason, I don’t think. They’re both responsible for this. I consider the things she suggested about him, the conclusion I drew: that he was hurting her. Was there any truth to that, or was she laying the groundwork for divorce? Things like child custody and alimony would be affected if a judge thought Jason has been abusive toward her. A claim of domestic abuse would swing the balance in Shelby’s favor.

  But I’m only theorizing. There’s no way to know for sure.

  I can’t stop myself. “How do you know? She told you?”

  “She didn’t have to,” he says. He says that he just knows.

  “Have you talked to her about it?” I ask.

  He shakes his head. He looks at me. His eyes are a mix of angry and sad. He’s sullen. He says, “I know how it is. When people get divorced, the mother always keeps the baby. Shelby can’t ever take my baby from me.”

  “Fathers have rights, too,” I tell him, but he isn’t wrong. Custody is almost always granted to the mother.

  He says, “Every other weekend isn’t good enough for me.”

  “Give it time, Jason. Talk to her. Maybe you’re wrong. Pregnancy is hard. You might have misread the situation. Maybe it’s the hormones making her distant, not some other guy.”

  “I’m not a fucking idiot,” he says.

  I swallow hard. His quick temper makes me nervous. I lower my voice and move physically away, though I’ve not yet seen him be physical, only verbal in his assaults. “I didn’t say you are.”

  “She’s cheating on me,” he says. “And there’s no way in hell that if and when she decides to leave me, I’m letting her take my baby away.”

  Later, Shelby wakes. The nurse comes in to check on her. Her dilation and effacement haven’t changed much. We wait a while longer.

  When Shelby fails to progress, the doctor orders Pitocin. This strengthens her contractions. Soon, Shelby is in pain. Jason wants to know why. “The fucking epidural isn’t working. Shouldn’t she be numb?” he asks.

  “Even with the epidural, the pressure can become more intense as time goes on.”

  “Call the doctor. Get him to fix it,” he says.

  “We need her to feel the pressure of the contractions now. It will help Shelby push your baby out,” I say, and then I turn my back to him. My energy needs to be spent comforting Shelby, not mollifying him. We try again to work on her breathing, but Shelby is too far gone for that.

  When she’s reached ten centimeters, the nurse has Shelby labor down for a while before she starts to push, in the hopes that the uterus and contractions will do some of the work for her. But the contractions are unbearable. There’s the greatest desire to bear down.

  When it’s time to push, I talk to Shelby about breathing, about effective pushing. When she screams at me that she can’t do it, I tell her that she already is. “You’re doing it, Shelby. You are doing it.” I smile encouragingly.

  When Jason looks like he might be sick, I suggest he step out into the hall for air. He does as I say. After a few minutes, he comes back.

  I feed Shelby ice chips during each push. She pushes a long while. First-time mothers who’ve had an epidural tend to push anywhere up to three hours, sometimes more, which is fine so long as the mother and baby aren’t in distress, or the mother too exhausted to push.

  By the time Dr. Feingold returns, Shelby is completely spent.

  What his patients like about Dr. Feingold is that he’s a solo practitioner. He’s not part of a big group. There’s comfort in that. When his patients deliver, they know just exactly what they’ll get. The other groups have upward of ten obstetricians on staff. When it comes to delivery, you might get one you like. You might get one you don’t like. You might get one you’ve never seen before. That prospect worries many. That’s why they settle for a no-nonsense man like Dr. Feingold. With him there are few, if any, unknowns. He’s been doing this for decades.

  The first thing Dr. Feingold says to her is, “The better you push, the sooner you’ll be done.” That’s not necessarily true. It’s also patronizing. That the baby doesn’t move despite Shelby’s pushing isn’t her fault.

  “I can’t do it,” Shelby cries out. The sweat drips from her hairlin
e. It rolls down her cheek. “Get this baby out of me,” she screams.

  Jason, beside me, is incensed.

  I pull Dr. Feingold aside and suggest that Shelby can’t do this, that she’s had enough. Shelby doesn’t have any real qualms in having a cesarean. It’s not her first choice. But she’s fine having one if necessary. And to me, taking her exhaustion into account, the prolonged labor, the fact that things have stalled, it seems necessary. Prudent even.

  Dr. Feingold is dismissive of my concerns. “I’m the doctor,” he reminds me, loud enough that everyone in the room can hear. He glares at me as he says it. “I’ve been in practice for thirty-odd years. Why don’t you let me decide how this is going to go, unless you have some medical degree that I don’t know about.”

  He walks away from me. He returns to Shelby. “Besides,” he tells her, as if he was talking to her all along, “a C-section will leave you with an ugly scar, and no one wants that.”

  A healthy baby. That was Shelby’s only request when we discussed her birth plan.

  Instead of a C-section, Dr. Feingold decides to use forceps to help get the baby out. Very few doctors use them anymore, mostly only old-school ones like Dr. Feingold. The use of forceps poses a potential risk. Dr. Feingold doesn’t discuss these risks with Shelby or Jason. He only tells her what she wants to hear: that he’s going to help get this baby out of her now.

  But that’s not all. Because Shelby isn’t allowed the opportunity to give informed consent before he cuts an episiotomy, using a pair of scissors to cut her perineum instead of having it tear on its own, if at all. An episiotomy should be an exception these days, not the norm. And it should always come with a clear explanation of the possible complications, of which there are many, from painful sex to fecal incontinence. I’m appalled.

  “Doctor,” I say tersely, but it’s too late, because it’s done.

  He glares at me over my client, where I stand by her side, trying to comfort her. “Would you like to wait in the hall?” he asks. I don’t move.