Embryo 1: Embryo

by JA Schneider

  “Jill...” It was Levine’s voice but she ignored him. She was almost done. Her heart was pounding.

  “Jill.” He was now by her side. His voice was tired, flat. She inhaled, stopped what she was doing, and looked at him.

  “It’s all over,” he said gently.

  “But…”

  “She arrested four minutes ago.” He exhaled heavily, starting to pull off his gloves.

  Jill felt her eyes mist over. She looked up to the head of the bed where Holloway was applying external heart massage.

  For long moments Levine also watched Holloway’s futile efforts, then turned back to Jill, his face drooping with fatigue.

  “We gave her intracardiac epinephrine, the whole works.” He hesitated. “She was mortally ill when she came in. We did everything we could.”

  Woody Greenberg sank down heavily in a wooden chair.

  Jill, still wearing her bloodstained gloves, stared in disbelief at the dead woman on the bed. Her abdomen still looked as if it contained a beach ball. A dead beach ball. Six minutes before, Levine explained, the fetal heartbeat had abruptly stopped, probably because its own blood stream had become as poisoned as the mother’s.

  Jill found herself fighting back tears. Her eyes traveled to the white maternity dress with lace eyelets, now reddened, draped over a bin. She tried to imagine the vibrant young woman who had put it on this morning, alive – no, doubly alive. Jill wondered if Maria Moran had been conscious when she’d been brought in; had been relieved at finding the skilled doctors of Madison Hospital eager to help her.

  And they hadn’t.

  It was time, as the nurse Cathy was saying as she moved numbly about, to “clean up for the next one.” And just as numbly, Jill watched the other nurse make out an I.D. card and hang it around the corpse’s big toe. At the head of the bed, Levine was filling out a report. His pen hand was shaking.

  Looking down, Jill saw that the bloodstains on her scrub suit, minutes before soaking and warm alive red, were now drying and turning brown. Just like that, she thought. A fat tear slid glistening down her cheek. She was aware of Greenberg leaving his chair and coming to her; of Levine now by her helping to remove her surgical gloves. One of the nurses, blurred, seemed to look over with a less sympathetic expression. Interns, her face said.

  Holloway was already outside. Someone had looked in to say that Maria’s husband, a fireman, had arrived. It was Holloway’s task to put a white coat over his awful bloodied scrubs, inform the man, and offer solace. And perhaps, if Ryan Moran could speak, gather more background on his wife’s case history.

  Jill looked a last time at Maria’s closed eyes, the bloodless face. She and the others put on white coats and left the cubicle. Levine and Greenberg bent and also offered solace to Ryan Moran, sitting on a wooden bench with his face in his hands.

  After quick showers and a change of scrub suits, Jill found Levine waiting for her. They walked in silence down the busy, connecting corridor as far as the arch. Ahead she saw the clamor of the living: pounding PlayStations, howling children, people arguing over their place in line.

  She turned to David. “I don’t want to go through there.”

  “I’ll run interference for you,” he said.

  She let him lead the way. Together they crossed the E.R. waiting area and entered a slow elevator.

  4

  Flowers – riotous bouquets, extravagant floral creations – had begun arriving around 9:30 for the happy new mothers. When Jill and David reached the OB floor, bouquets had overflowed the nurses’ station and were starting to take up floor space.

  “Looks like a funeral,” Jill muttered.

  “Yeah, depressing,” Levine said.

  They stood talking quietly, oblivious to the activity around them. Jill dreaded doing patient rounds. How do you just put on the Happy Face?

  David nodded. “Idea. We don’t both need to visit well patients.” He glanced at his watch. “You’ve got about forty minutes before clinic duty, right?”

  “Yes. 11:00 to 1:00 today.”

  “Ok, how ‘bout finding a quiet place to read today’s charts? Take some time to calm down. Sound good?”

  She liked the idea, and thanked him. He reached out to give her shoulder a friendly squeeze. With a rising warmth she watched him walk to the nurses’ station and pick up a clipboard. He seemed to remember something, and looked back at her.

  “Don’t forget Grand Rounds at 1:30. In the old building.”

  She nodded, then gestured in the direction of the long corridor lined with happy patients’ rooms.

  “Act cheerful,” she said.

  He made a face. Then turned, walked down the corridor and disappeared into the room of a patient more fortunate than Maria Moran.

  At the nurses’ station Carol Something sat behind the counter, ignoring the ringing phone as she clipped together a pile of lab reports.

  “Hi Carol,” Jill said, easing past her. “I’ll be needing the floor charts.”

  “Oh hi…” Jill was aware of Carol swiveling on her chair and watching as she pulled out the chart rack and began wheeling it away.

  “All of them?” Carol was out of her seat and peering anxiously at Jill over the countertop.

  “Half, actually. Anything the matter?”

  Carol dropped her voice. “Have them back by eleven. Before eleven. Stryker himself is leading today’s attending rounds. He’s already destroyed a few people this week, and if he loses his temper at me I’ll lose it! I’ve got a lot of stress at home. Him on top of it and I’ll be ready to check myself into Psycho!...”

  Jill smiled, and promised to have the charts back. She hadn’t been around this department long enough to fear Stryker as she knew others did; but on the other hand she didn’t want to annoy the Chief of Obstetrics. She had heard about his temper.

  A nurse passed, talking on her cell phone, and then two strolling patients wearing pretty pastel robes. It was peaceful here, and Jill took a deep, grateful breath. Visiting time was over and the squalling infants were all back in their isolettes in the nursery at the far end of the corridor.

  Her thoughts wandered back to Dr. William Stryker.

  It was, she reflected, impressive enough that he was chief of Obstetrics and Gynecology at Madison, one of the top teaching hospitals in the world. But he was also a world-famous fertility expert acclaimed for his pioneering work in human reproduction, as well as chairman of the hospital’s Genetic Counseling Committee. Jill peered down at the rolling chart rack as she thought of the word “genetic.” It was an important word in the hospital. Stryker, or Stryker’s team, were often featured in the media for their astounding breakthroughs in genetic research. And every discovery prompted either adulation or raging ethical debate – even among Stryker’s own medical colleagues. Many said he had gone too far. Many said science had gone too far.

  Jill reached the small room used for storing drugs and surgical supplies. She had seen this room before and loved it because it was a perfect, quiet nook with a floor to ceiling window. Entering, she saw sunshine streaming in and took a deep breath, and another, deeper still. Deeper than she had breathed in hours.

  Shutting the door, she pushed the charts to the desk by the window. The room was narrow. The two facing walls were lined with locked, glass-fronted medication cabinets. Below them, on both sides, were long counter tops jammed with equipment. Behind her was a stainless steel sink and a coffee pot.

  She sat, pushed the phone away to make more room, pulled out the first chart and opened it. This is what she was best at: scanning quickly and absorbing reams of information. She read, flipped pages, took notes and wrote orders. The second and third charts went fast. Pages in patient charts were color-coded, which made the going easier. Lab and X-ray reports were pink. Doctors’ order sheets were light green; progress sheets were yellow; TPR (temperature, pulse and respiration) sheets were light blue; nurses’ notes were white.

  Pages flipped; charts came out and went back. Nothin
g dramatic: Ms Andrews, who delivered early yesterday, was constipated; the one named Mazzini had diarrhea; Ann Kowalski’s episiotomy hurt – oops! Jill scribbled an order for a culture to be taken for infection and thirty milligrams of pain-killing codeine. She slid the order under the chart’s front clamp, and reached for the next few charts.

  Where was I…oh yes, Ms. Flaherty has sore nipples; Ms. Horowitz wants to go home; the one named Dowe doesn’t want to go home – “Ha!” Jill laughed out loud at that one. What else… Hollins is running a fever -

  Hollins…?

  Jill looked up, blinking.

  Mary Hollins who had the amniocentesis this morning? But amniocentesis patients were all sent home after an hour or so in the recovery room. It was a minor procedure. So what was she doing here as an inpatient?

  Jill reached and pressed a button on the intercom.

  “Yes?” The voice was not Carol Something.

  “Nurse, can you tell me if Dr. Levine is still on the floor?”

  “No, he isn’t,” said the voice. “He was called into surgery. Dr. Holloway was supposed to finish his rounds, but he isn’t here yet.”

  “And Dr. MacIntyre?”

  There was a pause, the sound of urgent, confused whispering, and the voice came back.

  “Dr. MacIntyre is in delivery, room ten, and I don’t know where Dr. Mackey is.”

  “Thank you.” Jill punched off, loaded up the charts, and wheeled them hurriedly back to the nurses’ station.

  The clock on the wall said 10:45. The floor seemed empty.

  Two student nurses were behind the desk, trying to figure out the buttons on the phones.

  Jill said, “Please tell the nurse that the rack is back and the orders are updated.”

  “What?” said one of the students.

  She hurried down the hall, trying to read the Hollins chart as she went. The patient had been admitted by George Mackey at 9:55. A terse note in Mackey’s awful handwriting recommended admission for later evaluation of “non-urgent symptoms.” The letters F.U.O. were scribbled, then underlined, indicating a fever of unknown origin. But the fever was only 100.2. Definitely low grade. Mackey was just being extra cautious.

  Under the fluorescents, Jill stopped and flipped from the admission sheet back to the nurse’s note, clocked just twenty minutes ago. Within thirty minutes Mary Hollins’ temperature had risen to 102.1.

  Jill frowned at the number. Two degrees higher?

  Room 824, MARY HOLLINS, read the card on the door.

  Jill knocked softly, and went in.

  It was a semiprivate room. The bed near the door was empty; the blinds over the window were drawn, diminishing the light, and the figure in the second bed was a vague hump.

  Approaching, Jill whispered, “Ms. Hollins?” The patient’s eyes were closed. She wore a hospital johnnie instead of the usual pretty nightgown, a giveaway that she had not expected to stay the night. The wedding ring said that a husband would probably be running in soon with an overnight case.

  Again, softly: “Ms. Hollins?” The woman’s eyelids fluttered and opened.

  The patient stared at her for a moment, as if trying to place her. Then a wisp of a smile crossed her lips.

  “Munchkin,” she said weakly.

  Jill grinned with good humor. She glanced over her shoulder. “Do you mind if I raise the blinds? I’d like to have a look at you.”

  Mary Hollins rolled her head slowly toward the window. “Yes, please.”

  Jill drew the blinds. Midmorning light poured in and a thin sound of traffic became audible.

  Hollins smiled wanly at the light. Jill turned back to the bed, pulled out a pen, and held it poised over the chart.

  “Well,” she said, resting an arm on the bedrail. “I see here that you’re running some fever. Is there anything specific that’s bothering you?”

  Mary Hollins inhaled slowly. “Dizzy,” she managed. “Feel so…dizzy.”

  Jill scribbled. “Any sore throat or cough?”

  “No.”

  “Any burning when you pass urine? Sometimes cystitis can cause – ”

  “No.”

  Jill studied her for a moment; then, jotting on a separate sheet, decided to order a urinalysis and complete blood count.

  “Okay,” Jill said, placing the chart at the foot of the bed. The history-taking part was over, now it was time for the physical. “I’d like to look you over just a bit.”

  With her penlight Jill examined the patient’s throat. Next she put on her stethoscope and listened to the lungs, here, there. The possibility of any kind of lung infection was remote, but it had to be ruled out.

  Removing the stethoscope, Jill lowered the sheet below the patient’s hips, then raised her johnnie almost as far as the breasts. Carefully she began to examine the exposed abdomen. Removing a Band-Aid from the navel, she checked the amniocentesis puncture wound for signs of infection. There were none. Then, fingertips pressing gently, Jill examined the rest of the abdomen. No sign of undue swelling. At five months’ gestation the fundus of the uterus was up to the navel, where it was supposed to be, although the area above was almost concave. The patient couldn’t have eaten much this morning.

  Without looking up Jill asked, “Have you noticed any change in your appetite?”

  Moments passed. No response. Jill looked up.

  Mary Hollins’ eyes were shut tight. Tears ran glistening down her cheeks.

  “Oh, please don’t! No, you’ll see…” Jill drew the sheet back up and patted Mary’s cheek. “You probably do have cystitis or something,” she floundered.

  Mary Hollins opened her still-brimming eyes.

  “We’d had it all planned. Career first, then children. I started trying to conceive when I was thirty-four, four years ago.” She paused, inhaled as if it were painful. “What a joke. We spent so many years being careful, then found out we were borderline infertile.”

  “But you’re pregnant now, aren’t you?” Jill said earnestly. “You’re going to have a baby!”

  Mary Hollins turned her head on the pillow and stared out the window. “Yes,” she said uncertainly. Her voice rose. “But why did the doctor have me stay? This fever …what’s happening?” She began to weep again.

  Jill reached for some Kleenex and dabbed at Hollins’ face. “The important thing,” she said softly, “is try not to get upset. I’m going to order some routine tests, but I’m sure whatever it is has nothing to do with the pregnancy.”

  “You’re very sweet,” said Mary Hollins gratefully.

  Jill gathered up her chart and prepared to leave. “I’ll send the nurse down with some aspirin.” She smiled encouragingly. “And promise me, no worrying allowed, okay?”

  “I’ll try,” Hollins said softly.

  Quick, back to the nurses’ station. An older nurse was irritably trying to explain the phone console to the two student nurses. More flowers had arrived and some water had sloshed onto papers on the desk. Jill loudly clapped her chart on the counter top.

  “Would you pick up this order for Hollins in 824? The lab tests are to go out stat. Also check the patient’s vital signs Q4h and give aspirin, ten grains, Q4h prn, temp over 100. The aspirin order is also stat.”

  “Yes,” said the nurse, mopping water from her papers. “As soon as I – ”

  “Now please,” Jill said.

  The nurse muttered something with no eye contact and reached for the chart. Jill checked her watch, startled, then frowned up at the wall clock to double check.

  It was 11:03. She was late for her clinic duty, dammit. By the time she got there, because of the long corridors connecting the new part of the hospital with the old, she’d be noticeably late.

  At least no sign of Stryker yet. Ha - maybe he was late!

  Don’t push your luck. Beat it, stat…

  In the elevator, at the rear behind some house staff in white and scrubs, Jill pulled out her small black notebook from her pocket. It was her special organizer for important memos
to herself. She wrote, then vigorously underlined, “Follow case of Maria Hollins.”

  Overhead the elevator dinged, people got off and got on, but she was just dimly aware of their movement.

  She stood, blinking down at the mistake she had written, and suddenly felt cold.

  5

  “Awful morning,” David Levine said to Sam MacIntyre. His voice was loud in the noisy cafeteria. “One amnio that’s not looking too good and one maternal death. Complete blitz. Awful, awful!”

  Jill stood unobtrusively behind him in line, pushing her tray along. It was 1:10. She had twenty minutes to bolt something down before running back up to Grand Rounds, a whole two new buildings away. The conference had been called important, so it wasn’t surprising that everyone in the department plus what looked like half the med school had converged on the cafeteria.

  She watched MacIntyre stuff an unpaid-for roll in his mouth. It saved time. Eat before you reach the cashier and then tell what you took.

  “And a stillborn for me!” MacIntyre hollered with his mouth full. “Healthy pregnancy and – bang! Patient’s brought in in premature hard labor and out comes this dead little…Jeez, what’s going on here?”

  Levine was frowning. “Which patient was the stillborn?”

  “Burke,” said MacIntyre. “Remember nice Mrs. Burke?” He shook his head and reached, grimacing, for a plate of something steaming, then glanced past David to Jill. “Oh, hey.”

  “Hi,” she said, wishing she were somewhere else in line. Her two hours in the outpatient GYN clinic had been undramatic. Mostly routine physicals, blessedly boring. Now she was back in the eye of the storm as the two residents rehashed the morning’s casualties. And it wasn’t only them. All through the cafeteria people in scrubs still sat over finished lunches, tensely comparing stories just heard. Even the noise seemed different: more shrill than usual.