“By what you’re telling me, she could be in peripartal cardiomyopathy. I won’t know for sure with the physical exam, but I may need to admit her to hospital to get to the bottom of this. Did she have problems with her other deliveries?”
René slowed as they approached the examination room and glanced toward the floor. “I’ve never seen her before today. The history is sketchy at best. I don’t think her kids are living with her,” she said quietly. “When I asked why she waited this long before getting prenatal care, she just shrugged. I was shocked when she told me she was eight months pregnant. I thought she was around five months.”
She bore a concerned expression that, the more he learned about the patient, rubbed off on him.
“Is she homeless? How did she get an appointment with you?”
“I do several pro bono appointments a month, and she said someone told her about me. Honestly? I think she may be involved in sexual services, and most likely lives on the street or in cheap flop motels.”
“Not the best circumstances to be pregnant in. If it turns out she does have what I’m suspecting, she’ll have to be admitted to the hospital, and we can get social services involved, for both her and the baby’s sake,” Jon said.
“I had my nurse draw a complete blood panel, and I got samples for STD tests when I examined her.” René knocked on the door.
“What about a drug screen?” he asked.
“I thought of that, too.” She swung the door open.
Jon glanced at the thirty-something woman, thin as a slip though pregnant, who sat on the examination table.
“This is Chloe Vickers,” René said, “and she is eight months pregnant. Today was our first appointment, and I’m concerned about her blood pressure and her heart.” She spoke to the patient, as if making sure she understood why the male doctor was in the room. “Dr. Becker is a cardiologist.”
The woman’s cautious gaze darted between them, her pasty skin almost opaque.
Jon produced his top-of-the-line stethoscope, warmed it with the palm of his hand and placed the bell close to the sternum in the birdlike rib cage. He listened intently, first on the right side at the second rib interspace, then he moved the bell to the left. He worked down to the third rib interspace, then to the lower sternal border. He repositioned Chloe on her left side and listened again, then had her sit up and lean forward and he listened to her heart once more from this angle. There was indeed a proto-diastolic gallop present.
Twenty minutes later, after a thorough physical examination of her heart, and additional gathering of medical history, Jon called the local hospital from René’s office to arrange for more tests and patient admission. He glanced across the baby collage as he waited for the house on-call doctor to pick up, and worried about the outcome for this mother-to-be.
“I’ve got a patient for you. Chloe Vickers. She’s a thirty-four-year-old female, multiparity, currently at thirty-two weeks’ gestation with abnormal EKG and elevated BP. I suspect peripartal cardiomyopathy. I want her on bed rest and sodium restriction for starters. Labs are pending. And if the echocardiogram confirms my predicted diagnosis, we’ll need to arrange for cesarean section ASAP.”
He glanced at René, who hadn’t left his side since she’d brought him in for the consultation. Other than the faint tension lines between her brows, she was the exact opposite of Chloe Vickers. She was fit and the picture of health; her color was creamy light olive with pink cheeks, and there was a spark of life in her deep honey-colored eyes. He tore his gaze away, while hoping René had lots of extra energy today, because Jon suspected she may be doing a last-minute surgical delivery before the day was over.
With the added risk that Chloe might take off if given half a chance, Jon personally arranged for her to be driven to the hospital, met her there and walked her to the office of admissions.
So much for sneaking out of the clinic early today.
The next morning Jon cruised by René’s office on his way to discuss his schedule with the receptionist, Gaby. The door was closed. A young woman with bright red hair, a stained-glass-patterned tattoo covering one arm and a brow ring, sat just outside, flipping through a magazine.
Immediately forgetting Gaby, he pushed on to knock on René’s door to see how she was doing, and the woman jumped to her feet.
“Sorry, but it’s Dr. Munroe’s quiet time,” she said.
“Pardon?” He must have heard wrong. Since when had René employed a bodyguard?
“She’s resting. She had a long night of surgery, and needs extra time with her feet elevated to make up for it.”
“And you are?”
“Gretchen. I’m her doula.” She extended her hand at the end of her highly decorated arm.
Oh, right, René had told him about hiring a woman as her pregnancy advocate. He shook her hand and made a U-turn. He’d wait until later to quiz René about their patient and how the C-section had gone, and besides, he really did need to talk to Gaby about his schedule.
At noontime, René didn’t come into the lunchroom, and even though he’d promised to avoid her as much as possible, he went looking for her. He’d been too busy all morning to call her office, and after seeing the size of Chloe’s heart on X-ray, he became really curious about the health of the infant.
With cardiomyopathy of this magnitude in their latest patient, it made sense that the dusky lavender-rose color of her lips had nothing to do with lipstick and everything to do with low oxygen.
He forked several bites of spaghetti and meat sauce before his curiosity got the best of him. He shoved his food aside. Rounding the corner to René’s office, determined to get some face time, he came to an abrupt halt. Tattoo lady stood behind René’s chair, massaging something into her temples.
“Take several deep breaths,” she said, and René did as she was told. “That should help your headache.”
This was wrong. Totally wrong. If she needed someone to give her a head and neck massage he could fill that bill. Hell, he could be a lot more creative than smelly cream and deep breaths. He’d distract her with a leisurely afternoon in his bed, working her into a frenzy and satisfying her every need.
Damn, he had to quit thinking this way, because he wasn’t doing himself any favors. He’d had to fight off his imagination daily since he’d kissed her, and his resolve was growing weak. He cleared his throat, and Gretchen snapped her head toward him.
René glanced up bearing a sheepish look, and peachypink cheeks, the color of the afterglow he’d guarantee her if she’d only jump into his fantasy—a fantasy he shouldn’t be having in the first place, remember!
“Hi,” she said.
“Hey. It smells like—” he sniffed the sweet aroma “—peppermint?”
“And eucalyptus,” Gretchen added. “Perfect for tension headaches—that’s what pregnant women suffer from when they don’t get enough sleep.”
“Ah.” He honestly couldn’t think of a proper response.
“Gretchen, thanks so much, but I’d like to talk to Jon if you don’t mind.”
The full-bodied and freckled, where she wasn’t tattooed, woman gathered her huge bag of goodies and prepared to leave the room. “Don’t forget to take your prenatal vitamins. Here.” She set a plastic container in front of René. “This is your lunch. It’s perfectly balanced for you and the baby’s dietary needs.”
He understood women had different perspectives than men on many levels, but had their clinic nurse practitioner, Claire, really recommended this woman to René? And René had hired her? Which part of the equation was he missing?
He folded his arms, leaned against the door and waited for the woman to leave. René slanted him a look filled to the brim with apologies and embarrassment. Once the woman had cleared the door, he took the seat across from René’s desk.
“I had no idea she would go this far,” she whispered.
He glanced over his shoulder. “She’s definitely into her job. I guess that’s a good thing.”
; She shrugged. “She’s nice enough. Very caring.”
“She could use a hint about knowing when to stop playing bodyguard, though.”
René let go a soft laugh. Up close he could easily see the fatigue, and a touch of purple smudged under her eyes.
“How’d the surgery go?”
She sighed. “Rough. It was really rough. Chloe had an incredibly high tolerance for anesthesia, which threatened her baby. I had to work fast, and the poor thing was so tiny due to IUGR. She barely weighed three pounds—at eight months’ gestation! Can you believe it?”
“Yikes. It’s not surprising about intrauterine growth retardation, because Chloe’s heart is a mess, and hasn’t been delivering enough oxygen to the fetus. Chances are she’ll suffer progressive deterioration of her heart, but there’s a slight chance it could go back to normal size. By six months from now we should know if the disease has reversed or not.”
“If we can keep track of her,” René said, unconsciously rubbing her tiny baby bump.
If he didn’t know better, he’d never suspect she was even pregnant, but he’d known the results, and she’d called him at the first sign of life. He’d been flattered that she wanted to share the news with him, then had the audacity to fall asleep on the phone. Yeah, Mr. Exciting—wasn’t that what Cherie had always called him?
“As for the baby, well, that’s another story,” he said.
“Do you suspect brain damage?”
“It’s very possible.”
“At least her baby’s in the NICU and social services will make sure she’s taken care of properly,” René said.
“Good.”
“Let’s hope the little one’s a fighter.”
Jon thought about the baby inside René, hoping it was a real fighter, too. He also thought about Gretchen and her bag of surprises, and suspected that from now on, René would share all things on the pregnancy front with her. So much for superfriend status. A pang of envy made him stand. He had no right to expect anything more.
“I guess you’d better eat your lunch,” he said, slipping out of the room. “And whatever you do, don’t forget those vitamins.”
He left her quietly laughing. It was the least he could do. Feeling as irritable as a duck in the desert, he thought how things would only get worse as her pregnancy progressed. He wanted to be involved, yet the price he had to pay was too great. And it wasn’t fair to René to insinuate himself into her life, only to leave.
“I think I know who the father is,” Lois whispered to Gaby near the front desk.
“I’ll tell you who I think it is, then you can tell me who you think it is. Maybe we think it’s the same person.” Gaby’s gaze lifted in time to see Jon pass. She quickly guarded her look and pretended to do some work. Lois flashed a glance over her shoulder, displaying similar surprise.
Maybe it was better to leave sooner than later.
He knew three or four doctors in practices who’d expressed an interest in him joining them, but had been too content to ever give it a second thought before. Maybe now was the time to start a job search; that is, if they would also be okay with him going on sabbatical.
CHAPTER SEVEN
Eighteen weeks’ gestation, late June
RENÉ lay on the paper-lined exam table as her doctor performed an ultrasound. The ethereal outline of the baby seemed to emerge from what looked like a triangular-shaped dust storm. A perfect profile of an alien child came into view, complete with huge head and torso, tiny hands, feet and turned-up nose. Could anything possibly be wrong with her baby?
She was thirty-six, and she recommended amniocenteses to her patients beginning at age thirty-four to rule out genetic disorders and chromosome abnormalities. In her opinion, this study needed to be done.
Once her doctor established the placement of the baby in her uterus and marked it, her nurse swabbed René’s belly with topical disinfectant, then placed a paper sterile field with a whole in the middle over the X marks the spot. Under constant ultrasound guidance to avoid injuring the fetus or placenta, a long needle was inserted into her abdomen. The pinch of entry through the skin was bearable thanks to topical anesthetic, but then came an odd pressure as the needle pierced her uterus and entered the fluid-filled sac surrounding her baby. She wouldn’t describe it as painful, but the process of withdrawing the fluid gave an odd pulling sensation as the syringe sucked thirty ml. into its barrel, and that definitely got her attention. Could the minor procedure cause a problem? She knew there was a small risk for miscarriage by having this done, but in her opinion, the greater gamble was not being prepared for a handicapped baby.
Gretchen was quick to be at her side, and René was grateful not to be alone through the procedure. But holding Gretchen’s hand left her wanting, and oddly enough she had a brief fantasy about Jon. Why couldn’t she get beyond him? In her thoughts, he sat beside her with narrowed eyes watching her every move, as if monitoring her well-being. The fanciful vision of Jon worrying about her gave an added sense of security to the procedure, even if only made-up.
Within a few minutes, everything was over and she was dressed.
“You know the routine,” René’s OB doctor said. “We’ll send the specimen to the special lab where they’ll analyze the cells and study the chromosomes. Report any bleeding immediately.”
Now all she had to do was wait two long and nerve-racking weeks for the results.
“By the way, do you want to know the sex of the baby?”
René had quickly looked away from this ultrasound, as she had with all the others to avoid seeing anything that might expose the sex. Many of her patients wanted to know the gender in advance, but not her.
“No, thanks,” she said, opting for the gift of surprise at the birth.
“What are you going to give Dr. Munroe for the baby shower?” Jon overheard his nurse, Lois, ask Christina, the medical aide, the next day.
“I was hoping to go in with someone so we can get her something really nice.”
Jon craned his neck to better hear the conversation.
“Oh, I’d like to do that. Let’s decide what we should buy at lunch,” Lois said.
“Sounds good. Um, who do you think the father is?”
“There’s no telling. A woman like Dr. Munroe could have any man she wanted.”
“You think she arranged to get pregnant? She never mentions a boyfriend, and she’s getting on in age,” Christina said.
“You mean, like a sperm donor, or a wham-bam-thank-you-ma’am?”
Jon had heard enough. He pushed back his chair and strode to the office door. “Ladies? Don’t you have work to do?” He thought about making a snide remark about how it wasn’t any of their business who the father of René’s baby was. He tried to figure out how he might react if he wasn’t personally involved. As it was, he felt paranoid, and thought it might seem too obvious if he said what was on his mind, so he gritted his teeth and forced a smile.
“Oh, sorry, Dr. Becker,” Lois said. “I’ll get your next patient in the room ASAP.”
He rubbed his jaw. He hadn’t thought about an office baby shower. Now he’d have to come up with a gift for René that wasn’t too personal. Something well-built…and functional…like him. Right. That was the last thing she needed. Or wanted.
He smiled, deciding to give René the same thing he’d given Jason and Claire for their son, a top-of-the-line stroller. On a whim, he made up his mind to purchase one with a special and extra feature, and he knew exactly where to buy it, too.
Saturday morning, René indulged herself in a shopping spree. She’d seen her hospitalized patients that morning and told Gretchen, who was beginning to overstep boundaries and get on her nerves, that she preferred to do this alone.
The woman had proved to be a bit overbearing with her ideas and suggestions, and René didn’t want a comprehensive rundown of every nursery item that caught her fancy. She just wanted to shop for her baby…in peace.
The Babies, Babies, Babies! store wa
s nestled in an upscale, Mediterranean-styled corner mall on Coast Village Road in nearby Montecito. She stepped into the display room and almost gasped at the assortment. How in the world would she be able to choose which crib, dresser and changing table she wanted with a gazillion sets? Every color, style, size—simple to ornate, over-the-top to understated to trendy—were on hand for the choosing.
She wandered toward the cribs: natural wood, cherry wood, dark wood and white; French country, modern and Scandinavian styled. There were cribs that could break down to become head- and footboards for future toddler beds, cribs big enough to take up the entire second bedroom in her home and cribs for twins and triplets. Everything seemed to have double functions, and for these prices she could see why.
Her head spun at the overabundance of merchandise with too many choices, and wished she’d invited a friend along to help her decide. She glanced across the store at the checkout desk and needed to grab the nearest crib rail for support. Should she hide? Why?
There stood Jon, Saturday casual in jeans and a snug bright green polo shirt he hadn’t bothered to tuck in. He produced a card and handed it to the lady.
Funny how the sight of him made her feel a bit giddy these days, especially since he’d been making himself scarce at work. At first she thought it was the hormones messing with her body, but she’d noticed a consistent tingle shower each time she’d seen him since their kiss. Man, he was a good kisser.
She had no right to think about him in that way—there was no purpose in it—yet occasionally her mind would drift to that night at his loft.
He turned just when she’d been remembering their kiss, and must have seen her with quite an expression on her face. His gaze gravitated to her lips, then, as if he’d been caught red-handed in some nefarious deed, he blushed. Full out, all the way to the shells of his ears, he reddened, and it became him.
The Heart Doctor and the Baby Page 8