by Barbara Ebel
The two men clutched the rim of the basket. They talked with a seriousness that could only be construed as concerning. The pediatrician gently loosened the baby’s blanket and allowed the other physician to perform a physical exam.
CHAPTER 4
The cafeteria of the University Hospital bustled with activity as Annabel slipped through the aisles and found an empty table. How disappointing to eat lunch alone, she thought. She didn’t even see any medical students around from other rotations. Maybe she missed them all because she peeled away from the labor and delivery floor later than her growling stomach wanted to. She had spent time in the ER with a pregnant patient who ended up not being admitted, but they had not informed her of that. Time may fly, heal, or steal, but to a medical student, wasted time was worse than being on a ship lost at sea.
Annabel reached for the salt as long fingers gripped it before she could and handed it to her. Tony stood over the table looking as forlorn as an abandoned puppy. He pulled out a chair across from her and sat without a word.
She jiggled salt on her side dish of steamed vegetables, hoping he wouldn’t be too chatty, especially if he wanted to discuss his girlfriend’s condition. At this point, he would be better off scrolling through Safari on his iPhone rather than asking her any obstetric questions to do with Bonnie.
He broke out in a smile. “My little girl is tiny, but I can hardly wait. Although I only wiggled my way through high school, she’s gonna go to college. And I swear, she’s gonna be a super soccer player.”
“You play?”
“Play?” He straightened his shoulders and beamed even more. “I’m a soccer coach.”
“Nice. You must enjoy the kids.”
“Yeah. That’s me. I have five siblings, so I grew up with people around me. I am more excited about this new baby than I ever imagined. Damn. Bonnie needs to marry me. But no mind; I won’t let the young one grow up without a father. As a matter of fact, this is so cool - I plan on giving her brothers and sisters too, like me … even if they’re half-brothers and sisters.”
Annabel thought he was getting ahead of himself, but at least he didn’t seem to be the type to shirk his responsibilities. She also wondered if there was a problem with the baby. Why had the pediatrician called in another apparent pediatrician? She stirred the straw in her iced tea. “Did you hold your new baby yet?”
He set his wide jawline in a stern scowl. “No. Not yet. They’re busy tending to her. I didn’t know that nowadays births are complicated by all this modern scientific mumbo jumbo. I mean, I bet my sneakers that nobody did genetic testing on me when I was born.”
“Genetic testing?”
“Some doctor upstairs told me they are going to test Baby Barker.”
After he left, Annabel finished her meal in silent contemplation. Her first OB patient had not only encountered a problem, but apparently her baby had too. Bonnie and Baby Barker were mired in bad luck today. To their better fortune, which Bonnie was ignoring, Tony was a young man on the sidelines who really seemed to care about their well-being.
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Upstairs, after scrolling for the information on the computer, Annabel made a note of Bonnie’s hemoglobin and hematocrit on the index card she wrote up for her patient. As with other rotations, she logged each of the patients she followed in such a manner and always had their pertinent information in her white jacket pocket. In her opinion, the young mother’s red blood cell counts were now acceptable. Of course, Bonnie had been transfused … the purpose of which was to bring the levels up so she would not continue to demonstrate the effects of an acute anemia, like what had happened in the OR.
Based on the scant reading she did before the rotation, she already knew that anemia is a common complication in a pregnant woman – if there are not enough erythrocytes or red blood cells that can carry hemoglobin, the functional iron-carrying protein. That critical protein transports oxygen molecules to the body’s tissues and organs. Too few blood cells and a body will be oxygen deprived … causing symptoms of fatigue, shortness of breath, dizziness, rapid heart rate, and impaired cognition.
She opened up her handbook and looked under the “physiology of pregnancy” and scanned several paragraphs. In the pregnant woman, it said, anemia was most often due to iron deficiency due to two reasons. The first reason may be due to decreased iron stores prior to pregnancy. Or, secondly, it may be due to increased demands for iron because of an increased need from the growing fetus and an expanded maternal blood volume.
She extended her legs under the desk of the computer station and thought back to her surgery rotation where she had observed trauma patients. That was where she witnessed more than ever the color coding of blood. Arterial blood filled with oxygen-laden hemoglobin was bright red, but after it returned to the lung without its oxygen, it would lose its brightness. That blood would become bluish and was more synonymous with venous blood.
Thinking back to Miss Barker’s postpartum hemorrhage, she couldn’t imagine a few hundred years ago when there was no such thing as large-bore intravenous catheters and packed red blood cells for transfusion. No wonder women quite often died during or after childbirth in those days. And that was without taking into account the other horrendous problems and complications of pregnancy and delivery.
In essence, she didn’t have to mimic what the anesthesia resident or the orderly had said. She already made up her own mind that women, even if they didn’t know it, took on a lot by becoming pregnant!
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“Are you going to sit there all day?”
Ling Watson paused as she delivered her comment while Annabel glanced up at her senior resident, who wore all the right curves in all the right places. Her nails were manicured perfectly and her fingers looked exquisite. She wore a solid blue gemstone on her right ring finger. The time she must spend on her hands, Annabel thought, was short changed when it came to her hair. She was blessed with smooth, shiny, jet-black hair, which she easily wore in a pulled-back, tight ponytail.
Dr. Watson tore down the hallway and Annabel caught up.
“Bonnie Barker’s H and H is 11 and 33,” Annabel said.
“Those are decent numbers, considering.”
“Yes, I read that anemia in a pregnant woman is considered to be a hemoglobin below 10. But did you know the pediatricians are doing some kind of a work-up on her baby?”
“I’m hard core about the fetuses of my pregnant patients, but I’m all too happy to turn the newborns over to pediatricians once they take that first breath of air, which, by the way, should be within the first ten seconds of delivery.” She stopped short. “You can come downstairs and watch if you want. A new patient. You can write up an H&P afterwards. Also, it’s a huge subject. Tomorrow, regurgitate to me the adaptations a newborn must make to extrauterine life.”
Annabel fidgeted with her hair as she trailed Ling into the elevator. At least that topic had been brushed over in courses such as physiology and embryology, but it was a complex subject. Now, for today and tonight, specific reading awaited her. It was doubtful she would have the time to address the personal items on her agenda.
In the ER, Ling barely glanced at the board as she swiped a stack of papers from the counter and brought them with her. She knew exactly where she was going as she shoved curtains back and entered a cubicle. Other than her protruding belly, a woman before them in a hospital gown appeared to be more like a medical patient than an obstetric patient. She struggled with difficulty breathing. Her hand rested on her abdomen as her quick breaths and unfamiliar situation caused her big brown saucer eyes to glance at them with fear.
“I’m not galloping, but I feel like a race horse gulping for air,” she said in a high-pitched voice. Annabel guessed her age to be nearly twenty, but her voice made her sound like a prepubertal teenager.
“How long has this been going on?” Ling asked.
“A few hours.”
“How far along is your pregnancy?”
“Last week I
was 28 weeks.”
“You been coming to prenatal clinic?”
“Yeah.”
“First pregnancy?”
“Yeah.”
“Any medical problems?”
“No.”
“Any problems during the pregnancy so far?”
“No,” she whimpered.
“Annabel, go check if the clinic chart notes have been sent over or if the secretary has printed out those notes from the computer.”
Annabel hated to miss out on watching her first full history and physical of a pregnant lady, but she did as she was told. She scurried out and put a name to a face by glancing at the ER board: Mary Chandler, eighteen years old. She was boldly designated on the board and chart as G1P0. The “G” stood for gravidity … the patient’s number of total pregnancies, including the current one. Had Ms. Chandler had any before, that number could have also included miscarriages and stillbirths. The “P” stood for parity, which was the number of pregnancies ending in a gestational age greater than twenty weeks. Miss Chandler’s G1P0 correlated with her confirmation that the current pregnancy was her first one.
“What were you doing when you were eighteen years old?”
Annabel swung around where she stood. Emmett, the orderly from upstairs, frowned.
“Not having babies, that’s for sure.”
He nodded. “I think these young girls were deprived of love as youngsters and are still longing for it. They think that by having a baby themselves, they will make up for that deprivation. They believe they’ll give and receive love to and from their offspring like it’s a winning gamble.” He sighed heavily, un-gripped the back end of a chair, and plopped himself down.
“It’s like this,” he added. “Going into their adulthood, they think they’re giving their future a value right off the bat. They ante up the pot with a newborn. Or so they think. In reality, they make themselves a donkey player.”
“A donkey player?”
“I forgot,” he said and shook his head. “You medical students don’t have time for anything else except medicine. I’m talking poker. These little girls deal themselves the worst hand. Like holding a 2 and 7 off suit.”
“I see. I’d better run along, though.”
She hadn’t expected the orderly to render such an opinion, but, then again, he could be a multi-faceted individual and this could be a side job for him. He could have a master’s degree in psychology and be a stellar card player for all that she knew. She grabbed a handful of the blue drape at Mary Chandler’s cubicle, ready to step inside. In four weeks, however, she was sure there would be no questions on her test about poker games.
-----
Ling took the clinic record from Annabel as soon as she entered. Mary Chandler swiped her hand along her belly like someone was ready to snatch her growing fetus away from her.
“You just did internal medicine,” Dr. Watson said to Annabel, “where you followed patients with high blood pressure mostly stemming from their lifestyle choices. Here lies a different ball of wax. There are hypertensive disorders of pregnancy. The state of pregnancy can instigate hypertension!”
“She said my blood pressure is way too high,” Mary said. She swiped at the side of her eye where moisture began accumulating, ready to slip down her cheek in the form of a tear.
Ling folded down the stretcher’s white sheet on Mary’s lower abdomen and applied gel to her skin. From the cart alongside the bed, she grabbed a hand-held electronic Doppler ultrasound device and smoothly glided it across her patient’s abdominal skin to evaluate the fetus’s heart rate. She took her time and finally nodded. Mary gripped the side of the stretcher in anticipation.
“You remember what they told you in clinic? What the normal baseline fetal heart rate is?”
“A little bit,” Mary said. “They told me that theirs is way higher than us grown-up people. Is my baby okay?”
“A normal fetal heart rate is between 110 and 160 beats per minute, which correlates with a good assessment of fetal status and well-being. Your baby is beating smack in the upper middle of normal.”
“Thank God! So I can go home?”
“No way,” Ling said. “Your blood pressure is 154/106.”
Dr. Watson pointed to the clinic chart, suggesting that Annabel take a look. Mary’s vital signs at each clinic appointment were jotted down on the inside flap of the folder. Annabel noticed the normal numbers around 110/70 for weeks … up until last week, when they registered a reading of 130/88.
“We need to check some labs, but it appears that you are preeclamptic,” Ling said to Mary.
“Pre what?”
“Preeclampsia … a hypertensive disorder of pregnancy. Right now, your diagnosis is very concerning. Good thing you came in, Ms. Chandler. Let’s get you upstairs. Stabilizing you and your baby is our highest priority at the moment.”
Ling pushed back the chart and eyed the woman’s cell phone nearby.
“Make your calls. You won’t be going home for dinner.”
CHAPTER 5
After several years of working the same job, Emmett considered himself an expert in the particular specialty of transporting obstetric patients. Little by little, he’d seen it all, or at least all that could be gleaned by escorting wailing mothers from one area of the hospital to another. On the other hand, the patients sometimes displayed an opposite expression – one of sheer joy if their baby had been delivered and mother and baby had healthy results.
Emmett glanced around the cubicle to make sure all of Mary Chandler’s personal possessions were stashed under the stretcher. He had all of her paperwork at the foot of the bed; not a problem since she was slightly elevated and she’d propped her knees up. He didn’t want to dillydally. When he heard Ling Watson use the term “preeclampsia” at the ER desk, he knew the obstetric floor would be expecting the patient and one of the first things someone would do upstairs was to put oxygen back on her via a nasal cannula.
“I’m taking you on a short journey,” Emmett said. “Out of the ER and on your way. You will like the obstetric rooms. Nice and comfy.”
“When I get to feeling better,” she said, “all I’ll want is food. Forget about later … right now I could eat a horse. Dr. Watson made it clear I was barricaded from going home for dinner, but that doesn’t mean I’m not eating here. With a lady doctor, she’ll get this preeclamptic disease under control right away. Then someone can smuggle me in some kind of a Big Mac.”
Emmett pushed the stretcher along and grinned. “Will anyone be coming by to keep you company?”
“I told my mom and dad. They live north of Columbus. My mom is taking off tomorrow and driving down.”
They reached the staff elevators and he pushed his load inside. A few floors up, they bounced over the lip of the door and headed down the main corridor.
“No one’s given me a bumpy ride in a long time,” she said. “Not even in a car.”
Emmett grew concerned and she smiled at him. “I’m just yanking your chain.”
“I see. You know what they say about rides. If you plant your feet on the ground and stay put, life will be predictable. But if you take a ride, life will be a lot more interesting and nothing is guaranteed. Including the bumps.”
“For sure,” she said as an aide from the desk approached and waved them to an empty labor and delivery room. Emmett turned in.
“What’s your name?” Mary decided to ask him.
“Emmett.”
“Hmm. Your mother blessed you with an uncommon name.”
“It’s been around. Apparently, Emmett is the masculine form of the female name Emma and I believe both origins are German.”
“I’m still wondering about baby names. Isn’t that crazy?”
Emmett slid the stretcher next to the bed and locked the pedals. Mary began to creep over.
“Nope. Happens here more often that you would think. Every week, anywhere from one to a handful of mothers will pick out their baby’s name at the last minute.�
�
She stopped for a moment to gather her breath. “Emma or Emmett. Those names have a ring to them. I’m going to consider them.”
“Be my guest,” he said and helped her scoot over. The nurse’s aide stood on the other side and spread the sheet up to Mary’s chest.
“I’ll be right back,” Emmett said. “I’m going to first take the chart work to the desk. The nurse assigned to Ms. Chandler will be expecting it.” He moved the stretcher to the side; he still needed to move Mary’s belongings somewhere else but figured he would do that when he came back. First things first, he thought.
At the counter, an obstetric nurse stretched out her hands for the paperwork as soon as Emmett arrived. Ling scribbled their new patient’s name on the OB board and came out of the room with Annabel trailing behind her.
“She’s preeclamptic,” Dr. Watson said, “bordering on having severe features. All of us need to start moving and put out this fire.”
The RN, chief resident, and Annabel headed to the room. Emmett turned and followed the three of them. After going through the doorway, Ling continued her hectic pace, her eyes straight ahead at Mary Chandler. She mis-stepped and plunged straight into the stretcher.
Ling righted herself, grimaced, and massaged her hip. She spun around and glared at Emmett. “Why the hell did you leave this here? No … actually, there is no excuse for leaving an obstacle in a hospital where it shouldn’t be.” Her hands landed on her hips. “Idiot!”
Mary Chandler shrank further into her bed and massaged her belly. Emmett swallowed hard and held his tongue. The RN looked away. Annabel kept her mouth shut too. Despite what happened and despite whose fault it was, she thought Ling Watson should have spared the outburst in front of their patient.
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Mary looked to the side while tampering with the pulse oximeter on her finger. The nasal cannula oxygen prongs were in her nostrils and the reading from the oximeter showed 96%. Annabel felt a wave of relief for the young woman. At least mother and baby were getting enough oxygen; if there was any further worsening of the situation, she knew her residents would move fast towards delivering the patient’s fetus.