I tell Jessica, “Order an H and H, coagulation studies, and get her started on fetal monitoring. And page OB to do an ultrasound.”
I turn back to Elizabeth. “Jessica is going to get you into a gown and then we’re going to run some tests to see what’s going on. Is there anyone you’d like us to call for you?”
She shakes her head and looks at the ground. “No. There’s no one.” Then she looks up at me with a forlorn face. “It’s too early, right? Thirty-two weeks is too early to have my baby. So much can go wrong.”
I walk over next to her and put my hand on hers. I notice her skin is velvety soft as I rub my hand on it to reassure her. I look down into her blue eyes, pooling with unshed tears. “We’re going to do everything we can to make sure you make it to full term. But if this baby wants to be born today, there might not be much we can do about it. Thirty-two weeks is early, but not too early. Plenty of babies born at thirty-two weeks are healthy. Let us run the tests and then we’ll take it from there. Okay?”
She nods, sniffing. I turn to walk away when I realize she has a firm grip on my hand.
“Sorry,” she says, her cheeks pinking up. She releases me.
“You’re scared,” I say, reassuring her. “It’s okay to be scared. But know that you’ve done the right thing for you and your baby by coming here.”
“But I can’t afford this. All those tests you rattled off, they sound expensive. What if I can’t pay my bill?”
“Don’t worry, honey,” Jessica says, chiming in. “Before you leave, you’ll sit with someone from patient billing to work everything out. It’s not like they won’t let you leave if you can’t pay. Indigent people come in here all the time.”
I shoot Jessica an annoyed look before she leaves the room to place the orders. “What she meant is that you pay what you can. Believe me when I tell you they slash the prices for self-pay. It won’t be as bad as you think.”
Elizabeth stares at the door Jessica just walked through. “Does she think I’m indigent? As in homeless?”
“No. Of course not,” I say. “We deal with all kinds of people here. She didn’t mean anything by it.” I vow to pull Jessica aside and tell her to have a little more respect for future patients.
“Do you have an OB that you normally see, Elizabeth?”
She shakes her head. “I go to the free clinic over on 27th Avenue every four weeks. I was there last week and they said everything looked good.”
“Have you ever gotten an ultrasound?”
“Yes, when I was eighteen weeks.”
“And that was normal?” I ask.
“Uh, I guess so,” she says, tensing up. “What do you think is wrong, Dr. Stone?”
“Maybe nothing, Elizabeth. Some spotting can be perfectly normal during pregnancy. But there is no way to tell until we run the tests. Just hold tight and try not to worry.” I laugh at my words. “I know, easier said than done, but that’s what they always told us to tell patients when I was in med school.”
Jessica returns to do a blood draw and put Elizabeth into a gown.
“I’ll be back when we have the results of your tests, okay?”
“Okay.”
I close the door to give them some privacy. Then I turn my attention to the next chart that gets handed to me. However, I can’t help but let my mind wander back to exam room three. To the girl who said she has no one.
Chapter Two
“We still on for dinner at Ethan’s tonight?” Cameron asks me in the residents’ lounge as we both catch up on paperwork.
“Yup,” I answer, not looking up from the pile of charts I’m updating. I stifle my yawn. “After I sleep for about twelve hours today, I’ll be ready for some serious drinking.”
“I heard that,” he says, slapping my arm on his way out of the room.
I look at the clock on the wall. 6:00 AM can’t come fast enough. As residents, we are assigned one weekend per month when we’re on call from Friday night through Sunday morning. Makes for a long damn weekend.
My oldest brother, Ethan, invited me over for dinner and some much-needed drinks. My other brother, Chad, will also be there. They are both married, so when we get together I usually try to bring Cameron with me just to make an even number.
My pager goes off, so I close the chart and carry the pile with me back to the ER.
Jessica hands me Elizabeth Smith’s chart. “All of her test results are in,” she says.
“Thanks.” I flip through the results, going over her blood work, which looks normal. When I see her ultrasound findings, however, I blow out a deep sigh. “Did they go over it with her yet?”
“Nope. OB was backed up, so they sent a sonogram tech down to do the ultrasound.”
“Right.” That means Elizabeth hasn’t been told anything. Techs aren’t allowed to reveal results to patients. “I’ll go tell her now. Can you please gather some literature on her condition for me, along with whatever you can find for pregnant women in need of assistance?”
“Right away, Dr. Stone.”
“And, Jessica? I’d prefer it if in the future, you don’t ever refer to patients as indigent. At least not in front of them.”
“I didn’t—”
I hold up my hand. “I know you didn’t say it about her, but it was inferred. Just please don’t let it happen again. Their dignity is already compromised when they are sick and in need of medical care.”
“Sorry, doctor,” she says. “I’ll go get that information right away.”
I don’t know if this patient is homeless or not. On the surface, it doesn’t seem like it. She’s clean, put together, and she doesn’t have any belongings with her other than her purse. Then again, people have a lot of pride. She might just be good at hiding it. It’s possible she could be newly homeless, kicked out by a husband who didn’t want a child. Or maybe she’s living in a shelter. New York City has a lot of shelters for women, and pregnant women would be taken as priority.
I consult with Dr. Manning and then take a breath before I enter the exam room to give Elizabeth the bad news.
“Ms. Smith, I have the results of your tests.”
She looks up at me wearily. She looks exhausted. She looks scared. And I’m about to make her day a whole lot worse.
“Your blood tests were all normal. That means you didn’t lose enough blood to have consequences for you or the baby. And the good news is that according to the ultrasound, the baby is right on track for thirty-two weeks. It looks completely healthy.”
Her hand comes up to her mouth, where she chews on the nail of her pinky finger. Looks like something she does when she’s nervous. She takes it out for a second to ask me a question.
“What’s the bad news?” she asks. “Whenever someone says ‘the good news is…’ that means there’s bad news, too. Am I in labor?”
“No. You aren’t in labor. We had you on the fetal monitor for two hours and didn’t detect any contractions. However, the ultrasound did alert us to a condition that would explain your bleeding. You have what is called placenta previa. What that means is the placenta is attached down by your cervix. There are varying degrees of placenta previa. Yours is called partial previa because the placenta doesn’t cover the entire cervix, just a portion of it.”
“But the baby is okay?” she asks, chewing on her nail.
“Yes, the baby is fine right now. But there are potential dangers with this condition, and you’ll have to deliver via C-section.”
She gasps in horror. “C-section?”
“It’s a relatively safe procedure, and in your case, much safer than a vaginal delivery.”
She closes her eyes. “But a lot more expensive.”
“You can’t worry about that, Elizabeth. Having a healthy baby is the only thing you should be concerned about. And that means taking care of yourself. I feel comfortable discharging you because the bleeding stopped and you aren’t showing any complications. But you’ll have to take it easy. Stay off your feet as much as possible,
refrain from sex, and don’t put anything in your vagina. And come back if you experience more bleeding.”
“Stay off my feet? I’m a dog walker. That’s just not possible.” Her head slumps and her chin falls to her chest in defeat. “How will I make money? I won’t be able to afford this as it is.”
“Staying off your feet is imperative to your health as well as the baby’s,” I say adamantly. “You’ll have to coordinate more frequent check-ups with the clinic. I’ll send you with your records so they can go over them. Jessica will provide you literature on your condition as well as forms for getting possible aid through government programs.”
“I can’t get any aid,” she says.
“Everyone who needs it can get aid.”
“I can’t,” she says.
“Why?”
Jessica comes in with Elizabeth’s discharge papers and an armful of pamphlets. I pull out my business card and write my cell number on the back before I hand it to our patient.
“Here’s my card. My personal number is on the back. I’m available twenty-four-seven.” I point to the literature Jessica put on the side table. “Follow those instructions, Elizabeth. Jessica will get you ready for discharge and answer any more questions you might have. If you need me to explain anything else, have Jessica come get me. I’m here all night.”
I step over next to her bed and put my hand on her trembling arm. “Take care of yourself, okay?”
She nods and mumbles words of thanks before I walk out of the room.
I think about how I love being an emergency medicine doctor. I love everything about it except one thing. We don’t have the patient follow-up that most other specialties have. Patients come into the ER and we treat them, but then they either go home or get admitted. We rarely get to hear about outcomes.
But the excitement, the adrenaline rush of being the first to deal with the carnage that comes our way, the multitude of procedures we get to perform ‘on the fly,’ far outweighs the lack of patient relationships that goes along with working in emergency medicine.
I think.
Damn it. Sometimes I hate my job for the very same reasons that I love it.
An hour later, when I’m paged back to the ER for a gunshot wound, my hands wrist-deep in a gangbanger’s abdomen until a trauma surgeon can be paged, I remember why I chose this specialty. And I completely forget that I haven’t slept in almost two days.
Chapter Three
“Gina was looking for you this morning before you left the hospital,” Cameron says, as we make our way from my building to Ethan’s.
“I know.” I sigh, guilt washing over me because I didn’t find her and make good on my promise. “I was beat. It was a long weekend.”
“Are you ever going to invite her to one of your brother’s dinner parties?”
I furrow my brows at him. “It’s not like that between us and you know it, Cam. And the last thing I want to do is ask her to go to dinner with me and have her think it’s a date. I like things just as they are. No complications. No strings. No added stress in my life.”
“There could be worse things than having Gina as your girlfriend,” he says.
I study him for a minute, wondering if there is deeper meaning there.
“Don’t get me wrong,” I tell him. “She’s great. A good doctor, a loyal friend. And the sex, it’s as good as it gets. I just don’t want to send her mixed signals. We have a good thing going.”
I wave at my brother’s doorman on the way by. Between Chad and Ethan both living in this building, I’m here often. The entire building staff knows me by now.
We’re met at the penthouse door by waves of incredible smells. Garlic. Hell yeah! I know this smell.
I pull my sister-in-law, Charlie, in for a hug. “You made lasagna?”
“Mallory made it,” she says, referring to my other sister-in-law. “She brought it up from her place and used my oven to cook it in.”
“Well, thanks to both of you. It’s my favorite.”
Mallory and Chad live in the same building, just a few floors down. It’s a joke among all of us that Ethan owns the penthouse yet Chad is the movie star. Chad, or Thad Stone, as he’s known in Hollywood, has seven movies and a TV series under his belt. While Ethan, our oldest brother, is a private investigator who owns his own agency. We all inherited enough money from our grandparents that we’d never have to work a day in our lives. But that’s not how our parents raised us.
Cameron and I greet Mallory and my brothers before digging into the case of craft beer I brought over. I hand one to everyone but Mallory, who is seven months pregnant with their first baby.
Ethan looks at the bottle of beer I handed him. “Don’t you want the good stuff? I’ve got some bottles of champagne on ice.”
I give him an annoyed look. “This is the good stuff, Ethan. A case cost me fifty bucks. That’s some damn fine beer.”
He laughs. “Fifty whole dollars? Are you sure you can afford that, Dr. Stone?”
“Bite me,” I say. “And don’t knock it ‘til you’ve tried it. It’s good shit.”
He holds up his bottle and we all take turns tapping ours against his before we drink. I watch his face as he swallows and then works his tongue around in his mouth like he’s some kind of beer connoisseur.
“Hmmm…” he ponders.
Charlie swats him on the back of his head. “It’s great, Kyle. Thanks for bringing it over.”
Chad coughs while saying, “Cheap son-of-a-bitch.”
Cameron joins Chad and Ethan as they laugh at my expense. I’m used to it. As the youngest of three brothers, all the teasing fell on me.
“Well, what do you expect,” Cameron says. “He spends his real money on his patients.”
Mallory smiles at me. She and I got close when she lived at my place for a few weeks while Chad was wrapping up a film in L.A. I think she understands my compassion for others more than the rest of them.
“I saw him handing a homeless guy a wad of cash last night,” Cameron tells the group. “And I heard he paid for some old lady’s leg brace last week.” He turns to me. “You’d better be careful or patients will be hunting you down expecting you to pay their bills.”
“I think what he’s doing is incredible,” Mallory says, getting up to set the table. “Don’t ever stop doing what you’re doing, Kyle.”
Ethan motions for me to give him another beer. “Hey, before I forget,” he says, “Mason hooked me up with some pre-season box seat tickets for next weekend’s game. You guys up for it? You too, Cameron.”
“Hell, yes!” Cameron shouts. Then he lowers his voice and says to me, “Damn, I’m one lucky son-of-a-bitch to have met you our first day as interns. A movie star brother. Friends who play for the Giants.”
“Dude,” Chad says to him. “Stop kissing his ass or it will give him a bigger head than he already has.”
“Oh, I’m the one with the big head, Mr. Jake fucking Cross,” I say, referring to his award-winning movie trilogy.
Chad punches me in the arm. “That’s Lieutenant Jake fucking Cross, you tool.”
Charlie and Mallory call us to the table for dinner. The girls tell us about the work they’ve been doing at Hope For Life, a program for pregnant teens who have been kicked out of their homes and have nowhere to go. The residential center helps girls navigate their pregnancy and then gets them back on their feet afterwards. It makes me think of Elizabeth. But as she’s in her twenties, she’s too old for the program.
“Bro!” I feel a kick in the shin under the table and look over at Chad who delivered it. “Can you tell me why the hell you’ve been staring at my pregnant wife the whole night? I know she’s gorgeous and all, but what’s wrong with you?”
“Sorry,” I say to him. Then I wince and turn to Mallory. “Sorry, Mal. Uh, I just can’t get my mind off a case I had last shift. She was about your age, and at thirty-two weeks, just a little further along.”
Mallory looks worried and puts a protective hand on h
er belly. “Oh, gosh, what happened?”
“She’s okay,” I tell them. “And so is the baby—for now. She’s got placenta previa. But that’s not what got to me. First, I found her outside the hospital sitting on a bench. She was scared to come in because she didn’t have insurance. And then, when I asked if I could call someone for her, she said she didn’t have anybody. But the way she said it was so sad. I actually think she doesn’t have anyone. Like she’s alone in the world.” I shake my head and down the rest of my beer. “It just really sucks, that’s all.”
“Oh, wow,” Mallory says. “That’s so sad. I can’t imagine being pregnant and alone.” She reaches over and takes Chad’s hand in hers.
“You have to let it go, Kyle,” Cameron says. “I know you want to fix everything and everyone. But you can’t. You’d better get used to that now or you’ll burn out on this job before you know it.”
I nod. “I know. For the most part, I can let things go. I do what I can and then the rest is out of my hands. But this girl, I don’t know, I just felt like maybe there was more I should have done. She was different. Better. More deserving somehow.” I run a frustrated hand through my hair. “Fuck.”
Cameron puts a supportive hand on my shoulder. Then I look around at all the fallen faces at the table. “Shit,” I say. “I didn’t mean to bring everyone down. I’m sure she will be fine.”
I nod to the large ice bucket on the bar that’s holding several bottles of champagne. “I’m not back on the clock for twenty-four hours. So how about we open those and get shit-faced?”
Chad laughs. “How about the three of you get shit-faced and I’ll be the one to make sure you and Cameron get home.”
“Sounds like a plan,” I say, just as my phone vibrates with a text. I pull it out to check it.
Gina: Enjoy your day off. But I expect payback tomorrow night!
I smile at the text. Best to stick to the things I can control and let the rest go. I tap out a reply.
Me: Looking forward to it.
Stone Vows (A Stone Brothers Novel) Page 2