“Oh, yes. One just last year. Unlike most of my patients, this one had had no antenatal care and the spinal defect came as a complete surprise."
Jack nodded as he continued to work on the deformed spine of the developing fetus. “Dr. Potter practices OB/GYN in England,” he explained. “When almost every pregnant woman receives prenatal care, there's a greater chance of recognizing problems soon enough to deal with them effectively."
Then he resumed describing what he was doing, and after a while called me over for a closer look. Standing beside him in front of the opened womb, with the repairs now completed, I felt a stirring inside me that I couldn't quite pinpoint. Perhaps it was the wonder of seeing a child before he was born, or the marvel of scientific accomplishment. More likely it was the knowledge that this man beside me was every inch the humane, skilled man I'd believed him to be. If it wouldn't have broken sterility, I swear I'd have stood on tiptoe and kissed him.
The skin around Jack's eyes crinkled and I could tell he was smiling at me. I gave him a sassy wink before stepping back to join the medical students. It was a moment I knew I'd treasure—especially when I returned to England in the fall.
* * * *
Dr. Hager continued to keep my clinical participation to a minimum, though other department members worked to include me. And on several occasions I volunteered at Angel's clinic way outside of Madison. This required my renting a car, but it felt good to be doing something worthwhile. The clinic was a little scruffy and lacking in the latest gadgets, but its patients were needy and grateful. It was a pleasure to work there.
It turned out that Angel and Cliff actually owned a house somewhere midway between Madison and her clinic, so that neither of them would have an impossibly long commute.
“But Cliff still found himself getting home late so much that we decided to buy a small place in Madison as a pied-à-terre,” Angel explained as we had lunch one day. “And you know how it is, Amanda. There weren't any simple little places at reasonable prices for sale, and Cliff saw Mayfield House and it reminded him of San Francisco, and suddenly we owned it."
I laughed. “Keeping it simple is never as easy as it sounds. Did he find Sherri, or did you?"
“I did. Without Sherri the whole thing would be impossible,” she admitted. “But it's easy to find tenants for the units because of the university. I usually interview them by phone, and Sherri checks them out when they come to see the place."
Naturally Cliff took no part in this process, I thought. Seeing my skeptical reaction, Angel shook her head and said, “You have to remember, Amanda, that I only work part-time."
“Yes, but it's always three or four days a week. And then you take care of a baby and a house and a husband. Considerably more than you husband does,” I offered pungently.
She grinned. “Hey, this is what I asked for when we decided to get married. My family lives close by and they help. And speaking of them, Amanda, I wonder if I could ask a favor of you."
“Anything,” I said.
“My mom is having a little difficulty with menopause. She doesn't like to talk about it with me, and she doesn't have a GYN of her own, but I'm sure she'd talk with you one day at the clinic if I arranged it."
“Well, of course. I'd be more than happy to do that."
Mrs. Crawford's problem turned out to be more than menopause, but less than the cancer I think she had unconsciously feared. Eventually I operated on her for a twisted ovarian cyst at the University, ably assisted by Sarah. Everything went well, as it should have, but I seemed to have earned a special measure of respect from both Angel and Cliff.
Cliff admitted one evening at Mayfield House that he'd never seen his mother-in-law so complaisant about a medical procedure. “Maybe Angel didn't tell you,” he said, “but her mother is actually almost allergic to doctors. It's a wonder Angel got into medicine at all."
And Angel could scarcely thank me enough for the way I'd managed to keep her mother both fully informed and astonishingly calm. “I've never seen any other doctor do that,” she admitted. “Lavinia Hager is nuts not to make use of your obvious talents."
But it was almost a month after the trip to Oconomowoc before Dr. Hager paged me to ask me to attend a delivery. Mystified by her change of heart, I showed up in L&D just as Dr. Hager was conducting board rounds on a patient about to be taken to the delivery room.
Ms. Stremler was an obese woman of perhaps 350 pounds. Dr. Hager was telling the group of medical students and residents, who stood well within earshot of the patient, that this woman would probably have to have a caesarean section because of her “enormous weight.”
Lavinia nodded curtly to me as I joined the group, continuing, “Because of her refusal to lose weight, her condition has become very shaky.” This brought on giggles from some of the group, one murmuring loud enough for me to hear, “Shakes like a bowlful of jelly."
“For that kind of behavior,” I said to him, giving my coldest stare, “you'd be put back six months in your medical progress at my university."
Dr. Hager ignored my interruption. “Ms. Stremler has evolving preeclampsia, so we have to move toward delivery. Women of her size seldom manage a normal vaginal delivery. Perhaps Dr. Potter would enlighten us on some of the problems morbid obesity has for a pregnant woman."
Ah, she'd brought me here to humiliate myself, despite the fact that I couldn't claim “extreme” obesity for my very own. Fat was fat to Lavinia Hager. Didn't she realize I'd performed this teaching service in my university for years with doctors, nurses, midwives, students? I proceeded to cover as many of the difficulties as I could think of without actually seeing Ms. Stremler's chart.
“It's difficult to get a decent ultrasound of the fetus because of the fat layers, so we generally don't have as good an indication of the baby's health when it comes time to deliver. Sometimes primigravidas of Ms. Stremler's size develop gestational diabetes.” Here I looked toward Dr. Hager for an indication if this was true in the patient's case. Hager nodded.
“This often produces a larger baby, which could make vaginal delivery more difficult. I imagine her doctors are considering the risks of a caesarean section, which are a surgical challenge in cases of obesity, so they have attempted to induce labor. Is that correct, Dr. Hager?"
“Yes, we're doing what we can to offset the consequences of her obesity. Tell the group about the risks of caesarean section for such women, Dr. Potter."
There was a snicker from the back of the group. If I had been sure who'd done it, I would have dismissed him or her. As I wasn't, I proceeded to explain about poor blood supply to the fat layer, the difficulty of choosing an incision site, anesthesia problems, multiple drains, postoperative complications, etc.
I launched into this discussion in my usual enthusiastic way, trying to make these youngsters understand that these were problems which called for making careful decisions. Frequently there was no right answer, just one with a better chance of success. As I began to comment on the subject of training doctors to handle such situations, since obviously there were many obese patients in our society, Dr. Hager interrupted me to say, “That's all we'll need to cover for the present, Dr. Potter.”
The board rounds group wasn't having any of that, however. By my passion for the subject they knew I would be able to answer questions that other OB/GYNs weren't always willing to address, and queries popped up from all over the group. Hager could not very well deny them the opportunity to learn, so she drifted toward the back of the group, impatient to leave, but not willing to do anything which would lessen her authority.
For a good ten minutes I supplied answers to interested questions in my usual frank and comfortable way. When a resident asked me something I didn't know because I hadn't examined the woman, I led the way to her bed, introduced myself and asked if I might satisfy our curiosity. She was a friendly woman who had probably been examined in front of dozens of training doctors and merely shrugged her shoulders with a big smile.
“No, I'd guess the baby isn't terribly large,” I said, after exploring with my fingers. “Eight pounds tops."
“Dr. Hager thought from the ultrasound that it would be much bigger,” someone said. “Because of her gestational diabetes."
“Well, of course I haven't seen the ultrasound, though we don't usually get a truly accurate one in these cases. Thanks, Ms. Stremler. I think they'll be wanting you soon in the delivery room. Best of luck."
Dr. Hager had appeared at my side. “I'm offering you the opportunity to act as Ms. Stremler's obstetrician, Dr. Potter. In the event she cannot deliver vaginally, I'm sure you'll be able to teach us something useful about British methods of c-sectioning an obese patient to avoid postoperative complications."
“I'd be delighted,” I said, smiling down at my first really challenging American patient since I'd come to Madison. “Will that be all right with you, Ms. Stremler?"
“I love your accent,” the woman replied. “It'll be a pleasure to hear you saying, ‘Push, push, push.’ And my name's Brenda,” she added shyly.
“Okay, Brenda. Let me get rid of all these innocent bystanders and you'll fill me in on your pregnancy before we trundle you off to deliver."
The unnecessary shift in obstetrician was highly irregular, but I believed the patient would be none the worse for having me, so I jumped right into the breech, as it were. Brenda was a thirty-two year old woman in reasonably good health and whether she delivered vaginally or by c-section, I was determined to do what I could to see an outcome of good baby and good mother.
When her cervix was totally effaced, we took her to the delivery room and set things up for a natural birth, with all the necessary equipment for an emergency c-section within easy reach. Brenda's husband had left her when she insisted on continuing her pregnancy. Her sister was supposed to have attended her delivery, but was in bed with the flu. So those of us in the delivery room became her family and her support system.
The nurse, the waiting pediatric resident, and I gave her mountains of encouragement. In the end we didn't even have to use the Mityvac suction device. Brenda had learned her lessons well in antenatal class, and used her breathing to help her push the little girl out before any distress occurred.
It was a beautiful birth.
Chapter Thirteen
Though I arrived back at Mayfield House quite late that evening, and exhausted, I felt magnificent.
Apparently it showed. Jack was seated alone in the living room, doing a crossword puzzle. When he looked up to see who had come in, he smiled. “You look like you just won the Nobel."
“That's how I feel, but it was just a successful high risk birth."
“I thought Hager wasn't letting you do any of those."
“This patient was extremely obese, and Hager thought it would be a good lesson for me to present her blind and then attend her delivery."
Jack looked appalled. “The woman is losing it. Someone should have a talk with her."
“Well, it's not going to be me.” I took a seat across the room and curled my legs up under me. “That's the problem with putting someone in power who has a nasty blind spot. Sarah told me Lavinia has never let an overweight resident into the program. As though weight had anything to do with capability."
“Actually,” he said, regarding me with his head cocked to one side, “you'd be the best person to talk to her. People who don't get into the program—well, who's to say whether it was because of their weight or because of a personality conflict or their evaluations? With you, it's obvious what's going on. Everyone in the department has probably recognized it."
“Oh, great. Just the kind of notoriety I've always craved."
Jack patted the seat beside him on the sofa. “Come sit here, Mandy. It will be all right."
I knew it wouldn't; he probably knew it wouldn't. But the intoxication of the delivery and the desire for some reassurance after Hager's attempt to embarrass me moved me to the sofa. We were, after all, in the main room of a large and well-populated building. Obviously nothing really important was going to happen. Not here, at any rate.
It was a long sofa, with comfortable fluffy back pillows and firmer seat cushions that supported you. I sat a foot or so away from Jack, but he inched over until his hip and shoulder were pressing against me. He took one of my hands and twined his fingers through mine. And we sat there looking at each other in a way that reminded me of dancing together at Oconomowoc.
When he cleared his throat, I raised my brows inquiringly. “Have you given any thought to what we talked about at the lake?” he asked.
“A lot, but I never get past a certain point."
“What point is that?"
“Where I can see that Nigel and I haven't had much of a relationship for a long time."
He frowned. “Then why haven't you done something about it?"
This was tricky. I shifted slightly away from him. “For a couple of reasons. I thought it was best for Cass that we were both there for her."
“She's twenty, Mandy. Almost on her own.” He glanced at our twined hands, then looked across at me. “So it's more than that. On the phone you told Nigel you loved him."
“Well, I do,” I admitted uneasily. “I just don't know how I love him anymore. A long time ago ... Well, that's sort of personal."
“It was pretty personal my telling you Karen and I slept together after we were separated. Help me understand your situation, Mandy."
Though I attempted to withdraw my hand from his, he kept a good grip on it and I smiled ruefully. “I'm not used to revealing stuff like this, Jack. It's hard for me."
“Oh, really?” he said, laying on the sarcasm. “I do it all the time. I stop strangers on the street and beg them to listen to my story."
“All right, so it's not what you regularly do, either. But I've never told anyone some of this stuff, even my best friends."
The line of Jack's mouth softened. “So I'd be the first person you told. Wouldn't that be okay?"
My cheeks flushed unexpectedly. “But it's like a betrayal, Jack. Nigel would hate it if he knew I'd said anything."
“But it's your life, too, and I'm not going to understand unless you tell me. There's something odd about your situation, or you wouldn't be considering having an affair with me."
Suddenly I was very hungry. “I haven't had dinner yet, Jack."
He shook his head in mock despair. “We'll go back and raid the kitchen. Sherri put something aside for you. Meatloaf, probably. You could make a sandwich."
He followed me back through the TV room, the dining room and into the kitchen. No one was around. Sherri had obviously finished cleaning up because the counter tiles were clean and only a wall lamp was on to give a warm glow to the room.
Cobalt blue tile and polished wood graced the room, with fabric touches here and there—the lamp shade, the seats of two kitchen chairs, a window covering. And over the cooktop a sparkling copper exhaust tube, with copper pans hanging from a cast iron rack. Cliff's sister, who was apparently responsible, was obviously talented at this interior decorating business.
Jack pulled up a chair and sat down backwards on it, motioning with his chin to the bread box. “We had a sourdough bread with dinner that would make a great sandwich."
God, I thought you had to go to San Francisco for real sourdough, but Sherri had either found or made a tangy round loaf. While I sliced bread, searched out the meatloaf and mayonnaise, and poured myself a glass of fruit juice, Jack filled me in on the other boarders’ dinner conversation. “Sophia is teaching reading to an illiterate adult. She's delighted that she thought of doing it."
“Humph,” I said. “I remember suggesting that to her practically the first day I got here."
“Crissy and Mark are arguing about the least expensive place to spend the summer."
“Are they going to do it together?” I asked, curious.
“It's hard to tell. They can't stop sniping at each other, but they also seem to rely on one another."
The paper napkins were in a blue plastic box that matched the counter, and the dinner plates on a nearby open shelf. I helped myself and sat down at the small oak table across from Jack. While he speculated on our Australian co-guests, I bit into my sandwich. Actually, I was even hungrier than I'd thought and pretty well worked my way through it before I made any comment on his tales.
“Have you seen any of his work?” I asked, referring to the sculptor, Rob Sharpe, who lived in the unit next to mine.
“Oh, yes. Before you came he had all of us to his studio to see his sculptures. He works with woods and does female figures. Usually nude but very artistic. Sophia was shocked."
“Naturally.” I prowled around looking for something to finish off my meal. The coconut cookies in the jar were not one of my favorite kinds. There was fruit on the counter and more in the fridge, but that didn't appeal to me. “I want something sweet."
If I'd been paying attention, I would have noticed that Jack had gotten up from his chair, but my back was to him. I felt his hands on my shoulders, turning me around. The look in his eyes made me swallow hard. Astonishing how quickly one's body can respond to that kind of message. He wrapped his arms around me and bent his head to kiss my lips in the sweetest, most provocative way.
After a long time, we drew apart for air and I said, “So I've decided on a different dessert. A woman is allowed to change her mind."
He shook his head. “We still have to talk this through, Mandy. I just wanted to remind you that we have a good reason for sorting it out."
“Then I'll have dessert,” I whined, rubbing my forehead briskly to dispel the haze. “A bowl of ice cream."
“Why not bring a piece of fruit and we'll talk in the garden?"
“Fruit is healthy. I don't want anything healthy,” I complained as I picked up an apple and followed him out the back door.
There wasn't a lot of light left in the sky, but it was warm enough to sit on the wooden bench where I'd first run into him. It occurred to me that he didn't look as depressed anymore. “The Prozac is working, isn't it?"
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