Saving Jane Doe

by Carolyn Purcell

  “What do we need to do about it?”

  “We just watch it. I want to repeat a pelvic exam on each visit until it has gone away. You need to be seen once a month,” I said to Ellen. “Usually I only do this whole exam the first time.”

  “Is there anything we need to watch for?” Jessie asked.

  “The cyst can rupture, and that can cause some pain. Let me know if you get any sharp pain on your right side.” Ellen’s eyes got wide and she twisted the tail of her sweater. “Don’t worry, Ellen. Even if that happens, it’s usually only painful for a few hours and then you are fine.” She relaxed a little but still looked fearful.

  “Don’t worry, honey. You’ll be all right,” Jessie said, reassured by my comments.

  “Jessie, Ellen mentioned that some of her friends said she should have an abortion. Did you discuss that possibility last night?”

  “Yes. We did. I told her I was absolutely opposed to it, and I knew her father would be, but I assured her that I will be there for her whatever she decides. In the end, it is her decision.”

  “He wouldn’t even have to know,” Ellen said. Jessie looked at me. I knew she was thinking how wrong she had been in thinking the same thing years before.

  “He might find out; besides, that’s not the point. You are the one who will have to live with the decision and the consequences. Guilt and grief will be lifelong burdens that will get heavier as time goes on.” Jessie spoke with a voice of experience and sadness that took us both back a few years.

  “Ellen?” I waited for her response.

  “When do I have to decide?”

  “With modern techniques, it is relatively safe within the first ten weeks. After that the risks increase. You should decide within the month. I want to go over what you can expect during pregnancy and how you should take care of yourself. Before I do, do you have any questions?”

  “Will my baby die like Mama’s did?”

  “Ellen, you were young,” Jessie said. “I didn’t realize you worried about that.”

  “It was terrible, Mama. It affected all of us.”

  “I’m so sorry, honey. I was so wrapped up in my own grief I didn’t see what it was doing to you.”

  “I’d rather be aborted than have that happen to me.” Jessie was silenced by that comment.

  “No, Ellen, you don’t have to worry about that,” I said. “The problem with your mother’s blood type that caused her stillborn babies doesn’t happen to Rh-positive women, and we know you are Rh-positive. There are risks though, especially since you are so young, but most of them are related to how well you take care of yourself, so let’s go over that.”

  That evening, after Ellen and Grace had gone to their rooms, Jessie said, “How about a drink?”

  “That bad is it?” We didn’t drink much. “Do we even have anything here?”

  “There’s a bottle of wine.”

  “Let’s open it.” As Jessie got the wine and glasses, I got the corkscrew. “When you and Ellen talked, did you tell her about your abortion? After her comment today about the stillborn babies, I wondered.”

  “No. George was adamant that I not tell the children why I was sick and didn’t come home, so I didn’t tell her, but I was stunned today when she said what she did. I had no idea she was so affected by those stillbirths.”

  “It sounds like she might have been more forgiving of you leaving if she had known the whole truth.”

  “Perhaps. Maybe I will tell her sometime. You know, Cara, if I don’t tell them the truth, I can’t really expect them to forgive me, and I need them to forgive me.”

  When Ellen got up Saturday morning, she seemed more mature. She had dressed, combed her hair, and put on boots while the rest of us sat around in our bathrobes.

  “I’m going for a walk,” she announced. “My doctor”—she smiled at me—“says I need to stay active with exercise, like walking, bicycling, or swimming. Sure can’t swim in this weather.”

  “I also said you should have regular meals. Don’t you want to have breakfast first?”

  “No, I’ll eat as soon as I come back. I won’t be long. I have to work up to long walks.”

  “It sounds like she may have made a decision,” Jessie said as the door closed.

  When Ellen returned, over a poached egg and whole wheat toast she informed us that she wanted to have her baby. The mood lightened as if someone had pumped helium into the air. Jessie hugged her and Grace jumped up and down. “I’m going to be an aunt!”

  When the excitement settled a bit, Jessie said, “Ellen, what exactly did Mark say when you told him you thought you were pregnant?”

  “He said if I was, it wasn’t his.”

  “Is that possible?”

  “No, of course not. Mark is the only one ever. Why do you ask?”

  “Ellen, I know your father. He’s going to want to make Mark marry you. I was just trying to see what Mark might say about that.”

  “He said it isn’t even his. I doubt he’ll want to marry me.”

  “I think you’re right. The question for me is do you want to marry him?”

  “I did, but now I don’t know. I thought he loved me, but if he did he wouldn’t say it wasn’t his baby. I don’t want to marry someone who doesn’t love me.”

  “And I don’t want you to either. Cara, how long will it be before Ellen’s pregnancy shows?”

  “The average for a first pregnancy is about sixteen weeks, but it’s sooner in short women and sometimes later in tall ones. With Ellen’s height it might be eighteen or twenty weeks, especially if she is careful about weight gain.”

  “That would be the end of May or the middle of June. Ellen, you could finish this year of school.”

  “But I don’t want to go back to school.”

  “Well, you don’t get everything you want. If you are going to be a single mother, you need to finish school. You’ve already done six weeks of this semester, and it would be crazy to waste it.”

  “Can’t I go to school here?”

  “It’s better if you stay where you are. You don’t have to discuss the pregnancy with anyone. When school is out, you can tell your father you want to spend the summer with me.”

  “Are you going to tell him I’m pregnant?”

  “No, I am going to leave that to you.”

  “I want to wait until it shows. If everyone can see, maybe he won’t try to make me marry Mark.”

  “That’s up to you. I just have one request. Don’t lie to him. If he asks you, you tell him the truth.”

  Ten days later, just as Jessie and Grace got home from choir practice, Ellen called in a panic.

  “Ellen says she has some bleeding,” Jessie said to me as she held the phone.

  “Ask her if it is as heavy as a period.”

  “She says no.”

  “Does she have pain?”

  Jessie shook her head. “No.”

  “Tell her there is nothing we would do at this point. She should rest as much as she can and call if she has heavier bleeding or pain. I’ll check her when she comes this weekend.”

  Jessie picked up Ellen early that Friday and brought her to the clinic. At this point the bleeding had stopped and there was still no pain. Ellen’s exam was normal except for the cyst, which was much smaller.

  “I think everything is fine, Ellen. The cyst is nearly gone. As a matter of fact, the cyst dissolving may be the reason for the bleeding. Sometimes there is a drop in the level of the hormone your body makes to maintain the pregnancy when the hormone production changes from the cyst to the placenta. It happens at about eight weeks, so that may be what happened. Anyway, everything looks good now. Let’s not worry.”

  “I was afraid for me, but I kind of hoped I might lose the baby,” she confessed. The sentiment did not surprise me so much, but Ellen’s being so straightforward about it did. “I’m going to be a terrible mother.”

  Jessie put her arm around Ellen’s shoulder. “It’s not surprising you feel that way now
, Ellen. Right now the baby is an interruption in your life. Give it some time. Soon it will become your baby and not your pregnancy. That makes a difference. Having had that thought doesn’t mean you will be a terrible mother.”

  I didn’t worry until a month later when Ellen bled again. The uterus had grown appropriately and there was no dilation of the cervix. I could hear the baby’s heartbeat and let Ellen and Jessie hear it as well. That reassured all of us, and it went a long way toward making this Ellen’s baby and not just her pregnancy.

  I am a terrible liar. If I think it, whatever it is, the idea arranges itself on my face, like an artist putting a painting on a canvas. When Ellen bled again at sixteen weeks, this time a large amount, I was very worried and both Ellen and Jessie could see it.

  “What’s wrong?” Jessie asked.

  “I’m not sure,” I confessed. “In the absence of pain, the most likely thing is a low-lying placenta.”

  “What does that mean?” Ellen asked.

  “It means that the afterbirth has attached to the uterus down close to the cervix, perhaps in front of the baby. I think we need to get an ultrasound to be sure.”

  Fortunately, we got the ultrasound that afternoon. In those days, ultrasound did not show anything like the detail we have now, but it was still amazing for Ellen to see the baby moving and the heart beating. She was as excited as I was worried. The placenta was indeed lying in front of the baby’s head. It was slightly off to the left side, giving me some hope that as the uterus enlarged, the placenta would grow up the side of the head. Still, this was the most central placenta praevia that I had ever seen.

  “Ellen, this does show a placenta praevia. That means the afterbirth is lying between the baby and the cervix.”

  “What does that mean?”

  “It means that you will probably have more bleeding. It means that we will not be doing any more pelvic exams. It means that you must not put anything in the vagina, like tampons, if you bleed. It means that you must not have sex. It means that you may have to have a period of bed rest toward the end of the pregnancy; you may need to have blood transfusions; you may have to be delivered early, and you may need to have a Caesarean section for delivery.”

  “Will my baby be all right?”

  “Yes, I think so. The baby’s biggest risk would be early delivery.” I didn’t tell her that the greater risk was for her life.

  “What should I do about PE class? I was jumping on the trampoline in class when I bled this time.”

  “You should avoid strenuous activity. I will give you a written excuse.”

  “I only have two more weeks. I’ll be glad when this school year is over.”

  “So will I.” I wanted Ellen close to the hospital.

  CHAPTER 7

  That spring was crazy busy. I was due to finish my residency at the end of June and had decided to stay in Lexington in private practice at Good Samaritan Hospital. A new doctors’ office building had been built right across the street from the hospital. Space was available for lease. Since it was in walking distance of the hospital, the location was perfect.

  The space was fourteen hundred square feet, with no internal partitions and bare concrete floors. I found a contractor who would build the office from plans I drew myself. I had read that all exam rooms need to be identical to improve your efficiency. The contractor didn’t want to do it that way because he wanted to back up the plumbing, but I stood my ground. Fortunately, Uncle Henry’s money made it easier to stick to my wishes. I had a friend who was an interior decorator and just starting her new business, so she helped with the décor. I was especially grateful for Uncle Henry’s money because, had I needed to borrow the money to build the office, interest rates would have been twenty-one percent.

  Busy as I was, I still never missed a finance class. Not only was I learning a lot, but I was having fun—until one week before final exams. As the class waited for our teacher, a stranger came into the room and announced that he would be finishing our class. Our teacher had some sort of medical emergency and would be gone the rest of the semester. After class, we asked for more information. All we were told was that it concerned a disease related to exposure to Agent Orange in Vietnam. When I called Jon’s office the next day, I found that he had not only left the university, he had left the city.

  Also, thanks to Uncle Henry’s money, Jessie was able to take a leave from her job at the end of May. She had spent all her free time that spring learning how to homeschool Ellen. She figured that if she could homeschool through the summer, then Ellen could have the fall semester off when the baby was born. At that point, they could either homeschool the second semester or enroll Ellen in school in Lexington. In either case, Ellen wouldn’t get behind in school.

  Now that I knew I would be staying in Lexington, I began looking for a house to buy. Ellen would be moving to Jessie’s and would soon add a baby to the household. I knew I would be in and out of the house at all hours—it would disturb everybody. Having a roommate was good for the time of grieving after Uncle Henry died, but I was ready for a place of my own. After about a month of looking, I found a lovely old house on Ashland Avenue. The backyard had shade trees but also one sunny spot for a garden. The house needed a lot of work, but now that I had found the contractor who was doing my office, I was undaunted by that.

  I made an offer for less than the asking price, and after some haggling—probably because of a large deposit and a cash payment—the offer was accepted. I used the same decorator and contractor to get my home ready for me to move. They estimated it would take three or four months. I set a goal to be in my home by Thanksgiving.

  Ellen came to live with Jessie on May 30, 1977. It was Memorial Day and graduation day for Mason County High School, Jeff’s graduation day. Jessie did not get an invitation or reserved seats with the family, but Grace told her when the graduation would take place. She arranged to leave Grace for the summer and pick up Ellen on that Monday so she could be there for graduation. It was some comfort for Jessie that both Grace and Ellen chose to sit in the back of the gymnasium with her rather than in the family’s reserved seats, but Jeff remained aloof. He did accept the gift she brought—a leather briefcase with MGJ, his monogram, on it—but he refused to open it in her presence, depriving her of a chance to see his reaction.

  Through Grace Jessie had learned that Jeff wanted to attend the University of Louisville to study accounting. He made it very clear that he did not want to be in Lexington. U of L was more expensive than UK, and Jeff had been denied a scholarship. Jessie offered to pay his tuition but he refused, telling her that he did not want anything from her. George was not so uncompromising. He accepted the money from Jessie, and Jeff did not know how his father had come up with the funds for him to attend the school of his choice.

  With Jessie’s attention to Ellen’s homework every other weekend and with the decrease in Ellen’s social life that accompanied her pregnancy, her grades improved. She got a 3.2 GPA that semester before she came to live with Jessie, the best she had ever done in high school. However, the best thing about Ellen’s education was Jessie’s homeschooling, which started the first week in June. After reviewing required subjects and discussing with Ellen what she wanted as electives, they decided on five subjects: English, driver’s education, Kentucky history, home economics, and band. She arranged the driver’s education through a local driving school, scheduled Ellen for private clarinet lessons, and had her audition for the youth orchestra. The English, history, and home economics she taught herself.

  Jessie may have made a mistake being a nurse instead of a teacher, because she had a gift for making the subjects come alive. For instance, in home economics she taught Ellen how to sew by having her make maternity clothes. At first Ellen objected to the idea of wearing homemade clothes, but Jessie convinced her that they would not look homemade when they finished. They bought patterns for maternity tops, skirts, and slacks, and Jessie taught Ellen the basic steps required to make the garments.
Then she taught Ellen how she worked her magic. They added buttons, bows, appliqués, and top-stitching. In the end, Ellen was the best-dressed pregnant teenager in Lexington. They made baby clothes too. Jessie even taught Ellen how to make curtains and a matching skirt for the crib in the baby’s room.

  Sewing was only part of Ellen’s home economics class. Jessie had her take the diet sheet I had given her for healthy eating during the second half of pregnancy and plan her own meals. She took her shopping and taught her how to cook. We all ate healthier. I even lost the extra five pounds I had gained. Jessie gave Ellen an allowance and taught her the basics of budgeting.

  Home economics was not Jessie’s only inspired class. She made Kentucky history come alive as well. She had researched possible textbooks, finding one that was readable. She set up a schedule that would have Ellen finished with the reading by mid-September, but the field trips were the best part. I even enjoyed some of them. We went to Blue Licks Park and visited the site of the last battle of the American Revolution, which Ellen learned took place in Kentucky.

  Jessie researched where Civil War reenactments were done, and one weekend we went to Perryville to learn about the Civil War battle that took place there. Jessie took Ellen to Cheapside, site of the slave market in Lexington. She even got Grace in on some of the history lessons. Grace spent the summer with her father, but she did come to Jessie every other weekend. Jessie had Ellen and Grace decide which side they would take in the Civil War. They were not allowed to choose the same side. Jessie wanted to make them understand what it was like for families to be divided by that struggle, emphasizing Kentucky’s unique position as a border state.

  As part of history and English, Jessie introduced Ellen to the Lexington Public Library and the reference department there. She taught Ellen how to find original newspaper reports of events that she read about in the history book. She had Ellen write a paper supporting her choice of sides in the war. Grace wrote one too, just for fun.

  I finished my residency at the end of June and started to work in my new office on July 1. My schedule was full from the very beginning, probably because I was the only female OB/GYN physician in private practice in the city. It bugged me that women wanted to see me because I was female. I wanted them to see me because I was a good doctor, but that remained to be seen. Since the few private patients I had attended as a resident were not due to deliver until later in the fall, my evenings were usually free. I did have a coverage arrangement with another doctor so that I had to be on call some weekends for his patients who were due. Still, it was a nice break from the grueling schedule of residency and allowed me to share some field trips with Jessie and Ellen.