Saving Jane Doe

by Carolyn Purcell

  When Ellen came to live with Jessie at the end of May, George expected that she would come home to visit him every other weekend. When she refused, he was not as accepting as Jessie had been. Still, Ellen refused to go home. Jessie suspected that Ellen had not told George about the pregnancy, but she stayed out of it. The healing that was taking place in her relationship with her daughter was visible. While neither of them had been thrilled about the pregnancy in the beginning, both Ellen and Jessie had moved on to focus on the coming baby, and they found joy in that. Jessie did not want to risk the fragile rapport she had with Ellen by insisting she tell George about the baby. Ellen would have to deal with that on her own.

  One very hot Friday evening in mid-July, George came unexpectedly to get Ellen for a visit. Ellen still had no intention of spending the weekend with him. A nice breeze cooled the back porch, where we all relaxed after dinner and watched Ellen model the latest outfit she had made. It was a pair of khaki culottes with a darker brown top. Ellen had designed this one totally on her own, and Jessie was proud of the result. Ellen had taken the same brown fabric as the rest of the top and made a large pocket right in the middle. Then she had used several different fabrics to make a head, body, ears, and eyes of a baby kangaroo, which she had appliquéd just behind and coming out of the pocket.

  Jessie and Ellen were gently swinging in the old-fashioned porch swing, and I sat at the table playing solitaire when George walked around the corner of the house. We had not heard him knock at the front and were surprised to see him; still, we weren’t nearly as surprised as he was when he saw Ellen. The look on his face left no doubt that Jessie’s suspicion had been right. He went red. I was afraid he was going to strike either Jessie or Ellen, but he controlled himself with clenched fists and teeth. He was furious with both of them, perhaps even more with Jessie than with Ellen.

  “Did you not think her father should know about this?” he said to Jessie.

  “Yes, I thought you should.”

  “Then why didn’t you tell me?”

  “I thought it was her place to tell you. Besides, we don’t talk much.”

  “Who’s the father?” he asked as he glared at Ellen, still clenching and unclenching his fists.

  “Mark Jones.”

  “I’ll make him marry you.”

  “She doesn’t want to marry him.” Jessie rose as though to make a buffer between George and Ellen.

  “I don’t care what she wants. No daughter of mine is going to have a baby out of wedlock. Does he know you’re pregnant?” he said to Ellen.

  “I told him I thought I was, and he said it wasn’t his. It is, but I don’t know how I can prove it. If he loved me, I wouldn’t have to. I didn’t tell anyone after I knew for sure.” Ellen’s voice had a note of maturity that I had not heard before.

  “He will marry you.”

  “It’s not like Ellen is the first single girl to have a baby,” Jessie said.

  “Well, the others aren’t my daughter. This is your fault.”

  “My fault?”

  “Yes, this would not have happened if you had been a decent mother to her.”

  “I tried to put her on birth control pills.”

  “And you gave her permission to whore around.” Jessie gasped and bent in the middle, like she had taken a belly punch. She stared at George, speechless. George, ignoring Jessie, turned on Ellen.

  “If you don’t marry that boy, then you will not be welcome in my house.”

  “I am not going to marry him.”

  “Don’t come knocking on my door when you need help.”

  “Don’t worry. I won’t.” Ellen screamed at her father’s back as he rounded the corner of the house.

  On Friday morning, July 24, I saw Ellen for a prenatal checkup. I was thrilled that her urinalysis and blood pressure were normal. Her weight gain and the baby’s growth were good. She was twenty-six weeks at that point.

  “Everything looks good, Ellen. I’m relieved that you’ve had no further bleeding. Still, I want you to continue your precautions. We’ll do another ultrasound when you get closer to delivery.”

  That afternoon, Jessie drove to Washington to pick up Grace for the weekend, leaving Ellen at home. She had planned a field trip for Saturday. The four of us went back to Frankfort; this time we were there to tour the capitol and visit the old governor’s mansion. We couldn’t help but remember the inaugural parade as we crossed the bridge leading to the capitol. Ellen laughed about it, and it was good to see her laugh. We did a lot of walking that day, and Ellen seemed a little tired by early afternoon, so we decided to call it a day. We were in the car, almost back to Lexington, when Ellen said, “I think my water just broke.” Grace was in the backseat with Ellen as Jessie drove.

  “It’s too early for that,” I said. “Are you having any pain?”

  “No.”

  It was Grace who noticed that it was not fluid. She gasped as she stared and pointed at Ellen’s blood-soaked pants.

  “Jessie, go to the hospital, quickly!” I said. This time there was a lot of blood.

  Jessie ran a stop sign right in front of a policeman. When he put on his light, we screamed out the window that we were going to Good Samaritan Hospital, waved for him to follow, and kept going. With gratitude and relief, we watched as he pulled around and kept his light and siren on leading the way. Grace and Ellen were both sobbing in the back and the policeman didn’t relieve their distress, but he did relieve mine and Jessie’s as she flew through stoplights.

  As soon as we got to the emergency room, I ran in, had an orderly take a stretcher for Ellen, and told the clerk to admit her directly to Labor & Delivery. I called the lab to order a stat complete blood count and type and crossmatch for four units of blood. When they came in with Ellen, I went with her to L&D while Jessie and Grace parked the car. I had already learned that you should only give a patient two fingers to squeeze when they need to hold your hand, but I guess it was a measure of my own distress that I gave Ellen my whole hand to hold as we flew down the hall. By the time we reached L&D my hand was numb. This was typical placenta praevia bleeding, extremely heavy and painless. Ellen was terrified. So was I.

  The Labor & Delivery suite was a third-floor wing of the 1954 building. A waiting room was the first door on the left before double doors opened into a wide hallway. On the left were three labor rooms and a small delivery/operating room at the back. On the right a little used labor room was first, followed by the nurses’ station and two delivery rooms. We took Ellen to the second labor room on the left, directly across the hall from the nurses’ station. It was the place most easily observed by nurses and doctors alike. The operating room, a few feet down the hall, was made ready in case we couldn’t keep up with Ellen’s blood loss. I noted with relief that no one was there in labor. It would be quieter and the nurses would have more time for Ellen.

  Ellen undressed and put on a hospital gown. By the time she got into bed, the lab technician came to draw her blood. When he finished and while the nurse checked Ellen’s vital signs, I started a sixteen gauge IV, apologizing as I did it. “I’m sorry, Ellen, this is going to hurt, but you need a big IV for a blood transfusion.”

  Her face looked pale. “Do you think I’ll need a blood transfusion?”

  “Yes, I’m almost certain of it. The test she just drew will be a baseline. We will repeat it in about an hour to see how much blood you are losing. Sometimes it seems like more than it really is.” I did not even believe that myself, though it was true.

  Ellen’s blood pressure was low, and her heart rate was faster than her usual. I wasn’t sure if it was because she had lost a lot of blood or because she was frightened. Perhaps both. Donna Lane, the L&D nurse, let Ellen listen to the baby’s strong, normal heartbeat, and that seemed to calm her a bit. Still, every ten minutes, when Donna checked and had to change another blood-soaked pad, Ellen’s eyes widened and she clenched the sheets even harder.

  Jessie and Grace had waited for me in the doct
ors’ lounge before, so I expected they would be there. It was located up the hall from the L&D suite, across from the nursery. As soon as Ellen was settled in the bed, her IV started, and my orders written, I went to tell Jessie she could come in with Ellen. I found them in the lounge, but Jessie was not in a position to go to Ellen. She held Grace in her arms as the child sobbed, saying over and over “Ellen’s going to die. Ellen’s going to die.” Jessie’s face was as white as Ellen’s, and her eyes were wide as saucers. She said nothing and looked as though she believed Grace was right.

  “No, Grace,” I said. “We are not going to let that happen. This bleeding usually stops on its own when you get off your feet.”

  “What if it doesn’t? She was bleeding so much.”

  “If it doesn’t then we have to deliver the baby, but we really don’t want to do that yet.”

  “It’s too little, isn’t it?”

  “Yes.” That brought on a new wave of sobs. “Jessie, I can stay with Grace for a few minutes if you want to see Ellen. Then you might want to take her home. Maybe Mrs. Applegate could stay with her if you want to come back. I need to stay here.” Mrs. Applegate was Grace’s Sunday school teacher, a retired schoolteacher who lived up the street from us.

  “That’s a good idea. I’ll call her when we get home.”

  “Turn left at the end of the hall, knock on the double doors, and tell the nurse you want to see Ellen,” I said as Jessie left the room.

  In one hour when Ellen’s blood count was rechecked, it showed her hemoglobin level had dropped one gram from her baseline level on admission, suggesting she had lost a unit of blood. Donna checked the bleeding and found it had not slowed.

  “It’s time to transfuse her,” I said. “Let’s hang the first unit. We don’t want to get too far behind this bleeding.”

  After the transfusion was started, Ellen started to shiver. “I’m cold,” she said. Donna covered her with two warm blankets.

  “That’s not surprising,” I said. Transfused blood comes straight from the refrigerator. “We’ll put a warmer on it. I need you to let me know if you feel anything else unusual while you are getting the blood.”

  When Jessie returned, Ellen’s lip trembled and she cried as her mother held her. She quickly got herself together and seized on the one reassuring thing. “The baby’s heartbeat sounds normal.”

  “That’s good, baby,” Jessie said. “I hoped we could avoid that.” She pointed to the blood as it dripped into Ellen’s arm. She knew the risks of blood transfusion as well as I did.

  “Unfortunately, I suspect this is the first of many, if we hold off delivering this baby.”

  “Are you thinking of delivering her?”

  “I’ve decided to give her eight hours for the bleeding to slow. At that point I’ll have to consider it. I’ll be right here at the desk if you need me.”

  As I sat at the desk, dictating my admission note and writing orders, I heard Donna talking with Jessie and Ellen. She had a wonderful way of relieving fear and tension.

  “That was a really cute maternity top you were wearing when you came in, darlin’,” she said to Ellen. “My daughter is pregnant, and I think she would love that. Where did you get it?”

  Ellen had been wearing the kangaroo baby top. “I made it.” She grinned at Jessie.

  “Surely not,” Donna said, obviously surprised. “Why, it’s adorable. Did you have a pattern?”

  “Only for the basic top. I designed the pocket and the baby kangaroo from a photo I saw in the encyclopedia.”

  “That’s amazing. You could sell those.”

  “I hope it isn’t ruined with blood.”

  “I’ll just go soak the bloody part of your clothes in ice water. That’ll do the trick. We’re used to getting blood out of things here.”

  When Donna left the room, Ellen said, “Mama, you said no one would know my clothes were homemade.”

  Ellen bled very heavily for six more hours while Jessie and I sat by her bed, frowning every time Donna changed a blood-soaked pad. Periodically, Jessie went to the lounge and called to check on Grace and let her know how Ellen was doing. At seven o’clock, Donna came in to say that she had asked the cafeteria to send up dinner for Jessie and me. It was in the doctors’ lounge. Ellen wasn’t allowed to eat until we were sure she would not have to be delivered. Jessie said she wasn’t hungry, but Donna insisted she needed to keep up her strength. She didn’t have to ask me twice.

  “You look worried, Cara,” Jessie said when we got to the lounge.

  “I am, Jessie. I hate to give her so much blood, but the baby won’t make it if I have to deliver her now.”

  “I know.”

  We had just finished eating when Donna called the lounge. “You might want to come and see this.”

  We hurried back to the labor room where Donna stood holding a half-soaked pad. “It’s slowing down.”

  Ellen grinned. “Don’t squeeze me too hard,” she said as Jessie hugged her.

  With the bleeding stopped completely after twenty-four hours, I felt it was safe enough to move Ellen for another ultrasound. Ultrasound machines were much bigger and less portable in those days. Jessie went along to watch. She had seen ultrasounds at her work, but this was her grandbaby.

  “What does it show?” Ellen wanted to know.

  The radiologist told her. “The placenta is centered over the cervix in front of the baby’s head. That’s why you bled. The baby’s measurements are consistent with twenty-six weeks. It looks like it is developing normally.”

  “Is it a girl or a boy?”

  “I don’t see external parts, so that suggests a girl, but I could just be missing it.”

  Ellen smiled. “I’d like a girl.”

  “This is a bad one,” the radiologist observed out of Ellen’s hearing. “I’ve seen a lot of praevias, but never one as central as this.”

  “I haven’t seen one as central as this either. I hope as the uterus grows, this placenta moves a little bit toward the back.”

  “Why’s that?”

  “If it doesn’t, even a C-section will be difficult.”

  “I don’t envy you taking care of this.”

  “What a way to begin my practice, huh?”

  On Sunday evening, Grace called the hospital. Her father had phoned wanting to know why Jessie hadn’t brought her home after the weekend visit.

  “I completely forgot that I needed to take Grace to George’s,” Jessie said as she hung up the phone in Ellen’s room. “He wants me to call him.”

  “Please, don’t tell him I’m in the hospital,” Ellen said.

  “I have to, Ellen. I have to explain why I didn’t take Grace, and besides, he’s your father and he loves you.”

  “He didn’t act like it this summer.”

  Not having a response for that, Jessie stood and kissed Ellen on the cheek. “I need to go call him.”

  Jessie called George and explained what had happened. When he didn’t offer to come to visit Ellen and get Grace, Jessie agreed to take Grace on Monday while Ellen was still in the hospital.

  When Jessie got back from George’s on Monday, she came straight to the hospital. Neither she nor Ellen discussed the fact that her father had not come to see her. If Ellen was disappointed, she didn’t show it. Jessie, on the other hand, wore a thoughtful frown, closed doors a bit harder than necessary, and avoided eye contact with Ellen. She didn’t want to increase Ellen’s unhappiness by showing her irritation with George.

  “There’s no question that you will bleed again,” I said as I discussed the ultrasound with Ellen and Jessie on Monday evening. “As you get further along in the pregnancy, the changes that take place in the cervix make it inevitable. Even complete bed rest will not prevent it, but rest will help you bleed less. The question is, do we do the bed rest in the hospital or let you do it at home?”

  “I’d rather be at home,” Ellen said, even as Jessie blurted, “I think she should stay in the hospital.” They both laughed uncomf
ortably, and Ellen looked at me. “What do you think?”

  “I think since you live here in town and since your mom is not working and can stay with you all the time, we can try letting you go home. Jessie, you will need to do your errands when I can be at the house. Someone who can drive Ellen to the hospital must be immediately available at all times. No more out-of-town trips.”

  George refused to bring Grace back two weeks later. At that point it was almost time for Grace to begin school, so Jessie had to pick her up. Grace liked her school in Lexington and had no intention of living with her father all the time. I stayed with Ellen, who made it through another week before she bled again.

  Solo private practice was very different from residency. In residency we shared call and the workload. In solo practice both the call and the work were all mine. Unless I left town or made special arrangements, I was on call all the time. I made two rules for myself. One was for the office and one was for my life outside the office. The office rule was that I could not sleep at night until the paperwork was done, the phone messages all checked, and phone calls made. Even if I had to leave for a delivery or a meeting, I had to go back to the office if I hadn’t finished. That rule kept me from having things hanging over my head that I didn’t like to do. It protected me from my tendency to procrastinate.

  The life rule protected my patients. No matter what celebration, birthday, wedding, Super Bowl party, Derby party, or whatever else came along, I could only have one drink. I never broke it, and there were plenty of times I was thankful for it. One was the next time Ellen bled.