Saving Jane Doe

by Carolyn Purcell

  I had a rare date to a football game with a friend from residency, Tom Porter. We tailgated before and after the party at the med school alumni tent. I had a beer with food before the game. After the game, beer flowed freely but I declined, remembering my new rule for life. About thirty minutes later, the ER paged me. Ellen was there.

  When I called the ER, I gave them orders to admit Ellen directly to Labor Hall. Then I asked the nurse to transfer me to Labor & Delivery. I didn’t have another quarter, and this was long before cell phones. I gave orders to draw a complete blood count, crossmatch more blood, and start an IV. Then I asked Tom to take me to the hospital. Jessie could take me home from there.

  When I got to the hospital, I was disappointed to find Ellen in the third labor room and four patients laboring in the other two. It was noisy, but Ellen and Jessie seemed calmer this time. They had been through it before and Ellen was not bleeding quite as heavily, probably because she hadn’t been walking all day. They had her IV going by the time I got there, and the fetal monitor showed the baby was fine. During the next six hours, Ellen, Jessie, and I listened as the laboring patients began to push and were rolled into the delivery room.

  After three hours, Ellen’s bleeding seemed to decrease. I was optimistic until a laboring patient had to be admitted into the second bed in Ellen’s room. She was in hard labor, terrified and out of control. She screamed with every contraction and cursed her husband in between contractions. The curtain between their beds failed to prevent a visible effect on Ellen who turned away, pulled her knees up, and assumed a fetal position. In a small voice she asked, “Is that how it’s going to be?”

  “No, it’s not going to be that way for you, and it isn’t that way for most women. Some Lamaze classes would have helped her know what to expect and how to deal with it. Part of her problem is that she’s afraid the pain is going to get worse or that the contraction isn’t going to go away. The pains last about forty-five seconds and then you have a couple of minutes to rest.”

  “I haven’t been able to go to my classes because of this bleeding.”

  “I know, but you don’t need to. Because of this bleeding, you won’t go into labor. You will have a C-section long before that.” I was surprised that the thought of a C-section could be so comforting, but Ellen smiled and Jessie sighed with relief.

  That time Ellen did not bleed quite as long or as heavily, requiring only two units of blood. She stayed in the hospital about three days and then begged to go home again. The baby had grown well, but it was still premature enough to have a very difficult time in the nursery. I let her go. I overheard one of my colleagues say he thought I should have delivered Ellen. They were the experienced ones, so I doubted myself. I didn’t know at the time that none of them had ever dealt with a central placenta praevia or that I never would again.

  On Sunday morning, two weeks after Ellen’s last bleed, Grace’s youth choir sang at church. Jessie wanted to hear her and do a video recording with her new video camera. I made rounds before church so I could be home with Ellen. I had nobody due to deliver, but I was on call for another doctor that weekend. He had no one in labor, so I thought it would be safe. Jessie planned to be gone only about an hour and a half.

  She had been gone twenty minutes when I got a call from the hospital. A patient, pregnant with her second baby, had come into the hospital, completely dilated on admission. I needed to go immediately. I checked to see that Ellen was not bleeding and left the number for the ambulance by the phone. I told her to call the ambulance if she saw one drop of blood, and I left the door unlocked so they could get in and she could stay in bed. I had no choice but to go. When I came out of the delivery room, where this second-time mother delivered a nine-pound baby boy after pushing for only twenty minutes, Ellen was in a labor room, bleeding again.

  “The ambulance brought me. I left Mama a note.”

  I could hardly believe this was the sullen, irresponsible teenager from only a few months before. She bled for about eight hours before abruptly stopping again, and she required two more units of blood. Even so, she remained slightly anemic. Ellen was thirty-one weeks now, and I was fairly certain the baby was still too immature to be delivered without risk of serious respiratory disease.

  “Ellen, I need to find out how mature your baby is,” I said.

  “How do you do that?”

  “I stick a needle into the uterus, draw out some fluid, and test it for the ratio of lecithin to sphingomyelin; it’s called an L/S ratio. It needs to be two before I deliver your baby.”

  “Does that mean I won’t have to wait until the end of October?”

  “It sure does.”

  “Then let’s do it.”

  Ultrasound confirmed the placenta location was unchanged; it lay directly in front of the baby’s head, which measured consistent with the estimated thirty-one weeks of gestation. Normal changes in the cervix as labor approached would increase both the frequency and the quantity of bleeding.

  “Look at this, Ellen, boy parts.”

  “Really? Let’s not tell Mom.”

  “That will be your call.”

  As I expected, the L/S ratio was only 1.6, indicating that the baby’s lungs were immature and he would likely have to be on a respirator to survive. Since I had proof that this baby would have difficulty if delivered, and since I had already garnered the criticism of my colleagues, I decided to wait again. Because the risk of more frequent and heavier bleeding posed serious risks for Ellen, this time she stayed in the hospital with two units of blood held ready in the lab for transfusion at a moment’s notice.

  Almost miraculously, Ellen did not bleed again until thirty-four weeks, at which time a second amniocentesis showed the L/S ratio at 1.9. That was close. I wanted it over 2.0.

  “Ellen, I’m going to deliver your baby by C-section on Monday in two weeks if you don’t bleed in the meantime,” I announced. “If you do bleed, I’ll do a C-section immediately, but I prefer to have it scheduled so the pediatricians can be better prepared for the baby.”

  “Will he be all right?”

  “Yes, I think so, but the longer we can wait the better for the baby, though with greater risk for you.”

  Ellen waited one more week before she bled again. It was the autumnal equinox, Tuesday, September 20. Jessie and Grace were visiting at the time. I had just finished in the office. I called the pediatrician and we went to the operating room. Current hospital rules allowed Jessie to be present, and Grace waited in the doctors’ lounge. In the interest of speed, Ellen got a general anesthetic rather than an epidural. It took a minute longer, but I made a low transverse skin incision. I figured I could handle criticism for that and the scar would never show. I did make a low vertical uterine incision, knowing that the placenta was attached over the part of the uterus we normally incise at C-section. The top of the vertical incision could be extended upward if more room was needed and the bottom came to the edge of the placental attachment. I placed my hand between the placenta and head and gently pulled the head through the incision; the body easily followed. A four-pound, six-ounce baby boy screamed as I handed him to the pediatrician.

  “He looks good,” she said. Jessie’s attention immediately went to the baby. She and the pediatrician stopped to show the baby to Grace on the way to the nursery while I delivered the placenta, checked for bleeding, and closed the incisions.

  I waited to check Ellen’s hemoglobin level after delivery before giving more blood. We had been able to deliver her so quickly that I hoped she wouldn’t need it. When it came back seven, she got one more unit. Fortunately, with the autotransfusion you get with delivery, she did not need more.

  The baby required ultraviolet light for jaundice but had no breathing difficulties and no feeding difficulties. He looked like a carbon copy of Ellen—blonde hair, blue eyes, and the same ski-jump nose. Since Ellen looked just like her father so did this baby. How ironic, I thought. I wonder when his grandfather will see him.

  Ellen
surprised me again. She took her pain medicine every three hours for twenty-four hours and then never asked for it again. She was hungry almost immediately and tolerated regular food on the second day. Maybe it was because she had been on bed rest for so long, but for whatever reason, she bounced in and out of bed like nothing had happened.

  When I stopped by for evening rounds on the second day, Jessie and Grace were visiting. “Your chart looks good—you look good. How’re you doing?” I asked Ellen.

  “I’m fine. When do I get to go home?”

  “Tomorrow, if your blood count stays up and this food stays down.”

  “Will Henry get to go home then too?”

  “Who?”

  “Carl Henry Green.” She beamed. “I named him for you and your Uncle Henry.”

  “But you didn’t know him, Ellen.”

  “Yes, but Mom talks about him all the time. My baby has a life because of you, and we have a home because of Mr. Henry.” So it was that the first of many babies was named for me, and my precious, childless Uncle Henry had a namesake.

  Though it was early fall, the day was very chilly. At home that evening Jessie and I built a fire, which always reminded us of Grace and the first night she had stayed in that house. What a miracle it was that her remission continued. Grace went to her room to do homework, while Jessie and I talked about Henry, the new and the old.

  “You know, it was Ellen’s idea,” Jessie said.

  “What was Ellen’s idea?”

  “The name.”

  “I was amazed.”

  “Are you pleased?”

  “How could I not be pleased? It is truly an honor for me. I don’t think it will ever cease to be, even if a hundred babies are named for me, but I may be even more pleased for Uncle Henry.”

  “Do you think he knows?”

  “I hope so.” We sat in a comfortable silence for a while. “Jessie, do you remember what Uncle Henry once told you?”

  “There were many things. What are you thinking?”

  “I was thinking about how he told you that God would redeem what happened to you, that from the bad He would bring good. I wonder what would have happened to both Grace and Ellen if you hadn’t been in a position to help them the way you have.”

  “I’m grateful every day that I have been able to help the girls. I wish I could have done more for Jeff. I’ve given money so he can attend the college he wants, but he doesn’t know, and now that he’s in college I probably won’t have much opportunity to see him.”

  I realized that as involved as I had been with Jessie’s family, I had only seen Jeff that one night after his middle school ballgame.

  “I need him to forgive me,” Jessie said almost to herself.

  After Jessie and Grace left to visit Ellen at the hospital, I continued to sit by the fire. When the phone rang, I was startled from an unplanned nap. “May I speak to Cara Land,” a vaguely familiar bass voice said.

  “This is she.”

  “Cara, this is Jon Parker, you may not remember me.”

  “Of course I remember you. I’m glad you called, though I didn’t expect that you would. Are you well?”

  “Yes, thank you, I am.”

  “I called your office the day after you left class and learned that you had not only left the university, but even Lexington.”

  “Yes, I’m in the Air Force Reserves, and I left to have tests at an Air Force hospital in California. I was a member of Air Force Operation Ranch Hand, the unit responsible for the aerial spraying of Agent Orange in Vietnam. Any time we have a problem, they want to investigate. I was there all summer.”

  “Someone mentioned Agent Orange and I gave you leukemia. I hope I was wrong. You know the curse of being a medical doctor.”

  “Yes, you were wrong, thankfully. I had a terrible skin reaction, more common and less deadly.”

  “I am so glad to have been wrong.”

  “I was wondering if you would go out with me. I’m going to be tied up for a couple of weeks, but the fall meet at Keeneland opens on October 7. Would you like to go with me? It’s a Friday so I know you may be working.”

  “I’d love to go. With this much notice, I may be able to arrange to be off. My only problem would be if I have already scheduled somebody for surgery.”

  “I understand. I wouldn’t want my doctor to change my surgery to have a date.”

  “Since I just started my private practice this summer, I don’t have much surgery scheduled. Can I call you tomorrow after I check at the office?”

  “Sure. My number is 255-6323.” I memorized the number, and we talked until the fire died and Jessie and Grace came home from the hospital.

  Ellen went home on the fifth postoperative day. She could have gone sooner, but she stayed so she could take little Henry with her. It seemed that all was going to be well for the fifteen-year-old mother, her baby, and her inexperienced doctor, but Ellen had gotten one transfusion too many.

  CHAPTER 8

  On October 7, a perfect autumn day, Jon Parker and I went to opening day of the fall race meet at Keeneland. The sky created a bright blue background for the red and gold trees spread around the grounds. Summer rains had kept the grass emerald green. I thought again how there were few places more beautiful than Kentucky in October.

  Jon looked gorgeous, wearing khaki pants, a light blue shirt, and a navy blazer. His navy tie was covered with jockey silks that represented some of the more famous stables. I had been to the races before, but not often. I didn’t know much about the horses or betting, but Jon had come to Lexington because he loved horses. He explained how he read the racing form and admitted that he knew a few of the trainers, who had given him some tips. First time out of the gate, we won the daily double. It paid thirty-nine dollars for a two-dollar bet. We split our bets and won a few more races, but that first ticket was special, as was the whole afternoon.

  Jon walked down to the paddock to look at the horses while they warmed up for each race. As he watched closely, he talked about conformation, ankle taping, and demeanor. I didn’t know whether it was better for the horse to be calm or excited, but it was clear that Jon was there because he loved them.

  At dinner after the races, Jon told me about growing up all over the world. His father, a career pilot in the Air Force, had been stationed in Germany, Hawaii, and a number of other states. Fluent in both German and Spanish, he had traveled all over Western Europe. As he talked I sensed that he was aware of the advantages that living in and traveling all over Western Europe brought, but he said it had been lonely at times. His parents were now retired to Florida.

  “I love to travel,” I said, “but I have always lived here.”

  “This has to be one of the most beautiful places in the world.”

  “I agree, but I think you may be influenced by those big animals you love so much.”

  He smiled. “Could be, but you need to see my farm if you want to see beautiful.”

  “I didn’t realize you live on a farm.”

  “Yes, three hundred acres, just over the Fayette County line on Paris Pike.”

  “That is some of the area’s best farmland.”

  “Would you like to come to dinner tomorrow evening? I’d love for you to see it.”

  “Sure. I will even arrange to be off and come without a pager.”

  If I were not already falling in love with Jon Parker, I would have been after that evening in his home. The drive out Paris Pike was a buffet for the senses. The air was crisp as I drove with the windows down to let the wind blow my face and hair. The stone walls and white fences stood against a background of gently rolling green pastures. Red and gold leaves covered the mature trees that lined the two-lane road. No wonder there was a movement to prevent widening it. That battle would be waged for years.

  After just a few miles, the noise of the city was gone. I turned off the radio to listen to the silence of the country. As I turned into the driveway lined with white wooden fences that led to Jon’s restore
d century-old house, I smelled the charcoal grill already burning.

  Jon’s house was a wonder of understated masculinity. There were no pictures of flowers on the walls, but neither were there deer heads. I did note a number of paintings of horses in races, in green pastures, and in barns. The dark brown leather sofa and chairs in his den were complemented by dark walnut tables, but the woodwork was painted white and the walls were covered with grass-cloth paper in muted shades of green.

  During the restoration the wall between the kitchen and den had been removed, making a great room. A huge stone fireplace stood in the center of the wall opposite the kitchen, flanked by built-in bookcases filled with books on subjects as diverse as horse breeding and world history. A bar with four stools separated the kitchen from the living area. The centerpiece of the kitchen was a commercial gas range with six burners and two ovens. I wondered if Jon did serious cooking.

  When Jon came to the door, a little dog accompanied him—not a breed familiar to me.

  “Hi, Cara, come in. I want you to meet Pippen.” Pippen was barking and jumping on my leg. “Down boy,” he said. The dog settled.

  “Hi, Pippen, you’re a cute one. What kind of dog is he?”

  “He’s a Norfolk terrier. In recent years they were made a separate breed. Previously, they were drop-eared Norwich terriers. They’re rare, less than three hundred born a year in this country.”

  I guessed Pippen’s weight. “You gotta love a man who lives in a big house on three hundred acres with a thirteen-pound dog.”

  “He thinks he’s a big dog,” Jon said with a deep chuckle that would warm my heart for years to come. “He once went after a Rottweiler. Fortunately, they were both on leashes and he didn’t get him.”

  “Pippen. Is that for Peregrin Took?”

  “Yes, so you know The Lord of the Rings.”

  “I spent one of my spring breaks in college reading it.”

  “What? No bikini-clad fraternity parties on a Florida beach?”

  “This has never been a bikini body.”