Saving Jane Doe

by Carolyn Purcell

  “I like the curves.”

  “And I like bald.”

  I moved into my newly restored old house during the first week of November, and Jon helped me. We had just finished carrying in the last box when Jessie called.

  “Cara, I need you to come,” she said as soon as I answered the phone.

  “Where are you?”

  “I’m at UK hospital with Grace. She fainted at school earlier today, and I brought her into the ER. We just saw Dr. Campbell, and she admitted Grace to room 413.”

  “Do they think her leukemia is out of remission?” I was sick to think that as soon as Ellen delivered, Grace might be ill.

  “We don’t know. They’ve drawn a lot of blood, but no results are back yet.”

  “What can I do?”

  “They said she may need to see a gynecologist.”

  “Oh . . . why?”

  “Her first period started about two weeks ago, and she’s still bleeding heavily.”

  “Maybe that is all that’s wrong with her. She looked good when I saw her two weeks ago.”

  When I got to the hospital, I found Grace looking pale. Her heart rate was rapid, and her blood pressure dropped when she sat up.

  “How much are you bleeding?” I asked.

  “Mom got maxi pads, and I have to change about once or twice an hour.”

  “That seems pretty heavy. How long have you bled like that?”

  “The whole two weeks.”

  “This all may be from acute blood loss,” I said as I offered a prayer that it was not a recurrence of her leukemia. “I think you will need a pelvic exam, but let’s wait until we get the blood work and I can talk to Dr. Campbell. Since she’s the attending physician, she will need to request a consult.”

  “Isn’t she too young for a pelvic exam?” Jessie asked.

  “No, but I will modify it a bit. I’ll get an ultrasound to check for ovarian masses and uterine size, rather than doing a bimanual exam. Also, they make small specula to use in children. Mostly, I need to see if there are masses or lacerations.”

  “Why would she have lacerations?”

  “I doubt that she does, but we have to be sure.” I avoided answering the question. “Most young women don’t ovulate until they have bled for about a year. During that year the periods can be extremely heavy.”

  “What do you do about it?”

  Before I could answer that question, Dr. Campbell came in with Grace’s test results.

  “Grace’s hemoglobin is seven. I have scheduled her for blood transfusion of two units of packed red cells. The good news is that there are normal numbers and no abnormal white cells. I believe this is from blood loss not leukemia, so I’m going to consult the gynecologists.”

  “Dr. Campbell, do you remember my friend, Dr. Cara Land? She’s a gynecologist. Would it be possible for her to do Grace’s consult?”

  “Yes, of course.”

  “I’ll go have the nurses set up the exam room on the third floor,” I said. “The sooner we check, the sooner we can get this bleeding stopped.”

  It is never easy doing pelvic exams on virginal twelve-year-old girls, but Grace was brave and Jessie held her hand. A small speculum is easily inserted as long as the child is not terrified and fighting the exam. If that happens, rather than force an exam that doesn’t tell you anything, it is best to use a general anesthetic. Grace was able to relax enough for an adequate exam without anesthesia. Her cervix and vagina looked normal. The ultrasound confirmed normal ovaries and no uterine enlargement.

  “Everything looks normal,” I said when all the tests were done. “This bleeding appears to be due to immature pituitary-ovarian regulation.”

  “Can you make it stop?”

  “Yes, Grace. The bleeding will stop with estrogen and progestin pills four times a day and IV Premarin. We’ll add the Premarin to your IV as soon as this transfusion is finished. You will need to take the pills for three weeks. When you stop you will have another period, but it will be shorter and more moderate in flow. After that I want you to take birth control pills.”

  “Isn’t she young to be on pills?”

  “It will only be for three months, so she can recover her strength and have light periods. Then we will control the bleeding with synthetic progestin every six to eight weeks if she doesn’t have regular periods on her own.”

  “I need to call your father, Grace,” Jessie said. “Is there anything you want me to tell him?”

  “Tell him he doesn’t need to come. I’m fine and will come to see him next weekend at my usual time.” Then, looking at me, she added, “I can go to see him then, can’t I?”

  “Yes.”

  When Jessie left the room to call George, Grace said, “I don’t want Dad to come and see me since he didn’t come to see Ellen. I’m afraid it would make her feel even worse. I can’t believe he doesn’t want to see Henry.” Only Grace would be thinking of her sister at a time like this, I thought.

  The medicines worked as predicted and Grace was discharged after three days.

  On Thanksgiving Day, Jon and I went to dinner at Jessie’s. Ellen was there with a healthy baby Henry. She had lost all of her baby weight and wore an outfit that she had designed and made. The pants were wide wale corduroy in a rich shade of brown, paired with a matching vest and ecru blouse. On the front of the vest she had appliquéd two small leaves in shades of rust with a larger one on the back. Ellen looked tired, but no one was surprised at that. She insisted on taking care of Henry, who was still waking at night. Henry weighed ten pounds and charmed everybody, including Jon.

  Grace had been to her father’s the weekend before so she was able to be present for all of Thanksgiving weekend, though she did have to spend part of her time catching up on school work she had missed while in the hospital. She looked grown-up, wearing navy slacks and a light blue turtleneck sweater.

  Jessie looked more beautiful than I had ever seen her. She wore what had become her trademark gray slacks and pink sweater and hustled around attending to everyone’s needs. She laughed easily and fussed over Henry. Both of her daughters were with her and past their frightening ordeals. After her prayer, in which she expressed thanks for those blessings and many others, she said, “In memory of Mr. Henry, I declare this the official opening of the eating season.” As if on cue, Jon laughed, and I realized he was a keeper. Even Ellen laughed this year.

  Jessie made a further announcement at that dinner. “I have decided to take a job at the Florence Crittenden Home after the holidays. They have an opening for a nurse.” Jessie and I were familiar with Florence Crittenden Home from our days working in Labor & Delivery at the UK hospital. It was a home for unwed mothers. The girls got their medical care and delivery at the UK Medical Center and continued their education at the home.

  “Ellen can still do homeschooling for the rest of this year, but she won’t need me at home with her all the time,” Jessie said.

  “I’ve decided that I would like to take the GED test and skip my last year of high school,” Ellen said. Before Jessie could protest, Ellen continued. “I think it will be better to be in college with a baby than in high school.” Ellen had not discussed this with her mother, but it seemed to be a mature, well-thought-out decision. “I want to study fashion design and merchandising.”

  “What a good idea,” Jessie said, smiling. “You’ll be great at that.” She walked around the table and hugged her daughter. “I am so proud of you, honey.”

  Jessie sighed as she sat back down. “Today would have been perfect if Jeff had been here.”

  “He wasn’t going to be at Dad’s either,” Grace volunteered.

  “Where was he going to be?” Jessie asked.

  “Dad said last weekend that he called and told him he was going to spend Thanksgiving with his girlfriend’s family.”

  “I didn’t even know he had a girlfriend. Do you know anything about her?”

  “Just that she lives here in Lexington and her name is Sara.”


  For the first time that day the smile left Jessie’s face. Almost as if to herself, she said, “Right here in Lexington and I won’t see him.”

  New Year’s Eve and Valentine’s Day had always been nonholidays for me. I may have had one date on New Year’s Eve, and when I was an intern on the Internal Medicine service at the Veteran’s Administration Hospital, one of my patients—a very charming alcoholic—gave me a box of bourbon balls for Valentine’s Day. Other than that, the only valentines I had received were the boxed variety I got in elementary school. Things were different in 1978 and ever after.

  Jon took me to a New Year’s Eve party at the Lexington Country Club. We danced in the New Year and kissed at midnight. Then on Valentine’s Day, he got down on one knee and presented me with a tiny black box.

  “Cara, I know we haven’t dated very long,” he said, “but neither one of us is getting any younger. I love you, and I want to spend the rest of my life with you and your patients. Will you marry me?”

  Both thrilled and shocked, I simply said, “Yes.” He could not have made a more perfect proposal. He clearly understood how much a part of my life my patients were, and I understood how lucky that made me.

  When I told Jessie that we planned to get married the following October, she immediately offered to help me with the planning. She knew me better than anyone and also knew I had no family to help. While I didn’t want a big wedding, I still had to arrange church, ceremony, music, reception, invitations, flowers, cake, dress, and a dozen other things about which Jessie knew and I did not.

  One Saturday in late March, I stopped by Jessie’s home to work on the planning. When I arrived Ellen came in rather shyly and asked to show me something. After I agreed, she went to her room and came back with the design of a wedding dress she had drawn. It was beautiful. She knew my taste for simple lines, no frills, and natural fabrics. The fitted bodice had a deep jewel neckline that extended to the shoulders. The long sleeves were decorated with covered buttons at the wrist, the same buttons that extended down the back. The tea-length skirt had a flat panel in front with gathers at the back.

  “If you like it, Mother and I will make it of silk and give it to you for a wedding gift,” she said. “Only if you like it.”

  “What’s not to like? The dress is beautiful, and it’s perfect for me. You considered that I would not like strapless or sleeveless. The flat panel in the front with gathers in the back masks some of my figure deficits. I love cotton, wool, and silk. Ellen, this dress shows that it was designed for me by a very talented young woman who knows me, wants to please me, and wants to have me look beautiful at my wedding. Thank you. I love it.”

  “I’m going to start now,” she chirped as she jumped up and left the room.

  Grace sat by the window with a pair of binoculars and watched a robin build a nest in a box she had put in a tree last fall. “Mother is going to help me, and we’re going to make the cake. I’m going to take a class in cake decorating this summer. What kind of cake do you want?”

  “My favorite is carrot, and I think Jon likes everything.”

  “Carrot it is. It needs to have white icing, and carrot cake does.”

  At ten in the morning on October 28, 1978, about one hundred guests watched as Jon Parker and I married in a beautiful ceremony at Christ Church Cathedral. I wore Ellen’s dress. Jessie was the single attendant. The church and country club were filled with calla lilies. Grace cut the cake that she and her mother had made, and Ellen kept the guest book. Jon’s father was his best man. We were happy.

  PART TWO

  CHAPTER 9

  Elaine screamed. The sound pierced three doors and reached the top of the stairwell just as I did. It erased all hope of the New Year’s Eve party I planned to attend that night. I rushed into the room and said, “Let’s waltz. One, two, three, in, out, out, in, two, three.” Almost immediately, she began to breathe with me.

  “That’s great. You can do it. That was the peak. It’s beginning to go away.”

  Twenty seconds later, she smiled as she turned to me. “I’m glad to see you, Dr. Parker. The contractions are getting much harder.” What a difference a minute makes, I thought as I smiled back at her.

  The birthing room with cherry furniture and hardwood floors did not look much like the labor rooms of twenty years ago when I started practicing Obstetrics. Ruffled curtains covered the windows and flowered wallpaper added to the homelike atmosphere, a marked improvement over bubblegum pink paint. Thick area rugs invited bare feet to curl their toes, and on a small counter a coffeepot invited family and friends to sustain themselves while the patients had to refrain.

  “Are we going to have a baby today, or do you want to have the New Year’s baby?” I asked.

  “I hope it’s today. We could use the tax break, and if these contractions aren’t the real thing, then I’m in trouble.”

  “Where’s your husband?”

  “He’s gone to the car to get my bag, and then he’s calling our parents. We’re going to ruin everyone’s New Year’s Eve.”

  I thought how New Year’s Eve is my least favorite holiday. “I would say you are going to make everyone’s New Year’s Eve. A new grandbaby is a great way to start the New Year. I doubt your parents will mind missing a party.”

  “I guess you’re right. They seem pretty excited about this baby.”

  “It looks like the contraction is coming again. Let’s get through this one; then I’ll check your progress. Take a deep breath in and blow it out. Again. That’s the way. When it gets too hard do the waltz breathing again.” She started to breathe just as I had instructed.

  While Elaine finished that contraction, her nurse assembled the supplies we needed to examine her. “This contraction is almost finished. Take a deep breath and let it out. Now relax a minute. When you’re ready, turn onto your back for your exam.”

  Elaine did as I requested, and I noted that she had more bleeding than I expected. I tried not to appear alarmed by the bleeding as I considered all the possibilities. Having your first baby at thirty-six is old enough to be considered high risk. I knew from ultrasound that the placenta position was normal, so I continued with the exam and told her the findings. My concern was that increased bleeding might mean premature separation of the placenta, a dangerous condition for both baby and mother.

  “The baby’s head is well down into the pelvis and perfectly positioned,” I told her. “The cervix is dilated five centimeters and completely thinned out.”

  At that moment a contraction started, bulging membranes ruptured, and clear fluid gushed out. It soaked my sleeve along with the pads on her bed. At least that time I missed the salty taste. The clear fluid brought with it reassurance of the baby’s well-being. Extra bleeding was apparently due to very active labor.

  “Your water just broke. You may get that tax break after all,” I joked as we waltzed through another contraction. As Elaine turned to her side to rest between contractions, I said, “He has a lot of hair.”

  “He?” she asked, laughing.

  “He, a generic term in preference to it.” They had chosen not to be told the sex of the baby from ultrasound.

  “Blond or brunet?”

  “Hey, I’m just telling you this by feel. I can’t see what color it is. Your contractions will pick up in both frequency and intensity now that your water has broken. If you feel you need medication for pain or want an epidural anesthetic, now is the time.”

  “I want to try to do this without medication.”

  “Fine, just let me know if you change your mind. I would like to use a fetal monitor. You’re having a little more bleeding than I expect, so I want to observe the baby closely.” She stiffened and I reassured her. “The amniotic fluid was clear so I think he’s fine. The monitor is just a precaution.”

  Elaine struggled through the next contraction, her fear magnifying her pain. When it ended she leaned forward and her nurse dropped the monitor straps behind her back and tightened them around h
er abdomen. Immediately we were reassured by the rapid heartbeat, which increased slightly as the baby kicked.

  “The baby looks fine,” I said. “I’ll be in the doctors’ lounge if you need me.”

  With that I left the room, picked up a cup of decaf, and headed down the hall. After four thousand babies, I still liked to stay at the hospital once they were dilated five centimeters. I knew it could be anywhere from one to seven hours before delivery, but I hated to rush in at the last minute. My presence in the hospital had a calming and encouraging effect, as Elaine had just confirmed.

  In the lounge, I settled down with my counted cross-stitch bell pull to stitch and wait. That bell pull, my first effort at counted cross-stitch, was a three-and-a-half-year project. Another patient and friend had loaned me the pattern, three scenes of Japanese women in beautiful kimonos, worked on Modena cloth with twenty-two stitches to the inch. Shades of pink and green were perfect for my home. I had just started that bell pull when I met Elaine. It was nearly finished. As I stitched I prayed that Elaine and her baby would be healthy and she would be spared a complicated labor. Soon, my mind wandered to the day I met her.

  CHAPTER 10

  Elaine Green was attractive, not so much that women were jealous or men lost their train of thought in her presence, nor so much for her strawberry blonde hair, big blue eyes, and great figure as for her expressive face, at once gentle and curious. Just watching her through the waiting room window, I liked her. Besides being early for her first appointment, which always garnered the favor of the office staff, she looked at an album of our baby pictures instead of People magazine. She turned the pages with a faint smile that broadened when she came to a particularly scrunched baby.

  For the first visit I always saw patients in my consultation office while they were fully dressed. Intentionally small, my office had two walls made of windows that gave wonderful natural light but made it cold in winter. Neutral-colored drapes were closed for warmth, but that summer day they were wide open to let in the sunshine. A light oak burl wood desk, wicker table, and rattan chairs created a relaxed atmosphere, a place conducive to intimate discussions.