The Doctor's Blessing

by Patricia Davids

  How often had she insisted Sophie Knepp wasn’t a high-risk patient? Unable to change his mind on the subject, she’d gone behind his back and delivered the woman at home anyway. What he didn’t understand was why Amber wouldn’t admit she’d turned her phone off on purpose. She’d been found out. She had nothing to gain by pretending anymore.

  Unless she was telling the truth.

  That nagging voice at the back of his brain was getting louder by the hour. He hadn’t known Amber very long but she didn’t seem like an underhanded person. She was warm and witty and devoted to the people of her community.

  Okay, there had been that time at church when she’d seated him with Gina Curtis. That had been a little sneaky but it was nothing compared to this. Was his ability to read a person that messed up?

  If she had told the truth, what could he do at this point? He’d already called her a liar. In front of her cousin, no less. Would she even accept his apology?

  He glanced at his watch. It was almost four and it was time to end this standoff. They had to work together. He would eat crow. One wouldn’t hurt him. There were plenty more out in the cornfields.

  He pressed the intercom button. “Wilma, ask Amber to step in here, please.”

  “Can’t.”

  Letting go of the button, he muttered a few unkind words under his breath, then asked. “Why not?”

  “She’s with Sophie Knepp and her new baby.”

  “Sophie wasn’t scheduled to come in until Monday. Is something wrong?”

  “Oh, yes.”

  He rose and headed for the door. Before he reached it, it flew open. Amber stood in the doorway with a look of panic on her face. “You need to come quick.”

  “What’s the matter?”

  “It’s Sophie Knepp. She’s hallucinating and muttering that God is taking another child away. She won’t let me see that baby.”

  “Is her husband with her?”

  “Yes.”

  They crossed the hall and Phillip saw Amber wasn’t exaggerating. Sophie sat plucking invisible things from the baby’s blanket and throwing them away as fast as she could. She kept muttering the same phrase over and over.

  Quietly, he asked Amber, “What’s she saying?”

  “That leaves are falling and covering her baby. She has to keep them away or her baby will be buried.”

  Phillip looked at her husband. “When did this start?”

  “This morning. She picked up the baby and started crying. I couldn’t get her to stop.” He stood against the wall turning his straw hat around and around in his hands. He looked worried to death.

  Phillip sat on a stool and moved in front of her. “Sophie, I’m Dr. White. Do you remember me?”

  She didn’t answer, didn’t make eye contact. He moved closer slowly and touched her hand. “Sophie, I need to see your pretty little girl.”

  She stopped picking and started crying. Carefully, he withdrew the swaddled child. Laying the baby on the exam table, he opened the blankets. The child looked asleep. To his relief she was clearly breathing. She was also very jaundiced.

  He looked at Mr. Knepp. “How long has her skin been so yellow?”

  “Since two days after she was born.”

  Amber broke in. “I told you to contact me if the baby’s jaundice got worse.”

  “When we saw the whites of her eyes were yellow, too, we knew God was taking her from us as He did our first children.”

  Puzzled, Phillip asked, “You’ve had other children with jaundice?”

  “Twin girls who both died before they were two years old. Then we had strong sons and more healthy daughters. Why has God put this burden on us again?”

  Sophie sat rocking herself and staring into space.

  Phillip said, “Elijah, your wife is very sick. This is a rare thing called postpartum psychosis. She needs to be hospitalized, but she will get better.”

  The man nodded without looking convinced. Phillip turned to Amber. “Call an ambulance, then call the hospital and tell them we need a mental health assessment for Sophie. After that, call the Peds unit and tell them we need triple phototherapy lights for this little one. I also want a total bilirubin level STAT along with standard admission lab.”

  “Yes, Doctor.”

  He asked, “Mr. Knepp, do you understand what jaundice is?”

  When the man shook his head, Phillip explained. “This is a common thing in newborns. Jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is a chemical produced by the normal breakdown of red blood cells. We all have a little in our blood. Normally, bilirubin passes through the liver and is excreted as bile by our intestines. This yellow color occurs when bilirubin builds up faster than the baby’s liver can break it down and pass it from the body. We treat it by putting the child under a special light. If the level is very high, we may have to do an exchange transfusion. To do that, we take out some of the blood with the high concentration and put in blood with normal levels.”

  “Will she die from this as our other children did?”

  “I’ll do everything I can to make sure that doesn’t happen.”

  Within thirty minutes, both Knepp patients were on their way to the hospital. Phillip was getting into his car to follow the ambulance when Amber came running up to him. She grasped his arm in a tight grip. “I have to know, Phillip. Did I miss something? The jaundice was barely visible the day after birth. I told them to bring her in if it got worse.”

  The look in her eyes tugged at his heart. He didn’t want to answer her. He wanted to pull her into his arms, kiss her and tell her everything would be all right, but that might be a lie.

  Home deliveries weren’t safe. Maybe she hadn’t missed anything at the birth, but a woman and her baby need round-the-clock observation for two days after a delivery. Most state laws require a mother and her newborn to stay in the hospital at least that long.

  He had tried to make that point. Amber had made it for him.

  When Phillip didn’t answer, Amber’s heart sank. “I saw them the day after delivery and nothing looked out of the ordinary. Lots of newborns have mild jaundice.”

  She bit her lip as she waited for him to say something, anything.

  “Amber, there are too many unknowns for me to start guessing now. We need some solid information. Let’s run some lab tests and find out why the baby is so jaundiced at four days old.”

  “Sophie’s blood type is O positive so it can’t be an RH incompatibility. Sepsis? The baby didn’t act sick or look dehydrated. Maybe it’s an ABO problem. And what about Sophie?” Amber knew she was babbling. She couldn’t help herself.

  He gripped her hand. “Calm down. You’ll drive yourself nuts doing this. Postpartum psychosis can occur anywhere from one to three months after delivery. I’ve not heard of a case starting four days after birth, but I haven’t researched it. Were the signs there when you saw her? We may never know. The best thing that could happen is happening now. They’re getting the treatment they need.”

  She withdrew her hand. “You’re right.”

  “Do you want to come with me to the hospital?”

  Shaking her head, she stepped back. “I’d only be in the way.”

  “All right, I have to get going. I’ll fill you in when I get back.”

  After he drove away, Amber went back inside the clinic. Wilma, getting ready to close up, slipped her purse strap over her shoulder. “Is everybody okay?”

  “Sophie was sedated enough to go calmly. Elijah looked like a zombie. I don’t think he knows what’s hit him. The baby was sleeping quietly in the car seat the EMS brought.”

  “Dr. White will find out what’s wrong. Don’t worry.”

  “You think he’s a good doctor, don’t you?”

  “As good as Harold. Maybe better.”

  Turning around, Amber began pacing across the lobby as she racked her mind for every little detail. “For a baby to get that jaundiced so fast, it
must have been worse than I thought when I saw her last. Why didn’t I pick up on that?”

  “Amber, you’re a great midwife. You love your patients. You’d never hurt them.”

  Pressing her hand to her forehead, Amber closed her eyes. “I remember checking her nose. I always push lightly on the tip of their noses to see what color their skin was underneath. I do that on all newborn checks.”

  “See? What did I tell you?”

  “I was so mad that day. Did my anger at Phillip cloud my judgment? Did I want to be right so badly that I fooled myself into thinking everything was fine? That baby could have permanent brain damage if her jaundice causes kernicterus.”

  “What does that mean?”

  “If the levels of bilirubin in her blood rise high enough to cross the blood-brain barrier, the bilirubin can enter her brain cells and damage them.”

  Wilma took Amber by the shoulders. “Some things are out of our control. We are human. Only God is perfect. Beating yourself up is not helping. Go home and get some rest.”

  Dropping her arms to her side, Amber nodded. “I will. First, I need to call Harold.”

  “That reminds me. The charts Dr. White wanted were delivered a little while ago.” Returning to her desk, Wilma picked up a large package and brought it to Amber.

  Taking it, Amber said, “I’ll see that he gets them.”

  After Wilma left, Amber retreated to her office and put a call through to the rehab hospital in Hawaii. When Harold came to the phone, she started crying. It seemed like she was always crying. How many tears did she have left?

  “Amber? What on earth is wrong? Get a hold of yourself. Has something happened to my grandson?”

  The fright in his voice forced her to gain a modicum of control. “Phillip…I mean, Dr. White, is fine. It’s nothing like that.”

  “Thank heaven. Then what is it?”

  After blotting her face and blowing her nose, she was able to relate the event of the afternoon with only a few hiccups.

  He said, “Another yellow baby for Sophie. I’m so, so, sorry to hear that. The twins she lost were such beautiful little girls.”

  “What was the cause of death?”

  “I’m not sure. It had to be some kind of liver disorder, but all the liver function studies were normal. It was very puzzling. Both Sophie and Elijah said they had family members who had lost children from the same thing. They knew the girls were going to die. I tried everything. Phototherapy and blood transfusions worked for a while, but once we stopped them the jaundice came back. There was nothing left to do but let them take the girls home to die. We accepted it as God’s will.”

  “That must have been awful for Sophie. Seeing this baby getting jaundice may be what triggered her psychosis.”

  “I imagine you’re right.”

  “I’ll let Phillip know what you’ve told me. I’ll pray this isn’t the same thing.”

  “I’ll do the same. All those tears over Sophie’s illness, that’s not like you, Amber. What’s going on?”

  “We need you back,” she moaned, then pressed her fingers to her lips. She had no intention of telling him that his grandson was breaking her heart.

  “I’m getting better by leaps and bounds.”

  “Are you? Honestly?”

  “Okay, now you’ve got me worried.”

  “Don’t be. Things are…okay here. I’m tired. I miss you.”

  “Are you sure there isn’t something else you want to tell me? Are you and Phillip still not getting along? Wilma told me he accused you of doing deliveries without his consent. I’m gonna have to have a talk with that boy.”

  “No,” she said promptly. “Just…just get well soon. Everyone misses you.”

  “Okay.” He didn’t sound convinced but he hung up.

  Amber settled the handset back in the cradle and lowered her head on her folded arms. She did miss Harold. Things were okay at the clinic. It was only her heart that was broken.

  She’d seen the look in Phillip’s eyes. The look that said she had messed up big-time. Exactly the way he had expected.

  Sitting up, she dried her face on her sleeve. After leaving her office, she locked up the building and got in her car. She didn’t drive home.

  Chapter Twenty-One

  When Phillip pulled into his grandfather’s driveway it was well after eleven o’clock at night. He’d had a long day and an even longer evening.

  Getting out of the car, he headed for the front steps. Someone rose from the wrought iron bench that circled the maple in the front yard and came toward him. He saw it was Amber when she stepped into the light coming from the front porch.

  She had her hands clenched tightly in front of her. “How are they?”

  “Both of them are doing better.”

  He heard her sigh of relief. “I’m so glad.”

  They stood staring at each other like strangers in the near darkness. How had their relationship gotten so out of whack?

  “Amber, you should go home.”

  “I needed to know how they are.”

  He walked toward the bench and sat down. She joined him but left some distance between them.

  Running his hand through his hair, he said, “Sophie has been admitted to the psychiatric unit. Little Grace had a bilirubin level of twenty-six milligrams per deciliter. We did an exchange transfusion and got it down to sixteen.”

  “That’s still a long way above a normal of four.”

  “She’ll stay under triple lights for now. We’re doing a workup to see if this is an infection. It doesn’t look like it.”

  “Will she have brain damage from such a high level?”

  “You mean will she want to be a doctor when she grows up?” He didn’t get the smile he was hoping for.

  “Phillip, please. Tell me.”

  “She’s lethargic but she isn’t showing the more serious symptoms of kernicterus. They’ll check her bili level again at midnight. I came home to get a change of clothes. I’ll be spending the night at the hospital.”

  She nodded slightly. “I talked to Harold about Sophie’s other children who died. He thinks it was some kind of liver disorder.”

  “All Grace’s liver studies are normal. You know that in some cases the reason for a high bilirubin is never found and the child recovers. Grace was a little dehydrated. I think she’ll be fine in a few days. Stop worrying.”

  “I can’t help feeling guilty.”

  He hated to add to her burden, but he didn’t believe in sugarcoating the truth. “To have a bili level this high this soon after birth, she had to have had some symptoms when you saw her.”

  Clasping her arms across her middle, Amber stood. “I’m so sorry. I thought it was ordinary newborn jaundice. I should have gone back to see her again.”

  “Amber, mistakes happen.” He rose and reached for her. She stepped away. She wouldn’t look at him.

  “You’ll stop all my home births, won’t you?” She sniffed and wiped her face with the heels of her hands.

  “I have to. You know that.” He hated giving her this news on top of everything else.

  She gave a short, quick nod. “I knew you would.”

  Picking up a mailing envelope, she held it out to him. “These are the old charts you wanted.”

  He took them, wondering what he could say to make this whole thing better. No words came to him.

  She said, “Thanks for giving me an update on Sophie and Grace. I’ll see you on Monday.”

  Before he could stop her, she vanished into the darkness.

  Phillip kept close tabs on Grace overnight. Her bilirubin levels dropped as expected. With no sign of infection or other underlying problems, he thought he’d be able to send her home in a few days.

  By early in the morning, he was able to gradually drop the number of blue lights to one. Her level stayed low and steady. He went home.

  He wanted to call Amber then, but he wasn’t sure what to say. In spite of being exhausted, he slept poorly. The phone rang
shortly after six-thirty the next morning. The news was good. Grace’s levels were much lower.

  He’d had the nursing staff take the lights off for six hours and recheck her. She might have some rebound but he didn’t expect much.

  Waiting was the hardest, so he called to get an update on Sophie. The report he got for her was good. Sophie continued to improve with medication, but she remained under the care of her psychiatrist. It might be several more days before she could be reunited with her baby.

  Getting dressed, Phillip got ready to go into work, eager to see Amber and find out how she was doing. The answer, as it turned out, was not well.

  She came in to work but remained aloof and withdrawn. He missed her smile more than he missed the sea. When he tried to talk with her, she found something to do elsewhere.

  A little after one o’clock, Wilma came toward him with a sheet of paper in her hand. “The hospital called over these lab reports for you.”

  “Thank you.”

  Just then Amber came out of the exam room. She muttered, “Excuse me.” Then she slipped between them and went into her office and shut the door without another word.

  He stared after her. “Wilma, what are we going to do with her? I hate to see her like this.”

  Patting his arm, Wilma said, “She’ll come around. She feels responsible. She’s going to have to learn to live with that. Medicine is not for the faint of heart.”

  “Amen to that.”

  “How are you doing?”

  “Me? I’m fine.”

  “Are you?” Wilma nodded toward Amber’s door. “I ask because you’ve got the same hangdog look on your face that she’s wearing.”

  As Wilma walked away, he glanced at the lab report in his hands. Grace’s bilirubin level had shot back up. Her jaundice had returned.

  This was not right. Puzzled, he went to his phone and called the pediatric unit with orders to restart the lights and retest her in six hours.