With an eye toward the bay, where they hadn’t drawn the curtains, Diana breathed a momentary sigh of relief. The center was familiar to her—her best friend ran the low-cost clinic and was a lifesaver to so many mothers in the community. No doubt the patient was here because of the education the center provided.
Diana’s initial impressions from the hospital monitors were that Francesca’s heart rate and respirations were normal, but her blood pressure was high. Too high. Diana suspected hypertension, possibly preeclampsia. The next second, she mentally worked through the algorithm of her diagnosis and the hospital’s status, which was at capacity. “We’ll have to see what we can do for her here. We might need a transfer because the ward is full.”
“I can start transfer paperwork, just in case,” Cecily answered.
Per professional courtesy, Diana waited for the nurses to do an initial assessment, and she followed up with her own, which included an ultrasound.
At the session’s end, she congregated with Cecily at the nurses’ station.
“She’s going to need an overnight for evaluation. I’m not loving the borderline low amniotic fluid. Let’s do the standard preeclampsia protocol, monitoring, labs, fluids, mag sulfate,” Diana said. “We’ve no beds in L and D. Do you have a spare down here?”
The nurse shook her head as she picked up the phone. “We don’t have any beds available for long-term monitoring, and that waiting room is filling up, too. The ICU is packed to the brim as well.”
“Damn.” Diana’s mind went straight to the logistics: the risk of transferring Francesca even ten miles down to the next hospital; then to her ward with its one last serene bed in a coveted, just-opened VIP suite; then to the incoming celebrity patient who had reserved that room.
The patient’s husband caught her eye. The coats were on the floor, the papers forgotten on his seat. He was gripping his wife’s hand. And as he spoke to the nurse at the bedside, the rest of the ER faded, and Diana heard only his voice. “She never gets headaches. Doesn’t get sick, ever,” he said. “Please tell me we’re staying.”
The decision weighed like a balance, tipping left and right. On the left, policy and money; the right, principle and health. In the middle was her conscience, her judgment, her ideals. The spirit of her grandmother hovering above her. Leora Gallagher, the woman Diana had looked up to, the woman she lost just months ago but, just as she had in life, seemed to find a way to insert herself into Diana’s everyday thoughts.
Leora had risked it all once in her life, and for one tiny baby, too.
“What would Leora do?” Diana said to no one in particular.
“Who’s Leora?” Cecily asked.
Diana shook her head, and the action rattled the balance so the factors jostled in her brain. She said the first thing that came to mind. “Forget it. No need to transfer the patient. We do have a bed upstairs: one of the VIP suites. I’ll admit her to that service.”
Cecily’s eyebrows shot up. “You’re sure?”
Diana took a deep breath. Right or wrong, she had to commit. “Yes.”
Technically, this patient arrived before Winter Storm, and technically, per their policy, those rooms were accessible to everyone, as dictated by census, once they were opened. And Diana knew well that not only was it either feast or famine in L & D, but in this business, it was all good and fun until it went to hell in a hand basket. She was making the right decision.
So why did it feel like, in avoiding the heat of this hell, she had jumped right off a cliff?
Chapter Two
Diana’s instincts had been right. While transferring up to the VIP unit for observation, Francesca’s water broke. After over an hour of active labor, the baby went into distress, prompting an emergency delivery by C-section that—while it brought chaos to the ward—ended well. Mom was fine, though still hooked up to an IV medication to bring down her blood pressure; the baby was stable, admitted to the NICU for overnight observation.
Now, Diana perched on Francesca’s hospital bed. The woman was tucked under the covers in a fresh hospital gown with an IV in each arm, eyes hooded from exhaustion, the sedative effect of pain medicine, and the remnants of anesthesia.
“Do you have any questions about your care?” Diana asked both the patient and her husband, Mike, who stood behind his wife.
“I just want to see the baby.” Francesca’s voice was a squeak. In her expression was a trace of fear. For her, the night had gone much too quickly.
“Of course you do. I’ll make sure I check in with the NICU so they can come down and give you an update. And, Dad, you can always go up there, at any time, as long as you have your security band.” She nodded at the bar-coded wristband that matched their baby’s, smiled, and squeezed Francesca’s hand. She wasn’t much of a hugger, but times like this even she needed to be comforted. She had succeeded in admitting Francesca to this VIP room, with Winter Storm conceding the space until a room on the postpartum ward cleared in the morning into which Francesca would move, but the worst wasn’t over. Her boss had yet to wake up and hear the news. “I’ll go now, in fact, and give them a call. Until then, you should rest, okay?”
“Okay. We need to think of a name still.” Francesca’s eyes blinked in slow motion, as if Diana’s permission was a trigger for sleep.
“That’s right, you do. If you’re taking suggestions, Diana is always a winner.” Diana winked, and with a last squeeze of Francesca’s hand, stood and walked to the suite’s entrance with the patient’s husband behind her. As she stepped out, Mike said, “I want to thank you, Dr. Cary.” His skin had gone ashen, face crumpled into the start of belated panic. “I didn’t know what to do.”
“You did the absolutely right thing by bringing her to the ER. You might have saved her life, and your baby’s. Her blood pressure was very high, and your baby needed a little help coming out.”
“This room, though. We can’t afford it. Heck, we couldn’t even afford the regular room. And I heard people in the ER talking. Did we take this room from someone else?”
“No, no, you didn’t.” Diana bit her cheek, stuck on the explanation of who the VIP room sought to serve and whether this was the appropriate time to explain it. “It’s about priorities, and who medically needs the room. Right now, that person is Francesca. In the morning, she will have to transfer rooms because someone else will need this one. But not to worry about that—the nursing staff will keep you updated. And as for insurance purposes, I’ll be sure to let whoever I need to know that it was my decision to put you in this room rather than transfer out, okay? After all, it was medically indicated.” She raised her eyes over his shoulder, to his sleeping wife. Beyond her, the city’s lights twinkled through plate glass. “But for now, you must rest, too. Your baby is going to need you.”
“Okay.” Mike heaved a breath, and a smile shone through. That smile tugged at Diana, a small reward for the decision she had to make. This would be a mess to sort out in a couple of hours, but currently she had a stable patient on her side.
You’re always right, Granny.
But as she stepped through the hallway’s double doors to the nurses’ station—which was now crawling with day nurses congregating with night nurses during the change of shift—her eyes lifted to the only person not wearing the unit-required scrubs. Suddenly, it was as if her foot had been caught in a pothole in the middle of a fast downhill sprint, and the only thing that came to her mind were three words. Granny’s words, too.