1
The second my pager goes off, I know it’s going to be bad news. Nothing good is ever paged at the end of your shift. I stop in the middle of the hall—my back sore and my neck stiff after fourteen hours on my feet—to check the pager when a nurse comes barreling down the hall.
“Dr. Carter, they need you in the ED stat. They have a thirty-three-week pregnant woman with severe painless vaginal bleeding.”
“Previa?” I question, reading through the page that says the exact same thing she’s telling me.
“Don’t know. She’s not our patient.”
“Tell them I’m on my way.”
Without another word, or even so much as a complaint since my shift technically ends in ten minutes, I run for the elevator, hitting the button. Just as the doors open and I step on, Grace Hammond, my resident—and my younger brother Oliver’s best friend—steps on beside me.
“You got paged too?” she asks, her voice soft and slightly melodic the way it always is even after a long day of delivering babies and performing surgeries. She leans back against the wall, folding her arms over her chest.
“Yep,” I reply, shifting slightly so I’m not so close to her. So the scent of her floral, coconut shampoo doesn’t infiltrate my senses. I hate being so aware of her. Still I can’t help but surreptitiously take her in. Grace’s blonde hair is wrapped up in a tight bun; her blue scrubs a shade darker than her luminous eyes that never seemed dulled by the grueling hours or the fluorescent lights.
I look away, chastising myself for the tenth time today.
“I thought you were off at seven.”
“I am,” I tell her. “But I got paged, so that’s how it goes.”
“Previa?” she guesses, clearly having the same thought I was. Heavy, painless vaginal bleeding in a pregnant woman in her third trimester can be signs of a lot of things, but a placenta previa—where the placenta covers the cervix—is usually at the top of my differential diagnosis.
“Probably, but we’ll see once we get in there. She’s not a patient on our service.”
Just then, the doors to the emergency department open and we’re immediately greeted by Margot, my sister Rina’s best friend and a nurse here in the ED. She starts talking a mile a minute, setting off at a good pace as she updates us on the patient while we head toward the trauma room.
“Thirty-year-old thirty-three-week pregnant woman, G1P0 presented complaining of heavy, painless vaginal bleeding. Vitals so far are stable, but she’s losing blood as quickly as we can give it to her, and her heart rate is tachy in the one thirties. Her blood pressure is a little low but holding at 96/62. Stat ultrasound confirms baby is not in any distress, but the placenta presents very low. Likely the cause of the bleeding, but since we can’t do a transvaginal ultrasound, difficult to tell if it’s a full previa. Patient reports no prior knowledge or diagnosis of a previa.”
“Alright,” I say, as we approach the trauma rooms. “Have you notified the OR yet?”
“Yes. They’re already on standby and so are peds and the NICU. They’re just waiting on you.”
“You look a little flustered, Margot,” I comment dryly, noting her flushed cheeks and messy dark curls. “All going smoothly down here?”
She flips me off without missing a step. “It’s July, Carter. Do you know what that means?”
I laugh under my breath as does Grace. “New interns,” Grace replies, because yeah, we have them too, though Grace seems to like her newbie, Dylan. I hate July. And August, for that matter.
“Yes,” Margot expels dramatically. “New fucking interns who think they’re God’s gift to medicine and that nurses are placed on this earth to do their bidding. I had to literally smack one of their hands away because he was about to attempt a pelvic exam on this woman. Can you imagine?” She looks to each of us, horror in her brown eyes. “Did he not realize that sticking his hand into a bleeding vagina with a high likelihood of a previa could possibly cause a placental rupture?”
This is why Margot is a kick-ass nurse.
“Obviously not,” I comment. “He’ll quickly learn that nurses save lives that interns attempt to collect. Thank you for that.” And I mean that genuinely. I can’t count the number of times nurses have not only saved my ass, but the asses of fellow doctors.
“Any time. Though I highly doubt it will be the last today I have to stop one of them from doing something stupid. The patient is in here.” She points to the door, and we stop in front of the trauma room. “Her name is Marissa, and she’s scared shitless. Her husband was at a conference, and we were finally able to get through to him. He’s on his way now.”
“Thanks,” Grace says, spinning around pushing open the door of the trauma room with her back as she talks to Margot. “You still coming tomorrow night?”
“I think so. I have to see what time I get off. Rina will be there for sure though. Same with the other girls.”
Grace gives Margot a wink and then we plow through the doors, straight into action. I nearly have to shove two interns out of the way—Margot wasn’t kidding with how fucking inept they are—and then Grace and I get to work. We assess the mother’s condition as well as the fetus’s. Within minutes we determine that yes, she’s losing too much blood from her previa to be stopped down here or even at all.
We have about ten minutes max to get this baby out of her before the mother goes into shock from blood loss and the baby goes into distress.
“Marissa,” Grace soothes, coming right up to the patient’s face, hovering over her and gently squeezing her shoulder. “We’re taking you up to the OR now. You’re going to deliver the baby.”
“No,” Marissa cries through her oxygen mask. “It’s too soon.”
“Unfortunately, we don’t have a choice. We need to do what’s best for both you and the baby, and that’s delivering it. I know you’re scared, but we’ll be with you every step of the way. Don’t worry, we’re going to do everything we can for you both. You’re in excellent hands.”
Grace gives her that warm smile, the one that always gets through to patients, and then we’re moving. Margot and another nurse are pushing the gurney as we all head for the elevator at a quick pace.
“You scrubbing in on this or is someone else taking over for you?” Grace asks me.
“I’ll take it. I’ve come this far.” We all step onto the elevator, the doors shutting. “What are you doing tomorrow night with my sister?” I question softly as my eyes cling to the glowing numbers as we ascend.
“Girls’ night. We even managed to force Amelia to come.”
Amelia is Oliver’s girlfriend. Oliver and Grace have been best friends since infancy. And forever, people just assumed they’d be a thing, but it never happened. They view and treat each other as siblings.
You’d think that would have made Grace an unofficial part of the family and I guess in a way it has. But not for me. I went away to college and then medical school. Did my residency down in Virginia Beach, only returning to Boston last year as an attending.