Embryo 1: Embryo

by JA Schneider

  8

  She was exhausted.

  From the stairwell on the fifth floor landing, she sat and looked out at First Avenue: the office buildings, the traffic inching through early sullen darkness that threatened a storm. Trudging people were going home, heading for hot subways, crowding into hot buses.

  For them, Jill thought, the day was finished.

  Her watch read 6:20. Four hours since the death of baby Sayers, nine hours since the Moran tragedy. If only she could fall into a bed somewhere, anywhere, just for a few winks. Her on-call room maybe, or her third floor walkup, or maybe just crash on a gurney in some nice, dark corner.

  Outside was getting so dark that the light in the stairwell cast her scrub-suited reflection on the glass. Her image looked ill. Something else on the glass suddenly moved, and she gave a start.

  “It’s called phocomelia.”

  She turned around. “Phoco…what?”

  David Levine, back in white jacket and pants, held a tape recorder. “The Sayers case. Want to hear about it?”

  She exhaled. She was too drained to say no. It occurred to her that she hadn’t told anyone where she’d be.

  “How’d you know where I was?”

  He sat down beside her, and gazed out at the view. “It’s where I used to come,” he said. “When things got bad.”

  She met his gaze.

  He had said it so simply, yet his words spoke volumes. He had been here: same place, same pain. Three or four years ago, maybe, but still…it was hard to think of him having ever been as vulnerable as she felt now. Jill studied his features. His face showed physical stamina – a trademark of most residents. How do they get that way? But his eyes…he looked so tired.

  Levine placed the recorder between his feet on the lower step. He drew a breath.

  “Phocomelia’s one of the rarest obstetrical aberrations,” he said. “In fact, today’s was the first I’ve ever seen.”

  Jill folded her arms around her knees. “I remember the term. It’s only supposed to happen in textbooks.”

  “Yup.” He grimaced, moved that recorder a bit with his foot. “I don’t think they’d want to hear this on iTunes.” He paused a moment. Then described the fetal growth disorder which, for reasons unknown, suppresses the development of limbs in the unborn. “The whole place is upside down over the Sayers case,” he said slowly. “They’re calling it the Thalidomide baby for some damned reason. Ridiculous. The mother has no history of taking any drug. I’ve been over her chart ten times.”

  “How is she?” Jill asked.

  “Sedated. I’ll be checking on her later…hold her hand or something.” He shook his head.

  Jill watched him. She liked that he was comforting; liked the way he talked, his lack of pretense, and the way those dark blue eyes looked right at her. She looked down. She had so misjudged him this morning. It seemed like long ago.

  “Want to get out of here?” he said abruptly.

  She was surprised. “What?”

  He got up, strode to the door, and held it open. “Come on,” he coaxed. “Wouldn’t you like to get some fresh air for a few minutes? A sandwich someplace near, instead of dinner at the Café Claustrophobia?”

  She stared at him, tongue-tied.

  “My arm is getting tired, Jill.”

  She gestured toward the window, at hazy gloomy First Avenue. “You call that fresh air?”

  “I call it outside. You coming?”

  “Okay,” she said, and smiled.

  It was dinnertime on the ward. They walked past wheeled, multi-tiered carts loaded with steaming trays. At the nurses’ desk he left his recorder to be sent down for typing. Moments later they emerged from the building by the front entrance.

  They stood briefly under the portico, David eyeing the gusty, darkening sky and Jill watching a paper cup tumble along the walk.

  She looked up at him in exaggerated, grateful wonder. “I’d forgotten what air that moved was like.”

  He laughed. They walked down the hospital drive and turned south onto the Avenue. The air was hot and sticky, but Jill didn’t mind; she inhaled as if it was Switzerland. They passed the Madison Pharmacy on the corner, and then a florist and a drycleaner.

  “You spent the rest of the afternoon in the clinic?” David asked.

  “Most of it.”

  “Well,” he said, “while you were there we had two deliveries. Both completely normal. I thought you’d like to know that.”

  “Gee,” she said. “Alert the media.”

  He smirked but said nothing. They turned into the Madison Deli and headed for a booth in the corner. A Garth Brooks song was playing low.

  Jill looked around, savoring the hominess of the place. An exuberant sign over the front counter read EGG ROLLS AND PIROGIES FRESH MADE. A bearded young man at the next table was sketching.

  Jill pushed back her hair and leaned her cheek on her hand. “Thank you,” she said in a long sigh.

  “For what?”

  “For pulling me out of there.”

  He was twirling the tassel on his menu. “Yeah. Bad day.”

  “Disproportionately bad, wouldn’t you say? I realize I’ve just been here eleven days, and that Madison is huge and gets the worst cases and a lot of emergencies – ”

  “Ten in an hour isn’t unusual.”

  “Ten like today’s cases?”

  There was a silence. Then he nodded. “Kinda like a cluster syndrome.”

  A waiter came and poured coffee. They gave their orders and the waiter left.

  “Custer?” she said. “As in Custer's Last Stand?”

  “Don’t be cute. Do you take sugar?”

  “Please.” She watched in surprise as he tore open a sugar packet and poured it into her cup. Then, to her greater surprise, he reached for her spoon and stirred.

  A long moment passed. Now he was playing with sugar packets. “It bothers me,” she said finally.

  He looked at her. “Tell.”

  She ticked off the items on her fingers. “Abruptio, phocomelia, MacIntyre’s stillborn and the Prewitt eclampsia,” she said slowly. “The first two rare, all of them with no antecedent symptoms. Do you suppose…is there any way they could be related?”

  Levine looked quizzically at her. He was about to answer when the waiter arrived with their Cokes and cheeseburgers. He was distracted momentarily. When the waiter left Jill said, “Well? Could they be related?”

  He was pounding an upturned ketchup bottle. “You’re serious?”

  She nodded.

  “You mean, related related, like common etiology and all that?”

  She shrugged and nodded again.

  “Eat your cheeseburger.”

  She stared down at her plate. There was a rumble of thunder outside, and she shivered.

  They ate silently for a few moments. Levine looked thoughtful. “Jill,” he said finally. “At a place like Madison, the only rule is the exception. Words like ‘disproportionate’ just don’t apply. As for those tragedies being related…” He shook his head sadly. “Nothing today had any common symptoms. Abruptio and phocomelia are poles apart medically. They were isolated tragedies, it’s just freaky that they happened on the same day but…”

  He shrugged his shoulders, at a loss.

  “I know,” Jill said. “Cluster syndrome. Words like ‘disproportionate’ don’t apply. The only rule is the exception.”

  Levine’s phone beeped. “Shit!”

  He answered and spoke briefly.

  “What’s up?” she asked as he rang off.

  “I’ve gotta go back.” He glanced at their unfinished food. “Do me a favor? Eat for two?”

  She shook her head. “I’m coming.”

  Outside, fat drops of rain fell as they started to run. Past the florist and pharmacy, across the side street against the light – cars stopped, horns blared – and up the drive toward the portico. With a hoot, David pulled ahead.

  “Hey, wait up!”

  On the sidewalk
outside the overhang he stopped and waited, grinning, his hands jammed into his white jacket pockets. The rain was heavier now and the wind was gusting. His face, like hers, was wet from the downpour. His dark hair blew about, but in the manner of a man used to the outdoors he made no move to push it from his brow.

  Heart hammering, Jill only half pretended to collapse into his arms. He caught her, laughing, and they looked into each other’s eyes. He brushed aside a strand of her long wet hair. “Are you going to be on call tonight?”

  “Yes,” she said, still puffing. “You?”

  “Yup.”

  He let go of her. Saw that her scrub suit was so wet that it clung to her curves, and felt an ache. Then he pulled off his white jacket.

  “Put this on,” he said. “Don’t walk through Emergency like that.”

  She understood – “Oh, ga-a” - and lowered her eyes to hide her embarrassment.

  He helped her on with the jacket. Stepped forward and kissed her on the cheek. “You’re too much,” he teased.

  Inside, looking at the throng in the main entrance, Jill said “Are you going to see Sayers? The phocomelia…?”

  “Later, if she’s awake.” David checked his watch. “Gotta run.” He smiled again and hurried off.

  “Maybe I will too!” Jill called after him, then realized he hadn’t heard. Broad-shouldered and lean, he moved fast across the teeming entrance hall and in a moment had disappeared from sight.

  9

  She took the elevator, and for once didn’t mind the press of the crowd or the fact that half of them were visitors in soggy raincoats. Her mind was clearing, sharpening, replaying her noontime conversation with Tricia about researching cases.

  On the OB floor she hurried up the hall, stopping briefly to peer in at the nursery. The sound of squalling was muted by the glass window. Three nurses wearing surgical masks moved among the rows of isolettes – the babies up front could be seen squirming or sleeping or screaming. Jill looked closer, a smile flickering across her face. Then she remembered the day’s events, and the smile vanished. She turned and hurried on.

  In the women doctors’ lounge she changed into a dry scrub suit and threw her wet things and David’s jacket into the hamper. She left the lounge and walked to the nurses’ station. “I’m taking the Sayers chart,” she said casually to the nurse on duty. The woman smiled vacantly and went back to her pile of order sheets. Jill pulled out the chart she wanted and carried it to the male doctors’ lounge.

  Still twice the size of the other, this one had a front sitting room that served as a general gathering area. She could hear someone in the shower around the corner, but the vinyl chairs in the front room were empty and the coffee table was covered with half-filled mugs of cold coffee: Tricia’s bright red one, Woody Greenberg’s with the painted bunnies, somebody else’s with the words, “Oh fuck it!” On the wall over the sagging couch was a lavish 1940s poster welcoming everyone to the Stork Club.

  Sitting before the coffee table, Jill opened the chart and glanced at the wall clock. It was 7:40.

  SAYERS, MARY JO, read the label on top. The patient had been in the hospital barely six hours and her chart was already thick. That was common for cases that turned out badly: the number of notes and lab tests alone was prodigious.

  Jill flipped pages until she came to “Delivery Report.” The white sheet was covered with David’s scrawl. He had written the date and time at the top and then, in large shaky handwriting, had described the case. The patient had gone into premature labor at an estimated twenty-two weeks’ gestation. The first stage of labor, beginning with the initial contractions, had lasted just two hours. Duration of the second stage was thirty-five minutes, culminating in a shoulder presentation accompanied by meconium-stained fluid and signs of fetal distress. Five minutes more elapsed until the third stage of labor – delivery of the placenta – at which point an umbilical vein blood specimen was taken and rushed to the lab.

  A long, shaky line was drawn under the last sentence. Next came a new paragraph, followed by more terse language describing the physician’s findings. The newborn, weighing two pounds, was grossly abnormal with vestigial limb buds. Diagnosis: phocomelia. Apgar rating 1. Infant tachypneic – rapid, shallow breathing – with a respiratory rate of 70. Infant succumbed at 14 minutes despite intensive efforts to resuscitate.

  Slowly, Jill began to turn pages again. She had no idea what she was looking for – what could she be looking for – but some impulse kept her from closing the chart.

  The shower in the other room had turned off, and a man’s humming could be heard along with much slamming of locker room doors.

  Jill continued reading. Let’s see…progress notes, nurses’ notes, more lab results, a history and physical done several months ago…

  She stopped, staring. Her eyes moved up to the top of the page; she stared again.

  Mary Jo Sayers had had a routine GYN exam on January 27. Today was July 11; Mary Jo delivered her premature child at twenty-two weeks’ gestation, or five and a half months. Jill counted on her fingers to make sure her math was correct. Then she looked up at the darkened, rain-streaked window.

  January 27 was exactly five and a half months ago.

  Mary Jo got pregnant on the day of her routine exam.

  Well, so what did that prove? A coincidence? Probably whoever did the exam was one of the hospital’s cuter interns or residents, and Mary Jo got all steamed up and ran home to her husband or boyfriend.

  Jill looked at the report again. It was one simple page. A routine exam on a healthy young woman. Handwriting she didn’t recognize. So who was the examining doctor? And why hadn’t he or she signed the report? The only identification was the sheet of paper itself: letters at the top read Madison Hospital Gynecology Clinic.

  David had said in the delivery room that Sayers was a Ph.D. candidate. Many students came to the outpatient GYN clinic because it was free.

  This is silly, Jill told herself. The gestation estimate was approximate. Sayers could have conceived a day or two before or after her exam. Her periods could have been irregular.

  “Hey! How’re you doing?” Sam MacIntyre came out of the shower room in a fresh scrub suit.

  “Confused,” Jill said absently.

  “Great!” Mac called back just as absently and headed out the door.

  This place. Smart people with brains scrambled from overload.

  She quick-scanned Mary Jo Sayers’ exam. She was a white, twenty-eight-year-old with no history of medical problems. She used no drugs or medications, didn’t smoke, rarely drank, had no allergies. There was no inherited illness in her family. Her job did not bring her into contact with chemicals or pollutants.

  Jill rose and brought the chart back to the OB nurses’ station. Then, crossing the foyer, she approached the elevators and pressed the down button.

  This is stupid, she told herself. Get an hour’s sleep. You could get called any minute.

  On the ground floor she made her way to the E.R. nurses’ station.

  “Do you still have the chart of Maria Moran?” she asked. “The patient was admitted this morning.”

  A middle-aged nurse smiled pleasantly and bent to look. “Moran…Moran…” she echoed, her fingertips moving down the file beneath the counter. Jill peered over to watch, then pulled back as the nurse straightened and shook her head.

  “No Moran. Sorry.”

  A clerk wearing glasses looked over. “Moran? I remember that name. Look in the out basket.”

  The nurse did. Tilting her head and reading sideways, she said “Aha!” and pulled a chart out of the tall pile. Smiling, she handed it across.

  Jill thanked her. “Busy day, huh?” she said, already flipping open the cover.

  “They’re all busy,” said the nurse. “You were lucky to find that one. Another five minutes and it would’ve been on its way down to the record room.” She reached to answer a phone.

  Jill flipped through the Moran pages, skipping pastel sheet
s until she came to the cream-colored one. At the top were printed block letters: MADISON HOSPITAL GYNECOLOGICAL CLINIC. To the right, in neat block letters, were the patient’s name and the heading “annual GYN exam.”

  Another plain, routine exam.

  To the left was the exam date: January 3.

  Jill looked up, her heart thudding. About twenty feet away, the sliding doors to the ambulance bay were open, exposing the glistening night. Two policemen and an orderly were struggling with a laden stretcher; somebody shouted that another stretcher was coming. The wind strengthened, sending a blasting sheet of rain into the vestibule.

  Frowning, Jill went back to the Moran chart. On the pathology page her pregnancy was estimated at twenty-five weeks.

  January third plus twenty-five weeks brings it to today…

  And December 20 was the date of Moran’s last period. Which made the exam the same day she was ovulating.

  Two coincidences?

  Gently, Jill closed Maria Moran’s chart, the gesture itself a reminder of a young life that was over.

  Her hands trembled. In a sick wave of memory she recalled that the hospital morgue, in the basement, was just below her feet. They must be there, she realized, looking down. Tiny Christopher Sayers and Maria Moran, her body in death still cradling her never-to-be-born child.

  Jill shivered, but not from the chill coming through the open doors.

  Outside, the sky lit up and thunder crashed.

  Shortly after nine o’clock, during a lull, Tricia Donovan went to the nurses’ station looking for the eclampsia chart. She couldn’t find it. Couldn’t find the nurse either. Frustrated, she went to the doctors’ lounge, where she found Gary Phipps and Charlie Ortega hunched over the chart she was looking for.

  She peered over Gary’s shoulder. “The Prewitt chart?”

  “Ah, yeah,” he said, looking up. “It’s been bothering us.”

  “Thought you said the hospital knew what it was doing,” Tricia challenged.

  Phipps glanced uncomfortably at Ortega, who was scanning a lab sheet. “The problem is,” he said, “we wouldn’t know what to do if a sudden idiopathic eclampsia came in. You were right. This one is weird.”