The Heart Doctor and the Baby

by Lynne Marshall

  Lisa was due to deliver her first baby in three weeks, and she’d had a smooth pregnancy up to now. They’d often exchanged pregnant anecdotes with each other, and had developed a special bond because of it.

  “What’s wrong?”

  “She didn’t really say, just that she doesn’t feel right.”

  A flashing yellow light blinked in the back of René’s mind. Lisa wasn’t a complainer or a hypochondriac; if she thought something wasn’t right, René knew she should look into it.

  “Tell her to come right in, and let Amy know.”

  Forty-five minutes later, a very pregnant Lisa sat on the exam table making René feel small in comparison.

  “What brings you in today, Lisa?”

  “I feel like I can’t catch my breath.” She punctuated her words with shallow gasps.

  With her uterus pressing on her diaphragm, René knew it was a common complaint, yet she took her pulse, which was rapid, and listened to her lungs and breath sounds, which were also fast, though her lungs sounded perfectly normal. Her blood pressure was mildly hypotensive, but within her normal range.

  “Any chest pain?”

  “I wouldn’t call it chest pain. I just don’t feel right.”

  “We’ll get an EKG to rule anything out. Have you had any unusual leg pain or injury recently?”

  Lisa shook her head. From her history, René knew Lisa had never had coagulation problems, but pregnancy could sometimes pull some pretty hairy cats out of the bag.

  To be on the safe and thorough side, René examined her patient’s lower extremities, and though no varicose veins were present, she did locate one tender area on the back of Lisa’s calf beneath a small bruise. “I’m going to order a D-dimer blood test, and if it’s positive, we’ll do an ultrasound of your leg to rule out deep vein thrombophlebitis.”

  “What’s that got to do with being out of breath?”

  René didn’t want to scare Lisa, but if she did have DVT, a pulmonary embolism could be the cause of her shortness of breath. There was no way she’d tell her that; though rare, pulmonary embolism was the leading cause of maternal mortality during pregnancy and up to six weeks postpartum.

  “It’s just a precaution, Lisa. I need to rule out all the possibilities before I make my diagnosis. Your lungs sound normal, no crackles or wheezing, so that’s good. Let me have my nurse check your oxygen saturation and do that EKG before you go to the lab. We’ll figure this out before you leave today, I promise.”

  Making a diagnosis of pulmonary embolism in a pregnant woman was a tricky task due to the tests required and concerns about fetal radiation exposure.

  “I’d like you to stick around while we wait for your STAT lab results.”

  Lisa nodded, and René waddled off to see her next patient, but her mind stayed on Lisa. She wanted to discuss the case with Phil, the pulmonary doctor in their practice. After she’d seen the other patient, she called Phil’s office, but he wasn’t there.

  When she inquired where he was, her nurse, Amy, told her it was his morning to do bronchoscopies at the hospital. She knew that. Her memory seemed to have shrunk in direct proportion with the growth of her abdomen. René lifted her phone receiver to call Jason, the family practice guy in the group, then remembered that after Jon had come back from vacation, Jason and Claire had left on theirs.

  That left Jon, the person she’d dodged for the past month. The person she was trying her hardest to forget and get over. Patient well-being trumped her personal concerns, so she walked to the back of the mansion-turned-clinic to find him in his office.

  He was on his way out, focusing on a report and heading for his closest exam room. “Oh,” he said, when he noticed her, his pupils briefly widening, then going back to normal.

  “Can I run something by you?” she said, itchy with discomfort and confusion at being so close to him.

  “Of course.”

  She gave him the thumbnail sketch on Lisa. She refused to look into his dark stare and, instead, she noticed the intricate geometrical interlocking pattern on his forest-green tie.

  Before she could finish with Lisa’s history, Amy rushed up. “It’s positive. The D-dimer is positive.”

  René thanked her. “Have you done the EKG? Oh, and put her on oxygen before you call for medical transportation to the hospital. She needs to go to the E.R. for an ultrasound of her leg and further testing.”

  “You might want to get a normal saline IV going, too,” Jon said.

  She and Jon stood in the hall and discussed the tricky situation of diagnostic testing for PE in a pregnant woman. They agreed the best test would be a ventilation perfusion lung scan, and if that proved indeterminate yet the clinical suspicion remained, pulmonary angiography would be a necessary evil. She hated to put both mother and baby at risk, but knew something much worse could happen if they didn’t treat a blood clot lodged in the lung. She worried about ordering a test for a pregnant patient that would involve radiation, even though in low quantities, but Jon pointed out the V/Q scan had the least radiation of any other diagnostic tests for PE.

  Being able to discuss the medical possibilities with Jon was reassuring and she was grateful to have him here. She’d missed his knowledgeable input, but more importantly, his friendship. Maybe it was time to let him know exactly how she felt. Maybe after all this—

  Before she could say a word, the interdepartment alarm went off. “STAT patient assist in first-floor waiting room.”

  René’s pulse spiked to where she could feel it in her temples. A sinking feeling had her praying it wasn’t her pregnant patient. She and Jon rushed to the front of the clinic to find Lisa collapsed on the floor with a huddle of people around her.

  Jon directed Amy to take over crowd control while he rushed for the crash cart. René went down on her knees beside the patient and felt for her pulse. Lisa was semi-conscious, and fighting for air.

  “Get some oxygen over here, and call an ambulance. Gaby, call her husband and tell him to meet her at the E.R. Cough for me, Lisa,” she said, hoping the exertion might help break up any potential lung clot blocking her breathing. Lisa did as she was told, but with little effort. Once the oxygen mask was in place, René asked her to cough again, and she coughed a little harder.

  “I’m afraid I’ll wet my pants,” Lisa said.

  Relief showered over René, and she grinned. If a patient was worried about wetting themselves, they couldn’t be too far gone. “You’re going to be okay, Lisa. Hang in. We’re going to get you to the hospital.” Hopefully it was a small clot that would resolve easily with treatment.

  Jon and Amy lifted Lisa onto a gurney and they rolled her into the first-floor procedure room.

  Jon inserted an IV, and René calibrated the patient weight and started the appropriate amount of heparin via piggyback into the IV. Because the drug didn’t cross the placenta, it was the safest anticoagulant to use during pregnancy.

  Jon stood by the crash cart with the Ambu bag in readiness, as Amy set up the heart monitor and pulse ox. The patient’s vital signs were challenged but stable. And most importantly, her oxygen saturation was within normal limits.

  The strain and fear evident in Lisa’s eyes tore at René’s heart. How would she feel in the same situation? Scared to death! She held Lisa’s hands tight and leaned over her. “We’re going to get you through this.”

  “What about my baby?”

  “Little Sara’s going to be fine. It’s you we need to focus on right now.” Unlike René, Lisa had insisted on knowing the sex of her baby.

  When the ambulance siren ripped through the air, René let go a relieved sigh. “The E.R. will do any tests necessary to rule out pulmonary embolism, and they’ll treat you with anticoagulants. We caught it early thanks to your suspicions about something being wrong.”

  Fifteen minutes later, with the patient in stable but guarded condition and on her way to emergency, René called in her report to the local E.R., only then noticing how shaky her hands were. When s
he’d finished, she called Lisa’s husband on his cell phone to bring him up-to-date. Lisa’s support system was in order. Her husband would soon be at her side. This was a luxury she didn’t have, by choice, at least in the beginning. Now she wondered how big of a mistake her original and seemingly well-thought-out plans had been. The baby kicked in protest, and she gasped.

  Jon rushed to her side. “Everything okay?”

  She nodded. “Just a little shook up from all the excitement.” Completely aware of his hands on her shoulders, she’d missed him, missed his company and friendship, and wished with all her heart things could be different.

  “Let me bring you a cup of tea from the kitchen.” In a flash the warmth from his touch disappeared.

  “Thank you,” she said, enjoying the brief respite in their strained relationship. “I’ll meet you there.”

  She made one last quick phone call, took a deep breath and gathered her shaken wits, then followed him down the hall.

  They sat together in the kitchen and sipped the peace-offering tea, and for a fleeting moment René pretended life was as it had been before she’d asked him to help with her pregnancy plan.

  “There’s something I want to tell you before you hear it anywhere else,” he said, shifting in his chair, giving a wary glance.

  She held her teacup with both hands, within sipping distance, swept her gaze from the pale honey-colored liquid to the tentative set of his eyes and the deepening crease between them.

  “I’ve decided to take a job with another practice, and I’ll be gone before you come back from maternity leave.”

  Afraid she’d drop the cup, she set it on the table before it could spill. Her throat tensed and her stomach cramped. She carefully schooled her expression, working to shut down the sudden anxiety as it nipped at her composure.

  How should she respond? I’m sorry I’ve chased you away. I’m sorry I used you, if that’s what you think. Please know I never thought of it that way. But as she stared at a lone crumb on the table, all that came out of her mouth was, “I’ll miss you, Jon.”

  She’d sacrificed their friendship and would have to pay the price. Their contract relieved him of any obligation to their child; he’d only agreed reluctantly to signing it in the first place, and with one major stipulation—that no one would know he was the father.

  Rumors and suspicions were flying around the office like unwanted flies. It was only a matter of time before someone put it together. Maybe he should get out before her misguided plan could cast an unbecoming shadow over his spotless reputation.

  How could she be disappointed? She’d set every single stipulation in place. Why should she feel abandoned? He’d never once promised to stick around. She swallowed the surprising words throbbing in her throat—What about me? Do you care at all?

  “I’ll miss you, too,” he said.

  They sat in strained silence, her unspoken words tensing the air.

  A muscle worked in his jaw, as if he had something more to say, but thought better of it. He stood. “Guess I’d better get back to work.”

  She blinked. That was it? How could she suddenly be so angry at him? She had no right. He wasn’t a mind reader. He didn’t know how she felt about him. But damn it, she was angry. Furious.

  She wanted to hate him for being so casual about up-ending her life. Why did he have to keep coming around? Why had she let him? Hell, even his daughters liked her. Why couldn’t she win him over?

  Thanks to Jon she would have a baby of her own. Though she wished with all of her might that things could be different, under no circumstances would she let him back. The pain of losing him once had been enough for a lifetime.

  Her mother’s famous saying whispered through her mind again—be careful what you wish for—and the hair on her arms stood on end.

  Two weeks later, on a bright fall morning, Jon walked with Phil Hanson from the clinic parking area. Phil had a smile on his face, and Jon figured that meant he’d had a great date the night before.

  “How do you do it, my friend,” Jon asked.

  “Do what?”

  “Survive out there in that sea of women.” Jon had felt nothing but icicles whenever he and René were in the same vicinity at the clinic since he’d told her he was changing jobs. He wanted things to be the way they were before, but took responsibility for messing them up. If he could take back that moment of weakness when he signed her contract, rationally believing he could handle it, he would. Yet the crazy contract was what had brought them together like never before. Would he trade their intimacy for the status quo?

  He hated the confusion.

  “Ah, waxing poetic this morning, I see,” Phil said, with a Jack Nicholson smile and sunglasses to match.

  If he’d been released in a sea of women, he’d surely be dead, because he could barely survive the effects of one special person. René. She’d talked him into her motherhood plan, and he’d taken things one step too far. Now he’d been relegated to mere office associate, and the whole thing stunk to high heaven.

  “Nah, just licking my wounds,” Jon said.

  Phil’s smile took on a whole new dimension, as if they were old military buddies and had been in battle together. “You think I never have to do that? Come on, a man works without a net and he’s bound to get hurt.”

  “What do you mean?”

  “Us guys jump into dating with our zippers opened and forget about the consequences. We forget about the Pandora’s box of complications that goes along with sex. Once the ladies find out we’re really as shallow as they suspected, they dump us. What do we do? We dust ourselves off and jump right back in with someone else. It’s a wild ride.” He patted Jon on the back, and forked toward his office next to René’s. “But it’s exciting and well worth the adventure.”

  Jon stood watching him, wondering if that counted as a heart-to-heart talk between guys. And more importantly, had he learned anything?

  Yeah, he’d learned that René deserved someone more exciting than him. Wasn’t that what Cherie had opted for after seventeen years?

  He glanced in the direction of René’s office, but her door was closed. She hadn’t arrived at work yet.

  He thought about her every single day and hated the fact that he’d fallen for her. She hadn’t bargained for that, didn’t deserve the extra frustration, and though it had been the toughest thing he’d ever done, he’d stayed out of her way the past couple of weeks like she’d wanted when she’d slammed the door in his face.

  They’d signed a contract and he’d honor it.

  Damn straight he would.

  By midmorning, Jon couldn’t help but notice René still wasn’t at work. He checked his calendar to see if he’d miscalculated the beginning of her maternity leave. Nope. Not due off for another two weeks.

  He strolled out to Gaby, who talked excitedly to René’s nurse, Amy. “Did you hear the news?”

  “What’s up?” he said.

  “Dr. Munroe is in labor!”

  CHAPTER ELEVEN

  JON raced into the maternity ward, straight to the secretary’s desk. He leaned over the counter, catching his breath. After he’d told Gaby to cancel all his appointments for the day, he’d broken a speed limit or two on the drive over. Though he worked closely with this hospital, Labor and Delivery wasn’t a regular stop on his rounds.

  Fortunately the ward clerk recognized him from when he’d followed up with Chloe Vickers’s heart condition.

  “I’m looking for René Munroe,” he said, breathless and practically vibrating with excitement.

  “Hi, Dr. Becker. She’s in labor so she’s not having visitors.”

  How should he put this, direct and to the point? “I’m not a visitor, I’m her birth coach.”

  That got the clerk’s attention. From above her computer monitor, her eyes sprung open and she gave him a disbelieving stare, complete with eyebrows nearly meeting hairline. “You’re her coach?”

  He nodded, putting on an air of authority, while st
raightening the knot of his tie and catching his breath. “Where is she?”

  The clerk pointed him to the room number, and he rushed around the corner. The labor room was surprisingly homey with hardwood floors, an overstuffed chair next to the hospital bed disguised by a bright quilt comforter and soothing pastoral prints framed and hanging on the walls. But she wasn’t there. He stepped outside and glanced up in time to see her walking toward him. She pushed an IV pole along the carpeted hall, and was draped in nondescript hospital gowns, one on backward acting like a robe to cover her hind end.

  Surprise stopped her midstep when she saw him. “What are you doing here?”

  “Reporting for duty. I’m your birth coach.”

  “No, you’re not. I dismissed you, remember?”

  He’d play along, but having let her down enough lately, he had no intention of leaving. He pulled on his ear. “It was so obvious that you didn’t mean it.”

  She tossed a glare at the ceiling. “Did so.”

  He decided to try the tried-and-true distraction method. “Who’s helping you?”

  “I’m doing fine by myself.”

  “When did you go into labor?” he said, joining her step for step.

  “Last night.”

  “Why didn’t you call me?”

  She broke the pace. “Because you’re not my coach anymore.” Irritation oozed over each word. He knew how edgy labor could make a woman, and chose to ignore it.

  “How far dilated are you?”

  “None of your business.” She resumed the pace.

  He took off his jacket, flung it over his shoulder and loosened the knot of his tie. “I’m not leaving.”

  “Nurse?” she said, to a passing L&D employee in bright pink scrubs and with a blond ponytail halfway down her back. “I don’t want him here.”

  She turned out to be a student nurse, who had no idea how to handle the situation. “I’ll get the charge nurse,” she said, looking at a loss and extremely anxious.

  Ha, Jon thought, he knew one of the L&D charge nurses. He’d taken care of her father’s heart attack last year. If he was lucky it would be her and he’d convince her to let him stay regardless of what René said. In the meantime, he followed her down the corridor.