Visiting Hours

by Tagan Shepard

  Alison all but sprinted to the bed and wrapped her friend in a hug. She tried not to let the worry lines show between her eyebrows when she drew back and perched on the edge of the mattress. She failed. Beth laughed, running her thumb over them to smooth them out.

  Alison asked in a mock serious voice, “How’s the Jell-O?”

  Beth shook her head. “Lime.”

  “Blech! Inexcusable!”

  “I know, right!” Beth looked over Alison’s shoulder and asked, “Would it be so hard for you people to stock cherry?”

  Dr. Baker stood near the door. “We save the cherry for the visiting heads of state and celebrities.” She took a hesitant step in and continued, “If this is a bad time, I can come back.”

  “No, Doctor, please stay. Stephen was just here.” Beth looked around the room as though she had misplaced her keys rather than her husband. “I’m sure he’ll be right back.”

  “I’ve told you a thousand times to call me Jess.”

  A voice from the hallway said, “Then you only have a thousand more to go before it sinks in.”

  Stephen had to duck his head to enter the room. His blond hair was pulled back into a short ponytail that fell just to the collar of his shirt. As he stood to his full height of just over six and a half feet, he reached out to shake the doctor’s hand. “Sorry to keep you waiting, Jess.”

  Stephen went straight to his wife’s side and kissed her cheek. He smiled at Alison before retreating behind Beth and fluffing her pillows.

  Dr. Baker pulled a rolling stool closer to the bed. “It’s my fault. I had a run-in with a cup of coffee. Literally. Then I had to try and lose a tail.” She smiled at Alison again and continued, “I’m afraid I couldn’t shake her. She followed me here.”

  Alison knew the color was rising in her cheeks and forced herself to look nowhere in particular. Stephen saved her. “It’s a good thing you brought her along. All of the decisions in this house go through Ali.”

  He laughed when he said it, but his nonchalance immediately chafed Alison’s nerves. Stephen was a wonderful man and a doting husband, but she wished he would take life more seriously. He was a gifted landscaper and could be designing gardens for the governor if he had any ambition whatsoever. Instead, he made just enough money to contribute to the household expenses, and left work early every day to play with their two-year-old daughter.

  “Well, then let’s get to it!” Dr. Baker’s entire aspect changed. Her eyes seemed to harden and a more neutral expression replaced the smile. “I’ve spoken to the Blood Bank. They’re putting in an order for the transfusion. It will take a little bit of preparation, and the OR isn’t available until tomorrow morning anyway. I was able to book it for ten o’clock.”

  The nonchalance evaporated from Stephen’s voice. “How long will the transfusion take?”

  “A couple of hours. Three at the most. After we’re done, there will be some minor testing. Beth, you’ll be under local anesthesia only. I’ll need you to keep me updated on how you’re feeling during and immediately after the procedure. You’re going to take an active part, but don’t worry, I’m going to talk you through everything.”

  “Can I be in the room?” Stephen asked.

  “Not for this one, Steve. I’m sorry. There will be a lot of movement in and out of the room, so we need to limit the number of bodies. Just as a safety precaution. I was able to get the operating theater, though, so you can watch the whole thing from box seats.”

  Beth gripped Alison’s hand like a vise, but her voice was steady as she addressed the doctor. “Tell me again what happens if you miss the vein?”

  Jess rolled forward a few inches, her voice smooth as silk. “If we can’t get to the umbilical vein for some reason, we can transfuse into his abdomen. He’ll still get the blood, we just won’t be able to give him as much. We might have to do a second procedure sooner than planned. Either way, he’ll get what he needs.”

  All the organs in Alison’s body had turned to cubes of ice. “I’m sorry to interrupt. I know I’m coming late to the party here, but exactly how late am I? What procedure? What blood?”

  She looked at Beth and didn’t even try to hide the worry. Her friend answered, “I’m sorry, Ali. It was just too much to tell you over the phone.”

  There was a light tap at the door and a stocky woman rolling a cart full of supplies stepped in. “Good afternoon. I’m from the lab. Just here to draw some blood.”

  “Yes. Thank you.” Dr. Baker turned to Beth and Stephen. “They have to do a lot of testing before the transfusion, so I’m going to get out of her way.”

  Beth let go of Ali’s hand and grabbed the doctor’s. “Dr. Baker.”

  “Jess.”

  “Jess, would you mind explaining everything to Ali? It’s just so complicated, and she’ll have a lot of questions I know I won’t be able to answer.”

  “Of course.” She said to Alison, “Why don’t we step outside and we can talk over in the waiting area?”

  Beth eyed the needle being prepared with something akin to terror. She’d always been afraid of needles. Sometimes she even cried when she had blood drawn, or so she said. These days she preferred to lose her dignity not with Alison but only in the presence of her husband, so Alison couldn’t be sure. Stephen gave her a friendly wave and she followed Dr. Baker down the hall.

  Waiting area was something of a grand name for the space. It was just an alcove with a couple of faded chairs jammed inside. She sat heavily in one of them, wanting to be back in Beth’s room talking to her instead of a stranger with a fauxhawk.

  Dr. Baker sat down facing her. “Where should we start? How much do you know about Beth’s pregnancy issues?”

  ‘Issues’ was not exactly the word Alison expected from a doctor about her friend’s medical state. Her reply had a snap to it.

  “I know she has a healthy daughter, but she’s had three miscarriages in the last two years. I know all of them were caused by her blood attacking the babies’ blood. For some reason Rhogam doesn’t help even though that’s what it is supposed to do. I know she’s been to five different doctors at three other hospitals and the last one told her she should just stop trying. And I know if you tell her that, you should prepare for her to get up and walk out of that room right now.”

  Dr. Baker laughed and sat back in her chair. “Well I won’t tell her that. At least not yet.” She looked thoughtful for a moment before continuing, “I guess I should start by telling you why Rhogam isn’t helping her. Rhogam is a drug used for mothers whose Rh blood types don’t match their baby’s. Most people know blood types as their ABO type and their Rh type. For instance, my blood type is A positive. That means my ABO type is A and my Rh type is positive. Positive means Rh is present, negative means it isn’t. Follow me so far?”

  Alison nodded.

  “Beth is type B negative. Rh is not present in her blood, so her body will see Rh positive blood as foreign.”

  “Exactly, so her blood can attack the baby’s because they’re different.”

  “Yes it can.” Alison started to interrupt. She knew all of this, but Dr. Baker continued.

  “Beth gives the baby blood while he is in the womb, and it sees his different blood. Her blood destroys his. That’s called hemolysis and it creates two big problems. The first is that baby doesn’t have enough blood to deliver oxygen and, second, the stuff inside a red blood cell is toxic if it gets out. When mom’s blood attacks baby’s blood we call it Hemolytic Disease of the Fetus or Newborn, and it can cause a miscarriage.”

  Alison finally got her chance to speak. “Right, but that’s not what’s happening here. If it was, Rhogam would stop it.”

  “Not necessarily. Rhogam isn’t perfect. It’s a drug. Like any drug, it doesn’t work on everyone. The last couple of doctors Beth went to believed that was the issue. That it wasn’t working because she’s unlucky. They were wrong. The issue here is not from Rh type, it’s from a different blood type. The mechanism is the same, but the c
ulprit is different.”

  Dr. Baker sat forward and spoke faster, warming to her explanation. “Most people think we have ABO and Rh and that’s it, but we actually have dozens of other blood groups. Almost everyone will go through life not knowing about them because they don’t usually affect us. The problem for Beth is not that she is Rh negative, but that she is Kell negative.”

  “What is Kell?”

  “Kell is another blood group. It works pretty much the same way Rh does. When a Kell negative mom has a baby with a Kell positive dad, there is the same danger of mismatched blood types as there is with Rh type.”

  Alison tried to wrap her head around the new information. “Stephen is Kell positive?”

  “He is. In fact, he’s a very rare type of Kell positive. It’s called the McLeod phenotype and it doesn’t always show up in standard testing.” She sat back again and sighed, sounding defeated. “After her last miscarriage, Beth showed a strong reaction to Kell so they checked Steve. It didn’t show up. I ordered the McLeod testing on a hunch and he has the markers for it.”

  “Is that bad for him?”

  “Not my area of expertise.” She moved on a little too quickly for Alison’s liking. “It wasn’t good for Ann Boleyn. It’s what got her killed.”

  Alison squinted. “That’s not true. Ann Boleyn didn’t die from some blood thing. With all due respect, I’m a professor of history. Ann Boleyn was beheaded by her husband Henry VIII.”

  It seemed impossible to wipe the smile off this woman’s face. She didn’t look at all perturbed by Alison correcting her. Instead, she laughed and said, “Very true. He beheaded her because she couldn’t provide him with a male heir. She had a daughter and then a string of miscarriages. He had her beheaded and tried for a son with Jane Seymour. Actually, all of his wives had issues with miscarriages. It’s just that Ann was the only one who got the chop for it. In any case, the evidence suggests he had McLeod and that’s why she kept miscarrying. So, it is what got her killed.”

  Alison disliked the semantics of the argument, but the doctor’s knowledge impressed her enough to keep her silent.

  “Enough history. What’s important right now is that Beth is going to have a hard time carrying any pregnancy to term. Her body is really good at attacking the Kell positive cells, and it is not something we can shut off. There is no Rhogam-type drug for it, so we have to treat the little guy’s HDFN.”

  “And how are you planning to do that?”

  “Aggressively.” She was all business again, the neutral expression firmly back in place. “For a start, Beth is on bed rest for the remainder of her pregnancy. It’s a significant period of time, but studies have shown that women on bed rest fare better in these cases. Second, we are going to have to take him early. I was hoping to get him to thirty-two weeks, but that is best-case scenario. Until we can deliver we focus on treatment through intrauterine exchange transfusions.”

  The world slipped in a little at the edges as Alison focused on her words. “And what is that?”

  “It’s a procedure that exchanges his blood, which Beth’s is attacking, with blood that she won’t attack. The problem, of course, is that he can’t exactly provide us with an IV site while he’s still in the womb. We use ultrasound to locate the umbilical vein, the main vein in the umbilical cord. We pass a needle through Beth’s abdomen, through the placenta and into the umbilical cord. When we hit that we pump in the good blood and hers backs off.”

  Alison’s own blood thumped in her ears. It didn’t take medical knowledge to understand all of the ways that could go seriously wrong. The thought was terrifying.

  Dr. Baker could see the fear in her eyes. “It sounds scary, I know.”

  “It sounds insane!”

  “It’s not that bad. And each time it gets easier.”

  “Each time?” Alison stood, her anxiety compelling her legs to move. “How often do you have to do this?”

  “As often as it takes. As long as the procedure remains safe. Problems can arise if we puncture the placenta too often. We’ll limit it to not more than once every week or two until we can deliver.”

  “Once a week!” She walked to the other end of the hall, wrapped her arms around her stomach and walked back. Dr. Baker hadn’t moved. “Will it work?”

  “It’s the best chance he’s got.”

  “Will it work?”

  Dr. Baker stood and faced her, her eyes full of regret. “I can’t answer that question. Not yet. I wish this were a TV show where I could tell you there will be a happy ending. I want their son to live. I want him to meet his sister. To play baseball and go trick-or-treating. Beth wants that too. She is strong and optimistic and, believe it or not, that helps. I can’t give you odds and I can’t give you promises. But if we don’t do this, I can tell you with a great deal of certainty what will happen.”

  Tears filled Alison’s eyes and she looked away, gritting her teeth against them. She nodded and Dr. Baker took the hint, walking back to the nurses station. Alison stared at the chair she had been sitting in until her eyes were dry and she felt like she could go back into her best friend’s hospital room without losing her composure. It took a very long time.

  Chapter Two

  When Alison stepped back through the sliding doors into the sunshine, the streets of Richmond were buzzing with life. It was just after five o’clock. Businessmen and politicians heading home for dinner packed the sidewalks. She slipped into the crowd and immediately wished she hadn’t. She fell in step next to a tall, slim man wearing a three-piece suit and a leather messenger bag strapped across his chest, shouting into his cell phone. The crowd was too thick for her to step away from him, so she was forced, for the second time today, to deal with someone who annoyed her.

  The State Capitol was just a block to the left, its emerald lawns and snow-white columns hidden by the façades of commerce, every other nearby building of the high-rise corporate office variety. Richmond’s downtown was a thriving business district and distinct from the other, more residential or cultural areas. The man walking beside Alison, yammering into his cell phone as if everyone else on the street cared what he had to say, was typical of the breed that plagued this part of the city.

  Nearly every aspect of his appearance was a mark against him in Alison’s eyes. To start with, his suit fit too well. A well-tailored suit suggested a vanity she found particularly distasteful in men. Then to wear a messenger bag strapped across the chest of a suit he paid so much for was simply ridiculous. The suit cost more than his monthly mortgage payment. The bag was sure to destroy his jacket.

  Then there was the massive, chunky watch that dangled loosely on his wrist. He’d spent hundreds of dollars on a watch and didn’t have the extra links taken out of the band. It suggested the casual sloppiness of wealth and privilege. It reminded Alison of her dad, who cared only about how to buy things, not how to maintain them. A car passed close to her, and the gust of wind sent a burst of the man’s cologne toward her. It was a sharp, chemical smell and he wore far too much of it. He let loose an obnoxious laugh at something he’d heard on his phone. The sharp pain that shot through Alison’s jaw was the only reason she stopped clenching her teeth. She hated people who laughed too loud. Mercifully, he turned down the next street and left her in relative peace. She focused on the city rather than the people in an attempt to relax.

  The skyline of Richmond, Virginia had changed drastically in the decades that Alison lived here. It had become a lovely, complex mixture of the old and the new. Alison passed the new City Hall, a towering steel and glass structure that exuded modern confidence, and glanced across the busy street at the rugged stone exterior of Old City Hall. The building sat in stark contrast to the towers around it, and yet its dignity was unmistakable. The roughly carved gray stone was a testament to the deep roots of this place, the longevity and solidity that its existence represented mortared together and solid as the day it was first built. Alison loved how Richmond was constantly blending the old and the new
, and most of that was due to the college whose hospital she had just left.

  Virginia Commonwealth University had garnered some national fame in recent years thanks to the success of its men’s basketball team, but the real impact of the school was written in the skyline. The college had existed in some form or another in the center of this city for almost two hundred years. Since its inception, the medical college earned VCU its highest praise. As Alison turned with the majority of the crowd around her onto 8th Street, she wondered how many of them still called the hospital MCV, or Medical College of Virginia, as she did. The name had changed to VCU Medical Center around the turn of the 21st century, but these were a people famous for their reluctance to release the past. Whatever name people used, the hospital helped provide the funds to revitalize Richmond’s once struggling downtown.

  The nineties had not been easy on the city. She’d witnessed it with the eyes of a teenager, and so hadn’t found the names for what happened to her beloved city until later. Recession and suburban flight had hit the downtown businesses hard. They shuttered their doors and jobs dried up. Crime soared and the homicide rate was staggering. Given the environment, most businesses fled to the surrounding counties along with their employees. The men in power suits surrounding her on the sidewalk had probably worked in office parks thirty miles west when they started their careers. Her father had been one of the lucky few who stayed, so Alison got to stay too.

  Meanwhile, VCU quietly and cheaply bought up block after block of the decaying city. They ripped down old buildings and replaced them with shiny new classrooms, dorms and art galleries. With each new structure came new jobs, new income, and slowly but surely the recovery crept along. Residents had mixed feelings about the bulldozing, but their city flourished with its new face. Alison’s feelings were mixed too, so many historical places decimated, but her city was beautiful again. A new type of beautiful, but beautiful nonetheless. Love them or hate them for it, VCU had cleaned the place up. Corporations decided Richmond was worth taking a chance on again.