by Melissa Yi
My kingdom for a CBC (complete blood count, not Canadian Broadcasting Corporation, in this case).
“What the fuck is going on?” said Bastard.
“She’s bleeding. I’m trying to stop it. Can I call for help?” I lifted my chin at the intercom, even as I kept pressing on Manouchka’s stomach.
Bastard made sure not to gaze too far south on Manouchka, but he steadied the gun at my own midsection. He said, “Don’t even think about it.”
Out of the corner of my eye, I thought I saw Tucker move back toward the wall and hit the intercom button with his shoulder.
I could’ve been mistaken, since I immediately dropped my eyes down to Manouchka’s belly, but my man was thinking again. If he’d accomplished his goal, the outside world could hear us and figure out the best time to bust in.
In case he hadn’t managed, I glanced over my right shoulder. I’d just remembered another way to alert the cavalry: the code rope near the incubator.
They showed us the code rope on orientation. I forgot because I haven’t seen a code yet, and maybe because I was getting delirious with fatigue, but the idea is that if you’re resuscitating a newborn, instead of running over to a phone and pressing 5555, you can just yank on the cord and keep on bagging/tubing/compressing that child.
I assumed Tucker hadn’t yanked it while working on David, probably too mindful of Bastard’s watchful eye, but he might’ve managed to alert the authorities now.
Thank heavens.
I don’t know how call bells work, exactly, but I think the patient either pushes a switch on a rope or the intercom button and it lights up at the nursing station. The secretary or a nurse will see that room 4392 needs help and press their own button at the desk to say, “Yes?” Or sometimes the nurse has to go to the patient’s room to shut it off.
Either way, if Tucker had managed to push the button, he’d activated the intercom, and now they could hear us.
He brought the authorities ever-closer to tearing us away from this madman.
In the meantime, though, I still had to save this woman’s life. And based on the blood slowly streaming out from between her legs, I’d have to step up my game.
CHAPTER 23
I tried to knit my thoughts back together.
Post-partum hemorrhage. No IV, no blood tests, no blood, no use with the external massage.
I gave Manouchka’s abdomen an eleventh-hour drumming, hammering down on the uterus through the belly, hard enough that Manouchka’s breath puffed out in protest, and she squeezed David, who uttered his thin, new baby wail.
Shoot. Or rather, don’t shoot.
Tucker offered me a crooked grin and raised his voice to be heard above the ruckus, “How’s it going?”
“She still seems floppy. I’ll have to do internal massage.” One hand inside the vagina, one hand compressing the belly. Sort of a one-two punch to the uterus, telling it to tighten up while we bring on the drugs.
Speaking of which, step four. Oxytocin. And five, Hemabate. Useful, useful drugs. “Can you get me some Oxytocin and Hemabate? And some IV equipment for yourself?” Once again, I wished for the Wayback machine for the good ol’ days when they used to install IV lines in every labouring woman.
“We can do Syntocin IM. Ten units instead of five,” said Tucker. He pointed at the delivery cart and raised his eyebrow at Bastard.
“Yeah, sure,” Bastard muttered. “Just shut that kid up. And don’t go anywhere.”
Manouchka hugged David to her chest. He settled for a second before he started crying again.
His mewling seemed to bounce off the ceiling and walls so they could reverberate in my ears an extra time or ten. Even I gritted my teeth, and I wasn’t a killer. As far as I know.
We’d have to keep David quiet before Bastard lost his shit even more.
Manouchka cradled her son to her chest, gazing at Bastard and then at me, pleading.
I belatedly realized her problem. “Um, she needs some privacy to nurse. Could you, uh...” I glanced at the thin bit of curtain slumped against the wall. Most of the curtains in the Family Medicine Unit get stuck halfway, but even some privacy was better than none.
Bastard followed my gaze. “No fucking way. Who knows what you cunts will get up to back there.”
The c-word? Really? I blinked at him, but I wasn’t really surprised that he’d broken out the most vile words while he vetoed some more basic human rights.
Fortunately, when I turned back, Manouchka had dragged a sheet over her chest and now struggled to arrange David one-handed underneath all the cloth.
I wanted to help her. I’ve read about breastfeeding, and I vaguely remembered something called the football hold, which is good if you’ve had a C-section, but I’m fairly useless in real life.
I cleared my throat and called to her above David’s intermittent bawls, “Good job. You can squeeze your breast and help aim it at his mouth.” I only knew that move because a nurse was counselling a new mother when I popped in on ward rounds yesterday.
David’s howls faded. His tiny body relaxed. I heard, or imagined I heard, miniature lips smacking.
“There you go, Manouchka. Good job.” I could never be a cheerleader. I felt like a fool, encouraging her when I had no real idea what was happening under that blanket, but I literally had my hands full with my last-ditch external massage.
I cocked my head at Tucker, who had ripped open the delivery cart and lifted out a clear glass vial not unlike the Lidocaine ones we use in emerg, except this one had a green bar on the label that I could spot from the bed.
Oxytocin. Also known as Pitocin. Either way, the drug to make the uterus contract. Praise be.
Thank God we kept drugs in the room. It made sense. When a woman bled, we needed Oxytocin now, not after running down the hall to input her name into the locked drug system. But this was my first post-partum hemorrhage, and the nurses were so good at magicking things up, I didn’t know where they located them. Oz, practically.
I allowed my shoulders and hands to relax for one gorgeous second just before I asked, “You’ve got Hemabate, too? Just in case?”
“No. That’s in the post-partum hemorrhage kit, at the nursing station.”
Too much to wish for. I said, “Let’s start with the Oxytocin. And toss me a new pair of gloves.”
“Aye aye, captain.” Tucker lobbed another sterile set at me.
I caught them. I would have liked to wash my hands again, but I trashed my old gloves, settled for a quick Purell from the wall dispenser, and got gloved up again.
Oh, no. “I need—”
“Me,” said Tucker, crossing to my side and squirting more gel on to the sterile side of the paper glove wrapper.
I mouthed, I love you.
His eyes flared, and he mouthed it back and took another step toward me, but Bastard said, “Fucking doctors with their fucking thumbs up their asses.”
Tucker turned back to the cart, unwrapped a syringe and shook the bottle before he ripped open a needle.
Bastard’s voice cut through the room with a new and dangerous note. “What the fuck are you doing?” Before Tucker could answer, Bastard took two steps toward him and snatched Tucker’s arm with his free hand. “No needles. Don’t you fucking dare.”
I barked in disbelief. “We’re trying to save this woman from bleeding to death. That’s how we give the medication.”
Too late, I realized how wrong that sounded when Manouchka bleated from the bed. She definitely understood more English than she was letting on, which made me the bad guy, even though I was trying to save her life. I tried to apologize with my eyes while Bastard blustered, “I know what I’m talking about. No needles, if you know what’s good for you.”
“Shit!” I said. I try not to swear in front of patients, so I was 0 for two, but this was unbelievable. “You want rivers of blood to pour out between her legs?”
Manouchka choked.
I said, “Je m’excuse, Manouchka.” I tried to throttl
e back my temper, but Tucker beat me to it. He dropped the needle and said to Bastard, who was still gripping his left arm, “You want Casey, right?”
“That’s what I’m telling you. You’re wasting my time.” Bastard shifted his gun. At this exact moment, he wasn’t pointing it at Tucker—it was more at the incubator—but my heart clutched anyway. I wasn’t willing to get shot over Oxytocin. Not if I could stop it the old-fashioned way.
I shoved my hand inside Manouchka’s vagina. I’d never actually done this part before, but I knew the theory. If you press on the uterus through the abdominal wall, the flaccid uterus just ping pongs around in the abdominal cavity. But if you secure the uterus with the other hand on the cervix, you can make sure those muscle fibres get a good rubdown, contract under the pressure, and stop bleeding.
Two millimetres into her vagina, my fingers immediately sank into a deep tear.
CHAPTER 24
As I advanced my fingers into Manouchka’s spongy vagina, I couldn’t kid myself about the size of her vaginal laceration.
It was like my fingers had fallen into a pothole. Or, since it was such a long tear, it was more like a trench. A World War I ditch of blood and soft tissue.
My heart battered my throat. I forced myself to breathe, to try and think logically.
No one talks about this, but pushing a baby out, 90 percent of the time, it’s okay. Minor tears at the most. The superficial ones, you can just let heal on their own. Bigger ones mean a few stitches. But the fourth-degree tears are the ones where you can rip your vagina into your rectum.
I’d sewed up a few of these lacerations, with the help of the consultants, but my brain kind of switched off. They’d say, “Sew here,” and I’d sew. The woman would always ask, “How many stitches?” and the doctor would hedge, “It’s kind of hard to say, because the stitches are running together.” (They’re running sutures, where you keep sewing without tying a knot and cutting the thread in between each stitch—I’m sure you can imagine how challenging that would be inside a vagina.) But whenever we have to sew the vagina, it’s usually a big job. Like, at least ten bites of suture.
I’d never repaired a vagina on my own before.
But I wasn’t on my own. I had Tucker.
I calmed myself and surveyed Manouchka’s private parts, as if I could check the tear with X-ray vision as well as my fingers.
If her perineum were a clock, the tear would be at six o’clock. It felt deep because the swollen mucous membranes enveloped my fingers, but she couldn’t have torn any deeper than a centimetre.
My finger pads crept forward, pressing south and meeting spongy resistance. That was good. I definitely wasn’t just falling into the empty cavern of her rectum. This was not a fourth-degree tear.
Finally, just when I reached the full length of my second and third finger, the tear grew shallower and ended.
I moved side to side to check, but this was the end of the road.
Massive phew. My shoulders sagged in momentary relief.
Tucker was talking to Bastard behind me. “Once we save this woman and her baby, we can find Casey. She’s waiting for us. But right now, we need to do it right. You wouldn’t want doctors who wouldn’t save a woman’s life, do you?”
Bastard paused to think about it.
Tucker waited for him, managing not to swear and/or scare the patient. Good thing one of us was still lucid.
The intercom crackled, but I ignored it. With any luck, the cavalry could hear us, but they wouldn’t tip their hand until they were ready to rumble.
RUMBLE. Please, cavalry, come and rumble this man before he murders us.
On cue, the operator cut in through the hospital loudspeaker. “CODE BLUE, FOURTH FLOOR. CODE BLEU, QUATRIÈME ÉTAGE.”
“What the fuck is that?” said Bastard.
So Tucker had pulled the code rope after all. My gaze zinged toward Manouchka’s. Her eyes widened and her hands seized on David, even though, from the way his head was lolling, I thought he was asleep and definitely breathing better.
I told Bastard, without turning around, “They must have heard that David was in trouble and started the code team. The pediatrician will come and resuscitate the baby. Sometimes the obstetrician helps. The obstetric nurses are very good at codes, they’re the ones who—”
Bastard snapped, “No one comes in here.”
I kind of expected that, but it felt worse when he said it out loud, especially when he walked toward me, suddenly sure, with the gun aimed between my breasts. “No one comes in here except Casey. No one leaves. This is my turf.”
Tucker opened his mouth and drew in his breath to speak.
I glanced at him, which made Bastard turn around. He jerked the gun right toward Tucker’s open lips.
My man snapped his jaw shut, fixing his gaze on the weapon.
“You tell them to fuck right off, or I’ll kill them. And you. And everyone else.”
My heart ached. My ears rang. I wanted to cry. Tucker, don’t die. Ryan, I’ll never see you again.
But then I thought, No way. I get to see Ryan again. This isn’t how it ends. That bastard doesn’t get to decide.
And Kevin, my little brother? He can’t just have his sister knocked off in a hostage-taking. This is Canada.
I almost laughed at myself right then. Like our national reputation as peacekeepers could keep all the crazies out. But if that was all I had to cling to, I’d take it.
“Stop that fucking code!” Bastard shouted, so Tucker pushed the call bell clipped on the bed and said, “This is Dr. John Tucker. The baby in Case Room One had meconium and has been successfully suctioned and is no longer a Code Blue. I mean, Pink. Repeat, the baby is no longer a Code Pink.”
The young woman’s voice answered him. “Thank you for the update, Dr. Tucker. Could we send staff in to assist you?”
“No one! No fucking one!” Bastard screamed, loud enough that the woman could hear him, because she said smoothly, “No additional staff required at this time. Understood. Who is speaking now?”
“Are you talking to me?” said Bastard.
Manouchka groaned, and more blood spurted out from between her legs and over my fingers, so I remembered my call of duty and advanced my hand inside her vagina while Bastard called, “I’m the one who decides here! I’m in charge!’
“Thank you for talking to us. My name is Olivia.”
“I don’t give a flying fuck what your name is. I need Casey Assim!’
“You’re looking for a patient, is that right?”
“For fuck’s sake!’ said Bastard, and verbally tore her a new one while Olivia tried to soothe him and my hand retreated from Manouchka’s already-torn one.
They talk about fisting. Personally, I’ve never done it or experienced it—until now.
My fingers had been too short to reach up to her cervix, so after I withdrew them, I slowly advanced my entire hand inside her vagina. Intellectually, I know that a baby is much wider than my arm, but it surprised me that I could insert my right hand and wrist inside her lady parts.
Heck, I probably could have fit two hands, except that Manouchka was whimpering and tensing her legs.
And that was just with her poor, ripped vagina. How could I reach all the way inside her uterus and start scooping away any stray flesh?
Then I remembered one of the obstetricians telling me, “I don’t always insert my hand inside the cervix. That’s only necessary for retained placental products. Otherwise, the key is internal uterine massage.”
“The placenta!” I said out loud.
“The placenta,” Tucker repeated. “You’re right. I’ve got to check the placenta. After I give the Oxytocin. All right, Ben?”
It was the first time he had called Bastard by name. I held my breath.
Bastard said, “No fucking way,” but he was still swearing at Olivia, and during the confusion, Tucker stepped back to the cart, ripped open the needle, drew up the Oxytocin, and quickly plunged it into Manouchka’s d
eltoid muscle with hardly a second to wipe an alcohol swab over her skin first.
CHAPTER 25
Oh, God. Tucker had violated Bastard’s ‘Thou shalt not use a needle’ commandment.
Manouchka flinched, but she didn’t make a sound. She understood that we had to do this as covertly as possible.
I barely breathed.
Bastard was now yelling at the intercom, “You get me someone who knows his ass from his armpit, and I’ll think about it!”
Tucker jammed the needle into its pink sheath, permanently covering it and insulating himself from a needle stick injury before he shoved the used syringe in his back pocket. Then he said to the still-arguing Bastard, “May I check the placenta in the bathroom?”
“Shut up, dickweed!”
I twitched, trying not to watch the bulge in Tucker’s scrubs, which was opposite the usual one. The needle was on him. If Bastard caught him with the syringe, would Tucker be able to talk his way out of it? He’d never make it unnoticed to the sharps container next to the incubator, so he’d either have to ditch it in the bathroom or carry it around as permanent evidence.
On the other hand, he’d finally given Manouchka her medication, and I was delivering her internal massage at long last. If Bastard wouldn’t let him check the placenta, I’d have to go for it the old-fashioned way.
Reaching forward, I grasped the rim of her gaping cervix between my scissored index and middle fingers. I could easily slide one, two, three or more fingers inside her the cervical os. Probably my whole hand could fit inside. David had done his job well.
Manouchka lifted her hips off the bed when I touched her cervix, but she bit her lip and didn’t cry.
They say the cervix isn’t well innervated, that it doesn’t carry pain fibres the way other organs do. Maybe this would be okay.
