by Tracy Weber
Great idea—one I should have thought of myself. I whispered to Justine, “I’m so glad it’s you tonight. I’d be a wreck with a stranger.”
She smiled. “I asked for your friend’s case when I saw you come in. You’re going to do great.” She gestured with her chin toward Rene. “Start by helping her calm down. While you’re at it, try to keep her husband from passing out.”
Sam’s birth coach training had obviously drained out of his brain, along with the blood that normally oxygenated it. His body swayed back and forth, about to topple. “She’s in pain, Kate. Do something.”
I pulled a chair next to the bed, pointed at Sam, and barked Bella’s favorite command: “Sit.” To Rene, I said, “Inhale as I count to four … ”
Justine gave us a thumbs-up sign when the contraction was over. “Six centimeters. You’re doing great!”
I continued my coaching, pulling from my yoga toolbox. “Tell you what, Rene. Let’s try some of the chanting we did together in Prenatal Yoga. The next time you have a contraction, we’ll chant the word ‘oh.’” I hoped chanting would slow down Rene’s breath, which would calm her. The “O” sound would vibrate low in her belly. “Think of the word ‘open’ when you chant.” Sending a subliminal message to her cervix couldn’t hurt, either.
Ten infinitely long minutes passed. Minutes filled with pained groans, rejected ice chips, and a mercifully short visit from the on-call obstetrician. Each of Rene’s contractions lasted longer and seemed to get more painful.
“The pain doesn’t go away after the contractions anymore,” Rene moaned. “My back is killing me.”
I whispered to Justine, “Is that normal?”
Justine hesitated. “It’s not abnormal. I suspect she’s having back labor.”
Great, just our luck.
Back labor—in which significant pain was referred to the mother’s back—was widely considered the most painful kind of labor.
Justine pointed to Rene’s chart. “She told the triage nurse that she didn’t want an epidural.”
“Really? When we created her birth plan, she asked for the drive-through option.”
Justine chuckled. “Women often change their minds once labor begins. I don’t like to push drugs on my patients, but some pain control might help her a lot.”
“I’ll ask.”
I joined Sam next to Rene. His face had turned from bleached-shell white to a sickly greenish yellow. “I can’t stand to see her hurting like this,” he whispered.
“Then let’s do something about it,” I replied.
I took Rene’s hand and asked, “Do you want that epidural we talked about?”
She gaped at me like I’d suggested crushing her spine, not injecting it with painkillers. “You told me that epidurals increase the risk of a C-section.”
“Sometimes, but—”
“Nobody’s cutting into my belly. Nobody. I plan to walk out of this hospital wearing my skinny jeans.”
“Rene, that’s not realist—”
She sat up and squeezed my hand so tightly, I expected to hear at least three metacarpals shatter.
“I said no!”
Justine shook her head at me from across the room, clearly warning me off.
So much for that idea.
I’d never felt more impotent. I wanted to help my friend. I needed to help my friend. But how? I nervously suggested every birthing option I could think of in rapid-fire staccato.
“Do you want to walk around? Do you want to get in the jetted tub? Do you want to squat? Do you want to get on the ball? Do you want me to rub your back? Do you—”
“I want you to shut the hell up and let me concentrate!”
Sam grabbed Rene’s hands, probably to keep her from punching me.
Justine took me aside. “Give her a minute to get through this contraction. Don’t take anything she says personally. Women say all kinds of things in labor.”
I knew that, of course, but Rene’s words still stung.
Justine continued. “When she’s ready to talk again, ask her if she wants some Demerol. It will take the edge off and help her relax.”
I cautiously tiptoed next to my friend. When the contraction was over, I spoke.
“Rene, what would you think about Demerol?”
Rene released Sam’s hand. He shook it, as if making sure his fingers were still connected.
“Yes, or that Stadol stuff you told me about,” Rene replied. “Something that’ll help me relax. I swear these little buggers are chiseling their way through my spine.” She groaned again.
“I’ll talk to the doctor,” Justine said. She picked up the phone, mumbled some words into the receiver, and hung up again. “Hang tight. I’ll be right back.”
Evidently “right back” meant shortly after the twins graduated from college. Or at least that’s what it felt like. Fifteen infinitely long minutes later, Justine injected the merciful brew directly into Rene’s IV line.
Which would have made me feel a whole heck of a lot better if her hands hadn’t been shaking so hard that she almost dropped the syringe.
I eased next to Justine and whispered, “Are you okay?”
She smiled. “I’m fine. My blood sugar’s a little low. I took some glucose a couple of minutes ago. It should kick in soon.”
Deep down inside, I had to have known she was lying, but I couldn’t admit it to myself. Not then. I needed to focus all of my energy on Rene.
The next hour passed in a million-year heartbeat. Rene rested off and on, but the contractions became longer and closer together. A mere three hours after she’d been admitted, she was almost ready to push—and to give up.
“I can’t do this anymore,” she wept. “I’m going to be a terrible mother.”
Sam stroked her hair. “Rene, honey, you’re going to be a fabulous mother.”
“He’s right,” I said. “You’re in transition. Remember, we talked about this. Transition is the stage in which laboring women want to give up. That’s good news. You’ll be ready to push soon!”
As the next contraction began, Rene sobbed. “The drugs aren’t working. Please, I changed my mind. I need an epidural. Now.”
“I’ll talk to Justine.”
Justine made another phone call, then took me aside. “Anesthesiology is really backed up. The anesthesiologist will get here as soon as he can, but that could be thirty minutes or longer. I’m pretty sure the first baby will already be here by then.”
“Can we give her more Demerol?”
“Sorry, the doctor already ordered the maximum dose. Try to keep her calm.”
Rene cried out, over and over again, begging for an epidural.
She certainly wasn’t acting like a woman on the maximum dose of pain medication. True, Rene could be melodramatic—over-the-top, sometimes—but when it counted, she was surprisingly stoic. This was no act. Rene was in agony.
I smiled and whispered sweet assurances to my friend, but my mind spun in circles, refusing to remain in denial even a minute longer. Rene said the drugs weren’t working, and I believed her. Was that because she’d never received a full dose to begin with?
I looked into Justine’s glassy, unfocused eyes, and my dream’s metaphor became suddenly clear. The dream hadn’t been about Bella after all. In spite of her challenges, I’d never considered Bella a burden. Not once. Bella was the greatest joy of my life. The staggering burden that my subconscious mind had shown me was Justine’s.
Clues I’d refused to acknowledge flashed through my mind in a dizzying, fast-forward slide show. Justine talking in yoga class about the unbearable pain of caring for a parent with advanced Alzheimer’s while mourning the loss of her husband and child. The red eyes. The stumbling gait as she crashed into the studio’s book shelf. The syringe she’d dropped in the bathroom. The extra-large piece of cake she’d
swiped from the party—a cake loaded with more sugar than any conscientious diabetic would ever ingest.
Justine hadn’t injected herself with insulin that day in the bathroom. It had been Demerol, or morphine, or Stadol, or one of the many other narcotics she had access to during all of those double shifts. At best, Justine was a drug addict. At worst, she was a thief, stealing drugs from the hospital or—worse yet—from her patients.
Justine needed this job. She needed to take care of her mother. If Dr. Dick ducked into the break room to hide from Liam and saw her shooting up …
She might very well panic and kill him.
The hollow ache in my belly assured me that I was right. But despite my certainty, the theory was still conjecture, and career-
ruining conjecture at that. I’d call Martinez and tell her my suspicions tomorrow. For now, I needed to keep Justine calm, focused, and hopefully sober for the remainder of Rene’s birth.
I was about to volunteer to get her some coffee when Rene had another contraction. She pushed Sam away, sat straight up in bed, and snarled in a voice straight from The Exorcist, “Either get me an epidural now or rip these demon spawn out of me!”
Justine took some measurements under Rene’s gown, picked up the phone again, and mumbled words I couldn’t understand.
When she hung up, she spoke to Rene. “Hang on there, sweetie, the doctor’s coming now.”
Rene pinned her to the wall with wide, hopeful eyes. “To give me the epidural?”
“No, hon, to deliver your babies. You’re fully dilated. It’s time to push.”
Twenty-Six
Rene pushed out both babies in an action-packed forty-five minutes. Moments after the second baby was nestled against her chest, Justine disappeared. Not long after, a new nurse appeared.
“Nurse Justine became suddenly ill. I’ll be with you for the next couple of hours.”
The doctor gave the new nurse a questioning look. She shrugged in return. If Justine had a drug problem, I had a feeling it wouldn’t stay secret much longer.
Rene, Sam, and what seemed like a thousand hospital employees oohed and aahed over the tiny humans. None of us could seem to stop smiling.
“Alice and Amelia,” Rene announced.
“What?” I asked.
“Their names.” She pointed to the blonde. “Alice, after Alice in Wonderland.” She nuzzled the brunette. “Amelia, after Amelia Earhart. They’re going to be adventurers.”
“Honey, that’s perfect,” Sam said.
“It’s more than perfect. It’s inspired.” I cooed at the bitsy beings. “They were cute in the ultrasounds, but that was nothing. They’re gorgeous.” I smiled at my friends. “They look exactly like the two of you.”
Rene’s lips fluttered, as if they couldn’t decide whether to form a smile or a frown. “I know,” she hiccupped. “One blonde, one brunette. They’re not identical.” Her hiccups turned into sobs.
I wrapped my arm around her shoulders, careful not to touch the breakable creatures. “Oh, honey. I’m sorry. I didn’t realize how much you wanted them to be identical.”
“Don’t be silly, Kate,” Rene admonished. “Who cares about that?” She covered her mouth and smiled through her tears. “Don’t you get it? One blonde, one brunette. Just like the puppies. The four of them are going to look awesome on my next catalog cover.”
Sam laughed. “That’s my girl. Always plotting. Maybe you should add puppy accessories to your baby line.”
I playfully punched him in the arm. “Don’t give her any ideas.”
Sam lifted Amelia off of Rene’s chest and reached her toward me. “Here, hold her.”
I longed to cuddle the doll-like creature more than I cared to admit, but she seemed too fragile—like porcelain. If I breathed, I might shatter her. I held up my hands and backed away. “No, I can’t, I—”
“You’ll be fine,” he insisted. “Hold your arms this way.” I pantomimed his position, and he laid her body so that it was fully supported by my forearm. “Don’t let her head drop.”
I cuddled that brunette sweetheart next to my chest and fell madly in love. In that moment, I made up my mind: Michael and I were going to talk about kids.
Soon.
I stayed with them for forty-five more minutes, then called Michael to let him know I was on my way home. I promised to visit the next afternoon and left Rene to bond with her new family.
I staggered up to my ancient Honda around five in the morning, so exhausted I felt like weeping. Even my fingers felt tired. So tired, I could barely lift my keys. A noise startled me from behind and I jumped. The keys clattered to the cement.
“I was beginning to think you wouldn’t get here in time.” Justine’s voice echoed through the empty parking garage. Her complexion was waxy. Her eyes were dulled in a narcotics-induced haze.
All feelings of exhaustion vanished, replaced by adrenaline-laced trepidation. Why was Justine waiting for me in an empty parking garage? More importantly, how long would it remain empty? Shift changes happened at seven, which meant that no one else was likely to be on this level for another hour at the soonest.
“I thought you went home sick?”
She didn’t reply.
I looked pointedly at my watch. “I’m exhausted. You must be, too. Whatever you want to talk about, let’s do it later, after we’ve both had some sleep.” I reached down to grab my keys, but Justine jerked my arm away and kicked them under the car.
“I’m afraid I won’t be available later.” She released my arm, pulled a knife from her jacket pocket, and pointed it at my chest. “I won’t hesitate to use this, but I think you already know that.” She pointed at my gym bag. “Hand me your bag and your jacket. We wouldn’t want you pulling out any weapons, now would we?”
I complied.
I should have been frightened, and honestly I was. But I wasn’t terrified. Justine’s energy—in spite of the weapon she pointed at my sternum—was defeated. Done.
She spoke in a monotone. “You know, I think I wanted you to figure it out.”
“Figure what out? Your low blood sugar?”
“Please, Kate. We’re done with all the pretending now. I saw the expression on your face when I put the Demerol in your friend’s IV. You know I’m not diabetic.”
She was right, of course. Just wrong about the timing. My subconscious mind had figured out Justine’s addiction when I saw her hands shake. My conscious mind had refused to admit it until an hour later. Not that the timing mattered now.
I tried to back away, but I bumped up against my car.
Justine stepped closer. “I don’t want to hurt you,” she said. “If you behave long enough to hear me out, you’ll come out of this fine.” She lowered the knife, but only by an inch. “I didn’t think I wanted to get caught, but I must have. There’s no other reason I’d have made so many mistakes.” Her eyes grew wistful. “Your friend’s babies are beautiful, by the way. I’m so glad I got to be part of their birth.”
“Are you high now?” I kept my voice low, hoping to soothe her, but it still echoed across the quiet garage.
Justine smiled. “Oh yes, but don’t worry; I only took half of your friend’s dose. I needed to be functional for her—for both of you. I took the rest of my stash after the babies were born. I’ve been saving up for today.”
“What’s happening today?”
She ignored my question and kept talking.
“Please don’t judge me too harshly, Kate. I’m a good nurse. Ask any of my patients. I simply couldn’t stand the pain anymore.” A weak smile lifted her lips, but the expression looked broken. “The yoga you taught me was great, but it’s no morphine.”
“What pain? The pain of losing your family?”
“Yes, and knowing that I’ll never have another child of my own.” Her words slurred. “The first time was so s
imple. Mom had been up all night, and I was exhausted. My patient needed Stadol, but not the entire vial. We’re supposed to have another nurse present when we discard the remainder, but we were busy, so she entered her number and left. I put the vial in my pocket and took it home. I finally got a full night’s sleep.”
“But one night wasn’t enough.”
“Not even close. You don’t understand how powerful these drugs are. I went from being in agony to being … numb.” She slowly shook her head. “Blissfully numb. Soon I was stealing anything I could get my hands on. Stadol, Dilaudid, morphine … Once I even licked a fentanyl patch before I put it on a patient.”
I flashed back to Rene’s desperate pleas during her last hour of labor. “You claim you’re a good nurse. How could you steal from patients in pain?”
“I didn’t. At least not always. Sometimes the other nurses signed off on drug disposals without witnessing them, like that first time.” She stared down at the floor. “Occasionally, like tonight, I gave patients a partial dose of their medicine. But never, ever if they lost a child. That pain is too unbearable.”
Her fist slackened around the knife’s handle. I reached out my hand. “Justine, give me the knife. You’re not violent, you’re sick. We can get you help.”
She tightened her grip again. “It’s too late for that, Kate.” Her words grew slower, more halting. “My mother … I picked out a facility. She doesn’t want to go, but it’s time.” She forcefully squeezed her eyes shut, then opened them again.
I hesitated, conflicted. Justine was dangerous, that much was certain. But she was also heavily sedated. If I rushed her, could I get to the knife before she cut me with it?
It was worth a try.
I leaned forward, slowly bent my knee, and placed my sole against the tire, preparing to push off with my foot.
Justine quickly pressed the tip of the knife against my throat. “Don’t even think about it, Kate. I don’t want to kill you, but I’ll cut you if I have to. Don’t make me hurt anyone else.”
