by K Carothers
Erin nodded, swallowing a lump in her throat. “Yes, me too.”
Nolan patted her arm. “Forgive me for turnin’ so heavy-hearted. We should never forget that all will be set right in the end. And if it isn’t right, it isn’t the end.” His usual radiant smile returned, chasing away the clouds that had gathered on his brow, and he led them over to the table, announcing, “Lunch is on me—if ye’re all willin’ to put up with a crass old Irishman.”
“Crass is an awful big word for an Irishman,” Greg quipped. “Did you mean to say ‘ass’ instead?”
“Greg, really,” Joanne said, though she couldn’t hide a smile.
“If oid meant arse, oid have said arse,” Nolan answered in an especially thick Irish brogue, his blue eyes twinkling with merriment.
Greg chuckled. “Fair enough, Nolan. But ‘arse’ or ‘ass,’ you can only park yours here if I pay for lunch.”
Greg and Nolan continued their friendly argument over who was paying while Erin sat down next to Jenna. Luke took a seat across from them, joining the conversation with the other two men.
“So, did anything interesting come up over there?” Jenna softly asked Erin.
“Yes,” she whispered back, grinning helplessly when she thought of her conversation with Luke. “I’ll tell you about it later.”
Lunch was an enjoyable affair, with plenty of lively conversation and laughter. Erin had attended many dinner parties in Boston over the years, especially after she’d married Peter, who came from a wealthy and socially prominent family in Boston. But she’d never quite been able to fit into that world, no matter how hard she’d tried. And when someone would invariably ask a question about her past, she’d hated telling her well-rehearsed lies. With this group she didn’t have to pretend to be someone she wasn’t, though, and the weight it lifted from her shoulders left her feeling unexpectedly at ease—even with Joanne, who knew the least about her. In fact, Erin felt a familiarity with Luke’s mother that was hard to explain. Joanne and her son definitely had more in common than just the color of their eyes.
Her own eyes strayed to Luke again, as they always seemed to do when she was around him. She watched, entranced, as he slid a forkful of pasta into his mouth. He glanced up, feeling her gaze on him, and she dropped her eyes back to her plate in embarrassment, hastily taking a bite of her sandwich. She really was just as bad as that twenty-year-old paramedic who’d looked at him with such adoration the other day.
Much to her relief, Nolan started talking to Luke just then. But as she put her sandwich down, Jenna leaned closer to her and whispered, “You and Luke look like you want to eat lunch straight out of each other’s mouths.”
“Jenna!” Erin felt her face get hot. Now it was official—she was worse than the paramedic.
Her friend smothered a laugh. “Blame it on the morphine.”
“Erin, would you be interested in taking a tour of the hospital?” Greg asked. “A lot has changed since you left. And you can see what you’d be dealing with in the ER.” He grinned. “We’re a little different here than Boston.”
“Yes, I’d like that,” Erin said, covering the remnants of her sandwich with a napkin.
“How about this evening? It sounds like the ER has been pretty quiet all weekend, so tonight would probably be a good time to go.”
Erin agreed, and they firmed up the details of their meeting. “What happened that you’re so short-staffed right now?” she asked.
“Two of our prior doctors were a married couple, and they decided to take jobs in Madison. That’s one of the difficulties in staffing a small town ER like this. Some like the slower pace, and some find they don’t. We’re not typically part of the knife and gun club, as you’ve been in Boston—although you seem to have brought it here with you.”
“Remember now, you’re a white cloud,” Luke teased.
Erin sent him a wry smile. “How could I forget after the way you reminded me yesterday?”
“I’ll have to keep bringing you more of those reminders,” he said in the same teasing tone. “Just to make sure you always have plenty on hand.”
“My cup—or I should say my bowl—will be overflowing with your generosity,” she returned with a grin.
Luke grinned back. “Like I said before, don’t use it up too fast. That’ll keep you in the clear.” Then he gave her the devilish version of his grin again. “I wouldn’t want you to have to stick a plunger into your bowl. They can be dangerous.”
Erin couldn’t help but laugh. “I have no rebuttal for that.”
Greg glanced between them with a bemused smile and told Erin, “By the way, you did a nice job treating that boy with the pneumothorax. Colin was quite impressed, and that’s not easy to do—believe me.” He chuckled. “And now he wants me to do everything short of kidnapping to keep you here for good. But it goes without saying, I would love to see that happen. In fact, Chase McKellar, one of our ER docs, should be working tonight, and maybe he can help us convince you to stay. He grew up on a dairy farm near Madison, but lived in Chicago for a while. You’ll probably find his perspective especially interesting.”
“Along with just about every other woman in town,” Jenna quipped. “He’s very good-looking, not to mention single. But from what I hear, he doesn’t socialize much.”
Greg lifted a brow in his wife’s direction. “So are you in the majority who find his ‘perspective’ interesting?”
“Well, I used to be a social worker,” Joanne deadpanned. “I’ve learned to take everyone’s perspective into consideration.”
Jenna and Nolan promptly broke into laughter, while Greg shook his head—though not without a glint of humor in his eyes—and turned back to Erin. “In any case, Chase took the job here because he felt like he was getting burned out in Chicago. Unlike the two who left, he discovered the big-city way of life wasn’t for him. And everything seems to be working out well so far—except for some of the women in town, I gather.”
Erin smiled half-heartedly at his jest, feeling a little guilty that they hoped she’d also stay. But then the conversation turned to other subjects and she was able to relax again. Until she realized she had another problem. A much bigger problem at the moment.
“Jenna,” she whispered uneasily when everyone else was engaged in other conversations. “What’s the bathroom like here?”
Concern immediately filled Jenna’s eyes. “Oh…I think I’d better go with you.”
They excused themselves, and Erin silently cursed herself for being so absent-minded this morning and forgetting to use the bathroom before they left the house. She was usually so careful about that, always fearful of exactly this scenario. Today wasn’t the first time she’d been caught in it.
Jenna led her around a corner to the bathroom, and Erin hesitantly opened the door—and blanched. There was a single toilet in there, and the lighting was dim. No stalls. No windows. It was the smallest bathroom she’d ever seen. And she was severely claustrophobic.
She quickly closed the door and leaned against the wall, dizzy at the very thought of locking herself in there. “Such a simple, stupid thing. It would take me a minute and I’d be done.” Humiliation and despair filled her eyes as she spoke. “But I can’t do it.”
“Let’s go home, Erin,” Jenna softly urged.
“No. You’ve been enjoying yourself. I’ll make some excuse about running an errand, then come back.”
“We were pretty much done here anyway.” Jenna touched Erin's arm sympathetically. “Please. Let’s go.”
After a brief hesitation, Erin nodded and followed her back to the table.
“Lunch was wonderful, but we have to get going,” Jenna announced.
Luke didn’t miss the change in their demeanor, especially Erin’s. Though she tried to hide it, he could tell she was upset about something. And with worry furrowing his brows, he turned his attention back
to Jenna. “Are you feeling okay?”
“Yes, I’m fine,” she responded, waving off the question. “Just a little tired.”
Luke stood up. “I’ll walk you out—”
“No, please don’t,” Jenna interrupted. “There’s no need.”
Erin was beyond mortified that everyone looked so concerned about Jenna. And with a hasty goodbye to the group, she made a beeline for the door, desperate to get out.
Luke watched in confusion as they exited the café. Everything had seemed fine just moments ago, and now Erin was back to acting as uncomfortable and distant as she had when they’d left church.
With an inward sigh he sat down again, completely disheartened.
Chapter
9
“Not what you’re used to, I know.”
Erin turned from her survey of the ER and looked up at Chase McKellar. Jenna was right, he was good-looking. He was probably a few years older than her, with finely chiseled features, golden blond hair, and bright, baby blue eyes. And he was very tall. He looked like he came straight out of a magazine ad.
“No, it’s not what I’m used to at all.” Erin glanced around her again. Two empty trauma bays faced a central workstation, and there were a handful of smaller rooms down the hallway on either side, most of which were also vacant. She was used to the constant flurry of activity at Boston General, with its forty-five ER beds that were rarely empty. Even at the slowest times it was never this quiet.
“Oh God, she’s coming! She’s coming now!”
The cry came as the main ER doors burst open and a nurse pushed a very pregnant patient through them in a wheelchair. The woman’s face was contorted with the pain of a contraction, and she continued to moan as she was rolled toward them, clutching the arms of the wheelchair in a death grip.
“Dr. McKellar, she’s about to deliver,” the nurse said. “I didn’t think we could make it up to the OB floor.”
Chase immediately turned to the unit clerk sitting at the desk behind them. “Lois, call OB and let them know what’s going on. We’ll take her to the GYN room in the meantime.” Then he and the nurse rushed down the hallway with the patient.
Erin looked at Greg Mathis, who’d been standing with her and Chase. “Is there an OB provider here right now?”
“Probably not. Our family docs do most of the deliveries, and Colin and I back them up for C-sections. I doubt anyone would be here this late unless there happened to be another woman in active labor.”
“The on-call doctor isn’t upstairs,” Lois said as she got off the phone. “I’ll page him right away. And there aren’t any postpartum patients on the floor tonight either, so I’ll have to call in the OB nurse too. But I know she can be here in less than ten minutes.”
Greg smiled at Erin. “It looks like things just got busy. Shall we lend a hand?”
“Of course,” she said, hurrying with him down to the GYN room.
The nurse had already gotten the woman into a hospital gown and was helping her up onto the bed. Sweat matted the patient’s hair, and she was breathing in short, rapid bursts. “I’m finally—getting—a girl,” she said between breaths. “Please—let her be—okay.”
“We will,” Chase reassured her, now wearing a sterile gown, gloves, and mask.
“Lois is calling the OB staff in,” Greg said. “We’ll stay and help until they get here.”
Chase nodded. “That would be great. Thanks.” And while Greg and Erin quickly put on sterile attire of their own, he introduced them to the patient.
“Have there been any problems with her pregnancy?” Erin asked.
“No,” Chase responded. “She’s right at forty weeks and just saw her OB doctor Friday. She was three centimeters dilated then, so they had planned on an induction tomorrow. It’s her fourth baby, and the other three were all normal vaginal deliveries.” He turned back to the patient after the nurse placed her feet into the stirrups, and examined her to check the baby’s position. “She’s crowning.”
No sooner did he say that than the woman let out a piercing cry as another contraction came, and the baby’s head emerged. Chase made sure the umbilical cord wasn’t wrapped around her neck, then waited for the rest of the body to slide out. It didn’t.
“I need you to push hard,” he told the woman, grasping the baby’s head and applying gentle traction to finish the delivery.
But the baby wouldn’t move. Her head retracted back against her mother and her reddened cheeks puffed out. It was the classic turtle sign. And for a second Chase froze.
“She has a shoulder dystocia,” Erin said, immediately coming around to the far side of the bed. It was something she’d dealt with more than once during her training. The baby’s anterior shoulder was stuck behind the mother’s pubic bone, keeping her lodged in the tight space of the birth canal. As a result, the umbilical cord was being squeezed shut, so blood couldn’t return to her body from the placenta, depriving her of oxygen. And she wouldn’t be able to breath on her own until the delivery was complete. Even though her head was out, she was suffocating.
Erin looked up at the clock. They had five minutes to free her before irreversible brain damage began to set in, with death not far behind.
She quickly let the patient know what was going on, then turned to the nurse across from her. “We need to push her legs back against her body, with her knees flexed. That will increase the space in the birth canal and hopefully dislodge the baby’s shoulder. And watch the clock. Call out the time after each minute has passed.”
Erin glanced at Greg, who’d lost a little color in his own face as he stood there regarding the infant’s reddish-purple one. “Can you push on her abdomen with your fist clenched, just above the pubic bone on my side? The baby is facing the other way, so if you push downward and somewhat laterally in that direction it can help force the shoulder out.”
Greg nodded and came over to stand beside her, pressing his fist down low into the woman’s protuberant belly.
Erin turned back to Chase for further direction, and he gave her an appreciative look, saying, “We’ll go all out with the next contraction.”
The woman uttered an anguished moan as it came. Erin and the nurse pushed her flexed knees as far back as they could, while Greg applied downward pressure on her abdomen. Chase pulled on the baby’s head at the same time, though not with too much force. Damage to the brachial plexus, the nerves that ran through the neck and controlled her arms, was a common thing to have happen in these cases, and doctors were often sued for it—by people who had never stood where he stood now.
The baby didn’t budge.
“It’s been one minute,” the nurse announced.
“Let’s get her on her hands and knees,” Chase said. “That might increase the pelvic diameter enough to free the shoulder.”
They rolled the woman over, and with the next contraction he gently pulled on the baby’s head again, with no luck.
“I’ll try to rotate the posterior shoulder.” Chase quickly slid the fingers of his left hand into the part of the birth canal closest to the rectum and pushed against the back of the baby’s shoulder.
But she still wouldn’t budge.
He then tried to work his right hand in on the opposite side to reach the stuck anterior shoulder. But after a moment he shook his head, grimacing. “I can’t get in.”
“Two minutes have gone by.”
“I—I need to lay down,” the woman said.
They turned her back over just as the obstetrical nurse walked in and observed the scene with wide-eyed surprise.
“Get the Broselow bag,” Chase told her. It contained all the supplies they would need to resuscitate the baby if it came to that. “And bring me 10 mls of 1% lidocaine and sterile scissors. I need to cut an episiotomy so I can get in there and turn the baby.”
He looked somberly at Greg. “We
should start preparing for an emergency C-section.” If there was no other way to get the baby out they would have to try pushing her back up into the uterus as a last resort, and then take the mother to the OR for a C-section. It was called the Zavanelli maneuver—and carried a high risk of injury to both of them.
“I’ll call in the OR crew,” Greg said, making a beeline for the door.
“I can do the internal rotation maneuvers,” Erin offered. “I have smaller hands.”
Chase nodded, switching positions with her. “Let’s get this baby out now, Erin.”
“We’re at three minutes,” the nurse announced.
“Is she going to be okay?” the mother cried, trying to lift herself up to see what was happening. But she moaned and fell back when another contraction wracked her body.
“She’s just being a little more stubborn than most, but we’ll get her out,” Erin said, squeezing the fingers of her right hand into the birth canal between the baby’s neck and the mother’s pubic bone. It was a tight fit, but she was able to reach the back of the stuck shoulder and push on it in a counterclockwise direction while Chase and the nurse flexed the woman’s legs against her body. Chase also used his other hand to apply downward pressure on the abdomen as Greg had been doing.
But the baby remained lodged.
Erin then slid her left fingers into the bottom of the birth canal and simultaneously pushed on the front of the lower shoulder and the back of the top shoulder in an attempt to rotate the baby.
Still nothing.
“Four minutes have passed.”
One minute left. Erin felt her heart start to pick up speed. You can do this, she told herself. You will do this. She’d never considered failure an option before, and she wouldn’t now. In medicine she expected to succeed, had prepared to succeed. It was what had always made her especially good at her job.
“I’m going to try delivering the posterior arm,” she told Chase. She’d never attempted the maneuver before, but she knew how to do it. She also knew there was a risk of breaking the baby’s arm or collarbone. But at least those could heal. And she might have to break the collarbone on purpose anyway, if the posterior arm maneuver didn’t work. Breaking the collarbone would reduce the width of the baby’s shoulders to help get her past the mother’s pubic bone. And if that failed, they would be forced to use the Zavanelli maneuver.
