“We want to pop over with something for Dylan before he leaves, okay? You know Leila worships him.”
“Good thing we arranged their marriage when she was born,” I said.
“We’ll have beautiful grandchildren,” Wanda said. “Check your calendar. The six of us haven’t gotten together in ages.”
“Remind Leila that her godmother misses our sleepovers,” I said, handing the phone back.
“Girl, be careful what you wish for. Now that Miss Model is with Ford and is making her own money, she’s getting an attitude.”
“See? You’re tired. She can come live with me, and you can visit anytime.” I was only half joking.
“Only if I get Dylan,” Wanda said. “Especially now that he’s grown and all the hard work is done.” She smiled and went into an exam room, and I did the same.
For the next few hours, I was Lillie Silva, BSN, RN, CNM, a woman who knew what to do and say, who could lose herself in her work.
Stephanie, who was indeed in the sweaty grip of menopause, had tried black cohosh, dong quai, and yoga for her hot flashes. “Lillie, I have to change my pajamas in the middle of the night, I’m so sweaty. I’m going to kill myself if these don’t stop,” she said.
“Oh, don’t do that,” I said with a smile. “I’m glad you tried the other stuff, but let’s go next level. Paxil, ten milligrams. It’s a subtherapeutic dose, and a lot of women say it’s a miracle drug.”
“Then give me the miracle,” Stephanie said. “Oh, Lillie, thank God there’s something.”
I tapped the script into the computer to Steph’s pharmacy. “Call me in a few days and tell me how it’s going.”
Rena and her husband were next, and my heart ached for them. She was a lovely forty-two-year-old woman trying to get pregnant for the first time. Unfortunately, she hadn’t been aware of how much fertility drops each year after thirty and had put it off to focus on her career. James, her husband, had normal sperm count and motility. We’d tried Clomid to no avail. Intrauterine insemination, where sperm was injected right into her uterus, hadn’t worked. Ultrasounds and hysteroscopy had shown nothing abnormal. In vitro was probably next.
Sure enough, they asked, then held hands as I talked about the process of in vitro, the cost, the chances. It wouldn’t be easy or fast . . . fertility drugs, egg retrieval, sperm analysis, blood work, the hope that the sperm would combine with the egg to start a healthy embryo. Their faces fell a little with each fact.
“What are the odds that we’d end up pregnant, say, within a year?” James asked.
I took a deep breath. I hated questions that involved statistics. I myself had bucked those odds, after all. “Obviously, I don’t know. Everyone is different. But my best guess, based on the data, based on the number of eggs we can retrieve, maybe . . . ten percent?”
There was a moment of silence. “Yeah,” Rena said. “That’s what we read on the internet.”
“Listen,” I said. “I know how important having a baby is to you. If you want to try this, I’m right there with you, all the way.”
“Thanks, Lillie,” Rena said. She and her husband exchanged glances. “But we’ve talked about this. Those aren’t great odds, so we’re gonna try foster-to-adoption and not put this old body through any more torture.”
“There are a lot of older kids out there who need parents,” James said. “They don’t have to have our genes to be our kids.”
Tears flooded my eyes. “I agree,” I said. “I think that’s wonderful. I’ll send you a list of some agencies other clients have worked with.” I stood up and hugged them both. Rena sobbed once, and I tightened my grip. I understood the pain of not having your body cooperate with what should have been a natural process.
But I had Dylan, at least.
Annie Blanco, age twenty-four, was seventeen weeks pregnant. “I want natural childbirth,” she said. “No drugs.”
I smiled. “That’s what we always aim for.”
“You delivered my sister’s baby last year. Laura Peters? A boy?”
“Oh, yes! She did such a great job.”
“That’s what I want, too. No pain, just breathing.”
I smiled again. “Well, there will be pain, I can just about promise you that. But it can be absolutely manageable. This is what your body was built for, after all. Unless there’s a reason to intervene, we won’t.”
“Awesome.”
I asked her about her diet, recommended prenatal yoga and some guided meditation for pregnant women, told her to get plenty of exercise. “Um . . . is it still okay to have sex?” she asked. She was a newlywed, and she blushed as she asked.
“Oh, absolutely,” I said. “Sex won’t hurt the baby. Feeling friskier these days?”
“Yeah,” she admitted, turning pinker.
“It’s the hormones. Totally natural. I bet your husband isn’t complaining.”
“He’s not,” she said, laughing.
I took out the fetal doppler and listened to the baby’s heartbeat. Annie’s eyes filled. “I love that sound,” she whispered.
“She can hear your heartbeat, too,” I said.
“Really? Sure, that makes sense. Oh.” The tears spilled over, and I held the doppler there a minute longer.
Pregnancy was truly miraculous.
When she was cleaned up from the gel and dressed again, we scheduled her next appointment. She hugged me before leaving.
At least I’ll have this, I thought. When Dylan was 2,662 miles away, I’d still have my job. The best job in the world.
The last patient of the day was a walk-in. “She won’t tell me why she’s here,” Carol said, clearly irked. “She wants to talk to a doctor or nurse. I guess I’m not good enough for her.”
“Don’t take it personally, Carol,” I said. I poked my head into the waiting room. “Hi,” I said. “I’m Lillie Silva, the nurse-midwife. Come on in.”
The girl—young woman—was blond, tanned and silent. “Hop on the scale,” I said, and she obliged. We went into an exam room. Each one was a different color of a soothing shade—gentle gray, sage green, slate blue—with abstract paintings on the walls and a mobile hanging from the ceiling. Hey. If you had to put your feet in the stirrups, you may as well have a pretty room for it. Another of my redecorating projects.
“What can I do for you, Bonnie?” I asked. “Cute name, by the way.”
“It’s fake,” she said.
“Okay.” This happened—clients came in for Plan B after a night of unprotected sex to prevent conception, or needed a pregnancy test, or wanted to go on birth control. “How can I help you today?” She wasn’t much older than Dylan, but I didn’t know her. A summer person, maybe, or someone who had driven here for anonymity’s sake.
“I need to get tested for STDs,” she said, her eyes filling with tears. “My boyfriend cheated on me and then dumped me.” She sobbed once, and my heart clenched for her.
I squeezed her shoulder. “I’m sorry. That’s so hard.”
“It is! I really feel like my heart is breaking in half!”
I handed her a box of tissues—the good kind, with lotion, not the scratchy kind. It’s the little things, and we had a lot of tears in this office, happy, sad, terrified. “A few questions first. Did you use birth control, and if so, what kind?”
They had used condoms (thank God). I went through the slew of questions, holding her hand when she cried. Sent her to pee in a cup, did a cheek swab, drew some blood. We had a quick HIV test here, so it would only take twenty minutes or so to get results. Then I told her to put on an exam robe (they were cotton . . . again, the little things), and had her put her feet in the stirrups. Her legs were shaking, poor baby.
In went the prewarmed speculum, and I did my thing. “Everything looks completely normal,” I said. “Go ahead and sit up. It’ll take about five days for us to get the results back. Okay if I leave a voice message on your phone?”
“Sure. Do you think I have anything?” she asked, her voice shaking. “I had that vaccine. For HPV.”
“Excellent. I can’t guarantee anything, but your odds are definitely lower because you used condoms. Every time, right?”