Oh,” said the whore known as Melissa. “I . . . I thought you delivered babies.” Her face flushed. “At the hospital.”
My heart was stampeding like a herd of buffalo. She’d used a different last name, not Finch, not Fairchild, but here she was. My replacement. Here, in my workplace—which was definitely one of the places I loved best—fouling it with her presence.
We stared at each other, dumbstruck. Then I gave my head a little shake and remembered who I was. Lillie Silva, BSN, RN, CNM. “I do deliver babies,” I said. “And I take care of the whole range of women’s health.” My God, that engagement ring could choke a pony. Brad bought that? Brad the cheapskate? He’d been so relieved there’d been a family ring I could wear so he didn’t have to buy me one.
On another note, I wondered if she knew I was the “performance artist” at her wedding.
“I . . . I have an appointment with Dr. Owens,” Melissa said.
“She was just called out on an emergency.”
“What kind of an emergency?”
Clearly, the self-appointed queen of Wellfleet wasn’t used to having to change her plans. “I can’t discuss other patients,” I said. One of our clients had gone into premature labor—four weeks early—and Wanda was riding with her to the hospital.
“Is it a baby?” Melissa asked.
I didn’t answer.
She looked away. “I guess I’ll come back when Dr. Owens is free.”
“Yeah, I think that would be best.” I took a deep breath. “But if this is an urgent medical issue, I . . . I can examine you. I don’t want you to delay getting treatment if there’s something wrong.” I so did not want to look at her lady parts. Then again, if she was here for an STD panel, it would be rather karmic.
“It’s minor,” said Melissa. “Something that can wait.”
“Okay, then. For the record, I do work here five days a week, unless I’m at the hospital delivering a baby.”
“I imagine there are other gynecologists in the area. I’ll use one of them.”
“Great.” I paused. “But Wanda is the only one on the Outer Cape.”
“That’s fine. I’ll go somewhere else.” She hopped off the table. “The fact that I came here . . . it’s covered by HIPAA?”
“It absolutely is. I can’t even tell anyone that you were here.”
“Good.” She flipped her long blond hair over her shoulder and stood up. God, she was so slim and pretty, even in an exam robe.
Suddenly, she bent over and put her hands over her left lower abdomen. “Ouch,” she gasped. “Oh, my God, that hurts.”
I went to her side and put my hand on her shoulder. “Take a breath. Have you had this type of pain before?”
“No! Never.”
“Let’s get you back on the table.” I helped her up. Her face was pale. I smeared my hands with antibacterial gel and put on gloves. I had to ask the question I dreaded. “Any chance you could be pregnant?”
“No! I’m on the pill, and I’m religious about taking it. I am not pregnant. I had my period last month.” She paused. “The pain is fading now.”
“Okay. Is it all right if I palpate your stomach?” My guess was an ovarian cyst, which could be like a knife in your stomach.
She winced again. “Um . . . yeah, okay.”
God, this was weird. I opened her robe, exposing the perfect skin over her stomach, and pressed lightly on the left side. “Any pain or pressure there?” I asked.
“No.”
“Good.” I repeated the move on the other side. “How about now?”
“Oof. There it is again.”
I put my hand just above her pubic bone, and there it was. The fundus, a small, firm mound.
She was pregnant.
All the blood in my body seemed to drain to my feet, and for a second, I felt dizzy. My heart sped up, and I could feel the pulse in my eyes.
Do your job, said my mother’s voice. I took a breath, held it for a second, let it go. “Does this hurt at all?” I asked, pressing gently around the baby bump.
“Not really. It . . . Well.”
“No, no, tell me. I’m a medical professional right now, not your husband’s first wife.” Those words popped right out, surprisingly. “Everything is confidential. I’ve been a nurse for almost twenty years.”
She closed her eyes (did she have eyelash extensions, or was she just blessed?). “I feel some pressure, and it . . . it makes me feel like I have to pee. Badly.”
“Okay. Tell me about your periods. Are they regular?”
“Yes. They’re light, because I’m on the pill. Which, as I said, I never miss.” She looked at me, and yeah, I had to hand it to God, her eyes were spectacularly pretty.
“You’re sure?”
“Yeah. I don’t— This is confidential? You can’t tell Bradley?”
Bradley. That stupid name was worse than Brad. “I can’t tell anyone except Wanda, and she can’t tell anyone outside of the practice. You could sue us for a ton of money if we said anything.”
“Okay.” She looked up at the mobile. “I do not want children. So I’m really, really good about taking the pill. Which is ninety-nine percent effective, right?”
“When taken correctly, yes. Do you take them at the same time each day?”
“Yes! Absolutely.”
“Every single day?”
“Yes. I mean . . . a few times, I’ve been maybe a couple hours late.” She closed her eyes. “It’s possible I could’ve missed one day. Oh, gosh darn it. Maybe two.”
And that, ladies and gentlemen, is why nine out of one hundred women on the pill get pregnant. For that magical 99 percent efficacy rate, the pill has to be taken at the same hour of every day without fail. “Have you taken a pregnancy test?”
She closed her eyes again, and two tears slipped down her temples. “No.”
“Okay. You can sit up now,” I said, closing her robe. She did, wiping her eyes. “Melissa, I’m guessing you are pregnant,” I said as gently as I could. My own feelings would have to wait, because without Wanda here, I was it. Carol wasn’t an ultrasound tech. And I couldn’t let a pregnant woman in pain leave, no matter who she was. “We have an ultrasound machine here, so let’s see what we’re dealing with, okay?”
“Do you do abortions here?” Her cheeks reddened.
“We don’t. You’d have to go to Hyannis for that.” I took another quiet breath. “Let’s do the ultrasound first, okay?”
“What about a pregnancy test?” she asked.
“I’m pretty positive about this. You need a full bladder for an ultrasound, so I don’t want you going to the bathroom first.” I paused. “Do you want to call Brad?” Don’t think about that. Focus on the patient.
“No!” She looked at me with scared, wide eyes. “This was not part of the plan.”
“I know this is a shock, but the more you know, the better you’ll be able to . . . decide how to move forward.”
And so I got the ultrasound machine and the gel we kept in a bottle warmer and asked Melissa to lie down on the exam table again. She stared at the mobile. I put the gel on her lower abdomen and pushed the transducer against her tummy.
She farted loudly, jumped and looked mortified. “Excuse me! Oh, gosh! I’m so sorry.”
“Happens all the time. Don’t worry about it.”
In 95 percent of my cases, this was the magical part, the moment they would never forget, especially with a first-timer. I slid the transducer down her abdomen, and there it was.
The thwack-thwack-thwack of the baby’s heartbeat. I didn’t say anything. Neither did she. I pushed in another spot, and the heartbeat took on a swishing sound. “That sound is the baby’s heartbeat,” I said, my voice husky. I cleared my throat. “So yes, Melissa, you’re definitely pregnant.”
“Oh, gosh.” She looked at the screen, her eyes widening even more.
“The fetal heart rate should be between one forty and one seventy, and it’s at one fifty-nine. Perfect. And here’s the fetus. You can see the head.” I paused, clicked the computer to take a measurement of crown to rump, the head. About twelve weeks along, a little more, maybe. There was the head, the choroid plexuses, the spine. The baby moved a little, and Melissa sucked in a breath.