Chapter 38: Special Delivery

August 19, 1989, Circleville, Ohio

"My monthly started," Kris said as we got out of bed on Saturday morning. "Do we agree I stop taking my pills today?"

"Yes," I replied. "Well, unless you want to confer with the Tsarina for her opinion!"

"I think not!" Kris said lightly. "She may have her opinion, but it's not up to her, as you remind her when she objects to a baby brother!"

We took our usual joint shower, and after we dressed, we found Rachel playing in her room. The gate we put across the door prevented her from going anywhere, but that would need to go soon, as it was approaching the time when girls could start to potty train, and Rachel was telling us now every time she urinated, which was the most important indication that a toddler was ready to be potty trained.

After I gave Rachel a quick sponge bath, I put on a fresh diaper, dressed her, and then the three of us went downstairs to have breakfast. Rachel had zero interest in bottles, so she drank milk from her sippy cup in addition to having Cheerios, a banana, and a waffle. She wasn't a fan of bacon, but she would eat sausage, so long as it was mildly spiced. After we ate, we cleaned up, then said morning prayers.

There was no band practice, as we didn't practice after gigs, so Kris, Rachel, and I went to Kroger earlier than usual, stopped at the bakery, then headed home to spend a few hours together as a family before my Saturday shift at Moore Memorial.

"What time are we leaving in the morning?" Kris asked.

"Matins is at 8:30am at Holy Transfiguration, so about 7:30am, so we're not late. The wedding is at 3:00pm, and we'll go to my sister's house after lunch, then back to the church."

"How long did you and Tasha date?" Kris asked.

"Off and on for about three years. Her dad severely limited how often we could see each other while she was in High School and wasn't thrilled with us spending time alone together even after she'd graduated. You know the rest — my ordination and the demands of my medical training made her reconsider."

"And then she married Nikolas Antipov, had Larisa, and divorced not long after," Kris observed.

"Yes, and I'll share some things about that with you as my wife. The main reason was that Tasha and I had been together."

"She told him she was a virgin?" Kris asked.

"No. She revealed she had missed the mark in that regard before they were betrothed. After they married, he ... hmm ... considered her sexuality to be a sign of 'harlotry', to put it in polite terms."

"She was that wild?" Kris asked with a twinkle in her eye.

"I think it's more that he was that prudish," I replied. "He would consider some of the things you and I have done to be signs of 'harlotry'."

"Oral sex?" she asked.

"Yes, and probably the ice cream toppings."

"Oh, please!" Kris exclaimed, rolling her eyes. "He sounds like some of those crazy monks who think sex is only for making babies and never for any other purpose under any circumstances."

"Bingo. On the other hand, that is the reason we'll be having sex for the next few months."

"The main reason, but not the only one!" Kris countered.

"I suppose we're allowed to enjoy it," I said with a smirk.

Kris simply rolled her eyes and shook her head. We played with Rachel, then at 11:00am, we had lunch, and after we'd eaten, I headed to the hospital for my shift.

August 19, 1989, McKinley, Ohio

"Mike," Nicki called out just after I'd checked in, "Paramedics three minutes out with an active labor."

"Page the OB Resident, stat!" I ordered.

"Right away," she confirmed.

"Jake, Heather, let's go," I said to my students.

"What do we do?" Jake asked.

"Pray the baby has the good grace to wait for the OB Resident to arrive!" I said with a smile.

"Mike," Nicki called out as we gowned. "OB is backed up. They'll get down here as soon as they can."

"Call back and demand an OB nurse with a delivery tray! Do not take 'no' for an answer. Then call for a neonatal cart."

"You're going to deliver?" Doctor Varma asked.

"Got any other ideas?" I asked. "I don't think a cork will work. You could take it."

"No, thanks!" he said firmly. "I'll stick to explosive diarrhea in Exam 3!"

He disappeared into the exam room, and I caught a whiff of what he'd mentioned and decided the possibility that I'd have to deliver a baby to be the far better choice.

"Need help?" Doctor Mastriano asked from behind us.

"I certainly won't refuse!" I replied. "This actually is my first rodeo!"

She laughed, "I heard you had a very successful OB Clerkship."

"Yes, but I didn't deliver any babies! Let's go!"

The four of us, along with Nurse Alice, went to the ambulance bay just as the EMS squad turned into the hospital driveway. They pulled up, and Roy jumped out of the cab.

"Daphne Reardon, seventeen; prima gravida in active labor; full term; pulse 90; BP 130/80; PO₂ 99%. No other complaints."

"Exam 2," I ordered, electing not to tie up a trauma room.

"Hi, Daphne," I said as we began moving to the exam room. "I'm Doctor Mike. When are you due?"

"Last week," she gasped.

"Did your water break?"

"Yes, in the ambulance."

"Are you on any medication?"

"Pre-natal vitamins and folic acid."

Once we were in the exam room, the seven of us carefully moved Daphne from the gurney to the exam table, which fortunately had stirrup attachments.

"Alice, stirrups, please; Heather, monitor, no EKG; Isabella, primary survey; I'll do the internal exam; Jake, nasal cannula, then check with Nicki on OB."

Everyone sprang into action, and once we had Daphne's feet in the stirrups, Alice cut away her shorts and panties.

"OB says they're busy," Jake announced.

I suppressed a groan.

"It's you and me, Mike," Isabella declared.

"Heather, IV Ringer's!" I ordered.

"IV Ringer's!" Heather repeated as she moved to get the IV kit and bag.

"Pulse 110; BP 135/80; PO₂ 99%," Doctor Mastriano announced. "Daphne, you're doing fine."

Alice squirted lubricant onto my gloved hand. I inserted my fingers and almost immediately encountered the baby's head.

"She's crowning!" I exclaimed. "Heather, get that IV in and get two surgical towels! Alice, Betadine! Daphne, do NOT push; Jake, go personally to OB and get a neonatal cart. Do not let anyone stop you. Just take one and bring it here. Move!"

"Yes, Doctor," he acknowledged and left the room.

Daphne groaned as she had a contraction.

"Don't push!" I commanded.

Alice quickly painted Daphne's thighs with Betadine, something that wasn't strictly necessary but was advised for emergency deliveries.

"Drape the towels over your arms," I said to Heather. "And I'll hand the baby to you so I can clamp and cut the cord. Daphne, when your next contraction begins, I want you to push!"

"O ... K," she gasped.

The brief pause to wait for the next contraction allowed me to run through what I'd learned in my OB rotation, which was now two years in the past.

"Alice, get a vial of Pitocin in case we need it," I ordered.

That was something that would be included with a standard OB tray, which I did not have.

Daphne groaned again.

"Contraction!" Doctor Mastriano announced. "Mike?"

"Daphne, push!"

She did, and her baby moved down the birth canal. She pushed again and delivered the baby's head. I carefully rotated it as I'd been taught, verified the cord hadn't prolapsed, and asked Daphne to push again, delivering the baby's shoulders. At that point, the little boy easily exited the birth canal, and I transferred him to Heather's waiting arms.

"You have a baby boy!" I announced. "Doctor Mastriano, suction bulb!"

She moved to use a small rubber bulb to suction mucous and other fluids from the baby's nose and mouth and was greeted with a strong cry.

"Clamp!" I demanded.

Alice handed me a normal ED clamp, which would have to do for our purposes, and I clamped the cord close to the baby's navel. I placed another clamp a few inches further along the cord, then Alice handed me surgical scissors, which I used to cut the cord.

"Apgar?" I asked Doctor Mastriano.

"Estimate at 8," she replied.

The monitor blared.

"WHOA!" Heather exclaimed. "Her BP just dropped!"

Before a conscious thought of why, I KNEW what had happened, as Daphne moaned and blood gushed from her vagina.

"Alice! Amp of Pitocin in the IV bag!" I ordered as I began a gentle external uterine massage.

"Blood loss volume?" Doctor Mastriano asked.

"Estimate 300ccs on the floor," I said. "Let's hang a unit of plasma to be safe."

Jake came into the room pushing a neonatal cart, followed by an irate nurse who was berating him and demanding he relinquish the cart immediately.

"Nurse!" Doctor Mastriano commanded. "LEAVE THIS EXAM ROOM IMMEDIATELY!"

Fortunately, the nurse complied, and Jake set the brakes on the neonatal cart, plugged it in, then adjusted the controls per my instructions.

"Heather, place the baby on the warmer, please," I said.

"How's she doing, Mike?" Doctor Mastriano asked.

"Just that one gush of blood," I said. "Her BP is already coming up. Do you want to manage the placenta or check the baby?"

"I'll manage the placenta; you delivered, so you check the baby."

We quickly switched places, I changed my gloves and went over to the bawling infant on the warmer. I warmed my stethoscope bell by holding it under the heat lamp for a few seconds and verified what I knew from the loud bawling — the baby had clear lungs and a strong heartbeat. I checked his eyes, which were clear, and saw no signs of jaundice.

"She's coming around, Doctor," Heather announced.

"Wha ... what ... happened?" Daphne asked.

"Your blood pressure dropped," I said. "You're OK, and you have a very healthy baby boy. Would you like to hold him?"

"Ya ... yes," she said.

I carefully picked up the baby, carried him to his mom, and helped her hold him.

"Hi, Tommy," she cooed.

"Five-minute Apgar is 10," I announced. "No jaundice."

I had one more thing to do, and that was the heel stick to verify blood glucose. Tommy cried loudly when I pricked his heel, but there was no helping that. I put the test strip into the portable glucose monitor and waited.

"Blood glucose is normal," I announced a few seconds later.

"Cartwright, OB," Doctor Marilyn Cartwright announced, coming into the room with a student.

I was tempted to give her a piece of my mind, but that could wait.

"Daphne Reardon, seventeen; prima gravida; delivered a full-term baby boy vaginally with no tearing; lost about 300ccs of blood; Pitocin and Ringer's, plus a unit of plasma; LOC about two minutes; pulse 110; BP 90/60; PO₂ 99%."

"OK. And the baby?"

"Well-formed baby boy; initial Apgar 8; five-minute Apgar 10; no jaundice; glucose 38; good breath and heart sounds; nose and mouth suctioned."

"Hi, Daphne, I'm Doctor Cartwright from OB. Looks like you had an adventure! How are you feeling?"

"Tired and weak," Daphne said.

"Let me examine you and your baby, then we'll get you upstairs. Mike, I have this."

"OK," I replied. "Jake, Alice, stay, please, until our charges are taken upstairs."

Doctor Mastriano, Heather, and I left the room and stripped off our gowns and gloves.

"Mike?" Doctor Williams called out. "Got a minute?"

"Yes," I replied, certain I knew what it was about.

I waved to Heather to follow and wasn't surprised to see Doctor Mastriano walking with us to the Attending's office.

"Let me guess," I said. "An irate call from the charge nurse in OB, right?"

"She said your med student stole a neonatal cart."

"They'll get it back in about twenty or thirty minutes," I replied. "It's occupied by a newborn baby boy that Isabella and I delivered because OB was too freaking busy to bother to come down or even send us a nurse with a delivery tray."

"She left out that part," Doctor Williams said.

"Of course she did," Isabella interjected. "They blew us off. Mike did a fantastic job on the delivery."

"How are mom and baby?" Doctor Williams asked.

"Good," I replied. "A bit of blood loss following delivery, a drop in BP resulting in brief LOC, but Pitocin and plasma resolved that. Baby is healthy, and mom won't need sutures. Marilyn Cartwright basically kicked us out of the exam room, but I left Jake and Alice with her and her student. They'll take mom and baby upstairs."

"I'll give Norm Zenker a call. Make sure the chart is fully updated with all the relevant details."

"Will do."

We left his office, and Heather and I went back to the exam room, I picked up the chart and made all the necessary entries and notations, including the flat-out refusal of OB to send a doctor or a nurse and my order to Jake to appropriate a neonatal cart. That would keep him out of trouble. When I'd completed the chart, I signed it and set it down on the counter.

"Let me see the chart, please," Doctor Cartwright requested.

I handed it to her, anticipating her response. She was a Resident, so anything she said carried the same weight as what I said. In the end, Doctor Northrup and Doctor Zenker would fight it out, if necessary.

"You didn't have to be a jerk about it," Doctor Cartwright said.

"I simply recorded the facts," I said. "Let's leave it to our Attendings to sort out, please. I have no beef with you."

"Doctor Mike?" Daphne said, thankfully interrupting the conversation.

"Yes?" I asked, moving over next to the bed.

"Thank you."

"You're welcome. Tommy is the first baby I've ever delivered."

"Wow! Really?"

"Really. I'm a trauma surgeon. I was trained to deliver babies, but it's not what I normally do. Good luck with your son."

"Thanks."

I left the room, and Nicki waved me over.

"Mr. and Mrs. Reardon are in the waiting room," she said.

"Let me check and see if Daphne wants to see them," I replied.

I went back into the exam room where Daphne was cuddling Tommy.

"Your mom and dad are here," I said. "Do you want to see them?"

"They can wait until she's upstairs," Doctor Cartwright said.

"Daphne is still in the ED," I said. "That means it's up to me. Daphne?"

"Yes, please," she confirmed.

"I'll bring them in for a minute," I said.

"Against my advice," Doctor Cartwright declared.

I wanted to give the typical teenage response — 'Whatever!' — about the turf war, but I simply let it go. Heather and I went out to the waiting room.

"Mr. and Mrs. Reardon?" I announced in a voice loud enough for everyone to hear.

A couple who were sitting side-by-side stood up, and I walked over to them.

"We're the Reardons," the man said.

"I'm Doctor Mike. Your daughter is fine; she delivered a healthy baby boy about fifteen minutes ago. She wants to see you, but you'll only be able to stay for about two minutes because we need to get her upstairs to OB."

"Did you deliver the baby?" Mrs. Reardon asked.

"I did," I confirmed.

"Thank you!"

"You're welcome. If you'll follow us, I'll take you to your daughter and grandson."

Heather and I escorted them into the exam room and I introduced them to an obviously unhappy Doctor Cartwright, and they both moved to Daphne's side.

"He's beautiful, Honey!" Mrs. Reardon said.

"Doctor, why is she being given blood?" Mr. Reardon asked.

"She lost a small amount right after she delivered, which is not out of the ordinary. In the Emergency Department, we're very cautious, so we gave her a unit of plasma to ensure there were no problems. Her vital signs are good, and both your daughter and grandson are fine."

"Thank you, Doctor," Mr. Reardon said.

"This was the first baby he delivered, Dad!" Daphne declared, sounding stronger.

"First?" he asked, sounding concerned.

"I'm a trauma surgeon," I said. "But we all know how to deliver babies, and there wasn't enough time for an obstetrician to get here after the paramedics brought Daphne in."

That wasn't quite true, but I wasn't going to air our dirty laundry in public, given Daphne and Tommy were both OK.

"Dad, do you have your Polaroid?" Daphne asked.

"In your mom's purse," he said.

"Doctor Mike, could we take a picture?" Daphne inquired.

"Sure," I agreed.

I posed with Daphne and Tommy while her dad took three Polaroid pictures, one of which he handed to me. I thanked them, then Heather and I left.

"Half-a-dozen walk-ins waiting," Nicki said.

I'd noticed a relatively full waiting room when I'd gone to see the Reardons, so that didn't surprise me.