Chapter 65: Bedside Manner

August 12, 1987, Greater Cincinnati, Ohio

"Good report," Doctor Kelly said. "And you figured out the question I wanted to ask her in private without prompting."

"I couldn't think of any other good reason for you to want to get her mom out of the room so urgently. So I developed a rapport, and then just asked her if she knew. She admitted to being suspicious after she missed two periods, and I'd say she was too scared to tell anyone. Her entire demeanor changed once her mother was out of the room."

"I agree. Let's go see her. I'll listen to her heart and lungs, but there's no need to repeat your physical, as it was thorough and I trust you."

"Are you sure you don't need to repeat it?" I asked.

"You went beyond what we normally do, but that was the right call for someone with basically no medical history. You didn't ask any questions about the father, did you?"

"No. I didn't want to upset her or have her clam up."

"Good decision. Most likely there's nothing she could tell us about him that would matter, as I seriously doubt if she knows his blood type and Rh factor. Good decision on the VD testing, too."

"I learned more than I ever wanted to know working at the Free Clinic during that Preceptorship!"

Not to mention the situation with my little sister when I'd taken her for her exam. I followed Doctor Kelly back to Elaine's room.

"I just need to listen to your heart and lungs," Doctor Kelly said. "Because Mike is a medical student, I have to double-check some things."

"How long before he's a doctor?"

"Just under two years," Doctor Kelly replied. "He's finished his classroom work and now he's getting practical experience."

"How long have you been a doctor?"

"Just over three years."

"Who's going to deliver my baby?" Elaine asked.

"Most likely I will," Doctor Kelly replied. "But it could be one of the other doctors."

"But not him?"

"No. He's a medical student, so he can only do certain things until he learns more."

"He's really nice."

"Yes, he is. We're going to step out to take care of a few things, but I'll make sure Mike comes back to check on you soon. In the meantime, press the call button if you need anything."

"OK," Elaine said.

We walked out into the hallway, and Doctor Kelly closed the door.

"She appears to have imprinted on you like a baby duck on her mama," Doctor Kelly said with a smile. "I'd say she has a serious crush on you."

"I got that impression," I said. "So what do I do?"

"At some point, casually mention that you're married. Don't make a big deal about it, just mention it. That's usually enough to break the spell."

"Are you sure we should?" I asked. "Right now she's acting mature and as together as a fourteen-year-old in labor could be. I think it might be better to wait until after she delivers."

"That is one option, though I'm not sure it's the best."

"We could bring her mom back in," I said flatly.

"OK, I know THAT is not the best option. Maybe if her mom calms down and psych can get her to at least behave semi-rationally, but right now she'd cause all sorts of problems. Let's try it your way. Our goal is to deliver a healthy baby and have a healthy mom. After that, it's up to social services. Are you OK with giving up any other procedures and exams?"

"I'd like to see the D&C, but I think Elaine needs me more."

"And that right there is the sign of someone who is going to be a great doctor. We'll see if we can do both. That might involve you staying past 6:00pm."

"I have nothing to do except go home to an empty room."

"That sounds so sad, but I realize it's because you can't go see your wife. Of course, it would also be the perfect line to pick up a nurse!"

"And it would be my funeral!"

We returned to Elaine's room, and I sat on the stool next to the bed while Doctor Kelly stood close to the door.

"Have you thought about what happens next?" I asked.

"You mean after I have my baby?" Elaine asked.

"Yes."

"I don't know. Mom said I have to give the baby away."

"Would you be OK with talking with someone who can help you?" I asked.

"Who?"

"A social worker. She'll help you figure out your options and help you to decide what to do."

"I don't have to do what my mom says?"

"I can't answer that," I said. "I'm a medical student, not a social worker or a lawyer."

"I guess I'll talk to her."

"Because you're fourteen, she's going to ask you about the baby's father," I said.

"Uhm, how much trouble would he be in?"

"It depends on how old he is. If he's in High School, probably not a lot. If he's older, then he'll be in a whole lot of trouble."

"Like how much?" she asked nervously, making it clear that he was older.

I contemplated how to answer and decided it was best to just be straight with her and tell her what had happened with Paul and Liz.

"When my sister was fourteen, she got involved with a guy in his twenties," I said. "When it was found out, he was arrested and went to jail."

"Your sister? Really?"

"Yes. He pled guilty to two charges and was sentenced to four years. He only served a little over two, and then was released on parole."

"What happened with your sister?"

"Counseling," I replied.

And just then, it dawned on me that I was the same age as Paul had been when he'd met Liz, and Elaine was the same age as Liz. Elaine's crush took on a whole different meaning, but I also could not fathom how Paul could have been attracted to a fourteen-year-old girl. It wasn't just being married, but the huge age gap and how young Elaine was. Yes, I'd married Elizaveta when she was sixteen and I was twenty-two, but those two years for each of us made a huge difference, with a six-year gap rather than a ten-year gap. Not to mention the age of consent, though I felt that was an arbitrary choice by the government.

"Will they make me tell?" Elaine asked.

"I honestly don't know," I replied. "But they'll certainly try very hard."

"How did your sister's guy get caught?"

"Someone found out and turned him in," I replied, concerned that if I admitted it was me, it might change Elaine's willingness to talk. "Will you answer a question for me?"

"Maybe," she said apprehensively.

"Did you want to? Or did he force you?"

"I wanted to," she said quietly. "Or I thought I did. It was a huge mistake, obviously."

"Will you tell me?" I asked.

"You won't tell if I don't want you to?"

"I can't promise," I said. "Because the facts of what happened might change things, and I wouldn't want to break a promise, I made to you."

"But you think the social worker will try to make me tell?"

"I expect her to, yes."

Elaine was quiet for a moment, then said, "It was our next-door neighbor. His daughter is my best friend."

Which put him in his thirties, at least, and I was positive he'd be going to prison for a long time if she told Family Services.

"Does your friend have brothers or sisters?" I asked.

"Yes. Both older. One is in college."

Which likely put her friend's dad in his forties.

"Is it OK if I call the social worker?" I asked.

"Yes," Elaine agreed, sounding a bit apprehensive.

I went to the wall phone and called the social worker again, and this time she answered. She apologized for not being available and promised to come right up.

"Will you stay with me?" Elaine asked.

"Yes. Doctor Kelly gave me permission to stay with you as long as you need. I want to put the fetal monitor on you now."

"OK."

I hooked it up and started the strip. It was still running when the social worker arrived.

"I'm Mrs. Abbott," she said. "You must be Elaine."

"Yes," Elaine replied.

"Mike, would you give us some privacy, please?"

"I have about five more minutes of monitoring to do," I replied. "Then I'll step out."

"I want him to stay, please," Elaine said. "He's been really nice and is taking care of me."

"Under the supervision of Doctor Mary Kelly," I quickly added.

"I might ask you some embarrassing questions," Mrs. Abbott said to Elaine.

"It's OK. I trust Mike."

"Let me get some basic information, then," Mrs. Abbott said. "And if you want Mike to leave at any point, he will, right Mike?"

"Yes," I agreed.

Mrs. Abbott asked her full name, which was Elaine Marie Webber, her address, her birthdate, her grade in school, and if she had siblings, which she did — two older brothers, Kenny and Tony. Her dad was an Air Traffic Controller at Greater Cincinnati Airport, and her mom was a real estate agent. Elaine earned good grades in school and worked on the school newspaper. She didn't play a musical instrument or participate in sports beyond gym class.

The monitor strip had run, and everything looked good, though Elaine's contractions were closer together. That meant I needed Doctor Kelly so we could do an exam, as I knew I couldn't do that without her supervision from the incident the previous week.

"I'm going to call Doctor Kelly to come to do an exam," I said.

"OK," Elaine replied.

I went to the phone and called the nurses' station and asked them to page Doctor Kelly, then went back to stand near the bed.

"Will you tell me who the father of your baby is?" Mrs. Abbott asked.

Elaine looked at me, and I felt compelled to nod. While I'd reconsidered the situation with Liz and Paul and could see Liz's point even if I didn't agree with it, I didn't think that Elaine's situation was similar. Not to mention the even larger age gap and my own feelings about even someone my age being with a fourteen-year-old girl.

"Our next-door neighbor," she said.

"What's his name?"

"Frank," Elaine replied quietly.

"And is he your age?" Mrs. Abbott asked. "Or within a year or two?"

Elaine bit her lip and shook her head, "No. He's my best friend's dad. I think he's like forty-three or forty-five, but I don't remember."

I saw Mrs. Abbott's knuckles turn white as she gripped her pen and tried not to outwardly show the rage I was sure she felt inside.

"Did he force you?" Mrs. Abbott asked carefully.

"No. I wanted to."

"Will you tell me why?" she asked.

"I had a fight with my mom," Elaine admitted.

"About?"

"I wanted to go to the movies with a boy I like who is sixteen now, and who will be a Junior, and Mom said 'no' and that I wasn't allowed to date until I was eighteen."

I felt like smacking my forehead on the railing of the bed in front of me. I could see waiting until sixteen to date, but eighteen just struck me as completely out of line. And a girl who was going to be a Sophomore going to the movies with a guy who was going to be a Junior seemed perfectly reasonable to me, though I suspected I might think differently in fourteen years. But, even if I did, I couldn't be like Deacon Vasily or like Elaine's mom.

"What happened?"

"My mom and I yelled at each other, and I told her it was up to me. She said it wasn't, and that I was going to do what she said. I ran out of the house and walked down the street."

"So you were angry with her?"

"Yes."

"Then what happened?"

"I saw Mr. Sheldon doing something with a machine in his garden. He turned off the machine to say 'Hi' and I asked if Shelly, my friend, was home, and he said she was at her grandma's for the day with her mom and brothers. We talked, and he said he was going to get some water and asked if I wanted some. I said I did, so we went into the house.

"He gave me some water and asked what was bugging me 'cause I guess it was obvious. I told him I was mad because I wanted to go out with a boy, and my mom wouldn't let me. I complained I hadn't even kissed anyone. He asked if I wanted a kiss, and I said 'yes'. When he kissed me, I knew I wanted to do it with him. We kept kissing until he took me to the guest bedroom, and we did it."

"What did you do?" Mrs. Abbot asked.

"He kissed my boobs and between my legs, then put his thing in me."

Doctor Kelly came in just then, interrupting the conversation.

"What's up, Mike?"

"Her contractions are about five minutes apart; baby's heart rate is good."

"Elaine, I need to do another exam," Doctor Kelly said, "to see how your baby is doing with being born."

"OK," Elaine agreed.

Doctor Kelly did the exam.

"Eight centimetres, fifty percent effaced; 0 station," Doctor Kelly said.

"What does that mean?" Elaine asked.

Doctor Kelly looked at me and nodded.

"That your baby is doing fine and is getting ready to be born," I said. "It could be anywhere from two to eight hours."

"Will you stay with me?" she asked.

"Yes."

"I'll come back in thirty minutes," Doctor Kelly said. "Mike, continuous fetal monitoring, please, because our young mother-to-be is fourteen."

Which made the delivery high risk for Mom and baby, at least according to the statistics. Doctor Kelly clearly wanted no surprises. I moved to hook up the monitor, and once the strip had run for a minute, Doctor Kelly checked it, then left.

"OK to continue?" Mrs. Abbot asked me.

"I don't see why not," I replied. "Doctor Kelly seems satisfied."

"What happened then, Elaine?" Mrs. Abbot asked.

"It hurt at first, but then it felt good. It lasted like ten minutes, then we kissed more, and after I said I really liked it, we did it again, and it felt really, really good. When we finished, I took a shower and went home."

"And did you see him again?"

"When I was visiting my friend, but we didn't do it again."

"And he's the only one you've done that with?"

"Yes. Not even kissing with anyone else."

"OK. I have what I need. Do you have any questions?"

"Mom said I have to give up the baby," Elaine said. "Is that true?"

"You don't have to, but if your mom and dad don't want to help take care of the baby, that might be the best thing to do. Let me take care of a few things and I'll come to talk to you after you have your baby, OK?"

"Yes."

"Mike, do you have a moment?" Mrs. Abbot asked.

I nodded, let Elaine know I'd be right outside the room, then followed Mrs. Abbott into the hallway.

"You know I have to have that man arrested today, right?"

I nodded, "I'm aware. My sister was in a similar situation at fourteen with a twenty-four-year-old man. That was six years ago. He received a sentence of four years for statutory rape and served a little over two."

"This will be aggravated criminal sexual assault, and the penalties are much harsher than they were in 1981. At least ten years, probably longer, given the extreme age difference. Does she know that's going to happen?"

"Yes. She told me who it was before you came up, and I let her know he's going to be in very serious trouble."

"I know you're just a medical student, but you have a rapport with her. How's she going to react to either giving up the baby for adoption or having Family Services take the child into foster care?"

"I don't think she has a clue about what being a mom involves, but I think she's going to bond with her baby as soon as he or she is born, and that's going to make things worse. That said, her mom completely lost her mind, so I'm not sure there's really an option."

"What happened?"

"Well, Elaine hid her pregnancy until she went into labor. Her mom freaked out, which I can understand, but she couldn't hold it together. Psych put her on a twenty-four-hour hold because she was completely hysterical and irrational. She ordered all the doctors and nurses out of the room, and I honestly think she'd have assaulted someone if she hadn't been restrained by the orderlies."

"Wonderful," Mrs. Abbott replied. "Do you know anything about the father?"

"Just what Elaine told you. I was careful to just let her talk and careful with the questions I asked."

"You've done a pretty good job for a medical student."

"Going through everything with my sister, as well as helping a friend who has schizophrenia, has helped."

"OK. I think we're going to have to take the baby into foster care while we sort this out. I need to call the Sheriff and the County Prosecutor and swear out a complaint. I suspect they'll want to speak to you. May I have your contact information?"

I gave her Doctor Cooper's name, address, and phone number, and said she could reach me there or at the hospital. She left, and I went back into the room with Elaine.

"So now what?" Elaine asked when I sat down on the stool next to the bed.

"Now you have your baby!" I said. "That's what you need to concentrate on doing."

"Can you tell me what that machine shows?" she asked, pointing to the cardiotocograph machine.

"The top line is your baby's heart rate, which is about 130 beats a minute. That's twice as fast as yours, and it's normal for a baby in his or her mother's womb. The other line shows your contractions, which are about five minutes apart. That, combined with the exam Doctor Kelly did, tells us how close your baby is to being born."

"And the other machine?"

"Your pulse and the percentage of oxygen in your blood. 76 is an OK pulse, and 98% means your lungs and heart are working properly together to make sure you and your baby get enough oxygen."

"You learned all that stuff in medical school?"

"Yes."

"Do you have a girlfriend?"

"I'm actually married," I replied. "My wife will be having our first baby in the next two weeks."

"Oh," Elaine said, sounding disappointed.

I decided I needed to change the subject, so I asked, "How are you feeling?"

"Uncomfortable," she said. "It's like there's this pressure on my insides down below my stomach."

"That's normal," I replied. "At some point, you're going to feel an urge to push, almost like going to the bathroom, but don't push unless a doctor tells you to, OK? Tell me, or a nurse, or a doctor when you feel like you have to push, OK?"