Chapter 66: A Crazy Idea

August 13, 1987, Greater Cincinnati, Ohio

On Thursday morning, I did pre-rounds with Nicole, then regular rounds, and finally went to see Elaine and April.

"Hi, Mike!" Elaine said brightly.

"Hi! How did you sleep?"

She giggled, "Like a baby! I woke up every two hours to feed April. It was SO cool!"

And when the social worker told her they were going to take April away, Elaine was going to be distraught. I could only hope that her mom came to her senses and decided, despite the difficulties, to allow Elaine to keep April. I couldn't imagine how tough it would be for a fourteen-year-old, but I'd heard from April Nash how difficult it was for an eighteen-year-old.

"Have you spoken to your mom or dad?"

"No. They said my dad could see me today, but only with the social worker here. It has something to do with me being fourteen and having a baby, but I didn't understand it."

"Until your parents come to terms with the situation, the State of Ohio will make any medical decisions."

"They said my mom calmed down, and she can come to see me later, too."

"Do you want to see them?"

"I guess so. The social worker thought it was a good idea. Can you be here?"

"I can ask," I said. "Did they say when you would leave the hospital?"

"Not before tomorrow because they want to make sure both April and I are OK."

April fussed in her bassinet just then.

"She wants to eat, and I'm sure she needs a new diaper. She poops a LOT for such a little thing!"

I chuckled, "Babies eat, poop, cry, and sleep. That is pretty much it."

"Will you bring her to me and a clean diaper and some wipes?"

I nodded, got a clean diaper from the stack on the shelf under the bassinet, along with the pre-moistened wipes. I took those to Elaine, who moved to sit cross-legged on the bed. I then carefully picked up April and brought her to Elaine, who accepted her, then proceeded to change the diaper. I accepted the soiled diaper and disposed of it in the container on the shelf of the bassinet.

"How are you feeling?" I asked.

"It feels like somebody rubbed my insides down there with sandpaper, but it doesn't hurt."

All I knew was that if something weighing six pounds came out of MY body, I sure as heck would hurt! Women who had given birth amazed me, and each birth I witnessed convinced me even more that if men had to give birth, humanity would die out in less than two generations.

"Any bleeding?"

"Just a bit," she said. "But I have a pad like I do for my period. I'm going to feed her."

"Do you want me to leave or turn away?" I asked.

Elaine giggled, "You saw my private parts yesterday!"

"Yes, but you have to be comfortable with me seeing you nurse her."

"You've seen that before, right?" she asked as she unsnapped the gown to expose her breast, which April quickly latched on to.

"Yes," I replied, still fascinated by the entire concept of nursing babies. "My High School girlfriend, whose name is also April, had a baby a year after we broke up and I saw her nurse her baby."

"Not yours, right?"

"Correct. We broke up right after graduation."

"Why?"

"She refused to even visit my church."

"And you dumped her for that?"

"No," I replied. "But what you don't know because I've been wearing scrubs is that I'm a deacon in the Russian Orthodox Church. And that requires my wife to be Russian Orthodox as well."

"When did you get made a deacon?"

"About two years ago, but I was made a subdeacon, which is like a deacon in training, a couple of years before that."

"Ours are usually my dad's age."

"What church?"

"First Baptist. People there will freak out about April. What church do you go to?"

"My home parish is Saint Michael the Archangel Orthodox Church in McKinley, which is about ninety minutes east of here. While I'm here, I go to Saint George in Loveland where a friend of mine attends regularly."

"I don't know anything at all about your church. Are you like the Catholics?"

"There are some similarities, yes, but there are also some big differences."

"Did you go to school for being a deacon?"

"No. Our priests usually go to seminary, but deacons usually have another vocation. Mine is medicine."

"Obviously!" Elaine exclaimed. "What would happen in your church?"

"There are some people who do 'freak out' as you say, but most people understand that it happens, and do their best to help the girl and her baby."

"So they aren't disfellowshipped?"

"Of course not," I replied. "The church is meant for sinners, including me! Why would I tell someone who is in dire need of God's grace to leave the church simply because they fell short of perfection? Remember 'Let him who is without sin cast the first stone'?"

"How long can you stay today?"

"I need to be with Doctor Kelly at 9:00am, and I'll have other things to do today, but I promise to check in with you as often as I can. When are your parents coming to see you?"

"Later, after Mrs. Abbot talks to me."

"OK. I need to go see Doctor Kelly. If you need anything at all, press the call button. Will you be able to put April back in her bassinet?"

"Yes. I just want to hold her for a bit after I feed her."

"OK. I'll see you later, then."

"Thanks for coming to see me!"

"You're welcome!"

I left the room and went to find Doctor Kelly.

"How are your patients?" she asked.

"Elaine is nursing April. I think there's going to be some serious trouble if they try to take April away from Elaine."

"I don't disagree, but remember, that's not part of our job. Our job is to ensure they're both healthy."

"I know," I replied. "But I can't ignore my other vocation completely, even though I know there is basically nothing I could do in this case to affect the outcome."

"Just keep your emotions in check," Doctor Kelly advised. "Don't totally turn them off, but understand you're part of a team which also includes social services, the chaplain, and, very possibly, the courts. All of us have our roles to play in ensuring what's best for Elaine and April happens, and we have to let the other members of the team do their jobs and trust that they will."

"Family Services has made mistakes in the past," I countered.

"So have doctors! Does that mean nobody should trust you? Or that someone who is not a doctor should take on our role?"

"No," I admitted.

"It'll be worse in the ER, when you won't know what happens to most of your patients because you'll pass them on to other physicians who will do THEIR jobs after you've stabilized the patient."

"That's been said one or two times before," I replied.

"And we'll keep saying it until it sinks in! Anyway, shall we prepare for the procedure?"

"Yes."

"Then please go do a pre-procedure check on Ms. Edwards. IV with saline, please. It'll be on the chart."

"Yes, Doctor. Oh, may I ask one question about yesterday?"

"Sure."

"Why didn't you offer Elaine a spinal block?"

"I had no medical history, and I felt the risk was too great. And for the next question, I'm sure your textbook said episiotomies are normal for very young mothers to prevent tearing, but I felt that risk was low as she was likely to have a baby on the low-end of the weight scale due to lack of prenatal care. But that's three years of experience speaking. I also find young women are far more tolerant of pain than older women."

"Thanks. I'll go check on Ms. Edwards."

I went to the nurses' station to find out what room she was in, then made my way there.

"Good morning," I said. "I'm Mike. We met in the ER yesterday and I need to do a brief exam to make sure you're OK for your procedure."

"OK," she agreed.

I looked over the chart and saw she'd been given a mild sedative and muscle relaxant, which was common before a D&C. That also informed me that her BP, pulse, and breathing could be affected, and that I needed to take that into account when I performed the exam. I did the routine checks of her heart, breathing, pulse, and blood pressure, and everything was within the acceptable ranges. That, combined with the blood tests which had been run, showed she was ready for the procedure.

"Are you still bleeding?" I asked.

"The pad the nurse changed this morning had a little bit of blood on it. It's OK if you need to check."

"I don't," I replied. "I do need to insert an IV."

"OK."

I went to the supply room and collected all the necessary items, then returned to the room and inserted the IV. I wrote the date and time on the bag of saline with a marker, then hooked it to the IV needle. Once that was completed, I went to the phone and called for an orderly to bring Ms. Edwards to the procedure room where, when we arrived, Doctor Kelly and Nicole were waiting.

"Mike, you'll observe," Doctor Kelly said. "Nicole will assist."

"Yes, Doctor," I replied.

That was the normal way for Third Years. I'd been lucky so far to get far more procedures than a typical Third Year, both when I was on my surgical rotation and so far on the OB/GYN rotation. They began with a confirmatory ultrasound, comparing the current image with the one from the previous day, and seeing the fetus had moved, and that there were no indications of fetal heart activity.

Once that was done, Doctor Kelly inserted a standard speculum, then administered local anesthesia. She began by stabilizing the cervix with a tenaculum, then used a sequence of lubricated Heger dilators to open Ms. Edwards' cervix. When that was completed, she carefully inserted a curette, which she used to gently scrape the inner walls of Ms. Edwards' uterus. Following that, a suction curette was used to perform a vacuum aspiration. Once that was completed, the container with the collected tissue was labeled, and I was asked to take it pathology where they would examine it to be sure that the D&C had collected all the material.

When I completed that task, I returned to maternity and checked on Elaine, who was napping, so I went to find Doctor Kelly.

"Pathology said tomorrow morning," I informed her.

"That's typical," Doctor Kelly replied. "She's here until Saturday, at least, to monitor for any complications from surgery or any missed kidney damage. You understand why Nicole assisted, right?"

"Yes, of course. She intends to match for OB/GYN, which is why she's doing a Sub-Internship. Only someone doing that, which she told me our first day, or someone going into fertility or possibly urology, would use OB/GYN as an elective."

"Or someone exploring the new field of in utero surgery. Do you know about the first procedure?"

I nodded, "In a supplement to our textbook handed out by our professor at Taft. In 1981, a doctor at UC San Francisco inserted a stent to resolve congenital hydronephrosis. The urinary tract blockage itself was removed via normal neonatal surgery after the baby was born."

"You wrote that in your OB/GYN notebook, I take it?"

"Yes. I expected a question similar to that at some point. Have any prenatal fetal surgeries been done here?"

"No. I hope to have a chance to observe one, but for now, they're highly experimental and only done in a few hospitals around the world. How is your charge?"

"Napping," I replied. "She nursed April this morning, and I'd say she has the potential to be a good mother if she has sufficient support, which I think is highly unlikely, given the impressions I have."

"You and me both. One thing I have seen in the past, and if Mrs. Abbott is convinced Elaine can handle it, would be placing Elaine in foster care with a family that would support her keeping the baby. But that's uncommon and requires all sorts of court proceedings to terminate Elaine's parents' parental rights."

I knew, from experience, about that, but I couldn't mention it because I couldn't risk Doctor Kelly asking questions I couldn't answer about the situation.

"What's next?" I asked.

"If you'd like to observe a hysterectomy, go find Nicole. She's prepping the patient now. One of the general surgeons does the surgery."

"Diagnosis?"

"Prolapsed uterus in a post-menopausal woman. Otherwise, we couldn't do the hysterectomy here. We'd have to either do a procedure that could spare the uterus or refer her to another hospital."

"May I say something?"

"Permission to speak freely!" Doctor Kelly said, trying to sound like a gruff drill sergeant, but failing miserably, causing both of us to laugh.

"I completely understand the concern about elective abortions, but refusing a necessary procedure on a woman who has not reached menopause seems wrong to me."

"To me, too, but the Roman Catholic Church objects to any procedure which amounts to sterilization, except as life-saving measure, and even then, some theologians object to it as a grave sin. The hospital prefers to refer such patients to other facilities. And you know the teaching on abortion, if followed strictly, means one cannot be done even to save the life of the mother. That is the general position of the hospital. And that's why termination of ectopic pregnancies, which would be fatal to both mother and fetus if left untreated, are permitted only with express permission."

"Orthodoxy doesn't require that stark choice," I replied. "Saving the life of the mother is permitted in all cases, though, obviously, if both can be saved, they should be. But a decision can be made to perform a procedure without an attempt to save the fetus if the mother's life is in danger. And, in the end, making the 'wrong' choice is dealt with by the woman's confessor, and isn't a 'mortal' sin, as it were. There is no problem with a woman electing to have chemotherapy to save her life, knowing it would terminate her pregnancy, something I know Rome forbids."

"The more I hear, the more reasonable your church sounds. Go join Nicole and I'll see you in surgery."

"Thanks, Doctor."

I observed the hysterectomy, which was completely routine, then went to check on Elaine, and found her nursing April while speaking with Mrs. Abbott.

"You can come in, Mike," Mrs. Abbott said. "We were just talking options before I bring in her parents."

"Mike, can you stay?" Elaine asked.

I didn't think that was a good idea, given how her mom had reacted to me the previous day, but that was Mrs. Abbott's call.

"That's up to Mrs. Abbott," I said. "Your mom was pretty upset that I was involved."

"My mom is a..."

"Careful," I said, interrupting her before she could say 'bitch' or some equivalent word. "You need to treat your parents with respect."

"They don't respect me!" she protested.

"Elaine, I think it would be better if Mike wasn't here. He can come to see you after your parents leave, OK?"

Elaine made a face similar to the ones Elizaveta made when she wasn't happy with me.

"Mike, if you come back after 1:30pm, that would be OK," Mrs. Abbott said.

"OK," I replied. "I'll see you this afternoon, Elaine."

I left the room as Elaine gave Mrs. Abbott a 'death stare'. I thought back to how Liz had reacted to my parents and to the social worker, and it had been similar. I hoped that things worked out for Elaine, but I knew that was Mrs. Abbott's responsibility, as both Elaine and April seemed healthy.

I checked my watch and saw it was time for lunch, so after checking with Doctor Kelly, I found Maryam so we could have lunch together. After we ate, I participated in afternoon rounds with Doctor Kelly, then went to see Elaine.

"How did it go?" I asked.

"Not well," she replied. "They insisted I have to give April up for adoption, and don't want anyone at church to know I even had her!"

"And what did Mrs. Abbott say?"

"She said it might be possible for me to live with another family who would help me take care of April and finish High School, at least, and maybe even go to college."

"Is that what you want?"

"I don't want to give April away!" Elaine declared. "I love her!"

"Make sure Mrs. Abbott knows that," I said.

"I will!" Elaine said fiercely.

"Is there anything I can do for you?" I asked.

"No, I don't think so, unless you can adopt me!"

"I don't think I could do that," I replied. "My wife and I are just about to have our own first baby, and that's where we need to focus."

"I know," Elaine said. "I was just being silly."

It was also likely that she hoped there was some remote possibility, but that was not going to happen. But an idea popped into my head and I wondered if it were even possible. I filed it in the back of my mind, knowing that my subconscious would work on it, and I could decide later if I should even broach it.

"I have some things to do," I said. "There are two women in labor, and I need to help Doctor Kelly. I promise to come to check on you before I leave. OK?"

"Yes."

The afternoon was busy, with a total of four women in labor, two of whom delivered before it was time for me to leave. I stopped in to check on Elaine, then left with Maryam.

"What are you doing tonight?" she asked.

"Same as always — dinner, a call home, studying, and maybe reading a bit. You?"

"Basically the same. See you in the morning?"

"Absolutely."

August 15, 1987, Rutherford, Ohio

"What did you want to talk about, Mike?" Mom asked when I stopped in to see her on Saturday on the way home.

"Just a crazy idea," I replied.

"How crazy?"

"This one nails the crazy meter."

"You've decided to marry Tasha and live like an Arab sheikh with multiple wives?"

I laughed, "Now there's an idea! Not THAT crazy! And how did you come up with that?"

"One of Stefan's clients told him about a kid from Milford who had some kind of triple marriage ceremony while a third woman was pregnant with his son."

"Let me guess," I chuckled. "His name is Steve Adams."

"How did you know?!"