Crossroads

Chapter Three

Hollis pulled off her surgical cap and snapped the paper tie on her mask, balled them up, and tossed them toward the trash can across the small anteroom adjoining the delivery room. She’d gotten a few hours’ sleep the night before, but her eyes felt gritty and her shoulders ached. She washed her hands and splashed her face with cold water. With luck she’d be able to put some time in on her bike before the end of the day—twenty miles cycling along the Schuylkill ought to work out the kinks.

“I thought you were off today,” Ned Williams said, stopping in the hall that ran the length of Labor and Delivery.

“I am—was.” Hollis pulled a few paper towels from the dispenser and mopped the water off her neck. Ned was a few years her senior in the department, a good-looking redhead with playful blue eyes, a smile that put patients immediately at ease, and an ex-wife and four kids. She gestured to the delivery room behind her. “One of my patients is a week early. I got the call just as the staff meeting finished. I’m waiting on her now.”

Three other rooms like the one where her patient was being monitored were reserved for women in labor. A fifth room was reserved for scheduled C-sections during the week and for emergency surgeries, day or night. Hollis spent a lot of time in that room. High-risk pregnancies usually went well, but when they went bad they went bad fast, and she often had to operate emergently to save the baby and mother.

“Anything problematic? I don’t mind giving an assist,” Ned said, a hopeful note in his voice.

Ned was double-boarded in adolescent medicine and did a lot of teen pregnancies along with routine OB, and he regularly referred his surgical cases to Hollis. He frequently hung around when he was off call, and Hollis often wondered if the excitement of the hospital was more satisfying for him than his personal life. Her father had loved his job, but he was home at five p.m. every day for supper unless he had a fire call-out. Then no one cared how late he was as long as he came home. Hollis dismissed the unfair comparison—her family wasn’t like most families she knew. She and her five brothers never fought, her mother and father were affectionate and still in love after thirty-nine years, and there was an unspoken rule that no matter how bad things got, together they could handle anything. That’s how it had been until one Tuesday in September when the Towers came down and Rob never came home. Everything changed after that. The world had changed, her world had fractured, and she’d vowed she’d never be that vulnerable again.

Ned was waiting, a faint smile on his face. He was just being friendly. He couldn’t know she didn’t want friends.

“Hopefully this will go smoothly,” she said. “She’s thirty-eight and had preeclampsia with her last delivery, but she’s been on bed rest for the past six weeks and her pressure’s looking good. She’s already fully effaced and moving right along.”

“Good enough.” He started to turn away, then paused. “What do you think about this whole thing with the midwifes? One of the OB practices I did a rotation with when I was a resident worked with midwifes. It was great, actually. I don’t know why, but for some reason, mothers seemed more comfortable with them, especially around all the prenatal stuff.”

“I think there’s plenty of room for other caregivers to get involved with prenatal and aftercare,” Hollis said. “But delivering high-risk mothers in an outpatient setting? Seems like a recipe for disaster to me.”

“Well, I guess you’ll get the chance to find out. Glad Dave volunteered you and not me.” He grinned. “Kind of feel sorry for the poor midwife, though.”

“Thanks,” Hollis said dryly. “I’ll try not to bite.”

“You off the weekend?” Ned asked.

“Yes,” Hollis said, although she’d told Bonnie McCann, who had the call on Monday, she’d back her up if she got busy. She wasn’t doing anything and Bonnie had three kids and a birthday party scheduled.

“I’ve got the kids on Sunday and I promised them a barbecue. If you’re free—”

“Uh…thanks, really. But I’ve got some stuff around the house I’ve been meaning to do for months. I think it’s home-repair weekend.” She didn’t spend a lot of time socializing with her colleagues—fortunately her schedule gave her an easy excuse to pass on dinners and department get-togethers. Friendships didn’t come without a price, and she was just as happy not to have even casual ties. She’d rather invest her energy and time in her patients. Those relationships were short but intimate and intense, and then everyone moved on with their lives. If she never made a long-term investment, she’d never be disappointed or, worse, devastated by loss.

Ned nodded as if anticipating her answer. “Okay, but if you change your mind, we’re only ten minutes from you.”

“Appreciate it, but I think I’ll be knee-deep in sawdust for the foreseeable future.” She wasn’t lying. Her second year on staff, she’d purchased a once-stately old Victorian opposite the small park a few blocks from the hospital. She could walk to work, and if she had an emergency in the middle of the night, she could be on-site in less than fifteen minutes. Somewhere in the last hundred and eighty years, the second and third floors had been divided up into apartments and then later reconverted, leaving many false walls and odd corridors that divided rooms in haphazard fashion. She’d been slowly working to restore all the original architectural details. She enjoyed returning the place to its lost grandeur. This spring she’d started exterior work and still had half the wraparound porch to go.

“Have a good weekend,” Ned said over his shoulder as he went off down the hall.

Hollis checked her watch. Mary Anderson was likely to deliver in the next two or three hours. She ought to be home by one and could get in a few hours’ work on the back porch, a bike ride before dinner, and maybe even get out on her Harley for a quick run after that. She was planning to pull up the pressure-treated wood someone had put down on the porch and replace it with stained oak planks. Some of the posts on the banister also needed replacing, and she had to find a carpenter who could cut her new ones to match.

Happily reviewing her plans for the day, she pushed open the door bearing her name in plain black letters and stepped into the anteroom adjoining her office. Her secretary allowed no one through without an appointment, and the single chair in front of her desk didn’t do much to encourage drop-in visitors. When she was at work, she wanted to work, not kill time with meaningless gossip.

“Hi, Sybil. Anything doing?” Hollis kept walking toward her office, not expecting Sybil to have much in the way of news. If there’d been anything important, she would have paged her. Sybil Baker, forty-five and looking thirty, twice divorced and “done with men,” had been with her since she’d taken the position at the hospital. She had been the executive assistant to the chairman for five years before Hollis arrived but didn’t like juggling all the departmental meetings that went along with the job. She preferred taking patient calls and scheduling office hours. She was also very good at settling down anxious patients and their families, leaving Hollis to concentrate on her clinic and delivery schedules. Hollis was the envy of every doc in the department.

“Actually,” Sybil said, and Hollis slowed, “your ten o’clock appointment is here.”

Hollis frowned. “I’m not scheduled to see anyone.”

Sybil gave her an odd look. “I thought you knew. You have a meeting about the midwife clinic?”

Hollis clenched her jaws, biting off a retort. God damn Dave. He could have warned her. “I didn’t know it was today.”

“Oh,” Sybil said, looking relieved. “That’s why I didn’t know about it. I was afraid you’d told me and I forgot to put it in your book. She seemed certain, so I thought it was best to have her wait in your office.”

Hollis glanced at her watch. Ten fifteen. Great. She disliked keeping anyone waiting—she ran her office hours as close to on schedule as she possibly could, and her patients often remarked how unusual that was for an obstetrician. There were times she was late or missed office hours altogether, but only when she had an unexpected delivery. Otherwise, she wanted her patients to know that she would be there when she said she would be there, for any reason. And that extended to other appointments she made. She’d missed a critical appointment once in her life, and she’d be paying for it until the day she died. She’d vowed then it would never happen again.

“Hold my calls,” Hollis said. “What’s her name?”

“Colfax. I won’t bother you unless it’s L and D.”

“Thanks.” Hollis pushed on through into her office. “I’m so sorry for keeping you waiting, Ms. Colfax.”

The woman in the chair rose and turned to face her. Hollis looked into the deep green eyes she remembered so very clearly. She could remember, too, the last words Annie Colfax had said to her before requesting another doctor. I never should have trusted you.

*

Annie had started out with reservations about this politically mandated project, and when she’d seen Hollis Monroe’s name on the office door, she’d known it wouldn’t work. She’d spent the last twenty minutes while she was kept waiting formulating her reasons why. Only now she couldn’t think of a single rational argument—anger blanketed her mind with a thick red haze.

Hollis Monroe was just as Annie remembered—arresting blue eyes, thick, tousled black hair, toned body. Her slightly rumpled scrubs gave her a faintly renegade air. She could see Monroe on the quarterdeck of a pirate ship, sword in hand and a victorious smile lighting her handsome face. At the moment, the surgeon appeared supremely focused, her intense gaze fixed unwaveringly on Annie as if nothing else mattered except this moment and what was happening between them. A rare skill that probably endeared her to patients, but Annie wasn’t endeared.

She’d always known she’d run into Hollis someday. Fortunately, hospital trips for her were rare. Her whole focus as a midwife was to provide safe, individualized, supportive birthing care at home or in an equally natural setting. On those rare occasions when a patient developed perinatal complications, she arranged their transfer to the nearest hospital if they had no pre-arranged obstetrician, but beyond the phone calls to exchange medical data and her report to the paramedics, her involvement with the hospital establishment ended then. She had hoped this new assignment wouldn’t require her to spend much time at PMC, and she’d hoped even more that she wouldn’t have to deal with Hollis Monroe for a long time to come. So much for hopes, as if she hadn’t learned that a long time ago.

“I’m afraid this won’t work.” Annie grabbed her briefcase. She wanted out of this room and away from the woman who reminded her of one of the worst days of her life. “I’ll find a replacement and have the clinic contact you.”

“That might be a little premature,” Hollis said, suddenly wanting to prove Annie Colfax wrong—despite the fact she’d been of the same mind not ten minutes before. Annie’s abrupt assessment and thinly veiled animosity bothered her more than they should. If the hostility had been purely professional, she might have dismissed it, but she knew it wasn’t and she didn’t know how to redress the past. She’d never had a chance to establish a relationship with Annie. At the first opportunity, Annie had requested another physician, as was her right. Hollis had accepted the decision and stepped aside. She’d understood the decision at the time—Annie was devastated by her unexpected surgery and terrified for the safety of her child. Annie needed to have control of her life, and if firing Hollis and blaming her for the outcome of her precipitous delivery would give her that control, Hollis couldn’t argue. Now so much time had passed she didn’t know this woman, and any explanation she might have offered would have to remain unspoken. “Why don’t we take a few minutes to discuss things. I just found out—”

“I’m sure you’re busy,” Annie said, striding quickly toward the door. “I was just leaving.”

“Ms. Colfax—” Hollis reached out without thinking and Annie shrugged away. Hollis held up her hands and took a step back, giving Annie space. “I’m sorry. Look, I know there were some difficulties between us—”

Annie snorted softly. “That’s a mild way of putting it.”

“Okay.” Hollis sighed. “This is unexpected and…awkward in the extreme, but we’re both professionals—”

“Are we? Tell me, Dr. Monroe, do you see me as your professional equal?”

Hollis had been hoping for détente, but if this was the way Annie wanted to play it, she wasn’t going to sugarcoat anything. “I’m not sure the comparison is fair, but it would be disingenuous of me to say I consider our training equivalent. Our expertise lies in different areas. I will grant that you are probably much better at counseling patients and their families prenatally and in the postpartum care of the mother and baby.” She shrugged. “My specialty is labor and delivery. The other aspects matter, sure, but that’s what I’m trained for.”

“Well, I’m not surprised.” Annie shook her head. “You’re not a whole lot different than many of the OBs I’ve met who somehow think the birthing part of bearing a child can be neatly carved out of the whole experience. Plus, considering your proclivities—”

“Excuse me? My proclivities?”

“You’re a surgeon at heart—and surgeons want to operate. That’s your raison d’être, isn’t it? If you didn’t operate, you’d be just like every other ordinary physician, or in this case, a lot like a midwife.” Annie smiled wryly. “God forbid.”

“So you’re saying I fabricate reasons to operate, that’s where this is going, isn’t it?” Heat flared in Hollis’s chest. She’d expected she and the midwife would have philosophical differences, but she hadn’t expected accusations about her ethics. “You don’t know me well enough to make that kind of assumption.”

Annie stared. “Really? I think I know you just about as well as anyone can, from personal experience. Tell me—what would have happened if you’d waited another ten minutes after Callie—that’s my daughter, in case you’re interested—was delivered? What if you’d continued uterine massage and given the drugs a chance to work? Do you think you might not have needed to take out my uterus?”

“I made a judgment call,” Hollis said. They were going to revisit the past after all. Four years might have passed, but she remembered those last few moments in the OR with absolute clarity. She hadn’t changed her mind. “In my opinion—in my professional, expert opinion—in another ten minutes, as you say, you would have suffered significant organ failure due to protracted blood loss, kidney failure, adult respiratory distress syndrome, and possibly death from hypovolemic shock. My goal was to get you out of that delivery room in the best possible shape so that you could take care of your daughter—”

Annie’s eyes sparked fire. “Don’t use my daughter as an excuse.”

“An excuse?” Hollis resisted the urge to strike back in her own defense, but Annie Colfax had been her patient, and she was angry and still grieving. “I’m sorry you feel that way. I can only tell you, you’re wrong. I did think about her when I made the decision to do the C-section, and I thought about both of you when I made the decision to take out your uterus. And I don’t regret either one.”

“No,” Annie said softly, “of course you don’t. Are you always so certain, Dr. Monroe?”

“When I pick up a scalpel, always.”

Annie’s anger drained away, leaving only an unanticipated melancholy. “That’s the point, isn’t it? You’re always sure it’s time to operate, but my expertise is in knowing when not to operate. In knowing what’s natural and tolerable and ultimately safe before, during, and after delivery. There’s a reason that the United States has one of the highest incidences of cesarean births in the world—because surgeons are making the decisions.”

“It’s pretty clear we’re at an impasse here,” Hollis said.

“For once, we agree.” Annie walked to the door and looked back over her shoulder. She’d thought she’d feel better if she ever had the chance to vent her anger and frustration to the one person who deserved to hear it, but she didn’t. The hint of pain in Hollis’s eyes made for a hollow victory. “Good-bye, Dr. Monroe.”