Crossroads

Chapter One

The on-call phone rang, waking Hollis from an uneasy sleep. She rolled over on the narrow bed, groped in the darkness for the cell, and swiped accept without looking. “Monroe.”

“It’s Honor Blake in the ER, Dr. Monroe. We need you down here STAT.”

“What is it?” Hollis sat up, the last vestiges of sleep driven from her mind by the familiar tightening in her belly and surge in her blood. Adrenaline rush—as potent as sex and twice as satisfying. She glanced at the battered plastic digital clock on the equally battered metal bedside stand. 3:32 a.m. Why did the complications always come in the middle of the night? For that matter, why did most babies choose to show up after midnight? Questions obstetricians had been asking without answer for centuries, probably.

“A twenty-four-year-old in the range of thirty-five weeks, and she’s hemorrhaging.”

“On my way. Can you call Labor and Delivery and tell them we’re coming?”

“Already done,” the ER chief answered.

“And page the on-call neonatal—”

“Already done.”

“Yeah, sorry. Guess this isn’t your first rodeo.”

“Not by a long shot. Are you awake?”

“And moving. Be right there.” Hollis disconnected, stuck the phone in the back pocket of her scrubs, and grabbed her lab coat off the back of the door on her way out. She’d only been at Philadelphia Medical Center a week after finishing her fellowship at a friendly rival hospital across town, but she knew all the shortcuts to the ER already. She took the stairs three at a time down two levels and pushed through the fire door to the ground floor. The wide, tan-tiled halls were nearly empty in the middle of the night. Empty stretchers covered with plain white sheets were lined up head to toe along one wall like sentries, awaiting six a.m. when the transport teams would begin ferrying patients from the ER and hospital rooms to X-ray, the OR, and all the many other destinations in the hospital. By the time the walk-in clinics opened at nine, the halls would be congested with foot traffic. Now the only people around were men and women from housekeeping—pushing floor polishers, rolling supersized trash bins, and steering canvas carts piled high with soiled linens.

Hollis cut around all of them as if she were still running track and dodging runners ahead of her. She held her stethoscope to her chest with one hand to keep it from banging her in the face and mentally ran the list of what she’d need to check on a third-trimester patient bleeding out. She hit the button for the automatic doors to the ER on the run and barely slowed as they lumbered open, squeezing through the narrow gap without breaking stride. A blonde in her mid-thirties wearing a Scooby-Doo smock looked up from the centrally located nurses’ station with a startled expression. Hollis called, “OB emergency?”

“End of the hall—cubicle ten,” the blonde said, pointing to the left-hand corridor in the T-shaped ER.

“Thanks…Linda.” Hollis hoped she’d gotten the name right and swerved around a couple of wheelchairs angled together, as if their invisible occupants were having a late-night conversation, and sprinted the short distance to room ten. A crash cart surrounded by resuscitation litter stood in front of the brightly lit space. Plastic IV bag wrappers, multicolored intravenous catheter caps, the tail end of a spool of EKG paper, and a deflated BP cuff marked the site of the action. A cacophony of voices reached her as she drew near.

Hang another unit…

Fetal heart tones are dropping…

BP’s crashing…

Where is OB?

“Right here.” Hollis skidded to a halt at the foot of the stretcher. She’d known what to expect—she was a brand-new attending, but this wasn’t her first rodeo either. Still, the chaos rocked her for a millisecond. The adrenaline surge made her vision swim, and then her focus kicked in. The analytical part of her brain took the wheel and she settled into the zone. One quick scan told her all she needed to know. The blue plastic-backed chucks under the woman’s hips, designed to keep her and the mattress dry, had long since reached their capacity. The white sheets under her parted legs were crimson. Blood dripped in fat red splatters onto the floor, making delicate snowflake patterns as it congealed.

Honor Blake said, “The ultrasound shows—”

“It’s an abruption,” Hollis said, pressing through the nurses and techs congregated around the stretcher to get up to the patient. Couldn’t be anything else, not with that much blood, but she grabbed the ultrasound printout just to confirm. Yeah, there it was—the placenta had torn away from the uterine wall, leaving a latticework of enlarged vessels wide open to pour out blood. “How much blood has she had?”

Honor wasn’t fazed by the obstetrician’s overbearing manner. Her spouse was a surgeon, and trauma or ortho or obstetrics, it didn’t matter—surgeons were all gunslingers with a touch of God complex. Maybe you had to be to cut into a living being with absolute confidence. This one was new, but by all reports, Monroe had a quick mind and quicker hands. Not much on sociability. Typical surgeon. “We’re on our third unit. The blood bank is sending another four upstairs to L and D.”

“Good.” Hollis assessed the mound of pale belly ribboned with delicate blue veins exposed where the white cotton sheet had been pulled aside. Above, the full breasts were capped with swollen chocolate nipples. She ran her hand over the distended abdomen. The uterus was a rock. A rock filled with blood and a baby who was going to be in trouble soon. “What do we know?”

“She’s in and out. History is scant. Twenty-four years old, prime ip, not much else.”

First pregnancy—always a bit unpredictable. Thirty-four weeks looked about right for her size—not dangerously premature if she delivered the baby now, but still, the baby would be at risk for pulmonary insufficiency and neuro complications. Couldn’t be helped, though—the mother was gushing blood faster than the nurses could pump it into her. “Any prenatal issues?”

“We don’t have records,” Honor said.

“Coags?” Women with abruptio placenta often developed bleeding disorders, and that spelled major trouble in the OR.

“Not back yet. But she’s clotting.”

“For now.” Hollis moved to the head of the stretcher. The dazed young woman looked younger than twenty-four, and pale to the point of translucency, her golden brown hair framing a finely etched face with luminous green eyes and lips that were still full and sensuous despite being nearly drained of color. “I’m Dr. Monroe. What’s your name?”

“Annie.” Lids tinged with gray shuttered closed. “Colfax.”

“Annie,” Hollis said gently, “when did you start bleeding?”

“An…hour…not sure. Can I have some water?”

“I’m sorry, no.”

“What about my baby?”

“You’re having quite a bit of bleeding and we’re going to need to operate. The baby needs to come out and we need to get the bleeding stopped.”

Eyes the color of spring grass—now surprisingly clear, considering her blood pressure was only sixty and she had to be scared out of her mind—opened wide and fixed on her face. “It’s too soon for the baby. I want to wait.”

Hollis bit off a retort. She didn’t have time to argue, but the young woman’s voice was strong. She was competent to decide. “I don’t think you can wait. You’re losing blood and the baby will suffer for it.”

“Just a little more time.”

“Look, is there someone with you or someone I can call? Spouse? A boyfriend?”

“No.”

“How about a family member we can—”

“No,” Annie said quite distinctly. “There is no one.”

No one. No friend? No lover? No family at all? The patient didn’t look like a street person or some paranoid dropout likely to be living off the grid, but Hollis didn’t have time to speculate on why Annie Colfax was alone during one of the critical moments of her life. “Okay, Annie—we don’t have time for much discussion. The baby’s at risk. So are you. You need a C-sectio—”

“No. No surgery.”

Hollis clamped down on a flare of temper. “We don’t have any choice, you—”

“No. Don’t believe…” Annie’s voice faded and her chin sagged.

“Pressure’s fifty palp,” a nurse announced. “Fetal heart tones are slowing.”

“We need to move here,” Honor said from next to Hollis. “I can try for a court order, but it’ll take time.”

“Goddamn it.” Hollis gripped Annie’s shoulder. “Annie. Annie! Look at me.”

Annie blinked, focused.

“If you don’t let me operate, your baby is going to die. You might too. Do you understand? You have to trust me on this, Annie.”

Annie was silent, searching Hollis’s face.

“Trust me,” Hollis said fiercely.

“No choice,” Annie murmured, a flat, dead patina stealing over her eyes. “Go ahead.”

Hollis turned to Honor, a flash of triumph and anticipation energizing her. Now she could take care of things. “Let’s go.”

Hollis grabbed one side of the stretcher and Honor took the other. Honor called, “Coming through. Get the elevator.”

Together they maneuvered the stretcher out of the cubicle and into the hall. One of the nurses raced ahead to get the doors. The elevator was waiting.

Two minutes later Hollis guided the stretcher into the delivery area where anesthesia and the labor and delivery nurses took over. Hollis went to scrub. Trust me, she’d said, and she knew what she was asking. Place your life and the life of your baby in my hands. Trust that I’ll know what to do to keep you both safe. The responsibility was enormous and everything she wanted. All she wanted.

The swinging door to the delivery room banged open and one of the nurses leaned out. “She’s crashing, Dr. Monroe. We need you in here now.”

“Prep the belly for an emergency section.” Hollis rinsed fast and, water dripping from her elbows like a trail of tears, followed the nurse into the OR. Another nurse waited with an open gown, and Hollis pushed her arms down the sleeves and snapped on her gloves. Fixing on the square of pale skin hastily draped with green cotton towels, she stepped up to the table and held out her left hand. “Scalpel.”

The steel handle slapped sharply into her palm, and with her free hand she tensed the skin on the Betadine-coated belly above the top of the uterus. She opened a twelve-inch incision just above the pubic bone, cutting down in one long, deep slice through fat and muscle and peritoneum until the uterus appeared. “Get the suction ready.” The uterus extended up out of the pelvis, pushing aside the internal organs, claiming its place of primacy. She palpated it quickly and found the baby’s head, mentally positioning the rest of the body as it curled up in the muscular sac, thinking about small fingers and limbs just beneath the last layer of muscle. With the blade she made a small incision low in the uterus, handed off the knife, and said, “Scissors.”

The large instrument snapped into her hand, and she inserted the lower blade into the uterus, sliding it close to the underside of the muscle and away from the baby’s appendages. She cut, and amniotic fluid and blood gushed out onto the table, running over the sides and onto the booties covering her shoes. She slid her hand in, found the head, and delivered the infant on a sea of blood. The little girl was blue and flaccid.

“Suction,” Hollis said sharply. The nurse passed her a soft plastic tube, and she gently cleared the baby’s airway.

Time halted for those heart-stopping few seconds before the first breath. Hollis’s gut writhed. The baby shuddered, the small chest contracted…expanded, and then she cried. Loudly. Tiny fists closed, arms flailed, and she struck out at a universe that had so rudely claimed her. The red face below a surprisingly thick shock of golden hair was indignant. Hollis grinned behind her mask. A fighter, this one.

“Welcome to the world, baby girl.” Hollis clamped the cord, divided, and she handed the baby to the scrub nurse. “Pass the baby to the neonatologist. We’ve got bleeding here.”

Her job wasn’t done. The uterus was atonic—soft and spent, unable to contract and close off the multitude of gushing vessels within its walls. Blood welled up, filling the pelvis.

“Push the Pitocin.” While anesthesia administered drugs to help the uterus contract, Hollis packed the cavity, applied pressure, and evacuated the remains of the placenta. But the bleeding continued.

“I’m having a hard time maintaining her blood pressure,” the anesthesiologist reported, his voice strained with tension. “I’m hanging unit five. She’s tachycardic and starting to show some aberrant beats. I’m not liking this.”

Hollis checked the clock. She wasn’t liking it either. The bleeding should’ve slowed by now, but it kept on.

“Got a run of V-tach here, starting lidocaine,” the anesthesiologist called.

Hollis felt the uterus again. Still soft, blood pouring out and no sign of stopping.

“We need to take this out,” Hollis said and held out her hand. “Clamp.”

*

Annie awakened to an ocean of pain. She didn’t know where she was, only that she hurt. She reached for her belly, the automatic motion she’d made thousands of times in the last eight months. And then the memories of the last few hours came rushing back. She’d been studying when the pain started, waves of cramping, agonizing pain. Relentless pain, unending. And then the bleeding. So much bleeding, and the dizziness and the weakness, and the fear. All of that without warning. She’d been helpless, and alone. But she was used to being alone.

She forced her eyes open, forced herself to think beyond the panic and the pain. She was alone in a dimly lit room, nothing on the walls, plastic vertical blinds partially blocking a gray, overcast sky. A faint odor of drugs and death. Hospital.

She tried to sit up, and the pain rose from her belly and consumed her. She dropped back, whimpering softly. With her right hand she followed the plastic cord wrapped around the handrail, found the call button, and pushed it. A minute later a youngish woman in a blue and red floral smock and pale blue scrub pants came into the room.

“Hi,” the woman said softly. “You’re awake. Are you hurting, honey?”

“My baby. Where’s my baby?”

The woman leaned over, her face coming into view. A kind face. Dark eyes, a wide, smiling mouth. “Your daughter is in the neonatal intensive care unit. She’s doing fine, but she’s a preemie, and considering how she chose to get here, the neonatologist wants to keep her in there awhile.”

“She’s all right?”

The nurse nodded and readjusted Annie’s covers. “Someone will be in to talk to you about how she’s doing and to check you over soon. But the last I heard, she was stable and sleeping.”

“When can I see her?”

“In the morning. Do you need something for pain?”

“No. I don’t want any drugs—”

“Honey, you’ve had a big operation. You’re going to need—”

“I’m fine. I don’t want any. Thank you.”

“All right. If you change your mind, just ring the bell.”

“Yes, thank you.” Annie closed her eyes, too tired to protest. The baby, her daughter, was going to be all right. Nothing else mattered.

She drifted until the sound of the door opening and closing roused her. With awareness came pain, a pattern she’d grown used to.

“Are you awake?” a deep, gentle voice inquired.

Annie opened her eyes. A black-haired woman in green scrubs leaned over her, both hands braced on the side rail. Her deep blue eyes were steady, piercing, unnerving in their focus. She looked tired—smudges of fatigue darkened the lids above sharp cheekbones. But even fatigued, she radiated strength.

“I…I…remember you. You were in the emergency room,” Annie said.

“Yes. I’m Dr. Monroe, the obstetrician. I delivered your baby. She’s beautiful. Green eyes like yours.”

Annie smiled. “The nurses said she’s all right. Is that true?”

“Yes. No one here will lie to you.”

“Everyone lies,” Annie said softly.

The doctor’s dark eyes flashed, but she said nothing. Annie was too weary and in too much pain to care that she might have offended her.

“There’s something you need to know, Ms. Colfax,” the doctor said. “You had what we call an abruption—the placenta separated from the wall of the uterus, causing you to hemorrhage and endangering the baby.”

Annie’s pulse tripped, stuttered, and started again. “I thought you said the baby was all right.”

“She is. She isn’t as close to term as we’d like, so she’s being monitored for any signs of immaturity.”

“I wanted to wait. To be sure she would be safe.” Annie’s chest tightened. Why wouldn’t anyone listen? Why must she always fight to be heard?

“I understand, but that wasn’t possible.” Hollis stifled her impatience. She understood women wanting to deliver vaginally, to be alert and aware so they could remember the birth, but sometimes safety—the mother’s and the child’s—was more important.

“But you said she’s all right…”

“She is. And you will be too.” Hollis looked into Annie’s eyes—the green verged on black, her irises almost eclipsed by her pupils. “How much pain are you having? I ordered morphine, but—”

“I’m all right. Tell me.”

“I had to do more surgery in order to stop the bleeding.”

A chill settled in Annie’s depths. “More surgery?”

“Yes. After the C-section, the bleeding didn’t stop. Usually it will once the rest of the placenta is removed. You were bleeding very heavily.”

“But that’s stopped now, isn’t it?”

“Yes, it is.” Hollis knew she’d made the right decision, but still, it was hard to admit she hadn’t been able to alter the outcome. “I had to remove your uterus, Ms. Colfax. It was the only way to stop the bleeding and save your life.”

Annie’s mind went blank. She was so cold. So cold.

Warm fingers clasped her hand. “I’m sorry, I know it’s a shock. I had no choice. You’re going to be fine now.”

Annie withdrew her fingers from between the surgeon’s. “You don’t know that. You have no way of knowing that.”

“You’re going to recover, you have a beautiful baby, and you’re going to go on with your life.”

“I never would have agreed,” Annie said, looking deep into Hollis’s eyes. “And I never should have trusted you.”