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Product Details
| ISBN-13: | 9798893242614 |
|---|---|
| Publisher: | Franklin Pub. |
| Publication date: | 06/28/2024 |
| Pages: | 250 |
| Product dimensions: | 6.00(w) x 9.00(h) x 0.68(d) |
Read an Excerpt
Private Practice
By Steven Mollov
AuthorHouse
Copyright © 2011 Steven MollovAll right reserved.
ISBN: 978-1-4634-2185-4
Chapter One
February 1988 had been a particularly heavy month for snow, even for the town of Breedville, New Hampshire. Its residents were used to five or six big storms each winter, and this year was no exception. The grass on the town mall hadn't seen daylight since Thanksgiving, and the white crust on George Washington's cap as he sat astride his mount in the square was beginning to look commonplace. Of course, snow was no problem for the folks of northern New England. The town budget always managed to have enough money to keep the streets clean, and a four-wheel drive could be found parked outside most homes.The snow was just beginning to slow when the phone rang in the Barron home. Joshua Barron, deep into a dream, was just sinking a 20-foot birdie in the Pebble Beach Pro-Am Tournament. The roar of the crowd blended in with the noise of the phone, and it took four rings before reality interrupted his flawless round of golf.
"Hello," Joshua sputtered. A pause. "Ah-hah, I'll be right there."
With the perfect putt a distant memory, the tired obstetrician trudged to the bathroom. He glanced in the mirror. The graying, tussled hair and unshaven face did not bespeak the impeccable professional who would show up at the hospital a mere thirty minutes later. Would you let this man deliver your baby? With this thought in mind, a grin slowly crept across Joshua's face. He knew that force of habit would transform his tired, middle-aged self into the confident obstetrician he was known to be. In less than ten minutes, Joshua was in the garage, warming up his '83 Jeep Cherokee. The cold blast of frigid air was the last stimulus he needed to jump-start his body. He backed the car out into the snow and headed down his quiet cul-de-sac towards Main Street and Breed General Hospital.
The call had come from Casandra Robinson, who worked the eleven to seven shift on the labor floor at Breed General. Sandy, as she liked to be called, was in her twelfth year at Breed, having spent all of her professional career on the maternity floor. She was a native of Breedville, leaving for only two of her thirty-two years to earn her nursing degree at the old Boston Lying-In Hospital. She eagerly returned to the familiar surroundings of her hometown following graduation. The city had been too hectic for Sandy, and though she appreciated the instruction and experience she felt she could only get in a big city hospital, she longed for the more peaceful pace of her quiet, rustic town.
Sandy felt badly waking Dr. Barron at home for the third straight night. He'd seemed so tired recently and had lost that sparkle in his eyes he used to get each time he welcomed another child into the world. Sandy liked working with Dr. Barron—he was so warm and upbeat, with the quiet confidence of a seasoned professional. She also knew that her feelings for him ran a lot deeper, but that had been discouraged years ago. Nonetheless, her calls to Dr. Barron these last few nights gave her the juvenile satisfaction of bringing him in to spend time with her. Ellen Landry felt like she had been pregnant forever. Her actual due date was not for another week, but she was grateful for the bloody discharge and the intense, persistent cramping in her stomach. This was her second pregnancy, the first culminating in a seven-pound girl two weeks overdue. Ellen was a regular of Dr. Barron's, a loyal patient for six years now. She still found it astonishing that she'd picked him out of the yellow pages during the second month of her previous pregnancy—not exactly the most discerning method. She should have requested a referral from her former physician, the local medical society, or even a neighbor over the back fence. But at the time, Ellen had been new in town. She let her fingers do the walking and never once regretted her decision. Her first pregnancy had been complicated by a variety of problems: first trimester bleeding, gestational diabetes, and then, the eternity of waiting two weeks past her due date. Throughout it all, Dr. Barron had been there for her, and she found his presence entirely comforting and reassuring. To Ellen's way of thinking, he could do no wrong, and she had since referred many of her friends.
Ellen's thoughts were interrupted by another tremendous spasm in her mid-abdomen, requiring her to lean against the kitchen wall for support. Her husband Jack was asleep. He had just gone to bed an hour before, insistent on seeing the end of Johnny Carson. Although he had been very supportive during her pregnancies and was a wonderful husband and father, Ellen knew that Jack was not one to get wrapped up in the minute-to-minute details of her labor. He was also not terribly fond of blood, pain or hospitals, and it had taken all of Ellen's powers of persuasion to get him to go through labor by her side. She had in turn felt terribly guilty when he hit the floor of the delivery suite like a felled tree as his baby daughter's head entered the world. Fortunately, the fall had been broken by a hapless student nurse witnessing her first delivery. The poor girl suddenly found herself sprawled on the floor, a limp 210-pound new father atop her. It had been a scene right out of a sitcom. As with the make-believe of television, no one was hurt, a little dignity was lost and everyone had a good laugh at Jack's expense. Since then, Ellen agreed that Jack could be in the waiting room for their next encounter with childbirth.
As the spasm of this latest contraction faded, she heard her mother's car enter the driveway. She had called her fifteen minutes earlier, and no amount of snow was going to stop Mary Johnson from assuming the grandmotherly duty of watching her sleeping granddaughter while her second grandchild was being born.
"How are you feeling, Honey?" she asked as Ellen opened the front door. "Where's Jack?"
Before Ellen could answer, another contraction began, and Mary ran to get her son-in-law. Mary and Jack had a wonderful relationship—as long as nothing important was going on.
"Jack, get up! The baby's coming!" She screamed as she shook him roughly.
"Huh? What's a matter? What are you doing here?" he sputtered, trying to gather his bearings.
"You're going to ruin the second delivery too, Jack! Except this one's going to be in your kitchen if you don't move your bum!"
The situation dawned on Jack, and he leapt into action and was dressed and ready to go within seconds. Despite the snow, the driving was not hazardous and Ellen and Jack arrived at the hospital in a matter of minutes. The admissions secretary started to ask for an insurance card, but changed her mind when Ellen started into her deep breathing. She instead whisked them both up to the maternity floor, where Sandy recognized Ellen from her previous pregnancy.
"Hi Ellen! How are you, Jack?" She saw that Ellen appeared to be in advanced labor and quickly helped her change, examined her and called Dr. Barron.
Joshua pulled into the doctor's parking lot at 3:15 AM, about thirty minutes after receiving Sandy's call. His transformation was now complete; the sleepy-eyed golf duffer had become an alert, take-charge professional. He ran to the emergency entrance and hurried to the elevator. This thing can't be tied up at three in the morning, he thought. Shaking his head, he opted for the stairs. At the mid-floor landing, he noticed an ache in his left shoulder and a tingling in the fingers of his left hand. The symptoms had been there before and he had dismissed it as a muscle strain. This time they lingered, and he found himself slowing his pace up the remaining steps. As the ache and tingling disappeared, his mind refocused on the clinical situation at hand.
"Hi, Dr. Barron," Sandy said. "Sorry to bother you again tonight. Mrs. Landry is pretty uncomfortable. She just broke her bag of water. The fluid is clear and the monitor strip is reactive."
"I guess I've just had a run of bad luck. Of course, if I keep doing my deliveries at night, I won't have to be disturbed during my office hours," he said sarcastically.
The sarcasm of Dr. Barron's logic was not lost on Sandy. It was well known that Joshua Barron had spread himself too thin and desperately needed a partner. Sandy knew that there were plenty of hospital personnel urging him to review applications, but she also knew that his practice was his life. His standards were simply too high, and he worked too hard, which worried her. What also worried her was Dr. Barron's current appearance—he looked quite pale, and a bit out of breath.
After listening to Sandy's report on Ellen's status, Joshua continued on to the obstetricians' lounge and changed into a green scrub suit. With Ellen's chart in hand, he made his way to her labor room.
"Hi Ellen," Joshua greeted her. "How're you handling them?"
Ellen answered with short hooo haaahs as her latest contraction reached its peak. Beads of sweat had broken out on her forehead as she sat Indian style on the labor bed, eyes fixated on the picture of her little girl, placed across the room strategically at eye level. As the contraction faded, she left her semi-trance.
"Hi, Dr. Barron," Ellen breathed. "I think I'm doing fine. Jack's in the waiting room this time—I told him it was okay with me. Besides, Sandy's been great."
Sandy smiled and blushed. She knew she was a good labor coach, but she never could handle a compliment well.
"I think you've really got it together, Ellen," Sandy said.
"You look like a great team to me," Joshua said, knowing that reassurance was the most important therapy at this time. He donned a latex glove and quickly examined Ellen before the next contraction started.
"Eight centimeters with the vertex at zero station," he reported to Sandy, who recorded it in Ellen's chart. "Have the lab draw a hematocrit and a second sample for blood typing. If the monitor isn't too uncomfortable, let's leave it in place. I'll go say hello to Jack." He left Ellen starting to breathe through another contraction while Sandy processed his orders.
Joshua found Jack in the father's waiting room. It was more like a large alcove than a room. The name had come from much earlier days, before societal changes had ushered (or perhaps unwillingly dragged) fathers into the labor room.
In more recent years, the room had become a hangout for other family members and friends. After his unfortunate experience with baby number one, Jack was opting for the old-fashioned way. Joshua found him in classic "pace mode" with a cup of coffee in his hand, his lips tight. If Joshua had asked for clean rags and boiled water, he would have responded immediately and fetched the requested items.
"How's she doin', Doc? Is she okay?" Jack queried.
"Ellen's fine, Jack. She's in great control and it shouldn't be terribly much longer. Try to relax."
Jack continued to pace. Joshua poured himself a cup of coffee and was just sitting down in a comfortable chair in the corner of the alcove when the ominous siren of the emergency alarm went off.
"What's that, Doc?" Jack asked frantically. He noticed a bright blinking light down the hall in front of Ellen's labor room.
"The baby's probably ready and they want me back there," said Joshua, aware of the control in his voice. He knew that the alarm was the nurse's signal for help, not delivery, but there was no point in rattling an already nervous husband. "I'll have to go, Jack. Try not to worry." He hurried to Ellen's room and disappeared inside. The blinking lights and siren subsided.
As the door of the labor room closed behind Joshua, the scene inside was worse than he had expected. Where before there was an uncomfortable yet calm laboring patient, pandemonium had broken loose. Ellen Landry was in a knee chest position with her buttocks up in the air and an oxygen mask covering her nose and mouth. The fetal monitor was showing a low heart rate of only sixty beats per minute. Sandy had acted appropriately, trying to position Ellen so that her baby would get the most oxygen and respond with a more normal heartbeat. To this point, this method had been unsuccessful. Joshua donned a glove. In examining Ellen, he found her cervix to be fully dilated and the baby's head just inside the vagina.
Sandy's voice was tense. "Dr. Barron, the heart rate doesn't appear to be responding to our usual maneuvers."
"I think I can ease the baby out with the vacuum extractor. Let's set her up for delivery and get me a pudendal set."
Sandy moved the appropriate instruments into place as Joshua helped Ellen turn onto her back with her feet resting on support plates, keeping her knees separated.
"My baby, my baby!" Ellen cried.
"Ellen, the baby is going to be just fine," Joshua reassured. "I'm going to help you deliver. Just listen to what I say and we'll get through this together." His voice was calm and reassuring.
Joshua injected the anesthetic. In seconds, both nerves that provided sensation to Ellen's birthing canal were numb, allowing Joshua to perform the necessary maneuvers to deliver her child. He attached a plastic cup to the baby's head while it was still in the vagina and Sandy attached the other end to a vacuum pump. After cutting an episiotomy to allow more room for the baby's head, he pulled on the plastic cup and gradually the head of the child appeared at the opening of the vagina. Ellen pushed hard, and in what took seconds but felt like hours, Joshua delivered Ellen of a large male child. He suctioned out the baby's nose and mouth and removed two loops of tight umbilical cord from around the baby's neck—the apparent cause of the sudden drop in fetal heartrate.
"I'm getting a heart beat of less than a hundred," Sandy said, listening to the newborn with a stethoscope. Joshua promptly rubbed the baby's back vigorously to stimulate respirations. He continued to suction the baby and stimulate him while Sandy covered the infant's nose and mouth with oxygen. The timer went off, signifying the infant was one minute old. Sandy and Joshua reviewed the baby's status.
"One for heart rate, one for tone, one for grimace. That's a total of three." Sandy was referring to the Apgar score, a list of five criteria which are graded and used to determine how well a baby is doing after birth. Suddenly, as if the infant had sensed that the poor adults in the room had suffered enough, he began to scream uncontrollably. A look of relief appeared on everyone's face. The baby responded quickly and by five minutes of age his Apgar score had reached nine out of a possible ten. The baby was fine and Sandy could continue with the more mundane activities of tagging and wrapping him in a warm blanket. Tears rolled down Ellen's face as joy and relief replaced anxiety and pain. Joshua easily delivered the placenta. The episiotomy was sewn up in short order and he began to fill out the chart.
"You okay?" Sandy asked Dr. Barron. Through the anxious moments of the birth, he had seemed his usual, controlled self. But now he appeared paler than before and was sweating profusely.
"I'm fine, Sandy," Joshua reassured her. He wished however that he could reassure himself as well. Something was wrong—very wrong. The shoulder pain was bothering him again and the fingers on his left hand were tingling. Feeling the room was closing in on him, he took the chart, and without congratulations to the new mother, headed for the doctors' lounge and a cold glass of water. In the lounge his breathing became easier and the shoulder ache settled down. He finished the chart and returned to the labor room to check on Ellen.
"Her uterus is firm and the flow is minimal," Sandy reported. Reassured, he congratulated Ellen and then went down to the father's waiting room to tell Jack the good news. He was now feeling considerably better and accompanied Jack to the labor room to visit with his new son.
(Continues...)
Excerpted from Private Practice by Steven Mollov Copyright © 2011 by Steven Mollov. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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