Audrey volunteered as a women’s health nurse practitioner once a week at the free clinic in downtown Salt Lake. Her patients were mostly low-income women without insurance or women experiencing homelessness. Audrey performed routine exams, administered a lot of pregnancy tests, and wrote prescriptions for common infections. The work was tedious and most of the time downright uninteresting, but after her time in Ethiopia, she couldn’t sit back knowing there were women in need in her own community. She had to share her skills where she could.
Audrey checked in with the office coordinator, Nancy, to get the information for her first patient of the day.
“I’m glad you’re here,” Nancy said, handing Audrey a patient file. “That sweet teenage patient of yours has been here since seven thirty waiting for you. She didn’t want to be seen by anyone else.”
Audrey glanced around the waiting room and spotted the familiar young woman. Her blonde hair spilled over her growing belly, where she rested a hand. “Claire,” Audrey called.
The teen looked up, and tension melted out of her shoulders. Claire hefted herself out of the hard-plastic chair and waddled toward Audrey.
Audrey smiled but noted the crease between the girl’s eyebrows. “Every-thing okay?” she asked as they walked down the narrow hallway back to a small exam room.
“I don’t know,” Claire answered. She climbed onto the exam table, and Audrey sat on a black rolling stool. She moved the stool so she’d be right in front of Claire.
“You seem worried. What’s going on?”
The girl swallowed, and her eyes turned red. Audrey could tell Claire wanted to cry but knew she wouldn’t. Audrey had been meeting with Claire since she was six weeks along—it was in this very exam room that she’d confirmed Claire’s pregnancy. She had been there to talk to Claire about her options a few weeks later when her boyfriend had dumped her and Claire was contemplating an abortion. Two weeks after that, Audrey had been there when Claire had decided to keep the baby. Soon after, the girl’s mom had cut her off because she’d wanted Claire to put the baby up for adoption. Having been raised by a teen mom herself, Audrey had misgivings about Claire’s decision, but having an opinion wasn’t Audrey’s job. Her job was to educate and support her patients. So Audrey had helped Claire find housing, a full-time job, and a GED course. She’d helped Claire sign up for Medicaid to cover the expense of the birth. And Audrey had every intention of being at the birth as Claire’s doula. Through all that, she’d never seen Claire cry.
Audrey waited patiently for the young woman to compose herself. When she finally spoke, her voice sounded thick. “I don’t think she’s moved since last night,” Claire said, her hand rubbing her stomach.
Audrey’s chest clenched with anxiety. “Okay. Sometimes babies have extended sleep cycles, and their movements change as they get bigger. Let’s check for a heartbeat.”
Claire shook her head. “I don’t think I’ll be able to stand it if you don’t find one.”
Audrey nodded, her brow creased. “Let’s try something else first. When was the last time you ate?”
Claire glanced away. “Lunch yesterday.”
Audrey wasn’t going to scold the teen for not eating. She knew Claire did her best. “Let’s feed you, then,” she said. “Once your blood sugar is up, baby will probably go crazy.”
She went to the supply room. It was not uncommon to have patients who needed food along with their checkups, so the room was well stocked with snacks. She grabbed a package of peanut-butter crackers and, from the fridge, a Pepsi. The sugar would get the baby moving.
Audrey returned to the exam room to find Claire had moved to a chair. Audrey handed her the snacks, and Claire popped the tab on the Pepsi first. She took a slow sip. “Do you think it’s because I haven’t eaten?” she asked. “She’s not dead, is she?”
Without the confirmation of a heartbeat, Audrey couldn’t say for sure. “Let’s give her a few minutes.” She gestured toward the snack. “Eat up.” Claire’s mouth curled into an unsuccessful smile, and she took another sip of soda. Audrey returned to the black stool and flipped through Claire’s chart, reviewing her blood pressure and weight from her last visit two weeks before.
She usually saw pregnant patients only once or twice because most transferred care to an ob-gyn or hospital nurse midwife. Claire had kept coming back, requesting Audrey every time. Audrey didn’t mind but knew that soon Claire would need to start seeing the doctor who would ultimately deliver her baby at the hospital. Medicaid didn’t cover home birth.
“Oh, thank goodness,” Claire suddenly said. “She moved!”
A tiny rush of relief washed through Audrey. “Thank goodness,” she echoed. She put Claire’s file back on the countertop. “Let’s have you hop back up on the exam table.”
Claire smiled big, her teeth showing, and left her chair. Once on the table, she lay back and lifted her shirt. Audrey applied lubricant to the wand of the fetal heart Doppler and pressed it to Claire’s stomach. The quick, reassuring whoosh of the baby’s heartbeat sounded through the room. Audrey listened longer than she usually would, making sure the beat was fast and consistent. “She sounds great,” she said. “Her heartbeat is between 130 and 140 beats per minute, which is perfect.” She took the Doppler off Claire’s stomach and handed her some tissues to wipe off the lubricant. Audrey found the tape measure and measured Claire’s belly. “Thirty-three centimeters for thirty-three weeks—right on track.” She motioned for Claire to sit up. Claire pulled her shirt back down and sat on the edge of the table, her face slack with relief. Audrey took her blood pressure next and scribbled down the numbers in Claire’s chart. “Everything looks good. Why don’t you finish your snacks.” Audrey smiled and motioned for her to hop off the exam table. Claire settled back into the chair and took another sip of the Pepsi. “If this happens again,” Audrey said, “drink something cold and sugary and do some kick counts. If you’re still worried, call me, okay? Don’t wait.”
Claire nodded but kept her head down.
“And can we talk about why you haven’t eaten since lunch yesterday?” Audrey asked.
Claire sighed and plucked the pop tab a few times. “I got busy, I guess. Then none of the food I had at home sounded good, so I went to bed hungry. When I woke up this morning, I realized I couldn’t remember the last time I felt her move and came straight here.”
Audrey nodded and touched Claire’s arm. Her eyes grew red-rimmed again, and Audrey’s heart contracted. She always got emotionally invested in her patients, even when a little more distance would probably be the best thing. But she couldn’t help it. She was a rescuer. She squeezed Claire’s arm before letting go. “If you didn’t have any food, you would tell me, right?”