“Yes,” Claire replied, sighing again. “I signed up for WIC a few months ago like you said. But it’s so restrictive on what I can buy—only healthy stuff, you know? Sometimes I just want a cheeseburger.”
Audrey laughed. “I understand. But you need to eat, okay? Even if it’s just toast and peanut butter and you have to choke it down.”
“Okay,” Claire said, setting her soda down and grabbing for the crackers.
“Have you been able to make an appointment with Dr. Ferguson?”
“Yeah, I saw her last Thursday. She seems nice.”
“She’s a good friend of mine. She’ll be your doctor when you go to the hospital to have the baby, so I’m glad you’ve been able to meet her.”
“She wants me to start seeing her for my prenatal visits . . .” Claire trailed off and took a bite of a cracker.
“Her office accepts Medicaid, so you wouldn’t have to pay, if that’s what you’re worried about.”
Claire narrowed her eyes. “Are you trying to pawn me off onto her?”
“No, that’s not what I meant at all.”
“Because you said you’d be with me until the end. That you’d be there with me as my doula, or whatever it’s called, when the baby came.”
“And I will,” Audrey promised. “You are welcome to keep seeing me on Tuesday here at the clinic. But it might be nice to get to know Dr. Ferguson better. That’s all I was suggesting.” Audrey leaned closer to Claire and caught her eye. “I’m here for you. I will be there when you have your baby. You have my cell-phone number. I don’t give that to just any patient.”
Claire assessed her. Audrey tried not to feel hurt by the girl’s suspicion. Everyone who had meant something to Claire had abandoned her, so it shouldn’t have surprised Audrey that she’d think Audrey would eventually abandon her too. Audrey knew all too well about abandonment; her biological father had written the book. She sympathized, and she wouldn’t hurt Claire that way. “I’ve got you,” Audrey said.
“Okay,” Claire eventually said.
Audrey tried not to smile too big. “Everything’s going to be okay.”
“Sure,” Claire replied with a half shrug. “Whatever.”
***
As Audrey unlocked her bike from the rack outside the clinic, her phone chirped. She pulled her phone from her backpack and read the text message: My blood pressure is climbing. I’ll probably be induced tonight. Call me.
It was from her friend Jessica, whom Audrey was planning to be a doula for. Her induction wasn’t supposed to be until Thursday night. Moving it up signaled a serious change. She dialed her friend immediately and asked for an update.
“My platelet count is low, and my liver enzymes are high,” Jessica said. “It’s HELLP syndrome.” A lump grew in Audrey’s throat, and she placed a hand over her chest to keep the anxiety at bay. HELLP syndrome could be deadly. The only cure was to deliver the baby. “I’ve been checked into the hospital and they have me on fetal monitors and some sort of medication, and I’m supposed to get a blood transfusion soon.”
“Have they said anything about doing an emergency C-section?” Audrey asked.
“The baby is fine, and I’m responding well to treatment. They’re willing to give me a trial of labor.”
Audrey nodded, her mind spinning. “How are you feeling about this?” she asked.
“A little scared,” her friend replied. “But Dr. Sandoval assured me we’ve caught it early, and since I’m at almost thirty-seven weeks, the baby should be fine.”
“That’s all true,” Audrey said. “This is a best-case scenario when it comes to HELLP.” She pushed from her mind what happened in the worst-case scenario. “What time do you want me at the hospital?”
“They said I’ll be taken down to Labor and Delivery between ten p.m. and midnight. It depends on when a bed becomes available.”
“I’ll be there at ten.”
The call ended, and Audrey checked the time: four forty-five. She had about five hours to eat, call her home birth patients to make sure no one was going into labor, and take a nap. Audrey mounted her bike and rode the five miles to her apartment.
Chapter 6
If Ammon were honest, he preferred patients who didn’t have birth plans. If a patient had no preferences, providing medical care was much easier for him. He didn’t have to argue or explain anything. He’d say, “It’s time to check your dilation” or “We are going to break your water to move things along,” and she’d say, “Sure, whatever you think, Doctor.” But this patient, despite the fact that she had a life-threatening condition, had a lot of opinions about what was going to happen to her.
“My doula will be here soon,” the patient said.
Ammon looked up from the birth plan she’d handed him and nodded. Great. A doula. Just another obstacle to him doing his job. He returned his attention to the plan to review her list of demands—four pages’ worth. But Sandoval loved birth plans and doulas. He encouraged all of his patients to have both.
Ammon took off his glasses and rubbed his eyes. He was only three hours into his fifteen-hour shift, and already he needed a Red Bull. He returned his glasses. “Thanks for making your wishes so clear,” Ammon said evenly. “We will of course do our best to follow your requests and discuss all procedures and interventions with you.”
Dr. Sandoval entered the room. He smiled at his patient. “Jessica, how are you feeling?” He went to her bedside. “This must be a bit of a shock.”
Ammon’s pager went off. One of his other patients was probably ready to deliver. Ammon touched Dr. Sandoval’s arm. “I’ve got another patient,” he said.
“Yes, of course. But come back as soon as you can. This is your first HELLP patient, yes?”
Ammon nodded.
“Good. I’ll have you take the lead on the induction. I’ll start the Foley bulb, and once you return, we’ll see if Jessica is ready for Pitocin.”
Ammon nodded, wondering how Dr. Sandoval knew without seeing her birth plan that the patient wanted a Foley bulb. Or maybe he’d just assumed and was right. The hospital midwives referred their high-risk patients to Dr. Sandoval because he was so naturally minded and patient-centered. He was a doctor of maternal-fetal medicine, a specialty of obstetrics, who cared for high-risk patients: pregnant women who were sick or had developed significant prenatal complications, women whose pre-born babies were going to be born with known health problems, and women pregnant with twins or triplets. Dr. Sandoval even delivered breech babies naturally. Ammon could learn a lot from him, and maybe he would be eager to learn if he didn’t already feel so burned out.