27

The emergency room doctor pulled his cell phone out of his pocket and called someone with whom he was on a first-name basis. He threw out a bunch of multisyllabic medical terms, then flipped the phone shut and put it back in his pocket.

He scribbled an address on a prescription pad. “You need to be at this office at eight A.M. tomorrow,” he said. He ripped off the paper and handed it to me, and explained that the man he’d just called was a doctor who specializes in the treatment of blood disorders. “Dr. Wolfe is possibly the best hematologist in Texas,” he said. “He’s booked for weeks, but he’ll get you in between appointments tomorrow.”

He asked me what pharmacy I used, then picked up a phone on the wall and repeated the information to a nurse. “We can’t treat the clot while you’re pregnant. All we can do is keep it from getting worse,” he explained. “Have someone pick up this prescription for you right away. Dr. Wolfe will give you more details, but you’ll take it every day for the rest of your pregnancy. If you promise to start taking it within the hour, I won’t hospitalize you.”

I nodded in agreement, still trying to process everything.

“This medicine you’ll have to take, it’s shots—you’ll have to inject them into your stomach,” he added.

“What?” I had a paralyzing fear and hatred of needles. “There’s no way.”

He leaned forward, and our eyes met. “Maybe you don’t understand how serious this is. These shots will probably save your life.”

I mumbled a chagrined response and picked up my purse from the floor. I thought we were done, but then he went back to the pad again. “I never do this, but this is my personal cell phone.” He finished writing, then handed me a last piece of paper. “Call me—or have someone else call me—if anything goes wrong.”

* * *

By the time my mom and I arrived at the hematologist’s office the next morning, my condition had gotten so bad that I could not even take one step on my own. She and I got from the car to the waiting room with me hopping on one foot, occasionally pausing for her to lift my right leg until it was horizontal, which eased the pain of blood flow putting pressure on the clot.

The nurse asked about my last birth, and I knew things were about to get weird.

“Was your son born at Seton or North Austin Medical Center?” she asked.

“Neither.”

“Which hospital was it, then?”

“He wasn’t born in a hospital. I went to the Austin Area Birthing Center.”

She looked up, confused. “Where’s that?”

“It’s in a strip center off of Loop 1.”

“Your son was born in a strip center?” She seemed to think she hadn’t heard me correctly. “Who’s the doctor there?”

“There isn’t one. Actually, I didn’t see a doctor at all for that pregnancy.”

She had an expression on her face as if I’d said that I gave birth in the woods on the eve of the full moon, with only the woodland creatures as attendants. After an uncomfortable silence, she continued, “Who was your midwife then?”

“Well, I didn’t have one in particular. There were a few. . .”

She flipped the page and suggested that maybe we should just move on to the next questions. Fortunately, she didn’t tell me that there would be a blood test until the very end, so I didn’t have time to agonize about it.

“Is this really necessary?” I asked as she wheeled me into the lab. “I’m sure it’s fine. Maybe we could just do another ultrasound on my leg.”

She jabbed the needle into my right arm and filled a vial with blood so red it almost looked black. Then she filled another, and another. And another. And—man, was one of their other patients bleeding to death or something?

When she picked the ninth test tube out of a bin, I asked, “Any idea why he needs so much blood?”

She pulled out the needle, released the rubber strap from my upper arm, and made eye contact with me for the first time since I’d been there. “Sometimes there are deeper causes for these things.”

Two days later, my mom drove me back to the office, and we waited in an exam room for Dr. Wolfe to deliver the blood test results. I thought it was annoying that he didn’t just have the nurse call me to let me know everything was fine. Given that I was now an invalid, it seemed like a lot of trouble for a two-second visit.

The door swung open, and Dr. Wolfe breezed in, holding a thin stack of faxed pages. “We got the results,” he announced. I noticed that the “. . . and it’s all clear” part of the sentence was missing. He rolled a circular stool underneath himself just in time to sit on it, looked again at the papers, and looked at me. “You have the prothrombin 20210 mutation.”

“The what?”

“Prothrombin is a protein your blood uses to clot. You have a quirk in your genetic code that makes your body produce too much of it.”

“And that’s where the clot came from?”

“Right. And there’s something else.” He flipped the papers to the last page and lingered over it, as if confirming that he hadn’t misread it. “This is incredibly rare, but you’re homozygous, which means you inherited the mutation from both parents.”

“From me?” my mom said, startled. She hadn’t expected to get her own medical diagnosis when she’d signed up to be my chauffeur that morning.

He nodded. “We know more about the risk factors for you, assuming you only have one copy of the mutation,” he said, speaking to my mom. “But we don’t know as much about your condition,” he said to me. “We know that being homozygous probably makes it worse, but we don’t know how much worse. It’s hard to study it because it’s so rare.”

I had a million questions (starting with: So did my parents meet at a family reunion?), but he’d already folded up the papers and straightened his posture. It looked like he was going to stand up at any second. He was clearly in a hurry to leave, since my last-minute visit had probably thrown off his entire morning schedule, so I tried to keep my questions to the minimum. “Okay. What does this mean?” I asked.

“Who is your obstetrician again?”

“I was seeing a group of midwives—”

“Oh. That’s right. You know that’s out now, right?”

I nodded. I got an email from the birthing center owner that morning explaining that they could no longer work with me as a patient because of the DVT. I’d been trying not to think about it.

Dr. Wolfe continued, “I’ll have the nurse make you an appointment with a high-risk OB I know. You’ll need to go to the hospital for the birth, and labor will have to be induced. If you go into labor while you are on the anti-clotting medication, it could cause serious bleeding issues.”

I was trying not to hide my visceral horror at the thought of so drastically changing my birth plan when I was eight months pregnant—not to mention the fact that our small business health insurance plan didn’t cover pregnancy, so we were now probably looking at at least ten thousand dollars out of pocket. And so at first I didn’t hear him when he asked: “What method of contraception were you planning to use after the baby’s born?”

All my thoughts stopped like a needle had scratched off a record player. I stalled by acting like I didn’t hear the question. So he repeated it.

My mom turned to look at me. Though she was probably thinking about her own surprising diagnosis, at that moment I felt certain that her simple glance in my direction conveyed a worry that I was going to embarrass us both by saying something like, “I’m not going to use contraception because the pope tells me not to!” I stalled again. “Why do you ask?”

Dr. Wolfe stood and slid his stool back under the desk in the corner of the room. “Your blood disorder is exacerbated by pregnancy. Pregnancy is a high-risk condition for you because of the chance of clotting, and so you should consider sterilization.”

I started to ask a question, but he wasn’t done with the bad news. “Also, after the baby’s born, we’ll dissolve the clot with a drug called Coumadin,” he continued. “It’s an FDA Category X drug, meaning you cannot take any chance of getting pregnant when you’re on it.”

“How long will I be on it?”

“At least half a year. But we’ll want to talk about the possibility of putting you on it for life since you’re homozygous.” He walked over to my chart that the nurse had left open on the desk. He picked up a pen and poised it over the paper. “So what’s the contraception plan?”

I was tempted to tell him whatever he wanted to hear—“I’m going to take the pill and the patch and the shot and put barbed wire around my uterus just for good measure!”—but instead I just stared at his hovering pen. I wondered if it would be weird if I pretended like I hadn’t heard him again.

“I understand,” he said. “There are a lot of options out there. Why don’t you think about it, and we can circle back at the next appointment.”

“Right! Of course,” I said, loudly and stiffly.

He stood and shook our hands, and before leaving he added, “If you don’t get sterilized, you’re going to need a backup method of birth control, too. This drug is serious business.” And with that, he walked out the door.