LEXIE
I’m onto my fourth consult Monday morning when the phone on my desk rings.
“Please excuse me,” I say to my patient, and I pick up the handset. “Yep?”
“Hi, Lexie—we’ve had a call from the hospital. Your sister’s condition has changed. They suggested you come right in.” The receptionist is hesitant and apologetic.
“What happened? What did they say?”
“That’s all. But it sounded urgent.”
I hang up, and I turn to the patient. I’ve forgotten her name. I know she’s here to get her antidepressant script refilled. Where were we up to? I try to flash her a calm smile, but I know I’ve failed to hide my state of mind when she says hesitantly, “Dr. Vidler? Are you okay?”
I look to the screen. Kerrie Nichols. Have I already asked her about side effects? How long has she been taking these meds? Is it time to review her dosage? What other medication is she on? Is she still depressed?
Your sister’s condition has changed. They suggested you come right in.
It sounded urgent.
I’ve forgotten my patient’s name again. I look at the screen. Kerrie Nichols.
I can’t make a decision about her medication now; panic has wrecked my concentration.
“I’m really sorry, Nicole,” I say. “There’s been an emergency.”
“It’s Kerrie,” she corrects me, and she’s confused and annoyed as I rise.
“I’m really sorry,” I say again. “I have to go. Please reschedule your appointment—there’ll be no fee for these consultations.”
I can’t leave her alone in my office, so I have to stand at the door while I hurry her out, then I run to the staff room. I unlock it with my swipe key and think of Annie and the time she used this very swipe key to try to rob this place, and how that almost ruined my career, and here I am using it two years later to run out to her—but what if she’s really sick, and what if the baby is in trouble?
It must be bad for them to ask me to come right in. Or does the staff at the hospital not realize I’m working, and how many people will be inconvenienced by this?
“What do you want us to do with your patients, Lexie?” the receptionist asks at the door as I’m pulling my jacket on.
I look at her blankly then say, “I’m going to have to reschedule all of them. All of them. I’m so sorry—I don’t think I’ll be back today. Please tell the patients I’ll do all of their consults for free when they return and please tell Oliver he can take it out of my salary and please—”
“Lexie, it’s going to be okay. I’ll squeeze your emergency patients in with someone else, and I’ll talk to Oliver and tell him what happened, okay? Just go to the hospital,” the receptionist interrupts me, apparently having had enough of my anxious ramblings.
I speed all the way to the hospital, and I double-park behind Sam’s dedicated parking space when I finally arrive. I run through the halls to Maternity, but her room is empty, so I run straight back to slam my palms down on the reception desk and ask the nurse behind it, “Where is Annie? Annie Vidler?”
“Are you Lexie?”
“Yes. What’s going on?”
Another nurse appears. She’s carrying a set of surgical scrubs, and my stomach drops all the way to my toes.
“She’s being prepped for surgery,” the nurse murmurs as she passes me the scrubs. “They’re going to do a C-section—Dr. Rogers is just securing consent.”
“Consent?” I repeat, and the nurse nods.
“She’s on the phone with the baby’s guardian ad litem. As soon as he gives the go-ahead, she’s going to start, so we need to hurry.”
I can hear my pulse in my ears. Annie wasn’t even allowed to consent to her own C-section, and that is maddening—but that’s not even the issue that matters most. Something has obviously changed with Annie’s condition, and for these drastic measures, it must be serious.
“What happened?” I ask as I follow the nurse to a bathroom.
“The baby went into distress. I’m not sure of the details.”
I pull the scrubs on in record time and run through the corridor after the nurse to the operating room. Annie is on the table—the epidural is already administered—and Eliza is behind a curtain, preparing for the surgery.
I have made it just in time, and I can’t believe that the peaceful weekend I spent with my sister has given way to this rush of chaos. Annie is sobbing, and I’m desperate to know why this C-section is being done, but I don’t want to ask until I calm her down. I take my place beside her face and perch upon the stool that a nurse hastily presses in my direction.
“Everything is going to be absolutely fine, Annie—just try to stay calm.”
“But they said the baby was in distress.” Annie is panicking, and I can hear the too-fast rhythm of her heart on the monitor. I squeeze her shoulder and force an entirely artificial smile.
“Let’s take some deep breaths, okay? I’ll take them with you. Let’s breathe in...”
Annie locks her eyes onto mine and inhales deeply, then exhales with me. After a few breaths, she closes her eyes and then nods to herself.
“I’m okay. I’m okay, Lexie.”
“Of course you are,” I whisper to her, and then I stand briefly to glance over the curtain. Eliza is moving very quickly, and I scan the faces of the other staff assisting her. It’s some seconds before anyone even notices me standing there—but when a surgical nurse does, she points downward and gives me a firm look. I fix a smile onto my face as I sit and focus my attention on my sister. “What do you think...girl or boy?” Annie’s teeth suddenly start to chatter and she shoots me an alarmed look. I squeeze her shoulder. “It’s just the epidural. It’s okay.”
“Girl,” she whispers, and she shoots me a watery, terrified smile. “I hope it’s a girl. I won’t be disappointed if it’s a boy either, but I kind of pictured a girl.”
I hear movement on the other side of the curtain, and move to rise again, but this time a nurse gently presses my shoulder to hold me in place. I frown up at her, and her gaze is stern. I hear more movement—and urgent whispers—and someone is saying the word meconium and I know what that means so I struggle to get back to my feet, then I open my mouth to argue with the nurse. She shoots a pointed look at Annie. I pull my jaw shut and force my attention back to my sister.
“Remember when we used to play ‘mommies and daddies’ in the woods behind the worship hall?” she asks me unsteadily. I pause and focus because I have to really search my memory, but after a moment it comes back to me. I smile sadly at her.
“I was way too old to play that game.”
“You did it for me. I loved it when you let me be the mom.”
“I was a bit of a control freak, wasn’t I?”
“Was?” she stammers through her chattering teeth, and we both laugh nervously, then she asks, “Will you and Sam have kids?”
“One day. We’re not in any rush.”
“You’ll be a great mom. You’ve already had a lot of practice.”
“You will be, too, Annie.” She all but rolls her eyes at me, and I shake my head at her fiercely. “You will. You need to start believing in yourself.”
“God, even when I’m giving birth and scared shitless you can’t help but lecture me,” Annie says, but she smiles with some fragility as she says the words. “I think I’m going to shake my way off this bed. And it feels really weird down there.” Her voice rises, and I hear her mounting panic as she says, “I can feel pressure—a lot of pressure.”
“Are you in any pain, Annie?” the anesthesiologist asks urgently. Annie stares into my eyes, but she shakes her head.
“No, but I can feel them moving inside me I think.”
“That’s quite normal,” I tell her gently.
“I don’t like it,” Annie says, then there’s more movement on the other side of the curtain and urgent whispering, and Annie winces and groans. “No, I really don’t like it. Please—can you stop?”
“Almost done, Annie,” Eliza calls over the curtain, and then there is another rush of movement and I see a nurse carry something tiny away from the bed. I lean back to peer around the curtain as several doctors and nurses crowd around a table on the other side of the room. No one chastises me now. Every single person in the room is frozen, waiting for the cry.
“What is it? What’s going on?” Annie asks me frantically. I look back to her, and tears are rolling down her face. Helpless, I rub her cheek with the back of my finger.
“The baby is out, Annie. The doctors are working on it now.”
“Working on it? What’s wrong with it?”
“It’s a little girl, Annie,” one of the nurses calls, and Annie gasps in delight and gives me a shaky grin.
“Told you,” she whispers. I can’t even smile at her—I’m holding my breath, trying desperately to eavesdrop on the staff, straining to hear some sound from the baby. The tension grows and grows, until I can hardly stop myself from walking right on over there to see what is happening.
But then I do hear it—a tiny, fragile growl, and then a cough and an equally tiny cry. I exhale heavily, as does every other medical professional in the room. Annie’s eyes widen.
“That’s her? The baby?”
“Give us a few more minutes and you can see for yourself,” one of the doctors calls. It’s only a moment or two later that a nurse walks toward Annie holding a tiny, blanket-wrapped bundle. She leans low and rests the baby right up against Annie’s shoulder.
“Hey there, Annie. Meet your little girl. Isn’t she beautiful?”
And the baby is beautiful—purple and tiny and scrawny, her face is all scrunched up in protest at the cold air, but regardless of all of that, Annie’s daughter takes my breath away. Annie lifts one hand, and awkwardly holding the BP monitor on her forefinger away, she gently strokes the baby’s cheek with her middle finger, too overcome with emotion to do anything but stare at her.
“Now, we have to take her through to the NICU for some tests. If she’s doing well, someone will bring her to you in recovery later.”
“I don’t want her to leave me,” Annie whispers, and the nurse shakes her head.
“Sorry, Annie.”
Annie glances at me.
“Can my sister go? She’s a doctor.”
“Ah...” The nurse glances around the room to the team, and at their nods, she turns to me. “Come on then, doctor-sister.”
“Don’t let her out of your sight, okay?” Annie whispers, and I hesitate.
“Are you sure you want me to leave, Annie? You’re going to be here for a while.”
“No, please go with her. I’m scared she’s going to start withdrawal and there’ll be no one there to comfort her.”
“That will take a while, Annie. Maybe a day or so. And she’s going to be okay with the NICU staff.”
“She should be with someone who loves her.”
I can tell from the determination in my sister’s voice that she’s not going to change her mind, so I follow my niece and her medical entourage from the operating room into the NICU. As we walk, a registered nurse pushes the humidicrib with the baby, and every now and again I peer down at my niece. She is covered in patches of vernix, but in between, I can see her skin has that strange, translucent, purple-red tone that premature newborns tend to have. Still, I’m surprised by how well she’s doing—she’s much healthier so far than I had feared she would be given the rush of the C-section. She is breathing on her own, for a start, and she is active—pressing her fists around her face, and stretching her legs uncertainly as she adjusts to the realities of life outside the womb.
“Why did they deliver?” I ask the nurse.
“Mom’s BP was unstable overnight, then Bubba here had a few strange trace results during monitoring this morning. They did an ultrasound, and the blood flow had deteriorated over the weekend. Dr. Rogers decided it was too risky to wait. A good call, too, I’d say, given that meconium. She’s a teeny thing, but she’s breathing so well—maybe she was a bit closer to term than we expected.”
In the NICU, the staff performs a number of tests on the baby. There’s a series of criteria hospital staff use to evaluate a newborn’s physical condition in the moments immediately after birth, a scale of health known as the Apgar tests. The baby’s results on this scale are better than I expect—she scores a five on the first check, and then seven points out of ten on the second five minutes later. Annie’s nameless baby is crying now, a weak, warbling sound, and a nurse shushes her gently as she rocks her in her arms. Even the cry is a good sign, though, and the nurses and neonatologists are cheerful as the tests conclude.
“This is much more pleasant than what I feared we might be doing with this one today,” one of the NICU nurses remarks as she pulls a tiny knitted beanie onto the baby’s head.
“What does she weigh?” I ask.
“A little under five pounds—but she’s doing very well, considering. You ready for a hold, Aunt?”
I’ve held hundreds of newborns during my training and the three years I’ve spent in general practice. Something about this one seems different, though, and I hesitate a moment or two before I nod. The nurse glances toward my shirt and says, “Skin-to-skin is best, if you’re comfortable with it.”
“With me? But...”
“Baby doesn’t care whose skin she’s cuddled up to, Aunt. She just wants to be held—she wants to feel the warmth of your skin and hear your heartbeat against her ear. We do kangaroo care here with some of our preemies. It makes a huge difference for the stability of their vitals. And if this baby develops NAS, she’s likely to need all the help she can get—but if you aren’t comfortable with it...”
I shake my head hastily as I unbutton my shirt. I open it all the way, but leave it hanging over my shoulders, and I leave my bra on. Once I’ve taken a seat in the recliner beside the humidicrib, the nurse unwraps the baby and passes her to me. It’s awkward—the baby has monitoring leads attached to her chest and an oxygen cannula in her nose. She’s cool to the touch so I reach to take the blanket she’d been wrapped in and I pull it around both of us.
“Hi there, I’m your aunt,” I whisper. The baby’s tiny skull rests against my breast. I see the shape of Annie’s features in my niece, and I feel an odd contraction in my chest. The baby squirms a little, but then her tiny eyes fall closed, and she relaxes into me—apparently unfazed by all of the frantic activity surrounding her birth. I laugh weakly and look up to the nurse, who gives me a knowing nod.
“I’ll be right over here if you need anything.”
The staff all shift around to other activities, but left in this corner of the NICU, I’m effectively alone with my niece. I catch her little wrist in my forefinger and thumb, and I stroke my hand along her tiny little fingers. Her skin is soft, and I’m suddenly startled to remember that this fragile, innocent child has already been exposed to heroin for its entire existence.
I know from my previous experience of newborns with NAS that this baby is likely to be fine for a day or so. There’s yet another assessment scale the nurses and doctors will use to rate her symptoms hourly, maybe even more frequently if she’s suffering. Once her symptoms reach a threshold, she’ll start opiate treatments—morphine, most likely. I ponder this for a moment, and immediately begin to imagine this fragile infant in the throes of withdrawal. My throat constricts. Watching Annie withdraw had been one of the most difficult things I’d ever seen, including all of the difficult things I’ve dealt with in my medical career.
I don’t even want to think about what this baby is going to go through—I want to pretend everything is going to stay peaceful, but now that the thought has crossed my mind, it’s all I can think about. The NAS babies that I saw during my rotations through the hospital where I trained screamed and shook and turned purple, suffering pain that no mother or doctor could completely take from them. All the medical staff can really do is keep their morphine up regularly, and step it down as slowly as possible over the early weeks of their lives.
Suddenly I’m livid—full of rage toward Annie—and hot tears of fury fill my eyes. I know addiction is a disease—as a doctor, I’m well aware of that. But the disease has now spread its ugly roots into the most vulnerable stage of another life, and for all of the times Annie has hurt me and I’ve forgiven her, I wonder if this is just one selfish act too many. She could have called me earlier. She could have found a way into treatment, if she’d called me. Instead, she’d buried her head in the sand, held tight to her pride and her habit, and now this tiny baby has to deal with the consequences.
Maybe I’ve let your momma down over the years, kiddo, and maybe she’s already let you down herself—but I promise, I’ll find a way to make all of this right so you two can have a life together.