Justin was joined by his parents, who had been sitting silently in the corner. Peggy and Ricky left Justin and his parents huddling together. The security guard nodded as they left.
“Peggy, if she dies, I’m going to melt,” Ricky said, misty-eyed.
“You’d better get in the freezer, then.” She watched to see if Ricky caught the metaphor. “We don’t want any melting around here. This may not end well.”
“I get it.” His face was ashen.
Peggy put her hand on Ricky’s shoulder, “You should feel good about what you have done for her. You gave her the best chance of survival you can. Your erythromycin idea to substitute for azithromycin was clever. If she dies, are we going to deliver the baby?”
“What? Seriously? I suppose we should, since she’s only a few weeks from her due date. I hadn’t thought of that. I don’t know how to do that.”
“A cesarean section, on her bed, right where she is. You won’t need sterile conditions, you won’t need to sew up all the layers, just get the baby out. Leave the placenta behind, and close the skin. All you’ll need is a scalpel, a cord clamp, and a skin stapler.”
“God, Peggy, no kidding?”
“Yes, just think. When you do this, it is all about the baby. You don’t need to do all the things we do to help the mother recover and heal. Just get the baby out and leave it at that.”
“OK. I’d better get Labor and Delivery ready for that. I might call Ann to help me.”
Ricky bumped elbows with Peggy and took off. Peggy went back in to check on Justin.
She found Justin still sitting in a chair, holding his mother’s hand. Peggy delicately put her hand on Justin’s shoulder. When he saw Peggy, he stood.
“I’m so sad,” Justin murmured. “I can’t believe this has happened. Is it because of her smoking and her pregnancy?”
“Partly. It’s because of this evil new virus. We’re seeing severe illness in pregnancy with no other health problems. I’m sorry she’s so sensitive to it.”
Peggy was momentarily distracted by a text.
“She’s dyin’ ain’t she,” Justin whispered.
“I’m afraid so,” Peggy said. “But I think Ricky can save your baby.”
“How does that happen?”
“She has a cesarean section right about now.”
“I want to be with Jenessa. I should hold her hand.” Justin was panting and sobbing.
Another text arrived. The baby had been born alive, doing well, and Ricky and Ann were “recovering,” the word Ricky had used. Peggy understood. The trembling doesn’t seem to come while you are working on a terrifying case, but in the first ten minutes after it’s over.
“There you are, Justin, your son was just born.”
“Did she die?”
“Yes,” Peggy said, “but your baby’s alive.”
Justin looked scrambled. “I have four kids but no wife.”
“Yes.”
“I want to see my son,” he said. “She had to die alone! Nobody should die alone.” They stood together, saying nothing.
“Nobody should die alone,” Peggy repeated.
“I need to call her mom. I’m not sure what I’m gonna say.”
“Tell it like it is. You have a son, and she has a grandson.” Peggy answered, making it sound simple. Not.
Justin pulled out his cell phone, punched buttons, and put it to his ear.
“Mum, it’s Justin.” He choked up.
Peggy heard “No, no, no,” on the other end. There was no more conversation. Peggy just stood still, her presence more important than her words. When the call ended, he accompanied Justin back to the waiting room to join his parents. No words were needed to convey what had happened. Two grandparents’ faces relayed surprise when they were told baby had been saved.
Washing his hands and face in the bathroom near the ICU, Peggy looked in the mirror. Ricky barged in the bathroom, sweat rolling off his face, bright red PPE marks across his cheeks, chin, and nose. “I can’t believe what I just did.”
“A true cesarean,” Peggy finished. “Congratulations? Or maybe it should be my sympathy?”
“I’m sorry.”
“I understand. Nobody wants to have to do one. But what you did was save the life of a little boy. You did a great job.”
“But I killed a woman.”
“No, you didn’t. The virus killed the woman. You prevented the virus from also killing the baby. Be sure to focus on the bright side.”
“That’s hard.” The rest of the conversation flowed by eye contact through the mirror.
Chapter 29
“I don’t think I want to do this,” Brian said, situating himself in front of Peggy on a rolling chair.
“What don’t you want to do?” Peggy asked.
Brian took a deep breath. “I don’t want to do anything. I don’t want to stop my opiates, I want my nightly weed, I don’t want to take this medicine, and I don’t want to work here.”
“That sounds like a step backwards.”
“But the expectation of me is insurmountable.”
“Hmm.”
“I don’t know if it’s worth it.”
“What choice do you have?”
“Just keep going the way I am.”
“Until JD and Emily terminate you? Until you fail another board exam? Until you alienate more friends and coworkers? Where does that end?”
“I don’t know. Just let it run where it runs.”
“Let’s go back to lymphoma and cancer of the pancreas.”
“Why does it have to be lymphoma and cancer of the pancreas?”
“Because you have about the same chance of dying. We know patients that are not treated are more likely to die.”
“How do you know all this stuff?”
“I read. I didn’t know any of it a month ago. Anything I don’t think I know enough about, I read.” Peggy reached for a few sheets of paper stapled together. “Here. This is what I found out about depression and substance abuse. The article is mostly about opiates. It was eye-opening for me. I didn’t know the prognosis was this grim.”
“I don’t see the similarity. How does this kill me?”
“Suicide or overdose.”
“I have never thought about suicide, I don’t know how I would do it, and I don’t think I could.”
“That’s a good thing. But it’s possible to do it by accident.”
“So, why’s this threatening?”
“Because so many opiate dependent patients do it, and most of them do it either impulsively or accidentally. It seems that families and caregivers rarely see it coming.”
“Is that what this says?” Brian flipped one of the pages of the little bundle.
“Yes, but maybe not in so many words. Just that the prognosis is surprisingly poorer than one would imagine, recurrence is common, and that death is unexpected. Like cancer of the pancreas.”
“I came to tell you that my Pain Management doctor gave me another medicine.”
“Suboxone?”
“Yes.”
“You told me. Something that prevents you from getting the high, the euphoria, of the opiates. It also makes it a little harder to overdose. Did you start it yet?”
“No. I am still taking some Percocet.”
“When did they tell you to start it?”
“When I have been Percocet free for a week.”
“OK. What else is going on?”
“Nothing.”
“You know about Elizabeth Kubler-Ross’s five steps of death and dying, right?”
“Yes, sort of. Denial, anger, bargaining, depression, acceptance. There, I guess I did remember.”
“Congratulations. Where do you think you are?”
“I am not dead or dying.”
“What does that tell you?”
Brian didn’t answer.
“Denial?”
“But I am denying something I am not sure is facing me.”
“What if this was lymphoma or cancer of the pancreas? Wouldn’t you wonder if they had interpreted the biopsy right? Wouldn’t you wonder if they had mislabeled the specimen and that the cancer was someone else’s?”