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Promises To Keep
By Susan Crandall
Warner ForeverCopyright © 2005 Susan Crandall
All right reserved.
Chapter OneThe revelation struck Molly Boudreau without warning, like a giant crashing wave of frigid water. The fierce power of it sucked the breath from her lungs and the determination from her heart. It was as if she'd stood deaf while the thunderous surge behind her had gathered power, numb while the ground had trembled in warning beneath her feet.
Deaf and numb and utterly unsuspecting. Her entire life had been centered upon becoming a doctor. Perhaps she'd emerged from the womb possessing a single-minded determination. It hadn't been a distant wishing as most childhood fantasies, but a ruby red laser beam, so focused and intense in its being that nothing distracted her from it. Not slumber parties, or big games, or boyfriends. Not financial obstacles-of which there were many for a poor girl from a small midwestern town. She hadn't wavered once in her resolve, not from grade school through the endless fatigue-strained hours of residency.
But suddenly she realized her focus had been the journey, the fight, with little concentration on what was to come after. She felt as if she'd been engaged in a frenzied uphill battle, wresting free of enemies that struggled against her, finding herself at the summit, breathless and bewildered by the lack of opposition.
A sense of disconnection settled heavily in the center of her chest as she stood in her beloved free clinic- which was in its unfortunate last days because of a lack of funding. This was her most recent, and most disappointing battle. And, as hard as it was to admit, this was the first time she'd met an obstacle she'd been unable to overcome. The clinic had been the sole reason she'd put up with the infuriating internal politics of her paying job at Boston General's emergency room.
For a long moment, she remained still, waiting for the unsettling feeling to pass. She shoved her hands into her lab coat pockets, staring beyond the clinic's crowded waiting area, out the large storefront window. Windwhipped sleet was icing over everything with dangerous swiftness. The unseasonably early arrival of this winterlike storm just compounded her sense of floundering. Seeking that inner spark that had always propelled her forward, she closed her eyes. She felt the swirl of motion around her, as if the rest of the world kicked into fast forward while she remained stuck in pause. She heard the crying babies, the quiet comforting murmurs of mothers, the motor noises made by a little boy near the front window pushing his matchbox car on the scarred, dark pine table.
"Dr. Boudreau!" A shout yanked her away from her battle with self-doubt.
Carmen, the girl working the sign-in desk, had jumped from her chair to support Sarah Morgan, one of the few patients Molly saw here on a regular basis. Sarah had come to the clinic over six months ago for prenatal care.
Molly had seen right away that she was different from the free clinic's usual maternity cases. For one thing, she wasn't a teen mother, or on her fifth pregnancy before her thirtieth birthday. She was expecting her first child and was just about Molly's age. She appeared well educated and was well dressed, yet utterly guarded about the details of her life-Molly had quickly deduced a woman in hiding.
Sarah had seemed as isolated and lonely as Molly. Molly's isolation was a by-product of her impossible schedule; she quickly learned that Sarah's was strictly self-imposed. Still, Molly saw a kindred spirit in Sarah's determination and independence.
Upon Sarah's invitation after her second visit to the clinic, they had forged a fragile friendship over coffee and conversation after clinic hours. Molly liked Sarah's quick wit and indomitable spirit. They had grown as close as two women could in their unusual situation. Sarah had been completely secretive about her past, the baby's father, or anything else that might have given Molly a clue to the reason she was living as she was. Even so, Molly felt they were friends; she might not know about the woman's past, but she knew what kind of person Sarah was inside.
Now, as Sarah's step faltered through the clinic door, she was clearly in labor.
Wrapping her arm around Sarah's back, Molly helped move her as quickly as possible toward the examination rooms. "I thought I told you to go straight to the hospital!" Sarah's knees wobbled and she groaned with a contraction. "Has your water broken?" Molly asked.
Sarah nodded once, her pale blond hair falling over her face. Then in a breathy whisper she said, "About two o'clock this morning."
"Jesus." It was nearly noon. Molly knew that Sarah had a serious aversion to hospitals, but she had no idea it was so severe it would eclipse her common sense. "You should have called 911-how in the hell did you get here?"
"Taxi." Perspiration beaded on Sarah's brow as they settled her onto an examination table.
Molly turned to Carmen and said quietly, "Get an EMS unit here now!"
Carmen hustled from the room. "All right now, Sarah, let's take a look and see where we are." Molly quickly swept her dark hair up into a pony tail to keep it out of the way. When she examined Sarah, she was stunned to see the baby was crowning. Even if the EMS was in the bay and ready to respond, it was doubtful that they could transport Sarah to the hospital before delivery.
Sarah started to push. "Don't push yet. Take deep breaths." Molly took a couple herself to calm her voice before she spoke again. "Looks like we're going to have this baby right here." Through pinched lips, Sarah said, "Good."
Molly's mouth went dry. Sarah didn't understand the risks. Molly had specialized in pediatrics. Under normal circumstances, with the proper medicine and equipment available she would feel confident in treating the baby once delivered. In this financially strapped clinic she had neither. Plus she'd never done a delivery alone, only assisted a couple of times during her rotation in OB/GYN.
What if there were complications? At least with the head visible, the baby wasn't breech. Should she do an episiotomy? Was it too late for that?
She wanted to chastise Sarah for not going to the hospital where emergency equipment and obstetric specialists were plentiful. She wanted someone to stand over her shoulder and tell her she was doing everything right.
But deep down, she couldn't deny the little rush that was building. This baby was coming-and Sarah depended upon Molly to keep both her and her child safe. It was all in Molly's well-trained, if ill-equipped, hands.
Inclining the head of the table and placing a couple of pillows under Sarah's shoulders, Molly pulled on gloves and said, "All right, next contraction, push."
She positioned herself to deliver the baby, listening for the scream of an approaching siren.
Sarah bore down with the next contraction. The baby's head pushed forward, then retreated slightly when the contraction was over.
Without a fetal monitor, Molly couldn't begin to tell if this baby was in distress. What if Sarah bled out? A thousand possible complications raced through her mind. Come on, she thought, babies were born for thousands of years without modern medicine. And lots of them died.
Molly shook off the thought. She coached Sarah through three more contractions. Where was that damn EMS? "Carmen!"
The girl came rushing back in with the cordless phone still in her hand. She looked as panicked as Molly felt. "They've got one unit in a ditch. And all others are dispatched- the storm...."
"Try Mass General." "I already have. They said they're having to prioritize. They're working a bus accident on I-93 right now." Molly gave her a quick nod. "Keep after them." Then to Sarah, "You're doing great. We should have this little one here very shortly." Sarah had already told Molly that she had no family and the father didn't know of the baby's existence. Perhaps she'd reconsider telling him. "Isn't there someone we can call for you?"
Sarah was between contractions. Her voice quivered as she said, "No one. Promise me-" Her voice strangled to a groan as she bore down with a contraction. The baby's head slid into Molly's hands; she rotated it slightly to the side, allowing the fluid to run from its mouth. Immediately she saw there was trouble. "I need you to stop pushing. Breathe through the next contraction."
"What's wrong?" Panic gave Sarah's voice new strength. "What's wrong with my baby?" Molly didn't answer, she had to concentrate on what she was doing. The cord was wrapped around the baby's neck. Everything was so slippery, the baby's neck so short, she couldn't get her finger under the cord. Sarah started to groan.
"Don't push, Sarah. Breathe!" If the baby moved farther down the birth canal, the cord was going to cut off oxygen. Statistics of previously normal babies handicapped because of oxygen deprivation at birth whirled in Molly's head. Seconds mattered.
Sarah huffed exaggerated breaths, fighting the urge to push.
The contraction lessened. Sarah blew out a long shuddering breath. "Good girl!" Molly made another try at getting her finger between the baby's neck and the cord. This time she was successful, but her grip was tenuous. With the slightest movement, she could lose it.
She was ready to try and slide the cord over the baby's head when Sarah had another contraction. "Breathe! Don't push." She didn't think Sarah was pushing, but the cord tightened around her finger anyway. "Carmen!"
The girl ran into the room. In a calm voice Molly said, "Be ready to hand me that bulb syringe."
Carmen quickly pulled on gloves and picked up the syringe. Molly hoped Sarah didn't see the wild-eyed fear in the girl's face.
The contraction relaxed. Molly's brow beaded with perspiration and she held her breath as she attempted to slide the cord over the baby's head. If the cord slipped from her grasp, she'd have to wait through another contraction. More risk.
Quickly, Molly moved the cord over the baby's head. In a rush of relief, she finally took a breath. Carmen put the bulb syringe into Molly's outstretched hand. She suctioned the mouth and nose. "Okay, push with the next one. We're ready for the shoulders." To Carmen she said, "Get several towels ready." In three minutes, the baby was delivered.
"A boy!" Carmen shouted excitedly. "A baby boy!" Silence followed. Molly laid the baby face down across her forearm and slapped the bottom of his feet. Nothing.
She again suctioned the blue-tinged mouth, then rubbed his back vigorously with a towel. Carmen stood watching with huge eyes and open mouth.
Sarah started to cry, a pitiful, helpless thin whine of fear.
"Come on. Breathe," Molly whispered as she slapped his feet again. The baby sucked in its first breath and began to cry like a hungry kitten. "That's it!" Molly wrapped him in a towel and laid him, squalling, on Sarah's chest.
Sarah repeated over and over, as if to reassure herself, "He's okay. He's okay."
"He's better than okay. He's great," Molly said, cutting the cord and watching the baby's color improve by the second. She looked to Carmen. "Get back on the phone. We need the neonatal unit to check him out and give him his walking papers. And Sarah needs a once over by an OB/GYN."
"How much do you think he weighs?" Sarah asked. "I'd guess at least seven and a half pounds-a good, healthy size." She massaged Sarah's abdomen to deliver the placenta. The danger to the baby was past, but until she was certain there wasn't going to be any immediate bleeding problem, Molly kept her attention close on the mother.
"Look at all that black hair," Sarah said with wonder in her voice. "I expected him to be bald as a billiard ball. I didn't have enough hair to hold a barrette until I was three."
Molly, preoccupied with her work, responded absently, "Must take after his father." It wasn't until she realized Sarah hadn't responded that she grasped what she'd said. "Sorry."
"His father was a redhead." Surprised, Molly looked at Sarah's face. This was the very first thing she'd ever said about the father. Sarah had acted as if there was no father. "Oh."
"You think I'm terrible. But his father is ... dangerous ... evil. I can't ever, ever let him near Nicholas. I won't put him on the birth certificate. I don't want there to be any link to that man." There was a certain panicked vehemence in Sarah's voice that Molly thought bordered on hysteria.
For a moment, Molly held her words. Circumstances had led her to believe that Sarah had been a victim of domestic violence, hiding away from an abusive husband or lover. Sarah herself had been as secretive as a mummy, not divulging the slightest detail of her past. But she had that haunted look about her, a humming tension, a jittery fear that never quite left her eyes. Molly had seen it dozens of times. But she had never heard even the most battered of women refer to her child's father as "evil." Surely Sarah's emotions were talking, the primal combination of protective new motherhood and raging hormones.
"You've named him Nicholas, then?" "Yes. Nicholas James." "After anyone in particular?" Molly fished. Sarah shook her head, but kept her gaze on her baby's face. "He's a person unto himself, a new start. He won't take after anyone."
There was a certain stony conviction in her words that made Molly reconsider. Maybe the father was truly bad. The siren she'd been straining to hear finally pulled up outside.
"Sounds like your chariot has arrived." "I don't really have to go to the hospital, do I? I'm fine. Nicholas is fine."
"I think you're both fine. But it's always a good idea to have a newborn under close observation for the first few hours. Besides, unless you have someone who can stay with you, I don't want you to go home yet. But if there's someone I can call...."
Something shifted behind Sarah's innocent blue eyes. Suddenly she looked much younger than twenty-nine. "No. I'm alone." Then she smiled warmly and cuddled the baby closer. "Or at least I was until now." Molly looked on, wondering what that connection must be like, having a human being completely created within your own body. And now that human being was a life force of its own, yet relying on you for every need. The awesome responsibility. The love.
Eighteen months ago, she'd had surgery to remove a tumor from her cervix. It had been more extensive than the surgical team had anticipated. The prognosis for Molly's carrying a child to term wasn't good. As she gave Sarah's hand one last squeeze before the paramedics rolled her out of the clinic, she wondered if this would be as close as she'd ever get to the birth experience.
Molly finished out her day with a satisfied buzz in her veins. Holding new life in her hands had helped eclipse the bleakness that had threatened to swamp her earlier- had pushed the dissatisfaction back behind the black curtain. Finally, the last patient was out the door and she was free to go to the hospital and see Sarah and the baby.
Excerpted from Promises To Keep by Susan Crandall Copyright © 2005 by Susan Crandall. Excerpted by permission.
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