Monday, October 13, 2008

Chapter 6 - A Miscarriage Matters

December 1947

Solomon walked in the back door of the clinic hoping to see Alice Hope sitting with her grandfather, but no such luck. Dr. Wall was in a better mood than usual. Alice must have done a good job of convincing him that his cashmere coat had been soiled for good reason. The old doctor didn’t say anything about it, or the so-called miracle resuscitation of little Charlie.

Solomon put on his white coat, stuffed his stethoscope into his pocket, and walked into the waiting room. Three patients were there. Mrs. Collins was in for her B12 shot. Jared Fox needed to have his blood pressure checked, and Clara Cash had brought little Henry to get his most recent stitches taken out. He’d cracked his head open this time on a swing set at school. Solomon hadn’t seen Clara in several months. She had looked anemic for years, actually since her last miscarriage. “Clara,” Solomon said to her, “why don’t you let me draw some blood on you while you’re here.”

“I’m fine, Solomon. I can’t afford doctoring on myself.”

“You can pay with one of your apple pies,” he said.

“Naw thanks,” she said.

“Okay,” he smiled, “but the offer’s good when you want it.”

Solomon decided to make a quick call to Alice Hope before he got started with patients.

“Hello?” Alice Hope’s mother answered.

“Afternoon, Miz Wells, is Alice Hope around?”

“Oh hello, Solomon. No, she’s gone to Gatlinburg with some friends from the Country Club. She’ll be back home tomorrow,” she said. “By the way, Solomon, I want to thank you for accompanying her to the church last night. She told me about the little boy you saved. I’m real proud of you.”

“Oh, thank you, Miz Wells. We were in the right place at the right time. I hope the boy doesn’t have any permanent damage from the hypothermia.”

Alice Moriah laughed, “You sound just like my father, Solomon.”

“Oh, okay,” he laughed, “would you tell Alice Hope that I called?”

“I sure will. Did you want her to call you?”

“Uh…no, just tell her I called.” It’s strange how sex makes a man feel possessive, Solomon thought. I wonder why she didn’t mention her out of town trip to me last night. When Solomon thought about last night in the car, he started to feel aroused again. Get a grip, man, he said to himself.

“Solomon, I need you,” Dr. Wall shouted.

Solomon left the swivel chair spinning. Dr. Wall’s voice sounded urgent.

A young woman stood in the waiting room holding a bloody towel between her legs. Dr. Wall reached for it and blood clots the size of his fist dropped to the floor and splattered on the linoleum. The woman moaned and bent over holding her abdomen. An older woman carrying a baby on her hip tried to help. “She be pregnant,” the woman said. “She commenced to bleedin’ come morning, but we had to wait ‘til her brother got home with the truck to brang her over here.”

Holding her by the arm Solomon asked, “Can you walk a few more feet?” She left a trail of blood as he led her into the examining room. He helped her get up on the exam table, and then he got a quick set of vitals.

“What’s your name little lady?” Dr. Wall asked as he put two fingers up against her cervix and palpated her abdomen for the top of her uterus.

“Kelly Craven,” she answered.

He said to Solomon, “She’s dilated about a centimeter.”

Solomon spread a sheet over her and said, “Raise your hips, Kelly. Let’s get this dress off.” He helped her sit up so he could pull the bloody dress over her head. He held an exam gown in front of her. Her face twisted with nauseating cramps, and she groaned as he helped her lie back and get her feet into the stirrups.

Dr. Wall pulled the lamp down to spotlight her perineum, and then he inserted a speculum. The stainless steel duck-billed instrument exposed her cervix. “Do you have any kids, Kelly?”

“Yes, sir, I got four,” she answered.

“Has this ever happened to you before?” Dr. Wall asked.

She shook her head no.

Solomon drew up morphine sulfate in a hypodermic. He pinched up the muscle on the side of her hip. “You’re going to feel a sting.” He said it automatically. He knew that the little sting was a non-issue when she was being body-slammed by cramps. “It will help with your pain,” he told her.

Dr. Wall squinted as he peered at her cervix through the opening in the speculum. “The fetus hasn’t been expelled yet,” he said. “How far along is your pregnancy, Kelly?”

She had a blank look on her face.

When was your last period?” Solomon asked.

“Early October,” she said.

“I need to get some blood, Kelly,” Solomon said as he wiped her finger with an alcohol-soaked cotton ball. He squeezed it and then hit it with the lancet. A bead of blood popped up. He touched a slide to it. Then he tied a tourniquet above her elbow. He wiped the vein with the alcohol cotton ball and held the needle over it. He turned the needle until it was bevel up, and then he stuck the vein being careful not to go through the backside of it. He pulled the plunger back sucking blood into the glass tube. He released the tourniquet with a snap.

Dr. Wall said, “Hon, I think we can pass on the ether. It will be over in a minute. This way you won’t be throwing up.”

Solomon remembered that he’d ordered lidocaine that they would be able to use in the future for D & C’s. It could be injected right into the cervix to numb it before dilation. Solomon kept up with the new medicine and the new techniques in the medical journals.

Dr. Wall inserted a dilator into Kelly’s cervix to make certain it was one centimeter. That’s how much room he needed to pass the curette through her cervix. The old doctor picked up the stainless steel, sharp-edged, spoon-shaped instrument and carefully inserted it into Kelly’s uterus.

Solomon started the lab tests on her blood. His back was to the exam table as he looked at the blood under the microscope. Kelly’s groans and grunts accelerated. Solomon turned around on the lab stool. Dr. Wall was sweating. He frowned as he peered though the hole in the speculum. The doctor cut his eyes toward Solomon and realized that he was watching him. He pulled the curette through the speculum and threw it on the floor.

Solomon slid off the stool and walked over to Dr. Wall. The old doctor wiped his forehead with a sleeve and stood up. He stepped back indicating to Solomon that he should sit down. Solomon straddled the stool. He was eye level with the hole in the speculum. He peered through it, and then he picked up a small square of sterile gauze with forceps. He pulled up on the tenaculum that Dr. Wall had clamped to Kelly’s cervix. He wiped her cervix with the gauze. Bright red blood oozed out of it.

The blood from Kelly’s miscarriage was dark and thick from its exposure to oxygen. Solomon knew that the bright red blood indicated arterial blood from a new source. It could be something simple like a cut on the uterine wall from the curette, or it could be more serious like a perforation through the wall.

Solomon looked up at Dr. Wall. The doctor was annoyed as he said, “I perforated it. I felt the curette go through the wall.” He backed up and sat down in a chair beside the counter.

Solomon asked, “How far had you gotten?”

“I was on the right side. I didn’t get to the left side yet,” he said.

Solomon eyed the small bowl containing the tissues that Dr. Wall had pulled through Kelly’s cervix. He put on sterile gloves and picked up a clean curette. He began to scrape the inside of the uterus. He listened for the gritty sound the curette made when he touched the wall. As he pulled out the curette, a tiny foot protruded through the cervix. This was the part of a D & C that he hated. He reached for it with small forceps, and then he placed the foot in the bowl. He would examine all the pieces later. When he finished, he turned to the doctor and said, “It clotted off. It was a minor perforation.”

The old doctor sighed and leaned his head back against the wall.

Solomon unclamped the tenaculum used to stabilize Kelly’s cervix during the procedure and pulled the speculum out of her vagina. He put the towels and instruments into the sink. He placed a towel over the “products of conception” and put them on the counter.

Dr. Wall got up and walked out of the room.

Solomon said, “Kelly, we need to keep you here tonight.” They didn’t usually do that for a D & C, but he was concerned about the perforation. He wanted to make sure that she didn’t hemorrhage during the night.

The clinic had one hospital-type room for patients. When a patient was in the room, Solomon stayed at the clinic so Dr. Wall wouldn’t have to do night duty. The old doctor’s balance was worse at night, and Solomon feared he might fall getting up for a patient.

Solomon fixed a bowl of warm soapy water. He got a clean wash cloth and towel and a bed pan out of a cabinet. He asked the old woman with the baby if she would help Kelly clean up. She shook her head no and backed out of the room. What the...? Solomon thought. At times like this he wished they had a female working at the clinic. Doing personal care for women didn’t bother him, but he could tell it bothered the patients. He tried to respect their modesty as much as possible, but sometimes there was no choice. He had to do what he had to do.

He washed Kelly’s perineum and thighs where the blood had dried and pressed a sanitary napkin against her. He lowered the hem of her gown and pulled out the exam table’s extension. “You can get out of the stirrups, Kelly,” he said.

He drew up penicillin in a hypodermic and gave her a shot of it in the hip. “This will keep you from getting an infection,” he said. It was another precaution because of the perforation.

Solomon grabbed a gurney from the back wall and rolled it beside Kelly. He patted it and said, “Can you scoot over here?” He held her hand as she leveraged his arm to scoot over. Solomon covered her with a sheet and rolled her into the room where she would spend the night.

The whole procedure had taken less than an hour. On his way back to clean up the exam room, he stopped by the kitchen where the doctor sat at the table. The old man looked glum with his hands neatly folded on the table. Solomon said, “She’s fine, Dr. Wall. She’s just fine.”

Dr. Wall said, “Thank you, Solomon.” He didn’t look up from his hands.

“I’ll clean up the exam room,” Solomon said, “and then we can talk, okay?”

Solomon pushed the gurney back into the exam room. He uncovered the small bowl with the “products of conception.” It was like a macabre jigsaw puzzle. He put the body parts on a napkin in the appropriate positions ... two arms, two legs, one torso, and one head. As much as he disliked this he needed to know that the complete fetus had been removed. Tissue left inside a uterus could lead to infection. As he worked, Solomon talked to the tiny three-inch long fetus. “Little baby girl, your body died before you could be born into our world. You’re in the Light World now. You don’t need this fragile flesh. You have your spirit body, and it’s beautiful.” It was Solomon’s way of having a funeral for her before he took her to the incinerator.

When Solomon returned to the kitchen, Dr. Wall wasn’t there. He looked into the doctor’s bedroom and saw that he was sleeping. He covered him with the quilt at the foot of the bed.

He looked in on Kelly. She was sleeping peacefully too. He felt for her radial pulse. Its rhythm and rate felt normal. He didn’t have to count to know that.

It was getting close to suppertime. Solomon found some ground-up steak in the icebox and some potatoes in the pantry. He found canned green beans in the pantry too. That would make a good meal for them.

Dr. Wall appeared at the kitchen door. “I need to talk to you, Solomon,” he said.

“Okay,” Solomon replied, “did I wake you?”

Dr. Wall sat down at the table. Solomon checked the food that he was cooking, and then he sat down too. He waited for the doctor to speak. When he didn’t, Solomon said, “Dr. Wall, you know as well as I do that a perforated uterus is rarely a problem. They heal on their own.”

Dr. Wall’s hands were folded neatly on the table again. He was looking at them when he said, “Son, these hands can’t do the things they used to do. They shake when I want them to be still, and they’re still when I need them to move. If you hadn’t come to work for me four years ago, I would have had to close the clinic by now.”

Solomon said, “Rooster Cove needs this clinic, Dr. Wall. It can never be closed.”

“Oh, I know the needs of Rooster Cove,” the doctor said. “Before you came to work for me, I tried to get a young doctor to take over my practice. Couldn’t find one interested. When I found you, I didn’t need another doctor. You became my failing eyes, my failing hands, and my failing mind.”

Solomon said, “Dr. Wall you’ve taught me more than I could learn in a decade of medical school.”

“That’s another thing that bothers me,” the doctor said. “You should be in college now, but I don’t know what will happen to the folks in the cove when you go off to college. What will they do for medical care? I’m not knocking what Patsy does, but you do so much more.”

Solomon said, “We have to find a way to meet the medical needs of the cove before I leave for school.”

“I don’t know the answer,” the old doctor said sadly. He got up from the table and looked at supper cooking on the stove. He took the potatoes off and drained them into the sink.

Solomon said, “I’ll go check on Kelly. She should come eat with us.”

Kelly was awake when he went into her room. He felt for her pulse. It was normal. He pulled a chair over to her bedside and sat down, “Are you cramping bad?” he asked her.

“It’s tolerable,” she said.

He took her hand in his and studied her face a moment. “How do you feel about what happened to you?”

“I don’t know,” she said, “I guess I feel a little sad.”

“I know you do. Losing a baby is sad,” he said. “She was part of you, and she is still part of you.”

Kelly’s eyes welled up with tears. “It was a girl?”

“Yes,” he said. He sat with her in silence for several minutes holding her hand between his hands. Then he said, “You’ll have some bleeding that will taper off in a day or two. If you have any pain, you call me.” He paused to give her a chance to speak. “Do you have any questions?”

She nodded no.

“You should have a period in four to seven weeks,” he said. “If you don’t, you call me. Okay?”

She nodded yes.

“Do you feel like you could eat something?” he asked.

“It smells good,” she said.

Solomon stood up. “Good,” he said, “let me check your pad to see how much you’re bleeding.”

She nodded, and then she shut her eyes.

He smiled and thought … She shut her eyes. If she doesn’t look at me, it’s like I’m not looking at her. He pulled back the sheet and looked at the pad. A spot the size of a silver dollar was on it. He covered her up and said, “You’re doing fine.” He walked to the water closet in the room and turned a light on. “There are more pads on this table. And there are towels, wash clothes, and a robe hanging in here. They’re for you. Go ahead and clean up and come to the kitchen for supper.”

She said, “Thank ye, doctor.”

Solomon grinned. It sounded nice to be called doctor. He went into the kitchen where Dr. Wall was taking the hamburger steaks off the stove. “Kelly’s having supper with us. She’s doing fine.”

“I’m glad,” the doctor said. Then he said, “Solomon, my granddaughter seems to be quite fond of you.”

“Does she?” Solomon responded. He wasn’t sure of that since she hadn’t bothered to tell him that she was going out of town with her country club buddies.

“Yes,” the doctor said, “and I was just thinking. If you feel the same way about her…I mean…if in the future you both should decide to become more than friends…uh, if you two were to marry, I would be happy to pay for your college and medical school.” He looked at Solomon for his reaction.

Solomon said, “Well, that could be in the future, I suppose. Alice Hope and I have been friends for so long that I don’t know if we could ever be anything more than just friends. But it’s a pleasant thought to consider.”

Dr. Wall said, “She’s a woman. I hadn’t noticed that until last night. I think a young man like you would be good for her. She’s immature about a lot of things, but she’ll be looking for a husband soon. I can see that her hormones are stirring.” He smiled about his statement.

The fact that he’d noticed it too was the last thing Solomon wanted to relay to Dr. Wall. “She’s eighteen years old. You’re probably right,” he said.

After supper, Solomon went into the dispensary and sank back into the big chair with the ottoman. He held a book in his lap, but his mind was on Alice Hope. She’d told him that she’d had sex with a lot of men. Is she with a man tonight?

Copyright © 2008 by Robbin Renee Bridges
Coping with Grief through Afterlife Communication

No comments: