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"I'm having some trouble getting a heartbeat," Julie Antonelli said. Her tone was steady despite the bad news. She looked at the anxious mother in labor who shook her head and turned to her husband who hovered by her shoulder. Too nervous to muster his meager language skills he grimaced in confusion.
"Espere un minuto." Julie held up a finger before turning to Maria, one of the delivery nurses. By law, the hospital was required to have a translator, and Maria spoke Spanish fluently.
"Tell them what I just said and add that this happens sometimes," Julie said. Maria translated efficiently and without drama.
The husband nodded stiffly and gripped his wife's shoulder. She lay back and closed her eyes. The concern was etched in the lines on their faces, but they both breathed a little easier now.
Julie's breathing, by contrast, sped up. After six years as a practicing obstetrician, she recognized a potential crisis in the making, and she wasn't about to let that happen. She already carried around enough guilt.
Not that guilt was all bad, she liked to tell herself, or, more accurately, to fool herself. Either way it reminded her just how precious life was. She focused on the nurse at her side.
"Maria, could you explain to Mr. and Mrs. Sanchez that I'm ordering an ultrasound machine brought in? I want to get a better look at the baby." So far neither a fetal monitor nor a scalp probe on the baby's cranium had yielded evidence of a heartbeat.
Maria translated while eyeing the monitors. "Two hundred over one-fifty," she whispered in English.
Julie nodded. The patient's blood pressure was dangerously elevated. Julie leaned toward the patient. "Car-lotta, are you a diabetic?"
"iCarlotta, es usteddiabetica?" Maria translated.
Carlotta shook her head.
"Have you had regular prenatal checkups, Carlotta?" Julie continued with a kind smile.
"l Carlotta, Usted ha tenido chequeos prenatales regularmente ?"
Carlotta shook her head. A contraction gripped her. She reached to squeeze her husband's hand.
Julie leaned over and patted her shoulder, watching the monitors for signs of distress.
Carlotta breathed through her mouth as the pain passed. She wet her lips. "Yo trabajo durante el dia cuando la clinica esta abierta," she said.
"I work during the day when the clinic is open," Maria translated quickly. Carlotta spoke some more. "She says that she couldn't leave work because she was afraid to lose her job."
Julie bit back an oath. "What kind of job does she have?"
"iEn que trabaja?"
"Soy la ninera de una familia en Grantham."
"She says she's" Maria started to translate.
Julie waved Maria off before the nurse could finish. "That's okay. Even I get that she's a nanny. You wanna make a bet that her employer never misses her doctor's appointments!" Julie could feel her anger mounting, but she needed to keep a lid on it for now. Concentrate on the situation at hand. But later all hell might just break loose.
The door bumped open as Tina, the other nurse, wheeled in the ultrasound machine. Julie wasted no time and moved to the side. "Tell her I need to raise her hospital gown to get a better picture of the baby."
Maria translated, explaining how the lubricating jelly made better contact with the transducer. Then she pointed to the monitor.
"Now, we'll get a look, all right?" Julie said calmly. She placed the ultrasound wand on Carlotta's raised belly.
Carlotta wearily lifted her head. Her husband peered into the monitor at the gray image. "lEse es el bebe?"
Julie nodded and flicked some dials. "Yes, that's the baby." She switched to another view, hoping to find what she had not been able to register so far. And then she caught it. The rapid, shallow flutter of the baby's beating heart.
Just then, another more severe contraction gripped Carlotta. She let out a piercing scream. Blood gushed out between her legs and onto the sheets.
The room erupted into emergency mode. Lights flashed, and an alarm sounded. "Call the O.R. for us," Julie ordered.
Maria got on the phone. Tina whipped open cabinet doors. She reached for some pads, and all three of the women packed them to staunch the blood flow, but it kept coming. "Let's get FFP going, stat." Julie didn't stop working on the patient as she ordered, calling for fresh frozen plasma containing clotting factors.
"I'm already on the way," Tina called as she rushed out of the room. She hastily pushed aside the ultrasound machine and banged the doors behind her.
"I need it yesterday," Julie urged.
She turned back to the expectant mother, whose face was streaked with tears as she hiccupped away her sobs. "Carlotta, the ultrasound shows that your baby is very weak. And we can't wait any longer for it to come out." Tina stormed in and hooked up the Iv bag. She got the line going immediately. She read out the signs to Julie in a trained staccato.
Underneath the hubbub and rapid-fire activity, Maria translated Julie's instructions, looking from mother to father and back to Julie.
Carlotta blinked rapidly and shook her head. She reached blindly for her husband's hand. "i Que, que es lo que esta diciendo?"
Julie knew they couldn't waste precious time. She needed Carlotta and her husband to understand what was going onnow, sooner than now. "You are experiencing eclampsia or pregnancy-induced hypertension. This is a very serious condition. Both you and the baby are in jeopardy, and I will need to perform an emergency cesarean section," she said quickly, urgently.
"iQue lepasa albebe? I don't understand?" Carlotta's husband looked from Julie to Maria. His face was contorted in fear. The tendons stood out in his neck.
Julie opened her mouth to spe
There was no time to answer. Carlotta's limbs went suddenly rigid. Her eyes rolled back. As if struck by lightning her body jolted, and foam immediately gurgled from the corner of her mouth.
"Magnesium sulfate. Now!" Julie yelled. She needed to control the convulsions. Tina readied the injection and handed it to Julie.
"Carlotta, Carlotta!" her husband screamed, his hands going to his face.
Julie administered the dose and checked Carlotta's vital signs. "Maria, explain to Mr. Sanchez that we are doing everything to ensure his wife's safety," she said, not bothering to stop, let alone look up. The antiseizure medicine was fast-acting, and Carlotta settled into unconsciousness, her breathing aided by an oxygen mask. Julie turned to the nurses. "Let's get a move on. I want this baby out of here and the mother out of danger. O.R. knows we're coming?"
"They're waiting for us," Maria said. "That was my first call."
"Then we're outta here," Julie ordered. Tina readied the IV poles. Julie put up the side guardrail and bent to push the bed. Maria, at the foot of the bed, pulled backward, banging the door open with her butt.
Julie put all her weight behind her efforts, keeping her eyes on her patient as the bed rolled swiftly forward. "Maria, explain to the husband that he'll have to stay in the waiting room, but we'll keep him informed."
Maria spoke rapidly.
Carlotta's husband brought up the rear, jockeying to get closer to his wife and reaching out his hand to touch the rolling bed. "You will save her and the baby, won't you?" he pleaded in Spanish with Maria translating.
Julie didn't need the English. She could sense what he was asking from the tone of his voice. And she could feel him breathing hard as he rushed to catch up with her. "Le prometo," she said as she continued to move forward. "I'll do every" Hanging on to the bedrails, she swiveled to reassure him face-to-face
And never saw the ultrasound machine.
The corner clipped her right in the side of her face. She momentarily saw stars.
"Doctor, are you all right?" Tina asked.
Carlotta's husband blanched. He held out a hand to help.
Julie blinked. "No, no, I'm fine, really. Estoy bien." She tried not to wince. "It's my stupidity. Really. Let's just keep moving everybody." She pushed the bed and nodded to Tina to get going again. "And, please, somebody get a social worker who speaks Spanish to stay with Mr. Sanchez." It's the least we could do, she thought.
They reached the operating theater, and an orderly held Mr. Sanchez by the arm as they whisked through the doors. Julie didn't bother looking back. All she thought about was the delivery and that it was going to be difficult. She would need all her training and expertise to guarantee a happy ending.
Thenno matter whatsomebody was going to pay.
And she knew just who.
Dr. Sebastiano Fonterra folded his arms and leaned on the blotter positioned precisely in the middle of his immaculate desk. A Venetian glass vase, black with orange swirls, was juxtaposed against the flat plane. It was a gift from the board of directors of Grantham hospital, and in Sebastiano's opinion, hideous. Naturally, he kept it prominently displayed.
Sebastiano offered a sincere nod to demonstrate his attentiveness to the stately woman sitting across from him who had been speaking to himno, haranguing himfor more than half an hour.
He smiled politely, masking the subversive fantasy bubbling in his brain, the fantasy of jumping atop his desk and, with his arms outstretched and his face raised heavenward, shouting at the top of his lungs, "Per me questo lavoro non vale la pena!" Which somewhat loosely translated to, "They can't pay me en...