All of a sudden George and the technician saw something that made them both start. George immediately rotated the monitor so that it was out of Laney’s line of sight. Both Laney and Carlos sensed the change in atmosphere.
“Is there anything wrong?” Laney asked anxiously.
“No, everything is fine,” George mumbled as he motioned to Carlos to hand over the probe. Surprised but happy to oblige, Carlos gave it to him and stepped aside. George moved the probe’s tip to Laney’s left side while staring at the monitor to guide him. He pressed in firmly, moving the tip in small arcs, and kept it up for almost five minutes. “Okay,” George said finally, lifting the probe off Laney’s abdomen. “All done. We have what we need, Laney. Now, just try and relax! There will be a wait for the OB consult because of so many deliveries. They’re knee-deep in newborns up there,” he added, smiling weakly.
The metaphor fell flat. Laney was in no joking mood. She watched George closely as he handed the probe to the technician. “Take advantage of the quiet and get some sleep if you can,” George added. He knew the medication they had given her to alleviate her stomach pains would have a sedative effect.
Turning to Carlos, George said, “Help Shirley clean up, then meet me in the imaging room.” He gave Laney a quick smile and a reassuring squeeze of her arm, and then left.
George retreated to the imaging room to be alone for a few minutes. He was stunned at Laney’s bad luck. It seemed unfair that she had to endure such horrific medical problems.
A few minutes later Carlos joined him. “So what’s up? I saw your reaction. What did you see?”
“Grab a seat,” George said as he pulled up the study on the monitor. He zeroed in on the fetus’s head. At first Carlos couldn’t see the problem. “Look at how much the fetus’s head is distorted,” George said, using a pen as a pointer. “Look how it slants back right above the orbits. Do you know what that means?”
“Not really,” Carlos responded.
“It’s a condition called anencephaly, meaning essentially no brain and probably no spinal cord. There’s no hope. It’s tragic, especially with Laney’s reluctance to have an abortion, but this changes everything. Her life is too much at risk to give birth to a child who will either be stillborn or die within days of birth.”
Carlos nodded in understanding as he stared at the image on the monitor, digesting the terrible implications.
George got up and went to look for Kelley. He found her busy suturing up a laceration. At his insistence she stepped out into the hall, keeping her gloved hands clasped to her sterile gown as George explained the bad news.
Kelley was stunned and dismayed. “The poor woman. Can you go back and tell her?”
“Sorry, but I don’t think that would be appropriate. That’s the purview of the doctors taking care of her, meaning you or your resident. Actually, the diagnosis is not official until it is read by an attending. I’m sorry. Of course you could wait for the OB consult to tell her. It’s your call. You and your resident.”
“I have several more lacerations after this one.” It was clear she wanted help.
“Talk to your resident when you’re finished. I hope you understand; information like this is not for the radiologist to give to the patient.”
“Okay, I understand,” she said reluctantly. “I’ll let my resident know. My guess is that he’ll want to wait for the OB consult.”
“Whatever! But it’s important for the OB resident to know the results of the ultrasound before seeing Laney.”
“Of course,” she said.
“I could handle that part for you if you want.”
“That would be great. Thanks.” She tried to smile but her lips twitched.
“What I’ll do is get a radiology attending to review the case immediately so that it will be part of the record. That way, when the OB resident comes down, it will be available. But I’d still like to talk to whomever it is first.”
“Got it,” Kelley said, then added, “In some respects this could be a blessing in disguise. With the condition of Laney’s heart, I doubt if she would live through giving birth. Do you think the OB people will now be able to convince her to have an abortion?”
“We can hope.”
“God! What a tragedy. As a woman, I can really relate.”
“I can well imagine. I’ll get the final read on the ultrasound and we’ll go from there.”
“I appreciate your taking the time to come and tell me. Thank you.”
“You’re welcome. My pleasure. By the way, I happen to think you are doing a bang-up job after being here only two and a half days.”
“Thank you again.”
“I mean it,” George said. “Now, get back to your suturing. We’ll talk later.”
George poked his head into the imaging room and got Carlos’s attention. “Everything hunky-dory?”
“No problems, boss,” Carlos reported cheerfully.
“I’m going to get an attending to sign off on the ultrasound. Text me if there are any problems.”
Carlos gave a thumbs-up.
Back in the ER proper, George saw Debbie carrying on as usual at the main desk. As he passed, he caught her eye, and to his surprise she actually smiled back. Maybe he hadn’t done anything to upset her last night, after all.
There were a number of radiology attendings who could sign off on Laney’s ultrasound, but Clayton, an authority on ob-gyn imaging, was probably the best. For George it represented a degree of irony, considering the man’s womanizing. He made a beeline for Clayton’s secretary. “I need to see Dr. Hanson.”
“He’s finishing a cardiac catheterization. I can tell him—”
“That’s okay. I’ll find him. Thanks!” George knew the cath room Clayton preferred. Just as George approached, he was snapping off his sterile gloves.
“George!” Clayton said. “What brings you to this neighborhood?”
“I was hoping you had a moment to look at an ultrasound on a gravid young woman in the ER. I’d like to get it into the record before she has an OB consult.”
“Sure. I have a moment right now.” He waved for George to follow. “How many months pregnant?”
“Around seven,” George said. He then gave an encapsulated version of Laney’s case, including what he thought the ultrasound showed.
“Geez,” Clayton commented. “Poor thing!”
They went into an empty reading room. George sat down at one of the terminals and began entering Laney’s hospital number.
“I ran into Debbie Waters earlier,” Clayton said. “She said she had a really good time, which I was pleased to hear.”
George was skeptical. “Did she actually tell you that?”
“Of course. She had a good time and looks forward to doing it again. You are in luck, as I happen to know she is in between boyfriends.”
George was frankly disbelieving. “She barely gave me a sideways glance this morning. I admit I had more to drink than I should have. I was worried that I had offended her.”
“She didn’t mention anything other than she had a good time.” Clayton pulled over a chair and sat down to watch as the video of Laney’s ultrasound began. He watched it several times, freezing the frame at key points. Finally he said, “Unfortunately I totally agree with your impression. Definitely anencephaly. For sure the fetus is doomed. I’ll sign off now.” As he did so he added, “They’ve got to get her to abort. No sense risking the mother’s life.” When he was finished he turned to George. “Done. Anything else?”
George shrugged. “That’s it. I appreciate your time. Thanks.”
“Glad to be of help.” Clayton smiled and stood up. “But don’t let Debbie Waters’s workday persona put you off. I’m telling you, she had a great time last night. And tell me the truth: Did you enjoy yourself or what?”