got to wean myself away from her,’ Marty explained, and Sophie, understanding, gave her a hug.
But avoiding Carlos was less easy. She had barely finished a planned Caesarean delivery of triplets when she was called to A and E—an ambulance bringing in a teenager with severe abdominal pain and vaginal bleeding.
Marty beat the ambulance, but not by much, and wasn’t surprised to find Carlos by her side as the attendants wheeled the young woman, looking childlike in her green and white checked school uniform, into the trauma room.
‘Regan Collins, fifteen, BP 120 over 65, pulse 90 and firm, temp 99.3, severe cramps and bleeding,’ the ambo recited as he handed over the paperwork. ‘We have her on fluid replacement but haven’t done anything for the pain.’
‘Because she could be pregnant,’ Marty murmured under her breath to Carlos.
She stepped forward and introduced herself to Regan, who looked as if she needed a hug more than medication.
‘You’ll be OK,’ Marty reassured her instead. ‘We’ll take a look at you and see what’s what.’
The girl grasped her hand and squeezed it tightly, fever-bright eyes looking pleadingly into Marty’s.
‘You won’t tell Mum,’ she begged, and Marty’s stomach tightened. She hated these situations—hated being the one who had to break her patient’s confidence.
‘You’re a minor, Regan, and you were at school when this happened. The school will already have contacted someone in your family.’
‘But I could just be sick—she needn’t know what it is,’ the girl said desperately, still clinging to Marty as if she held the promise of salvation.
‘Well, I can’t tell your mother what it is if I don’t know,’ she told Regan. ‘So how about I examine you and we take it from there?’
‘Mum can’t know,’ Regan wailed, then burst into noisy sobs.
Now Marty did hug her, gathering the girl’s upper body in her arms and holding her close, making soothing noises as she patted Regan’s back.
She used her free hand to smooth dark strands of hair back from the girl’s face, while an errant thought flashed through her mind. Would Emmaline’s hair stay black?
It was none of Marty’s business.
‘Hush now,’ she said to Regan, when the storm of tears appeared to be subsiding. ‘We’ll sort it out.’
But Regan’s head moved against her chest, denying this as an option, her drama-filled adolescent mind certain this was the end of life as she had known it.
‘You can’t, nobody can,’ Regan cried, confirming Marty’s thoughts, but the teenager allowed herself to be lowered back on the trolley so Marty could examine her, questioning her gently all the time.
When did she last have a period? Were they regular? Did she have a boyfriend? Was she having regular sex? Using protection?
Beside her, Marty could feel Carlos all but squirming—it was obvious why he hadn’t become an O and G specialist! But when he murmured, ‘I could never ask Sudanese women these questions,’ she understood.
‘Maybe a female nurse could,’ she suggested, as she completed a gentle internal examination of the patient.
‘It’s all Rosemary’s fault!’
Marty looked across at Carlos and smiled but he was looking slightly ill and so anxious Marty felt she should be reassuring him as well. He obviously didn’t know that once teenagers starting blaming someone else, they were back in control.
‘Why?’ Marty said, and Regan started crying again.
But this time Marty continued about her business, asking Carlos to take some blood to go to the lab. ‘We’ll do beta HCG as well as the usual tests, and blood typing in case we need to operate,’ she told him, knowing he’d know enough to realise the test for human chorionic gonadotropin would tell them if Regan was pregnant.
Or had been!
Palpating Regan’s stomach, Marty found it to be soft, with no discernible lumps or masses, although Regan moaned with pain when Marty pressed on the uterus.
‘We’ll do an ultrasound now.’
‘Rosemary said she knew how to get rid of a baby.’
Images of olden times—of back-yard abortions and quack remedies to bring on a miscarriage—flashed through Marty’s head while her chest tightened with anxiety for the young woman—barely out of childhood—and the damage she might have done to herself.
But when she said, ‘How was that?’ her voice was gentle and contained, and Regan, taking heart apparently from Marty’s tone, admitted to exactly what Marty had been dreading.
‘With a knitting needle.’ The words were little more than a breath of sound but the thought of the damage Regan might have done herself made Marty shudder. Although in early pregnancy, with the foetus so tiny, it was unlikely any amount of poking would have caused the miscarriage.
Regan began to cry again, but this time defensively.
‘I had to do something! My mum would have killed me.’
‘Instead of which you could have killed yourself if you’d got septicaemia or bled to death before someone realised you were in trouble,’ Marty told her.
She wanted to say more—to wag her finger at the girl and yell a little. Say things like, ‘Surely you’ve heard of safe sex? Surely by your age you know something about birth control. The pill?’ but angry though she was about what she felt was the stupidity of teenagers, she knew now wasn’t the time for a lecture. Later on she’d have to counsel the girl on just these things, but if Regan was angry and resentful towards her, she wouldn’t listen.
The ultrasound revealed early pregnancy, now interrupted by this episode of blood loss.
‘I need to take you into Theatre for a small operation to have a look in there and clean things up. We call it a D and C, dilatation—opening up your cervix—and curettage, scraping around your uterine walls.’
‘That’s gross!’ Regan protested, then she brightened. ‘But it’ll get rid of the baby.’
‘We’re not doing it to “get rid of the baby”, as you so bluntly put it,’ Marty retorted. She was finding it more and more difficult to maintain sympathy for this self-focussed young woman. ‘We’re doing it to minimise the risk of infection and, far from being gross, it could well save your life.’
Regan must have picked up on Marty’s mood, for a tear slipped from one eye and slid down her cheek.
‘I’ve been stupid, haven’t I?’ she quavered.
‘Very!’ Marty agreed, but she gave the girl a warm hug. ‘And although in the end things will be OK again, they’re going to get worse right about now because we need your mother’s permission to do the op.’
Carlos
