baby over to Jack at the bar, or if Jack wasn’t there, Paige or Preacher or Mike were more than willing to babysit. For the most part, David could be counted on to remain content for the half hour or so Mel needed to see a patient as long as she had the bouncy seat with her and he was neither hungry nor dirty. He still took two long naps a day—one in the morning and one in the afternoon.
Mel had been back from Sacramento less than two weeks when a teenage girl from Virgin River came to Doc’s and asked to see her. Carra Jean Winslow was fifteen and Mel had never seen her before. In fact, even though Mel had lived and worked in Virgin River for just over a year, she didn’t know the girl’s parents. Taking note of her age and obvious anxiety, Mel took her to an examining room before asking her what she needed. When a fifteen-year-old girl who didn’t cough or wheeze or bring her parents came in to see the nurse midwife, the possibilities seemed pretty limited and obvious.
“I heard there was a pill that could keep you from getting pregnant if, you know, you had sex,” she said. She said it very quietly, looking at her feet.
“Emergency birth control. But it’s only effective if the intercourse has been very recent.”
“Two nights ago,” she said weakly.
“That’s recent enough,” Mel said, trying to put her at ease with a smile. “Any problems? Pain? Bleeding? Anything?”
“Bleeding. There was some bleeding.”
“First time?” Mel asked, smiling kindly. The girl nodded. “Have you ever had an internal exam before?”
She shook her head and looked down again.
“I’d like to check you, make sure everything is okay. It’s not as terrible as you think,” Mel said, touching her arm gently. “How much bleeding?”
“Not too much. A little. Getting better.”
“How do you feel? There?”
She shrugged and said, “Still a little sore. Not bad.”
“That’s good. I assume, if you’re interested in emergency contraception, you didn’t use a condom….”
“No,” Carra answered.
“Okay, we can handle this. Can I get you to undress and put on a gown for me?”
“My mom. No one knows I’m here.”
“That’s all right, Carra. This is between you and me. I’m only interested in your health. Okay?”
“Okay,” she said.
“I’ll be back in a few minutes. Everything off, just the gown.”
Poor thing, Mel thought. She ached for young girls who had just stumbled into this sort of thing without planning, without being sure. And that described almost all young girls. But at least she was here, avoiding yet another disaster. She gave Carra plenty of time to get undressed, but didn’t leave her waiting long enough to tangle up her nerves, then returned to the exam room.
“Let’s get a blood pressure and listen to your heart first,” she said briskly.
“I have to pay you myself,” Carra said. “I don’t want my parents to know about this.”
“Carra, confidentiality is important in this office—you can trust that,” she said. “This is all going to work out.” She applied the blood pressure cuff, noting there were a few small bruises on the girl’s upper arm. “You have a couple of bruises here,” she said.
“It’s nothing. It was … volleyball. It can get a little rough sometimes.”
“Looks like someone grabbed you,” Mel suggested.
The girl shrugged. “It happens.”
Mel got the blood pressure, which was normal. She listened to Carra’s heart, looked in her eyes, checked her pupils. Except for the nervous pounding of her heart, she seemed to be in good shape. She showed her the speculum, explained the procedure and eased her carefully into position for the pelvic. “Nice and slow, feet right here, slide down for me. That’s it. Try to relax, your knees apart, honey. Thank you. This isn’t going to be bad at all, so take some deep breaths and try to relax.”
“Okay,” she said, and began to softly cry.
“No crying now,” Mel said gently. “Everything is going to be all right, because you came to see me right away.” She gently parted the girl’s knees and was frozen. Her labia were bruised and swollen; there were bruises on the insides of her thighs that bore a striking resemblance to the bruises on the girl’s upper arm. An unmistakable thumbprint and fingers. Oh, God damn. Mel stood from her stool and looked over the drape at Carra’s face. “Carra, I can see that you’re very sore. Bruised and swollen and a little torn. I’d like to proceed, take a closer look to be sure everything is all right. But only if you’re up to it. Are you okay?”
She pinched her eyes closed, but nodded.
“I’ll be as gentle as I can,” Mel said. She put on her gloves but set the speculum aside. “I’m just going to check your vagina and uterus, Carra—I’m not going to use the speculum because you’re sore. I’d like you to take a deep breath for me, then let it out slowly. That’s it,” she said. “It’ll just take a minute. Don’t clench. Relax your muscles, Carra. There you go, very good. Tell me, does this pressure hurt?”
“Not so much,” she answered.
Why do these things always come in batches? Mel thought. I’m not over Brie! Carra’s vaginal wall was torn, ragged. Raw. Her hymen was ripped open and looked like so many little fingers. She completed her exam quickly, and while she didn’t have a rape kit handy, she did have a sterile swab with which she took a vaginal specimen, although it could be too late for any DNA recovery.
“Okay, Carra, let me help you sit up.” Mel snapped off her gloves and helped Carra get herself settled, legs dangling off the table. “I’m concerned about what happened to you, Carra. It looks like you’ve been hurt. Want to tell me about it?”
She shook her head and a couple of big tears spilled over. Carra was a plain girl with an oblong face, bushy, unshaped brows and a small problem with acne. And right now, a really bad case of regret and fear and nerves.
“It will be confidential,” Mel said tenderly. “It’s not just the bruises, Carra. Your vagina looks ragged. Torn. The damage isn’t serious. It’ll heal. But from everything I can see—”
“It was me. It was my fault.”
“Something like this is never a woman’s fault,” she said, and she used woman purposely, although this was a mere girl. “Why don’t you tell me what happened, and we’ll go from there.”
“But you’ll give me that pill?” she asked desperately.
“Of course. We’re not going to let you get pregnant. Or sick.”
She took a deep breath, but it brought the tears harder. “I just changed my mind when it was too late, that’s all. So it’s my fault.”
Mel touched her knee.
