up on the exam table, showed him the digital thermometer and asked him if he knew what to do with that. He pointed to his ear and Mel laughed happily. “You’re an expert at this,” she said. She picked up the stethoscope and asked, “Mind if I listen to your heart?” He shook his head. “I’ll try not to tickle, but it’s hard for me, because tickling is kind of fun—I just love hearing the giggles.” On cue, he laughed, though softly. Mel let him listen to his own heart, then hers. She palpated his lymph nodes while he listened to his chest, his leg, his hand. She looked in his ears and throat, and by the time she’d gotten that far he was already getting comfortable with her.
“I think he might have a little virus—doesn’t seem to be too serious. His temp is only a hundred. Have you given him anything?”
“Children’s Tylenol, last night.”
“Ah, then he’s in pretty good shape. His throat looks a little red. Keep up the Tylenol, lots of fluids. I don’t think you have to worry. If he gets worse, of course…”
“Then it’s safe to just keep driving…?”
Mel shrugged. “I don’t know, Paige. Want to talk about you? I’m here to help, if I can.”
Her gaze instantly dropped and that was really all it took. Mel knew where this was going. She’d spent years in a big-city emergency room, and had seen more than her share of battery victims. The bruise on the young woman’s face, the split lip, the fact that she wanted to keep driving… away…
Paige lifted her gaze. “I’m a little pregnant. And spotting.”
“And a couple of bruises?” Mel asked.
Paige averted her gaze and nodded.
“Okay. Would you like me to have a look?”
Paige looked down. “Please,” she said softly. “But what about Chris?”
“Oh, not to worry. I’ve got that covered.” She bent at the waist and smiled into Christopher’s handsome brown eyes. “You like to color, buddy? Because I have a ton of coloring books and crayons.” He nodded shyly. “Good. Come with me.” She helped the little guy down off the exam table and with the other hand, pulled a gown out of the cabinet and handed it to Paige. “Why don’t you put on this gown. I’ll give you a few minutes. And try not to be afraid. I’ll go slow, be gentle.”
“Um… Are you leaving him alone?” Paige asked.
“More or less.” Mel laughed. “I’m leaving him with Doc.”
“He seems a little… shy… around men.”
“It’ll be fine. Doc’s good with kids, especially the shy ones. He’ll just make sure this guy doesn’t do surgery or run away. Beyond that, it’s just coloring. At the kitchen table.”
“If you’re sure…”
“We do it all the time, Paige. It’ll be okay. Try not to worry.”
Mel took Christopher to the kitchen, and after setting him up with coloring books and crayons, she refilled her coffee. Decaf. She wasn’t enjoying coffee nearly as much these days. Then she went to the office and got out a new patient form. Given the situation she believed she faced, she would examine the patient first before frightening her with paperwork. Clipboard in hand, she asked Doc to keep an eye on the child in the kitchen while she performed a pelvic.
Being a few months pregnant herself, Mel had a sick feeling at the thought of anyone hitting a pregnant woman. It never ceased to amaze her that a man could live with himself after doing something like that. Forms on her clipboard, her small digital camera in her shirt pocket, stethoscope around her neck, coffee in hand, she tapped on the door and heard Paige softly say, “Come in.”
She put the clipboard and her coffee on the counter and said, “Okay, then… Let’s get your blood pressure first.” She picked up the blood pressure cuff and went to apply it to Paige’s arm and was frozen. There was a huge hematoma that covered much of her upper arm.
Mel put the cuff aside and gently pulled the gown away from Paige’s back; she had to concentrate not to gasp. She pulled the gown over Paige’s shoulder, down her arm, exposing the bruises on her back, arm, chest. She carefully lifted the gown at the bottom, exposing her thighs. More bruises. She looked at the girl’s face. Tears glistened on her cheeks. “Paige,” Mel said in a whisper. “My God…”
Paige put her hands over her face. Shame at having let it happen.
“Have you been raped?” Mel asked gently.
She shook her head, tears flowing. “No.”
“Who did this to you?” she asked. Paige just closed her eyes and shook her head. “It’s okay. You’re safe right now.”
“My husband,” she answered in a whisper.
“And you’re running away from him?”
She nodded.
“Here, let me help you lie down, slowly. Carefully… Are you all right?” Paige nodded, not making eye contact, and reclined on the exam table. Mel gently moved the gown around. Her chest, breasts, arms, legs—all covered in bruises. Mel palpated her abdomen and Paige winced. “Does it hurt here? Here?” When Paige nodded or shook her head, Mel moved on. “Here? Here?” Mel gently rolled her from one side to the other—her buttocks were bruised, as were her lower back and upper thighs. “Any blood in your urine?” she asked, and Paige shrugged. She didn’t know. “The only way I can get a clean urine specimen if you’re spotting is with a catheter, Paige. Would you like me to do that? Just to be sure?”
“Oh, God. Do you have to?”
“It’s okay. Let’s check what we can, first. Any chance you’ve had an ultrasound with this pregnancy?”
“I haven’t even been to the doctor yet,” she said.
Another symptom, Mel thought. Battered women didn’t take care of themselves, or their pregnancies, out of fear.
Paige sucked on her sore bottom lip, staring at the ceiling through glassy eyes while Mel examined her. “Okay, let me help you sit up. Easy does it.” Mel listened to Paige’s heart, looked in her ears, checked her head for lumps and lacerations. “Well, Paige, you don’t appear to have broken bones. At least none that I can detect. I wouldn’t mind getting an X ray of your ribs, just to be sure, since you have some tenderness there, but with you being pregnant and all. Frankly, if it were up to me, I’d admit you to the hospital.”
“No. No hospitals. I can’t have any records of any kind…”
“I understand, but realize, this looks very scary. How heavy is the bleeding?”
“Not too bad. Less than, say, a period.”
“Okay, lie back and slide down. I’ll be as gentle as possible.”
When she was in the position, Mel pulled on her gloves and took her stool. She touched the inside of Paige’s thigh before touching her external genitalia. “I’m not going to use a speculum for this exam, Paige. Just a pelvic to estimate the size of the uterus. If you have any discomfort at
