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“Your baby is fine, Mary.” She smiled across the room at Steve, who was leaning against a wall. “And you’re doing great, too, Dad.” Steve mustered a small smile in reply.
“Here comes another…” Mary pushed as best she could through the force of the contraction. With legs open and feet resting on the birthing bars, she sat at a fifty-five degree angle, grabbing her thighs.
“Oh-oh-oh…”
“Good work, sweetheart.” Steve spoke in an attempt to be reassuring. He couldn’t watch anymore, poor man. Lydia was about to suggest he take a breather, when suddenly the baby was crowning.
“The baby’s coming, Mary!” the doctor said.
The next contraction came only seconds after the previous. “Keep pushing, Mary,” Lydia urged.
Valiantly Mary bore down and the baby’s head delivered—large, pink and topped with matted black hair. Oh, he’s beautiful, but Lydia no sooner had that thought than the head receded partway into the birth canal.
She glanced sharply at the doctor, who frowned in return.
“One more time, Mary,” he instructed.
The next contraction should have done it. Mary’s face contorted with the effort of pushing. But nothing happened.
Fear, sharp and cold, froze Lydia. Something was terribly wrong here. The baby’s shoulders were trapped within the pelvis.
“Heart rate is one hundred,” the nurse reported. She put in a call for more help and a second nurse arrived a moment later.
Come on! Come on! Lydia chanted silently as another contraction proved as ineffective as the one before. Lydia slid in next to the doctor.
“Shoulder dystocia?”
Dr. Ochoa nodded.
Lydia had dealt with this complication before and delivered healthy babies every time. Still, she was very relieved that she’d made the decision to transfer the birth to the hospital.
“Why isn’t the baby coming?” Steve asked. “Is this normal?”
Far from it. In this position, the baby’s supply of oxygen was compromised. Every second counted. But Lydia was trained to project calm, even in moments of crisis. “We’re trying, Steve.”
“Let’s reposition the mother.” Dr. Ochoa’s tone was becoming more curt by the moment. Lydia did her best to reassure Mary as the bed was lowered to a flat position. Each of the nurses took one of Mary’s legs and lifted it up and back toward Mary’s ears. The doctor swept his fingers inside the stretched tissue of the perineum.
Seconds ticked by. A minute.
Lydia empathized with Dr. Ochoa as he tried desperately to angle the baby’s head down to the floor. But this baby simply would not move. Ochoa was sweating now, trying various maneuvers in increasingly desperate attempts to release one of the baby’s shoulders. If he had to, Lydia knew he would break the clavicle. They were running out of time.
“What are you doing?” Mary could barely utter the words through her exhaustion.
“Trying to get the baby out.” Lydia glanced at her watch, calculating the time that had already passed.
Come on! Come on!
“But we didn’t—” Another contraction knocked the words out of Mary’s mouth. She bore down and Lydia prayed.
“Come on, baby!” His face was turning blue. They had to get him out, his heart rate was continuing to drop. Eighty. Now sixty. Blue skin deepened to purple, and Lydia fought to keep calm.
“What’s happening?” Steve searched faces anxiously. He and Gina were standing too far back for him to actually see the action.
More personnel flooded into the room. Among them, Lydia recognized Dr. Joanna Weston, an excellent local pediatrician. No one bothered with the pleasantries of a greeting. All eyes focused on Dr. Ochoa and the baby he was trying desperately to bring into the world.
“Try a lateral push.” The doctor continued to work at delivering the shoulder, while one of the new nurses applied pressure across Mary’s abdomen hoping to dislodge that stubborn shoulder.
“Come on, honey,” Lydia urged. “This will be the one that does it.”
And it happened. With a grunt of effort, the doctor managed to pull out the anterior shoulder, then the posterior one. The baby was finally out.
Normally Lydia felt relief at this point. But not today. The baby’s face was bluish-purple, his body flaccid and blanched.
His. The baby was a boy. And big. Lydia’s estimate had been correct. He had at least a pound on his sister.
But he wasn’t breathing. Lydia watched the doctor check for a pulse. She could tell by Ochoa’s furrowed brow that he didn’t find one. He clamped and cut the cord, then passed the baby to Dr. Weston. She was the only one who could save this baby now.
Dr. Weston moved quickly and efficiently. She suctioned the baby before beginning to bag him with oxygen.
“Oh, my God. Is my baby okay?” Mary started to weep.
Turning from the resuscitation efforts, Lydia focused on Mary. She smoothed Mary’s damp hair and murmured softly. Gina, she noticed, was patting Steve’s shoulder.
As she repeated meaningless, comforting phrases, an internal dialogue ran through Lydia’s mind, a prayer for the baby lying lifeless under Dr. Weston’s care. Oh, Lord, please let this baby be all right. Please let him be strong and healthy like his sister. Mary and Steve are such good people, excellent parents. Please…
As Lydia prayed, Mary began to bleed. The flow was too heavy. The doctor inserted his hand into the vagina to see if the placenta was separating.
The next second Mary’s eyes rolled back and her body fell limp. She immediately turned blue.
God, no!
“We need oxygen! Fluids!” Dr. Ochoa ordered tersely. “And let’s get a second IV going.”
Lydia stepped back to give the nurses and doctor better access to Mary. The primary nurse began to bag her with one hundred percent oxygen.
“Code blue to room three-twelve stat.”
As the nurse summoned yet more help, Lydia guessed what had happened. Amniotic fluid embolism. She’d seen a few in her career. When the amniotic fluid was sucked into the mother’s circulation, the results were instantaneous and often dire.
This whole delivery was turning into the worst obstetrical nightmare anyone could imagine.
Lydia thought of little Sammy, probably sleeping at just this moment. That little girl needed her mother. They couldn’t lose Mary tonight. They just couldn’t.
While the nurses concentrated on their jobs, Dr. Ochoa delivered a complete placenta. Blood from Mary’s uterus flowed freely onto the doctor’s shoes, splattering onto the tile floor. The second nurse massaged the uterus frantically, but the bleeding continued.
“Pitocin!” the doctor ordered.
Another nurse, having anticipated this need, got the drug flowing through the second IV. At that moment the crash cart and team arrived and Mary was intubated. The team frantically tried other drugs to try to stop the bleeding.
Lydia stood back, watching the scene helplessly. The average pregnant woman carried about six liters of blood. At the rate Mary was hemorrhaging, she’d lose it all in a matter of minutes.
“We’ve lost her pulse! She’s in cardiac arrest!”
The doctor from the code team began chest compressions. Lydia stepped back to the wall, not wanting to get in anyone’s way. Still, her attention remained riveted on her lifeless patient. Mary was too young to die. She had so much to live for.
“Hang on, Mary. Please, please, hang on.” Mary couldn’t hear, not above the noise level in the room, but Lydia spoke anyway, her words like a prayer.
“How’s the baby?” she asked.
Dr. Weston threw her a frustrated look. “Still no respiration or heart rate. He isn’t responding…”
Were they going to lose them both? Oh, God, please no! “Come on, Mary. You can survive this. Your family needs you.”
Family. Steve. Lydia scanned the room anxiously but couldn’t see Mary’s husband. He wasn’t in the room anymore. Nor was Gina.
LYDIA HAD PROMISED Mary she wouldn’t leave her. And she didn’t. The team continued their resuscitation efforts for forty minutes, fifty…an hour. Dr. Weston eventually had to give up on the baby. She squeezed Lydia’s shoulder on her way out of the room. Lydia continued to pray for Mary.
But they couldn’t bring her back.
At just after nine, two hours after arriving at the hospital with the Davidsons, Lydia stepped out of the birthing room into the cold, wide corridor. A pregnant woman waddled by her, frowning at the blood splatters on Lydia’s thick socks and Birkenstock sandals.
“Lydia.” Gina approached from the far end of the corridor. Sorrow filled the air between them like a heavy cloud.
“You’re still here.” Lydia was unable to meet the other woman’s gaze.
“I’ve been with Steve.”
“Where is he?”
Gina pointed in the direction she’d come from. “The doctors are talking to him now.”
Lydia swallowed. She felt as though she should be the one to bear the awful news, but hospital protocol required that the attending physician announce a client’s demise.
“I’ll check on him,” she told Gina. “You go home now. You need to be with your husband and children.”
Gina brushed tears from her eyes. They clearly weren’t the first she’d shed that night. They would be far from the last.
Lydia hugged Gina, then forced herself to continue down the hall. She found Steve in a small waiting room, collapsed in one of a dozen poorly upholstered chairs clustered around a vending machine. Dr. Ochoa and Dr. Weston had just left.
“I’m so sorry, Steve.” Lydia felt a hundred years old.
He said nothing. Lydia wanted to cradle him in her arms, but he wouldn’t even look at her.
Lydia knew there were no words to soften his loss. “Steve, the hospital teams tried their best. They really did.”
He didn’t seem to hear. “I’ve lost both of them.”
The words tore at her heart.
“Yes.”
Finally Steve lifted his head. He stared at her with outrage, and she could hear what he didn’t say. We trusted you. You said everything would be okay.
“No.”
Lydia held out her arms.
“No!” He rose from his chair and turned, not to her, but to the soda machine. Raising his fists, the big, powerful man started to pound, one fist after another. “No! No! No!”
Each word conveyed crushing disbelief. How could she help him? Lydia was willing to do anything. If only she could take his pain and bear it for him.
She waited for his initial rage to subside, for him to be still. “Steve, let me call someone. How about your mother?”
His chest convulsed and he started to sob. “No!” he cried out once more, then bolted from the room like a panicked child. Once in the corridor he ran past the elevator to the stairs.
“Steve, come back! Let me help!” Lydia tried to follow, but in her sandals, she couldn’t keep up. Finally, she skidded to a stop, grasping at the handle of the door to the stairwell. As the door gave, she caught one glimpse of the top of Steve’s head.
And that was the last she saw of him.
CHAPTER TWO
HOME LATE FROM THE OFFICE, Nolan McKinnon, editor and owner of the Arroyo County Bulletin, was just about to dig into his second slice of pizza when a police call came over the scanner sitting next to his toaster. Nolan recognized the voice of his good friend, Miguel Eiden.
“We’ve got a 10-45 on Switchback Road. Get an ambulance and backup. Now.”
God. It wasn’t even ten o’clock. Wasn’t it too early for a traffic accident on a Saturday night? Nolan grabbed a notepad and pencil and waited for the details.
“Ten-four, Miguel,” said the dispatcher. “How bad is it?”
“It’s a mess. Single-vehicle accident about ten miles past Manny Cordova’s place. Looks like the driver lost control and ran into a rock wall at speed.”
Nolan’s full-time reporter, Cooper Lorenzo, had been on call last weekend. Which meant this “mess,” as Miguel had put it, was all his. Sighing, Nolan closed the cardboard box over the still-hot pizza and went for his camera.
He loved most things about owning and managing the local newspaper, but late-night calls, especially for stories like this, were never fun. Still, people expected newspapers to cover these personal tragedies.
Fortunately they didn’t occur often in a town of five thousand people.
A minute later, sitting high in the seven-year-old Explorer he’d just bought off an old friend of his father’s, Nolan zipped out of his neighborhood, bypassing the commercial heart of Enchantment. Sometime between now and when he’d picked up his pizza it had begun to snow. The white flakes battered his windshield as he left town limits. Switchback Road cut into the sparsely populated Sangre de Cristo Mountains that bordered the northwest side of Enchantment. The narrow, twisting route was picturesque during daylight hours, but it had a checkered history. Every year the townspeople could count on at least one bad accident, most caused by excessive speed.
As a teenager, Nolan had done his share of wild driving. But shortly after he’d begun work full-time at the Bulletin, he’d reformed. He’d seen some grisly sights in the past ten years. He really didn’t want to experience another. He thought of his pizza cooling on his kitchen counter and the game on TV that was only half over.
Shit. What a life.
Nolan took a sharp corner slowly, his tires jostling on the poorly maintained pavement underneath the fresh snow. Ahead he spotted the flashing lights of emergency vehicles in the dark.
The left-hand side of the road was cordoned off. Without the luxury of wide, paved shoulders, police had done their best to leave a narrow corridor open. Two officers stood at either end of the wreck, directing the sporadic traffic.
Nolan pulled over to the far left, just as an ambulance took off from the scene, sirens blaring.
