The Fetal Position 2
by Leyla Harrison
spar...@videotron.ca

Disclaimer: I don't own any of the ER characters.  Sure wish I did,
though -- I betcha I'd be rich!

Rating: R for potentially disturbing themes and situations.  Read on at
your own risk.

Timeline: This story takes place after Point of Origin (late season 5)
and has spoilers and/or references for that episode, Nobody Doesn't Like
Amanda Lee, and Love's Labor Lost.

Summary: A patient with troubling symptoms plays a prominent role as
Kerry finds herself plagued by frightening dreams that have a meaning
she can't understand.

Note: I'm not a doctor, or a medical expert.  However, there is a bunch
of medical stuff going on in this story.  I did some research, but I
know I still didn't get everything right.

****

I'm breathing heavily when my eyes blink open, my body curled up again
into a tight ball.  It's impossible for Sarah Morgan to be my mother, I
tell myself as I unstretch painful limbs; she's younger than me by ten
years.  It's just the stress; the odd disappearance of her symptoms.  I
must have been thinking about it when I fell asleep.

"Kerry?" Carter is calling through the closed door.  "Are you all
right?"

"I'm fine, Carter," I call back.

"You cried out in your sleep."

I hesitate, then get up, put on a robe, and open the door.  He's dressed
for bed; in the background I can hear the TV on, the sounds muffled.

"I'm sorry," I tell him.  "I didn't mean to disturb you."  I gesture
towards the living room.  "I thought you went to bed."

A shrug.  He looks concerned, not disturbed.  "You didn't disturb me.  I
was just worried."

"What -- What did I say?"

"You said the name Julia.  Twice."

Julia.  I rack my brains; nothing.  I don't know anyone named Julia.

"Are you sure?" I ask.

He nods his head up and down.  "Are you sure everything's all right?"

"I just haven't been sleeping well lately, that's all.  I'm fine,
Carter."

He eyes me; he knows there's more to it but he's too hesitant to ask,
too afraid I will not want to talk about it.

"Good night, Carter," I tell him, and shut the door gently before he can
ask me anything more.

I turn and lean my back up against the closed door, wondering.  Who the
hell is Julia?


****

I'm still up when Carter comes home from his shift the next evening,
well past one in the morning.  I'm working on some tax papers; the
deadline has passed but I was able to get a well-needed extension.

"Rough night?" I call out.

He nods, taking off his coat and setting his bag down by the front
door.  He comes into the living room and sinks down on the couch. He
looks drained.

"Sarah Morgan was back in the ER."

"I thought she was admitted to OB last night," I say, surprised, setting
aside the paperwork.

He nods.  "She was discharged this morning - they couldn't find anything
wrong with her, so they sent her home.  She came back in around
dinnertime."

"Same symptoms?"

Carter nods.  "I don't understand it, Kerry.  Eclampsia doesn't just
come and go -- not that acutely, and not without treatment, anyhow.  I
know it can start gradually and get worse, but once it's that severe, it
stays that way until it's treated."

"What happened? Did her symptoms disappear again?"

"Just like before.  She has two seizures.  I didn't even have a chance
to get any meds into her -- just Ativan, again -- and her BP went back
to normal after the seizure.  She was pretty freaked out.  Apparently
some insensitive asshole nursing assistant, someone in training up in OB
told her that her seizures were going to cause severe brain damage to
her baby."

"Jesus," I groan.  "Why on earth would they tell her that?"

"I have no idea."  He runs a hand through his hair.  "I stayed until she
was admitted.  This time to medicine, with an OB consulting.  Her mother
came in with her this time -- she was pretty concerned as well.  Asked
where you were.  She wanted to know what the hell was causing this.  And
to be honest, so do I."

He leans back on the couch.

"You look exhausted.  You should get some sleep," I observe.

"I know," he says, then stands up and comes over to the desk where I'm
working, taking a quick glance at the papers spread out over the desk.
"Taxes?  Aren't you a bit late?"

"I missed the deadline, but I got an extension.  Did you do yours
already?"

"Accountant did them," he explains, with a casual shrug.

"Lucky you."

"I guess.  See you in the morning."

"Good night."

****

I don't dream that night, and I'm relieved when I wake up to find that
I'm stretched out comfortably, my arms at my sides.

****

The next day, I'm back at work on the evening shift again.  I've just
gotten my ID badge and am coming out of the lounge when the paramedics
roll up.

"Thirty year old female, 32 weeks pregnant -- "

I look down.  Sarah Morgan is lying on the gurney.

"Damn," I mutter, loud enough for the paramedic to hear, and he stops
the bullet to give me a surprised look.  "Let me guess.  High BP,
dizziness, nausea, blurred vision.  Eclampsia."

"What, do you know her?"

Sarah is writhing in agony.  I nod my head.  "She was admitted last
night.  They must have discharged her again.  This is the third time in
four days that she's been here."

"Well, her BP's normal.  She seems to be in active labor, no signs of
eclampsia, but she said she had a syncopal episode just after her water
broke."

"She's not eclampsic?" I ask, surprised.  The paramedic shakes his
head.  The  regular paramedics must be on vacation because I've never
seen him before in my life.  Randi's on the phone at the desk.  "Get
Carter and tell him to meet me in Trauma One," I tell her, and she nods.

"Oh God, it hurts!" Sarah cries out, and I touch her hand.

"Sarah, when your water broke, was the fluid clear?"  She nods her head
at me.  We get into the trauma room and Carter enters with Chuny, just
in time to get Sarah transferred to the bed.

"You've got to be kidding me," Carter says when he sees who the patient
is.

"All right, on my count, one, two, three," I snap, ignoring his remark.
We move Sarah and she moans.  "Did you hit your head when you passed
out?"  She shakes her head.  "All right, let's get a CBC, lytes, get her
on a fetal monitor, and I want an ultrasound right now."

"BP's 90 over 60, pulse 108," Chuny calls.  "Pulse ox is 95 on room
air.  Baby's heart rate is 140."

"Let's give her 2 liters by nasal cannula for now," Carter says,
checking Sarah's heart and lungs.

"Sarah, I'm going to examine you, all right?"

Her eyes are filled with panic.  "Is something wrong with my baby?"

"No, no," I do my best to soothe her, pulling on a pair of sterile
gloves.  Chuny squeezes some lubricant on my fingers.  "I just want to
take a look at your cervix and see how much you're dilated, all right?"
Sarah looks fearful, but nods.  "She's 8 centimeters," I tell Carter,
and he looks up.

"Everything's good up here," he tells me.  He has a look of concern in
his eyes, though.  I don't blame him -- with the way her symptoms kept
vanishing, I'm almost afraid they'll suddenly reappear.

"Well, let's call OB and get her transported upstairs.  I want to move
her as soon as I run the ultrasound."

"No!" Sarah cries, and grabs my arm with surprising strength.  "I don't
want to go up there again.  They -- they -- "

"Sarah, it's all right," I tell her.

"Ultrasounds's here."  Carter switches it on and takes a look.

"I don't want to go up there," she tells me, more determined.  I take a
moment to try to calm her, but she won't listen.

"Dr. Weaver," Carter says, his voice tight.

"What?" Sarah demands.  "What is it?"

I step over to Carter's side and look at the screen.  "Frank breech
position," he says, pointing.  "It wasn't in this position last night."

"Or when I saw her," I comment.

"She needs a C-section."

I shake my head.  "Almost half of all breech babies are delivered
vaginally, especially when they're in the frank breech position.  The
bottom's down and the legs are extended towards the face -- " I point.
"They could still deliver her vaginally, spare her the C-section."

"Transport's here," Malik calls in.

"I'm not going!" Sarah all but shrieks.  "Please!" She looks at me,
terrified.  "Please don't make me go up there."

"Tell them to hold on, Malik."  I return to her side.  "Sarah, listen to
me.  Your baby is in the breech position, with its bottom ready to come
out first, instead of the head.  You can still deliver vaginally, but
you need to go up to OB because it would be better if they -- "

"I'm not going," she insists.  "You said I can still have the baby the
normal way, right?  So why can't I do it down here?"

Carter catches my eye over the table.  Well?  he's asking.  Why not?

I sigh.  "Malik, cancel transport, page the OB on call and tell them to
get down here right away.  We could use a little backup.  Chuny, let's
get a line going, normal saline.  And let's all gown up."

****

"Where the hell is OB?" I snap, from my position between Sarah's legs.
"Don't push, Sarah.  Not yet."  She moans; sweat is beaded on her
forehead.

"They've been paged twice; they're tied up," Chuny tells me.

"Page them again."  I glance over at the fetal heart rate.  108.  Not
great, especially since it was 140 ten minutes ago.  Something about all
of this is making me worried.  "You all right up there, Sarah?"

She nods, breathing heavily.  "I just -- God, it hurts."

"I know, honey, just hang in there.  It's going to be just fine."

I try manually to move the baby into a normal position; I've done it a
few times before with success with breech position babies but I'm having
no luck this time.

"All right, Sarah, we're going to give you some medication in your IV to
get the contractions going faster, because we want to get the baby out
pretty quickly once it starts coming."

"So the head isn't stuck in there too long?" she asks.

"Right.  Carter -- "

"Pitocin, I'm on it.  Damn it -- fetal heart rate is down to 90."

"Chuny, page OB again and tell them to get down here right now -- "

"She's seizing!" Carter cries, alarmed.

"Damn it, damn it."  I grab her legs, which are flailing in the
stirrups.  "Ativan, 3mg, now!"

Carter's holding her head and shoulders and reaches swiftly for the bite
block, getting it in her mouth.  I grab onto her arms and lower body as
best I can.

"BP is falling, 80 over 40," Chuny calls out, as she's pushing the
Ativan.  "Pulse ox is 86.  The baby's heart rate is 80."

"Eighty?" I ask, alarmed, looking over at the monitor.

"Switch her over to 8 liters of oxygen by mask.  What the hell is going
on?"  Carter asks me.

"I'm not sure, but I do know that we have to get that baby out, now."

Chuny nods.  Sarah's seizure eases, then ends.

"I'm your mother," Sarah slurs.  The words tumble around in my head, and
a wave of icy dread fills me -- the dream.  She said the words in my
dream.  I freeze momentarily, and Carter's voice snaps me back.

"She can't deliver vaginally.  We can't get her to push in this
condition," Carter says.  "She's altered."

"We need to get that baby out, Carter.  Damn it, where the hell is OB?
She's going to need a crash c-section.  I sure as hell don't want to do
that down here, but if we have to -- "

Carter looks over at me, panic etched on his face.  "Dr. Weaver, I think
-- I think we need to get OB down here."

"I'm well aware of that, Carter.  But they're not here.  Apparently
they've been swallowed by a black hole.  You're here and I'm here.  And
we have to get that baby out.  Find Dr. Greene and -- "

"You don't understand," he's practically stuttering.  "When I was a
student, there was a patient of Dr. Greene's -- but the baby almost
died, and the mother -- she died, and -- "

I cut him off.  "Are you implying that I'm not capable of my duties as a
physician?" I ask, stung by his implication.  "Because if you are,
Carter, feel free to step out of the room."

"That's not what I'm saying, Kerry," he protests, slipping up by using
my first name.  Chuny glances up.  He only uses my first name when we're
at home.  "I'm saying this patient has presented twice before with
strangely occurring and resolving symptoms and we have no idea -- "

"She's seizing again," I interrupt him.  "Get that bite block back in
her mouth.  Push another 2mg of Ativan.  God damn it!  What are her
vitals?"  Carter, Chuny and I are holding her down as best as we can.

"BP is 60 palp, pulse ox is 89, pulse 60.  Baby's heart rate is 75, and
it's still going down."

Moments tick by; the only sound in the room is the beeping of the
various machines and Sarah's thrashing.  Then she goes still.

"Her pulse ox is down to 82," Chuny breaks the silence.  "She's bradying
down.  And the baby's heart rate is down to 65."

"We've got to get her intubated!"  I head to the top of the bed and
lower it flat.  Chuny hands me the ET tube before I even ask for it, and
I work quickly and smoothly. "Bag her.  Damn it, we need another nurse
in here."

Chuny pokes her head out the door.  "Haleh!" she calls.

Haleh hurries in and takes over the bagging.

"Lost her pulse," Chuny calls, her voice uncharacteristically edged with
fear.

"Charge the crash cart.  Carter, start CPR.  And someone get OB down
here, now, damn it!"  It's rare that I panic, but I'm feeling it now; I
don't know what the hell is going on with this patient.  All I know is
that we need to get that baby out of there.  Chuny hands me the
paddles.  "Charge to 300.  All right, clear."

I place the paddles on Sarah's chest and her body jerks.  We all look up
at the monitor.

"Oh my God!" a voice wails.  "What are you doing?"  I look up to see
Sarah's mother.

"Get her out of here," I yell.  Chuny steers her out, but I can still
hear her sobbing from behind the door.  Haleh takes over the crash
cart.  "Charge to 360.  Clear!"

Again, Sarah's body jumps.

"Got a pulse," Haleh announces, sounding relieved.

"Keep bagging her.  Carter, get down here and help me with this."

"Baby's heart rate still 65."

The last time I scrubbed in on a c-section was years ago.  All right,
calm down, you can do this, I tell myself.  I peel back the covering of
a tray and my eyes skitter over the instruments.  I pick up the
scalpel.  "All right," I say, taking a deep breath.  "Get some Betadine
on her belly.  Let's do this."

I hesitate over her skin, the blade of the scalpel catching the light
and gleaming, like a little bright wink.  As I'm about to make the first
cut, the doors burst open and two doctors in scrubs charge in.  "What
the hell are you doing?"

"What took you so long?" Carter snaps.

I'm not even pissed off; normally if someone, anyone, asked me what the
hell I was doing in my own ER I would lose my head.  Instead, I'm filled
with relief.  "This woman needs a c-section, now.  She's had multiple
episodes of spontaneously resolving eclampsia, seized a few times, and
at one point we lost her pulse.  The baby's in frank breech position and
the fetal heart rate is 65," I tell them.  My hand is still gripping the
scalpel, which I've managed to move away from Sarah's body.  I glance up
at the monitor.  "Vitals are stable but she's still altered from the
seizures."

"Let's get her upstairs, now," one of the two docs says. I have no idea
what their names are, and to be honest, I don't much care.  I just want
everything to be all right.  "Get her mother to sign the consent and
send her upstairs."

"All right, you heard them, let's get her going," I say, setting down
the scalpel at last, and unhooking the pulse ox.  "Put her on a portable
monitor.  Haleh, can you go up with them?"  She nods.  I hand her the
drug box.

And in moments, they're out the door, leaving Carter and I alone in the
trauma room.  But only for a few seconds.

"What's going on with my daughter?" Mrs. Morgan bursts in and grabs me
by the arms, shaking me.  "What have you done to her?"

I stumble slightly from the force of her anger and Carter gently tries
to pull her back.  "She's going to be fine, Mrs. Morgan.  We need you to
sign a consent form so the OB doctors can do an emergency c-section."

"I'm not signing anything.  Not until I know what is wrong with her!"
Her voice rises with panic and anger.

"Mrs. Morgan, your daughter's baby is in a breech position and they need
to get the baby out right away.  They can't deliver her vaginally
because she suffered two seizures and her mental status is altered," I
explain, trying to keep my voice calm.  "The baby's heart rate is
dangerously low.  They need to operate immediately if they are going to
save the baby's life."  Carter produces a consent form and holds it out
to her with a pen.

"Please, Mrs. Morgan.  Please sign the form," he says quietly, calmly.

She glares at me.  "You did something to her," she accuses, venom
dripping from every word.  I'm so stunned that I can't speak.  My mouth
drops open slightly.  "Whatever you did to her or said to her made this
happen."

"Mrs. Morgan -- " Carter tries again, attempting to regain control over
the situation.  "Please.  Please sign this and then you can go
upstairs."

She takes the clipboard and signs, her eyes barely leaving my face.  She
shoves the board at me, ignoring Carter.  "Don't come near my daughter
again," she warns me.  "Don't you dare come near her ever again."  And
with that, she stalks off towards the elevators.

I stare at her as she walks away, and Carter shakes his head.  "She's
just out of her mind with worry."  He looks at me.  "Kerry?"

I glance down at the consent form, my mind still reeling from her
outrageous accusation.

I hereby consent…understanding all the risks…

The words blur in front of my eyes.

And then, at the bottom, her signature.  Julia Morgan.

"Oh my God," I murmur, and Carter touches my arm.

"Kerry?  Kerry, don't worry about what she said, she was just upset --
"  I thrust the consent towards him, and he looks over it.  "What?"  I
point to the bottom.  He looks up at me, realization dawning.  "Do you
know her?"

I shake my head mutely.  My head is suddenly swimming.  In a daze, a
vague memory enters my mind, of a fire, licking flames, dense billowing
smoke.  I'm crouched in a dark corner, making myself as small as
possible.  I'm curled up in a ball, coughing, choking.  Crying.  My arms
and legs are pulled up to my chest, my fists balled up tightly.

"Hey.  Kerry.  Kerry."  I can hear Carter saying my name, but he sounds
very far away.  "Carol," I hear him call, his voice alarmed.

Cool hands touch my wrists.  "Kerry.  Are you all right?"  I look into
Carol's eyes, deep and bottomless.  I shake my head.  No.  I am not all
right.  I don't know what is going on, but I am definitely not all
right.

Carol and Carter walk on either side of me, to the lounge.  I touch the
doorframe and stop.  "No.  I'm fine."

"At least come in and sit down for a minute," Carol says.  "Just for a
minute."

I'm really in no place to argue with her; I'm dizzy and lightheaded.  We
go into the lounge and I sit on the couch.  Carol checks my pulse and
blood pressure.

"Her pulse is a little fast.  120," she tells Carter softly.  "BP's 110
over 60.  What happened?"

Carter shakes his head.  "I'm not sure.  She just -- kind of spaced out
for a minute there and got pale.  I thought she was going to pass out."

"I'm all right," I insist, feeling a little stronger.  "I'm fine."

"Are you sure?" Carol asks, still looking concerned.  I nod my head.
She glances at Carter.  "Call me if you need me."

"Thanks, Carol," he says, and she leaves the lounge, leaving Carter and
I alone.  He waits for a long moment.

"Carter," I start, slowly, "I need you to do me a favor.  Right now."


END / The Fetal Position (part 2 of 3)