“The previa is new?”

“Yeah—this is her first baby, but she’s had a couple of misses.”

“Send her to the ER and have them call me. I’ll be down as soon as she arrives.”

“Thanks. Appreciate it.”

An hour later one of the ER attendings paged her. “Got Ned’s patient here. She’s not bleeding now but we typed and crossed her. Just in case.”

“Good. Tell the blood bank I want four units standing by. I’ll be down in five minutes.”

“Name’s Ellen Goodwin. Bay twelve. Thanks, Hollis.”

Hollis found Ellen, a thirty-five-year-old African American woman with bright deep brown eyes, waiting anxiously with her partner, Sheri, a fortyish blue-eyed blonde with a quick smile.

“Hi, I’m Dr. Monroe—Dr. Williams asked me to stop by and see you.”

Introductions were made and she did a brief exam. “I’m just going to review your MRI and I’ll be right back.” Five minutes later she returned and pulled a stool over to the bedside. “You have what we call placenta previa. Part of the placenta—the vascular tissue that carries blood and nutrients to the fetus—is lying so low in the uterus, it’s covering the cervix.”

“Is the baby in danger?” Ellen asked in a surprisingly calm tone.

“Not yet,” Hollis said. “But there’s a risk of more bleeding, and if that happens… Do you know the sex yet?”

Ellen smiled. “Yes—we’re picking out boy’s names.”

“He could be in trouble if you start bleeding and don’t stop.”

“What about Ellen?” Sheri asked.

“We never like to have a mother bleeding—and uncontrolled hemorrhage is a risk in this situation.”

Ellen took Sheri’s hand. “What do you suggest?”

“The baby is close enough to term to be delivered. I recommend an elective C-section first thing in the morning.”

“Tomorrow?” Sheri breathed the words as if in shock.

“Yes. This way we can control the delivery and get the placenta out before there’s a lot of blood loss—usually. You need to know there’s still a risk we’ll lose more blood than we’d like.”

“And then?” Ellen still looked and sounded calm.

“Then you may need blood transfusions or, worst-case scenario, I’ll have to remove the uterus to stop the bleeding.”

Sheri’s face went white. Hollis pulled over a chair. “Why don’t you sit down, Sheri.”

“I’m fine,” Sheri said, sitting abruptly.

“We want more children,” Ellen said.

“I understand,” Hollis said. “That would be my last option.”

Ellen nodded. “Fine. Let’s go ahead.”

“All right.” Hollis stood. “You’ll be admitted tonight. I’ll schedule you for eight a.m. Bright and early tomorrow you’ll have this baby.”

“Thank you,” Ellen and Sheri said together.

By the time Hollis had filled out the paperwork, it was close to seven. She grabbed a pizza from Giovanni’s on the way home and ate it out of the box on the back porch. The house was dark and still. Her mother kept telling her to get a dog. Maybe she should.

After wrapping the remains of the pizza in foil for breakfast, she changed into a sleeveless T-shirt and cut-off jeans and went to work. She kept busy until almost eleven, working on the house. She tore out a wall where she’d mentioned to Annie she wanted to put a powder room, pounding at sections of old plaster and lathe that left her coated in a fine white dust, and shored up the sagging beams with new vertical posts. She quit when her back was too stiff to swing the hammer and heft the chunks of debris out the back door any longer. She’d worn gloves to protect her hands, but her forearms ached and she needed to rest them before surgery the next day. She took a long hot shower, hoping the pulsing water would relax her. It didn’t.

She lay in bed in the dark, with only a sheet covering her hips and the windows open to catch the faint currents of air. The temperature outside hovered in the low seventies and sweat soon misted her skin. She stared at the ceiling, at the wavy patterns of light and dark made by moonlight filtering through the branches of the hemlock outside her window. She thought she could make out the shape of a monkey riding a tricycle.

She’d managed not to think of Annie for twelve hours. She thought of Rob almost every day, but in a distant way, as if through a curtain of rain. The instant her mind conjured up his face or a conversation or a memory of time they’d spent together, the curtain thickened and images dissolved, shielding her from the full force of the pain. Her shields had failed her when she’d seen the photographs of Linda’s family and remembered her own family and the special bond she’d shared with Rob. That little break in her defenses had been the beginning, maybe, but Annie was the one to break through all her barricades. Annie crossed her barriers like they weren’t even there, and that scared her. She was in danger of becoming attached, seriously attached, and attachments could be deadly. When they broke, or worse, were severed by random tragedy, they left you bleeding with no way to stop the hemorrhage. She’d vowed never to put herself in that position again, and she was in very real danger of doing just that.

She tossed and turned, too hot in the warm night air. Finally she got up and took another shower, and still, she couldn’t relax. She pulled on a T-shirt and blue-and-white-striped boxer shorts and walked barefoot down to her front porch in the dark. She sat in an Adirondack chair with a worn canvas cushion, alone in the night. Cars occasionally passed, and now and then she heard the distant peal of laughter or a deep rumble of conversation from an open bedroom window. She ached, as lonely as if she were marooned on some faraway planet.

She wasn’t alone—she had family she could call, but what could she say? Everyone grieved over Rob. Everyone bled. But only she carried the guilt. She dropped her head to the back of the chair and rubbed her eyes. She’d told Annie things she’d never told anyone. She’d made her last confession a week before the world exploded and hadn’t been back to Mass since. She might be forgiven her sins, but she wasn’t ready to accept absolution. Rationally, she knew she wasn’t at fault for what had happened to Rob, but she’d played a part in the tapestry of fate that had put him there that morning, all because she’d put someone first over him, because she’d taken him for granted. He’d always been there, and she’d just assumed he always would be. The next time would be time enough—and she never had another time. She’d never be able to say all the things she’d felt her entire life but never thought she needed to say.

Still, she’d confessed to Annie—the words pouring out as if from a stranger’s mouth. Why, she didn’t know. Annie would offer her forgiveness, not recognizing the magnitude of her transgressions, and maybe that was why she’d confessed what she’d never said out loud.

Annie. Annie with the understanding eyes and tender touch. If things were different, would she have taken Annie to meet Rob? Look at the woman I found—isn’t she amazing? Rob would have flicked her a high sign behind Annie’s back—Yeah, you did good, Monroe. But things were what they were—Rob would never see his own child, and Annie didn’t deserve her ghosts.

Rob’s loss had left a huge gaping hole in her life, a sorrow she couldn’t put aside. So she’d done the only thing she could—she’d withdrawn into a self-protective shell and buried herself in her work. Now Annie had cracked the shell, and she wondered if all the careful artifice of her life would fracture next.

Finally, exhausted, she made her way up to bed and lay face-down on top of the sheets, naked, alone, and accepting she had no answers.

*

The next morning, Hollis stood in a lukewarm shower until the grogginess was gone. She had a cup of coffee and was at the hospital by seven, alert and with nothing on her mind but Ellen Goodwin. At seven thirty she went to see her in the pre-op area.

“Hi, Ellen. Sleep okay?”

“Fine. How about you?”

“Like a rock.” Hollis smiled at Sheri. “How are you doing?”

Sheri rubbed Ellen’s arm. “I’m fine. We’re excited. It can’t be too soon.”

Ellen squeezed Sheri’s hand. “We’ve tried and tried and didn’t think it was ever going to happen. Now we’re almost there.”

“Good. Not much longer.” Hollis signed some of the paperwork on Ellen’s chart and placed it at the foot of the stretcher. “The anesthesiologist will be coming to take you back in just a minute. I’m going back to scrub, but you may be asleep by the time I get into the room. They’ll start an epidural, but you’ll be sedated so you may not remember everything that happens.” She looked at Sheri. “As soon as things quiet down a little in there, I’ll have the nurses call out to let you know how things are going. Don’t be concerned if you don’t hear anything for forty-five minutes or so. Sometimes we get a slow start.”

“I understand. Take as long as you need. I just want them both to be healthy.”

“Good enough. I’ll talk to you as soon as I come out.”

“Thanks, Dr. Monroe.”

Hollis squeezed Ellen’s knee. “Ready?”

“More than ready.”

“Me too.”

Hollis walked back to the OR and told the nurses she was ready.

“I’ll page anesthesia,” Sue Gregory, the scrub nurse, said. “Anything special you need?”

“I don’t think so. Who’s on call for neonatology?”

“Karl Provik.”

“Good. I’ll let you know when to call him.”

“Okay, Hollis, thanks.”

Hollis scrubbed, Sue gowned and gloved her, and as soon as anesthesia was ready, she stepped up to the table and Sue passed her the scalpel. She made the Pfannenstiel incision just above the pubic symphysis at the junction with the lower abdomen. She cut down through subcutaneous tissue and divided the rectus. The uterus looked fibrotic, somewhat pale, as if it hadn’t been getting enough blood. She was glad they hadn’t waited. She made the incision in the uterus and Sue sucked up the amniotic fluid as it gushed out. The color was good—clear, no signs of fetal distress. She widened the incision with one hand inside and palpated the baby’s head. She delivered the baby and clamped the cord.