“She’s in and out. History is scant. Twenty-four years old, prime ip, not much else.”

First pregnancy—always a bit unpredictable. Thirty-four weeks looked about right for her size—not dangerously premature if she delivered the baby now, but still, the baby would be at risk for pulmonary insufficiency and neuro complications. Couldn’t be helped, though—the mother was gushing blood faster than the nurses could pump it into her. “Any prenatal issues?”

“We don’t have records,” Honor said.

“Coags?” Women with abruptio placenta often developed bleeding disorders, and that spelled major trouble in the OR.

“Not back yet. But she’s clotting.”

“For now.” Hollis moved to the head of the stretcher. The dazed young woman looked younger than twenty-four, and pale to the point of translucency, her golden brown hair framing a finely etched face with luminous green eyes and lips that were still full and sensuous despite being nearly drained of color. “I’m Dr. Monroe. What’s your name?”

“Annie.” Lids tinged with gray shuttered closed. “Colfax.”

“Annie,” Hollis said gently, “when did you start bleeding?”

“An…hour…not sure. Can I have some water?”

“I’m sorry, no.”

“What about my baby?”

“You’re having quite a bit of bleeding and we’re going to need to operate. The baby needs to come out and we need to get the bleeding stopped.”

Eyes the color of spring grass—now surprisingly clear, considering her blood pressure was only sixty and she had to be scared out of her mind—opened wide and fixed on her face. “It’s too soon for the baby. I want to wait.”

Hollis bit off a retort. She didn’t have time to argue, but the young woman’s voice was strong. She was competent to decide. “I don’t think you can wait. You’re losing blood and the baby will suffer for it.”

“Just a little more time.”

“Look, is there someone with you or someone I can call? Spouse? A boyfriend?”

“No.”

“How about a family member we can—”

“No,” Annie said quite distinctly. “There is no one.”

No one. No friend? No lover? No family at all? The patient didn’t look like a street person or some paranoid dropout likely to be living off the grid, but Hollis didn’t have time to speculate on why Annie Colfax was alone during one of the critical moments of her life. “Okay, Annie—we don’t have time for much discussion. The baby’s at risk. So are you. You need a C-sectio—”

“No. No surgery.”

Hollis clamped down on a flare of temper. “We don’t have any choice, you—”

“No. Don’t believe…” Annie’s voice faded and her chin sagged.

“Pressure’s fifty palp,” a nurse announced. “Fetal heart tones are slowing.”

“We need to move here,” Honor said from next to Hollis. “I can try for a court order, but it’ll take time.”

“Goddamn it.” Hollis gripped Annie’s shoulder. “Annie. Annie! Look at me.”

Annie blinked, focused.

“If you don’t let me operate, your baby is going to die. You might too. Do you understand? You have to trust me on this, Annie.”

Annie was silent, searching Hollis’s face.

“Trust me,” Hollis said fiercely.

“No choice,” Annie murmured, a flat, dead patina stealing over her eyes. “Go ahead.”

Hollis turned to Honor, a flash of triumph and anticipation energizing her. Now she could take care of things. “Let’s go.”

Hollis grabbed one side of the stretcher and Honor took the other. Honor called, “Coming through. Get the elevator.”

Together they maneuvered the stretcher out of the cubicle and into the hall. One of the nurses raced ahead to get the doors. The elevator was waiting.

Two minutes later Hollis guided the stretcher into the delivery area where anesthesia and the labor and delivery nurses took over. Hollis went to scrub. Trust me, she’d said, and she knew what she was asking. Place your life and the life of your baby in my hands. Trust that I’ll know what to do to keep you both safe. The responsibility was enormous and everything she wanted. All she wanted.

The swinging door to the delivery room banged open and one of the nurses leaned out. “She’s crashing, Dr. Monroe. We need you in here now.”

“Prep the belly for an emergency section.” Hollis rinsed fast and, water dripping from her elbows like a trail of tears, followed the nurse into the OR. Another nurse waited with an open gown, and Hollis pushed her arms down the sleeves and snapped on her gloves. Fixing on the square of pale skin hastily draped with green cotton towels, she stepped up to the table and held out her left hand. “Scalpel.”

The steel handle slapped sharply into her palm, and with her free hand she tensed the skin on the Betadine-coated belly above the top of the uterus. She opened a twelve-inch incision just above the pubic bone, cutting down in one long, deep slice through fat and muscle and peritoneum until the uterus appeared. “Get the suction ready.” The uterus extended up out of the pelvis, pushing aside the internal organs, claiming its place of primacy. She palpated it quickly and found the baby’s head, mentally positioning the rest of the body as it curled up in the muscular sac, thinking about small fingers and limbs just beneath the last layer of muscle. With the blade she made a small incision low in the uterus, handed off the knife, and said, “Scissors.”

The large instrument snapped into her hand, and she inserted the lower blade into the uterus, sliding it close to the underside of the muscle and away from the baby’s appendages. She cut, and amniotic fluid and blood gushed out onto the table, running over the sides and onto the booties covering her shoes. She slid her hand in, found the head, and delivered the infant on a sea of blood. The little girl was blue and flaccid.

“Suction,” Hollis said sharply. The nurse passed her a soft plastic tube, and she gently cleared the baby’s airway.

Time halted for those heart-stopping few seconds before the first breath. Hollis’s gut writhed. The baby shuddered, the small chest contracted…expanded, and then she cried. Loudly. Tiny fists closed, arms flailed, and she struck out at a universe that had so rudely claimed her. The red face below a surprisingly thick shock of golden hair was indignant. Hollis grinned behind her mask. A fighter, this one.

“Welcome to the world, baby girl.” Hollis clamped the cord, divided, and she handed the baby to the scrub nurse. “Pass the baby to the neonatologist. We’ve got bleeding here.”

Her job wasn’t done. The uterus was atonic—soft and spent, unable to contract and close off the multitude of gushing vessels within its walls. Blood welled up, filling the pelvis.

“Push the Pitocin.” While anesthesia administered drugs to help the uterus contract, Hollis packed the cavity, applied pressure, and evacuated the remains of the placenta. But the bleeding continued.

“I’m having a hard time maintaining her blood pressure,” the anesthesiologist reported, his voice strained with tension. “I’m hanging unit five. She’s tachycardic and starting to show some aberrant beats. I’m not liking this.”

Hollis checked the clock. She wasn’t liking it either. The bleeding should’ve slowed by now, but it kept on.

“Got a run of V-tach here, starting lidocaine,” the anesthesiologist called.

Hollis felt the uterus again. Still soft, blood pouring out and no sign of stopping.

“We need to take this out,” Hollis said and held out her hand. “Clamp.”

*

Annie awakened to an ocean of pain. She didn’t know where she was, only that she hurt. She reached for her belly, the automatic motion she’d made thousands of times in the last eight months. And then the memories of the last few hours came rushing back. She’d been studying when the pain started, waves of cramping, agonizing pain. Relentless pain, unending. And then the bleeding. So much bleeding, and the dizziness and the weakness, and the fear. All of that without warning. She’d been helpless, and alone. But she was used to being alone.

She forced her eyes open, forced herself to think beyond the panic and the pain. She was alone in a dimly lit room, nothing on the walls, plastic vertical blinds partially blocking a gray, overcast sky. A faint odor of drugs and death. Hospital.

She tried to sit up, and the pain rose from her belly and consumed her. She dropped back, whimpering softly. With her right hand she followed the plastic cord wrapped around the handrail, found the call button, and pushed it. A minute later a youngish woman in a blue and red floral smock and pale blue scrub pants came into the room.

“Hi,” the woman said softly. “You’re awake. Are you hurting, honey?”

“My baby. Where’s my baby?”

The woman leaned over, her face coming into view. A kind face. Dark eyes, a wide, smiling mouth. “Your daughter is in the neonatal intensive care unit. She’s doing fine, but she’s a preemie, and considering how she chose to get here, the neonatologist wants to keep her in there awhile.”

“She’s all right?”

The nurse nodded and readjusted Annie’s covers. “Someone will be in to talk to you about how she’s doing and to check you over soon. But the last I heard, she was stable and sleeping.”

“When can I see her?”

“In the morning. Do you need something for pain?”

“No. I don’t want any drugs—”

“Honey, you’ve had a big operation. You’re going to need—”

“I’m fine. I don’t want any. Thank you.”

“All right. If you change your mind, just ring the bell.”

“Yes, thank you.” Annie closed her eyes, too tired to protest. The baby, her daughter, was going to be all right. Nothing else mattered.

She drifted until the sound of the door opening and closing roused her. With awareness came pain, a pattern she’d grown used to.