“Not sole responsibility,” Dave said. “Co-responsibility. And, Hollis, these are professionals.”

Hollis considered that a matter of debate, but that wasn’t her fight. Turning the care of her patients over to someone she didn’t choose, might not even trust, was. “All the same, we’re dependent on the midwife to make the call about transferring for appropriate care in an emergency.”

Dave cocked a brow. “That’s the point, isn’t it? You don’t consider anything short of hospital-based obstetrical care to be appropriate.”

“I didn’t say that.”

“Look, Hollis,” Dave said with the patience that had won him the dubious honor of heading the department, “it stands to reason that someone who specializes in high-risk pregnancies, who sees only the worst complications under the worst possible circumstances, would be leery about practices that seem completely counter to your own. I understand your position, but we’re not going to be able to ignore the groundswell in natural birthing methods.”

“Nor are we going to want to,” noted Bonnie Cramer, a fertility specialist. “More and more of my patients are asking about home deliveries, and I’ve been referring them to midwifes. It’s what the patients want, and if we don’t address their needs, they’re just going to go somewhere else.”

“And that’s why,” Dave said with a gleam of triumph, “the hospital board wants this combined high-risk care program. We’re going to have to deal with this marriage of methods, and the board wants us to initiate the alliance.”

“I’m not going to refer to anyone, anywhere, if I don’t believe it’s in the best interest of the patient,” Hollis said.

“And we wouldn’t want you to,” Dave said reasonably. He leaned forward, his calm blue eyes set on Hollis. “I know you’re far too professional to let your personal opinions affect your judgment. If this combined clinic gets off the ground, just keep an open mind.”

“I’m not going to have any choice, am I?” Hollis hated being railroaded, but she was a team player at heart. If she wasn’t, she wouldn’t have joined the department.

“Actually…no.”

Hollis’s colleagues laughed quietly. Dave was the ultimate diplomat, but he wasn’t one to be swayed once he made a decision. If the joint high-risk OB-midwifery clinic went through and forced her to work with alternative-birth midwifes, she was just going to have to live with that.

“I’ll do my best,” Hollis said.

“I have no doubt.” Dave smiled. “That’s why I’m putting you in charge of the exploratory committee that will evaluate this group and propose the best way to integrate the midwifes into our management program.”

“Me?” Hollis looked around the table. There were at least three people she could think of who were better qualified—or at least whose practices weren’t as busy as hers. From the look on Dave’s face, arguing wasn’t going to make a difference. She was stuck with this job. The most she could hope for was to get it done quickly, and if she was lucky, she’d find some reason to sink the whole crazy idea.

*

Annie spread a thin layer of mustard—not mayo, we don’t like mayo—on wheat bread, closed the cheese sandwich, and cut it into neat quarters—not triangles, squares are nicer. She slid it into the Batman lunchbox and added an apple, a small bag of animal crackers, and boxes of milk and juice. She zipped Batman closed and set the lunchbox next to a bright pink hoodie. The one just like your black one, only prettier.

“Callie, time to go.” She listened for the rush of footsteps while mentally running through her get-ready-for-preschool list. Silence. “Cal? You can finish the drawing later. Let’s go.”

“Have you ever seen a blue elephant?”

Annie turned, lunchbox in hand. Today Callie had chosen a bright green T-shirt with multicolored stars and a pair of lemon-yellow shorts. The T-shirt made the deeper green of her eyes even richer, accented the fiery highlights in her copper curls, and induced the smattering of freckles on her milk-and-honey skin to dance. Her daughter was beautiful, and Annie allowed she was only a tad biased. “I’ve only seen the elephants in the zoo—remember them? And they’re gray.”

“They were muddy.” Callie took the lunchbox, her eyes serious behind the lenses of her round, pinkish-brown eyeglasses. “My elephant is blue.”

“When you get home you can show me all the animals you drew, okay?” Annie took Callie’s hand and scooped up the hoodie on the way out the back door for their two-block walk to the Friends school on Green Street.

“Are you going to be home tonight or is it a baby night?”

“Mmm, I think tonight is a watch Cars night.”

Callie grinned. “You always want to watch Cars.”

“Okay,” Annie said, swinging Callie’s hand. “You choose.”

“Cars.”

Annie laughed. “Smartie. If I can’t pick you up after school, Suzanne will, okay?”

“’Kay.”

Moving into the Germantown section of Philadelphia had been the right decision. The Fairmont area had been more convenient when she’d been in school and juggling daycare and classes, but now she had a little more freedom in her schedule and Germantown had a great community atmosphere. Many of her patients lived in the area, the schools were affordable and known for their diversity, and three of her associates, all with children about Callie’s age, lived nearby, so they could share childcare when one of them was on call or had an emergency. Plus, the Philadelphia Medical Center was a five-minute ride from just about anywhere in the area if she needed to send a patient in, which thankfully had been rare so far. She disliked everything about the place, but hospital backup was still a necessity.

“Mommy, there’s Mike. Can I go see him?”

“Hmm? Oh, hi, Robin. Hi, Mike.” Annie waved to the mother of one of the other children in Callie’s preschool class. Robin was a muscular, dark-eyed, dark-haired forty-year-old and the partner of one of Annie’s patients. A towheaded four-year-old jumped by her side, grinning wildly at Callie. Annie bent down, kissed Callie, and handed her the hoodie. “Go on. Have fun today.”

“I will.” Callie raced to Mike.

“I’ll take the cubs the rest of the way,” Robin said as she met Annie on the sidewalk.

“Thanks. I’ve been meaning to ask you—Callie isn’t five yet, but she really wants to play T-ball this summer, and I was wondering if I could sign her up? Her coordination is pretty good already.”

“Sure—it’s mostly a social thing anyhow.”

“Great.”

“We could use an assistant coach,” Robin said with a devilish grin.

Annie laughed, betting that Robin got a lot of mileage out of that grin. “Linda has my e-mail. Send me a schedule and I’ll let you know if I can help out.”

“Will do. Oh—Memorial Day barbecue at our place Sunday. Bring Callie. You can meet the rest of the neighborhood.”

“Thanks—we’ll be there.” Annie watched Robin and the kids head down the block to the big red brick building on the corner, waited to wave to Callie one last time, and headed for home. She had a half hour to get ready and drive over to the Germantown Women’s Wellness Clinic where she had a full morning of patient visits scheduled. She picked up her pace. Maybe she’d have time for a quick bagel and another cup of coffee. Being a single mom with a full-time job that frequently took her out at all hours of the day and night left her no time for herself, but at least she was never bored. Or lonely. Almost never lonely, and those times when the stillness caught up to her in the dark and her bed seemed as big and empty as an ocean, she thought about how lucky she was. She could support herself, she loved her job, and she had Callie. She was her own woman at last and no one would ever take that from her. She had everything she needed.

Just as she’d passed through the gate in the white picket fence and started up the walk to the pale yellow gingerbread Victorian she had been lucky to rent, her cell chimed. She paused to check the readout, mentally preparing to rearrange her day if she had a delivery. At least a dozen patients were due in the next month, and with babies—well, they kept their own schedules.

Her heart sank. It wasn’t the switchboard. It was her boss.

“Hi, Barb,” Annie said.

“Are you on your way to GWWC?”

“Not yet—I just took Callie to school.”

“Oh good.” Barb Williams sounded brisk and efficient, as always. She had to be that and a whole lot more to oversee seventy-five midwifes in Pennsylvania alone, and another three hundred in the Northeast.

Annie waited, pretty sure she knew what the call was about. Her stomach tightened.

“The board met on a conference link this morning. They voted six to one in favor of the resolution.”

Annie sat down on her front steps. A fat sparrow plucked at the grass in the small square of front yard inside the meandering fence, searching for worms. At not yet nine the sun cut through the leaves of the huge maple by the corner of the house with enough heat to warm her skin. Summer weather and it wasn’t quite June. She loved spring, but nothing lasted forever. She drew a breath and chose her words carefully. Barb would have been one of the yes votes.

“I’m still not sure I see the reason for this. We already have well-established protocols for urgent situations requiring hospital care. Why formalize anything further? The more we ally ourselves with medical practitioners, the more likely we are to be subjected to outside regulation.”

“I know you’re not sold on this, but our insurance premiums will go down if we’re handling high-risk pregnancies in association with an obstetrician. That alone was incentive enough to sway the board.”

“If we become hospital based, we lose our main purpose for existing,” Annie said, hearing the heat in her voice but helpless to stop it. Their whole specialty was geared toward providing women with a safe alternative to hospital birth—why weaken their mission by allying with hospital-based practitioners?