Obstetrix(25)

I asked Sarah to please at least sit at the far end of the room and pretend to be working on something else, which she did. “Good morning, Brother Nick,” I said, having him sit down opposite me on the rolling chair. “I’m Dr. Elizabeth, and I asked Sister Chloe to send you in because it sounded like you might be having some difficulties getting her in a family way.”

He nodded, silently, and stared at the floor.

“Can you tell me, do you need … better instructions? An explanation of what to do?”

He shook his head. “Brother Jason talked to me before the wedding,” he said.

“Are you having trouble maintaining an erection?”

He looked at me, wide-eyed, and said, “I shouldn’t be having trouble. Chloe’s beautiful, anyone can see that. She’s a beautiful girl.”

I looked at his bright, terrified eyes, his absolutely rigid shoulders, and his hands clasping each other in his lap, and I thought, This poor boy.

I had a couple of guesses as to what the actual problem was, and at the very top of my list was that Brother Nick was gay. The way he said, “Chloe’s beautiful, anyone can see that” had the ring of someone trying to convince himself that beautiful also meant desirable. While some deeply closeted gay men in this community might overcompensate with bluster and aggression, Nick was merely himself, gentle and quiet. I could understand why Chloe wanted to keep him.

“A girl can be perfectly beautiful and entirely desirable and there are a long list of reasons why a man might have trouble maintaining an erection that have nothing to do with his desire for her,” I said. Even if Sarah hadn’t been here, asking Nick if he was maybe just not that into girls seemed like a bad approach. “I’m going to send you home today with some sildenafil, which you may have heard of under the brand name Viagra.” We had it in the cabinet; Sarah gave it to several of the older men.

“Isn’t that for old dudes?” Nick said.

“Lots of older men take it,” I said. “But it works for anyone dealing with erectile dysfunction. My theory is that you’re in sort of an anxiety loop, and giving you a medication that will just fully guarantee an erection will help you have some procreative intercourse. I’ve seen”—this was true—“quite a few men for whom that worked.” I mean, I was not the main person who treated them, since I’m an ob-gyn, but I see men in my office pretty regularly when they come with their wives for prenatal appointments, and I’d heard all sorts of stories. “Are you able to climax from masturbation?”

He drew back, horrified. “I don’t do that.”

I decided to stick with the sildenafil option for now, rather than bringing up the possibility of artificial insemination. “I can give Chloe some tests that will tell her when her most fertile time is; take one pill, wait a half hour, and then try. Use some lubricant to ease the way so you won’t hurt Chloe, and if you have to stroke yourself a bit before you enter her, as long as you reach climax while penetrating her, you’ll be able to get her pregnant.”

I fetched the key from Sarah, unlocked the cabinet, and got out the pill packets, having him list the meds he was currently taking (absolutely nothing, not even a multivitamin) and running through the risk factors (he didn’t have any). He stared frozen in the chair for a moment, staring at the little boxes of pills.

“Is there anything else I can help you with?” I asked.

His eyes were still bright with a little bit of terror. “Sister Ginny, she was Chloe’s sister. Older sister.”

“That was Brother Ethan’s wife, the one who died?”

“Yeah. She was a lot like Chloe. Beautiful and quiet and you feel like a little wind might blow her away, you know? And when she had her baby, she died.”

Oh. I mean, I might still be right about him being gay, but that wasn’t the real problem.

“Brother Nick,” I said, very firmly, “I will not let Sister Chloe die. Not from pregnancy, not from childbirth.”

I could see some of the tension going out of his shoulders, his ears flushing red. He nodded once, then gathered up his things, including the pills, put on his coat, and went back out into the snow.

“I gave him those pills a month and a half ago,” Sarah said, the second the door had closed. “I don’t think he’s using them.”

“Maybe he will now,” I said. “What did kill Ginny?”

Sarah’s face looked shuttered. “Severe placental abruption at thirty-six weeks.”

Placental abruption is when the placenta detaches early from the uterine wall. This can happen spontaneously or be the result of trauma. With the severe kind, where immediate delivery is necessary, if you get the mother to a hospital quickly, an emergency cesarean usually makes it a scary story, not a tragic one.

“The other doctor was here?” I asked.

“Dr. Jana, yes. She said we should call an ambulance and that there wasn’t anything she could do.”

“What did you do?”

“I gave her Pitocin,” she said. “I couldn’t do a C-section, I wouldn’t know how, but I thought maybe if I could speed things up it would save them, or at least save Ginny. It didn’t.”

Pitocin would be useless in that situation. I’d never lost a mother to placental abruption. I tried to imagine standing there, not acting, a woman bleeding out in front of me. I would absolutely not be able to do that.