“Oof. There it is again.”
I put my hand just above her pubic bone, and there it was. The fundus, a small, firm mound.
She was pregnant.
All the blood in my body seemed to drain to my feet, and for a second, I felt dizzy. My heart sped up, and I could feel the pulse in my eyes.
Do your job, said my mother’s voice. I took a breath, held it for a second, let it go. “Does this hurt at all?” I asked, pressing gently around the baby bump.
“Not really. It . . . Well.”
“No, no, tell me. I’m a medical professional right now, not your husband’s first wife.” Those words popped right out, surprisingly. “Everything is confidential. I’ve been a nurse for almost twenty years.”
She closed her eyes （did she have eyelash extensions, or was she just blessed?）。 “I feel some pressure, and it . . . it makes me feel like I have to pee. Badly.”
“Okay. Tell me about your periods. Are they regular?”
“Yes. They’re light, because I’m on the pill. Which, as I said, I never miss.” She looked at me, and yeah, I had to hand it to God, her eyes were spectacularly pretty.
“You’re sure?”
“Yeah. I don’t— This is confidential? You can’t tell Bradley?”
Bradley. That stupid name was worse than Brad. “I can’t tell anyone except Wanda, and she can’t tell anyone outside of the practice. You could sue us for a ton of money if we said anything.”
“Okay.” She looked up at the mobile. “I do not want children. So I’m really, really good about taking the pill. Which is ninety-nine percent effective, right?”
“When taken correctly, yes. Do you take them at the same time each day?”
“Yes! Absolutely.”
“Every single day?”
“Yes. I mean . . . a few times, I’ve been maybe a couple hours late.” She closed her eyes. “It’s possible I could’ve missed one day. Oh, gosh darn it. Maybe two.”
And that, ladies and gentlemen, is why nine out of one hundred women on the pill get pregnant. For that magical 99 percent efficacy rate, the pill has to be taken at the same hour of every day without fail. “Have you taken a pregnancy test?”
She closed her eyes again, and two tears slipped down her temples. “No.”
“Okay. You can sit up now,” I said, closing her robe. She did, wiping her eyes. “Melissa, I’m guessing you are pregnant,” I said as gently as I could. My own feelings would have to wait, because without Wanda here, I was it. Carol wasn’t an ultrasound tech. And I couldn’t let a pregnant woman in pain leave, no matter who she was. “We have an ultrasound machine here, so let’s see what we’re dealing with, okay?”
“Do you do abortions here?” Her cheeks reddened.
“We don’t. You’d have to go to Hyannis for that.” I took another quiet breath. “Let’s do the ultrasound first, okay?”
“What about a pregnancy test?” she asked.
“I’m pretty positive about this. You need a full bladder for an ultrasound, so I don’t want you going to the bathroom first.” I paused. “Do you want to call Brad?” Don’t think about that. Focus on the patient.
“No!” She looked at me with scared, wide eyes. “This was not part of the plan.”
“I know this is a shock, but the more you know, the better you’ll be able to . . . decide how to move forward.”
And so I got the ultrasound machine and the gel we kept in a bottle warmer and asked Melissa to lie down on the exam table again. She stared at the mobile. I put the gel on her lower abdomen and pushed the transducer against her tummy.
She farted loudly, jumped and looked mortified. “Excuse me! Oh, gosh! I’m so sorry.”
“Happens all the time. Don’t worry about it.”
In 95 percent of my cases, this was the magical part, the moment they would never forget, especially with a first-timer. I slid the transducer down her abdomen, and there it was.
The thwack-thwack-thwack of the baby’s heartbeat. I didn’t say anything. Neither did she. I pushed in another spot, and the heartbeat took on a swishing sound. “That sound is the baby’s heartbeat,” I said, my voice husky. I cleared my throat. “So yes, Melissa, you’re definitely pregnant.”
“Oh, gosh.” She looked at the screen, her eyes widening even more.
“The fetal heart rate should be between one forty and one seventy, and it’s at one fifty-nine. Perfect. And here’s the fetus. You can see the head.” I paused, clicked the computer to take a measurement of crown to rump, the head. About twelve weeks along, a little more, maybe. There was the head, the choroid plexuses, the spine. The baby moved a little, and Melissa sucked in a breath.