Birth Right

Birth Right

by

Byron C. Calhoun

Copyright 2014 by

Byron C. Calhoun

Smashwords Edition

Dedicated to my loving wife Kathryn, my special children-Paul, Daniel, Joshua, Faith, Mercy, and, my gracious Lord Jesus Christ to whom I owe all. Soli Deo Gloria!

". . .whereunto ye do well that ye take head, as unto a light that shineth in a dark place, until the day dawn, and the day star arise in your hearts." II Peter 1:19

Chapter 1

James Gerrard Phelan’s six foot-three inch frame covered the ground swiftly as he strode down the hallway of St Francis Hospital, past old labor room 1, and, on to labor and delivery room 2. The hospital remodeling turned three of the previous four obstetrical labor rooms/suites into Labor, Delivery and Recovery Rooms or LDRs as the nurses affectionately called them. The movement to normalize pregnancy into a natural event and less of an illness finally reached New Bedford. Walking by the old labor room 1 often triggered memories from James’ subconscious of the Mary O’Brien case of two years ago. He supposed he would never completely recover from her tragic death by a lethal intravenous injection of potassium chloride (KCL) by the town’s most prominent matriarch-Mrs. Steuben. James sighed. His thoughts turned to his nearly one year old son Joshua. He would be one year old in about 3 weeks. Josh had been born in that same labor room 1. James, running his fingers nervously through his auburn hair, shuddered involuntarily at the thought of how close to death his wife Abbey (short for Abigail) had been. Mrs. Steuben tried to kill her with intravenous KCL in this very labor room almost a year ago. Abbey Phelan possessed a zeal for life which complimented James as well. James marveled at her ability to keep her willowy, five foot-seven inch frame in such wonderful shape, especially after the two children. Abbey had long blonde hair most often swept back with a ribbon at the nape of her neck. Her coiffure always looked neatly combed. Even working with James in the hot barn in the summer, she looked wonderful. But, most attractive of all to him were her blue eyes that sparkled with life. James never tired of looking into them. He sighed again, Abbey just plain matched him perfectly.

James’ thoughts flit to his son and he chuckled. Josh thrived under the watchful eyes of his four mommies. Martha O’Brien, a mature 11 years, Elizabeth O’Brien, six years old, was his daughter Sara Phelan’s age. The O’Brien girls lived with the Phelan’s since their mother’s death. Sam O’Brien, their father and husband of the deceased Mary, helped run the Phelan family farm while farming his own 50 acres of land. Sam’s son, ‘little Sam’ (almost 2 years), lived with the Phelan’s too, providing an ‘adoptive brother’ and thoroughly boy playmate for Josh.

Yes, mused James, things were certainly going well for the two families right now. Just so sad that Mary could not be here to share in the joy. He shook off the sad memories of Mary’s death and switched his mind back to the medicine at hand. Work provided a soothing balm to the grief for his friend’s and the girl’s loss. James sauntered onto the floor waving cheerily to Stephanie, the labor and delivery nurse.

Hey, Stephanie. How’s Ms Johnson doing in labor? Stephanie Hill worked mostly the day shift and her husband Fred worked at the nearby dairy plant. She wore her auburn hair swept back in a pony tail and bubbled with good cheer as he talked.

She’s great , but she’s asking when that epidural can be done? asked Stephanie.

Anytime you think she’s ready, returned James pleasantly.

Okay, I just wanted to make sure you didn’t need to examine her cervix before the catheter placement. Sometimes you like to wait for the epidural until the patients reach 4-5 centimeters in the active phase of labor, replied Stephanie.

You’re right. She’s a multiparous patient in her third pregnancy. Guess I ought to make sure I can give John enough time to get the catheter placed properly. He gets really testy when they deliver in the bed before he doses the catheter, laughed James.

John was Dr John Fredericks, MD, the anesthesiologist on-call that day for labor and delivery. He was an excellent obstetrical anesthesiologist bringing a wealth of experience and training to the hospital. John’s recruitment rested partly with the obstetrical department who sought a well-trained, motivated individual to provide pain relief for the obstetrical services.

James changed quickly into clean mauve scrubs with the green ties. He was not overly impressed with such corporate morale building ploys but he had to admit the scrubs were not at risk for disappearance due to their unique coloring attributes. He shed his office shoes and slipped into his rubber, working, washable clogs. These new plastic clogs sure saved a lot of other shoes and could even be put into the autoclave for sterilization. Mrs. Johnson rested in LDR three between contractions as James entered the room.

How are you doing today, Angela? inquired James.

I’m ready for that epidural, Dr Phelan, puffed Mrs. Johnson.

Dan, are you ready for this new baby yet? teased James.

I guess so, grinned Dan Johnson. At least the nursery is painted and I’ve got the infant car seat!

Great. Can’t leave the hospital without the car seat. Let me quickly check your cervix between contractions Angela to make sure you’re not ready to push yet, said James.

I’m not ready yet. I can tell, responded Angela.

I know, but it’ll make Dr Fredericks a lot happier if I do this first before he gets started, returned James.

Okay, I’m ready, sighed Mrs. Johnson.

If you’ll just relax as much as you can and take slow deep breaths, I’ll check your cervix, declared James.

James already wore his sterile glove on his right hand. He took some sterile lubricant from Stephanie and gently checked Mrs. Johnson’s cervix.

You’re just 4-5 centimeters and perfect for the epidural. Has she already received her fluid bolus for the epidural? asked James removing his glove and placing it into the trash.

Patients routinely received intravenous hydration of about 1,000 cc’s of fluid to make sure if the epidural anesthesia happened to block their sympathetic nerves in their legs that their blood pressure didn’t drop. The sympathetic nerves provide electrical messages to the muscles surrounding the arteries in the legs and thighs to keep constricted (resting tone) thereby maintaining your blood pressure. Rarely, the epidural analgesia blocks those messages with medication and causes pooling of blood in the extremities with an adverse lowering affect on the blood pressure. If the pressure drops too much, the circulation to the uterus, and, hence the baby, may be affected. The decrease in blood flow to the baby may manifest as an abnormal fetal heart rate tracing indicating fetal stress. Fortunately, with routine fluid loading, the risks for hypotensive effects on the baby are minimal.

She’s had her IV bolus and is ready for Dr Fredericks, replied Stephanie.

Good, you’ll beep John then? inquired James.

Sure, Dr Phelan. Do you want the usual dosing of the catheter? asked Stephanie.

Absolutely, don’t want to make it so Angela can’t push, said James.

If the epidural gives the patient too much medication, the patient’s muscles would be paralyzed as well as the pain nerves numbed. The reversible paralysis make it practically impossible for the patient to push due to the dense neural blockade of the skeletal nerves to the voluntary pushing muscles. It also may lead to malpresentation of the babies’ heads’ so they do not come down the birth canal in the proper manner causing longer labors with harder pushing.

James wandered out to the desk to document his cervical examination, the fetal tracing, and the intravenous fluid bolus orders. He waited for John Fredericks to appear. He liked to talk personally with the anesthesiologist if he could. That way James could give a brief past medical history, social history, and the progress of labor up to that point. It was time well spent. Many times things were not in the chart or the charts were incomplete. James could fill in the missing data, especially the social issues at hand.

John Fredericks appeared on the labor and delivery deck. He hailed James asking who needed the epidural anesthesia.

Who you have in labor this time, James? asked John.

Angela Johnson, at 4-5 centimeters. She’s a 29 year old G3P2002 with no prenatal complications in active labor. She’s healthy with no known allergies, medical problems, and weighs about 135 pounds. Stephanie already gave her a 1,000 cc bolus of LR. She’s just starting to get uncomfortable and is awaiting your arrival, finished James.

Great. I’ll dump this white coat and get the catheter in. When I’m done I’d like to talk to you if I can, responded John.

Sure, I’ll finish up my dictation from this morning and wait for you in the break room, replied James.

The request brought a questioning look from James, but John disappeared into the locker room to hang up his lab coat, exiting from the opposite door in the hallway. James wandered over to the break room, entered it, and sat down next to the dictation phones. The wall held 5 dictating stations for the physicians for operative reports, notes, and admission history and physicals. James grinned wryly. The suggestion for more stations had been his idea. He’d been dictation physician of the quarter several times. The physician who kept his paper work from being delinquent received recognition at the quarterly hospital staff meeting and obtained a sizable cash donation to his or her unit. James sat down and knocked out his operative report from the lapascopic ectopic pregnancy he’d done earlier in the morning and dictated the addendum to his last note about Mrs. Johnson’s epidural. He leaned back to stretch and glanced at his watch. Almost 10:00 Am he noted. It’d be good to be off at noon after a hard night of call. That was assuming Angela delivered before noon. He hated leaving things for the others to finish up but that was the deal they all made regarding post-call days so people didn’t burn out. James picked up the newspaper and turned to the comics page. It was the only page he consistently refused to miss in the paper each day.

John Fredericks strolled into the room and glanced around.

Can I buy you a cup of coffee, James? asked John.

Sure. I’ll spring for a bagel or two, grinned James.

Good. I told Stephanie to beep us if she needs us, responded John.

Okay. Down to the ‘staff-caff’? asked James as the hospital cafeteria was known.

That’s perfect. Let’s get our coats and trot down there, affirmed John.

The two grabbed their lab coats as an outer cover and started down the stairs to the cafeteria on the ground floor. Physicians could drink all the free coffee and soda they wanted while in the hospital. James selected two, large, home-made, tasty blue-berry muffins and sat at a table.

Muffins looked too good to pass up after a hard night of call. Mrs. Hallahan makes them from scratch and fresh blueberries are always an added bonus, shared James.

Outstanding! Need any sugar for your coffee James, asked John.

No thanks, just a little cream for me please, responded James.

John passed the creamer to James and looked around carefully.

I don’t want you to think I’m paranoid but I received this letter yesterday and it has me worried, began John.

Really? What does it say? said James with his interest piqued.

I think you ought to read it yourself, said John.

James read, "‘I am so depressed and terrified since you treated me 3 years ago. I have nightmares about my surgery. You were there with a resident while he stuck my back 12 times to get my spinal anesthesia. You laughed and said if ‘If I wasn’t so fat that I wouldn’t have this problem and here is another fur coat for my girlfriend’. I felt them cutting on me while you gave me drugs. My thoughts emptied out of my head and floated around the room. I saw your voices circling around the room. I remember leaving the operative table, and traveling up the sidewalk. With each step I took, there was less pain. I was surrounded by a wispy, white fog, and there was a wonderful peace. I didn’t want to leave but decided to make myself come back so I could check on my baby. The next thing I remember is telling my heart to beat and my lungs to breath. Then, there was the excruciating pain. I could hear people yelling my name but I couldn’t respond and it was weird. I could see myself as they operated on me. You laughed again said, ‘there is one more for my Porsche’. My boyfriend told me that they stood over me with my eyes open for about 5-10 minutes before I responded. I was in the recovery room for over 6 ½ hours and didn’t get to see my baby the whole time. On the way out of the recovery room, they jerked the back of