Hope on the Rocks by Annabeth Albert
Twenty-Seven
Quinn
“Man, Dr. Melanie sure chose a day to call out.” Maria rolled her shoulders. Even her usual stoic cheerfulness had been tried by a morning that simply would not quit. In addition to the usual assortment of cases, we’d had two complicated ambulance transfers to Coos Bay, which had put all of us behind schedule. “We’ve been hopping.”
“Agreed.” I picked back up the tablet I used for patient notes. “Who’s next? Exam room three?”
“That’s the female with dizzy spells. Normal vitals. I got a urine sample like you asked.”
“Good. Thank you.” I nodded at her. She was experienced enough to know what we needed to rule out, and getting lab work started would save us time after the exam.
“Those numbers are being run right now. Results should pop up any moment. Do you want to visit with room four while we wait on the results?”
“No, three has been waiting long enough. Let me at least start the exam. Send the results to my tablet as soon as we have them.” I clicked around on my tablet to bring up the record for room three. As soon as I saw the name, my abdomen went rigid and my arms tingled. Ramona. Hell. But aloud, all I said was, “Oh.”
Something about my expression must have given me away because Maria’s head tilted, and she stepped closer, lowering her voice. “Everything okay, Doctor?”
“Someone I know…socially.” I realized belatedly how that probably sounded, so I quickly added, “Not personally. Just a sister of a friend.”
“Ah.” Maria laughed knowingly. “I was born here. I know ninety percent of our non-tourist patients. Do you want me to see if the PA can take her?”
“No.” Our poor PA had had to take most of my overflow while I’d dealt with the two emergent transfers. “We’re so swamped. I’ll do it.”
I knocked on the exam room door, same as I always would, and kept my voice professional. “Hello. I hear you’re a little dizzy today.”
“It’s you.” Ramona groaned from her place sitting on the edge of the exam table. Maria hadn’t had her gown up yet, but she looked plenty uncomfortable even in her shorts and T-shirt. “I was really hoping they’d assign me to someone else. No offense.”
“None taken.” I quickly sanitized my hands. “I can assure you that I take confidentiality very seriously. But if you’re uncomfortable, I can switch you to our physician’s assistant. However, it will likely mean a little more waiting.”
“No, let’s get this over with. I told Adam I’d get my blood pressure checked. Which I did, and the nurse said the numbers were normal. But somehow, I’m still here.”
“Nurse also said you had a dizzy spell while she was in here.”
“A little one. It’s mild.” She had the same stubborn streak and dismissive tone as her mother, the type of person who could dislocate a shoulder and still try to work a full day. “Give me some electrolytes or something, and I’ll be fine.”
I had years of experience dealing with the I-can’t-be-sick crowd, so I simply ignored her order and picked up the light tool. “I’m going to look in your eyes now.”
“Oh.” Her pretty mouth made a perfect circle. “Could it be a migraine thing? Like what Adam gets?”
“That’s a possibility.” It wasn’t my working theory, but given the family history, some sort of headache wouldn’t be a surprise. “Nurse said you weren’t sure on your cycle. Do you ever get mid-cycle or premenstrual headaches?”
“No. I cycle so erratically that it’s hard to say anything is PMS.”
“Got you.” I made a quick note on the tablet. “What about eating? Do you get headaches if you don’t eat? Did you skip breakfast?”
She laughed heartily at that. “You think my mom would ever let me skip breakfast? Never. I had a cinnamon roll, which okay, not ideal, but I’m not diabetic either.”
“No judgment. Your mom is an amazing cook.” I was about to broach the subject of blood work to rule out something with her blood sugar especially given unpredictable cycles that could indicate something like PCOS, but then my tablet chimed with her lab results. Crap. Some days I truly hated being right in my hunches. “Can you try again to estimate your cycle for me?”
“Before we left, I think. May-ish? Maybe…” Frowning, she trailed off. “Wait. You’re not thinking I’m pregnant, are you? We use condoms, and like I said, I’ve never been regular.”
“It’s not simply a guess. The urine test says you’re pregnant.”
“Fuck.” She flopped back against the pillow on the exam table. “This can’t be happening.”
“Breathe for me. We don’t want you getting dizzy again. Do you want some water?”
“No. I’m good.” She stayed with an arm over her face. “Tell me false positives happen all the time.”
“I’m sorry. A false positive would be pretty rare. Now I’m going to order bloodwork to confirm the HCG numbers, and you having any sort of guess as to your last cycle will help us interpret those numbers. Given the dizziness, I’m also going to order an ultrasound, stat.”
“No. No ultrasound.”
“No?” I wheeled closer to the exam table, trying to sound both sympathetic and professional at the same time. “I know this is a big shock, but we need to get the tests because we don’t want to miss an ectopic pregnancy or other complication.”
She exhaled hard, breath ruffling her strawberry-blonde bangs. “I get that. But Adam’s waiting on me. I don’t want him or Mom knowing. Not yet.”
“I can get a tech in here for the blood draw right away. The results should be in by tonight possibly, tomorrow morning at the latest. And the ultrasound wouldn’t be here. I don’t have a sonographer on staff. But I can write the referral, get you in somewhere ASAP.”
“Maybe I can work out something to go get that done in Coos Bay,” she mused.
“That’s absolutely an option. And as I said, this is a confidential appointment. I’m not telling anyone other than what I have to put in the chart. Also, no matter what the blood work says, I can do any type of referral you might require. You have options.”
“Yeah. Thanks.” She took another deep breath, finally sitting back up. I put out a hand to steady her. “Guess this explains the mood swings. Damn it. I was so mean to Darren. So mean. Now I’m going to have to tell him. That should be fun.”
“You don’t have to tell anyone. Not until you’re ready,” I said firmly, knowing that position was likely going to catch me some attitude from her overprotective brother.
“I wasn’t dizzy with Teddy. Sick as a dog with vomiting even before the test popped, but not dizzy.”
“Each pregnancy is different, and the heat could play a role here.” I clicked around on my tablet, trying to get her referrals and lab work in as quickly as possible. “But that said, I am concerned enough to want that ultrasound ASAP. Don’t skip that, please.”
“I won’t, but I’ll have to see what I can work out to get one without the family knowing. No idea what I’m going to tell Adam when I go back out there. Fuck.”
“Tell him it’s a hot day.” This wasn’t the first patient I’d had who didn’t want a companion knowing something, and my priority had to be her and her confidential medical information, not Adam’s feelings. “Your electrolytes were a little off, exactly as you suspected. Normal vitals and we’re running some blood work. That’s really all he needs to know.”
“Promise?” She pursed her lips.
“Promise. I’ve got to chart your test results, but it’s confidential, I assure you.” I grabbed a pad of paper from the nearby side table and dashed off a number. “After-hours tonight if you start bleeding or any other new symptoms, and since you don’t want to tell your mom or Adam or anyone else yet, you can call me.”
I was bending a few guidelines, but I genuinely was concerned about the chance of an ectopic, and the last thing I wanted was anyone, let alone Adam’s beloved sister, going through that alone, trying to tough it out past serious symptoms.
“Thanks.” She neatly folded the paper and placed it in her purse. “Adam’s right. You are sweet. I can see why he’s so far gone on you.”
“Not sure about that,” I demurred, but I hoped she was right. Hoped he still felt like that after this thing with Ramona played out. “I’m only doing my job. I’m serious, Ramona. Don’t ignore warning signs. You can call or text me anytime.”
“I might take you up on that.” She offered me a wobbly smile.
“Good.” I returned the smile, but inside, my stomach kept cramping. I wasn’t going to rest easy until she had test results and a plan. Knowing secrets was the life of a small-town doctor, but I hated the position this put me in with Adam. Last night had been truly magical, and not only the sex. I’d liked being around his family, being included and accepted. All I could do now was hope everything worked out, us included.
