Chapter One
“Dr. Jewell to LDR 3, STAT.”
I thrive in emergencies, those situations when my heart hammers in my throat, the seconds slip away, when a mother’s life hangs in the balance, or a baby in the womb deprived of oxygen needs a heroic rescue. In those critical moments, I’m focused and purposeful. I’m no longer a mother, a widow, or a woman with a missing sister, but simply a surgeon with steady hands and singular purpose. It’s the only time I feel whole.
Adrenaline floods my bloodstream, and my heart rate increases to meet the emergency as I race toward the labor and delivery unit. LDR 3. Julie Monroe’s room. Julie’s one week past her due date with her third baby. I delivered her second daughter last year without complications. A full-term delivery in a patient who has had successful deliveries in the past should be routine, yet something’s wrong.
Soft instrumental music plays, and Dr. Maura Stevens, my junior resident, bustles around as I enter the warm, dim room. The curtains are drawn against the moonlit night, and a tension that doesn’t belong fills the room. It’s in the expression of the experienced labor and delivery nurse as our eyes meet.
Julie’s husband is absent. Good. I won’t have to endure his stare today, that predatory gaze that makes my skin crawl, or watch how Julie flinches when he touches her arm, how she checks his expression before answering any question.
Her mother, Irene, wipes her forehead with a washcloth. “Breathe,” Irene whispers into Julie’s ear. “Think of your baby girl. Focus on Emma. She’ll be here soon.”
Irene hovers at Julie’s bedside; her thin shoulders curved protectively over her daughter. Her movements are precise—the instinct of a woman who’s spent a lifetime caring for others. Her gray-streaked hair remains in its neat bun, every strand defying the emergency unfolding around her. I place my hand on Irene’s shoulder, and our eyes meet in silent understanding before she returns focus to her daughter.
Julie rocks against the bed rails, her blonde ponytail dark with sweat. Behind the oxygen mask, her face flushes crimson as she draws measured breaths. A piercing scream tears through the mask.
Maura jumps at the sound, sending a stool skittering away on its wheels. Maura’s petite and professional in her starched white coat, her asymmetric dark bob contrasting with my nearly six-foot frame and blonde ponytail—a youthful look that doesn’t always serve me well in hospital corridors.
Julie throws her head back and continues to rock. With a working epidural, she shouldn’t be in pain.
My stomach tightens as the fetal heart monitor’s numbers flash red. The rate has plummeted to the sixties—fetal bradycardia. Ice floods my veins as years of training kick in—the baby hovers near death.
“Call anesthesia, respiratory therapy, peds, and my attending, Dr. Wells,” I tell the charge nurse, fighting to keep my voice steady. “What’s the story?” I ask Maura, trying to piece together what’s happening while simultaneously running through worst-case scenarios.
“We gave her oxygen and a bolus of IV fluids,” Maura explains in her thick Southern drawl. Any other time, her accent would be soothing. Not now, with a baby’s life slipping away. “We tried position changes.”
I snap on sterile gloves, muscle memory taking over while my mind races. Hundreds of deliveries, and this feeling never gets easier—the wave of urgency, the weight of two lives in my hands.
Julie’s scream cuts off as she collapses against the bed. Sweat glistens on the bedrails where her hands held them. Her eyes find mine, wide with terror. “What’s wrong?”
“Your baby’s in distress.” I force my voice to stay calm, though my heart hammers. These moments are the hardest—when I know something’s wrong and can’t let my fear show.
My exam confirms everything I’m dreading. The baby’s head floats out of the pelvis, and Julie’s blood flows freely. My worst fear crystallizes into certainty—uterine rupture. A clock starts ticking in my head—every second counts because without immediate intervention, we could lose both mother and baby. I’ve seen it happen before and refuse to let it happen again.
“We need to do an emergency C-section.” Everyone stares at me. “Now!”
The team jumps into action as another nurse and the anesthesiologist burst into the room. The charge nurse alerts the OR staff to prepare, and the anesthesiologist gives a bolus of medication through Julie’s epidural.
This baby’s heart rate has been down for five minutes, and we have about ten minutes total before we risk permanent brain damage or even losing the baby.
“Type and cross for four units of packed RBCs,” I tell the nurse, estimating Julie’s blood loss at 500 cc and climbing.
Julie clutches her mother’s hand like a lifeline. “Is Emma okay?” The fear in her voice mirrors what’s churning in my gut.
“You’re bleeding, and your baby’s not getting enough oxygen.” My voice remains firm but gentle. “We’ll do everything possible to help Emma.”
I turn to her mother, steeling myself. “You wait here.”
Irene’s mouth drops open. One glance from me silences questions. I understand her terror—God, do I understand—but I can’t spare the emotional energy to comfort her right now. Not when there’s no promise of a happy ending.
The ghost of another loss haunts the edges of my mind—my second child, a perfect baby girl, born too soon. My throat tightens as the memory threatens to overwhelm me. I squeeze my eyes shut, forcing the image away.
Not now.
Not this time.
“Let’s go.”
As the nurse wheels the bed toward the OR, Julie stares up at the ceiling lights, her face frozen in fear. I run ahead, my mind in the operating room, counting precious seconds. One minute. That’s all we’ll need once we make the first incision—one minute to get that baby out alive. Please let us be fast enough.
Four minutes left.
I burst into the surgical suite, the stark arena of steel and light spreading before me. Monitors hum at the anesthesia station while sterile cyan drapes cover gleaming instruments. The neonatal team claims their corner, resuscitation warmer glowing amber against the white walls. Four mounted surgical lights flood the center stage—the operating table.
The surgical team races through the door with Julie, each person doing their assigned task. Blood pressure cuffs, IV poles, and monitoring cables create a web around Julie. The automatic doors whisper shut, sealing us in this cold, antiseptic bubble where every second counts. Maura positions herself across the table from me.
Three minutes.
I don a surgical hat and mask but don’t have time for the usual formal scrub. The team transfers Julie to the operating table. I insert a catheter, rip the sterile covering off the instrument tray, and pull on sterile gloves. Machines beep, indicating Julie’s blood pressure is too low and her heart rate too high.
Two minutes.
The surgical staff get into position, putting on gowns and gloves and preparing their tools. I lift Julie’s hospital gown and pour Betadine over her midsection.
The epidural numbs her body below the chest, allowing her to stay awake during the procedure. Julie bucks and thrashes on the bed as I slap on the blue surgical drape, exposing a square of flesh over her swollen abdomen.
Julie’s panicking.
“Breathe in and out, slow and deep,” I say, encouraging her to remain calm. The anesthesiologist holds up a syringe, suggesting he can give medication to lessen her anxiety. I acknowledge with a nod.
Julie’s eyes focus on the overhead lights as she whimpers and chews on her bottom lip.
“We’re going to take good care of you.” I position the drape, hiding her face from view of the surgical field.
One minute.
Standing on Julie’s left side, I test the level of anesthesia by pinching her abdomen with forceps. I pinch hard. She doesn’t flinch. “Anesthesia’s adequate.”
I pass the scalpel to Maura. She stares, unmoving. “Maura, now!” It’s her responsibility to perform the surgery. As chief resident, I teach and supervise the junior residents.
Forty seconds.
Maura’s frozen. Pulse beats thunder in my ears as precious seconds slip by. What the hell is she doing? I won’t lose this baby. Not like this. My heart’s already racing but somehow speeds up even more, pounding against my ribs like it’s trying to escape.
“Maura, go!”
She’s staring through me, eyes glazed, sweat beading on her forehead. Julie’s dying on this table. Emma’s dying. Every second of hesitation costs us everything.
Thirty seconds.
I rip the scalpel from Maura’s limp hand.
Skin. Cut.
Fascia. Cut.
Muscle memory guides my hands while possibilities cascade through my mind. I’ll deal with Maura’s freeze-up later. Right now, all that matters is getting this baby out. I drop the blade onto the operating stand and use my hands to separate Julie’s abdominal muscles.
Blood, so much blood, and when I enter the peritoneal cavity, I find the baby’s head floating in the abdomen, not inside the uterus. The torn womb gapes open, pulling the umbilical cord tight over Emma’s shoulder and around her neck. No flow. No oxygen. This child has been functionally holding her breath for ten minutes.
The familiar metallic scent floods my nostrils. I don’t react or think; I do what years of training have taught me. I elevate the baby’s head, but her shoulders remain caught behind the uterine wall. My wet hands slip as I pull the tissue that’s choking Emma. I tear the womb wider and feel the sudden give as she slides out.
Time freezes, and my heart stutters. She’s ghostly pale and limp. No movement. No breath. No cry.
No, no, no!
My hands move automatically—clamp, cut, pass her to the pediatrician. My eyes stay locked on that tiny, still form as they start resuscitation. Please breathe, baby girl. Please.
Julie’s bleeding yanks my attention back. God, there’s so much blood. Sweat runs into my eyes, soaking my mask as I work. “I need a fluid bolus. Where’s the transfusion?”
“Hanging it now,” the anesthesiologist responds. “Antibiotics?”
“Ancef, two grams.” My voice stays steady even as panic claws at my chest.
Blood wells out, spilling over the edge of the wound like a storm surge. Despite the lap pads, despite my suction catheter sucking greedily, Julie’s blood flows over the drapes and onto the table and splashes to the floor. Warmth seeps through my gown, soaking into my thighs and flooding my socks. If I can’t stop the bleeding, Julie may not survive.
My mind races through the downward spiral that’s already starting—Julie’s heart straining to pump with less and less volume, desperately trying to get oxygen to her brain. Her kidneys are shutting down. Every second of bleeding brings her closer to death.
“More lap pads,” I say, choking back the waver in my voice. I won’t lose her.
I stuff sponges in the pelvis, all around the uterus. Using a cupped hand, I scoop out the large clots and shove more towels inside Julie’s open abdomen. The bleeding slows. I hold pressure on the uterus to tamponade the flow of blood and control the bleeding.
Breathing deep, I assess the situation. The monitors at the head of the table flash her heart rate at 135—tachycardia, but her blood pressure holds steady, and oxygen saturation remains good. She’s stable, at least for now.
I turn toward the baby. No movement. The nurse performs chest compressions on the tiny body. Oh, God, no. “How’s baby?”
“Not good,” the pediatrician says.
Our supervising physician, Dr. Wells, bursts into the operating room, holding a mask over his mouth and nose. Wrinkled clothing hangs on his frame, and the pillow’s imprint creases his cheek. “What the hell is going on?”
“We had a uterine rupture,” I say. “Transfusion’s going in now. The tear extends to the cervix. I’m not sure...”
“I’m going to scrub in.” He exits the room to wash.
Maura’s shoulders hunch. “I’m sorry,” she says, the words barely audible.
How could she freeze like that? In critical moments, speed is essential. Berating her now will only worsen a tense situation. “We can talk about it later,” I say. “Here, hold pressure.” I use sponges to clear our view as Maura presses down on the gaping hole in Julie’s uterus, staunching the hemorrhage. “Now we can plan our next steps.”
The neonatal team fights to save Julie’s newborn. Ten minutes without oxygen can be devastating. I take a deep breath and silently pray.
Chapter Two
I peer over the drape at Julie, her skin porcelain white, lips drained of color, tears streaming
down her cheeks.
“Emma’s getting excellent care,” I say, keeping my voice steady. “Your uterine wall tore
during labor. If I can’t stop the bleeding, we may need to do a hysterectomy.”
“No, please.” Julie’s voice quavers. “We have three daughters, and Andy wants a son.”
Even now, she worries about what her absent husband wants. “I understand.” Her eyes glaze over as she stares into the lights.
Blood drips off the operating table onto the floor, and surgical instruments are strewn about on the Mayo stand. Wells returns, dons sterile attire, and stands beside Maura. I release my hold on the laparotomy sponges, and we explore Julie’s open abdomen. I methodically extract each pack until we locate the hemorrhage. We clamp, cauterize, and suture.
“How the hell did you get this tear?” Wells asks.
My eyelid twitches. We saved two lives while he slept, yet he offers no acknowledgment. But Wells is my boss, and I need to be respectful, even if he isn’t. I check my attitude and give a measured reply. “When we entered the abdomen, we found the torn uterus,” I say. “I had to extend the tear superiorly to get the baby out.”
His hands shake as he expertly massages our patient’s womb. I suck in a breath, remembering the rumors about his drinking.
“This uterus is too thin. You might need to take it out,” he says.
“She doesn’t want a hysterectomy.”
He huffs. “Well, you’ll need to close it in multiple layers.”
The fragile, jagged edges of the uterus complicate our work, but I strengthen the closure by overlapping tissue layers. The reconstruction holds, and bleeding stops.
I glance at the neonatal warmer, where the pediatric team clusters around baby Emma. Her chest flutters with rapid, shallow breaths. A tiny fist rises as if in defiance.
“What about your patient, Dr. Jewell?” Wells says.
I snap my attention back to Julie. “She’s at high risk for infection since we weren’t able to scrub before surgery,” I say. “We attempted to maintain a sterile field. Antibiotics will help.”
Wells turns toward Maura. “Why didn’t you do this case?”
Maura’s eyes widen as she stares at me, seemingly pleading for help.
“It happened quickly,” I say. “I stepped in because time was critical.”
Wells strips off his gloves and marches out without responding. My shoulders relax as the tension seeps from the room with his departure.
Maura’s tight expression softens, color returning to her previously ashen face as she mouths “thank you.”
We dress Julie’s wound, then escort her back to labor and delivery for recovery. Irene stands, waiting. Her eyes widen at our blood-covered scrubs before softening when she sees her daughter. Once Julie’s stable, Maura and I slip away to change our soiled uniforms.
My phone interrupts with a blaring show tune—Alaina’s ringtone. My chest constricts. I’m not sure which is more difficult, being a doctor or mother to a teenager. She probably wants permission to download another app, or maybe there’s some other urgent teen drama.
I press the accept call button, and before I get the phone to my ear, I hear her.
“Mom. You’ve got to help her.”
My daughter rarely asks for help, and her voice has an intensity. She’s upset. My heart rate starts to rise. “Help who?”
“This girl at our True Love Waits Meeting. She’s bleeding. I called an ambulance, and they’re taking her to the hospital.”
The sound of my daughter pleading makes me want to move mountains. “Okay, slow down. Who’s the girl?” I move to the elevator to make my way to the Emergency Department on the first floor.
“Holly. She’s from D.C. Tonight was her first meeting. I found her bleeding and crying in the bathroom.” Alaina sniffs back tears.
I push the elevator call button again as if pressing it repeatedly will make it come sooner. “Take a breath, Alaina. Is she having her period?” The doors slide open, and I hop on.
“No. Mom,” Alaina says in an exasperated tone. “She’s pregnant.”
* * *
