Revealing the Real Dr. Robinson (10 page)

“An ECV?”

“I know there are a lot of various non-medical traditions on how to turn a baby—playing soft music at the pelvic bone so the baby will gravitate toward it, putting ice at the top of the abdomen so the baby will turn away from it. But an external cephalic version is relatively easy, and if it works it saves Beatriz from having a Caesarean section.”

“You’ve done them before?”

Shanna nodded. “And had pretty good luck. It doesn’t always work, but in my opinion it’s always worth a try. And since you have that nice ultrasound machine...”

“Thanks to my brother-in-law. When he found out Amanda was pregnant, he ordered state-of-the-art everything for obstetrics. Otherwise I might have to sit near the end of the bed, strum my ukelele and hope the baby turns toward my music.”

Shanna laughed. “I didn’t take you for a ukelele man.”

“I’m not. But my mother always thought I had the music in me, which I didn’t, and when I was younger she bought me a mighty fine electric guitar and an amp that turns up so loud it would shake the currasows right out of the trees.” He smiled. “Large birds. Size of a wild turkey.”

“So you’re a rock star.”

“Hardly. Haven’t touched a guitar since I was a kid. Wasn’t very good at it when I did.”

“Then the currasows are safe. Good for them, too bad for me. I’d have liked to hear you play.”

“Trust me. When I was a kid, nobody liked hearing me play, but it didn’t matter because I loved it. Loved the way I shattered windows, knocked things off walls...in the neighbor’s house across the street.”

It was a new way to picture Ben, talking about something he loved other than medicine. Something she hadn’t anticipated but really, really liked. Naturally, her mind went wild with the thought—skin-tight jeans, ab-tight T-shirt, ripped, exposing flesh. That was an unexpected jolt of nice she hadn’t seen coming, but one a girl could certainly enjoy lingering on for a while.

“What’s the smile about?” he asked.

“Thinking about delivering Beatriz’s baby,” she lied. “She’s thirty-seven weeks now, and I’m hoping I’ll be here long enough to do the delivery. Want to help me with the ECV?”

Ben finally stepped into the office. “Give me five minutes, okay?”

“Five minutes. And, Ben, about that kiss...” She’d wanted it. No denying that. No telling him that, either. “I didn’t come here to get personally involved, if that’s worrying you. We made a mistake, it’s over. Live and learn.”

“Live and learn. And I’m sorry I put you through my usual reaction.”

Shanna laughed. “One thing’s for sure—you’ve got it down to a science.”

“They say practice makes perfect.”

But for Ben practice brought about heartache. She could see it in his eyes, and that sadness cut right through her. Which was precisely what her grandfather had lectured her about—she was too emotional to succeed at Brooks. So far, though, none of that was changing. And for the first time since she’d left she was beginning to wonder if she wanted to go back there. The question was always out there about her grandfather not taking her back, but she’d never thought she might be the one to sever the ties. It was on her mind now.

“And perfection takes practice,” she said, still trying to come to terms with how she might be the one to cut herself off from her family, and not the other way around.

“Well, perfect or not, as a friend, do you want to go down to the village with me later on? Maybe have dinner, listen to some music? No off-limits lists involved.”

It was really too bad she didn’t want to get involved as much as he didn’t want to get involved, because Ben would have been the one. Undeniably, unquestionably, the one. Really, too bad. “In what kind of time frame? I’m assuming you have a time limit on that.”

He winced then smiled. “Okay, I deserved that.”

Biting back her own smile, she arched playful eyebrows at him. “You’re right, you did. So, how about we get through the ECV then see what happens afterward?”

“Fair enough.”

She nodded then stepped out into the hall. “Five minutes, Ben.” Five minutes to collect her wits, because Ben had just asked her out on a date, whether or not that was what he’d intended. And she’d put him off. Of course, if he’d been standing there in rock-star clothes rather than well-worn and faded scrubs... Thing was, in her mind right now he was in well-worn and faded scrubs, and looking as good as he would in rock-star clothes. Causing her breath to catch, her pulse to increase a beat or two.

Just a reaction to something that didn’t exist. That was all it was. Nothing.

* * *

When he entered the obstetrics procedure room, the patient was on her hands and knees on the floor and Shanna was sitting on a stool, holding an electric toothbrush. This was where most doctors would have stopped whatever was going on, no questions asked, and quickly come up with another plan. But somehow the doctor with the toothbrush looked like she was totally in control of the situation, and if Ben hadn’t already put his faith in her, it was clear from the expression on Beatriz Rivas’s face that she had all the faith in the world. So he simply slipped in and took his place standing along the wall, watching and waiting for Shanna’s next move.

“I had her start the rocking yesterday,” she said to him. “I don’t like to give anesthesia before the procedure. Don’t even like using tocolytic drugs—” meant as a relaxer “—because they can increase the mother’s pulse rate as well as the baby’s heart rate, and lower the mother’s blood pressure, which can put extra strain on her heart. And that’s not to mention they can make her jittery, anxious and nauseated and also send her into labor. So I try the more natural approach, and pelvic rocking helps.”

“Makes sense. But the toothbrush?”

“Actually, studies have shown that vibroacoustic stimulation can startle the baby into moving away from the woman’s spine, which makes him or her more easy to turn. I just happen to like the buzzing sound an electric toothbrush makes. It’s gentle, and I’ve had it work.”

“But no ukelele?” he asked, smiling.

“Sorry. Your uke’s untried, my toothbrush isn’t.” Grinning, she held it up, hit the switch, then let it buzz for a second.

“Somehow I don’t see this approach being used at Brooks Medical Center. But I could be wrong.”

She shook her head. “Not wrong. If any of my family members walked in on this...” Standing, she bent down to help Beatriz up from the floor. “Let’s just say that any encounters you’ve had with my grandfather in the past would have been a walk in the park in comparison. So now...” She gestured for Ben to turn around as she helped Beatriz into an exam gown, but he chose to leave the room instead. Privacy was his own personal issue, which turned it into a priority for his patients. So often in medicine, when all the basic elements were broken down, and all the tests taken, the only thing some patients were left with was their self-respect. It was always his aim to leave that intact as well as add his share to it.

In this case, he was glad for a short reprieve, where he simply went to the desk across the hall and sat down. Too much work was finally beginning to catch up with him. He was a little achy today, with a bit of a headache. Nothing eight or ten uninterrupted hours of sleep wouldn’t fix. Except he didn’t have eight or ten hours anywhere in his schedule, and the foreseeable future wasn’t going to be any different. Two of his doctors had left the day before and no one had come to replace them.

But in a week, he promised himself. When his new staff was on board and oriented to the hospital, when the final verdict that the yellow-fever cases were isolated and not an outbreak, when a couple of his more critical cases had turned the corner—that was when he’d take his eight or ten hours. Shut his eyes, hopefully dream of Tuscany...

“Ben,” Shanna whispered, practically in his ear. “Wake up. Are you okay?” Asked to the accompaniment of gentle nudging.

A moment passed before he was aware of her standing over him, looking down. The back of her hand was laid across his forehead like she was a mother checking a child for fever.

“Don’t know how it was where you went to med school, but where I went we had an actual class on catnapping. Taught us how, when, where to grab them, including standing up, leaning on a wall, napping with eyes open so no one will know you’re napping...”

“Napping with a fever?” she asked.

He rolled back in his chair to get away from her. “There’s a difference between warm and feverish. I’m warm. Need to take off a layer of clothing to get more comfortable.”

“What are you denying, Ben?”

“Nothing.”

“You’re rundown.”

“And I’m entitled to be rundown.”

“But you got back off a holiday not so long ago.”

“More rundown from that than from work.”

“It’s true what they say, isn’t it?” she asked, spinning away from him. “That doctors make the worst patients.”

“That would assume I’m a patient. I’m not.” He stood, followed her to the exam-room door. “Look, I appreciate your concern, Shanna, but I’m not sick. I’ll admit I’m tired, I’ll admit I wouldn’t mind getting a good night’s sleep. That’s as far as it goes.”

“You’re sure?” she asked, before she pushed open the door. “Because I can handle more if you need a day or two off to recover. Or even a night off to sleep. Like tonight. Skip the night on the town so you can sleep.”

She spun to face him. Then simply stared. Looked deep into his eyes for so long he wasn’t sure if she was assessing him for something or trying to discern a lie the way his mother used to do—that long, hard stare, followed by, “Benny, I know you’re not telling me the truth.” Only thing was, he wasn’t lying about anything. He wasn’t sick. Left to the scrutiny of an overly compassionate doctor, that might be the way it looked. But he knew his body...the good and the bad of it. Right now, he was tired. That was all.

Shanna cared. And she worried about him. Worried too much. It was a nice feeling, having someone worry about him outside his mandatory worriers—his mom, his sister and even to some extent his brother-in-law. Nothing he was going to get used to, though. Because Shanna was just passing through, like it or not.

Today, he didn’t like it.

CHAPTER EIGHT

“S
O
,
WHERE
do we begin?” he asked Shanna, deferring completely to her knowledge in carrying out the external cephalic version.

Shanna glanced at him, studied him only the way Shanna could—a hard, through-to-the-bone stare like she was seeing more than he wanted anyone to. Like she was trying to find the soul he fought to keep shrouded. Finally, she nodded.

“I’d like you to monitor the baby’s heatbeat, Dr. Robinson, as well as Beatriz’s vital signs. Her baseline is already charted, so I think we’re good to go.”

Smiling at her patient, she exuded confidence and caring. It was written all over her, everything she was, and everything that made her a good doctor. Ben liked the way she cared, the way she got involved. Doctors with that level of passion were hard to find, especially coming from the kind of institution Brooks Medical Center was, and he could understand why her family wanted her back. She was rare in the profession. Someone to admire for her compassion. “Good with that,” he said.

“So, are you ready to get this baby turned over?”

“
Sí,
Doc Shanna,” Beatriz responded.

First, she gave Ben a smile, then she turned her attention back to her patient. “Okay, first, relax. You may feel a little discomfort, but you’ve already had two other babies and this isn’t anything compared to that.” Handing Beatriz the toothbrush, she instructed her to simply hold it near the baby’s head, then she examined the woman’s belly until she found the baby’s exact placement.

Glancing at Ben, she said, “Normally this is where I might do an ultrasound to determine the positioning, but baby Rivas has taken a mighty strong position against Beatriz’s pelvis—his or her bottom is deeply seated there—so I’m going to tilt the head of the table down to help baby move away from there. Except...” she winked at him
“...this table doesn’t tilt, so guess what?”

He chuckled. “I’m going to make it tilt. Probably with a couple of nice big medical texts that work better to prop up a table than hit a wall.”

Two minutes later, Ben was positioning them under the table legs, making a mental note to go looking for better exam tables whenever he had the chance. He was welcome to scrounge used equipment in any number of hospitals throughout Argentina. In fact, that was how he’d started Caridad—with scrounged equipment from other hospitals. For now the medical texts were much better suited under the table than against the wall, and Shanna was busy manipulating Beatriz’s belly, turning the baby like it was something she did every day.

Watching her, feeling his admiration for her continue to spiral upward, he saw the good rapport she found with her patient. Saw the ease, the caring. Especially saw the way Shanna kept Beatriz smiling with her lighthearted chat about baby names, even though without painkillers the procedure could be excruciating, and probably was. All of it was amazing to watch, every facet of Shanna’s bedside manner, every nuance of her skill.

“Okay, now. Just think of this as a tummy massage with a little extra pressure,” Shanna said while she oiled up Beatriz’s belly then began in earnest the kneading that would turn the baby round, placing her left hand where the baby’s head was positioned and the right at the baby’s bottom. “You’re definitely going to feel some pressure and discomfort, so let me know if the pain gets too bad because we can stop, and I’ll give you something to ease it.”

“Vital signs holding nicely,” Ben said, feeling almost superfluous in the room now as Shanna had everything so much under control.

She smiled at him. “Well, up on this end I’m being kicked. Someone’s really fighting me on this move. And from the force of the kick I’m betting we may have a future soccer star here.” She leaned a bit more into Beatriz and alternately pushed then rolled the baby to a head-down position for a moment, pausing to slide the ultrasound probe over Beatriz in order to view the positioning. “Not bad,” she murmured, twisting back so Ben could have a look.

“He’s going to turn right back round, though, isn’t he?” Ben asked. “Once you get him fully positioned.”

“The stubborn ones usually do. Unless we hold them down for a while. You know, win the battle of endurance.” She glanced up at him but didn’t smile. Instead her expression was thoughtful, serious. “And that’s a battle I always win, Ben. Against stubbornness, against anything else that gets in the way of what I need to do.”

Was that a warning to him? “Your point being?”

“For future reference, that’s all. You’re pale, your eyes have dark circles under them and either you’re going to take care of it or I will. Because you need to rest.”

“Is it a boy?” Beatriz asked, totally oblivious to the subtext going on around her.

Returning her attention to her patient, softness came back to Shanna’s expression. “Yes, I believe it is. And he’s a big one. Looks ready for that soccer ball,” she answered. “See, to the left? That’s his head. And to the right, that’s his...” Grinning, she moved back into position. “Definitely a boy, Beatriz. No doubt about it. Did you want a boy?”

Beatriz smiled contentedly. “We have two daughters. A son will be nice this time.”

“So, boys’ names...” Shanna said, pushing harder on Beatriz’s upper abdomen as the baby finally started to co-operate and slide into place. “Esteban, Gerado, Miguel...” Sucking in a deep breath, she bit her bottom lip and pushed even harder. “Rafael, Raoul...” Another solid push, and this time when she sucked in her breath she held it and gave one last final prod to Beatriz’s belly. Then let out her breath, smiled and nodded.

“And Nehuen, which means strong, because your baby is strong enough to give me quite a fight, Beatriz.” She nodded Ben over to her side of the table then instructed him where to place his hands. “Dr. Stubborn, meet Baby Stubborn. You two should hit it off well. As for me, my back needs a break so, Ben, will you hold the baby in place for a few minutes so he doesn’t reposition himself?”

He laid his hands on Beatriz’s belly, let Shanna physically manipulate him to the exact spots she wanted braced, and the feel of her hands with oil on them, sliding over his hands, purposely splaying each of his fingers into position...it was all he could do to focus on the fetal monitor. “Your technique was...I guess the only thing anyone could really say was flawless. When I’ve seen these done they were always more invasive, stressful. Is this something you learned at Brooks?”

Twisting from side to side to relieve the tightness in her back, she shook her head. “No. We have an outstanding obstetrics department so once my patients are confirmed pregnant, I send them to the experts. Can’t say that I’ve ever actually done the procedure at Brooks. But trying to make the ECV less stressful is something that made sense to me the first time I ever saw one done. I was still a resident, working through my obstetrics rotation. My advisor asked me to assist him in the procedure, which I was glad to do.

‘But he was so...rough. Too rough, I thought. Didn’t establish rapport with his patient, didn’t use oil to make the rub more gentle. A lot of subtle deficiencies, I thought. Then when the baby didn’t cooperate he resorted to using more drugs than I care to remember. Drugs were his first line of response and I don’t necessarily believe in that if the ECV can be done without them. That’s the way I am about everything—the fewer drugs used, the better.

“Anyway, that first time, all I saw was how scared the mother was and how oblivious to her needs the doctor seemed to be. At least, from my perspective, which could have been a little off since it was my first time. The next time he was called out to do an ECV, I asked him if I could try it and I pretty much did just the opposite of everything he’d done and it seemed to work. Could have been a different kind of response from the patient, could have been my ideas were actually good. Don’t know. But I liked the result, and continued to use my way throughout the rest of my obstetrics rotation. Haven’t done the procedure since then, though.”

She twisted a little too hard to the right, winced, grabbed her lower back, then twisted back to the left to straighten out her kink. “Don’t get me wrong. My advisor was an excellent doctor and an even better instructor, but somewhere in the mix I think he lost his bedside manner. Watching him, with all his excellent medical skills and his sub-par people skills was when I decided that a doctor’s manner in healing is nearly as important as the actual healing.”

“Well, however you accomplished it, this baby has surrendered peacefully. He’s holding his place just fine.” And so was Beatriz, who’d dozed off at the end of a procedure that was often traumatic. Shanna was right, though. The manner was important. And when that manner came from Shanna, it resulted in the smile like the one on Beatriz’s face. Like the one he felt in his heart.

Now, even more than before, he wondered what had gone so wrong in her life, or her medical practice, that had caused Shanna to leave one of the most reputable medical institutions anywhere and come to the jungle. Especially one where she was part-owner. Before today, he’d thought it might have been impulse or wanderlust. Or that she was just someone traveling the world in search of herself. All those made sense to him and in so many ways he understood that. Of course, that was coming from the perspective of someone who’d searched for the same thing and walked away empty.

What didn’t make sense about Shanna, though, was Shanna herself. Everything she did was well thought-out, nothing came without a precise motivation. And there was nothing about her that was lost. Or, at least, appeared lost on the surface. Which meant there was something much deeper going on with her. Something that made him wonder what would have caused her to pack it in and end up here.

He really wanted to think that the call of the humanitarian cause might have lured her, but he knew better. She had a reason for being
here.
And it was something she wouldn’t, or couldn’t, divulge to him. So, damn it, what was it? What wasn’t she saying?

“Look, I think we’re good here,” he finally said. “Why don’t I go get one of the volunteers to sit with Beatriz for the next couple of hours, and if nothing changes, we can send her home?”

“I could use a break,” she admitted. “Go somewhere and try to exercise out the knots.”

“Your back aching that bad?”

She nodded. “It comes and goes. Usually just some kinks from an old injury.”

“Another one of those Shanna stories? You know, the foibles of youth?”

Nodding, she said, “Big foible.” She stepped aside as Consuela Alvarez made her way to the bed and turned to shoo Ben and Shanna on their way. “Big,
big
foible. My family had picked out some kind of surgery for me to pursue, but bad backs and operating tables don’t mix.”

“I don’t see you as a surgeon. Not that you don’t have the skill but you like the personal interactions.”

“Precisely. But for the Brooks family, family practice is too mundane. Good for someone else but not us.”

“Someone else, like me?”

“Obviously, I don’t look down my nose at family practice, because it’s what I chose. And I think you’re a natural for family practice, but I could see you as a surgeon,” she said.

He shook his head. “I thought about general surgery for a while. Couldn’t see myself tied down to an operating room all day, so I looked for something with some variety. Which, for me, turned out to be what I’m doing. It’s good, too, because I like being someplace where the expectations are different.”

“You mean expectations of you?”

“No, not of me. But of medicine in general. The people here want to keep it simple. Pure. Maybe fundamental. They’re happy to get penicillin, yet during my residency when I prescribed it for a patient I was told it was outdated, that there were better antibiotics, to at least prescribe one of the updated penicillins. Yet, plain, old-fashioned penicillin’s a perfectly good drug that works, and it’s a lot less costly than any other antibiotic on the market.

“Your ECV’s another example. You tried the simple thing first, and it worked. So I guess what’s maybe the most important thing to me is that I like the expectation that medicine can still be pure. Or fundamental. And that’s not my patients’ expectations. It’s mine.”

“Then you’re a country GP at heart, aren’t you?”

“And proud of it. The bigger medicine gets, the more impersonal it becomes. But when someone is sick and needs a doctor, they still want to feel like their doctor cares in something other than a corporate-detached kind of way. So long live the country GP, because that’s where the true personal medicine is still being practiced.”

“The country GP who has found himself happy in a jungle village. There’s something quixotic in that, Ben Robinson. I envy you your choice. And your dream.”

An expression crossed her face, one that was sad, full of melancholia, and that was when he knew, when he finally could see her conflict. Somehow Shanna was caught between two medical ideals, trying to figure out which one she wanted. That was probably a simplified version of it, but he’d bet his best stethoscope that was where it had all begun for her. “For me, it was a simple choice. I tried it on, it felt right. So I adapted it to fit me.”

She smiled. “Well, I think the good thing is that your kind of medicine still exists to give medicine as a whole that more rounded, compassionate edge.”

“Until it gets shoved so far back nobody can find it. It’s already happening in a lot of places. The United States... Express the sentiment of being a country GP to your colleagues and they look at you like you’re crazy. Make a house call? No one does it anymore. Go back to simpler prescriptions? Some pharmacies don’t even stock them.”

“But the country GP found his country, and his practice, didn’t he? And he’s practicing happily-ever-after. Isn’t that the way it should be?”

“I don’t know, Shanna. You tell me.”

That sad, melancholic look passed over her face again. “When I was a girl, still in middle school, I accompanied my father on a lecture tour throughout Europe. He’s the medical academic in the family. Anyway, most of the time he stuck to the large cities and universities, but in England he went to visit a former colleague who lived in some little village...I don’t remember the name. It was old, coastal, very quaint. Buildings two hundred years old that would have been condemned for old age where I came from but still had a vital purpose in that village.