The Doctor's Blessing (15 page)

“H
ow long are you going to keep giving me the silent treatment?”

Phillip watched as Amber ignored his question, laid the patient chart he’d asked for on his desk and walked out of the room. Apparently, she could be silent a little longer.

Wilma, standing on the other side of his desk, tucked her pencil behind her ear, crossed her arms and scowled at him. “I don’t know what you did. I’ve never seen her this upset.”

Shooting her a sour look, he asked, “What makes you think I’m to blame?”

“Because you’re a man.”

There was no point arguing with her logic. He was beginning to think he had liked Wilma better when she was a timid mouse. Who knew she could become a spitting cat when her friends were in trouble? “Just order those forms and check to see if we have more printer ink somewhere.”

“Yes, sir.” She rolled her eyes and started to leave, but stopped at the door and turned around.

“What now?” he demanded.

Pointing at him, she said, “Don’t be crabby with me, young man. I’m old enough to be your grandmother. I deserve some respect.”

She was right. He folded his hands and made himself smile. “I’m sorry, Mrs. Nolan. What is it you wanted to tell me?”

“That young Mennonite doctor who was here last year called after you left last night. He wants to come interview for the position.”

Phillip’s spirits shot skyward. Maybe he could get Harold the partner he needed. “That’s great. Thank you, Wilma. I’ll give him a call and we can set something up.”

“Maybe he’ll be smart enough not to go around upsetting the Amish, Harold and everyone else.” She closed the door behind her when she left.

Phillip’s elation popped like a balloon hitting a thorn tree. It had been like this for three days. Amber spoke to him only when necessary. Wilma never missed a chance to deliver a jab. If this was how his last three weeks were going to go, he honestly didn’t think he could take it.

How was he supposed to run a clinic with a nurse who wouldn’t speak to him? Maybe he should have handled the whole thing differently.

He had cooled off considerably by the time Nick Bradley dropped him at the office after leaving the Knepp farm. After all, Amber had been found safe and sound. Mrs. Knepp and her daughter seemed fine. He had checked on them before he left the farm. He’d almost called Amber then to apologize but his pride had held him back. He wasn’t wrong. She was.

How often had she insisted Sophie Knepp wasn’t a high-risk patient? Unable to change his mind on the subject, she’d gone behind his back and delivered the woman at home anyway. What he didn’t understand was why Amber wouldn’t admit she’d turned her phone off on purpose. She’d been found out. She had nothing to gain by pretending anymore.

Unless she was telling the truth.

That nagging voice at the back of his brain was getting louder by the hour. He hadn’t known Amber very long but
she didn’t seem like an underhanded person. She was warm and witty and devoted to the people of her community.

Okay, there had been that time at church when she’d seated him with Gina Curtis. That had been a little sneaky but it was nothing compared to this. Was his ability to read a person that messed up?

If she had told the truth, what could he do at this point? He’d already called her a liar. In front of her cousin, no less. Would she even accept his apology?

He glanced at his watch. It was almost four and it was time to end this standoff. They had to work together. He would eat crow. One wouldn’t hurt him. There were plenty more out in the cornfields.

He pressed the intercom button. “Wilma, ask Amber to step in here, please.”

“Can’t.”

Letting go of the button, he muttered a few unkind words under his breath, then asked. “Why not?”

“She’s with Sophie Knepp and her new baby.”

“Sophie wasn’t scheduled to come in until Monday. Is something wrong?”

“Oh, yes.”

He rose and headed for the door. Before he reached it, it flew open. Amber stood in the doorway with a look of panic on her face. “You need to come quick.”

“What’s the matter?”

“It’s Sophie Knepp. She’s hallucinating and muttering that God is taking another child away. She won’t let me see that baby.”

“Is her husband with her?”

“Yes.”

They crossed the hall and Phillip saw Amber wasn’t exaggerating. Sophie sat plucking invisible things from the baby’s
blanket and throwing them away as fast as she could. She kept muttering the same phrase over and over.

Quietly, he asked Amber, “What’s she saying?”

“That leaves are falling and covering her baby. She has to keep them away or her baby will be buried.”

Phillip looked at her husband. “When did this start?”

“This morning. She picked up the baby and started crying. I couldn’t get her to stop.” He stood against the wall turning his straw hat around and around in his hands. He looked worried to death.

Phillip sat on a stool and moved in front of her. “Sophie, I’m Dr. White. Do you remember me?”

She didn’t answer, didn’t make eye contact. He moved closer slowly and touched her hand. “Sophie, I need to see your pretty little girl.”

She stopped picking and started crying. Carefully, he withdrew the swaddled child. Laying the baby on the exam table, he opened the blankets. The child looked asleep. To his relief she was clearly breathing. She was also very jaundiced.

He looked at Mr. Knepp. “How long has her skin been so yellow?”

“Since two days after she was born.”

Amber broke in. “I told you to contact me if the baby’s jaundice got worse.”

“When we saw the whites of her eyes were yellow, too, we knew God was taking her from us as He did our first children.”

Puzzled, Phillip asked, “You’ve had other children with jaundice?”

“Twin girls who both died before they were two years old. Then we had strong sons and more healthy daughters. Why has God put this burden on us again?”

Sophie sat rocking herself and staring into space.

Phillip said, “Elijah, your wife is very sick. This is a rare
thing called postpartum psychosis. She needs to be hospitalized, but she will get better.”

The man nodded without looking convinced. Phillip turned to Amber. “Call an ambulance, then call the hospital and tell them we need a mental health assessment for Sophie. After that, call the Peds unit and tell them we need triple phototherapy lights for this little one. I also want a total bilirubin level STAT along with standard admission lab.”

“Yes, Doctor.”

He asked, “Mr. Knepp, do you understand what jaundice is?”

When the man shook his head, Phillip explained. “This is a common thing in newborns. Jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is a chemical produced by the normal breakdown of red blood cells. We all have a little in our blood. Normally, bilirubin passes through the liver and is excreted as bile by our intestines. This yellow color occurs when bilirubin builds up faster than the baby’s liver can break it down and pass it from the body. We treat it by putting the child under a special light. If the level is very high, we may have to do an exchange transfusion. To do that, we take out some of the blood with the high concentration and put in blood with normal levels.”

“Will she die from this as our other children did?”

“I’ll do everything I can to make sure that doesn’t happen.”

Within thirty minutes, both Knepp patients were on their way to the hospital. Phillip was getting into his car to follow the ambulance when Amber came running up to him. She grasped his arm in a tight grip. “I have to know, Phillip. Did I miss something? The jaundice was barely visible the day after birth. I told them to bring her in if it got worse.”

The look in her eyes tugged at his heart. He didn’t want
to answer her. He wanted to pull her into his arms, kiss her and tell her everything would be all right, but that might be a lie.

Home deliveries weren’t safe. Maybe she hadn’t missed anything at the birth, but a woman and her baby need round-the-clock observation for two days after a delivery. Most state laws require a mother and her newborn to stay in the hospital at least that long.

He had tried to make that point. Amber had made it for him.

When Phillip didn’t answer, Amber’s heart sank. “I saw them the day after delivery and nothing looked out of the ordinary. Lots of newborns have mild jaundice.”

She bit her lip as she waited for him to say something, anything.

“Amber, there are too many unknowns for me to start guessing now. We need some solid information. Let’s run some lab tests and find out why the baby is so jaundiced at four days old.”

“Sophie’s blood type is O positive so it can’t be an RH incompatibility. Sepsis? The baby didn’t act sick or look dehydrated. Maybe it’s an ABO problem. And what about Sophie?” Amber knew she was babbling. She couldn’t help herself.

He gripped her hand. “Calm down. You’ll drive yourself nuts doing this. Postpartum psychosis can occur anywhere from one to three months after delivery. I’ve not heard of a case starting four days after birth, but I haven’t researched it. Were the signs there when you saw her? We may never know. The best thing that could happen is happening now. They’re getting the treatment they need.”

She withdrew her hand. “You’re right.”

“Do you want to come with me to the hospital?”

Shaking her head, she stepped back. “I’d only be in the way.”

“All right, I have to get going. I’ll fill you in when I get back.”

After he drove away, Amber went back inside the clinic. Wilma, getting ready to close up, slipped her purse strap over her shoulder. “Is everybody okay?”

“Sophie was sedated enough to go calmly. Elijah looked like a zombie. I don’t think he knows what’s hit him. The baby was sleeping quietly in the car seat the EMS brought.”

“Dr. White will find out what’s wrong. Don’t worry.”

“You think he’s a good doctor, don’t you?”

“As good as Harold. Maybe better.”

Turning around, Amber began pacing across the lobby as she racked her mind for every little detail. “For a baby to get that jaundiced so fast, it must have been worse than I thought when I saw her last. Why didn’t I pick up on that?”

“Amber, you’re a great midwife. You love your patients. You’d never hurt them.”

Pressing her hand to her forehead, Amber closed her eyes. “I remember checking her nose. I always push lightly on the tip of their noses to see what color their skin was underneath. I do that on all newborn checks.”

“See? What did I tell you?”

“I was so mad that day. Did my anger at Phillip cloud my judgment? Did I want to be right so badly that I fooled myself into thinking everything was fine? That baby could have permanent brain damage if her jaundice causes kernicterus.”

“What does that mean?”

“If the levels of bilirubin in her blood rise high enough to cross the blood-brain barrier, the bilirubin can enter her brain cells and damage them.”

Wilma took Amber by the shoulders. “Some things are out
of our control. We are human. Only God is perfect. Beating yourself up is not helping. Go home and get some rest.”

Dropping her arms to her side, Amber nodded. “I will. First, I need to call Harold.”

“That reminds me. The charts Dr. White wanted were delivered a little while ago.” Returning to her desk, Wilma picked up a large package and brought it to Amber.

Taking it, Amber said, “I’ll see that he gets them.”

After Wilma left, Amber retreated to her office and put a call through to the rehab hospital in Hawaii. When Harold came to the phone, she started crying. It seemed like she was always crying. How many tears did she have left?

“Amber? What on earth is wrong? Get a hold of yourself. Has something happened to my grandson?”

The fright in his voice forced her to gain a modicum of control. “Phillip…I mean, Dr. White, is fine. It’s nothing like that.”

“Thank heaven. Then what is it?”

After blotting her face and blowing her nose, she was able to relate the event of the afternoon with only a few hiccups.

He said, “Another yellow baby for Sophie. I’m so, so, sorry to hear that. The twins she lost were such beautiful little girls.”

“What was the cause of death?”

“I’m not sure. It had to be some kind of liver disorder, but all the liver function studies were normal. It was very puzzling. Both Sophie and Elijah said they had family members who had lost children from the same thing. They knew the girls were going to die. I tried everything. Phototherapy and blood transfusions worked for a while, but once we stopped them the jaundice came back. There was nothing left to do but let them take the girls home to die. We accepted it as God’s will.”

“That must have been awful for Sophie. Seeing this baby getting jaundice may be what triggered her psychosis.”

“I imagine you’re right.”

“I’ll let Phillip know what you’ve told me. I’ll pray this isn’t the same thing.”

“I’ll do the same. All those tears over Sophie’s illness, that’s not like you, Amber. What’s going on?”

“We need you back,” she moaned, then pressed her fingers to her lips. She had no intention of telling him that his grandson was breaking her heart.

“I’m getting better by leaps and bounds.”

“Are you? Honestly?”

“Okay, now you’ve got me worried.”

“Don’t be. Things are…okay here. I’m tired. I miss you.”

“Are you sure there isn’t something else you want to tell me? Are you and Phillip still not getting along? Wilma told me he accused you of doing deliveries without his consent. I’m gonna have to have a talk with that boy.”

“No,” she said promptly. “Just…just get well soon. Everyone misses you.”

“Okay.” He didn’t sound convinced but he hung up.

Amber settled the handset back in the cradle and lowered her head on her folded arms. She did miss Harold. Things were okay at the clinic. It was only her heart that was broken.

She’d seen the look in Phillip’s eyes. The look that said she had messed up big-time. Exactly the way he had expected.