induced labor should be regulated

11

IN THE REAGAN’S BACKYARD their Golden Retriever barks at the sound of the door chimes having been rung. Pamela opens the front door and finds who she was calling for much earlier this morning, Detective Alvarez. She invites him in and they light in the displaced space of the reception room, both a bit awkward on a couch. He opens his PowerBook and spins it around to show Pam.

“This is Doctor Reagan, right?”

“Yes.”

He watches her. Golf shorts, sleeveless white button down top, tan, on her haunches, knees together, feet parallel, shoulders tense, leaning in. Everyone’s suspect.

“And you saw him last at Lowe’s?”

“No. The last I saw him he was in that man’s truck.”

He reads the display. The look of the lack of preparation is a ruse. “Oh, yes, the white Ford, the man from the store. Do you know this man?” he asks.

“No. I never saw him before.”

“And he was with you at the store?”

“He was in line ahead of us, yes.”

“Did your husband seem to know this man?”

“No, I don’t think so.” She has no idea, honestly. She doesn’t seem to even know her husband, a rift that began when they returned from a service opportunity in Uganda. Doctor Reagan worked with the nascent Médecins Sans Frontières, or MSF, where he initiated family planning training among an exploding population in crisis. He team-taught in General Obstetrics and Urogynecology and established field clinics during the early reign of Idi Amin while Pam volunteered with MSF support in triage and in teaching hygiene. A year after their return to the States, Gray established a practice partnership with another Doctor Reagan of no relation other than their internship rotations at San Mateo General and all he seemed to focus on was delivery, where before he was intent on specializing in Gynecologic Oncology, a field with a burgeoning need for physicians and research. South Highland Women’s Center was established in a growing small bedroom-community where deliveries of middle-class healthy white babies to double-covered babymakers proved extraordinarily profitable.

She did not know with whom he golfed when she was not golfing with him. She paid little attention to his associations, rarely accompanying him to conferences and dinners and tournaments and retreats. She was never part of the country club. Her ambitions centered around the NGO work and philanthropy she discovered being immersed in her volunteer work with MSF, more widely known as Physicians Without Borders. The couple never had what centers most couples in a home – children – and as such they went two different directions in their contributions to humankind.

She managed South Highland the first year but quickly recognized the impending clash of two strong and bright personalities bound in matrimony, so she hired Elaine Southwick to manage the practice. The gulf in the Reagan’s relationship grew from there leaving Pam now to wonder just how well she does know her husband.

“And this was at Lowe’s, the one on Redwood Road?”

“Yes, that’s the one.”

Detective Alvarez types some notes. She is not going to like what he needs to say next, a correct assumption he made in her assessment. Most of Alvarez’s experience in this jurisdiction is in investigating missing children and child sexual abuse. The occasional missing person case involving an adult male typically turns out to be man-fleeing-wife. Mrs. Reagan is sharp, she’s beautiful, affluent, obviously active, intelligent. He has a hard time imagining why her partner would flee.

“Mrs. Reagan,” his tone in premonition, “I’m a little early on this one. It’s protocol to wait twenty-four hours on a missing person, because, you know, you just don’t know. More often than not the missing person just got a wild hare, a late poker night, an old friend shows up.”

“An old girlfriend,” she says.

Alvarez’s eyes go to the ice on her ring finger, the fresh roses on the table behind the divan, the recent photograph of the very happy Reagans on the deck of their sailboat.

“I’m sorry, Mrs. Reagan. It’s the most popular motive in a disappearance like this.”

“He didn’t leave me,” she says in tones more convincing of herself.

“Is there anyone at the practice who might know his whereabouts? Anyone who he may have crossed lately? A disgruntled patient, a malpractice suit in the works?”

“People are suing all the time.”

Alvarez types some more. Of course they are. This is a litigious time. People are sue-happy. But his notes serve to remind him to research just how many people are suing compared to other OB/GYNs in the area. He is unconvinced, though, of foul play. No ransom demands, no contact. Just poof. Gone.

THERE’S LITTLE HUBBUB for a Monday at Lowe’s with a few do-it-yourselfers off the weekend pattern. The shift manager who was interrupted earlier this morning has managed to get the clearance tags assigned in different departments until he is interrupted again, this time by Detective Alvarez. The two descend the customer service platform and walk the checkout aisles. After Pam’s inquiry, the manager has some context for the detective’s questioning and having reviewed the register tape, he knows where the transaction took place and stops at the point of purchase, still closed since the weekend rush.

Alvarez steps up to the register counter as if he were making a purchase and from his standpoint makes a visual survey. Big box stores have inventory controls. It’s just a matter of finding them. Alvarez tilts his gaze up and there it is, the little black bubble of a surveillance camera.

“Does that work?” he says.

In a corner of this Lowe’s is a climate controlled room with the store’s transaction servers fed with cable trays stuffed with dozens of data lines, a few of which carry a video signal into a smaller room tucked into a corner. Inside it is a small desk with a pair of large computer monitors tied to freestanding servers upon which is displayed matrixes of images fed by twenty-four security cameras, half of which come from the transaction area. The shift manager is seated at them on a stool, nothing comfortable enough to encourage the perusal of security footage. Over his shoulder is the detective watching as the manager shuttles through hours of footage acquired at fifteen frames a second.

“That’s the time of the transaction?” says the detective. The manager nods, handing over the photocopied portion of the register tape. And then Alvarez sees it, the unmistakable feature of two people in line with a rolled up area rug seen from directly above.

“Wait, go back,” and the video rewinds a few frames to when a man in a ball cap and black t-shirt enters the frame. “Stop there, please. Now, go frame-by-frame.”

The manager taps the right arrow on his keyboard and the monitor shows now full-screen the angle of this one particular camera, a man in the cap and t-shirt and the woman and the man with the rug who line up behind them. Each frame jerks them in the movement of the man in front turning, moving a bar in his hand, then dropping his contents, picking them up, while the woman observes and the man peeks around the rolled-up rug to see what is going on. The two review the footage again, but the man in the ball cap is unidentifiable.

“Any other angles on this register?”

“No, this is it,” says the manager, realizing the futility of the installation of probably all his security cameras. They are aimed at cash register drawers, not at the faces of patrons who may prove later to be kidnappers.

“I’m sorry. This is it,” he says. And this is nothing.

IN IAN’S DIVISION of the contents of his house he has spared a few items from the produce boxes along with a cordless power drill and an outlet adaptor he’s retrieved from the garage. These sit on the plastic that covers the dining table along with a pair of EMT utility scissors and an unopened box of latex exam gloves left over in Virginia’s medical supplies, a small bag of adult diapers, and a plastic grocery sack containing a canister of diaper wipes, cans of Ensure and bottles of Gatorade. There are a number of issues Ian needs to attend to as his plan comes together, the first of which is Gray’s wellbeing. That includes hydration and feeding, keeping his respiratory system open and clearing his waste. No imminent need should stand in the way of the reason behind the fate of these two men coming together. Ian is going to give Gray an education about the ramifications of Virginia’s botched delivery and what it took to maintain her living for ten years. He has that documented, sitting on the table as well under the drill in three stacked overstuffed FedEx pouches. What he does not have is the record of his wife’s care.

FOR THE WHOLE of Virginia’s life, Ian and Linda had never confirmed the origin of her condition. Neurologists and geneticists alike did more than their share of shoulder shrugging when it came to diagnostic attempts. The initial MRI of Ginny’s brain indicated a gross atrophy of white matter, the myelin sheath that protects the nervous system, but its cause remained a mystery, at least to her parents. The two went through genetic testing at the university’s medical center, screening for genetic metabolic abnormalities, but the results cames up negative, though nothing ever seemed conclusive. It is the reason the McDaniels had no other children. There were no guarantees, the uncertainty too high to risk something like this again.

It was after Virginia’s death when Ian, by chance, began to uncover the mystery of it. Before his department at the university exploded in enrollment, Ian served as the coach for the school’s speech and debate team. One of his competitors was researching evidence for a case, her resolution being induced labor should be regulated, an argument that caught Ian’s attention. Linda’s labor was induced.

The student was struggling to find evidence, so Coach McDaniel was helping her, taking a deductive approach. The two were in his office, he at his computer and she seated on the other side of the built-in peninsula of a desk, the monitor turned so they could both view the results of the search engine query. Ian had typed in the word pitocin, and ten links displayed in Google’s browser with another ten thousand or so links to go. Ian clicked one opening a page from a pharmaceutical company. They both scanned the contents until they found a link titled, Overdose Indications. Clicking on that opened a laundry list of symptoms and the girl at the desk took notes duplicating that list in her notebook. Ian had a different response. He read, silently:

“Cardiovascular: Arrhythmias, bradycardia

Central nervous system: Brain or CNS damage (permanent), neonatal seizure

Hepatic: Neonatal jaundice

Ocular: Neonatal retinal hemorrhage

Miscellaneous: Fetal death, low Apgar score”

Fetal death, low Apgar score. Surely those last two are not interdependent, Ian thought. And such was his defense mechanism, a sterile logic that kicked in whenever he was at the cusp of something earth-shattering. Save for fetal death and retinal hemorrhage, Ginny had every symptom and as for the hemorrhage, he didn’t know for sure since he didn’t see her blue eyes until the second day of her life.

The three accordion file folders larger than Bay Area phone books stuffed into FedEx pouches back at the house was Virginia’s medical file. He had made a number of attempts to leaf through them and crack the code that seems to semantically insulate physicians from patients and their parents. And while Ian was adept enough to wrangle denotative meaning in terms that appeared with surprising redundancy, he doubted his own ability to make big-picture sense out of all the notes, the charts, the strips, the MRIs, and especially the last, most painful part of the file in that third folder.

“Coach, you okay?” she asked. She saw Professor McDaniel biting his lower lip, his jaw thrust forward, his eyes going over the list again and again. He moused back to the search field and typed in Doctor Raymond DeVilliers, hit return and his screen filled with only four search results. There was one in Chicago, one in Salt Lake City, one in Los Angeles, and one in San Francisco. They were all for the same doctor, a neonatologist. Her question was ignored. Instead, Ian picked up the handset of his office phone and dialed the first number autonomically, never consciously making the decision to do so. The call connected and Ian asked if Doctor DeVilliers was in. He was told he was in California at his office in Los Angeles. Ian disconnected and dialed that number. It was crazy for him or anyone to think they’d be connected immediately, but Ian left a message, his name, Virginia’s name and then the time frame when Doctor DeVilliers looked into the records of her gestation and neonatal development. He was the neonatologist enlisted by the attending neurologists early in Ginny’s care.

Ian’s office phone rang no more than thirty minutes later with a Los Angeles area code starting the number in the caller ID digital display. It was then just the professor, his student having abandoned her post in seeing her coach become rigid and escalated and non-responsive to her, and he answered the phone. It was Doctor DeVilliers himself. Ian asked if there had ever been a link formed between Ginny’s CNS dysgenesis and the use of pitocin to induce Linda’s labor.

“Do you have her medical file?” was the doctor’s response. Ian confirmed he did.

“Send it to me and I’ll have a look.”

Ian did, that afternoon. FedEx, overnight, the return address was that of the university with Ian’s office code. This was something best left to just him. Linda was in no condition to deal with the potential implications of what might exist within the reams of Ginny’s medical history. Two weeks later when Ian returned to his office after class he found on his desk three thick FedEx packages with return addresses from DeVillier’s office in Chicago. He opened all three, one of which had a hand written note, succinct with an illegible signature save for the D and the V.

“See the tabs. Call me with questions.”

There were two yellow sticky-notes, one a dozen pages into the file, the second just a few more pages beyond. Ian turned to the documents where he found contents that had been highlighted. One suggested the possibility of pitocin overdose, the other the discovery of evidence of an earlier brain bleed, both notes by the same pediatrician, the very pediatrician recommended to the McDaniels by Doctor Reagan. His office was located in the same medical arts building that housed the South Highland Women’s Center.

Ian made one call back to DeVilliers with two questions. One dealt with the likelihood of an external cephalic version – turning the fetus from outside the abdomen – resulting in brain trauma, and the other, how much is considered to be an overdose when pitocin is prescribed to use to induce labor. The highlighted record had no numbers, no amounts of what was prescribed, and no notes of what was administered, because that information was part of the treatment of the mother, not the baby. That information would be in the mother’s chart. The answers from Doctor DeVilliers were concluded with his recommendation of a good malpractice attorney and his willingness to testify in behalf of Virginia’s case with Ian and Linda as plaintiffs. When Ian shared this news with his wife – the discovery of not one but two insults to their daughter’s delivery, and DeVilliers admonition to take legal action – her reaction was at first silent as her mind played it all out. When it reached its inevitable conclusion, one that would inculcate her culpability in the minds of a judge or a jury, that it would be shown to one and all that it was she who was responsible for the suffering and death of her daughter, she told her husband in no uncertain terms that she would have no part of it, that it would destroy what was left of her, that they should get over it, leave it alone, let Ginny be. She’s dead. There’s nothing that can be done about that.

Ian filed anyway. He was counseled to settle. He wanted justice and pressed that the case go to court. In its hearing the case was dropped due to a statute of limitations and its incredibly shitty timing with frivolous malpractice suits clogging up the docket. With that and Linda’s plummeting depression, Ian put it all away.

Until this afternoon.

The grounds of any good argument are based on evidence. While Virginia’s FedExed files had documented the results of Doctor Reagan’s slip of hand and negligence of care, what Ian needed were Linda’s charts, with treatments and orders, to prove his case to his hostage.

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