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Unanimous

Office of Doctors Kucher, Kucher and Lee
Oahu

Dr. Kucher entered the exam room with a smile and extended his hand. "Good afternoon, Catherine, here for your annual?"

"Hi, Doctor. Yes." She smiled at the sixty-ish, fit man in a green scrub shirt as he removed a scrub cap from his shaved head and tossed it in the trash.

"Congratulations on your marriage," he added as he read the note on her chart. "Any plans for children? If so, we'll have you meet all three doctors in our practice so you're familiar."

"Actually, yes." She couldn't suppress a smile. "We just decided to start a family. I thought we could discuss it today."

"Great, providing you have no other concerns or complaints, let's review a few things."

"No issues. I'm feeling good."

The doctor grinned at her enthusiasm. "This would be your first pregnancy, correct?"

"Yes."

"Any family history of endometriosis for you, multiple miscarriages or difficult pregnancies for your mother?"

"No, and I'm an only child."

He scanned her chart. "I see you've just had a physical and you've been been diligent with your GYN checkups, that's excellent."

"Since I saw a lot of different doctors depending on my duty station, I always figured the best person to keep all my records was me."

"Perfect. Since I've only examined you twice before, let's hope our records are up to your standards," he joked with a smile as he tapped the screen containing her chart. "I'm going to go through the rest of our preconception questions and if you have any questions or concerns, stop me and ask at any point, okay?"

She shifted slightly on the exam table and smiled. "Okay."

"Have you always used oral contraceptives?"

Catherine shook her head. "I used depro-provera when I was in-country. Most of us did. It's easier when you can't be worried about a pill a day. But other than that I've been on the pill. I've been on it steadily for the past eight years."

"Any issues?"

"None. I was always very regular."

"Your husband has no history of STDs?"

"None."

"And I see from your last test, you've never been exposed to HPV. That's …" he cocked an eyebrow. "unusual."

"Really?"

"Really." He smiled.

She shrugged. "I've never had unprotected sex."

"Well that certainly cuts your chances of exposure down to almost zero." He glanced up. "And I absolutely believe you."

She looked confused. "Why would I lie?"

"Oh, Catherine, I'm an OB/GYN, I get lied to every day." His eyes crinkled at the corners. "Probably more than cops do. Not everyone is as honest about their health, never mind unprotected intercourse."

"I was never trying to have a baby," Catherine said as though it were obvious.

"Smart lady. Good for you. Now for my next question, approximate number of sexual partners in the past five years?"

"One."

"In the past five years?" he repeated, making sure she'd heard correctly.

She grinned. "One."

"And can you guesstimate the number of partners your husband has had in five years?

"Just me."

"Has anyone in your family or your husband's family ever had any of the following? I'll read off a list, just respond to any that are a yes, alright?

"Got it."

"Structural birth defects, chromosomal abnormalities, intellectual disability from other or unknown causes, developmental delays, been on the autism spectrum, had multiple miscarriages or stillbirths?"

"No for me and I'm pretty sure no for Steve's family. We don't have every bit of … information on his mother's side."

"That's perfectly fine." Dr. Kucher made a note and smiled. "We just gather as much info as possible. I have a few safety questions next. Have you ever been a victim of domestic violence?"

Catherine shook her head. "No."

"In your current relationship, do you ever feel threatened or are you physically or verbally abused? Have you ever been kicked, hit, or slapped? Have you ever been forced to have sex against your will?"

"Absolutely not."

"Please understand we have to ask."

She nodded slowly, feeling sad that any woman would have to answer 'yes'. "Of course."

"Just a few lifestyle questions and we're all done. Do you use tobacco products, or are you exposed to secondhand smoke?"

"No."

"Do you drink alcohol?"

"Yes."

"How much and how often?"

"Socially and sometimes with dinner."

"Do you or your partner use recreational drugs?"

"Never."

"Do you drink caffeinated beverages?"

"Coffee and tea, usually a cup or two a day unless we're pulling a long duty shift." She tilted her head and added, "Sometimes a soda. Should I stop?" she asked, willing to do whatever was needed, even before a baby was on the way.

"Once you conceive, you'll want to switch to decaf and pregnancy-safe herbals. For now, we're all done with the third degree. If there is anything else that you think is important that wasn't asked, by all means please do," Dr. Kucher said. When Catherine indicated there wasn't, he turned to don gloves. "Let's check you out and get you on your way. Please move all the way down to the end of the table…"

After the exam, Dr. Kucher removed his gloves and put them in the waste receptacle as she returned to a sitting position. "Everything looks just fine. We'll have your pap results in the patient portal next week. I normally suggest a preconception hepatitis B vaccine, but I know you've had one."

Catherine nodded. "I've been vaccinated against pretty much everything, so yes."

"Then we're about finished, why don't you get dressed and I'll be back shortly."


When he returned a few minutes later, the doctor sat on the stool and motioned Catherine into the patient chair. "Now, what questions do you have for me?"

"Just one right now."

Dr. Kucher smiled, "Go."

"How much of an issue is my age?"

"While conception is never guaranteed at any age," he said as he leaned forward. "I'm sure you've read all the statistics on pregnancy after 35. And if you have any specific concerns, we'll address them. The conception rate for women aged 35-39 is 70-80% after one year of trying and 90% at two years. Those are good odds. You wouldn't balk at a 70% return on any investment, right?" He nodded with Catherine.

"Once you conceive, you'll be monitored more closely than, say, a woman who's 25, but let's not over stress. All of those older mom statistics can sound scary, but population studies don't take into account whether or not the moms took good care of themselves or if they received appropriate prenatal care. I know you'll make sure you do both of those; you're a very healthy woman, you exercise, you eat well. Your weight is on target." He smiled pleasantly. "And your chance of having a healthy baby should be similar to that of a younger woman who is also in good health."

Catherine's smile lit her face. "That's … great to hear. I … we weren't ready before. Now, it's time."

"That's very important, too. Being ready." He smiled. "And there are a lot of benefits to being a slightly older parent. Age brings with it emotional stability, psychological strength, and financial security. Besides, I believe slightly older parents have the ability to bring a child into their lives, rather than making them the sole focus of the parents. Usually a much healthier scenario for the child and the marriage." He patted Catherine's hand.

"So what you should do is finish your current cycle of pills and just don't start a new one. Stopping mid-cycle will induce a period and can throw you off. No need to have you feeling ill. We'll start you on folic acid and prenatal vitamins now." He made a note. "We could do some preliminary fertility tests for you and for your husband, but we say try for six months and if nothing happens, then we'll investigate. How does that sound?"

Catherine nodded. "That sounds really good."

"If nothing is happening in three months, you'll want to increase the frequency of intercourse, say from twice a week to maybe three or four times." Catherine's eyes widened at those numbers, but she hid her grin with a small cough as the doctor continued, "But I don't tell couples to start using predictor kits and the like till we let mother nature take a turn first. We don't want intimacy to become a chore." He smiled pleasantly.

"Go home, stop your pills and live your life. If you have any questions, we're here."

Catherine stood. "Thanks, Doctor. I appreciate it."


McGarrett/Rollins Home

Steve stood as she entered. "How'd it go?"

"Good." She leaned into his kiss after greeting Cammie. "The doctor opted not to do any tests or anything until we try for a few months." Her eyes lit with her grin.

"What?"

"He also said we might want to increase our frequency," she tried to resume a serious expression but failed, "from maybe twice to three or four times."

"Really?" Steve's brow lifted. "He suggested he have sex four times a day?"

Catherine couldn't hold back a laugh. "A week."

"A week?" Steve looked aghast. "Did you tell him -"

"No, I didn't think the doctor needed to know at this point that we are clearly at the highest end of the spectrum."

"Twice a week?" Steve repeated, clearly taken aback.

"I don't think our frequency is going to pose a problem." She stepped up and wrapped her arms around his shoulders, linking her fingers behind his neck.

"How long 'til you stop your pills?"

"I have to finish the pack. So another few days."

Steve kissed her softly. "Another few days."

Catherine turned in his arms and grinned at Cammie, who had taken up her spot on the bolster bed. "What do you think, Cammie? You ready to expand our family and become a big sister?"

At the dog's happy 'woof' Steve laughed and kissed Catherine again. "Looks like it's unanimous."

# End thanks for reading

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