Incomplete Lullaby
by Author's Tune
AN: I like angst...and the different friendship dynamics that flitter in and out of Private Practice. In case you don't pick that up by reading this fic :-)
It's awkward; doing an ultrasound on yourself. And doing it in the middle of the night, feels so shameful and childlike. The dull glow of the monitor pulled close to the trolley and the instrument held backwards in your own hand. But the answer is quickly available and not broadcast through the office before your feet hit the ground.
The absence of a heart beat on the tiny foetus is all the more evident, even to a neonatal surgeon, when just weeks earlier it was pulsating so strongly on the screen. Like a slap in the face obvious.
In the rarely found silence of the office, Addison set everything back in place, buttoned her jeans, lowered her top and curled on to her side. Drawing her knees slowly up towards her chest, she ducked her chin and squeezed her eyes shut, holding the tears in only briefly before they ran over her temple and onto the sheet.
It might have been awkward doing an ultrasound on herself, but it was at least possible. Managing the D&C herself wasn't an option and she knew she needed it. Her body wasn't letting go of the cells inside of her, keeping them there as if continuing the façade of a healthy pregnancy. Her abdomen cramped ever so slightly and the first signs of a heightened body temperature were becoming noticeable. If it wasn't removed, she would become septic. For a brief moment she indulged herself in self pity; so envious of the women they treated in the practice who had supportive and loyal partners. Someone next to them to hold their hand, kiss their cheek and make the decisions when making them seems impossible.
She shook the thought off. Why spend time wishing for something that isn't available and probably not even possible. Her track record spoke for itself.
"…and they want an elite athlete. How many Olympians do they think we have that donate sperm? These people are irrational. What ever happened to just wanting to have a healthy baby with two arms and legs? Now people want to engineer the next bloody…I don't know…who's a famous athlete? I don't even know. We spend too much time at the office, we should start watching football or something."
Addison drew in a slow breath and blinked; she hadn't even realised she had reached Naomi's door and clearly having missed the start of their conversation, she faltered. "Umm…yes," Addison responded, acutely aware at the inadequacy of her attempt to maintain a sense of normalcy and control. She had nothing to give and the tears were welling involuntarily beneath her lower eyelids.
"What is it, Addi?" Naomi was on her feet, although still protected by the large desk that she had been unsuccessfully trying to utilise to distract from her most recent complicated case. "What's wrong?"
"I ah…" she trailed off, looking to the ceiling and fanning her face with her hands. She emitted a few sounds, air being caught in her tightening throat and attempts at articulating the remainder of her sentence. Exhaling heavily in frustration, she shook her head quickly from left to right. "Sorry."
She didn't move though, almost immobilised mid chaotic thought with one hand on the door frame and the other on the door handle of Naomi's half opened door. "Sit." A basic instruction, something to follow easily that didn't require any verbalisation.
Addison slumped in to the corner of the comfortable sofa, backed against the wall under the blinds which protected the room from inquisitive colleagues. Naomi quietly clicked the door closed and sat, one leg tucked under her and facing Addison. "I'm sorry," Addison offered.
"Reading minds – Violet's area of expertise, not mine. Me, you kind of have to talk," Naomi said softly, smiling and flicking Addison's arm with her finger tips. She earned an anguished nod in return and a shrug.
"I don't know how it happens sometimes," Addison responded. "I've got it all sorted in my head and then I walk through this door and I'm suddenly a mess."
Naomi nodded, curling her fingers around Addison's forearm. "Well, mess away; just talk along with it."
They sat quietly for a few moments with the sound of the second hand ticking away on the old analogue wall clock, seeming to emphasise the prolonged silence. "I just," Addison began, gritting her teeth in frustration at her lack of ability to control the uncertainty in her voice. "I just need your help with something. But it has to be between you and me. I just need your help, Nay."
"Mmmm," Naomi nodded. "Of course, anything, you know that." Addison stared into her eyes as if searching for something invisible. Wanting to communicate without having to say any words; words made everything real. "Don't make me hug you, before you tell me. That's just not the way things work. But I'll do what I have to do." Naomi smiled and spoke so gently, running her hand down Addison's arm before seeking her hand and holding it tightly.
"I need you to do a D&C," Addison whispered, eye contact gone as her gaze fixated on her lap. "Tonight. I'm getting…it's getting infected."
"Addison…" Naomi responded softly.
"I just need you to get it out Nay, please. I need it out." Addison's hand trembled and a tear ran down the end of her nose and dripped to her lap. "Please?" she repeated, covering her face with both hands and folding her body forward.
"Of course," Naomi responded gently. "Of course I will."
"I'm sorry I didn't tell you. I'm sorry I didn't…" The words were muffled by her hands, pressed unmoving to her crumbling face.
Naomi shook her head, reaching out and leaning her body forward to wrap her arms around Addison. "Shhhh. Don't be crazy, it's okay. Just be a mess for a while. You're allowed to be a mess this time."
"It's complicated," Addison stated, sitting back with her legs pulled up to her chest and shoes discarded on the floor.
Naomi smiled. "Is that in your usual understated style?" she asked and earned a shrug in response. "How far along?"
"I don't know, maybe about sixteen weeks. I didn't do measurements, I didn't really look to see when it, you know. Just wanted to check for the heartbeat."
"Why didn't you call me to do the ultrasound?" Naomi asked in concern. "You shouldn't have had to do that alone."
"I knew something was wrong. And well, I'm complicated."
"You know I'll need to do it again, don't you."
"Yes, I haven't completely lost my medical expertise since I became the patient."
Naomi rolled her eyes. "So then you know that I need someone else in there. I can't anaesthetise you and do the procedure."
"You have to," Addison dropped her voice to a whisper. "I don't want anyone else to know."
Naomi sighed and let it go for the moment. "Kevin?"
"What about him?"
"Well, sixteen weeks. I'm guessing Kevin's?" Addison nodded slowly. "You didn't tell him?"
"No."
"Okay," Naomi responded. It didn't surprise her in the least; they were all so guarded. An occupational hazard perhaps, so many hours of every day, spent under a professional veil.
"Do it without a general," Addison stated suddenly.
"What?"
"I'll have it without a general anaesthetic. Just use a local."
"No. No way, Addison. It's painful, it's uncomfortable. It's distressing," Naomi said, searching her mind for every possible reason that Addison might accept. It wasn't clinically indicated, wasn't a reason that the best neonatal surgeon in the country would accept.
"It's necessary."
"No, it's not. I get that you don't want everyone to know but they would understand. Take your pick, we've got an office full of doctors who would all do anything for you. Well, when they're not so self absorbed in their own drama but still, generally anything. And this, this they would do."
Addison shook her head before indulging her nervous habit and raking her fingers through her hair. It resulted in a few more stray pieces falling forward and shadowing her face, hiding her eyes. She didn't answer, simply ignored the reality and left it alone, for dealing with when the pressure became greater. "Did I deserve this? Is this karma? Is my entire life going to just be making up for all my screw ups only to be punished anyway?"
"No. Life doesn't work that way, you know that as well as I do. Crappy things happen to good people; all the time."
"Yeah and crappier things happen to bad people."
"You're not a bad person Addison," Naomi stated, realising that she wasn't having a logical conversation with her generally rational friend.
Addison sighed heavily and rolled her eyes. "Well, I am. And this, this is karma."
A heavy silence fell over them, both lost in their own thoughts. Naomi reached forward, slipping her hand gently into Addison's and said quietly, "You think that because you had a termination, you don't deserve to be happy? Even I think that's ridiculous."
Addison stared at her, her heart racing. She didn't respond, she didn't even know how to. Thoughts were running chaotically through her mind but she wasn't able to put words to any of them. They were too harsh, too shameful. Nothing but self deprecating self talk. She felt Naomi squeeze her hand and tug slightly on her arm. Shaking her head, she pushed the thoughts aside, as if they disappeared with the simple act. "Local anaesthetic only. And Violet, Violet can be there."
"Come on Addi - I'm not doing a d and c on you with a local, that is just crazy," Naomi withdrew her hand and gestured wildly in frustration. "And Violet? As much as I think you need to talk with Violet, I'm not sure her assistance in this surgery, and I know you know this is surgery, is in your best medical interest. This isn't her domain."
"Nay," Addison began, swallowing and exhaling heavily. "I am so close to walking away from this office, from this practice and this town and never, never coming back. I don't know how to handle this. I can't handle this right now. At all. I've got a fever and it's getting worse, please don't make me leave. Okay?"
Naomi panicked for a moment; there was something in Addison's expression that seemed to indicate that she was very serious. She would walk out, away from everything; she was that close to the edge. "Okay...okay. Just...okay."
"You're not going anywhere, Violet," Naomi strode into Violet's office, catching her by the elbow and pulling her back towards her desk.
"What do you mean, I'm not going anywhere? It's seven at night, we're the only ones here. This is the point where we go home to our miserable lives and pretend that we're independent, feminist women."
"You're not going home yet, we have a crisis and you're needed."
Violet rolled her eyes and slumped into her chair, tossing her handbag to the floor. "Why, why are all the crises at night? I could have a date you know, a date with the formidable Bill Clinton and my right hand."
"Firstly, over sharing," Naomi muttered, pushing some items across Violet's desk and sliding to sit on it. "And secondly, how long has it been since you've done Gynae?"
"Gynae? I'm a Psychiatrist Naomi, just in case you missed that memo over the last decade or so."
"Did you do an intern term or anything? Can you just be serious for two minutes," Naomi snapped, voice raised and fingers rubbing at her forehead.
"Okay, I can do that. What's going on?" Violet said calmly, leaning forward. When she received no response, she continued gently. "I actually did a little, I did a rotation as an intern and did a year of my residency in Obstetrics before I had my first abortion and changed my career plan. Why?"
"You need to help me do a d and c without anaesthetic."
Violet coughed and laughed lightly. "You need me to do what? I realise that we embrace the co-op idea but this might be crossing the line. Are you and Addison fighting again? She'll help."
"It's for Addison. And she's being very weird about it all and well, she chose you. And for the record, you wouldn't have been my choice."
"Thank you. I think. But hang on, for Addison? What she's not doing Gynae surgery these days? What have I missed? I don't think our indemnity insurance covers me doing any type of surgery."
Naomi shook her head and waved her hands in front of her. "Sorry, no. Addison has had a missed miscarriage, she needs a d and c and is having some melt down about it all and she has asked me to do it, which is fine. But it's not something I can just whip up alone, you know. And she's refusing to have an anaesthetic, because that would mean going to the hospital and theatre and she's wanting a cone of silence. And she chose you. Your guess is as good as mine as to why."
Violet nodded slowly, her mouth forming words before any sound came out. "Whoa," she eventually muttered. "Is she, I mean - she's obviously not okay."
"Well, she's spiked a temp which means she needs to do it tonight but other…"
"No," Violet interrupted, "that wasn't what I meant."
"Oh," Naomi responded, slowing down and looking at Violet. "She thinks it's her fault, because of her termination. She thinks she deserves this."
Violet nodded slowly. "And the limited egg, fertility issue thing. I'm surprised she's even functioning." Naomi nodded, letting her chin drop as tears welled in her eyes. "You okay?"
Shrugging her shoulders, Naomi said softly, "Every day we save someone, somehow. But ourselves - we're not so good at saving ourselves; or each other."
Violet nodded, reaching to linger her hand lightly on Naomi's shoulder. "Then let's go save one of us."
"So," Violet began, trying to keep her tone light. "I would like you to take note Addi, you've got me in scrubs." Addison forced a smile up at her, anxiously lying back while Naomi manoeuvred the ultrasound machine towards the bed. "And, there's no couch," she added, trying for the second time to slip her hand into Addison's, but again, it was rejected. Just pushed away as if holding on meant she was done, defeated.
"Alright; I just need to do the ultrasound, get some details and then we can get this done, yeah?" Naomi asked softly. She looked nervous and on edge, taking slow and deliberate breaths to control the slight tremble in her hands.
Addison simply nodded, positioning the sheet over her pubic bone and raising the gown to expose her abdomen. She turned her head away as Naomi began the ultrasound, intently staring at the screen and tapping at the keyboard to capture measurements. "Sixteen weeks, five days," Naomi stated softly, "there's no heart beat." Addison blinked repeatedly, head turned and eyes fixated to the right of Violet. "You must have been further along than you thought." She didn't respond, just closed her fists around the gown that she clutched to her chest. Naomi and Violet glanced at each other, questioning glances thrown over the bed.
"So what now? What are the options, Naomi?"
"I can deliver," Addison answered, "just induce me."
"You need a hospital."
"No."
"Yes."
"No," Addison raised her voice and sat up. "If neither of you will do this then...then I can't stay here. I can't." She slid off the table, clutching the sheet with her. "I have never asked you…" she trailed off, voice catching in her throat and the anger dissipating quickly. "Let me go," she pleaded tearfully as Violet stood in front of her, two hands gripping her shoulders.
"I'm not the expert that either of you are," Violet began firmly. "I'm, you know, the eccentric therapist that tends to annoy people. So, I don't get to have an opinion here on the best treatment. But, I do know that walking out of here isn't such a great idea."
"Just let me go."
"Where Addi, where are you going?" Naomi asked.
"Please let me go," Addison repeated, staring weakly at Violet.
"Ummm," Violet responded, "no."
"No?"
"Let Naomi make this decision. She knows you and she knows what is best."
Addison's eyes flickered and she bit at her bottom lip. "Fine. Just let me go."
Naomi moved to stand behind Addison, wrapping her arms around her waist resting her chin on her shoulder. "No," she stated softly, "not a chance. This is the time to be a mess, remember?"
"I don't want to be a mess right now. I've cried, I'm done with crying. I just want this...this out."
"What is it; that you want out?" Violet asked gently.
Addison scowled. "You know what."
"Yeah, I know. But I want you to say it."
"Don't psych me."
Violet smiled calmly, unfazed. Years of therapeutic work meant that her skills kicked in almost automatically; it was a detriment at times. She could slip so easily into the therapist role and lose touch with her own personality. And sometimes friends didn't need a professional, they just needed someone to be there and hate the world with them; not someone that was desperate to talk them around to accepting it. "It's a baby; your baby."
Addison's eyes clouded over and she tensed against Naomi's hold. "It's not anymore," she replied, holding on to bare remnants of control. "Can we get this done or am I going to walk out of here?"
"What I'm going to do," Naomi began, "is phone Charlotte and get an OR prepped with an Anaesthetist and admit you as a Jane Doe." Addison shook her head weakly but Naomi continued, unwavering in her decision. "This is the way it's going to happen. You'll be out by midnight, tucked up in bed with the two of us standing guard. You got that? And while I'm on the decision making roll, you're taking some time off, no arguments – even if I have to take you on a vacation to make sure of it."
Addison glanced up to Violet in a final, silent plea for intervention. It remained unanswered. "I told you, the experts make the decisions."
"Right, I'm going to go and make the calls. Vi, is going to make sure you don't run on us."
Violet nodded her agreement, hands still gripping Addison's shoulders as Naomi quietly slipped out of the room. They stared at each other momentarily, each trying to figure out what action to take, what to do next. It was Violet that moved first, releasing her hold for the first time to step forward. She drew Addison tightly against her, guiding her face towards her shoulder and wrapping her arms against her back. "You don't need to…" Addison whispered, her sentence trailing off.
"Naomi will never forgive me if you leave," Violet replied, smiling. "And hey, it's this or I offer you my closet – which I actually recommend. I like it there."
"You're hugging me so I don't run?"
"No – I'm hugging you because you need it, even if you think you don't. And the not running thing, that's an added bonus."
Addison nodded, silently allowing the tears that had been pooling in her lower lids to tumble down her cheeks. "How do I do this?"
Sighing, Violet tightened her hold with one arm wrapped around Addison's back and the other, gripping her ponytail between her shoulder blades. "You're already doing it."
The response was a chocked cry, a guttural and tortured sound that brought tears to Violet's eyes. Addison dipped her chin and pressed her forehead to Violet's clavicle, sobbing into the nape of her neck. Her body trembled and limply moulded against her colleague; the façade finally torn apart by grief.