Chapter 28: What's Wrong with Twin B?
Annalisa sat with Owen and Amelia as a tech performed the 3-D ultrasound. The room was silent except for Annalisa's occasional requests that the tech snap a picture now and then. When the ultrasound was completed, Annalisa encouraged Amelia to get dressed and wait in the waiting area while the films were analyzed. She offered them a tight grin as she headed out the door.
"That's not good," Amelia opined as she dressed. "If we are waiting to meet her in her office, that's a bad sign, Owen." The pace of her speech quickened with each word.
"We don't know that, Mia," Owen corrected, placing his hand on one of her shoulders. "Every doctor has a unique style. Maybe Annalisa always discusses any result in her office." After holding her coat up for her, Owen looked out the window. He was lost in his thoughts.
Amelia grabbed her purse and headed toward the door, then turned her head over her shoulder, snapping anxiously, "You coming?"
"Yeah," Owen responded as he brought himself back to the present moment. They walked to the waiting area and Owen's pager sounded. He looked down at it and frowned, "I need to deal with this. Can I send someone up to sit with you?"
"You don't have to do that," Amelia told him with a dismissive tone. "I'm fine. We don't know anything yet, right?"
"Right," Owen leaned down and kissed his wife then ran toward the elevators.
Amelia sat in the area all alone and flipped quickly through every magazine. She fumbled through the pages more to give herself something to do than because she was looking at the articles. Occasionally, she would stand up and pace around the room. Owen ignored Amelia's request that he not send somebody and explained the situation to Derek. After patting Owen on the shoulder and encouraging him to hang in there, Derek assured Owen that she wouldn't know Owen had sent him.
Derek grabbed some scans he'd reviewed earlier in the day and headed to the waiting area where Amelia sat. "Amy, I'm so glad you're still here," Derek remarked with delight.
"I am. I am here. What's up?" Amelia expressed as she attempted to appear as normal as possible.
Derek held up a scan of a complicated tumor. He didn't actually want or need her advice, but it gave him an excuse to talk to her and sit with her. "This is my surgery tomorrow," he revealed.
Amelia's eyes widened with delight at the thought of removing that tumor, "Wow. It's a beauty."
"I love how tumors make you smile," Derek scoffed. "Anyway, I'm planning an anterior approach right about here." He pointed to a specific area on one of the scans.
"That sounds reasonable," she affirmed as she took the scan to get a closer look. "You could also position the patient, so you began here or here," she suggested as she pointed to other entry options. "If it were my surgery, I'd either choose your approach or my first suggestion. This one over here puts you at an odd angle later in the surgery when you get to this part of the tumor."
Derek leaned over and examined the scan with his sister, allowing as much time as possible for the two of them to simply become lost in the film. Anything that ate up her waiting time and provided someone to sit with her was worthwhile. The siblings lost themselves in the scan for at least 30 minutes.
Over the loudspeaker, an announcement interrupted the silence, "Dr. Robbins, please call 7833. Dr. Robbins, 7833." Since the words were broadcast hospital-wide, Owen, Derek and Amelia all heard them.
Derek clasped Amelia's hand and comforted her, "I'm sure it's not related."
"Yeah," Amelia tentatively squeaked. "Except that's Annalisa's extension."
"You're not her only patient, Amy," Derek reminded her. Amelia just glanced at her brother as she squeezed Derek's hand.
After sending a quick text to Amelia letting her know he was on his way, Owen hurried down the hall and pressed the elevator button impatiently multiple times. Arizona appeared with a happy grin and stood next to him. The two greeted each other as Owen pressed the elevator button again.
"You know that doesn't help, right?" she expressed.
Owen looked at her blankly, "Yeah."
The elevator arrived and the two discovered they were headed to the same floor. He was anxious, but tried to make conversation, "Where are you headed?"
"Annalisa Wakefield asked me to consult on a case," Arizona offered without concern. She had no idea Amelia and Owen's twins were the patients.
"Oh," Owen uttered heavily.
"How about you? Where are you headed?" Arizona asked.
"Amelia and I are waiting to meet with Annalisa. She's analyzing our babies' films," Owen said with a frown as he folded his arms.
Arizona grimaced awkwardly and echoed Owen, "Oh." After a brief pause, she fumbled for additional words, "I'll … uh… we'll get you back to chat as soon as possible, ok?" Owen grinned and nodded his head.
Owen joined the two neurosurgeons and took a seat. They were both simply staring ahead as Amelia held the slides in her lap. Trying to start some sort of conversation, Owen lifted the slides toward the light and expressed, "Quite the tumor. When are you operating on that, Shep?"
"Tomorrow," Derek responded. Owen observed that Derek was distracted.
Annalisa came out the door and motioned to Owen and Amelia, "Doctors, thanks for waiting. Come on in."
Derek stood up and excused himself, but Amelia kept hold of his hand, "Will you come too?"
Derek was stunned. "Sure, I suppose. Owen, do you mind?"
Owen responded confidently, "Whatever Amelia wants. It could be helpful to have another set of ears in the room." He put his arm around her and guided her forward by placing his hand on the small of her back.
Arizona was in the consultation room when Annalisa returned with the other three. Attempting to remain emotionless and expressionless, Arizona nodded as she saw each doctor arrive.
"Why are you here, Arizona?" Amelia asked anxiously. Turning to Annalisa, she repeated her inquiry, "Why is Dr. Robbins here?" Owen delicately pulled Amelia down to a chair.
Annalisa began to share factually, "Dr. Shepherd-Hunt, Dr. Hunt and Dr. Shepherd, before I begin, I want to assure you that Twin One looks completely healthy and on track. The great majority of our findings provide reason for celebration. Neither twin is taking up more space than the other. All signs are hopeful with one exception. Dr. Robbins and I would like to show you some slides of Twin Two."
Standing up, Annalisa placed the first slide onto the light box. She began with the most comprehensive view of the baby. Each subsequent slide offered a closer view than the slide that preceded it. Annalisa smiled widely as everyone viewed and was captivated by the 3-D image of the baby. "The fetus has well developed limbs, fingers and toes. As you can see, the fingers and toes are still fused, which is completely normal. Twin Two has an independent thumb already, which is early but fine. Facial features are still vague. Vital organs appear to be functioning and both twins will double in size over the next 3 weeks."
"Then what's the problem?" Owen choked out, attempting to clear his throat.
Arizona stood and put up the next slide. She began to explain, "We had to request an incredibly magnified view to even begin to wonder what we might be seeing. Annalisa noticed this bump during the first ultrasound. She and I have analyzed the next slide in depth. Let me show that to you." Arizona put an enlarged version of a slide on the light box. As neurosurgeons, both Derek and Amelia identified the problem right away. Derek put his hand over his mouth and chin and closed his eyes. Amelia stared deeply at the image. Owen saw a concern but did not have the expertise to diagnose it.
Taking over, Annalisa pointed at the detailed image, "It is too early to be completely sure, but we both suspect the baby might have a neural tube anomaly. The spinal cord may even correct itself. We'll need to keep a close eye on you, Amelia, and the babies. Even so, there's no reason for you to remain on bedrest. You'll need to reduce your stressors and avoid standing still for longer than 3-4 hours, so you'll have to delegate some of your procedures."
"Derek here would be happy to take my fun and complex surgeries, I'm sure," Amelia quipped sarcastically.
"What's the next step, Annalisa?" Owen inquired, still in doctor mode.
Annalisa explained, "I'll be honest, a large majority of parents choose to terminate at this point. We can discuss reduction to a single pregnancy if you'd like."
Owen looked deeply at Amelia as Amelia answered, "No termination." Owen nodded.
"Then we'll perform another 3-D in 3 weeks. From that point, we'll know what the next step might be. This is a step-by-step process with options and decisions at each step, rather than a big picture plan. At this stage, it's nearly impossible to predict beyond the next few weeks," Annalisa explained.
"What decisions will we face next?" Owen asked.
Annalisa tried to make eye contact with Amelia, but Amelia's gaze remained fixed on the scan. She looked as if someone had drawn all the air out of her lungs. Turning to Owen, Annalisa explained, "At 13 and 16 weeks, we'll look for more detail and keep an eye on Twin Two's development. If you want to revisit the topic, termination remains an option for some time. It is possible no decisions will arise until the definitive diagnosis, which will come around 19-20 weeks. Let's focus on each present moment for the next 9-10 weeks as best as we can. As always, if anything strange occurs or if you have questions, just call."
Amelia was tightly holding Owen's hand as the doctors offered information. Her head felt foggy from all of the overwhelming information. Derek analyzed the scans and discussed them with Annalisa and Arizona. To Amelia, their voices sounded like the adults in Charlie Brown cartoons. In the middle of someone's sentence – she wasn't even sure who was speaking - Amelia uttered, "I… I need to go home. I can't talk about this anymore."
Owen stopped mid-sentence and put his arm around Amelia, "Then let's go home."
"You have the union negotiations and the resident reviews and budget reports," Amelia reminded him blankly.
"Yep. That's all on my desk – where it will stay for the rest of the day."
Derek stood up and hugged Amelia, attempting not to become teary. He whispered to her, "Anything you need…you know to call, right?" Amelia nodded without emotion.
Owen thanked Arizona and Annalisa and mentioned he would be in touch to set up the next appointment. Both doctors forced grins and nodded. Leaning down toward her ear, Owen whispered to Amelia, "Let's take the elevator to the basement and go out the North doors. Less chance of running in to people. Just lean into my chest and close your eyes. I'll talk to anyone who tries to chat with us." Amelia nodded numbly. Her only goal was to go through the necessary motions until she could crawl into bed and hide from reality.
A few days later, a soft and cool breeze woke Amelia up. She sat up in bed and noticed Owen was not next to her. Seeing the balcony doors wide open, she put on her robe and headed outside.
Owen had been up most of the night tossing and turning. Finally, at 4:30am, he decided to sit outside and listen to the water lap against the shore. Wrapped up in a blanket and sitting up on a lounge chair with his chest against his knees, his back heaved up and down and he sobbed into his hands to muffle any noise. He wanted to protect and tend to Amelia during the day, so he had been allowing himself time to fall apart every morning before anyone awoke.
Amelia's heart sunk when she neared her husband. He had appeared so optimistic and resilient since the ultrasound. In many ways, he had served as her strength. She had been so comforted by his words and steady presence that she assumed he simply wasn't hurting like she was. Now she saw a fuller picture. Publicly, and even with his wife, he was emotionally contained and calm. Inside and in early morning private moments, he lived in terror and dread. Slowly, she approached him from behind and cleared her throat softly to avoid surprising him. She gently placed her hand on his shoulder, and softly cooed, "Owen."
Slowly and deeply inhaling and exhaling as he quickly wiped his tears away, his hoarse voice croaked, "Mia." He reached up his hand and grasped hers without looking at her. "I don't want you to see me like this."
Amelia pulled up a chair next to his, "How about if I sit next to you and not look?"
Softly chuckling, Owen sniffled and clarified, "That's not exactly what I meant, but, yeah, sure."
"Owen," Amelia began quietly, "I hope you know I want to be here for you as much as you've been here for me. You don't have to hold your angst inside or hide it from me."
He leaned back in the chair and lay down, pulling the blanket off of his body and handing it to her, "Here. You're going to get chilly."
Amelia stood up and put it back on his body, then squeezed next to him on the chair. She suggested, "How about we share it and keep each other warm?"
Owen embraced her and held her tightly, leaning his head against hers. The couple stretched out together under the blanket. They each held the other as if life depended upon it.
"Do you think the baby can sense the spinal irregularity? Does it hurt? Can Twin One sense that there's a problem?" Amelia pondered aloud as she watched the water and took a sip of Owen's lukewarm coffee.
Owen shook his head and ran his fingers through his hair, "I don't know, Amelia. I … I just… can't go there. I don't … I don't know."
Caressing his chest and torso, Amelia suggested, "Maybe you should stay home today. You've been carrying all the unknowns, all the burdens of being Chief, and our day-to-day family realities on your shoulders. You need to take a break."
"I'll be fine," Owen declared clearly but unconvincingly.
"It's my first day back, Owen. If you come in, you'll fret over me all day long. You'll be distracted whether you're reading documents, hovering over me, or operating. Stay home," Amelia insisted then joked, "I'll even write you a doctor's note."
He grabbed her hand and chuckled, "I'm going back to bed then." Then he stood and kissed the top of her head before walking back into the room. Once again, Amelia's heart sunk as she replayed the conversation in her head. Owen was a stalwart source of strength and comfort to her; however, at least at this point, he was unwilling to let her reciprocate. She thought to herself, I'm not sure if he realizes that allowing me to care for him would help me not hyperfocus on the babies and all the concerns. Isolating himself won't serve him or us well. The same chair that had provided a resting place for Owen earlier, now enveloped Amelia as a few subtle tears fell from her eyes. The predictable lapping of the water along the shore seemed to be the only predictable reality.
Any guesses on what the diagnosis may be? Comment below.