Dallas, Texas
"Dallas Memorial? Are you saying something is wrong?" holding Pam's clammy hand in his, Bobby spoke for her, asking Doctor Miller straight what was going on. After having several appointments with several different specialists about how the neurofibromatosis that ran in Pam's family would affect her pregnancy, it was not from her regular obstetrician at a routine second trimester appointment that he'd expected to hear she needed hospital care.
"I'm saying I'd like another opinion", avoiding answering the question with a yes or no, Doctor Miller's calm demeanour was far from reassuring. She'd already left the exam room once to consult with another doctor, he considered that a second opinion, so surely if she was seeking a third opinion something was wrong.
Looking at Pam, he could tell she was stunned, and he couldn't blame her; she'd found herself unexpectedly pregnant months ago and since then nothing had been simple. Certain she was in no state to ask questions, he spoke for her again, "may we know why?"
"Yes, of course. Mrs Ewing's blood and urine tests are normal, however, her weight and measurements should be steadily increasing but they've been static for some time now, and combined with continued reports of no movement, an assessment at Dallas Memorial is appropriate", explaining her reasoning, Doctor Miller's words brought him no comfort.
"To decide what?" suspecting a lack of weight gain and movement was serious, he optimistically hoped that it was as Pam had suggested, a result of stress rather than anything more worrisome, but he knew better than to believe that, if it was that they'd be talking about relaxing and taking care of herself at home, not a hospital visit.
"I wouldn't feel confident ruling this as anything yet, that's why I'd like another opinion. Dallas Memorial has a highly qualified team and Mrs Ewing will receive excellent care there", saying words, her comment meant very little; Pam had always spoken of Doctor Miller as straightforward but he felt the opposite, she was hiding something, he just didn't know what.
"I don't doubt that, I'm just asking if we're supposed to be preparing ourselves for bad news", desperate for the answer to be no, he needed to know if it was going to be yes, he had to prepare himself for the shock of heartbreak and for the responsibility of caring for Pam.
"Please Mr Ewing, let's see what the doctors at Dallas Memorial have to say first", repeating herself, she offered him a sympathetic look.
"Does this have anything to do with the neurofibromatosis?" finding her voice, Pam asked a question of her own, one that was understandably weighing on her mind.
Shaking her head, Doctor Miller surprised him, saying, "at the moment I don't think so".
"How soon can we be seen at Dallas Memorial?" sounding anxious, Pam's question was one he had himself.
"Potentially as soon as this afternoon, I can call them now to check", not straying from her calm tone, Doctor Miller finally offered something that actually resembled assistance, not a moment too soon either, because her comments indicated the issue was one that needed to be addressed urgently.
"We'd like that, thank you", accepting her offer, Pam gripped his hand tightly.
A number of hours later, after a long afternoon of tests, questions and examinations, they sat in silence as they waited for Doctor Henderson to return to the consultation room following the extensive investigations.
Studying Pam, he appreciated that her hand was resting protectively on her abdomen. He knew she was willing their baby to kick, roll, or make any movement at all to give her a sign that he or she was healthy and content inside her, however, from her facial expression, he knew there was little cooperation happening.
Watching as the door opened and Doctor Henderson entered, their silence held until he shut the door behind him, but as soon as it did Pam asked, "is our baby ok?"
Sitting, he took a breath and hesitated for a moment before answering, "well, the previous amniocentesis and electronic foetal monitoring we've completed today appear normal, but…"
Delivering what sounded to be positive news so far, he paused midway through a sentence, causing Pam to inhale loudly, as if she was anticipating the remainder of his explanation to be devastating.
"But I understand why Doctor Miller was concerned", finishing his sentence, he paused again before continuing with his findings. "We're working with conflicting information. Based on fundal height, gestational weight and reports of lack of movement it would appear your baby is smaller than average, which can be cause for concern, however, the rest of the tests you've had indicate that everything is as it should be, so Doctor Miller was right to refer you here for further investigation".
"What do you conclude from that investigation?" unsure how to interpret the details the doctor was presenting, he asked for clarity. It sounded to him like their baby was just small, not ill, but he wasn't a doctor and he had no idea whether small was code for something else.
"I don't believe there's immediate cause for concern, the foetal heartrate is normal, and nothing abnormal has shown up in the panel of tests. In saying that, I would recommend increased monitoring, I'll ask Doctor Miller's practice to setup weekly appointments going forward. A full range of investigations will be performed but mostly we'll be looking for increased weight and measurements, that means eating more and worrying less. If you notice any changes, anything that just doesn't feel right then I urge you to seek medical attention", kind, but firm, the doctor's words came as a relief to him.
"Thank you, we will", standing, he reached over the desk to shake the doctor's hand, appreciative of everything he'd told them.
"So I shouldn't be worried that I can't feel the baby moving yet?" sounding tense still, despite the generally good news, Pam's question brought him back to the cold reality of their situation.
"No, with the baby being smaller than average at this moment in time it might take a few more weeks for you to feel anything. In time, with increased gestational age and weight you should begin to see and feel your baby", reassuring Pam, Doctor Henderson's comments were comforting to him too. He couldn't physically feel what Pam did, but emotionally he felt he was experiencing similar feelings to her.
"Thank you", nodding, Pam appeared grateful and relaxed.
"You're welcome", smiling, Doctor Henderson's demeanour put him at ease and for the first time all day, he felt hopeful.
To be continued…