Annie hadn't been feeling great for a few days when she paged Josh to an exam room.
"What's going on," Josh asked, "are you okay?"
Annie locked the door behind Josh.
"What's going on," Josh asked.
"I think I'm pregnant ," Annie blurted, "I'm tired, my boobs hurt and I'm really nauseous, I've vomited twice today and a couple times yesterday and I never got my period after having the IUD taken out. I've been nauseous for a few days. I've hardly been hungry."
"When should you have gotten it ," asked Josh. He was surprised they had only just started thinking about a baby and letting nature do its thing. They weren't even really trying yet. They were going to wait until after his birthday in a couple months to start actually trying. They had been using condoms and they were good about it.
"I don't know about two or three weeks ago I don't remember," Annie replied, "we've been so busy I only noticed today. I've hardly left the hospital in the last few weeks. I go home to sleep and shower."
"When was your last one," Josh asked.
"Beginning of August," Annie replied, "when we saw Carina."
"Do you think," Josh asked.
Annie replied, "maybe. We did have that night in the on call room with no protection, and we've forgotten a couple times at home two. I've felt off all week, even last week something felt different. There's enough symptoms plus I've been nauseous on and off all day for a few days which isn't like me."
"Do you think you're pregnant," Josh asked.
"Looking at my symptoms I'd say 90% chance I am," Annie said, "we agreed that we would try for a baby this year. That it was time."
"We did. Do you want to do a test," Josh asked.
Annie took off her lab coat and extended her arm, "take my blood to the lab. It's the best test."
"Are you sure you want me to do it," Josh asked.
"I want this between us until we know it's alright and healthy," Annie said.
"Of course," Josh said, "ready?"
"I am," Annie replied.
Josh drew the blood test, "under your name or Jane Doe?"
Annie replied, "my name I guess. With HIPAA they can't tell anyone other than you as the dr or me. Mark it confidential."
"I'm going to put a rush on it," Josh said.
Annie went back to work but she was distracted when she met Bailey in the OR.
"Altman get your head in the game," Bailey snapped, "are you going to resect this woman's bowels or not."
"Sorry Dr Bailey," Annie replied.
She continued with the surgery frustrated with the interference from Bailey who's teaching style was much more involved than the attendings she usually worked with. As a 5th year her attendings mostly watched and offered suggestions on routine procedures to make her more efficient. At this point Annie who had specialized cardio at the start of her third year was doing pacemakers, stents and valve replacements almost daily. She was used to her mother's, Maggie's and Nathan's hands off approach with her. After years of building her skills they knew Annie's thought process in the OR enough to loosen the reins and let her try almost anything. Teddy was often Annie's favorite teacher. This year they had a bucket list of surgeries that Annie wanted to learn beyond the day to day list, together they were going to do them all. Friday she was doing a quadruple bypass without stopping the heart she was working on. It was a two person procedure that she was scheduled to do with Teddy but Nathan was going to take over if something came up. Either way Annie was to be the lead surgeon.
As Annie was checking on her patient post op Josh messaged her to meet him in an on call room.
Annie's heart stopped; he had her test results.
She replied that she was on her way and rushed to meet him.
"I haven't looked," Josh said, passing Annie a folded paper with the results.
Annie unfolded the paper, "I'm anemic, TSH and T4 are elevated for me but not alarming TPO is really elevated that needs to be checked and my white cells are elevated."
"Keep looking," Josh replied.
Annie scanned down the page, "I'm pregnant."
Josh kissed her, "we're having a baby."
Annie grinned, "we're going to be parents ."
Josh said, "How far along?"
"6-7 weeks I guess" Annie replied, "we should go see Carina."
Josh replied, "she's here today, text her."
Annie typed, "just got a positive pregnancy test blood work indicates 6-7 week range can you see me today?"
Carina typed, "in office come now."
"She can see us now," Annie told Josh.
"Let's go," Josh said.
Annie and Josh headed upstairs to Carina's office.
Teddy watched them go in the direction of the OB wing and wondered. Then shook her head Annie would have come to her if she suspected. Her daughter would have told her if she was thinking about a baby. But Annie and Josh looked giddy and had their arms around each other, they gave each other a quick peck while waiting for the elevator. It wasn't like them to be affectionate with each other at work. Teddy knew that outside of the hospital they were very affectionate almost to the point of being too much at times. Annie had mentioned wanting a baby after their residences were finished but she hadn't said anything about trying or even having started to think about a baby.
Annie knocked on Carina's door, the OB let them in right away.
"Dr Altman, good to see you and you brought Dr Riggs," Carina said.
"Dr Deluca thank you for seeing me right away," Annie replied, "you've met my husband Dr Josh Riggs."
"Of course I have. It slipped my mind that you were married," Carina replied, "so you have a blood test that says you're pregnant."
Annie passed the paper to Carina, "and anemic with an elevated white cell count. White cells aren't startling. I had a virus last week but it may not have been a virus now that I think about it. I have Hashimoto's disease and my TSH and t4 are within normal limits but are elevated for me, my TPO is very elevated and concerning. We will need to watch that."
Carina skimmed the page, "your blood work shows the baby should be at about 6 or 7 weeks. We can try to see them on an ultrasound but there may not be a visible heartbeat yet. It's early for a scan."
"Let's do the initial exam and then look," Annie said.
Carina went through her initial exam with Annie and asked a few questions about her medical history and family history. Carina was surprised that Annie only knew Teddy's side of the family, knowing the chief of surgery she thought they would know more about Annie's biological father. Josh was also only able to give a partial history, he knew his father's side of the family though Nathan but no one knew much about his mother's side. Annie's initial exam looked good but Carina adjusted her thyroid medication as a precaution, raising the dose to make sure Annie's body would support the baby. Her thyroid function would have to be carefully monitored. Carina answered all of Annie and Josh's questions . Doing an ultrasound she found a tiny but healthy fetus and a faint flutter of the growing heart. Carina printed the pictures and handed them to Annie.
"Do you want to hear the heartbeat," Carina asked.
"Yes," Annie and Josh said together.
Carina turned on the speaker.
"It sounds good," Annie said her eyes filled with tears, "that's a healthy baby heart. It's the best sound I've ever heard."
"Our baby sounds good," Josh said, "and is growing perfectly. "
"Looking at your baby I'd say you're 6 weeks and 5 days," Carina said, "and that would line up with conception about 14 days after we removed your IUD. Baby looks good for just under seven weeks."
"It's a perfect little baby bean," Annie said.
"Our little monkey," Josh said.
"I'm going to put your due date between May 10 and 15," Carina said.
"Is everything okay," Annie asked.
"It all looks good Grace," Carina said.
"When will you know a precise due date," Josh asked.
"I want to see how your baby grows before I decide," Carina said, she returned to the charting program adding a few notes to Annie's chart.
Josh pulled Annie to a sitting position and she smiled at him.
"We're going to be parents," Annie said, "our own baby. A family of three."
"You're going to be a mom," Josh beamed.
"You're going to be a dad," Annie smiled.
Josh kissed Annie, "I love you."
"I love you too," Annie replied.
"Before you go to Dr Altman," Carina said, "I would advise you to let the chief of surgery know soon , as your pregnancy does affect your job. You can not use the portable X-ray machine and need extra protection for the fluoroscope. You have to avoid any source of radiation."
"You know the chief is my mother," Annie replied, "we were hoping to wait to tell our family."
"As your attending she needs to know," Carina replied, "there are immediate impacts on your workload and what you can and can not do."
"Are things safe to tell family," Annie asked, "I thought we had a few weeks to wait."
"Tell your mother," Carina said, "you're young and healthy the baby looks good. I see no reason not to share the news with your mother and stepfather."
"We will this week," Josh said.
"I will see you soon. I want to monitor your thyroid function in two weeks to make sure your levels are where they should be. If something feels wrong, call me anytime Grace," Carina said, "I will answer any questions Chief Altman has about what you can and can not do."
When they left the room Annie said, "I wanted time to keep this just us before we told mama."
"I know but we have to keep our baby safe," Josh said.
"They're coming for dinner tomorrow," Annie said, "let's tell them then. I'll come up with something. Tonight we celebrate. "
"How," asked Josh.
"Let's go for dinner, then home for a movie or a bath, then to bed," Annie said.
"Isn't that what created this," Josh asked.
"Maybe," Annie said with a wink.
"You pick dinner," Josh said.
"I'm not super hungry," Annie said, "and my stomach is off. Let's decide on our way home."
"You tell me what you want," Josh said.
"I don't know. I'm still queasy," Annie said.
"We can pick later. What can I do babe," Josh asked.
"Just hold me for a minute before we have to work," Annie said, "I need you with me for this. I can't do this alone, I'm scared."
"I'm nervous too," Josh said, "but we will do this together. I am here every step of the way. You have to tell me what you need."
"Right now I need a hug," Annie said, "and apple juice, it always settles my stomach."
"I can do the hug now and there's juice in the lounge and cafeteria," Josh said.
They sat on the couch outside Carinas office and took a moment to enjoy the good news.
Josh put his hand on Annie's stomach, "hey little one it's daddy I can't wait to meet you."
Tears filled Annie's eyes, "don't make me cry at work. No one can know yet."
"You can't hide it forever," Josh said.
"A few weeks. Give it six or seven weeks so everything is okay," Annie said.
"Annie are you okay with this," Josh asked.
"I want this. You, our baby, me. The three of us," Annie beamed, "I'm really excited. Are you okay with this? Do you want this?"
"I do. I want this baby and to be there with you," Josh promised, "I'm excited. You know I'm going to get really over protective."
"Only around X-rays," Annie said, "for now."
"You have to be careful," Josh said, "Annie I'm excited. I'm a dad."
"You are and I'm a mom," Annie beamed.
Their pagers both buzzed. They quickly kissed then went their separate ways to complete their shifts.
Josh walked to the ICU to check on his patient. He was a little shocked. He was going to be a dad. Annie was pregnant. He was excited but a little nervous and suddenly really worried about Annie. She'd hardly eaten all week and that usually wasn't something he made a stink about when she was stressed or busy but now she had to eat. He was excited in 9 months they would have a baby in their arms. Suddenly he was amazed by her. Seeing the scan and the tiny beating heart that was real this was his family. He wanted to be there for her for all of it. No matter how sick, grumpy or hormonal she got he would be there for all of it.
Annie was paged to the pit for a cardio case. She arrived and quickly diagnosed the heart attack and brought them up to the cath lab. This was something she needed to tell an attending she was doing. Annie paged Teddy who was the cardio attending on call.
"Let's get an intern to do it," Annie said.
"Why," Teddy asked.
"Mine haven't done one yet," Annie replied, "I can teach it."
"You teach and rescue if needed," Teddy said, "I'll supervise."
Annie nodded, "okay."
Teddy watched as Annie grabbed a protective apron and then passed in to her intern.
"I don't get one," Teddy asked.
Annie passed one to Teddy.
The intern was nervous and shaking.
"I'll do it," Annie huffed.
Teddy watched as Annie accessed the man's vein and began to work her way towards his heart. She opened up the blocked arteries near the heart then sent him to the cardiac ward directing an intern to monitor and page her if anything changed.
"Is everything okay," Teddy asked, "you were eager to pass that off and have been distant all day."
"I'm good," Annie said, "can't believe this is my last year here."
"Maybe not," Teddy said, "you're going to apply to our fellowships."
"Cardio, peds cardio and peds," Annie said, "I'll apply to the fellowships at Seattle Pres and the university of Washington," Annie said, "we really want to stay in Seattle it's our best chance of staying together."
"You and Josh won't go anywhere without the other," Teddy said.
"We can't," Annie said, "the same hospital is preferred but we have to be in the same city."
"Most trauma fellowships are a year. It would suck but you could make it work if you have to," Teddy said.
"We can't be apart," Annie said, "we really want to stay here. This is home and where we belong. Our family is here."
"You've been really spoiled doing your residency here and with family all around you," Teddy said.
"This isn't a good time to go," Annie replied.
"What do you mean," Teddy asked, "is everything okay?"
"Josh and I are great but your chief and we're helping more with Ali and Leo which we love doing. Nana is getting older and needs more help. Josh is doing a lot of mentoring with Faroke," Annie said. She almost slipped and blurted her news to Teddy in the scrub room.
"We're looking at hiring a nanny so we don't have to rely on family now that my schedule has gotten crazy," Teddy said, "it's not what I ever wanted for my kids but I think we need one. "
"You're not hearing me, we love having Ali and Leo," Annie said.
"You should be focused on you and Josh. Finishing this year maybe thinking about starting a family. You and Josh could start talking about a baby if you wanted," Teddy said, "not babysitting your little siblings."
Annie fought to keep from telling Teddy the news. She wanted to tell her then and there but had promised Josh they would both be there when they told Teddy and Owen. Teddy's starting a family comment hit a little too close to home today and Annie wanted to tell her that they would be having their own addition to the family in May. When Her mother mentioned thinking or talking about a baby Annie had to literally bite her tongue not to tell.
"We need to be close to family," Annie said, "hopefully if we have to leave Seattle we can at least stay on the west coast. But we'll go together."
"You could make a year or two work if you had to. Don't hold yourselves back to be a couple," Teddy said, "if you got offers like Mayo or Columbia, Hopkins, Annie you have to go. It's not like I wouldn't bring you on as attendings when you finish fellowships if you wanted to come home. As long as I'm chief you will always have a place. There will always be a place for you here."
"We have to stay together mama. I can't do this without him right with me," Annie said, "I don't want to start over in a new city. My people are here. This is home."
Teddy eyed Annie critically, "what aren't you telling me. There's something going on. You've been quiet all day eager to hand things off to interns. You and Josh disappeared for a while. You went white when I mentioned a baby of your own and have been crabby all week. You're pale and look like you're not feeling well sweetheart are you sure you're okay?"
"I'm fine it's just fifth year stress," Annie lied, "I didn't get Chief resident. I have to find a way to make myself stand out for fellowships. Everything counts this year. The stakes are higher than ever and it's stressful."
"This isn't just work stress sweetheart there's something else going on," Teddy said, "you really didn't like my comment about your own baby what's going on? Have you and Josh been talking about it?"
Annie desperately wanted to tell Teddy what she had found out earlier that day. She wanted to tell her that she was grumpy because she felt nauseous, she thought she was going to vomit again and just wanted to go home. But she had promised Josh he could be there when she told her mama. She wanted to tell Teddy what she was feeling and what she knew. That she was panicking about being a mom. That she felt terrible and just wanted to go home and sleep. Annie wanted Teddy's advice, she needed her mother.
"We had that talk awhile ago," Annie said, "it's really that we've hardly been home again. That stem cell project is taking a lot of time."
"We can get junior residents," Teddy said, "you sure you're okay? You look worn out, when was the last time you really slept?"
"I haven't been sleeping great. Josh has been on nights for a couple weeks and I've been coming in early to get to all my patients and do skills labs for interns," Annie admitted.
"How many labs have you been doing," Teddy asked.
"Three a week," Annie said, "it's typical of my year Altman and Riggs will pick up the slack. She can't complain because her moms the chief."
"Stand up Annie," Teddy commanded, "it's not doing you any favors. I saw you do it when we were in Haiti. You told Chris and his friends exactly what they were going to do and how they would do it. You can lead, you can command, you need to do it. That's why you weren't the Chief resident, you don't use your voice. Stand up and tell your group that you won't be taking extra work on."
"I'm done with my surgeries for today," Annie said, "I have a few post ops I need to check then to finish preparing my skills lab. It's an easy one on connecting with kids and making kids feel safe."
"So how to be you," Teddy laughed.
"Every day this week and next," Annie replied, "but I should go get set up. This group is full of keeners who will be there early."
"Enjoy your skills lab," Teddy said.
"Were off tomorrow, do you and Owen want to come for dinner with the littles," Annie asked.
"Usual time," Teddy clarified.
"Of course," Annie said.
"Well be there," Teddy replied.
"See you tomorrow," Annie said as she walked out of the lab.