Robin Cook: Mindbend

Putting down his pen, Vandermer took out his stethoscope and gave Jennifer a rapid but thorough physical examination, peering into her eyes and ears and listening to her chest and heart. He tapped her knees and ankles, scratched the bottoms of her feet, and inspected every inch of her body. He worked in total silence. Jennifer felt as if she were a piece of meat in the hands of a very competent butcher. She knew Dr. Vandermer was good, but she could have used some warmth.

When he finished, the doctor sat down and quickly wrote his findings on the chart. Then he asked Jennifer about her menstrual history and the date of her last period. Before she could ask any questions he motioned her into a prone position and began the pelvic.

“Just relax now,” said Dr. Vandermer, finally remembering that his patient was probably anxious. Jennifer felt an object enter her. It was done smoothly and expertly. There was no pain, just an unpleasant fullness. She could hear Dr. Vandermer speak with the nurse. She heard the door open and saw the nurse leave.

Dr. Vandermer stood up so that Jennifer could see him. “The IUD is still in place, but it looks like it is low. I think it should be removed.”

“Is that difficult?” asked Jennifer.

“Very simple,” said Dr. Vandermer. “ Nancy went to get me an instrument. It will only take a second.”

Nancy returned with something that Jennifer could not see. She felt a fleeting twinge of pain. Dr. Vandermer stood up holding a coil of plastic in his gloved hand.

“You definitely are pregnant,” he said, sitting down at the desk and writing anew on the chart.

Jennifer experienced a rush of panic similar to the one she had felt the moment she saw that the home pregnancy test was positive.

“Are you sure?” she managed with a quivering voice.

Dr. Vandermer did not look up. “We’ll confirm it by laboratory tests, but I’m sure.”

Nancy finished writing labels on the specimen tubes and came around to help Jennifer remove her feet from the stirrups. Jennifer swung around so that she was sitting on the side of the examination table.

“Is everything all right?” she asked.

“Everything is perfectly normal,” assured Dr. Vandermer. He completed the chart, then spun around to face her. His expression was as neutral as when he’d first entered.

“Can you give me some idea of what to expect?” asked Jennifer. She folded her hands to steady them and put them on her lap.

“Of course. Nancy Guenther will be your nurse practitioner,” Dr. Vandermer said, nodding at the nurse. “She’ll go over things like that with you. I’ll be seeing you for routine visits monthly for the first six months, then every two weeks until the last month. Then weekly unless there’s a complication.” Dr. Vandermer got up and prepared to leave.

“Will I be seeing you each time I come?” asked Jennifer.

“Generally,” said Dr. Vandermer. “Occasionally I might have a delivery. Then you would be seen by one of my associates or Nancy. In either case they would report directly to me. Any other questions?”

Jennifer had so many questions she didn’t know where to begin. She felt like her life was coming apart at the seams. She also had the feeling that Dr. Vandermer wanted to leave now that the exam was over. “What about when it comes time for my delivery?” she asked. “I don’t mind seeing someone else for a routine visit, but when it comes to delivering, I feel differently. You’re not planning a vacation around my due date, are you?”

“Mrs. Schonberg,” began Dr. Vandermer. “I haven’t taken a vacation in five years. I go to an occasional medical meeting and I’m planning to lecture at a cruise seminar in a couple of months. But that certainly will not conflict with your due date. Now if you have no more questions, I’ll turn you over to Nancy.”

“Just one more thing,” said Jennifer. “You asked about my brother. Do you think it is significant that my mother gave birth to a defective child? Does it mean I might do the same?”

“I sincerely doubt it,” said Dr. Vandermer, edging toward the door. “Leave the name of your mother’s doctor with Nancy and we’ll call and find out the details. Meanwhile, I plan to do a simple chromosomal study on you. But I don’t think there is anything to worry about.”

“What about an amniocentesis?” asked Jennifer.

“At this point I don’t think there is any need for such a procedure, and even if there were, it couldn’t be done before your sixteenth week. Now if you’ll excuse me, we’ll see you in a month.”

“What about an abortion?” asked Jennifer anxiously. She didn’t want Dr. Vandermer to leave. “If we decide not to have this child, is it difficult to arrange for an abortion?”

Dr. Vandermer, who’d had a hand on the door, stepped back in front of Jennifer, towering over her. “If you are interested in an abortion, I think that you are seeing the wrong doctor.”

“I’m not saying that I want one,” said Jennifer, cowering beneath his glare. “It’s just that this isn’t a good time for me to be pregnant, as you said yourself. I haven’t told Adam yet and I don’t know what his reaction will be. We depend on my income.”

“I don’t do abortions unless there’s a medical reason for it,” said Dr. Vandermer.

Jennifer nodded. The man obviously felt strongly about the issue. To change the subject she asked, “What about my working? I’m a dancer. How long will I be able to continue to work?”

“ Nancy will discuss such questions with you,” said Dr. Vandermer, glancing at his watch. “She knows more about that kind of stuff than I do. Now, if there is nothing else…” Dr. Vandermer moved away from the examination table.

“There is one other thing,” said Jennifer. “I’ve been nauseous in the morning. Is that normal?”

“Yes,” said Dr. Vandermer, opening the door to the corridor. “Such nausea is present in at least fifty percent of pregnancies. Nancy will give you some suggestions on handling it by altering your diet.”

“Isn’t there something I could take?” asked Jennifer.

“I don’t believe in using medication for morning sickness unless it’s interfering with the mother’s nutrition. Now if you’ll excuse me, I’ll see you in a month.”

Before Jennifer could say another word, Dr. Vandermer was out the door. He closed it behind him, leaving Jennifer with Nancy.

“Diet is a very important part of pregnancy,” said Nancy, handing Jennifer several sheets of printed material.

Jennifer sighed and let her eyes drop from the closed door to the sheets of paper in her hands. Her mind was a whirl of conflicting thoughts and emotions.

Adam turned west on Twelfth Street, heading directly into the wind and rain. It was pitch dark already, despite the fact that it was just seven-thirty. Only a half block to go. He had an umbrella, but it was in sad shape and he had to wrestle with it to keep the wind from inverting it. He was cold and damp, but worse, he was exhausted, mentally and physically. The all-important presentation had not gone well. Dr. Norton had stopped him not once but twice for grammatical errors, interrupting Adam’s train of thought. Consequently, Adam had left out an important part of the case history. At the end Dr. Norton had merely nodded and asked the chief resident about another patient.

Then, to round out the day, Adam had been called down to the emergency room because it was understaffed and had been given the job of pumping out the stomach of a young attempted suicide. Inexperienced in such a procedure, Adam had made the girl vomit, and he’d caught it smack in the chest. And if that weren’t bad enough, fifteen minutes before he was to be off duty, he got a complicated admission: a fifty-two-year-old man with pancreatitis. That was the reason he was so late coming home.