Robyn Carr - Temptation Ridge

“Tomorrow is appointment day and I have three prenatals and four Pap smears. Since you’re working here, you can assist. How does that sound?” Mel asked.

“Like a very slow day.”

“The thing about country medicine is that it runs hot and cold,” Mel said. “This town is so small that days, sometimes weeks, go by without anything exciting. Then everyone will pass around a virus and they’re all hacking up a lung, and while they’re doing that, everyone else is having an accident or going into labor. You have to be ready for everything, and nothing.”

Shelby never tired of Mel’s stories drawn from her nursing career, from the wild days of big-city emergency medicine, to the transition to small-town doctoring. For Shelby, working in a hectic urban E.R. sounded exciting, though she wondered if she’d really enjoy living in a big city. But being a nurse in a town as little as this didn’t seem to have enough jazz for her. More and more she thought she might end up in an emergency or operating room in a place like Santa Rosa—something between big and small. Or perhaps Eureka or Redding.

“Having come from a big-city hospital, there was one thing about small-town medicine that took me by surprise,” Mel said. “In no time at all, your patients are your friends. If there’s some intervention you can’t get to them in time, you feel not only that you’ve failed a patient, but let down a friend. For example, hardly any of the women in this town had been having regular mammograms, and when I finally got a nonprofit foundation to bring a portable X-ray unit to Virgin River to examine the women over forty, one of my best friends was diagnosed with aggressive, advanced breast cancer. She died—and I keep kicking myself for not getting the thing done sooner.”

“You must feel you can never do it all.”

“To the contrary,” Mel said. “I feel I have to think of everything, and I must do it all. To many of these uninsured rural women, Doc and I are all they have. These Pap smears—I’ve cajoled almost every one of them. I call them, I push them, I get them in here and charge only lab costs.”

“It’s an easy thing to let slide, I guess,” Shelby said.

“But you wouldn’t let it slide,” Mel said.

“Well, that hasn’t exactly been a priority the last few years,” Shelby said with a laugh. “But I’ve been meaning to talk to you about that….”

Mel’s back stiffened instantly. “How long might you have let that go?”

“I haven’t had one,” Shelby said.

“What?”

“I’m an extremely low risk,” she said. Then she lowered her eyes. “I haven’t had sex.”

Mel sat forward. “That’s kind of unusual. At your age.”

“I haven’t had a boyfriend. Oh, I dated a little in high school, but not seriously. I’m the product of an accidental pregnancy and my mom raised me alone. If we hadn’t been lucky enough to have Uncle Walt, life would have been a terrible struggle for us. My mom always felt so guilty about that, about taking all his help. I was scared to death of something like that happening to me. Mostly, I was afraid of disappointing my mom and my Uncle Walt.”

“You were very cautious….”

“Well, yes. And I was shy. And then I became nearly a recluse, taking care of my mom. The only men I came into contact with were married doctors, male nurses or hospice volunteers. And here I am, probably your first twenty-five-year-old virgin.” She made a face. “Please, I really don’t want the whole town to know I’m a helpless, recovering introvert who lived with her mother for twenty-five years.”

“Shelby, you know everything in this clinic is confidential—you took the oath when you decided to help out here. Besides, what you did for your mom gets nothing but admiration around here,” Mel said. “It was very selfless. And if you don’t mind me saying so, you seem quite sure of yourself.”

“Oh, I got over a lot of that shyness while I was taking care of her. I had to be assertive to be sure she was getting what she needed medically. Once you learn to stand up to a highfalutin neurologist, you can handle the bag boy at the grocery store just fine. I’m not crippled by shyness anymore, just a newcomer into the big, free world,” she said. “And I don’t want to be unprepared….”

“Honestly, I don’t want the first thing inside you to be a speculum, but you should be examined. There are other concerns—not just cervical cancer. There’s uterine cancer, ovarian cancer. And then you should be protected. Ready. When that time comes, you shouldn’t have too much to be worried about—I can’t imagine you still have a hymen with all that riding….”

Shelby sighed. “I wonder if it will ever happen.”

“It’ll happen.” Mel smiled. “Let me ask you something—how important is it to you that the first time be noticeably the first time?”

“That’s not a big issue with me.”

“I think I can get you through an exam without changing the whole landscape too much.” Mel took a breath. “Let’s do it.”

“Now?” she asked squeamishly.

Mel nodded. “Get naked. I’ll meet you in the exam room. You know where the gowns are.”

A few minutes later Mel let herself into the exam room to find Shelby seated on the table. “Take a deep breath,” Mel said, smiling. “It’s going to be fine.” She helped to ease Shelby into the position, keeping a hand on each thigh so she wouldn’t slide too far. “The good news is, I have really small hands.”

“Thank God for that, huh?”

Mel chuckled and took her stool, snapping on the gloves. She selected a speculum, then selected a smaller one. “Easy does it,” she said, slipping it in. “Well, here’s a surprise. Hymen is still partially intact. After all that riding, I’m amazed.” She collected the Pap smear and removed the speculum. “I was able to slip past it with the swab, but what’s left of the hymen might be sacrificed when I palpate the uterus and check your ovaries.”

“It has to go sometime,” Shelby said. “I was sort of hoping to lose it the way the other girls do.”

Mel chuckled. “This is going to work out better for you. We’ll get everything checked out and find you a dependable pill. No shocking surprises for you, Shelby.”

“A twenty-five-year-old virgin. How often do you see that outside a convent?”

“You’re not the first,” Mel said, standing. She gently palpated the uterus. “Since you don’t have any symptoms or problems, I’m not going to stretch my hand in there any farther today. Your periods are regular?”

“Extremely.”

“No pain between periods?”

“None.”

“It’s all good, Shelby.” She pulled off her gloves. “I usually do the breast exam first, but under the circumstances I wanted to get the pelvic out of the way. Let’s have a look,” she said, pulling the gown to one side, then the other to gently examine her breasts for lumps.

“I’ll take you up on the birth control pills, even though I don’t have any use for them at the moment,” Shelby said.

It would be unethical for Mel to ask Shelby if she had someone in mind for that position. Another handicap of being a small-town practitioner—seeing the hot little glances exchanged in a neighborhood bar. “Well, I think it’s healthy to have a sex life with a responsible partner,” she finally said. “I think it’s unhealthy to have an unplanned pregnancy. Choose very carefully. Be prepared. Play it smart,” she said. “There’s one more thing. I probably don’t have to lecture on this, but—”

“Condoms,” Shelby said. She smiled and a flush reached her cheeks. “I should probably have some of my own, in case…”

Mel patted her hand. “I love having beautiful, intelligent women for patients. Get dressed and I’ll round you up some supplies.”