Special Delivery

By Steven Mollov

Joshua Barron and Alex Faber, physicians practicing in Breedville, New Hampshire once again take the reader through the day-to-day drama of the field of obstetrics and gynecology. From life affirming saves, to the tragedy of a maternal death, the field is intricately intertwined into the fabric of life which we all take for granted. And as a rogue physician induces the miscarriages of teenagers for what he considers a noble cause, the right to play God is caught in the crosshairs. See the medical world through the eyes of these two physicians as they continue to practice together.

• Language: English
• Publisher: AuthorHouse
• Release date: Nov 28, 2018
• ISBN: 9781546269175

Steven Mollov

Steven Mollov is an obstetrician gynecologist who has been practicing in Massachusetts for over forty years. This book is a fictional account of numerous experiences that he has encountered over the course of his career. He looks forward to sharing these personal stories with the reading public. Special Delivery is Dr. Mollov’s third novel.

Book preview

CHAPTER ONE

I T WAS WINTER AGAIN in the town of Breedville, New Hampshire. Snowfall had been lighter than usual, but there was still enough of the powdery stuff to keep the slopes up north busy during February school vacation week. It was 1992 and the weathermen were showing their disappointment with the lack of major storms, pulling out footage from previous years. The townspeople were not disappointed and there was still a surplus in the budget for snow removal. George Washington sat astride his steed in the mall with not a snowflake covering his hat. The town, nestled along the banks of the Merrimack River between the lakes to the south and the White Mountains to the north was a growing community. It didn’t hurt that a major manufacturing plant of the phone company called Breedville home, providing employment to a significant segment of the town. The ski season provided winter tourist business, the summer was for outdoor sports and antiquing and of course, the fall brought out the leaf peepers. Garrison Breed General Hospital, the largest medical facility north of Concord tended to the ills and accidents of the tourists and local populace and the labor floor seemed to be busy regardless of the season. Breedville OBGYN and Drs. Barron and Faber served the obstetrical and gynecologic needs of its citizens and preparations were being made to add a new midwife service to the mix. It was just another year in Breedville, and the drama would continue.

Come on Julie, the tall dark haired lacrosse player said. You know you want to!

No, Brad. I’m not interested.

Don’t you remember the July 4th celebration, or the night of the gym dance?

That was four years ago! she answered.

I still remember it like it was yesterday.

Then you go fantasize. I’m out of here!

Not so quick. He grabbed her arm as she turned to the door.

Julie Barron could not understand how she had let herself into this situation. Brad Hancock was a former high school boyfriend. The two had matriculated at New Hampshire State University in Concord two years ago. Going their separate ways, their worlds reunited at a fraternity party on campus. Several beers later, she found herself in his dorm room. It was clear he was trying to re-ignite an old flame. It was also clear she wanted no part of it.

It had been two years since her mother had died from breast cancer. Julie Barron, only daughter of Joshua Barron, Breedville, New Hampshire obstetrician, had turned from rebellious teenager to mature, confident young adult. Her relationship with Alex Faber, Joshua’s obstetrical partner, had helped her with the transition. She had moved on from Brad after several sexual encounters junior year in high school that ended badly for her, first with a urinary tract infection and then with an early unwanted pregnancy. Though she knew that they would both be attending the same college, she had lost contact with Brad on the sprawling state campus and their surprise meeting at Theta Rho was both pleasant and inviting. Discussions of shared good times combined with several beers, helped lower her guard. She was interested in more conversation which he convinced her would be better suited to a quiet dorm room than a noisy fraternity party. Brad had other interests in mind. His little head was firmly in control of his bigger head as he grabbed her arm, preventing her from leaving.

Brad, no! Let me go! she screamed pushing him away with her free arm.

But his high school football days as well as college lacrosse had built him up into a strong athletic figure and Julie’s diminutive stature, which she inherited from her mother was no match for his strength. He pushed her onto his bed and her fear and anger could not stop him. He reached up her skirt and ripped off her underwear. She calmed down long enough for him to pull down his pants and expose himself to her. Her sudden calmness played off his ego as he thought she would now become a willing participant. But a firm knee to his groin caught him off guard as he rolled over in excruciating pain, freeing Julie up from her captivity.

I told you I wasn’t interested! she screamed, as tears covered her face. I’m out of here and don’t ever come near me again!

The dorm room door slammed, leaving Brad to nurse his wounds.

Frances Faber was not having a good day. Her job as a paralegal was very demanding and she found herself having to stay late again in order to keep ahead of the tide of business at Richard Barron’s law firm. The youngest sister of Alex Faber had long since left the inertia of her family home in Queens, New York and at the encouragement of her older sibling completed community college and had become a paralegal in a Boston firm. Joshua, Alex’s partner had been able to secure her a position in his brother’s law practice. The work was satisfying but her social life was slow. Frances had been a party girl in New York, but with the new responsibilities of a full time job as well as the watchful eye of her older sister, she dated infrequently, abhorred the bar scene, and had a small circle of girlfriends to share a movie or go to Fenway Park where she would revel in the success of her hometown Yankees beating the lowly Red Sox. It was 1992 and the Yankees were just starting another stretch of successes.

On this particular day, she had received a notice from her nurse practitioner that her pap smear was abnormal and that she would need further evaluation. A list of available gynecologists accompanied the bad news. She called her sister from work.

Hi, Alex, it’s me!

Alex didn’t have to think very hard.

What’s up Sis? Alex asked.

I’ve got a problem, she said. I just got a notice that my pap smear was abnormal and I need to see a gynecologist. Can you take care of this for me?

Sounds like you need a colposcopy, Alex responded.

A what? How about a little English for your baby sister.

A colposcopy is a procedure where a physician uses a special binocular to evaluate your cervix, which is where the abnormal pap smear is coming from.

Sounds painful.

It really isn’t. It’s like having a prolonged pap smear. Sometimes the doctor needs to take a biopsy and you feel a pinch. It’s really not a big deal.

Can you do this for me? Frances asked. You know, keeping it in the family and all that.

Not a good idea. You should have someone who is more objective. Alex thought for a moment. I’ve got a colleague in Manchester who is a gynecologic oncologist, a specialist in this kind of problem. I’m sure he would be happy to help you out. Let me set up an appointment for you.

Thanks Sis, you’re the best! Frances was off the phone before Alex could say another word.

How are things going at home, Joshua? Randall Thomas asked him. That was usually the way these therapy sessions would begin. Randall was a slim bespectacled man of diminutive height and long hair. He had known Joshua Barron ever since he moved up to Breedville to start his psychiatry practice. He had now been seeing Joshua for nearly two years, taking him on soon after his wife died.

Nothing new, Randall, Joshua answered. With Jim finishing up at Dartmouth this year, Julie at New Hampshire State for her junior year and Jeffrey a senior in high school, things are pretty quiet around the house. His voice showed little emotion.

What about the labor floor? You guys really busy? Randall continued.

Same as always. Nothing unusual. Joshua’s normal enthusiasm was gone. It died with Elizabeth and had yet to make a reappearance.

Joshua, have you thought any more about going on medication? I know I’ve been pushing you but I don’t feel we’ve made any really progress since we started.

I’m okay Randall. Really. The office is busy. I’m working on the set up of our new midwifery service. Alex has been a great support to me and the kids, especially Julie. I’ll admit I don’t have the same enthusiasm as I used to. I still miss her, Randall. I miss her very much. His voice began to choke up.

Alex Faber was having a busy day on call. With two deliveries under her belt, she was attending to a third, a woman she had previously delivered two years before. Being well into her fourth year of practice with Joshua Barron, Alex was developing a following of her own, including the deliveries of several women whom she had previously taken care of. To Alex, this is what it was all about. She had left City Hospital of New York after her residency and one year on the staff. Despite being a city girl all her life, she followed her heart to a busy practice in New Hampshire. The first two years were quite hectic; an assault by a former lover, her re-establishment of a relationship with her former husband who was now the president of the hospital, her close personal friendship with Elizabeth Barron, Joshua’s wife, her involvement in the discovery and destruction of a large baby producing business, her remarriage to Ron Dorcik and the death of her friend Elizabeth from breast cancer. The last two years were less eventful but still professionally and personally satisfying as her patient load increased and her relationship with Ron blossomed all over again. Yes, things had quieted down and she found herself taking everything in her stride. Her thoughts returned to the present when the warning light and buzzer came on from her laboring patient’s room.

Dr. Faber, you’re needed in Room two. Mrs. Jensen is getting more uncomfortable and the fetal heart rate is down.

As she entered the labor room, the nurse had placed her patient in a knee chest position to try and elevate the heart rate. Cheryl Jensen was extremely uncomfortable, having trouble maintaining the awkward position. Alex checked her cervix, finding her fully dilated with the head just inside the vaginal opening.

Sandy, let’s get her on her back and set up for delivery. This baby is coming out whether we are ready or not!

They flipped her on to her back and in short order, the baby was crowning. There was no time for anesthetic and fortunately the delivery was quick. Alex barely got her gloves on as a vigorous little girl made her entrance into the world. The relief was dramatic as her newborn was placed on her stomach while the baby cried immediately and often. There was a collective sigh in the room as the more mundane activities of cord cutting, placental removal and repair of a small tear ensued.

Well, Dr. Faber, the excited mother exclaimed. You’ve delivered my whole family!

But Mrs. Jensen, Alex responded, you have three girls. You don’t want to try for a boy? she asked, tongue in cheek.

No thank you, Dr. Faber, said the exhausted mother. I’ve done my part. I’ll just have to settle for playing with my little nephews.

Alex bid her patient congratulations and left the room to attend to the paperwork. As she was filling out the forms, she was approached by Sandy, the nurse who had attended the birth.

Dr. Faber, can we talk when you get a chance?

Sure, Sandy, I’ll be done in a minute.

The two women met in the doctors’ lounge.

What’s on your mind, Sandy? Alex asked.

I’m worried about Dr. Barron, she answered.

How do you mean?

He’s not the same, not since he lost his wife. She continued. He’s lost the light in his eyes, his enthusiasm. I know because I’ve been working with him for so many years. He’s different, and …

What, Alex pursued.

He’s making mistakes. Not big ones mind you, but little ones. He often doesn’t complete his paperwork as he used to. I’ve had to remind him of some orders, birth certificates, things like that. Other nurses have noticed the differences as well. He seems distracted, distant. I don’t think the patients pick up on these, but we do, I do. I feel uncomfortable talking to you about these things. I care very much for Dr. Barron and I don’t want to cause any trouble for him.

Alex knew there were problems with Joshua. He also seemed to be distracted in the office, not finishing some of his notes on time, making billing mistakes and occasionally being short with the staff. But sharing her concerns with the labor floor nurses would be inappropriate. She would have to confront him in private.

I’m sure he’s okay, she responded to Sandy. We all get distracted at times.

But…., she stopped herself. I guess you’re right, Dr. Faber, as she backed off from further confrontation. Maybe I’m just a little too sensitive, she admitted. I… I mean we all care greatly for Dr. Barron and maybe worry needlessly. Thanks for listening to me, Dr. Faber. With that she left the room, leaving Alex to her thoughts.

Joshua was off for the day and Alex had a full office schedule. Fortunately, her busy night had cleared the board and there were no other women in labor. Her first patient of the day was Linda Silva, a thirty-five year old in whom Alex had inserted an intrauterine device or IUD. She had delivered her third child six months ago and wanted to put an end to her childbearing career. Her husband was less certain than she and so the compromise was an IUD. It would provide her with very effective birth control without her having to remember to protect herself and still gave the couple the opportunity of keeping their options open in the future. Her chief complaint today was pelvic pressure and cramps.

Hi, Mrs. Silva. What brings you in today? Alex asked as she entered the exam room.

I think there is something wrong down there. Linda responded.

How do you mean?

Well, I have been checking the IUD string like you suggested on a monthly basis and it seems longer than usual recently. Also I thought I felt something sharp way up inside, near the string. The cramps began three days ago and ibuprofen doesn’t seem to be doing the job.

Have you been bleeding? Alex continued.

Well, as you told me, the IUD would change my periods and they completely stopped within a month of insertion. Now I am noticing some light bleeding.

Alex suspected a problem.

Let’s take a look.

Linda had been undressed from the waist down with a sheet covering her. She lay back, putting her feet in the stirrups. Alex inserted a speculum to view the cervix. As she suspected, the IUD itself was sticking out of the cervical opening. This was a sign of uterine rejection of the IUD and Alex had no choice but to remove the device.

I’ve got good news and bad news, she reported to Linda Silva.

What’s the good news? her patient asked.

I found the problem and your cramps and bleeding should cease.

And the bad news? she continued.

Well I’m afraid your IUD was coming out. It was no longer protecting you and I had to remove it, Alex said.

You don’t think I’m pregnant, do you? she asked anxiously.

Probably not, she answered. But I will run a pregnancy test just to be sure.

What do I do now for birth control, Dr. Faber?

You still have several good options, including another IUD. Why don’t you get dressed and meet me in my office.

Alex left the patient getting dressed. She turned to Lois Wilner, her office nurse.

Lois, did Mrs. Silva give you a urine sample?

Yes she did, Dr. Faber. Do you want me to send it for a culture?

No, she answered. Run a urine pregnancy test on it.

Sure thing, Dr. Faber.

Linda Silva met Alex in her office to discuss what her options were for birth control at this time. They didn’t get far in the conversation when the phone rang.

Sorry to disturb you, Dr. Faber, but I thought you would want to know that the urine test was positive.

Alex looked at her anxious patient who did not yet realize that her situation was about to get worse.

Thanks, Lois.

She turned to Linda Silva.

I’m afraid we have another problem, Mrs. Silva

Well at least I’m not pregnant. What is the problem?

Alex just looked at her with a sympathetic expression and there was a sudden awkward silence in the room.

You have a positive pregnancy test, Mrs. Silva.

How could that be? she responded, tears starting to fill up her eyes.

If the IUD was out of place, it would not be protecting you from a pregnancy, Alex answered. Also even if it were in the right place, an IUD does not protect against an ectopic pregnancy. I’m going to need to order a pelvic ultrasound to find out where the pregnancy is and how far along you are.

I don’t believe this is happening, Linda Silva said to herself. What do I do now? she asked, turning to Alex.

I’ll know more after the ultrasound. I’m sure I can get one for later this morning and then we can meet back here to discuss what’s next.

What’s next is that I have a fourth child! she exclaimed. Alex handed her a tissue.

We don’t know that, Mrs. Silva. There are several possibilities. Removing the IUD may interfere with the pregnancy and cause a miscarriage. Or, she continued, you might not have a pregnancy in the uterus.

I don’t understand. Where else could it be?

An IUD only protects against an intrauterine pregnancy. Sometimes, a pregnancy can implant in a fallopian tube, even with an IUD in place. That would be an abnormal pregnancy and would need to be terminated.

Terminated! Linda said, her voice starting to rise. I’m Catholic. I could never terminate a pregnancy.

We’re not talking about an abortion here, Mrs. Silva. A tubal pregnancy could never progress to term. It usually causes bleeding and pain after several weeks. A woman’s health would be in jeopardy if a tubal pregnancy was not terminated. But I think we’re getting a little ahead of ourselves right now. Let’s check the ultrasound and then talk further.

Alex accompanied the confused woman out to the desk to set up an emergency ultrasound and a follow up visit for later today. Fortunately, she was able to get her in for an ultrasound immediately and would be her first patient of the afternoon. The rest of the morning was less eventful. There were routine prenatal patients and a few annual exams. Lunch was a sandwich from home, eaten in her office. Fortunately, the labor floor was quiet and she was available for Mrs. Silva at one o’clock.

The ultrasound had shown no pregnancy in the uterus and instead there was a small gestational sac to the left of the uterus, probably in the fallopian tube. Again there was good news and bad news.

There appears to be a gestational sac in the left tube, Mrs. Silva, Alex told her as she sat down in her office. There is no evidence of a pregnancy in the uterus.

So what do I do now? she asked.

You do not seem very far along, Alex answered. You can probably avoid surgery. We can give you medication to end the pregnancy and then we can discuss further any future birth control plans.

I told you before that I can’t have an abortion, Dr. Faber.

It isn’t what you are thinking, Mrs. Silva. There is no pregnancy in the uterus so you wouldn’t really be terminating a healthy pregnancy. The pregnancy in the tube will never make it to term and in another several weeks, if it is left alone, it will rupture the tube and you will find yourself in the emergency room in a lot of pain, facing imminent surgery. That is what we used to do with all ectopic pregnancies. Fortunately, we now have medication that can treat these early abnormal pregnancies and so prevent having to operate. I can send you to the emergency room to receive a dose of a medication called methotrexate, which should end the tubal pregnancy and allow the body to heal on its own.

The fact that she would not be having an abortion or have to go to the operating room sat well with Linda Silva.

I will have my nurse order up the medication. You will need to sign some papers about this treatment and have your blood drawn several times over the next few weeks to see that it is responding. I would encourage you to avoid intercourse while you are under treatment, until we know that the pregnancy has resolved.

Why should I avoid sex? she asked. I’m already pregnant.

You could rupture the tubal pregnancy before the medication has a chance to work, and then find yourself in the operating room anyway. Although there is always a chance that this could happen spontaneously, even while we are treating you, it would be less likely if you refrained.

Alex accompanied Linda Silva to the front desk to set up her injection as well as her blood studies.

I will want to see you in about two weeks, to see that everything is okay. Obviously, if your pain increases or you feel dizzy or weak, let me know right away.

Alex returned to her office. Her next patient, a forty year old was in for a routine check up. Although her breast and pelvic exams were completely normal, the patient was complaining of a persistant sore throat. Her internist had cultured it on several occasions and could not find a strep infection. He had written it off as a viral pharyngitis. Alex had noticed that she had been treated several months ago for a vaginal infection, with resolution of the infection on a subsequent culture. Her suspicions were raised and she took a throat culture looking for gonorrhea and chlamydia. Sure enough, several days later, the culture had returned positive for gonorrhea and she had to explain to the embarassed married mother of three that she had a sexually transmitted disease in her throat. The penicillin would take care of the infection, leaving her to take care of her partner!

The day became less eventful as she finished up office hours around five.

Anything I can get for you, Dr. Faber? Lois asked, before leaving for the day.

I’m fine, thanks, Lois. Have a good night.

CHAPTER TWO

"I REALLY WOULD LIKE to hire her, but if it’s going to cause a rift in our marriage, I’ll turn her down and look fur ther."

Liz turned finally, and her tears were coming fast and furious. Joshua’s eyes began to moisten as well. He reached to give his wife a reassuring hug, but was stopped short by the swift tug of his seatbelt. They both started to laugh, thinking of a moment almost thirty years ago in his Mustang convertible where two seat belts had kept two young lovers at bay. Their tears and laughter mingled as he kissed her deeply, their lips fused together in an attempt to erase any doubt. They were deep into the kiss when a tapping on the window startled them. They had obviously not seen the blue flashing light in the rearview mirror. Joshua opened his window and the patrolman’s flashlight invaded their private darkness.

Oh, I’m terribly sorry Dr. Barron! Mrs. Barron, he nodded. I didn’t recognize the car. My deepest apologies.

That’s okay, officer. You just made my wife and I feel about thirty years younger. We’re grateful to you. The red-faced patrolman slunk back into the night and turned off his flashing lights.

My place or yours, Dr. Barron?

Joshua turned to his wife who was ready with another kiss. Do you want to get us into some more trouble, young lady?

Yes, lots of trouble, Dr. Barron.

Joshua sat back in his arm chair. The room was dark when he heard the front door open. The sudden bright flash of the living room light interrupted his thoughts and brought him back to the present day.

Hey, Dad. What are you doing sitting in the dark? It was Jeffrey, the Barron’s youngest, returning from band practice.

Just resting after a long day, Son.

What are we doing for dinner? asked the hungry teenager. Food was never far from Jeffrey’s mind.

I didn’t prepare anything, Jeffrey. I guess it’s pizza or take out Chinese.

His beeper went off as a dinner decision was being made. He called the labor floor.

I’ll be right there, Sandy, he reassured her, turning back to his son.

Here’s some money, Jeffrey. I’m afraid it’s pizza without me, he said as he walked out the door.

But, Dad…. You only gave me a dollar bill!

Joshua didn’t hear him as he started up his car and left for the hospital.

Frances Faber didn’t have to wait long for her appointment with Aaron Speiser. Alex had called the gynecologic oncologist later that day and was able to get her right in. She had met him during her first year in practice regarding a pregnant patient of hers who had had cervical cancer. The two had communicated for months as the pregnancy had progressed, culminating in a cesarean section performed by Alex at the Manchester hospital where Aaron worked followed by a radical hysterectomy to cure her of her disease. There had been a mutual attraction between the two clinicians, though Alex’s life was too complicated for involvement at that time. Aaron had later helped her out on a difficult case at Breed General Hospital. He was more than willing to accommodate her younger sister.

Good morning, he said shaking her hand in his office. I’m Dr. Speiser. I believe your older sister Alex sent you here.

Yes, thanks for seeing me on such short notice. I feel like a VIP.

Well you are, being Alex Faber’s sister. Alex and I have shared several patients over the past few years. What seems to be the problem?

Frances handed him the pap smear report from the gynecologic clinic she had attended in Boston.

"She said you would explain it better to me and felt it wouldn’t