QUALITY OF CARE EXCERPT "Of all the gin joints in all the towns in all the world, she walks into mine." Those were actually the first words that came out of Gordon's mouth that first night. Never mind that it was actually he who had arrived at my gin joint, or more precisely 3A East in the Ridgefield Valley Hospital. Never mind that it was he who came to me, not the other way around. Lydia, I remember, was laughing, laughing as she rolled along in the wheel chair, with a plaid wool blanket wrapped around her knees. Her laugh was like the chiming of bells, up and down the scale, always had been. If you had asked me, in the intervening years, before they came into the hospital that rainy night, which I would have recognized first, Gordon's basso voice, or Lydia's chiming laugh, I wouldn't have known— Gordon's, no Lydia's, no Gordon's. But the truth was, I knew in an instant that it was both of them. When I first saw them, Gordon wheeling Lydia down the long polished hallway of the labor and delivery floor, she was looking at him, her head turned and her chin tilted upwards, her hair in that same loose blond pony tail, the one she had always worn. It was raining hard that night, though we barely noticed up inside the hospital with its double-paned glass and recirculated air. Lydia had droplets of moisture that clung to the short hairs that had pulled out of her ponytail and framed her face. She was looking up at him, and he was pushing her, saying something, I couldn't hear what, just the low reverberation of the sound below the words. I could just imagine how he had sweet-talked the aide who walked obediently alongside. I'll push, he had said, smiling sweetly. Hospital policy, the aide had grumbled sotto voce as she stepped aside and let him grasp the plastic handles. I was standing behind the desk at the nurse's station with a patient's chart in my hand, dressed like I usually am, in green scrubs, a lab coat, blue rubber clogs. I had just raked my fingers through my thick brown curls, so that they were sticking straight up off my forehead. "Doctor Raymond," one of the nurses was calling to me from behind, but I didn't turn my head for a second, long enough for him to look up and see me, and that's when he said the Humphrey Bogart bit, about the gin joints. And it was true wasn't it? For what on earth were any of us doing right then in that precise spot? "She just come up from the ER," the wheelchair attendant said. "The one I told you about, Dr. Raymond," said Doris, the stout unit secretary who was seated in front of me. That was when Lydia saw me. She was smiling, but I could see the tension around the corners of her mouth, and when she saw me she slumped over a little, like she had been making an effort to hold herself rigid before. I saw what looked like relief on her face and she said in a voice that was half joy and half nervous exhaustion, "Oh my God, Clara? Clara, is it really you?" Her expression opened up a little, her eyes looked up full of innocence, hope. "Maybe I really do have a guardian angel," Lydia said. It would be just like Lydia to think she had a guardian angel, just like her to think that I might be one of its manifestations. Then Gordon said, "What on earth are you doing here?" A dumb question. I was right where I was supposed to be. He was the one who was so vividly out-of-place. His eyes had always been blue, and they still were, smooth cheeks, two-day old razor stubble, black tousled hair. He was smiling, lopsided, irascible. There was a glint of gold at his left earlobe. Lydia looked the same as ever, except that she was pale, and there was a small mound under the blanket. Pregnant. Of course. Otherwise what would she be doing here, on 3A at Ridgefield Valley Hospital, 9:47 pm. on that rainy Monday night. "Well, a better question is what are you doing here?" Lydia let out a long breath, almost a sigh, and Gordon touched his fingers gently to her temple and leaned a little closer to her, like he would pick her up and carry her if it were needed. He looked exactly the same, and I remember distinctly that it seemed, right then at the beginning, that the years had rested lightly on him, barely leaving a mark at all. Maureen, the cute little nurse, the one with the green eyes, said, "Dr. Raymond, this is a gravida one para zero. Came up through the ER, thirty-four week IUP, one brief episode of spotting, now resolved." I decoded automatically, without thinking about it. First baby, about eight months along, mild complaints, maybe something, maybe nothing. "Room three's open," Doris said, jerking her head to one of the open doorways down the pink and teal hall. "Lydia, can you tell me what is going on?" "Well, we were driving up from Philly," Lydia said. "On our way to the Berkshires," Gordon said. "And I started feeling a couple of cramps," Lydia said. "Just a couple?" "I thought it was because I had been sitting too long, so I asked Gordon to get off the turnpike so I could go to the bathroom." "You know the Joyce Kilmer Exit. I think that I will never see..." "A thing as lovely as a tree?" Lydia continued. "And so you were cramping a little," I said. "And then, when I went to the bathroom, I felt better." Lydia said. "Except that I was bleeding." "How much?" "Well, not much. Just a spot or two. I think it stopped already." "How big was the spot?" "How big?" "As big as a baseball? As big as a dime?" "Oh, just, you know, pink, on the tissue, when I wiped." I processed automatically, scant bleeding, not significant, in most cases. "Any leaking fluid?" She shook her head, spraying me lightly with drops of moisture from her hair. "Cramping, pressure, lower back pain?" She nodded no. "Just, you know, a tiny bit crampy, um before, but now, no." "Are you still feeling the baby move?" I saw the anxious look pass over Gordon with this question. "Kicking up a storm. It's a little girl," she said. "We saw a blue hospital sign, so I told Lydia we had to get off and get it checked out." "I thought he was being silly." "No, that wasn't silly," I said, practiced as ever, even under the circumstances. "Any bleeding in third trimester can be a sign of a problem. How are you feeling now?" "I feel fine now. I mean, I feel delighted. Oh my God Clara, how weird is it to get off the New Jersey Turnpike and come in and find you here. I mean maybe that's what the cramping was, like some kind of sign..." She trailed off again, shifted, uncomfortable in the wheelchair. "Do you think she's okay?" he said. "I mean don't you think we should do some tests or something?" "Let's put her on the monitor for a while and I'll see what I think is going on." "God, Clara. That would be great." That was the first time he said my name, and I felt it, same as I always had, the way my knees gave a little shake. "Doctor Raymond," I saw Kathy's head peeking out from one of the labor rooms. "Angela says she has the urge to push." I turned back to Maureen again, all business now, in a hurry. "Put Mrs. Robinson on the monitor. I'll come in and check on her later." "I'll be back in to check you in a few minutes." I left them like that and went into room seven, where I could see that the perineum was bulging and Kathy had already set up the delivery tray. * * * The funny thing is that it wasn't my night to be on call. I had traded with Walter that night because he wanted to go to a Devils game. Walter has never been like that either. He never asked me to cover call lightly—he worked all the time, sick or well, holiday or not, as regular as clock work. But his son was in town and he wanted to take him to the Devils game. Just one of those coincidences that make up a life. He would have been there, not me, and that haunts me for any number of reasons, because I still am not sure if I was meant to be there, or if I wasn't meant to be there, but the fact is that I was there, and that's how this story came about. © Elizabeth Letts BUY THE BOOK online from your local independent bookstore via BookSense, Amazon or Barnes & Noble.