“Tell them we’re not quite ready and to stand by.”

Just a few minutes later, Sierra was holding her baby girl. The baby had been dried off, cleaned and wrapped in a couple of receiving blankets. Connie was kissing Sierra’s head, then the baby’s head, then Sierra’s again. Eleanor was murmuring, humming and talking softly as she cleaned up as best she could. A pair of scrub pants were found for Sierra and her jeans were put in a bag while Connie took charge of her purse.

“Hold her close to warm her up,” Leigh said. “Wow, what a great job you did!”

“What a great job you did,” Sierra said.

“I haven’t done that since my rotation in OB in med school. The beauty of working in a big ER, you can almost always find an OB when you need one. You better be camping on the hospital steps for the next one!”

“Next one?” Connie and Sierra said in unison. “We weren’t planning this one!”

But as Leigh recalled, Sierra and Connie had so much going on in their lives, trying to foster Sam and finalize his adoption, nearly losing him to his maternal grandmother in the process, that Sierra had been a little sloppy about taking her birth control pills.

Leigh’s life had also been very hectic while she lived and worked in Chicago so she had opted for a birth control implant. You don’t have to think about it! You don’t have to remember it every day, don’t have to apply it or insert it or... She thought about that for a moment. When did she get that implant? A couple of years ago? She should think about replacing it, but when did she get it? It was effective for up to four years. It was easy to forget about it, especially when you weren’t putting it to the test.

Then she remembered exactly when she got it. Helen had just returned from her Mediterranean cruise. A couple of years ago...

She called Sierra’s OB, who was a woman Leigh knew and liked and had planned to get in touch with one of these days for her own annual exam. “Dr. Carlson, your patient, Sierra Boyle, decided to deliver in my clinic. Mother and baby seem to be in excellent health. Any instructions before the ambulance loads them up and brings them your way?”

“Fabulous! Do you have a line TKO? What drugs did you administer?”

“We didn’t have time for an IV and there were no drugs—she was in a big hurry. She came in to see me about a terrible backache, which almost immediately turned into a delivery. But we can start an IV now.”

“Please do,” Dr. Carlson said. “Just as a precaution. And how does Sierra feel now?”

“She says she feels much better and her back doesn’t hurt at all. So, I’ll expect a little something extra in the Christmas card this year, right?”

“Of course! And it will look like a fruitcake!”

As soon as the clinic had quieted down and the other patients were all taken care of, Leigh sat at her desk and scrolled through her calendar on her phone. Then she called Helen.

“Auntie, just out of curiosity, when did you go on that Mediterranean cruise? The one you took with Maureen and a couple of your girlfriends?”

“That? Let’s see... That was right after the conference in Denver when I won that award...that best of the year thing... Are you thinking about a cruise, honey?”

Leigh rolled her eyes. “No, just trying to remember when that was.”

“I’m looking. Scrolling back through my calendar... Oh, here we go. Five years ago.”

Leigh dropped her phone. She grabbed it. “That long ago? I thought it was a couple of years ago! Did you go on two cruises?”

“I went on one a couple of years ago with Marti and June but that was down the South American coast...”

“Oh God,” she said.

“What’s the matter, Leigh?”

“I’m...ah...looking for the perfect vacation and I can’t remember which one you raved about most.”

“Not those two,” Helen said. “I was partial to the river cruise, the European river cruise. That was the best. I can get you the information if you like.”

“Yes,” she said. “Yes, please.”

They said goodbye and Leigh let her head fall to her desk with a soft bang. She resisted the urge to keep banging it.

She thought it was a couple of years. Three years, maybe. Her patients did this all the time, but she didn’t. Her patients always thought their last mammogram was last year until you got the imaging records and it was three years ago. That Pap smear? “Maybe two years ago,” they would say. “How does six years sound?” she would ask. And the dreaded colonoscopy. “I just had it five years ago.”

“No, it was actually twelve, according to your chart. It’s past time—you’re going in. Prepare to prepare.”

No one remembers when they last had their teeth cleaned. “Did I get a flu shot? Yeah, wasn’t that about a year ago?” Try two. If it weren’t for roots, they wouldn’t know when they needed hair coloring. The car goes in when the warning lights go on. But Leigh was a doctor! Smarter and more responsible than the rest.

“Yeah, doctors are the worst,” she heard her mentor say.

How did this happen? When she was in Chicago, the imaging center and her gynecologist’s office would notify her that it was time. But she changed doctors and then she moved. She notified her doctor’s office that she was moving and would be finding new health care providers in her new location...a year ago. Doctors’ offices weren’t reliable with reminders. They would either never send a reminder or keep sending one for twenty years after you’ve informed them you changed doctors.

It should come as a red postcard, she thought. Your implant is losing power as we speak!

And since their STD screenings had come back negative, she and Rob had not bothered with condoms.

This can’t happen, she said to herself. I will it not to happen.

She waited until Gretchen was taking out the trash and Eleanor was busy telling Bill Dodd about the excitement of Sierra’s delivery. She went to the medicine cabinet and pilfered a pregnancy test. She would take it home. The good news was, Helen was having dinner at the Crossing since she’d had dinner with Leigh the night before. The bad news was, Rob said he might sneak away from the pub for a little while.

She thought the intelligent thing to do would be to wait until after seeing Rob to pee on the pregnancy stick. She wouldn’t be able to keep from telling him. She’d tell him either way—tell him she had been so terrified or tell him that, damn it all, they had a problem. She was doomed.

She was also pregnant.

“Oh, shit balls,” she said out loud.

She headed for the shower. Well, she thought as she stood under the warm spray, things were starting to make sense. She was a little touchy, oddly fatigued and—she touched her breasts—a little sensitive. And headed for one of the most difficult conversations of her life.

Without wine for courage...

* * *

At about seven, Rob texted. Have you eaten? I can bring something from the bar.

She wasn’t hungry and she didn’t think she would be for a while. She declined his offer and he came over straightaway. As usual, he scooped her up into his arms and kissed her passionately. When he probably would have pointed her right to the bedroom, she said the most hated words in the entire English lexicon. “We have to talk.”

“Oh boy,” he said.

“I’m pregnant. It’s entirely my fault. I made a mistake. I was relying on an unreliable birth control implant, unreliable because, for lack of a better word, it had expired and I didn’t realize it had lost its effectiveness. Or maybe it was never very effective but I wouldn’t know because, until I met you, it has never been put to the test. So, here we are.”

He backed up and sank slowly to the sofa, elbows on knees, his head in his hands. Then he lifted his head. “Aunt Helen?”

“Not back from dinner yet,” she said.

“When did you find out?”

“Two hours ago. A series of medical events at the clinic made me ask myself, when did I get that implant? And is it time for a new one? In checking, to my absolute shock, I’m overdue. Really, I hardly ever thought about it, and when I did, I remembered it as being about three years. It was actually over five. It’s effective for up to four years. I’ve had so much going on, and until you came along there was no sexual activity, so...”

“Holy God,” he said.

“Listen, I know what you must be thinking,” she said. “That I’m an idiot. I am. But I’m not devious. This was a complete accident. I was not planning a family. I’ve been very happy with things just as they are.”

“Do you have a plan?” he asked weakly.

She cleared her throat. “Yes, in about two months, I’m moving to another state and no one need ever know.”

“What? Stop that!” he said.

“I wasn’t prepared for that particular question. I just found out, Rob. Just. I haven’t decided on anything yet. I thought the first order of business was to inform you.”

“And no one else knows? Even Helen?”

“I’m not in the habit of keeping important things from Helen. But no, I haven’t told her yet.”

“What about the doctor?”

“I haven’t seen the doctor,” she said. “I’m a doctor. The symptoms I was ignoring are real and the pregnancy test confirmed—”

“Goddammit, we should have been using condoms! I’ve never taken a chance like that before, but you were using birth control and the blood test showed no STIs and... And... You know what I mean...”

“I’m not sure I do,” she said. “Can you be more specific?”

“It was just us,” he said. “It was so good.”

“Indeed,” she agreed. Au naturel was always good. “Who knew it was risky? I know this is a complication you don’t need in your life and I’m sorry. I made a mistake.”

“You don’t have to say that,” he said. “I was a very willing participant. And took no more precautions than you.” He shook his head. “I was a runaway train.”