Chapter 2 - THE EMPTY ULTRASOUND
For three full seconds, I could not move.
Daniel’s words hung between us on the porch.
A massive abdominal tumor.
Not a baby.
Something that could rupture and cause my sister to bleed to death.
Inside the house, people were laughing again. Someone had turned up the music. Through the front window, I could see my mother carrying a stack of pink paper plates toward the dining room while Emily stood beside the cake, smiling as though nothing in the world was wrong.
The contrast was unbearable.
“Are you sure?” I whispered.
“No,” Daniel said. “Not without imaging. But I’m sure enough that we cannot wait.”
He was already dialing 911.
I grabbed his arm. “Maybe it was just the baby’s position. Maybe you felt an artery.”
“Claire, I deliver babies for a living.”
His voice was quiet, but his eyes were filled with fear.
“A fetus at twenty-nine weeks does not create a single broad pulsation directly beneath the upper abdominal wall. Her abdomen also felt unusually rigid. There was no change in contour when she shifted her weight, and I couldn’t identify anything resembling a fetal back, head, or limbs.”
My throat tightened.
“But I felt movement.”
“You felt something moving with her heartbeat.”
The front door opened behind us.
Emily stepped onto the porch, one hand under her belly.
“What are you two whispering about?”
Daniel immediately ended the call and slid his phone into his pocket.
“Emily,” he said gently, “when was your last ultrasound?”
She blinked.
“What?”
“Your most recent prenatal ultrasound. What date was it?”
Her smile faded.
“I don’t remember the exact date.”
“Was it at your regular obstetrician’s office?”
“Yes.”
“What’s the doctor’s name?”
The silence that followed changed everything.
Emily looked at me.
Then she looked toward the window, where our mother was still moving around the party.
“Why are you asking me all this?”
Daniel stepped closer but kept his hands at his sides.
“I felt something unusual when I touched your abdomen. I think you should be evaluated today.”
“Evaluated for what?”
“I don’t want to frighten you before we know.”
Emily’s face hardened.
“Then don’t.”
She turned toward the door.
Daniel caught her gently by the elbow.
“An ambulance is coming.”
She jerked away from him.
“You called an ambulance?”
Her voice rose sharply enough that conversations inside the house stopped.
The door opened wider. Our mother appeared behind Emily.
“What happened?”
“Nothing,” Emily said. “Daniel is overreacting.”
“I hope I am,” he replied. “But we need to be certain.”
Mother looked from Daniel to me.
“Certain about what?”
I could not force the words out.
Daniel did.
“I don’t believe Emily is experiencing normal fetal movement.”
My mother frowned as though he had spoken in another language.
“What does that mean?”
Before Daniel could answer, Emily pressed one hand against the side of her abdomen.
Her face changed.
The anger vanished first.
Then the color drained from her cheeks.
“Emily?” I reached for her.
She took one unsteady step backward.
“There’s something wet.”
A thin red line appeared beneath the hem of her cream dress.
My mother screamed.
Emily looked down.
The blood was not pouring, but it was spreading quickly enough to stain the fabric between her legs.
“No,” she whispered. “No, the baby.”
Daniel moved instantly.
He lowered her onto the porch and checked her pulse.
“Claire, get towels. Linda, unlock the front gate and send someone to flag down the ambulance.”
My mother did not move.
“Mom!” I shouted.
That broke the spell.
People rushed through the house. The music stopped. Gifts were knocked from chairs. Someone began crying. Someone else called for ice, as though ice could solve whatever was happening.
I ran inside, grabbed three clean towels from the kitchen and returned to find Daniel kneeling beside my sister.
Emily was clutching his wrist.
“Save her,” she begged. “Please save my baby.”
Daniel’s expression nearly broke me.
He placed one hand over hers.
“We are going to take care of you.”
“Promise me.”
“I promise I will do everything I can.”
The ambulance arrived less than six minutes later.
To me, it felt like an hour.
The paramedics lifted Emily onto a stretcher while Daniel delivered a rapid summary. He did not tell them his full suspicion in front of everyone. He said only that she was reportedly twenty-nine weeks pregnant, had abnormal abdominal findings, vaginal bleeding and possible hemodynamic instability.
One of the paramedics placed a fetal Doppler against Emily’s abdomen.
We all waited for the rapid galloping sound that every pregnant woman recognizes.
Instead, the machine produced a slow, powerful rhythm.
Seventy-eight beats per minute.
Almost exactly the same as Emily’s pulse.
The paramedic adjusted the device.
The sound did not change.
He looked at Daniel.
Daniel looked away.
My mother covered her mouth.
“No,” Emily said. “You’re doing it wrong.”
The paramedic tried another position.
Nothing.
“Her placenta might be anterior,” my mother offered desperately. “Maybe the baby is turned around.”
Daniel did not answer.
Emily began sobbing as they loaded her into the ambulance.
I climbed in beside her. Daniel followed in his own car because the paramedics needed room to work. My mother remained at the house long enough to send the guests home, then came behind us with my aunt.
During the ride, Emily gripped my hand so tightly my fingers went numb.
“Tell me Daniel is wrong,” she whispered.
“I don’t know what’s happening.”
“He always thinks of the worst possibilities because of his job.”
“He’s trying to help you.”
“I am pregnant.”
“I know what you believe.”
Her eyes snapped toward mine.
“What I believe?”
I immediately regretted the words.
“I mean, you’ve had appointments. You’ve heard the heartbeat. You’ve seen the ultrasounds.”
She stared at the ambulance ceiling.
“Of course I have.”
But she did not sound convincing.
At St. David’s Medical Center, the emergency department moved with terrifying efficiency.
Emily was taken directly into a trauma bay. Nurses cut away her cream dress. Blood was drawn. Two large IV lines were inserted. A portable ultrasound machine was brought in.
Daniel stood near the foot of the bed, no longer acting as my husband or Emily’s brother-in-law. His posture had changed. He was watching the monitor with the focused stillness I had seen whenever he received a difficult call from the hospital.
An emergency physician named Dr. Patel pressed the ultrasound probe against Emily’s abdomen.
The screen filled with gray shadows.
I had seen pregnancy ultrasounds before. Even I knew what we should have been looking for.
A round skull.
A curved spine.
Tiny limbs.
A flickering heart.
There was none of that.
Instead, a huge irregular mass occupied most of the screen.
Dark areas appeared within it, surrounded by branching channels of blood flow that glowed red and blue when Dr. Patel activated the Doppler setting.
He moved the probe lower.
Then higher.
Then to the opposite side.
His jaw tightened.
“Where’s the baby?” Emily asked.
No one answered.
“Where is she?”
Dr. Patel turned off the Doppler sound.
“Emily, I’m not seeing a fetus.”
The room went silent.
She laughed once.
It was a small, broken sound.
“That’s impossible.”
“We need a formal scan and a CT angiogram immediately.”
“You’re looking in the wrong place.”
“The mass is filling a large portion of your abdomen and pelvis.”
“My baby is behind it.”
“We’re going to investigate every possibility.”
Emily looked at Daniel.
“You said you would save her.”
He walked to her bedside.
“I said I would do everything I could to take care of you.”
Her face crumpled.
“Why are you talking like there isn’t a baby?”
Daniel’s eyes were wet.
“Because right now, we cannot find one.”
Emily began screaming.
Not crying.
Screaming.
She tore at the blood pressure cuff and tried to pull out an IV. Nurses restrained her gently while I held her shoulders and begged her to breathe.
“You’re lying!” she shouted. “Ryan heard the heartbeat! I heard it every month!”
The name stopped Daniel.
“Ryan went to your appointments?” he asked.
“My fiancé goes to all of them.”
“Which clinic?”
She refused to answer.
A nurse administered medication to calm her enough for the CT scan.
As her eyelids grew heavy, she kept repeating the same words.
“Ryan heard her.”
“Ryan saw her.”
“Ryan promised.”
The CT results came back twenty-five minutes later.
By then, my mother had arrived.
She was standing beside me when the surgical oncologist entered the consultation room.
Dr. Naomi Shah was in her early fifties, with silver threaded through her dark hair and the steady manner of someone who had learned never to waste time with false comfort.
She placed the images on the wall monitor.
A large white mass filled almost the entire center of Emily’s abdomen.
“It measures approximately thirty-three centimeters,” Dr. Shah explained. “It appears to originate from the right ovary or the tissues immediately surrounding it. It is highly vascular, meaning it has developed an extensive blood supply.”
My mother clutched the arms of her chair.
“Is it cancer?”
“We don’t know yet.”
“Is there a baby?”
Dr. Shah paused.
“No.”
My mother made a soft moaning sound.
I stared at the image.
“How could she believe she was pregnant for seven months?”
“Some ovarian tumors produce hormones, including human chorionic gonadotropin. That’s the hormone detected by pregnancy tests. It can cause missed periods, breast tenderness, nausea and other symptoms associated with pregnancy.”
Daniel leaned toward the screen.
“What about the bleeding?”
“There is fluid in the abdomen that may be blood. One of the vessels feeding the mass appears unstable. It could be leaking intermittently.”
“Can you operate?”
“We may have no choice.”
Dr. Shah enlarged another image.
“The mass is pressing against the inferior vena cava, the bowel and the right ureter. It has displaced several organs. Removing it will be extremely dangerous because of the blood vessels involved.”
My mother began crying.
I could not.
I felt too cold to cry.
“What happens if you don’t operate?” I asked.
“It may rupture. If that happens, she could bleed to death before we can control it.”
“And if you operate?”
“She could bleed to death during surgery.”
My mother covered her face.
Daniel asked, “Can interventional radiology embolize the feeding vessels first?”
“That’s what we’re discussing. It could reduce the risk, but the anatomy is complicated.”
A nurse entered before Dr. Shah could continue.
“Doctor, the patient is awake. She’s asking for her sister.”
I followed her back to the trauma bay.
Emily looked smaller beneath the hospital blankets. Without the cream dress and the glowing attention of the baby shower, she no longer resembled an excited mother-to-be.
She looked terrified.
I sat beside her.
For a while, neither of us spoke.
Then she whispered, “They said there’s no baby.”
I took her hand.
“I’m so sorry.”
Her fingers trembled.
“They’re wrong.”
“The scans are clear.”
“But I took six pregnancy tests.”
“The tumor may have caused positive results.”
“I had morning sickness.”
“I know.”
“My stomach grew.”
“I know.”
“I felt her moving.”
My voice broke.
“That was the blood moving through the mass.”
Emily turned her face toward the wall.
A minute passed.
Then another.
Finally, she asked, “Where’s Ryan?”
“I don’t know. He wasn’t at the party when the ambulance came.”
“He went to get ice.”
“For forty minutes?”
She closed her eyes.
I watched her expression carefully.
“Emily, what clinic did you go to?”
She said nothing.
“Was it here in Austin?”
Still nothing.
“Did you ever see a licensed obstetrician?”
Her breathing changed.
That was the moment I understood.
Not everything.
But enough.
“Emily.”
“I wanted to tell you.”
A chill passed through me.
“Tell me what?”
“Ryan said you would ruin everything.”
“What did he say I would ruin?”
“The family. The wedding. Mom’s happiness.”
Her tears slid into her hair.
“He said Daniel would take over. That doctors always make things sound worse so they can charge for tests.”
“What tests?”
She swallowed.
“Three months ago, I woke up with terrible pain. Ryan took me to an emergency room in San Marcos. They did a scan.”
My heart began pounding.
“What did the scan show?”
“He said it was a fibroid.”
“What did the doctors say?”
“I don’t know.”
“What do you mean, you don’t know?”
“Ryan talked to them while I was medicated. He told me the baby was fine and the mass was harmless. He said I needed a special private clinic because regular doctors might pressure me to terminate the pregnancy.”
“Did you ever speak to the emergency room physician yourself?”
She shook her head.
“Who ran the private clinic?”
“A midwife named Selena. Ryan knew her.”
“Did she do ultrasounds?”
“Yes.”
“Did you see the screen?”
“Sometimes. But it was always blurry. She said the mass was blocking the view.”
“What about the heartbeat?”
“She used a Doppler.”
A fake Doppler could play any sound.
I could barely breathe.
“Emily, did Ryan ever show you the written emergency room report?”
“No.”
“Did you ask for it?”
“He said the hospital lost it.”
The door opened.
Daniel entered with a police officer and my mother behind him.
My mother looked sick.
“What happened?” I asked.
Daniel held up his phone.
“I tried calling Ryan. His number has been disconnected.”
My mother lowered herself into a chair.
“There’s more.”
She handed me her phone.
On the screen was an alert from her bank.
That morning, someone had transferred eighty-six thousand dollars from an account labeled EMILY BABY FUND.
The account had been created to help Emily and Ryan with medical costs, a nursery and unpaid maternity leave.
Ryan had been given access.
The entire balance was gone.
Emily stared at the screen.
Her lips parted.
Then she looked at me with an expression so full of shame that it hurt to see.
“He knew,” she whispered.
“Knew what?” the officer asked.
Her eyes filled with tears.
“He knew there was never a baby.”
Before anyone could respond, the cardiac monitor began screaming.
Emily’s blood pressure dropped.
Her abdomen tightened visibly beneath the blanket.
She gasped once and curled forward in pain.
Dr. Shah rushed into the room as blood began seeping through the sheets.
“The mass is rupturing,” she shouted. “Get her to interventional radiology now!”
They pushed me away from the bed.
The last thing I saw before the doors closed was my sister reaching toward me with a blood-covered hand.
May you like
And the last thing I heard was Daniel telling the surgical team that they might have only minutes left to save her.
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