Shawnee County, Kansas
Tuesday, May 23, 2007
Dean sat in the parking lot of the Land’s Crossing shopping center and counted the cars in the immediate area of the lot. “There are four of them. Why would there be four cars if there aren’t any other patients scheduled until nine o’clock? That’s an hour and a half away.”
“They probably all work at the clinic. Now come on,” Sam urged.
“If you see anybody we know, tell me, and we’re leaving. This was a bad idea. We’re too damned close to Lawrence.”
Dean followed Sam anyway, though, and they walked into the empty waiting room of the Land’s Crossing Women’s Center. “Go on,” Sam said, and pointed at the reception desk. Dean paused for a few moments, but then went on and leaned against the counter.
“I have an appointment at seven-thirty,” he said.
The heavy-set receptionist put down her coffee cup and looked up. She tilted her head to one side. “Oh... you do?”
“Yes. Look, is Sabrina here? She’s the one I talked to last week and she set up the appointment.”
“No. Sabrina won’t be in until ten o’clock. Let’s see here... okay, there it is. Deanna Summers at seven-thirty, to see Dr. Hughes?”
“It’s Dean Summers.”
“Oh. I’ll correct that on the schedule, um, Summers.” Geraldine frowned and made a few keystrokes. “All right, you can wait over there in the waiting room, and we’ll call you in in a few minutes.”
Dean sat down next to Sam and picked up the stack of magazines strewn haphazardly on the small table to his left. “Ladies’ Home Journal… Elle… Highlights… isn’t there anything good to read?”
"Here." Sam handed over the copy of Time Magazine that he’d picked up; it wasn’t the best reading material, but better than makeup tips and handbag fashion. Dean leafed through it while they waited.
A short woman in a white coat opened the door next to the desk, holding a clipboard. “Deanna Summers?”
The receptionist growled something at her, and she winced. “Dean Summers?”
“What did I do in a past life to deserve this?” Dean sighed. He got up from the chair and nodded at the nurse, then looked back at Sam. “I’ll be back in a little while. Don’t get into trouble while I’m gone.”
“I’ll behave. I guess this means no throwing the Tyco trains in the corner?”
"Or the Legos." Dean rolled his eyes and walked back through the hallway.
“We’ll be in Room Four,” the nurse said. “My name is Julie. I apologize for the confusion “ her handwriting, Sabrina’s, that is, is a bit scribbly. Hard to read." She held one of the doors open for him. "Up on the exam table, now, and I’ll take your blood pressure.”
Dean waited tensely while Julie put the cuff around his upper arm. She tried to close the Velcro, then frowned and removed the cuff. “I’ll have to use the extra-large cuff,” she said. “You have a lot of muscle mass.”
“I work out,” he said. Julie was better-looking than Geraldine, he decided. Curvy, but not to the point of being round. If he wasn’t already seeing someone... well, it couldn’t hurt to look.
“That’s good. I should get to the gym more often, really “ now, hold still.” The cuff ballooned and tightened, then started to loosen in small increments. “One twenty-five over eighty. Normal. Now we’ll get your height and weight.”
Dean stood against the ruler and watched Julie stand on tiptoe to put the measuring bar over his head and check to make sure that it was straight. She copied down a number from the ruler and then started tinkering with the weights.
She tapped the 50-weight to the 150 line, then slid the pound weight across its balancing bar. 20… 25… 30… 35… 40... 42. “I do not weigh a hundred ninety-two pounds,” Dean protested.
“No, it’s a hundred eighty-nine. We subtract three for clothes.” She looked him over, heavy jeans and thick shirt. “Maybe four for you. One hundred eighty-eight. Well, your vitals are fine. What brings you to the clinic today?”
“Uh.” Dean glanced over at the door to make sure that it was closed. “I need a pregnancy test.”
She raised her eyebrows, but jotted something down on the clipboard. “All right “ there’s a twenty-dollar fee for urine testing, though, and most insurance companies won’t cover this.”
“That’s fine. I’m paying with a credit card.”
“The bathroom is down the hall, last room on the right. Do you know how to do a clean catch?”
“A what?”
“Okay. There’s a box of wipes on the counter in the bathroom, wipe from front to back with one of those, then catch the urine mid-stream.” She handed him a cup. “We’ll need up to this red line here… it’s not much, just an ounce. Bring this back to me and we’ll analyze it, and Dr. Hughes will be with you shortly.”
“Um, sure.” Her instructions made no sense, but he took the cup and did his best to follow them.
Dean was stuck waiting for more than twenty minutes. He heard voices outside, but couldn’t make out what they were saying. Just when he was getting frustrated and ready to leave, the door creaked open and someone else came in.
She was probably in her mid-forties, with dark blonde hair going silver on the sides, and was only a few inches shorter than Dean. “Good morning,” she said, with an apologetic smile. “I’m Doctor Hughes.” She closed the door and flipped through a few pages on the clipboard, the same one that Julie had been carrying. “I’m very sorry about this. I’m going to need to ask you a few questions, if you don’t mind. When did your last menstrual period start?”
“My what? I’ve never had one!”
Dr. Hughes nodded and laid the clipboard down next to the sink. “I’m sure this is all a shock to you, and I’ll do all I can to help, but I need more information. Did you ever have a period before starting hormone therapy?”
“Hormone therapy? What are you talking about? I’ve never taken steroids.”
“I meant androgenizing hormones,” she said. “You were born female, am I right?”
Dean snorted. “No. I’m a man, and I always have been.”
“I’ve worked with transsexuals before. I’m a professional and I don’t judge. You can tell me the truth.”
“I understand that. But I am not, and have never been, a woman.”
“Then there must be some other cause for your symptoms and test results, possibly a hormone imbalance of a kind. I’ll do what I can to diagnose you here but I may need to refer you to an endocrinologist. The pregnancy test came back positive.” Unfazed, she pulled a plastic package out of the cabinet underneath the sink and tore open the plastic, then handed him the white fabric contents. “Undress and put this gown on, and I’ll start the exam, Mr. Summers.”
“Just call me Dean. If you’re going to see me naked, we ought to at least be on a first-name basis.”
Dr. Hughes nodded, unimpressed. “If that makes you feel more comfortable, Dean, we can do that.”
She poked and prodded his abdomen, sometimes nodding, sometimes frowning. Dean took it all in silence, hoping that she would eventually say something. After several minutes, she pulled the hem of his exam gown back down to his thighs and straightened up. “I don’t mean to scare you, Mr. Sum - Dean, but there is a mass in your lower abdomen that is unusual. Normally I would have an X-ray taken, but without knowing the cause, I’d prefer to start with an ultrasound. We’ll have it set up in ten minutes.”
Even though he was absolutely sure of the cause of his symptoms, Dean couldn’t help but be a little bit worried. Sam had mentioned cancer, and he’d heard of some cancers that developed teeth and hair. Was that a possibility? Could a cancerous mass be producing excess hormones and grow so fast? He was only twenty-eight, sure, but Kevin Fredericks had only been two years older than that when he was diagnosed…
He lay down bravely in the ultrasound room when he was called in. Julie calibrated the machine and Dr. Hughes put on a pair of thin rubber gloves. They took a small blood sample to be analyzed, and sent it off with another nurse. Then Dr. Hughes pulled the bedsheet up to the bottom of Dean’s belly and lifted his gown enough to expose him from the bottom of his chest to about six inches below his navel.
Nervousness was sufficient to keep him from getting aroused.
“This is going to feel cold,” said Dr. Hughes, and she spread a thin layer of a clear, jelly-like substance over his skin. “I’m just going to be making a picture of what’s inside you… it uses sound waves, so we won’t need to be using a needle or scalpel today.” She drew a probe, one inch wide and about a third of an inch thick, across his abdomen, while Julie stood beside her with a narrower probe, staring at the screen. Several minutes passed and the screen began to show a picture.
Julie shrieked and dropped the probe.
“What? What is it?” Dean twisted his head around to see the screen, but at his angle, he couldn’t make anything out but gray blotches on a black background.
Dr. Hughes put her hand on Julie’s shoulder to steady her and looked up at the screen. The color slowly drained from her face and her jaw trembled, but she otherwise contained her reactions. “Julie, make me a few printouts, if you don’t mind,” she said quietly. Julie nodded and shakily walked over to the printer.
“What’s wrong?” Dean shouted.
“I’m not sure that anything is really wrong,” said Dr. Hughes, “but that is clearly a fetus. I’d estimate eighteen weeks, maybe nineteen.” She put the probes away and handed Dean a few paper towels to clean himself off with. “In my sixteen years of practice “ five in general practice and eleven in obstetrics and gynecology “ I have never seen this. I don’t understand how it’s even possible for a man to become pregnant. The only mentions of such a thing in medical journals, that I’m aware of, are one quack’s experiments almost thirty years ago, and a few instances of parasitic twinning, which isn’t technically a pregnancy.”
Dr. Hughes took the printouts from Julie and picked up the blood results and then led Dean back the exam room. “Do you have any idea what might have caused this? Are there any stretches of time, maybe in January or early February, that you don’t remember?”
“Not other than when I was sleeping,” said Dean.
“All right.” She nodded, and handed the first of the small stack of papers to Dean. “As you can see here, there’s no question that the mass I felt was the fetus.” She pointed to a blurry image that looked not like the otherworldly creature that he had been expecting to see, but more like a doll, with a human-shaped head and defined limbs that folded near its torso.
He stared at the picture, and his throat tightened. “It’s human, right?”
“Of course, Dean. A completely human boy.” She smiled sadly and shook her head. “It’s a miracle that you didn’t miscarry and have life-threatening complications. As I’m sure you know, you don’t have a uterus. I didn’t see any female organs on the ultrasound, although a more detailed one and possibly an MRI later might find them. It’s entirely possible that you have undeveloped ovaries and they somehow… were triggered to develop later. I don’t think that’s what happened, because of the location of the fetus, and the fact that you don't even have a vagina, but at this point any explanation has to be taken as a possibility.”
Dean shook his head. “There's nothing like that. So where is it… he?”
“It appears that a pocket of tissue near the end of your sigmoid colon has pinched off and has been growing and stretching to accommodate the fetus. At the place where your colon and rectum join. Luckily the growth is slow enough that your organs can shift around it, and it doesn’t appear to be obstructing your bowels at all. Any of that could change, though.”
Dean clutched the printed picture as she went on. It wasn’t an amorphous it anymore; he was Dean’s son. And Sam’s son. A little Winchester boy.
“Everything appears to be normal. Most of your hormones are within an acceptable range for this stage of pregnancy. Your testosterone is very high, but given your sex, it’s also within reasonable standards. I don’t think your life is in any immediate danger. If it was, I’d suggest that we call an ambulance to take you to the hospital now and terminate the pregnancy. However, you should be fine for another few days.”
“Why? What happens in a few days?”
“There is no guide to go by for a case like yours. Complications could arise at any point. It’s possible that they won’t, but that’s a chance I don’t recommend taking. Your intestines could twist around each other or become blocked; the tissues around the fetus could tear and leak. Those could kill you if left untreated. I don’t think you should wait any longer than necessary before aborting. If you had a surgeon in mind, I suggest that you get in touch with her or him as soon as you get home today. If not, I can perform the procedure as early as Friday morning; this is simply termination of an ectopic pregnancy, although a highly unusual one.” She gently touched his arm. “Dean?”
“I can’t,” he said. “This is Sam’s boy.”
“Who’s Sam?” Then she shook her head. “I’m sorry. That’s not any of my business. The choice is yours, ultimately. I can’t force you to do anything. But the longer you wait, the more you risk your own health and your life.”
“What if we waited just part of the time? Premature babies can survive. I know it’s probably too early now, but what, another month? Two?”
“One month would give him a small chance at survival. He would be in neonatal intensive care for a long time and even if he does survive, which he might not “ he would probably have permanent health problems. Living to adulthood in a situation like that is rare. Two months would be better, but you’re playing a chancy game if you think you can even make it that long.”
“It’s not a game. This is my son,” Dean snapped.
“I understand that. But I have to be honest with you. Continuing this pregnancy is dangerous. There is no way to predict what will happen to you or your son. And right now there isn’t enough room in your pelvic outlet for a full-term baby to pass through, or one even close to full-term. If for some reason you couldn’t get to an emergency room for a caesarian in time, both of you would die. The gap is wider than I would have expected it to be, but you need at least another inch of space.”
“I’ll make sure I’m not more than a couple of hours away from a hospital, then,” said Dean. “When’s my due date?”
Dr. Hughes sighed and shook her head, but she flipped open a chart and ran her finger down the side of the laminated page. “I can’t give an exact date. I can estimate to within a week, and my estimate would be October twenty-seventh.”
“What’s the soonest he could be delivered and still be healthy?”
She stood next to him and looked straight into his eyes with a firm stare before her gaze dropped. “Early in October. Possibly late in September. He would be small, and take a little longer to thrive, but I wouldn’t anticipate any serious problems.”
“Then I want to schedule the caesarian for the first week of October.”
Dr. Hughes nodded. “We can do that for you. I have to tell you one more time that this is a very hazardous choice, and my official advice is for you to terminate the pregnancy this week.”
“No.”
“In that case, I’d like to see you back no later than June twenty-sixth; that’s four weeks from today. Call me if any problems come up and if you even think it could be a medical emergency, go to the ER.” She gathered up her papers, except for the printout that Dean still held. “You can get dressed and go back to the desk, and Geraldine will check you out. Best of luck to you, Dean.”
They shook hands and Dr. Hughes left. Geraldine confirmed the next appointment and asked for payment. “Look, I, uh, am going to have to bring it tomorrow,” Dean said. “I forgot. My credit card has a limit on how much I can use it one day and I forgot that I used it to get gas this morning. Can I bring it in tomorrow?”
“You have twenty-four hours, and then we have to bill you an extra twenty-five dollars per day,” Geraldine explained.
“Not a problem. I’ll be here at this time tomorrow. Thanks.”
Sam jumped out of his chair when Dean came back into the waiting room. “Well? What happened? What did she say?”
Dean shrugged. “Not much. Confirmed what we already knew.” He handed the sonogram picture to Sam, and they went out towards their car. “That’s him.”
“Wow,” Sam said. “I didn’t think it would look that much… that much like a baby already.” Then he frowned. “How does she know it’s a boy?”
“You know, for all your time in college, you sure didn’t learn much.”
“Okay, I know how to tell the difference between a boy and a girl, but I can’t see details that fine in this picture.”
“Dr. Hughes was probably in grad school when you were in diapers and has more practice at picking out details on fuzzy ultrasound images. Now come on; we have to figure out how we’re going to get four hundred dollars in less than twenty-four hours.”
“Dude, just use the credit card. It's what you always do.”
“They’ll probably figure out that it’s a fake eventually, and I don’t want to have to show up with a different card with a different name.”
“Not in a week or two, they won’t.”
“Sam, I’m coming back in a month. And probably the month after that, and after that. He’ll be born in October.”
Sam blinked, and made a noise halfway between a laugh and a loud exhalation. “Dean, are you crazy? How are we going to go around hunting and fighting if you’re as big as a Winnebago? And then toting an infant around?”
“I don’t know yet, so give me a little time. I’ll come up with a plan.”
Sam climbed into the car and strapped himself in. “Dean?”
“What?”
“I’m glad you’re going to see this through,” he said. “And I’m here for you. Whatever you need, man. He’s my son, too.”
“Thanks. Let’s go get breakfast, all right? I’m starving, and there have been some strange disappearances down in Oklahoma. I want to get some food and start looking up information on the missing hikers.”
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