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Chapter One Once upon a time, there was a doctor who loved to run. Up at her version of dawn, she sought solace on the road before her brain was fully awake. She found rest in the movement of her legs as they kept time to the music in her playlist; she escaped into the beats of the song and away from the minutia of the everyday hum of DC life and traffic.

One could find it odd—that running gave her rest—but Diana Gallagher-Cary couldn’t explain it any other way. When her feet hit the pavement, the will to move, the direction to take, the speed at which she accomplished each step was of her own volition. She could choose to stop at Starbucks and order that delicious Frappuccino for comfort whenever things—not running—got her down. She could sprint her entire route or walk it without guilt, because running was, solely, for her.

Running also served Diana well when every step meant the difference between witnessing her job’s daily miracles or missing them entirely.

Especially today, Valentine’s Day.

The labor and delivery ward at Alexandria Specialty Hospital, a generous size at ten labor beds, was almost at capacity. Eight patients were in active labor; of the eight, two were pushing. Another patient was on her way up from the ER, hoping to usher her baby into the world on this auspicious day, or the hour that’s left of it. About ten months ago, a summer storm had knocked out power for almost twenty-four hours to most of the DC area, and tonight was the proof.

Diana’s job, as the on-call house OB, was to get babies delivered and mothers recovered in a cost-effective and timely manner.

Correction: That was Diana’s mission for all patients except for those VIPs who occupied two very exclusive combined labor, delivery, recovery, and postpartum suites, where neither expense nor effort was spared.

With her hands stuffed in gloves where her sleeves ended, her curly hair in a tight bun, and wearing decorative eyeglasses that did nothing for her except protect her eyeballs, Diana approached the woman in VIP suite #1 with practiced measure and natural confidence despite her exhaustion. The back of her neck was damp. She’d sprinted there from the emergency room a floor down, cutting through the nurses’ break room to snag a couple of lumpia from the Valentine’s potluck the night nurses had planned, changing out of a soiled scrub top, and blowing by the elevator to take the stairs in twos, which would have impressed even an Ironman. Her gaze jumped from the silver cart parked near the infant warmer that held all her sterile supplies and equipment for the delivery to the moaning patient on the bed, then to the nurse and husband standing nearby. In the background, beeping machines and the baby’s heart rate amplified through a machine’s speakers mimicked the beat of one of the dubstep songs on her running playlist.

“Hello, Senator Preston.” Diana halted at the head of the bed, where Senator Madeline Preston of Virginia rocked on her hands and knees. “I’m Dr. Cary, the OB on call. I’m covering for Dr. Bahar until he arrives; he had a bit of car trouble.”

Madeline’s hair draped over her face, and the back of her neck was exposed, shiny with sweat. Her husband, the graying lead singer of the rock band SMAK, stood to his full height at the opposite side of the bed, though his expression was like a child’s, vulnerable and disheveled despite his rugged good looks. In his hand was a cup of ice chips.

Madeline moaned. In between breaths, she said, “I don’t ... want you. I ... want ... Dr. Bahar.”

I want him, too. Believe me. Dr. Bahar was going to owe her one. Diana plastered on a smile and through gritted teeth said, “I understand your concerns, but I promise I will do my very best to fill his shoes.” Diana kept her voice light and reassuring to mask her impatience. She hated covering for these VIP doctors; the hospital staff shouldn’t have to, with the daily census they carried on L & D. She should’ve been out there with the rest of her patients.

“They told me that since this is my first baby, I would be in labor forever. They lied.” Madeline growled and lifted her damp face. Her eyes glistened with tears. The next second, a guttural sound emerged from her throat, and her gaze seemed to focus elsewhere—inward. Another contraction.

Her husband sprung to his duties; the palm of his hand made contact with Madeline’s lower back. He dug in like a Swedish masseur, and his face contorted with effort. His sleeve tattoos wiggled as his muscles contracted and relaxed.

“Good. Breathe, Mama. And great job, Dad. That’s the way,” Diana said reflexively. She scanned the amount of fluids in the IV bag and the pattern of the baby’s heartbeat on the monitor. Nice and steady. She surveyed the suite. Unlike the rest of the rooms on the labor and delivery ward, which only accommodated mothers in labor and during their short recovery after birth, these suites were used for the entirety of a mother’s stay, from labor, to delivery, to recovery, and then postpartum. The VIP suite was also three times larger. Champagne sat in a chilled bucket on the windowsill. Off to the side was a real bed—not a pullout chair—with 1,200-count Egyptian cotton sheets for Madeline’s husband for the two nights they would stay if mom and baby progressed without complications. Currently, untouched room service with fine tableware sat on a cart in front of a love seat across from a fifty-four-inch television, which now piped soothing classical music through its speakers, a specific request outlined on Madeline’s birth plan. Through the open door to their private bathroom peeked a Jacuzzi tub and a separate stand-up shower.

Diana considered all of these amenities “wants,” but Senator Preston and her husband could afford the reservation fee for one of these astronomically expensive suites where the rich and the privileged could have their birth plans followed to a T. In the lap of luxury and comfort, this was deeply unlike the way the rest of the world’s mothers delivered their babies.

Diana tore her eyes away from the room’s details, pushing her lower-middle-class values down, and planted them back on the person—the people—who mattered: the patient and the baby she was minutes from bringing into this posh environment. Diana had joined Alexandria Specialty Hospital’s staff knowing she would be caring for patients across the spectrum of privilege; that, during call, she might have to admit and care for VIP suite patients before their exclusive, personal OB doctors arrived. It wasn’t her job to judge the excess. Outwardly judge, anyway.

“How’s it going, Lettie?” Diana approached the nurse as she readied extra sheets and towels at the corner of the room, away from the senator.

Lettie Vasquez, too, was part of the normal staff of the ward, especially assigned to this patient because of her caring demeanor (which this clientele soaked up like a sponge) and her ability to put privilege in its place (like the time when a president’s son had insisted she answer his phone calls while his wife was in labor). She was a veteran on the staff, with two decades of experience and wisdom that had helped Diana in more than one sticky situation.

Great nurses were worth their weight in gold and then some.

“Ms. Preston’s contractions are coming about a minute apart now,” Lettie said while Madeline groaned in the background. “And pretty regularly. I just checked her, and she’s ten centimeters and ready to push. Did you eat?”

“Yes, ma’am. I snuck in some of your lumpia a few minutes ago.”

A smile graced Lettie’s lips. “Good. You have to take the opportunity when you can. Especially tonight, when the patients are nonstop.”

“You don’t have to convince me. Your food is really the best,” Diana declared.

“Ay, I’m sure your mom makes better lumpia than I do.” She brought the sheets to the baby warmer and turned on the oxygen and suction machine, just in case.

“She tries.” Diana snorted as she pulled a face mask from the wall. “She likes to create ‘versions.’” Her mother was a wonderful woman, but she spiced up many of the traditional recipes much like she accessorized her wardrobe: randomly. Diana found that her best Filipino meals were during call, when her favorite nurses got together to share food, sometimes even at her request. And though it was uncommon to do so, she’d sometimes join them in the nurses’ break room to soak in a bit of her culture—if but one-quarter of it—even for a few minutes at a time.

“That’s what food is: versions. But maybe one day I’ll share my recipe with you.” She glanced askance at Diana with a sly grin. “Maybe.”

“Are you both just going to stand there? This baby is going to fall out!” Madeline demanded.

No, the baby was not falling out, but Diana heard the telltale tones of panic and determination in Madeline’s voice.

So Diana settled herself on a rolling stool and affixed a mask to her face as Lettie pushed the cart of instruments and a portable overhead light to within arm’s reach. Diana aimed the light just so. This was the time when the rubber met the road, Senator Preston’s moment of truth. This was the moment when the senator would show strength rivaling that of any world-class athlete, when education, economics, and privilege took a back seat. “All right, then. Let’s have a baby.”

Diana pulled the mask down as she exited the room, face cooling as the hallway AC hit her warm skin. The sounds of success—a crying baby, Madeline cooing, and her husband chatting gregariously on the phone—muted as the suite door closed behind her. Diana’s heart rate, which had been at a sprinter’s pace, had begun to ebb from the satisfaction of a job well done. Her body didn’t know the difference between a runner’s high and a doctor’s high, and right now, she was on top of the world.

The hallway was quiet until the double doors opened to the nurses’ station. Four wings jutted out like spokes from this one central area, the hub of activity, despite the hour: almost two in the morning. Nurses milled about with clipboards in their hands; others were on their work-assigned phones discussing patients with their respective providers. Nursing assistants pushed vital signs equipment from one room to the other. Diana passed the wide windows of the soundproof nursery behind its own security doors, where two nurses each fed a baby, while a dozen in their respective bassinets waited their turn.

Hospitals were not meant for sleep.

“Dr. Cary.” The night’s charge nurse, Millie Grant, approached her. All business despite her dangling teddy bear earrings—the unit’s staff was required to wear hospital-provided teal scrubs for additional security, and individuality was expressed in myriad ways. Two hospital Spectralink phones hung precariously on her lanyard. “I need you.”

“What’s up?” Diana, accustomed to multitasking, sat in front of a computer and logged in. She clicked on Madeline Preston’s name, then on the notes section, where she typed her standard delivery note, one ear cocked toward the nurse.

15 February

Normal vaginal birth. Infant female born at 0105, 7 lbs. 14 oz.

“Dr. Mendez called for you in the ER.” Millie eyed Diana knowingly.

Apgar score 9/10.

Patient’s estimated blood loss within normal limits. Current vitals within normal limits.

Assume standard recovery and postpartum procedures.

Diana grumbled at being summoned downstairs, by her ex no less. “Anything else?”

“Ms. Storm just called, and she’s on her way. She feels like she’s in labor.”

“Feels like labor? Signs and symptoms?”

“She thinks she had a contraction a few minutes ago.” Millie shrugged, resigned. “And she wants to come in.”

“Have you called her provider?” It was, yes, the Winter Storm, pop star and social media maven who’d humbly started on the YouTube scene five years ago as a fresh-faced singer with a guitar and was best known for throwing her exes and frenemies into her love—or hate—songs. The bottom line was, besides being a VIP, Winter Storm was high-maintenance as a human.

“Dr. Thompson is on his way. But there’s a bigger problem. That last patient who came up from the ER brought our official census to capacity, which never happens.”

Diana nodded. The VIP rooms were not counted as part of room availability, since they were opened only when a VIP was actually going to be admitted, and at that point would be allotted on a first-come, first-served basis. And just as there was the risk for VIPs to be admitted to the general population if both VIP rooms were filled, once opened, the VIP rooms could be occupied by non-VIP patients.

“All right, so we transfer out and redirect patients, and open VIP two for Winter Storm,” Diana said. “We do what we have to do per the protocol. After we’re done here, let the ER know so they can divert potential labor patients. Oh, and inform our hospital supervisor so he’s aware of the closure.”

Millie did not move, something else clearly on her mind. Diana sighed. Never once had she closed the labor ward to patients, and her body was feeling the work she’d put in tonight. As soon as she got home from call, she was going to treat herself to a bath and a glass of wine. Even if it was going to be at eight in the morning.

“What is it, Millie?”

“Your mother called. Several times on the ward, since she couldn’t reach you on your cell.” Millie held out a stack of Post-its with what Diana recognized as the scribbled handwriting of the ward’s secretary.

She took the Post-its and flipped through them. Call mother at home or a version of it was on each one. Diana groaned.

“That good, huh?” Millie surmised. The look of concern was unmistakable on the nurse’s face. Nothing would get past her, not in this environment, where most caregivers had an eagle eye for family drama.

It was sometimes a little too close for comfort. Diana stuffed the Post-its into her front pocket.

“How is Ms. Margo, anyway? And how are you?”

Diana slowed her movements and took care with her next words. Millie had called her mother by her Instagram handle, Ms. Margo. Margaret Gallagher-Cary was a celebrity in her own right, if one called going viral because of her wacky fashion sense and keen photographic eye being a celebrity. But what came along with it was everyone knowing—or presuming to know—everything about Diana’s and her mother’s life. “She’s all right. And I’m fine, too, thank you.”

“Today’s post, actually showing us her bucket list? It gave me all the feels.” Her eyes gleamed. “One day I’m going to do a bucket list, too. You’ll have to send her my best wishes. But I bet it will be another change for you, won’t it? I know I’ve said it time and again, but if you need anything, at all ... change, in all ways, is tough.”

“Thank you. I appreciate it, but I’m fine.” Diana smiled and kept her mouth shut despite wanting to commiserate. She could have gone on and on about how the changes in the last six months had rendered her unsteady. With her granny Leora passing away, and her mother moving in to make Diana’s town house her “home base” as she and her best friends conquered this elusive bucket list, on top of Dr. Mendez ... it all gave her whiplash. And Millie would have probably empathized—she might’ve given Diana some much needed advice. Night after night of raw emotion, relationship-driven conflict, tragedies, and happily-ever-afters within the context of baby-delivering required nurses to have acute social awareness.

But Diana was the MD on call. Though there wasn’t a hierarchy in the ward, the reality was that nurses looked to physicians for patients’ orders, and sometimes, for the final say. Diana had learned early to compartmentalize, to shove her personal concerns to the rear when she drove into the parking lot of Alexandria Specialty. Narcissism had no business in health care, where her job was to act outwardly, help others, put people first.

Diana clicked on the “log off” button on Madeline’s chart, and it reset her plummeting mood. “I have to head out. I’ll be on my phone. Time to see that Dr. Mendez.”

Millie nodded in understanding, and a wry smile bloomed on her face. “That’s right. And don’t forget the fourth pillar of our mission here at Alexandria Specialty. ‘To provide kind, reliable, and straightforward customer service.’ Even to other doctors.”

Here was the thing about labor and delivery: it was either feast or famine. Standard procedures dictated that mothers in labor had two methods of entry to the hospital: through the normal prenatal and preregistration process at the labor and delivery ward for those who were patients of providers of Alexandria Specialty, and the ER for all other cases.

Tonight, the ER had been a revolving door of pregnant ladies, but Diana’s current focus was on the man in the white coat at the nurses’ station holding a clipboard.

“Carlo.” Diana stuffed a hand in her pocket and gripped one of her pens to steel herself. She’d successfully avoided him the last week despite them being on call at the same time.

Dr. Carlo Mendez faced her. He was the epitome of perfect proportions; his smoldering look was out of a GQ magazine. When they first met, he was even a model on the side. Not only was his face a true work of art, but his body was, too. At five ten, with a chiseled face, wavy and properly disheveled hair, and a mouth full of perfectly straight white teeth, he had been a sight to behold. He still was, until she remembered that he was a cheating rat.

“Hey.” He used his flirtatious voice, closed the chart, and gestured her to his office. “I passed by the house before work. I was hoping you were going to be there.”

“Nope. I’m here, as you can see. What did you need?”

“I tried to pick up a couple more of my boxes, but Margo wouldn’t let me in.”

Go, Mom. Pride swelled in her chest. Her mother may be flighty, but she had a backbone still.

“You should have called me before showing up. You know my rules.”

He stepped in closer. “Forget the rules, Diana. It’s been six months. Can we end this ... cold shoulder? I want to come home. Hasn’t it been tough on you, at all? Haven’t you missed me?”

She clicked the pen in her pocket, hard, just enough to take the edge off. It had gotten better for her, actually. The hurt had transformed itself to something she could work with—realization, with some anger—but she was ready to move on.

“You should have thought of that before sleeping with another woman and keeping me in the dark for a good year about it.”

His face softened. “Diana, please. I made a mistake. At some point you have to forgive me. I’ve forgiven you. Look, it’s not too late. I mean, construction’s going on at our house, for renovations we both drew up, for God’s sake. We can fix this.”

Diana seethed under her breath, though she focused on pasting a saccharine smile on her face. Before they’d broken up—or, before she threw him out of the home they’d purchased together—they’d taken out a home equity line of credit to build a balcony and to renovate the master bath. It wasn’t a wedding ring, but it seemed a commitment enough, coming from him. Or so she thought.

“This is about you removing your items unless you want them trashed or donated to the Salvation Army. This is not about me. This wasn’t my fault.”

“Okay, fine.” He shrugged. “You had no hand in our breakup at all. Even if you pushed me away every step of our relationship. I mean, after five years, it got tiring having to extract any kind of emotion from you.”

“I’m done.” She bolstered her spine straight while attempting to unravel his pretzel of words. He was good at this ... this talking. The combination of his radio-worthy voice and his disarming cadence always threw her off her game.

“What do you want from me?” She eyed him. “I can tell there’s more. Out with it; I’ve got a ward full of patients waiting for me.”

“I miss Flossy.”

“Oh, no, no, no.” Forget being civil. Diana’s voice raised an octave higher. “Don’t bring her into this.” Flossy was their Havanese, their one baby, and sadly the collateral damage.

“I want visitation.”

“That’s ridiculous.” She raised an eyebrow, wary of this new turn in the conversation. Their breakup had brought out a different side of Carlo. What had been endearing and loving now presented itself as manipulative and passive-aggressive, like the distance had removed the filter she’d placed on him for all these years.

“I received approval from my landlord, and, I mean, she is mine.”

The hairs on the back of her neck stood. “She is not.”

“I bought her with my credit card, if I remember correctly. I left her with you because I thought it would be easier for transition’s sake, but I miss her. Hell, you didn’t even want her. You wanted to send her back to the breeder.”

“You can’t have her,” Diana said firmly. True, she hadn’t been thrilled when he walked in the door three years ago with Flossy, then named Starla by the Sea. She had been firmly against breeders, but Flossy fit in her hands and had this thing with toilet paper—she’d gone bananas over it, tearing rolls to shreds. Diana had become a mother overnight. The dog filled her heart as she and Carlo’s relationship grew. Being a fur mama had become a part of her.

But before Carlo opened his mouth for what she knew would be a rebuttal, the ER’s double doors opened to admit a woman being pushed in a wheelchair, belly round and high, hands cradling her head. A man, harried, and with a wild look on his face, followed, arms overloaded with jackets and insurance papers from the front desk. A nurse ushered the group into a bay, and the flurry of getting the patient into the bed and taking her vital signs began.

Cecily, the assigned ER nurse, nodded at Diana as she approached. “Francesca Smith. Thirty-six weeks and six days, complaining of a headache, abdominal and back pain for most of the day. No provider listed. Last seen four weeks ago at the Old Town Women’s Center.”

With an eye toward the bay, where they hadn’t drawn the curtains, Diana breathed a momentary sigh of relief. The center was familiar to her—her best friend ran the low-cost clinic and was a lifesaver to so many mothers in the community. No doubt the patient was here because of the education the center provided.

Diana’s initial impressions from the hospital monitors were that Francesca’s heart rate and respirations were normal, but her blood pressure was high. Too high. Diana suspected hypertension, possibly preeclampsia. The next second, she mentally worked through the algorithm of her diagnosis and the hospital’s status, which was at capacity. “We’ll have to see what we can do for her here. We might need a transfer because the ward is full.”

“I can start transfer paperwork, just in case,” Cecily answered.

Per professional courtesy, Diana waited for the nurses to do an initial assessment, and she followed up with her own, which included an ultrasound.

At the session’s end, she congregated with Cecily at the nurses’ station.

“She’s going to need an overnight for evaluation. I’m not loving the borderline low amniotic fluid. Let’s do the standard preeclampsia protocol, monitoring, labs, fluids, mag sulfate,” Diana said. “We’ve no beds in L and D. Do you have a spare down here?”

The nurse shook her head as she picked up the phone. “We don’t have any beds available for long-term monitoring, and that waiting room is filling up, too. The ICU is packed to the brim as well.”

“Damn.” Diana’s mind went straight to the logistics: the risk of transferring Francesca even ten miles down to the next hospital; then to her ward with its one last serene bed in a coveted, just-opened VIP suite; then to the incoming celebrity patient who had reserved that room.

The patient’s husband caught her eye. The coats were on the floor, the papers forgotten on his seat. He was gripping his wife’s hand. And as he spoke to the nurse at the bedside, the rest of the ER faded, and Diana heard only his voice. “She never gets headaches. Doesn’t get sick, ever,” he said. “Please tell me we’re staying.”

The decision weighed like a balance, tipping left and right. On the left, policy and money; the right, principle and health. In the middle was her conscience, her judgment, her ideals. The spirit of her grandmother hovering above her. Leora Gallagher, the woman Diana had looked up to, the woman she lost just months ago but, just as she had in life, seemed to find a way to insert herself into Diana’s everyday thoughts.

Leora had risked it all once in her life, and for one tiny baby, too.

“What would Leora do?” Diana said to no one in particular.

“Who’s Leora?” Cecily asked.

Diana shook her head, and the action rattled the balance so the factors jostled in her brain. She said the first thing that came to mind. “Forget it. No need to transfer the patient. We do have a bed upstairs: one of the VIP suites. I’ll admit her to that service.”

Cecily’s eyebrows shot up. “You’re sure?”

Diana took a deep breath. Right or wrong, she had to commit. “Yes.”

Technically, this patient arrived before Winter Storm, and technically, per their policy, those rooms were accessible to everyone, as dictated by census, once they were opened. And Diana knew well that not only was it either feast or famine in L & D, but in this business, it was all good and fun until it went to hell in a hand basket. She was making the right decision.

So why did it feel like, in avoiding the heat of this hell, she had jumped right off a cliff?