Sunday, September 29, 2013

Shards To A Whole: Chapter 208

McGee-centric character study/romance. Want to start at the beginning? Click here.

Chapter 208: Jimmy

When they put Molly to bed, and Jimmy still hadn't heard anything from Tim, he had gone from nervous to really worried.

So he did something he'd never done before.

Technically Jimmy is a doctor. He's kept up with his continuing education units and made sure to maintain his medical license in Virginia. Mostly it's just a point of pride. He had to finish medical school to be a Medical Examiner, he didn't actually have to do his residency and get his MD. But he did it.

And as a registered doctor in the state of Virginia, he has access to the Federal Medical Database. And sure, the bugs aren't all worked out, and the backlog on old data is about ten years long, but back in January, all new casework, test results, consultations, and notes are supposed to be uploaded so any doctor can get full medical records at a moment's notice.

So, he got online, registered with the database, and checked.

He spent a good half an hour studying the ultrasounds, read Dr. Draz's notes, and her suggestions, thought they were fairly reasonable, and came to the conclusion that he had not heard anything from Tim and Abby because they were probably at home getting hysterical about this.

Breena sat next to him, reading over his shoulder, looking concerned.

He stood up, kissed her, and said, "I think I'm going to go make a house call. You feel like sending that to Ducky, so I can get them a third opinion, fast?"

"Sure. You want me to have our OB look at it?"

"Might as well. I'm guessing Tim's gonna need to be talked off a ledge, and Abby's probably feeling pretty disappointed."

"Yeah, she was hoping for an unmedicated, home birth."

At home?
"At home?" Jimmy's never gotten that. He knows some people do it, voluntarily. But he wouldn't get a cavity filled without pain medication and properly trained medical professionals right next to him, let alone anything longer or more painful than that. And having both delivered babies (he, like everyone else who was a medical intern, had a six week long OB rotation) and been there for the delivery of both of his own children, he's pretty comfortable with the idea that it really hurts, lasts a hell of a lot longer than a filling, and is way more dangerous.

His personal theory, that the whole natural childbirth thing is women being just as macho as men, if not more so, (because he doesn't know any guy, anywhere, ever, who would sign up to spend twenty hours having his testicles stretched to ten times their original size without a ton of drugs) and this is their way of proving who has the biggest dick, is one he hasn't felt any need to share with Breena or Abby, though given that this was something Abby's in favor of, he may decide to share it with Tim.

"I kept telling her that the hospital isn't that bad, and that the drugs are really very nice, but apparently there are a lot of girl in HR and Accounting and a few other departments who came by the lab, dropped off cute little presents, and proceeded to tell her absolute horror stories about how bad their births were. She's pretty scared."

"Okay." He picked up his phone, hit Tim's contact, and before Tim could say anything said, "I'll be there in twenty minutes. Put your computer down, pry Abby away from hers, and go watch a sit-com while you wait for me, okay?"

"Jimmy?" He can hear the fear under the surprise in Tim's voice.

"You didn't call. That meant something was wrong. I stole Abby's medical records, wanted to know what was up before I called, and from there it wasn't too hard to figure you'd be scared. Sit tight. I'll be there soon. We'll go over everything together, and hopefully get you off that ledge your about to jump off of."

"I'm not that bad."

"Sure you're not. Look at your right hand."


"It's shaking isn't it?"


"Go. Get on the sofa, put something stupid and funny on, I'll be there soon. If you want, I'll grab Ducky on the way, and be there in about an hour."

"Rather have you here alone, faster."

"Sit tight, I'll be there soon." He hung up and looked at Breena. "He's terrified." Then he hit Ducky's contact button on his phone. "Hey, Ducky, Tim and Abby didn't get good news from the doc today. Breena's sending you the scans and everything. Feel like looking them over and heading to his place?"

Ducky's voice is grave as he says, "How bad?"

"I don't want to prejudice your opinion. Take a look and head over to their place. Tim's terrified. I'm sure Abby's sad and scared. They could use some handholding from people who know how this works."

"Certainly. I'm opening my email." He can hear Ducky messing with his computer. "I'll be there in an hour or so."


Breena looked up from forwarding everything to their OB, and gestured for Jimmy to come closer. He did, and she kissed him. "Give them my love and a kiss."

"Tim, too?" Jimmy's not looking thrilled at that.

"Especially, Tim. He needs one, and it might shock him enough to help break the panic."

That was a good point. "If he hits me, it's your fault."

Breena smiled. "He's not going to hit you. At least, not until Bootcamp on Saturday. Get over there, talk them off the ledge, and give both of them a smooch from me."


Bedside manner was never one of Jimmy's strengths. Mostly because of his skill at saying whatever the least appropriate thing for the given moment. But, he's been getting a lot better at that over the years.

And right now, he's got one main guiding principal going: Do Not Scare Them Anymore Than They Already Are.

He's thinking that shouldn't be too hard. He's also thinking that what likely happened was their Doc explained what was going on in a rather soothing sort of way. They both sat there, pretty scared, not really taking it in, and not knowing what sorts of questions to ask. Then they got home, researched the hell out of it, and got really scared, and had no one to ask anything besides the internet which is more or less the worst possible place to study anything that you find personally scary.

Family, especially family that's expected, doesn't have to knock at the McGee house, so he just walks in when he gets there, and sees the two of them following his directions. They are on the sofa, looking in the direction of the TV, and he can hear a laugh track.

He's absolutely certain they aren't actually watching it, though.


You stay on the sofa, and you don't
encourage her!
Tim hops up to greet him, and Jimmy gives him a hug. Abby starts to get up, and Tim glares at her, so she stays sitting.

It's true that Jimmy will never, ever call Tim out on overreacting about possible dangers to Abby or Kelly. He will never say Tim is being unreasonable, or that he's got no right to be scared. It's also true that he can feel Tim shaking and this level of scared isn't good for either of them. So, arm wrapped around Tim, he says, "Come here, Abby, join the hug."

And she does, looking fairly pleased that he's not treating her like she's made of glass. And now Tim's glaring at him.

"You carried her to the sofa, didn't you?" He got that out, and then Abby was there, nodding yes, rolling her eyes, so he pulled her close, too and took a moment to hold both of them, trying to be calming just by being there.

He kissed Abby's forehead, looked her in the eye, and said, "You're going to be fine." He petted her tummy. "Kelly is going to be fine." Then he turned his head two inches to the right, kissed Tim on the cheek, which he looked horrified at, but it does seem to have shocked him out of his fear, at least, he's not shaking anymore. "The kisses are from Breena. She thought you'd need them." He stared Tim in the eye. "Tim, your girls are going to be fine. Come on, let's sit down and go over this. Abby, can you get us a stack of paper and some markers."

"I can get it," Tim answered.

"I know you can. But you need to know she can walk around and not break, so Abby's gonna get us the supplies, and you and I are going to sit down and wait for her to do it." When Abby headed upstairs, Jimmy quietly said, "Look, I know you two; your emotions feed hers and vice versa, so you have to keep it together. That's your job: be the man, and that means playing cool, especially if you aren't. You wanna have a full-on freak out with me and Gibbs, that's fine. We will support you through it, and if it takes more than a day, we'll come up with a lie for why you aren't home. But from now until that baby comes out, you absolutely cannot panic in front of her. Scared is fine. Sad is fine. It's good for her to see this affects you, too. So terrified you're treating her like a light breeze'll hurt her, that isn't! You're just making her more upset, and that makes you more upset, and you end up with a positive feedback cycle from hell."

"What if it was Breena?"

"Then I'd be exactly where you are if not two steps further down the panic line, and you'd be telling me to calm the fuck down and not lose it in front of her because not losing it is my job! Only one of the two of us needs to be sane at any given time, but both of us have to be able to fake it. So, until you can handle this on your own, I'm here to help you stay cool. But you've got to be able to grin and bear it."

Abby headed down, put a few markers on the coffee table and headed into Tim's office for paper.

Once she was out of earshot again, he asked, "We good on that?"

Tim gritted his teeth and narrowed his eyes. Jimmy took that as consent.

Abby was back half a minute later with a stack of typing paper. Jimmy knelt in front of their coffee table, and waved them to come close. "As I told Tim, I stole your medical records, checked the scans, and sent copies to Ducky and our OB, so third and fourth opinions'll be heading your way soon. In fact, Ducky'll probably be here soon, maybe with Penny, and possibly having consulted with a few of his buddies as well."

Really awful, really.
Jimmy took the black marker and drew a circle on the paper, then stuck two small, vertical lines right next to each other at the bottom of the circle.

"Okay, this is a really awful drawing of a uterus. Those lines are the cervix. Normally, as the third trimester wears on, those lines get shorter and further apart." He added arrows pointing right and left.

"Now, usually, the placenta is up here." He added a red blob at the top of the circle. "And when you go into labor the contractions pull the cervix sort of up and apart." He gestured with his fingers with a drawing up motion.

"Both of you with me?"

They both nodded.

Evil bloody jellyfish.
He snagged another piece of paper, drew another circle, two lines, and a red blob right at the bottom over both of the lines. "That's a placenta previa. As you can see it's lying right over the cervix. Placentas are pretty tough. If you've ever seen one in person, they look like an evil bloody jellyfish from your worst nightmares. They're rich in blood, lots and lots of vascularity, so like your lips, if you cut one it bleeds like crazy. They also don't stretch. So, if one half of the placenta is over here, and the other half is over there," he's circling each side of the placenta pointing out even more clearly that it's straddling the cervix, "you've got a ticking time bomb, because the parts of the uterus it's attached to are moving further and further away from each other. And, not to put too fine a point on it, it's also between the baby and the exit. This is a bad thing."

He grabbed another sheet of paper. Drew yet another circle and two lines, and this time drew the placenta blob three centimeters up and to the left of the cervix. "If I'm reading the scans right, and it looks like Dr. Draz thinks this is what's going on, too, this is what your uterus looks like. First and foremost, you don't have the placenta waiting for the floor under it to rip apart and it's not blocking Kelly's way out. So that's the very good news part of this."

Jimmy gestured with the marker while he said, "Okay, so possible trouble comes when everything thins out and starts moving. The cervix and walls of the uterus move up and back, great. Well, there's this big blob of blood sitting there, and it's attached to that wall, so it sort of smushes as the contractions continue, and that can cause bleeding issues."

He grabbed the drawing of the normal uterus. "Also, usually, after the baby's out, you keep having contractions to expel the placenta, and stop the bleeding. Most of the contractions come from up here." He's circling the top of the uterus where the placenta is. "Which makes sense because it's pulling everything up and out. Likewise the hardest, strongest contractions aren't at the cervix end of things, because that's got to be soft and flexible enough to get the baby out." He looks up at Tim and Abby, who are staring at this ridiculously inaccurate drawing like it's the revealed Truth of God. "With me so far?" They nod, not looking away. "So, the mechanism that gets the placenta out and shuts off the bleeding doesn't work all that well because the placenta isn't in place to take advantage of it. So, once again, potential bleeding problems.

"According to Dr. Draz your body hasn't really gotten the message that the baby's gonna come out anytime soon. The uterus is a big, strong, thick muscle, especially at the cervix end, because it's got to keep that baby in there." He drew a quick and dirty, but significantly more accurate, sketch of a female pelvis. "So right now, you've got this pile of muscle, skin, and bones all working together to keep everything inside you in there. So, yeah, you don't want to take up bungee jumping, but for right now, there's not much risk of anything happening. You've got a nice, contained unit, and it doesn't much matter one way or another where your placenta is."

The fact that Abby hadn't just flashed Tim an I-told-you-so look told Jimmy exactly how scared both of them must be.

"But starting soon, your hipbones are going to spread out. Your uterus and cervix will thin out and spread. After all, the final goal is get the baby out, and that won't happen if everything stays shut tight. And as things spread out, the possibility of tearing gets higher."

"What's higher?" Tim asked.

"I don't know. Not an OB. Dr. Draz had in her notes something like 7 out of 10 women she's seen with your kind of previa do just fine, and I've got no reason to think she's wrong."

"What's fine?" Tim wanted to know.

"Not a mind reader in addition to not being an OB, but I'll guess she's thinking that in seven out of ten cases the uterus keeps growing and the placenta moves far enough out of the way to not be an issue."

"Did you ever deal with something like this?" Abby asked.

"No. I delivered twenty-two babies solo, and helped with seventy-three more during my OB rotation. Nothing like this, though. Of course, they don't let Interns work on the high-risk patients."

"But it is a high risk," Tim added, staring at Abby, terrified, stroking the back of her neck.

Trying to be soothing.
Jimmy squeezed his shoulder. "Yeah, but there's a huge difference between high-risk and get-your-affairs-in-order. If it was 1950, hell, 1980, this would be a huge freaking deal. But it's not. Your OB knows this is an issue. You know it's an issue. You go in, you get the c-section, they take everything out in one fell swoop, pump some Pitocin in to make sure the bleeding shuts down, and if it doesn't, they've already got you typed and matched for more blood, possibly your own if you want to do that, pints of it on ice waiting for you, clotting factor at the ready if need be, and if worst comes to absolute worst they can have a hysterectomy done in a matter of minutes. But you don't die. Kelly doesn't die. Four or five days, ten tops, you're home from the hospital with her and get to see how well you function on no sleep."

I don't want...
And while Tim found that reassuring, it wasn't the right tact for keeping Abby less scared. "I don't want a c-section, let alone a hysterectomy!"

Jimmy nodded, realizing his tactical error on this. Tim's worried about losing the loves of his life, and Jimmy, who is also a husband, and Abby's best friend, is feeling the same sort of thing. Abby's worried about being cut to shreds, mutilated, and losing Kelly. She's not looking at this as a life or death situation for her.

Jimmy tried a different tact. "Look, this isn't likely to happen. Kelly's about two pounds now. She's going to triple in size, maybe quadruple, possibly more between now and when she's ready to come out. Your uterus is going to grow like crazy. By the time you hit regular contractions everything will have likely moved out of the way.

"But if it doesn't, if it was Breena, I'd say get the c-section as soon as they'll do one. But you're not Breena. I've done four c-sections, and yeah, they aren't minor surgery. It's not getting a few stitches. Your abdominal wall does not appreciate being cut open. But, assuming Dr. Draz actually knows what she's doing, and my guess is, since you're still going to her, she does, the risk levels for a planned c-section should be minimal.

"But again, I'm not an OB, I'm not your OB, and it's not my body getting cut open, so I've got a somewhat different take on what's going on here. What I do know is that the last thing you want is the emergency, bleeding all over the place, get-that-kid-out-STAT c-section…"

They all heard the door open, footsteps, and a gentle voice saying, "Dr. Palmer, I concur," at the same time.

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