Page 1 of Cascade

CHAPTER ONE

Opal

APRIL

“I’m so sorry to be late,” I repeat again, sweating as I open my bag and pull out my instruments.

“Hey,” my patient, Indigo, says, patting my hand. “It’s really fine. Truly.” And when I meet her eyes, I can see that she means it. If only I could give myself this same grace. Lateness triggers all kinds of big feelings for me. Growing up, being late meant missing the last bus home and having to walk. Being late meant the heat got shut off.

“I’m still figuring out all the back roads between these towns,” I tell her as she and baby Gavin settle onto the couch. I can’t help but smile at my little patient. He’s such a chubby, pleasant baby. I reach out to greet him and he clutches my finger, making me giggle as the warm press of his hand surrounds mine. So trusting.

I love my job on days like this, days where I get to travel to see families in their comfort zone, check in on them. Most of my patients have happy homes like this one, but some…look more like how I grew up. Those are the houses where I’m most needed, and that’s what made me late this afternoon.

The Oak Creek Inn where Indigo lives and works is about as cute as a home can be. No sign in this house of overflowing ash trays or hidden piles of empty alcohol containers. No evidence of hoarding or shut off water supply. Just love and comfort and functional electricity.

“Should we get started?” I pull out my clipboard and work my way through the standard postnatal questions. I came to the midwife center with a multi-year grant to visit patients in their homes and chart follow-up care for a year after birthing. I have the training and the ideas and, shockingly, the funding. All I needed were the patients.

The little midwifery group near the small town of Oak Creek seemed like a great fit. They needed more hands. They had access to patients in three counties and admitting privileges at a great hospital not too far away. They seem excited by my research, too. Nobody has to tell me that this method will improve outcomes, but we want to prove it with data. We want to change how health insurance funds care for families.

The three months since I moved here have been a total whirlwind, starting with catching Indigo’s baby the very first night I got keys to my new rental.

Indigo talks through all the questions from my health survey, her singsong voice a comfort as she explains how she has wrapped Gavin into her work running the Inn. “Especially this spring,” she says, “there was no shortage of little old ladies eager to hold him when they were all in town for the cherry blossoms.”Accepts and asks for help,I write on the chart, smiling. “Hey!” She says. “How come we didn’t see you out at the cherry blossom festival? Mary Pat—you know from the food co-op—anyway, she tapped the maple trees early this year, so it was a combination syrup boil/blossom gazing sort of thing.”

I shrug. “I was probably at a birth,” I tell her. And it might be true. I could just as easily have been home double-checking that I’d cleaned the lint trap on the dryer. Triple checking the directions for how to walk the route into town until my fear at getting lost with a dead cell phone battery superseded my ability to even leave the house. I try to pivot back to Indigo and Gavin. “Nursing still going well?”

This baby’s rolls have rolls, and I nod while I make notes about Indigo’s milk supply. We talk for awhile until we are interrupted by my phone. During appointments, I only have it ring if my bosses at the midwife center call with something urgent.

“I’m sorry,” I say to Indigo. “I have to take this.”

I step into the hall and listen as Caroline tells me to drop everything and meet a client at the hospital. She’s got severe cramping and spotting and, at 18 weeks along, that’s just not good news.

I hang up and begin jamming my equipment back into my bag. “Indigo, I’m so sorry,” I tell her, hurrying. “I have another patient in distress. Can I reschedule with you later?”

She plunks Gavin on his blanket on the carpet and crouches to help me load up my stuff. “Don’t you even worry about it,” she says. “Go on and help that mama, whoever she is.” She squeezes my wrist and I smile at her before rushing out the door.

CHAPTER TWO

Opal

JUST DRINK IT.I spin the glass around in circles on the bar, staring.Just slam it down and be done with it.

I hunch over the bar, willing my mind to stop racing through all the possible scenarios that could ripple out from the simple act of me downing this shot of whiskey.

This is a thing people do after a terrible day at work, right? Slam back a drink. It should just take the edge off, and then I’ll tell the bartender all my woes and feel better. Right?

No. I’m paralyzed, staring at the glass.

This could be the gateway to a life lost to alcoholism, just like my father. It could all start with this one whiskey—and I might not be able to stop. I’d forget to feed my cat, forget to check on my patients, get fired for showing up at work drunk.

Or maybe it’ll just help you relax and you’ll go home, watchOutlander,and go to sleep.

I’d love to forget about today if I could. My patient lost her baby today—a much-desired, very-loved baby. I am glad I was able to be with her, to be the one to deliver most unimaginable news, to hold her hand as she was wheeled into surgery.

I do my best to form a connection with each pregnant patient, and while I always celebrate in their delight, that also means these devastations settle into my bones.

When this happens, I feel their loss and their pain as all my own grief simmers close to the surface. The thought spirals grow worse after days like these. I already know I will struggle to leave my house tomorrow morning, that I’ll check the locks dozens of times and walk back inside to make sure the gas stove isn’t lit.

I exhale slowly, hating the way these thoughts hold me prisoner.

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