Chapter Text
Samira was dead on her feet.
Her head pounded, her stomach turned, and despite sleeping for literally her entire day off even though she had a million things to do, she was currently so tired she was certain she’d fallen asleep standing up at least twice today. Nobody had caught her, as far as she could tell, but she wasn’t sure how she was supposed to take another month and a half (at minimum) of feeling like this. It was insane to her the way she was just expected to upkeep her normal life while her body was growing a new person with new organs. Although, not upkeeping it would mean she would have to give up her biggest secret and stop what she loved doing to fill her time. It wasn’t worth it to give it all away without a medical reason. Pregnancy wasn’t emergent. It wasn’t contagious. It didn’t require her to slow down so why would she. She was strong. She could power through at least this one shift.
She found herself counting down the minutes until she could curl up in bed and go to sleep again. Each moment she was awake felt like a miracle. Another 57 minutes and her shift would be over. She could go home, take a mildly hot shower which was not hot enough by any means and go to bed. She found herself craving the feeling of a hot, steamy shower. The way the water would relax her skin and muscles. There was no pain in the shower. Just relief. The feeling of a warm hug enveloping her with the steam. She was a big fan of cranking the shower temperature to a level that was almost guaranteed to melt human skin. Jack loved sneaking into the shower with her and then complaining about how hot it was. She refused to lower it for him most of the time. She wasn’t going to be cold in her own shower. Now she didn’t have a choice. High temperatures in pregnancy could cause neural tube defects. She wasn’t risking spina bifida for a warm shower. After her lukewarm -- cold -- shower she would curl up in her warm blankets until the next morning where she would have to pull herself from the sheets and do it all over again. She knew pregnancy would be rough. She knew the first trimester was less than a cakewalk. Nobody ever told her she would be more akin to a zombie than a living, breathing human being.
She was pulled into another case, hopefully her last one before the night shift strolled in to take over. She got an assessment of the patient. A late stage xylazine wound that would need debridement and an x-ray to rule out bone damage. The patient was unhoused and clearly didn’t trust the emergency department to begin with so Samira was working extra hard to hold herself together and make sure her patient felt comfortable. It wasn’t this woman’s fault she had a severe wound complicated by years of drug use, but it was Samira’s responsibility to remain professional and not hurl at the smell of decaying flesh. She knew that any indication of discomfort on Samira’s end could mean this person never sought out medical care again and with a wound like this, deep and covered in dark black patches of necrotized flesh, that could mean this patient’s life. At the very least, her arm.
Samira had always prided herself on having a strong stomach. Smells didn’t bother her. Gore didn’t bother her. It was the bare minimum skillset of an emergency medicine physician to be impervious to the gross, wacky, and weird. They’d been taught to have a good poker face from the beginning. Her’s rarely wavered until about a week and a half ago when the morning sickness caught up to her. Now, the thought of anything but saltine crackers and ginger ale nauseated her (sometimes those nauseated her too) and any strong smell twisted her stomach in ways she’d considered anatomically impossible.
The patient was wheeled out for x-ray, worried that the wound had compromised her muscle tissue and bone. They already had surgery on stand by. Samira made sure to remind her how much strength and courage it took to come in as the patient was wheeled away, just hoping she would come back from x-ray and not slip out the front door the first chance she got.
Samira put her hands on her knees, trying to catch her breath and push down the nausea that so readily wanted to erupt.
“Didn’t take you as someone with a sensitive stomach,” Cassie took a step forward. She scanned Samira, looking her up and down. More annoyed that she wasn’t able to hold it together than worried. Samira was usually better than this about reserving her judgement.
Samira shook her head, taking a few deep breaths. “I’m good. I’m sorry. It’s not her. I meant what I said to her. That’s fine. I just need a minute.”
She managed to stand up straight, hand hovered lightly over her flipping stomach, and make it to the breakroom without being stopped by anyone else. She hadn’t eaten much all day and she was dehydrated. She was hoping that a little bit of food would stop the churning in her belly.
Samira opened the fridge for her lunch box, a couple of snacks buried in there. Jack wouldn’t let her leave the house without a snack and a bottle of water anymore. The refrigerator smell, old refrigerant and rotting leftovers, wafted as she opened it, assaulting her senses. Unfortunately, the final straw for her.
“You okay?” Cassie asked, a tilt of her head. Samira was looking particularly green as she stood over the breakroom trashcan, very clearly having just puked into it. Her early judgements on Samira’s inability to hold herself together around a patient fell away, noting that something was actually wrong. Samira wasn’t being judgemental. She was sick.
“I’m fine,” she groans, reaching down to tie up the bag. She tossed it in the red biohazard bag around the corner from the door and hobbled back over the table and chairs inside the breakroom with a plop and a firm huff.
“You sure?” Cassie does a quick scan with her eyes, already formulating a differential diagnosis. Food poisoning was at the top of her list. Maybe a stomach virus. Appendicitis was not off the table. “You look... green. And I’ve never seen you queasy because of a patient before.”
Samira huffed, knowing she was probably going to have to reveal her secret, despite how much she didn't want to. She could have played it off as something else but a lot of it was contagious and she didn’t want the workup that came along with it. She was determined to keep this under lock and key for as long as she could. Not that she wasn’t excited or that she thought her coworkers wouldn’t be supportive, she didn't want the unnecessary attention. That's how rumors spread and she was far too tired for rumors. “Morning sickness is a bitch,” she finally huffs, making sure no one else was entering the room.
“Morning--” Cassie’s expression was blank for one moment, running back through her differential. Morning sickness wasn’t on the list. Samira wasn’t... oh! It had all clicked into place as a look of realization flashed on her face. Excited but not too overbearing or presumptive. “Samira! How do you feel?”
“I feel... okay. Don't get me wrong, I am excited about the baby but I can’t keep anything down and if Langdon doesn’t stop wearing that cologne I’m going to puke on his shoes. I heard him asking someone else if I was mad at him. For the record, I am not, but I can’t stand the smell of him and I’m not sure how you tell someone that even if you tell them you’re pregnant.” She rambled on for a moment, she’d had so much built up that she wasn’t able to talk about. She usually did a pretty good job not bearing all the details of her personal life anyway but in some ways she felt like a tea kettle about to bubble over.
“I did a really good job not throwing up into any patients today but the fridge--” she gagged just thinking about it. “But it’s so early. Our first ultrasound is tomorrow. So, like, please don't tell anyone. I don’t need a secret betting pool about it.”
Cassie shakes her head. She wouldn't ever think of sharing something like that about someone else. “The fridge was my biggest enemy when I was pregnant too. I was sick for like 16 weeks with Harrison. But, I woke up one morning and it was gone.” Cassie expresses sympathetically.
That was something Samira was starting to notice. Everyone had some form of pregnancy horror story. Or just a story. In all of her late night doomscrolling searching for information, and hate reading mommy blogs, and hate watching mom tiktok for advice about early pregnancy and surviving the first trimester, everyone had a comment about how they were sick or tired, or had to do regular IV fluid infusions because they were so exhausted. And when it got into labor and delivery stories? Samira shuddered at the thought, leaving those to confront at a later date. She’d already had nightmares, she didn’t need more fuel.
Samira shoots her a look. The idea of having to experience this level of nausea for the next 11 weeks was daunting. Cassie gave her a comforting smile, “it gets better. You’ll get the second trimester reprieve soon enough. And then it’ll be kinda miserable for a while again in a different way. And then the baby is usually worth it at the end.”
Samira laughs softly, “I’m hoping the kid is worth it. I’m returning it if not.”
Samira's eyes fall to the floor for a second. Not that long ago she was commiserating with Cassie about how she didn't have anyone. How she'd put her whole life on pause for medicine. She always planned to find someone to settle down with. She didn't really plan for it to be someone almost 20 years old than her but as fate would have it. She'd done it. She found someone who she loves and now she is married. And has a baby on the way. Times change. Life comes at you fast, etc.
“Hey, there you are,” Jack smiled, just coming in for his shift, his face falling seeing how uncomfortable she looked. “You okay?”
Samira nodded, tracking Cassie as she stood up, “your secret’s safe with me. But just so you know, there’s already a betting pool. There’s been one for a while. I haven’t put any money on it because I think that’s a little too far but... it’s out there.”
“Of course there is,” Samira huffed and rolled her eyes.
“I’ll cover the xylazine wound. See if you don’t get out of here early,” Cassie says, but backpedals into the room. “There are these good ginger candies that helped a lot with my morning sickness. I’ll see if I can find them. Probably placebo but something is better than nothing.”
Samira offered her thanks, and trained her attention back to Jack, who was now looking over her with a watchful eye. “I’m okay. I threw up in that trashcan.”
“Are you sick?”
She knew he wasn’t stupid but she was at her wits end. She was exhausted, sick, and hadn’t been able to eat properly in days. She briefly imagined blowing him up with her mind, instead she blinked audibly at him. “I’m pregnant.”
“Right.” He nodded once, his once confident stance falling into apology. “Did you eat?”
“I can’t open the fridge,” she admits with a little grumble. Her voice was much smaller than she expected. Annoyed that she couldn’t do some of the most basic tasks.
He almost laughs, only stopping because her face had fallen into a warning glare. “You... what?”
“The smell,” she huffs. “Something is rotting in there and it smells awful and I can’t open it without gagging.”
“Do you want me to--”
“No!” She interrupts quickly, not wanting the backlash from the fridge again. She was certain there was nothing in her stomach to lose but she couldn’t take dry heaving over a trashcan. “I’m fine. I’m leaving soon anyway. I’ll get something at home, or on the way home, or something. I’ll see you in the morning for the ultrasound. Have a good shift.”
Samira exits the breakroom and basically bee-lines her way out of the hospital, passing only briefly at her locker to gather her belongings and change into her street clothes. She was certain that if anyone came looking for her, Jack and Cassie would cover for her. She stops for fast food on the way home, eats a few bites of it before deciding that it wasn’t worth it. Fully unappetized by the smell. She showers -- cold -- and climbs into bed. Asleep almost instantly until her alarm goes off the next morning.
--
Samira wiggled her foot in front of her, her legs crossed as she filled out the doctors office paperwork. She wasn't sure if it was nerves or her full bladder -- that she was now used to emptying every 30 minutes on the dot -- required for the ultrasound but she felt possessed by something to move her body as she filled out the very large packet of OBGYN related forms. She smiles at Jack as he walks into the room, handing her a cup of coffee. She’d cut back her caffeine intake significantly, but she couldn’t go without it, especially not cold turkey. She checks a couple of boxes, writes in some medical history, and reads over the form. “I was not aware you had to provide your entire life story beyond a medical history in order to have a baby,” she comments, filling in another box.
“I mean, they need our occupation, our undergraduate degrees, BOTH our blood types. They're asking if we need preschool referrals,” she huffs, somewhere between an annoyance and a laugh scribbling something else into the sheets of paper. Flipping through the packet again to make sure it was filled out. “The kid is negative 32 weeks old. Should I have preschools in mind?”
“You've known you were pregnant for more than 45 minutes and haven't applied the baby to college? Tick tock, Amma. Gotta get on that," Jack taps his watchface. Samira shoots him a glare.
It always made her heart tumble when he called her ‘Amma’. It hadn’t really solidified for her that she would have someone that calls her that seriously and not in a vaguely sarcastic way like Jack had done for the past few weeks. “We haven't even set aside a bedroom yet, let alone started looking at preschool options. We really need to do that. The bedroom, not the preschool. I was thinking the one closer to our room. We can move the office to that room at the front of our house. It leaves the guest room on the other side of the house. Seems better when people stay with us and it’s easier when the baby wakes up in the middle of the night.” She’s rambling now, but it's keeping her mind off everything else.
“That makes sense to me. I think it’s the bigger room though, but she deserves the bigger room I think.”
She rolls her eyes. A look of annoyance but her smile remains. Jack was hoping, and had immediately assumed, the baby was a girl. He wouldn't accept any alternatives and was desperately trying to get her on his side. Admittedly, she wanted a girl too but she found it funny that it got under his skin so she was staunchly neutral on the sex of the baby. She did, however, find it very cute how much he wanted a daughter. He told her over and over again that he just wanted a million more of her. The thought of even one more girl like her in the world melted him into a puddle. The world has enough of him. They didn't need another. The sentiment was sweet and a little cheesy but she couldn't help but blush every time.
She hands Jack the clipboard and motions toward the reception desk, “will you go give this to them?”
Jack returns the clipboard while Samira looks around the office. Everyone in different life stages and pregnancy stages. Some late term, some with their newborns. Some are not pregnant at all. It felt strange to think she was going to be in their shoes soon enough. The feeling was heavy in her chest, daunting but also exciting. Thrilling and a little suffocating. To think she was going to have a little one of her own to hold and cherish and watch grow up. Her knee continued to bounce as she thought about the future. The way she was building a life she’d almost thought she’d missed out on. One that she’d put on hold for so long. One that had been avoided for so long so that she could live out the dreams of her career. So that she could make a difference in the world. A difference to medicine. She’d owed her father that much. And she hoped she could be half the parent she was. She had no doubt that she’d picked the right father for her children though. He tossed his arms around the back of her chair, his thumb rubbing softly over her arm, immediately easing at the touch. She silently wished she couldn’t be read like an open book.
Her name is called soon and she's led back to an exam room, the ultrasound machine set up next to the bed, a TV on the opposite wall so they could see while the measuring and dating was done. Samira settled onto the table, pulling up her shirt and wincing as the gel hit her stomach. A small apology from the tech about the temperature. Samira thought that maybe it could be a little warmer than ice cold but smiled and nodded anyway.
She watched the screen intently, her mind shifting into clinical mode. If she was looking at this ultrasound clinically, she wouldn’t be attached if something was wrong. Maybe it was the wrong way to think. It was surely the most pessimistic way to think but she couldn’t help the guard she’d put up. She watched as the grey, grainy image flashed on the screen, locating the fundus of her uterus and a noticeable dark spot in the middle -- a gestational sac. The probe moves around and something resembling a gummy bear flashes on the screen, curved around itself. Too small to see any individual structures but there was a noticeable flicker in the middle.
A heartbeat.
Samira reaches out to grab Jack’s hand. Her professionalism and clinical judgement falling away. Feelings overwhelmed her before she had the ability to stop them. She swore she heard Jack gasp. He’s watching just as closely as she is, only taking his eyes off the screen to grab her hand and squeeze it once. A reminder that he was by her side. The tech clicks a couple of buttons and a train chugs through the room. Samira had heard this sound before, people came into the emergency department often for first trimester bleeding only to find out that the bleeding was normal and that their baby was fine. Heartbeat chugging away through the room as the bated breath turned to a sigh of relief. This was the first time she’d been on the other side. The only time she’d ever been the one holding her breath as the ultrasound probe poked into her belly. The only time that she’d ever wanted to cry at the whooshing sound of fetal heart tones. It still didn’t quite make sense that this was happening to her. That this was her ultrasound and that... fetus -- baby -- on the screen was hers. If she didn’t have the near constant nausea and fatigue that could only be akin to the need to hibernate for the next month and half, she wouldn’t believe any of this.
She glanced over at Jack who was looking at her like she hung the moon, “that’s our kid.” He was breathless, pressing his forehead into hers before placing a kiss there and standing back up. A small laugh left his throat. Nervous. It was cute.
Samira couldn’t convince herself to speak. She just looked up at him. She was almost certain that if she opened her mouth she would start sobbing. And she was certain the ultrasound tech in this room didn’t get paid enough for that.
“How have your symptoms been? Lot of morning sickness?”
Samira nodded, “it’s been awful. I can barely eat.”
“I think I know why,” the tech says, moving the ultrasound around to get the right angle. “Usually happens with twins.”
“With... what?”
She looks at the screen and feels her eyes bulge out of her head. Two gummy bears. Two little flickers on the screen. She looks around the edges, trying to find out more information. She ran through the risks in her mind. Twin-twin transfusion syndrome is at the top of her list. It could be deadly. Intra-uterine growth restriction. PPROM. Pre-term delivery. NICU stays. It flashed through her mind so fast she couldn’t keep up. There was a roaring in her ears and she doesn't know if she had temporarily become deaf or if that roaring was another heartbeat filling the room and mixing with her own as it pounded in her ears. Was it hot in here?
She looked at Jack who had found himself a seat next to the head of the exam table, his hand still in hers but much more clammy. A silent look laced with a threat -- how could you get me in this situation -- and fear.
“Twin A measures seven weeks, six days. Heart rate is 154. Right on track. And twin B is one day behind. Perfectly normal. Heartrate 152. I can see a septum in between the amniotic sacs but I’ll have the doctor come in to speak with you before you leave but first,” she hands Samira a roll of pictures. “First baby pictures for your fridge.”
Samira takes the pictures, giving the tech a small thank you and wiping the apparent tears that had managed to slip from her eyes, and hands them over to Jack for him to hold onto. She cleans herself up from the ultrasound gel and gets situated on the bed, sitting up this time. Jack takes a step closer and rubs her shoulders up and down a couple times, placing a kiss against her forehead. A silent check in. She sighs softly and nods at him. Their moment interrupted by a knock at the door.
She doesn’t get much information that she didn’t already know. The twins -- twins -- are likely mono-di so they didn’t share a placenta, immediately knocking away the fear of TTTS, but they would continue to monitor closely and she would meet with a maternal fetal medicine specialist to stay on top of the pregnancy. Everything was controlled but she felt so beyond out of control. She had about a million questions that couldn't be answered. A million things that only time or a crystal ball could tell her. A million things to worry about. To mull over. To fret on.
Other than that, pregnancy management was pretty standard. Take a prenatal vitamin with folic acid, don’t drink, don’t smoke, don’t eat raw fish, reduce caffeine intake. Everything she was already doing and that everyone knew about pregnancy. She scheduled a follow up appointment in a few weeks, but silently prays that the first trimester symptoms have gone away by then. She’s not hopeful. Especially with the new information that came to light.
Samira was pretty quiet as she processed it all. As she thought through all the changes that were coming quicker than she could manage. She was relieved, of course, that everything was healthy with her and the baby but there was still so much to think about. So much to consider. Even more to plan for. She already felt like she was drowning.