Dr. Goodwin closes the patient ledger, sets it on the exam room table and walks through the door. The patient’s name had been Leti, and when Dr. Goodwin passes through the doorway into the quiet waiting room, the same eyes greet her, staring with fear and hope. Leti’s mother stands when she sees the white doctor. Dr. Goodwin takes the woman’s pink-palmed hands in her own. They lower themselves to the waiting room bench, scrubbed clean with bleach this morning.

“Leti,” The woman says. “She no comes home.”

For a moment, her name being said aloud, Leti is present again. Dr. Goodwin closes her eyes and sees the handwriting on the patient ledger. The loop of the cursive “L”, whimsical but confident, followed by a shaky “e-t-i” is etched in her memory.

Leti, a young woman—really a girl—had come to the outpost clinic in the late afternoon, the team of foreign doctors already gone for the day. Dr. Goodwin counted inventory when she heard the knock. She cracked the rusted door enough to see the bright whites of scared, sunken eyes and let the girl in. The girl slumped on the bench, and pulled her knees to her chest. Dr. Goodwin gave her a bottle of clean drinking water, and opened the tattered ledger, pages damp with humidity. The thin, sweaty girl wrote her name in the book and handed it back.

“Leti?” Dr. Goodwin read and looked at the girl. As she spoke, a thick trail of blood seeped from between Leti’s thighs onto the bench. Dr. Goodwin lifted the spindly patient into the makeshift exam room and placed her flaccid body on the table. She found the pocket ultra sound, flattened the sensor over Leti’s lower belly and watched a shadow jump on the screen. The shadow did not move, a crown-rump length of 9 centimeters, 14 weeks.

“How long have you been bleeding?” Dr. Goodwin asked.

Maten an. When I gather morning eggs. Then I walk all day.”

Leti’s voice was a whisper. She closed her eyes. Her chest rose and fell as she took rapid breaths. Dr. Goodwin saw the pool of blood expand. She looked around for someone to help, but she was alone. Dr. Goodwin held Leti’s hand and watched as blood spilled onto the table and dripped over the edge. She knew there was nothing she could do. Leti slipped into unconsciousness. With a convulsion, Leti’s malnourished body heaved and expelled the half-grown life. Both were pulseless.

Leti’s mother arrived the next afternoon.

“She lost too much blood. Mwen regret sa,” say Dr. Goodwin. “I couldn’t do anything to make her better.” She paused. “Or the baby.”


Leti’s mother turns her face, all eyes and bones, toward Dr. Goodwin, then bows her head; tears find the bottom of her mahogany chin and drip over the edge. She grips the doctor’s damp pale hands, the last hands to touch her daughter.

“Thank you. For take care Leti.”

Leti’s mother gathers her sack, opens the metal door and walks down the stairs. Dr. Goodwin turns past the waiting room bench and sits on the exam room table. She picks up the ledger, heavy in her hands. She opens again to the page with Leti’s name, runs her finger over the letters. Dr. Goodwin curls her knees into her chest and shakes to the guttural melody of Leti’s mother’s sobs coming through the window.


Elizabeth Lahti

About Elizabeth Lahti

Elizabeth Lahti is a Portland, Oregon area physician who has found a way to merge her passion for doctoring with her passion for writing. She teaches Narrative Medicine at OHSU and sometimes writes with her patients to more fully know their experience of illness. She is part of the Full Frontal writing collective, a local group of writers focused on the art, process and practice of writing.
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