Chapter summaries Bloodline Jess Lourey

Chapter 20 Summary and Analysis: The Prenatal Visit

⚠️ Spoiler Warning: This guide contains detailed spoilers for the entire novel. Proceed only if you've finished reading or are comfortable knowing the plot.

Summary

Joan Harken (using her maiden name) arrives for a prenatal checkup at Dr. Krause’s office, relieved not to be addressed as Mrs. Schmidt. The receptionist, Cornelia, leads her to an exam room where she changes into a gown and presses a button to signal readiness. Dr. Krause enters, a small older man with wire-rimmed glasses and thick white hair. He asks if she is “in a family way”; Joan confirms she believes she is five months pregnant and feels fine. He calls Cornelia back to take vitals, scolding her for not doing so earlier. Joan is measured at five feet six inches and 121 pounds, having gained only two pounds. Dr. Krause then performs a brief physical exam, feeling her forehead, neck, and arms. He notices an unusual erythema multiforme scar on her left arm—her smallpox vaccination scar, which resembles a figure eight. Joan mentions that her boyfriend Deck has a matching scar, though he is four years younger. Dr. Krause suggests a tainted vaccine batch could have affected a group of children but notes the age gap makes that unlikely. He tells Joan that the Minnesota Department of Health is sending a medical crew to collect blood samples and record disease immunity, and she should mention the scar. Joan, eager to leave, says she has work. Dr. Krause asks about her hours and advises no more than ten hours a week, avoiding exertion. He forbids alcohol entirely, allows up to four cigarettes a day, and prescribes Valium (diazepam) to calm her nerves. Joan is shocked, recalling her mother’s Valium use, but Dr. Krause insists it will not harm the baby or milk production. He commands her to breastfeed for the first week. Joan feels reduced to a “breeder cow” and complies. He schedules a follow-up in four weeks, saying an internal exam is unnecessary and will request her records from Minneapolis. After he leaves, Joan notices he forgot her chart. She reads his notes: her information on top, and at the bottom, Dr. Krause’s assessment: “Patient is uncooperative. Possible risk.”

Key Events

Joan has an initial prenatal appointment with Dr. Krause, using her maiden name.
Dr. Krause gives her a brief physical exam and comments on her smallpox vaccination scar.
He mentions a state health department crew collecting blood samples and suggests she report the matching scar.
Joan asks about alcohol consumption; Dr. Krause forbids it and prescribes Valium, also allowing limited smoking.
Dr. Krause commands her to breastfeed for the first week and schedules a follow-up in four weeks.
Joan reads the doctor’s private note labeling her “uncooperative” and a “possible risk.”

Character Development

Joan Harken: Her vulnerability deepens. She fears being called Mrs. Schmidt, seeks control by using her maiden name, but the doctor’s commands—forbidding alcohol, prescribing Valium, ordering breastfeeding—strip her autonomy. Her internal rebellion (wanting a drink when told she cannot) reveals a desire for self-determination. Reading the critical note intensifies her sense of powerlessness.
Dr. Krause: Emerges as an authoritarian medical figure who runs a tight office and expects compliance. He scolds the nurse, dismisses Joan’s preferences, and leaves a judgmental note that characterizes her as uncooperative. His casual prescription of Valium and tolerance of smoking reflect the era’s lax medical standards.
Cornelia: The nurse is cowed by Dr. Krause, shrinking around him. Her subordinate role underscores the power imbalance in the clinic.

Themes, Symbols, or Motifs

Medical Authority and Female Autonomy: Dr. Krause’s commands—no alcohol, breastfeeding mandate, Valium prescription—illustrate how mid-20th-century medicine could strip women of bodily autonomy. Joan feels reduced to a “breeder cow,” a motif echoing her earlier sense of control being an illusion.
The Vaccination Scar: The figure-eight scar on Joan’s and Deck’s arms symbolizes a mysterious shared past and potential medical malpractice. Dr. Krause’s interest and the state health department’s upcoming visit hint that the scar may foreshadow a larger conspiracy.
Secrets and Surveillance: Joan’s private medical chart becomes a site of betrayal; the doctor’s note labels her as a risk without her knowledge. The idea of unseen judgment (the “proper Minnesotans” gossiping behind her back) recurs.
Appearance vs. Reality: Joan presents as cooperative but internally chafes. The clinic seems professional but is a place where her preferences are overridden. Her weight gain (only two pounds) suggests she is not fully embracing pregnancy.

Why This Chapter Matters

Chapter 20 deepens the subplot of Joan’s pregnancy and her uneasy relationship with the medical establishment. It introduces the mysterious vaccination scar that both Joan and Deck share, linking them to a possible public health scandal. Dr. Krause’s authoritarianism and his prescription of Valium foreshadow later tensions between Joan’s need for independence and the forces—social, medical, and perhaps government—that seek to control her. The chapter also sets up the state health department’s blood sampling as a potential plot point. Joan’s discovery of the doctor’s dismissive note amplifies her isolation and distrust, pushing her closer to investigating the truth about her own life and the community.

Study Questions and Answers

Why does Joan feel relieved that the receptionist calls her “Miss Harken” rather than “Mrs. Schmidt”?
- Joan fears being subsumed into her boyfriend Deck’s identity and wants to be seen as her own person. Using her maiden name is a small assertion of independence in a situation where she has little control.
What is the significance of the smallpox vaccination scar on Joan’s arm, and why does Dr. Krause find it unusual?
- The scar is an “erythema multiforme” mark shaped like a figure eight. Dr. Krause notes it resembles a tainted batch of vaccines that affected a group of children, but he is puzzled because Joan and Deck are four years apart, making it unlikely they received the same bad lot. This hints at a possible cover-up or shared exposure.
How does Dr. Krause’s treatment of Joan reflect the era’s attitudes toward pregnant women?
- He gives her a commands about diet, medication, and breastfeeding without discussion, prescribing Valium casually and allowing smoking. He expects total obedience and labels her “uncooperative” when she questions his authority. This mirrors the limited agency many women faced in medical settings during the 1960s.