Tom

An excerpt from my memoir I'm currently pitching, "The Dead I've Known," about hospice nursing and infertility. This is from the penultimate chapter, when my son was finally born.

I woke in the small hours of the morning on December 14, 2015 in a warm puddle that smelled brackish, fetid and feral, an animal scent that pooled under my heavy hips and seeped into our expensive Tempurpedic mattress. My water had broken, a strange idiom that means that the amniotic fluid surrounding the fetus, which is contained in a sac called a membrane, had ruptured. It is the same sort of sac that holds together the whites of an egg. Water break, or sometimes waters, plural, break, a strange kind of image. Not separate, or divide, like Moses did. Not like a 15^th century translation of the Aeneid, telling of a wave smashing across the bow of a ship: “High as a hill the jaw of water break/And in a heap came on them with a swack.” What is breaking, really, is the membrane, and the water—the fluid—simply gushes out.

We left for the hospital. I don’t remember waking my husband. I don’t remember the ride to the hospital. I do remember checking in and being examined. I wasn’t dilated at all, not even a centimeter. The obstetrics resident eyed me doubtfully. “Are you sure it was your water breaking?” he asked. Was he insinuating that I had pissed myself, that I had woken in a lake of my own piss and confused it for the start of labor? My due date was December 16. I was just about right on time. Still, his questioning made me second guess myself. Had I simply peed the bed? Was this real?

It’s a well-documented phenomenon that women, and especially pregnant women, and especially pregnant women in labor or immediately after childbirth, are treated suboptimally. Women’s pain isn’t taken seriously, for one. Their questions and concerns about their progress and symptoms are discarded or trivialized. Maternal mortality actually increased between 2018 and 2021, a freakish and terrifying pattern that seems to have more in common with the medieval ages than our technologically, pharmacologically advanced era.

Many of these affected women are disadvantaged in some way, either because they are a racial minority, or because they are not native English speakers, or because they live beneath the poverty line. They haven’t any health literacy, maybe, to ask the right questions, or they haven’t the deep, ingrained sense of privilege required to demand satisfactory answers of people (mostly men, even now) in white coats. I’d seen it many times on the ICU and in hospice care—brown and Black families who loved each other just as much as rich, white families, whose loved ones were just as deserving of services, took a backseat to the families who could make their voices and concerns heard above the constant din of need that healthcare workers faced.

If I was honest, I’d been part of that pattern of mistreatment in large and small ways. Some days, on the unit, busy and exhausted, I’d neglecting to secure a translator for patients or families who didn’t speak English and simply went about my business of taking care of the patient without explaining or offering any rationale for what I was doing. Sometimes I spent extra time with families and patients who could manifest a sufficiently squeaky wheel, and failed to call or check on patients who couldn’t, not because they weren’t also in crisis but because they weren’t able to properly make their needs known. In hospice and in the ICU, both, I’d certainly been able to empathize and connect with families and patients who looked and sounded more like me—white, educated, middle class.

Having doctors look askance at a question or statement made by me was nothing new. As a working nurse whose job was to bother doctors for orders and medications, that happened all the time, of course. And it had happened to me as a patient, too, despite my upper middle class status, my level of education, my facility with the language of health care and my knowledge of pathology and treatment. Despite the color of my skin. But something was different, now. It wasn’t only happening to me, a lone woman with a lone concern. It was happening, in a way, to my child. And that I could not abide.

So I pressed. I asked that the resident perform the fern test, something I’d learned about in nursing school, where a sample of the fluid is placed on a slide and allowed to dry. If it dries in a pattern that resembles a fern, with delicate, graceful sodium crystals that arc out over the slide like ornate fronds, that shows that the fluid is amniotic fluid. That would prove it, I said. That would prove that I knew what I was talking about. My waters had broken. This baby was coming, no matter how dilated I was or wasn’t according to him.

He shrugged dismissively. Fine, fine. I think a sample was collected. Maybe not. In any case, shortly after, I was admitted. I’d prevailed.

My son was coming. He was close, now. My dead hovered, watching, waiting. Their cold hands lay lightly on my shoulder. Their breathless silence was like the silence between your own skull in the middle of the night, piercing, high-pitched, all-encompassing. I paid them no mind. I forgot to be scared.

Of course, that’s just what they wanted.

Birthing stories are tedious. I’m sure there are some sick fucks out there who love nothing more than to hear about hours of tortuous labor and this or that complication with a birth gone awry. To me, it’s a little like hearing about someone’s dream—it just has nothing to do with me, or with anything. Birth and labor, like dreams, exist in their own world, governed by their own odd physics and inscrutable laws, with realities and choices that shift and bend according to whatever circumstance presents itself. Maybe, in one story, the baby is breach, from the old English brēc, meaning pants, which signifies the butt of the baby is coming first, instead of the head, which is dangerous and difficult to deliver. Maybe then, as in a dream, someone lays hands on the woman’s stomach and voila! The baby is fixed, its orientation made right as if by magic, and then the baby is delivered without complication. Or possibly the story is that the “cord,” meaning of course the umbilical cord which supplies blood and oxygen to the fetus, is wrapped around the newborn’s neck in such a way that the baby cannot breathe, and the delivery people frantically rush to untangle it, or cut it, or somehow free the baby to fill its lungs with oxygen before its tiny pulsing brain begins to die. Miraculously, they do. Or maybe the story is that the baby simply flew out, no one was ready, the nurse came in and took a look and began to scream (in reality, I have never, ever heard another nurse scream on the job) and then before you know it there’s little Johnny, and what a head of hair!

Blech. As in, a sound of disgust. Blech. From the old English blech, meaning, who fucking cares.

Nevertheless, here is my birth story, in brief.

The doctor on call that night, finding me with no more fluid to cushion and protect the fetus and seemingly no other signs that I was ready to deliver, decided to induce labor by giving me escalating doses of the drugs that cause contractions to come and the cervix—the vaginal opening through which a baby will pass—to dilate. It worked, somewhat. My husband and I watched the movie “Exodus: Gods and Kings,” starring Christian Bale as a muscular, violent Moses while we waited for my body to get, for once in its life, with the program and start to dilate. Hours passed. We watched it again. Then we watched it again. “Follow me and you will be free!” cried Christian Bale, muscles rippling, porn ‘stache bobbing, the sexiest imagining of Moses ever created.

The contractions began to be excruciating, and, remembering what Patti in the ICU had said to me long ago, that there is no first prize for suffering, I opted for an epidural. It did nothing. The baby’s head, they said, was pressing into my spinal cord. I began to shiver uncontrollably. I had a fever. It had been twenty-four hours since my water had broken and I was still not ready to deliver vaginally, still not dilated to a sufficient degree despite all the drugs, and now I was potentially infected, and could transfer that infection to my baby, too. I would have to have a C-section, said the doctors. Yes, yes, I said. Whatever it takes. Whatever is needed. I was in the room, then, seemingly only moments later, and I remember shaking violently on the operating table and wondering whether that would make it hard for the doctors, none of whom I had ever seen before, to make the incision. I remember turning to the woman by my head—a nurse? An anesthesiologist? I asked her when they’d begin. “They’ve already begun, honey,” she said. “They’re in.”

The doctors wrested him from me with a sucking sensation, a tremendous pressure like an elephant sitting on my abdomen and then like a vacuum pulling and when he emerged, the mass of bloody flesh that was of me but not me, was silent. I watched two people take him quickly, purposefully, over my left shoulder to a sink, or a table, or who knows what was there. I’d learned about labor and delivery nursing in school, of course. I knew they were probably using a bulb syringe on him to clear his mouth and nose. They were doing other things, too, assessing him, warming him. And yet I knew he should be crying. I knew that above all.

Newborns are graded according to the Apgar scale, a simple test conducted at one minute after birth and then again at five minutes. It has been proven to give a valid, standardized indication of how well the baby is doing and how well they’re likely to do. In an Apgar score, a newborn is awarded either a score of zero, one or two, with two being the best, in categories including heart rate, respirations (breathing), color, muscle tone and reflexes. Composite scores, then, range from zero to ten, with ten indicating a very healthy newborn with no acute issue. It was invented by a physician named Virginia Apgar, a woman born seventeen years before Elisabeth who also knew at a young age that she wanted to be a physician, and became a trailblazer in her chosen field of anesthesiology. Dr. Apgar ultimately went on to study teratology, the science of birth defects. Teratology, from the Greek teratos, meaning monster. She became vice president of the March of Dimes, an advocacy group that worked to prevent infant mortality.

My mother-in-law had always joked that my husband received a score of ten upon birth, and that it was only the first of many accomplishments. That baby’s son, my husband’s son, meanwhile, was still silent. My son.

“Why isn’t he crying?” I said to no one, to everyone. “Why isn’t he crying? I don’t hear him crying.” I couldn’t see beyond a paper sheet that was strung up to block my view of the surgery. Behind it, doctors and nurses tasked with my health were sewing me back up, putting organs back into place, double and triple checking that no bloody gauze or empty syringe was left behind in the surgical melee. No one answered me.

Virginia Apgar must have known about Elisabeth. Dr. Apgar died in 1974, at the height of Elisabeth’s foray into popular culture. They were two female physicians making waves in their professions at a time when women in medicine were few and far between. And they were two women who knew death: Elisabeth, of course, knew it best, but Dr. Apgar knew a more terrible version, a fresher kind of death, the end of a life that had barely begun. And Elisabeth must have known about Apgar: Elisabeth, after all, had been born a tiny “two-pound nothing.” They were connected in more ways than one.

And that day, that moment, they hung there, Elisabeth and Dr. Apgar. They waited behind my head, just outside my vision. Mr. R was there, Mr. R and his wife whom I’d never met, and their baby, stillborn. Nana was there, drinking Jagermeister, in a cloud of baby powder. D. was there, and her wound pulsed through her. Mr. F. was there, flat on his back in a bed not unlike the one I lay in now. All my dead, all my many disbelieving and angry and sad dead. All my hopeful dead. All my patients, the ones I’d helped and the ones I’d failed due to ineptitude, or laziness, or disregard, or some combination. They stood with me. They held me. They grazed the edges of my hospital bed with their icy hands. They waited.

My own loved ones were there, too. My gentle, funny uncle Frank, who died when I was a new nurse on the ICU of a brain tumor, and his father, my Poppy Frank, who sat with me on the stoop in Howard Beach when I was young and died when I was in junior high. Another Uncle, Larry, who told me once that “hate is a very strong word” and gave my brother a skateboard, and his father, my Poppy Larry, whose casket my then-boyfriend, now-husband had helped bear at his funeral not long after we started dating. My college roommate Melissa, a brilliant, beautiful lover of rom-coms and Bruce Springsteen, who died the year we graduated. Mr. Troeller, a beloved, eccentric teacher, who died when I was still an undergrad. My dog, a one-eyed shih tzu named Tony. Cousin Leah, Cousin Harry. Jim from next door. We waited for his cry. There was a breath, mine. And another. And another. Silence, still. Silence through the whole OR, it seemed. I’d been in rooms where bad things happened, been the one who knew the bad thing first. I knew that silence, I thought. I recognized it.

“Is he crying?” I said. My voice sounded calm. Why was I so calm? What was the fucking matter with me, why wasn’t I yelling and screaming and demanding that they fix him, fix whatever it was that needed fixing?

But I didn’t yell and scream, I didn’t demand. My voice came measured from me, the same voice I used with my patients’ families—clinical, practiced. It was Dr. S’s voice, when he’d told me I was experiencing a miscarriage. It was the voice of the nurse on the ICU all those years ago who’d told me that she wasn’t going to call me after my shift was over to ask me any question about any patients. It was a different voice, a knowing one. And yet it was mine.

“Is it okay?” I asked again.

“It is, it’s okay. He is crying,” said the woman at my right side, and I looked at my husband, gowned and gloved and masked and with a blue cap over his dark curly hair, tears in his eyes, and then I looked back over my left shoulder and the baby was indeed crying, the nurse or doctor or whoever she was had been right, it was alright. Maybe the baby had been crying all along. Maybe I simply hadn’t heard him. Someone else in a gown and a surgical mask, one of those demons who’d been working on him for an eternity, brought the child to me, and she put my baby’s face beside mine and I kissed him, and then they gave him to my husband and he held him, and the baby was crying and it was alright. The pain was gone, the terrible sharp stabbing of the baby pushing against my spinal cord, and the violent shivering was slowly beginning to abate, too. He was out of me. He was in the world. My dead dispersed, faded from the room.

The baby. The baby was there. My baby. My son. We named him Thomas. Tom was there, at last.

And in a room soon after, some kind of open room with three walls only for observation immediately following the surgery, I lay with Tom as the skin of my chest touched the skin of his cheek and he began to root, looking for milk, a reflex calling on instinct, thousands of years of knowing contained in his genome made real in his automatic drive for my breast.

My husband, Dave, slept on a chair beside me. I smiled and smiled. I was no longer pregnant, thank god. I was no longer anything or anyone that I’d ever been, it seemed. Everything was different. A line came to me from that famous James Joyce story, “The Dead:” “His own identity was fading out into a grey impalpable world: the solid world itself which these dead had one time reared and lived in was dissolving and swindling.”

My identity faded, too. All those things I’d believed about myself, who I ought to be, the kind of life I ought to live, the right dining room furniture, the sauce on Sundays, the notion of what a correctly formed girl, woman, wife, family should be—they swirled up and out of me in a panicked whirlwind and dissolved. It would be a long time before I found my own way, before I finally forgot those echoes of self-correction and self-denial that had made me so hyper-focused on attaining motherhood, for sure. The deep grooves they’d dug into the grain of my soul were not so easily smoothed over. And, truly, they’d ultimately wrought a good thing—this son, this baby, my Tom—for which I’d be forever grateful. But in fulfilling themselves, they also put the lie to themselves. That life they promised meant nothing. Nothing meant anything at all except this child, this other beating heart, not of me but still mine. I was a mother, and he was here. My baby was present, fulfilled at last. The rest of it could go to hell and meet my dead.

No, that wasn’t right. My dead weren’t gone, they hadn’t left, I hadn’t bested them. The dead never, ever leave us—I knew that better than anyone. Another line from that Joyce story, the final line, drifted out of the relative quiet of the four a.m. hospital corridor. The story’s protagonist, Gabriel, named after the angel who announces the birth of Christ, is sitting watching the snow fall over Dublin. He understands for the first time in his life that his wife is a person separate from him, her life and loves were real, and that they’re part of him, too, and he’s part of them, and he’s reborn himself in that understanding. All of us, he realizes, those that gave gone before and those of us who are yet to come, we are connected, we are equally blessed, or fucked, or simply affected. “His soul swooned slowly as he heard the snow falling faintly through the universe and faintly falling, like the descent of their last end, upon all the living and the dead.”

My soul swooned. My dead nodded sagely, approvingly. Maybe I’d had them all wrong. Maybe they’d dogged me all these years not to keep me from motherhood but to teach me this, to let me know the profound sweetness and gravity of my own existence, to lead me here, to the only right moment, the beginning of everything else. The rest fell away. My baby was in my arms. I was a mother. At last, at last.