A Life Beyond Reason

by Chris Gabbard

  Nineteen months after August’s death, in June 2015, I pulled out the birth records. The document stack was seven inches high. Following the dismissal of the lawsuit in 2004, Buchanan & Buchanan had shipped this material to us via UPS. For nearly eleven years the box containing these papers had been gathering dust in a closet. On a rainy afternoon, I carried the stack to my desk and started going through it. It was completely disorganized. With August’s passing I now had the time to read carefully through the documents. At last I had a chance to solve what I’d been calling “the mystery of the ear,” the reason for the ear-shaped abrasion on August’s forehead at birth. Sixteen years earlier, the four doctors at the family consult at Loma Prieta had gaslighted us, not wanting to say anything that might lead to a lawsuit. What was it that they wouldn’t tell us?

  I took solace in going back and reading about August’s beginning. Sifting through the sheets offered a means of holding on to his memory. They brought back events that I had forgotten. The prince of indeterminacy was gone, but this material made me feel close to him. Arranging the papers chronologically seemed to be the first thing to do. A lot of pages had to be sorted through, and many were duplicates. Slowly they gained a semblance of order.

  Ilene didn’t want to look at them. She found the idea too painful. Of the two of us, one had given birth, the other had only witnessed. As with her mother’s death when she was nine, she viewed August’s birth as the worst of traumas. It was a laceration in time, and no healing could ever occur.

  Not that I blamed her for not wanting to look at the birth records. Examining them would only raise troubling and unanswerable questions about what we should have done or done differently.

  “Why are you doing this?” she asked me one afternoon.

  “I want to know what happened to our son,” I replied.

  “But why?” said Ilene. “What’s the point? It won’t change anything.”

  Ilene stood in the white-framed doorway. I was sitting at my desk but had turned my chair around to face her. In the days immediately following August’s death a year and a half earlier, she and I had found ourselves screaming at each other. We didn’t know why. The reasons reached beyond fathom. Our outbursts exceeded blaming each other. They came from a pain so deep we thought it had no bottom. We were wounded animals with no place to lie down. Ilene began seeing a therapist, and I started writing this book.

  Screaming at each other turned out to be a brief phase, and we began to speak lovingly again. Anne Bradstreet wrote, “If ever two were one, then surely we”—a sentiment that is true for us. And we got a dog, and he became our comfort animal. And almost every morning we started getting up early to run together, something we had not been able to do when August was alive. If it was still dark outside, she wore a flashing blue light on her back and I, a red one. From the rear, we resembled a distant police car with its lights flashing.

  “You want justice, don’t you,” she said that afternoon, walking over and standing in front of where I was seated. There was no hint of criticism in her voice, but the statement also wasn’t framed as a question. It was more of a comment, an observation, a realization, as though the thought had just struck her at that very moment that this was what I was up to.

  “The law let us down.”

  “Yes, it did.”

  “I want justice for August,” I admitted. “It’s my duty as his father.”

  “Well, there isn’t any justice,” she said in a neutral tone tinged with resignation. “And there won’t be any either. At least not for August. The world isn’t like that.”

  “Then what is the world like? What is there any of?”

  She was silent. Had I stumped her? But no. Placing her hand on my shoulder, she said, “There is only love.”

  For months I went about the task of studying the birth files by fits and starts. But I was a slacker: I would come back to the documents after letting them sit untouched for weeks. Searching for an answer was like looking for a line at the bottom of the sea. I began to wonder if perhaps Ilene and I had been wrong to focus all of our attention on the test results of February 22 and March 1. On these two dates the personnel of the OB-GYN practice had conducted stress tests on the fetus, and the results had been poor.

  We had assumed that the practice had not responded diligently to these indicators of a potentially bad outcome and so had been negligent. The baby was already in trouble, we had thought, when we arrived early Wednesday morning, March 3, at the hospital for induction and delivery. But now I started examining instead the labor process itself, the events taking place between the morning of March 3 and that of March 5.

  Was something that happened in the delivery suite during that time the cause of August’s problems? Dr. Latchesik had stated under oath in her deposition that it wasn’t until 3:33 a.m. on the morning of March 5 that she first learned that a serious problem had developed. She said that at 3:33 a.m. the problem had, in her words, “already begun.”

  I went meticulously through the birth records, looking for a mention of the per diem nurse, who had been our main labor and delivery nurse, but I did not find one. So I called Joanne. She was Joanne Bluhen now and living on Alameda Island with husband Kevin and four children. We had last seen her when she and other friends joined us to disperse most of August’s ashes into the waves at Tennessee Valley Beach in Marin County.

  “Cowboy!” she said, recognizing my voice, “a blast from the past!” Then she added in her faux Southern accent, “What’s shakin’?” After a moment’s pause, she added, softly, “Natsukashii,” a term she then told me that her mother used. She explained that it was a word for remembering, a feeling of nostalgia, a fondness when experiencing something for the first time in a long time.

  We chatted for a while, and then I got around to the reason why I’d called, to get information about the morning of August’s birth. She said she couldn’t remember much about it, at least nothing specific.

  “What did you tell our lawyer when he deposed you?”

  “Deposed me? No one ever deposed me.”

  “What? No one ever deposed you?” I was shocked. “You never talked to our attorney, Byron Greyscale?”

  “No. No one ever contacted me.”

  “That’s strange. What about the hospital attorney?”

  “No, never heard from him either.”

  “Hmmm. Do you remember, in the hour before the birth, the two nurses and the resident talking about the baby’s heart rate?”

  “Oh, man! Do you expect me to remember that?”

  “The black nurse in her thirties, you know, and the very young white nurse? The black nurse was the main labor and delivery nurse. They talked about the heart rate? And the resident, she came over and said that the heart rate must be Mom’s?”

  She paused for a long while and then said, “No, I don’t recall anything about that. But, then, I was gone for a while. Remember? I’d gone back to my apartment and then returned. The birth suite was deserted, and then everyone came back, and then the birth happened. So, I can’t help you about that.”

  I had no choice but to peer through a glass darkly on my own. And yet, as Lucy Grealy observes, “Sometimes it is as difficult to know what the past holds as it is to know the future.”

  It was March 5, 1999. The clock on the wall behind the blond woman at the nurses’ station read 3:23 a.m. “Everyone’s giving birth,” she told me, then added that the doctors were “very busy.” I said, “I just want them to know that my wife is ready.” To this she replied, “They’ll come when they can. They’ll get that baby out in no time.”

  When I returned to the birth suite after my feckless attempt to summon a physician, I related to Ilene and Joanne what had just happened at the nurses’ station. “Something of an interesting conversation, to say the least. The nurse asked me the meaning of ready. And then she said all the doctors are busy. No one’s available. Evidently everybody’s giving birth.”

  “You lie!” Joanne exclaimed, looking bo
th panicked and angry.

  “The nurse seemed to think this is going to be a very easy birth,” I said.

  “I’m going down to the nurses’ station myself and make a big stink,” said Joanne, and she was just about to stomp down there and complain loudly when the per diem nurse, the blond nurse, and the third nurse returned all at once.

  “Are you guys back with us?” asked Joanne in a hostile tone.

  “We’re here,” said the per diem nurse.

  Dr. Atropski, the resident physician, soon followed them in. By now it was 3:28 a.m., and the four of them then didn’t do anything. They seemed to be waiting for something.

  Finally, at 3:33 a.m., Dr. Latchesik, the attending physician, came into the suite and immediately gowned and gloved up. The last time Ilene, Joanne, and I had seen her was at 3:03 a.m., at which time the resident had told her that a problem was occurring with the electronic fetal monitor. Now, at 3:33, as she prepared herself for delivering the baby, Dr. Latchesik asked, “There was a problem with the monitor?” A short and seemingly casual discussion followed about whose heart rate the now-detached fetal monitor had been reading at 2:55 a.m. Given the low numbers, Dr. Latchesik quickly affirmed with a characteristically decisive little head bob whose heartbeat it must have been. “Yes, it must have been the mother’s,” she said. The two doctors were completely at ease, exhibiting no sense of urgency.

  Suddenly a specially dispatched pediatric team of seven or eight residents and medical students roared through the door with the self-importance of a college football squad taking the field. Why they were there or who summoned them I had no idea. This was at about 3:35 a.m. They wheeled with them a small table and used it to establish a makeshift station ten feet to the left of Ilene’s bed.

  The residents and medical students were full of good cheer, acting as if the baby had already been born. The only female among them was a tall, young, and slender woman with a long black ponytail, Dr. Wang, a senior resident physician. She was more serious in bearing than the other team members. Later that day she came to speak with us, to express her concern. She was the only one of all the medical professionals present in the delivery suite that morning who did.

  The baby’s head began to crown. Was this at 3:41? Joanne and I were positioned on opposite sides of the bed. I was holding Ilene’s left hand, Joanne her right. Ilene seemed stupefied but determined to finish the process. Dr. Latchesik went down on one knee between her legs and told Joanne and me to say “Push!” in unison every few seconds.

  It must have been at 3:42 that I saw Dr. Latchesik’s eyes pop wide open. Her attention became tightly focused, like those of a pilot when a plane suddenly shows signs of trouble in flight. She called to the nearby team, “There’s an abrasion on the baby’s head!” Then she shouted, “We’re going to use the vacuum!” Dr. Atropski and the per diem nurse sprang into action and swiftly readied the gear. Standing again, Latchesik positioned the vacuum-extraction device and told Ilene to push, and Ilene obeyed, and then came another order to push, and on the third try there was a great whoosh, liquid gushing, and with a flood of brownish amniotic fluid, the infant tumbled out headfirst.

  The body that emerged at 3:44 a.m. was gray, limp, and lifeless. The umbilical cord was wrapped twice around his neck. Dr. Latchesik hurriedly clamped and cut the cord and handed the newborn to Dr. Atropski behind her, who whisked him over to the specially dispatched team where Dr. Wang and the residents were waiting. The team began attempting to resuscitate him.

  Everyone’s activity seemed frantic, and everyone whose faces we could see had wide-open eyes and grim “Oh no!” expressions. All the while, the baby didn’t cry. He didn’t make any sound at all. For the first minute, most of what Ilene, Joanne, and I could see was the scrum of residents’ and students’ backs.

  Dr. Latchesik was the first to regain her composure. She was standing near Ilene’s delivery bed, and she informed us, reassuringly, “The baby is merely stunned.” Contradicting this verbal assertion, though, were the apprehensive looks of others, whose faces were becoming more and more visible. Some of them had begun glancing back at us, to check our reaction. Dr. Wang and I exchanged glances, and I knew then that things were going very badly.

  I wasn’t looking at Joanne, but I heard her mumble, “I can’t believe this is happening.”

  The per diem nurse walked toward Ilene’s bed, moving so slowly that she seemed to advance frame by frame, as if all of this was the footage of a dream. As she approached, she held my gaze as though communicating something important. Like everyone else’s (except for Dr. Latchesik’s), her eyes were wide open and worried.

  Dr. Latchesik spoke again, as calmly as before: “This sort of thing happens all the time.” We were all waiting for the baby to breathe. But how many minutes were going by? When he finally began breathing, everyone exhaled. It was cause for celebration. Still, the newborn wasn’t crying or making a sound loud enough to hear. I could tell from her demeanor that Dr. Wang was convinced that a calamity was still unfolding. Not so the others. A little party had broken out: the residents were cheering and the students started high-fiving. Dr. Wang quickly shushed them.

  “Show Mom and Dad the baby!” called Dr. Latchesik optimistically. She was still standing beside Ilene’s bed. A male resident next to Dr. Wang complied, and he hoisted the little body high into the air, a trophy of medical rescue.

  As I went through August’s birth-related papers in 2015, I returned to one of our attorney Byron Greyscale’s last letters, the one dated June 28, 2004. As I was rereading, a sentence jumped out in a way that it hadn’t before: “With all of the evidence establishing that August was delivered within 10 minutes of the bradycardia, we cannot establish that [the hospital] was negligent in its care and treatment of you and August.”

  Dr. Latchesik had claimed in her deposition that the thirty-minute bradycardia clock began ticking at around 3:33 a.m. But did more than one clock exist? Another might have started at 2:55 a.m.

  Earlier in the same letter, Byron had written, “Dr. Baelish re-reviewed the heart rate tracing and believes that the heart rate seen on the heart monitor tracing is Ilene’s and not August’s.”

  At 2:55 a.m. Dr. Atropski had said that the sluggish heartbeat—80 beats per minute when it should have been 110 to 160—“must be Mom’s.” The per diem nurse had voiced doubt about this, suspecting that the heartbeat was the baby’s.

  I remembered that shortly after August’s birth, a friend of Ilene’s, Dr. Romano, a pediatric neurologist, had said that the electronic fetal monitor (EFM) was unreliable. And in August’s case no one had relied on a monitor. I went online to read up on EFM and found the guidelines of the American Congress of Obstetricians and Gynecologists, which state, “When EFM is used during labor, the nurse or physicians should review it frequently.” I also found a May 1999 article in American Family Physician examining the limits of EFM, which evidently are numerous. It reported that some clinicians believe that EFM provides valuable information but that it takes an expert to properly interpret the results. Had Dr. Atropski not been enough of an expert? About EFM I started repeating something in my head: It was unreliable, and no one relied on it. But this mantra didn’t have an itinerary. I didn’t know where to go with it.

  I began wondering about Dr. Latchesik and her knowledge of a problem with the monitor.

  And I had another thought. Even if the monitor was unreliable and everyone had assumed that the fetal heart rate given by the monitor was the mother’s, didn’t this then mean that the baby’s heartbeat was going unmonitored? The fact that he was not being monitored did not rule out that he was experiencing distress. Equally possible, might the reading have indicated that the baby’s heartbeat had become too weak to detect and so was being overridden by the mother’s? Wouldn’t this too have indicated distress? And I had yet another thought: surely the medical experts involved had already thought about these things.

  Whether the monitor was reliable or unreliable, the per diem
nurse had detected a problem. Being an outsider, perhaps she wasn’t used to the way things were done at Loma Prieta, so she had noticed something that the others didn’t and pointed it out, but no one listened. Did they ignore her because she was the only black person working on an all-white crew? Was it because she was a per diem? Did these factors combine to render her invisible? Did I contribute to her invisibility? After all, I myself never bothered to catch her name. In his memoir Black Man in a White Coat, Dr. Damon Tweedy notes that the input of African American medical professionals is often discounted. Had the others in August’s delivery suite listened to what the black nurse had to say, our son’s outcome probably would have been immensely better. I have no doubt that he would be alive today.

  It now seemed obvious that Dr. Latchesik mistook the time in her deposition. She claimed that she had learned of bradycardia at 3:33 a.m., but she didn’t become aware of it until 3:42. I had seen her eyes pop wide open—that’s how I knew. Yet, regarding the legal case, I’m not sure what difference fudging the time would have made. In another vein, I could see that, in the early morning of March 5, the sheer number of births occurring at once had overwhelmed the staff. I also now understood that skepticism about EFM had become prevailing wisdom. Dr. Atropski and Dr. Latchesik had a shared disregard for it, and this was a mistake, but I could understand why they made it. They were doing what made sense to them.

  What I couldn’t understand, however, was why Dr. Baelish had been so quick to gloss over the error occurring at 2:55 a.m. He had reviewed the fetal heart tracings for that time and, with the benefit of twenty-twenty hindsight, should have been able to see that the resident’s misjudgment had swelled into a self-echoing, self-certifying chorus. I could only assume that he had given Dr. Latchesik’s deposition testimony extraordinary weight. But why? Why would he do this?

  I lay in bed, mulling over all of this, and then I got up and padded as quietly as I could through our house with groaning floorboards to August’s room at the back, now my man cave. It must have been maybe 4:30 or 5 a.m. I opened the door and turned on the computer. In the little elfin grot, both windows were dark. Through the east-facing window I could see the black silhouette of the foliage in the neighbors’ yard against a slightly less dark slate sky. I Googled Dr. Lisette Atropski. She was now working in San Diego. Next, I Googled Dr. Sandra Latchesik. As I learned about her, a picture began to form, and I switched from Google to my university’s databases. After a bit more searching, there it was, as conspicuous as a bright-orange trail marker. She was a leader in the field of obstetrics and gynecology, having published a large number of articles. At the end of 1999, a few months after August’s birth, she had been appointed to head an OB-GYN department at a top teaching hospital in Chicago.