Small Great Things

by Jodi Picoult

  If I weren't so terrified, I would laugh. That's it? That's the way Odette glossed over the racism that led to that damn Post-it note on the file? It's almost impressive, the way she so neatly flipped it so that before the jury got a glance at the ugliness, they were looking at something else entirely: patients' rights. I glance at Kennedy, and she shrugs the tiniest bit. I told you so.

  "On Saturday morning, little Davis Bauer was taken to the nursery for his circumcision. The defendant was alone in that room when the baby went into distress. So what did she do?" Odette hesitates. "Nothing. This nurse with over twenty years of experience, this woman who had taken an oath to administer care as best she could, just stood there." Turning, she points to me. "The defendant stood there, and she watched that baby struggle to breathe, and she let that baby die."

  Now I can feel the jury picking me over, jackals at carrion. Some of them seem curious, some stare with revulsion. It makes me want to crawl under the defense table. Take a shower. But then I feel Kennedy squeeze my hand where it rests on my lap, and I lift my chin. Do not let them see you sweat, she'd said.

  "Ruth Jefferson's behavior was wanton, reckless, and intentional. Ruth Jefferson is a murderer."

  Hearing the word leveled at me, even though I have been expecting it, still takes me by surprise. I try to build a levee against the shock of it, by picturing in quick succession all the babies I have held in my arms, the first touch they've had for comfort in this world.

  "The evidence will show that the defendant stood there doing nothing while that infant fought for his life. When other medical professionals came in and prodded her into action, she used more force than was necessary and violated all the professional standards of care. She was so violent to this little baby boy that you will see the bruising in his autopsy photos."

  She faces the jury once more. "We have all had our feelings hurt, ladies and gentlemen," Odette says. "But even if you don't feel that a choice was made correctly--even if you find it a moral affront--you don't retaliate. You don't cause harm to an innocent, to get back at the person who's wronged you. And yet this is exactly what the defendant did. Had she acted in accordance with her training as a medical professional, instead of being motivated by rage and retaliation, Davis Bauer would be alive today. But with Ruth Jefferson on the job?" She looks me square in the eye. "That baby didn't stand a chance."

  Beside me, Kennedy rises smoothly. She walks toward the jury, her heels clicking on the tile floor. "The prosecutor," she says, "will have you believe this case is black and white. But not in the way that you think. I'm representing Ruth Jefferson. She is a graduate of SUNY Plattsburgh who went on to get a nursing degree at Yale. She has practiced as a labor and delivery nurse for over twenty years in the state of Connecticut. She was married to Wesley Jefferson, who died overseas serving in our military. By herself, she raised a son, Edison, an honor student who is applying to college. Ruth Jefferson is not a monster, ladies and gentlemen. She is a good mother, she was a good wife, and she is an exemplary nurse."

  She crosses back to the defense table and puts her hand on my shoulder. "The evidence is going to show that one day, a baby died during Ruth's shift. Not just any baby, though. The infant was the child of Turk Bauer, a man who hated her because of her skin color. And what happened? When the baby died, he went to the police and blamed Ruth. In spite of the fact that the pediatrician--who you will hear from--commended Ruth for the way she fought to save that infant during his respiratory arrest. In spite of the fact that Ruth's boss--who you will hear from--told Ruth not to touch this child, when the hospital had no right to tell her to abandon her duty as a nurse."

  Kennedy walks toward the jury again. "Here is what the evidence will show: Ruth was confronted with an impossible situation. Should she follow the orders of her supervisor, and the misguided wishes of the baby's parents? Or should she do whatever she possibly could to save his life?

  "Ms. Lawton said that this case was tragic, and she is right. But again, not for the reason you think. Because nothing Ruth Jefferson did or didn't do would have made a difference for little Davis Bauer. What the Bauers--and the hospital--did not know at the time is that the baby had a life-threatening condition that had gone unidentified. And it wouldn't have mattered if it were Ruth in the room with him, or Florence Nightingale. There is simply no way Davis Bauer would have survived."

  She spreads her hands, a concession. "The prosecutor would have you believe that the reason we are here today is negligence. But it was not Ruth who was inattentive--it was the hospital and the state lab, which failed to promptly flag a severe medical condition in the infant that, if diagnosed sooner, might have saved his life. The prosecutor would have you believe that the reason we are here today is rage and retaliation. That's true. But it's not Ruth who was consumed by anger. It was Turk and Brittany Bauer, who, lost in grief and pain, wanted to find a scapegoat. If they could not have their son, alive and healthy, they wanted someone else to suffer. And so, they targeted Ruth Jefferson." She looks at the jury. "There has already been one innocent victim. I urge you to prevent there being a second."

  --

  I HAVEN'T SEEN Corinne in months. She looks older, and there are circles under her eyes. I wonder if she is with the same boyfriend, if she's been ill, what crisis has overtaken her life lately. I remember how when we got salads down in the cafeteria and ate them in the break room, she would give me her tomatoes and I would pass over my olives.

  If the past few months have taught me anything, it's that friendship is a smoke screen. The people you think are solid turn out to be mirrors and light; and then you look down and realize there are others you took for granted, those who are your foundation. A year ago, I would have told you that Corinne and I were close, but that turned out to be proximity instead of connection. We were default acquaintances, buying each other Christmas gifts and going out for tapas on Thursday nights not because we had so much in common, but because we worked so hard and so long that it was easier to continue our shorthand conversation than to branch out and teach someone else the language.

  Odette asks Corinne to give her name, her address. Then she asks, "Are you employed?"

  From the witness stand, Corinne makes eye contact with me, and then her gaze slides away. "Yes. At Mercy-West Haven Hospital."

  "Do you know the defendant in this matter?"

  "Yes," Corinne admits. "I do."

  But she doesn't, not really. She never did.

  To be fair, I guess, I didn't really know who I was, either.

  "How long have you known her?" Odette asks.

  "Seven years. We worked together as nurses on the L and D ward."

  "I see," the prosecutor says. "Were you both working on October second, 2015?"

  "Yes. We started our shift at seven A.M."

  "Did you care for Davis Bauer that morning?"

  "Yes," Corinne says. "But I took over for Ruth."

  "Why?"

  "Our supervisor, Marie Malone, asked me to."

  Odette makes a big to-do about entering a certified copy of the medical record into evidence. "I'd like to refer you to exhibit twenty-four, in front of you. Can you tell the jury what it is?"

  "A medical records folder," Corinne explains. "Davis Bauer was the patient."

  "Is there a note in the front of the file?"

  "Yes," Corinne says, and she reads it aloud. "No African American personnel to care for this patient."

  Each word, it's a bullet.

  "As a result of this, the patient was reassigned from the defendant to you, correct?"

  "Yes."

  "Did you observe Ruth's reaction to that note?" Odette asks.

  "I did. She was angry and upset. She told me that Marie had taken her off the case because she's Black, and I said that didn't sound like Marie. You know, like, there must have been more going on. She didn't want to hear it. She said, 'That baby means nothing to me.' And then she stormed off."

  Stormed off? I went down the staircase, inste
ad of taking the elevator. It is remarkable how events and truths can be reshaped, like wax that's sat too long in the sun. There is no such thing as a fact. There is only how you saw the fact, in a given moment. How you reported the fact. How your brain processed that fact. There is no extrication of the storyteller from the story.

  "Was Davis Bauer a healthy baby?" the prosecutor continues.

  "It seemed that way," Corinne admits. "I mean, he wasn't nursing a lot, but that wasn't particularly significant. Lots of babies are logy at first."

  "Were you at work on Friday, October third?"

  "Yes," Corinne says.

  "Was Ruth?"

  "No. She wasn't supposed to come in at all, but I'm pretty sure we were shorthanded and she got pulled in to do a double--seven P.M., running straight into Saturday."

  "So you were Davis's nurse all day Friday?"

  "Yes."

  "Did you perform any routine procedures on the infant?"

  Corinne nods. "At around two-thirty I did the heel stick. It's a standard blood test--it wasn't done because the baby was sick or anything. All newborns get it, and it goes off to the state lab for analysis."

  "Did you have any concerns about your patient that day?"

  "He was still having trouble latching on for breast feeding, but again, that's not extraordinary for a first-time mom and a newborn." She smiles at the jury. "Blind leading the blind, and all that."

  "Did you have any conversation with the defendant about Davis Bauer when she came on shift?"

  "No. In fact she seemed to ignore him completely."

  It is like an out-of-body experience--sitting right here, in plain sight, and hearing these people discuss me as if I am not present.

  "When did you next see Ruth?"

  "Well, she was still on duty when I came back on shift at seven A.M. She'd pulled an all-nighter, and was scheduled to leave at eleven A.M."

  "What happened that morning?" Odette asks.

  "The baby was being circumcised. Usually the parents don't like to see that happen in front of them, so we take the infant to the nursery. We give them a little bit of sweeties--basically sugar water--to calm them down a little, and the pediatrician does the procedure. When I wheeled in the bassinet, Ruth was waiting in the nursery. It had been a crazy morning, and she was taking a breather."

  "Did the circumcision go as planned?"

  "Yes, no complications. The protocol is to monitor the baby for ninety minutes to make sure there's no bleeding, or any other sort of issue."

  "Is that what you did?"

  "No," Corinne admits. "I was called for an emergency C-section for one of my other patients. Our charge nurse, Marie, accompanied me to the OR, which is her job. That meant Ruth was the only nurse left on the floor. So I grabbed her and asked her to watch over Davis." She hesitates. "You have to understand, we're a tiny hospital. We have a skeletal staff. And when a medical emergency happens, decisions are made quickly."

  Beside me, Howard scribbles a note.

  "A stat C-section takes twenty minutes, tops. I assumed I'd be back in that nursery before the infant even woke up."

  "Did you have any concern about leaving Davis in Ruth's care?"

  "No," she says firmly. "Ruth's the best nurse I've ever met."

  "How long were you gone?" Odette asks.

  "Too long," Corinne says softly. "By the time I got back, the baby was dead."

  The prosecutor turns to Kennedy. "Your witness."

  Kennedy smiles at Corinne as she walks toward the witness stand. "You say you worked with Ruth for seven years. Would you consider yourself friends?"

  Corinne's eyes dart to me. "Yes."

  "Have you ever doubted her commitment to her career?"

  "No. She has pretty much been a role model for me."

  "Were you in the nursery for any of the time that a medical intervention was taking place with Davis Bauer?"

  "No," Corinne says. "I was with my other patient."

  "So you didn't see Ruth take action."

  "No."

  "And," Kennedy adds, "you didn't see Ruth not take action."

  "No."

  She holds up the piece of paper Howard has passed to her. "You stated, and I quote, When a medical emergency happens, decisions are made quickly. Do you remember saying that?"

  "Yes..."

  "Your stat C-section was a medical emergency, right?"

  "Yes."

  "Wouldn't you also say that a newborn suffering a respiratory seizure qualifies as a medical emergency?"

  "Um, yes, of course."

  "Were you aware that there was a note in the file that said Ruth was not to care for this baby?"

  "Objection!" Odette says. "That's not what the note said."

  "Sustained," the judge pronounces. "Ms. McQuarrie, rephrase."

  "Were you aware that there was a note in the file that said no African American personnel could care for the baby?"

  "Yes."

  "How many Black nurses work in your department?"

  "Just Ruth."

  "Were you aware when you grabbed Ruth to fill in for you that the baby's parents had expressed the desire to prohibit her from caring for their newborn?"

  Corinne shifts on the wooden seat. "I didn't think anything was going to happen. The baby was fine when I left."

  "The whole reason for monitoring a baby for ninety minutes after a circumcision is because with neonates, things can change on a dime, isn't that right?"

  "Yes."

  "And the fact is, Corinne, you left that baby with a nurse who was forbidden from ministering to him, correct?"

  "I had no other choice," Corinne says, defensive.

  "But you did leave that infant in Ruth's care?"

  "Yes."

  "And you did know that she wasn't supposed to touch that baby?"

  "Yes."

  "So you screwed up, essentially, two times over?"

  "Well--"

  "Funny," Kennedy interrupts. "No one accused you of killing that baby."

  --

  LAST NIGHT, I dreamed about Mama's funeral. The pews were full, and it wasn't winter, but summer. In spite of the air-conditioning and people waving fans and programs, we were all slick with sweat. The church wasn't a church but a warehouse that looked like it had been repurposed after a fire. The cross behind the altar was made of two charred beams fitted together like a puzzle.

  I was trying to cry, but I didn't have any tears left. All the moisture in my body had become perspiration. I tried to fan myself, but I didn't have a program.

  Then the person sitting beside me handed me one. "Take mine," she said.

  I looked over to say thank you, and realized Mama was in the chair next to me.

  Speechless, I staggered to my feet.

  I peered into the coffin, to see who--instead--was inside.

  It was full of dead babies.

  --

  MARIE WAS HIRED ten years after I was. Back then she was an L & D nurse, just like me. We suffered through double shifts and complained about the lousy benefits and survived the remodeling of the hospital. When the charge nurse retired, Marie and I both threw our names into the ring. When HR went with Marie, she came to me, devastated. She said that she was hoping I'd get the job, just so she didn't have to apologize for being the one who was chosen. But really, I was okay with it. I had Edison to watch after, in the first place. And being charge nurse meant a lot more administrative work and less hands-on with patients. As I watched Marie settle into her new role, I thanked my lucky stars that it had worked out the way it had.

  "The baby's father, Turk Bauer, had asked to speak to a supervisor," Marie says, replying to the prosecutor. "He had a concern about the care of his infant."

  "What were the contents of that conversation?"

  She looks into her lap. "He did not want any Black people touching his baby. He told me that at the same time he revealed a tattoo of a Confederate flag on his forearm."

  There is actually a gasp from someone i
n the jury.

  "Had you ever experienced a request like this from a parent?"

  Marie hesitates. "We get patient requests all the time. Some women prefer female doctors to deliver their babies, or they don't like being treated by a med student. We do our best to make our patients comfortable, whatever it takes."

  "In this case, what did you do?"

  "I wrote a note and stuck it in the file."

  Odette asks her to examine the exhibit with the medical file, to read the note out loud. "Did you speak to your staff about this patient request?"

  "I did. I explained to Ruth that there had been a request to have her step down, due to the father's philosophical beliefs."

  "What was her reaction?"

  "She took it as a personal affront," Marie says evenly. "I didn't mean it that way. I told her it was just a formality. But she walked out and slammed the door of my office."

  "When did you see the defendant again?" Odette asks.

  "Saturday morning. I was in the ER with another patient, who had suffered a complication during delivery. As nurse supervisor, I'm required to make that transfer with the attending nurse, who happened to be Corinne. Corinne had left Ruth watching over her other patient--Davis Bauer--postcircumcision. So as soon as I possibly could, I ran back to the nursery."

  "Tell us what you saw, Marie."

  "Ruth was standing over the bassinet," she says. "I asked her what she was doing, and she said, Nothing."

  The room closes in on me, and the muscles of my neck and arms tighten. I feel myself frozen again, mesmerized by the blue marble of the baby's cheek, the stillness of his small body. I hear her instructions:

  Ambu bag.

  Call the code.

  I am swimming, I am in over my head, I am wooden.

  Start compressions.

  Hammering with two fingers on the delicate spring of rib cage, attaching the leads with my other hand. The nursery too cramped for all the people suddenly inside. The needle inserted subcutaneous into the scalp, the blue barrage of swear words as it slips out before striking a vein. A vial rolling off the table. Atropine, squirted into the lungs, coating the plastic tube. The pediatrician, flying into the nursery. The sigh of the Ambu bag being tossed in the trash.