In Every Moment We Are Still Alive

by Tom Malmquist

  I’m sitting in the corridor outside F21 when an anaesthetic nurse holds out her porcelain-like hand. Jaleh, she says. I stand up. Has something happened? I ask. I’m supposed to fetch you and bring you to the operating theatre, she answers. For the caesarean? Yes, the caesarean. Now? She twists a white pearl earring. Yes, now, you can come with me, it’s over there, come on. I follow her as she bounces along the corridor in her camouflage Crocs. Post-op is a large room with about twenty beds in it, separated by partition screens. Wait here, I’ll just check if we have a green light, she says and goes up to a staff desk in the middle of the room, where she starts to talk to someone wearing some kind of goggles who seems to be in charge. She gestures, they both look at me. His head drops forward and he picks up a telephone. She comes back and whispers: It can be a bit like that, the doctors all have their own territory. With a wink, she walks over to a storage room and searches the shelves. This one should fit you, she says, handing me a dark blue set of scrubs and a turquoise cap. Then she stands waiting in front of two steel doors that lead into the Central Operations Emergency and Trauma Unit. I feel silly, like a kid in fancy dress, especially with the ridiculous cap. Do I really have to wear this? I ask. She’s walking backwards into the ward when she answers: Things have to be sterile in the operating theatre; it’s not that bad, is it? So I can come into the operating theatre? Exactly. Next to Karin? Exactly. Thank you, thank you so much. The fluorescent lights reflect against the smooth plastic floor, forming a central line in the corridor. Along the sides are bright yellow refuse bins and trolleys brimming with emergency equipment. She stops and says: This is us, Emergency Room 11. Do I have time to go to the loo? I ask. Yes, she says, pointing towards a corner of the corridor. On the right, it says staff toilet but you can use it, she adds, then calls out behind me: No need to run. Only a few drips come out of me, I zip myself up and avoid the mirror. I sound like an animal when I put my fingers down my throat over the washbasin, but the contents of my stomach don’t come up, it’s just a dry retching. I take off my cap and rinse my face. In the vestibule by Emergency Room 11 is another washbasin, I wash my hands again. The anaesthetic nurse holds the door open for me while I knead disinfectant gel into my fingers. Don’t forget the cap, she says. I put it on. The effect of the room seems to force itself on me: the burning surgical lighthead, the operation table lift, the pale blue walls, the floor pattern of rectangles and rhombi, the steel trolleys, infusion stands, monitors, an almost big-city feel of nearly twenty doctors and nurses getting themselves ready, and then Karin, wearing the same cap as me, lying in the middle of the room, her stomach obscured by a green curtain suspended between posts on wheels. You can sit here, says the anaesthetic nurse. Okay, thanks, I reply and sit by Karin’s left arm. It’s on a steel armrest padded with nylon. Hold her hand, she says. Okay, thanks. I work my hand into Karin’s, my palm wet. On my right the anaesthetist stands by a monitor, on the phone. He takes a few quick steps forward and taps me on the shoulder: Hi there. I’m worried I might knock her somehow and interfere, I think my hands are shaking? I ask the anaesthetic nurse. She looks down at Karin’s arm and turns to the anaesthetist: It’s okay if he holds her hand, isn’t it? He peers over his glasses and answers: No problem, the arm is good there, she’s strapped in as well. He looks at me and adds: Of course you should hold her hand. The staff behind the curtain are wearing surgical masks and caps covering their ears and throats, sort of flimsy balaclavas. One of them, the theatre nurse, turns around and says: Okay, let’s have the run-through, surgeon goes first. The consultant answers: Agneta Arvidsson, obstetrician, consultant at the Women’s Health Clinic, I’ll be operating today. It’s an emergency section partly because of the mother’s condition, recently diagnosed with leukaemia, and partly because we’re concerned the child might otherwise risk developing breathing difficulties because of high numbers of blasts in the circulation. The mother has been kept sedated since yesterday, intubated on a respirator, I’ll come back to that. She returns to her preparations. One by one they introduce themselves: the nurses, assistant nurses, midwives, and doctors. I tense up about also having to introduce myself, having to stand up in my silly operation cap and give away how close I am to collapsing and maybe being carried out and separated from Karin and Livia. Only when it’s the anaesthetist’s turn to speak and he explains that I’m the father of the child do I feel calmer. Behind me, by one of the doors, stands a man in a white hospital uniform. He’s the only one who’s not wearing scrubs, apart from his cap. He stands rigid, almost like a skier: straight, strong back, firm legs, tight shoulders. When it’s his turn he says: My name is Holger Kinch, I’m a doctor from ECMO, the patient has had acute respiratory fluctuations since yesterday, I’m here in case a full gas substitution is required. An assistant nurse stands next to me and reads out what it says on Karin’s identity tag. I hear a voice from the other side of the room, repeating her social security number. More nurses come forward and read from the identity tag and more voices echo them at the other end of the room. I forgot, whispers the anaesthetic nurse. She’s holding a surgical mask: Put this on. I try but get it stuck around my throat. You have to put those behind your ears, she points out, helping me extricate myself from the rubber bands. When I manage to get it on the sound of my own breathing drowns everything else out, I have to hold my breath to follow what’s being said around me. Someone calls out: Pre-op skin prep completed, sterility confirmed. I squeeze Karin’s hand. The anaesthetic nurse puts a glass of water on the floor. Thanks, I say, pulling down my mask and drinking. She squats while the consultant talks about the blood loss they can expect. How are you holding up? she asks. I had a splitting headache before, but it’s better now, thanks. Okay, let me know if you want to ask anything. Thanks. I try to dry my hands on the hospital gown, but all I do is spread my sticky sweat over the plastic. The operation nurse raises her voice: Are we all agreed that we’ll check status whenever necessary? They respond in unison: Yes. The consultant says: Making the first incision now at 14:21…today…She looks around. After a pause, the assistant nurse says: Twentieth of March. Someone laughs. Well, that’s what happens when you’re overworked. Right, the twentieth of March, says the consultant. The anaesthetic nurse hurries over to a pump rack and starts turning a valve on some sort of cartridge, then adjusts the catheter in Karin’s arm. The anaesthetist says: Well done, Jaleh, that’s looking better. A nurse holding on Karin’s breathing mask says: Coughing, thin, bloody slime. Karin’s body starts shaking almost imperceptibly, but I feel it, like tiny tremors running through my hand. I hear them talking behind the curtain, there’s a clattering of steel, a sucking sound, I squeeze Karin’s hand tighter and I whisper: I’m here, darling. I bend forward, I close my eyes, hear some scattered applause and a scream, shrill and horrible but also beautiful, sustained, so incredibly loud; I recognise the consultant’s voice: The time is 14:35, enter as time of birth. I open my eyes and stand up without letting go of Karin’s hand. The consultant is holding Livia by the legs, as if she’s bleeding prey. If the father can hear me now, a baby that doesn’t yell is a bad sign, this is excellent, you have a strong voice, yes you do, you’re a lovely girl, says the consultant. I don’t have time to process what’s happening, I’m suddenly chasing after the team from Neonatal, one of them carrying Livia in a white towel, she’s pink and sticky, and the other pushing a cart with the placenta in a kidney dish. The anaesthetic nurse follows me out and as we reach the door she points: That’s the nurse from Neo, that’s the midwife, and the one by the oxygen is the children’s doctor, the paediatrician. They’ve put Livia on a bench that’s apparently known as a neonatal resuscitation table. Livia is given oxygen via a mask, the paediatrician listens into a stethoscope. The heart sounds good, she says, then adds, with great composure: She’s a really beautiful little girl, congratulations. The others agree. I suppose you say that to everyone, I say. Yes, she responds, but one doesn’t always mean it. There are two clamps at the end of the umbilical cord, which is light t
urquoise and about twenty centimetres long. The nurse looks at me and asks: Can I give you a hug? Okay, I say, and she embraces me. Do you have a name for her? she asks. Livia, I answer. Olivia, that’s lovely, would Dad like to cut Olivia’s umbilical cord? Will I hurt her? I ask. No, it’s just blood vessels and connective tissue, it’s like cutting your nails, she says, handing me a pair of surgical scissors. No, here, you cut here, she says and points. I cut, she applauds. Tom, someone wants to talk to you, says the anaesthetic nurse and nods towards the emergency room. I turn around and see the anaesthetist on the other side of the small rectangular window; he pulls down his mask and gives me a thumbs up, but just before I realise it’s him standing there I have a sense that it’s actually Karin, and in that instant I almost call out: Everything’s fine, darling. The midwife holds up the wet placenta. She points at the umbilical cord, which points upwards like an old Chinese drawing of a tree trunk, the veins like branches and the amniotic sac the crown of leaves, and she says: You can understand why it’s called the Tree of Life. Yes, I answer. Do you want to keep it? Keep it?! I exclaim. Yes, she answers. No thanks. Don’t panic, I usually offer, some people want to eat the placenta. Are you joking? No. I certainly don’t fancy a bit of placenta, I say. No, fair enough, it’s usually the mothers, it’s supposed to have a number of positive effects, stimulating milk production and balancing the hormones. Anyway, I was only asking. Right, well I had no idea it could do that, I say, and lean over Livia. Can I hold her hand? Yes, of course, says the paediatrician. It’s so small it doesn’t even reach around my finger, light red nails, so tiny. The paediatrician peers at me: I’ll tell you one thing, your daughter is a real whopper bearing in mind she’s one and a half months premature, but she needs to go into Neonatal for some help just to get started.

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  It’s dark apart from a bright lamp over Livia’s incubator. Her face isn’t pretty, isn’t sweet; it’s thin but also swelled up, wrinkled, chapped like an old, sick person. I see no trace of Karin’s sanguinity in her. It’s as if Karin’s blood disease has corroded her. She’s got a nappy on, and a pale lemon-yellow hat, and a silicone band across her nose with an oxygen tube curling over her little head into her nose, like a space mask. We’ll be feeding your daughter via nasogastric tube with PreNAN Discharge, says the nurse. Uh-huh, and what’s that? I ask. It’s like breast-milk with a bit of extra zing; you should Google it if you want to know more. I’m sure it’s fine, I don’t have the Internet on my phone anyway, I say. Sounds sensible, these days people just sit about fiddling with their phones, she says. I tell her it’s mainly because I can’t afford it, then, while we’re talking, Livia goes quiet and starts moving her head around as if she’s looking for something. Did you talk to your daughter while she was in the womb? asks the nurse. I suppose I did, now and then. How did you do it? What do you mean, how? Because she recognises your voice, she points out. No, really? I don’t think so, I say. Oh I do think so, you know I’ve picked up a few things while I’ve been working here, which is a long time. Okay, if you say so, I say, keeping my eyes on Livia. She says Livia’s not just reacting to the sound of our voices, she’s listening, it’s quite clear. The other nurse comes over from an incubator at the other end of the ward, and asks: Did you talk right up against the bump? Yes, but mainly I just sang, it calmed Livia’s mother down, I answer. Just imagine, even in the womb we’re so receptive, she says. Absolutely incredible, says the other nurse. Excuse me a moment, I say, and hurry into the corridor.

  In front of the bathroom mirror I notice I’m still wearing the dark blue scrubs and cap. I throw the entire get-up into the bin and sit on the toilet lid. I check my phone: fifteen missed calls, one from Mum and four from Dad. I read the texts and reply to a couple of them. Livia has fallen asleep by the time I come back. Her right foot has been bandaged. I had to put some dressing on her foot, she kept wanting to kick off the catheter the whole time—a determined little lady. Do you want to hold her? Won’t that wake her up? I’m sure she’d like to sleep close to her dad for a while. Okay. She fetches a shirt, which she refers to as a nursing smock. Everything has to be sterile, this is all we’ve got, she says. Okay, fine. I take off my T-shirt and put on the soft top, which is open down to the navel. She places Livia across my chest. After a while I call the nurse over, she asks how it’s going. I’m breathing so fast, I say, do you think it might wake her? Oh no, it’s fine, she looks quite happy. Uh-huh, yeah, but isn’t it getting a bit hot? I’m so damned hot. She puts her hand on Livia’s throat. No, she’s sleeping really well. Someone’s looking for you, says the other nurse, gesturing towards the corridor. It’s the anaesthetist from the emergency room. Hello there, hi, he says, just to say Karin’s readings are looking a lot better, she’s back in CIC for dialysis, I thought you’d want to know. Thanks a lot, I answer. He rubs disinfectant gel into his hands and comes closer. He caresses Livia’s back with his finger. Amazing, has she opened her eyes yet? I look at the nurse, who smiles: You’re the father, not me. I don’t think she’s opened her eyes yet, I answer. It’s just the best when they do, he says, and gives me a thumbs up on his way out. The nurses give him slightly smitten gazes: That doesn’t happen every day, doctors from other wards visiting. Or maybe you know him? No, I answer.

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  In Room 1, a bag of Karin’s blood is suspended in the dialysis machine. Blood is pumped out, blood is pumped in. The doctor in charge of it is as grey as the consultant at Söder Hospital, but bony like me and my father. He becomes animated when I ask him about the machine. It removes the waste products from the blood, it’s the same principle as in Laval’s separator, you know, the guy who separated the cream from the milk, he says. Uh-huh, okay, I answer. A nurse from Neonatal has taken a photo of Livia, which she’s already developed and laminated. In the photo, Livia is lying in the open incubator with the oxygen tube. She has her mother’s mouth, the same vermilion colour, the pronounced Cupid’s bow, and under the photo is written in marker pen: Livia 20/3-12. I look for a place to put it. The nurse watches me. Here, she says, reaching towards a console and handing me a roll of surgical tape. She suggests I stick the photo up on a horizontal aluminium beam behind the bed. But then Karin can’t see Livia, I point out. No, I suppose that’s true, what about here? she suggests, pulling out the adjustable bar of the table lamp. The photo ends up taped slightly wonkily above Karin. I sit on the stool and take her wrist in my hand. Hi, darling, I wanted you to know that Livia is well. In the corner of my eye I can see Persson in his light blue hospital issue shirt. It’s good that you’re talking to her, I often recommend that, he says, looking at the photo. Congratulations on your daughter, he adds. Thanks, I answer. Tom, can I talk with you for a moment? Has something happened? Stay calm, this is about you, he answers. His hands are folded across his belly, like a vicar, as he squats down. I’ve been through similar situations, I’ve sat there just as you’re doing now, he says, eyeing me compassionately. Uh-huh, okay, thanks a lot. There are three things you need to remember now, just three things, three important things, he explains and shifts his position, going on in a voice of unrelinquishing gravity: First, sleep, you have to sleep or you won’t be able to sustain this, second, food, you mustn’t forget to eat, or you won’t have the strength, third, get out of the hospital as often as you can or you’ll start going round the bend.

  I run into David outside the elevators to the Neonatal ward. He’s sweaty, puffing, his hands shaking as usual, a sort of congenital nervousness, which in some curious way disappears as soon as he meets people he doesn’t know, after which he becomes self-confident and talkative. He’s brought a teddy bear for Livia, which he takes out of the plastic bag as if it’s some kind of curiosity he found on the way. The nurse puts the teddy on a shelf above the incubator. Thanks, David, that’s really nice, I say. He sits there watching me holding Livia in my arms. He asks the nurse a couple of questions. Then she asks: Do you have any children yourself? A daughter, s
he turned two a couple of weeks ago. Tom is her godfather, he adds. David, sorry, that’s so embarrassing, I say. David laughs and replies: If you were the type who remembered your own birthday, then it might be a problem. He turns to the nurse: Tom’s going to be thirty-four in a couple of days, he’s probably forgotten. Actually, only a few days ago Karin was asking me what present I’d like, I say. David ejects his portion of snuff with his finger and runs his hands over his shaved scalp. When he’s sad or serious he looks like a seal.