A crowd of people filled the room. A person I figured was the mother was wringing her hands, a trail of tears blazing down her cheeks. She and a man I assumed to be the father were standing near the door, holding each other up. His eyes were red and puffy.
Parents know. They know the way we know life is gone as the gurney is rolled through the ambulance doors. Parents know because these angels whisper their last words in their ears and butterfly-kiss them good-bye. The others in the waiting room were sitting or pacing, both fearful and hopeful in their anxiety.
“Hello, I’m Dr. Harper,” I said. “Are you the Tally family?” They all stiffened.
The mother’s eyes were clouded with grief. “Yes,” she whispered.
“Please come with me,” I said.
An older woman among them stood and told everyone but the parents to stay in the waiting room. She was authoritative, an upright and strong presence. I figured she was the grandmother. The husband supported the mother on the right side and the grandmother on the left as they ushered Mom through the waiting room doors and into the front of the ER. The curtains in front of the Resuscitation Room, which was just feet away, had been drawn so they could not yet view the scene.
“Would you like to come with me to the room right over there where we can sit?” I asked.
“No,” the mother whimpered. “Please, please, just tell me now,” she implored.
If she hadn’t been held up on both sides, she would have tumbled to the floor. She began to wail and sway.
“Jessica, please, please let the doctor talk,” her mother said as she stroked her daughter’s hair.
Deb asked again, “Are you sure you all don’t want seats?”
“Nooooooo, teeeelllll meeee!” the mother shrieked as she clutched her chest.
Her mother embraced her and turned toward me. “I’m sorry. It’s okay. You can tell us.”
“I’m very sorr—” I began, but before I could finish the word, the mother fell to the floor.
She had already known, but the words were irrevocable confirmation. The father collapsed as well and lay embracing her on the floor. The grandmother gasped, clasping her left hand over her mouth and holding her right hand to her breast. She stood tall. Her watery eyes held fast.
There was no space between the mother’s cries for me to say anything, no space for words.
I could not share the thoughts that were circling in my mind: There was no space in their grief. I couldn’t tell them, I’m very sorry you lost your angel baby. I’m very sorry he died while you were sleeping and you didn’t get to say good-bye. I’m so sorry that he was already dead when the EMS team arrived and that despite that thirty-five minutes of squeezing his tiny heart and pumping it full of enough drugs to jump-start a car, we couldn’t summon him back to life. I’m sorry I couldn’t intubate your baby. I’m sorry. It’s just that when I propped up his tiny head and inserted the laryngoscope blade, I felt I was hurting him. I’m sorry that the last thing his little corpse experienced was prodding and poking and pressing and tearing. I’m sorry that your beautiful boy is gone. I’m sorry that I can’t tell you why, and I’m sorry I can’t make it hurt any less.
“I’m so sorry. I’m so very sorry,” I said into the space. Everyone else in the front end of the department was silent. The only sound was the parents’ wailing and a distant shuffling in the back of the ER. Then the mother tore back the curtain and ran to her baby, spilling once again to the tile beneath her feet. The father was not far behind, crying and pacing and barely able to support his own weight against gravity.
“How did this happen? Why did this happen? He was perfect! He was perfect! Nothing was wrong! Nothing was wrong,” the mother yelled up to the sky, invisible beyond the hospital ceiling.
The grandmother walked to her side and collected her daughter from the floor.
A call came in at Wendy’s desk: the mother’s obstetrician phoning our department. Wendy answered it and walked over to the mother.
“Mrs. Tally, a Dr. Thomas is on the phone for you. Would you like to take it?”
“Yes, yes,” the woman managed to say, and followed Wendy to the phone. She grabbed the receiver in her right hand, cradling her head in her left hand as she braced herself against the section of the counter encircling the doctors’ and nurses’ station that was in front of Wendy. “Dr. Thomas! I don’t know what happened! I don’t know what happened!” Then she listened for a moment and responded. “I know, I know . . . I know . . .” She dissolved into sobs. “There was nothing wrong the whole nine months . . . I know . . . I know . . .”
The grandmother had just returned from the waiting room, where she had gone to notify the rest of the family. I walked over to her.
“I’m very sorry,” I told her. “Do you have any questions? Is there anything we can do for you?”
“Do you know what happened?” she asked.
“I know that when EMS responded to the nine-one-one call, Christopher was not breathing and his heart was not beating. He was not alive at that time. EMS worked really hard to try to bring him back. They gave him medicine to try to start his heart again and make him breathe, but they were not able to bring him back. When he arrived here his heart was not beating and he was not breathing. He was not alive. We continued these efforts when he arrived, but we were not able to bring him back, either.”
She stood facing me, heartbroken, silent with grief.
“Do you know if he was sick at all? Were there any problems with the pregnancy or delivery or after?” I asked her.
“No. It was tough for them to get pregnant, but when they finally did, everything went well. She was never sick. The delivery went well. They were out of the hospital in two days. The baby had a perfect checkup visit. Everything was perfect.” She stared at me. “How does this happen?” she asked, shaking her head.
I took a breath. “It’s so hard to say. Sometimes it’s an underlying medical problem a baby is born with. It’s nobody’s fault. It’s just one of those things in nature. Other times, we never have any diagnosable reason for why it happens. Again, I am truly sorry.”
“Thank you, thank you,” she said, before lowering her head and walking back over to her daughter.
Dr. Thomas asked to speak to me. I took the phone and, at the request of the family, informed her of what had happened. She told me the story of the difficult conception. She recounted how happy the parents had been to be pregnant. They were such a cute, hardworking couple, she said. She told me she had known the young woman since she was sixteen years old, and now here it was, sixteen years later, and she was delivering her first baby. Everything had gone like clockwork. Her voice cracked as we said our good-byes and acknowledged that it had been a very hard night.
As I ticked the pertinent boxes on the death note and hospital chart, my mind began to wander, but I had to keep redirecting my energy to the work. I sent off an email to the medical director requesting smaller pediatric blades in the event of future neonatal codes, one more discussion point for the next staff meeting. I heard Pam muttering to the tech that I should have been able to intubate the child, that there had been no equipment problem; the issue had been me. The tech responded that it didn’t really make a difference, since there had been no bringing the dead infant back to life. I heard Deb say that we really should have proper pediatric equipment and that Pam shouldn’t be criticizing me so harshly.
I spoke to the medical examiner on call, then notified Organ Donation that this, like any neonatal death, would be a medical examiner case, so not a candidate for organ donation. Ultimately, the family left, and Baby Tally was wrapped snugly in his white blanket and rolled away to the morgue.
One by one, the hours passed.
Finally, my shift ended and I found myself at home as the sun rose. I drank a glass of red wine, chased it with chamomile tea and a Benadryl, and fell into a shallow sleep. Hours
later, I awoke feeling heavy and with one thought: I had failed the baby. It was two hours before night shift number two this week.
I knew that my mother would be off work by now. I picked up the phone to call, to tell her of my failure while I prepared my dinner. I stood over my new yellow soup pot from Williams-Sonoma—the pot was part of my strategy to buy fancy cookware to encourage me to cook, to get on with life. Much like the monthly auto-renew membership to my yoga studio, this strategy, of investing financially in something that would force me to participate in life, always worked. I couldn’t stare at my pricey pots, pans, and high-speed blender without feeling sufficient guilt over not making use of them regularly.
As the soup simmered, I choked on a flood of tears. In that moment, I realized that in all my years of training, I had never really cried. During my residency, when people were brought into the emergency room beaten and stabbed and later died in my arms, I didn’t cry. At family conferences, when I had to inform wives that I’d had to put their husbands on ventilators and had no idea whether those men would ever breathe on their own again, there were no tears.
And when I had been a desperate girl, a child without a childhood, praying to the crescent moon at midnight that my family might survive, that I might survive, I didn’t cry. The pain might have scorched my throat, my eyes might have misted up, but I never truly let myself feel the burn, never lowered the floodgates. My divorce only months before had shattered me in ways I had never imagined, but even then, I hadn’t fully allowed myself the luxury of a stream of tears. There wasn’t time. I had to get through it; I had to push past it to survive and excel. Now here, after graduations, after my divorce, between night shifts, between the cracks in the crumbling stories I had told myself of what my life should look like by now, there was an opening for reflection.
The truth was I had never cared about “marriage.” I was never a girl who thought there was anything special about the title of “wife.” Both its historical roots (women used as property) and the state defining legitimate versus illegitimate love to bolster both the patriarchy and the heteronormativity on which it depends had stained the institution in my eyes. Instead, I valued a spiritual union, which is something that can never be bestowed by anybody besides the two souls in the relationship. Sure, traditional marriage made sense from a business perspective, if the conditions of that business were best served by such a contract.
When I was young, I didn’t dream of being a mother. Most people I knew of chose a partner with the same level of meaningful intention as Ken marrying Barbie, then reproduced reflexively like cattle, so, in my estimation, the mere acts of coupling and multiplying never conferred any singular importance or achievement to neither humans nor the one-celled organisms who can do this too. I figured motherhood would happen for me one day in the future, when I got around to it. It wasn’t something I needed to do, but I took for granted that I would. I suppose I took it for granted in the same way I assumed that I would encounter the partner with whom it would make sense to share my life—settling was not an option.
I stood stirring my soup of the day, a rustic chicken stew with quinoa, chickpeas, and a selection of veggies, allowing rivers of salt to flow down my face. With each turn of the spoon in the pot, I remembered what it was I actually missed: a healthy, soulful connection to another person. And now that the option of having a family seemed to have evaporated, I grieved that I’d lost the chance to do childhood and spiritual marriage right, the way I had never known them for myself.
During our call that day, I told my mother about Baby Tally. I recounted how he had looked like Eli and the baby I didn’t have. I told her that this new city was far lonelier than I had ever imagined possible. But worst of all was that I might never get to raise a child the way a child should be raised, to provide her with the love and shelter she deserved.
My mother responded reflexively the way many mothers feel they have to. She told me that the baby’s death hadn’t been my fault, that none of it was my fault. She ended with a statement as certain as fact that of course I would have the family I wanted one day. She spoke as if time weren’t a factor, as if the future held limitless possibilities for me—whatever I wanted.
But I knew better. I knew that days morph into years, which turn into decades that don’t promise particular outcomes. In the same way, no matter how “perfect,” a soul can take its leave from earth in twelve days or twelve years without so much as a hint.
It’s human nature to want to bind ourselves to the parts of life we hold dear whether those parts are actual people, events, items, or dreams. We want to fasten them to us so they’re safe and near us forever. But this type of binding frays and tears until, even when we fight the awareness, we’re forced to see how illusory the reliance on permanence is. What we have, in all its glory, to hug and hold, to caress and learn, to feel and grow, is simply right here and right now. If we are lucky, the bond holds in the moment—and the experience of it shines and breathes and expands. Then our story can change in an instant, and we may never be given the gift of why.
I didn’t have an answer. Baby Tally’s family didn’t have an answer. We had all been broken in that moment—broken open by shock and grief and anger and fear. I didn’t know how or when, but this opening could lead to healing. After all, only an empty vessel can be filled by grace; but to get there, we had to help each other rise while we shed the same tears. We had to get up and start again.
FOUR
Erik: Violent Behavior Alert
Four a.m. is often a magic hour. In emergency departments all over, chances are there will be a lull in, and respite from, the action at around this time. The main overhead lights of the ER will still be turned down to accommodate patient rest for a couple more hours before the change in shift. It’s a time when the doctor on duty can catch up on paperwork or other tasks, and maybe even steal a moment, as she sits at her desk, to watch the barest beginning of sunrise glistening through the windowpane. She squints as her eyes adjust to daylight and longs for the moment when she can walk out of the hospital inspirited by the light of a brand-new day. And for a couple of hours, she is reminded that she, too, is a diurnal human being.
In several hours, at 7 a.m., before I’m free to get in my car and drive home, I will take my place around a large walnut table with six nurses and two other physicians for the code meeting, where we will review issues regarding any medical resuscitations performed in the hospital. Together we will pore over the long code sheet, finding where the word atropine was written during a patient resuscitation on the telemetry unit last week. “The exact location of this wording is critical to saving lives,” said no one ever who actually saves lives. Nevertheless, after twenty minutes of our discussing the word’s location, I will endure a similarly inconsequential discussion about whether to move the space on the code sheet for “fingerstick glucose.” During a 4 a.m. lull on the night shift, I prepare my thoughts on these matters, thoughts that boil down to one question: Why are we meeting about this?
Tomorrow I will get the notification, the phone call or email that I hope will announce the promotion that will deliver me from being merely an attendee at such meetings to being the chair. Just under two years into the relatively minor administrative positions of director of departmental performance improvement and then ED assistant medical director, I was bored. The hospital had just created a new position for an administrator to oversee quality on a larger scale throughout its operations. It was a job I wanted and knew I would be good at. My ED chair couldn’t promote me any further within the department—the existing directors weren’t going to be leaving or dying anytime soon—and therefore supported me in pursuing the position.
I had assessed there might be more meaning for me, more potential for me to make an impact, when I was in charge of something. I knew that when I prescribed rest, ice, compression, and elevation to a patient with an ankle sprain or explained to a patient with tooth pain that
there wasn’t an abscess or dental emergency, but that it was critical for her to follow up with a dentist for a detailed exam—when I did these things, I knew that these patients could hear me and that there was the potential for something important to be accomplished. I also knew that in no part of my medical training had I dreamed of spending hours contemplating how best to make sure blood cultures were drawn within four hours of a patient’s being admitted to a regular hospital floor with community-acquired pneumonia. Frankly, it felt unfair having to spend so much of my life as a physician ruminating over minutiae that didn’t actually improve people’s lives. There had to be ways for me to climb this administrative ladder meaningfully. I’d find out tomorrow.
Since graduating from my residency a couple of years before, I’d grown increasingly jaded and restless, and was not sure that working at an administrative level in a hospital was even what I wanted to do anymore. Yoga was helping me to cope and clarify. Gym workouts were helping, too, as was expanding my social circle. I had succumbed to peer pressure to join the online dating scene, in an effort to “get back out there”—this, specifically, did not help—but my entry into that world had been hesitant at best. It had nothing to do with fear; for the first time in my life, I was beginning to feel that I had found a certain comfort in my own skin.
The beautiful and unexpected gift of my thirties was that I liked myself no matter the bumps or blemishes, or the raucous laughter that erupted into snorts under the right circumstances, or the smelly farts from the yummy lentil soup I made (so delicious, but I learned to enjoy it sparingly). My aversion to online dating had nothing to do with the vulnerability of putting oneself on exhibition to thousands of strangers. To the contrary, I’d always found it fascinating to share a conversation with someone entirely unknown. I firmly believe that any interaction can be meaningful, even if only a brief exchange. No, I wasn’t afraid of online dating. I just wasn’t sold on its effectiveness. Yes, I was well aware of the compelling arguments of two friends who had met their current husbands online. (The same two friends later told me, independent of each other, that they would get divorced if only they had the energy to be single again, but they preferred to settle for an unhappy marriage as a means to ensure they could have a child before the “advanced maternal age” of thirty-five.) Given that I didn’t need “practice” in dating, the notion of wading through hundreds of online profiles seemed to be merely a way to settle for Mr. I-Guess-I’ll-Give-Up-Give-In-and-Make-It-Work-Somehow in a more time-efficient manner.
The Beauty in Breaking Page 6