by C. P. Boyko
They arrived at the hospital the next morning at seven; by nine Rachel had been officially admitted to the maternity ward. Burris told several people about their appointment with Doctor Leahy, and was finally informed that the doctor would not be in till the afternoon. “Not that there will be much for him to see by then!” —“But, you know, he has scheduled us for an induction.” —“Yes, the midwife will be by at 11:30. But then the drugs usually take several hours to have any effect. Don’t worry! We know where to find Doctor Leahy if we need him.”
Because the prenatal ward was full, Rachel was given a bed in the large communal postnatal ward. The other beds were occupied by wan, disheveled women, some of whom cradled or breastfed newborns. Several had visitors, who spoke in murmurs. The room was not cheery. The bisque- and daffodil-colored walls were peeling; the garish overhead lights buzzed; a television news program that no one was watching contended with piped music that no one was listening to. But Rachel and Burris did not admit their disappointment, afraid to give dismay a foothold so early. They settled down, sighing and smiling bravely, as though to a meager picnic.
While waiting for the midwife, Burris moved the car from the short-term to the long-term parking lot.
At 10:30 a nurse came to take a blood sample. Burris said, “We took care of all that when we were last here.”
—The nurse shrugged. “I guess these are different tests.”
—Burris asked what tests they were. The nurse named some of them; they sounded familiar. “Those are the same tests.” —“Well, I guess we’re doing them again, just to be safe!”
—Rachel put her hand on Burris’s arm.
At 12:30, while Burris went in search of food, the midwife arrived with the pessary. She was affable and gentle, but the way she teased Rachel about the tightness of her cervix made her feel guilty, as if she were wasting the staff’s time. She wondered too how many more people whose names she did not know would put their hands in her vagina by the end of the day.
The midwife then attached an elastic belt to Rachel’s abdomen, and connected it by cables to a printer, which began to slowly produce a paper record of the baby’s heartbeat. The midwife watched it for a couple of minutes, then turned it off. “All systems go,” she smiled. “Now, we shouldn’t expect much change for twelve hours or so.” —“Right,” said Rachel, dissembling her surprise. —“So make yourself comfortable. Read a book, go for a walk, get a bite to eat. I’ll be back to check on you regularly, but do press that call button if you feel the contractions starting.”
Burris returned with juice and sandwiches. Rachel felt uncomfortable eating in bed, and suggested they go for a walk. —“What about the midwife?” —“Oh, she came and went. She said it was all right. Nothing’s supposed to happen for twelve hours yet.” —Burris looked at her suspiciously. —“I think that’s normal,” she said. —He gestured at the monitoring belt. “What about that thing?” —“It’s not turned on. I guess I could take it off for a while . . .” —Burris looked doubtful. —They stayed where they were. When Rachel needed to use the bathroom, she plugged herself back in to the dormant machine on her return.
Time passed. Burris and Rachel watched the doctors, nurses, orderlies, and midwives dash to and fro, talking mostly to one another and giving most of their attention to their patients’ charts. One young resident, like a border guard scrutinizing a passport, looked from Rachel’s chart to Rachel and back again, then walked out shaking his head. She did not see the midwife who had inserted her pessary again.
Burris bought a newspaper, and together they attempted the crossword, lingering over the most difficult clues, in no hurry to finish. Rachel, tethered to the monitor, sat or crouched in various positions on and beside the bed; every position was uncomfortable, but lying on her back was intolerable. Burris, believing pain a sign of progress, urged her to remain supine as much as possible.
The woman in the next bed awoke, and gazed at Rachel with groggy tenderness. “First time?” she asked. —Rachel nodded. —“Don’t worry about a thing. It’s much easier than they tell you. When the time comes, you’ll know what to do. Take me, for instance.” And in the same tranquil, reassuring tone, she told them a phantasmagoric tale of pain, blood, danger, and fear, whose moral seemed to be that whatever happened, it was all for the best. —“And your baby . . . ?”
—The woman made a dismissive gesture. “Eight pounds seven ounces. She’s with her daddy and grandma. They’re around here somewhere. She’s fine.” Then she became earnest, and offered advice. “Screaming helps; don’t feel bad about screaming. Also, you have a lot more blood in you than you might think. And whatever happens, don’t let anybody talk you out of an epidural. I don’t know what I would have done without mine.” She laughed reminiscently. “I really thought I was going out of my head for a while there.” —Rachel expressed her regret that she was allergic to painkillers. —“Oh. Well.” The woman’s eyes lost their focus. “Anyway, you’ll be okay.”
At six o’clock, a midwife turned on the fetal monitor for a few minutes, made a sour face, and asked Burris if Rachel would be wanting an epidural before the anesthetist went home for the night. —“No. She is allergic.” —“Because I would get one now, if I were her. She might not be able to get it done when the contractions start in the middle of the night, when we’re short-staffed.” —“I understand that, but she has an allergy to pain-relieving drugs. It’s on her chart. See?” —The midwife seemed offended. “I was just asking. It’s her decision. It’s all the same to me.”
Leahy visited briefly, evidently on his way somewhere else. He did not examine Rachel, but congratulated her on her progress and promised to start her on a synthetic oxytocin IV drip first thing in the morning. “It’s too late today. Get some rest if you can, and have happy dreams of that cervix opening.” He shook Burris’s hand and was gone. Nevertheless, they both felt reassured.
At eight o’clock, the hormone began to take effect. Without warning, she was racked by a wave of pain that began in her lower back and reverberated up her torso before slowly draining away. It felt as if her spine were vomiting, as if her vital force were shaking itself free of her body. “Good, good,” said Burris, and set the timer on his wristwatch before pressing the call button. —“What’s the matter, sweetie?” asked the nurse. —“The contractions are starting.” —A midwife they had not seen before was called to examine her cervix. “Well, you’re effaced, but not dilated at all yet.” She explained, with a wink, “Still a long way to go. Now, can I get you something for the pain?”
At 8:45, the television was turned off, and Burris and the other visitors were informed that they must leave. He was astounded. “I was told I could stay with her the entire time.” —“Yes, in the delivery room, or on the prenatal ward, but not here. These women have just given birth; they need their rest and their privacy.” —He asked if there was nowhere in the hospital he could spend the night. —“There’s plenty of public areas, but you won’t find them very comfortable. You might as well go home and sleep. You won’t be allowed back in here till morning, even if anything does happen.” —Swallowing his anger, he spoke to the nurse at the desk, who promised to call him if Rachel was moved to a delivery room during the night. He thanked her and went home—where he dozed fitfully on the couch, harassed by nightmares of traffic jams and full parking lots.
At ten o’clock, the piped music was extinguished and the overhead lights were fractionally dimmed. All around Rachel, machines hummed and beeped, babies gasped and cried, and new mothers sought relief from soreness in creaking beds, while hospital staff bustled back and forth in the hallway, and from farther away came the sounds of alarms, rattling carts, and the mewling and groaning of a woman in childbirth. Rachel could not sleep. In between contractions, she paced the perimeter of her bed or nibbled on the food that Burris had left behind. “I wouldn’t do that,” said her neighbor in the next bed. “If they have to sedate you for an operati
on, you might throw up and choke on your own vomit.” —Rachel reminded her that she was allergic to painkillers. —“Still.”
When Burris returned in the morning, nothing seemed to have changed, except that his wife looked more haggard. He massaged her feet and helped her remove the monitoring belt until it was needed again. He asked at the desk if Rachel could join him for breakfast in the cafeteria. The nurse was appalled. “Certainly not. She’s scheduled for an IV insertion at ten o’clock.” —He pointed out that this was an hour away. —The nurse made self-absolving gestures. “If you want to risk missing your wife’s induction, and maybe having to wait till Monday morning, please be my guest.” —He went alone to the cafeteria, and brought back sausages and eggs. Rachel, mindful of her neighbor’s censure, said she wasn’t hungry; and indeed, whenever the contractions came or she rolled absentmindedly onto her back, food was far from her mind.
At ten o’clock a young resident, who introduced herself as Doctor Fulhill, gave the curtain around Rachel’s bed a symbolic tug, then examined her cervix. Her expression clouded over. “Where is this woman’s pessary?” —No one knew. The resident examined her again, more roughly, then invited first a nurse, then a midwife to try. —“It’s not there anymore,” they agreed. —“Did you take it out?” —Rachel shook her head. —“You sure?” —She nodded. —They all searched the bedclothes and the floor, but the pessary was not to be found. Doctor Fulhill’s irritation, which Rachel imagined directed at her, made her feel like a child. Too late, the doctor tried to console her. “No matter. These things happen. I was only going to take it out anyway. We’ll get your IV started now, and things should get moving again.” —The nurse, imagining that the doctor’s irritation was directed at her, chided Rachel for removing the monitoring belt, and told her that once the IV was in place, she would need to stay put—“So we can keep a close watch on baby’s heartbeat.” —“What about going to the bathroom?,” Burris asked. —“Oh, we’ll put a catheter up her for that.”
Rachel lay still and silent on her back, listening to Burris’s voice murmur soothingly, while these things were done.
By noon the contractions were stronger and coming more frequently; she had to remind herself to breathe when they were at their height. She would have liked to moan or bellow, but was conscious of the other women and their families. She promised herself that she would holler her head off when she was moved to the delivery room. That time, however, still seemed ages away. Every hour now her monitor was turned on and the interval between her contractions measured (these measurements deviated somewhat from Burris’s, for Rachel did not always tell him, and could not always distinguish, when one contraction ended and another began). The midwives wanted to see peaks every two or three minutes; but Rachel’s contractions were still irregular, and sometimes ninety seconds, sometimes ten minutes apart. So, every hour, they increased the percentage of hormone in her IV drip.
At three o’clock, Leahy came by to wish them luck; he was leaving town for the weekend. They were both flabbergasted. Burris managed to stammer some words of protest. —“Don’t worry,” said Leahy. “I’m leaving you in the very capable hands of Doctor Paschava. I believe you met him at the clinic?”
—They had not. —“Well, that’s the way of childbirth. You never know just when it’ll happen, and we can’t be everywhere at once. That’s why OBs, like birds of a feather, flock together.” Before leaving, he asked Rachel if she would like an epidural. “Sometimes it helps speed things up.”
Burris almost sobbed. Collecting himself, he took Doctor Leahy aside. “We discussed this the very first day we met: my wife is allergic to painkillers.” —“Oh,” said Leahy, “I doubt that very much. Tell me, do you use opiates much in your practice, doctor? Then you know that they can cause itchiness and nausea, certainly, but never a full-blown immunological allergic reaction. After all, there are opioids produced endogenously in the brain.” —All Burris could do was splutter; he did not understand why Leahy had waited till now to tell him this. —“What precisely is it that she’s supposedly allergic to?” —Burris told Leahy what Rachel had told him: that she had once vomited after inhaling nitrous oxide. —“Also not an allergic response,” said Leahy. “And besides, N2O has nothing to do with opiates.” He gave a conciliatory smile. “If it makes you feel better, I’ll put a note here on her chart that she’s not to be given air and gas. And we’ll start her out on a small bolus of morphine to see how she likes it. All right?” He showed Burris the amended chart: Allergic to pain relief (nitrous oxide only). “All right?” —His mind in turmoil, Burris capitulated.
Holding his wife’s hand, he watched her closely while a nurse injected the morphine into her IV line. Her brow smoothed, and her eyes softened. Nothing else.
He felt like a fool and a failure. All this time, he could have spared her much pain.
Rachel said, “I feel a little better all of a sudden. I must be getting my second wind.” —“Excellent, darling. That’s excellent.”
In the late afternoon, a doctor, evidently not Paschava, because a woman, arrived to perform an artificial rupture of the membranes. —“An artificial what?” said Burris, standing in her way. —“An amniotomy. We want to break her waters. Often it helps the labor along.” She showed him a thin plastic utensil like a crochet hook. “We put a little tear in the amniotic sac with this guy, and the amniotic fluid comes out, which sends the signal to the uterus to really start squeezing.”
Burris said, “Shouldn’t she have an epidural first?”
Rachel was too exhausted to object. The morphine had worn off and her back was in constant pain, which even the contractions could scarcely augment. Her hands trembled, her eyelids fluttered, and tiny muscles in her face twitched. When she closed her eyes, grains of fatigue exploded in her skull, and the fragmented hubbub of dreams crowded in upon her thoughts. She only intermittently remembered that she was giving birth; most of the time, she thought she was sick and dying. She wished that the doctors would hurry up and cure her or put her out of her misery. Perhaps the epidural would do one or the other.
“This shouldn’t hurt,” said the doctor, “but I can send the anesthetist over as soon as I’m done here.” —“All right,” said Burris. “Thank you.” —“Thank you,” echoed Rachel.
A midwife changed her catheter bag, then helped her lie down. Her arms were strapped to perpendicular armrests, the foot of the bed was lowered, and her legs were spread and lifted into stirrups. A bolt of pain, as though from a bastinado, shot up her spine from her sacrum; she gripped the armrests and clenched her face and neck to keep from screaming.
“May I . . . ?” said Burris, gesturing at the curtain. —“Of course,” said the doctor, who had already begun the procedure. —He drew the curtain, and found himself on the other side of it, grinning fatuously at the neighbor’s infant. “What an adorable little nipper.” He went to the nursing station for more ice chips, which was all that Rachel had been permitted to eat since that morning.
When the doctor had finished, she gave Rachel’s arm an exhortative squeeze. “Now you’ve really got to get cracking, love. Without the amniotic fluid, the baby’s at an increased risk of infection. So I want to see you push that little one out in let’s say under twelve hours—or else we might have to resort to a C-section, which would be a shame after all the hard work you’ve done.” —This ostensible pep talk had on Rachel a decidedly astringent effect. She feared a C-section, but did not know how she could labor any faster. She succumbed to a moment of self-pity, tears streaming down her cheeks. Why could no one help her?
By nine o’clock, the end of visiting hours, the anesthetist still had not appeared. Burris refused to leave, demanding instead that Rachel be moved to a delivery room. A nurse referred him to a midwife, who referred him to a doctor, who examined Rachel and referred him back to the midwife. The midwife shrugged. “She’s only five centimeters dilated, so it’s a bit early. But the room is
available now. I really don’t care.”
A gurney was fetched, but Rachel asked if she could walk. The midwife, who had other patients in more advanced stages of labor, suppressed her impatience. “Of course, dear. It might even be helpful. Let gravity do some of the work, you know.” The monitor belt was removed, and Burris and the midwife helped her to her feet, out of the damp, stained bed that she had occupied, with only brief breaks, for thirty-six hours. She shuffled down three long corridors, the midwife supporting her, Burris rolling her IV pole, amniotic fluid trickling down her thighs, but the pressure on her spine so reduced that she felt almost revitalized.
The delivery room was not entirely private; it was shared by another woman, separated from Rachel by a collapsible screen. She emitted deep, lowing moans, as of perpetually renewed revulsion. Rachel at last felt free to let loose a grunt or two herself; but whenever she did, the groans on the other side of the screen faltered and paused.
Shortly before midnight the anesthetist burst in, looking as harried as a fugitive run to earth. He had just come from the operating room, where his patient had suddenly and unaccountably expired. Though her death had not been his fault, his colleagues’ sullenness had left him feeling implicated, and he had taken refuge in a stance of defiant disgust. He looked at Rachel’s chart and said, “Where’s your scalp electrode?” —“I don’t know.” —He turned to Burris. “Why hasn’t she had a scalp electrode inserted? Jesus.” He walked out before Burris could reply. He returned fifteen minutes later, and explained that he could not administer the epidural without a fetal monitor in place, and that, since Rachel’s amniotic sac had been ruptured, it might as well be the more reliable scalp monitor. Burris started to apologize, but the anesthetist made an interruptive gesture. “Forget it. I’ll be back in an hour, if you care.”
Burris, gritting his teeth, went to inform the midwife that, according to the anesthetist, his wife needed a fetal scalp monitor before she could be given an epidural. —“Oh, fiddlesticks. He’s just being difficult.” Nevertheless, she agreed to placate him, and inserted the electrode herself two hours later. After studying the printout, she congratulated Rachel on her progress. —“How far dilated am I?” —“Nearly six centimeters!” Seeing Rachel’s disappointment, she added, “But your contractions are getting a lot closer.”