Eleven Hours (13 page)

Again Lore sponges herself with a towel Franckline brings from the sink. “Let's get you ready for the next one,” Franckline says. She positions Lore over the pillows and phones the charge desk. “Patient in room 7 may be ready to push. Can someone call Dr. Elspeth-Chang?”

The next contraction comes quickly and lasts longer than a minute, but although the pain seizes Lore and shakes her, this time it does not panic her. The need to push has receded somewhat, and she praises Whomever or Whatever for this deliverance. No one told her that pushing might be so terrible, so rough-pawed and bestial, much worse than the cleaner, sharper pain of the contractions. The child is waiting a bit, has decided to stay with her a bit longer. In her birth plan, Lore gave orders that the baby should be laid on her chest as soon as it emerges and that she wishes to cut the umbilical cord herself. The idea of doing so in fact fills her with unease. The flesh, she imagines, will be tough and resistant under the scissors. She has a terrible image of not being strong enough to cut neatly, of having to twist and gouge to get the thing done.
I am father and mother both to this child
.

She turns her head, rests. Not long ago, Lore might have thought that any child of hers would have not one parent but three: her, Asa, and eccentric Aunt Julia. Julia, who didn't understand children, was afraid of them, and only once, that Lore knows of, ever painted a picture of one. A birth scene, in fact: a squatting woman and the emerging torso of a child. Unusual in that it stood in Julia's studio uncovered, unusual in that Julia did not speak of it bitterly, self-punishingly. She seemed willing to appear almost fond of it. The woman had a flattened appearance and the background was luridly floral with the same harsh greens and reds and purples that Julia and Lore had gazed at in the Expressionist gallery that long-ago evening. The child's face was visible: a nightmare face, blurred and misshapen. Although Lore was afraid that any comment could spur Julia to throw a drop cloth over the easel and clam up, she could not resist saying that the child was awfully unattractive.

Julia shrugged.

“But I like it,” Lore added honestly, meaning the painting. It captured something for her, something about her own mother, maybe—not what her mother might have gone through in labor so much as what she had gone through raising her on her own. Her mother had cared for her, but there must have been times when she'd felt she was being split open by the burden, that she was struggling to expel an ugly, indistinct scream.

“Do you? I'll give it to you.”

Julia had never offered her a painting before. Never again would she. Yes, yes, she would take it, said Lore, thrilled.

Asa protested. He didn't like the painting, he confessed, and he returned to his argument about not having Julia's things in the apartment. Lore badgered him to give it a chance for a week or two. They tried hanging it in the living room, the bathroom, finally the bedroom. Asa held it to the wall yet another time. His eyes met Lore's, and then both of them broke out laughing, laughing so hard that Asa dropped the picture on the floor and Lore had to go get tissues for her eyes: there was no way that this painting could ever hang in their bedroom or for that matter anywhere else that belonged to them. It was simply too disturbing—too
Julia
. Without further discussion, Lore wrapped it in brown paper and stashed it in the hallway closet. When she moved out of the apartment, she spared it, left it resting neatly in its place against the closet wall. Even in her rage she could not damage one of Julia's paintings. Julia's soul resided in them; it would have been worse than a bodily murder.

Would Julia and Asa ever have a child themselves? Just weeks ago Lore would have called it impossible; Julia had neither the desire nor the stability. But nothing is truly impossible; every day makes Lore understand that more clearly. A child can travel down a three-centimeter-wide canal and emerge from an opening even smaller. Lore could one day decide to tell Asa the truth about Soleil, the truth he surely already knows. Not for his sake but for Soleil's. Although …

Franckline's voice rises up behind her. “You're leaking a little blood. I was watching to see if it would stop, but it's been going on for a few minutes. I'd like to get you onto your left side, okay? It improves the oxygen flow to the baby.”

“Why? I mean, what could that be from?” asks Lore, her throat constricting.

“I don't know.” Noises behind Lore, Franckline moving about.

“How much is a little? A little-little? Or more than that?”

“If it continues we're going to want to put an IV in,” Franckline says, as she helps reposition Lore on the bed. Without asking, she is attaching the stretchy bands of the fetal monitor. Franckline's failure to answer Lore's question makes Lore's stomach go washy with anxiety. “Just to keep you hydrated,” Franckline continues, “while we figure out what's going on. It could be broken blood vessels from the pushing. I'm going to get the doctor now.”

Lore wriggles on her side to see if she can detect the blood, but her belly is in the way and she doesn't want to contort herself out of position. She's hot and a little faint. A psychological reaction, she tells herself: don't let your imagination get going. A contraction arrives, too soon, and there is nothing to do but grip the tight bedsheet under her fist. Her finger throbs again. She moans as best she can, surrendering almost gratefully to the pain that will for a minute or two keep her from thinking or worrying. She fights to stay still. Movement, she thinks, could increase the bleeding. In some unspoken prayer she wills the blood to slow.

The resident slips into the room, the same one from this morning, Dr. Merchant (she catches his draft of energy and a glimpse of his fine hair before she sees his face). “Ah, yes, the Department of Education lady,” he says. “Sounds like a little excitement going on here. Let's take a look.” He studies the paper that spits slowly from the monitor printer. Lore thinks he'll make some comment about it, but he doesn't.

He stretches on his gloves, then asks her to part her legs. He stops to lay a hand on her knee. “You must think we're all sadists,” he says.

She clenches her teeth as he goes in—one more moment, one more moment, she repeats to herself, yet the doctor stays and stays. “Your water still hasn't broken,” he says, and Lore feels vaguely reprimanded. The pressure of his fingers fills and then fractures every remaining private space, and she makes loud complaining cries that she knows will make no difference. “Seems normal,” he says, pushing deep one more time, then withdraws. Lore turns her head into her arm, panting. There is a heavy, wet trickling against her thighs. “Good news. You're at eight centimeters. One hundred percent effaced, zero station. You're going to have this baby this evening. I can't say what the bleeding is, but we'll be watching the monitor, and I'll come back in a few minutes. Franckline, start an IV, and let's get some oxygen ready, too.” To Lore: “Don't do any more pushing, okay? You still have a little ways to go.”

Lore begins to ask about the oxygen—is it really necessary? Will they stick a mask over her face? Must they go ahead with the IV? But she doesn't have time to say much, because she feels a new cramping, followed by a pain that doesn't start somewhere like a quiet bass line, but is at its loud, crashing climax almost immediately. She hears herself yelling out. Something seizes inside, and her belly goes hard as rock. Her inner vision dims. Something falls on the floor with a ping, strangely audible amid her own cries (she hears herself as an echo rebounding from some distant, craggy surface). Hands move around her, gripping her shoulder, asking what is hurting, what is wrong? She does not know! She does not know! Oh, God, it does not stop! Her belly is stone. Someone struggles to hold her down.

“It's okay, it's okay,” Franckline says to Lore, who realizes in that moment that it's not okay, that something very bad must be happening. She can't figure out if sound is still coming out of her mouth. Hear me, hear me, please! Things start to happen very quickly: an unfamiliar voice, Dr. Merchant giving orders, a wad of something is pressed to her groin. Her bed detaches from its place, rolls out the door and down the hallway. Footsteps beating alongside. She is aware of a rhythmic pumping between her legs, like the glug-glug of shampoo coming thickly out of a bottle, and then a gush. People are calling out. She can't catch her breath and she thrashes on the moving bed, but Franckline—she is sure it's Franckline—holds one arm firmly and asks her to stay calm, the calmer she can be the better, they need to get her baby out. She'd like to be still but she can't; the pain is in charge, filling her eyes with sparks.

The lights grow brighter and then dimmer again. People talking in some sort of gibberish. Fear, terrible fear, crashes in, worse than the pain, so that she yanks a mental curtain down against it in haste.
I am not afraid
. The light grows brighter than ever, the rolling bed halts abruptly, and Lore would not have believed that there was room inside to feel any more suffering, but now there is an agonizing intrusion, so intimate and so objectionable that her lungs burn with the screams she emits.

The body is not a solid thing but a sac of liquids netted with tendons and bones, of wriggling, dividing cells and traveling electrical pulses. It is prone to leakages and eruptions. It rocks on the tides of hormones. In the early weeks of Lore's pregnancy, a group of cells divided off from the embryo and became the placenta, branched with blood vessels like a great flat leaf. Some error—neuronal or in the genetic coding or due to a harsh bump against the corner of a school desk, who knows—resulted, at thirty-two weeks, in a small piece of the placenta pulling away from the uterine wall. Lore never knew of it; the blood that leaked out was trapped between the rest of the placenta and the wall and did not flow down. As the child grew closer to being born, the placenta sheared away further, but the new blood too continued to be concealed, held in by the great amniotic sac. When Lore's labor became advanced and the baby descended sufficiently in the vaginal canal, some of the trapped blood trickled out of her body. And when Dr. Merchant punctured the sac—it would have been punctured, spontaneously or intentionally, sooner or later—the large pool of blood was suddenly released, and the uterus clenched in a great and pauseless contraction.

Who can be blamed for this? The mother felt no symptoms. The labor nurse checked her and her baby's vitals frequently. Dr. Elspeth-Chang ordered the routine number of ultrasounds—and ultrasounds do not always detect even advanced abruptions. Dr. Merchant followed the protocol of breaking the membranes of a woman whose advanced labor is progressing erratically.

What if there is no one at all to blame?

Lore's veins are dehydrated, hard to locate. Franckline palpates for anything puny, slippery, rolling. She plunges in once and misses. No time left for error. She brings her attention to a fine point, locates a line, and goes in. “Let's move,” says Dr. Merchant, and Franckline hooks up the bag of saline while running alongside the bed.

A young woman wearing a bed jacket, taking a break from the boredom of her labor room, flattens herself against the wall, alarmed, eyes dropping from the shrieking patient to the blood spattering onto the floor.

No scrubbing, just move it, and the catheter has to go in
now
, calls out Dr. Mankowitz, the attending, as they wheel into the ER. Lore's screams when the catheter pierces the urethra will join the collection that appears in Franckline's dreams sometimes, along with the ragged woman's shouts of “Father!” at the cathedral in Port-au-Prince, and the silent spasms of the child who never actually cried, never made one sound of life.

Lore is rigid and fighting as they lift her onto the surgical table. She is powerful in her terror and her rage. The tech tears open Lore's gown and the quick dump of Betadine turns her belly into a spreading orange-yellow stain. The oxygen mask is wrestled over Lore's mouth and soon she is mercifully absent.
We are coming
, Franckline says silently to the baby within.

Dr. Mankowitz tells the anesthesiologist to intubate.

The tech calls out that the baby's heart rate has plunged to 45 beats a minute.
We are coming
, repeats Franckline, to Lore this time. She and the tech put grounding pads under Lore's thighs and tip her gently into position, a pillow under her right side.
That's right, you don't even know we're here. Sleep, sleep
.

“Cut her vertically,” Dr. Mankowitz tells Dr. Merchant. The scalpel goes through the subcutaneous flesh and the fascia and into the peritoneal cavity. How quickly a body can be cut, how easily its innards exposed. Now the uterus. Franckline applies clamps to keep the walls open. The cavity is a sea of blood. She fights a tickle of nausea. Down beneath this blood is a creature, alive or dead, just as inside herself there is this same flesh, fat, fascia, blood, creature. She suctions while the tech sponges. Willfully she narrows her mind to the suction tube, the cavity dimensions, the rapid controlled movement of her tool. Her ears filter out all extraneous noise.

“That's as good as we're going to get,” says Dr. Mankowitz, and Dr. Merchant sloshes into the uterus like someone dropping his hands into a small, extremely dirty sink.

In a moment he has extracted the bluish rag of flesh, its eye sockets filled with blood and its ears tiny teacups of blood, blood thickly painted all along the torso and legs, but they can see that it is a girl. The tech suctions mucus out of the nose and mouth and the child shudders slightly. Imperceptibly, they all lean in: the child is alive; there is time and there is hope. Dr. Mankowitz cuts the great fleshy rope and the child is handed over to a
NICU
nurse, to be carried to the warmer and hooked up to an IV.