Then, in 2010, La Brea Medical Center (a pseudonym), another of the nation’s top teaching hospitals, recruited her to become the chair of its Department of Obstetrics and Gynecology. According to that hospital’s magazine, she was “a nationally renowned expert” in maternal-fetal medicine and a prolific author of peer-reviewed publications.
It was 5:50 a.m. In the eastern sky appeared crepuscular light presaging a gray morning. Was it possible that Dr. Baelish had deferred to an eminent authority? I Googled Dr. James Baelish. Three people with that name were practicing medicine in the United States, but only one was an OB-GYN. Since the late 2000s, this one had been practicing in Springfield, Missouri. Was this him? This doctor had been working at UCLA in the early 2000s, so, yes, this had to be him.
Leaving Google and returning to the databases, I found that Baelish too was an accomplished scholar, although he was not nearly the high flier that Latchesik was. He had published thirty-two articles, all of them in a single academic medical journal. I wanted to learn more about Baelish, so for the next forty minutes I tried different keyword combinations on Google. I was like someone at the slots in a casino, trying to hit a jackpot.
And then I found something. Slate had recently reprinted an article from the mid-1990s in which Dr. Baelish was mentioned. What especially caught my eye was information about where he was working in 1996: he was “the director of the high-risk obstetric unit” at La Brea Medical Center.
The identification of Baelish with La Brea raised a question. Were the positions at this medical school and hospital that Latchesik and Baelish held the same or closely aligned? Moreover, both doctors were perinatologists, and this made me wonder: in California, how big could that field be?
More searching in the databases revealed that in 2007 Latchesik was appointed to the editorial board of the obstetrics and gynecology journal that had published all thirty-two of Dr. Baelish’s articles. She joined the board long after he had published there.
What was I to make of these findings? There was nothing inherently incriminating about the two doctors being leaders in the same subspecialty and having ties to the same journal and to the same hospital and medical school. These discoveries seemed to be more than mere coincidences but less than smoking guns.
At best, these discoveries were meaningful indicators. Neither doctor was laboring in obscurity. Both were wellknown physicians in their field. Both were perinatologists. Dr. Baelish was a respected elder figure, and Dr. Latchesik was a startlingly bright up-and-comer. In all likelihood, Baelish would have spotted Latchesik’s rising star. At the very least, he would have served as a peer reviewer on at least one of her many journal articles, and it is likely that they would have crossed paths at conferences. The chance that the two didn’t know each other was next to nil. In the birth records that Byron had sent him, the names had not been redacted. Dr. Baelish would have seen that the defendant was Dr. Latchesik. He would have recognized the name.
Now I knew what the question was that Ilene and I should have asked back in June 2004, in our last communication with Byron. We should have inquired whether someone had tracked down the per diem nurse in Sacramento. Byron was right: her name appeared nowhere in the birth records. I surmised that no one had gone to the trouble of questioning her. The per diem had disappeared from the documents and notes, if her name had ever been in them. Without her, the legal case could never have gone forward. If my memory was correct, and if the per diem nurse had been deposed, she would have challenged Dr. Latchesik’s claim that bradycardia didn’t start until 3:33 a.m. She would have said that it started at 2:55 a.m.
But there was something that rendered the per diem’s testimony irrelevant. Byron had written, “Dr. Baelish re-reviewed the heart rate tracing, and believes that the heart rate seen on the heart monitor tracing is Ilene’s and not August’s.” Why was he so aggressively shooting down the possibility that the heartbeat might have been August’s? To be cleared of malpractice, Dr. Latchesik needed the heartbeat at 2:55 to be the mother’s. Was that why?
Dr. Baelish’s assertion that the heartbeat was the mother’s ran contrary to what took place forty-nine minutes later. The only empirical way to assess the accuracy of this “expert opinion” would have been to weigh it against the outcome. However, a healthy birth did not take place. The outcome at 3:44 a.m. did not logically match Baelish’s assertion about what was happening at 2:55 a.m. The one did not follow from the other. In fact, the two together formed a non sequitur.
And that’s when the reality hit me. We should never have fired the pit bull attorney Allan Lerch. Byron didn’t notice the non sequitur. Or, more likely, he didn’t spend enough time thinking about it. The most charitable construction one could put upon Dr. Baelish’s reading of the data was that it was exceedingly conservative. The feminist literary scholar Sandra Gilbert, who successfully litigated her husband’s wrongful death at the UC Davis Medical Center, relates a remarkably similar situation in her 1997 book Wrongful Death. In it she reports her attorney telling her, “Our guy [the outside medical expert that the attorney himself had hired] . . . is being very conservative. . . . Haven’t I told you all along? These guys don’t like to testify against each other, they’re very very careful about what they say, what they’re willing to say.” Byron, though, didn’t have the courtesy to tell us that much, if he even thought of it. He made no effort whatsoever to contextualize Baelish’s reading of the evidence. He just accepted it at face value. And once Baelish had thrown cold water on August’s case, thus making a settlement seem less likely, Byron unceremoniously dumped us. No point remained in deposing the per diem nurse in Sacramento. Even if she verified that Dr. Atropski had discussed a low heart rate at 2:55 a.m. with the nurses, Baelish had already rendered the issue moot.
I learned two lessons from this sixteen-year odyssey that started in 1999. I found out that it is a lot harder to sue for medical malpractice than people think. And I discovered that, while science may serve humankind, humans can corrupt science.
One day Ilene came home from her physical therapy practice, the one she had come to own, and told me that she had had an interesting conversation with one of her patients, Dr. Hermes. An anesthesiologist in his early sixties, he was a physician who often served on obstetric cases at a local hospital.
During the session the conversation turned to August’s birth, and, at his behest, she told him the story. When she finished, he remained silent for a moment, and then he said, “I can’t say for certain what happened. But this sounds like a classic case of an obstructed labor.” He went on to explain: “This is also known as labor dystocia, and it occurs because the baby can’t exit the pelvis during childbirth due to being blocked. This happens even if the uterus is contracting normally.”
“I had a lot of pain in my pelvic area despite the epidural,” Ilene said.
“His head might have been hitting against the pelvic bone,” Dr. Hermes went on. “It’d be like ramming your head into a door, slowly but repeatedly. Like this,” he said, and he slammed his fist into his palm, then paused, then slammed it again, and again paused. Bam! Pause. Bam! Pause. Bam! Pause. Bam!
Stories of medical errors are easy to dismiss, but a close family member of his had recently experienced a serious one, so he was open to the idea. And then he said something that was unprecedented, for us at least: “Someone should have noticed,” he told Ilene, “that the labor wasn’t progressing and ordered a C-section. I am truly sorry that August received such poor care. That shouldn’t have happened.”
“Then a medical error isn’t just a figment of our imaginations?”
He chuckled quietly, shook his head, and said, “Is that what they wanted you to believe? Listen, here’s what probably happened. It’s not complicated. August experienced fetal distress during the delivery, and maybe he was experiencing it in the days leading up to the delivery. But whenever it started, it wasn’t detected, and as a result he suffered severe brain injury and cerebral palsy. And that’s why he
had the life he did.”
The answer to a riddle seems so obvious once it is revealed. After Ilene came home and related Dr. Hermes’s opinion on the matter, three words formed a permanent rhyme in my mind. The rhyme summed up the story of August’s life:
dys-toc-i-a,
dys-ton-i-a,
dys-top-i-a.
AFTERWORD
I AM IN AUGUST’S OLD ROOM, NOW MY MAN CAVE. It is 6:40 a.m. on Thursday, March 5, and it is sixty degrees Fahrenheit outside. It is a gloriously tranquil time in our backyard garden, which appears through one of this room’s two windows, the south-facing one. Peering through it I have a close-to-the-earth perspective. The garden is lit by the pale light of predawn. To see it, I have to peer around the large desktop computer monitor. In May 2014, four young and energetic landscapers arrived one morning to install this memorial garden, a bereavement gift, which I call Parvaneh, from the Persian word for butterfly. A landscape architect designed it. The four men scraped away what remained of a scraggily lawn and populated the space with porterweed, milkweed, penta, and trailing rosemary. In the center they placed a dwarf Persian lime tree. Then they laid down a thick bed of pine-straw mulch a richer and redder brown than the sandy soil beneath.
Already in place in this backyard were three trees—an oak, a maple, and a birch. During the late morning and early afternoon hours they provide shade, but through their spotty foliage enough light glimmers to keep this nursery happy. The landscape architect selected plants likely to attract butterflies, and, as intended, the Monarchs have found their way. In the midst of the lush foliage their wings quiver. From time to time they alight on the dwarf Persian lime, the heart of the bower. On a typical day at noon, its little green leaves and balls of fruit glint in the intense light. Mixed among the tree’s roots are some of August’s ashes.
This morning I awakened prematurely from a dream in which I vividly saw him. In it he was laughing, the laugh of Medusa. A line from Our Song, “Losing My Religion,” comes back: “I thought that I heard you laughing, but that was just a dream.” With the dawn’s first glow I had climbed out of bed—quietly so as not to awaken Ilene—and padded through the house to the little elfin grot, where I sat at my desk and uttered my aubade: “Wakee, wakee.” But I understood all too well that he never would. Outside, the predawn radiance unveiled the bird-filled world, and through the east-facing window the neighbors’ oaks silhouetted the lilac sky. After another ten minutes or so I heard Clio, the coffee muse, grinding beans.
Clio has big brown eyes, and these days she wears a T-shirt that says “Merde.” She has her own mind. Yesterday she said to me, “I’m going to be a better person than you.” When she was fifteen, I texted her saying that I was looking for a song on iTunes by Michael Kiwanuka called “Love and Hate” but couldn’t find it. She replied that I was being old-fashioned. “No one buys music on iTunes anymore.” She is a ballet dancer. Ballet mingles the exquisite with the excruciating, beauty with pain. The attitude derrière and the other contortions of her dance express a willed and graceful dystonia. It is as if she were taking August’s grotesque posture and transfiguring it into art.
Today is August’s birthday, and I feel a little sadder than usual. Sometimes the past catches up with me. I fall through a trap door into the events of long ago when August was alive, and these moments are painful. I can barely breathe, and I tear up. I don’t have a precise word for describing this feeling more stabbing than nostalgia.
The birth records long ago fizzled into a remainder, a leftover assortment of stale facts that didn’t make any difference because they couldn’t give us our son back. Emily Dickinson writes, “But are not all facts dreams as soon as we put them behind us?” Where is the empirical truth now? Where has the scientific evidence gone? Men supposedly want to fix things, but what was I supposed to fix? My son was broken far beyond my power to repair. In no way could I go back in time, make things right, and save our boy. Life on earth had continued to run its course. For a time it carried August in its flow, but then one day it started to run on without him.
Solving the mystery—of what happened at his birth—has become irrelevant. Who cares now who made what mistake? I started out in anger, wanting to burn down the house of medicine, but I have arrived at an unexpected place. To everything there is a season, and that means it is time to forgive, as I myself would want to be forgiven. Who among us doesn’t go into the courtroom of life demanding justice, only to find himself humbled and pleading for mercy?
What do Ilene and I have now? Throughout our house we have scuff marks and indentations on walls and doorframes. Some are deep dents. Each of these is approximately ten inches above the floor. They are the vestiges of where, as we rolled August through the house, his wheelchair’s foot pedals banged. And we have August’s sonogram. It resembles an old-time Polaroid snapshot. In the center, a fuzzy black-and-white image appears, a westward-moving hurricane just formed off the coast of Africa. And we have Clio and the illumination she brings. She is a wild orange lily in an Appalachian meadow.
And by far the strangest surprise of the entire adventure, I can no longer accurately call myself an atheist. I don’t know what I am exactly. I have moved a long way away from the purely rationalist, materialist, and secular worldview I once held. But into what have I turned? Because of August, I became the least likely of pilgrims. I am still uncomfortable with the word grace, but August changed everything. For a moment, the doors of perception were cleansed.
If I could see God in August, I should be able to see God in others, even in his doctors. God is something that we humans can bring into the world. God exists in the relations between all of us. Whenever asked these days, I tick the box for agnostic—I have become comfortable with merely asking questions. While not categorizing myself as a believer, I do accept that the spirit dwells within me and in everyone I meet.
I was fortunate to have fallen in love with August. I was extraordinarily lucky that lightning struck. I didn’t feel, or ever feel for long, that taking care of him was pointless. Loving him wasn’t automatic, and it doesn’t necessarily happen for other parents of significantly impaired children. If parents want to avoid going through what Ilene and I experienced, the slowly unfolding logic of the Enlightenment has already made it possible for them to do so. The rational solutions of the brave new world can spare parents from having to care for a child such as August.
Knowing what I know now, I would not avail myself of these solutions, not for all the world. There were a few times, as I described, that I experienced the sensation while looking into August’s eyes that I was staring into the face of God. The spirit was within him, and my glimpsing it there served as premonition of recognizing it in myself. At the time of his birth I didn’t know that he would develop into a beguiling little fellow, that he would elicit great love from us and from many other people, or that like a Yaqui shaman he would introduce me to a separate reality. And I didn’t know that this separate reality was actually the world of my own heart, my capacity to give and receive love.
Coffee fumes waft in through the crack at the bottom of the closed door. Today there’s a cerulean sky. Out the room’s south window the top branches of the tall, skinny pine tree in the Jones’s backyard catch flame in the sun’s opening beams. Within moments the treetops of the entire neighborhood alight with fire. Laughing Orange explodes everywhere. How grateful I am for this light! At last the long solar eclipse is over. The sun shoots a brief horizontal ray through the room’s east window. The analog clock on my desk says that it is 6:55 a.m. On the wall to my right lands a golden patch of sunlight, a drop of illumination about the size of a quarter. Windmill-wings blue surrounds this spot of Laughing Orange—the laugh of Medusa. But I still find myself in a quandary: in which of the two colors does the truth lie?
Through the south window I survey Parvaneh. Let us cultivate our garden. But oh, what birds are these? Robins? But why should I ask. They have been here all along. I look out the other window. In
the east, the sky gleams like the burnished gold leaf of a medieval panel painting. Aurora. Hail, holy light, the eternal, coeternal beam! Through the filigree of oaks and moss shines a new blazing world. Looking into the heart of light, the silence—my eyes need a moment to adjust. August’s story is a circular book, one whose ending folds back around to the first page, where I begin it over again. The end is where I start. He and I travel together. We’re a couple of rich men now. Despite knowing each mile of this journey, I embrace it. Incipit vita nova.
ACKNOWLEDGMENTS
I WOULD LIKE TO EXPRESS MY GRATITUDE TO THE many people who helped me write this book. Among them are the brave souls who soldiered through early manuscript versions and gave me emotional support and constructive feedback. This list includes Rachel Adams, Mary Baron, Michael Bérubé, Elea Carey, Cristina Case, Jim Cassidy, Terry Castle, Ilene Chazan, Miriam Chirico, Lennard Davis, Helen Deutsch, Elizabeth Donaldson, Hollie Donaldson, Christine Cipperly Dunden, George Estreich, Sandra Gilbert, Monica Gold, Molly Hand, Nina Handler, Pam Hansen, Maureen Harkin, Orin Heidelberg, Kayla Hilliar, Sujata Inyengar, Marjorie Khosrovi, Tim Ledwith, Leza Lowitz, Andrea Lunsford, Sally Coghlan McDonald, Elizabeth McKenzie, Emily Michael, Carolyn Kresse Murray, Betsy Nies, Mike Northen, Mark Osteen, Karen Poremski, Julia Miele Rodas, Ralph James Savarese, Carol Schilling, Christy Shake, Joan Venticinque, Beverly Voloshin, Kate Washington, Jillian Weise, Mike Wiley, and Mark Woods. My sincere apologies to anyone I have left out.
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