My turn.
“Ms. Ryuan,” Katz says. “I’m telling every employee that it’s very important that there be no communication with the press about the absent patient.”
I can’t resist. “You mean the missing baby or are you referring to the ‘absent patient’ that somebody kidnapped?”
“Do not try to corral me into an angry, sarcastic discussion, Ms. Ryuan, and in the future, I’d ask you to leave your bad attitude in the parking lot. Whatever the circumstances,” he says, his eyes filled with the irritation that always shows up during our very rare encounters. “Discretion is very important while the police investigate the absence.”
Again, I can’t resist. But this time I’m serious. So serious that I ignore my buzzing cell phone. “I’m no expert, Dr. Katz, but I’d think the more information that’s out there, names and photos and facts, then the better the chances of somebody who knows something coming forward and helping us find—”
“Thank you for your thoughts, Ms. Ryuan, but as I just said, there’s no need for a discussion. Right now everything is in the very capable hands of—”
“Lucy!” I hear someone shout. Then almost immediately again, even louder, “Lucy!”
Within seconds Tracy Anne Cavanaugh is standing next to me. Young and blond and almost too perfectly pretty, Tracy Anne completely ignores Katz.
“I’ve been trying to reach you. I’ve been calling and calling. Val is ready to go. And Troy is with her. But there’s a problem, a real problem, with Val.”
Great. Now my problem is that Val has a problem.
Tracy Anne and I take off. If we had left a cloud of dust, Barrett Katz would be covered with it.
CHAPTER 4
“WHAT THE HELL IS this?” I shout as Tracy Anne and I rush into Valerina Gomez’s birthing room. I am truly struck by the horror of what I see before me. Val has been shackled with wrist and ankle restraints. She looks like a woman forced into admission at a mental hospital during Victorian times. Val is screaming, sweating, struggling. Her wrists and ankles are red from the shackles. Her hospital gown is way up above her breasts.
I look at Troy Jackson. He’s a strong, hefty African American guy, and both my assistant and one of the best midwives I’ve ever worked with. He’s efficient, organized, and kind, and he can be as tough as a large pit bull when he decides to.
“How the hell could you let them do this, Troy?” I yell at him.
The tone of his voice matches the anger in mine. “You think I let this happen? Don’t you think I did everything but punch them to prevent it? And by ‘them’ I mean that nurse over there. She said if we didn’t restrain the patient, she’d call Security. You sure as hell didn’t think this was my idea, didja?”
Troy is pointing at floor supervisor Nurse Deborah Franklin.
“Get her undone. Get my patient undone,” I yell. “Hurry up. Jesus, leave someone alone with general hospital staff and this is what happens.”
Troy and Tracy Anne begin removing Val’s restraints. They know the nurse isn’t going to mess with me.
Val is yelling with delivery pain. I take two giant steps toward Deborah Franklin, who stands with her arms folded.
“What the hell were you thinking?” I say to her. I practically spit the question out.
“I ordered the restraints as a precaution,” Franklin says.
“GUH staff should not be anywhere near midwife services unless they are requested. What are you even doing in here? Get out. Just get the hell out,” I yell.
Franklin doesn’t move. I could continue my battle with Franklin or I could shut up and work with my patient. That’s an easy decision for me. If the decision is easy, the execution takes a lot of willpower on my part. Okay, get strong, Lucy. Be the best there is. From this moment on my concern is completely aimed at Val.
“Let’s relax, Val. Let’s just relax,” I say. I take Val’s hand. She’s shaking, not quite uncontrollably but way more than a woman in labor should be. Tracy Anne dabs at Val’s face with a damp lavender-scented cloth. Lavender is about as hippie as we get at GUH Midwifery.
Then, through barely clenched teeth, Troy speaks to me softly, “Lucy, I did everything to stop Franklin.”
“I’m sure you did, Troy,” I say. And I mean it. “Let’s stay focused now. This is going to be tough, and we are off to a very bad start.”
Tracy Anne pulls up a screenshot of Val’s most recent sonogram on the bedside PC. Nothing new. Twins. The second baby is in complete breech position. That means the feet want to come out first, and the head wants to come out last. We knew this for the past two months. There was not much we could do except fight off anyone who said we should perform a C-section. But any discussion and planning are in the past. Now the difficult circumstances are nonnegotiable. Now we’ve got to deal with them in real time. First things first: I need to have a very intense discussion with the very screwed-up mother-to-be.
Tracy Anne is helping Val with her breathing and her counting. The tremors from Val’s hands have spread to her arms and shoulders. She is shaking even worse than before. All the lavender cloths in the world are not going to absorb the perspiration that’s streaming out of her.
I hear Deborah Franklin say, “Now perhaps you can see why I ordered restraints. Your patient is going through withdrawal. She should be delivering under general anesthesia. I’m going to call OB for help.”
“You call OB, lady, and you better call orthopedics, too. You’re gonna have some broken bones to tend to,” Troy says.
“Ditto,” I say.
Honestly, I don’t think Nurse Franklin is frightened of me. But Troy, one of the nicest, gentlest people I know, can look absolutely terrifying, weighing in at just under 300 pounds, and with steely eyes that look as if they could flash fire if he wanted them to blaze.
“You people are living in another world,” says Franklin. She can rant all she wants. All I know is that she’s not moving to call OB. And I wouldn’t put it past Troy to try to stop her physically.
From here on in, I just ignore Franklin. I kneel on the delivery bed and hold down Val’s shoulders.
“Listen,” I say firmly but not unkindly to Val. “Like it or not, you’re about to have two babies right now. It’s going to be tough.”
Val screams.
Okay. Yelling back at this frail mother will get me nowhere. I move into soft gear.
“Just stay calm. Concentrate. Just do what I say. We’re in this together. I’ll do my job. And you do yours.”
CHAPTER 5
PUSHING. SCREAMING. HOWLING. “EVERYTHING’S looking good with the first baby,” I say to Troy. “But once we start with the second one, we’re gonna need—”
Troy finishes my sentence, “I know … an on-call doc in case we need a C-section with the breech. I already notified OB surgery. Thought I’d best get them ready rather than count on that crazy-ball Nurse Franklin.”
“Good man,” I say.
Deborah Franklin, who has yet to leave the room, says, “C-section, huh? I thought you guys never did those.”
“We hate ’em, but we hate dead babies even more,” Troy says.
Then I speak. “And now, once and for all, Deborah, get the hell out of this birthing room. I will not hesitate to call Security to have you removed from a restricted area.”
Deborah Franklin leaves.
Troy smiles and turns to me. “You’ve got such a nice way with words.”
My voice goes loud as I say, “The mother is at nine centimeters, and …” I pause. I watch. “And now she’s ready.”
Val screams out, “I need one of those epidemics.”
Troy and I, of course, know what she means, and I’m hoping Troy will take on the job of telling her that it’s way too late in the process to even consider an epidural.
“This game is in the final inning, baby doll,” Troy says. “You just breathe some quick breaths and push when Lucy tells you. You’re with us. We’re all a team.”
Val speaks through
her tears. “But I need some painkillers. I can’t—”
“Val,” I say. “Let me ask you something. Why do you think everybody always disagrees with me?”
“How would I know? All’s I know is that I can’t go on with all this pain,” she says.
“Val,” says Troy. “Nobody in God’s green world can stop you from going on with it. This isn’t in your hands now. This is no longer your decision. Your babies coming out is part of the good Lord’s plan. So … big push.”
The word push is barely out of Troy’s mouth when a baby comes sliding out of Val.
That’s right—sliding like a Snickers bar out of a candy machine. I don’t know whether it’s the quickest and easiest delivery I’ve ever helped with, but it’s in the running.
Even more spectacular is this: we are holding a remarkably healthy baby girl. Cord gets cut. Eyes get cleaned. Blanket tucked in and around the infant girl. On the scale: five pounds, three ounces. That’s a nice size for a twin, a very nice size. It’s especially, miraculously fine for a mom who’s a serious drug user. Pediatrics will test the baby for infant addiction, but the signs so far are showing that we’ve got a normal, healthy, bouncing baby girl on our hands.
“Gimme. Gimme. Gimme my baby,” Val is yelling.
When there are multiple births, the firstborn baby is placed on the mother’s shoulder as the next baby is delivered. It’s comfortable and safe for the baby and the mama. It also leaves a nice twin-size place for the second baby. Troy moves to rest the first baby on Val’s shoulder. She has an idea of her own.
“Let’s rest a few minutes while I get to know this one. Let’s not go get the new baby right away,” Val says.
Troy’s face—and I guess my own—clearly looks like he’s thinking, Is this woman just plain insane?
“I hurt too much,” she sobs. “I have to stop. I’ll spend the time learning to know my baby.”
“We don’t have time for a discussion, Val. There’s a baby inside you who’s got to come out.”
This conversation takes place while I am wrist-deep inside Val.
Troy has now handed the first baby off to Tracy Anne.
Meanwhile, I notice three ob-gyn residents have arrived in the room. A motley crew, as they say: one black, one white, one Indian. Surprisingly, the white resident is a man. That’s fairly unusual these days—a male ob-gyn—but now’s not the time to start a discussion about it. The group of doctors-to-be is quiet. I warn them to hold all their questions until after the delivery. Actually, I’d like to ask them to leave. But I don’t. I just warn them to keep very, very quiet. The mom and the babies are starring in this production.
Troy begins massaging Val’s belly. She has one fewer baby inside her, but her belly remains large and hard. We’ve never been sure that this belly massage has an effect on a patient, but it’s become almost like a good-luck gesture. We’ve just got to do it.
“Go easy, Troy. Go easy,” I say.
He shoots a look at me. It’s gentle, yes, but it says, I don’t need directions, Lucy.
Tracy Anne has returned from depositing Baby Number One in the nursery. She approaches me, stands close to me, then whispers, “They’ve already got a social worker waiting to see Val when she’s well enough. They know she’s a user.”
“I never filed a warning with the city,” I say. Then I realize what must have happened.
“I bet that bitch Franklin notified Social Services,” I say. “We can’t worry about it now. Damn it. Give us a hand here.”
Tracy Anne nods and begins wiping Val’s head and lips and throat with our endless supply of moist lavender cloths. I keep trying unsuccessfully to gently manipulate the fetus into a more “benign” delivery position. To be honest, this procedure rarely works. And this time is no exception. What’s more, there is a small but steady stream of blood beginning to cover my gloved hands.
“I’ll call surgery,” says Troy. “She needs a section.”
“Wait,” I say. “I’ve got an idea.”
“I’ve got an idea, too,” Troy says. “My idea is, let’s get someone in to do a C-section.”
I ignore him. I need to give it one more try. Not to worry, I don’t ever object to calling in an OB person if necessary. But I know when to make that call.
“Help me move her,” I say. I remove my bloody gloves and pull on a new pair. “Come on. You take one side. I’ll take the other. Let’s get her into the bathroom. Tracy Anne, go inside the bathroom and turn the shower on full blast, very hot, as hot as someone can stand it.”
“But she’s bleeding, Lucy,” Troy says, his voice full of alarm with a touch of outrage.
“Just do what I tell you to do, for Chrissake,” I snap back at him. “Tracy Anne, go into the bathroom and blast the shower water up as hot as it’ll go.”
Tracy Anne rushes into the adjacent bathroom. Troy and I begin lifting the screaming, weeping Val.
“Lucy, have you ever done this before?” Troy says.
I don’t answer him.
CHAPTER 6
VAL IS ALTERNATELY SCREAMING and sobbing. I test the shower water with my hand. Tracy Anne has, as always, followed instructions. It is full-blast hot. I lower it to a still very hot, but not scalding, temperature. Then I slip Val’s hospital gown up and over and off.
No, I have never used this method before. But my mama was a practicing midwife in West Virginia, in a place and at a time when there wasn’t always a doc to do a C-section. Sometimes you’ve got to do whatever it takes to get the baby moving.
Val vomits on the bathroom floor as we try, as gently as possible, to get her into the shower stall. We three midwives are wearing disposable paper slippers. The soles of these slippers are so well engineered that you could walk on a frozen lake and not fall.
I ask Val to lean against the wall. She doesn’t move. I realize that one of us is going to have to get in there with her. It certainly won’t be Troy; he’s way too big. I step into the shower myself. I move Val’s hands onto the tiled shower wall.
“The shower helps with the pain,” I say.
“No, it don’t,” Val yells. Frankly, I bet she’s right about that. She is yelling a string of other nasty, angry sentences. Her outrage is aimed at us three midwives, and a man by the name of Alonso. Alonso seems to be married, and it is Val’s hope that Alonso and his “fucking wife” will die and burn in “fucking hell.”
Troy steps in. In his incredibly soothing voice, he says over and over, “Move with the contractions. Just move with the contractions.” The hot water is steaming up the bathroom, like it’s a bad day in the Amazon rainy season.
The contractions are coming much faster now, and Val is not cooperating with my directions or Troy’s directions. She is not moving with the contractions.
“She’s ready,” I yell, and I pitch my voice louder than Val’s. Then I tell her to kneel on the shower floor. She doesn’t move. So, very firmly, and as smoothly as possible, I ease her down to a kneeling position. I kneel next to her. I bend her over. I urge her to give “a really big push.” Amazingly she cooperates.
After the big push, and equally amazingly, two infant legs appear. Please, God, let this go well. Please, come on.
God must have heard me—this is not always the case—because with one more push the baby’s torso slides out.
Now the most dangerous part of all: we need the head. And the head is refusing to make an appearance. I cannot even see the neck or chin section. I am afraid that whatever flesh I think is emerging is actually the umbilical cord twisted around the infant’s neck. I know that in a moment we’ll have to call an OB surgeon in for a C-section. Tracy Anne is holding her phone in her hand. She’s ready to make the call as soon as I give the signal.
“One more breath. And one more push,” I say.
And then it happens. The baby comes out. I immediately create the metaphor that I will use when I tell the story of this delivery: “The baby popped out like the cork from a bottle of champagne.”
> Champagne bottle or not, this second baby, another girl, is in serious distress. This baby girl is tiny, really tiny. A guesstimate weight? Three pounds. What’s as worrisome is the baby’s skin—a horrid purplish color, deep purple.
Troy cuts and clips the umbilical cord.
My stethoscope says the baby is breathing normally, but that important first scream of life has yet to emerge.
Val is yelling, “What is it? What is it?” as I hand the baby to Tracy Anne, who places Baby Number Two in a portable incubator and rushes her to Neonatal ICU.
“It’s another girl,” I say. “She needs help. Don’t worry. We’re going to get her all fixed up for you.”
“What’s wrong?” Val yells.
“Nothing that we can’t take care of.” I hope. God, I hope.
Troy slowly, carefully, lovingly helps Val to a bed. I remain in the bathroom to blot and shake off as much water as I can. I remove my shirt. I wring it out. I’m a mess. I look like a mess. I feel like a mess. But I’ve got to keep moving.
CHAPTER 7
A FEW MINUTES LATER—maybe five minutes—I step out of the bathroom and into the patient room.
The room is totally empty. No Troy. No Tracy Anne. Most upsetting, no Val.
I rush into the corridor. It’s crazier than usual. Along with the rolling gurneys and rolling wheelchairs, along with the patients walking with dangling IV packs, along with doctors and nurses and flower deliveries and meal deliveries, there are uniformed and plainclothes police officers, and right in front of me is the head of ob-gyn, Dr. Rudra Sarkar. Rudi, but I have never called him by that name. I have never seen Dr. Sarkar flustered or angry. Today is no exception.
Sarkar smiles at me and says, “I hope you don’t mind that I looked in on your birthing procedure today, Ms. Ryuan.”
The Midwife Murders Page 2
