Small Great Things

by Jodi Picoult

  Time? 10:04.

  "Ruth?" Kennedy whispers. "Are you all right?"

  I cannot get my lips to move. I am in over my head. I am wooden. I am drowning.

  "The patient developed wide complex bradycardia," Marie says.

  Tombstones.

  "We were unable to oxygenate him. Finally, the pediatrician called the time of death. We didn't realize that the parents were in the nursery. There was just so much going on...and..." She falters. "The father--Mr. Bauer--he ran to the trash can and took the Ambu bag out. He tried to put it on the tube that was still sticking out of the baby's throat. He begged us to show him what to do." She wipes a tear away. "I don't mean to...I'm...I'm sorry."

  I manage to jerk my head a few degrees and see that there are several women in the jury box who are doing the same thing. But me, there are no tears left in me.

  I am drowning in everyone else's tears.

  Odette walks toward Marie and hands her a box of tissues. The soft sound of sobs surrounds me, like cotton batting on all sides. "What happened next?" the prosecutor asks.

  Marie dabs at her eyes. "I wrapped Davis Bauer in a blanket. I put his hat back on. And I gave him to his mother and father."

  I am wooden.

  I close my eyes. And I sink, I sink.

  --

  IT TAKES ME a few minutes to focus on Kennedy, who has already started the cross-examination of Marie when I clear my head. "Did any patient ever complain to you about Ruth's expertise as a nurse, prior to Turk Bauer?"

  "No."

  "Did Ruth provide substandard care?"

  "No."

  "When you wrote that note in the infant's chart, you knew there would only be two nurses working at any given time, and that there might be a possibility the patient might be left without supervision at some point during his hospital stay?"

  "That's not true. The other nurse on duty would have covered."

  "And what if that nurse was busy? What if," Kennedy says, "she got called away on an emergency C-section, for example, and the only nurse remaining on the floor was in fact African American?"

  Marie's mouth opens and closes, but no sound emerges.

  "I'm sorry, Ms. Malone--I didn't quite get that."

  "Davis Bauer was not left unsupervised at any point," she insists. "Ruth was there."

  "But you--her supervisor--you had prohibited her from ministering to this particular patient, isn't that right?"

  "No, I--"

  "Your note barred her from actively treating this particular patient--"

  "In general," Marie explains. "Obviously not in the case of emergency."

  Kennedy's eyes flash. "Was that written in the patient's chart?"

  "No, but--"

  "Was that written on your Post-it note?"

  "No."

  "Did you advise Ruth that in certain circumstances her Nightingale pledge as a nurse should supersede what you'd ordered?"

  "No," Marie murmurs.

  Kennedy folds her arms. "Then how," she asks, "was Ruth supposed to know?"

  --

  WHEN COURT BREAKS for lunch, Kennedy offers to get us a bite to eat, so that Edison and I don't have to run a gauntlet of press. I tell her I'm not hungry. "I know it doesn't feel like it," she tells me. "But this was a good start."

  I give her a look that tells her exactly what I'm thinking: there is no way that jury isn't going to be thinking of Turk Bauer trying to resuscitate his own son.

  After Kennedy leaves us, Edison sits down beside me. He loosens his tie. "You all right?" I ask him, squeezing his hand.

  "I can't believe you're the one asking me that."

  A lady walks by us and sits beside Edison on the bench outside the courtroom. She is deeply involved in a text conversation on her phone. She laughs and frowns and tsks, a human opera of one. Then finally she looks up as if she's just realized where she is.

  She sees Edison beside her, and shifts just the tiniest bit, to put a hair of space between them. Then she smiles, as if this will make everything all right.

  "You know," I say, "I'm sort of hungry."

  Edison grins. "I'm always hungry."

  We rise in tandem and sneak out the back of the courthouse. I don't even care at this point if I run into the entirety of the media, or Wallace Mercy himself. I wander down the street with my arm tucked into Edison's until we find a pizza place.

  We order slices and sit down, waiting to be called. In the booth, Edison hunches over his Coca-Cola, sucking hard on the straw until he reaches the bottom of the glass and slurps. I, too, am lost in my thoughts and my memories.

  I guess I didn't realize that a trial is not just a sanctioned character assassination. It is a mind game, so that the defendant's armor is chipped away one scale at a time, until you can't help but wonder if maybe what the prosecution is saying is true.

  What if I had done it on purpose?

  What if I'd hesitated not because of Marie's Post-it note but because, deep down, I wanted to?

  I am distracted by Edison's voice. Blinking, I come back to center. "Did they call our name?"

  He shakes his head. "Not yet. Mama, can I...can I ask you something?"

  "Always."

  He mulls for a moment, as if he is sifting through words. "Was it...was it really like that?"

  There is a bell at the front counter. Our food is ready.

  I make no move to retrieve it. Instead I meet my son's gaze. "It was worse," I say.

  --

  THE ANESTHESIOLOGIST WHO is called that afternoon as a witness for the State is someone I do not know very well. Isaac Hager doesn't work on my floor unless a code is called. Then, he arrives with the rest of the team. When he came to minister to Davis Bauer I did not even know his name.

  "Prior to responding to the code," Odette asks, "had you ever met this patient?"

  "No," Dr. Hager says.

  "Had you ever met his parents?"

  "No."

  "Can you tell us what you did when you reached the nursery?"

  "I intubated the patient," Dr. Hager replies. "And when my colleagues couldn't get an IV in, I tried to help."

  "Did you make any comments to Ruth during this process?" Odette asks.

  "Yes. She was doing compressions, and I instructed her at several times to stop so that we could see if the patient was responding. At one point, when I felt she was a little aggressive with her chest compressions, I told her so."

  "Can you describe what she was doing?"

  "Chest compressions on an infant involve pressing the sternum down a half inch, about two hundred times a minute. The complexes on the monitor were too high; I thought Ruth was pushing down too hard."

  "Can you explain what that means to a layperson?"

  Dr. Hager looks at the jury. "Chest compressions are the way we manually make a heart beat, if it's not doing it by itself. The point is to physically push the cardiac output...but then let up on your thrust long enough to let blood fill the heart. It's not unlike plunging a toilet. You have to push down, but if you keep doing that and don't pull up, creating suction, the bowl won't fill with water. Likewise, if you do compressions too fast or too hard, you're pumping, pumping, pumping, but there's no blood circulating in the body."

  "Do you remember what you said to Ruth, exactly?"

  He clears his throat. "I told her to lighten up."

  "Is it unusual for an anesthesiologist to suggest a modification to the person who is doing compressions?"

  "Not at all," Dr. Hager says. "It's a system of checks and balances. We're all watching each other during a code. I might just as well have been watching to see if both sides of the chest were rising, and if they weren't, I would have told Marie Malone to bag harder."

  "How long was Ruth overly aggressive?"

  "Objection!" Kennedy says. "She's putting words in the witness's mouth."

  "I'll rephrase. How long was the defendant aggressive with her chest compressions?"

  "It was only slightly aggressive, and for
less than a minute."

  "In your expert medical opinion, Doctor," Odette asks, "could the defendant's actions have caused harm to the patient?"

  "The act of saving a life can look pretty violent, Ms. Lawton. We slice open skin, we crack ribs, we shock with extreme voltage." Then he turns to me. "We do what we have to do, and when we are lucky, it works."

  "Nothing further," the prosecutor says.

  Kennedy approaches Dr. Hager. "Emotions were running very high in that nursery, weren't they?"

  "Yes."

  "Those compressions that Ruth was doing--were they adversely affecting the infant's life?"

  "On the contrary. They were keeping him alive while we attempted medical intervention."

  "Were they contributory to the infant's death?"

  "No."

  Kennedy leans on the railing of the jury box. "Is it fair to say that in that nursery, everyone was trying to save that baby's life?"

  "Absolutely."

  "Even Ruth?"

  Dr. Hager looks right at me. "Yes," he says.

  --

  THERE IS A recess after the anesthesiologist's testimony. The judge leaves, and the jury is removed from their box. Kennedy spirits me away to a conference room, where I am supposed to stay, so that I remain safely sequestered from the media.

  I want to talk to Edison. I want a hug from Adisa. But instead I sit at a small table in a room with hissing fluorescent lights, trying to untangle this chess game in my head.

  "You ever wonder?" I ask. "What you'd do, if you weren't a lawyer?"

  Kennedy glances at me. "Is this your way of telling me I'm doing a shitty job?"

  "No, I'm just thinking. About...starting over."

  She unwraps a piece of gum and passes me the rest of the packet. "Don't laugh, but I wanted to be a pastry chef once."

  "Really?"

  "I went to culinary school for three weeks. I was eventually conquered by phyllo. I just don't have the patience for it."

  A smile dances over my face. "Go figure."

  "What about you?" Kennedy asks.

  I look up at her. "I don't know," I admit. "I've wanted to be a nurse since I was five. I feel like I'm too old to start over, and even if I had to, I wouldn't know where else to go."

  "That's the problem with having a calling," Kennedy says. "It doesn't just pay the rent."

  A calling. Is that why I unwrapped Davis Bauer's blanket when he wasn't breathing? "Kennedy," I begin, "there's something--"

  But she interrupts. "You could go back to school. Get a medical degree or become a PA," she suggests. "Or work as a private caregiver."

  Neither of us says the truth that squeezes into the small room with us: convicted felon doesn't look good on a resume.

  When she sees my face, her eyes soften. "It's going to work out, Ruth. There's a grand plan."

  "What if?" I say softly. "What if the grand plan doesn't come to pass?"

  She sets her jaw. "Then I will do whatever I can to get your sentence minimized."

  "I'd have to go to prison?"

  "Right now the State's leveled several charges against you. At any time if they decide they don't have the evidence to support them, they might drop a greater charge in favor of conviction on a lesser one. So if they can't prove murder, but they think they have negligent homicide locked up, Odette may play it safe." She meets my gaze. "Murder has a minimum sentence of twenty-five years. But negligent homicide? Less than a year. And to be honest, they're going to have a very hard time proving intent. Odette's going to have to tiptoe through her questioning of Turk Bauer or the jury's going to hate him."

  "You mean as much as I do?"

  Kennedy's eyes sharpen. "Ruth," she warns, "I never want to hear you say those words out loud again. Do you understand?"

  In an instant, I realize Kennedy is not the only one thinking six moves ahead. So is Odette. She wants the jury to hate Turk Bauer. She wants them outraged, offended, morally disgusted.

  And that's exactly how she will prove motive.

  --

  I'VE ALWAYS ADMIRED Dr. Atkins, the pediatrician, but after hearing her list her credentials and rattle off her CV, I'm even more impressed. She is one of those rare individuals who has more awards and honors than you'd ever expect, because she's humble enough to not mention it herself. She is also the first witness to take the stand who looks directly at me and smiles before turning her attention to the prosecutor.

  "Ruth had already done the newborn exam," Dr. Atkins says. "She was concerned about a potential heart murmur."

  "Was that a significant concern?" Odette asks.

  "No. A lot of babies are born with an open patent ductus. A teensy little hole in the heart. It usually closes up by itself, the first year of life. However, to be safe, I scheduled a pediatric cardiology consult prior to patient discharge."

  I know, from Kennedy, that Odette will be assuming the medical issue Kennedy referenced in her opening statement is this heart murmur. That she's downplaying it, already, for the jury.

  "Dr. Atkins, were you working on Saturday, October third--the day of Davis Bauer's death?"

  "Yes. I came in to do the patient's circumcision at nine A.M."

  "Can you explain that procedure?"

  "Of course, it's a very simple operation during which the foreskin of a male infant's penis is removed. I was running a little late because I had another patient with an emergency."

  "Was anyone else present?"

  "Yes, two nurses. Corinne and Ruth. I asked Ruth if the patient was ready, and she said she was no longer his nurse. Corinne confirmed that the infant was ready for the procedure, and I performed it without incident."

  "Did Ruth say anything to you about the circumcision?"

  Dr. Atkins pauses. "She said maybe I should sterilize the baby."

  Behind me, in the gallery, someone whispers: Bitch.

  "How did you respond?"

  "I didn't. I had work to do."

  "How did the procedure go?"

  The pediatrician shrugs. "He was crying afterward, like all infants do. We swaddled him tight, and he drifted off." She looks up. "When I left, he was sleeping...well...like a baby."

  "Your witness," Odette says.

  "Doctor, you've worked at the hospital for eight years?" Kennedy begins.

  "Yes." She laughs a little. "Wow. Time flies."

  "During that time, have you worked with Ruth before?"

  "Frequently, and joyously," Dr. Atkins says. "She is a terrific nurse who goes above and beyond for her patients."

  "When Ruth made the comment about sterilizing the infant, how did you perceive her statement?"

  "As a joke," Dr. Atkins says. "I knew she was kidding. Ruth isn't the type to be malicious about patients."

  "After Davis Bauer's circumcision, were you still working in the hospital?"

  "Yes, on a different floor, in the pediatric clinic."

  "Were you made aware of an emergency in the nursery?"

  "Yes. Marie had called the code. When I arrived, Ruth was compressing the chest."

  "Did Ruth do everything according to the highest standards of care?"

  "As far as I could see, yes."

  "Did she indicate any animus or bias against this child?" Kennedy asks.

  "No."

  "I'd like to jump back a bit," Kennedy says. "Did you order any blood work to be done on Davis Bauer after his birth?"

  "Yes, the newborn screening that's done by the state of Connecticut."

  "Where does the blood work go?"

  "The state lab in Rocky Hill tests it. We don't do it in-house."

  "How is it transported to the state lab?"

  "By courier," Dr. Atkins says.

  "When was Davis Bauer's blood taken for the screening?"

  "At two-thirty P.M., on Friday, October third."

  "Did you ever receive the results of the newborn screening test from the Connecticut state lab?"

  Dr. Atkins frowns, considering this. "Actually, I don't reme
mber seeing them. But of course by then it was a moot point."

  "What is the purpose of the test?"

  She lists a series of rare diseases. Some are caused by genetic mutation. Some are issues with not having enough of an enzyme or protein in the body. Others result from not being able to break down enzymes or proteins. "Most of you have never heard of these conditions," Dr. Atkins says, "because most babies don't have them. But the ones that do--well, some of the disorders are treatable if caught early. If we make accommodations through diet or medicine or hormone therapy, we can often prevent significant growth delays and cognitive impairment by starting immediate treatment."

  "Are any of these conditions fatal?"

  "Some, if they're left untreated."

  "You did not have the benefit of the results of this test when Davis Bauer had a seizure, did you?" Kennedy asks.

  "No. The state lab is closed on weekends. We usually don't get Friday's results back until Tuesday."

  "What you're saying," Kennedy mulls, "is that it takes almost twice as long to get the test results back if the baby has the misfortune to be born at the end of the workweek."

  "That's true, unfortunately."

  I can see the jury perking up, writing down notes, listening intently. Behind me, Edison shifts. Maybe Kennedy is right. Maybe all they need is science.

  "Are you aware of a disorder called MCADD?" Kennedy asks.

  "Yes. It's a fatty acid oxidation disorder. Basically, an infant who has it will have trouble breaking down fats, and that means the blood sugar drops to dangerously low levels. It can be managed with early detection--a careful diet, frequent feedings."

  "Let's say it isn't detected. What happens?"

  "Well, infants who have MCADD have a significant risk of death during the first clinical episode of hypoglycemia--when that blood sugar goes south."

  "What would that look like?"

  "They'd be sleepy, logy. Irritable. They wouldn't nurse well."

  "Let's say, hypothetically, a baby with undiagnosed, untreated MCADD was about to be circumcised. Is there anything about that procedure that might have exacerbated the disease?"

  The pediatrician nods. "Normally there would be fasting after six A.M., because of the upcoming surgery. For a baby with MCADD, that would lead to low blood sugar--a potential episode of hypoglycemia. Instead, ten percent dextrose would have been given to the baby prior and afterward."

  "You drew blood from Davis Bauer during the code, didn't you?"

  "Yes."

  "Can you tell the jury the results of his blood sugar at that time?" Kennedy asks.