Arms Wide Open

by Patricia Harman

  I wipe my eyes surreptitiously. Am I sad that in this university community there are only seventy-five people willing to stand up to the government? Am I lonely because Tom wouldn’t come with me? Or am I moved, that even in these dark times there are a few souls who continue to witness for peace?

  A small boy walks back and forth with a sign almost as big as he is. When Mica was three, he carried the same sign against his little shoulders. WAR IS NOT HEALTHY FOR CHILDREN AND OTHER LIVING THINGS.

  We shall overcome, someone begins. We shall overcome someday . . . the crowd joins in, but I don’t open my mouth. Will we overcome? Can we? With the destruction of the rain forest, the economic meltdown, global warming, wars and rumors of wars around the world, the forces of ignorance seem more insidious than ever. Once “We Shall Overcome” defined our generation. Now it’s more like “We Will Survive.”

  CHAPTER 9

  Beast

  Early Saturday morning, Tom and I are startled awake by thunder. When we rise, we’re surprised to see snow floating down like feathers. The sun flashes out, golden under the low slate clouds, then the thunder rumbles again. Strange weather for early November.

  Tom hands me a mug of coffee and we park ourselves in our pajamas in the white canvas chairs. Leonard Cohen’s “Waiting for the Miracle” is playing low on the stereo.

  “Did you get the visa applications?” Tom asks.

  “Yeah, I faxed them back and sent the passports yesterday. What a hassle. I had no idea it would be so hard to get into Russia. Think we really should go?”

  Tom gives me his half smile. “The tickets are already paid for.” He knows how lonely I’ve been for Mica and this is part of my Christmas gift.

  We sip our coffee and watch as the brave nuthatches swoop down to the bird feeders but are scattered by bigger birds. “It’s been weeks since we’ve seen a cardinal, where could they be?” I ask Tom. “I heard that, despite the weird early snow, this is the warmest fall on record. Are the birds as confused as we are?” I wait for an answer, not sure I’ll get one.

  “Maybe.” Tom’s a man of few words, but I chatter on . . .

  “And yesterday I got an e-mail warning that bears have been sighted in Blue Rock Estates. Did you get it? A woman who lives at the outer edge of the development says she saw one rooting through her trashcan. Residents are warned not to leave their garbage out and to guard small children and pets.” I repeat this last part with a snicker. “We live only ten miles outside of town. How could there be bears in Blue Rock Estates?”

  Tom laughs. It’s so good to hear his familiar chuckle. “People in this neighborhood get hysterical over the smallest thing . . . I’ve got to make rounds at the hospital. I’ll be home in a couple of hours.” He rises, pulls on his green L.L. Bean jacket, and goes out the front door. I smile to myself, thinking of a large hairy beast making its way though this affluent suburb.

  It’s not impossible; the black bear population in West Virginia is growing. If a bear really is close by, I know where he’s headed . . . our beehives. I finger the silver Navaho bear, a talisman that I wear lately on a chain around my neck. If a bear is somewhere in Blue Rock Estates, he knows where I am.

  JON

  I’m on my way home from work and must stop as seven deer cross Blue Rock Drive, five adults and two fawns. They mosey over the medium unafraid. It gets like this in the autumn during hunting season. Here in Blue Rock Estates, a woodsy suburb where shooting is forbidden, we are overrun with flower- and shrub-eating varmints. You might as well have a sign at the stone entrance, DEER PARADISE.

  It was late fall, just this time of year, that I began my clinical rotations in midwifery school twenty years ago. I had been apprehensive about how I’d fit in with the traditional university program, a hippie self-taught midwife who’d already delivered one hundred babies at home. Now the jig was up and I was in a huge tertiary monolith about to do my first hospital delivery.

  “I’m going to take a smoke break,” Mary Rose tells me as she leaves the labor room without warning. St. Paul Ramsey is a far cry from the cabins and farmhouses where I’d delivered babies before.

  Mary Rose, my preceptor, is not what I’d expected. I’d hoped for someone sympathetic toward homebirth, but M.R. is a hard-bitten veteran who’d served in the military. I’m careful not to bring up the subject of her armed forces career. She’d probably been a nurse in Vietnam while I was picketing the draft board.

  Our patient, twenty-one-year-old Carla Flores, a small, dark-haired girl with a belly the size of a watermelon, is in active labor and I’m wondering where her husband or mother is. Maybe she doesn’t have one. I’m her family today, her sister, her mother, her midwife. It’s Carla’s first baby, and when we’d checked her an hour ago, she was five centimeters dilated.

  The young mother keeps her eyes closed most of the time, no chitchat between contractions, and I honor that. She isn’t like me. To deal with the pain of labor, I needed breathing patterns, back rubs, kinesthetic distraction, music, walking, bathing in water. All women cope differently.

  “You all right, Carla? You look so beautiful and strong. Is there anything I can do?” I sit down on the one chair in the austere room, a hard-backed wooden rocker.

  The girl cracks an eye. “Beautiful? I don’t feel it.”

  “Is there anything I can do? Rub your back, massage your feet?”

  “You’d do that? Rub my feet? Would it help?”

  “Maybe a little.”

  “OK.”

  For thirty minutes, as I stand at the end of the hospital bed massaging Carla’s little rough feet, I stare at the mountains and hills running along the fetal-monitor strip. Once I would have been gazing through windows of a cabin at the lush green hills of West Virginia. I hum a lullaby under my breath. To my little one’s bedside in the night . . . comes a new little goat, snowy white. The song may or may not soothe my patient, but it soothes me.

  Carla moans.

  “You doing OK?”

  She shakes her head no. “It’s my back!”

  Great, I think. Back labor. “Do you want to get out of bed?”

  “Can I?”

  I step to the door and look up the empty corridor. There are no nurses around. I don’t know what the rules are in this inner-city hospital. I guess it’s all right. We’re midwives, for God’s sake!

  I turn off the fetal monitor, help Carla step into her slippers, and assist her to the bathroom. “Sit here for a while. If you lean forward, it takes the pressure off your back.” I show her how to open her legs and bend down until her head is almost between her knees. “Do you want me to stay here and rub your back?”

  Carla gets that faraway look in her eye as another contraction comes on. “No, I’ll be all right. I need to go to the toilet.”

  Her calm amazes me. At this point, many women would have asked for pain medicine. I retreat to the birthing room, an old OR suite, and straighten the sheets. The walls are cream tile, but the nurse-midwives have made an effort to make the space seem more homey. There are framed pastoral landscapes on the walls, and the hospital bed has a flowered quilt. This is the first birthing room at St. Paul Ramsey and it’s clearly an afterthought, an attempt to keep up with the fancier hospitals.

  There’s another moan from the bathroom. Where is my preceptor, anyway? I hope she didn’t forget about me. I step into the hall and look out again. An intern in blue scrubs nods as he hurries by.

  Behind me, in the john, I hear a low growl and I turn to skid across the linoleum. “Carla! Don’t push.”

  “I’m not pushing. The baby’s pushing!”

  “Well, don’t help it. Go like this. Hoo! Hoo! Hoo!” I show her what I mean as I guide her to the bed and tip her over on her side. “No pushing. Just blow. It may not be time yet.”

  Who am I kidding? Of course it’s time. The
sound of that grunt is universal. With one hand I reach for the call light and press the red button; with the other I grab a pair of exam gloves. Carla’s eyes are wide open.

  “Hoo! Hoo! Hoo!”

  Mary Rose jogs into the room and takes in the scene with a glance. “What the hell? Why didn’t you call me?”

  I already have my fingers in the patient’s vagina. “Fully dilated and plus one station,” I report. “I didn’t know she was progressing. She was so calm; the contractions didn’t seem very strong. I got her up to the bathroom and—”

  “You got her up to the bathroom without doing a vaginal exam first?!” M.R. scolds.

  “Ughhhh,” Carla yells and I feel the baby move down another inch.

  “Well, get ready, for God’s sake!” That’s Mary Rose.

  I slide the girl up but take time to touch her face. “It’s going to be OK.”

  My instructor drags a delivery table over. I pull my sterile gloves off and remove the end of the bed so that the woman’s bottom is right on the edge.

  “Gown!” she commands, holding out a sterile surgical robe backward. I’d helped the physicians on with theirs many times but fumble as I stick my arms into the sleeves.

  “Now gloves,” M.R. orders like a drill sergeant, nodding at a new pair opened on the bedside table.

  “Hoo. Hoo. Hoo. Hoo. Hoo!” I encourage Carla.

  The instructor, also gloved and gowned, kicks the rolling stool over and nudges me to sit down.

  We both take two deep breaths.

  “We’re ready now, honey,” Mary Rose says softly to Carla, her first gentle words, and I see another side to her. “You can push.”

  Toward me, M.R.’s not so gentle. She grabs my hands in hers and holds them over the baby’s head. From somewhere, an RN appears, replaces the monitor belts and sets up the infant warmer and oxygen.

  Beep . . . beep . . . beep . . . . . . beep . . . . . . . . . beep. The fetal heart rate is decelerating, but it’s just head compression. This baby will be out in two minutes. I try to give the fetal scalp a tickle to speed up the heartbeat, but my mentor’s hands are glued over mine.

  Carla lets out a long yell and curls forward.

  “That’s the way, honey! Hold your breath as long as you can while I count,” the RN instructs. “One thousand one. One thousand two. One thousand three.”

  There’s too many cooks cooking this stew. Carla’s doing fine, just as she is, without the RN’s help.

  If we were at home in her bedroom, I’d be putting olive oil on her perineum right now. I look over at the gleaming silver instruments arranged in rows on the sterile delivery table, half expecting to see a little cup of mineral oil, but of course it’s not there.

  Beep . . . . . . . . . beep . . . . . . . . . . . . beep . . . . . . . . . . . . beep. M.R. lets go of my hands and reaches for a pair of scissors.

  At first I assume she’s getting ready to cut the cord, though the head’s not out yet, but she nudges me with her elbow and forces the scissors into my hand, then injects Xylocaine into our young patient’s perineum. Now I know what she wants me to do . . . cut an episiotomy.

  So here I sit. The head of a dark-haired infant crowning before me. I know how to get this baby out without a laceration or episiotomy in two minutes, if Mary Rose and the enthusiastic nurse would leave me alone, but I am the student, enrolled to learn.

  I take the scissors and cut, feel the skin crunch between the blades, see the blood ooze . . . and deliver the baby. It’s not a good feeling, but it’s done. The very pink body swivels out, Mary Rose cuts the cord, and the RN takes the tiny boy to the infant warmer.

  “If the heart rate’s down, you have to cut an episiotomy right away,” Mary Rose whispers. “The OBs watch us, and if you hesitate, they’ll start coming in to every delivery to supervise.” She looks at the door. “We don’t want that.”

  “My baby. My baby,” Carla cries.

  “Everything all right?” a balding OB asks, peeking in from the hall.

  “Fine,” Mary Rose and the nurse answer together.

  It isn’t until we’re done stitching and have the new mother cleaned up that Carla gets to hold her tiny one. “Jon,” she calls him, with tears in her eyes.

  Just then there’s a knock at the door and a thin young man in jeans and a West Point T-shirt comes in. “I got here as fast as I could.”

  Carla looks up and there are tears for real now. She holds out the baby. “Your son,” she says simply, as if introducing a prince. The father kneels at the bedside, glances at the baby, takes his woman’s head in his hands, and holds it to his heart.

  “Thank you,” he says.

  So this is Carla’s rock, her hero. When her eyes were closed and she was so quiet during the hard contractions, he’s the one who was holding her hand, as Tom and Stacy once did for me. Behind her eyelids this is the partner that stood whispering, “You can do it. You can do it.”

  Mary Rose and I don’t say a word, but she wipes her eyes and I realize that she’s crying. She takes my hand. We are both crying . . .

  The deer make it over to the golf course on the other side of the road and wander down the hill. I stop at the mailbox and pick up the mail. There’s a letter reminding me that it’s time to renew my membership in the American College of Nurse-Midwives.

  Most people think all midwives do is deliver babies. They don’t know that some are employed by family-planning clinics, some teach in universities, and some, like me, work in women’s health practices doing prenatal visits and gyn. As I gather my briefcase and pocketbook, my water bottle and scarf, I mull over my day. It’s not that all the patient encounters had the intensity of birth . . .

  Haala, nineteen, from Saudi Arabia, is expecting her first child. She doesn’t speak English, has never had a pelvic exam, and is scared to death. Her husband, an engineering student at the university, must translate every word I say. She sits on the exam table, her arms closed around her chest, wearing the regulation blue exam gown, her burka still covering her head. I use my hands and my smile to communicate and finally make her laugh . . .

  Martha, forty-five, is getting divorced; she cries when she tells me how she found out that her husband of twenty-five years cheated on her with a coworker, a woman Martha had actually befriended. Her mascara is running. I roll my exam stool closer and wipe her wet face with the back of my hand . . .

  Priscilla, fifty-one, has a sixty-year-old husband, a retired coal miner, who’s unable to have sex. He refuses to discuss his problem with his doctor. I ask Priscilla if she’s ever tried a vibrator, and give her a handout showing where to order small tasteful devices. We giggle like girls . . .

  I support these women, praise them, teach them, like any midwife would do for a pregnant patient. I tell the women that they are beautiful and strong, the same way I did when Carla was giving birth . . . but these women are giving birth to themselves.

  Winter

  CHAPTER 10

  Homecoming

  Tom and I have returned from our long-planned trip to Moscow, a beautiful city of marble subways and Russian Orthodox cathedrals with golden domes. Rose can hear now, with her little bone-conduction hearing aid that she wears on a crocheted headband like a miniature hippie. And this time when I sang her to sleep, I know she heard my lullaby. It helped my feelings of separation just to sit on the sofa with Mica, my little blond boy, now a big man. We held hands like we used to when he was two and we walked through the Minnesota woods.

  Back at work, we discover that the staff has decorated the office for Christmas. An artificial fir tree, covered with silver and mauve ornaments, sits in the corner of the waiting room. Silver snowflakes, each one bearing the name of a staff member or provider, hang from the ceiling.

  The first thing I hear when I hit my desk is that Ruby, our pelvic-pain pati
ent, is pregnant. Her chart is on top of my stack with a message to call her.

  “Hi Ruby, this is Patsy Harman, nurse-midwife. What’s up?”

  “Oh Patsy, I’m glad it’s you. I don’t feel so good today.”

  “My nurse, Abby, told me you came in and had a positive pregnancy test. She says you’re about five weeks along and she set you up for a new OB visit. How don’t you feel good?”

  “My stomach, my lower stomach. I’m cramping. Oh, Patsy. I’m afraid I’m gonna miscarry.”

  “Are you spotting?”

  “No.”

  “Have you made love lately?”

  “Yeah, just this morning. Could that make me miscarry?”

  “No, Ruby. Intercourse doesn’t cause miscarriages, but it could cause your endometriosis to flare up. Why don’t you just rest today? If you start bleeding or the pain gets worse, you should go to the ER. I really think things will be OK. Next week when you come in we’ll have to start weaning you off your narcotics. Did the nurse tell you that? They’re not good for your baby?”

  “So, I’m not going to miscarry?”

  “Ruby, I don’t know for sure, but since you aren’t spotting, I don’t think so. Just rest, OK? And come to the ER if you begin to bleed . . . There’s nothing we can do for a miscarriage anyway. No way to stop it, but I bet you’ll be OK.” I say my good-byes and get off the line, then flip through the rest of the charts.

  Fifty percent of the calls we get are from the chronic-pelvic-pain patients, who represent only 5 percent of our practice. Some of the women are manipulative, wanting more narcotics. Some just need reassurance. Some may be having a true emergency. You have to really listen to sort it all out . . .

  Ruby’s been on narcotics for three years. She started them when she was waiting for surgery and afterward, when she was no better, continued. It will be hard to get the young woman off, but we’ll step down gradually. Stopping suddenly would cause both the mother and fetus to go into withdrawal.