Eleven
SUNDAY MORNING WASN’T GOING WELL. FORTY-ONE-YEAR-OLD CRISTINA Lang’s labor had slowed to a crawl after fifteen trying hours, and Meg watched the fetal monitor with narrowed eyes, her mouth a grim line on her pale face. The baby’s heart rate had been fluctuating for the last hour, and was now in a steady downward trend. In a voice low enough that only Susan, the labor nurse, could hear, Meg said, “You’re right: I don’t think we have any choice. Get her prepped.”
To the sweat-covered mother-to-be she said, “Cristina, you’ve worked awfully hard, but I think we’re going to have to take over. Your cervix doesn’t want to finish dilating, and I’m not sure why yet, but your little guy’s getting stressed. We don’t want to see him suffer any long-term effects, okay?”
Cristina’s husband Martin, a stocky man whose landscape company did Meg’s yard maintenance and many of her neighbors’, looked alarmed. “Take over? You mean she can’t do the VBAC?”
“I’m sorry,” Meg told him. “It was worth trying, but her failure to progress and the slowing fetal heart rate suggest that the baby’s having trouble.” She turned to Cristina. “Sometimes even the most prepared moms have to go with plan B. Susan is going to get you all set up, and I’ll see you in the OR in just a few minutes.”
Cristina reached for Meg’s hand. “He’s okay? My baby, he’s going to be all right?”
“He should be fine, as long as we get him out soon. Try not to worry.”
“Okay.” The woman nodded, and Meg read the relief in her eyes. “Okay, good.”
Meg squeezed her hand, then gave Martin’s shoulder a pat as she moved past him and out of the room to head to the OR. Her mind was focused on the task ahead as she walked down the hallway and around the corner. When she stumbled just before reaching the door to the OR suite, she recovered her balance quickly and went on to get herself ready to deliver the baby.
She ran the hottest water she could stand and scrubbed all along the ridges of her nails and the creases in her hands. Having to use a scalpel to finish Cristina’s job was regrettable but necessary, and she looked forward to the moment when she would lift the slippery infant out and hand him over to the nurse, a fresh miracle hot and pulsing with the force of all life. The regular opportunity to witness a child’s first shocked breath was why she chose obstetrics; nothing was more wondrous, more startling or fantastic. Every healthy child was a symbol of possibility. All these new tiny people she helped enter the world reminded her that her own life was not terribly significant—and made it easier for her to forget her own disappointments.
Keith, the portly scrub nurse whose own wife was due to deliver their first any day, pushed open the door. “We’re just about set. You ready, Doc?” he asked.
She turned off the water with her elbows. “Be right there.”
He nodded and stepped back into the operating suite. Meg glanced through the window as she dried off, considering the baby’s position, previous scar tissue on Cristina’s uterus, how much time had passed since she’d made the decision to operate. Emergency C-sections were her least favorite part of her occupation, the riskiest of all procedures just by their nature. The mothers required general anesthesia, the babies were always in distress—these surgeries felt like crapshoots despite her expertise, despite her absolute dedication to her patients. She only ever had to do them when what was supposed to be predictable and routine became a cascading flow of everything opposite.
She backed into the suite, keeping her hands sterile, and stood still while a tech assisted her with gown and gloves. Her right arm, the one that was giving her trouble, felt a little stiff, sluggish as she held it out for the glove. As soon as the tech stepped away, Meg lifted both arms above her head and stretched.
“Need a nap?” asked Clay Williams, the new surgeon who would be assisting. “Susan said you all have been at it all night with this one.”
“We have,” Meg agreed as she approached the table, where he stood facing her from the far side. “But I think I’ll wait on the nap until after we finish.”
“Well, I s’pose that is the better protocol,” Clay joked, his mouth hidden behind the light green mask but his smile apparent in his eyes—as was a kind of interested regard that surprised her. Was he flirting? He added, “You pros know best.”
He had to be several years her junior, and they’d worked together only a few times, socialized at a couple conferences, chatted before or after staff meetings now and then; even so, she had the distinct feeling he was attracted to her. Her response was friendly but circumspect: “I tried that napping-during-surgery approach and, well, somehow the results weren’t up to AMA standards.”
“Bah, rules are made to be broken,” Clay said—alluding to marital rules, perhaps? Or was she just imagining that sparkle of interest, that suggestive tone?
The anesthetist, a serious, middle-aged man named Leo, spoke up then, bringing Meg’s attention back to the job at hand. “She’s all set.”
Meg looked closely at her now-unconscious patient, at the draping around Cristina’s iodine-orange belly, at the tray of instruments nearby, checking that everything was in place. “What was the last fetal bpm?” she asked, referring to the baby’s heart rate.
“Eighty-one, right before we unhooked her.”
Very low, but not absolutely critical. Meg nodded at the assembled team of nurses, technicians, and a pair of neonatologists, and said, “Okay then, let’s make a birthday.”
At first, everything seemed to be fine. She reached for the scalpel, grasped it with no trouble, aligned the blade with Cristina’s skin just above the pubic bone. Then it was as if all the strength simply leached out of her arm. The scalpel dropped from her fingers, tumbled onto the edge of the operating table and down to the floor, landing with a clatter. Meg looked up, embarrassed and concerned. There was a baby in distress here; her arm could not refuse to cooperate.
“Butterfingers,” she joked, sweat breaking out on her forehead, dampening her armpits and her palms, inside her gloves.
“Mmm, a candy bar does sound good, but I think another scalpel’s the better choice,” Clay said.
“Right, a scalpel,” Meg nodded, trying to play along. She looked down at her hand. It rested, yet, on Cristina’s belly, on the mound of a baby who was almost certainly fading fast. It took all her concentration to lift her arm and pull it in, close to her chest.
“Here you go,” the tech said, holding out a second scalpel. Meg looked at it, its steel blade glinting under the lights, taunting her. The moment stretched out in long, agonizing delay as Meg willed her arm to extend normally. It felt leaden.
Clutching her wrist with her left hand, she stepped back abruptly.
“Dr. Williams, would you proceed?” she said, feeling the eyes of everyone there watching her with concern. “I have a…a cramp. In my hand.”
“I—sure,” Clay said. He hurried around to her side and reached for the scalpel. “Thanks for the opportunity,” he added, making it seem like she was staging this as a favor to him.
Marshalling her focus away from her arm and onto the crucial matter of delivering Cristina’s baby, she guided Clay through the relatively unfamiliar-to-him procedure. He worked quickly and with steady assurance, but when he pulled the baby out, it was clear that something had gone very wrong. The tiny boy was well formed but gray, motionless as Clay put him in the hands of the neonatal specialist. Clay glanced at her, his eyes full of dread.
Her own heart had plummeted, but she tried to reassure him. “You did everything right.” Behind them, the specialist and his team worked to revive the baby. “Let’s finish up here,” she nodded toward her patient, who, as difficult as it was for any obstetrician to remember when there was trouble with the baby, remained her priority.
“Right,” Clay said. “Do you want me to—”
“Yes,” she said, her voice low. “My arm…” She frowned behind her mask.
“No problem.”
“Thank you.”
She stoo
d by, feeling helpless in every sense. What had gone wrong? She reviewed Cristina’s labor in her mind, recalled the events and procedures of the surgery, thought again about the baby’s heart rate troubles—but as soon as Clay delivered the rest of the umbilical cord and the placenta, the culprit became obvious: a knot in the cord.
“Shit,” she said, reaching for it with her left hand. “It must’ve gotten looped early in her pregnancy.” Rarely, but once in a while, a very active fetus with a longer-than-usual cord could manage to loop through it. Rarely, but once in a while, an ultrasound would fail to show it. Then, at some point in the labor, the knot, which had been loose enough not to be a problem, tightened up or got compressed, cutting off the baby’s blood and oxygen supply. In the minutes—literally minutes—between when the monitor had been removed and Clay had reached in to pull the baby out, the baby had crashed. Silently, fading away without a struggle. There was no way for them to know, or to do anything differently even if they had known. Except…except for those forty-five or so seconds after she’d dropped the scalpel: it was possible that those seconds made the difference. Clay nudged her with his elbow, and when she looked at him, he shook his head as if he were reading her thoughts, as if to say, Don’t go there.
She looked behind them, at the slumped shoulders of the group surrounding the warming table, and swallowed hard.
ALONE IN AN ELEVATOR TWO HOURS LATER, CLAY AND MEG RODE IN silence until he reached forward and pushed the Stop button.
Startled, she said, “What are you doing?”
Clay touched her chin, to get her to look up at him. “It’s not your fault.”
She looked away. “You don’t know that. If I hadn’t screwed up my arm—”
“You didn’t know it was going to cramp up just then.”
“I knew it could. It happened once last week.”
“Once. Last week.”
She appreciated his support, but the truth was that she’d had a hint while getting suited up, and she’d ignored it. And now a baby was dead.
Clay continued, “Look, suppose we could have that minute back. The baby might have survived—I double-emphasize ‘might’—in which case he almost certainly would’ve been severely brain-damaged from what had already occurred, and dependent on his poor parents for the rest of their lives. A vegetable, if you’ll forgive the crassness of the term.”
“Maybe,” she acknowledged, imagining Cristina and Mark trying to manage the needs of such a child along with their chubby, charming two-year-old daughter Chloe, whom she had also delivered by emergency C-section, without a hitch. She saw their baby boy with vacant eyes, a permanent feeding tube, a ventilator, no future—and couldn’t wish such a life on anyone.
Clay took her right hand with both of his, massaging it gently, and looked into her eyes. “We can’t save them all, you know. Hell, we can hardly save ourselves.”
She knew without asking that he was referring to his attraction to her, a married woman. Saying they had no control, not over death and not over whatever strange forces brought people together, not over love. She let his eyes hold her that way for a long moment, a moment when the comfort and support and affection of someone who truly understood was exactly the salve she needed.
Unfortunately, it couldn’t last. “I have to get going,” she said, the rest of the day’s obligations intruding, reminding her that her world existed outside this tender gesture, that she was wrong to welcome it.
Clay said, “Me too.” But still he held her hand, and she didn’t pull it away. “Meg…”
“Clay.”
He sighed quietly, then let go and leaned over to start the elevator again. It gave a small lurch and began the rest of its journey to the main floor.
He said, “You’re a damn fine doctor. Everyone says so.”
“You did a good job today,” she told him.
The chime sounded and the doors slid open. She stepped out first, into a crowd of lunchtime visitors. “Try to enjoy the rest of your weekend,” she said.
He nodded, his eyes unreadable. “You too.”
She walked away from him then, and away from the hospital, the paperwork, away from the grieving parents who had so graciously already absolved her of wrongdoing—for now anyway. Her other responsibilities were calling: she needed to phone her father and cancel their dinner date, Savannah needed to be picked up from the game Meg had missed, Brian text-messaged her from the golf course, asking her to buy a bottle of Moët for a friend of his who’d just gotten engaged. Self-indulgence, especially with Clay Williams, was a luxury she could not afford.
Twelve
SAVANNAH AND RACHEL SOAKED IN THE POOLSIDE SPA WHILE MEG STOOD at her black granite kitchen counter making a turkey sandwich. The counter was so glossy that she could see her reflection, a tired woman with a deep crease between her brows; she reached up and pressed the crease, stretched her cheeks to erase the scowl. That was better, but she thought she might have the granite changed for something matte; the glossy stuff was obviously meant for Suzy Homemaker types who whistled pleasantly while they mixed and kneaded and dolloped and minced and sautéed, nothing more taxing than making a tasty meal on their minds. A kitchen counter should not remind a woman of her stresses and faults; it was bad enough just to have such a beautiful kitchen in the first place, its underuse a vague but ever-present guilt.
Through the open patio doors she could hear the girls laughing, hear their cell phones ringing every few minutes, while she concentrated on smoothing mayonnaise onto cracked-wheat bread with her right hand. She dipped her knife into the jar, scooped little globs of mayo, spread it easily with the knife’s tip, over and over again without even a hint of weakness. “Son of a bitch,” she said.
When her own cell phone began vibrating in the pocket of her white linen pants, it startled her and she dropped the knife onto the floor. She took the phone from her pocket, saw it was her sister Kara, and answered, her eyes on the knife.
“Hello, sis,” she answered, making her voice normal, as she’d done for the girls when she picked them up. How accomplished she was at pretending.
“Did you see it?” Kara asked.
“Did I see what?”
“The official announcement—Carson’s engagement, what else?”
Kara would be all a-tizz about that. She’d followed Carson’s career and life like a groupie, just as she’d once trailed Meg and Carson over the hills and fields of their farms. “I saw something about it on the CNN website,” Meg said, bending down to get the knife. “Is that what you mean?”
“No, no, not that. The Ocala paper’s got the real official thing.”
“How do you know?” Meg asked, picking up the knife. Kara lived in Northern California now, near Travis Air Force Base where her husband Todd, a master sergeant three years away from retirement, was finishing out his enlistment.
“I read it online—how do you think I keep up with what’s going on back home?” For Kara, who’d had four homes since leaving Florida in 1992, only Ocala would ever be the real thing. She’d told Meg she was trying to talk Todd into going back there when he got out of the service; she wanted to start a plant nursery. She had it all planned out and was certain it would be a hit. Of all the Powell girls, Kara was the most like their father.
“I assumed you were psychic, obviously,” Meg said.
“Oh, I wish! Then I wouldn’t have to ferret out every detail of the kids’ lives. God knows they don’t tell me anything. Well, at least I can read the news—and you really need to see this. You get the paper, right?”
“We do—but I haven’t read it yet.”
“You haven’t read it? Jesus, it’s four-thirty out there—what’ve you been doing all day?”
Kara’s innocent question was an ice pick in Meg’s gut, but she made herself stay calm. “I had a mom in labor all last night and this morning, then Savannah had a softball game this afternoon. I’m just getting a chance to make a sandwich and sit down for five minutes.”
“Well, don’t sit yet—get the paper so you can see this.”
While Meg tracked the paper to the den, where Brian had left it after his cursory glances at the front section and sports, Kara asked how their father was doing.
“Haven’t you talked to him?” Meg said.
“Not in about two weeks. He’s being pissy about us not being able to visit this summer. Screening his calls, I assume. But I know he’s fine or you’d have told me.”
Of course she would think that; gatekeeper of information was Meg’s role, had always been her role. Her parents had left her to mind her sisters, and now her sisters had left her to mind their parents—parent, now—and always, she was to keep everyone informed. “He’s doing okay. Settling in. His left kidney’s acting up.”
“Is he eating right? I swear, he’s so stubborn! What’s the deal with the kidney?”
Meg pulled out the newspaper’s lifestyles section, where the engagement and wedding announcements appeared each weekend. “I’m not sure; I told him to call his nephrologist.”
“There you go with the big words,” Kara teased. She was bright but not college-educated, having married Todd at nineteen, three years after meeting him at Meg’s wedding, where he’d parked cars for a few extra bucks before starting basic training. Four kids—all boys—had followed. Meg hoped Kara would prevail with her desire to come back to Florida; she missed her sister, who had been her closest friend besides Carson. She and Beth were close now too, and she could visit any of her sisters by plane if she could just find the time. Time, however, hid from her as well as Savannah had done in department stores when she was little. Anymore, time stubbornly refused to be found.
Returning to the kitchen, Meg said, “Okay, so I have the paper—lifestyle section, I presume.”
“Open it to page two.”
Meg did, and there was the announcement. “Grammy winner Carson McKay to wed Miss Valerie Haas of Malibu, CA,” read the caption beneath a photographer’s picture of the betrothed couple. Meg closed the paper.
“Well?” Kara said. “Isn’t she just as cute as you can imagine?”
Souvenir Page 6
