by Joanna Coles
I dutifully examine the various exhibits and wallcharts on fertilization and chromosomes until I reach a dummy of a pregnant women clad in a loose hospital smock, sitting in the gynaecologist’s chair with her legs spread wide in the chrome stirrups. The wallchart explains the basics of the gynae’s trade. No one else is in the room and I feel a little odd, as though I have burst in on this most intimate of examinations. The entire focus of the exhibit lies concealed beneath the folds of the white smock, and I can’t help wondering whether, like the rest of the exhibits, this one too is a ‘working model’. I sidle closer to the dummy patient intending to flip up the hem to satisfy my curiosity when suddenly there is a great roar all around me and I am surrounded by a posse of particularly aggressive schoolkids. I retreat and soon they are chanting, ‘Ged-em-off! Ged-em-off!’ and they peel back the smock themselves to examine the dummy’s genitals. But an immediate groan of disappointment goes up and they roar off to the next room.
I am left alone in the room once more. Just me and the gynaecologist’s dummy, with its smock now up over its head to reveal the source of their disappointment – a smooth, plastic, genital-free crotch. It feels wrong to leave the dummy in this desecrated position so I move in to pull the smock down again and make her decent. Just as my fingers close around the hem, I hear a gasp. It is Joanna’s mother. She quickly moves away and I suspect she thinks I’ve been interfering with the dummy.
Hanging on a peg on the wall is a strange white cotton suit of some sort. I walk over to the panel, which explains its use. It is a pregnancy suit, which simulates the feel of being heavily pregnant. There is no one around so I quickly slip it on and Velcro myself into it. I walk about briskly to get the feel of it, and then, growing in confidence, I bend to try and touch my toes. Immediately I feel a small twinge of pain in my lower back.
I feel their presence before I hear them. The school party has returned. They are soon dancing around me, jeering and poking me in my false belly as I struggle out of my pregnancy.
Monday, 20 July
Joanna
Now in my third month, I am always hungry and, though eager to order in supper, am still working out my position in the Great Sushi Debate. Since arriving in New York we have eaten sushi take-out on average three times a week.
No one cooks in New York. It wasn’t until British friends came to stay, several months after we had moved here, that we first opened our oven door. And that was only because they had offered to cook Sunday lunch. My friend Meredith, who has an acute storage space crisis in her small apartment, uses her pristine oven to store her jumpers.
But sushi, comprising as it does almost entirely raw fish, presents a problem for the pregnant. According to the American pregnancy bible, What to Expect When You’re Expecting, sushi is ‘completely taboo’. But this, though widely read, is a mean-spirited tome whose advice on how expectant mothers should treat themselves includes this: ‘Before you close your mouth on a forkful of food consider “Is this the best I can give my baby?” If it will benefit only your sweet tooth or appease your appetite, put your fork down.’
I am thinking of mutinying against What to Expect When You’re Expecting, as it seems to suggest one can only expect bad things pretty much throughout the pregnancy, so I call Dr Levy and ask his advice.
‘You can eat everything,’ he assures me. ‘Just do it in moderate amounts.’
‘Even sushi?’
‘Well,’ he hesitates slightly, probably weighing up the legal repercussions if he gets it wrong. ‘I’d say probably no more than once a month.’
I call Helen, a writer friend, to ask her advice. Now on her second pregnancy, she is significantly more relaxed than I am and I was impressed to see her tucking into a large bowl of clams last week – another food strictly verboten by What to Expect When You’re Expecting. She laughs and assures me her doctor has told her she can eat as much sushi as she likes. ‘After all, Japanese women do,’ she says.
‘Well, Japanese women eat it all the time when they’re pregnant,’ I retort, when Peter protests at my suggestion of calling Sakura with our regular sushi order.
‘Well, it’s up to you,’ he says, ‘but imagine how awful you’d feel if you miscarried because of a piece of raw squid.’
I concede grudgingly and call our regular order in to Mama Buddha, our local Chinese, instead.
Wednesday, 22 July
Peter
I accompany Joanna to her amniocentesis tests under some protest and we are both squeezed into Jeannette Patrazzi’s little office, high above Third Avenue on 17th Street. The notice on her door describes Ms Patrazzi as a Genetic Counsellor – an entirely alien concept to me – but then New Yorkers have counsellors for most things, so why not genetics?
She sits us down to interrogate both of us in turn about our families’ medical histories, searching for any signs of inherited diseases. On her clipboard, with all the speed of a pavement artist, her pen flashes out our genetic heritage. It is a macabre family tree that is devised by cause of death. She quizzes us about our ethnic backgrounds with all the finesse of a Nazi purist, but explains that this is necessary because you can run but you can’t hide from your genetic history. It will always catch up with you.
Each ethnic group, she explains, has its own special genetic booby trap, the downside of otherwise useful environmental mutations. Blacks have a hereditary predisposition for sickle cell anaemia (a condition causing severe organ damage and blocked blood flow) which is associated with heightened resistance to malaria. Ashkenazi Jews have a 1:200 chance of carrying the gene for Tay-Sachs disease, which is otherwise associated with resistance to TB, ‘a serious killer in the East European ghettos’, Ms Patrazzi reminds us. ‘Babies with Tay-Sachs don’t live beyond the age of three. They suffer from mental retardation, paralysis, dementia, blindness and cherry red spots on the retina.’
Caucasians’ genetic cross to bear is cystic fibrosis, which causes abnormal secretions in the pancreas and trachea. Eventually, she goes on, infected bronchial secretions can block the lungs and can often lead to death.
When bombarded with the concentrated treatise of what may be wrong with our baby, it seems to me amazing that anyone ever gives birth to a normal baby. With my tendency to gloomy outlooks, I naturally become convinced that we cannot escape one of the thousands of cunning inherited diseases, each a deadly reef around which our genes must navigate.
Over tea later I am skimming idly through the New York Observer when I spot a full-page ad for Sloan-Kettering Hospital. It features a collage of sepia snapshots from a family album. A beaming baby romps in the foreground. Underneath the copy reads: ‘You’ve got your father’s eyes and your mother’s sense of humour. But how do you know you won’t get your grandfather’s cancer?’
Wednesday, 22 July
Joanna
The actual amnio is booked at Beth Israel tomorrow, on condition we attend a ‘genetic workshop’ at the hospital today.
Our counsellor introduces herself as Elena. ‘Now the first thing to remember is that amnio is optional,’ she smiles, sizing us up. There are four of us altogether, me and Peter – the sole man; a homely looking black woman in an African print dress called Rita, and a large, dark-haired woman with fuchsia lips so startling in her whey-faced complexion that I can’t stop sneaking glances at them.
‘You’re probably wondering what actually happens,’ says Elena. ‘We find the pocket of fluid known as the amniotic sac and extract some fluid with a needle. Ultrasound is used as a guide, so we don’t hit the baby, and I should tell you to bring a bottle of water with you because a full bladder tilts the uterus and makes the ultrasound easier.’
‘Last time I had an ultrasound’, interrupts whey-face, ‘they told me to drink eight cups of water in fifteen minutes. I told them they were going to have an accident on their hands!’
‘Eight cups?’ exclaims Elena. ‘I think they meant eight ounces.’
‘Well, they said eight cups,’ whey-face insists def
ensively.
‘Well, for amnio’, Elena giggles, ‘one glass is just fine.’
‘Does it hurt?’ demands Rita.
‘No, an anaesthetic is not necessary, the abdomen doesn’t have many pain receptors, it is mostly fatty tissue.’
We all nod in unison.
‘Excuse me, but did you just say the baby is bathing in its urine?’ interrupts Peter.
‘Yes,’ says Elena patiently. ‘And drinking it.’
‘Oh, gross,’ says whey-face, discreetly unwrapping a boiled sweet, smuggling it to her lips and disguising the whole action with a cough.
‘Maybe Sarah Miles is right,’ whispers Peter.
Holding up a sheet headed ‘Chromosome Abnormalities in Live Births’, Elena battles on, explaining how the baby’s cells are extracted from the amniotic fluid and cultured to see if all is well.
‘Now, let’s look at what might go wrong with the actual process,’ she says gingerly, glancing round to check we’re all still listening. I am frantically taking notes, Peter looks mildly embarrassed, Rita appears alarmed and whey-face, arms crossed belligerently, has mentally checked out from the whole process.
‘One in two hundred experiences a complication, though that’s a national figure, and here the risk is probably lower,’ Elena continues. I jot this down, vaguely aware this doesn’t tally with my doctor’s figure. ‘It’s very rare, but the baby might be too active, in which case we would stop. And if the uterus is contracting, they may have to insert the needle twice.’
There’s a scraping noise as Rita pushes her chair back and drops her head between her knees, moaning. Elena passes her a bottle of water. ‘If the baby moves towards the needle they remove it immediately. Or the needle may get stuck.
‘Any time a chromosome is missing there’s going to be mental retardation,’ she adds soberly. ‘Down’s syndrome occurs when there are three number twenty-one chromosomes. The legal limit for abortion in New York State is twenty-four weeks,’ she concludes. ‘We will support you whatever your decision.’
Of the three women I am the only one to go ahead and confirm my appointment for the next day. The other two both refuse to sign the consent form. ‘It’s selective breeding,’ says whey-face, pursing her strange lips before commanding Elena to cancel her appointment and stalking out.
‘Even if there is something wrong I couldn’t have a termination,’ says Rita, waving at her husband who has just arrived and is mouthing apologies through the glass door.
Thursday, 23 July
Peter
Joanna, true to her tendency to do things to excess, has followed the pre-amnio instructions too literally. Her sheet has told her to present herself with a full bladder. So at the Blue Water Grill on Union Square, where we treat ourselves to lunch, she absorbs most of a litre bottle of San Pellegrino, followed by a cup of mint tea. When the grainy sonogram takes shape on the TV screen above the examining couch, the obstetrician is taken aback.
‘My God,’ he gasps, ‘that’s one full bladder. I’m surprised there’s room for the baby in there.’
Joanna is mortified. She is sent out to relieve herself and returns chastened.
The grainy image is back on the screen as the doctor runs the sonogram wand over her stomach.
‘Ah, that’s better. Do you want to know the sex?’ he asks.
‘No!’ says Joanna vehemently.
Personally, I would rather like to know so that I can mentally prepare myself. And also so that I can refer to it as ‘he’ or ‘she’ rather than ‘it’. But Joanna has read somewhere that knowing the sex beforehand increases the chance of post-natal depression by ruining the surprise of the birth. I would imagine that the birth itself is quite exciting enough without needing the supporting act of the gender lottery.
The flickering sonogram continues for a few minutes, its image updating every few seconds while both doctors stare intently at it. They appear to see something noteworthy and swap what look like meaningful glances.
Everything is now ready for the amnio itself. Joanna squinches her eyes shut in anticipation. I am sitting at the bedhead, peeping around the curtain. I swallow dryly at the ghastly sight of the other doctor fitting a foot-long needle to a big plastic syringe. He looks like a rifleman affixing his bayonet for an infantry charge. He approaches the tight little dome of Joanna’s stomach with his gleaming spike and lifts it up to gain momentum for the downward stab. Joanna’s belly looks as if it will pop like a party balloon. I feel rather woozy. The doctor glances up at the overhead screen to correct his aim, so that the needle will plunge into the amniotic fluid and not into the baby’s tiny body. I think I am going to pass out. I imagine myself falling forward on to the theatre of operations and knocking the doctor off his aim, causing him to stab our baby.
As the point of the needle punctures the pale taut flesh my eyes close involuntarily for a second and I fall back heavily in my chair, exhaling loudly. When I look again the large plastic syringe is filling up with a liquid that appears to be diluted urine. It is agonizingly slow, but Joanna’s eyes are still safely closed and she does not appear to be in any particular pain. Finally the plastic chamber is full, and the doctor withdraws the needle in a swift clean motion and dabs the entry wound with a cotton-wool swab.
With all the bogus bravado of the coward, I find myself enquiring nonchalantly about the technical details of the amniotic fluid. It is in fact urine, explains the doctor. He confirms that the foetus drinks and excretes it. We begin our lives drinking urine. And for that matter we spend nine months suspended in a sac of piss. It does not seem to be a particularly elegant way to arrive on this earth.
Somehow I know, even before the door is closed, that the cab ride home will be the ride from hell. The traffic is flowing strongly up Third Avenue, but even before Joanna is strapped in, the driver hurls the vehicle into the fray with only the merest flick of a derisive glance in his mirror. I lean forward, all fatherly concern.
‘My wife’, I explain, ‘has just had a big operation. She is still very sick. Can you drive slowly, slowly.’ He ignores me completely and turns up the Middle Eastern disco muezzin music. We begin one of those co-ordinated red-light crossings that can happen in New York if the timing is wrong. On the fourth early red he is forced to concede to a bus.
In my early days in New York I too was an exuberantly reckless cab passenger, never giving the seat-belt a second glance and urging my drivers to ever greater speeds. But, as well as Joanna’s delicate condition, there is another factor which has converted me to the cause of safe cabbing. I have recently read a piece in the New York Times Metro Section that said that no tests have ever been conducted on the safety of the New York cab.
The problem is not with the vehicle itself. This model has been extensively tested at General Motors’ crash labs. But when it arrives in Queens some contractor whacks in an armoured Plexiglass screen. No crash-test dummy has ever been put through its paces with this thick translucent husk. In the event of a crash, the human passenger’s head smashes against a screen whose overriding design requirement is to stop the bullet from a handgun at close quarters. Terrible things happen to the human face when it is in unimpeded collision with such a material.
‘Please?’ I implore. ‘We are not in a hurry.’ I look at his New York cab licence photo, which by New York City law must be displayed in full view of the passenger. It shows a surly man, who bears an uncanny resemblance to the World Trade Center bomber. His name is Ahmet Dalliwhal, and he has, I imagine, probably picked up his driving skills on the Karachi turnpike, the most fatality-strewn stretch of road in the short but violent history of fossil fuels.
‘Please, Ahmet,’ I implore. Using their actual names is a trick that sometimes works for me, it somehow bursts through the thick cocoon of rudeness they learn at cabbie school. ‘Ahmet, you go slow?’
He looks at me in the mirror with complete incomprehension and not a little disdain.
‘Oh, leave it,’ says Joanna crossly, scooting rig
ht down in her seat for safety.
Thursday, 23 July
Joanna
I decide to take the doctor’s advice of bedrest seriously and retire with the cordless and my address book to make some calls. I ring David Usborne, my usually chipper rival on the Independent, to quiz him for gossip.
‘I feel dreadful,’ he says. ‘I’ve got a hangover and last night I was refused entry after waiting half an hour in line at Mother, that night club round the corner from you.’
‘Why?’ I ask, envisaging perhaps a fight.
‘It’s SO humiliating I can hardly bear to tell you,’ he groans. ‘It was because I was wearing a cardigan.’
Friday, 24 July
Peter
Not normally given to great acts of solicitousness, I am overly attentive to Joanna, treating her as though she is an invalid or a patient who has just undergone major surgery. Whatever the risks, Joanna evidently finds my behaviour irritating. She makes it clear that she isn’t interested in me talking-the-talk. She wants me to walk-the-walk. This, she makes clear, entails delivery of tea and any other required refreshments to her bedside, a general lack of personal criticism for the foreseeable future and uninterrupted possession of the TV remote control. If I comply in these, and various other ways that may make themselves known to her in due course, I will be able to prevent her from some terrible side-effect.
