Small Great Things (2 page)

Not everything that is faced can be changed. But nothing can be changed until it is faced.

—
J
AMES
B
ALDWIN

T
HE MOST BEAUTIFUL BABY
I
ever saw was born without a face.

From the neck down, he was perfect: ten fingers, ten toes, chubby belly. But where his ear should have been, there was a twist of lips and a single tooth. Instead of a face there was a swirling eddy of skin with no features.

His mother—my patient—was a thirty-year-old gravida 1 para 1 who had received prenatal care including an ultrasound, but the baby had been positioned in a way that the facial deformity hadn't been visible. The spine, the heart, the organs had all looked fine, so no one was expecting this. Maybe for that very reason, she chose to deliver at Mercy–West Haven, our little cottage hospital, and not Yale–New Haven, which is better equipped for emergencies. She came in full term, and labored for sixteen hours before she delivered. The doctor lifted the baby, and there was nothing but silence. Buzzy, white silence.

“Is he all right?” the mother asked, panicking. “Why isn't he crying?”

I had a student nurse shadowing me, and she screamed.

“Get out,” I said tightly, shoving her from the room. Then I took the newborn from the obstetrician and placed him on the warmer, wiping the vernix from his limbs. The OB did a quick exam, silently met my gaze, and turned back to the parents, who by now knew something was terribly wrong. In soft words, the doctor said their child had profound birth defects that were incompatible with life.

On a birth pavilion, Death is a more common patient than you'd think. When we have anencephalies or fetal deaths, we know that the parents still have to bond with and mourn for that baby. This infant—alive, for however long that might be—was still this couple's son.

So I cleaned him and swaddled him, the way I would any other newborn, while the conversation behind me between the parents and the doctor stopped and started like a car choking through the winter.
Why? How? What if you…? How long until…?
Questions no one ever wants to ask, and no one ever wants to answer.

The mother was still crying when I settled the baby in the crook of her elbow. His tiny hands windmilled. She smiled down at him, her heart in her eyes. “Ian,” she whispered. “Ian Michael Barnes.”

She wore an expression I've only seen in paintings in museums, of a love and a grief so fierce that they forged together to create some new, raw emotion.

I turned to the father. “Would you like to hold your son?”

He looked like he was about to be sick. “I can't,” he muttered and bolted from the room.

I followed him, but was intercepted by the nurse in training, who was apologetic and upset. “I'm sorry,” she said. “It's just…it was a
monster
.”

“It
is
a
baby,
” I corrected, and I pushed past her.

I cornered the father in the parents' lounge. “Your wife and your son need you.”

“That's not my son,” he said. “That…thing…”

“Is not going to be on this earth for very long. Which means you'd better give him all the love you had stored up for his lifetime right now.” I waited until he looked me in the eye, and then I turned on my heel. I did not have to glance back to know he was following me.

When we entered the hospital room, his wife was still nuzzling the infant, her lips pressed to the smooth canvas of his brow. I took the tiny bundle from her arms, and handed the baby to her husband. He sucked in his breath and then drew back the blanket from the spot where the baby's face should have been.

I've thought about my actions, you know. If I did the right thing by forcing the father to confront his dying baby, if it was my place as a nurse. Had my supervisor asked me at the time, I would have said that I'd been trained to provide closure for grieving parents. If this man didn't acknowledge that something truly horrible had happened—or worse, if he kept pretending for the rest of his life that it never
had
—a hole would open up inside him. Tiny at first, that pit would wear away, bigger and bigger, until one day when he wasn't expecting it he would realize he was completely hollow.

When the father started to cry, the sobs shook his body, like a hurricane bends a tree. He sank down beside his wife on the hospital bed, and she put one hand on her husband's back and one on the crown of the baby's head.

They took turns holding their son for ten hours. That mother, she even tried to let him nurse. I could not stop staring—not because it was ugly or wrong, but because it was the most remarkable thing I'd ever seen. It felt like looking into the face of the sun: once I turned away, I was blind to everything else.

At one point, I took that stupid nursing student into the room with me, ostensibly to check the mother's vitals, but really to make her see with her own eyes how love has nothing to do with what you're looking at, and everything to do with who's looking.

When the infant died, it was peaceful. We made casts of the newborn's hand and foot for the parents to keep. I heard that this same couple came back two years later and delivered a healthy daughter, though I wasn't on duty when it happened.

It just goes to show you: every baby is born beautiful.

It's what we project on them that makes them ugly.

R
IGHT AFTER
I
gave birth to Edison, seventeen years ago at this very hospital, I wasn't worried about the health of my baby, or how I was going to juggle being a single parent while my husband was overseas, or how my life was going to change now that I was a mother.

I was worried about my hair.

The last thing you're thinking about when you're in labor is what you look like, but if you're like me, it's the first thing that crosses your mind once that baby's come. The sweat that mats the hair of all my white patients to their foreheads instead made my roots curl up and pull away from the scalp. Brushing my hair around my head in a swirl like an ice cream cone and wrapping it in a scarf each night was what kept it straight the next day when I took it down. But what white nurse knew that, or understood that the little complimentary bottle of shampoo provided by the hospital auxiliary league was only going to make my hair even frizzier? I was sure that when my well-meaning colleagues came in to meet Edison, they would be shocked into stupor at the sight of the mess going on atop my head.

In the end, I wound up wrapping it in a towel, and told visitors I'd just had a shower.

I know nurses who work on surgical floors who tell me about men wheeled out of surgery who insist on taping their toupees into place in the recovery room before their spouses join them. And I can't tell you the number of times a patient who has spent the night grunting and screaming and pushing out a baby with her husband at her side will kick her spouse out of the room postdelivery so I can help her put on a pretty nightgown and robe.

I understand the need people have to put a certain face on for the rest of the world. Which is why—when I first arrive for my shift at 6:40
A.M.
—I don't even go into the staff room, where we will shortly receive the night's update from the charge nurse. Instead I slip down the hall to the patient I'd been with yesterday, before my shift ended. Her name was Jessie; she was a tiny little thing who had come into the pavilion looking more like a campaigning First Lady than a woman in active labor: her hair was perfectly coiffed, her face airbrushed with makeup, even her maternity clothes were fitted and stylish. That's a dead giveaway, since by forty weeks of pregnancy most mothers-to-be would be happy to wear a pup tent. I scanned her chart—G1, now P1—and grinned. The last thing I'd said to Jessie before I turned her care over to a colleague and went home for the night was that the next time I saw her, she'd have a baby, and sure enough, I have a new patient. While I've been sleeping, Jessie's delivered a healthy seven-pound, six-ounce girl.

I open the door to find Jessie dozing. The baby lies swaddled in the bassinet beside the bed; Jessie's husband is sprawled in a chair, snoring. Jessie stirs when I walk in, and I immediately put a finger to my lips.
Quiet
.

From my purse, I pull a compact mirror and a red lipstick.

Part of labor is conversation; it's the distraction that makes the pain ebb and it's the glue that bonds a nurse to her patient. What other situation can you think of where one medical professional spends up to twelve hours consulting with a single person? As a result, the connection we build with these women is fierce and fast. I know things about them, in a mere matter of hours, that their own closest friends don't always know: how she met her partner at a bar when she'd had too much to drink; how her father didn't live long enough to see this grandchild; how she worries about being a mom because she hated babysitting as a teenager. Last night, in the dragon hours of Jessie's labor, when she was teary and exhausted and snapping at her husband, I'd suggested that he go to the cafeteria to get a cup of coffee. As soon as he left, the air in the room was easier to breathe, and she fell back against those awful plastic pillows we have in the birthing pavilion. “What if this baby changes everything?” she sobbed. She confessed that she never went anywhere without her “game face” on, that her husband had never even seen her without mascara; and now here he was watching her body contort itself inside out, and how would he ever look at her the same way again?

Listen,
I had told her.
You let
me
worry about that.

I'd like to think my taking that one straw off her back was what gave her the strength to make it to transition.

It's funny. When I tell people I've been a labor and delivery nurse for more than twenty years, they're impressed by the fact that I have assisted in cesareans, that I can start an IV in my sleep, that I can tell the difference between a decel in the fetal heart rate that is normal and one that requires intervention. But for me, being an L & D nurse is all about knowing your patient, and what she needs. A back rub. An epidural. A little Maybelline.

Jessie glances at her husband, still dead to the world. Then she takes the lipstick from my hand. “Thank you,” she whispers, and our eyes connect. I hold the mirror as she once again reinvents herself.

O
N
T
HURSDAYS, MY
shift goes from 7:00
A.M.
till 7:00
P.M
. At Mercy–West Haven, during the day, we usually have two nurses on the birthing pavilion—three if we're swimming in human resources that day. As I walk through the pavilion, I note idly how many of our delivery suites are occupied—it's three, right now, a nice slow start to the day. Marie, the charge nurse, is already in the room where we have our morning meeting when I come inside, but Corinne—the second nurse on shift with me—is missing. “What's it going to be today?” Marie asks, as she flips through the morning paper.

“Flat tire,” I reply. This guessing game is a routine:
What excuse will Corinne use today for being late?
It's a beautiful fall day in October, so she can't blame the weather.

“That was last week. I'm going with the flu.”

“Speaking of which,” I say. “How's Ella?” Marie's eight-year-old had caught the stomach bug that's been going around.

“Back in school today, thank God,” Marie replies. “Now Dave's got it. I figure I have twenty-four hours before I'm down for the count.” She looks up from the Regional section of the paper. “I saw Edison's name in here again,” she says.

My son has made the Highest Honors list for every semester of his high school career. But just like I tell him, that's no reason to boast. “There are a lot of bright kids in this town,” I demur.

“Still,” Marie says. “For a boy like Edison to be so successful…well. You should be proud, is all. I can only hope Ella turns out to be that good a student.”