The Middle of the Night – Complete

Vasser sat at the front desk, feeding another chart, sheet by sheet, onto the patient’s green plastic ID card in the beige stamping tool.

“Whoosh – clomp – ca-chunk. Whoosh – clomp – ca-chunk.”  Vasser’s left hand melded with the handle she deployed to emboss each patient’s particulars into the lower right corner of every page. On one side of her desk sat a pile of blank charts all collated and ready for the ten or so patients expected to roll onto 5L during her 11 PM to 7 AM graveyard shift.

“That the Red Blanket?” I asked as I walked by, pausing to glance at the white board behind her, checking if I had another admission while I was delivering Maria, the shoulder dystocia.

Vasser paused mid-clomp, gave a little shake to her curly, unkempt dirty blond hair, and resumed her feverish chart creation. Grabbing another page, she turned away from me and looked at the stapled sheaf of papers, rumpled from the elevator ride on the bed with Maria, saying in her sing-song voice, “Maria Garcia.” She glanced at the whiteboard behind her.”  Dr. Truscott.” She resumed the tedium of admitting another new mother to our hospital without further acknowledgement of my presence.

I sank into a rolling chair at a little desk built into the alcove across from her. A clock on the wall started to hum, clicked once, then again as the hour and minute hands lined straight up together. Midnight. Sixteen hours into my 24-hour shift on 5L, nearing the end of my third of six months on Labor and Delivery scattered throughout the first year of my Ob-Gyn residency.

            Why hadn’t I seen this girl, this GN, Cheryl Hanna, before? She knew her way around the delivery room, it clearly wasn’t her first night on the job. Had I been so wrapped up in the continual effort of becoming a doctor that I had dropped all awareness of anyone around me, seeing others merely for how they could help or hinder the eighty hours of work loaded on me each week?

            As I waited for Vasser to finish my chart, a bed rumbled by on my right, followed by the nurse – my nurse – who’d helped in that shoulder dystocia. Turning the corner towards the post-partum room, she glanced back at me, subliminally acknowledging my presence. I began to fill out the forms from the chart Vasser brought over.

            A minute later, a creamy arm, lightly tinged with tan, reached out, palm up, while a quiet, almost laughing voice asked, “Can I have my part, please?”

            Looking up, once again a smiling face caught me, this time unencumbered by a mask. Blue eyes held mine, and I sensed a tug inside between stolid immobility and warm engagement. Maybe it was the late hour, lack of sleep, but instead of handing them over without a word – the standard interaction between me and any woman my age those days – I said, “So, why? Why do you want to be a midwife?”

            I picked out the nursing sheets, tapped them on the desk to even the corners, and kept them close to my chest. Cheryl blinked twice, waiting. Grayer appeared from the hall leading to the labor rooms, officiously announcing, “Miss Hanna! You’ve a new admit in C. And post-partum needs Garcia’s chart.” Her eyes flitted between the two of us who remained transfixed at the desk. I sighed, and handed the papers over to Cheryl.

            I headed to the small break room adjacent to the lab where we’d first met, hoping the look on my face served as a beacon, a lighthouse warning of Grayer’s advance, yet showing the safe route around the shoals.

            Opening the half-fridge, I yanked out a plastic cup of orange juice, meant for diabetic patients in hypo-glycemic crisis, ripped off the aluminum foil seal, and slurped the contents in one gulp. My forearms shivered while a cold electric pulse shot up my spine and down my legs. My hands shook a bit as I tossed the cup towards an open trash can, causing me to miss wide left. Obstetric emergencies no longer fazed me; I could rescue a fading baby in under ten minutes from the time I called an emergency C-Section. Something else, not the shoulder dystocia, had sapped my strength. The shot of orange juice revived my mind, but still I felt cold. I clenched my teeth, and sat down, steeling myself for the next crisis sure to come my way sometime in the next seven hours.

            I breathed slowly, my thoughts drifting. I glanced at the bulletin board, and noticed something new amongst the baby pictures and tired cartoon strips: a of map Mexico. A swath of colored pins covered the area below the US border, in Baja California, Sonora, and Chihuahua. I walked over to the map, bent down and squinted, wondering what they all meant. 

“I think the other nurses don’t like that,” I heard behind me. The inner shivers started up again.

            “Huh?” I managed, turning round to the door, seeing Cheryl once again, smiling at me.

            “I ask all my patients where they’re from, then I put a pin there. I get the feeling the staff here, the ones who’ve been around forever, don’t like all these ladies coming over to have their babies.”

            I raised one side of my mouth, a half-hearted returning smile. My eyes crinkled, and I shook my head several times. “Why? Who cares?”

            “Well, I’m interested in finding out. They’ve all got a story, all these patients. Everybody else sees them as an imposition, not a person – the Eclamptic. The Footling Breech. You know? The other interns make fun of them, the residents ignore them as people. And the nurses – the nurses act like these women have stolen something.”

            “Why’d you do that, stick those pins in?”

            “I don’t know, I’m interested in that kind of stuff.” She paused, waiting. When I said nothing, she went on, “I was an Anthropology major.”

            “Where? When?”

            “UC Santa Barbara. I graduated four years ago.”

            “1971?”

            “Uh-huh.” Her smile turned dreamy as she nodded affirmation.

            “So you’re what, 25?”

            Another nod. “April 11.”

            “No! My birthday’s April 9th! 1949, right?”

            She checked at her watch. “I’m on break now, 15 minutes. Want to go down to the cafeteria, see if we can find something?”

            “It’s closed at 10, you know.”

            “Yeah, but sometimes they leave stuff out.”

            “Or you can sneak into the coolers, get some pudding.”

            The Women’s Hospital cafeteria occupied the first basement, along with the lab. We took the service elevator, sharing the car with bundle of soiled linens, headed for the sub-basement laundry. Cheryl wrinkled her nose at the foul cargo. At this late hour, we had an express trip covering six floors without a stop.

            Florescent lights popped and flickered overhead, and our blue shoe covers added a scratchy refrain reflecting off the green concrete walls. The sliding gate protecting the cafeteria remained open wide enough to allow only one of us to slither in  at a time. I headed straight for the cooler, and grabbed two bowls of wriggly chocolate pudding while Cheryl fiddled with the coffee urn.

            Glancing my way, she raised a white ceramic cup, questioning with her eyes.

            “Nope, never drink it. All it does is wake me up,” I said. She giggled, pouring herself some over two heaping spoonful’s of sugar.

            “Any milk in there?” she asked. I grabbed a pint carton, the top already folded open. “So, an OB who doesn’t like coffee?”

            “Yeah, never got into it. Everybody else needed it to stay awake at night to study. I wake up at 6 naturally, and did all my studying early, before classes. In the evenings, I’d go around to people’s rooms and bother them.”

            “Where did you go to college?” We pulled out two round-bottomed chairs, the aluminum feet scraping a loud echo across the floor of the empty room.

            “In Connecticut. Wesleyan.”

            “How’d you get out here?”

            “The only medical schools I got into were USC and University of Cincinnati. I grew up there, and didn’t want to go back, I guess. Besides, if I was going to spend eight hours a day in class, then study all night, I thought it would be a good deal if it were always nice when I did go outside.”

            She nodded, stirring some milk into her coffee. I pulled the Saran Wrap off the bowls of pudding, and slid one over to her. The space between us narrowed, and I felt a warmth start to fill the cavernous room. “So did you always want to be a doctor?”

            “Well, not always, of course. When I was a kid, I planned to be a baseball player in the summer and a mountain climber in the winter. But when I was fifteen, one day in the spring I was sitting on the diving board by our pool, and thought about what I should do ‘when I grow up.’ My mother’d always told me I could do, could be anything I wanted, and I was still young enough to believe her, so I ticked through a lot of things, and decided to be a doctor.”

            Cheryl stayed quiet while I paused, so I went on. “I wanted to deal with people with no artificial barriers between us – just me and them, helping take care of the one thing they really have, their body.”

            “But why OB?”

            “I went to medical school thinking I wanted to be a psychiatrist. But during the first summer, I worked in a child psych clinic here, and realised I didn’t want to sit on my rear end eight hours a day listening to people tell me how bad the world is. In the fall of my third year, the first night on my OB rotation,” here I looked up, toward the now unseen melee in 5L, “I fell in love with it. Bam, just like that. Women came in, labor progressed, babies came out. It was exciting, and things mostly go well, not like other parts of medicine. I wanted to be around that more, I guess.”

            Cheryl fixated on her coffee, so I added, “The more I do it, the more I learned, being born, it’s the one thing we all have in common, the most human thing there is.”

            Cheryl raised her head, solemnly looked at me, and said, “Mothers. We all have a mother. That’s what I like about it, why I want to be a midwife. It’s where I can help change the world, getting mothers and their babies off to a good start in life. What could be more important?”

            While she talked, I noticed a familiar. When I did that first night on OB. When my father took me on my first ride up a chair lift, and down a ski slope on Dollar Mountain at Sun Valley. When I won my first ribbon in a swim meet, coming in second place. My face softened as I took in her sincerity.

            “I’ve gotta go back,” she said, setting down her half-empty coffee cup. “Grayer’ll kill me if I’m not on time.”

            I followed her to the elevator, waiting open for us. Once inside, she“5”, and I found myself asking, “Listen, maybe we should go out after work sometime? Did you ever see The Godfather? Part 2 came out last week…” I clenched my jaw, wondering where that had come from. Not me, at least not the cautious, introverted left side of my brain. Something, someone else had spoken.

            As the doors slid open, she turned and said, “Sure. I’ll see you at 7:30, when I’m off? We can talk then?”

ii

            Seven to eight in the morning, chaos rules in the County Hospital labor and delivery unit. Tension builds during the pre-dawn of six AM – the most common hour for women to deliver. Something to do with the evolutionary advantage of having a full day following birth in which to care for a vulnerable newborn? That traffic jam spills over into the next hour, when exhausted nurses, whose night ends at 7:30, are relieved by their counterparts coming in at seven. An intern would often start a delivery with one nurse, and, mid-maneuver, turn round to greet a new face, who knew next to nothing about the patient in their care. The doctors had no such relief, despite the next group appearing at eight AM. Whatever we started, we finished, sleep-deprived thought we might be.

            Luckily, I found myself with no laboring patients after Maria Garcia, and hustled upstairs to finish my morning. Without changing out of my scrubs, I shot down to the cafeteria, where I grabbed a tray and slid it onto the rails, bypassing the eggs, lumpy dried-out oatmeal, and coffee mugs, settling in front of the collection of cereal boxes. Disdaining the opportunity to simply slit open the Raisin Bran along the perforations dissecting the smiling sun-face on its cover, I grabbed a white ceramic bowl, adorned with a simple green line encircling the outward flowing rim. After a night on call, I needed a simulacrum of luxury, a cut above pouring milk into a cardboard box lined with wax paper. Onto my tray went an open carton of milk, a sealed cup of orange juice, and a glass to complete the illusion of being treated well.

            Turning round, anticipating falling into a chair in an isolated corner behind one of the faded yellow concrete pillars, stained from decades of soup spills and gravy accidents, I caught a colorful flash to my right. At first glance, I couldn’t be sure, but a second look at the straight blond, sun-bleached hair spreading half-way down her back, and I knew that nurse from the shoulder dystocia sat there. My brain mis-fired, counter-manding its own orders to seek solitude. Twenty-four sleepless hours had decimated my defenses against that smile. Hoping to see it again, I found myself walking to her table.

            “Thanks,” I said, still holding my tray.

            She looked up, boggy-eyed, not smiling anymore. “Huh?” she said.

            “That shoulder dystocia, helping me out.”

            “Oh, yeah…” She appeared dispirited. I no longer felt like a hero. “They took it down,” she went on.

            I waited, still standing, wondering if I should sit and talk, hear her out. The memory of her smile kept me rooted.

            “My map, the one of Mexico, where I pinned the towns the patients come from. Someone tore it down, crumpled it into the trash.”

            “Aw, that’s not fair,” I returned.

            “No. Having babies, that’s supposed to be a good thing. When I was a little girl, like three or four, I played with dolls, tell them I loved them, imagine having one, a real baby, for myself.” She shook her head slightly, while I sat down. “Then, my mother was pregnant with my brother, when I was about six. I pretended I was pregnant, too, stuff pillows under my shirt and waddle around like her.” Still watching her, I ripped open the top off the Raisin Bran, poured it into the bowl, added a second box, and drowned the flakes with milk. “I always wanted babies, I guess, always fascinated by birth.”

            “What do you mean?” I managed between slurps of soggy cereal.

            “In middle school, my father helped me once with a science project, Chick embryos. We went to a store, got some fertilized eggs. They sold them by the day of fertilization or something. We bought about twenty, to cover the three weeks until they hatch. I broke them open, and my dad took pictures of the little babies.”

            “Wow, that must have been a big hit.”

            “Well, no, this was Brentwood. There was another kid, Yasha. He was a little genius. He did his project with little windows in the eggs, so you could seem them inside, still growing.”

            I mumbled understanding, hoping no milk dribbled from my mouth while I nodded.

            “Later, in high school, I worked at my father’s hospital, Santa Monica. I had a job, ‘X-Ray tech assistant’ one summer.” I raised my eyebrows while she went on. “All sorts of stuff I did. Like aiming beams at lines doctors had drawn for cobalt therapy.” She started smiling with the memory. “There was this one time, I took a little old lady down. She was all wrinkled, with caked-on make-up and lipstick put on crooked. While I rolled her wheel chair into the elevator, she cackled, “I’m OK. Just give me some whiskey and I’ll be fine!’”

            I almost snorted out some cereal as I laughed at the image. “Yeah,” I said.

            “But the thing about it I liked, my favorite part, was taking someone down from labor and delivery. They’d order a fetogram, to look for a breech baby, you know.”

            “Is that when you decided to be a mid-wife?”

            “No, that came later, after college.” Her furrowed brow turned serious again. Sighing, she said, “After college…”

            “Santa Barbara,” I said.

            “Yeah, I got home from Isla Vista, and didn’t know what I wanted, what I should do…” Again she faded, her inner glow turned dark. “Um, I was in my parent’s house, listening to the radio and playing in my father’s darkroom. My sister was going to nursing school, one day we were talking. She told me about the new bio-psycho-social model. Incorporating a person’s family, life situation, culture. I was an Anthropology major at UCSB and that attracted me . I didn’t want to empty bed pans, like our mother did. Almost as an after thought, she said, ‘You know, there’s midwives.’ Nurse-midwives, she said. And instantly I knew, I knew that’s what I could, what I had to do.”

            “Why?”

            “I could see myself going to some island, maybe in the Caribbean, living on the beach, helping women have their babies there. Maybe have one of my own.” She arranged her tray, getting ready to leave.

            “Wait,” I said. “Wait…we’re going to a movie remember?”

            She cocked her head. “Oh yeah. What was it?”

            “Godfather. Part 2. Supposed to be better than the first one.”

            “I never saw it,” she said, fiddling with her silverware. 

            “When should we go?” Determination drove me forward. “How’s it gonna work, if you’re on nights?”

            “I’m starting six weeks of days?”

            “So we could go on Saturday, then?”

            “Saturday, tomorrow?” She looked up. Her face carried a mixture of exhaustion and apprehension. Maybe this wasn’t going to work out. She’d seemed so friendly a minute ago, talking about midwifery, delivering babies on the beach.

            “Sure.” I tried to make it sound natural, something we always did. “Where do you live? It’s playing all over. We can go somewhere to eat first. I’m in Alhambra, I have the day off, so I can drive anywhere, you know.” I saw myself dancing around, an eager puppy begging for a treat.

            “I don’t know, My place is out in Venice. At the beach. That’s a long way…”

            “It’s no problem, come out on the Santa Monica, maybe see it in Westwood. All right? You’re off at, what, 3:30, I can get you at five?

            She looked at a little silver watch, loosely flapping on her wrist. Spinning it several times around, she clicked her thumb nail against her index fingertip. She glanced up at two other interns, down from 5L. One nodded briefly; she didn’t respond. Turning to me, she said, “43 Breeze. You know how to get there?”

            “I’ve got a Thomas map book. I can figure it out.”

            “No, it’s not a street. Venice has these walkways. You’ll have to…”

            “Don’t worry,” I insisted. “Take my number.”

            She pulled a pen from her shirt pocket, and scribbled the seven digits on the pant leg of her scrub suit, a habit we all had from taking notes on the fly. As she left, one of the flickering fluorescent tubes went dead, and the room grew darker.

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