I woke up to the shrill bells of my cell phone, smacked the nightstand in the dark, and grabbed the first phone-shaped object my fingers landed on.
I squinted at my bedside alarm clock and tried to make sense of the fuzzy numbers blinking red. It was 5 a.m.
“Mmhm?” I said, my eyes still closed.
“Hey, babe.”
My husband, James, was en route to another hospital visit. As the assistant pastor of our local church, every Wednesday he had the task of attending the surgeries of church members. He’d be there to pray, hold a nervous hand, and try to ease the way. Chemotherapy doses, hip replacements, and the like were all handled at our very capable local hospital. The more complex procedures, for heart patients in particular, fell to the specialized physicians of Riverside Hospital in Columbus, over an hour away, where he was headed now. The night before, he’d warned me he might have to call if he got tired on the road. Procedures are always scheduled at unholy hours of the morning, and he’d have to leave by 4:30 a.m. to get there in time.
“Tired?” I asked.
“Yeah. It’s so dark out. Sorry,” he said.
“No, it’s OK. I was only half-sleeping anyway. This baby’s all over the place. It’s like a soccer game in my stomach,” I said. I pulled the bed sheets up to my chin, lifted my swollen belly, and changed sides. I pressed down with my hand and tried to calm him, to still him.
“What?” he said.
“I said it feels like a soccer game in my stomach. This kid is going crazy.” I held the phone with my shoulder and covered my mouth to stifle a yawn.
It was apparent to me from the very first flutters that we had an active baby. He was our first child—so what did I know really?—but he seemed full of energy to me. Then flutters gave way to nudges, which gave way to wholly formed joints pressed hard against tender flesh, and then finally the tumbling vertigo of an entire body turned upside down in a single moment.
“I think we’re really in for it,” I said when people asked how the pregnancy was going. “He’s going to be a little James. Always busy. Always moving.”
I tried to focus on what my husband was saying, to make idle conversation and ignore the frenzy of activity in my stomach, but it was difficult. He was a busy little baby, to be sure, but this was ridiculous.
***
It was the fall of 2003, and I was a half-hearted accountant. Everyone seems to be born with at least one thing they’re good at; accounting is not mine. I worked part-time for a manufacturing company filled with cubicles and stoic faces.
Crisp October leaves brushed against square-paned windows as I made my way to my own gray square that morning, smiling and greeting as I went, past Nora watering her plants and Eva, who had almost certainly come in hours ago to get a head start and was already elbow-deep in spreadsheets.
I settled into my straight-backed chair and stared at the mountain of receipts in front of me. The day hadn’t even started, and I was already behind. I yawned, still groggy from the early-morning phone call. I was almost certain I could enter receipts with my eyes closed. Instead, I promised myself I’d sleep during lunch.
Christy from payroll stopped by my desk to ask how I was feeling and how the baby was doing. I rubbed my stomach and realized I’d not thought about him yet. He usually kicked the most in the morning, but I hadn’t noticed anything so far.
“Grab a cappuccino,” she suggested. “He’ll perk right up.”
“Yeah, you’re right.” I grabbed my purse to scavenge for loose change and made my way to the break room. I smiled at coworkers as I passed, but fear traveled like lightning through my veins, pooling in my gut.
I inserted some coins, placed the paper cup under the spout, and selected a large vanilla cappuccino. I hadn’t been drinking much caffeine since becoming pregnant, and if anything was going to do the trick, this was it.
I chugged my sugary drink and pretended to focus on my work. But I kept fidgeting in my chair, leaning left, leaning right, reclining, and watching the minute hand march its way around the clock. I pressed on my belly, trying to nudge him awake. It had been thirty minutes. Shouldn’t there be something by now?
I decided to call the doctor, just to be safe.
***
The exam room was dripping with mauve. Somebody somewhere had definitely decided it was the go-to color for moms. Let’s paint everything mauve, they’d said. Moms will go crazy for it. It made me nauseous.
My hospital gown was a more muted shade of pink, speckled with tiny rosebuds. The front of the gown had discreet openings in the bodice designed to give mothers greater ease when feeding their little ones those first few days. The back was entirely open, leaving my spine naked against the cool, sterile sheet.
A green cursor blinked on the black screen of an ultrasound machine.
James stood next to me, wedged between the head of the hospital bed and a maze of gray power cords. The nurse came into the room and closed the door behind her. She introduced herself to us, asked what my symptoms were and why I’d come in, then said she was going to take a quick listen with the Doppler.
A fetal Doppler is a handheld device used to find a baby’s heartbeat. It’s covered with gel so it can move smoothly around the mother’s belly until the heartbeat can be detected. Some women, after hearing the beat of their babies’ tiny hearts through a Doppler for the first time, compare the sound to the thunderous galloping of horses.
The nurse gently pulled up my gown, tucked it out of the way, and squirted some of the cold gel onto my stomach.
“Well, OK, Kelly, let’s wake this little guy up,” she said.
Empty static filled the room as she slowly moved the paddle around my large belly, her head tilted slightly, ear listening hard. I was almost seven months pregnant, and I’d been through this a number of times at my regular appointments, so I waited patiently for the thumping.
Nothing.
She tried another angle. “It’s possible he flipped around,” she said as she tried the other side of my stomach.
My eyes searched the empty air as I waited for the sound that always came.
Seriously. Somebody should do something about the mauve. Truly heinous.
Why was this taking so long? It had never taken this long.
“Don’t worry,” she said. “Sometimes it’s hard to find the heartbeat this late in the pregnancy.” She sat the paddle aside for a moment and began to feel around my stomach. “I’m sorry. I know my hands are cold,” she said. “Just trying to get an idea of how this little guy is lying.” She picked up the Doppler again and placed it on my abdomen, higher up this time.
The thumping we’d been waiting for exploded from the tiny speaker, and the staccato of a strong heartbeat filled the room. James and I released the breath we’d collectively been holding, laughed and smiled at each other.
“That’s your heartbeat, sweetie,” she said to me, eyes soft: an apology.
Our smiles fell as she moved the paddle again, back to the silence, to static, the question in my eyes now. “It’s all right,” she said, patting my leg. “I’m sure everything is fine. I’ll go and get the doctor, and we’ll take a closer look with the ultrasound machine.” She smiled, pulled my gown back down, and left the room.
Machines hummed idly. A few minutes passed, and an older man dressed in a white lab coat entered. Dr. Brown, my usual doctor, was at a conference out of state, so he was covering for her today. His name was jammed somewhere in the two cursory sentences he spoke to me, but I didn’t catch it. He didn’t ask for our names.
His back rigid, he sat down on the round stool at the side of the bed, applied more cold gel, pressed the ultrasound paddle firmly onto my stomach, and looked at the black screen. We watched as wavy black and gray pieces of nonsense floated onto the screen. Disjointed blobs collected themselves, gathered their edges, and took form, and a vision of our son slowly came into focus. The doctor mumbled to himself, maneuvered a computer mouse with his free hand, and used it to click on pieces of the picture, to zoom in closer and back out again.
The nurse stood patiently and looked on from behind, waiting to see if perhaps she’d missed something. Why wasn’t anyone saying anything? My eyes moved from the doctor to the nurse, to the screen and back.
“So . . . what do you see?” James asked as he craned his head around the machinery and tried to answer his own question, to make sense of anything on the screen.
“Well,” said Doctor No-Name, his eyes not leaving the screen, spectacles perched upon the end of his nose, “the aortic valve isn’t pumping.”
“So . . . wait. What does that mean?” James asked, giving voice to my own confusion.
And then, flatly, the doctor said, “Well, I mean the baby’s dead.” He pulled his glasses from his nose and finally looked me in the face, blank detachment in his eyes, the ultrasound paddle still held against my belly.
James’s thick hand slipped from mine as he dropped and collapsed onto the floor. He wept loudly, drowning out the machinery.
I noted him absently. The nurse’s lips parted, and she reached for me in a reflexive move of protection, then remembered herself, clasped her hands in front of her, and averted her eyes. The second hand on the industrial-style wall clock continued to tick. A ceiling fan lightly blew the short hairs at my temples. The room was so cold. Really, uncommonly cold. The doctor continued to stare at me, blankly. It seemed as though I should say something.
“I need to go,” I said without emotion and threw his cold hand from my stomach. I jerked the pink gown roughly down and returned his blank stare with fierce detachment of my own.
“I said I’m done. I need to go.”
And I did.
***
What does it mean to do no harm? When he composed the now famous oath, was Hippocrates speaking merely of preserving the body—that which is biological? If so, the oath might seem relatively easy to recite. Of course, a physician might say. Of course, I’ll do no harm.
But what if we interpret it more holistically, to mean that caregivers should do no harm in any capacity? That would require another level of commitment entirely.
The physical shock of a sudden loss is inevitable. Nothing can temper the force of the blow. The blood rushes, the barreling train car of space and time screeches and groans as the emergency brake is thrown, inertia propels you forward, and numbness and denial slam into the chest.
The baby is dead echoes still, almost ten years later, and bounces idly about my mind. Are there different words he might have used? Undoubtedly. Were there words he could have spoken that would have made me feel less devastated? Perhaps not. But certainly there were words that would have made me feel less like I’d been slapped across the face, with his full weight leveled behind the blow.
***
Three days.
“Come back in three days, and we’ll induce delivery,” he called to me after I emerged from the bathroom, dressed in my own clothes again, the rosebuds and the pink thrown to the floor. “That’s when your doctor will be back in town.”
I ignored him, left my husband on the floor, and kept moving, a human tomb sprinting for the exit.
I pushed through the heavy wooden door and headed for the elevators. Cold steel doors closed in around me, and I was finally alone. I pressed the star marked L and rode the elevator down the two floors.
A loud bing severed the silence, and steel gave way to an air-conditioned lobby and the disorienting buzz of voices. My eyes wide, darting, I absently wondered where I should put my hands. Not my stomach. No, not my stomach anymore.
Keep walking. Out. I just needed to get out. I headed frantically for the doors, did my best not to make eye contact.
“Excuse me, Miss. Miss? Excuse me?”
I turned to see a woman who seemed to be in her early seventies, at the very least. She sat behind a veneer-paneled desk marked Registration. The desk was in the center of the room, and I wasn’t sure how I’d missed it before. I stared at her in confusion, arms limp at my sides.
“Yes, you, ma’am,” she indicated in my direction. “I think you forgot to fill out some paperwork when you came in earlier?” She smiled at me. A nice lady, really. Just trying to do her job.
I stood there, staring at her.
Another bing, and James came out of the elevator, headed toward me.
I had to get out. I turned back around and headed for the door.
“Miss! Excuse me! You have to fill out this insurance paperwork!”
James tried to catch up to me, called over his shoulder that we’d take care of it later. Wide-slatted wooden benches lined the perimeter of the lobby and propped up dozens of strangers who watched us from the corners of their eyes, glad for some diversion to help pass the time.
“I’m sorry, sir,” she said, “but it has to be now.” Firm and authoritative now. Good for her.
“We’re leaving,” he said flatly.
I was nearly free then, nearly to the doors.
“Sir! The paperwork—”
“Look, we just found out our baby is dead, OK?” he shouted at her with all the venom he could manage.
I stopped and turned to look at him: my husband, my biggest cheerleader and fiercest defender. He stood there in the middle of the lobby, looking helplessly back at me, his face blotchy from the tears, his eyes shot through with grief and humiliation.
Silence.
All the eyes in the room turned to me, to my stomach—the bench-fillers at full attention now. Registration lady had the decency to look abashed, her mouth falling open as we turned to leave. Glass-paned doors parted, and I was finally free. The midday sun blazed, and I turned my face toward the heat, blinding myself and allowing reality to disappear into luminescent orbs of yellow and orange.
***
According to The Lancet’s Stillbirth Series, “Around 2.6 million stillbirths (the death of a baby at twenty-eight weeks’ gestation or more) occur each year. Although 98 percent of these deaths take place in low-income and middle-income countries, stillbirths also continue to affect wealthier nations, with around one in every three hundred babies stillborn in high-income countries.” Though infant mortality has continued to drop in the United States during the past several decades, stillbirths have remained relatively steady—and account for almost as many deaths as those of babies who die before their first birthday. In the United States, where the guidelines for what constitutes a stillbirth—20 weeks’ gestation or a birth weight over 12.5 ounces—are more liberal than in some countries, about one in every 160 pregnancies ends in a Stillbirth; that adds up to about 26,000 each year nationwide.
In “Work-Up of Stillbirth: A Review of the Evidence,” a number of factors are listed as contributors to stillbirth in developed countries. Infection accounts for up to 25 percent of stillbirths; other significant factors include genetic abnormalities, fetal maternal hemorrhage, and multiple gestation. Other, less common factors include outside exposures, various maternal characteristics and diseases, fetal growth restriction (a fetal weight that is below the tenth percentile for gestational age), and umbilical cord accidents.
Many institutions report up to two-thirds of stillbirths as “unexplained,” but often no effort is made to find a cause of death. Finding a cause, however, is crucial in helping families begin the long journey toward healing.
***
I stood on the white pavement outside the entrance to the hospital, dialed my parents’ number from my cell phone, and waited for the connection. I’d called my mother on the way to the hospital, and she’d been anxiously awaiting my follow-up. She answered on the first ring.
“So,” she said, “how’d it go?”
“Um, well . . . Yeah, I guess the baby’s dead,” I fumbled, delivering the same blow I’d been given.
“What? Kelly, wait . . . What? What do you mean?” She was crying now. “Kelly, what do you mean?”
“Yeah. Well, I actually can’t talk right now, Mom. I’m gonna go.”
“Wait!”
I hung up and tucked the phone into the pocket of my maternity pants. Pants designed to trick people into thinking you’re wearing regular pants. Full-paneled liar pants, pulled up and over my swollen stomach.
Both sets of our parents arrived later that same day. Our mothers washed dishes and swept floors, prepared elaborate meals, and offered them to me. They were hopeful I’d make an exception and eat something. I didn’t see the point.
Our fathers hovered nervously around the edges and fixed loose doorknobs and replaced blown light bulbs. Girlfriends stopped by and painted my toenails, washed my hair, and placed my head in their laps. Church people came to help box up the baby items we’d strewn across our home: the crib that lay half-assembled in the living room, the baskets of baby clothes I’d meant to start washing. They put it all in the nursery and closed the door behind them. We’d painted the baby’s room blue the week before, laughing and planning, me telling James to be careful not to drip, together standing back to admire our work. Now it was a crypt for things I couldn’t look at. Everyone waited for me to say or do something, to finally lose it. I didn’t cry. I just wanted to be alone.
The nights were the hardest. I worried about what the baby would look like when it came time to deliver. I had nightmares about what I’d see when they placed him in my arms. Visions of horribly disfigured, half-formed babies haunted me every time I closed my eyes.
On the third day, I woke up before my alarm went off. The house was quiet as I padded barefoot down the hallway and made my way to the bathroom.
I closed the door behind me, grabbed a towel from underneath the sink, and turned the shower knob to a few degrees hotter than normal. I hadn’t showered since the morning we’d gotten the news. I’d managed to avoid mirrors completely over the last three days and had closed my eyes whenever I’d needed to change clothes. I was afraid to see, scared that if I really looked at myself, the protective fog that was wrapped around me would lift and everything would become real.
Steam billowed over the top of the glass shower doors and hovered above me. I hesitated. Maybe I could forget the shower, go to the hospital dirty. Who cared, anyway?
But I was tired of running.
“It doesn’t matter,” I said to myself. “None of it matters.”
I looked up to the white popcorn ceiling, took off my clothes, stepped into the shower, and pulled the door shut.
Blistering water saturated my scalp and worked on dulled nerve endings. I was glad for the heat, that I could feel something. I stood there for a long time, enjoying the quiet and the solitude. No one would check on me in here. It was just me and him.
Him.
I opened my eyes and looked down, watched as steaming water ferried away numbness on rivers that flowed smoothly over my rounded stomach; my hands landed, reflexively, there.
I inhaled sharply, vacuuming up moist air. It was the last gasping, groping breath before the final descent into the black. I doubled over, clasping my hand over my mouth to silence the sobs. I cradled my stomach and finally allowed that the last two days had been real; I was cradling an empty shell. My son was gone.
***
We arrived at the hospital later that morning, made sure to check in at the registration desk, and were ushered up to the maternity floor. A nurse led us down the hall of labor and delivery suites. She stopped outside room 207. There was a white cardboard lily taped to the door.
“What’s that for?” I said.
“Oh,” the nurse said, “that lets us know there’s a special case in this room.” She opened the door, and we went inside.
James dropped the suitcase by the couch, and the nurse handed me a rosebud gown. I changed in the bathroom, folded my clothes, and put them on the sink ledge. There was a little card next to the faucet that said “Congratulations on Your New Arrival!” It was tied to a silver baby spoon with a thin blue ribbon, a picture of the chubby Gerber baby engraved on the stem. I brought it out and handed it to the nurse.
“Can you take this away, please?”
“Oh, I’m so sorry. Someone was supposed to remove that.”
I lay down and pulled the sheet over my stomach.
“Someone will be by in a minute to put in your IV,” she said.
I thought it was funny that, before all the craziness of this week, the part of childbirth I’d been most worried about was the IV. I’ve been terrified of needles all my life. At my very first prenatal appointment, mere weeks after I’d discovered I was pregnant, I walked into my obstetrician’s office, prepared to receive my congratulatory gift basket (maybe a cute diaper bag), armfuls of samples, and obligatory brochures outlining what I could (and could not) eat, which medications were forbidden, and other useful information. I was not, however, prepared for a blood draw. No one had mentioned that it was standard procedure or that I’d be asked to sit there quietly while they extracted eight vials of dark red liquid from my veins.
“This is a normal prenatal workup,” the phlebotomist said as she lined up the glass vials next to my arm. I had a full-blown panic attack before she even touched me and ended up on my back, on a cot.
Now the moment of the IV insertion was finally upon me, and I didn’t care. What did it matter, really? They couldn’t hurt me, I thought. None of them. I had nothing left. Physical pain was a relief, compared with the other.
No one could hurt me any more. I was invincible.
***
Fourteen hours after we arrived, Elijah Mark was silently born. When they placed him in my arms that October morning, the fear was gone. There was no confusion, no gore, no feature out of place. I felt sheer, incomprehensible joy. It didn’t make any sense, but I was so incredibly happy. It seemed angels hovered around us to ease the way, to make the impossible possible. I had only those few moments with our son, but it was as if all of heaven gathered to watch. James stood beside me, tears in his eyes, arms wrapped around us, and we were a family, touching fingers, touching toes.
I smiled at our parents.
“Isn’t he amazing? Look at my son. Look what we made.”
It must have been terrible for them to stand there, run through with grief, and watch us hold him, to see smiles on our faces. How they must have wanted to splinter into a thousand pieces on the floor. Instead, they kissed us, held him, and took pictures. Three days later, we laid our baby in the cold fall ground.
The autopsy read, simply:
Infant male
Twenty-five weeks gestation
Two pounds
Twelve and a half inches long
Unexplained stillbirth
***
In the aftermath of a traumatic event, some details recede to the blurry gray edges of the frame while others stand up, stiff like colorful pop-up book cutouts, their bright reds and greens imprinted upon the forefront of memory. All the while, the wizard behind the curtain of the mind decides which images to show us repeatedly and which to discard.
I have forgotten many things over the last ten years, but what I have permitted myself to remember is the face of every kind person who cared for me then: the nurse who tried to protect me from the truth that first day; the other nurses who doted on me later, offering me foot massages and chocolate milkshakes; and the people who dropped in on me at home, ever so casually, to make sure I was OK, months after we’d buried him. Each and every one of those people is a powerful testimony to the strength of the human spirit. In every moment, we possess an astonishing ability to affect (sometimes permanently) the lives of those we encounter, to do either great good or great harm.
More than anything, I remember his tiny face and how he looked like James, peacefully sleeping, hands folded still. He was wrapped in soft flannel, a knit cap on his head, a medical bracelet, small enough to slip onto my thumb, cinched around his ankle.
***
What events precede the revelation of meaning in a seemingly idle moment? How does clarity finally come? Is there some part of us that folds in on itself, protecting, shielding, standing as sentinel in front of that which we cannot yet bear to acknowledge? And what part of us decides when it’s finally OK to know? OK to tell?
It was many years before I would think about the soccer game again and even more years before I realized that was the last time I’d felt him. And more still before I would allow that what I had ignored that October morning was most likely the last frantic struggles of my own child.
***
“What do you mean it’s like a soccer game?” James laughed, grateful for the conversation, driving hard into darkness.
“Oh, never mind,” I said, rubbing my eyes. “I think it stopped.”