Seconds before my water breaks, twenty-three weeks into my pregnancy, I roll onto my side and hoist myself out of bed. Pain has jarred me from sleep. It’s early, the morning sky still black. I’m visiting my parents in Los Angeles with my husband, Rob, and our three-year-old son, Ian, who are asleep here in the bedroom I once shared with my sister. I’ve felt the sharp tightness in my abdomen for days, but I think it’s due to exhaustion from teaching or the strain of raising Ian while another child grows within me. The nurse practitioner, Melissa, told me earlier this week it was “just Braxton Hicks,” those practice contractions that get a woman ready for the real thing. “Pregnancy hurts,” she said in her high, chirping voice. I left the office feeling silly and slightly ashamed.
I hear Melissa’s voice in my head now, telling me to drink some water. So I shuffle to the bathroom. That’s when I feel the warm gush between my legs. I stand there for a moment, paralyzed, then pull down my pajama pants and stare at my soaked underwear.
I have to shake Rob a few times before he opens his eyes.
“I think my water broke. I need to go to the hospital,” I say.
It takes a moment for my words to register. “Oh, my God,” he says, though he doesn’t fully understand the implications, not the way I do; I’ve read all the books and scoured the online discussion boards about fetal development. I know how dangerous it is for a baby to be born this soon. I glance at the crib where Ian sleeps on his back, his Spider-Man doll pushed up against the wooden slats.
Rob goes to my parents’ bedroom, and I hear their murmuring voices, then the floorboards creaking as my mother enters, her hair rumpled from sleep. “Honey, you think your water broke?” she asks. I nod and say we need to get to the nearest hospital. My obstetrician is back home in the Bay Area, hundreds of miles away.
My mother, usually talkative and quick to laugh, is silent as she pulls out of the driveway. I can feel my daughter, Olivia, move within me, the contractions growing stronger. “It’s too early, it’s too early, it’s too early,” I say. Rob reaches from the backseat and rests his hand on my arm.
At the emergency room the doctor on call verifies that I’ve lost most, but not all, of my amniotic fluid, the medium that surrounds the baby in the womb. She has me transferred to a hospital with a neonatal intensive-care unit. I spend the twenty-minute ambulance ride on a gurney that’s tilted so my pelvis is higher than my head, to stem the flow of fluid. Rob and my mother follow in the car.
At the hospital I’m given a private room, which one of the orderlies cheerfully tells me is a rare treat. My nurse’s name is Mary, and she’s in her late forties, with a broad face and intelligent brown eyes. “Girls are stronger than boys,” she says. Among “micropreemies” the girls survive more often. She straps the fetal-heart-rate monitor onto my belly, and I hear the rapid, staccato beating of Olivia’s heart. “Listen to her,” Mary says. “She’s doing great.” I’m right on the edge of having enough fluid left to carry the baby close to term, she tells me. I should focus on resting and drinking. “And think good thoughts. They always help.” My body is still tilted, head down, and I feel an ache at my temples. Before Mary leaves, she gives my feet a bracing rub to warm my toes.
Rob and my mother haven’t arrived yet. I note the hardness of my deflated belly, the way Olivia squirms and twists. I can’t feel any leaking between my legs and wonder if this is a good sign. Mary returns and tells me how holes in the amniotic membranes sometimes heal. She’s seen it happen. She says the doctors will put me on antibiotics and also recommend steroids to speed the development of the baby’s lungs, so that if she is born soon, she’ll have a better chance. I agree to this plan, of course: anything that will help make her stronger. Mary smiles as if I’ve given the answer she wants to hear.
I close my eyes and imagine a protective wall enclosing Olivia, a wall composed of healed membranes. I’ve been grappling with the notion of God for years, but now I begin to imagine him commanding my cells to multiply and join together to seal the compromised tissues. I feel a flash of shame — I’m the proverbial atheist in a foxhole — but I can’t keep myself from praying.
Rob knocks lightly, then comes in. My mother hangs back for a moment, clutching her purse, then approaches and kisses my forehead. I tell them that antibiotics and steroids are on their way. We cling to the idea that these medicines will save the baby.
Mary administers the steroid shot in my rear, and I feel a burn that spreads down my leg. Then she elevates the head of the bed and helps me sit up so I can swallow the antibiotics. The perinatologist, Dr. G., will be in soon for a consult, she says.
I glance at the clock on the wall; it’s close to 7 AM. Ian will be looking for us when he wakes. My father is with him, of course, but suddenly I need Rob to be there, too.
“Please go check on him,” I say. “You can come back later. I’ll talk to the doctor.”
It takes some reassuring that I’ll be fine, but Rob finally agrees to go. He gives my hand a squeeze. “Be back in a flash,” he says.
By the time Dr. G. enters the room, my mother has nodded off in the chair, and I’m watching the local news to distract myself from the undulating of my uterus.
Dr. G. wheels in a sonogram cart and asks my mother to leave so that he and I can talk privately. He is professorial in demeanor, with curly gray hair and wire-rimmed glasses perched on the tip of his nose. He drags the cart next to the bed and squeezes a dollop of clear ultrasound gel on my skin. Then he picks up the transducer, spreads the gel around, and pushes the instrument against my stomach. The pressure makes me nauseated. I can feel the hard curve of my swollen womb and Olivia’s small body inside it. I twist my head to see the monitor, with its ghostly shapes. I know what the doctor is looking for — dark pockets of fluid, or what’s left of them — but I can’t make out much. I’m grateful not to see Olivia’s foot or her profile or her tiny beating heart.
Dr. G. keeps the transducer on my stomach for sixty seconds, if that. He gives the screen a cursory look, not even squinting to study the fluid pockets, or what is left of them. Then he clicks off the machine and wipes the gel from my stomach with a white cloth. As I pull down my gown, he settles into the chair, pushes his glasses up, and studies me for a moment.
“OK,” he says. “Let’s talk.”
Just five weeks ago, during my eighteen-week ultrasound, the technician gave us the news that we were having a girl. A daughter.
“We only do boys,” Rob joked. “We’re girl amateurs.” He was already in love.
“You’re a goner,” I would tell him in the days that followed. “Watch out for her little finger and getting wrapped around it.”
That night I phoned my parents with the news. My mother had been hoping for a girl. “No relationship is like the one you have with your daughter,” she had told me both before and after Ian was born. Even though she loved Ian and doted on him, she thought I was missing out on some deeper form of intimacy. And I believed her, even though I wouldn’t admit it.
Rob sits in the same chair where Dr. G. sat just an hour ago. He has spent the morning tending to Ian. They went to the park, made tunnels in the sandbox, and played superheroes on the jungle gym: Ian was Spider-Man; Rob, Batman.
I want to tell Rob what Dr. G. said, but without using words. Maybe if I touch him, put my hand on his face, he will just know. Inside me Olivia squirms, then comes to rest.
Dr. G. spoke quickly and bluntly, offering me a list of possibilities, one of them being that Olivia will escape this inauspicious beginning unscathed — but, in his estimation, that possibility is highly unlikely, bordering on miraculous, and he doesn’t believe in miracles, he said. He believes in the images the transducer conveyed; in the dates that make Olivia twenty-three weeks; in the probability of compression deformations and cerebral palsy and massive brain bleeds and paralysis and blindness. He believes in tubes attached to her fetal skin — skin so delicate it can tear at a touch. He believes in powerful antibiotics that could cause her organs to revolt. He has seen it before.
There was judgment in his voice when he told me, “We’ll keep her alive, if that’s what you want. That’s our job.” He didn’t say that keeping Olivia alive would be needless, absurd, even cruel, but he may have been thinking it. He gave me a crash course on the statistical probabilities, then quizzed me on the numbers to make sure I’d remember them.
Now I rattle them off to Rob. The message is clear: she’ll probably die, and if she doesn’t die, she’ll be very sick.
Rob’s eyes are on the floor, not on my face. He seems to let the information rest in his body for a moment, feeling the weight of the future that now looks nothing like the one we envisioned just a day ago, with a whole and healthy daughter, all pumping arms and legs, her dark hair flying behind her as she plunged headlong into the world.
“And that’s not all,” I say. “There will probably be mental retardation. And cerebral palsy.” I tell him about the brain bleeds, also highly likely in a baby this premature. Massive ones. There’s no predicting.
“Jesus,” Rob says. “This is unbelievable.”
“I don’t think we can do this,” I say, and my throat constricts around the word this and everything it represents. I close my eyes and put my hand on my abdomen, pressing my palm against Olivia.
Dr. C., the neonatologist, comes in next, and I go over with him the litany of horrors Dr. G. gave me, posing each one as a question. Retiring and tentative, Dr. C. nods and agrees that it’s all very possible. Rob stands in the corner of the room, his arms crossed, letting me take the lead. Dr. C. doesn’t sit, as if he won’t be staying long, but he does have information for us. He says that 75 percent of women deliver within a week of membrane rupture. He says that if they induce labor now, and Olivia is alive, we will have complete say in her care and how much we want the doctors to do to keep her alive. But if I deliver a few days from now, my daughter will be twenty-four weeks, and the hospital’s ethics board will step in to limit our choices.
“What do you mean?” Rob asks. Neither of us imagined anyone else would be involved in this matter of our daughter.
“What I mean,” Dr. C. says, “is that at twenty-four weeks she will be considered viable.” If she makes it to twenty-four weeks, he explains, and then has a category-four brain bleed — a catastrophic brain bleed, the kind that can cause all of those terrible things we now know about — we may not be able to make the call on how to treat it and whether we want to keep her alive.
Rob asks about the likelihood of that, and Dr. C. repeats the probabilities Dr. G. gave me earlier. Rob nods and says, “Uh-huh,” a habit of his that betrays impatience, anxiety. I can only listen, still taking in this new element, the ethics board. Then a question takes shape in my mind: “If I were your daughter,” I ask Dr. C., “what would you want me to do?”
I stare into his impassive face, searching for a reaction, a passing emotion that will answer the question for me, but he reveals nothing. I imagine he’s had this conversation before. I wonder how inured he is to it all.
Finally he asks, “You have a son, don’t you?”
“Yes,” Rob says. “Ian. He’s three.”
“What I would say is you need to think about your son.”
After Dr. C. leaves, Rob and I talk. I don’t remember the exact conversation, but I remember the sorrow and Rob’s drawn face.
We can’t do this to her.
All those tubes, and she’s so little.
This will be what’s best for her. She won’t suffer.
She would have half a life, if that.
Catastrophic brain bleeds. Jesus.
How could we do that to her?
What would happen to us, to our family?
How will we take care of Ian?
“I can’t,” I say, to all of it.
“I know,” Rob says. “We can’t.”
It’s getting late. Rob intends to stay with me tonight, but I want him to put Ian to bed. We agree that he’ll leave for a few hours and come back by nine. Nothing will have changed by then.
When the nurse returns, I have her send for Dr. C. I will tell him to induce me tonight. The sooner the better. Week twenty-four is just a few days away.
Everything that came before the conversation with Rob feels distant now — everything, that is, but one moment during those first few hours in the emergency room, before my transfer to this hospital; before Dr. G.’s statistics and stark data. We were still hopeful then, and my mother said to me, “Don’t give up on her.” Of course not, I thought. Not ever. What kind of mother gives up on her baby?
The night nurse, Terry, says I won’t need an epidural for this delivery: “It’s not going to last very long, and the baby’s so small.”
“Of course,” I reply mechanically. Rob is back from my parents’ house, having made sure Ian is tucked in. My mother sits in the corner of the room, flipping through a celebrity magazine. We are waiting for the real contractions to start. I try to ignore Olivia’s movement inside of me, but I can’t, and I begin to cry. Rob strokes my arm.
When the contractions do come, they are sharp and unmistakable. I ask Terry if I can have a painkiller. She injects Demerol into my IV, and I grow drowsy and start seeing colorful geometric patterns whenever I close my eyes.
After an hour or so, Terry comes in and asks me to assess my pain level. The contractions have grown from a needling pinch to the shuddering pain I remember from my labor with Ian. The Demerol is doing little more than making me sick. I say I want an epidural, and Terry goes to get the anesthesiologist.
As we wait, I tell my mother she doesn’t need to be here for this. We’ll be all right.
She grabs my hand. “Are you sure?” she asks. I sense her gratitude.
“I’ll feel better if you’re home with Ian,” I say.
She bends over the rail of the bed and kisses my cheek. When I see she’s crying, I cast my gaze downward, struggling against a feeling that’s like panic, only heavier and more oppressive.
I have two epidurals by the time the labor ends. When the anesthesiologist comes to administer the second, nine hours after the first, I can tell he is irritated with me. “I’m giving this to you,” he says, “but you’re not going to feel your legs at all after this, not for a while. And it’s going to take you much longer to walk when it’s over.”
I shouldn’t have to feel anything, motherfucker, I want to say as I assume a curled-up position so he can hit my spinal cord. I want to rip the anesthesiologist’s heart out of his chest; I want him to feel the bewildering pain of the universe’s sucker punch; I want his imagination trampled like some hapless pedestrian run down by a tank. And I also want his hand to be steady as he injects me with liquid numbness so there’s nothing left to feel.
As the night wears on, the hospital grows quiet. An orderly wheels in a cot for Rob. Occasionally Terry comes to gauge the progress of the labor, but otherwise I feel as if we were in an abandoned wing, cut off from the business of birthing around us.
At one point Terry rolls in a baby warmer: a clear plastic box with an overhanging lamp. “Just in case,” she tells me. “But nine times out of ten, these little ones aren’t born alive.” We’ve already been through the protocol with Dr. C.: If Olivia is born alive, they will make her as comfortable as possible without taking any extraordinary measures. No tubes. No oxygen. It is highly unlikely she will survive the birth, but we need to plan for that slim possibility.
I imagine my daughter alive, and for a brief, unthinking moment I feel a surge of joy. I see myself holding her swaddled, bringing her close to my chest, examining her face. And then I think, And if she survives? What then? The answer seems clear: I will love her. I will love her and mother her through incubators and tubes, through lung infections and brain bleeds. I will mother her through her flailing fight for life. And if she survives that, I will mother her through wheelchairs and tube feedings. I will mother her to ruination if I have to.
And that’s when I begin a silent chant, one that will haunt me in the months to come: Please don’t be alive. Please don’t be alive. Please don’t be alive.
Rob sits on his cot, facing me. The mood is growing darker the closer we get to the delivery, but we don’t talk about it. Instead we talk about going home and what a relief it will be. We speak in fragments.
“To be in our own bed,” Rob says.
“Away from hospitals,” I reply.
I think of our house, where Ian’s bedroom is right across the hallway from ours, and how we often hear him humming to himself in the morning, the precursor to a day of bug hunts and action-figure fights. I imagine holding him.
The door opens, and the curtain slides back. Terry looks distracted and harried. It seems as if it’s been a while since her last check-in, but my sense of time is unreliable. “Such a busy night. I’m so sorry,” she says, and she checks the reams of paper generated by the contraction monitor. After two epidurals my lower half is utterly numb. I have no sense of what stage of labor I’m in or how strong my contractions really are, but I assume we’re in for more waiting.
Terry approaches my bed and lifts the white sheet that covers my lower body. “We’ve had a birth,” she says, her voice tight.
“Someone just gave birth?” I ask. I imagine the labor-and-delivery nurses rushing into another woman’s room to attend to a delivery. No wonder no one’s been around.
“No,” she says. “You’ve given birth.”
A cry catches in my throat.
“Is she alive?” Rob asks, panicked, his eyes on the sheet.
“No,” Terry answers.
In the months to come I will wonder: How long had it been since she came out? Had she been alive? What if I hadn’t demanded that last epidural? Would I have felt her pass out of me then? I picture her still breathing, nestled between my legs, shrouded from view by the sheets. Perhaps she heard Rob and me talking about going home.
Terry walks to the white phone mounted on the wall and picks up the receiver. “We’ve had a delivery here. I need someone, now.” Another nurse brings a warm blanket and drapes it over my upper body. “It’s OK, honey,” she says. “Do you want to hold her?”
“I can’t. I’m too scared.”
Rob looks frightened, too, but he leans over the bed and gazes for a long moment at what’s behind the sheet. Finally he turns to me, his eyes red. “Don’t be scared,” he says. “There is nothing to be scared of. I promise.”
A nurse bathes Olivia, then swaddles her in a receiving blanket and puts a white beanie on her head. When she places my daughter in my arms, I can hardly register her weight. She is tiny, perfectly formed, doll-like. Her eyelids are still fused together. Delicate blue veins stretch across them. I stroke her cheek with my fingertips and whisper, “I love you so much,” and tell her she looks like her brother, that she has his mouth, his lips. I hand her to Rob, and he cradles her, kisses the crown of her head, and tells her he’s sorry. We uncover her to look at her hands, those exquisite fingers.
She weighs one pound, one ounce. Her footprint is the length of my thumb. We fill out the death certificate with her full name: Olivia Katherine Thurtle.
The next day, after I’ve been discharged, Rob drives me back to my parents’ house. Ian comes to the door but stops at the threshold, reluctant to approach me. He puts his fingers in his mouth and clasps his father’s leg. He’s been told that I was in the hospital, and that there was a baby who died, but I’m sure none of it makes much sense to him.
“Hi, sweetie,” I say, bending down so my face is level with his. “I’ve missed you.”
After the short flight home to the Bay Area, we pull into our driveway to see that March has brought with it green sprigs on the trees. There’s a cardboard box on our doorstep. Rob parks in the garage, and I unbuckle Ian from his car seat and bring him inside. The house smells of disuse. Rob turns on the furnace, which hums to life. Ian peels off his winter coat and runs through the rooms, checking to see that everything in his domain — the Lego bin, the watercolor paintings, the bed — is exactly as he left it.
The box on the doorstep is heavy. It contains strawberries, a bottle of wine, a wedge of cheese, and a loaf of bread. There’s also a note from some friends that reads, “So that you don’t forget the good.”
I walk down the hallway into the bathroom and gaze at my face, already less full than it was when I was pregnant. My eyes have dark circles around them. Otherwise I look the same, and I marvel that I don’t appear more changed.
In a few hours I will unpack my suitcase and see the pink T-shirt I’ve had for weeks, the one that says GIRL in black letters. I will fold it, put it on the bed, hesitate, then grab it and ball it up.
In two years we will move into a new house, and I will decide not to pack the little flowered dress with matching ruffled bloomers — the only item of clothing I ever bought for Olivia. I will place this dress in a box with my maternity clothes to send to my sister, who will be pregnant then with a daughter of her own.
I have Olivia’s ashes in a maroon box, which I have opened just once. If she had lived, she would be in second grade. Here is how I imagine her: She still has her baby teeth. She prefers to sit on Rob’s lap, not mine. She loves her brother fiercely but takes his toys without permission. She wants him to read to her after her bath. She has his round face and mouth but a nose we can’t quite place. She’s rougher than Ian, more likely to slam a door if angry. She has me draw butterfly tattoos on her arm with my eyeliner, asks me to weave clover into her braids. She’s good at making faces and does a mean imitation of her father’s booming laugh. Every so often she talks too much in class, and the teacher has to flip her behavior card from green to yellow as a warning. She wants to be an archaeologist, or maybe a pilot, or a cowgirl. She doesn’t know exactly. We tell her not to worry. She’s only seven. She doesn’t have to know for certain.