There is no answer, and I realize I am the one who is supposed to reply.
“I was here with the baby,” I say, my syllables accented in rhythm to the compressions I am still doing. “His color was ashen and respirations had ceased. We stimulated him, but there was no gasping or spontaneous breath, so we began CPR.”
“How long have you been at it?” Dr. Atkins asks.
“Fifteen minutes.”
“Okay, Ruth, please stop for a sec…” Dr. Atkins looks at the cardiac monitor. The heart rate, now, is 40.
“Tombstones,” Marie murmurs.
It’s the term we use when we see wide QRS complexes on the cardiogram—the right side of the heart is responding too slowly to the left side of the heart; there’s no cardiac output.
There’s no hope.
A few seconds later, the heartbeat stops completely. “I’m calling it,” Dr. Atkins says. She takes a deep breath—this is never easy, but it’s even worse when it’s a newborn—then tugs the Ambu bag off the tube and tosses it into the trash. “Time?”
We all look up at the clock.
“No,” Brittany gasps, falling to her knees. “Please don’t stop. Please don’t give up.”
“I’m so sorry, Mrs. Bauer,” the pediatrician says. “But there’s nothing we can do for your son. He’s gone.”
Turk wrenches away from his wife and grabs the Ambu out of the trash. He shoves the anesthesiologist out of the way and tries to affix it again to Davis’s breathing tube. “Show me how,” he begs. “I’ll take over. You don’t have to quit.”
“Please—”
“I can get him to breathe. I know I can…”
Dr. Atkins puts her hand on his shoulder, and Turk collapses into himself, an implosion of grief. “There is no way you can bring Davis back,” she says, and he covers his face and starts to sob.
“Time?” Dr. Atkins repeats.
Part of the protocol of death is that everyone in the room consents to the moment it occurs. “Ten oh four,” Marie says, and we all murmur, a somber chorus: I agree.
I step back, staring at my hands. My fingers are cramped from performing the compressions. My own heart hurts.
Marie takes the baby’s temperature, a cool 95. By now Turk is anchored to his wife’s side, holding her upright. Their faces are blank, numb with disbelief. Dr. Atkins is talking softly to them, trying to explain the impossible.
Corinne walks into the nursery. “Ruth? What the hell happened?”
Marie tucks Davis’s blanket tight around him and slips the little stocking cap back on his head. The only evidence of the trauma he’s suffered is a small tube, like a little straw, coming out of his pursed mouth. She cradles the baby in her arms, as if tenderness still counts. She hands him to his mother.
“Excuse me,” I say to Corinne, when maybe what I really mean is Forgive me. I push past her and skirt the grieving parents and the dead baby and barely make it to the restroom before I am violently ill. I press my forehead to the cool porcelain lip of the toilet and close my eyes, and even then I can still feel it: the give of the rippled rib cage under my fingers, the whoosh of his blood in my own ears, the acid truth on my tongue: had I not hesitated, that baby might still be alive.
—
I HAD A patient once, a teenage girl, whose baby was born dead due to class 3 placental abruption. The placenta had peeled away from the uterine lining and the baby had no oxygen; the severity of the bleeding meant we almost lost the mother as well as the newborn. The baby was sent to our morgue pending autopsy—which is automatic in Connecticut for the death of a neonate. Twelve hours later, the girl’s grandmother arrived from Ohio. She wanted to hold her great-grandchild, just once.
I went down to the morgue, to where the dead babies are kept in an ordinary Amana refrigerator, stacked on the shelves in tiny body bags. I took the baby out and slipped him from the bag, stared for a minute at his perfect little features. He looked like a doll. He looked like he was sleeping.
I just couldn’t find it in myself to hand this woman an ice-cold baby, so I wrapped him up again and went to the emergency room for some heated blankets. In the morgue, I swaddled the baby in them, one after another, trying to take the chill from his skin. I took one of the knit caps we usually put on newborns to cover the peak of his head, mottled purple with settled blood.
We have a policy, if a newborn dies: we never take him away from the mother. If that grieving woman wants to hold her baby for twenty-four hours, to sleep with him tucked against her heart, to brush his hair and bathe him and have all the moments with her child she will never get to have, we make it happen. We wait until the mother is ready to let go.