ON THE DAY BEFORE GINNY WAS BORN, Linda went in for a final check-up before the scheduled delivery. She was at thirty-eight weeks and according to all the signs she was good to go, except for one thing, Ginny hadn’t turned. This was a concern two weeks previous where Doctor Reagan’s PA gave Linda some exercises she could do that would encourage her baby to move into the proper head-down position. Linda was faithful to the breech-correcting routines, from a breech tilt where she laid down on her bedroom floor and put her hips up on a short stack of pillows, raising her pelvis up above her head, to getting down on her knees with her arms on the floor ahead of her in an effort to open up her uterus to make more room for Ginny’s head. Neither routine worked, and there she was the day before her scheduled delivery in one of South Highland Women’s Center exam rooms being tended to by Doctor Reagan himself. Her belly was uncovered and glistened from the ultrasound jelly used during the ultrasonography. Doctor Reagan used these images to determine the baby’s breech position – bottom down heading into the birth canal instead of her head presenting like it should. He stood at her right side and spread the gel over Linda’s belly and felt with both his hands for the baby’s buttocks at the base of Linda’s abdomen just outside the lowest point of her uterus. Once he found it he pushed in firmly underneath the baby’s position and lifted her rear free of the more constrained area of Linda’s uterus. The pressure was intense for Linda who was grateful her bladder had yet to refill.
Once the baby was dislodged, the doctor pushed with his right hand below Linda’s belly, cupping the baby’s rump and going up her abdomen while he pulled down where the baby’s head was positioned, simultaneously rotating the unborn infant counterclockwise until he could feel the baby’s head lodge low into the narrower part of her uterus engaging the birth canal. Ginny’s slow-motion somersault felt like everything was being anatomically rearranged inside Linda’s body and once the move had reached its terminus, Linda shuddered a chill that seemed to fan a nauseating resettling of her own organs. “That should do it,” he said, wiping the gel off his hands with a white terrycloth towel. “A nurse will be in to clean you up.” And with that he was out the door of the exam room.
Linda laid there on the exam table and caressed her belly with her hands feeling for her baby’s movement. She moved them carefully over her surface, pausing at each position, waiting to sense the infant settling in to her new position as she had imagined her to do. But, she didn’t feel a thing.
“Do you know a Doctor Raymond DeVilliers?” Ian asks as he pours the remaining Ensure from the can into the cath tip syringe. “He’s a neonatologist. Nice guy. Helped me wrap my brain around what you did to Ginny.” The can is empty and the milky cream-colored fluid slowly sinks through the tube. “External cephalic version. You turned Ginny the day before Linda delivered.” Just before the syringe completely evacuates with Ensure, Ian follows it up with a shot of Gatorade, orange mixing with the remnants of the Ensure. It looks like a Julius.
“You’ve done those a hundred times, right? Usually with a monitor and a follow-up ultrasound, but there’s no record of that.”
He sets down the Gatorade bottle while he still holds the feeding syringe with his other hand up as high as he can given what little slack is coming out of Gray’s nose. With his free hand Ian reaches over and pulls a document off the wall and brings it under the light coming through the hole in the door and reads aloud. “‘Baby Girl McDaniel. CAT-scan indications of blunt force trauma, brain bleed under fontanelles.’ Doctor Richard Bryant, the pediatrician you hand off to. That’s his report, the one we never heard about.” Ian holds the document in front of Gray’s face so he can read it, too. He doesn’t. Ian lets it fall to the concrete floor.
“So, you turned Ginny, a practice frowned upon in OB circles, even in those days, and damaged her brain enough for it to bleed into her fontanelles. And the next day you strip away the myelin from her neurons with an overdose of pitocin.” He picks up the Gatorade and pours another shot. “She never had a chance.”
Ian drinks what’s left in the bottle and tosses it on the floor. It’s plastic and bounces and rolls down the imperceptible slope of the unit’s floor until it rests against the rolling door. He pulls the CAT-scan down from the wall and holds it front of Reagan. “We were told that her brain had fully developed, but for some reason it atrophied leaving little else but a brain stem.” Ian lets the film fall to the floor. Gray’s feeding tube has emptied, so Ian corks it and tapes the end of the catheter back onto Gray’s face. He now takes the seat in front of Gray and leans in on his knees, dead-on to him.
“On her second day of life they’re telling us she’s brain dead. All she does is seizure, no suck reflex, low Apgar. A neurologist tells us to let her go, ‘a tough decision,’ he says.”
Baby McDaniel’s isolette was parked diagonally along with a half-dozen other infant incubators in Highland Memorial’s small Newborn Intensive Care Unit. It was relatively new then without much consideration given the ergonomics of parent-involved care in the NICU, arranged more for the logistics of nursing care, access and monitoring. Parents were just one more thing that got in the way. Any who accessed the NICU had to scrub in and dawn gowns that would cover street clothes and booties that covered shoes. So attired was Ian.
Linda remained an inpatient at Highland having had an emergency C-section so she was already clad in a gown and semi-reclined in an industrial Lay-Z-Boy next to Virginia’s clear cocoon. The little family was in between doctor visits and vitals and Linda had just shut her eyes while Ian stood nearby, studying everything he could take in of his daughter. One of the tending nurses walked behind Ian and managed to drop a stainless steel tray upon which were some type of instruments. The tray and its accessories crashed to the floor disrupting the reverence of such a context. Ian never took his eyes away from Ginny, though, and witnessed something that manifested the antithesis of what they had been told. Ginny opened her eyes and turned her head in Ian’s direction, from the source of the sound. She heard it and she responded. A transfer to a children’s hospital and an MRI confirmed that Virginia did indeed have a full brain, it was her white matter that atrophied, axons that lost their myelin inhibiting the transmission of neural signals between the cerebrum and lower brain centers.
“The neurologist was wrong. Up to that point I thought all you guys were gods, saving lives and healing people and fixing things and delivering babies. But you’re not. You’re just regular people.” That last thought is reconsidered. “Well, not you. You’re a fucking butcher.”
Ian pulls another photo from the wall behind him and puts it up in front of Gray’s face. It is a class picture where Virginia is placed in the front row of students in her special red wheelchair.
“She was a fourth-grader when she died. She could read, do math, talk to us by sign language and a computer. Her brain was intact. She lost her white matter to you, but her grey matter was all there.”
He sets the picture down on a box.
“And her heart was all there. She survived respiratory therapy five, six times a day, every day of her life. Percussion, suctioning, inhalers – Albuterol, Alupent, and Atropine to decrease her secretions. She was tube fed every two hours. She never made it out of diapers, and she never spoke. See a pattern here, Doctor Reagan? All I really wanted was for you to know what you did to my little girl.”
He stands and turns to the wall of records, the names of mothers and babies, the attestation of lives cruelly affected.
“All the rest of this was gravy – those mothers, your wife. My wife asked me for a divorce before she killed herself, otherwise I’d have brought her by for a visit, too.”
Ian’s emotional detachment in his diatribe is not an indication to Gray that the rest of this is going to go well and as Ian takes his seat again he notices a change in Gray’s eyes, one he hasn’t seen since Sunday. They are widening under his retreating brow as much as they can under the duress of the duct tape. Were his mouth free Ian might see it open autonomically to accommodate his body’s increased need for oxygen. His nostrils flare slightly instead.
Ian is getting a little louder. “You’re a doctor. You’ve watched people die, I’m sure.”
The McDaniels took a weekend trip to Monterey to visit family four days before Virginia passed away. She was doing well and the coast had just cleared of an aggressive tropical depression that blew down signs and a few trees, but nothing that would keep the McDaniels at their home in Highland on a beautiful Fall weekend. They left on a Friday afternoon and arrived at Ian’s sister’s home that evening. The air in Monterey still smelled of its tropical trespasser, having roiled its atmosphere with dust and foreign particles mixed with domestic creating a gas cocktail that smelled of a flooded river. The thought never occurred to Ian nor Linda nor Ian’s sister that the tropical depression may tout exotic molecular impurities vaporized and inhaled by one who would not have the immune system to naturally process and kill the airborne threat, and by Saturday morning Ginny was desaturating and her lungs were filling with fluid.
The McDaniels made their way back to Highland by midday, struggling to keep Ginny’s oxygen saturation at ninety percent on a flow of five liters. They called Ginny’s pediatrician from a pay phone along the way who was kind enough to be waiting at their home when they pulled into the driveway. Inside, the doctor listened to Ginny’s lungs and noticed a pink powdery accumulation around her nose and mouth. Her oximeter showed eighty four percent and her liter flow was maxed.
“Her pulmonary alveoli are disintegrating,” the pediatrician said to Ian and Linda. “This makes it increasingly difficult, if not impossible for her to exchange oxygen.” He gently swabbed the corner of Ginny’s mouth with this finger and showed it to her parents. “This powdery substance is her lung tissue.” Ginny watched the three who surrounded her. “Her lungs are filling with fluid as well. There’s no amount of oxygen that would adequately sustain her. We could intubate her, buy her a week or two.” He paused in the inevitable.
“Or?” Ian asked.
“Or we can make her comfortable here, away from clinical interruptions.”
And they did. Ian called his parents who lived in California at the time and apprised them of Ginny’s turn, fighting for composure with every word. He then held the phone to Ginny’s ear as they said their goodbyes, just to the point where Ian could hear his mother sobbing and he brought the handset away from Ginny’s hearing. He told his parents he’d call them later and disconnected. Linda took her turn and dialed her parent’s number, waited and connected. When her mother picked up, Linda froze in the simultaneous effort to keep herself together and somehow break the news that they were calling so Ginny could, in a sense, say goodbye. But, she could not. Ian could hear his mother-in-law on the other end, Linda? Linda? Is everything okay? and gently took the phone from Linda’s ear and repeated for her parents what he had done for his.
Ginny slipped into a coma not long after, as her pediatrician said she would. Linda and Ian held her together and separately, taking turns but never far away from her as she continued her pulmonary descent, through that night, through Sunday and on until Monday morning. In the early hours Ginny’s breathing had succumbed to the pressure of her failing lungs taking shallow rattled breaths about every twenty seconds. Then thirty. Ian and Linda were sitting on their bed, facing each other, their legs crossing, both cradling their dying daughter when she took her last breath. And they held each other and they cried over her still, peaceful little body.
“Wait a minute,” Ian says to Gray with a thought suddenly dawning on him. “Do you even have kids?” Gray closes his eyes. “You don’t! So you can’t even imagine what that’s like. You couldn’t, you’re incapable.”
Ian stands and folds his chair and leans it out of the way against the side wall. He takes the adirondack by its armrests just to each side of Gray’s wrists and rotates the chair and Gray half way around facing the closed rolling door and the polished white bathtub. He clicks on the overhead lamp and the tub’s parabolic and gloss increase its light reflecting it up into Gray’s face.
“Linda died in that tub.” Ian rummages through Virginia’s box and finds a roll of cloth medical tape. Then standing upright he tears off four short strips, sticking each just barely on the edge of one of the arms of the chair and then stows the tape back in the box. He leans the adirondack back and begins a procedure that is not unfamiliar to him – with each small swatch of cotton adhesive tape he catches the twitching eye lashes of Gray’s right upper eye lid with one end and secures the other end to his brow. Then the upper left side, then the lashes below them, taping them to his cheek, and then the same with the lower right side. He brings Gray back to his upright position, who is now unable to close his eyes. Gray is trembling, barely able to breathe through his nose in his newfound panic. Ian finds a corner of the duct tape on Gray’s mouth and pulls it off in one slow and steady move. Gray gasps his next breath, breathing easier now, the panic notwithstanding.
“I’m sorry!” says Gray in suspicious awareness of his own peril. “I’m sorry, Ian. I’m sorry about your girl, I’m sorry!”
Ian takes his Leatherman out of its sheath on his belt and unfolds a blade.