Ava, p.8
Ava, page 8
“Same,” Spencer said as he brushed her hair out of her face. He set up her bedside table with her hand lotion, lip balm, and phone charger. Then he settled into the recliner next to her with a pillow and blanket. They both slept off and on through the night, waking when Angela came in to check Larkin’s vital signs and cervix.
The next morning, Angela came in to tell them goodbye at the end of her shift and introduced them to the nurse who would be taking over for the day. Allina looked to be younger than Angela and was just as friendly. She wore a blue lanyard with bichon frise dogs all over it and a gold necklace with a photo of a little boy in a small heart frame. She told them she was fluent in English, Spanish, and Tagalog and had worked in the labor and delivery unit for three years.
Angela expected that Larkin would still be there when she came back for her evening shift as primips take longer to induce.
“Primips?” Spencer asked.
“Yes, first pregnancies. Inductions can take two to three days sometimes. Maeve is on the smaller side, so it may take less time,” Angela explained.
The thought of waiting that long to deliver was bittersweet to Larkin. She would be able to keep Maeve inside her longer, but that would only delay the inevitable. Larkin wasn’t sure what she wanted, but it didn’t really matter—the Cytotec would decide for her.
After twenty-two hours since Larkin arrived, Allina told her that her cervix was ready to start the Pitocin, and she changed out the IV fluids for medicine. “The anesthesiologist will be in to start your epidural once you’re about four to five centimeters dilated,” Allina told Larkin.
Spencer left for a quick trip to a nearby fast-food restaurant to get her a cup of her favorite crushed ice.
Since being admitted the night before, Larkin had been getting texts from family members, friends, and coworkers who were thinking of her and Spencer. She replied with simple heart emojis and thank-yous. As she looked out her hospital window, she could see the sun was setting and the sky was a beautiful array of pastels.
The first contraction came, and Larkin’s gaze shifted from the window to the monitor next to her. It didn’t hurt like she had expected it to. It felt like a quick jolt and squeeze to her abdomen, and she saw the spike appear on the monitor as it happened, but it wasn’t bad at all. She hoped Spencer would get back before it got worse.
She texted Aubrey: hey you
hey!!!!!!! i have been thinking about you a lot but i didn’t want to bother you. i love you and spencer and i am sending you soooooo many hugs and sooooooo much love.
Larkin felt another quick jolt and replied, thank you friend. i am just starting to contract.
have they checked your cervix lately? got the epidural yet? you are getting an epidural right?
yes no and hell yes
good. i want you to be comfortable ok? and don’t let some resident do your epidural. i know it’s how we learn but i don’t want anyone practicing on you
Larkin smiled as she texted: good advice. i won’t
and i know you don’t want anyone there besides spencer but i wish i could be with you
i know you do. thank you for understanding
when you are feeling up to it, come visit. or i can come there ok?
of course
kisses
Larkin hesitated to reply, then typed, i’m really scared
want me to call?
no. i just wanted to know you are there.
always
Spencer walked in with Larkin’s big cup of ice and kissed her on her head. Allina came in behind him and checked her cervix again.
“You’re about three centimeters, Larkin,” Allina announced as she removed her gloves. “You’ll probably be ready for your epidural in another hour or so.”
The contractions were starting to feel stronger, but Larkin was still surprised at how mild the pain was. She wondered if her emotional pain was blunting her physical pain. Or maybe her body knew she couldn’t handle both and was extending her a simple kindness.
Shortly after Allina left, the anesthesiologist had her sign the consent for the epidural and explained the procedure. She asked him if he was a resident or a fully trained doctor. He grinned and asked if she knew someone in medical school.
“Yes, why?” Larkin asked.
“Because medical students never want other students or residents practicing on the people they love.” He chuckled and promised he had done thousands of epidurals. He also said he was glad she had a good friend watching out for her.
Once Larkin was about four centimeters dilated, the anesthesiologist came back. He had her sit up on the bed as he sat behind her. She felt something cold and wet on her back as he explained that he was sterilizing the area. He told her she would feel a pinch to her lower back while he injected numbing medication. Then he placed the epidural.
“You’re a champ, Larkin. All done,” the anesthesiologist told her. “The pain medication should start working in about fifteen minutes or so.”
It was becoming more and more real that she was having her baby today. She was sure there had to be other women on the same floor experiencing the same things: the contractions, the cervical checks, the epidural placement. But she was sure they were excited and had friends and family with them and in the waiting room. As she watched her contractions becoming more frequent on the monitor, Larkin wondered if they would play the lullaby announcement for Maeve.
Angela took over for Allina as the evening staff started arriving.
“Back again!” Angela exclaimed. “Allina told me you have been progressing well. I’ll be back to check you again later. There’s going to be a full moon tonight, so we can expect a lot more babies, like yesterday. Maybe even more. Some nurses say it’s just a myth, but I’m a believer. Those same nurses always make sure to ask for the night off every full moon, though,” she said, rolling her eyes. Larkin could tell she was only pretending to be irritated.
Spencer was in the chair beside her, updating family members via text. Larkin looked down at her pregnant belly and held it. She would rather stay like this forever than give birth.
Angela came in again and checked her at about one in the morning. “You’re getting very close, Larkin. Dr. Parrish has been calling to check on you. I’ll let her know when to come.”
Spencer had dozed off. Larkin gently grabbed his arm to wake him. “It’s almost time,” she said.
He leaned over and kissed her hand, her arm, and her cheeks. “I love you more than anything, Larky Lark.”
“I love you, too, Spence.”
Angela stopped in for one more cervical check. “It’s time to call Dr. Parrish,” she said.
It’s time, Larkin thought. I’m not ready. I’ll never be ready. When she felt a wave of panic, she tried to focus on breathing slowly.
Dr. Parrish came in, greeted them both, and right away gowned and gloved for the delivery. Angela helped Larkin bend her legs and put her knees near her shoulders. She moved her closer to Dr. Parrish, who was adjusting a sterile drape. Dr. Parrish grabbed an instrument—it looked like a long crochet hook—and shortly afterward, there was a large gush of water that seemed to go on forever. Another nurse came in to help hold Larkin’s legs.
As the next contraction came, Dr. Parrish told Larkin to push like she was having a bowel movement. Angela told her to tuck her chin to her chest and start pushing hard while she breathed through her mouth. Larkin repeated this as several more contractions came, with Spencer encouraging her and wiping sweat from her forehead with a cool washcloth.
Larkin heard the NICU team come into the room and the sounds they made while getting their supplies ready. She heard plastic packaging being opened, metal objects being set down, and instructions being given as to who would bring the baby to the warmer and who would assign the Apgar scores. She also heard the incubator being rolled next to the warmer. While she was resting after the last contraction, she saw the warming bed had been turned on, the light glowing on a blanket and stethoscope below. The team stood there in blue gowns, wearing masks and gloves and surgical caps with only their eyes visible, waiting for Maeve to arrive. She wondered how often they came to a delivery like this, and if it got easier for them each time. She also wondered if staying detached was an innate skill or if it was learned with time.
“Okay, Larkin, one more hard push,” Dr. Parrish said. “Right now. You can do this. Breathe through your mouth and push, push, push, push!”
“You can do this, Larkin,” Spencer said encouragingly.
I can. I can. I don’t want to. I have to. I’m sorry, Maeve, I’m sorry, she thought.
“Push, push, push!” Angela repeated.
“Good job! Here she comes!”
“One more big push, Larkin!”
She pushed as hard as she could and then heard Dr. Parrish yell, “Good job. She’s here!” The doctor grabbed a blue bulb syringe and suctioned Maeve’s mouth and nose.
Larkin and Spencer heard a weak, wet cry. They got a quick glimpse of her, bloody and purple, as Dr. Parrish handed her to the neonatology team. They wouldn’t resuscitate her if she stopped breathing, but they were there in part because it was a teaching hospital and most of the residents had not seen an anencephalic baby before. As they dried and suctioned her further, Maeve didn’t cry anymore. Larkin and Spencer strained to see past the doctors and nurses who huddled around their newborn and murmured about “respiratory effort” and “muscle tone.”
After a few more minutes, the neonatology team quietly filed out of the room, and Angela gently placed Maeve skin to skin on Larkin’s chest. On Maeve’s head was a small, white knitted cap that had been made by a hospital volunteer. Larkin was thankful for this, and she was sure Spencer was, too. They wanted to see the rest of Maeve—not her defect. They had seen enough babies on the internet that they knew what to expect. They didn’t want that to be part of their memory bank for this day.
Larkin and Spencer looked at every inch of her tiny body below the little beanie and slowly took her in. She had perfect fingers and toes. One hand was wrapped around Spencer’s finger. They knew it was simply a reflex, but it still made them smile. Maeve’s back felt smooth and warm as her mother rubbed her hand against it. Larkin could feel her daughter’s chest rise on hers, along with the fast beating of her heart. Her mouth and nose were perfect. Her eyes were closed, a little puffy and swollen. She looked like any other baby as long as the cap covered her head.
After Dr. Parrish sewed up a small tear in Larkin’s vagina, Larkin was moved to a wheelchair with Maeve still on her chest. Spencer gathered up their things, and Angela pushed them to their room in the NICU. The room was called the Tranquility Room, and it had soft lighting and a queen bed. Watercolor paintings of nature scenes hung from the walls. Two large recliners and a coffee table were across from the bed. Larkin wondered how many parents before her had said their goodbyes in this room.
Angela got Larkin settled into bed, and their neonatology nurse, Betty, came in and introduced herself. Betty had over forty years of experience and was confident and motherly. Her silver hair was held back in a tight bun. During her career, she had taken care of at least a dozen other anencephalic babies at all different stages. Some were stillborn. Some had lived only a few minutes. One had lived three weeks—her mother had been barely out of high school and had left the hospital with her boyfriend, abandoning her baby girl when she was less than 24 hours old. No family members had come to see her, and the Department of Children’s Services had made arrangements for her body when she’d died.
Betty put Maeve on a monitor and told Spencer and Larkin she would be just outside the door if they needed anything. When the monitor came on, they could hear the fast, steady beating of Maeve’s heart.
Angela said goodbye and thanked them for letting her help take care of Maeve. She promised she would have them play the lullaby for Maeve before she left.
Spencer lay in the bed next to Larkin. She tried to offer Maeve her breast, but Maeve didn’t attempt to latch or seem interested, and Larkin called for Betty to help. Betty showed her how to hand-express colostrum from her breast, and they gave Maeve small amounts in a syringe, but she took very little.
Larkin and Spencer were both exhausted but too anxious to go to sleep. They knew the monitor was on and Betty was just outside the door, but it did not help them relax. The room that had been designed to offer tranquility had failed.
Larkin looked at the baby she and Spencer had made, however imperfectly, now sleeping soundly on her chest. The lullaby started to play overhead for Maeve, just as Angela had promised. Larkin knew Maeve couldn’t hear her voice, but she wanted to sing for her in the only German she knew, the lullaby her mother had sung for her:
Guten Abend, gut’ Nacht,
mit Rosen bedacht,
mit Näglein besteckt,
schlupf’ unter die Deck’:
Morgen früh, wenn Gott will,
wirst du wieder geweckt,
morgen früh, wenn Gott will,
wirst du wieder geweckt.
Guten Abend, gut’ Nacht,
von Englein bewacht,
die zeigen im Traum
dir Christkindleins Baum:
Schlaf nun selig und süß.
schlau im Traum’s Paradies,
schlaf nun selig und süß.
schlau im Traum’s Paradies.
Larkin kissed Maeve’s cheek and hoped that maybe she could dream, despite what the doctors had said about her level of awareness and what she knew logically to be true. She hoped after this life, there would be a beautiful life ahead of her in a place where she was whole and could live the life that had been denied to her.
The new parents spent their time with Maeve telling her how much they loved her and softly singing their favorite songs to her. The beeping on the monitor suddenly started to slow. The number that had been wavering between 140 and 160 dropped to 78, then 54, then 42. Betty came in and turned off the monitor, as she’d been instructed by the neonatologist. She told Spencer and Larkin that Maeve’s heart was shutting down.
Larkin felt her own heart beating faster and faster, rising up as if it could jump out of her throat. She felt like she could barely breathe. Her hands tingled with a feeling of pins and needles.
Betty asked if Larkin wanted her to stay with them or get the doctor. Larkin shook her head quickly. She just wanted it to be her, Spencer, and Maeve. Spencer was a quiet but steady presence. He didn’t cry. He didn’t speak. But she felt his arms around her, holding her tight, kissing the top of her head.
They swaddled Maeve in a hospital blanket printed with pastel ducklings and sat up in bed, taking turns holding her. After a few minutes, Maeve started to gasp like a fish out of water. Her mouth opened and closed like a goldfish that had jumped out of its bowl. Her sweet, perfect face turned blue. She seemed hungry for oxygen but at the same time was drowning in air she couldn’t breathe.
Although Spencer and Larkin had been told that this would happen, it was more agonizing to watch than they’d expected. The feelings of helplessness that washed over them were unbearable.
Larkin could only weep and whisper into Maeve’s knitted cap, “I’m sorry. I’m so sorry. I’m sorry.”
After three hours and twenty-seven minutes in this world, Maeve was gone.
CHAPTER 16
The old Lie: Dulce et Decorum est . . .
—Wilfred Owen, poet
Betty came in and listened to Maeve’s heart and lungs, then texted the neonatologist on call. The neonatologist listened again to Maeve’s quiet, unmoving chest and officially pronounced the time of death.
Betty brought in a small crib for Maeve. It had a special cooling mattress inside. The care team had told Larkin and Spencer about this months ago. It would keep Maeve’s body maintained for longer so they could spend more time with her. Larkin and Spencer called their parents so they could come to the hospital to meet and then say goodbye to their only grandchild.
Larkin and Spencer asked Betty to take Maeve for what would be her first and last bath. She left for a bit and came back with Maeve dressed in a tiny white gown with eyelet lace trim and a matching soft white hat with a small bow on the side. It looked like a dress for a child’s baby doll, and Betty told them it was. The NICU nurses and volunteers kept a donated supply of little clothes like these for times like this.
The nursing staff had made a remembrance card with Maeve’s hand- and footprints. Betty also gave them a lock of Maeve’s hair, tied with a pink ribbon. Spencer and Larkin had noticed a little bit of dark hair peeking out from under her hat—it looked just like Spencer’s. Betty asked if they would like for her to take pictures of them holding Maeve. They thanked her for offering and agreed.
After Betty took the pictures with Spencer’s phone, Larkin said quietly to her, “After our families visit, I don’t remember what we do next.”
Betty explained that they could take Maeve home for a little while and then bring her back if they wanted. They would provide them with a Moses basket and the cooling mattress if that’s what they wanted to do. Or the funeral director could bring Maeve to their house. Otherwise, if they preferred, Maeve could go directly to the funeral home and they could arrange to have her buried or cremated.
Larkin had forgotten they had been told months ago that they were able to take Maeve home before she went to the funeral home. Larkin could carry her in her arms while Spencer drove. Betty told them the hospital would provide them with a letter to give to a police officer if they got pulled over, and the NICU would alert the police before they left the hospital. The thought of explaining to law enforcement why their baby was not in a car seat and then having to provide a letter explaining the circumstances filled Larkin with dread. They decided to have the funeral director take her from the hospital and have her cremated.
“There are no wrong decisions,” Betty said. “We want you both to do whatever makes you comfortable. You’re her parents. It’s your choice, okay?”
Larkin nodded and thought, My choice. After all these months of carrying her. After all this pain and worry. After watching Maeve gasp, watching her turn blue, watching her die. Now I have a choice. It provided her little comfort.
