A Walk Among the Headstones

Being a midwife is an intensely social experience; you spend much of your work day inquiring about the intimate details of others’ lives, advising, caring, comforting. It is work that I love, but that sometimes leaves me overstimulated and emotionally exhausted. I have found that there’s no better antidote for that flowering hyperdrive of humanity than taking a stroll among the dead.

*****

The clinic is a mess; women double-booked for prenatal visits, overflowing from the waiting room to the hallway. The nurse is loudly protesting the conditions of her labor. I, like a baseball player sliding into home plate, have finished seeing women for the morning just as the medical assistants are leaving for their lunch break. I have 60 minutes before it all starts again: the belly checks; the fetal heart tones bouncing around the room; the vague descriptions of skin rashes, itches, sharp pains. Mostly from women I have never seen before and will never see again.

My car is parked outside; I should eat, but I drive instead. I can’t stand to look at the pale clinic walls any longer, or to wonder what the temperature is outside while we sit inside, shivering in the air conditioning. Despite having come to this clinic every week for almost a year, so many of the surrounding streets are practically unknown to me — I turn left, then right, then right, then straight, seeking unfamiliarity after unfamiliarity. I come to the open entrance of the Hill Cemetery. There is a sign posted that is probably forbidding or limiting my entry, but I can’t be bothered to read it. I slow to graveyard speed, and enter.

Inside is a village of the dead: rolling acres, back streets and main streets. Ostentatious neighborhoods of the wealthy, their resting places built of marble up into the sky; cramped, cement-covered quarters of the modest; dramatic lookouts over the Hudson River, today made only for me and the legions of the unseeing. I wend through the silent hills, absurdly looking for somewhere unobtrusive to leave the car. There is nowhere, so I stop in the middle of one of the streets of the deceased.

After a frenzied morning surrounded by the living, I take peace in the silence of the passed-over. I am alone, and not alone. No one advertises to me, nothing demands my attention, and gentleness is prized. There is finality here — there are no decisions to be made. I move as slowly as possible; the harsh midday sun leaves my body confused, unsure where to hide. The sudden heat of a rapid-onset summer has killed the grass in swaths. Small yellow bulldozers sit halted, dotted across the still landscape.

I become aware of a distant rumble, of a figure riding a motorized lawnmower coming towards me up the path. I make apologetic movements for being in his way, and he motions back to me that I’m ok — and then drives up the hill and around me, narrowly avoiding the headstones. I feel momentarily guilty, reading in his face pity for my status as an apparent mourner. There is no way to explain my presence otherwise.

My mind wanders and when I snap out of it I find that I have walked hundreds of meters down a winding way to a cul-de-sac of graves plotted in a generous circle. At my back are a series of giant, toppled crucifixes, each snapped off at the base in some unknown incident of weather or time. At my feet: a small brick of granite sunken into the earth bearing the capital letters: BABY NAN. To the left, an identical brick with only the dates: JULY 9-JULY 16. To my right, the same diminutive brick again, this one blank.

Notes from the Clinic

As a student, one of my favorite places was not the L&D unit but the outpatient clinic, where we saw an endless line of women with every imaginable issue come in and out of the four cramped exam rooms. Some had infections, some needed prescriptions, some were pregnant when they didn’t want to be, some couldn’t get pregnant and didn’t know why. Sometimes they came alone, and other times they brought their children, their partners, their mothers, their friends. I carried around a little notebook in my pocket on those long clinic days, scrawling clinical short-hand so that I would remember the diagnostic cutoffs for gestational diabetes, say, or the ultrasound results indicating the need for an endometrial biopsy. I spent a lot of time being nervous about what I would encounter during a day at the clinic, as indicated by the following snippet that I found today in the back of my little notebook.

*****

What will I find behind the door?

The slightest grin, a quiet anticipation of the first sounds of the muffled, aqueous heartbeat so longed for?
Or a suppressed desperation, the dread of a tiny, internal gnawing, the hope that there is some explanation for this feeling other than a child that she does not want?
Or the tired, resigned sigh of a seasoned mother who knows how many more gray hairs another baby will bring, of the honesty she does not offer — dear God, let this be the last!

I scrawl my notes in preparation, I scan them one last time, I breathe deeply and close my eyes before entering.
I make myself like a blank page to be filled with the woman’s pleas and inquiries, her interpretations, her offers of thanksgiving.

Behind door #2 I hear a metallic crash, the unruly work of a toddler’s blunt fingers against a tray of medical instruments, followed by the swift, sharp: Jorge! Basta!
Behind door #3, a soft weeping, as she understands that the child will be born, but not live.
Behind door #4, the pointed cry of the cervix being gripped, of an IUD placed, of the pain she didn’t know was coming.

And I head to door #1 to deliver the measured, non-news we all want to hear:
Everything is alright, today. Today, there’s nothing for us to worry about.

I stand outside the fern-green door: she anticipates me from one side, and I anticipate her from the other.

The Long Wait, or, Other People’s Babies

During my midwifery training I worked 24 hour shifts on the Labor & Delivery unit of a community hospital. Several independent practices run by midwives or obstetricians admitted women to the unit; the practice with which I worked almost exclusively saw women who were recent immigrants to the United States, and who were insured by Medicaid (public insurance) due to their low household incomes. Women from the other practices tended to be higher-income and covered by private insurance. As a general rule, I was not allowed to assist with births unless they were for women whom we had cared for at our prenatal clinic, which is as it should be.

  *****

A woman has been hastily escorted onto Labor & Delivery; the familiar hissing noise of the unit’s automatic double doors opening brings me scurrying hopefully into the hallway. The curse of the student is the desire always to be considered worthy of assistance (pick me, pick me!), the anxiety ever present that you will miss out on that critical experience that will make you feel, finally, competent.

But I am shooed away from the room. The woman is “not mine,” I’m told: “one of the Privates.” I stuff my hands into my lab coat pockets and skulk back to the midwives’ office, where I sit flipping through stiffened back issues of medical journals.

The days without births are the longest days. It’s the nature of the time — not electrified with the rush of an impending new being, not suffused with the peace that finally comes when everything has gone well: a contented baby clasped against the chest of a beaming new mother; a feeling like that one, perfect note for which Miles Davis claimed always to be searching. No, the days without births are staccato; my mind only half-able to engage, always in a state of tension like a muscle ready to spring into extension. Without a release of that energy my mood turns sour by nightfall.

The hours wear on with all but one room standing empty and pristine; fresh bed linens and sealed, sterilized instruments await the flurry of activity associated with a new arrival. For now, this one woman has the L&D floor to herself.

To stave off restlessness I sit outside her room and listen to the noises of her labor through the drawn curtain: the rise and fall of her moans, her labor as a stringed instrument. The low tones of her doula, the uncomfortable interjections of her husband. I watch the patterns created by the dual monitoring of her contractions and the baby’s heart on a screen at the nurses’ station, trying to find a correlation with the human sounds emanating from below the curtain; I cannot.

My calves go numb from squatting against the wall and I rise to move the minutes along. I complete my rounds on the postpartum unit early, listlessly. The women with their new babies seem uninterested in another face, another interruption, further instruction.

Returning to the labor floor, I pass the visitor’s lounge; the three silent, grey-haired occupants can only be expectant grandparents. I make the mistake of lingering too long outside the door. My white lab coat has caught their attention and they turn with a start, in unison, to hear the good news of a new baby’s arrival. No news! I say, unsatisfactorily. No news is still news, says the grandpa. We’ll just wait here, the two grandmas say. We don’t want to be a disturbance.

The light through the windows changes from yellow to grey and I watch clouds creep over the broad sky above the Hudson River. I hear sudden shrieking coming from the hallway and rush out, anticipating an imminent birth; instead I find the nurses huddled around a screen in the empty triage room cheering for Spain versus the Netherlands. The birthing woman herself remains hushed, and I wander up and down the hallway silently reciting clinical algorithms to occupy my mind: Repeat pap smear in 12 months…Colposcopy if HPV 16/18 positive…10-day progesterone challenge followed by a withdrawal bleed…TSH will be high and free T4 will be low…

Finally, the corridor is filled with the sudden vocal peaks and exhortations to blow, to pant, that mean that a labor is ending, that a baby’s head will soon be born. I tiptoe to the curtained doorway of the woman’s room — That’s it! I hear, The head is born! Now just rest before the last push. I know that I have less than a minute. I quickly slap the oversized metal button that opens the L&D doors, and see the three grandparents-to-be poised in the hallway. I gesture sharply to them to hurry, mouthing silently, Come right now! They skitter through the doors onto the labor floor, and we form a semi-circle outside the woman’s room. One more push, we hear, and then the wave of joyous cries of the woman, her husband, the nurses, the midwife.

The grandparents look to each other — has it happened?

The husband’s relieved voice reaches us from under the curtain: It’s a girl. The grandmas weep, the grandpa cups his face in his hands, and then: the short, sharp cry of their first grandchild. One of the grandmas jumps up with delight, and tears line the cheeks of all three.

I retrieve tissues from the nurses’ station, pass them around and then simply hand over the box. It will be a while now, I whisper. They nod vigorously and silently and, clutching each other, return to the worn black couches of the visitors’ lounge.