First Words

I have heard the azan, the Muslim call to prayer, under the scorching sun and the early morning cover of darkness: at the edge of the baking savanna of Sumberwaru in East Java, green mangoes fat on bowed branches; at the lunar feet of the Anti-Atlas mountains outside Tafraoute in southern Morocco, the trembling voice of the muezzin competing with low thunder from the horizon and the tinny sound of Salif Keita from my travel speaker; watching the sun sink behind the Pidgeon Rocks of Beirut, Cyprus just off in the unknowable blue distance; over the PA system of an airless Dhaka shopping mall, the smells of new plastic sandals and sour milk mixing in the fluorescently lit stairwells; curling through stone windows into the Loge of the Empress in the Hagia Sophia, the great calligraphic panes bearing the name of Allah hanging over mosaics of the Virgin Mary like the tags of rival gangs in a subway underpass; and, most quietly, among the demolished neighborhoods of the Kashgar that once was, snow falling silently in the dusty streets, mustachioed men proffering glass goblets of pomegranate juice so thick and so tart. But I now most often hear the azan on the fifth floor of my modest brick hospital in New York City just after a child has come into the world, when he is still slick and grimacing on his mother’s chest wrapped loosely in a cotton blanket.

 

On an evening like any other, I emerge from a triage room, my palms wet with hand sanitizer. I recognize Rokeya from behind by her long, black pony tail shot through with strands of silver, now falling over the back of a wheelchair in which a nurse is conveying her to a labor room. The nurse’s leisurely pace is at odds with the fury of Rokeya’s pain so evident in her blanched knuckles and rigid arms. I have been on the floor for 12 hours and had stepped into triage for a quiet moment, steadying myself among the sterile specula and IV starter kits for a further 12 hours over night. Pressing my hand to the Purell dispenser on the way out the door is merely a tic I’m unable to break.

I feel a tiny righting of the course of my day at the sight of this woman, a relief after hours of triaging strangers. As a shift worker, I never know whose birth I’ll be attending when I wake up in the morning; when it happens that fate matches me with someone that I know and have cared for there is a locking together of puzzle pieces and a claim that I lay to her in birth: I know her, I say, I’ll take her.

By the time I enter her room, Rokeya is sitting upright on the bed wearing the standard-issue, blue-flecked hospital gown and a shocked expression, flanked by two silent women that I guess are her mother- and sister-in-law. This labor is nothing like her last, nineteen years earlier. Then she was twenty years old, in the blur of the first year of marriage, occupying a room on the first floor of her in-laws’ home on what was then the outskirts of Dhaka before a fleet of new concrete buildings swallowed the surrounding area whole. Then she was just a bride, still skinny, for whom life had proceeded largely as expected, who knew some material comfort as the daughter of a secretary to the Assistant Superintendent of Police of the Bangladesh Civil Service. Her marriage had been arranged without displeasure to Anwar, a round-faced youth hoping one day to pass the BCS examination himself and work alongside his father-in-law.

In those days, Rokeya was concerned with learning how to be a wife, having given up her study of medicine after her first year.  Whereas she had observed their preparation in her girlhood, she now took responsibility for her family’s iftar meals during the month of Ramadan, laying out dish upon dish of dried dates, ghugni and muri, jackfruit, jilapi. Rinsing blood from the cavity of a sinewy chicken’s body, she sometimes thought of the four cadavers weighed down with bricks in a secluded tank of beetroot-red formalin at the medical college; she had barely worked to hide her disgust as caustic fumes from the embalming fluid filled the laboratory and had waited as briefly as she thought respectable before accepting her mother’s suggestion of marriage instead of year two of the MBBS.

Piping thin batter into a pan of frying oil at dusk, Rokeya knew nothing of the recurrent miscarriages that were to come after the quick conception and birth of her daughter, or of the secret meetings with an elderly woman neighbor to discuss redressing whichever of Rokeya’s past misdeeds must have brought this misfortune on her family. She knew nothing of what it would mean to lose a husband after only four years of marriage, to have his name unacknowledged in a brief news report of the bus crash that would take his life, among a dozen others, on the proto-highway that cut through her neighborhood in an eruption of cracks like a dry riverbed.

She could not have foreseen her penetrating grief at the loss of that man she still only half-knew, her years of widowhood as a returnee to her parents’ house with her little girl, her eventual emigration to the United States to live with an aunt whose teeth were blackened with rot at their bases, or her remarriage at age thirty-seven to the bachelor proprietor of a 99-cent store on Church Avenue. She had never imagined our meeting in a windowless, antiseptic room of my prenatal clinic with barely enough space to fit the two of us, an exam table and a sink. Nineteen years earlier, she could not have known that the English she had so dutifully studied as a girl would be the language of our meetings, or that the first hands on her second-born’s head would be mine.

 

Before I entered midwifery, during my training as a nurse, I was taught never to sit on a woman’s bed during labor; it was deemed too intimate a posture between strangers. I often remember such admonitions from my favorite nursing instructor Moira, a warm and formidable Irish woman in her sixties, straight-backed and clad in pressed white shirts, intent on impressing upon us a respectability no longer guaranteed us by the profession alone. A nurse never sits! she chastened us students as we waited in the hall outside the simulation lab. Or, crooning over a medical mannequin: Now we’ll be administering digoxin, which we will never refer to as what? An anti-arrhythmic, yes, because it is properly called what? A cardiac glycoside, correct. That is what will set you apart… But Moira never taught us how to greet a laboring woman. I have learned by trial and error to stop asking a woman in pain how she is feeling, to avoid that temptation of the workaday greeting. I sit by her side, I call her by her name, I tell her how glad I am to see her, and I mean it. We are intimates, she and I, though we may be strangers.

On this evening, I lower myself onto the empty space beside Rokeya’s bent knees, the mattress crackling quietly beneath my weight, the air full of her moaning. She does not address me. “I am in pain–”  she says to the room in general, “– too much pain — not like before — not like last time –”

Her female relatives sit gravely at either side of her bed, their sure palms resting on her arms, as still as geckos high on the wall. These women are not the typical family members who stare alternately at the electronic fetal monitors and at their smart phones; they know something about labor and, I sense, about pain more broadly: that it requires the full attention of those in attendance, that it demands a steadiness that betrays no doubt, no impatience, and no fatigue. When everyone else in the room is poorly equipped for birth, frozen in a corner or skittishly scanning their social media, I know that the night will be long and that I will collapse into a narcotically deep sleep long after daybreak. But for Rokeya I provide only the most basic of assurances: that I will do everything in my power to ensure that she and her baby will live, leaving the rest to her own efforts and the comforts of those who truly know her.

Hers is the progression of the unanesthetized body: sweat forms at her hairline and then at her upper lip; a contraction comes and she presses her fingertips into the muscles above her pubic bone; she sticks her chin out before vomiting into a pink, plastic basin that the nurse has placed by her side; she says that she just cannot and we tell her that she already is. She pushes just six times to move the child’s head out of her body — why do I gingerly dab a whorl of his wet hair just then? One more endless push and his body emerges in a rush of fluid into my hands. I hold him suspended for only a moment before placing him on Rokeya’s chest, the pulsating, dusky coil of his umbilical cord still connecting him to the inside of her uterus. Her cries turn to weeping and she clutches this wet, squalling creature, his eyes black and open, his ten fingers splayed in taught fans like the petioles of two palm branches.

Her mother- and sister-in-law wipe drops of sweat from their cheeks and adjust the dupattas they have let fall from their heads during the work of supporting her. I take in their faces now for the first time and notice a split-second of bewilderment come over the mother-in-law. Her eyes scan the room, seeking some object unknown to me: I am not it, neither is the nurse who is occupied with injecting oxytocin into Rokeya’s thigh to prevent bleeding.

Allah, she mumbles, seemingly in spite of herself. Allah — and I remember what she is looking for: a man to whisper the azan to the baby, the first words it will hear in this world, on this side of the birth divide. Finding no man, avoiding her daughter’s gaze, she leans over her grandchild’s head:

Allahu akbar, she says in a small voice into the newborn’s right ear, and then again, more steadily, Allahu akbar. She slowly turns the baby’s head to reveal his left ear — Allahu akbar — as I see the sister-in-law dialing a number on her phone. She has called Rokeya’s husband, still detained at the 99-cent store on Church Avenue. It seems he has been expecting this call and he wastes no time by greeting the callers; the phone is positioned over the baby’s right ear and from the pinhole speaker comes the improbable, quivering voice of this man who thought he might never be a father. The room comes to a hush, the regular chatter about the baby’s activities and, worse, the nurses’ business with women in the adjacent labor rooms, silenced. His thin intonations fill the labor room:

Hayya ‘alas-salah — Hurry to prayer
Hayya ‘alal-falah  — Hurry to success

We hold onto this woman, a new mother again after so long, I at her feet, her mother- and sister-in-law at either arm. The newborn is placid, pacified, evincing life only through his pink skin, intensely concerned brow, and the occasional involuntary twitch of his limbs: his first alpha sleep on earth. The mother-in-law turns the baby’s head once more for the recitation of the iqama, which the father begins remotely and without hesitation:

Qad qama tis-salah — Prayer has begun
Allahu akbar!

I encourage the afterbirth with gentle traction on the umbilical cord, twisting the purple body of the placenta like a cheesecloth as it comes into view, gathering its membranes together to prevent their tearing, catching it all in a metal kidney basin between Rokeya’s thighs. Her bleeding stops, she needs no stitches. I look up and observe her as she murmurs in Bangla to her son, barely ten minutes old and already awash in words and words. Whole volumes are written recording our last words, our dying words, but what of these first words from the birth bed? Would there exist other such volumes if only Great Men had given birth? Is it not enough that I once knew an old midwife whose husband had died in Vietnam and who whispered into the ear of each new baby: Be well and may you never know war!

I am reminded of the words of 16th century poet Kabir, so withering in his criticism of the faddish distractions of religious practice and of the muezzin’s ostentatious cries heavenward to grab God’s attention:

Surely the Holy One is not deaf, he writes.
He hears the delicate anklets that ring on the feet of an insect as it walks.

Had he himself witnessed that thing most unassumingly holy, that sanctity that needs no naming and no exegesis? Had he himself heard the tiny, tin bell of birth?

2 thoughts on “First Words

  1. I read your words as if I could sense the energy in the room. I so understand what you are writing about. I too am a CNM and former l+d nurse. I’ve witnessed a form of God many times before…

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