The midwife comes home to a many-roomed house; dim lights illuminate the windows even when she is away at her work. After a day that began before sunrise, the door to the house comes open easily. She turns no key; there is no lock. As she enters, the scent of the house comes over her: cool, humid, gently salty, as if just inland.
She reaches her hand out in the barely lit entryway and leans her weight against a section of wall painted in a woman’s hot exhalations, the exhalations that came when she insisted that all of her strength was gone. She feels for the switch of a lamp in the corner and the light appears as the pale yellow of a woman’s closed eyelids, her head thrown back against the pillow, resting atop the mountain of her success.
Underfoot, the floor is an intricate network of wooden inlay: a late gush of blood interlocking with an urgent grip on the midwife’s arm that leaves a bruise the next day. A sharp creak as she ascends the stairs; one finger held silently at a woman’s lips — Please, he can never know. Her house is this way: drawing the curtains for the night, a woman’s long black hair held away from her neck, damp with sweat. Sinking heavily into the bed, pulling starched sheets up over her legs, the delicate weight of a newborn laid in her arms — We did this together. Somewhere in the house is always the first birth: a back-issue magazine consigned to a high shelf or a deck of stiff playing cards in the side table drawer.
She can’t remember the day the house was finished — wasn’t it built by some other midwife? Some years ago she spent a single night in one of its small bedrooms looking out onto the street, the sidewalk dark and damp with late autumn rain. Over time she spent so many nights in the house that it simply made sense to stay; one day she finds that she has carved her initials into the soft wooden banister. She recalls no single moment in which this became her home, no date on the calendar to distinguish the before from the after.
But if you have time, let me tell you a story of before and after.
A nurse approaches me on the labor floor, tapping a ballpoint pen to the clipboard she holds tightly in front of her. “Twenty-one years old, baby number one, 32 weeks pregnant, not feeling the baby move,” she reports. She rattles off the woman’s vital signs and most recent lab results. “She’s not ours,” the nurse sniffs — that is, she does not come to us for prenatal care. “She’s in triage room 20 whenever you’re ready for her.”
Rising from my desk I cross the floor and take a moment to read the electronic fetal monitor displaying the pattern of the baby’s heart. I watch this jittery yellow line proceed across the screen, its occasional rises and returns painting a reassuring digital picture. Below that, a line reflecting the electrical activity of the uterus: flat, quiet, no contractions at all, just as I would hope for in a woman only eight months pregnant. Without laying eyes on the woman I know that her baby is likely in fine condition.
I casually consider what I will tell her; I am also thinking of the previous two women who have appeared in triage with the same concern. I am also half-considering: a training on breastfeeding that I need to complete; the birth I attended yesterday and what I could have done to prevent the hemorrhage; the anthropological text on birth practices in south India that I haven’t yet finished; a letter I’d like to write.
Entering room 20 I find a young woman seated on the exam table; she is outfitted in clean, dark leggings, a tidy yellow sweater and glasses framed in navy plastic. Her hair is smoothed into a tight, shellacked bun. The mildly chemical scents of dandelion shampoo and laundry detergent perfume the air. I know that I will find her skin softly clammy with cocoa butter; she is presenting her body for examination.
I introduce myself and ask her what has brought her to the hospital this evening. She stares at the pastel walls of the triage room. “I don’t feel the baby moving so much,” she says. She is hoarse. “Also I think I have the flu.” I help her lie back and see her wince when her shoulders reach the worn, brown plastic of the exam table. I ask her if she is in pain. “Oh yeah,” she says flatly. “But it’s nothing new. I hurt all the time.”
As she pulls up her sweater and I place my hands on her abdomen I immediately feel the unmistakable form of a fetus changing its position, its intentions unknowable as it flexes and extends, as it draws fluid into its lungs and then expels it, an imitation of breathing. I gingerly take the woman’s hand and place it atop the mound of her belly. “Do you feel this?” I try to look her in the eye but she has shifted her gaze to the ceiling. “This is your baby moving.”
She is quiet, and I am quiet, and the grainy, electronic representation of the fetal heart is the only sound in the room, rising and returning. A thought crosses my mind of a woman’s complex perineal laceration that took me an hour and a half to repair; I wonder if she is healing. ”Oh. Yeah well I guess I do feel him now.”
I take in the picture of this woman on the table: no sore throat, no vomiting, no diarrhea, no chills or malaise. The nurse has already told me her temperature but I place my hand on her forehead — no fever. She closes her eyes under the weight of my palm and tears begin to drop heavily from the beneath her glasses; I pull a cheap cardboard box of tissues from a drawer beside the table and touch one of the thin, white squares to her cheekbone. She takes it from my hand and covers her eyes.
I take the bulky monitors off her abdomen and wipe ultrasound gel from her skin. “Your baby is just fine,” I tell her, “and I don’t think you have the flu.” The corners of her mouth tense; her eyes are giant with tears as she stares at the fluorescent light fixtures.
“But you are not fine,” I add.
And the words surface in my head: And I am not fine. They are new to me and are quickly submerged beneath the memory of a man who assaulted his wife in triage last month, trying to pull out her IV before we called the police.
She shifts to her right and pushes herself up awkwardly to sitting. Nudging her glasses up her wet nose, she looks at me. “Doctors always say the baby is fine. I come in and they check the baby, they say the baby’s fine and they send me away. But I think I’m dying.”
And I am not fine — the thought turns over in my head.
The details tumble out: bulging discs in her spine that make it hard to walk or sit, prescription pain medications that she has been warned against taking while pregnant, chiropractors and physical therapists refusing to see her until after the baby is born. Severe depression for which her physician will no longer prescribe her medication because “it might hurt the baby.” Counselors that are angry at her for missing appointments; she doesn’t want to get out of bed anymore. No one at home to help her prepare for this baby that she doesn’t want, no one to put a hand on her lower back. Pain in her mind and pain in her body, each intensifying the other until she has come to this moment in which it seems that she is dying or would like to be. Then she asks if, when the time comes, we could please numb her and do a c-section so that she won’t have to feel anything.
I exhale heavily. Another black man was shot by the cops for no reason last week; today’s news is full of images of the protesters. And then there is this woman in front of me.
I tell her that see her terrible pain and that I will not send her out of the hospital without making a plan for her to feel better; I tell her that she is a human being not an incubator and that she deserves to feel well. I ask her if she has a plan to hurt herself or someone else and she says that she does not. I ask if she would agree to speak with our social worker and she says that she would. I ask if she would like me to take care of her for the rest of her pregnancy — she says yes, and the yes feels like a bright green tendril in the dirt.
She and I sit over a clean sheet of paper and make lists: the medications it is safe for her to take; the ways to soothe her back pain until our medicine clinic can evaluate her; names of friends and relatives that she can call on for help; problems she would like to talk about with a counselor. We write this all down because it is something for her to hold on the way home, to keep in her coat pocket, and because in writing, unlike in thinking, you must eventually come to a stop. I make her an appointment to see me in the prenatal clinic the next day at eleven o’clock and, because no one knows what a midwife is, she says: “You’re the first doctor who ever listened to me.”
I am aware of a growing pain in my chest, a crackling like circuitry on the fritz.
As I watch her leave the labor floor I imagine: the next three women who will appear in triage with the same concerns; the next birth during which there will be a hemorrhage; the long run I will take when I get home. I think of the woman whose labor I will be inducing later this evening, wonder when the first labor was successfully induced with modern medications, and think how interesting it would be to read a social history of the induction of labor. My boss’s comment to me during my recent job performance review appears in mind: “Even during an emergency we look at your face and can’t tell that there’s anything wrong — that’s a good thing.” Because I am not fine. Some time later, my shift comes to an end.
The next morning in the prenatal clinic my breath feels uncomfortably humid. There is a bitter taste on the back of my tongue; my body is electric and ungrounded. It is 10:50, it is 11:00, it is 11:10. I have no sooner realized that the woman from triage is never coming to her appointment than another woman’s chart appears on my desk for review. I stare at it blankly.
There is a knock at my clinic room door and, before I can answer, the midwife next door has stuck her head in the room. Katherine is a senior midwife and a comfortable presence: she speaks with calm and deliberateness; she places her hands surely. She outfits herself in soft knits and delicate beads and sits with the stillness of a cat. I see her mouth begin to form its typical inquiry into my day, “You doing ok?” — an offer of her experienced perspective, should I need it — but she sees something in me and stops, her face arranging itself into concern. Slipping into the room and seating herself next to my desk, we look at each other the way animals do, without fear or social grace. Her eyes are serious and unblinking as I recount the story of the woman from triage room 20, of my hours spent with her, of her hopelessness, of her failure to appear today as if she has broken a promise to me.
“What’s her name?” Katherine asks me.
I search my memory and find only the crackling of circuitry on the fritz. Some low panic comes over me — what is her name?
I have been told that I have a memory like a steel trap: so sharp that it makes those close to me nervous. I will remember: the unstable living conditions of a woman I met once three months ago; the exact wording of an argument I had last summer; the exchange of vitamins and minerals in the kidneys as explained during a lecture in graduate school three years ago. But for the first time in months I find nothing in my mind at all — no thoughts of tasks to be completed, no blood tests or chest x-rays to be ordered, no clinical questions to which I’ve been meaning to look up the answers, no reminders of books to be added to my personal reading list.
After some pause, I say all that I can manage to Katherine: “I can’t remember.”
She trusted me, she told me that I had helped her, and today I can’t even remember her name; we are strangers to each other, after all. I cover my face with my hands and find that my cheeks are damp with single tears.
With no preamble, Katherine tells me that I have burnout, and asks me how long I’ve been at this job. I protest that it’s been less than a year, so burnout is impossible.
“And how long ago did you attend your first birth?” I don’t answer.
Yes, that first birth: five years and two months ago, as a doula in a public hospital in China’s Yunnan province. That I will always remember — the woman, her birth, her son, his name: Gabriel. Born into my bare hands because there was no one else, because the instinct is to reach out hands to catch a baby falling into the world. Dabbing my cheeks dry with a paper towel, the room smells faintly of the thin Himalayan air at 11,000 feet.
“I remember this moment when I was a new midwife,” Katherine says plainly, “before I understood about the trauma.” She outlines a plan for how I am going to complete this day and for what I will do when this day is over. I want to be listening because the plan sounds like a good one — something about rest and self-care — but I can’t, because I don’t believe her. What trauma? That total exhaustion, that dim view of humanity, that pop psychology explanation for being not strong enough or compassionate enough — that doesn’t sound like me at all. I tell her as much and she looks at me with an expression that goes some distance beyond pity.
And so, because the will to excuse our own dysfunction is so strong, that is not the moment between the before and after of this story. It is only some days later, after yet another night shift with its bleary sleepless hours punctuated by the adrenaline of birth, and after a long drive out of New York City, up the east coast to New England and back again — the miles passing beneath my feet opening some meditative corner of my heart — that it finally comes. I find myself at home slowly returning to their rightful places all of the untidy objects of my apartment: the mail that has accumulated on the glass coffee table, the shoes lying on their sides in the hall, the empty teacup on the window sill. My whole body hurts. I roll a mat out on the living room floor but there is no way to stretch out the pain; I give up and begin to fold my clothes instead.
As I sit turning back shirt sleeves I feel slow a heat come over me, rising up my spine, up my neck and behind my ears, finally settling in my forehead. For a moment I think I’m coming down with something; I actually get out a thermometer but there is no fever. I go to the mirror by my bed and, leaning towards it, hope to see the face of someone familiar to me: one who comforts a woman with a warm and steady hand, one who brings her a measure of peace. Instead, I see for the first time what Katherine saw: a tension in my face that I barely recognize; I am not fine. Although it should have been clear, although it is everywhere in my writing, I only now take in the full picture myself in this moment and on my face I see: the terrible violence in women’s lives, their stab wounds and HIV infections; their stillbirths on the sidewalk, their babies brought onto the labor floor in plastic buckets; their babies born having seizures; their babies born addicted to drugs; their infections and lacerations and hemorrhages that I have worried are my fault. I look in the mirror and see these things for what they are. I call them trauma and it sounds, suddenly, correct.
I close my eyes and feel my mind go silent, as if the plug has been abruptly pulled on that crackling circuitry, all of the painful energy draining from me in an instant. My body is cool and quiet, a long fever finally breaking.
I awake in a darkness like the pupil of an eye. Throwing off my heavy blankets and feeling my way out of the bedroom, I enter the kitchen and put my hand into an open drawer, withdrawing a box of matches. I strike one and it springs into flame. Moving to the kitchen window I touch the match to the wick of a short, white taper candle waiting upright on the sill, and then to another. Long shadows appear behind the objects of my kitchen: a purple glass vase in the shape of a woman’s gratitude; she says I took away her suffering. A thin trail of sulphurous smoke from the extinguished match curls through the air: the first time I surreptitiously leaned in to inhale the finely scented skin of a newborn’s head, feeling like a pickpocket. I move from room to room in this way, lighting candles, lighting lamps.
What is this house that I have built? On what date did I see these rooms for the first time, and when did I come to dwell in them? That first day when they said Get the midwife! and they meant me? — no, years before then. My first birth of midwifery school? — no, even before then I had laid the foundations. The first time I was taken in to a woman’s confidence? — perhaps then, although that is a memory long since faded.
There is certainly this: five years ago, when I said that I would one day do this work, women began to tell me the stories of their own pregnancies and losses. So eager were they to unburden themselves that I found I needed only to hold out my hands and women would give me their stories of pain and triumph like bricks and bolts of cotton, like lengths of pine and knotted rugs. I never thought to choose among these stories or to put them aside; I collected them all in case I disrespected a woman by forgetting her, in case I might need them again, and because it was it was possible to keep them all when there were only a handful of such women, before they became fifty, then a hundred, then five hundred. When my arms could no hold no more, I stacked the bricks into walls and laid the pine into floors; I built a house from the intimacies of women, sewing the cotton into pillows and rolling out the rugs beneath my feet.
I was reminded recently of William Morris’s admonition that we should have nothing in our houses that we do not know to be useful or believe to be beautiful. Standing in the light of incandescent bulbs, taking in the walls of what has become my home, its objects illuminated by a dozen tiny fires, I see instead of such curation the horror vacui that I have created over the course of years: books stacked from floor to ceiling, all of the infections I have cured; a hundred landscape paintings, women’s internal places of retreat during the pain of labor. Paper bags of bric-a-brac wait in the hall: recollections of hard night shifts destined for delivery to the doorsteps of unsuspecting friends and lovers. My cheeks burning in this recognition, I am nonetheless grateful that in the diagnosis lies the cure. Settled at my broad mango wood table during quiet evenings and the long hours of a post-call afternoon, I am now turning these objects over in my hands: does it serve me to remember those mistakes that caused a new mother’s fever? Is my life more exquisite for the addition of a new father’s prayerful exclamations at the birth of his son?
I have a fear of the cold and dark months, associating them with the theft of my freedom, with being forced indoors away from the freezing rain. And so I am amazed to find, for the first time in years, that I feel no dread at the close of these short December days but feel instead a peace like the quiet whistling of a kettle on the stove.
In the dark of this winter, at this turn of the year, I am giving away these possessions.