The first time I decided to have a second child, I was following convention. Our older son would be five by the time the new baby was born. It was time. My husband, Karim, was ready, and so I agreed. I was ready to buy a new house, decorate a new room—maybe in pink. I was ready to be pregnant and eat more cake. But I was reluctant to introduce myself as the mother of two.
One child is okay. One child will fold himself into the back seat of a two-door coupe. But two children? Two children require more car, less living room, a big backyard. Two children suggest you’re in it for good. It is harder to find babysitting, harder to have sex, harder to be you with two children. So I wasn’t 100 percent thrilled. Though I knew it was the right thing for my life. A decision Karim and I would not regret.
I was pregnant before we really tried. Before I had even laid all these thoughts out.
I was so charmed that he wanted another baby. And flattered, validated as a mother. He wanted another baby with me. So I was pregnant. And determined to take pregnancy in stride. I was twenty-four. Healthy. Pregnancy is not a medical condition.
We went on hikes and on long bike rides. I drank tea (caffeinated), gave piggyback rides, went to concerts and the pumpkin patch. I didn’t throw up. I didn’t feel too tired. I hardly felt pregnant at all. I went to prenatal appointments, prepared four-year-old Sam for the new baby. A baby is great, I told him. A baby will make you laugh and be your friend. A baby will be the best thing that ever happens to you.
He was sometimes skeptical but mostly uninterested. I took him to hear the heartbeat for the first time. He held my hand and cringed when my blood was drawn and smiled shyly at the attention from the doctor and nurses.
Sam was at school when the first call came. Karim was at the kitchen table, repairing his glasses with a tiny screwdriver. I was flipping through a catalog.
The nurse said my AFP test numbers came out too high for my eighteen weeks. There was too much alpha-fetoprotein from the baby’s liver in my blood. Something about a possible neurological defect.
Or maybe twins, I countered. I read the pamphlet.
She scheduled me for an ultrasound with a specialist forty-five minutes away. I researched AFP. Called my sister. Cried. Hyperventilated. Felt melodramatic for overreacting.
I didn’t tell my parents—they had a vacation planned at the time of the test, and I hated to worry them for what would surely turn out to be nothing. Karim was starting his end-of-year use-or-lose-leave-time vacation the Friday of the appointment. It made sense to start the vacation by getting this cleared up. Everyone assured me everything would be okay. I agreed.
The doctor’s waiting room was a bare rectangle. Walls lined with chairs upholstered in mauve. I was tempted to leap from chair to chair while I waited.
I was having twins! Or maybe my due date was earlier than the thus far predicted May. I filled out the form. A genetic Cosmo quiz.
Are you Jewish, Hispanic, over thirty-five? Are you and your spouse related? Do you have any history of genetic problems in your family?
We aced the test. All noes. Congratulations, you’re having a healthy baby.
The waiting room began to fill. There was a Hispanic couple with a three- or four-year-old daughter. There was an older couple. Waaaay older. I felt sorry for them. I nudged Karim and whispered, There must be something wrong with their babies. They must have failed the questionnaire. He nodded in agreement.
We went in and met the doctor. Bald and unfriendly and delicate, he performed the ultrasound silently in the cramped, dark room. He didn’t make small talk, didn’t point out the baby’s body parts. He kept the screen to himself. We thought he might have social problems.
He left the room (my belly sticky and exposed) and came back with a nurse in pink scrubs. She ran the machine. She left the room.
He came back. The prognosis is not good.
I was still smiling to encourage the doctor’s social skills.
There’s very little amniotic fluid. Terminate. Soon. You’re young. Have another baby later. Are you leaking fluid?
Your outcome won’t be good, You have to decide soon. Before it’s too late to be legal.
At some point, I dropped my smile, refused to accept it. Demanded a rematch with another ultrasound machine. They worked us into the schedule for Monday. We walked out through the waiting room, tears streaming. And the couples waiting must have felt so sorry for us.
The hours after you get bad news are like airplane turbulence. The weightless rise on the first impulse to convince yourself that you misheard, that the information was faulty. The grasping and scrambling on pure air. And then the down side, the drag: when you’re yanked down from your gut and you just want to fold.
I rested my head against the cold window of the car, letting it bounce against the vibrating, buzzing glass. Karim drove fast, expertly, left-handed. His right hand was in my lap, enclosing my left hand, almost touching my rounding belly. Several times words formed in my mouth, and when I released them, they bounced between us, as hollow as tennis balls.
My oldest sister, Mona, picked Sam up from school that first day. She had made beef Stroganoff (my craving) and bought sparkling cider to celebrate the inevitable all clear. When she answered the phone, I echoed the doctor: “The prognosis isn’t good.”
It was dark in her living room. Mona had recently moved, and the room was empty aside from an ornate bench and an opulent rug. I sat on the edge of the bench and dialed my aunt the pediatrician.
When she answered, I stood and traced the edge of the rug with clockwise steps. I told her what the doctor had told me and then answered all her questions.
The fluid is low. Five cc’s. Eighteen weeks. High AFP. Dr. Khrusey. I’ll have another sono on Monday.
She didn’t offer her classic you-are-overreacting irritation, didn’t explain how it was really not such a big deal. Just told me to prepare for a difficult journey.
I canceled the follow-up appointment scheduled for Monday. I went to better appointments arranged by family and friends with prominent doctors; doctors with websites and publications.
We saw the beautiful doctor whose waiting room was packed full of pregnant women grumbling with discontent at Food Network on the television. When she performed the ultrasound, she turned a little screen toward me so that I could see as well. With the fluid so low, there was only gray, with the steady pulsing of a small heart in its midst. Then she held my hand and cried; she had lost a baby of her own just months before. Her nurse cried too. Karim kept his eyes wide and dry and asked questions.
We had another appointment after that, with Johns Hopkins doctors—the best of the best. The Hopkins doctors were narrow and intellectual and striking. They didn’t wear makeup, didn’t seem to brush their hair. They wore sweaters and socks of thick, practical wool with their scrubs. They gave us a jewel of hope and put me on light bed rest for a month. Karim gave a homeless man a twenty on the way home, succumbing to superstition after years of cocky agnosticism.
On bed rest, I watched every movie anyone recommended: The Royal Tenenbaums, The Life Aquatic. I fell asleep during Star Wars three times, until Karim gave up. I wet the bed a few times, woke hopeful, and went to the doctor thinking the fluid leak mystery had been solved, that we might finally know where it was going.
While I was inert, a tsunami in South Asia caused hundreds of thousands of deaths and left families devastated. I avoided the news, but Mona was obsessed, so the stories reached my ears. Against my will, it put my woes in perspective, all these people drowning on land. But inside my body my child was withering, the amniotic sac clinging to its limbs like a plastic bag.
According to the Internet, some babies with oligohydramnios in early pregnancy do make it. The baby was active, that was unusual, surely a good sign. I was drinking bottles upon bottles of water. I lay on my left side, removed caffeine from my diet completely. Pomegranate juice was supposed to be good, and I drank a tart cupful every afternoon. I tried anything that was recommended. Except for God. If he existed, he was clearly overwhelmed.
After my month was up, I went back to Johns Hopkins. Nothing had changed; my baby was still alive, the fluid was nearly nonexistent. A decision might have to be made after all. During the ultrasound, the doctor found that the baby had a cleft lip and palate. That was the first solid thing wrong with the baby.
Before that it was the fluid, only the fluid, and so many guesses on how the low fluid might affect the baby. The bladder appeared to be filling and emptying, and “practice breathing” was evident, and we saw sucking motions, and the baby was moving, moving. So it seemed like maybe the fluid was their problem, not ours. But the cleft lip and palate made three things wrong, and miracles more elusive.
I underwent genetic testing. The testing rooms at Hopkins are cavernous, sterile cubes of gray. They rubbed iodine on my belly and in dim light punctured my abdomen with a long needle and, guided by ultrasound, led it into the placenta and pumped in and out. Hard. I welcomed the pain. Everyone was so nice, so compassionate. But I remembered the things I’d done wrong:
I hadn’t been off the pill for long before I got pregnant (two weeks).
I had a couple of drinks (five weeks).
I had to stop to breathe during a tough bike ride (ten weeks).
I lost control of a fight with Karim (fifteen weeks).
I went to a concert in a smoky bar (seventeen weeks).
I was bad about prenatal vitamins (most weeks).
The apricot placental tissue was sucked into the syringe, and my uterus cramped. As the iodine was wiped from my belly and the lights were turned up, the doctor said:
“Take it easy today and back to normal activity tomorrow.”
“No bed rest?”
“It didn’t seem to help, so no.”
Even the best of the best were giving up.
After putting Sam to bed, I brought the CD player from my bedside table into the bathroom and plugged it in next to the sink. I pressed play, turned the volume up, filled the tub halfway with warm water, and climbed in. I held my breath and lay down face first, checking that my ears were fully submerged, balancing my weight on my folded elbows to keep the pressure on my belly minimal. The edge of the drain plug pressed into the top of my head. I could hear long notes of music playing through the water and the garbled lyrics. When I pushed myself up on to my arms, the air felt sharp against my face and neck, the music seemed too loud. So I took another breath and lay back down.
I turned on to my side to see Karim kneeling at the side of the tub on one knee. I pushed the wet hair from my face and smiled at him.
“Oh. Sorry.” I realized what he thought he had walked in on. “I wanted to hear what the baby hears. There’s not really this much fluid in there, but there’s fluid in the rest of my tissue. I think the baby can hear me singing. I think it hears you too.” I pulled the knob, and hot water rushed into the tub. When the water level rose to the overflow drain, I raised my foot and pushed it off. “I’m not suicidal. Are you?”
He furrowed his brows. “No. Why would I be?”
“Why would I?”
Karim sat on the lid of the toilet. He gave me a half smile through the rising steam, and I missed him. I missed the crinkles at the corners of his eyes when he laughed, and I missed hearing what he really thought. I missed his old confidence, his I-can-solve-anything attitude. I missed making plans. We scheduled only as far as dinner tonight, what movie we should watch next. Each unwilling to bring up the topic our lives spun around lest the other be reminded of it in a rare moment of peace.
I unplugged the drain. Karim passed me a towel and steadied me as I stepped over the side of the tub. I stood in front of him, and he rested his head against my damp body.
I protected my baby—there wasn’t any fluid there to cushion my movement. I walked slowly to avoid jostling. Karim suggested tying pillows around my middle. I laughed. He wasn’t joking.
My cousin was getting married, so rather than risk slipping in heels, I ventured out to buy flat dress shoes, a first in my adult life.
In the mall I felt absurd, conspicuous. Like a bear posing as a person. I felt certain that someone would stop me and tell me that I should be home crying. Karim walked beside me, his hand at my elbow. Within fifteen minutes I bought my shoes and left the mall. Another first.
My mouth always tasted unwashed, my hair lay flattened on one side. Deep circles had carved space under my eyes, and my cheeks were swollen from so much unearned sleep. A fog clung to me. I donned silk, lipstick, jewelry. The reflection of the sequins on my clothes made me wince.
The wedding was held in a plush ballroom adorned with chandeliers, yards of tulle and vases of flowers set on pedestals. At any point, the doctors told me, I was likely to become a tomb. I hadn’t felt the baby move for a day and a half by the evening of the wedding. I smiled in pictures, ate what was served, congratulated the happy couple—all the while moving through syrup. I avoided adult conversation, and when it found me, my responses were mumbled and peculiar. Karim spent the evening taking photographs of our nieces, nephews, and son. Each time our eyes caught, he tilted his head to the side, and I shook my head.
And when finally, on the car ride home we played music loud and I felt distinct kneading against the inside wall of my abdomen, I was not entirely relieved.
We met with a genetic counselor. Her office had two tweed chairs for us to sit in. I noted the placement of the tissues. There were tissues everywhere these days. Everyone expected me to cry.
While she asked us about our families’ medical history, Karim sat at the edge of his seat, jiggling his far leg. I couldn’t feel it, but it annoyed me. We offered my grandmother’s cancer, my father’s thyroid, Karim’s grandfather’s heart attack and early demise. Karim offered an autistic cousin, which seemed to pique her interest.
She showed us a chart of neatly arranged tooth-shaped chromosomes and told us about trisomy 23 and spina bifida. She told us adoption was an option.
At home it was back to the Internet. We googled cleft lip. It’s not a big deal, it can be corrected. There’ll be a little scar above the lip, but so? Cleft palate gets trickier.
I drew my tongue across the roof of my mouth. The joint jutting out would be missing in the baby’s mouth. So the baby wouldn’t be able to drink milk without a feeding tube. Breastfeeding—my magic trick—would not happen. A chunk of my resolve broke off and floated away. We began to divide.
When you die, Karim would tell me, I will have you cryogenically frozen.
When you die, I invariably responded, I will have you buried.
In eighth grade, I told the class that I was pro-choice for everyone, but pro-life for me. In tenth grade, a friend of mine was on her second abortion. I hit the prayer mat, reaching out to a God I had been on the outs with for years. In eleventh grade, I took a pregnancy test in the girls’ bathroom at school and was relieved to have no decision to make. The following year my grandmother, watching my trash can like a hawk, noticed that I hadn’t had my period in two months. I used tampons, which she did not recognize. She offered to take me for a quiet abortion. In college I discovered science. I pored over the laws of chemistry. For once, it made irrefutable sense. I took astronomy, calculus, physics—with each course, guilt over my doubts lifted until I was finally free of God. And then this.
Everyone told me to pray. There is a special prayer, the Istikara, Muslims use to help make decisions. A specific Quranic verse is recited just before bed, and the correct path is revealed in dreams. In short, have a nightmare, and forget it. Have a happy dream, and go for it. I wanted to believe that if God wanted my baby, He would take him. That I just had to wait, and it would all unfold. If I did lose the baby, we would eventually be reunited, and I would see it take its first steps in heaven. But I had seen a fair bit of His handiwork and had no confidence in His thought processes. So the decision would have to be mine.
Karim and I discussed it gently, one of us retreating when the other became agitated. He brought me articles from the Internet—babies who had made it. I carefully highlighted the differences between their cases and ours. I was not leaking fluid, our baby was younger, my fluid was lower. I had pored over these same articles, had asked the doctors many of these questions. I pointed out that while the doctors said the baby was going to die horribly and then he did was not a particularly compelling or interesting story, it was probably the more common one.
The uncomfortable truth was that it was ultimately my decision. While Karim was pleading with me to keep his baby alive, I thought of the baby, gasping for air like a fish out of water. I thought of Sam, burdened for life with a younger sibling who wouldn’t be a companion. I thought of Karim, already stretched, trying to juggle the added expense and stress of a very sick child. I thought of myself, consumed forever with childcare and destined for a ponytail and untamed eyebrows.
One day, between movies, my cousin and I happened upon an episode of Oprah. Her guest that day was Mattie Stepanek’s mother. Mattie was born with dysautonomic mitochondrial myopathy and passed away just shy of his fourteenth birthday. His mother spoke of his last moments: the intensity of his pain, the deterioration of his body as his muscles distorted and twisted him from within, causing him to lose his hair and fingernails while she begged him to stay alive for her. She spoke of his amazing accomplishments, his poetry and speaking engagements, and the lives he touched. She didn’t regret a moment of it. All I could think of was Mattie’s fingernails falling off.
When I finally made the decision, it seemed so sudden—they told me it was a boy, they told me he was starting to get clubbed feet, they told me there was no hope. Hope was starting to feel like a selfish luxury, and so I succumbed. I wanted this over. I wanted to be with Sam, to make pancakes with him and enjoy his four-year-old wisdom instead of shuffling him from family member to family member. I wanted it to end.
I had seen all the pieces before—the low-fluid ultrasound, the sharp, stark line of the needle as it enters the image on the screen. Though they turned the screen away from me, I could see it all. Karim watched the screen. He held my hand, but my guilt and his uncertainty made the motion feel automatic.
I wanted to shut my eyes, but I forced myself to look at Karim’s face. His jaw was clenched, his eyes wet. The needle went in, full of adrenaline. I imagined it piercing through the soft, unformed fetal breastbone, entering the heart that I had seen pulsing rapidly at my first prenatal appointment, the heart that I had lain in examining rooms listening to.
Oh. The doctors (residents really—doctors are reserved for life saving) whispered among themselves briefly. They prepared a second needle.
It didn’t work? I considered reconsidering. Was this a sign? Should I just get up and run, leave my shoes, my purse, my pants? In went the needle again, and this time it worked. Karim let go of my hand. I shut my eyes, and they cleaned me off, turned on the light and began to tidy up. I put on my maternity jeans.
They led me down a long hallway with no doors. Behind me were the series of passageways that led to the ultrasounds, the examining rooms, the genetic counselors’ offices. Before me, the nurses’ station in the blue-tiled labor and delivery ward shone.
Pulling a twenty-three-week-old fetus from the womb is not simple. First, a steady drip of Pitocin is fed into the bloodstream to induce contractions. One thousand milligrams of Tylenol are also administered to fight the inevitable fever that arises when the body resists relinquishing the baby. Next, to begin the dilation of an unwilling cervix, toothpicks of seaweed are forced into the tight tissue every hour or so.
I watched CNN during my first seaweed treatment. With studied focus, I read the ticker tape to the doctor and nurse, and we discussed current events like friends.
Karim stood by the bed, folding and unfolding his arms and staring at the television. When the doctor and nurse left the room, he sat next to me on the bed, and I pressed my face into his neck. His warm skin smelled of home.
I felt the baby twitch and brought my hand to my stomach. Rigor mortis?
After a few hours, the Pitocin began to kick in. Another drip was attached, this time with morphine. The nurse handed me a button that would release the painkiller into my blood. My fever spiked, and I began to vomit.
Mona, who had brought our mother along after arranging childcare for Sam and her own daughters, tied my hair back with a child’s turquoise flowered tie pulled from the depths of her purse. My mother looked frightened and hollow. Karim held the kidney-shaped bedpan under my mouth until I lay back.
I opened my eyes, needing to vomit again. Karim, the thing. I need the thing.
The room was amber and blurred. I heard only shuffling and murmuring. They couldn’t understand me, and I growled louder, frustrated, my mouth felt full of rocks, my jaw twitched. The effort to speak exhausted me, taxed my diaphragm. I had a faint impression of the bedpan being passed from hand to hand until Mona or Karim or my mother was holding it in front of me. I retched and lay back.
Time passed. One nurse left, another began her shift. The contractions started to come. I still had not used the morphine. I was in control of that, swallowing the pain.
A few times I opened my eyes, and the room was quiet. Two people had left the room, and the third was snoring softly on the chair in the corner. I had nothing left to offer the bedpan, so I sat in the dark with my hands folded under my belly until sleep took me again.
As night began to give over to morning, the contractions came closer together. Karim had just fallen asleep, and I hated waking him. He stood and rubbed his eyes with his fingertips, disoriented. The shake of his head, the crush as he brought himself to the present made me fully conscious for the first time in eighteen hours.
This is usually the exciting part. He came and stood to the right of the bed, pressed the back of his hand against my cheek.
My sister and my mother stood behind him, near my head, and I heard my sister whisper to my mother: You can stay, but do not gasp.
I pressed the button twice, ready for the morphine.
The gentle doctor whom I had seen while I still held hope arrived. She and the nurse assembled in the room with a timid resident. The doctors stood at the foot of the bed, and the nurse stood to my left.
The nurse put her hand on my left leg and told Karim to put his on my right, as he had nearly five years earlier. I looked at the ceiling, pushed once, and hardly felt the baby’s body pass out of mine. My mother gasped.
The doctors rushed him to the edge of the room, away from me, and the nurse began to massage my belly for the afterbirth. Hardly any fluid at all, she mumbled. And I was relieved.
My mother and sister left us alone. When the doctor brought him back to me, he was bundled into a hospital blanket, shrouded.
She gingerly peeled back the edges of the blanket, uncovering his face, like flower petals. I was as eager to see him as I had been to see my live baby. His face was small, pointed, and beautiful, in spite of the cleft lip. As she transferred him to me, she explained that the right side of his body was open, had never closed.
The bundle was light, like a nightmare in which your baby has disappeared. But he was there, and when I pulled back the blanket to see his body, his inky purple intestines were spilling out of his right side and sticking to the cotton. His entire body was the length of my forearm.
I opened his mouth, gently pushing down on his chin with my forefinger. There was no cleft in his palate. The roof of his mouth was whole and joined. He could have been fed without a tube.
His tiny tongue lay neatly behind his lower gums, pinkish gray and pointed like a cat’s. He had faint eyebrows and eyelashes. His eyes would not open. His hands were gummy and curled, his brow furrowed.
My mother returned with a croissant and attempted to force bites into my mouth. I turned my head away, and golden flakes fell onto the receiving blanket enveloping the baby. I laughed hoarsely through tears. Imagine when they do the autopsy. They’ll find cafeteria croissant all over him.
Karim took the baby from my arms, and my mother continued to feed me, both of us shivering with the laughter that comes too close on the heels of tears.
I held him one more time before the nurse came to take him. I kissed the tiny concentric swirl of fine hair on his cold, yielding forehead. And then he was gone.