By Michael Ward
It was just after midnight on the Ides of March when I first held my daughter—merely an hour old—and watched the nurses try to save her mother’s life. Still dazed from the cesarean section, J. lay shaking on the hospital bed. Her fever had spiked to nearly 104 degrees, and significant blood loss during the surgery had cut her red blood cell numbers by half. Between trying to decipher the medical jargon that bounced around us and glimpses of the pained, wide eyes the nurses often presented when they looked at her, I kept thinking back to Macbeth.
One day some nine months before, as I hunkered down in the icy air conditioning of a Dallas summer day spent indoors, J. walked down our stairs with a smile. In her hand was a pregnancy test. Though it was a surprise that it actually happened, it was no less a welcome one; we had been trying for several months by that point. But just as you can feel a room change when the air conditioning clicks off and the oppressive Lone Star heat laps at the windows, so too does the room change when you learn, for the first time, you will be a parent.
It is then that you enter the liminal space of becoming a parent. Some people don’t want kids or can’t have them; some people already have them. But for another group, there are 40 weeks spent fretting over what’s about to happen. It’s sort of like being told there will be a party for you, but nothing more. Not quite a surprise, not quite known. This period of months is soon lost once the actual parenting begins. With time, memories morph, dissolve, or lie but they rarely sharpen.
A full-term pregnancy takes one through three seasons of life, three-quarters of a revolution around our nearest star. It is one of the longest gestational periods among mammals, any animal really. Physically and emotionally taxing, just a few hundred years ago it killed up to one out of every 20 women who tried it. Those numbers have, thankfully, dropped through the intervening centuries, but not to zero. In 2021, more than 1,200 mothers in the United States alone died as a consequence of pregnancy. It’s a mortality rate two to three times higher than most other developed countries. The rate is even worse for women of color and, like J., older moms.
We drove to the hospital for the pre-induction appointment in my two-door, standard-transmission small car. Anyone could tell, theoretically, that such a vehicle wasn’t ideal for carting around a new family. But I proved the point empirically by adding a car seat in the backseat, which in turn launched my driver’s seat forward and encouraged my knees to flirt awkwardly with the dash. A little closer to the windshield, I kept my eyes on the sky.
March weather in Dallas is, at best, capricious. The city sits near the foot of “tornado alley,” an unofficial meteorological designation spun up by Air Force officers during the Eisenhower-era study of severe weather on the Great Plains. When viewed from a distance, tornadoes are spectacular demonstrations of nature. From within, they are monstrous nightmares. As I shifted into first gear on March 13, the air was chilly and leaden with humidity. In the distance, silver clouds gathered.
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Hospital administration called me a “support person” for J. I took that to mean I could stay close but out of the way, lest I cause more trouble than my presence was worth. Within minutes of arriving at the hospital, four or five nurses—actual support persons with education and real experience—swarmed J., who sat up in the bed in the middle of the room. They hooked her up to a handful of devices that charted vitals like her pulse and blood oxygen levels. Here’s where I made a mistake.
A nurse appraised J.’s left arm, tracing a finger down her veins, inspecting them as a grocer might inspect a bundle of asparagus or rhubarb. Satisfied, she inserted an intravenous cannula into J.’s median cubital vein. Now, I’ve had blood drawn from my veins dozens of times in my life, and, while not particularly pleasant, I’ve always been able to watch with a certain curiosity. That evening, however, blood unexpectedly spurted out of her vein, dribbled down her forearm, and stained her floury white bedsheet. I looked away, but it was too late. My head began to feel lighter; the activity in the room began to slow down; my blood pressure dropped. I wasn’t nauseous, but I knew that if I stood up, I’d risk collapsing into the medical equipment. So I did the only thing I knew I could do: I sat still and avoided becoming the undo center of attention and listened to the voices in the room fade away.
Music from an old, scratchy radio began to fill my ears. Strange, ethereal, and hypnotic, it was nothing like I had ever heard before. I listened and wondered why I was hearing music at all. The next thing I knew, the brown eyes of the nurse who had administered J.’s IV were looking right at me. From behind her mask, she cried out, “Are you ok?”
For a moment, I didn’t know where I was. I looked over to the right to find J. with the shimmery, salty remnants of tears trailing from the corners of her eyes. I had been unconscious for mere seconds—apparently stuck in some position with my legs stretched outward and my face contorted, like a Zoom call with a cursed WiFi connection—but it might as well have been an hour for all J.’s concern. The fainting experience I had is known as vasovagal syncope, which the Mayo Clinic notes can be triggered by the sight of blood. What the clinic is silent on is how fainting, when your only real job is showing up, comes with soul-crushing side effects.
An exam that followed revealed J.’s cervix had dilated only about two centimeters. Underwhelmed by such progress, her gynecologist inserted a Cook’s balloon, a device with two bulbs inflated with saline, to “encourage” the cervix to open. Invented by Israeli gynecologist Jack Atad in the 1990s, it’s similar to how one might use an air wedge to force open a locked door. If that analogy sounds distressing, it only gets worse.
Francis Bacon wrote in 1605 that a doctor’s job is “not only [to restore] health, but [to mitigate] pain and dolors; and not only when such mitigation may conduce to recovery, but when it may serve to make a fair and easy passage.” If you’re in pain, you go to a doctor. If it’s not pain, exactly, which brings one to a physician then maybe it’s what Dr. Oliver Sacks once termed “a general feeling of disorder,” an awareness that something is wrong, a lack of internal homeostasis. That’s at least psychological pain. However measured and in whatever capacity, pain had punctuated J.’s anxieties leading up to the birth. Mine, too, if I’m to be honest. But what if the doctor is the cause of the pain? Pain and medicine often find themselves locked in a feedback loop.
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If the pain of the Cook’s balloon was intense for J., so were the contractions. That first evening in the hospital, an anesthesiologist came into the room with a roll cart. After barely a word to J., he began opening drawers and unfolding the tools of his trade. He inspected J.’s back much like the nurse had inspected her arm. Satisfied, he began to insert an epidural into her spine. (Given my recent medical history, I was not allowed to watch this.) Within minutes, fentanyl coursed through J.’s veins. Effectively today’s ether, the notorious drug is a synthetic opioid that was isolated in 1959 by Belgian doctor Paul Janssen and given a brand name as lofty as its nineteenth-century counterpart: Sublimaze. The drug successfully alleviated pain for tens of thousands of patients—mostly those with cancer—before it was used on women in labor.
Just before 8 a.m. the next day J.’s amniotic sack ruptured. Throughout the day, as I scrawled notes from the couch next to her bed, she was placed in various positions—left side, right side, peanut pillow wedged over here, elbow over there. These bed-ridden gymnastics were all in service of encouraging our unborn daughter to shift to a better delivery position while J.’s labor progressed. But the labor didn’t, in fact, progress. By 9 p.m., more than twelve hours later, J. was encouraged to go forward with a cesarean section.
After the nurses had wheeled J. out of the room and began prepping her for surgery, I was left alone to don a set of scrubs and booties. Not since my time in Medical Explorers, back in high school, had I worn scrubs. I looked into the bathroom mirror and saw a man dressed as the doctor he once thought he would become. Now I was moments away from becoming something else: a father. Those next moments, however, would prove devastating.
The nurses wheeled J. into the operating room, which looked so like every such room I’d seen on television or in movies it was surreal. The circular, overhead lights as large as gladiators’ shields. The cool mint green coverings draped over stainless steel tables. The way the light reflected lifelessly off the metal. The faceless doctors and nurses behind masks. The morbid chill of the air. The feeling that I was the only one in the room who didn’t absolutely have to be there. J. didn’t need me by her side; the surgery could’ve happened without my presence.
The surgical team then erected a three-foot vertical curtain starting near the top of her chest. Neither she nor I could see around it, but it wasn’t draped to the ground. There, directly next to my feet, were the light blue booties of the gynecologist. For the next half hour, I witnessed grasping and pulling and tugging. J. flinched and shook. The air in the room felt like that spilling from an open refrigerator, and I felt guilty thinking it was cold when next to me J. was splayed open. As the procedure continued, my gaze occasionally fell to the floor where the formerly blue booties of the surgeon had turned red with blood.
Suddenly, our daughter cried out.
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A birth is an act of violence. One being is expelled from another through one of two methods: painful muscle contractions or a knife. For me, I was transported 35 years into the past. There, in my seat on the far side of Ann Gorman’s middle school English class, I tried to make sense of Macbeth. As a young student, I had only a vague understanding of a cesarean section and certainly no idea of its traumatic impact on a woman’s body.
Written about the same time that Francis Bacon was writing about physicians and pain, it’s a famously bloody production: bloody clothes, bloody faces, bloody hands, bloody daggers. It is all a vasovagal syncope trigger if ever there was one. In Act IV Scene 1, the infamous witches even conjure a “bloody child” to the stage. “Be bloody, bold, and resolute,” the boy says. “Laugh to scorn / The power of man, for none of woman born / Shall harm Macbeth.” We’re told in the stage directions that the boy then simply “descends.”
This enigmatic message is, of course, lost on Macbeth. In the final scene of the play, as he and his archenemy Macduff battle to the death, Macbeth reiterates his prophesied invincibility. Macduff parries with one of the greatest plot twists in English drama. “Despair thy charm, / And let the angel whom thou still hast served / Tell thee Macduff was from his mother’s womb / Untimely ripped.”
Ripped is right. The cesarean section to which Macduff alludes—and answer to the riddle “not of woman born”—was likely performed on Macduff’s mother because she was dying and could not complete the labor. A knife was plunged into her body with little regard for her life and in a concerted effort to save that of the unborn child. Given maternal mortality rates at this time, many of the people in Shakespeare’s audience would’ve known of a mother who had died during pregnancy or labor. Though rare, they may have even known a child born like Macduff. Such a child may have been considered a peculiar sort of miracle.
Though not through the birth canal, my daughter was no less “of woman born.” I was there when it happened. The woman was J., and as she was brought to the recovery room, she was shaking, visibly distraught, and had lost more than a third of her blood. As the nurses looked at her vitals, their eyes grew wider. What led to J.’s shaking and her pallid presentation was not the waning effects of fentanyl, as might’ve been expected. Rather, they were the symptoms of something potentially more dangerous than the very surgery she had just undergone.
To give a clear understanding of what was involved with this surgery, J.’s doctor described the “ripping” this way.
A low transverse incision was made sharply. This was carried down to the underlying fascia with Bovie cautery. The fascia was incised in the midline and extended laterally sharply. The underlying rectus muscles were dissected off bluntly and sharply. The peritoneum was entered sharply and this incision was extended superiorly and inferiorly…. The incision was extended laterally manually… Brisk bleeding was noted from the right uterine vessels.
After four years of medical school, four years of a gynecological residency, and years of private practice, such a description sings with the tenor and dispassion of a beat cop’s report of a crime scene. The “brisk bleeding” noted during the procedure was itself unrevivable without modern medicine. This all was carried out not in a dank, eleventh-century Scottish castle but in a state-of-the-art medical facility in Dallas.
After her amniotic sack ruptured earlier that morning and while she labored in various positions throughout the day (and I—woefully unencumbered—wrote notes), bacteria multiplied in her uterus, infecting the tissues surrounding our daughter. The result was that not only did J. suffer significant blood loss during the operation, but she was fighting an infection known as chorioamnionitis. Without antibiotics, which didn’t exist until 1928, J. would’ve been treated with little more than cold compresses and prayers that her fever might break and the baby would be delivered normally. The infection would likely have overtaken her by midnight. Doctors, with their own pained eyes, would have had little choice but to remove our daughter, “untimely ripped,” at the expense of her mother. With antibiotics, her fever dropped and the shaking subsided. J. was alive. And several hours after the surgery, she first held her daughter.
The last evening that we were in the hospital, I watched the sky grow from an anemic yellow to anthracite black. Rain began to smash against the window. From seven floors up, the rest of the world looked remarkably far away. Our phones pinged and alerted us that we were under a tornado warning. Within minutes, a handful of nurses entered our room to usher J. and her massive hospital bed into the hallway. I pushed our daughter in the hospital carrier right behind them. The corridor, which had remained quiet for days, was filled with a dozen moms, fellow support persons, and babies. There, in that hallway, we waited for the storm to pass.
Michael Ward, M.S., is an essayist and fiction writer. His work was most recently featured in The Pinch (University of Memphis), The Twin Bill, and Diagram. He has forthcoming essays in X-R-A-Y and The Museum of Americana. Michael lives in Dallas with his wife and daughter.