Breaking Through

by Katherine C. Barnes, UMMS 2009

Finalist 2007 Gerald F. Berlin Creative Writing Award

She, the first year medical student in blue-gray scrubs with a ponytail and an eager expression, was assigned to the ob intern, a non-descript twenty-something with dry sallow skin below his eyes, wearing a white coat loose around the shoulders. She followed him down a hall that looked like the hall she’d come in through and much like every other hall on every floor of the hospital, brown linoleum, no windows, gurneys pushed out of the way and abandoned, and numbered doors. He paused outside a closed door and shuffled through some papers. She waited. “This will work,” he said and knocked.

The first thing she saw inside the room was a drawn curtain from ceiling to floor that the intern didn’t bother to draw back, he pushed through. She followed. Beyond the curtain were large windows on the far wall, and two beds off to the right. In one of the beds was a young woman curled up and facing away from the door. A young man in a baseball cap stood at the far side of the bed and looked up at them as they entered. The nearer bed was empty. On a table between the two beds sat a machine connected to the woman’s full abdomen by wires. The machine beeped rhythmically, insistently.

“How’s it going in here, folks?” the intern asked. The woman didn’t turn, her hair hid her face, and most of her body was wrapped in twisted blankets, but the young man, her husband responded. “We’re tired,” he said, “but we’re doin’ okay.” He reached down and took his wife’s hand.

“I’m going to leave a medical student here with you, if that’s alright.”

The young man nodded affirmatively and glanced at the medical student, now standing to the side and slightly behind the intern. The young woman in the bed finally turned her head and lifted it briefly to see who the newest person in the room was before letting it drop back to the pillow.

“I’ll be back,” said the intern and he was gone behind the curtain. The medical student heard the muffled sound of the door falling shut.

The medical student looked around the room. There were a couple of empty chairs along one wall. There was a window seat cluttered with stuff belonging to the couple, a sweatshirt, a purse, a shopping bag. She walked a little ways towards the window and then thought better of it. She stopped where she was and moved back to where she’d originally been standing. “Is this your first baby?” she asked quietly. “Yes,” the young man nodded. The machine continued to beep. The medical student folded her hands in front of her and then let them drop to her sides.

The nurse came in wearing flowered scrubs. She pushed briskly through the curtain. “How are we?” she asked as she moved to the side of the bed. She smoothed the young woman’s hair back from her face, lifted her head and readjusted the pillow, pulled the blankets free of the woman’s legs, smoothed them and tucked them back around her and then looked at the readout from the machine. “You’re doing great, honey,” she said and patted the young woman’s shoulder. “Can you help her out here, Dad?” She asked. “She’s gonna push again.”

The nurse helped the woman to a seated position and reset the bed. She pulled the blanket up around the woman’s hips revealing a disposable sheet stretched beneath her, stained with blood and feces. She arranged the woman’s legs so that they were bent at the knee and making sure that the young man was offering his hand to the woman’s grip she told her to push. “Push, push, push!” and then a break to breath, words of encouragement, then “push, push, push!” words of encouragement and then a break.

The medical student took a step towards the chairs along the wall. She wavered a little on her feet and sweat had broken out on her upper lip. Fluid was dripping from the woman’s vagina onto the sheet.

The attending came in. “How’s it going in here?” he asked and strode across the room to the machine. He pushed a button and read some numbers. “Baby’s a little stressed,” he said without looking up. He made a note and turned towards the couple. “Baby’s not totally happy right now, but I think once he moves past the pubic bone he’s going to be just fine.” He pursed his lips and nodded at them and then, “I’ll be back.”

The medical student watched him go out, dipping under the curtain. She listened for the door. She imagined herself pushing past the curtain on her own way out. She felt hot, and wetness in her armpits and sweat dripping down towards the small of her back. She flexed one knee and then the other and checked again that the chairs were close by.

The woman had been resting for a few minutes. The nurse had covered her up while she rested, but uncovered her again folding the blanket back. “I’m going to check where the baby’s head is,” she said firmly, moving down to the foot of the bed. She reached a gloved hand deep into the woman’s vagina, bending her elbow and and bracing her other hand on the woman’s knee. “Now push!” The woman whimpered and strained and red fluid flowed out of her vagina around the nurse’s arm. Feces seeped out below onto the sheet. The young man fixed his gaze across the room and squeezed his wife’s hand.

The medical student left the room. She pushed past the curtain and felt it cling to her as she reached out for the door handle. She pulled it open and slipped out, closing the door as softly as possible, hoping that they would assume she had somewhere else she needed to be, something important to do, if they’d noticed her departure at all. In the brighter artificial light of the hallway she looked up to see the intern moving quickly towards her. “How’s it going in there?” he called. “What’d the attending say?”

“He said that the baby’s not happy,” the student tried, “but that once he makes it past the pubic…” And she fell. She didn’t crumple, but fell like a tree to the ground. The sound of her head striking the linoleum covering the concrete of the floor was sickening. And then she twitched, her eyes rolled back in her head showing the whites, her arms and legs jerked against the floor, and she wasn’t breathing. The intern got to her quickly, but he’d been too far away to catch her. He hadn’t seen it coming.

The medical student lost control of her bladder. A pool of urine formed on the floor and the nurses called by the intern stepped over and around it. After a few minutes she came to. One nurse held a cotton bandage against her head where the skin had split open over the bone. Another nurse held her hand. When the color came up in her face and her eyes focused the nurses explained where she was, what had happened and made her stay put until a gurney was brought to load her into the elevator and carry her down to the emergency room.

The second-year resident grabbed the medical student’s chart off the door in the emergency department. He opened the door without knocking and stood at the foot of her bed. He asked her some questions and then sewed her up. He gave her three stitches and written instructions. “Medical student, huh?” He laughed and then got serious. “You better figure this out before you really hurt yourself.”

The medical student made her way back to the labor and delivery floor. She changed out of her wet scrubs in the bathroom and back into her own clothes, wiping herself off as best she could with paper towels and warm water. She tried not to look at herself in the mirror because the way her skin puckered under the stitches and the bruise rising around her eye, blue and magenta, made her nauseous.

Her roommate came to pick her up. On the way home, the medical student let her head tip to one side against the headrest and closed her eyes. As she listened to the hum of the engine and braced herself against the bouncing of the car over potholes, she wondered if the baby was born. She wondered if the intern felt badly that he hadn’t caught her. She wondered if the resident had done a careful job with her stitches. She wondered if the loss of feeling in her face would go away with the swelling. She wondered if she’d ever be able to watch another delivery. She wondered if she’d ever want to try.