- This Is How It Always Is
Her seeming entourage led Rosie to the largest building and ushered her in. It was unlike anything she’d seen before in her life—it was beyond imagining—but she recognized it immediately as home. The rush of the few doctors and nurses at hand, the focus of the medic doing eye-of-the-storm triage amid the rest of the room’s hurricane, the tang of blood and panic, the antiseptic smell augmenting rather than assuaging all the other ones, equivocal spills best avoided, patients unable to ask, afraid to know: an emergency room.
There were no gurneys, no beds, no curtains, no monitors, no machines. Patients lay on plain wooden platforms covered in scraps of sheets or old, felt-lined tablecloths falling into tatters. Patients lay spooning other patients in a tangle of IVs. They shivered against the walls, trailing blood or vomit or bandages into the corners. They sat on the floor between the wooden platform beds so the staff darted around them like swallows. It was impossible to tell who was waiting for treatment and who was waiting for a loved one, whose mangled and missing limbs were emergent and whose had been that way for decades, whose drawn and pallid faces, damp brows, hollow, shining eyes bespoke fever and whose fear and whose had merely frozen that way after too many years in that sorry state. There was a small folding snack table just inside the door with a foot-tall stack of papers weighted down by a rock: single-sheet intake forms.
It was not yet seven a.m.
Having deposited her where she was clearly meant to be, Rosie’s entourage faded away, back to whatever posts they had temporarily abandoned in order to welcome her. Who had taken Claude, and where? There was no one even to ask.
“Ready?” A teenager at the folding table nodded encouragingly toward the pile.
Rosie wasn’t sure what she’d been expecting. A jungle orientation of some sort? An HR tutorial on tax and benefit forms? A lecture from Legal on sexual harassment? Somehow, she’d expected calm assurances regarding her child and what he would do while she worked. Somehow, she’d imagined something between truck repair and meeting patients. But there was nothing.
The paper on the top of the stack directed her to bed 8. There, Rosie was surprised, having identified obstetrics some buildings ago, to find a patient in labor, healthy labor from the look of it. When she investigated further, she was even more surprised at what she found between the patient’s spread knees.
“You’re the mechanic,” she could not quite stop herself from saying.
K grinned. “Also midwife.”
Improbable though this seemed, K the mechanic seemed to have everything under control, but she asked Rosie to stay anyway.
“Early,” K explained. “She schedule C-section in hospital next month but she not make it.”
A scheduled hospital caesarian delivery somewhere this rural and remote struck Rosie as nearly as improbable as an auto mechanic delivering a premature baby. “Why did she have a C-section scheduled?”
“She have scarlet fever when she was child.” K delivered from the patient’s clenched fist a damp, crumpled envelope from which Rosie extracted a letter, faded and ancient and, besides all that, in a script she could not name, never mind decipher. The patient paused between contractions to look very proud.
“She have scarlet fever and then two-week walk to city to see doctor. Probably her family have some little money. Doctor took picture, looked her heart, wrote down some note for if she pregnant. She lucky. But then she labor early.”
Was Rosie here to treat mother or baby? “How early?”
“Maybe thirty-two week.”
Rosie looked around. It wasn’t just that she saw no NICU incubators, no mechanical ventilators, no bili lights. It’s that asking about them seemed absurd. Surely if they had a neonatal cardiopulmonary monitor, they’d also have sheets and actual beds? “And the letter? What does it say?”
K shrugged and made soothing sounds at the patient as the baby crowned. “Cannot read all. And very short. But damage. Lesions. You know?”
Rosie at once did and did not know. She’d never seen heart disease caused by rheumatic fever—they were so careful with strep these days, and it was so easily treated—but patients with the sort of damage it caused were generally advised against pregnancy, the stress of not just labor but the pregnancy itself too great on compromised heart valves. That ship having clearly sailed, the only tack left was to wait and see who needed help afterward: mother with a too-weak heart or baby with too-weak lungs. Rosie stood and held her hand while the patient pushed and cried and waited, panted, pushed, and cried, while K eased out the head, turning gently, then the shoulders, no hesitation, the rest of the baby rushing out wet and slick as an otter, the baby crying, the new mama crying, even Rosie tearing up a little. It had been a long time since she’d been on this end—either end really—of labor and delivery, and she was jet-lagged and overwhelmed. And relieved. The baby was very small, too small, but pink, crying—if not loudly, if not lots, at least a bit. K swaddled him in a scrap of heretofore T-shirt that read EAST LAKE HIGH BEACH WEEK 2009: SURF THIS! and laid him in his mama’s arms, right up against her scarred heart. The patient was euphoric, weepy-grateful. K and Rosie too and the other waiting, watchful patients on their wooden platforms all around them. All was miracle and celebration. Through the haze of this wonder, Rosie gazed over the throngs of people still waiting and decided to leave the coda of this case in the car mechanic’s apparently multitalented hands.