A blank screen as a post? A cardboard sign with three letters? Maybe I could hold it up at a rally? March through the streets and let someone else chants the words? Or perhaps there’s a story? One that speaks of the injustice still inside us, the villainy that must be cut out else it will worsen to rot? But be forewarned. These images can’t be unseen. Like a knee on the back or a man who begs his last breath, the faint of heart should stop here.
Hydrops Fetalis.
The hydrops is Latin. It means swollen with water, from the Greek hydros. Fetalis means fetus, the miracle that is new life. Incubating in the bliss that is equal parts maternal and Divine. Curled and reaching, tiny fingers, tiny toes. Translucent arms like ribbons in the sea. Eyelids as thin as a single layer of cells, just thick enough to keep out the awful light.
I remember my own eyes’ visions, some time back through time’s blurred arc, between fetus and doctor. Ms. Greene’s fourth grade class, the slow-motion clock on the wall, its skinny fingers that swept circles within circles as the Earth did the same. It was between 10:00 and 10:50 a.m., history per the poster on the wall with its Sharpie-scheduled plan. Meadow Oaks Elementary, Mulholland Drive, just past the Valley’s sprawl. I was in my own becoming. Incubating in youth’s bliss. Ready to transition into whatever comes next.
“They would lead them into huge rooms. The size of 5 of these classrooms but without windows, without much light.” Ms. Greene said. She was tall. With sharp features. A paler-than-comfortable white. Narrow-set eyes. Rouge-heavy cheeks. She was my only teacher so far that wasn’t a Mrs. Even then I saw the differences. Even then I didn’t know what they meant.
“The rooms were tiled, with drains on the floors and nozzles on the walls. Keep in mind the Jews hadn’t eaten or been cared for in weeks, months, sometimes years. Just enough food and water to survive. Crammed in spaces too small. No beds to lay down on, no toilet, not toothbrush, no soap. Can you imagine them as they entered? 30 of them? 50? 100? All that sadness? All that filth? The smell of sweat, the smell of urine, the smell of poop?”
The class giggled.
Ms. Greene kept on.
“There probably wasn’t much humanity left inside them. They’d been treated like animals. And after being treated one way for so long, folks tend to think of themselves in the same way.”
The giggling had stopped. Something unfamiliar in the air.
And then, Ms. Greene paused. The class hanging on a string. The good part would come next. The hero’s redemption. Good’s triumph over everything bad.
But she good never came. Instead, a fork in the road.
“So what were they thinking? In that moment they stepped into those rooms?”
Nobody dared.
I looked around. At Hayes, the class clown. At Julie Handleman, the only kid as smart as me, her straight brown hair that once I had ventured close enough to smell. Like coconuts and sunshine. Like summer by the pool. When the skin is still wet, when the wind starts to blow.
Something uncomfortable. But a discomfort that we shared.
“Happy?”
The class laughed again.
“Happy,” Ms. Greene repeated, her eyes looking for the fool. And then that uneasiness that had belonged to the entire class condensed like a laser, now on me. I felt a creeping agony within, every cell of my skin like fire ants, a fluttering of fear and disgrace within my heart. I looked at the door. I looked at the clock.
“And why do you think they were happy, Steven?”
“I don’t know,” I backtracked. “It was a shower, right? Maybe they wanted to get clean? Maybe they still had hope?”
The class laughed. Ms. Greene smiled. The clock swept on.
Hydrops fetalis.
It sounds better in Latin. In Latin, it explains it all. In just two words, a diagnosis, a cause, a prognosis, perhaps a cure. And something else hidden in the Latin. A secret known to me and not you. It’s the Latin that draws the line, and, like every line, defines the separation. And with that separation, two sides. A better and a worse. On my side, I understand. On your side, you don’t. And because I’m the one who understands, I know exactly what you’re going through, the fear and the suffering, the desperation, the brittle hope.
Of course, that’s not the truth. It’s just one of those things we tell ourselves when the mirror looks back.
Hani was from Somalia, with skin as dark as a night with no stars. Such details as the color of her skin are relevant. Always have been. Somehow, still are.
Hani was referred from clinic. A G2P1 at 17 weeks. That meant this was to be Hani’s second child. The first was a girl. Her name was Bilan, or first born. She had sphinxlike eyes, with irises so dark their brown bled into their pupils’ black. They were the same color as the thick braids that shot out from her head like two coiled cannons, straight up and out until they bent beneath their weight and hung downwards like two thick ropes. I can still see those ropes, the onyx weave of their tight braids. I imagine them as strong enough to hold the weight of a man.
There was an innocence to the girl. It radiated from beneath her skin, like liquid light. It was the kind of light we all can remember. The kind of light we can still see. Every time we close our eyes. Before we first blinked the world in. It still lives behind that thin veil that separates you from me. It’s the light of love, dripping and sweet, the only light that existed the day the universe was born, the one we go back to, when this broken world slips away.
I watched her there, her braids, her eyes, her chocolate cheeks that sucked inwards and relaxed that pulsed two dimples on either side as her will worked the blue lolli on its paper stick.
Next fall, Bilan would start preschool. And then, Hani would birth her second child. Bilan would have a brother. And the world would grow again.
But then a classmate of mine couldn’t hear the heartbeat. And, so, Hani was sent to me. It was my first week of O.B., my soul riddled from the experience of the month before. Adult medicine was the hand I’d played for those grinding four weeks. Here, life trumped death. Joy, sadness. Hope, despair. It was the same surrender. But celebration filled the space behind it. Not that empty, hollow grief.
I remembered the little girl, or, more exactly, her ropes of braids. In a vague sort of way. The way one remembers a smell. I had met her in clinic, maybe 2 months before. I remembered her symptoms more than her, the sore throat, the goopy eyes, the lymph nodes like swollen grapes beneath my fingers. It was an upper respiratory infection. And with the diagnosis, a pathway, an understanding, a plan. Bilan would get better, I had told Hani. It was a virus. A virus by any other name…
Epstein Barr.
Cytomegalovirus.
Parvo B19.
Coxsachie.
Herpes 6.
Toxoplasmosis.
Which name didn’t matter. Each ended the same.
Hydrops fetalis.
Or, maybe, the line between us is what’s wrong, the Latin secrets that divide. Bad doctors hide behind these secrets, in the sterile sanctity of Latin words and reasons why. These doctors find their truth in the pathways, in the sequence of steps connected with arrows and straight lines. Inked in black and white on index cards, pinned to walls, memorized, understood. Latin names. Scientific names. Lists of causes. Lists of cures. Four years of medical school. This white coat. So much distance between them and you, you and me.
Good doctors, though, sink beneath the names and reasons, leave the what and why pinned there on the wall. There is a grit and nastiness to this ocean of humanity, beneath the surface of things we understand and their Latin names. Within the depths, a murk both painful and precious swirls. And its waters wet us the same. Light mixes with shadows. Black with white. Arrows flow both ways. And the line between she who suffers and he who cures bleeds like brown on black, sky on sea.
I was neither at the time. A doctor, but not yet bad, not yet good. Still in residency, I was in the process of my own becoming. Like Hani’s baby inside her, I was still growing, connecting synapses, stretching my still-pink arms within the cosmos’ pool.
The sun was setting when Hani registered. I watched as one of the fresh crew of night nurses squeaked her name in dry-erase marker on the board. 20 yo G2P1 at 17 weeks, a circle with a minus sign. FHT, for fetal heart tones. There she was, in blue and jilted scribble, wedged between a 32-year-old multip at 7 cm and a 24-year-old primigravida complete and dilated and ready to push. Both would deliver before midnight, I hoped. Which would leave room for some sleep, I calculated. That was before Hani, her bright starlight eyes, her daughter Bilan with her braided ropes.
The O.B. floor is a funny place. Like the hospital, it’s a microcosm of the world in which we live, the pleasure and the pain. At our hospital, it’s housed on the fourth, the highest floor. The second and third floors were for the sick patients. Cancer and heart failure, broken pelvises and amputated stumps, festering skin, failing breaths, stink and filth, pain and decay.
Sometimes the nurses would wake me in the middle of the night to pronounce a patient dead. That was last month. I would ride the elevator up from my call room, push 2 or 3, never 4. I’d wipe the sleep from my eyes, count my blessings it wasn’t something worse, something that might take all night. I used to pull the stethoscope from my shoulders, confirm the silence with my ears. I used to wipe a cotton swab across their eyes that wouldn’t blink. I used to turn their heads quickly and watch their pupils not move. By now, my third year, I didn’t bother. The stillness hung heavy. The way a black hole must feel from up close. I could sense it from the door.
But on this, the fourth floor, God offered His solace to the suffering below. On this floor, Heaven touched Earth. It was the same elevator, the same ding. But lighter souls spilled from its belly. Children laughed. Balloons tugged. Fathers with their pride, their shoulders pulled back. But even here, life more complicated, joy and suffering jumbled up.
I would never get used to the screams. Certain pains are passed through generations, the bone-curling shrieks of every woman before. We would close the doors, of course, try to seal in all that suffering. But life is nasty. And that nastiness is like a slime that seeps beneath doors and through walls. These barriers we erect are riddled with holes – we are not so separate after all. And suffering’s pain is a tar. It sticks to us all, like injustice, like lies, like the weight of another man’s hatred, his knee pressing down.
My least favorite part was when the new arrivals first heard them. And that same discomfort, that creepy crawling in the skin that I first felt in fourth grade. And the moment our eyes would meet, their fear and my guilt. It was uncomfortable enough, me a young man, my fingers still inside. These women with their bent knees, their secrets spread, the goop of lubricant, the bright light. My index and middle fingers outstretched. 2 cm? Maybe 3? My eyes averting theirs, pinned to the safe disconnect on the wall. And then the neighbor’s shriek like an icepick, a sound no human should make. I’d look down. She’d look up. And in an instant, I would feel it. The first punch of wind of a storm that’s too strong. They had thought they could do it. And now, they could not.
But after the storm, the calming seas. The melting clouds. The cherished blue again in a sky still wet with screams. And there, in the newborn silence of agony’s after, a second sound. Through the gooey vernix and squished-up eyes, the satin skin and corniced lips, the yawning arms, the cone-shaped heads. That undeniable wah-wah-wah-wah in its quick-rhythmed cadence. Bliss and joy at its zenith, like the first dawn the day the Universe was born.
And while that first sound was insufferable, of that second sound I would never tire. That second sound, for me and them, made the whole trip worthwhile.
But what then for Hani? What when there’s no second sound?
For hydrops, the list of causes is long. Four index cards wouldn’t fit every name. Even in the microscopic print of those Pilot Razor Point pens with their bright colors and plastic caps. The list of treatments, on the other hand, was sparse enough to not even need a single card. Delivery. Unless it’s too late.
Or, in this case, too early.
Back then, the chance of a fetus surviving outside of his mom was 50-50 at 25 weeks. Survival dropped sharply towards zero in the 2-3 weeks just before. At 17 weeks, Bilan’s brother didn’t have a chance.
To make matters worse, the baby didn’t have a heartbeat. Or, if he did, my colleague in clinic across the street couldn’t hear it. No heartbeat meant no life. Which meant it might be too early and too late.
But maybe, with an ultrasound, I could detect it.
I hid within the causes, held tight to the hope.
I ran the list of causes through my head.
A hole in the heart.
A clot in the cord.
A gene that held on when it should have let go.
An enzyme that didn’t fit.
Bones built too soft.
A knot of intestines.
A virus.
One her sister had shared.
Those brown-black pools of innocence. That dreamy bliss of youth. All those dreams, every colors, still perfect. Nothing of ugliness in the whole wide world. Those sucking cheeks like twin heartbeats, their dimples like starlight that blinks and then fades. Those twisted braids like two ropes that would lift the weight of a man were he to sink beneath the sea.
Hydrops fetalis. So little of what matters in just a name. Latin-coded secrets. Word-stuffed hypotheses. Arrow-driven mechanisms. Privilege and explanation and excuse where all that’s left is to feel.
Often, there are no words for so much pain.
I stared at the screen’s fuzziness, black on white in clouds of fuzz and grey. The ultrasound was the third vertex of a triangle that bridged Hani and me. Her eyes on the screen. The screen’s reflection in mine. My arm across the table, my hand beneath the sheets. My skin on her skin. I could feel the gel’s warmth through my gloves. It was cool when I started. I’d been scanning too long. I shifted the ultrasound’s probe vertically again, horizontally again. I scanned up. I scanned down. Left and right. Again. And again.
I could feel her hope dwindling. Perhaps she felt it in me. And then that familiar stillness, the gravity of so much weight that even holds back the light. It didn’t belong here. That stillness. That weight. Not on this floor. Please not here.
And then those eyes on me. Like two lifelines. Their ends floating right there in the still sea.
And that feeling in my skin. The one that warned me not to look. The one that warned me to run away.
And that cursed silence. A silence so loud without the screams.
Hani already knew. But she had held onto that hope that my knowledge could save her from her truth. But then she took her eyes off the screen. And still her eyes pulling at me. And then it was me, the only one still holding on. I turned the probe vertically, horizontally. I pressed harder. I scanned again and again and again.
I couldn’t grab hold of her lifeline. She would drown me with the weight of all that pain.
I wasn’t a good doctor then.
I switched off the ultrasound. I turned on the lights. Sometimes there aren’t words to explain the pain in our hearts.
The concern with hydrops is the swelling. The birth canal is already a tight fit. Add the extra girth of edema to the trunk and limbs and cranium and there’s an even greater risk of the fetus getting stuck. To make matters worse, Hani’s fetal lie was breech, which meant the feet were pointing down and the head would come out last. This added the extra risk of successfully delivering the smaller body only to find oneself stuck with no way to deliver the head.
Ultimately, the decision was made to deliver Hani vaginally. At 17 weeks, the powers-that-be hedged their bets on the body’s tiny size trumping the increased girth of the swelling. They were good doctors, the ones whose job was to decide. Despite the risks and the science and the standards of care, nobody wanted to leave the young woman with an incision whose 30 staples and lifetime scar would remind her of this heartache for every night to come.
And so, Hani was induced. Tourniquet. Needle. Saline drip. A smaller bag of pitocin, the chemical made in the brain’s hypothalamus that tells the muscle of the uterus to contract. Contractions on pitocin clench the fists of pain more intense. Pitocin, like what would happen next, is not for the meek.
But Hani was a warrior. She remained tight-lipped and stoic throughout that eternal night. Through the transition period of her pitocin’s torture, Hani didn’t make a sound.
And silence still as she pushed. A solemnness shared like a contagion on this floor typically reserved for celebration and private joy. Secrets ooze through these walls, no different from the screams. Death’s scent seeps and lingers. We are all in this together, when all is said and done.
Push.
Breathe.
Push.
The cycle on repeat, through the hours, through the years.
I wasn’t there for the birth. I can see it, though, in the stone-set images of my imagination’s past. First the legs. Blue and swollen. Finger dents on soggy skin. The buttocks next, cold and lifeless. The torso, gaunt and grey. The bones of the spine tenting fragile skin, fingers too tiny to be real. Everything ugly. Everything wrong. There was so much potential in this world. And then this, the unthinkable. The thing no human should experience, no human should see.
And then, the nightmare we had feared.
The head too swollen to slide out.
Push.
Breathe.
Pull.
For out it must come. No matter how bad the pain. Truth, injustice, every sin and the hatred that feeds it. Every unfairness that has no reason why. It all needs a reparation. It all needs a resolve.
But first, we must hold the ugliness to the light.
First, we must force our eyes open as we stare at the sun.
The heavy, beating silence.
Before the worst that’s yet to come.
Pitocin as it drips. The body’s rhythm like a drum. The clenching fist of the next contraction. A last breath in. We’ll work together. You push. I’ll pull.
And then a sound that breaks the silence. All that resistance letting go. Like the pop of a lolly as its stick is ripped from its top. A moment’s flash. And then the ugly and unthinkable truth of what just happened settling in.
I don’t blame myself. Nor should you. We are all in our becoming. Not yet good. Not yet bad.
And another list of names.
Like the viruses that took Bilan’s brother.
Trayvon Martin.
Tamir Rice.
Michael Brown.
Eric Garner.
Philando Castile.
Breonna Taylor.
Ahmad Aubrey.
George Floyd.
Names to pin to the wall. Names we try to understand. Names to hide behind. Names to draw lines between you and me.
And maybe, just maybe, it’s not enough to just not be bad. Maybe it’s not okay to hide behind excuse and privilege, to point our fingers and claim our innocence from this vantage that the same system allowed. And maybe it’s never okay to think of only ourselves when our sisters and brothers are drowning, leave the lifeline just floating there within reach.
I shouldn’t have stared so long at that screen. The fuzzy images of black and white, the heart’s not beating, the shapeshifting fuzz of grey. I should have held fast to her eyes, share the space of her pain, hold her hand through the silence, let her watch as I cried. I could have shown her that neither of us have the answers. That sometimes there’s no reason nor why, no understanding despite the Latin names.
But now, the work still ahead of us. The injustice that must be cut out.
And the pain like thunder’s rumble.
And still a hope, like the sun.