THE BIRTH PLAN | Matthew Bucknor
We spent so long trying to pick a song. As if the sounds that he heard when he passed from the pressure and darkness into open air and light— as if the particular choice of key or cadence, harmony or rhythm— that those few minutes of sound would define him and the scope of his aspirations and the extent of whatever small good change we might wish for him to bring to the world. I wanted Debussy, but Zoe laughed that straight back in my face. We settled on Best Part, a modern R&B classic, the slow burn of two soft voices longing for new love. Aside from the hospital and the obstetrician and the commitment to an epidural as early as seemed allowable, this was the only birth plan we had made.
Against the backdrop of this melody, I stare at my new son across the room, laying under the artificial heat of the infant warmer. Elijah. He stares back at me—I know he can’t see me yet, but his deep brown eyes pour all over me. His limbs flail, but otherwise he is quiet. “A little too quiet,” the nurse says, and so she places a small needle into his heel to check his blood sugar, to which he emits a piercing squeal and graceful arc of urine which lands in her hair.
I know this is funny and I want to laugh, but I can’t laugh right now because I know what arterial blood looks like and I know the code words they’re saying that mean, “it’s not stopping,” but Zoe doesn’t know. She can’t see or feel what is happening within and beneath her, and so, instead, I hold her gaze firmly, tears streaming down my face, and I say to her, “You did it. You’re amazing. I love you so much.” I say these words over and over, as if I can’t think of anything else to say, which is true, because as these words fall out of my mouth, all I can otherwise think is please don’t leave me and I can’t do this alone. I feel as if I am being ripped clean in two.
Zoe closes her eyes. Her light olive skin is coated in beads of sweat, magnifying scattered brown freckles. Her darling Afro puff has collapsed under its own weight, flopped to one side of her head. You are the most wondrous and beautiful thing I have ever seen, I think. I turn the words over in my head. I am terrified to say them out loud because they sound deeply honest and tender; the kind of words you remember saying before someone close to you is lost. But the light panic at the foot of the bed is steady. And the blood dripping from the corner of one bedsheet is falling faster, like an IV line slowly opened. And so I turn back to Zoe's face and bring my lips close to her ear and I say, “You are the most wondrous and beautiful thing I have ever seen.” She squeezes my fingers limply and centers my palm against her chest.
When we first checked into reception for labor and delivery, Zoe pleaded with me to tell the staff I was an oncologist. “Sweetie, I’m not sharing a room and I don’t want to see a medical student at any point in the next month. So please be a darling and tell them you’re a doctor and not your typical friendly Negro?” She said this with my favorite of her smiles—top teeth dominant, the small gap between central incisors on full display, lush ruddy bottom lip covering the rest. It took all my strength to deny her. But the sentiment felt too much like a threat, like fear under duress, which is not how I wanted our son to greet this world. Never mind the risk of doubt. So I whispered, “let’s wait and see,” and as luck would have it, there were only private rooms available and no medical students on the floor.
More nurses come into the room, gathering near my wife’s feet, staring in the general vicinity of her groin. I know things are getting worse. I know that normally there wouldn’t be this many people in the room, that there should just be the three of us, held together close under the spell of new life. Part of me wants to yell at them, “Do you know I’m a doctor?!” As if they are saving their compassion and skill for another set of patients. As if I have failed Zoe by not acquiescing to her earlier request. I know it defies logic, but I look back at her face, which has turned ashen, and all I can imagine is the color draining away until she is an alternating collage of blacks and whites, the color of newsprint, the color of the stories of new black mothers dying that I can’t seem to escape, the ones that make me cry into the crevices of my keyboard every single time.
The life continues to pour out of her. I am frozen, impotent. Wishful that, if I hold perfectly still, this moment could reverse itself. That this monster threatening to consume us might not see our small family of three in my stillness.
They are saying the placenta was “low-lying.” They are pumping Zoe full of hormones meant to stop the bleeding. They are calling out her blood type—O positive. The delivering obstetrician presses firmly on Zoe’s pelvis in a circular motion. With the other hand, she inserts a decompressed balloon into Zoe’s bleeding womb and inflates the device. I check off each action in my head as if one misstep would require me to take over. Glistening suture and needle in gloved hand, standing at the foot of the bed. And then what? I think. And then what? I grow more resolved in my stillness.
A circulating nurse brings Elijah to Zoe’s chest. The look in the woman’s eyes is severe—a look I can only read as: enjoy this brief moment while you still have it, you will not have it for long. Elijah’s skin is a pale brown, paler than I imagined, and it occurs to me that he has not yet seen the sun. That he might not be held by his mother in the amber light of dawn, or blistering heat of midday, or soft glow of dusk. Zoe’s eyes spring open as his weight settles into her. She takes his head filled with dark curly hair and presses his cheek against her breast. Her eyes dance all over his body. They recognize every single cell in an instant. She makes a noise that sounds at first like hysteria, then grows quiet, the soft coos intermittently drowned out by sniffling sobs and wet kisses: “He’s so beautiful…Elijah, I love you…Elijah, thank you…”
Then she turns to me and says, “Geoffrey, call my mother. Call her and tell her everyone’s okay.”
Zoe’s mother, Michelle, had lived with us for two long weeks, a week before and after the due date. I knew better than to argue this arrangement. Her sister Katrina had lost a son the day he was born and Michelle had always blamed her absence for the abbreviated life. As if some matriarchal spell was lacking in the minutes after birth, which might have prevented the tragedy. She would have waited even longer for Elijah but would have almost certainly lost her job.
I take my phone from my pocket. “There’s no reception, Zo. I’ll go out in a few minutes.”
Zoe shakes her head dismissively and points to the door.
My eyes glance down toward the obstetrician, Dr. Kahn, who immediately holds my stare. I’m not sure if she is trying to tell me something. Trying to tell me not to go. I turn back to Zoe. “Baby, I think I should stay with you. I think it can wait.”
“Geoffrey, please just call her real quick and come right back. Everything’s okay.”
I look again directly at Dr. Kahn. She is a smartly dressed, middle-aged woman in fitted purple scrubs, with round tortoise shell frames across her brow. She is not the obstetrician Zoe had seen throughout the pregnancy, but was on call covering the group. There is an inexplicable look of calm surrounding her and I lean into that space. I’m not sure how to ask. I hold her eyes while I respond to Zoe, “I’m just a little worried baby, you’re bleeding a little…”
“Worried?” the doctor snaps, with an ironic smile across her lips. “You can’t be worried.”
I look at her perplexed.
“Do I look worried?” she asks. She verifies first with Zoe, who shakes her head and smiles.
“Um, no, I don’t think so.”
“You neither.” She stares firmly at me and punctuates the last syllable as if trying to hit me with a pair of forceps. Then she turns to Zoe: “Sweetie, you had some bleeding afterwards, but I think it’s stopped. Everything looks stable. We’re going to leave this balloon here for the first 24 hours to make sure, but we should be able to take it out tomorrow. Don’t worry.” She glances at me again with that last word.
I look down at the sheets along the side of the bed, soaked in a light red hue. There’s only stillness. Miraculous, wonderful stillness. I turn back to Zoe’s face, which remains pale, but a slight hint of color has returned.
“Call. My. Mother.”
I pace circles outside the door to Zoe’s room, holding my cellphone out like a metal detector in search of signal, but no luck. Briefly, I consider asking at the nurses’ station but there are only faces buried in computer screens and I feel incapable of the small talk required to intrude. I walk quickly down the hallway and out of the maternity ward. My phone flickers between one and two bars of signal, but the call still won’t go through.
Eventually, I take the elevators down to the first floor and exit the hospital. There is a thick, driving rain and my shirt is drenched in seconds, but the phone call is brief. I tell Michelle that Zoe and Elijah are happy and healthy. I can’t quite make out her blubbering response, except that she makes me promise to send pictures soon. She kisses the receiver repeatedly and we both say goodbye in a fit of laughter. I hang up and yell nonsense words at the top of my lungs into dark gray San Francisco clouds. I laugh and cry and head back to the main entrance, then up the elevator to maternity.
When I buzz the ringer to be let in, at first there is no response. I buzz again and hear a disembodied voice float through the speaker, “Can I help you, sir?”
I slide a few steps over to visualize the gatekeeper. She is a thin woman in pink scrubs, with short blond hair cropped beneath her ears. I’m guessing she’s about my age but it’s unclear if she’s a nurse or a medical assistant or a security guard. Her name tag reads, “Beth.”
“Can I help you?” Beth asks.
“Yes, thanks. I need to get back to my wife, she just delivered.”
“What’s the name?”
She looks at me blankly. “Your wife’s name.”
“Sorry, Zoe Porter.”
“And you are?”
“Her husband…Geoffrey Martin.”
“Mr. Martin, do you have a wrist band?”
“No. What wrist band?”
“The matching wrist bands that the three of you are supposed to have. Where’s yours?”
I look down forlornly at my naked wrist. “I don’t know. She was bleeding, a lot was going on, I think they forgot. And then I went out to call her mom. Didn’t you see me leave?”
“Maybe someone else was here. Please could you just let me in? She had a postpartum hemorrhage, bleeding after the birth. I need to get back to her.” I pray that I have said the words “postpartum hemorrhage” with enough clarity and confidence that she will be dissuaded from further inquiry.
“Give me one second, okay? Just need to check one thing.”
I pace the few feet next to the door like a classic expectant father. I know Zoe and Elijah are fine—I’m pretty sure—but the minutes tick away and I feel myself slowly unnerve. At first, it’s only a slight quickening in my chest; breaths consumed in rapid succession, eyes unable to rest. But I can see the nursery across the hallway and the indignation becomes more acute. You should have told them, I think.
I begin to press the buzzer every few seconds. It sounds like an abrasive rotary telephone. But there’s not even the faintest response, not a hint of movement on the other side of the window. Then I hit the steel door. It’s thick, reinforced metal and makes no sound at all. I shift to the thin pane of glass next to the door and pound in raps of three. A few staff in the distance glance in my direction, puzzled, and then return to their respective work. I pound harder and harder until the knocking is audible, until the pain sears at the edge of my knuckles. I see Beth at the opposite end of the hallway, whispering into the ear of a security guard, but she makes no effort to move back toward the door.
Suddenly, I’m undone. I hit the glass harder still, and waive frantically at Beth like we are old friends. I alternate punches with my hands, like a boxer working a body bag, my breath wincing with each blow, until thin streaks of blood run down my knuckles, and the glass begins to crack, then dent, and finally explodes into a small shimmering firework of tiny crystal splinters.
I survey my injured hand in disbelief.
Calmly, I reach through the broken glass and rotate the handle until the door slowly creaks inward. I stare at the ground, at the remnants of the broken window spread over brown linoleum. There is an eerie quiet on the unit, punctuated by occasional outbursts of maternal and fetal heart rate monitors. Countless sets of eyes are trained on me. I walk quickly into Zoe’s room with my gaze cast downward.
Inside, everyone has left. It’s just her and Elijah sleeping peacefully. And me. I walk to her and take our son from her arms and hold him up to the light. Then I climb into the bed and tuck Elijah between us. I remove my shirt so my chest is pressed directly against his back with his against hers—all skin to skin. I hold my phone up to the ceiling and take a selfie. None of us smile. Zoe asks me why my hands are bleeding, but I shush her and squeeze them both closer, while I wait for the others to come.
Matthew Bucknor is an Assistant Professor of Radiology at the University of California, San Francisco, where he serves as Chair of the department’s Diversity and Inclusion committee. He received his medical degree from the Stanford School of Medicine and is a member of the Pegasus Physician Writers at Stanford.