Seven Thousand Miles
The mother lies on her back, her arms strapped to the cross of the operating table, shivering uncontrollably. The operating room is swashed in artificial light that sheens off the white walls, the frames of the stainless-steel cabinets and the glass casings. The monitor bleeps out her heartbeat, and every second a drop of fluid falls from the IV bag into the reservoir feeding the tubing. Rusty iodine trickles in tributaries down her protuberant abdomen.
She is alone, girlish with strands of black hair spilling out from the blue surgical hat onto her neck, her skin light brown and unblemished. She blinks her matted eyelashes and I can see the hint of terracotta hue on her waxy lips. I can’t help but wonder how it is that she is alone? Where is the father and where are her parents, siblings, or friends?
I walk over to the head of the bed and stoop down to introduce myself.
“Hi, I’m Dr. Rattray. I’m going to take care of your baby.”
“Thanks, I’m Tara.” she says, pausing while nausea crests over her and she cranes back, looking for the nurse anesthetist to cup a blue bag to the side of her mouth.
“Sorry,” she apologizes.
I stand with the respiratory therapist next to the warmer bed and we check the oxygen tubing, the ambu bag and the pressure in the suction tubing. In the minutes before the delivery, my mind wanders. I think of how the windowless operating room is timeless, seasonless—a constant temperature no matter the time of year, bright operating lights no matter the time of day. I think back to the birth of my own son over a decade ago, of reaching my arm over the rail of the bed and the squeeze of my wife’s hand as she bore down and the sheen of sweat in the declivity where her clavicles meet. I remember the blotches of little burst capillaries over her chest and my own helplessness in it all.
That first night, after everyone left the room, I stood there cradling my son in my arms in the dimly lit hospital room, my wife slipping into sleep. Each time I set him down in the clear plastic bed he would stir, his lower lip trembling before he broke into a wail, as if now, separated from the tidal rhythm, the constant dampened thrum of blood moving through his mother’s arteries, he was overcome with loneliness.
I picked him up, feeling his little body under my forearms, his feet slipping out from the hospital-issued blanket. I lowered my face down to his and felt his soft breath feathering against my cheek, sweet and milky. My love for him gushed up from a spring I never knew existed, crested over my heart, drenching it with an aching throbbing that rose in my throat. The weight of responsibility and the hope of the future melded together and confused my thoughts; his eyelids blinked and fell, and his breaths became slower, his thin ribs moving against my arms. One corner of his mouth rose, and he sighed and let the breath out.
Now I look at this 22 year old woman, alone in an OR of masked faces, numb from the chest down, while the surgeon stands over the tray of instruments; to one side of her head the floppy airway bag hangs limp and there are dials to control the gas canisters and to her left the IV pole, the rolling cart with clear drawers and labeled medications and above her the whitewashed ceiling and the disembodied arm of the bright surgical spotlight.
When the obstetrician slides the scalpel over the taut skin it separates freely layer by layer, the blood welling up blotted with cotton, the scalpel drawn across again, patient, and sure. Soon tendrils of smoke rise and curl and collapse in on themselves as the bovie moves through muscle, then the tugging as the abdominal muscles separate. The scalpel glides across the rice paper amniotic sac and I hear the splash of fluid as it gushes out and over the plastic collection bag.
The obstetrician reaches her arms into the open cavity, grasping at limbs and seconds later the baby lurches out, wet, and glistening and bloody. His head lolls down on his chest, his arms and legs hanging flaccid. They rush him over to the warmer where we dry him with blue surgical towels, rub his back and suction clear thin fluid from his mouth and nose. He doesn’t breathe. The respiratory therapist listens for the heartbeat and mouths forty to me as I clamp a mask over his mouth and nose and squeeze down on the inflatable bag. With each squeeze, his chest rises and falls as the air spirals through the dark tunnels of his bronchioles and into the sticky grape-like sacs of his alveoli.
“I can’t hear him crying. What’s going on?”
I turn towards the sound and see an OR nurse, short, floral head cap, heavy eyeliner, pointing a cell phone towards us. She is only a few feet from us, and I wonder, suddenly unnerved, who is watching us from the screen.
“The doctor’s working on him. He’s not breathing yet” the OR nurse explains.
“Tell them to do something. That’s my boy!”
Again, the respiratory therapist listens for a heartbeat and this time says sixty, then eighty then a hundred as I keep squeezing the bag, watching the yellow needle swing on the manometer and his little chest rising with each breath, color seeping into his skin, washing away the pale blue. After a minute and a half, I pull the mask from his face, and we rub his back again and he sucks in a breath and lets out a prolonged wail. I feel the tone rising in his arms and legs and listen to the nice, rapid patter of his heart. The nurse brings the phone in closer.
“Is he OK? Caleb buddy, you’re crying. It’s OK, daddy’s here.”
In the screen, I see a man with a flat top, thick framed bottle glasses and light-colored fatigues. The nurse whispers, Afghanistan.
Pixels of sound and light bounce 7,000 miles over a thick green canopy of wooded land, marshy swamps, and the white capped, azure blue of the Atlantic Ocean to merge and reconfigure on a screen somewhere in the dry, arid heat of an Afghan summer.
“Wow honey, you did great,” he says, and Tara smiles.
“Hey doc, does he have all ten fingers and ten toes?”
The camera swings around to me and I smile too. “Yes, he looks great—he wasn’t breathing for himself at first, so we gave him some breaths, but now he’s doing just fine. He’s a good-looking guy, congratulations.”
That night I sit on the couch, reading to my daughters. My youngest daughter’s body molds into mine. Fine strands of hair fall across her face and her large brown eyes are serious and intent. On the other side her sister sits, her body in constant motion, moving against me and away, legs under her then out. Full, wavy blond hair spills over her shoulders, her blue eyes fixed on the page. In the background, I can hear my son practicing piano, the grace notes falling into lilting melodies, like a bird riding threads of a breeze. Outside the window, the evening sun hits the tops of the pines and the trees slowly sway into each other; the grass is a patchwork of shadow and light.
I think of the new father. I picture him on a wooden bunk in a plywood forward operating base, dust on the floor, dust on his rucksack. I picture him bouncing along a furnace of rutted dirt roads, the thick glass smeared with dust, the drone of the engine incessant, and always, the heavy dread of sudden explosion coming through the floorboards. That night he will go to sleep with the dream of his son, the longing for his wife rising over the arid desert valley, floating through the steep ravines of the wadi, over the ancient mud-walled villages. In the morning, he will check his boots for scorpions, scrape a razor over his patchy stubble and climb into the belly of a Humvee. He will never have those first moments I had with my son, and his wife will muddle through the nighttime feedings alone and pray a wordless prayer so deep and constant and aching—that he will come home safely. I pull my girls close and think of how I know nothing of sacrifice.