CALL		10/23/92 * 23:06		BOU.DOC

Jennifer Sandler is the magician here tonight. Renee Gilbert plays the role of her beautiful, silent assistant. Soon a baby will spring from the trick box of Renee's belly. Sandler prepares for her performance to the accompaniment of the hidden infant's own heartbeats, which come thudding through the internal monitor with the steady rhythm of a galloping horse. The shining instruments are set out, the brilliant lights focused. At the last moment the internal monitor is removed, and in the thick, new silence, Renee is curtained off from her own abdomen by the blue drape, which the nurses hang from two IV stands so that it falls just above her navel.

What's going on? Renee's eyes immediately ask. She knows she's going to miss the good part. I want to tell her, but I'm new here and afraid to speak unless spoken to. With a crowd pleasing sweep, Sandler draws the blue triangle of the scalpel forward. The attending physician, Gus Grant, is letting her lead. He follows her with the pad, catching the surge of blood. Sandler's fingers glide and turn, face his, bow, and glide again. Red seeps across until Grant catches it.

Renee's nose twitches. She's the only one in the room not wearing a mask. She wrinkles her nose again and I have a strong urge to reach over and adjust her epidural. I'm sure she's in pain.

"An itch?" the anesthetist asks.

She nods. The woman scratches Renee's nose. Sandler uncovers the pink dome of the uterus, which pushes up against the eye-shaped window in the transversus abdominis. She nods to Grant, and he hands the bladder blade to the scrub tech while he and Sandler lean back and pull hard. I hold my breath, wear my poker face. The window in Renee's belly only yawns an inch wider, the uterus rising higher toward the white light. Renee's eyebrows form question marks.

"Almost there," I whisper, stepping forward. I can't help myself. I'm not doing a damn thing. It must be my job to talk to Renee. I try to ignore the silence that surrounds us.

"How you holding up?"

"I'm glad it's almost over," she tells me. She's been in the hospital since one this afternoon. She was only at twenty-nine weeks, so when she came in contracting, Grant checked for ruptured membranes and urinary infection, then hydrated her and put her on terbutaline to stop her or at least slow her down. He also gave her a shot of betamethasone to accelerate fetal lung maturity. At twenty- nine weeks, the air sacs of the lungs don't hold enough surface tension for the lobes to expand. Betamethasone stimulates the production of the surfactant. Renee's contractions didn't slow, so Grant put her on magnesium sulfate to supplement the terbutaline. Her membranes ruptured and then, at six o'clock, the baby scared the pants off everybody with persistent late decelerations. That's what finally reserved Renee this prime, dinner-hour table in OR.

"Have you picked names?" I whisper. We're the two youngest in the room, not counting whoever's inside.

"Jordan."

"How about a girl?"

"Jordan. Thought we had another week or two," she says, her mouth turning down in a mock pout. She thought she had another ten.

"I like Jordan."

"My father's name," she says. She speaks in the slow New Orleans style, as if the two of us are strolling beneath the live oaks of a peaceful avenue. She's a thin woman where she isn't pregnant. Her wrists are thin. She's the color the nurses here call cream.

I step back to look past the drapes. Sandler's hands turn, lean, glide. Her steel wand deepens the crescent in the uterus. Sandler and Grant work faster. Their hands pass, dip, pass. Sandler stops, nods. They lean forward until their masked noses almost touch. The silence is complete. One of Sandler's hands disappears, then the other.

The baby leaps, blue, green under the lights. Renee's eyes find it in midair. For an instant we all disappear. There's only Renee and her baby floating above her. Sandler suctions the baby's nose and mouth. Grant clamps and cuts the umbilical cord and passes the kid, who is a boy, to Chris Spellman, the neonatal attending. Spellman lays him firmly in the middle of the table. We go to work.

"Eight forty-one," the circulating nurse calls. I wipe glistening vernix off Jordan's belly and back. Spellman holds the oxygen catheter to his nose.

"One minute," the nurse calls out.

She's waiting for Apgar scores, which summarize a baby's condition. Spellman ignores her. We can see the baby's condition. He's pale and his chest sucks in with every breath. I put a mask on him and push air into him with the bag. He turns a shade or two darker, and Spellman's worrying shoulders drop an inch. The same nurse who called for scores comes over to bracelet the kid's ankle and ink his feet and finger as if this were a normal delivery. Spellman frowns her right back across the room. He wants to get this boy dry and warm before we take care of the bookkeeping. The baby's crying now, but not well. Spellman holds him up for Renee. She looks. Her eyes carry him right through the air to her. Now it's midnight, Bou. I'm on call. My hands walk up and down this keyboard like Jennifer Sandler's own. Green words dance across the screen, the way they have since I thought of you an hour ago. It's four years, four months since we said goodbye, or whatever we said. You're still the one I want to tell about my day. That makes this a love letter, doesn't it? I'm writing you a love letter.

I just can't get used to Labor and Delivery. For one thing, the colors up here are ridiculous. Hospitals are supposed to be white, but the narrow corridors of this wing are yellow, the floor is speckled black, white, and pink, and inside the miniature delivery rooms, the walls are tiled to breast height, bright pink above. For another thing, I can't adjust to the rhythm of this place. Delivery's like a nursing home crossed with a fire station. For hours nothing happens, then all at once everything goes crazy. There are two separate and supposedly equal teaching hospitals under this roof, Tulane's and Louisiana State's. This morning there were five births in an hour, just on the Tulane side. But tonight after the C-section, there was absolute silence on both sides of the delivery hall.

Sandler sewed up Renee's uterus and tucked it back inside. Grant left for another delivery and the third-year resident, Tim Clinton, came in. He sewed up Renee's belly while Sandler chatted with her about Renee's five-year-old, Marcy. Turns out Marcy doesn't want a baby brother or sister to come live in her house and use her old crib. She asked this morning if the new baby couldn't live down the street at her friend Jamie's house.

Clinton's another one of my new bosses. He asked me who I was and if I knew anything about outboard motors. I told him no and that I was a fourth-year subintern who'd been in neonatal and was starting OB. Good to have you aboard, he said, and then told me all about his motor anyway. He's pretty sure he's got a sticking carburetor, and from the symptoms he described, I had to confirm that diagnosis. He imitated engine noises while stitching up Renee as delicately as if he were embroidering a pillowcase. Finally Renee's belly was crossed by a single stitched line. The circulating nurse and the scrub chanted inventory in a soothing nursery rhyme. They have to make sure no instruments are left inside the patients.

I told Renee goodbye, as if she were the guest of honor, and left her chatting with Sandler and the nurses. I watched a Monopoly game in the unit clerk's office until I got sleepy. The RNs, LPNs, aides, and scrub techs all hang out in Unit Clerk, which looks like a big kitchen, with two phones and a copy machine next to the sink and a school clock on the wall. Finally I wandered toward the Residents' Room to lie down, but instead found myself in Nurses' Conference in front of this computer. No one ever uses the machine, or this room. I pulled a sweater and a jacket off the monitor and flipped on the CPU. Up out of the hard drive flew the winged-staff-and-serpent caduceus, then a full-screen banner saying WELCOME TO MEDWARE, and finally a menu. I picked CHART, which gave me a divided screen, the bottom half filled with medical abbreviations and a list of lab result tables, the top half blank except for a pulsing cursor. I started writing to you. The words just poured out. I started describing the C-section. I knew you'd want to know everything. I had to type as fast as I could, just to keep up with your questions.

Kate, the head night nurse, came in fifteen minutes ago. She told me this IBM arrived with the Great Cash Transfusion of 1990, after the Joint Commission on Accreditation of Health Care Organizations nearly shut Charity down. The commission found a few minor problems with the hospital, such as poor blood banking, thirty beds together in undivided wards, no fire doors between corridors, and no significant records on the patients. I exaggerate, but Kate says this PC, the steel doors between wards, and the cloth partitions inside the giant rooms were supposed to drag Charity into the modern era.

To my eye, the results are only so-so. I'd say the hospital is now hovering in the late '50s, but then I'm in no position to criticize. Who knows where I am. All I can say with confidence is that I'm not in New Orleans, I'm not in October 1992, and I haven't even decided if I want to be. I should make use of this computer and these scattered hours of something like leisure, because I probably won't have this opportunity again until I retire. Over the next ten weeks I could update my records and try to figure out what's wrong with me. I think it's a memory problem. I've got to free up some working memory, or I'm always going to function in the fog that has surrounded me since last spring. My trouble is backlog. The records for one year in particular--a year you know everything and nothing about--are such a mess that my only chance of sorting through them is to toss everything out and start from scratch.

I'll go high tech and put the whole year into this computer. Perhaps in that way I can create an order not my own. I'll work at night and during the day, whenever it's quiet. There's nothing I won't tell you, except how much I'm still thinking about you, which you know. I'll write about my New Orleans and especially about that Paris we knew, which stubbornly refuses to stay in the past.

I'll conjure you right up into the air, Bou, the way Sandler abracadabraed Jordan out of Renee's belly. Then, when you're floating in front of me, I won't reach out. I'll just look, while everything else disappears.


Excerpted from the book LOVE Enter by Paul Kafka, 
reprinted by permission of Houghton Mifflin Company.
Copyright (c) 1993 by Paul Kafka.

All rights reserved, including the right of reproduction
in whole or in part in any form.

mende@het.brown.edu