“…Tanya, thirteen and fourteen. Mellie, eighteen and twenty-two. Farah, you’re direct report on Upper side, Hee-yoon, Lead on Lower.” The on-coming nurses shifted, the room abuzz with an undertone of conversation as the young women – mostly under thirty – began to gather their belongings.
“And there’s an Elective tonight. Irina, you’re facilitator.” In the sudden silence, twenty-six pairs of eyes turned from the Charge Nurse to seek out the grim-faced, heavy-set nurse who sat planted in a chair near the far wall. Irina’s facial expression didn’t change, but her nostrils expanded slightly, a sign the Charge took as assent.
“Fine. I’m at 67701. Call me.” Charge indicated the phone hanging from the neckline of her maroon scrubs. She turned and opened the door of the conference room and waited while the swirl of nursing staff passed through and out onto the floor for night-shift.
Irina sat for a moment, waiting for the rush to pass, and then took out her phone, the grim line of her mouth growing, for a moment, more severe as she joined her eyebrows in concentration. She texted silently, her thumbs moving with practiced speed. Then, rising with effort from the too-small chairs, she tucked the phone into her pocket, and hobbled toward the door, stiff with sitting. Her phone dinged and she tugged it out, read the message and tapped absently at the table beside her where Hee-yoon was still trapping her unruly hair. Hee-yoon glanced up, nodded a greeting, lifted her duffle bag to her lap and began rummaging through the contents. Irina passed on.
The Lower Side of Chester Memorial Hospital’s Labor, Delivery, and Recovery ward handled inductions and Caesarean-section prep. The labor rooms were modest, containing a delivery bed, a small couch and a warmer for the newborn. The Law was posted conspicuously on the door, laminated for easy cleaning by the janitorial staff. Closer inspection revealed several paragraphs of verbiage concluding in a paragraph of italicized print.
“The Equal Rights Constitutional Amendment provides the right for termination of pregnancy at any stage of the pre-, peri-, and postnatal periods, up to and including one year after birth. Any effort to counsel to the contrary shall be considered a breech of law subject to the full penalty thereof.”
The termination of the products of conception was an elective procedure, but nonetheless, the Law required insurance companies to cover the full costs associated, including medical waste fees.
Hee-Yoon dropped her bag under the desk of the Lower Side Nurse’s station and turned to update the white board with her name and phone number as Lower’s Head Nurse. Two other nurses chatted easily near the file cabinets. Scanning the schedule while tucking a stray strand behind her ear, she noted one planned induction and the Elective. Room Seven. The monitor showed two other rooms in use, both of whom were near delivery, if the regular rise and fall of the contraction tracing was any indication.
Across the hall, a bustle of activity in Room Four. Hee-Yoon noted the arrival of Dr. Goff and after a few minutes of muffled voices, the clear, high-pitched cry of a newborn. Instinctively, she glanced at the clock. Seven twenty-seven. She imagined the nurse typing furiously in an effort to record the time of birth and attend to the needs of mom and baby. Laughter hung in the air and momentarily lightened the nurse’s heavy heart. Then she straightened and refocused on the screen in front of her.
With a few crisp keystrokes, she brought up the record of Room Seven and scrolled through pages of labs until she came to physician’s notes. Normal pregnancy. The hint of a social situation. No partner. Presented this morning with labor symptoms at forty weeks, two days. Full term. First mention of Elective at 11:15 AM. Why? Hee-Yoon tucked her hair behind her ear.
She reflexively looked up, searching for the source of the interruption.
“Ma’am?” The other two nurses now turned to look at the smiling diminutive woman in a blue volunteer jacket. “I’m one of the labor-companion volunteers,” she said in a low, calm tone. “Would you like assign me to a particular patient?”
Hee-Yoon paused, her mind transitioning from the Elective to the face in front of her. She took in the volunteer badge, the uniform, the sweet smile of what must be a retired school teacher. The woman laid her hands on the desk and tapped her fingers gently, waiting for the Lead -Nurse to reply. The conversation around the desk resumed.
“Go to Room Seven,” said Hee-Yoon, quietly.
With a smiling nod, the woman turned, padded down the hall and knocked on the farthest door.
“I’m Chari, a labor companion,” she called softly. “May I come in?”
To a muffled reply, she pushed open the door and stepped around the privacy curtain at the same time receiving a pump of sanitizer from the dispenser on the wall. She rubbed her hands thoroughly as she took in the scene before her.
From the tangle of tubes and wires on the bed she distinguished a young woman of medium-build, bulging with the promise of late pregnancy. She lay stiff and still, her eyes drooping and face expressionless. Chari moved toward her.
“May I touch you?” she asked quietly
The mother-to-be shrugged and turned her head toward the couch.
“Do you need to?” demanded a woman with pursed lips from her perch on the couch.
Chari took the mother’s hand and stroked it gently, careful to avoid jiggling the IV taped there. She smiled at the tired face in the bed, and then glanced at the speaker. “Every woman in labor deserves some compassion,” she replied simply.
“Like you people know what the hell compassion looks like,” smirked the sitter.
“Are you with Mom?” asked Chari, raising her eyebrows.
“Yes,” came the terse reply.
“She’s my Escort,” whispered the laboring woman, staring at the prancing dancers on the muted television.
“Escort?” Chari asked calmly stroking the patient’s hand. She sent some peaceful energy into the room, looking to diffuse some of the bristly behavior.
“I’m the source of real compassion here,” snapped the woman on the couch. She tilted her chin toward Chari, daring her to ask. Chari didn’t.
“I’m the real compassion,” the woman continued, “because I’m helping a woman get the healthcare she has a right to.”
Chari laid down the hand and fussed with the blankets. “You couldn’t get healthcare?” she asked the woman in the bed.
“I-“ started the patient.
“She couldn’t get the healthcare she needed,” interposed the Escort. “When she wanted to end this pregnancy, she couldn’t do it because it was too expensive.”
“I-“ started the patient.
“So I am here to make sure that she gets what she wants. And if I see anyone trying to change her plan, I’ll have the video,” here she pointed to her cell phone, perched on a tripod on top of the patient’s bedside table, “and a lawyer on speed dial.” She sat back with a flourish.
“You have a birth plan?” Chari inquired.
“Her plan is clearly stated in her patient records. Are you an authorized healthcare provider? You have no business asking unless you are part of her team. That’s a HIPAA violation, and I have video proof and a lawyer on speed dial!”
“So, you are planning to terminate the baby at birth?” Chari asked quietly, picking up the hand again?
“VIOLATION!” screamed the Escort. “Violation! I caught it on video! You called it a baby! You’re trying to influence her decision! She has a right to her own healthcare decisions without influence from outside sources!” Her triumphant crow crumpled in her throat as she fumbled the phone off the tripod and thumped the screen with an angry forefinger.
“I-“ the patient started.
“Damn. Well, it’s going now, so I’ll catch you if you try to do it again! What is your name?” She leaned forward to read Chari’s badge.
A commanding knock interrupted her efforts, and Irina barked her entrance.
“The doctor is coming in to check her,” she announced, indicating the patient. “Everyone out.”
“You can’t order me out,” started the Escort, “I’m her – “
“Out!” bellowed Irina. “Vaginal exams are not performed for an audience!”
Chari laid the hand down, smiled at the vacant-eyed face still fixed on the dancers and left the room, dispensing foam into her hands on the way. The Escort stumbled her way out momentarily.
“Would you like a cup of water?” asked Chari.
“From you people? Hah! You’d probably try to poison me! You’re a bunch of killers, hauling unwanted brats out of women like chunks of meat!” Chari drifted away, leaving the Escort standing in the hallway, muttering and forcefully thumbing her phone.
Chari took refuge in the Soiled Linen room. Lining the walls stood wheeled bins big as beds filled with blue bags of sheets, towels and gowns used during the day’s earlier births. Someone would come and take them to the laundry in a few hours. Another bin held red bags of biowaste: articles contaminated with human waste products. In one corner, a sink, disinfectant spray, and a shelf where boxes of used birth tools waited to be collected for sterilization. A mop and bucket. A box of white Patient Belonging bags that should have been stored in Clean Supply.
She took a deep breath, consciously bringing up peace from the well within her soul. She waited while the peace spread through her body. Several more cleansing breaths and she opened her eyes again. Digging her phone from her pocket, she thumbed through the texts and selecting one, read it twice.
When she returned to the room, Irina was capped and masked, laying out the instrument table in her sterile gloves. The Escort hovered nearby.
“Listen, lady,” snapped Irina as Chari rubbed sanitizer into her hands, “if you don’t back up, your breath is gonna contaminate all these tools and I’minna have ta start over.”
“I’m just making sure you have what you need for this…event,” snipped the Escort.
Irina held up a large pair of scissors from the jumble of hemostats and gauze. “You lookin’ for these? Wanna be the one to stab the spinal cord? Well, I gottem right here.”
The Escort looked to see if the patient in the bed heard and was opening her mouth to complain when she caught sight of Chari at the bedside. “Oh. You’re back. Why are you touching her again?”
“My job is to give comfort during labor,” answered Chari, patiently. “Every woman deserves comfort in labor.”
“Not if she doesn’t want it,” replied the Escort. “That’s MY job. To see that she gets what she wants and ONLY what she wants.”
Irina spread a blue sterile sheet over the table of instruments and pushed it close to the bed. “The doctor says you’re ten centimeters,” she said to the patient, not unkindly. “It’s time to push. Even though you have an epidural, you can probably feel the urge. Do you?”
“Sometimes,” started the patient. Her Escort interrupted.
“Is the doctor going to be here soon? I don’t want you starting anything until he’s here.”
“She,” answered Irina, tersely. She crooked a finger at Chari, who was wiping the patient’s face with a warm washcloth, “Help me with the screen.” From a long closet on the wall, Irina and Chari wrestled with a screen on wheels shaped to fit across the delivery bed, blocking the patient’s view of anything happening below her chest.
“Why –“ the patient started, her eyes growing wide.
“So you don’t have to watch it, obviously! God! It’s a mess! Why didn’t you do this earlier?” She gestured around the room. “All this could have been avoided!” The Escort’s eyes rolled in their sockets. Chari almost felt sorry for this woman, who had clearly seen too much in her line of work.
Sweat stood out in large drops on the patient’s forehead, and Chari wiped them away. She leaned in close behind the screen to adjust the blood pressure cuff and whispered, “You don’t have to do this, you know.”
The patient closed her eyes tightly and started to cry, her enlarged abdomen shaking the screen with each sob.
The Escort turned away in disgust.
Rubbing her hands with sanitizing foam, the doctor yanked back the curtain, glanced from the table to the screen and walked to the head of the bed.
“I’m Doctor Harman. You’re having an elective post-birth termination tonight?”
“You broke the Law! You can’t use the word ‘birth,’” interrupted the Escort. “The word creates unnecessary emotional traum – “
“Enough,” cut in the doctor, “I will do my job according to the standard operating procedures of this hospital, and those standards include asking every question I deem medically necessary in plain language. I assume you’re the escort. Understand this law, Ma’am, if you interfere with the provider/patient relationship, I’ll have you escorted out by Security. Is that clear?”
“You can’t talk to me like that!” the Escort protested. She inhaled to continue her tirade when Dr. Harman stalked to a speaker on the wall and pressed a button. A moment later, a man responded.
“Security, may I help you?”
“Yes, this is Dr. Harman. LDR, Room…” She looked to Irina for confirmation.
“Seven,” Irina and Chari replied in unison.
“Seven,” the doctor continued. “I have a patient escort that I am concerned may interrupt my patient/provider relationship. Would you please send an officer to the floor in case we need one?”
Over the Escort’s muttered curses, the security officer agreed. The doctor tapped the speaker with her finger and turned back to the patient.
“As I was saying, my name is Doctor Harman, and my notes show that you intend to have a post-birth termination this evening. Is that correct?
The patient nodded.
“And you understand that like any procedure, this one carries risks that include hemorrhage, tissue damage, and infection?
The patient looked toward the Escort, who avoided her eye, and back at the Doctor. She nodded again.
“Do you have a destination in mind for the remains?”
“The remains of the products of conception. Do you wish to have them after the procedure or do you agree to let the hospital dispose of them?”
“She doesn’t want to keep the bloody mess you’re going to make!” stormed the Escort, waving her phone. “I’m getting a lawyer!”
“Get your lawyer in the hallway,” commanded Dr. Harman. “I have a job to do here.” She stuck her head out the door. “Good. Security is here. Please take this woman to the waiting room.” To the escort, “We’ll call you back when we’re finished.”
Against her protests, the Officer led the Escort away.
In Room Seven, Irina stumped around making a hundred different preparations for the procedure. Chari stood resolutely behind the screen holding the patient’s hand, encouraging periodic pushing. The doctor, splash shield around her face, stood at the base of the bed, newly converted to facilitate delivery.
“Crowning,” Irina stated flatly as curly black hair appeared in the birth canal.
“I’m going to give some numbing,” announced the doctor toward the screen. Irina advanced with a vial of anesthetic, read the label aloud, and removing the lid, presented it toward the doctor. Sterile syringe in hand, Dr. Harman inserted a needle into the vial and drew up 10 ccs which she turned and slipped under the skin of the just-visible scalp.
In a few minutes, a small boy’s body slipped silently into the world accompanied only by the sound of his mother’s labored breathing.
Chari spoke comfortingly to the patient, shielded from the lower half of herself. “Now we just have some clean up work to do, and we’ll send you off to get some sleep on another floor. Chari stole a glance around the screen to the foot of the bed.
Stethescope in hand, Dr. Harman listened intently, moving the bell over the chest. She met Irina’s eyes and nodded silently. As silently, Irina suctioned the nose of the newest member of the human race and felt his slowing pulse. Picking up the giant scissors, Dr. Harman severed the umbilical cord between two clamps. With one smooth motion, Irina gathered the small body into a bundle, tightly wrapped in one of his mother’s disposable absorbent bed pads and deposited him carefully in a cardboard box Chari withdrew from the cupboard under the sink. Irina placed it carefully in the red biowaste bag and covered it lightly with another used pad. With her thumb, she forced three holes in the plastic and tied the top closed.
Chari glided back to the head of the bed. “Just a few more steps,” she smiled. “First, the placenta will come out, then the Doctor will check to see if you need a stitch or two.” Her smile waned a bit. “I’m sorry,” she said, squeezing the patient’s hand “but my shift is over and I have to go now. Irina will take good care of you.” She smiled her farewell and accepted a half-hearted nod as thanks.
With gloves on her hands, Chari took up an armful of crumpled sheets on one side and the red biowaste bag in the other. She nodded curtly to Irina and the Doctor, who ignored her. Through the door, down the hall, past the nurse’s station, Chari walked, looking neither left nor right until she reached the Soiled Linen room. Once inside, the automated light flicked on and Chari rolled a waste bin in front of the window on the door. Ducking behind it, invisible to passers-by, she tore open the red bag and removed the box. A practiced hand assured her that breath was still in him. Tucking the pad around him closely, she glanced at the clock on the wall. Ten more minutes of anesthesia. It was beginning to wear off already, she could tell by the convulsive fluttering of his eyelids.
As she reached for a “Patient Belongings” bag, someone opened the door. Chari froze. She turned slowly, hoping her body would shield the baby from view.
It was Hee-Yoon.
“I see you are done with your shift. It was a short one tonight.”
“Let me help you with this clean-up.” The Lead Nurse held open the Patient Belongings bag and waited while Chari placed the box within. With great care, Hee-Yoon clipped the plastic handles together and poked a hole through the bag with her index finger.
“Now, before you go, I have a patient waiting by the doors to the waiting room. Would you please push her wheelchair out to the parking lot? Her husband is waiting to pick her up.
Chari nodded again.
“Fine. I’ll finish in here. You go along.” Hee-Yoon placed the armful of sheets in the soiled linen container and pushed the biowaste bin back toward the wall. She tapped it twice before Chari stripped off her gloves and left the room, bag in hand.
By the ward’s main entrance, a woman sat bundled in a wheelchair. Her large red cape covered her entire frame and draped nearly to the floor. She tapped her fingers impatiently on the arms of the chair.
“My things,” she said, gratefully. “I almost left without them!” She accepted the bag Chari held out and tucked it under her cape where its presence became undetectable. The caped woman chattered loudly as Chari pushed her out the doors and across the waiting room. Chari touched the elevator ‘down’ button and heard a muffled squeak. The eyes of the two women met. At the same moment, an accusing voice rose behind them.
“Hey! You! Labor person!” Chari ignored the hail and smiled as if the caped woman had said something funny.
“Cheeky! Sherry! Whatever your name is! Are you done? The lawyer has a few things to discuss with the doctor. Take me in there!” Turning slowly, Chari watched the Escort advance, shaking her phone at them. With perfect timing, the elevator chimed its arrival and Chari whisked the wheelchair inside. The caped woman moaned loudly.
“Be careful! I’m fragile! You can’t just throw me around in this thing!” She moaned again, louder this time.
“I’m sorry,” said Chari to the Escort, pressing the ‘L’ button, “I have to take this patient to her car. I suggest you call the nurse’s station.” The doors closed as the caped woman raised another wail that sounded remarkably similar to a newborn baby’s cry.
In the lower lobby, Chari walked the chair sedately to the door, her patient chattering animatedly. Scanning the parking lot, she saw him. There in the first row, next to a minivan with a running engine, a clean-shaven man stood tapping his fingers on the hood. When he saw Chari and the wheelchair, he opened the sliding door and hurried to help the woman into the back seat. She bent double, clutching at her abdomen in what appeared to be aching pain, but made the transfer from wheelchair to van with surprising agility. Before he slid the door closed and darted to the driver seat, Chari caught a glimpse of the woman fitting a stethoscope to her ears.