Patience
Marnie’s eyes swept over the patient. Phoebe Packard was positioned on her back with the head of her bed raised to a forty-five-degree angle, the ventilator chuffing each breath. There were three intravenous lines and one arterial line streaming from her limbs, as well as a Foley catheter half-filled with rusty urine. Though only a few hours after the devastating event, there was an odor of staleness that hovered above the bed, like the patient had started to rot, right there. Marnie closed her eyes, said a silent prayer, and took a breath. She loved a challenge.
Phoebe’s right hip was raised slightly, tipping her uterus and its precious cargo to optimize blood flow. The fetal monitor tapped out a regular pattern. This baby boy was tolerating his mother’s condition well. At twenty-three weeks’ gestation, the only hope for him was to stay tucked inside that magical womb. The ICU nurse joined her at the bedside.
“I’m your babysitter,” Marnie said.
“Tough start to your day?” Priscilla asked. They had been friends for years.
“Sure, I guess.” Marnie rubbed her eye with the back of her hand. “I wasn’t here when she came in, but the night nurse, Devya, looked like a deer frozen by high beams.” Marnie thought of how Devya’s breath smelled like peppermint Tic Tac’s and tobacco as she spoke about Phoebe’s accident, the head injury, then the brain bleed.
Devya’s hands shook. “She talked to me during most of the night. Isn’t that weird? Thank God her husband made it here before the stroke. It happened right in front of him.” She smoothed her ponytail. “Suddenly she grabbed me, then said ‘oh.’ That was it.”
Marnie relayed the conversation to Priscilla, then turned to her patient and stroked her forearm. “Phoebe, I’m Marnie,” she said softly. She watched for a twitch of the eyelid, for a jump of a muscle in the neck, and glanced at the monitor to see if her patient’s pulse quickened when she spoke. There were no changes.
“Nonresponsive, nothing since she’s arrived,” Priscilla said. She shook her head, arching her peppery brow in a way that flattened her smile. She was a twenty-five-year veteran, a former flight nurse, who worked with the most difficult patients. Marnie knew one thing; when Priscilla shook her head, it was as good as any pronouncement from the coroner.
“I hate when they come pregnant.” Priscilla flipped through some papers. “Grab a good chair from the nurses’ station.” She adjusted the IV pump and emptied Phoebe’s urine into a graduated cylinder. She gestured around the room. “Everything’s fresh here, new sheets, there’s a blanket over there.” She wrinkled her nose. “Everything’s fresh but the patient.”
“I’ll wash her up.” As the first caregiver in the line of defense, Marnie’s job was to monitor the baby and watch for signs of distress. To keep the baby alive. She wondered how many weeks it would take until Phoebe’s body gave out.
Priscilla paused in the doorway. “Holler if you need me.” She added, “And make sure you don’t move her tube. They had a hard time getting it in.”
Marnie examined the clear tape on Phoebe’s face and the way it braced the tube from every angle. She said in an even tone, “I’ll be one of your nurses today and the next two days. Probably longer, in fact.”
Her voice echoed in the tiled room and bounced against the coated metal equipment placed in an arc around Phoebe’s head. She thought about Phoebe’s people, her husband, and her parents. And about how she’d take care of her own daughter if she were in the bed in front of her. The idea of this flooded Marnie’s soul with pain so she shut it down. She remembered the words of the nun from nursing school with the fuzz-pilled cardigan who taught her to separate herself from her patients, to keep them at arm’s length.
“This is a clinical situation,” Sister Mary-Something told the class. “Treat it as such. Do your job well but, remember, they are not your loved ones, and it is not your pain, so don’t take it on.”
Phoebe’s skin was dewy, with a mystical cast to it. Marnie swirled a damp cloth over her patient’s face and neck, moving warily under her breathing tube. The young woman’s hair matted into a nest above her ear, so Marnie grabbed a comb. It was a small hospital issue, meant for a man’s short cut, and she worked it over the spot until the snarl of brown fuzz came loose. It was typical hair with false streaks through it, painted like tinsel over the drab color. Nothing enchanting about that.
A bruise formed on the edge of Phoebe’s hairline on the right. Marnie wondered if this was the point of impact that caused the intracranial bleeding and set into motion a course of events that resulted in the catastrophic stroke that nearly killed this young patient and her child. Marnie didn’t remember much about cerebrovascular events or strokes. At fifty-two, she was an experienced nurse, year after year of evaluations filled with interesting stories of the complicated pregnant patients she sought out, but never one who suffered from this condition. She’d add this broken mother to her diary that night; the personal account that she kept hidden from the medical record.
“You didn’t deserve this,” she whispered, admiring the way that Phoebe’s hair was cut so it splayed evenly across her pillow. If the situation was different, she’d ask Phoebe who her hairdresser was, perhaps make an appointment there. She dabbed Vaseline on Phoebe’s lips and hoped it would keep the delicate skin from eroding.
“Your baby is doing just fine,” Marnie murmured as she washed and dried Phoebe’s underarms, her chest, her hips, her legs, her toes. She rubbed the bar of soap against a new washcloth and gently separated Phoebe’s legs. The smell of must sharpened the air but dissipated quickly with a few careful wipes. She rinsed the basin, peeled off her gloves, then looked around the glassed-in room. A large digital clock was tacked above the doorway. In addition, a small locker and corkboard made up the decorative elements. She added her name to the white board by the door underneath Priscilla’s and Devya’s. Oxygen tubing hung like limp string down the wall behind the bed. A small plastic angel, white, but flaked with gold fake filagree, sparkled on the windowsill. Marnie considered it for a moment.
When Priscilla came back, they turned Phoebe and made sure her back and bottom were clean and dry. They worked in tandem, pulling the sheet and lambskin taut under her, smoothing the blanket in one swift motion. They placed her limbs on pillows, around rolled towels to make sure her joints were supported.
“Doesn’t it feel like we’re turning an incubator?” Priscilla asked, a light note in her tone.
“I suppose.” Marnie smiled at the dark humor. “Let’s hope.”
Phoebe’s hand shifted on the bed and Marnie readjusted it.
“Find me when you want a break,” Priscilla said.
Marnie nodded and pulled her chair close to the bed. She touched her fingers to Phoebe’s forearm.
“I suppose we’ve got time to get to know each other, you and me,” she said.
Phoebe’s eyelids twitched. Marnie drew closer. She took a breath and watched her stillness. The gentle hiss of the respirator and the fetal monitor were the only sounds in the room.
In the silence, Marnie felt a sense of foreboding laced with hope. Perhaps she could bring this patient from the brink. Did she have that kind of power? She strained her mind and tried to visualize it. She felt a quick vibration, as if a bee buzzed past her arm. She clicked her eyes open and saw a shock of electricity, a flare of a sort, that glanced off Phoebe’s head. Since she was attached to a nest of machines, Marnie followed the neatly placed wires and tubes up and down her body, ran her fingers to their origins, and assured that no electricity escaped. She studied Phoebe’s face, blank in its expression, then it happened again. A wisp of light flashed with a fine quiver, then circled Phoebe’s jawline. The ring of white shimmied, paused to caress Phoebe’s cheek, then dissipated as quickly as it came.
“What the hell was that?” Marnie felt a thrill down her spine.
She turned to the window to find the source. The sun was beaming through a dusky cloud, but the slatted filter of the vertical blinds made it hard to see anything unusual. The ventilator continued its hiss, the fetal monitor its staccato, and the hum of the ICU outside the door was unchanged.
In the closet, next to a bag of blood-stained clothing, was a gift sack that gaped open, with a children’s book and a Vermont Teddy Bear tucked inside. The bear held a giant card. He stared at Marnie, his eyes shiny dots of coal, his head cocked at an angle. She wished he could speak.
A rap on the door jamb startled her. Isaac Packard, Phoebe’s husband, froze in the doorframe. “How is she?” He scanned his wife’s body. “All these tubes. My God.”
“I’m Marnie, the labor nurse,” she replied. “She’s stable.”
“The baby?” His voice was raw.
“Listen, you can hear him.” Marnie turned up the volume on the fetal heart monitor for a few seconds and Isaac’s shoulders released.
He pulled a chair close and wriggled to the edge of it and grabbed Phoebe’s hand. “Squeeze my hand, babe, squeeze it.”
Her paste-white hand drooped with gravity, and he dropped his chin, then leaned in to kiss her forehead. His eyes were bloodshot.
“I don’t think she’s awake enough,” Marnie said. “But keep trying.”
A trio of doctors clamored in. The tallest one spoke with a clinical cadence.
“Twenty-eight-year-old, first baby, twenty-three weeks, significant for partial abruption. Post MVA yesterday with catastrophic CVA this morning. Vitals are stable, questionable brain activity at present. Plan is to monitor, maintain the pregnancy to reach viability.”
Isaac stood. “MV, CV? What’s that mean? I’m the father. I mean, the husband.”
Michael Silvana thrust out his hand.
“I’m Dr. Silvana,” he said. “MVA is short for motor vehicle accident, CVA—that’s the stroke. Don’t worry, we’ll take good care of him.”
Isaac’s eyes widened. “Him? I don’t understand.”
“We’ll keep the baby alive by keeping her alive,” Silvana continued. “But I’m afraid that your wife’s condition is grave.”
Isaac smeared the tears on his cheek with the back of his hand. “What if Phoebe dies?”
“Let’s focus on the fetus, he is doing everything right.” Silvana scrolled through the fetal heart rate printout. “All good.”
They left with a flash of white coats. They had healthy moms to see too.
“Would you like some privacy?” Marnie offered. “I could go into the hallway, as long as I can hear the monitor.”
He shook his head and sighed. “I’m not sure.”
“Can we call someone?” she asked.
They shared a long silence. Finally, Isaac bent over his knees and looked directly at her.
“What happens next?”
“We wait,” said Marnie. “We make sure the baby is okay, that’s why I’m here. I’ll watch his heart rate, and monitor Phoebe for contractions.” She wanted to say more; she wanted to make sure he understood how serious the situation was, how he should prepare himself. But his eyes were laced with hope.
“And, if she does? Have contractions?” He rubbed his forehead and looked away.
“We’ll keep giving her medicine to keep the baby inside. He’s too small to be born yet.”
Isaac blinked and continued to stare into the corner of the room. If only there were something for him to hang onto. Marnie searched for the wisp of light again.
“Tell me how it happened.” Marnie’s eyes flickered around Phoebe’s face.
Isaac rubbed his neck at the edge of his stubble. He had a closely cropped afro and long eyelashes. He twisted the bottom of his shirt, a green Life is Good Henley, then rubbed his palms on his jeans.
“The ambulance brought her. After the accident. I couldn’t find her at first.” He stared at the plastic angel and added, “They should have people out there, on the street, to give directions.”
“They had to clear her in the emergency room,” Marnie said.
“When I caught up with her, she said it hurt, right here.” He pointed to his left side. “There was something on the ultrasound, but they said it would be okay.”
He swallowed with a hard gulp. The fetal monitor ticked steadily in the background.
“She was bleeding from the placenta. They kept saying ‘she’s stable.’” He flexed his fingers. He walked to the window and leaned on the sill. His phone vibrated from his back pocket and he pressed to stop it.
“I can’t do this,” he said, not turning around.
“It’s been a long night for you.” Marnie voice soothed. “Can I get you some water?”
He shook his head no and turned to her.
“The last thing she said to me was, ‘something’s wrong, something’s wrong.’” He began to weep. “Then she touched her head and grabbed the nurse.” He pressed his hands to his eyes.
“I’m so sorry,” Marnie said.
“That was it, the last thing she said to me. It wasn’t ‘I love you,’ or any of the good stuff. How is this possible? She’s five years younger than me, too young to have a stroke. We joked that she’d take care of me when I got old.”
He walked back to the bed and looked down at his wife’s belly.
Marnie picked up the gift sack. “Would you like to take this home?”
He tilted his head at the bear then regarded the card. He read aloud the messages sprinkled over it from coworkers wishing Phoebe a ‘restful pregnancy,’ a ‘great little vacation,’ and a ‘speedy delivery.’
“It was her last day of work. The doctor told her she needed bedrest. She must have loved this,” he said. He tacked the card on the corkboard across from Phoebe’s bed and placed the teddy bear on the windowsill next to the angel. Flowers weren’t allowed in ICU but the bear in the blue hoodie was okay.
“When she wakes up, she’ll see him,” he said, running his hand over the fur.
*
“Huzzah! That was a save,” Michael Silvana said. He put a hand up for Marnie to tap.
She knew exactly what he was talking about. Phoebe was not the save, the save was the baby that percolated inside her.
He swallowed a gulp of beer and belched from the side of his mouth. Dr. Silvana, thirty years at the hospital, was a prick even on his best day. To his credit, he regularly performed nonchalant acts of heroism. He walked by a patient’s room once, stopped by the look of terror on a young obstetrician’s face. The baby’s head lodged itself tightly in the mother’s pelvis, and Silvana spun the baby out as if removing a cork from a wine bottle. It took a moment for any reaction, then the tiny girl screamed from her toes and the entire room erupted in laughter. So, though an asshole at times, Marnie and her colleagues tolerated his affronts as a trade-off for his life-saving skills. Heroes are often forgiven their faults.
“We gotta keep her alive just a few more weeks and then we can deliver that baby.”
Marnie sighed. “No chance at all for the mom?”
“C’mon, she’s gorked. Hey, it happens. The kid should be okay if we’re careful.”
Marnie thought about the distance created by the crude terms they sometimes used. Calling patients gorked or alluding to an imaginary drain that souls traveled through, one that ended in eternity, created a disembodied barrier that helped prevent a slide into someone else’s grief. But the reality was that Phoebe weighed greatly on them all.
They were at Sampson’s, the neighborhood bar. It was a throwback, reconfigured to remind its middle-aged customers of their college pubs. The room was filled with sticky wood and lively chatter. Sixties’ classics thumped from an old-fashioned juke box, quarters lined up along the sole pool table, and much of the hospital’s day shift hung in small groups. It was a Friday, the day most people ended their week with, yet in the hospital, it was the start of two twelve-hour shifts together, with close-knit camaraderie tucked in between patient care. The bartender knew Marnie well and placed a whiskey sour in front of her. She twirled the straw and pierced the orange slice. Sampson’s used the old recipe and added an egg white. She needed a little protein after the day she’d had. The Monkees sang in the background.
“Something else, Marnie?” the bartender asked. “How about a burger?”
She nodded. “Medium rare. Smother it with onions,” she replied, glad for food to soak up the whiskey.
HIPAA medical privacy laws were skirted in this bar. At nearly every table, hospital staff rocked their chairs together and spoke in low tones about their current losses and success stories. They laughed loudly at cases that could only be described as unusual.
“The kid ate three ball bearings,” said one nurse. “That’s like the guy I had a few years back who swallowed an inch-long screw,” said another. “Had a screw loose, we still laugh at that one.”
She ate her burger in silence, dipping the fries first in malt vinegar then alternating bites with ketchup. She loved the pungent greasiness of the meat, the way it slid down her throat, leaving a coating. The whiskey was her salve, Silvana too.
Some days, Marnie felt a whole-body ache from pushing stretchers filled with oversized patients. But they were brimming with life, and Phoebe was not. Marnie hated the way the veins on the back of her own hands buckled and the tiers of heavy skin that draped along her once graceful ballerina neck. She did not feel as sharp as she once did, and retirement was still many years away; she hoped she’d last. After her divorce she was left with a small condo and a bulky cat with a broken fang and a white heart on his paw. She received enough alimony to pay her electric bill each month. As she stared at the bottle of whiskey behind the bartender, the light reflected in the mirror and caught her eye. She chewed on her straw and thought about that strange orb that she imagined and how it touched Phoebe’s face.
*
Each week that passed brought hope that the baby would survive. And the absolute certainty that Phoebe would not. They treated one infection, then another. Marnie organized a team of nurses to cover each shift, in order to provide continuity of care, something the hospital touted as part of their best practices’ initiative. One morning, she caught her breath when she arrived at Phoebe’s empty bed. The sheets had been stripped off and the room smelled of fresh disinfectant. She looked at Devya.
“What happened!” she asked, the rise of dread thrumming her chest.
“It’s okay, they’re just giving her a trach,” Devya said. “She’ll be back from the O.R. in a few.”
The doctor moved Phoebe’s tube from her mouth to her neck, leaving areas abraded by tape on her face that Marnie dabbed a thin line of Aquaphor onto twice a day. The team of nurses kept Phoebe’s mouth clean and her bottom free of bedsores as they monitored her baby. Always the baby as their bellwether. They could do little else for Phoebe aside from a special bed to ease the pressure on her limbs. A peacefulness settled into the room, the fetal monitor punctuating its steadiness.
Marnie avoided the visitors who arrived at the end of her shift. They stood in pairs by the bedside and shook their heads. Phoebe’s parents, a frail couple in their early seventies, eyes stained with heartache, seemed to grow weaker as the days passed. Marnie could not handle their torment; there was only so much she had to give to this family.
After two weeks of his vigil, Isaac said, “I really have to get back to work.”
When he visited, he paced the room and made small talk with the nurses, but he could no longer engage with Phoebe. Marnie learned that he was gently quiet for his size, loved to take a five-mile run each morning, and put some of each paycheck into a college fund for his son. He telephoned often, but Phoebe’s status never changed. Marnie observed his slow detachment from the marriage, protecting himself from the deep pain that incised him.
One afternoon, it happened again.
The doctor was doing a portable ultrasound on Phoebe. Marnie saw the light flicker, but he did not acknowledge it. He started to speak but cut himself off.
She confronted him before he left the room. “Did you see that?”
“Yeah, it was nothing,” he assured her. “Don’t believe everything you see.”
Two days later, Priscilla and Marnie were changing the sheets and Marnie startled when an orb danced along the arterial line.
“That goes to her heart,” Marnie said. “You saw it, didn’t you? Am I losing my mind?”
Priscilla shrugged. “Trick of light, that’s all, nothing to concern yourself with.” Priscilla regarded Marnie carefully. “Stress effs with our minds. You wouldn’t believe the things I think I’ve seen in this place.”
To pass the time, Marnie read Phoebe The Velveteen Rabbit and The Boston Globe. She placed the fluffy teddy bear on the bed, stroked Phoebe’s hand over its tacky fur, and played her own Spotify playlists to stimulate anything that was left of her brain. On occasion, Phoebe’s eyes fluttered open, but they were empty.
The next time the orb appeared, Marnie was in the middle of a telling Phoebe a story about a patient whose baby literally fell out in the parking lot. Marnie found the woman straddling something, her legs dangling out the passenger side. The woman shuddered, shook her head violently, pointed down to the bulge inside her pant leg and said, “No.” Marnie pulled the waistband down carefully so she could fish the bloody, squirming guy out while the mother screamed atop his screams, “I’m not ready yet!” Marnie animated the story as she told it to Phoebe.
Phoebe’s light appeared then, as if it were a bolt of laughter, and etched a line under her chin. Marnie watched it fizzle to a speckled patch, then disappear. She touched the blush of pink that was left. It felt warmer than the rest of Phoebe’s face. The slatted blinds gaped slightly, so she pulled the shade wide open and swept the sky for a flight path contrail or a flock of geese or anything that could disrupt and shadow the sun. The clouds were high and serrated, only partially formed, concealing nothing in the deep blue.
*
“I mean, it’s weird, right? That I see this strange light that seems to touch her?” Marnie asked.
Dr. Silvana was curled up against her back, his leg thrown over her ivory thighs.
“It’s just a trick of the eye, that sort of thing isn’t real,” he said. He kissed her hair. “Maybe you should take a few days off from her?”
“She’s my patient, why would I?” Marnie slipped from underneath him.
“True enough, she won’t be here much longer anyway,” he said. He slapped the covers over her and stood. “Gotta get going, I’ve got surgery in an hour. Who knows, maybe there’ll be a lightshow in the OR too.” He chuckled and grabbed his clothes.
She heard the shower spraying on and off his body. While she had someone naked beside her, she figured it would be a safe space to talk about the light, but she was mistaken. Next time she’d try the bartender at Sampson’s.
*
Ten weeks passed in a haze of routine for Marnie. Bed bath, reposition, monitor the baby’s heartbeat, change the sheets. As Phoebe’s belly grew, her body sunk beneath it until her bones were simply scaffolding. Marnie picked up an extra half shift each week to make sure her patient was tended to properly. She wanted this baby to survive, she needed this baby to survive.
“She likes a pillow between her knees,” she told Priscilla. “She grunts when I rub her back,” she continued.
“Won’t hurt anything,” Priscilla said with a shrug. She cleaned the puncture in Phoebe’s neck that, for weeks, oozed with serum. “Damn codes, it’s amazing they have all their parts afterward,” Priscilla said.
Marnie was in the OR the day that Earl Berhane Packard, named after his maternal grandfather, emerged covered in dime-sized clots of old blood. He looked around the operating room, perfectly astonished. Isaac stood by the infant warmer and tears streamed over his mask as Marnie blinked back her own. She watched as he and the boy formed a new family. It happened in an instant.
During Earl’s first three days of life, Marnie spent her breaks in ICU. She was there to help the neonatal nurse when Isaac settled their son on his mother’s bare chest, weaving him through tubes and wires, watching her ventilator pump against the bit of extra weight on her body. Isaac wanted this much before they let her go. Earl was small, seven weeks shy of his intended birth date, but consumed donated breast milk in impressive amounts. Marnie told Phoebe all about him and placed damp cabbage leaves on Phoebe’s swollen ducts as her breastmilk came in; the normal physical changes persisting, somehow, in the background of a brain that forgot how to do nearly everything else.
“Why bother?” asked Priscilla. “Tomorrow’s the day, anyway.”
“I have to do something,” Marnie replied. “Maybe she’s more comfortable.”
On the day that Phoebe died, Marnie and Priscilla disconnected each wire and cut the tracheostomy tube even with the hole in her neck, to keep it in place for the autopsy. Isaac stood behind the curtain and wept again, his racked sobs background music to their work. Marnie placed Phoebe’s wedding band into Isaac’s hand. Their two rings clinked together, as if offering a toast to the future.
*
“Marnie, someone is here to see you,” Devya said with a wink. “Name’s Earl.”
Isaac held his son who, with his nasal tube taped to his face, reminded her of his mother. Isaac removed a pastel knitted cap to show off the skim of black fuzz. Earl’s adult-sized eyes wept a grainy discharge. Isaac presented him proudly to Marnie.
“Wanted you to see him before we leave. He has that feeding tube but otherwise has been doing great, gaining weight like a champ.”
Marnie cooed and stroked the baby’s head.
“Your Mama did a good job,” she said, hoping she didn’t upset Isaac.
“I wanted you to have this too.” Isaac handed her an envelope; the name of a spa blazed across its front. Devya held her own envelope and grinned at little Earl.
“It was a pleasure, an honor really, to care for Phoebe and your baby,” Marnie said, tucking the envelope into her lab coat. “I’m so sorry about the circumstances.”
He looked down quickly and swallowed.
“You both did so much for her. I, um… we, appreciate it,” he said with a slight nod at his son.
“Our pleasure,” said Marnie.
“Oh, and you left this,” he said. He handed Marnie the angel from the windowsill.
“It’s not mine.” She looked at Devya who shook her head no. “You should have it.” She pushed it back gently. “Maybe she helped keep your son safe.”
He shrugged and tucked it into the diaper bag. Devya put her finger up as if to say something, then dropped it. They stood for a moment, in a half circle of silence.
“I’ll walk you to your car,” Devya offered. “I’m headed out anyway.”
Marnie held the door as they left. Isaac’s gait was confident and his arms full.
She watched as a spark of light traced down the hall behind them.
Nancy J. Fagan's recent work can be found in Breath & Shadow, You and Me Medical Magazine, and Abilities, Canada. She is an RN with a BA in English from Mount Holyoke College and is currently an MFA candidate at Vermont College of Fine Arts. She lives in western Massachusetts with her husband and two ridiculous cats.
