Read an Excerpt
Who Do You Think You Are?
A tiny new body slick with blood, limbs unfolding for the first time into air. The
very first time she saw a baby born, Maggie knew: This was her moment.
Like a farmer who follows an unexpected breeze blowing out of a hillside and
finds himself in an endless, fabulous underground cavern: This is the glory
that was there all along, just waiting for me. Maggie finds herself in all kinds
of unlikely places thinking of birth — in the shower, on line at the bank
machine, or now, driving to work. For the first time, for the first time — the air
of the world inflates a brand-new set of lungs, air sacs like tiny bubble wrap.
And a heart no bigger than a golf ball beats and beats again. Maggie will
never get over it.
She is on her way to work, and this is her job, taking care of
those babies in the first moments and hours and days, making it go right
when it starts to go wrong, helping the hearts and lungs that cannot do it on
their own. Maggie will never doubt her choice: This is her moment, this is her
window, this is where her game is played. You get only certain moments,
certain sequences, certain golden hours, even in medicine, times when every
decision makes a real and true difference for a whole life's stake. She was
raised with religion, Maggie was, and she has reimagined and reinvented
herself as a woman of science and a woman of medicine, but she knows holy
when she sees it. She knows a miracle. And this participation in the miracle,
this knowing what to do, is her job, her place in the universe. If she prayed,
which she was raised to do butwhich she doesn't do — if she prayed, she
would probably pray, Thank you for letting me be here, thank you for letting
me help, thank you for a brain that understands what to do, and hands that
can do it. But she doesn't pray; she works. She does her job.
She drives to work, a little too fast because this is Boston and
that's how everyone drives but also because she wants to be there. She
doesn't eat in the car, though at red lights she notes the coffee drinkers and
bagel and muffin eaters in the other cars with a certain fellow feeling,
admiring their commuter privacy as she savors her own. She likes her car,
she likes even this little piece of being in control — well, what doctor
doesn't? Alone in her comfortable car, Maggie sings. She puts a gospel tape
into the tape deck and sings along, loud enough sometimes to leave her
throat slightly raw, bouncing her voice off the luxury tan leather interior, taking
her curves with the swing of the melody. It is Maggie's most unbuttoned
moment of the day, though in fact she is buttoned tight into respectable
Maggie parks her car in the doctors' lot, picks up her briefcase,
and off she goes. Into Blessed Innocence Hospital for Infants and Children
not through the main lobby doors but through the sliding- glass emergency
entrance, which is that much closer to the parking lot. Through the green
entrance hall and right into the bright white corridors of the emergency room,
quiet and calm at this early hour, charging in as if she's coming off an
ambulance. I belong here: a good way to come to work. Here I am, where I
Upstairs in Newborn Intensive Care are the new babies brought in
overnight, hooked up to their heart monitors, lungs bathed in oxygen — to
Maggie, they are the most important patients in the hospital, and she thinks
of them, always, as she comes in — but today they belong to someone else.
Today she is on her way to her mailbox, then up to her office, on her way to
spend the day writing up a research project, yakking on the phone with
colleagues, sorting through papers. But though all she is heading for is her
mail- box, her desk, her computer, though she doesn't ever work in the
emergency room, she still walks into the hospital with a deep breath of
ownership; she still claims these corridors as home turf.
And this morning the emergency room claims her in return;
someone pops out of a trauma room and grabs her arm. Mark Kristensen, a
senior resident she has supervised in the past, up in that newborn intensive
care unit. A wiry, deft boy, conscientious and intense, rumored to be
destined for a brilliant career in endocrinology.
"Dr. Claymore!" he says, and she notes that he looks genuinely
rattled. He clings to her arm. What does it take to rattle a senior resident at
the end of a long night in the ER? Mark Kristensen is very smart, but maybe
not the person you want calling the shots in a crisis; more of a thinker than a
doer. A little cerebral — a research guy.
"Maggie — Dr. Claymore — what a piece of luck!" Then he
swallows, takes a deep breath, and says to her more calmly and more
formally, "We need your help here, please."
"What's going on?" She walks through Emergency every damn
morning, and even when it's insanely busy no one tries to rope in a passing
But he does not let go of her arm; he is pulling her into the trauma
room, which turns out to contain all the purposeful medical chaos absent
from the quiet hallway.
"I got a fourteen-year-old here been in an MVA."
So what? Maggie could answer. What do I know about fourteen-
year- olds? What do I know about motor vehicle accidents? But she has
already guessed the punchline, and though some small part of her is
grumping about not getting upstairs to her desk and why can't the residents
do their job for crying out loud, most of her is suddenly eager and buzzing
and on: Let me at her!
The girl on the table is chunky and childish in appearance. She
wears a loose sweatshirt and ratty jeans, which are being efficiently cut off
her body by two nurses with shears. She is writhing, moaning on the metal
exam table, screaming when the intern jabs in the second IV line. But her
movement is limited; she is strapped to the table, and her neck and
shoulders are immobilized with large red foam blocks. Until an x-ray shows
no injury to the spinal cord, they don't want her to move her head or neck,
and they cut her clothing off rather than roll her or jar her, rather than pull
anything over her head. The shears clip rapidly up the front of the sweatshirt,
splitting the lettering in half. Parkdale Country Day. Underneath, just above
the girl's left breast, is a tattoo of a snake encircling a rose. Maggie herself
reaches for a box of surgical gloves and sorts rapidly through the sealed
packets. Eights, eights, nines, what the fuck do they think, that all doctors
are big men with big hands? Ah, a seven.
Mark Kristensen has been over at the bed, checking the girl's vital
signs. Now he comes up to Maggie, nervously thanks her one more time.
"How far along is she?" Maggie asks.
"We've called over to St. A. They're sending an OB —"
"How far along is she?"
"Best guess is maybe twenty-two, twenty-three weeks. Doesn't
really show." He gestures to the abdomen of the girl on the table. An
abdomen Maggie has already noted: looks plump but not particularly
pregnant. An abdomen that suddenly arches up off the table as the girl
screams out a long, quavering howl of pain and terror.
"Baby's crowning," says one of the ER nurses, employing the
patented I've-certainly-seen-all-this-before tone of ER nurses everywhere.
"Looks like OB isn't going to make it," Maggie says cheerfully to
Mark. Pats him on the shoulder. "You do the delivery, I'll take care of the
baby." As Mark seats himself on a metal stool at the bottom of the table, as
the nurses gently bend the girl's legs and fit her feet into the stirrups, Maggie
sets up for the baby. Selects the smallest endotracheal tube out of the crash
cart drawer, turns on the wall oxygen, turns on the warming lights that a
nurse has just wheeled in for her, a metal tree on wheels with a cluster of
lights at the top like pointy coconuts. She rips open the pack of gloves and
snaps them on to her hands, tight and taut as the skin.
"Where are the rest of the doctors?" she whispers to the nurse.
"The intern's out sick —"
"What if I hadn't been passing by? Is Mark supposed to handle
the mother and the baby all by himself?"
"Here it comes!" says one of the people over at the big table,
around the mother.
Maggie is ready. The lights burn down on the back of her neck, a
familiar and oddly comforting warmth, warming up a table ready for that wet,
cold little passenger. Was the girl in labor before the car accident happened?
Was she being driven to a hospital, perhaps, or did the trauma send her into
premature labor? Who was driving, one of her parents, her boyfriend? Is the
driver alive or dead? All vague questions, all of very little interest right here
and now. The oxygen is hissing and Maggie wants that baby, wants that
baby in her hands, wants that baby to be a little further along than Mark
Kristensen thought, wants that baby to have a chance.
A very premature baby, whatever other problems it may
encounter, doesn't usually have a hard time passing out of the birth canal.
It's easier to push out a one-pounder than a seven- or eight-pound full-term
baby, even if your head and neck are immobilized and you're screaming and
you're only fourteen years old and not very big. The baby comes out in a slow
corkscrew, blue and glistening into Mark's hands, which catch it and ease
the final half-turn of buttocks, legs, feet. Mark holds the baby, which fits
easily into his hands, and looks from side to side. The nurses hand him cord
clamps, scalpel, nudge him along. Mark probably hasn't caught a baby since
medical school, but at least his hands don't shake; he isn't afraid of the baby
itself. Babies are his business, but they're Maggie's business too, and this
one is hers. Let Mark deal with the fourteen-year-old pediatric patient on the
table. He swivels on his stool and Maggie takes the tiny thing from his hands
and lays it gently down on her table, in the warm spot under the waiting lights.
The baby is limp and gray, not a good sign. It's not really a baby
yet, to tell the truth, but what the residents call fetusoid. A disproportionately
large head, bruised and tinged with blue, like a thin-skinned fruit fallen victim
to an early frost. Arms and legs like chicken bones, and no tone in the
muscles at all.
Maggie is not thinking any of the things you might expect her to
think. Not thinking, Oh, how sad, how perfect. Not noticing the perfect
fingers, so whisper thin and slightly curled (though she would probably notice
if there were not five on each tiny hand). She has no awe to spare right now
for life and its formation, no grief. She has bonded with this baby, become
this baby: This baby is hers and she is his. His — she has registered the
bean-sized penis, and the smooth sac of testes.
"Looks a little older than twenty-two weeks," she says to no one
in particular. Her fingers have checked the pulse, squeezing the thick coiled
umbilical cord where it meets the baby's stomach; the cord twists between
her fingers, its slippery vigor the most alive thing about the baby. But way
down deep where this baby is rooted at the cord, there is a pulse beating.
Not as fast as it should be, but beating. Maggie's other hand is applying
oxygen, and she is annoyed; this could be done by a nurse, and would be, in
a real delivery room, with a real delivery room nurse. The nurse she had
expected to help her has gone over to check on the mother, who is having
some bleeding. I am in charge. You are helping me. Maggie tries to put this
thought into her gesture as she beckons the nurse to join her at the table. I
have done this hundreds of times, and you are all damn lucky that I
happened to be passing by.
"Heart rate's about fifty and dropping," she says firmly. "Let's put
the tube down, give him some breaths, and see how he does." Looking down
at the limp body, which in its thirty seconds of independent life has not yet
tried to take a breath, she adds, "I think he's gonna be a real fighter."
There is no one second when she turns it around, no one instant when the
baby makes the choice to live. You could argue, in fact, that the baby does
not get the chance to make that choice; Maggie's history is his destiny. She
spends her entire working life concerned with the saving of sick and
premature infants. She knows her business. She is more than a hundred
times his weight, she has been alive twenty million times as long as his
couple of minutes, and she does not question her right.
She gives the baby breath. A tube narrower than a drinking straw,
though made of a much firmer plastic, is down in his airway. The nurse's
hand is ready on the oxygen bag, but Maggie pulls the bag away. A
newborn's lungs are stiff, particularly a premature newborn's, and she wants
those first few breaths to go in with sufficient pressure. She squeezes down,
watching the hand swing on the face of the pressure gauge.
At one minute of life, the baby got his first score; Maggie awarded
it automatically as she requested a dose of adrenaline and shot it down the
breathing tube. The one-minute Apgar score was one out of a possible ten;
the baby got one point for having a heart rate. Nothing for breathing, nothing
for color, nothing for muscle tone, nothing for a grimace when the breathing
tube went down. Maggie was already focused on the five-minute score as she
got ready to slice off that stump of umbilicus and insert an emergency
intravenous line into the big vein leading up inside the baby's belly. The drugs
slide in through the line threaded through the umbilical stump: adrenaline to
kick the heart, some normal saline fluid to get the blood pressure up.
Oh, the joy of it! No one who has not personally and individually
saved a life and started a heart will understand it, and perhaps only those
who have been fortunate enough to save a life right at the beginning. The
heart rate comes pumping up, and the nurse, listening through her
stethoscope, calls it out with pride. "Heart rate's sixty. Heart rate's eighty.
Heart rate's up over a hundred!"
"He's pinking up!" Maggie says, and the two of them exchange a
nod over the little body, which is no longer quite so ghostly a gray. As the
trunk first turns a bruised lavender color and then gradually takes on a more
convincing rose, the hands and feet by comparison look shockingly dark and
dead, dull purple steel molded into baby toes as small as ball bearings. And
the five-minute Apgar is four, and by then the baby is committed. He's on his
And then, somewhere between his five-minute Apgar and his ten-
minute Apgar, as the obstetrician finally comes running into the room to take
over at the gurney, the baby kicks. Flexes his legs up into the proper chicken-
wing folded position, finally, and kicks out.
"We got us a keeper here," Maggie announces, a little bit too
loudly, in that strange fishing jargon that becomes second nature in the
delivery room, as if you could actually throw a too-small specimen back into
the welcoming warm waters of the womb. "He's a fighter, all right." And she
straightens up for a minute. The scalp at the part in her hair feels baked by
the warming lights; there is sweat on her forehead, and her shoulders ache
from bending and from tension. It is a familiar combination of discomforts,
just as it is a familiar joy; it is the composite delivery room moment when the
pressure eases enough to let her be aware of her own cramped and sweating
grown-up body once again, when she is no longer wholly and completely
focused on the physiological functions and responses of a newborn body,
when she knows she is winning.
Hospital routine takes over. The mother, her bleeding under control, is
wheeled off to a bed on the postpartum ward of the adjoining adult hospital,
St. Ambrose; she'll get her spine films on the way, and, the obstetrician
points out brightly, now that she's no longer pregnant, she can have belly
films too, just to make sure there was no abdominal trauma from the car
accident. The resident from the newborn intensive care unit has arrived to
take the baby upstairs, and Maggie, having carefully supervised the baby's
placement in the rolling incubator, has yielded her prize, this heart-beat-
powered newborn, this — yes, go ahead and say it — this miracle of
oxygenated cells and mechanically expanding chest.
As Maggie strips off those snappingly tight gloves, flexes her
shoulders, rolls them up toward her ears with a pleasurable ache, as she
systematically washes her hands and imagines all the while the progress of
that incubator — down the hall, into the elevator, up to the fifth floor and
Newborn Intensive Care — Maggie is also conscious of a responsibility that
is still hers, still undischarged. All these things fit together in her mind at this
particular moment: the let-there-be-light glory of the life-giving touch, the
mechanics of hospital cleanliness, the incubator's journey down those
familiar corridors, and then one last disagreeable but undeniable duty. A
rather interesting mix of the cosmic and the petty, though she herself would
see no particular contrast here. She may have left religion and prayer far
behind, but fundamentally she is a believer, Maggie is, and she knows that
from the petty to the cosmic is never more than one short step in a hospital.
As in, Good attention to gloving and hand-washing will reduce the spread of
hospital-acquired infections and help save lives. She would say this, she
would mean it, and she would practice accordingly; she scrubs thoroughly
and conscientiously at the sink, each finger soaped and rinsed. Proper
attention to detail will save lives — she knows it's true.
As will prompt attention to the derelictions and misjudgments of
residents. She does not particularly set out to humiliate Mark Kristensen in
public, but, in all honesty, it never occurs to her to take him out of this room,
still full of nurses and other emergency room personnel. She has something
to say to him, and here they both are, and she wants to say it and be done
and get on to her mailbox.
"Mark, nice job on the delivery." The OB resident and a nurse are
wheeling the mother away.
"Thanks," Mark says. All pleased with himself and proud. "You
really bailed me out there, though. I appreciate it."
"What if I hadn't been walking by in the hall? You're the
emergency room senior — you need to be prepared for whatever might
happen. You panicked, Mark, when you figured out she was going to deliver.
You left your patient! You left your patient and went rushing out into the
hallway — and you were lucky, you bumped into a neonatologist. But what if
I hadn't been there? Were you planning to just keep going till you found
someone, anyone, to come hold your hand? Or were you planning at all?"
Maybe the drama of the occasion has gotten to her; her voice is a
little shriller than she'd meant to pitch it, her tone more severe. Mark has that
stunned, slapped-in-the-face look that means he may yell and he may whine
and he may make excuses and he may even, god help us, cry.
Maggie corrects her tone. Softer, gentler, firm but
constructive. "You need to think ahead, Mark. There's no way you should
ever be here alone. You get tied up with one patient, someone else rolls in —
if the people who ought to be here don't show up, you need to call in
reinforcements, and the time to do it is before the emergency happens. Do I
make myself clear?"
The nurses are looking at them, or rather, not looking at them
rather too carefully. Mark is reading off a list of excuses about a sick intern
and the junior resident away interviewing for fellowships and the attending
went to a code upstairs, and the sick call resident is on her way in but she
had car trouble, and he himself only left the room to call for backup.
"Well, next time," Maggie says, looking pointedly at the phone on
the wall, "call from here, or send a nurse. If you're the only physician in the
place, you stay with the patient. But the other thing I'm trying to say is, don't
put yourself in the position of being the only physician in the place. This time
you were lucky, she was lucky, the baby was lucky. Next time someone
might be unlucky."
She nods at him in dismissal, strides briskly past the not-staring
nurses, out of the room and down the hall, off to pick up her mail.
See her down in the basement, see her march along. Tap tap tap of pumps
on concrete, swish swish swish of woolen skirt. In a week the month will end,
the new month will begin, the hospital wheel will turn and she will be on
service, in charge in the newborn intensive care unit, and then there will be
medical action and plenty. Babies and deliveries and ambulances; her head
will be full of ventilator settings and medication decisions. And that sounds
only good to her. Today was meant to be a day of reading and writing and
academic work, set back, removed from the blood and breath on which her
profession is built, but that morning intrusion of reality was welcome enough.
What I do is real, what I am is real.
Her mailbox, one square cubby in the honeycomb that covers the
mailroom wall, is stuffed with envelopes and journals. Maggie grimaces
automatically; so much junk, so much nonsense mail. Into the big plastic
garbage bin by the door goes a fat wad of mail too dreary to be opened —
notices from physician recruiting services and cellophane-windowed
envelopes from medical publishers thick with cards to be returned so that one
or another brand-new, overpriced textbook can be sent to her immediately.
She is left waiting at the elevator with her more real
correspondence. A manuscript from a colleague, sent for her comments, an-
other from a journal sent for review. A small pile of letters. The New England
Journal of Medicine and the Journal of Maternal Fetal Medicine. Around her
the workday and the hospital chug along in their usual patterns, undisrupted
by the small drama of the emergency room premature birth. And Maggie
herself is focused now on other details, her fingers eager to finish sorting the
mail. In the elevator, scan the contents of the journals, see if there's anything
interesting or anyone she knows getting published. In her office, close the
door and open the envelopes and go through them quickly, put the garbage in
the garbage, deal with what needs to be dealt with. In even this small and
trivial planning of this small and trivial moment of her working day, here are
Maggie's strengths and her weaknesses: She is organized and disciplined
and neat, she is reliable, faithful, and competent, but she is smug and
sometimes arrogant and far too wedded to her own arrangements. Not such a
bad balance sheet for a doctor, is it? And she was right, after all, in what she
said to Mark Kristensen: Why should his feelings matter more than an error
of judgment that might have meant a patient hurt or sick or dead?
Upstairs, in her unnaturally orderly little office, she slits open each
envelope with a letter opener, not above the small pleasure of neatly torn
paper. Piles up the three or four things that need answering in the in-basket.
Turns over the next envelope, notes automatically, even as she slips the
point of the opener into the slight gape at the corner of the folded flap, that
this is interoffice mail, a letter from the Department of Cardiology at Blessed
Innocence Hospital for Infants and Children. A report on a patient? An
invitation to a seminar? Probably not a personal note of any kind, since there
is no doctor's name scrawled in above the Cardiology logo on the envelope.
And then, as she slits the paper, placing her incision precisely on the fold,
she notices something else: There is nothing else on the envelope at all, not
her name, not her address. A blank Department of Cardiology envelope — is
it really for her?
Maggie unfolds the letter, takes her last innocent breath, and sits
staring at it, recognizing what it is. Look at this. See what this is. Oh my
god, would you look at this? Who would send this to me? Can you believe it,
look what came in the mail. And finally, under it all, maybe, a little bit of here
is the letter I always knew would arrive some day.
The formal salutation: Dear Dr. Maggie Claymore. A correct and
secretarial beginning, which makes the lack of a sign-off or a signature that
much more blatant. But then, what sign-off would you use in an anonymous
piece of hate mail? Sincerely? Very truly yours? She reaches nervously for
her beeper, fingering the on-off switch. It is on, of course. She is not one to
leave her beeper accidentally off, or to delay replacing the battery.
Dear Dr. Maggie Claymore,
Maybe you think you stupid evil self-satisfied woman that
everyone is fooled by you but it is not true!!! who do you think you are???
When you parade through the hospital the people are whispering to each
other that you are a cruel and harsh bitch and that you do harm to your
patients and to young doctors who come to you for training in fact everyone
hates you and is always sorry to work with you and if you think that no one is
aware of the disgusting lies and cheap tricks which got you where you are
then you are wrong and some day you will be more than wrong you will be
found out and you will have to leave but why don't you just make it easy on
everyone and QUIT NOW!
And then she pushes back her chair, leaves her desk, leaves her
mail in a heap, and she is out in the hall, moving fast, almost running. Tap
tap tap, her shoes tear up the linoleum tile. She disdains the notoriously
tardy elevators, she pushes open the door to the stairwell and pitches herself
forward down the stairs, pulling herself along on the banister. All morning she
has looked somewhat dignified, queenly in her kingdom, but now she is a
woman dressed for business running down stairs faster than her shoes will
allow, her blouse pulling out at the waist; she is distressed and disarrayed
and, by the last of the five flights, puffing. Back in the mailroom, she stands
staring at the mailboxes, confirming what she already knew: there are no
names on the boxes, only a number neatly printed in white on a dark green
label below each space. Maggie has no idea what her number is; she locates
her box by eidetic memory. Here it is, this is mine, in this particular location,
I'd know it any- where, I could find it in the dark. In fact, she now sees, her
box is number 372.
The mailroom director is sorting medical journals into boxes. He is
a big man, tall and also very fat, with black hair down to his shoulders, a
smoothly shaven almost ridiculously pink face, and a diamond earring in his
left ear. He wears a denim work shirt and immaculately white painter's
"How do I know which box belongs to someone?" Maggie asks
him, hearing her own voice out of breath and inappropriately intense.
"Who?" He sends a pile of copies of the Journal of Pediatric
Infectious Diseases pinging neatly into one box after another until a whole
row has been serviced, neat blue covers protruding from each and every
cubby. "You could check the address labels on those magazines and you
wouldn't find a single one out of place."
"But what if I wanted to leave something for someone — if you
"I'm generally here." He smiles at her, a pink and maybe slightly
creepy smile. But then, she is in a mood to find things creepy. "You're
always free to leave things in the basket there." He indicates a large blue
plastic laundry basket prominently displayed on the counter and labeled with
a sign in fluorescent orange letters: mail drop.
"Do you keep a list somewhere of which box belongs to whom?"
He jerks his thumb at a small crowded bulletin board in the far
corner of the room and pays no attention at all to her as she goes over to
look. His Boston Herald is spread out there on a small table, next to a
portable radio and cassette player and a stack of cat breeding magazines.
There are several Polaroid pictures of strangely shaped orange-yellow cats on
the bulletin board as well, space-creature animals with big moony eyes and
round disc ears, along with lists of mailing costs, hospital security directives,
and an invitation to a support staff picnic from a couple of months ago,
complete with elaborate directions and a carefully drawn map of Brookline.
Under this, she finds the list of box numbers, pockmarked with
holes from all the notices that have been pinned on top of it. She verifies that
her name is there, next to 372, and stands wondering what to do next.
Should she ask him whether he had noticed anyone putting anything in her
box yesterday or very early this morning? Ask maybe if anyone else had
come looking to find out who went with which box? It seems suddenly
embarrassing, as if he will know immediately what is in that letter upstairs on
her desk — and it is then at that moment that she realizes that she does not
want anyone in the hospital to see the letter. Not even the mailroom guy.
It might be worth pointing out that Maggie has never really been
particularly aware of the mailroom man before, though she is scrupulous
about emptying her mailbox every day and therefore sees him regularly. Sees
him but doesn't see him; the truth is that like many doctors, she more or
less accepts the hospital support system without examining it closely. The
halls are cleaned and the food is served in the cafeteria and machines are
repaired and she is not really aware of the people who do these things, of the
dark blue maintenance boiler suits and the light green housekeeping dresses.
And instead of asking any detective questions, she nods
assertively to the mailroom guy, though he either doesn't see her or chooses
to ignore her, and she goes briskly out of the mailroom. Furious with herself,
but also flat and defeated, she goes back up those five flights of stairs, locks
herself in her office, and reads the letter again, for the second, third, and
fourth times. She is peculiarly troubled by the absence of commas and
almost finds herself reaching for a pencil to add them in, as if the letter would
be less strange if only it were properly punctuated, less suggestive of the run-
on hatreds of a boiling angry mind.
Maggie would rather be, oh, how she would rather be, in the newborn
intensive care unit. While she sits at her desk and tries to make herself work
on various important things, a grant proposal, a journal article, a lecture
outline, they are taking care of her baby in the newborn intensive care unit.
Her baby, single-handedly and handily snatched away from death — are they
taking proper care of him? Paying full and proper attention to his many
needs? And any- way, who would send her an anonymous letter? You do
harm to your patients — what an outrageous thing to write. Everyone hates
What kind of settings is her baby requiring on his ventilator? Does
he have an umbilical artery line in? What did his blood count look like? Will
the ventilator blow holes in his lungs? Will he bleed into his head and wind up
neurologically damaged? No, she believes he's bound to come through just
fine; he's the probably unwanted child of a high school girl, and those babies
do better than you expect them to. It's a basic superstition of newborn
medicine: The unwanted, casually conceived babies do well, and the so-
called premium babies are in danger. If this were the desperately wanted
child of a well-to-do couple in their forties who had spent expensive years
going through the dark maze of infertility treatments to bring about this
glorious result, well, then you would have a setup for disaster. Or so thinks
Maggie, who is herself half a well-to-do couple, who is close to forty, who has
not managed to get pregnant in several years of trying, and who has avoided
all intimations of infertility treatments. Someday. Maybe. Maybe not.
The team in the NICU is three interns supervised by a resident, all in turn
supervised by an attending neonatologist. In a week it will be Maggie's turn to
fill that slot, but right now it is being filled by Hank Shoemaker, who would
definitely not be Maggie's first choice for her baby. Still, he knows what he's
doing. What he's doing right now is this: He is trying to make the intern on
call, a clueless woman named Marjorie Fallon, think intelligently about
ventilator settings, and it is a losing battle.
"So if the baby isn't oxygenating well you're going to —" He
pauses, waits for her to supply the information. Instead she makes a great
show of considering this incredibly basic question, waiting for him to answer
it himself so she can nod and agree.
"Well, which would you increase, the pressure, the rate, or the
"You wouldn't want to increase the rate," she ventures.
"Marjorie, it's the middle of the night, the baby isn't getting enough
oxygen, you're the only doc around, the nurse comes and asks you what to
do. Don't tell her what not to do, tell her what you want done."
The two of them stand looking down at the baby, who is
completely still on an open warming table under lights. The breathing tube
that Maggie inserted down in the emergency room is taped to the baby's
upper lip, a little silver heart sticker fastens a temperature probe to the rib
cage, a gauze bandage holds an oxygen sensor on the toe, the plastic
umbilical venous line runs into the abdomen, and a nurse has just put a
regular intravenous line into the arm. Still, to Hank, this baby looks
insufficiently connected up; he looks at the baby and thinks, That
endotracheal tube should probably be changed, the baby needs an umbilical
artery line. Plugged in, he thinks. We need to get this baby well plugged in.
"Increase the oxygen?" Marjorie suggests, though without
"Yes, you could do that, but remember, very premature babies do
have these stiff little lungs, and I think I'd personally go up on the pressure
before I went too far with the oxygen." Marjorie nods, as if to say, My
In fact, Marjorie keeps on nodding her enthusiastic agreement
with whatever he says, and he feels a little sorry for her; she is one of the
poorest excuses for an intern he can ever remember seeing, and she is trying
so hard to cover her inadequacy by employing these transparent medical
student tactics, by staring into his face to try to read the answer he wants,
by earnestly presenting him with data he hasn't asked for and doesn't need.
She stands there now, chewing her lower lip. It's a pretty lower lip; she is
actually very good-looking, in a sort of sexy schoolgirl way. She has long
wavy brown hair pulled back with a plaid headband, and she wears neat
Shetland sweaters and plaid skirts. When Hank first met her, he expected
her to be smart and competent; she looked like the person who would pop up
with the right answer. But she isn't smart, or maybe she has just come to
the limit of what her brain can do, and Hank knows it, and the other interns
know it, he supposes, and so does just about everyone else.
"Hey, Hank!" Justin, the resident, all excited about something. A
new baby coming in by ambulance? An interesting delivery across the bridge
in St. Ambrose, the adjoining hospital? With relief, Hank turns away from
Marjorie, who is now studying the ventilator with a bright, excited expression,
as if she hasn't ever seen one before.
"Hey, Hank, get this! That baby, the one Maggie Claymore saved
in the ER this morning?"
"What about it?"
"His grandfather is a state senator or something — and get this,
his daughter was pregnant and he didn't even know it! She sneaks out of the
house at night and runs around, and she was driving around with her
boyfriend, and everyone was drunk, naturally, and they get into this accident
at five a.m., and the next thing you know, she delivers in the ER and Maggie
resuscitates her twenty-three-weeker!"
"Between twenty-three and twenty-four weeks, I thought we
"When I was an intern, I once saw Maggie try for a twenty-two-
weeker." Justin is half admiring, half derisory; he admires the medical skill,
but he knows he is talking about an extremist.
"She doesn't like to give up," Hank acknowledges. He would agree
that Maggie is often too aggressive about resuscitating borderline babies, and
certainly much too aggressive about prolonging extreme and heroic care for
very premature babies who are not doing well. He would not pretend to
admire her, or even to like her. But this particular resident is getting a tad too
cocky for Hank's taste as well. "Maggie was the one on the spot this
morning," Hank says firmly. "The doc on the spot makes the call."
"Yeah, well, there are four men in suits out there and a newspaper
reporter and a lady from the hospital PR office. You want to talk to them or
you want me to? It's all because of who the grandfather is."
"I'll talk to them," Hank says, fumbling at the neck where his
yellow precaution gown is tied. He can't get the knot undone, and Marjorie
the intern reaches over and does it for him. "Thanks," Hank says. "Justin, you
might just go over this baby's plan with Marjorie, review the ventilator
management." And he lumbers off; he is a big and ungraceful man, and he
knows it. He is most at home in the world when he is doing procedures,
when he is threading a tube into a newborn artery, for example. His stumpy
fingertips can rest with feather delicacy on an infant wrist to sense a pulse,
his slumping shoulders and awkward elbows can hunch in over a tiny
troubled baby and guide the needle, the tube, the scalpel, to where they need
to go. He had once been portrayed in a hospital Christmas show by an intern
wearing a Smokey the Bear mask, and in his most secret foolish fantasy, he
had entertained the notion that the nickname might stick, that he might
become known in the hospital as Smokey or The Bear, suggesting an
affectionate regard for his size and his strength. But as far as he knows, no
one has ever called him by either name, and if he has a hospital nickname he
doesn't know it, which means he probably doesn't want to know it.
While Hank talks to the men in suits, offering guarded hospital catchphrases
about the medical condition of this newborn baby, Maggie is sitting,
frustrated, at her desk. She has tried to edit an article, tried to work on her
grant proposal, and she is getting nowhere. Usually she has no trouble
focusing, shutting out everything else, but today there are two separate
worries nagging at her, and they seem to draw strength from each other. She
keeps thinking of that baby, wondering whether even now they are giving up
on him, deciding he is too small and too sick to live, and she keeps thinking
of that letter. The result of these distractions is that she is left edgy and
irritated, though without quite knowing who is irritating her, since after all, she
doesn't know what is going on with the baby, and obviously, she doesn't
know who sent the letter.
She tells herself she is just going down the hall to use the
bathroom; there is actually a bathroom closer to her office, but that one is
used by patients as well as staff, and Maggie, who is fastidious, doesn't
think it is cleaned often enough. Also, she once found a mother in there
snorting cocaine. Therefore she has every excuse to take the longer walk to
the staff bathroom near the NICU and, after she uses the bathroom, to stand
for a minute or two looking through the window. The NICU is set squarely into
a corner of the hospital building, and the corridor tracing the angle of its
inside walls is glass from waist level up. Thus, two sides of the NICU are
mostly window; the design is supposed to offer parents a literal window into
the weird world inhabited by their sick newborns. Curtains had to be added
on the inside so that the nurses could prevent parents from looking in on
particularly gruesome procedures, or deathbed scenes. Nurses, and most
especially residents, often neglect to draw the curtains before getting down to
the business of extracting blood from a one-pound premie, and the director of
neonatology occasionally receives an angry letter from a casual passerby
who has witnessed something particularly unpleasant.
So Maggie pauses at the window, peering in, imagining herself on
the other side. She feels, as she always does, a small surge of pride, looking
into this, her rightful place. Neatly spaced rows of babies, the sickest out on
warming tables, the rest in plexiglass incubators, boxes for babies who no
longer need to be observed quite so closely. The banks of monitors, the
chrome and tube arrangements of ventilators, the purposeful nurses. And it's
easy to see where her baby must be, over there on the warming table where
the intern and the resident are talking. But as she watches from behind
glass, Maggie can clearly see that something is going wrong; the intern and
the resident have broken off their conversation and are looking down at the
baby in concern, and the nurse is bending over the table, fussing with the
monitor, suctioning the airway.
My baby. My baby. And so for the second time that day, Maggie
rushes into a room where she is not really supposed to be the doctor, this
time without an invitation. She is at the bedside, she is pushing in next to the
intern, a woman she doesn't know, a pretty and competent-appearing young
woman clutching a clipboard. Marjorie Fallon, M.D., on her nametag. "What
is it, what's wrong?" Maggie asks.
"The ET tube is clogged," says the intern importantly, though she
does not appear to be doing anything to either diagnose or correct the
problem. The resident, a good-looking, cocky guy named Justin, with whom
Maggie has worked before, is listening to the baby's chest with his
stethoscope, and the nurse is suctioning the tube once again with a thinner
Justin takes the stethoscope out of his ears. "I don't think it's
clogged," he says to the nurse. "I think it's out. I think it's in his esophagus."
While he is speaking, the nurse has hooked up a bag and mask
and another nurse has come over to join them, pushing a metal cart with
"Are you sure?" Maggie reaches over and unhooks a stethoscope
hanging from the warming table. But the resident, Justin, has already
untaped the tube from around the baby's mouth, already slid it out, like
someone unhooking one of those proverbial fish: throw him back, he's too
small. Now the nurse has the transparent plastic donut of the face mask
clamped over the baby's nose and mouth and she's squeezing the oxygen
into his lungs while Justin gets ready to put in a new tube. The numbers on
the oxygen monitor, which had dipped down into the sixties, start trending
slowly up toward a hundred percent again.
"Okay," Maggie says, "go ahead and bag him up. Justin, are you
comfortable with this, you can tube him?"
For the first time, Justin turns and looks at her, really registers
that she is there. Maggie supposes that she has tweaked his ego by asking
this question, but what the hell; this is a very tiny baby and a very sick baby
and her baby, and she is not so sure that endotracheal tube needed to be
pulled so hastily; a little more suctioning, a little repositioning, and maybe
the baby could have been spared the trauma and danger of a second
intubation so soon in his life.
Justin does not actually speak to her; instead he speaks past her
to Hank Shoemaker, who is approaching at an ungainly trot across the
room. "The new one's trying to die," Justin calls out. "That tube had an awful
lot of play in it. It came out of the airway and I had to pull it. I'm going to
Hank, as he reaches the warming table, nods quickly to Justin,
and what he says to Maggie is "Checking up on your big save?"
"I came by to see how he was doing," Maggie says. "I happened
to be here when Justin decided to pull the tube."
"The tube was out," Justin says. "It was in his esophagus."
"Okay," Hank tells him, man to man, maintaining strong eye
contact, just to let Maggie know how little she's needed. "Now let's put it
Maggie steps back as they bustle around. The baby is Hank's
patient, Justin's patient, not her patient. She knows this. She would like to
push them both out of the way, dig an elbow into each back, clear the
runway, and put that tube in herself. But she steps back and stands next to
the intern, watches from a short distance away as Justin intubates the baby,
not completely smoothly, not on his very first try, but reasonably competently
and reasonably efficiently. On the second try, he gets the tube where it
needs to be, down through the vocal cords. As they are taping in the tube
and hooking the baby back up to the ventilator, Maggie smiles at the intern
and makes her way out of the NICU. In a week she'll be in charge. She'll
maybe have to take Justin down a peg or two — but on the other hand, she
likes him for being decisive, sure of himself, and skilled. Justin is the kind of
resident she was herself. Hank, on the other hand, is an asshole, but that's
hardly news. Too bad if he thought she was checking up on him, too bad if he
can't understand why she's invested in this baby. Too bad if he can't deal
with women doctors, she thinks, remembering how he failed to include the
intern, Marjorie, in any way when they were intubating the baby.
As Maggie walks back to her office, she is making a variety of
promises, to this young woman who needs teaching, to Justin, who needs a
better medical model than Hank Shoemaker, but above all to the baby, who
is indeed and triumphantly still alive. And she has, for the moment, stopped
thinking about the letter.
Copyright © 2004 by Perri Klass. Reprinted by permission of Houghton Mifflin