The Best American Essays 2013 (23 page)

In the final analysis, the decision to withhold medical care is not a decision that can be practiced, and rehearsed, and fully prepared for, outside of the realm of combat. How could that ever be accomplished with any modicum of reality? Could a medical officer simply say, as I did in training, “Bang, you’re dead” or “Put the black tag on this one,” and with that feel the same gut-ripping tension that combat evokes? No, the reality of triage tends to hit more like the force of a bomb blast. In an instant, fragments of stone and metal explode through the air with such velocity that when they hit a human target, even if the target is not killed, it is stunned and bleeding and breathless. It is that environment in which a military doctor or medic makes a live-fire triage decision and then must stand against the ballistic force of its consequences.

Somewhere in the process of making notes about the expectant patient, I paused and moved toward the middle of the bed. I put my hand on the patient’s leg, just as the general had done. I laid it there, let it linger. From where I stood, I stared directly into the expectant soldier’s face. I watched his agonal breathing, a long sighed breath followed by an absence of movement, and that followed by three to four shallow breaths. I matched his breathing with my own breathing. I timed the slowing pattern with my watch. I made some mental calculations, then looked away. Once again I noted the quiet of the room and the whiteness of the walls. I noted the empty beds, and the ceiling, and the antiseptic smell. Again I watched the expectant soldier, who was oblivious to all of my watching.

I stood at the triage bedside thinking if this were my son, I would want soldiers to gather in his room—listen to his breathing. I would want them to break stride from their war routines, perhaps to weep, perhaps to pray. And if he called out for his dad, I would want them to become a father to a son. Simply that: nothing more, nothing less—procedures not in Department of Defense manuals or war theory classes or triage exercises.

I moved to the head of the bed, placed my right hand on the chest of the patient. And my hand rested there with barely any movement. I turned to the other soldiers, gave them an acknowledgment with a slight upturned purse of my lips, then looked away. I lifted my hand to the patient’s right shoulder and let my weight shift as if trying to gently hold him in place. I half kneeled, half bent—closed the distance between our bodies. I noted the weave of the fabric in his skullcap dressing and the faint show of blood that tainted its white cotton edges. I lingered. I prayed for God to take him in that very instant. I whispered, so only he could hear, “You’re a good soldier. You’re finished here. It’s okay to go home now.” I waited. I watched. I saw the faces of my own sons in his: was glad they were not soldiers.

I finished, stood up, and walked to the foot of the bed. One of the soldiers asked me if there wasn’t something I could do. I said no. I meant no. I wanted my answer to be yes. I faced the captain and put my hand on his shoulder, told him that we were finished, that his soldier did not feel pain, that he would be gone soon, and that everybody had done everything they could. The tone of my voice was neither comforting nor encouraging, neither sorrowful nor hopeful. It was, as I remember, military and professional.

I think about that expectant soldier so often. I know I would have seen his name in his hospital chart or been told his name by his commander. I did not take the time to write it down anywhere, and that bothers me. It bothers me because years later he remains nameless—just like so many other soldier-patients I encountered—and I think I equate that namelessness with a form of abandonment for which I feel personally responsible. I do understand, in a professional sense, that the patient was not abandoned, that his triage was purposeful, and that it allowed an ascent to medical efficiency which, in the end, saved other soldiers’ lives. But I also understand that the theoretical basis of triage quickly erodes when confronted with the raw, emotional, human act of sorting through wounded patients and assigning triage categories. In my mind, the theoretical and the practical wage a constant battle, so that whenever I participate in a triage decision, part of me says
yes
, and part of me says
no
.

I sometimes find myself wanting to speak with the expectant soldier’s mother and father. I want to tell them that their son did not die alone in a triage bed—that he was not simply abandoned or left as hopeless in a secluded corner room of a distant combat hospital. I want to assure them that he died in the company of men who stood watch over him as if guarding an entire battalion and that we tried to give everything we could give—that we tried to be more than soldiers or generals or doctors.

When I tell the story of this particular soldier to my medical colleagues, I always mention that triage is a necessary part of war. I tell them it’s a matter of compassionate medical necessity and the entrenched reality of combat—that it’s the exercise of a soldier’s final duty.

Occasionally, though, I think about telling them how I wished I could have done something, anything. But then I realize I cannot tell them that, because in fact I did do something, and I am left with the nameless face of an expectant soldier and countless sheets of history filled with decisions made by doctors at war. I am left with my own understanding that we who are soldiers are all triaged.

I want to remember the expectant soldier as a person with a name, but I have come to accept that I cannot. I remember instead the triage room. I recall the general who placed his hand on a young man. And I see the drifting once again—the fading of a soldier back into the womb from which he was born into life. I see him loved. He is a soldier. Wounded. Triaged. Expectant.

MARCIA ALDRICH

FROM
Hotel Amerika

I
N WHAT I HOPED
would be our final appointment with the midwife, she guessed you weigh eight pounds and four ounces and that you will come soon.

I woke up late, having spent the night beached on the couch in the living room, memorizing the distinguishing signs of every rash chronicled in Dr. Spock’s baby book, until nodding off around six. The book lay open to cradle cap, flaking patches of skin on the tops of newborn heads, which might be “cracked, greasy, or even weeping.”

I’m ten days past the date you are supposed to arrive and too uncomfortable, too wrung out with anxiety to sleep. In the last weeks, after an hour or so of tossing in bed each night, I’ve been shuffling to the couch so that your father might sleep undisturbed. In the mornings I lumber into the shower, stand under the spray, and cry. I brace my arms against the shower walls and let the water rain down my face and stream over my breasts and enormous stomach.

This morning I waddled to the bedroom and sagged in the doorway. Your father took one look at my forlorn figure and said, “Come on, let’s get out of here.”

We wound our way slowly down Twenty-second Street to the entrance of Ravenna Park, and inside the park to the old-growth ravine with freshwater springs welling from the tall walls and flowing into Ravenna Creek.

As we entered the muddy trail down to the creek, Richard took my hand in his to brace me for our descent. We walked at a glacial pace, mimicking the first untroubled humans, on the path that looped through the waterlogged ravine, Richard consciously slowing his pace, me trying to move myself forward. At the end of the mile loop, we huffed up from the ravine and emerged by the tennis courts, where we rested a bit, sitting on a bench beneath a bracelet of blooming cherry trees, the branches dipping down around us. Though it was only noon, I lay on my side on the bench and put my head in Richard’s lap. Sitting on the bench, we spoke of our anticipation, and wondered how much longer we had to wait until you, our first child, would be born. At that moment we weren’t anxious. How could we be anxious, sitting on the warm bench, the world alive and green, and the branches of the cherry framing our hopes?

I’m telling you this because few events are more momentous than birth. Every child wants to know about her birth and asks,
Where did I come from?
Many are answered with a birth story that speaks to the child of who she is and will be and that sets her life in motion in a particular way. Mothers know the story and tell it like a favorite fairy tale to the child, who rests her head on her pillow, on her way to sleep.

But sometimes the stories of origin are troubled, riven with complexity and unanswered questions, and bespeak a cloudy future.

My parents never spoke of the circumstances surrounding my birth, and I am in possession of only a few meager facts.

• I was born on February 26 in the dead of winter
  .
  
• No baby pictures were taken
  .
  
• No baby book, where the important milestones are recorded, exists
  .
  
• I was installed in a wood-paneled room down a long corridor at the back of the house
  .
  

The absence of any information made me puzzled about my place in the family. When visiting friends, I couldn’t help notice the gallery of framed photos chronicling their life from birth and wonder what it meant that there was no documentation of my life displayed in my house. Luckily I wasn’t asked to produce an autobiography or photo collage at school, and so the lack of material didn’t become a public issue, only a private worry. I was the only child of my mother’s second marriage. As a young woman she had married and given birth to two daughters in quick succession, and then her husband died unexpectedly. My sisters were separated by less than two years and formed a strong unity around my mother, as was only natural given the circumstances. Their births were well documented, and two ornately framed photos, one of each of them, sat on my mother’s dresser, directly across from her bed. After struggling for years on her own, my mother married my father, and four years later I was born. Ten and twelve years separated my sisters from me, a gap that could not be bridged. Though we lived under one roof, it was as if we had been born into two different families. The first family was short-lived but cast a long shadow.

One winter evening after dinner while we were washing up the dishes, I asked my mother what she remembered about my birth. She was taken aback by the question and responded as if she were the subject of a police interrogation. “You were a small baby, only five pounds, and had to stay in the hospital several weeks before you could come home.”

“What was wrong with me?”

“Nothing lasting,” she said as she wiped the counter for the second time. I couldn’t understand why she didn’t want to share the details of my birth, why she seemed to be keeping something from me. “Your birth weight was a little low,” she reluctantly continued, “and doctors were more cautious then than they are now. Mothers routinely spent two weeks flat on their backs after giving birth.” She finished in a matter-of-fact tone. It didn’t occur to me then to ask why I was so little or to question her about her pregnancy and prenatal care. It wasn’t until I became pregnant myself with you that I began to wonder about such details. But that night in the kitchen I could only think to ask, “Do you remember anything else?”

She said, “You weren’t born as planned,” and she looked at me hard, as if an old anger had been stirred out of the corner. “You were two weeks past your due date and in the middle of the night my water broke.”

I didn’t have the foggiest idea what she meant by waters breaking. She seemed angry, angry at me. The words
water breaking
were part of a puzzle called my birth I had to assemble.

“Anything else?” I pestered. I wanted to know what happened after the waters broke.

That was it. She was done telling me the story of my birth. She hung her apron on the handle of the oven door and joined my father in the den to watch the nightly news.

My mother’s defensiveness on the subject of my birth led me to believe that the day, the event, my first entrance onto the stage and into my mother’s life, was complicated by emotions I didn’t understand and would never understand. I came to think, perhaps irrationally, that from my mother’s point of view my birth was a mistake, and that was why all the memorializing forms were blank. Instead of caressing the event in memory, she entered a state of amnesia from which she never awoke. That winter evening after dinner was the only time in my childhood that I pried even the slightest sliver of information from the wound.

In high school, on the bus ride, while some of my girlfriends were making up the names for their future children, I’d make up stories of my birth, as if I were a character in search of a play. The births I imagined all took place out of doors, as if I were a wild animal—

• In fields
  
• In meadows
  
• In mountains
  
• In a valley
  
• In the woods
  
• In a ravine
  
• By a stream
  

And my mother and I were always alone, mother and daughter, the essential couple.

Here is one story I made up:

On a Sunday morning in September, my mother drove out of town, by herself, deep into the country of farms and pastures and ponds, until she reached an orchard. The orchard was on a rough incline, under an open sky. She was in the midst of pulling apples down from the branches and putting them in her bag when she sank down among the dropped apples and I was born.

This story is preposterous on many levels. I wasn’t born in September. I never knew my mother to pick any fruit by hand, and certainly the apples we ate were all store-bought. You can tell I didn’t know the first thing about birthing. Imagining my mother making a bed below the boughs and giving birth to me as if she were a doe and I her fawn is a fairy tale. I don’t ever remember my mother lying in the grass or on the ground of any sort. We never even had a picnic at a table. Yet despite its utter lack of veracity, this was one of my birth stories.

After my mother’s death, my father discovered a cache of photographs she had stashed away. All the photos were a revelation; just their existence required me to rethink my portrait of my mother. But one photo stood out: it was a baby picture of me. No one is holding me, neither my mother nor my father. I’m lying awake on my mother’s bed, the one place where I most longed to be as a child. In this photograph I seem to be looking up at the person taking the photo. It must have been my mother’s shadow pointing the camera. The bedspread is white and the blankets I’m swaddled in are white. I look small and dwarfed among the snowy folds. I’m holding my hands up in a defensive position, and even then my hands were clenched. I can hardly say what I felt looking at this picture after having spent the bulk of my life believing no pictures of me as a baby existed. And here I am, at long last, on my mother’s bed. It’s just a little square photo, so small it could easily have disappeared and never been recovered. But it has; it is a fact, and like other facts, it complicates everything.