The Wild Impossibility

Regal House Publishing, LLC

February 27, 2011

Kira gripped the wheel, focusing on the road ahead. Berkeley awoke in the cool grasp of water — fog unraveling in treetops and blossoming from the asphalt, rain plummeting earthward in ecstatic downpours and gray-blurring the creeping cars and huddled storefronts. California, a place of rain-fueled excess in winter, of choked aridity in summer. You could flee the San Francisco Bay Area, fog-chilled on a summer morning, and end the day watching the sunset in the high desert with sweat beaded on your brow. Wherever you were, the other existence — fogbound or sunburned — would seem like a dream state, a fantasy you'd only imagined.

At the hospital, Kira parked in the employees' lot and killed the car engine. Six forty-five in the morning and the day already seemed long. She yanked her keys out of the ignition. Time to go to work. In some odd twist of logic, the neonatal intensive care unit was the one place where she could block out the unrelenting memories of her own baby, Aimi — the ceaseless thinking, the nagging what-ifs. It was the pace, she supposed, the mental intensity of tending to the critically ill. If the staffing office had allowed it, she'd have worked seven days a week.

After changing into scrubs, Kira went to the nurses' station to check the assignment board. She had Baby Bowen, a thirty-four-weeker, stable and on minimal meds. Not a busy assignment, and because of that she was scheduled to get the first transport, if there was one. Good. The more distractions, the better.

"Hey, Teresa," Kira greeted the charge nurse. "Any transports on the horizon?"

"Twins coming from Travis. You've got Twin A. You'll be busy."

Kira checked the board again. "We lost Baby Taylor?"

"Last night, poor little guy."

No surprise. He'd been hanging on by a thread, one of those babies who seemed likely to make it, then had one complication after another. The mother hadn't been involved and maybe that was just as well. At least she didn't have to hear a doctor tell her that her child was dead.

Kira scrubbed in, trying to quell the kicked-in-the-throat feeling the word "mother" gave her. Six weeks since her own mother had died, and Kira still caught herself picking up the phone to send her cat videos or pictures of baby otters, or to set a lunch date at their favorite Sicilian place. Two deaths in less than a year, deaths of the most intimate kind, of people whose tissue she had shared — one whose body she had come from, another she had created. Kira marveled at it sometimes, the malignancy of fate, God, whatever force or power could deliver that kind of cruelty. These days, she turned away when she saw women her age out with their mothers. But young mothers and their babies, she cornered them and asked, "How old is she? What's her name?" or "Does she sleep through the night yet?" If the mother allowed it, Kira would touch the warm, sweet-scented head, close her eyes and pretend the child was Aimi.

Shift report on Baby Bowen revealed a typical preemie scenario: born at twenty-nine weeks, now stable on fifty percent oxygen and moderate ventilator settings, the usual fare of steroids and diuretics around the clock, sedatives and morphine as needed. Lab work was due at eleven; if his next blood gas was good they'd wean the ventilator settings.

"Has he needed much sedation?" Kira asked.

"I gave lorazepam around three; he was a wild man," the night nurse said. "Oh, and the IV in his foot is out; I couldn't get a new one. Sorry. I left you a scalp vein that looks decent. Good thing you're a better stick than I am."

The night nurse left and Kira tested the bedside alarms, adding to the orchestra-gone-haywire beeps and chirps from seventeen bedsides. As usual, the Unit was noisy and crowded, an amorphous, pulsating hive of nurses and attendings, haggard interns and residents, X-ray techs and respiratory therapists, social workers and anxious parents. West Coast Children's, with the biggest NICU this side of the Rockies, was not a place for people who liked things calm and quiet. It got the sickest of the sick, the high-risk babies, and it always had, even before the crack-baby boom in the '80s. The transport teams never stopped.

Baby Bowen looked good. Too tiny and too young, but he might make it.

Kira was taping a new IV in place when Teresa zipped past. "Transport's twenty minutes out," she called to Kira. "The parents are on their way."

The team rolled in five minutes early. Twin A was a micro-preemie, barely bigger than Kira's hand, on a hundred percent oxygen and maxed-out ventilator settings, paralyzed with Pavulon so she wouldn't fight the machine. Eyelids still fused, skin like tissue, body limp as a waterlogged leaf.

"Twenty-two-weeker?" Kira said.

"Yeah, with a head bleed," the transport nurse said. "Two transfusions so far, and nada." She gestured to the other transport incubator, six feet away. "Twin B's not much better."

"What about the mom? Drugs?"

"Nope, she's clean. Primipara, bed rest most of the pregnancy."

The transport nurse grabbed her gear and headed out, and Kira began her intake assessment of the baby. She was brittle as hell, her oxygen saturation nosediving, lungs wheezing like an underwater accordion. The blood Kira drew for an arterial gas was so dark she'd have sworn it was venous.

The on-call resident came by, a sleepless second-year. "Uhoh," she said, looking at the ventilator. "Have you sent a gas yet?"

"Just now," Kira said. "It's going to suck."

The attending swooped in and scanned the chart. "Let's transfuse and do an EEG asap," he said. "She's probably not viable. Let me know when the parents get here."

Packed red blood cells, an exercise in futility. The baby wasn't going to make it and she probably shouldn't. The NICU could work some impressive miracles, but this was one tiny girl with shit for lungs and a vascular system with the substance of a cobweb. As high-risk as they got. Cardiac problems, neuro, metabolic, cognitive, GI — all were more likely than not. If this baby lived, she'd be blind from months of oxygen therapy, probably end up with cerebral palsy. Her only chance would have been ECMO, medical science's best effort to replicate the process of oxygenation, but her gestational age ruled that out. So would a head bleed.

Kira called the blood bank, then the charge desk. "Somebody's going to have to cover Bowen."

Thirty minutes later, Twin A was going downhill. The gas was abysmal. The docs would probably suggest discontinuing support for both babies, if they lived long enough for the parents to get there. And they might. Some of the babies you'd swear were going to die any second managed to wait for their mothers to arrive, and Kira had seen it happen too often to think it could be chance. But most of the babies who did cling to life for those minutes or hours had been out of the womb for a few weeks. Some had known their mother's warmth, held skin to skin against her breast despite ventilators and tubing, the mother's heartbeat going half time in a counterpoint to their own. These moments were all the comfort the babies would get in their brief lives, and they seemed to know it. And waited, hoping to feel that warmth one more time.

Twin A's heart rate spiraled down. "Hang on, baby girl, your mama's coming." Kira stroked the baby's head and the heart rate struggled upward. Placing the bell of the pediatric stethoscope on the tiny chest — it covered the baby from neck to navel — Kira listened. Pitiful breath sounds. Too young, too goddamn tiny. Not viable.

Aimi would have been.

Stop. Kira swung her ponytail behind her shoulder as if the movement would silence the memory.

Ten minutes later the parents arrived, swollen eyes raw in oatmeal faces. Standing next to Twin A's bed, they gripped the side rails with colorless fingers. This child, and her twin six feet away — nothing else in the room existed.

The attending pulled Kira aside. "They agreed to a nocode," he said. The best option, he was probably thinking, but that didn't make it a good one. "God, sometimes I hate this job."

A no-code. Kira looked at the Clarksons, ordinary people now being asked to do the extraordinary. Choosing was worse than having the inevitable forced on you. Even now hope illuminated the Clarksons' faces, diluting their despair. Couldn't a miracle happen now, for them, for their babies?

"Would you like to hold her?" Kira asked Mrs. Clarkson. "Here, let me help you." Baby to breast, if only for a moment. She turned off the monitors; even with the ventilator pumping that tiny chest, Mrs. Clarkson wouldn't need a machine to tell her that her child was dead. And no parent should see the flat line announcing their child's death.

"I'll sit with Jessica," the father said, and kissed his wife.

"I'm here, Jasmine," Mrs. Clarkson whispered. "Mommy loves you." She began to cry, a strangled sound; moments later the father's sobbing echoed hers.

Everything else went quiet, or as quiet as a busy room could get. The parents wouldn't notice. At times like this the world became small, uninhabited. Kira had sat like Mrs. Clarkson did now, holding her dead baby. This mother wouldn't know anyone else was there. This mother was somewhere else, lost. Going on would seem incomprehensible, the future an impossible thought. Nothing mattered but the agonizing emptiness in her belly and the still body in her arms. A universe of two.

* * *

Four hours later, Kira sat in her car and cried. That poor woman would never get over the loss. You never did. Lose a baby and you lose yourself. Blood and tissue, yours and your child's, commingled then ripped apart. Images flashed through her mind — Twin A, now a tiny bundle in the morgue; Aimi's body, a rounded weight against her chest. The grief intensified, bloomed like a hot flash. Aimi in her arms, eyes like her father's, hair that promised to curl like Kira's and her mother's — this six-pound proof of family, of bloodlines, gone.

Say the words: Your child did not live.

Kira pressed her hands to her eyes. Her fingers felt oddly warm; within seconds, her palms burned with a dry, fiery heat that reached for bone. Confused, she looked up, thought something had happened outside because everything was monochrome, the pinked orange of raw salmon. It must be late, already sunset — but no, the color was changing, now warm yellow, now cooler, an acid green. Cortisol rushed through her bloodstream, a junkie feeling, hands shaking, a staccato thrumming at her temples. She closed her eyes, opened them again. The green was still there, a watercolor wash. Then it faded, leaving only shadows.

A girl's voice. Kira jerked around, expecting to see someone behind her. The backseat was empty. The voice was in her head.

I hear them coming and pull his arms tighter around me. I can hardly breathe.

Fear like Kira has never known. She sees — or senses, because everything is gray, veiled, lines and shapes mere suggestions of three-dimensional objects — a small interior, rough metal walls, a wooden floor. She tries to open her eyes, but they're already open. She's awake, in the hospital parking lot, in her car. She's not dreaming. Her body shakes. The voice again, compelling yet flat, a monotone so out of tune with the words spoken that Kira's fear skyrockets.

They're closer now; I can hear their voices, my brother's harsh, my father's softer, dangerous. The door opens and I plead with them, but they ignore me. They drag us outside.

A pink breath of air, sage-scented and cool. Kira has no bones, no muscles. No sound but her breath, the wash of blood in her ears. Fear inflames her.

My brother struts like a fighting cock. He's come to right a wrong, of course he believes that. But there is no wrong but him, him and my father. I beg them to let him go. I might as well not open my mouth.

The gun rises and I scream.

In an instant, the scene disappeared. Daylight pierced the windshield, searchlight sharp. Kira sat shaking, fingers digging into her arms, hair glued to her neck. Breathe, she thought. Don't panic. But no one had dreams at four o'clock in the afternoon, wide awake in a car. A hallucination then? No, impossible, she'd fallen asleep, it was a dream, a bizarre grief response. Nothing more.

Kira sat immobile in the driver's seat, afraid that if she moved the world would again lose its color, the voice would invade her head. At last, bloodless with cold, still numbed with fear, she started the car. Key in ignition, spark of life, surge of power — all normal, thank God. As she shifted into first, the engine choked, then shuddered back to life.

Kira stepped on the gas, desperate for home, for wine or whiskey, for her comforting bed. She would burrow into the blankets, pretend that what had just happened was nothing to worry about, cry for Aimi and her mother, feel the weight of their absence flatten her spine. She would dream, wake her husband Dan with her tossing, ignore the chasm widening between them. These were the new rules. They weren't normal, but they were predictable.

June 16, 1945

Maddalena squeezed Regina's hand as they walked past the Manzanar guardhouse. The day was blistering, hotter than usual for spring, but she didn't care about the sweat and stink. She was here, finally, in this mysterious place she'd seen only from the back of her father's car on the road to Independence, or from the back of her horse, riding on Foothill Road. From either direction Manzanar looked the same — flat, repetitive rows of colorless, dismal-looking buildings and dry streets, giving off an air of despair she could smell from a distance.

The camp had been off limits since the day construction began more than three years ago. Her mother's orders. It was dangerous, Mama said; who knew what the enemy might do? Maddalena had thought about arguing — she'd heard that the camp was going to be home to families, and how dangerous could grandmothers and children be? — but it would have been pointless. Once Mama made up her mind, that was that. Maddalena had kept her word and ventured no farther east than Foothill Road, but that didn't stop her from wondering what went on in the camp, what those people, supposedly so different from anyone else in Owens Valley, were like. So when Mrs. Henderson poked her head into Regina's room, where the girls were sitting on the bed playing Hearts that blistering day, and said she was going to an art show at the Manzanar community center and did the girls want to join her, Maddalena jumped up.

"Yes! I mean no," she said. "I can't. My mother won't let me anywhere near Manzanar. She thinks it's dangerous. She's afraid of the Japanese."

"She's entitled to her opinion, dear, but I think they're lovely folk."

"You've been there before?"

This was astonishing. Not only was Mrs. Henderson, who wrote poetry and painted with oils, a mellow, indulgent mother — the opposite of fearful, overprotective Mama — she was daring! Brave! Or, if she was wrong about the Japanese and Mama was right, perhaps foolish.

"I go several times a year," Mrs. Henderson said. "Their gardens and art shows put the rest of the county to shame. But we must keep peace with your mother. Oh, don't look so down in the dumps. You're going, and we'll make it our little secret."

Maddalena bounded out of the bedroom and down the stairs before Mrs. Henderson could change her mind.

"Wait up!" Regina called.

In the front hall, Mrs. Henderson tied back her hair and put on a pair of dark glasses. Then she summoned the girls outside and settled authoritatively into the driver's seat of her husband's dark-green Chevrolet pickup. Shaking off her surprise, Maddalena climbed into the truck bed after Regina. It seemed there was nothing Mrs. Henderson couldn't do.

As they bumped along the desert road, Maddalena gripped the edge of the truck bed, stealing glances at the camp through spumes of dust. Such an adventure, made all the more delicious by being forbidden. Little by little Manzanar filled the horizon, creating a rush of anticipation so thrilling that Maddalena wished the trip would take longer.

Once through the gate, Mrs. Henderson parked with a jerk of the brake and Regina leaped out. Maddalena stood in the truck bed trying to absorb everything at once.