49. Lily
LILY
Iwas, by every professional standard I own, the worst patient Doc Halvorsen ever delivered a baby for. I stand by all of it.
We had a plan. I want that established before anybody judges what follows.
The plan was Rhinelander. That is sixty-two minutes on the state road.
The bag had been in the truck since the middle of summer, the paperwork had been in the glovebox with it, and a list of three numbers had been taped inside the cupboard door since the spring.
There was even a fallback that involved Kenny Lindqvist and a van.
I built that plan myself. I've moved patients for a living and I know exactly how a transfer falls apart.
My daughter had opinions about the plan.
My water went at twenty past four in the afternoon, standing in my own kitchen with a dish in my hand, three weeks and two days before her date. There was no gradual anything. It was a faucet, and then it was a contraction that folded me over the counter, and then, four minutes later, another one.
They were four minutes apart from the very first one.
I've taught student nurses that early labor gives you hours.
I've said the word hours in a calm voice to a hundred frightened women.
I stood in that cabin with my forehead on the counter and did the arithmetic on my own pelvis and understood, with total clarity and considerable annoyance, that I wasn't going to see Rhinelander.
"Sacha, it has started."
He was in the doorway already. He had come from the slope at a run and there was a hammer still in his hand.
"The bag is in the truck."
"Put the hammer down and listen to me." I got upright.
"We are not going to Rhinelander. Four minutes apart from the first one means this is going fast and it means I have somewhere between one and four hours, and sixty-two minutes on a state road is not a thing I am doing in the second stage. We are going to Halvorsen's."
He looked at me for exactly one second.
"You are certain of the timing."
"I'm a trauma nurse and it's my pelvis. Get the truck."
We got to Halvorsen's front door in twenty-six minutes, on a road he took at a speed I intend never to discuss with him. He was standing on the porch in his shirtsleeves when we came up the drive, with the door already open behind him.
"Marge telephoned," he said. "Get her inside."
"How did Marge know?"
"That woman knew before you did," said Halvorsen, and got hold of my elbow.
I have to say something about that room before the rest of it, because a person reading this is going to picture a country doctor's parlor and a kettle.
He had it ready.
There was a proper delivery bed in the middle of that front room, brought over from somewhere and made up.
There was oxygen. There was a bag valve mask on a tray, sized for a newborn, with the seal already checked.
There was suction. There was a warmer with a towel folded on it, a stack of clean linen, and an IV pole.
A resuscitation card was taped to the wall at eye height, and it was the current one and not the version from nine years back.
That man had been getting that room ready since the thaw and hadn't said a single word to me about it.
I stood in that doorway between contractions with my hands on the frame and read the room the way I read a bay at the start of a shift. Every single thing I looked for was where I'd have put it myself.
"You knew this was going to happen in here."
"I have been expecting a woman with a fast pelvis and a sixty-mile road," Halvorsen said. "I have been a doctor in this county for forty-one years. Now stop reading my equipment and get on the bed."
This is the part where I have to be honest about my own behavior.
I was a nightmare.
I've never once in my life had a patient do to me what I did to that man for the next three hours, and if I had, I would have gone home and thought seriously about my career.
I corrected his coaching. He told me to breathe with him. I informed him, mid-contraction and through my teeth, that patterned breathing has no evidence base for pain control in active labor, and that he was welcome to carry on if it was helping him personally.
"Noted," said Halvorsen.
I asked to see the fetal heart trace and then read it myself, out loud, with commentary.
"One thirty-four with good variability," I said. "You're not going to tell me that, though, are you. You're going to tell me she's happy."
"She's happy."
"There it is."
I told him his dilation script was outdated. That's a real thing that happened and I've been assured that four people on the porch heard it through the window.
"You're almost there, Lily. Good girl."
"Doctor," I said, "with total respect, you need to update your cervical dilation script. That one has been out of date since about 2009. Nobody says almost there anymore because it is meaningless and it makes women feel like they are failing an exam."
"Then what am I supposed to tell her?"
"You give her a number and then you shut up."
"Seven," said Halvorsen, and shut up.
Somewhere in the third hour I offered to do it myself.
I meant it at the time, and I want that on the page.
I said that if it was going to take this long, I'd rather be at the business end where I could see what was happening.
He could talk me through it. I would be extremely calm about it, which is the funniest thing anybody said in that room all evening.
Halvorsen took his glasses off, put them in his shirt pocket, and turned to Sacha.
"Forty-one years," he said. "This is the first patient who has ever tried to file a performance review on me in the middle of a contraction."
"I am aware."
"I am charmed. I want that understood. I am completely charmed and I am not going to give her the satisfaction of saying so."
"He can hear you," I said. "I can hear you. Somebody put a number on the board."
Now I have to write about Sacha.
I've gone back and forth about how to write this part, because it is the funniest thing I have ever seen and it is also the thing I'll be holding onto when I'm eighty.
That man has walked into a room with three armed men in it and had his pulse stay under seventy.
I've watched him lie to a professional killer in his own yard with his hands loose at his sides.
He crossed a frozen lake in a shirt to have a conversation with somebody who wanted him dead, and he came off that ice with me in his arms and a face like weather.
He was, in Halvorsen's front room, entirely useless.
He was not absent, and that is the thing about him.
He never left that bedside once in three hours, not for water, not for the bathroom, not when Marge came in with a tray and told him he looked like a man who had been shot.
He was there for every second of it with my right hand in both of his and his forearm going white where I had hold of it.
But he couldn't do anything, and it was destroying him.
"Tell me what to do."
"There is nothing to do."
"Lily, give me something."
"There's nothing to fix. That is what this is." I got a breath in. "You want a job? Count for me. Out loud, from one, when it starts, and stop when I stop squeezing."
He counted. He counted through every contraction for two and a half hours in a low flat voice.
About halfway along, the numbers started coming out in Russian and he never noticed, and I didn't tell him.
I would have lain there and listened to that man count in Russian for the rest of my life if it had been on offer.
At one point I looked up and there were tears going down his face and he was still counting. He said twenty-two. He said twenty-three. His voice stayed perfectly level and there was not one break anywhere in it.
I've never loved anybody more than I loved him at twenty-three.
The porch deserves a chapter of its own and it is going to get four paragraphs.
There were, at the peak, twenty-four people in Halvorsen's yard.
Marge ran it. Of course she ran it. She set a folding table up on the grass with an urn on it, and she wouldn't let anybody onto the porch itself, because the porch was for family.
Then she had to work out on the spot what family meant.
Her ruling was that family is anybody who was on that lake in the winter.
Kenny got up there. Earl got up there. Sivertsen was in a chair somebody had carried out for him.
Earl Dombrowski walked sixteen laps of that yard. I know the number because Deborah counted them out loud to annoy him, and it worked.
Dmitri was three hours out and driving. Alexei rang the porch from Minneapolis every twenty minutes until Marge took the call herself.
She told a man who has arranged the movement of things across four borders that he would be informed when there was anything to inform him of, and that in the meantime he was to eat something.
And through all of it, out through that window, I could hear a low murmur of people who hadn't gone home.
The woman who never stayed anywhere long enough to be missed was in a front room in a town of four hundred and twelve. There were people standing out in that grass in the dark because not one of them wanted to hear it from somebody else in the morning.
She came at four minutes past eight in the evening.
I'm not going to describe the last twenty minutes clinically, because I've read a hundred charts of it and not one of them has ever contained anything true.
What I have is this. There was a moment when I understood, completely and without panic, that there was no version of it in which I got to stop, and that the only way out of that room was through it.
And there's not one thing in two years of running that prepared me for it, and there was nothing to plan and nowhere to drive, and it turns out I could do it anyway.
"Head," said Halvorsen. "Give me one more like that one. Do not push. Breathe her out."
"That's better," I said. "That's much better coaching."
"Shut up, Lily."
And then there was that sound.
Every nurse knows it and nobody is ever ready for it in their own room. It isn't a cry at first. It is a wet furious complaint from something the size of a loaf of bread that has decided the entire arrangement is unacceptable.
"There she is," Halvorsen said. "Oh, that is a good one. Listen to her."
Sacha made a noise I've never heard out of him before or since, and stopped counting at nineteen.
They put her on my chest. Somebody put a towel over both of us. The yard went off like a stadium, because the window was open and the whole crowd of them heard her at once. Earl Dombrowski's voice came up over the top of it, and then a car horn, since in that town there's always a car horn.
She was furious and slippery and impossibly hot, with one eye open and one shut. She got a fistful of the front of my gown inside four seconds, which is the fastest anybody in this family has ever committed to anything.
Seven pounds and one ounce, three weeks early, with a cry you could hear across a yard.
"Say the name," Sacha said.
I hadn't said my mother's name out loud since the day we buried her.
I want to be exact about that. Not once in two years had I managed it.
I've said my mom and my mother and her ten thousand times.
I haven't been able to put the actual word in my mouth.
It came with a room and a corridor and a couch, and somewhere along the way I'd decided, without ever deciding, that I would carry the name and never use it.
I said it to her first. Before I said it to him, before I said it to the doctor, before anybody in that yard got told anything.
"Hello, Nora," I said.
Then I had to stop for a while, and Halvorsen found something urgent to do at the other end of the room, and Sacha put his forehead down on the edge of that bed next to my shoulder and didn't move.
"Nora," he said, when he could.
"Nora, after my mother." I got my hand up into his hair. "And there is a middle name, and I want you to hear it before you decide anything about it, because I have been holding it since the spring."
"Lily, wait."
"Nora Rourke Volkov."
That man didn't make a sound.
I've watched Sacha Volkov take a bullet graze and set his own stitches and say nothing.
I've watched him hear his child's heartbeat and go down a wall onto a country doctor's floor.
I'd never seen what happened to his face in that room, and I'm not going to try to put it on the page, because it belongs to him.
"You do not have to carry him alone anymore," I said. "He gets to be part of something that's alive. That is the only thing I'm asking. If you hate it, say so right now and it never happened."
It took him a long time.
"Say it again," he said.
"Nora Rourke Volkov."
"Again."
"Nora Rourke Volkov. She's going to hate it in school and she's going to be extremely proud of it at about thirty."
He laid his hand over the back of that baby's head. His hand covered all of it, and his fingers were shaking, and they haven't shaken since.
"Daniel Rourke was twenty years old," he said, to her, in a completely level voice. "He carried boxes up a stair and he was kind to a man who did not deserve it. You have his name in the middle of yours. It is not a debt and you will never once be asked to pay anything on it."
Then he told her that his own mother was called Yelena, and that she taught arithmetic for thirty-one years. Between the two of them, he said, this child now had more people standing behind her than most children ever get. Nora slept through the entire speech with her mouth open.
Marge came in ten minutes later with the urn and no permission whatever, took one look, and burst into tears in the doorway. I promised never to mention it again and I'm mentioning it in writing.
Earl was allowed in at nine. He got as far as the end of the bed, looked at that baby, said "Well, now," in a voice with nothing left in it, and went straight back out to the porch to tell everybody something they had all already heard.
Halvorsen wrote his own note out longhand at the desk with his glasses back on. When he had finished he brought it over for me to read, because he knew exactly what I would do with the rest of my life if he didn't.
At the bottom, under the timings and the weight, in that terrible handwriting, he had written: Mother in excellent condition. Mother is a menace. Both are hereby discharged into the custody of the town.
They put her in my arms, and every road I'd ever driven away on finally ended, all at once, right there. The running stopped forever. Sacha looked down at our daughter like she'd personally rearranged the stars. "She has your eyes," he whispered, wrecked. "God help us all."