DAMAGED PEOPLE is set to be released June 28! In recognition of that, I decided to add an excerpt just to give a flavor or it. This chapter – the hospital scene – was originally the first in the book. On rewrite, I decided it would be better off as backstory, so it now comes somewhat later. However, it represents the initial tragedy that propagates itself through the generations of the Siperstein family, and so seemed to be the logical place to start. See if it doesn’t pack a punch.
It had all gone well, Carolyn thought. Joe had walked her into Admissions, waiting till the nurse had wheeled the chair out from behind the desk. He eased her into the seat before going back outside to park the car properly. The hospital lobby was spotless, all polished brass and chrome, with shiny linoleum floors and scrubbed white walls. She’d picked Jamaica General just because of its well-deserved reputation of sterile environment and scientific advancement. It was 1946, for heaven’s sake. What was right for her mother in 1918—home birth with a nurse on hand—wouldn’t do at all for her, what with the fearsome threat of childbed fever and hemorrhage. After all, her own mother had lost her firstborn and nearly died herself. No, Dr. Salinger had promised her the newest technological and medical advances in obstetrics at Jamaica General: induction, sedation; why, they could even give her something to wipe away the memory of childbirth. She hardly remembered giving birth to Tommy two and a half years ago; it had been so easy, so painless. And this time, the last thing she remembered was getting that Nembutal injection. She woke up on clean linens in a hospital bed, cocooned in soft white curtains, a capped figure silhouetted at the foot of the bed, a bundle in her arms.
The worst thing about it, she guessed, was having to remain in the postpartum ward for a week. Being awakened for early temperature-taking like all the other patients, monitored and forced to follow hospital rules about eating, exercising, defecating: the bed pan every four hours whether you wanted it or not. Confined to bed for no less than seven days following delivery. One was allowed to dangle one’s legs on the eighth day, to sit in a chair on the ninth, to walk on the tenth and, thankfully, to go home on the eleventh.
Breast feeding was discouraged: not scientific enough, Carolyn supposed. A sterile bottle was given every four hours, regardless of whether the baby cried or not. Not that you saw your baby more than three times a day, anyway. Baby Russell was in a separate, sparkling newborn wing tended by bustling nurses twenty-four hours a day. Everything was upfront and visible to the public through wide windows. In fact, Joe, the proud father, never failed to inspect his son on his way to see her at visiting hours. The nurse held him up so he could see the baby through the glass. He looks just like your Pop, Joe told her. Bald, he meant, of course. They laughed together.
Yes, it had all gone well. If only they could bring little Tommy to her, she’d be content to lie here forever. But the hospital had strict rules. No children in the obstetrics wing other than newborns. Visitors were allowed in at 2 p.m. and 7 p.m. sharp, but only after signing in and only two at a time. No friends or family in the laboring room. A patient must be separated from her family upon admission, stripped of her clothes, shaved, scrubbed and purged. Sometimes restrained, all in the pursuit of a germ-free environment. It was for her own good, she guessed. Still, Carolyn missed Tommy’s little hotdog arms hugging her legs; his mass of soft fine hair lit up like a golden halo in the sun; that fit of infectious giggles whenever he got tickled. Joe said he asked “Where Mommy?” every morning when he woke up and every night when he put him down. “Soon,” his daddy told him each time. What else could you say to a toddler who couldn’t tell time? Anyway, it wouldn’t be long now. Tomorrow she’d be able to dangle.
The curtain parted. Joe’s face, a broad smile on it, peeked through. “How about a little light in here?” he said, drawing the curtain back and around the circular rod to reveal the ward around them. Twenty white enamel hospital beds, each set apart by curtains, lined the room, most filled with young, happy postpartum women. Visitors were filing in through the arched entrance door, armed with books and shopping bags, balloons and candy, all of them seeking out their loved ones in a sea of identical partitions. Joe dropped some magazines and a box of chocolates onto her bedside table before leaning down to give her a long and tender kiss.
He sat down in the lone visitor’s chair, scooting it forward as close as it would go to have a look at her. So lovely she was, even in that flannel nightgown with no makeup, her blond hair matted and tangled from days of round-the-clock bed rest. How, he often wondered, had he, Joseph Siperstein, ordinary working stiff from Brooklyn, New York, managed to end up with a doll like this?
“See the baby?” Carolyn asked, smiling.
“Through the glass,” Joe said, returning her smile. “Guzzling a bottle the nurse was giving him.”
“I wish they’d bring him by to nurse,” Carolyn sighed. Her breasts hurt. They’d given her an injection to dry up the milk. It hadn’t worked very well.
“How’s Tommy doing?” she asked. They’d had to rush off into the night. Joe had told her how confused and desolate Tommy’d been that morning with no one there but Joe’s parents. The poor little guy: Before this he’d never known a day when she wasn’t there.
“Fine, but he misses his mommy. So do I! Nothing’s the same at home without you. I went to give Tommy some apple juice from the fridge and it slipped out of my hands. Glass everywhere. Mom came in and shooed us both out. What a sticky mess!”
He’d taken off the week from his layout artist job in a Manhattan advertising firm, planning to work from home as Tommy played quietly at his feet. She laughed, despite herself. “So, caring for a toddler hasn’t turned out to be as easy as you thought!”
“Did I ever say it was an easy job?” he asked, eyebrows up.
“Only every day when you come home from the office, ready to kick the dog, if we even had a dog.”
“Really?” he said.
He truly looked shocked. Men!
“Oh, Joe,” she said, exasperated. “How many times have you mentioned how nice it would be to stay home all day and nap in the afternoon? Fifty? A hundred?”
“I meant Tommy,” he insisted.
She laughed again. Joe never could admit that he was wrong. In fact, that had been the basis of their few but memorable fights. And, of course, he was quick to anger as well. But, well, no one was perfect. Anyway, she’d loved Joe from the long-ago rainy day when that tall, wavy-haired stranger gave up his seat for her at Walgreen’s lunch counter.
“I miss both of you,” Carolyn said, lifting her hand to his stubbly cheek. A flood of tenderness welled up in her chest. How she loved her two darling boys! Three darling boys; she’d almost forgotten.
“Well, not long now,” Joe said.
“Four more days,” Carolyn agreed. “Is Tommy excited to meet his new brother?”
“Seems to be,” Joe said, opening the box of candy. “Though it’s hard to tell what a two-year-old thinks. Chocolate?”
Carolyn grimaced suddenly.
“Is chocolate so painful to think about?” Joe asked, laughing, taking one and placing the box back on the bed table.
“No,” she said. “It’s just my left leg.” She threw off the covers, showing a slightly swollen calf.
“Hurts?” he asked, touching it.
She grimaced again. “Aches a little,” she said, leaning over to rub it.
“Well, we can’t have that,” Joe said, scanning the room for a nurse.
“It’s really not that…,” Carolyn began, but he was already calling out to the tall, rail-thin woman in white stripping a bed on the far side of the room. She watched the nurse sigh, put down the linens, and walk over.
“What’s the matter?” the woman asked, her long thin face severe.
“My wife’s leg is swollen. Could you take a look at it?”
The nurse barely gave it a cursory glance. “Edema,” she said. “Not uncommon in postpartum.” Then, turning to Carolyn, she added, “I suspect your extremities were swollen during pregnancy as well.”
“Well, yes, but….”
“Elevation should help,” the nurse said. “I’ll bring you another pillow for your leg.”
“Thank you, Nurse Hanson,” Carolyn called after her as the nurse walked across the room and through the swinging doors.
“Not much of a bedside manner,” Joe said.
His wife shrugged. “Oh, she’s all right. The nurses have a million patients. If you had to run around taking temperatures, checking blood pressure and making beds, you might not be so cheerful either.”
“It just makes my blood boil. Here you’re stuck in bed and not feeling well to boot, and she can’t spare a little sympathy.”
“You’re always reacting to things of no importance, Joe. I’m fine.”
The nurse was back with a pillow. “Here, this should do the trick,” she said, in one quick motion loosening the blanket, scooting the pillow under Carolyn’s leg and tucking the whole thing back in.
“Thank you,” Carolyn said, but the nurse was already across the room. She lay back, closing her eyes and leaning back on her pillow. So tired.
Joe sat back, watching her. She looked a little pale.
At last Carolyn opened her eyes. “Sweetheart,” she murmured. “Why don’t you get back to Tommy and give your mom a break? You don’t need to babysit me. I’ll be home before you know it and everything will be back to normal.”
“Well, maybe a nap will be good for you.” He bent over and kissed her tenderly on the lips. “Tomorrow, then.”
◊ ◊ ◊ ◊ ◊ ◊ ◊
The next day at two in the afternoon, Joe came in to see Carolyn sitting on the edge of the bed.
“Dangling your legs! It must be the eighth day,” he announced, dumping some more magazines onto an already overflowing bed stand and ducking down to plant a kiss on her cheek. Her skin felt clammy to his lips. In fact, now that he looked at her, Carolyn didn’t look at all well: sweaty and ashen.
“Hi,” she said with a weak smile between labored breaths. “Could you help me back into bed, Sweetie?”
“Of course.” He lifted her legs up onto the bed, and eased her backwards with her head against the pillow. “How’s the leg?” he asked after he had settled her.
“Still swollen, I guess. I hadn’t really” – she stopped to breathe – “noticed.”
“Carolyn, I’m concerned. I’m going to find the nurse.”
She didn’t try and stop him. Joe went off, out the swinging doors, speeding back some minutes later with the horse-faced Nurse Hanson.
“Your husband says you’re not well,” the nurse began, before taking one long look at Carolyn. “I’m going to page Dr. Salinger,” she said, hurrying off.
“That woman is so brusque,” Joe said as he stopped at her bedside. He could hear his wife breathing fast. “What is it, Carolyn? What’s wrong?”
“Just that I can’t seem to get enough oxygen into my lungs.”
“You are looking a little blue.”
Nurse Hanson was back, pushing an instrument cart before her. “Dr. Salinger is on his way,” she said, as she came to the side of the bed.
“She’s having trouble breathing, Nurse,” Joe said. “What do you think’s the problem?”
The nurse lifted Carolyn’s other wrist, feeling for her pulse. “128,” she said after a minute, picking up the chart on the side of the bed and writing. No answer.
“Is that bad?” he asked.
“It’s a little fast,” she conceded, reaching over to the cart for the blood pressure cuff, and winding it deftly around Carolyn’s upper arm. “126/72,” she said, unwinding the cuff and picking up the chart again.
Carolyn drew in a long, raspy breath.
“I’m going to get you some oxygen,” the nurse said, heading back across the room.
Several minutes later, she returned with an oxygen tank equipped with a cellulose acetate mask. “This will help to ease your breathing,” Hanson said, lowering the mask onto Carolyn’s frightened face.
They waited a minute or two, the nurse’s eyes alternating between her patient and the doors to the outside corridor. Joe could see the color coming back to his wife’s face.
“What’s wrong with her?” he asked. But just at that moment the ward doors swung open to reveal Dr. Salinger, young and serious, striding towards them. Of medium height, with glasses and a receding hairline, he seemed nevertheless to Joe to be a white knight coming to their rescue.
“Mrs. Siperstein – Carolyn,” he said, as he stood over her at the bedside. “We’re going to have to sit you up.” He nodded to the nurse, who was already cranking up the head of the bed. Then he reached around and pulled the curtains around the bed.
“I’m afraid that you are in the way,” the nurse said to her husband.
Joe tried to move aside, but Carolyn’s grip on his hand grew tighter.
“You’ll have to step outside, sir,” Hanson tried again.
“No.” Studying his wife’s masked face, Joe asked, “You want me to stay, don’t you, Carolyn?”
“Oh, God, yes,” she cried from beneath the mask.
“The hospital has its rules, you know,” the nurse fretted.
Carolyn’s grip was like iron for such a sick person. Don’t leave me, it said. He could feel the desperate need and the love in that hand, the same hand that caressed him, that cuddled their son. “To hell with the rules,” Joe growled. “You’ll have to drag me away to get me to leave.”
Nurse Hanson looked over to Salinger for his support but the doctor overruled her, instead. “Then you’ll have to stand over there,” he said, waving Joe to the foot of the bed.
“Carolyn,” Joe said, stroking her hair. “Don’t worry, Sweetheart. I’ll be right here.” Her grip loosened and he moved off to where the doctor was pointing. At that, the nurse picked up the chart from the foot of the bed and got set to write.
Dr. Salinger pulled over the lone chair and lifted the stethoscope from around his neck to his ears. “Now, Carolyn,” he said, “I’m going to examine you. We’ll have to take the mask off for a few minutes. As soon as I’m done, we’ll put it back on.” He gently lifted the mask and set it on the bed. Carolyn took a long ragged breath.
Joe kept guard as the doctor began to listen to her chest.
“Breathing is labored,” the doctor noted. “Heart rate is 129 beats per minute with a widely split second heart sound and tricuspid regurgitant murmur.”
The scene seemed surreal. Just yesterday, Joe remembered, they were saying she’d be home in no time at all, and now all of a sudden she was practically at death’s door. There were no answers to his questions of what was wrong, just a lot of medical jargon that didn’t help at all.
The doctor’s hands gently palpitated Carolyn’s neck. “The skin feels cold and clammy and appears slightly cyanotic. Some swelling and distension of the veins on the right side of the neck.”
Carolyn’s breathing was becoming difficult. “Let’s put this back on,” Salinger said, gently lifting the oxygen mask back up to Carolyn’s face. Her breaths became slower, more regular. “That better?” he asked, his hands already proceeding to her abdomen. “Likely fluid buildup in the liver.” He lifted the blanket from her legs and stopped, frowning. “Quite a lot of swelling in the left calf.” He flexed her left leg. Carolyn grimaced behind the mask. “Pain?” the doctor asked her.
“Calf pain on dorsiflexion of the left foot. Indication of deep venous thrombosis.” He looked up at the nurse who was writing on the chart. “Didn’t you notice this swelling in the leg, Nurse?”
Joe felt hot with anger. He’d told that nurse YESTERDAY that her leg was swollen. She’d hardly looked at it then. All she did was stick that damn pillow under her leg, and now look where they were….
“Yes,” Hanson replied, her body stiffening. “But I just thought it was edema… You’ll see I elevated….”
Dr. Salinger waved her excuses away with a shake of the head. “Diagnosis,” he concluded, “is venous thrombosis in the left leg indicating a high probability of pulmonary thromboembolism.” He paused a beat and stood up. “Nurse, we’ll need 1/100 grain of atropine subcutaneously right away as well as a ½ grain of papaverine intravenously.”
“Yes, doctor,” Hanson replied, hurrying off.
“But what does that mean – pulmonary thromboembolism?” Joe demanded from across the bed.
The doctor crossed to the foot of the bed. He turned Joe around with a hand on his back and discreetly walked him a few paces away.
“A blood clot that formed in her leg seems to have moved to the arteries of the lung,” Salinger was saying. On he went, describing how the clot is formed somewhere in the peripheral veins, mostly those of the pelvis and lower extremities and then can be thrown from there in the form of small showers or large massive clots into the right side of the heart and from there into the arteries of the lung. That this happens sometimes after delivery because evolution has equipped a new mother’s blood with greater coagulation in order to prevent hemorrhaging during birth. That, with loss of fluids and the consequent lower volume of her blood, the postpartum period—specifically between the fifth and twelfth postoperative day—seemed the most likely time for clots. Fortunately, only a small percentage of women were in any immediate danger….
Joe tried to listen but it was all too much. The words went on and on while he watched dust motes sparkling in the light, happy mothers laughing with their guests, Nurse Hanson pushing through the swinging doors, wheeling in an intravenous rack.
“But will she be all right, Doctor?” Joe demanded.
“As long as the clot has not plugged the main artery completely,” the doctor replied.
Why, Joe wondered, did they never get to the point? “So how do we know if the clot hasn’t plugged it completely?” he asked just as a cry rang out behind them.
They parted the curtains to discover Nurse Hanson back at the bedside with Carolyn, looking oddly limp, her eyes closed, one arm hanging over the side of the bed.
“Sweetheart!” Joe called, running to her. There was no response.
“She’s fainted,” the nurse said.
“The atropine, Nurse!” Dr. Salinger shouted.
Hanson handed over a hypodermic. The doctor gave her the injection. “Prepare the papaverine,” Salinger told her. As the nurse moved away to set up the intravenous, Joe reached over and picked up Carolyn’s limp hand in both of his.
A few moments later, his wife opened her eyes, “Joe,” she quavered, muffled by the mask.
“I’m here,” he said. Her eyes stared back at him, pleading for reassurance. He smiled as best he could. What cold crumbs of comfort could he possibly give her? That she’d be all right if her main artery was not plugged completely? That only a small percentage of women were in any danger?
“I love you, darling,” he told her. “Tommy and Russell love you.” He stifled a sob. “You’ll be okay.”
If she smiled, it was invisible behind the mask. Her only response appeared to be a strange rattling sound, short and discontinuous like crackles.
“What’s that?” he asked the nurse, who was in the midst of hooking up the intravenous and in no mood to answer questions.
“I’ll finish the intravenous line,” the doctor shouted. “Go prepare a hypodermic of 100 mL of heparin sodium solution!” The nurse stood there, frozen. “Go!” Salinger shouted, and she scurried off.
Carolyn’s crackles became gasps. “Turn the oxygen up!” Joe shouted at the doctor.
“It’s on full,” Dr. Salinger said, releasing the pin on the intravenous. “But the papaverine should dilate the pulmonary vessels and combat the bronchial spasm.”
They waited, watching the doors to the corridor. Carolyn continued to gasp under the mask.
“It’s not helping!” Joe cried. “Do something!”
“Give it time to work,” the doctor said.
But there was no change: just more rattles and rales, the two of them standing helpless over Carolyn, until the sounds broke off entirely.
The doctor ripped off the mask, placed his lips on the patient’s mouth and did a minute of artificial respiration. He put the stethoscope to her chest, then pounded on it. Another minute of mouth-to-mouth. Listened again, and pounded again.
She’s not dying, Joe thought to himself, as if in a dream. She can’t be dying. Not Carolyn. She’s so young, so full of life. Not dying. The love of his life? The mother of his children? What would he do without her? How could he go on?
Thank God, Joe exulted as the nurse came running in through the swinging doors, the last resort in her hand: the newest wonder drug, heparin, to break up the clot! But Dr. Salinger just stood up wearily, shaking his head.
“Give her the injection!” Joe shouted, moving menacingly toward the doctor. “Why don’t you give her the injection?!”
“I’m sorry, Mr. Siperstein,” he said to Joe, standing in his path. “I’ve done my best.”
“Your best? You’re not doing anything! Here, nurse, give it here! I’ll do it myself!” Joe shouted, grabbing at the hypodermic in Hanson’s hand, but she only snatched it away.
The doctor laid a heavy hand on his shoulder. “Joe,” he said gravely. “She’s gone.”