2024 Program for Humanities in Medicine Health Professions Creative Medical Writing and Art Contest: “These Small Things” by Courtney Hart

It is 1988, and I am three. I pad into my parents’ room and clamber up onto big bed — it used to feel like a life raft in the ocean, with the two centers of my universe sleeping within it. My father is there now — a soft, safe mountain. I starfish across his belly and ask him why he is crying. I find out in adulthood that I said, “Is it because you’re sad about Brennan?” My father has told me that he was shocked by the question, though he doesn’t say whether it’s because he was surprised at my intuition or because he was suddenly staggering, jolted off balance as I sweetly asked him to account for the reason behind his weeping. I think, though, that perhaps he shouldn’t have been startled by my directness either way — what three-year-old is going to mince words when piecing together why her baby brother has died before he even lived?

 

I was with my mother when she discovered that my brother’s heart had stopped, on his due date. Until then, she’d had a healthy, uncomplicated pregnancy. A true knot in the umbilical cord, we discovered later, was what caused Brennan’s death. I was ushered out to the receptionist’s desk to draw, blissfully unaware of my mother’s emotional wreckage contained by the door behind me as she waited for my father to come. I imagine that the receptionist did the best she could with me, in an office made for adults. I wonder if they have crayons by now — maybe just a few in primary colors, paper peeling off, and a well-worn coloring book, for times like these. 

 

When my brother was born on December 5th at Yale New Haven Hospital, he was no less beautiful than had he been living. If you ask her, my mother will tell you about the kindness of the nurses, the kindness of her doctor. She has said that she will remember this kindness for the rest of her life. I picture them treating her like some delicate hothouse flower, gloved hands gentle, voices subdued. They must have delicately swaddled my brother, snugged the knit hat onto his soft head. They pressed his feet onto an ink pad for footprints. They took pictures, gingerly wrapping a knitted baby blanket around him. My mother and father were able to keep Brennan with them until they felt ready to say goodbye — if any parent is ever ready for that moment, the sharp cleaving into life before and life after.

 

“Why?” I asked my mom and my dad. Sometimes, these things just happen, sweetheart. I stayed with my Uncle John during my brother’s funeral service. We went for ice cream, I’ve been told.

 

It is 2019 and I am a new doula, supporting my sixth family. The mother has become beloved to me — she has fielded a few rough challenges during her pregnancy with astounding grace, and we’ve bonded over our shared love of obsessing over music harmonies, have uncharitably howled with laughter at the baby-naming proclivities of our fellow New Yorkers. On her baby’s birthday, her daughter emerges into the world crying lustily, rosy and flushed with breath. It is almost an afterthought when the obstetrician mentions the true knot in the cord, and we marvel at its twists while she assures my beloved client that it did not affect her baby in the slightest: “After all, just look at her,” she says. The knot is breathtaking and terrifying to behold. After I make sure that the photos and videos are airdropped, after I embrace my client tightly before tucking her in, after I press my forehead against the baby’s swaddled belly for one whispered moment of gratitude and feverish relief,  I make it all the way to the sidewalk of 1st Avenue before the violent, heaving sobs come.

 

It is an October evening in 2022, and I am writing my application essay for midwifery school. “Why do you want to be a midwife?” Yale asks me. “Ameliorating health disparities,” I write. “Walking alongside families through a beautiful life transition.” “Reproductive justice.” “Trauma-informed care.” These are all words that I use in my essay. I don’t say a word about my brother.

 

It is 2024, and it is my fifth clinical shift as a midwifery student on the same unit where my parents had those precious few golden hours with my brother. I feel clumsy, slow, acutely self-aware of my inexperience. Some days, it feels like my brain is expanding at light-speed, making connections between what I’m learning in the classroom and what I’m seeing on the floor, and other days, it feels as if even the most basic information is like water through a sieve. 

 

I’ve begun, perhaps, to find my footing. I’ve learned that I should always keep a spare pair of sterile gloves, size six for my small hands, in my pocket just in case. I feel more comfortable taking an H&P in triage. I know now that I should simply embrace that cervical exams will feel confounding for quite a bit longer. On this fifth shift, it is 4:54 am and I am cloaked in a scratchy hospital blanket on the plastic couch in the provider’s lounge, foolishly denying myself sleep while poring over treatment algorithms for anemia in pregnancy, when my phone rings about the intrauterine fetal demise in room 472.

 

There is this thing that I do to ground myself in a hospital room if I’m in danger of losing composure. I dig my nails into the palm of my left hand, and it delivers just enough muted discomfort to restore me to temporary equilibrium, occupying my mind elsewhere from my own sadness. I do this now as I stand beside our patient’s bed, bearing silent witness to her primal screaming, to the sobs wracking her tensing body. We are deferential to her suffering in our hushed tones and our cautious movements. 

 

Afterward, our patient lies limply, her thick hair tangled, chipped purple polish on her toes, a streak of blood drying on her right thigh. She is unspeaking, staring distantly into the furthest corner of the room -  adrift in her own sea of thoughts, while around her are volleying questions, pleas for certainty though we can offer little, prayers for answers where we can give none. Her husband chokes out the question. Sometimes, these things just happen, I hear. I take her hand as she gazes into my eyes. Hers contain oceans of pain.

 

She does not want to hold her baby. It’s her right, I insist silently to myself: it’s her choice. Still, it feels like frantic wings beating, a panicky bird trapped in the ribcage of my chest. It feels like precious golden time slipping away.

 

Her baby is beautiful, with a thick cap of glossy black hair. I take care to support his soft head as I snug the knit hat onto it and delicately swaddle him. We press his feet onto the ink pad. We take pictures, tenderly wrapping a knitted baby blanket around him. I cradle his solid weight as I whisper a wish to him for nothing but beautiful endless sky.

 

These small things, at least, I can do.

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to read more about yale school of nursing (ysn)’s other prize winners in this contest, please visit ysn news.