The Runaway Midwife
Dedication
Dedicated to R.P.
(my beautiful, brilliant, beloved friend)
Wherever She Flies
Contents
Dedication
Prologue
Winter Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Spring Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Summer Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Fall Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Winter Again Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Acknowledgments
P.S. Insights, Interviews & More . . .* About the author
About the book
Praise
Also by Patricia Harman
Credits
Copyright
About the Publisher
Prologue
Next to the dead man lying on the beach, mostly covered with snow, is a dead swan, its neck twisted at a strange angle.
A woman stands staring, not sure who she feels sadder for, the man or the bird. Then she turns for the cottage, hoping the waves of Lake Erie will take them away.
It’s not that she’s an unfeeling woman; she’s just felt too much.
Winter
CHAPTER 1
Flying
The sun, a red eye, is just going down as we speed across the frozen waters of Lake Erie. Even with the ski mask on, my face is freezing and my eyes run with tears, but whether from the cold or my damaged heart, I don’t know.
I think about my daughter. I think about my patient Robyn who died just days ago. I think about my friend Karen whose unexplained suicide has left me crippled. I think about the sudden turn my life has taken.
“This is safe, right?” I yell up to my driver as we bump over rough ice. “The cabbie said some men on snowmobiles went through and drowned around Middle Island last week.” Lenny stops, turns on the Ski-Doo headlights and puts on a pair of clear goggles.
“Those guys were yahoos—didn’t watch where they were going. You can tell by the surface where the ice is weak . . . You have someone meeting you on Seagull Island? I can’t stay around.”
“Yes,” I lie. “Just leave me on the west side of Gull Point. You know where that is? There’s supposed to be a little cove there. They’ll pick me up on the road.”
In truth there are no friends. It’s just me and the ice and the snow and the now darkening sky. Big cumulous clouds sweep past the stars and for a minute I stretch out my arms just to feel like I’m flying.
“Hold on now!” Lenny suddenly warns before he makes a sharp turn around a pyramid of ice that juts up from surface.
“Yikes!” is all I can say.
Finally the half moon rises and illuminates the sky. The words to an old song Karen used to sing come to me . . . I see the bad moon arising, I see trouble on the way. But trouble has already found me.
We hit a tilted sheet of silver at an angle and take air as we crash. “Whoa!” yells my driver, and when I grab him around the waist, I find that Lenny’s broad back in his black snowmobile suit shelters me from the wind. (He might be an outlaw, but he’s a warm outlaw.)
“Is that the island?” I shout to my escort as a low dark shape rises up on the horizon.
“Yeah.”
“How much further?” We hit ripples and bounce up and down.
“Another twenty minutes.”
A half mile from shore, Lenny cuts the lights and moves in slowly.
“This is Gull Point,” he says in a whisper. “Because of ice slabs that have blown in, I can’t get any closer, so you’ll have to walk, but tread lightly.
“Once you’re on the beach, if you go along that path through the woods, you’ll come to the road.” He indicates an open place in the shadows a short distance away. “I hate to leave you like this, but I can’t afford to get caught by Customs or seen by any of the locals.” He helps me off and I’m embarrassed to say I have to hold on to him until my legs get their strength.
“Thank you, Lenny. I don’t want you to get in any trouble. I really appreciate your help and I’ll be fine. I really will. I’ll be fine.”
It’s colder here than in Ohio and I shiver as Lenny gets back on the snowmobile. “Call me if you need anything,” he says. Then I’m alone, but I’m not fine. Not fine at all.
Canada
I pause on the beach, watching until the light on the snowmobile fades into darkness, then I shake myself to get moving. The sooner I get to shelter, the sooner I’ll be warm, but it’s hard going.
Lenny had said there were cakes of ice, but these are blocks of frozen lake water the size of doghouses and bathtubs. Twice I slip and fall and one time my backpack comes off, but I hold on to my tears.
When I finally get to land, I mentally celebrate. I’m in Canada without a passport. I made it! But the celebration doesn’t last long. Once off the beach, I’m surprised to find the snow is twelve inches deep, and even with my flashlight I lose the trail and have to retrace my path; then I end up in the brush, snag my snowmobile suit and cut up my face. Finally I make it to the unplowed road and throw down my heavy pack.
There are no sounds of human habitation, no car noises, no barking dogs. There are no lights in the distance. Why would any sane woman do this?
MOST PEOPLE WON’T understand why I ran, though some will, the ones who have been there. You’re going about your life, coping as well as you can, dangling from a silk thread in the wind, and then one day the line snaps. The breaking point for me was my patient’s death.
But it wasn’t just that. The line was already fraying. My best friend, Karen, had committed suicide six months earlier. My husband, Richard, was screwing around. My nineteen-year-old daughter, living on the other side of the globe, wasn’t answering my phone calls or texts. And then my patient Robyn called out my name as she died. “Clara!” she called.
She called for me and I wasn’t there.
CHAPTER 2
Grenade
It was nine o’clock Monday morning, three days ago, when I dropped into hell . . .
“Sorry I’m late,” I tell my nurse-midwife partner, Linda, as I slip in the back door of Mountain-Laurel Women’s Health Clinic in Torrington, West Virginia, and throw my briefcase on a chair in my office.
“You’ll wish you were even later when you hear the news.” She closes the door. “Sit down.”
I take off my jacket and do what she says.
“A patient died at a home birth last night.” She cuts right to the chase. “They’ve taken
her body to Pittsburgh for an autopsy. The baby is fine . . . but the woman was Robyn . . . your patient Robyn Layton. She hemorrhaged and died before the emergency squad could get to her.”
Her mouth is still moving, but I can’t hear a word. A grenade has gone off and I’m deaf from the impact.
“Are you listening? A sheriff’s detective has contacted the hospital and Dr. Agata, the administrator, wants to see you . . . Are you listening? Are you getting this?”
My head is in my hands and I feel sick to my stomach. I pull the wastebasket over but nothing comes up.
“Robyn is dead?” I hear my voice come out of a tunnel. “She can’t be. She was fine when I left her. I didn’t stay for the delivery. I was only there for a short while to give labor support. She knew from her first OB visit that the hospital doesn’t allow us to do home births anymore. I left her with the doula Sasha Tucker. Robyn is dead?”
WORKING ON AUTOMATIC pilot, I stumble into the exam room to see my first patient, but it’s no good. I go through the motions, asking how she feels, is she eating well, any contractions? I measure the uterus, listen to the fetal heartbeat, tell her to return in two weeks and hurry out.
“Linda, I can’t do this. I have to go home. Tell Agata I’ll call him tomorrow. Tell the secretaries to cancel my patients. Say I’m sick. Say it’s a terrible migraine.”
“But Agata wants to see you today! He insisted. This is serious. They’re talking about charging you with medical negligence.”
“I’m sorry, I have to go home.” She stands in my way, but I grab my coat and briefcase and push past her, tears running down my face.
I need to call Sasha, find out what happened. Poor Mike! Poor little kids! Poor Robyn!
But Robyn is dead . . .
Sasha
In the parking lot, I sit in my cold Volvo for a moment, drying my tears, and then find the doula’s number on my cell and arrange to meet her at a café in Oneida, halfway between Torrington and her home near Liberty.
As I drive into the mountains, I recall the last prenatal visit I had with Robyn less than a week ago. Everything was fine; baby head down and ready to go. Cervix already four centimeters dilated. Blood pressure and all other vital signs normal.
Mike was at the visit as well as the kids. They brought me a quart jar of honey from their honeybees and drawings the little girls had made of what they thought the new baby would look like.
Robyn and Mike had always been two of my favorite patients. Six years ago, before the hospital got the new CEO, I’d delivered baby Wren at their farm near Hog Back Mountain and three years later, their second daughter, Sparrow. Now Robyn is dead? It didn’t seem possible.
Since Karen’s suicide, I’ll admit, I haven’t been myself. There’s a hole in my heart and my brain’s fallen into it. Now I wonder if Robyn died because of something I missed.
SASHA TUCKER, MOTHER of five, all born at home, gets to the Sunflower Café before me. The doula, with disheveled long blond hair and dark circles under her eyes, is a mess and I can tell she’s been crying.
We both order tea. The waiter, a longhaired guy wearing jeans and a T-shirt that says CELEBRATE LIFE, offers us lunch, but neither of us can eat. I can barely swallow.
“So, what happened?” I whisper when he walks away. “Robyn was low risk. I helped her have two babies at home before. She was as healthy as they get, an organic farmer for God’s sake! Everything was fine when I left her last night.”
Sasha’s hands tremble as she chews on her fingernail. “Before you were out of the driveway, Robyn had an urge to push . . . Just like you told me, she was entering second stage.”
Then the doula describes the birth so dramatically I feel like I’m there . . .
“A FEW MINUTES after you pulled out of the drive, Robyn wanted to squat and Mike and I assisted her into position. Her water still hadn’t broken and I was excited that the baby might be born in the caul . . .” Sasha takes a sip of her peppermint tea then puts the mug down.
“‘Push, Robyn,’ I say. ‘Push gently, your baby’s almost here.’ Everything was so peaceful with the votive candles on the dresser, the grandmother and the two little girls sitting in the rocking chair . . . but all of a sudden Robyn clutches her chest. ‘I can’t breathe,’ she says.
“Then all hell breaks loose. The amniotic sac bursts and there’s blood everywhere. All I can think is . . . maybe she wasn’t fully dilated and her cervix ripped, but there’s nothing I can do until the baby is out.
“I hear the grandmother gasp. Mike is pacing back and forth, flapping his arms like a stork, but Robyn has her eyes closed. She hasn’t looked down. She thinks it’s just her water pouring out of her. I swipe some oil around the perineum and order her to keep pushing. ‘It’s coming now, Robyn. Your baby is about to be born.’ ”
To get Sasha to stop her rush of words, I hold up my hand like a traffic cop. “Was the baby okay?”
“Yeah, fit as a fiddle, thank God . . . I cut the cord and hand him to the grandma, but I can’t get the blood to stop and Robyn keeps saying, ‘I can’t breathe! I can’t breathe!’
“Oh, Clara. I wish you’d been there. I was so scared. All that red all over the floor . . . I’ve never seen anything like it.
“I get Robyn up on the bed and do everything I can think of,” the doula continues. “I massage the uterus and give her a swig of black cohosh to drink. ‘Call 911!’ I shout and the grandmother runs out of the room with the baby and the two little girls.
“My mind is jumping around like a squirrel. Maybe she has a fibroid uterus. Maybe she has a clotting disorder. Why is she bleeding? I deliver the placenta and the uterus is rock hard. . . . Then all of a sudden, Robyn pushes herself up on her elbows. She sees all the blood. ‘Clara!’ she cries. I guess she got confused and thought I was you.”
“She called my name?”
“Yes, ‘Clara! I can’t breathe! The pain! The pain!’ She holds her chest. Her face is gray, blue around the lips.
“‘I can’t breathe!’ she says again. Then Robyn’s eyes roll back in her head. Damn! I think. Is she seizing? Is she going into shock? Is she having a heart attack?
“‘Stay with us, Robyn. Stay with us . . . Mike, talk to her!’
“Blood is still pouring out of her. I have to get it to stop! I reglove and look for a vaginal or cervical tear, but there’s nothing and the blood keeps coming. Finally we hear the ambulance siren in the distance.
“God help us. God help us! I pray, but either God doesn’t hear or he has other plans, because as I watch the red coming out of Robyn, it slows to a trickle and then stops.”
The doula tells me how she did CPR. She describes the look on the paramedics’ faces when they came into the room and saw all the blood. She explains how the medics started two IV lines, ran them wide open and continued cardio-pulmonary resuscitation on the way to the hospital, despite the fact that it was clear Robyn was gone.
SASHA AND I hug in the parking lot. “It will be okay,” I tell her. “You did everything you could.” But in fact, I don’t think it will be okay at all.
For sure, the death will get in the papers. Possibly we’ll be arrested. Most likely I’ll get sued and lose my nurse-midwife license. The lawyers won’t go after Sasha because she doesn’t carry malpractice insurance and she doesn’t have a state license to take away. She’s just a mom helping other moms.
Before we part, I’d ask the doula if she thinks I should go by Robyn’s house, try to clean up the mess and give Mike some support, but she says no.
She’d stayed for three hours with the little girls until he and his mother-in-law got back from the hospital, and she’d already scrubbed the floor and changed the linen. Mike was still in shock and family and friends were already arriving from Charleston. She said I should go tomorrow.
Breakdown
Driving slowly, I end up in the county park out by Crocker’s Creek and try to call my daughter, Jessie, a sophomore at Torrington State University, who’s studying
with the sociology department in Australia. It’s been three weeks since I talked to her. Once the two of us were close, but this last year a sinkhole has opened between us.
Today I really need to hear her voice, and when her cell is answered on the other side of the globe I get excited. “Jessie. Jessie. It’s Mom . . .” Then the line goes dead. Tears come to my eyes again.
I stare at the low gray clouds, now spitting snow while I finger the silver medallion on a silver chain my friend Karen gave me. MIDWIVES HELP PEOPLE OUT, it says, above the imprint of two tiny feet. I didn’t do much to help Robyn.
I suppose I should call my husband, before he reads about the home-birth death in the paper, but when I dial Richard’s number he doesn’t answer and, suddenly exhausted, I don’t leave a message. It isn’t just the patient’s death and fear of getting blamed for it . . . it’s Robyn’s death and everything else.
OKAY, SO LET’S imagine this for one moment. Your best friend and ob-gyn physician colleague commits suicide by jumping off the side of a cruise ship and no one knows why. You feel responsible. You talked to Dr. Karen Cross every day. You’re a sensitive person, for God’s sake. Shouldn’t you have known the pain she was in?
Then three months later you find out your husband is cheating on you again. You’ve been to couple’s counseling before and the counselor determined it’s a form of addiction. This time, still grieving your friend and walking around like a ghost of yourself, you don’t have the strength to deal with it.
And then your OB patient dies and you’re blamed?
Imagine all this for a minute. Sound impossible? I can tell you it isn’t.
IN THE OLD days, they called it a nervous breakdown. I don’t know what it’s called now . . . but the challenges before me—confront my bastard of a husband, argue with the hospital CEO about my role in my patient’s death, face a possible arrest for medical negligence all the while grieving both Karen and Robyn—overwhelm me.
I’m at the point where ordinary sensible solutions like counseling, antidepressants and divorce, things I would recommend to my patients, seem like climbing Mount Everest with two broken legs.