Jay Baruch
A Little Heart


The ER doctor intubates the year-old boy. A column of vomit rises up the breathing tube. He suctions out sour smelling chunks from tiny lungs. Two ER nurses work busily. The doctor hears the younger nurse breathing fast, imagines the boy's father discovering the infant motionless in his crib, two hours after putting him to bed. The doctor has a son the same age, and wonders if he's sleeping safely through the night. His son vomits often: formula, milk, baby food of all kinds. This could be his son, the doctor thinks. He looks at the stone-faced father standing at the foot of the infant's stretcher, tugging low the brim of his Red Sox cap, embracing his quietly tearing wife from behind. The doctor and his wife could be these parents.

No, the doctor reminds himself. His wife is a meticulous mother. He's a savvy and cautious father. Besides, these parents look like kids themselves: the father lost in scruffy, oversized skateboarder clothes; the wife wearing a brown and peach fast food uniform. But it's the North Face backpack at their feet, zippered halfway, that stops the doctor's eye. Inside there are diapers, baby powder and wet wipes. The doctor is dumbfounded. On arrival, the infant's skin was a lifeless color, and the parents brought along the diaper bag. He is afraid they've watched too many doctor shows on TV and expect miracles from him. The doctor feels himself getting a little angry about this and rattles off more orders. The drugs aren't working, but he feels the pressure of the well-stocked diaper bag, much fatter than his son's diaper bag.

                                                                 *

The younger nurse presses the heel of her hand into the infant's elastic chest. She's trembling, trying to count out a rhythm in her head. The parents are standing there, watching, which only makes her tremble more. What would they say if they knew this was her first infant code? What if this was her child and the nurse doing chest compressions was fresh out of nursing school? Now the younger nurse is really trembling. There's a dry sucking sensation at the back of her throat. She thinks she may have to vomit and eyes the nearest garbage container.

The younger nurse looks over at the older nurse. The older nurse isn't much older than the younger nurse, but she's been a nurse for fifteen years and it shows; weathered skin, bags under tender green eyes, a fit body, a smoker's cough.

                                                                   *


The older nurse is giving medication through the IV. She stares at the clock high on the wall. She yawns. She looks expectantly and impatiently at the doctor. She shakes her head. She glances up at the clock again. "Call it," she whispers to the doctor, "You're giving them hope."

"That's all I have to give," the doctor whispers back to the older nurse.

"Shame on you," says the older nurse.

"Parents need to know we did absolutely everything."

"No," says the older nurse, trying to keep her voice down. "They need honesty. The hard truth."

The older nurse is tough and practical. Her daughter is serving time in a woman's prison in upstate New York. The older nurse is now raising her two granddaughters, each from different fathers who, the older nurse believes, are in prison, too.

The older nurse hates pointless behavior. She likes the doctor, but doesn't like working with him because if there is a point to his actions, he doesn't point it out to her. The younger nurse told her once she considered the doctor thoughtful. Now the older nurse really doesn't like the younger nurse. But the older nurse knows the younger nurse is like so many other younger nurses, ripe with optimism and nervous energy. And one day, the younger nurse will become an older nurse, and when this happens, she might like her more.

                                                                 *

The doctor explains to the parents how a heartbeat now would be cruel. It would pump blood to a dead brain.

"We understand," the father says. "How about five more minutes?"

The older nurse drops her head, looks sadly at the infant and thinks, "Poor, poor, child." She leans close to the doctor's ear.
"Nice going."

"Give another round of epi," the doctor says.

"But this is the last round," the older nurse whispers. "The fifteenth round. After this, the fight's over."

The doctor nods his head. "We'll see. We might have to go into extra-innings.

"Extra innings! There are no extra innings in boxing."

"This isn't boxing," says the doctor, solemnly.

                                                                 *

The older nurse asks the young parents if they wish to hold the infant's hand. Both the mother and father respond with opaque stares. The older nurse moves her index finger through the palm of the infant's dough-soft skin. She motions to the mother to come over. The mother's petite body freezes. Her brunette hair is cut short. Large, silver hoops jingle from her ears as she shakes her head, no. The older nurse takes the mother's hand, and with a gentle tug, places it on her child's. The mother wells up with tears. She snorts loudly, looks back over her shoulder to the father, who turns and leaves the room.

                                                                 *

Nausea sits at the very back of the younger nurse's throat. She's confident nothing worse will come in its place. She's been pressing the infant's chest for over forty minutes. Concentrating so intently on the nausea distracts the younger nurse from the reality of what she's doing. A cool monotony washes over her.

Initially, the younger nurse has to fight off her own tears, the sick feeling in her belly, but now she's hungry. She's bored and hungry. The younger nurse moves a half step, gives the mother room to hold her infant's hand. But the infant is small, and the younger nurse must continue pressing his chest, so she and the mother are rubbing shoulders. The mother smells of greasy food, and this makes the younger nurse hungrier. Thinking about food distracts the younger nurse. In her entire life she can't recall ever being this hungry.

                                                                 *

Cardiac resuscitation is a recipe to be followed. The doctor concentrates on the infant when he needs to. But his mind wanders. He thinks of how his son sleeps. Diapered butt thrust into the air, chubby hands pillowing cheeks wet with drool. When the doctor looks down, it's his son whose skin is mottled at the ears and back. And the young mother now looks like his wife.

He fights the urge to leave the bedside and call home. Wake his wife; wake up his son, too. Maybe roust up the dog. Make sure the whole family is breathing.

The young father returns to the room, hands deep into his pockets, his jeans pulled low on the hips. The doctor looks at him with embarrassment. The mother's eyes are squeezed shut. The doctor closes his eyes, too, takes an exhausted breath. He still sees his son in the front of his head, not with his eyes, but just as clearly. It could happen, the doctor can't help but acknowledge to himself. The unimaginable is possible.

                                                                 *

The doctor calls the code; declares the time of death. 3:45am. The younger nurse covers her mouth in shock, as if stumbling upon the infant for the first time. She watches the older nurse sponge the infant clean; first the head, then the arms and chest, then the pudgy legs and back. The younger nurse can't believe what the older nurse does next. She takes a diaper from the parent's bag, secures it tight around the infant and places him in the mother's arms. The mother's face becomes a knot of unexpected joy and unbearable grief. The mother holds the infant in the crook of her arm, brings his face to her chest, and slowly, cautiously begins to sway, humming low, as if lulling her son to sleep. The younger nurse starts crying. The older nurse shoots her a look that says "Stop that."

The younger nurse leaves the ER, strolls the parking lot. The night is warm, muggy, teeming with stars. The need for tears has past. She can see the father leaning back against a red pick-up, the radio playing low, cigarette aimed towards the sky. She walks to the ambulance entrance. On a far curb, in the otherwise quiet darkness, she sees the doctor sitting, face buried in his hands, shoulders heaving. The younger nurse walks over, anxiously looking for someone to share her grief. She places her hand on the doctor's shoulders. "Go inside," the doctor says through his palms.

                                                                 *

The doctor, the older nurse and the younger nurse sit in the break room, sipping burnt coffee. They don't say a word to each other. There are many other places to sit, but they chose the same square coffee-stained table. There are two defrosted burritos in the microwave that smells of freezer burn. "If you called the code sooner," says the older nurse, "we wouldn't have missed the roach coach."

The younger nurse is surprised by the harsh tone. She thinks it disrespectful.

The doctor looks up sleepily. "Are you saying I should make medical decisions based on when the food truck comes?" he asks.

The younger nurse turns her head from side to side, like watching a tennis match, crunching thoughtfully into raw sticks of carrots and celery.

The older nurse rips the packaging from another burrito.
"The kid looked like he'd been down forever on arrival." She takes a bite. "You weren't thinking of the parents. You definitely weren't thinking about the roach coach."

"Hey, that's my burrito," says the doctor.

The older nurse chews ravenously. "Not anymore."

                                                                 *

The night moves in a slow, dopey haze. The younger nurse feels like all the blood has been drained out of her. She has to care for other patients now. The code is over, but thoughts of the infant shadow her. A bulky young man with a twisted ankle screams at her for waiting so long. He's in pain. She's unsure if she should tell him about the dead infant. She apologizes for the wait, informs him that they've been busy with a very sick child.

"I've been here half the night," yells the young man.

"Shh," says the older nurse, striding boldly towards the young man. "A child died tonight. We're not in the mood."

"But…"

"Behave yourself," says the older nurse. "Or I'm going to put you in time out."

The younger nurse approaches the older nurse in the medication room. "How do you move on as if it was no big deal?"

The older nurse draws medication into a syringe. There's an air bubble. "Just…like…this," says the older nurse, flicking her finger several times against the outside of the syringe. The bubble rises to the surface and disappears.

                                                                 *

The doctor's wife is unhappy that her husband has called in the middle of the night. Now their son is crying and the dog is yelping. He explains to her why he had to call. "Listen to what's going on here now," she says to him. He hears his son shrieking, and the dog is barking madly. "You weren't thinking," she says.

"Oh no!" he says. "You don't understand."

"You weren't thinking," says the wife.

                                                                 *

Hearing his son's piercing cry clears the doctor's head; the image of the dead infant curls away from the image of his son. Over the next few hours, the doctor finds it easier to focus on other patients.

But then the young mother returns to the ER. She walks into the treatment area holding a healthy boy that looks exactly like the dead infant. A neat, gray-haired gentleman walks beside her, his steps slowing to keep pace with hers.

The doctor blinks, knuckles his eyes; it's really her moving towards him, the familiar backpack stuffed with diapers slung over one shoulder. The infant is breathing. He's sucking on a pacifier.

                                                                 *

The younger nurse crosses her chest, hugs herself, and shakily lowers into a chair. "I don't think I'm cut out for this," she says.

"None of us are," says the doctor.

"Speak for yourself," says the older nurse, standing with a fist on her hip.

The younger nurse wonders if the older nurse was a hard ass as a younger nurse. She watches the doctor button his white coat, straighten his back, and rub his chin. He appears calm and pensive, as if dead patients typically return healthy to the ER. When the younger nurse last saw the mother, she was holding the infant tight across her arms in the same exact way. Now the fear has returned. The younger nurse can't decide what's more frightening: watching a healthy infant die, or a dead infant come back to life.

                                                                 *


The doctor tries not to look at the infant, but he hears slurps and yawns.

"I'm a caseworker from child protective services," says the gentleman. The doctor is surprised to get such a strong handshake from someone wearing a worn corduroy sport jacket and crinkled slacks.

"So," says the doctor, trying to hold himself together. "What can
I do for you?"

"Take a look at the boy," says the caseworker.

The doctor hears the younger nurse gasp behind him.

"OK," the doctor says. "Then what?"

"The infant who died a few hours ago, this is his twin brother."

"Twin?" the doctor says.

"I need this one examined for evidence of abuse."

                                                                 *

The older nurse looks at the mother; head slung low, wet hair touching the shoulders of her white T-shirt, which hangs to the ripped knees of her jeans. She's alone. The father isn't with her. This could be her daughter, the older nurse thinks.

"Abuse? How can you be so cruel?" the doctor asks, loudly.

The older nurse listens in when the caseworker pulls the doctor aside.

"The boyfriend left the children alone. He put the kids to bed, then ran across the street to hang out with his buddies at the liquor store."

"That guy was the boyfriend?" the doctor asks. "Where was mom?"

"Mom was at work."

The older nurse catches the mother wiping tears with the back of her wrist. She admires the mother's steely toughness. Their eyes lock. Neither one blinks.

                                                                 *

"Boyfriend?" the doctor thinks to himself, lifting the sleeping boy into his arms. The boy groggily reaches for the mother. She rubs the boy's back, whispers that it's OK. The boy resists lowering to the stretcher. The doctor wants to hold the infant, not examine him. He knows he can't think that way. With the mother's help, the doctor undresses the infant. There's dirt beneath toenails and fingernails, in the creases of feet and hands. There are black-and-blue marks on his knees, the size of quarters, and scratches on both elbows. The doctor's son is marked with similar toddler wounds.

"What do you think?" the caseworker asks the doctor later in the privacy of the medication room.

"I'm comfortable sending him home."

The caseworker exhales. His breath smells of mint and nicotine. "We have an active file on them," the caseworker says.

"Sure there's bruising, but that doesn't mean abuse," the doctor says.

"We're taking custody of the child until we can investigate further."

"Is that really necessary?" the doctor asks. "My kid has bruises everywhere. He falls down and gets banged up."

"That's your kid," says the caseworker. He scratches his neck, shakes his head while skimming papers in a manila folder. "I have no choice," says the caseworker, as he opens the door to leave the medication room and inform the mother.

"No. You can't," the mother wails. "Please don't."

The mother's eyes dart from the doctor to the younger nurse. "Please," she says, her voice cracking.

The older nurse looks down at her clogs, clicking against the floor.

The younger nurse raises her voice. She stops when the older nurse tugs the back of her shoulder and whispers in her ear, "Careful, you're crossing the line."

The younger nurse slips a box of tissues within arm's reach of the mother, rolls her eyes and bristles at the older nurse, then walks away.

"Do something," the mother begs the doctor. The doctor opens his mouth but catches himself. What can he say? Twice in one night he couldn't return her child to her.