Ramola retells the fairy tale from the beginning to keep from crying.
Natalie is tiring, losing to the infection. Her shouts have become the mumbles of a person talking in her sleep. Her eyelids flicker but do not remain open. Ramola wonders if her fading consciousness is the sole work of the virus or of possible aortocaval compression syndrome as a result of her lying on her back for an extended period. Such a position is not advisable for even healthy patients and could be placing stress on the baby, but Ramola cannot safely move Natalie onto her left side.
Ramola places two hands on Natalie’s abdomen. The baby moves and lashes out. She says, “I don’t know if I can do it.”
She thinks, but doesn’t say: I don’t want to do this. I can’t do this. I won’t do this.
Natalie squirms under her hands. Ramola lifts them away as though she touched a hot stove.
As a medical student, Ramola assisted with more than a half dozen C-sections during her six-week OB/GYN rotation. For most of the procedure she simply observed the attending obstetrician and a resident perform the surgery. She was often tasked with retracting the abdominal wall to give the obstetrician a clear view of the surgical field. The abdominal rectus muscles are generally not cut during the procedure and are instead separated and moved to the side. During her final C-section as a medical student, they allowed Ramola to tie three sutures as the uterus was being closed up.
As a pediatric resident Ramola had to complete newborn nursery rotations and was often on call nights. When summoned to the OR for C-sections her job then was to take the newborn, ensure the baby was stable, and to perform any resuscitation that might be necessary. She was not standing at the operating table in those instances, but in those hazy, overworked, late hours, she would often fight to keep focus by following the discussion/instructions between the obstetrician, the OB resident, and nurses.
Ramola retells the fairy tale. And then retells it again.
“Then Nats said, ‘Do you become a rose tree, and I the rose upon it?’ When the terrible men arrived they found only a rose tree and one rose on it.”
Ramola retrieves Natalie’s phone from the sweatshirt pocket. As she does so, Natalie turns her head and opens and closes her mouth like a goldfish. It’s a myth that goldfish retain memories for only three seconds.
Getting to the home screen does not require a password. Natalie must’ve turned off the lock-screen setting prior to succumbing to infection. Her phone’s battery is at thirty-one percent, still plenty of charge; a cruel reminder of how little time has passed since Natalie was bitten.
Ramola opens the Voyager app to hear her friend’s voice again. She doesn’t make it through the first message.
Natalie’s breaths are shallow and she is no longer speaking, crying out.
Ramola returns to the kitchen, tries her phone. She sits with her eyes closed, and breathes deeply. Attempting to still her shaking hands and galloping heart rate, Ramola leans on her stress-reduction technique as she did on Bay Road when attempting to get Natalie to drink water. She imagines a whiteboard, this one bigger than any other she’s used before. The broad, blank board is there for her now. She was unable to imagine it while in the same room with Natalie.
She begins the handwritten list of instructions using black marker and her careful, looping cursive: The first incision, horizontal near the pubic hairline, a six-inch cut. It could be longer if necessary. (This line is written shakily on the board with the implication that the cut can be longer because Natalie does not have to be stitched up afterward.) The rectus muscles are normally retracted and pulled out of the way. (She will not have that luxury here and her cursive m’s and l’s are sloppy, indistinct.) Cut through or split the rectus sheath and the muscles themselves. (This will result in more blood loss, which is reflected in her misspelling of “muscles.”) There will also be the peritoneum to contend with prior to reaching the uterus. The bladder and intestines might need to be pushed aside. (She cannot just hack and slash her way through if Natalie is to remain breathing throughout as much of the procedure as possible. For the baby to survive, Ramola needs to keep that four-minute oxygen clock from winding down to zero. Because of all this she writes in a harsh slant, the letters avalanching downhill, and she crosses out “intestines” and inexplicably rewrites it in printed capital letters.) Cut through the three layers of the uterine wall without injuring the baby. (Neither hunting knife nor paring knife are meant for the tough, delicate, precise cutting, and this final line is an illegible smear as though she erased it with the flat of her hand.)
Ramola tries to envision a successful surgery resulting in a live birth, and she tries to envision an after. But she can’t see anything beyond her dying friend strapped to the bed.
What am I going to do? I don’t want to do this. I can’t do this.
How can I possibly do this?
Ramola first cuts the tape between Natalie’s ankles and pushes her legs apart. Natalie doesn’t stir.
She cleans Natalie’s face with wipes and a kitchen towel. Carefully slipping the elastic band over her head, Ramola covers Natalie’s nose and mouth with a painter’s mask. Natalie doesn’t stir.
Ramola deposits the used tape and soiled towels into a garbage bag along with the leggings, underwear, and blue shirt-dress
