The Ultimate Transition

She was only fourteen. Fourteen. A tiny wisp of a girl, a pale, sweet, freckled face encircled by ringlets of short red hair. And she was going to become a mother. She had gone into labor the night before, things had stalled, and her labor was to be augmented with pitocin. When she went to her local hospital, her blood pressure had shot up, so she was transferred to our unit. She labored in the haze of a magnesium-induced fog, an attempt to prevent the seizures for which she was at risk because of her blood pressure.

The father of her baby was nowhere to be found. "He's too young for that" his parents had explained to her. I'm thinking...hmmm...well, he wasn't to young to make the baby...and she doesn't get to say "I'm too young for this". Instead, she prepared to raise, with the help of her family, the little boy that she carried.

She had wonderful support though. Her sisters were there...all four of them, all with the same fair skin and curly copper-colored hair. They ranged in age from mid-thirties to late teens. It seems our little mother had been a surprise baby herself, conceived during a rebound relationship of her mother's shortly after her sister's (half-sisters, but sisters, just the same) father's death. It was not lost on her that she was the offspring of yet another absentee father.

Her mother wasn't there. I didn't know why, but many telephone calls were going out to friends and family who seemed to be in close contact with the soon-to-be grandmother. Perhaps there wasn't transportation, or enough money for her to get the several hundred miles from her home to her daughter's bedside. That happens a lot on my unit...we transfer mothers in from hundreds of miles, covering three states. A lot of the families of the mothers we care for are desperately poor...too poor to follow the ambulance or Medivac helicopter to our hospital.

I felt sad for her. A woman needs her mother when she is about to give birth...especially such a young girl-woman; but this precious young woman was surprisingly, yet precariously stoic...the kind of stoic that made me caution myself to choose my words...even the inflection of my words carefully...lest I cause her to burst into tears.

Her sisters were lovingly, literally at her beside. When they weren't hovering near the telephone, they hovered over their laboring sister, rubbing, massaging, loving, wiping away the occasional tear. When she balked at the idea of getting an epidural, they encouraged her...gently...to reconsider. "So much pain", they murmured, more to each other than to her..."why take more?"..."especially when there's a choice".

She chose the epidural. While we usually allow only one support person bedside during epidural administration, I broke policy and let them all stay, because I couldn't bear to tear them away from their little sister who seemed to depend on them so. She suffered no untoward side-effects from her epidural, so I placed her foley, tucked her in, and stepped out of the room.

I felt a tap on my shoulder. When I turned around, I faced the oldest sister, who was wiping a tear from her cheek.

"I wanted you to know...we're not purposely being rude to you"...rude??? They had been anything but rude. I thought they had been perfectly lovely, and I told her as much. "Well", she said, "Thanks...but there's so much going on...I just wanted to let you know; She doesn't know...and we're all having a difficult time keeping it from her. Our mother is dying. Literally. Probably tonight. She has breast cancer".

Now, how many times does a nurse hear something like that? Not often, I would imagine, even on a unit prone to as much melodrama as ours. But, indeed, this was the situation, and here we all were: A fourteen year old girl about to give birth to her first child; her four older sisters to whom would soon fall the responsibility for them both; a still fairly young woman, their mother, hundreds of miles away, slowly slipping into that pre-death coma from which she would never wake up; and me, not quite certain how to respond to the sad uniqueness of it all. Instinct took over and I wrapped my arms around the now sobbing sister, as I held back my own tears.

I showed the sister our family consult room...the little room near the back of our unit that is used for physicians to talk to family members when things aren't going as planned with the birthing women they are supporting. It holds an institutional wood and vinyl couch, and two chairs, along with a lamp and a selection of out of date magazines; not much in way of comfort, but at least it's private...and it has a telephone.

The sisters each took turns going into the consult room to check in with the family that was caring for their mother. She was "in and out" they said. She seemed to be aware of what was happening to her "baby" daughter. Through a haze of pain killers, she had been repeatedly asking to speak her, but the family wanted to spare the laboring girl the pain of knowing her mother's death was imminent.

Our little mother slept through most of her labor until she abruptly sat up in bed and called out for her mother. "He's coming now! When will she be here?" I checked her, and indeed, her baby was nearly crowning (pretty rare for a first-time mother). I called out for a "doctor for delivery", and instantly the dark womb of the room became once again a bright, too-noisy hospital room. The sisters took their place around the bed, I "broke the bed down", the resident took her place at its end and began exhorting the girl to push.

She refused. "I won't!" she wailed..."Not until she get's here!" We all stopped and looked around at each other. By now, anyone who was involved in her care new what was happening. Eventually this baby would be born no matter if his mother pushed or not...but as often happens, his heart was slowing with each contraction as her body moved him ever closer to his birth. Most babies do fine, even with this...but it can be unnerving if the birth isn't imminent...if the mother isn't helping things along by pushing...at least a little.

The youngest of the four sisters finally broke rank from the Circle of Women around the bed and picked up her cell phone...you know, that piece of equipment that you're not supposed to use in the hospital because it might interfere with the other machinery? Too bad...she was on a mission, and I wasn't about to stop her. She punched a speed dial number, spoke quickly into the phone and placed it next to her laboring sister's ear.

"I will. I promise. I know. I love you tooooo.....", and her little body twisted up off of the pillow with a powerful involuntary push, and as her sister lifted the cell phone high in the air, a tiny, five-and-a-half pound little girl wailed her way into the world amidst the sobs of joy, surprise, and heartbreak of her mother and aunts (so much for the accuracy of late-term ultrasound). Time of birth...4:01 A.M. Grandma was listening.

After promising into the cell phone that she would call back soon, the youngest sister snapped it shut and began to attend, along with her older sisters, to her little sister and niece. As a group they dried the baby off, and placed her against her mother's body. The older sisters, mothers themselves, gently encouraged the new mother to hold her daughter close, showing her how to feed her, pointing out every precious, miraculous, infinitesimal little finger, toe, and wisp of downy, copper-colored hair. The baby never cried, not once after her entrance announcement...but curled into her mother's warm body, turned little her head sideways, and watched her aunts smiling down at her.

I moved around the room as inconspicuously as I could, clearing away the delivery paraphernalia, charting, and tidying up between checking on the new mother and baby. Once satisfied that all was in order, I left to give the new family their privacy. A few minutes later, the oldest sister walked up to our reception desk and asked for me. When I approached her, she asked me..."What time was she born?" A tear rolled down her cheek with my answer.

"Our mother died at 4:05".

Now I was crying...and not just a dainty little sympathetic tear or two to streak down a cheek...no, I had to be sniffling with the red nose and blood shot eyes of someone who has had entirely too little sleep...it wasn't pretty...but it was heartfelt, and the sister knew it. She asked that no one say anything to her little sister until she had had a chance to get a few hours sleep, after which they would tell her, and of course we all agreed...but it wasn't easy to stifle those tears and act cheerful while I helped the new mother into a wheelchair and tucked her baby into her arms for their trip to her postpartum room.

As often happens, I never saw this patient or any of her family again. I wonder how she reacted when she learned of her mother's departure so soon after her daughter's arrival. Two souls had literally crossed in the night. Did they reach out to and greet each other along the way? Did that precious little baby feel the warmth of her Grandmother's kiss on her cheek? Will she carry a tiny, almost imperceptible memory of it with her? She will most certainly experience her love through the love of her very young but very special mother and her very special Aunts. She is part of a very special Circle of Women indeed...one that reaches down from heaven, flows through her family, and wraps itself around her.

A bittersweet story...but a very fortunate little girl.