"Tell them I'm on my way!" I take off at a run, heading for the stairwell. There's no way I'm waiting on the elevator. My heart pounds and my breath comes in pants as I push through the door and head down the four flights of stairs that stand between me and the ER.
I hit the last landing and shove through the door into the ER corridor at a pace that's just short of an outright sprint, and one of the techs spots me and waves me toward bay three without me having to ask. I can hear it and feel it before I get there — the elevated voices, the sounds of the monitors, the particular tension that fills a room when everyone in it knows the situation is sitting right at the edge of being absolutely life-threatening.
The attending, Dr. Reeves, looks up the second I push through the curtain. He's mid-thirties, and nothing really ever gets to him. But right now? Right now he's got the expression of someone who has been managing a situation with insufficient resources and is relieved to see a familiar face. "Harrison. Good, I need you."
I'm already moving to the bedside, taking in the patient in one practiced look, trying to figure out what the fuck is going on. She's young, maybe early twenties, and she's unconscious. Her color is wrong. Her face is swollen in the way that preeclampsia gets when it's been allowed to progress unchecked for too long, and the monitor beside the bed is telling a story I do not like the sound of. I look at the readout and feel my stomach drop.
"What do we know?" I ask, pulling on a pair of gloves from the box on the wall.
"Thirty-six weeks, came in unresponsive in the parking lot. Boyfriend brought her in. No prenatal care, no medical history, nothing." He says the last word with a clipped edge that tells me he's already been through the frustrating part of this conversation with whoever gave him what little information he has. "Apparently she wanted a free birth, maybe? Natural medicine only, no intervention, and no doctors."
I look at the monitor again and then back at him, and I don't school my expression as well as I probably should. A free birth, which means she'd made an intentional choice to reject every safeguard that exists to keep her and her baby alive, and now she's here unconscious with her blood pressure at a level that should not be compatible with consciousness, and her baby in distress on a monitor she would have refused to be hooked up to if she'd had any say in the matter. I understand the impulse toward natural choices in birth, I genuinely do, but this is what happens when that impulse goes unchecked and unguided and ends up here, in an ER bay, without anyone who knew her medical picture having had the chance to catch this weeks ago when it was still manageable.
"The baby is in distress," I say, because the tracing on the monitor is not good. The fetal heart rate is decelerating in a pattern that I've seen enough times to know we don't have the luxury of waiting on anything. "How long has she been on the monitor?"
"Twelve minutes."
Twelve minutes of this tracing is twelve minutes too many. "We need to deliver her."
"That's where we are." He's already moving, calling over his shoulder to the tech to get the crash cart positioned and to page whoever can get down here fastest. "I need you on the baby the second she's out."
"I've got her," I tell him, and I mean it in a way that goes beyond my job, the way it always does with the babies. I've been doing this long enough that I should have more distance than I do, but I've never been able to maintain that distance when it comes to the infants. I don't want to. It's the part of me that my mom says makes me good at this job and my dad says is going to give me a heart attack before I'm fifty, and they're probably both right.
Everything moves fast after that, the way it does in these situations where the room goes chaotic into a series of actions and decisions and there's no space for anything except the work. Dr. Reeves is calm and precise, the way I’ve always known him to be. He has the kind of calm that isn't the absence of urgency but the control of it, and the team around him moves with the knowledge of people who have trained for exactly this and are doing their jobs.
The delivery itself takes less time than I expected.
The baby comes out quiet.
She's blue, and my heart thuds against my chest. My stomach gets heavy, and I’m scared to death. This kind of blue usually doesn’t resolve itself. We have to work.
I take her, and I work, and I don't let myself think about anything except what I'm doing. Stimulation, airway, warming, the things my hands know how to do without my brain having to think about it, the things that were drilled into me through years of training and hundreds of births and every single moment of this career that has asked something difficult of me. The room is very quiet except for the sounds of the equipment and the low, terse exchange between Dr. Reeves and his team over the mother, and I am aware of all of it at the edges of my focus while the center of everything is this small blue girl who needs to decide she wants to be here.
Ten seconds.
Twenty.
Please want to be here. Come on, I tell her in the part of my head that runs underneath the professional, the part that has always talked to the babies because I don't care how that sounds to anyone. Come on, sweetheart. You're here. Stay here.
Thirty seconds, and then she cries.
It's not a big cry. It's thin and reedy and furious and it is the best sound I have heard in recent memory, and the relief that moves through me is so complete and so physical that my knees actually soften for a second and I have to consciously find my footing again. I don't collapse, because I'm a professional and there are still things to do and this baby is still going to need to go to the NICU, but it takes everything I have to remain standing.
"She's got a good tone," I hear myself say, and my voice comes out steady, which is its own kind of accomplishment given the state of the rest of me. "We need transport up to the NICU."
The next several minutes are controlled chaos as we coordinate the handoff, making sure the baby is stable enough for the move, communicating with the NICU team, documenting what I can while the ER team continues stabilizing the mother. By the time I hand off to the transport team and step back from the warmer, my hands are steady but the rest of me is running on the aftermath of adrenaline, and that particular hollow and shaky feeling you get when the crisis is over but your body hasn't quite caught up with the information yet.
I strip my gloves and drop them, and I stand at the edge of the bay for a moment just letting myself breathe, because the mother is alive and the baby is alive and those are the two things that matter and I need to let them actually land before I do anything else.
Then I walk out.
I make it to the corridor and keep going, past the desk and through the main ER doors and out into the ambulance bay, which is cold and mostly empty and exactly what I need. I lean against the exterior wall and pull my phone out of my scrub pocket, and I dial before I've fully thought through what I'm going to say, because there is exactly one person I want right now and that has been true for long enough that I'm done pretending otherwise.
He picks up on the second ring.
"Hey, Pretty Girl."
The sound of his voice does what it always does, which is to take the sharp edges off everything and make the world feel slightly more manageable. I close my eyes for a second. "Hey." My voice comes out rougher than I intended. "Where are you?"