Red Tide

Erin Connal

The sky began to glow as Grace drove to work, the black giving way to deep blue. It was then that she noticed the vultures. She had seen turkey vultures in Florida before, a handful scavenging, risking the traffic to pull at the remains of some animal swollen with death on the highway. This though? Here there were too many to count. They circled and swooped in the sky ahead, as if guiding her to the hospital where she worked.

It was summer in Florida and the heavy humid air carried with it the kind of smell you could taste. The sulfur of low tide sometimes reached the hospital, only five blocks from the waterfront, but Grace knew immediately that this was something else. There had been reports of red tide for a few weeks. There had been more algal blooms in two years than in the last decade combined. People had finally started paying attention now that it was bad enough to make them sick. The sea life had been suffocating all along but lately the beaches were so littered with death that there was nowhere to spread out your beach towel. It was costing the state in tourism revenue and so politicians had started to pay attention too, with everyone blaming everyone else.

Grace felt a dryness in her throat as she arrived at work, coughing as she swiped her badge to enter the employee entrance. The door didn’t give, jarring her. She held her badge over the sensor and pushed again before noticing the handwritten note taped there: ALL STAFF USE AMBULANCE ENTRANCE.

An ambulance arrived as she approached the entrance. A patient was wheeled out of the back, the stretcher thumping as it hit the pavement. Grace stood aside as they rushed through the sliding glass doors. One of the EMS crew was performing CPR and Grace saw the patient’s chest bounce back with each compression. She heard them rattle off the usual overdose protocol in their arrival summary and she watched as they rolled the girl down the corridor to the ER. This girl seemed different to the usual opioid patient. Not skin and bone like the rest. She had color in her face and even a little baby fat. She looked young, as they often did, and as she was wheeled around the corner Grace could see her face. Her eyes were closed and her expression was peaceful, as if dreaming.

It wasn’t until the girl was out of sight that Grace realized the smell had followed them in. She had expected some relief as she entered, but the stench had infiltrated the hospital. It somehow smelled worse inside than out, concentrated and festering.

The only person in the office she shared with the other 12 internists was the departmental secretary who couldn’t leave the phones. She said that the others had gone to the roof. Grace took the stairs to the garden and joined her colleagues huddled on the northwest corner of the roof, some shielding their faces from the smell wafting up from the water. They could see most of the waterfront from up there and the bridge to the north that connected the mainland to the island. From a distance the water — undulating with the bellies of thousands of dead fish — looked like mercury.

Did you know a group of vultures feeding is called a wake? Asked one of her colleagues.

Grace focused on one bird and watched it glide and turn, repeating the same line in the sky three times before her eyes began to sting and her vision blurred.

It was just after rounds that morning when the girl showed up on Grace’s patient list. She thought of these patients as girls, even though they were adults, and lately she had been caring for several of them at a time. There were rehab centers all over Florida that people from out of state came to. They did their rehab, got out and stayed in Florida rather than returning home. Many of them would start using again. There were men too, but for some reason the vast majority of the opioid addicted patients in the hospital were young women. Some of them were mothers. There was something particularly upsetting about that to Grace. Seeing a child with a child of their own. Some stayed through the six-week inpatient antibiotic treatment. Recently she had one patient abscond with intravenous access in place so she could go home and shoot up directly into the line left sticking out of her neck.

This girl wasn’t a bounce back, she was new, and now she lay unconscious in the ICU bed, her body covered by the thin white hospital blanket, her arms by her sides, attached to I.V. fluid bags. The room was calm. Noise made by the ventilator punctuated the silence, rhythmically compressing air in and out of her lungs. The nurse had written “Jane Doe” on the white board in the room and Grace added her name as the primary physician: Dr. Cameron. She didn’t know what to write in the goal of care section. Grace figured this girl would probably not come out of the coma and so Grace’s goal would be to convince her next of kin, if they were able to find anyone, to turn off life support. But she couldn’t write that in there, so she left it blank.

She put in orders; a drug screen, blood work, EKG and chest x-ray and set the television to the music channel. It was doubtful the girl could hear the music but the sound of the ventilator hissing with each contraction irritated Grace.

As she walked back to her office Brahms’s lullaby was being played over the hospital’s PA system. The music was part of a new hospital policy and while it was designed to notify security about the transport of newborns, most people thought it was a celebratory thing, to punctuate the birth of a baby in the hospital. Passing the circular nurses’ station Grace heard one of them say that she used to work in labor and delivery and she expected it would play between eight and ten times a day. She then remembered the module she had done when she first started at the hospital about the different security codes. The infant abduction was the code pink. It was apparently quite common for people to steal babies from maternity wards. This lullaby was part of the security protocol to prevent such an event, to put staff on alert. Nothing had ever happened at her hospital. Grace couldn’t imagine why anyone would want to steal another person’s baby. The concept seemed completely absurd to her. As absurd as how long the elevator was taking. Grace pressed the elevator call button repeatedly, leaning her body into it, knowing that doing so would not help to speed the thing up.

When Grace arrived home from work that night her husband Steve was preparing dinner; she collapsed onto a bar chair at the kitchen island and reached for his beer.

Rough one?

Always, she said and swallowed some beer before listing some of the highlights.

Oh, and the red tide has infiltrated the hospital, she added. The whole place reeks. Everyone’s coughing and wheezing. It’s a disaster.

Gross, he said as he put down the spatula and walked over to hold her in his arms.

It smells good in here though, she scanned the chopping board over his shoulder, seeing onion peel and tomato juice, What’s cooking?

Indian, he said, kissing her on the neck.

She poured herself some wine and Steve said, Are you on your period?

No, she said, drinking the wine in one swift motion, Just having a sip, she said, before placing the empty glass in the dishwasher.

Abstaining from alcohol, and the Go with the Flow app that tracked her period and predicted her fertile days, had been Steve’s idea. Steve was a nurse in the NICU, which meant that he knew enough to have strong opinions.

When she had mentioned a study that she had read in JAMA about the effects of alcohol intake on implantation Steve read it and latched on to it. They had been trying to get pregnant for six months at that point and he was convinced that the theory held water. So, it was decided that Grace would abstain from alcohol unless she was menstruating. For a week a month she had a free pass. And each time that week came, rather than regretting the arrival of her period which meant she’d failed to get pregnant, she embraced her week of being able to drink, guilt free.

It had been three months since the JAMA article and since the app download and it was all proving more difficult than Grace had anticipated. After realizing how much she craved a drink after work she began to cheat, sneaking one here and there. The stress of her job manifested in her body. Some days she felt like she was carrying the weight of some other Grace on her shoulders. A couple of drinks helped to numb the physical pain, to loosen the muscles, to lengthen her neck.

Grace considered it a matter of if, not when, she would get pregnant. She knew the statistics on what her Obstetrician had apologetically called “geriatric pregnancy,” using air quotes and a tone of regretful sarcasm. Grace was 35. She had done a chief year and hadn’t finished her internal medicine residency until she was 31. She still wasn’t in a rush to start a family. She was four years into actually making money, paying back the student debt that she sometimes envisioned as cancer cells, thriving and multiplying at a rate faster than her account balance.

When Grace returned to work the next day, her Jane Doe was in the same condition. The red tide smell remained and the place was full of workers replacing the filters on the HVAC system. She entered the girl’s room and was surprised to see a man sitting at her bedside. One of the nurses had updated the whiteboard with the patient’s name: Cristal.

A hospital catering cart was rolling by when Grace introduced herself to the man at Cristal’s bedside.

We’ll take that. Right here, Grace gestured to the table at the patient’s bedside where they left a tray with a hot breakfast and a cup of coffee. The man sat up straight and turned the volume down on the TV.

Some breakfast for you, Grace said, as she walked around to look at Cristal. Grace noticed how his t-shirt hung off his body, like it belonged to someone else. The aroma of eggs and sausage merged with the red tide smell in the room. He didn’t lift the lid on the meal, but took the coffee and added sugar and creamer.

You’re not what I expected, the man said to Grace in a gravelly voice.

What did you expect? Grace said, listening to Cristal’s lungs through her stethoscope.

Not someone so, young looking? he said, then, You don’t look like a Dr. Cameron.

Grace was used to this by now. She had lost count of how many patients and family members had mistaken her for a nurse or a technician of some kind.

What’s your name? she said.


So Dirk, tell me about Cristal, she said, brushing off his insult.

She learned from Dirk, the boyfriend, that Cristal had completed a ten-week drug rehab program in Orlando. He turned out to be a decent historian which surprised Grace. They had been using dilaudid, heroin, morphine — whatever they could get their hands on, he said — for at least a year. Dirk examined his hands when he mentioned them, as if reminded they were there, his bony fingers nursing the cup of coffee. He had driven to Orlando to collect her and they celebrated her release from rehab by shooting up dilaudid. It made perfect sense. Cristal had been clean and her body had become sensitive to the drugs again. She probably injected a dose she was once used to, without realizing it could kill her. It also explained her general appearance. Clean and healthy looking, no track marks.

Here, Dirk said, passing Grace a scrap of paper with a name and a local number written in his shaky hand.

I don’t want to be here when she comes though, her Mom hates me. They had a fight when Cristal told her that she wanted me to get her from Orlando, he said.

As the sun rose, clearing the east tower, it streamed into the room and illuminated dust suspended in the air. With his arms crossed in front of him Grace noticed the bruises. The small dark marks stood out amongst the ginger freckles that covered his pale skin. She nodded and said she’d make the call.

Grace walked over to the nurses’ station to check in with them in private. Her nurse, Karen, said some labs just came back. Grace pulled up the chart on her tablet. She scanned through the results and one thing jumped out at her. She showed Karen, who scrolled until she saw it.

She’s pregnant, Karen whispered.

hCG is 186,000. I’ll put in a consult with Obstetrics. No word to the boyfriend, Karen. He’s not her next of kin. I’m going to call her Mom. Page me if the Mom shows up. And keep a close eye on him. He seems to be clean but I don’t want him using in here.

Grace arrived home before Steve that night. He was working as charge nurse that day so she knew she had at least an hour to herself. She poured herself a finger of gin, mixed it with soda water, drank it then showered. Back in the kitchen she found a pizza in the freezer and slid it in the oven. She was preparing a salad when Steve came home.

You’re never going to believe this, she said to him as he joined her in the kitchen and before he could respond, she continued, That patient of mine, admitted yesterday, my comatose Jane Doe, she’s pregnant.

She had stopped cutting the tomatoes and was gripping the knife upright by the handle, the tip of the blade in the wooden chopping board.

Can you believe it?

How pregnant?

It measures at 12 or so weeks. I consulted OB and they did a scan today. She was in rehab for ten weeks. She must have been, like, five minutes pregnant when she went in.

So, she’s been clean for most of the pregnancy?

Grace nodded as she scooped the tomatoes up on the knife blade and put them in the salad bowl, Except for the overdose, of course.

Steve poured himself some wine from the bottle that he had opened the night before. He took a sip and said, I’m sorry, Grace.

Oh, it’s fine, she said, tossing the salad, I’m getting used to not drinking.

That’s not what I meant, he said, looking at her and then at his glass, It just doesn’t seem fair.

As she took the plates out and set them down on the kitchen bar his words settled on her skin.

Fair? You mean that she’s pregnant and I’m not?

It hadn’t occurred to Grace until Steve pointed it out. She had been too distracted by the prospect of having an interesting patient for once. She had spent hours researching the literature earlier that day and couldn’t find one similar case written up in any of the journals. Could a comatose woman support a pregnancy? She just couldn’t say. The pregnancy survived the overdose, so if that was any indication perhaps it was possible. This was the kind of thing that made everything else — the endless C.O.P.D., the doctor shopping junkies, the demented geriatric patients — worth it. This was a challenge. It was why she had become a doctor in the first place.

From then on, Grace monitored Cristal’s condition closely. Her mom, Lynne, had shown up and was in the room most days when Grace stopped by — brushing and braiding Cristal’s long hair, reading to her from a bible that the chaplain had brought. To Grace’s surprise Lynne and Dirk had made amends and the two of them were often there together when she rounded.

Lynne managed Cristal’s care. At first, she seemed unwilling to accept that Cristal was not going to recover. She talked of miracles. Of people coming out of comas against all odds, after years. As weeks passed Cristal’s condition remained dire but the baby continued to grow. The presence of the baby, and the fact that it was growing, seemed to spark hope in Lynne. It was as if her hope was transferred and somehow even fortified. Dirk seemed better too. His eyes were clearer, his bruises were fading and his voice had a weight that wasn’t there when Grace first met him. Rather than acknowledging the morbid reality of the situation — that Cristal had been reduced to an incubator and it was very likely that the baby would miscarry, after which life support would be shut off and they’d lose them both — Lynne and Dirk sat at her bedside alternating between prayer and daytime talk shows.

The case had drawn the attention of the ethics board and the hospital’s office of legal counsel was looped in. It was decided by the head of internal medicine that a committee would be set up to manage Cristal’s case. Grace would remain the lead internist but she was required to collaborate with the entire care team, which included obstetrics, nursing, pharmacy, pediatrics, critical care, anesthesiology. There were awkward confrontations in the initial meeting. Some expressed concern about the contradiction that Cristal’s case presented. Cristal was the patient and it was her condition that they were focused on treating. But without the baby, it would be recommended that Cristal be taken off life support. It was the baby that was keeping Cristal alive. And without Cristal there was no baby. Not until it was viable at 24 weeks. As Grace saw it, the boundaries were blurred. She assured the team that she was caring for Cristal and realized then that she needed to be very careful with her documentation moving forward.

Before long there were more people than chairs in the conference room at the weekly meetings. The whole hospital was talking about Cristal, even though they had warned everyone against any HIPAA violations. It was clearly communicated that the hospital couldn’t afford to make mistakes. They didn’t want the press to get involved. Grace let go of her excitement about writing the case up. She knew they’d never allow her to publish a paper on it.

At the 20-week ultrasound Grace stood in the corner of the room watching along with the lead obstetrician, the ultrasound technician, and Lynne. As measurements were made of the organs, cranium, and the chambers of the heart, the baby moved around as any other 20-week-old baby would, at times making it difficult for the technician to locate the anatomy.

As she watched the screen Grace remembered back to medical school when they learned about fetal development. She had forgotten so much of it over the years. The technician was measuring the femur when the baby kicked its leg.

Certainly active, the technician said, annotating the still image she had captured, measuring the bone.

Lynne stood beside Cristal, holding her limp hand, watching through wet eyes. Cristal’s eyes were open. Grace washed her hands, put on some gloves, and reached over to close them. It was drafty in the room and she didn’t want Cristal’s eyes to dry out. Grace wanted to ask the obstetrician when a kick can be felt by the mother. She figured it was something she ought to know and would have to look it up later. Grace had hated her obstetrics rotation in medical school. She remembered a particularly traumatic labor and delivery that she wished she could forget. The feeling in her chest when she almost dropped the baby replicated itself every time she cast her mind back to her one and only delivery. They had been warned the babies could be slippery but apparently Grace hadn’t been listening at the time.

Grace watched Cristal’s small bump closely, slick with ultrasound gel. She desperately wanted to place her hand there to feel for movement. She knew that Cristal would never feel her baby move, but perhaps Grace could.

And there you have it, the technician said, taking a screenshot, freezing the movement of the tiny grey shape floating on the screen. Grace couldn’t make out what they were looking at. The obstetrician turned to Lynne as the technician typed the word ‘female’ on the top right corner of the image.

It’s a girl, she said.

Lynne nodded as if she already knew. The technician printed a strip of the images and handed it to Lynne.

Did you want a copy of these for your paper chart, Doctor Cameron? She asked, and Grace nodded and reached across Cristal’s body for the long strip of paper.

When Grace came home from work that night, she hung up her coat and searched the pockets for her phone. She found the printout instead. She took it out and unraveled it, studying each image closely. Grace was surprised at the clarity of the black and white images, especially the one that showed the feet. She examined the two little grey shapes that seemed to float, unattached in negative space and almost see through, and was reminded of the time she made footprints in wet concrete on the sidewalk as a child. She had immediately regretted doing it and every time she walked to the park after that — wracked with guilt — she would insist they cross the street so that her mom wouldn’t see what she had done. There was no need for her to have the photo strip and she wasn’t sure why she had said yes when asked. Once she had it, though, she couldn’t bring herself to throw it in the trash.

Standing in her bathroom, holding the photos in her hands, Grace didn’t know what to do. It was like a secret that wasn’t hers. She made sure to fold the paper in a way that would not crease the images, just the spaces in between, and placed it in the back of her vanity drawer.

It’s a girl, Grace said to Steve in the kitchen. He had fish on the stovetop and didn’t turn around.

My patient’s baby. It’s a girl. The ultrasound was today.

Oh right, he said as he was tenderly arranging grilled salmon on a bed of sautéed rainbow chard.

I’m trying to replicate the meal we had at that place in SoHo, he said, referring to a trip they had made to New York the year before.

When they first started dating Grace was impressed with Steve’s skill and passion for cooking. It had been something she loved about him, though she could not recollect any such meal. She nodded and said, Looks delicious, but the smell of it made her ill.

She went to open a window but remembered the red tide. Inside smelled like fish cooking, outside smelled like fish dying. As she was clearing the counter so they could sit and eat, she remembered what the obstetrician had said about the baby’s potential viability at 24 weeks. Grace needed to keep Cristal alive for at least another month, enough time for more growth and for the baby’s lungs to develop. The more time the baby spent inside Cristal, the better chance the baby had, assuming Cristal’s body would continue to comply.

Steve was talking about how he couldn’t find any local fish at the store because of the red tide. He would have preferred to make the dish with grouper, but chose salmon instead, and farmed salmon at that. Grace was trying to think of anything else she could do to help reach, and preferably surpass, the 24-week mark. That day she had consulted the nutritionist and planned the necessary caloric intake through the feeding tube, taking the pregnancy into account. She was controlling Cristal’s blood pressure and electrolytes. The nursing staff was on a strict schedule to reposition her body in the bed every two hours to prevent bedsores and her eyes, unable to blink, were moistened regularly. This was all the usual protocol for a patient like Cristal. But Grace also spent time sifting through Cristal’s medications and removed anything she deemed potentially harmful to the baby, even if Cristal’s care called for it. She had decided to ease off the dosage for the pain meds. She didn’t want the baby to be born dependent. And there was nothing to suggest that Cristal was capable of feeling pain. It was the first thing that she thought she might be challenged on. But she did it anyway. She would change the dose gradually, easing it down in steps in case Cristal did respond to it and in case any of the nurses were paying close attention to her orders.

Grace turned to face the living room and spoke then: Without the baby there is no Cristal. And if the baby makes it to viability, or even better, to term, once outside of the womb she is the focus and Cristal ceases to exist.

What are you saying? Steve asked.

I said that out loud? Grace asked.

Steve nodded, When did you start talking to yourself?

As they sat down at the dinner table and Grace was staring at Steve’s face, her gaze fell on his eyes. He was explaining that he had cooked the fish skin side up first and noting the fat content of farmed salmon compared to the leaner wild salmon. Grace was thinking about Cristal’s eyes and the trouble the nurses had been having with infection when Steve said, holding the bottle over his glass, You didn’t grab a glass, no wine tonight?

He tested the fish with his fork. The sight of the soft pink flesh flaking away at the grain made Grace nauseous. The smell of the salmon filled her nose and her mouth watered. Grace reached for her phone and opened the Go with the Flow app. The home page announced: You are on day 35 of your current cycle.

Grace took the home pregnancy test in the morning and the second line, the one that made it a positive test, appeared, shadowy and pink. As the line darkened, her heart raced. She thought of the two little feet from the ultrasound and reached in her drawer to look at the print out. Steve knocked gently on the bathroom door but still it startled her.

How did it go? he said through the door. She shoved the photo in the back of her drawer before letting him in.

It took a few days to get an appointment and the in-office test and blood work confirmed it. Her 10-week ultrasound was scheduled. Steve switched his shift so that he could go to the ultrasound appointment and immediately downloaded an app on his phone to track the pregnancy.

On the morning of the appointment, Steve was reading aloud to Grace as she ate a piece of toast. He told her that the baby was the size of a prune and that bones and cartilage were forming at 10 weeks. The thought of a prune and bones and cartilage made her stomach sink and she pushed her plate aside, leaving the toast half eaten.

In the darkened ultrasound room, Steve stood beside her as she lay on the table, her bare feet resting on the stirrups. They waited in silence as the tech probed around her uterus. With every wave of the wand there was a whooshing noise. When the tech removed the wand and excused herself from the room Grace had a feeling of dread. Steve reached for her hand and held it. Their clammy palms were clenched together when the doctor walked into the room.

Hi Grace, the obstetrician said, the tech was having a hard time locating your little one so I’m going to take a look for myself.

After washing her hands, she began searching and tilted the screen towards her with her free hand. She stopped probing the wand all around and pushed it deep in one area, making Grace wince.

Oh, there it is, the doctor said, I see now.

She turned the screen for Grace and Steve, Do you see that there?

She was pointing at a little grey oval floating on the black screen.

It’s empty, Grace said.

I’m afraid so.

The doctor turned the monitor away from them then and retracted the wand and washed her hands. She turned the lights back on and elaborated on the blighted ovum inside Grace’s uterus: it was common, it wasn’t anything she did or didn’t do, at some point it would spontaneously miscarry or she could have a procedure to expedite the process.

The procedure was an abortion, but the doctor didn’t call it that. She didn’t need to, both Grace and Steve understood exactly what she was saying. The doctor spoke in the usual shorthand reserved for patients who are also doctors. And while Grace was glad to be spared anything she didn’t need, the doctor’s straightforwardness seemed to give no room for empathy. Grace herself consistently scored low on the bedside manner section of the reviews they gave patients at the end of their hospitalizations. For the first time she was experiencing it as a patient.

There was an image of a tropical beach illuminated by the overhead lights in the ceiling above her. The HVAC vent beside the image directed the flow of cold air to where Grace lay. Her inner thighs trembled, her knees still high in the air, her bare feet in the stirrups of the table. She shivered, laying there, surprised to be noticing the palm trees and the glowing blue sky above her for the first time. And wishing she had worn socks. She imagined the beach scene littered with dead sea life and the azure blue water cloudy and dark with red tide.

I’m sorry this happened, the doctor said, but the good news is, this means you can get pregnant.

She explained that they could try again after the procedure to remove the blighted ovum. That plenty of her patients had this happen and then had healthy pregnancies afterward. She made it sound like good news.

The doctor tore the strip of photo paper out of the machine. It showed the little grey oval in the black circle of Grace’s uterus. Then she dropped it in the trash.

On the drive home Steve echoed the doctor’s glass half full approach as Grace sat limp in the passenger seat.

It means no IVF, he was saying.

They could keep trying, she agreed with Steve, but next time, if there was a next time, they would not be getting their hopes up. She had spent weeks getting used to the idea that she had the beginnings of another person inside of her. She was annoyed that she had allowed herself to get excited at all. She knew the statistics. She knew better.

As they were stopped at a red-light Grace was thinking of the alcohol she had been sneaking in the months prior. She knew that it couldn’t have caused the unsuccessful pregnancy but doubt and guilt merged in her chest and she realized then that her legs were still trembling.

They drove past the hospital on the way home from the doctor’s office and Grace thought of Cristal. How could she still have a baby after the overdose? How come two junkies could get pregnant but she and Steve couldn’t? Steve was right. It wasn’t fair. At first the tears fell in silence. She didn’t have to blink them out. They streamed freely down her cheeks and neck. At some point her nose became too blocked to breathe and she gasped for air. She could no longer hide it and cried, open mouthed, smearing her wet nose and eyes with the back of her hand. Steve put his hand on her thigh and rubbed but all she could think of was the image of the empty sack in her uterus. The little grey something with nothing inside of it on a photo strip discarded in the trash.

Grace had the procedure done on a Friday. She didn’t have time to wait around for a miscarriage to happen, especially at work, and she wanted to get back to normal as soon as possible. Plus, the thought of having morning sickness when she wasn’t even pregnant made her skin hot.

Rather than have it locally they drove south for over an hour to the closest referral hospital. Grace didn’t want to see anyone she knew during the procedure or in the recovery suites. It was straightforward and she felt relieved afterwards. She was given some strong painkillers and she took one before bed that night. She slept until late the next morning and woke with a cloudy head. Steve came into the bedroom mid-morning and lay down beside her. She rolled into him and he stroked her hair. It came back to her then. A dream she had during the night. Grace had gone into Cristal’s room, dressed in her hospital gown from the surgery, and lay down next to Cristal in the bed. In the dream Cristal appeared like she did when she first arrived. Not sick, just sleeping. Peaceful. The edges of their bodies blurred as if they were two pieces of a puzzle. She wondered if she would have remembered the dream at all if Steve hadn’t joined her there in bed, pressing his body up against hers.

On Monday morning the first patient Grace went to see was Cristal. She lay in the bed bolstered on her side by pillows. Grace crouched down beside her. She couldn’t remember when Cristal had started to look so sick. Her skin seemed like it was stretched too thin over the landmarks of her face. The redness around her eyes seemed worse than ever before. It worried Grace. She decided it was time to call Lynne and suggest a permanent total tarsorrhaphy. She had been thinking about it for weeks and was hoping to avoid it. The other option was to remove Cristal’s eyes, but she preferred not to have to do that, so she would suggest the procedure to have them sewn shut instead. Cristal’s pregnancy was in the 22nd week. They were so close to viability and Grace was focused on getting her to 24 weeks without major infection. She could not afford for her to get an infection in her eyes after everything they had done to keep her healthy so far.

The vultures returned on a Friday and Grace watched them from the rooftop of the parking lot at the end of her shift. It had been a rough week. Dirk had made a scene in the room the day after the tarsorrhaphy. He had seen the results of the procedure, Cristal’s gaunt face with sutures in her eyelids, and had asked what would happen next. Grace told him that the eyelids would eventually heal and meld together so that her eyes would no longer be exposed to air and dry out. She would still have her eyes, but they would be protected from the elements. He stormed out of the room. He had been clean since he had arrived at the hospital, the day after Cristal’s admission; but he returned later that afternoon, high on something and was yelling at the nurses. Grace was in the room with Lynne discussing the need to stem infection when she heard his voice. She was making progress with Lynne who was only then beginning to process that her daughter would never see again. Never live again. That it was the machines keeping her alive. Cristal had been brain-dead for months, but it took sewing her eyelids for it to register with her mom.

What happened to her eyes, Dirk was saying, what happened to her eyes?

Grace stepped forward putting herself between Dirk and Lynne. He was yelling something at Lynne but he wasn’t making sense. Karen called security from the nurses’ station outside the room. Grace managed to calm him down in the time it took them to come. Apparently, the response time was under 2 minutes but it felt longer to Grace. The guards secured him, but in the scuffle, he managed to kick the table. It rolled into Grace’s abdomen and she folded forward in pain.

She was leaning on the windowsill, her belly hollowed out and breathing deep through the pain in her stomach when a vulture landed on the rooftop outside the window. It held a fish spiked by its claws. It started to eat, tearing the flesh up and off with ease. Grace watched as it threw its red featherless head back, swallowing each piece whole.

They had Thanksgiving just the two of them. Steve made Cornish hens instead of turkey and they bought the rest of the fixings from the fancy market store by the hospital. They only had the one day off together and Grace had planned to talk to Steve about giving up on the baby making schedule. Even talking about it made her anxious. They sat on the couch after dinner and she brought it up. She was surprised at how supportive he was. He agreed that they should just relax and enjoy themselves. He made it sound simple. She had always felt that the pressure came from Steve, but sitting on the couch, her legs draped over his, she was having trouble making sense of it all.

Forget the schedule, he said, as he filled her glass with the pinot he had been drinking, If it happens, it happens.

Grace had been prepared with a defense, to argue her point. She thought he would start throwing statistics at her about their likelihood of getting pregnant, a downward slope. But he didn’t. Leaning her body into his, she kissed him. She had meant for it to be just a kiss, but soon found herself slipping out of her shirt and swinging her leg over his lap. He pulled her into him and for the first time in a long time she actually wanted him. Their sex life had been scheduled for months by the app that was telling her when she was most fertile. It had felt staged for so long and because they were doing it regularly there hadn’t been any spontaneous sex in months. So they went for it on the couch, and it was more passionate than it had been for ages, like how they used to be when they met. When they were finished and Grace realized that the curtains were open, she gasped. Steve, facing the street, had known all along and he laughed at Grace who ran over to yank them closed.

It’s a little late now, he said.

As she stood in the living room, looking at Steve reclined on the couch, naked except for his socks which never got removed, she began to laugh. She couldn’t stop or slow it down and laughed so hard and deep that she eventually fell to her knees and grabbed at her tight belly. She couldn’t remember the last time she had laughed like that.

In the weeks that followed, Grace tried to avoid Lynne. She checked in on Cristal when she thought Lynne would not be there. Most of the time she was able to dodge her in person and talk on the phone if necessary. Last thing on a Friday, Grace approached the room slowly and listened for the voice of a TV evangelist. They all sounded the same to Grace with their southern accents and seesaw cadence and Lynne was almost always nodding along to their sound bite sermons, switching her gaze between Cristal’s body and the television mounted on the wall above. When Grace entered the room, she saw Lynne there reading quietly to Cristal from her bible. Lynne gestured to the bible and said, We have the Almighty to thank for the health of that little baby, you know.

The words burrowed under Grace’s skin and she took a deep breath before saying, Not to mention all of the doctors and nurses.

Grace noticed the smell then. A bowl had been set on the windowsill with coffee beans in it. She walked over to it, adjusting its position.

The nurse put that there today, Lynne said.

Grace nodded, breathing deeply to try to counteract the anger rising in her.

Lynne reached for Cristal’s hand and placed it on her belly, smiling. The smell of the coffee made Grace’s heart race. Coffee in the room was a bad omen. It was what the nurses did to mask the smell of a dying patient. She was furious that her nurse, Karen, would do that. Grace walked over to the other side of the bed and picked up Cristal’s hand.

Let’s leave that here, Grace said, moving Cristal’s arm back to her side and straightening out the IV that was attached to a bag at her bedside.

We don’t want to accidentally dislodge one of these lines, she needs her fluids.

Having Cristal’s arm on her belly was in no way impeding the fluid line, but the sight of Cristal’s arm nursing her pregnant belly made Grace uneasy.

I don’t think you should touch her, she said to Lynne.

She’s my daughter, Lynne said, moving the bible from the table to her lap.

She’s my patient, Grace said.

As Grace was leaving the room Lynne said that she would pray for her at church on Sunday.

We’ve all been praying for you, and the other doctors and nurses, for weeks now, she said.

What gives you the right? Grace said, and before Lynne’s face could register an expression, Grace was gone. She was walking so fast that she ran into a janitor in the hallway who had been pushing a cart with dirty linens towards the exit. She swiped her id and the doors swung open.

The lullaby started to play then.

She took the stairs to the third floor. There was no escaping the music, the notes bounced off the concrete in the stairwell. She rushed towards the walkway for the physician parking on the third floor. She was almost running. The lullaby started again.

As she passed the nurses station, she saw Karen huddled with some other nurses.

Must be twins, Karen said.

Coffee, Karen? Seriously? Grace yelled, as she passed by and headed towards the exit. She couldn’t walk fast enough. There was no getting away from it, not until the last few notes filled the air and then dissipated as the doors swung closed behind her.

On a Saturday Grace saw Dirk at Publix. She was standing at the entrance waiting for Steve who had gone back to the car to get the reusable canvas bags. Dirk was sitting out front on a bench smoking beside another man, older than Dirk and with leathery skin, more skin than his small body seemed to need. When Dirk yelled out to Grace, the older man seemed confused and annoyed to be woken up.

You took her eyes, Dirk was saying as he sat, holding onto the bench like it was a raft drifting on the Gulf of Mexico. Grace was stunned, watching him rock back and forth.

You took her eyes Doc, he said again.

Grace was shaking her head.

I didn’t take them, she said.

You did, he yelled, You took her eyes.

The afternoon sea breeze had filled in and was blowing the cigarette smoke in her direction. Breathing in the smoke woke her out of her stunned position and she went from confused to enraged.

I didn’t. But if I wanted to, I could have, she said.

Her words were stolen by the wind and Dirk looked back blankly.

I could have, she was yelling.

What’s going on? Steve said, arriving beside her.

Nothing. Come on, let’s get out of here, she said, grabbing his hand and heading back to the car.

Who was that? Steve said.

No one.

Could have what?

She shook her head and told him it was nothing, just some crazy patient.

Cristal was in the 35th week of the pregnancy when she went into labor. Grace was the first to realize it was happening when she dropped into her room before leaving for the day. Pulling the blankets back down she reached for Cristal’s wrist. She felt the rapid tapping of her pulse. Grace counted, and as the feeling of excitement turned to dread, Grace’s heart raced too, catching up with Cristal’s. She placed her hand flat on Cristal’s belly and felt the baby move. It was a distinct sharp movement. She checked the screen on the electronic fetal monitor and it showed a line zig-zagging.

Grace called for the obstetrics nurse and she confirmed the contractions on the monitor. She pointed out the two lines of the graph, one showing Cristal’s contractions, the other the baby’s movement, rising and falling together. The contractions were regular, five minutes apart. The room was all of a sudden full of movement, nurses rushed in and then out again. Phone calls were made, and specialists were paged.

Within ten minutes Cristal had been moved to the labor and delivery floor. Cristal’s body was transferred onto the operating table and was being prepped for an emergency C-section. The obstetrician on call was on her way; anesthesia arrived as Grace was pacing the hallway, trying to reach Lynne. In the last meeting Grace had made a quip about Cristal being unable to feel pain when they were discussing how much anesthesia they would administer in the event of a C-section. It didn’t go over well with the anesthesiologist, or with anyone in the room. The same anesthesiologist was there, administering drugs as they had planned, as Grace was on the phone trying to get a hold of Lynne. Grace left a message for Lynne and then texted Steve, I’ll be late. Eat without me.

The baby girl was wrapped up tight in the hospital swaddle. A white bundle striped with pink and blue — she couldn’t have moved if she wanted to. A tiny hat had been stretched down over her head and was folded just above the ridge on her forehead where her eyebrows would eventually be. She lay with her eyes firmly closed, her eyelids red and slick with antibiotic ointment.

All of the routine tests had been performed and everything came back normal but the baby was still going to be transferred to the NICU. Grace offered to wait for the transfer nurse. She refused to leave when the nurses told her that customarily it would be a neonatal nurse who would wait in the room for the transfer nurse. Grace didn’t like the snarky tone they used. They finally left her there in the room with the baby and a hush fell over her. It was finally just the two of them. Grace had never seen such a small baby before. The pediatrician had been happy with her birth weight, 5 pounds, 3 ounces, but to Grace she seemed too small. Impossibly so.

Grace leaned over the bassinet with her head to the side, hovering her ear above the baby’s face. She wanted to be sure she was breathing. She couldn’t see the baby’s chest moving and as Grace stood back up she realized that she’d never held a baby before. Not once. Not ever. She had always been too afraid. She slid one hand under the head and the other under the middle of the swaddle. The little eyes moved under the closed eyelids and once in her arms she could feel the baby’s warmth.

Images of the surgery invaded Grace’s thoughts. The surgeon reaching down and lifting the baby out of Cristal’s body, splayed open at the belly. The blood. Blood like a low budget horror movie. She saw them sewing Cristal back up. Blue gowned figures stooped over her abdomen. Cristal’s bulging eyes behind her eyelids melded and healed shut. Her gaunt cheeks. The little tattoo on the soft flesh beside Cristal’s ankle, a music note.

She thought it was absurd that they took all of that effort to put Cristal back together. Before long Grace would be turning off the life support, once she was back up in the ICU. It was the last thing she wanted to think about as she stood in the room with her baby cradled in her arms. She began to move gently around the room, stepping lightly, shifting her balance from side to side as if transported from land to water, like a boat moored in a calm bay.

What are you doing?

Steve’s words hung in the air for a moment before she turned.

What are you doing? Grace said, holding the baby closer then.

We were short staffed. I got called in. They said you’re refusing to leave the room. Is that true? What’s going on Grace?

I’m trying to see her eyes. She won’t open them.

Hasn’t anyone ever told you, never wake a sleeping baby? He said in a voice softer than usual, suspicious sounding.

I just want to see if she has your eyes. Or mine, Grace said.

They’re probably blue. Most babies are born with blue eyes. Grace, I think you should go home now. I’ll be home in a little while and we can talk then.

She continued to float around the room, unable to take her eyes off of the baby. It was as if some switch had been flicked deep within, something primitive and instinctual. As if her own survival depended on her constant gaze upon the baby.

Grace, I need to take the baby. I need to transfer her to the NICU.

His voice was professional and firm and she was surprised it was his and not someone else’s.

The lullaby began to play then.

Grace placed the baby on her back in the bassinet, tucking the loosened edges of the swaddle underneath her tiny body.

That’s my cue, Steve said, his voice was soft again and he began to push the cart out of the room with the baby bundled and resting silently in the bassinet on top.

Grace stood at the threshold of the room and watched. As Steve walked away his back became a pale blue shape in a white tunnel. He didn’t turn around. The doors at the end of the corridor connecting the maternity ward to the NICU swung open fast, then closed, slower. Then the lullaby was over.

Erin Connal is an Australian born writer who has lived half of her life in the United States. She was recently awarded a 2022 PEN/Robert J. Dau Short Story Prize, was shortlisted for the 2021 Disquiet Literary Contest and was a finalist in the 2021 Northwest Review Fiction Contest. She has also been published in Virginia Quarterly Review. Erin received her MFA at NYU and is currently working on a novel and a collection of short stories.