The surgeon held out a gloved hand, palm up, and said, “Scalpel.” He made a smooth, long, incision across my wife’s belly, below the umbilicus and above the pubic hair. Sally’s skin spread. The thin layer of fat glistened yellow, and small red dots appeared along the edges of the skin. One spot blossomed larger, and blood trickled into the incision. The surgical assistant touched the spot with the electrocautery pen, and a blue spark buzzed. A small puff of smoke rose into the cold, bright air, the incense of burned blood.
The latex gloves were smeared with red, but not enough to make them slippery. The exact and silent movements of the surgeon and assistant became more urgent. They dissected and tugged. Gripped and cut. Down through the muscles of the abdominal wall, grasping, stretching, and, digging quickly, down to the hard purple muscle of the uterus. A pause, followed by a low transverse cut, and a gush of clear fluid that sloshed out across the table. The room quieted, save for the slurping sound of the surgeon’s hand plunging into the belly, up to the wrist.
The surgeon groped around blindly, found the head, and then pulled upward, wrestling the baby out through the wound.
Sally was in bed in the recovery room. I was standing next to her. They had taken the baby somewhere. Dr. Gage pulled the curtain open; the guides in the aluminum track made a clicking, clattering sound. He had taken off his OR hat, and his forehead had a red arc across it. Dark sweat stains were under the arms of his green scrubs.
“I just checked on the baby,” he said. “Congratulations. She’s beautiful. She seems healthy, had great APGAR scores.” He paused. “She has two small heart murmurs—probably a small VSD and a patent ductus.”
Sally and I were both medical people, so we understood—two small holes in the heart. A patent ductus is a remnant of fetal circulation: a connection between the aorta and the pulmonary artery, which normally closes at birth. A VSD is a ventriculo-septal defect: a hole in the wall between the two largest chambers of the heart.
I took a deep breath. Maybe it wouldn’t be too bad. The VSD could close on its own. So could a patent ductus.
Sally turned her head a few degrees to the side, keeping her eyes on Dr. Gage.
“We’ll get an ultrasound of the heart,” he said. “Make sure.” His voice was gentle and clear.
“And?” Sally said.
“She has Down syndrome.”
Sally shrieked. Fists at her side, neck veins bulging, she took a big gasp of air and screamed again. The wailing ricocheted off the walls and ceiling.
My heart beat fast. I leaned down, and placed my forehead next to hers, hairline to hairline.
She continued wailing.
I kept my head touching her head. Her screaming was full throttle.
Her gasps for air became more frequent.
I closed my eyes.
A nurse brought the baby into the recovery room to feed.
“Do you want to hold her?” the nurse said.
I shook my head.
Sally reached out. “Hello, Sarah.” Sally’s voice was musical, and hoarse from the screaming.
Sally hoisted the bottom edge of her gown and tucked it under her chin. Her breasts were swollen and heavy, with faint blue veins visible through the pale skin. “Let’s see how we do.”
The nurse watched as Sally grasped her breast.
“Farther back from the nipple,” the nurse said. “Sarah needs to get a big mouthful.”
Sally held Sarah close, and brushed the baby’s cheek against her nipple.
Sarah opened her mouth wide, like she was yawning, and Sally pulled her into her body.
Sally smiled.
“Like a pro,” the nurse said.
I let out a pent-up breath.
Sally looked down at Sarah. In oil paintings of the Madonna and child, the light is soft and the shadows softer, and breastfeeding looks peaceful and quiet; it is suffused by a radiant calm. But surrounded by the pastel stripes of this too-bright cubicle, this meeting of saliva and skin, milk and tongue, was a slurping, grunting, air-whistling-through-the-nostrils affair. And there was a cold bright light shining down on this baby.