The Heart's Truth: Essays on the Art of Nursing

Becoming Flora

69 Becoming Flora She was the last patient to arrive that August Friday, an urgent add-on at the end of the day. The secretary’s note, a terse fragment, oozed condemnation—“Patient -weeks pregnant, thinks her water broke a few nights ago but didn’t bother to call”—an attitude I was all too ready to pick up and run with. It had been a long busy week, and I was tired. Tired of standing, tired of listening, tired of doing exams, tired of the noisy kids in the waiting room, and tired of pleading with those mothers who continued to smoke, drink, do drugs, or jeopardize their pregnancies in other ways. I took a deep breath and closed my eyes for a second. Then I walked down the hall and knocked on the door of exam room three. The woman (I’ll call her Flora) sat at the end of the exam table, undressed and draped from the waist down—blond, angular, jittery, and nail bitten. I wondered if she was high. I stood over her, fully dressed and crisp in my white lab coat. My smile was automatic and superficial. “Hello Flora,” I said. “I understand you think your water might have broken. Tell me what happened.” “Iknowmywaterbroke,”shesaid.“Imeanitwaslikeafloodorsomething.Itwas maybe a day or two ago. I don’t know, maybe last weekend? I can’t remember.” I moved the rolling stool closer to the table and sat down. Flora’s legs were thin and rashy. Her feet were bare, half moons of dirt were under the toenails, and thick yellow calluses hardened her soles. I remember thinking that those calluses might be an apt metaphor for Flora’s life. “Is the baby moving?” I asked. “I guess,” she said. “Maybe not so much today.” “Are you having contractions?” Flora shrugged and scratched her nose with her index finger. She had tattoos on her knuckles, the do-it-yourself kind made with a cork, a needle, and some 70 the heart’s truth blue ink. One tattoo was a heart with an arrow through it. The other was a heart torn in two, its jagged edges no longer approximated. She caught me staring. “Oh these. I did some time in Hanover,” she explained, referring to a women’s prison a few hours away. “Broken hearts,” I said, feeling a glimmer of empathy. “I guess we’ve all been there.” “No shit,” Flora said, laughing and throwing her head back. I could see her teeth, small and uneven but brilliantly white. She was almost pretty. When I pulled the stirrups out of the exam table and motioned her into position, she apologized for her unshaven legs. I placed the sterile speculum into her vagina and a pool of foul, greenish amniotic fluid spilled down the speculum handle. “Uh oh,” I said, looking over the sheet to see her face. “Your water has definitely broken. And I think you’ve got an infection. What’s been going on?” In my mind’s eye I pictured her at an all-night party. I conjured her man, his grimy fingers. I began to feel remarkably clean, conveniently forgetting the seamier details of my own past. After finishing the exam, I pushed back from the table, dropped the speculum into a bucket of disinfectant, and stripped off my gloves. My fingers were moist and wrinkled. My gold wedding band sparkled under the exam light. “We’ll have to get you right up to Labor and Delivery,” I said. “It looks like your water’s been ruptured for a few days—” “Good,” she interrupted. “I’m way ready to have this baby.” After a pause she added, “The baby’ll be okay, right?” “When your water breaks prematurely because of an infection, and when that infection’s had a few days to take hold—” I searched for the right words, and then decided to give it to her straight. “This is serious, Flora. You’re just twenty-two weeks pregnant. If the baby is born now, there’s a chance it might not survive.” Tears welled up in Flora’s eyes and streaked down her cheeks in thin single lines. She wiped her face, smudging her thick eyeliner into two black blotches under her eyes. She looked at me. “I just did a little coke, not much. I mean, we had this party going on last weekend and everything. And then my water started coming out but the baby was moving a...