To the Anesthesiologist
I can’t remember your name—was it Karl or Mattias? Or neither? It got lost as each person in identical green scrubs and hairnets announced their names one by one, swarming around my bare body under the cold white lights of the operation theatre. Midwives, obstetrician, surgeon, nurses, anesthesiologist. They blurred as I swung my legs over the side of the hospital bed, hunching my back as you instructed, maximizing space between the vertebrae of my spine for the puncture: failed epidural out, spinal block in. I knew the consequences of even a millimeter too far to the left or the right. I exhaled surrender, hoping you had good aim.
I did not expect to end up here (I am not sure anyone who has an emergency C-section does) just as I did not expect to be in labor for three days. I had imagined birth to be intimate and intuitive; one body giving way to another body. In hypnobirthing class, I wrote affirmations on post-it notes and stuck them on my bathroom mirror and computer monitor. They said things like “My body knows how to birth my baby” and “Each wave brings me closer to my baby” and “Breathe.” I can now understand what Lucy Jones, in her book Matrescence, meant when she wrote about wanting to torch the entire hypnobirthing industry to the ground after her first birth—a line that haunted me with an eerie sense of clairvoyance when I first read it seven months pregnant. If my body knew innately how to birth my baby, then why was I here surrounded by bodies in scrubs, about to undergo a major abdominal surgery named for a male Roman emperor?
There was, though, something clarifying about the sterile, bright order of it all. Part of me was relieved to finally hand this labor over to someone else. I wonder now about my labor and yours: what separates them, where they meet. My labor was singular: one I could not train for, an ancient labor for which my cells and muscle fibers somehow were primed, but one my mind—the spade of my other labor as a professor—failed to grasp. It was the first, maybe the last, time I would engage in this labor. There was no time to hone my craft. Your labor was another day on the job. How many of these same surgeries did you have today before mine? How do the profound once-in-a-lifetime and the everyday-mundane coexist in the same instant?
“Part of me was relieved to finally hand this labor over to someone else.”
Did you read my chart before entering the theatre? I wonder if it included the 54 hours of labor, the scorching white-hot iron of contractions searing through me eventually one minute apart, two sleepless nights. You probably didn’t read the “birth letter” my husband Tobias and I wrote, the one our pregnancy midwife and hypnobirthing instructor encouraged us to write to the birthing team we wouldn’t meet until the birth. We voiced a desire for “avoiding unnecessary interventions,” oxytocin-boosting nuances like dimmed lights and hushed voices, and a preference to conduct the birth in Swedish to avoid any miscommunication with care providers. That letter became our unwitting middleman. Each new midwife on shift introduced themselves with regret that the birth was not unfolding as we had hoped, that unfortunately our wishes in the letter couldn’t be met, before suggesting another cervical dilation check or bump in pitocin. Tobias later said that he wished we’d thrown the letter away, so the birthing team could meet us where we actually were—in a very different birth than we could have imagined—and I had to agree.
You, on the other hand, met my body in its trembling moment of surrender. You sat in front of me, having titrated my dose of anesthesia, while your colleague slipped the needle into the space between my vertebrae. With your head hung down to the level of mine, you told me it would feel like a warm heavy blanket was spreading over my body. You were right. In my stupor, I reported to you what I could feel as the numbness grew: nauseous, heart racing, body like a puffy spacesuit, a vague tug as the surgeons separated my stomach muscles, scared. You assured me all of it was normal.
Tobias, who held me more than any of the six midwives on rotating shifts in the days preceding, pressing my hips to relieve each contraction, finally broke down as the warm heavy blanket spread. His face had been an anchor of calm when I asked him, mid-panic attack and contractions, questions like, “Am I going to pass out? Or die?” Now, it contorted into tears below his hairnet, just as you asked him if he’d like to put on some music during the surgery. When Tobias—a musician himself—froze and couldn’t remember a single artist’s name, I suggested José González, our shared favorite. “Heartbeats” came on—the song to which he proposed at a live concert, the song to which our parents walked down the aisle at our wedding. You said, “This is one of my favorite songs, too.”
Now that I was absent of sight, my sense of sound exploded to capture it all. I heard José González’ voice: To call for hands from above / To lean on / Wouldn’t be good enough / For me, no. I heard my husband’s muffled sobs. And then, I heard the sound I had been waiting days, months, maybe even a lifetime, to hear. The sound of her: a shrieking, piercing, fierce scream of life.
You heard me begin speaking to her; you heard me not stop. If she couldn’t see me, couldn’t touch me, I wanted my voice to be the first sound she heard. The midwife held her up to my eyesight briefly—greyish skin turning quickly pink, a head full of hair, matted in blood and fluids. Tobias, his gloved hand resting on my shoulder, was speechless, his sobs standing in for words. “Can we weigh her first?” the midwife asked, whisking her away before I could answer. Tobias, torn between us, glancing from her to me and back again, followed reluctantly to clip the cord. I watched, my hand outstretched toward them, suspended between elation and despair; empty and barer than before as gloved hands tugged and stitched me up with surprising speed. You pointed to a screen to show me the cord clamp from an overhead camera. This is how it all felt: like watching a movie of the most intimate experience of my life in third person.
The nausea was intensifying, my body earthquaking. Empty of her, I needed another body to anchor mine. I asked you to hold my neck, and you did, palms cradling the base of my skull. For a few short minutes, they draped her little-big body over my trachea, my one swath of exposed skin. I felt the longed-for comfort of her warm, writhing, weighted presence and the discomfort of her placement on the exact spot where the morphine-induced nausea was stirring. I resented how this paradox—the entwinement of comfort with discomfort—inadvertently highlighted my own body’s fragility and numbness, when all I wanted was to be a staid harbor for hers. Between dry heaves into a plastic bag you retrieved for Tobias to hold, I remember gasping for breath as I told her how proud I was of her, how long and hard the journey was, how glad I was that she was finally here. In my delirium, you heard me beg them not to take my daughter from me. I knew the importance of the coveted “golden hour” of infant and mother skin to skin. There was unfortunately no time. I needed to be wheeled into the post-op room, the room where patients’ bodies “woke up” from the numb curtain, the room where newborn babies and partners were not allowed. Tobias would stay with our daughter. I didn’t see them leave, but I felt the absence of their warm light.
I remember how the rest of the team fled the room quickly—an ambulance had just arrived with another woman whose Cesarean was far more “emergency” than my own.
“My husband is with my daughter,” I said to you, “They have each other. Who is going to stay with me?”
I caught a glimpse of your face before you could edit it; it also looked in pain. “I will,” you told me. “As long as I can.”
I’m not sure if this was part of your job description, but you followed me in the gurney from the birthing ward to the general hospital. Phone calls weren’t allowed in the post-op room, you told me, but I had a few minutes as we wheeled the halls. “Call Tobias. Call your parents. Now.”
“It was hands—not the ones cutting me open or stitching me back, but the ones steadily holding the part of me that could still feel.”
It was as if you had pointed to a bridge I didn’t know I needed to cross. Through the phone, I heard my parents’ worry veiled by soothing reassurance. I heard Tobias telling me, over and over, that he and our daughter were waiting for me, promising we would be together soon. These voices reminded me that all the people who constituted home—our daughter included—had not disappeared but were very much right there, with me in some not-so-distant moment that transcended what felt like a cruel eternity.
Those four hours of separation from my newborn daughter, her first hours of life, waiting for my body to wake up, for my cloudy legs to move so I could be discharged to meet her, were the greatest and most significant pain I have ever felt: a pain no analgesic could numb. When you told me you had to leave, the only words I managed were thank you—words that can only hold so much. What I didn’t say in that moment, and what I can say now, my daughter napping in the carrier on my chest, her sweet-soft milkbreath a metronome as I write this letter, was that for weeks, when I laid down to steal away any margins of sleep I could find, the moment I closed my eyes I was back in that theatre, replaying every moment. I want you to know the scene ends with your hands holding the base of my skull. It was not language. It was not medicine. It was hands—not the ones cutting me open or stitching me back, but the ones steadily holding the part of me that could still feel. It was being there, helping me land into the here-ness of my body, of her body, of the still-tender space ripped between us. It sliced through any sense that my pain was inconsequential or unwitnessed.
The one person responsible for ensuring I was numb enough to not feel the scalpel pierce my lower abdomen, to not feel my innards being rearranged and reassembled, to not feel hands pulling my daughter out of me, to survive the most significant thing my body would ever create, was the person who made sure I felt something: human, alive, there.
About the Author
Alexandra Middleton is an essayist and medical anthropologist. Her writing has most recently appeared in Electric Literature and The Rumpus. An assistant professor at the University of Copenhagen, with a PhD in anthropology from Princeton, Alexandra is currently working on her first book—an ethnography about the first people living with neuromusculoskeletal prosthetic limbs—to be published by Duke University Press. She is also the founder of WITHIN, a workshop series and global community that integrates somatic techniques for writing from, through, and into the body. Originally from Oregon and California, Alexandra lives in Malmö, Sweden with her husband and daughter.
Read Alexandra’s “Behind the Essay” interview in our newsletter.
Edited by Tusshara Nalakumar Srilatha.
Header photo by Piron Guillaume.
