Labor Pains: Pushing to Keep the Spirit of Nursing Alive

By Rita Batchley

In a tale filled with poignant birth stories, Labor Pains are necessary for a health care system that is dying to get better.

Do you know what nurses do for a living? Or maybe, you only think you know.

Ride along with, Paige O’Neill RN, a labor and delivery nurse who brings babies into the world for a living but can’t seem to have another of her own. As a natural born healer, Paige intuitively knows how to relieve the pain of her patients; but when it comes to her own suffering she relies more and more on alcohol.

When a healthcare Goliath takes over the small community hospital where Paige works, a new business plan focuses more on making money than caring for its patients. A tragic death becomes the tipping point and the nurses decide to take matters into their own hands.

From the tender moments in the delivery room to the dark alleys of binge drinking, this timely trip will open your eyes to what really goes on behind the scenes of a large medical center.

Labor Pains has many layers: as new lives struggle to come into the world; a united purpose grips the nurses and a political movement is born. In many workplaces, nurses need only do their jobs and go home, but at Mercy Hospital getting involved in politics has become a matter of life or death. Healthcare is changing. The battle lines between big box brands and patient care have been drawn and nurses can no longer remain neutral.

Giving birth is hard, but giving birth to change can be even harder. A whole new meaning to Labor Pains emerges when a labor union organizes the nurses to stick together to make the necessary changes. A professional nurses’ association, the Nurses Alliance for Quality Healthcare, teaches the nurses to push back in order to take a stand for the quality of care they believe in.

“I am proud to have been a nurse for the past 32 years and I cannot encourage women enough to read Rita Batchley’s book, LABOR PAINS. I was reluctant to read the book because I had lived that life. I was a labor and delivery nurse for 14 years before becoming a midwife and I was fearful of being too critical of Rita's book. But alas, in honor of this past Nurses' Day and at a friend’s urging I started the book and was not able to put it down. Please support this hugely talented writer, and as a bonus you will have a whole new insight to the extraordinary highs, joys, and personal fulfillment of a labor and delivery nurse as well as the challenges of working in health care in the 21 century. Rita has written a very special book, and as a nurse I can't thank her enough.” Maureen Brett Mohyla, RN

"Labor Pains, is very entertaining. Batchley’s writing engages the reader with twists and turns from the first chapter right through to the very end. Nurses and students especially will enjoy the birthing stories while connecting with Paige around a variety of personal and professional trials and tribulations.

Rita Batchley’s ability to use fiction to illustrate how skilled assessments and interventions of seasoned nurses make huge differences in patient experience and clinical outcomes is fantastic! I have high praise for this because I believe it is imperative that nurses, doctors, administrators, and consumers gain insight into the value and complexity of RN work. And all too often it is illusive or invisible. Batchley’s ability to make “it” visible is a gift to the profession and healthcare.
-- -Beth Boynton, RN : Confident Voices in Healthcare

• Language: English
• Publisher: Rita Batchley
• Release date: Jul 6, 2014
• ISBN: 9780989996211

Rita Batchley

Rita Batchley is not your ordinary RN. She is a teacher, author and speaker who happens to believe that nurses hold the key to real healthcare reform. Since graduating from nursing school over 28 years ago, Nurse Batchley has helped to deliver more than 3,000 babies and now, in her breakout novel Labor Pains, she delivers a gripping story that breathes life into the spirit of nursing. This timely story of an RN on her spiritual journey during the takeover of a community hospital by a medical monopoly is sure to be loved by today’s nurses as well as those yearning to be delivered into a world where the primary ingredient in medicine is caring.As “The Nurses’ Nurse,” Rita has dedicated her life to support nurse to patient ratio laws and she tells the effects of nursing on nurses as only someone with her experiences can. Rita contributes essays and editorials by way of her blog www.TheNursesNurse.com. She has dedicated her life to support nurse ratio laws.

Book preview

Chapter One

Great Expectations

No one’s going to die on my watch, not if I can help it. Paige O’Neill started her shift on the Mercy General maternity ward with a routine walk through her obstetrics department. She made a beeline past the feline pride of chatty women dressed in scrubs huddled at the nurses’ station gossiping over cups of coffee.

Talk later, Paige thought. First check that the delivery rooms are ready. All is quiet now, but around here, disaster strikes quicker than a heartbeat. It won’t matter that Merci-Corp spent ten million bucks remodeling this place! What good is it if it isn’t set up properly? Women ask me all the time if they should have their babies at home. I say: home deliveries are for pizza, not babies! The minutes lost getting here could mean the difference between life and death, a normal baby and a brain-damaged one. Why would anyone risk that?

Paige swung into Delivery Room One with the same vigor she had when she first started her nursing career ten years ago. Monitoring these rooms for safety was her sacred ritual. Here machines and instruments had to come alive for use with split-second accuracy to serve and protect life. Averting catastrophe was a huge part of her job, but when disaster hit there was nothing like being prepared.

Paige noticed the vacuum was broken on a suction canister in one of the newborn warming-cribs. With a strong grip, she quickly replaced the cylinder, then returned to the nurses’ station where Joyce, the off-going RN, needed to update Paige.

As in times immemorial, the two women sat across from each other to discuss the ancient wisdom of childbirth. Combined with the technologies of science and the spiritual skills of shamans these modern day Nightingales planned for a birthday party their patient would never forget.

Jessica Ross and her family in Room Two are not very happy, Joyce said. She labored at home most of the night, and when she got here with her husband and mother, she wanted an epidural. The trouble is Dr. McVeigh, from anesthesia, refused to come in and do one without a cash deposit up front.

Can he do that?

Apparently so. The patients aren’t reading the fine print of their insurance policies, and without the hundred bucks the anesthesiologists won’t come in, especially in the middle of the night.

I can’t believe we’ve come to extorting money from labor patients.

Well, believe it, because her husband put up a big stink and called the nursing supervisor, who backed up Dr. McVeigh’s demand. By the time her bossy mother talked the husband into going to the ATM, Jessica was yelping like a hyena with its leg chewed off. The two of them are useless as labor coaches, if you ask me. They make Jessica more nervous.

Did she get her epidural?

I was just getting to that, Joyce grated with impatience. I went to medicate her with morphine while we waited for Dr. McVeigh to get here. I checked her and she was already eight centimeters. Too late for her to get the morphine.

Did you tell her how it would affect the baby?

"I tried, but you should’ve seen her husband’s face. He looked at me as if I were the one who had gotten her pregnant. When Dr. McVeigh finally got here the patient wouldn’t hold still, and her mother wouldn’t stop chastising him for taking so long to come in. He finally gave back the hundred bucks and refused to put in the epidural. Jeeze. I swear the world’s gone mad."

Nurse to Labor Room Two, nursing assistance to Labor Room Two, Angie, the ward clerk, announced over the intercom. The secretary of the department, or the watch commander, as Paige liked to call her, Angie was quick to answer the call lights and even quicker to throw her advice in your general direction. When Angie took aim, there was little to nothing she missed.

"You’d better get in there, before they report you to administration," Joyce warned.

I feel like I have to push, a red-faced woman pleaded as Paige arrived.

Beads of sweat rolled off the woman’s forehead and her tight grimace told Paige to work fast. The momentum of what was about to happen afforded only a brief introduction and a quick exam.

Hi, Jessica, my name is Paige. I’m your nurse and it looks like I need to check you. Paige guided her gloved hands toward her patient. You’re almost complete, but don’t push. I need to call the doctor. Paige dashed toward the exit as she snapped her spent gloves into the trash. I’ll be right back. Remember, breathe through the pain; but whatever you do, don’t push! Paige warned before she sped to the nurses’ station.

On the phone, Paige heard the disappointment in Dr. Frazier’s voice, Are you sure she’s ready to deliver? Paige knew from report that it had been very busy earlier that morning. This would be his fifth delivery since midnight. I was just getting ready to sit down for a nice breakfast with the wife, he croaked.

Well, you’ll have to reheat your eggs. This is her third baby. Paige winced, looking down at her watch. Dr. Frazier’s shift wasn’t over for another forty-five minutes; he wasn’t supposed to leave the hospital. That could be a nightmare for any one of his patients before the next doctor arrived.

How much time do I have?

If she sneezes, the baby will be out.

I’ll be right there.

Paige sighed as she hung up the phone. After 25 years as an obstetrician, she figured, Dr. Frazier had probably attended over 10,000 births. He had seen a lot. A quiet meal would have been nice. But what the hell was he thinking, going home when he knew his patient had a good chance of delivering before his shift was over? Even worse, Paige knew that if he didn’t make it and she had to deliver the baby, the hospital would not get reimbursed. Then he would probably blame Paige, as he’d done the previous week when he lied and told a patient she hadn’t called him in time. He had said it as if Paige had forgotten to call him, as if it had slipped Paige’s mind that a car was about to run over her.

Paige quickly returned to Room Two. Jessica was completely dilated, huffing and puffing through every contraction. From the way Jessica’s red face bulged with determination Paige could see that she was bearing down with her pain. After laboring for hours, this final stage seemed like a marathon. Jessica’s blank stare told Paige that all thought and reason had shut down; it would be impossible for Jessica to listen, even if Paige tried to tell her not to push. In order to wring out every ounce of energy she could muster, Jessica had gone into overdrive.

Maybe Dr. Frazier’s sold his soul to Merci-Corp, damn-it, but I didn’t sacrifice my kid and bust my butt to become a nurse to be steam rolled by a courtroom full of lawyers. If he thinks I’m going to lie down and let his lackadaisical attitude ruin this delivery he’s got another thing coming! I will get Jessica to that delivery room in time; and I’ll deliver the baby myself if I have to!

The final sprint was on; the stopwatch had clicked go. Now it was up to Paige to see who would get to the finish line first. Transferring Jessica to Delivery Room One from the dark womb-like quarters of the labor room meant focusing all of Paige’s skill; preventing a baby from delivering mid-hallway was no easy task. Paige shoved her clipboard and chart under the pillow supporting Jessica’s head, then piled a truckload of personal belongings at the foot of the bed so all the bags of clothing and such would be taken along. With a quick tug, Paige unplugged the equipment, released the bed’s brake, and strained forward to a creaking start. With adrenaline pumping, she began to thrust the bed with the mom-to-be down the hallway, followed by the entourage of family. Her back strained as she struggled to push the heap forward when Christine Martin, her co-worker and best friend, stopped Paige in her tracks.

Hey, what are you doing, trying to move that bed by yourself? she asked, hands on her hips, looking stern despite her rainbows-and-unicorns scrub top. Like an over-protective hen, her dark eyes penetrated with a look that could stop a high-speed car chase.

I could use some help, now that you mention it, Paige answered, feeling the red in her face burn with embarrassment. Christine had scolded Paige many times for not calling for help. The two had started out as new grad nurses ten years ago; and although Christine always had her back, Paige was used to doing things on her own.

With Christine’s strength pushing from the rear and Paige now pulling from the front, the bed moved like a covered wagon lumbering into the new frontier. Their muscles strained to keep the momentum going as they steered precariously around a corner, avoiding a crash into the nearby wall.

Keep your hands inside the bed, Paige ordered, nodding toward Jessica. You don’t want to get your fingers smashed going through that doorway.

Underneath her baggy scrubs, Paige could feel the strain pulling at her lower back. The loose strands of strawberry-blonde hair tickling the end of her pert nose were quickly corrected by a puff of air curled from the corner of her mouth. High cheekbones camouflaged whispers of wrinkles, and a pair of glasses framed green eyes that hawked the horizon for anything with the nerve to stand in the way of her delivery room.

Before the caravan careened around another corner, Paige said to the family, Wait here. We’ll come and get you when we’re finished setting her up. Then, after going through yet another doorway, they reached their final destination. Through the broad window, the Pacific peeked out from behind a row of palm trees, a huge contrast from the dark squeeze chute they had vacated. Central California, the last stop in the West, where Paige had settled more than a dozen years earlier, was the farthest outpost from her birthplace in New York City.

Compared to Queens, Harbor Bay was tranquil and relaxing, especially overlooking the water at dawn. Most mornings held remnants of a foggy haze where pods of dolphins leapt up to hug the marine layer. But on this day, the sky greeted the sun with a wide blue horizon. Up above, gulls replaced airplanes that had roared over Paige’s childhood.

Jessica panted as Christine and Paige parked the bed and prepared for the delivery. Paige’s heart raced as she set a sturdy shoe down firmly on the bed’s brake. "You’re doing great, Jessica; now just breathe. Don’t push! You’ve got to get through these next few contractions until everything’s set up," Paige said, untangling the I.V. She rested her palm over Jessica’s hand, feeling a current of energy flowing from her heart into Jessica’s, transferring an infusion of courage and strength.

Good job, Jessica, Paige coached, We’re almost done setting up. Blow away the urge to push. Breathe and surrender, breathe and surrender; soon you can push.

Christine flipped a switch, activating the bed’s remote control options. She pushed her dark-brown bangs off her forehead, and with a piano-key smile she brightened the room with her cheerleader good looks.

This is a special bed that makes it easier for you to deliver, explained Paige.

With that, the bottom half of Jessica’s bed fell away. Paige lifted off a large portion of the mattress to expose the underlying stirrups, handlebars and a catch-all basin. Like a mechanic’s grease pit in a car service station, the automatic bed allowed for easy access to an otherwise hidden place.

You’re almost there, Jessica!

Near the foot of the bed, Christine snatched the sterile cover off the rollaway table in the corner of the room. Rows of stainless steel scissors and clamps glistened under the bright lights.

Rest your legs up on this while I adjust your stirrups. You’re going to put your hands here and pull your legs back, Paige instructed. Breathe through the next contraction while Christine scrubs your bottom and the doctor gets ready.

I'll send in the family. Call me if you need anything else. My new patient looks active. I've gotta go, Christine said, washing Jessica’s perineum hurriedly before leaving the room.

Paige nodded. It always amazed her that within five minutes of meeting each other, the nurse could be attending to a patient’s most intimate details. Hi. How you doing? I need to prep your privates for this procedure. It wasn't unusual for different nurses to rush in and out to help one another when the patients needed assistance. It could mean life or death, or, as in this case, a simple task that required them to work as a team. As long as the primary nurse asked for it, backup help was merely a shout away.

Jessica’s husband Jason and her mother Alice entered the delivery room and stood, like bookends, on either side of the bed. Jason, a dark-haired man in his thirties, stood at attention. His bright brown eyes shone with intensity. After the many hours of his wife’s labor, every muscle in his body appeared stiff. Like a soldier’s, his arms charged downward pointing to the floor, and his jaw tightened as if he were biting a bullet with Jessica’s every wince.

Do you know what you’re having? Paige asked to lighten his mood.

It’s a boy, Alice blurted. Good thing too, ’cause with a house full of girls, he never gets a word in edgewise. She tilted her head toward the expectant father.

Me and my dad painted the baby’s room blue last weekend, Jason offered. Since my mom died a few weeks ago, my dad’s been a wreck. He’s outside pacing the lobby as we speak. He can’t wait to see his grandson.

This’ll be the first boy on both sides, Alice quipped. Jason’s an only child.

Alice gripped the bedside railing and leaned over to see the baby’s head crowning between Jessica’s legs. Alice began jumping up and down, applauding her daughter’s every move. Her skin jiggled on her skinny frame as she bounced.

Where’s the doctor? The baby’s almost out, Alice boomed like thunder.

Let’s stay nice and calm, Paige said, flashing a look at Alice. He’s right outside scrubbing. Focus on your breathing, Jessica; remember, surrender and breathe through the pain. Wait until the doctor says you can push.

Doctor Frazier entered with clean hands extended, graying eyebrows peaked over his goggles, and a surgical mask covering the rest of his face. The doctor had arrived. He proceeded to the foot of the bed. As if he were royalty. Paige helped him don his surgical gown and gloves. Majestically he turned to face his subjects.

Okay, you can push now, Dr. Frazier announced. His tall, skinny frame, barely wide enough to make a shadow, loomed over the bed.

Jessica let out a forceful growl of relief.

I can see the rest of his head. He’s got tons of hair! Alice squealed.

It was the culmination of nine long months. Their child, a concise composition of rhythm and harmony, was about to be launched from the cosmos. Of all the billions of potential combinations that could occur, this individual, with its design so purposeful, had consented to break through this exact arrangement of time and space. The room filled with a burning curiosity: will he have her blue eyes, his dark hair, or maybe granny’s bossy personality? The mystery would soon be solved. The possibilities were endless.

Quickly, one deep breath, a push, and through the outstretched anemone of Jessica’s body burst the seed of a new life. Jessica let out a bellow of warm air at the same time her baby’s lungs expanded with the full force of its first breath.

As at all the times Paige had witnessed a birth, she held her breath from the moment of the delivery until she heard the baby’s first cry. Her adrenaline rushed until wails filled the room; even then, before she could exhale a sigh of relief, Paige needed to see for herself that the baby had changed from its dusky blue to a shade of rosy pink. Whaaaaaa.

Paige heard the wail of the baby. The pact between the creator and the universe had commenced. With this arrival, a unique physical, emotional, and spiritual being had joined the earthly clan. A slick, pink body covered in blood and amniotic fluid slipped into the doctor’s hands. Most noticeably, a tiny face, scrunched up as if it had been lying down funny on a pillow, stared up at them. A sigh escaped from Paige’s lips, releasing the mounting tension that had coincided with the climax of the birth.

The intensity receded and Paige’s shoulders relaxed as the delivery room took on its magic. Bright and airy compared with the stuffy labor rooms, this was the place that transformed a laboring woman into a goddess. Sometimes howls and screams echoed from the confines of these four walls. Other times, women gave birth in utter silence. Now, Jessica’s face was peaceful; it captured new power and energy that made her like the sun, the center of her newborn’s solar system, a force that would influence every day of her child’s future.

How is my baby boy? Is he all right? Jason asked, crooking his neck to get a better look.

Dr. Frazier gazed down past the umbilical cord. Your baby boy is a girl!

A girl! A grip of disgust seized Jessica’s face.

Yep.

Oh my God, a girl. I can’t believe it. We have everything ready for a boy, Jason frowned.

Paige glared at Jason. His practical side had caught him off guard. The hours spent preparing for a son had reassured him. Now his disappointment weighed heavily, contorting his whole body as if he had just taken a sucker punch.

Well, she can still wear blue, but I don’t know about that race car theme you did in the nursery, Alice chimed.

She could like race cars, Paige bantered. These days, girls can do just about anything. Who knows? She might even drive one some day.

That’s true. Dr. Frazier looked up. Paige has a good point.

The baby rested like a football supported by Dr. Frazier’s left forearm and skinny waist. The doctor’s right hand adeptly clamped the cord; he then extended the scissors, handle pointing out, in Jason’s direction.

Do you want to cut the cord?

Sure. Jason’s arm, visibly shaking, reached for the scissors. Where do I cut?

Dr. Frazier directed the blades between the two clamps. Right here.

Jason made a clean snip and the baby was placed on Jessica’s chest.

It’s seven fifty-seven, Paige called out the time of the birth, September twentieth, a great day to be born! Gently she rubbed the baby, as if cleaning her could wipe away the disappointment saturating the room. She knew the baby could feel the tension.

Ultrasounds could be such a curse, Paige thought. If I ever have another baby, I want to be surprised as to whether it’s a girl or a boy. Having another baby was something Paige wanted desperately. It seemed ridiculous to care whether it was a boy or a girl—as long as it was healthy.

Quickly, while the newborn was secure between her mother’s breasts, Paige suctioned the baby’s mouth and nose with a bulb syringe. The baby sputtered and cried, then whimpered with the nervousness of Jessica’s heavy breathing. Jessica locked her chin to her chest and glared at the baby. Her arms lay loosely; she protected the child from falling, but she made no attempt to hug or cradle the infant. Another girl, she complained as she jerked her head to look the other way.

Do you want me to put the baby in the warming crib? Paige asked, swooping the newborn up to protect her from Jessica’s disappointment. The child, less than five minutes old, who knew no limits to the abundance of the universe, had already been condemned for not being enough.

Jessica nodded. Paige took the baby to the crib. Jason stepped closer and looked at his new daughter, Hey, look, Hon, she has my dimple, the one on my right cheek.

From Paige’s point of view, with the way the ultrasound had fooled everyone, she was sure this child was special. The baby slowly opened her clenched eyes and looked up at her father. The tension gradually dissolved from Jason’s jaw as Paige watched him look into his daughter’s eyes for the first time. Jessica continued to face the opposite wall; tears rolled down her cheeks.

C’mon, Honey, look at her, she’s beautiful, Jason encouraged. Besides, we wouldn’t know what to do with a boy.

Jessica refused to look. She continued to sigh and bite her lower lip.

The baby began to cry in throaty bursts of protest. She knows exactly who she is, Paige thought. She doesn’t care what anyone thinks, not yet, anyway. Paige felt a strange tingling of energy pulsate through her as she had, off and on, from before a time she could clearly remember. Her whole body trembled with a power that surged with awareness.

Listen to her, Paige let out. She’s trying to tell you her story. She wants you to know what happened to her, where she’s been these past nine months.

Hello, Baby, Jason soothed, kissing her face. I have a daughter; I have another daughter. She’s so beautiful. His eyes brimmed with tears.

Paige bent over to look more closely. The baby was calm now, dozing peacefully. "She is beautiful. Do you have a name?"

Michelle! Jason burst out, for my mom.

Yes, Michelle, Jessica said, finally responding to her baby. Her tired face beamed a flash of recognition.

Doctor Frazier waited for the placenta’s delivery and collected the cord blood. The doctor’s gentle tugging made Jessica grimace and sigh impatiently. Jason continued to look intently at his newborn, studying her every detail.

Hello, Michelle. I love you. I’ll always love you, Jason said, his promise echoing for all eternity to hear. I think my mom played a trick on us, he laughed. She switched the baby to a girl right before she was born. She always wanted a daughter, and now we have three.

Yeah, I know, you don’t have to remind me, Jessica whined. "Sleepless nights, diaper rash, teething-I can’t wait."

Oh, come on, now, Jason pleaded. It’s not fair. I know there’s a reason she was born a girl; there’s a reason for everything. He had fancied himself with a son, but already he acted as if he couldn’t imagine a life without this little girl.

You can always blame Jason, Dr. Frazier chuckled to lighten the mood. It’s the man’s sperm that determines the sex of the baby. It’s his fault if he makes only girls.

I just wanted to give him a son, Jessica sighed.

Looking at Jessica, Jason said, We tell the girls all the time that we don’t get to decide what’s best for us; now it’s our turn to listen. She’s perfect for our family.

Jessica smirked. Her brow loosened, but her jaw stayed tight. Like Anne Boleyn, needing to produce a male heir had become a matter of life or death. Her disappointment in losing her prince would not easily subside. Paige wondered if a bad case of postpartum depression loomed in the near future. She would remember to make a report on Jessica’s chart for the staff to look for more unusual remarks or behaviors that would require follow-up.

Finished with his part of the delivery, Dr. Frazier glanced over at the baby and explained that the pediatrician would come by that afternoon: If everything checks out, you’ll all go home tomorrow evening, he said as he navigated past all the equipment, removing his surgical garb along the way. Underneath the blue gown, mask, and goggles, his green scrubs blended him in like camouflage with the rest of the hospital’s homogenized consistency. His body long and thin, gave him a likeness to Oz’s tin man. With a brief look he could take charge, smoothing any situation. These days, Dr. Frazier rarely gave up the show of his perfect white teeth; but when he did, the world was a better place because when he smiled he meant it.

Lately there hadn’t been much to smile about. With its purchase of Mercy General, Merci-Corp had very tight reins on doctors, like Frazier, who had agreed to stay on board as contracted staff. Others, who remained in private practice could maintain their autonomy, unlike Frazier who was owned by the corporation. He had to make every patient encounter an opportunity to strike gold.

I’ll see you in the morning, Jessica, Dr. Frazier called out. Turning to Paige he whispered, Thanks, Paige, I barely made it, even though I ran every red light. By now my eggs are rubber—but at least you saved my bacon. He grinned.

Thanks for noticing, Paige smirked. I’ll let the next doctor on call know if anything else comes up; and next time, be sure to stick with the cafeteria’s eggs.

Standing over the warming crib, Paige started the newborn’s examination. While listening with her stethoscope, Paige smiled as Michele’s small hand reached up and grabbed her index finger. The baby was unusually pretty, with fluffy brown hair and peachy skin. She felt as soft as rabbit’s fur. It’s going to be rough, Kid, growing up with a mother so ruffled, Paige thought. A tight grip hardened her heart. She sighed, remembering the celebration that had occurred after her own daughter’s birth. That night, in the hospital room, Paige’s husband had sneaked in a bottle, and pink champagne had bubbled in plastic flutes to toast their child’s arrival. At the time, a couple of sips had seemed silly, but now she was proud of their little act of defiance.

As Paige stood over the baby she could feel the warmth from the crib radiating down from the heating element overhead. The temperature matched her anger, which sizzled like a fuse. For years she had bargained and pleaded to have another child, but her wish had been denied. White rage squalled like a blizzard, obscuring her sight. As if her blindness had suddenly made her invisible, she had the urge to pick up the baby and run from the room. Instead, Paige swallowed hard, wrapped the adorable infant in a blanket, and carried her over to Jessica.

Look at that sweet face, she said tenderly. She looks just like you. So what if she doesn’t have outdoor plumbing? That shouldn’t bother you as long as she’s healthy.

How would you know? Jessica jeered. I’ve always wanted a boy. Three ultrasounds said we were having a boy, and now another girl!

"Well, this isn’t all about you, Paige snapped. Let’s get back to what’s really important—the baby. She deserves to be happy, but that’s not going to happen if you keep treating her like a second-class citizen." Jessica stared; her mouth hung open, lips quivering. Paige set the baby in the mother’s arms. Jessica’s tears splashed onto the cotton blanket.

Hey, don’t talk to my wife like that, Jason defended. Can’t you see she’s just upset right now?

The shock waves still vibrated as Paige realized she had crossed the line. I’m sorry, she apologized, her face burning with embarrassment. She had become that bitchy nurse so stereotyped in the media. Paige finished up the delivery record and transferred the family to the maternity ward.

Kim Lyons, the charge nurse on duty listened to Paige’s full report of the delivery. As team captain, Kim scribbled notes to be handed off to their manager, who kept track of the nurses’ productivity which in turn determined how much the hospital could bill along with a nurse’s hourly labor room rates.

What was Frazier thinking? Leaving right when he knew his patient could deliver, Kim asked as she tucked her pen behind her neatly groomed brunette hair which was swept back in a bun. Her crisp white lab coat hung just right over a curvaceous figure, making the highly decorated badge over her heart stand at attention. The glossy laminated picture ID displayed a much younger version of Kim surrounded by colorful pins that honored her various nursing awards.

He wasn’t thinking, because it’s obvious he just doesn’t care anymore, Paige explained. His professional calling has been reduced to a business plan, without as much as a thank you.

In a way I can’t blame him, this merger with Merci-Corp has been like a bitter divorce; and, after getting my walking papers after fifteen years of marriage, I know exactly how he feels.

But he’s taking it out on the wrong people. It’s the patients who end up suffering. What if there had been an emergency and he wasn’t there?

Don’t be so dramatic, said Kim, knitting her eyebrows into a furtive knot. You said so yourself that your patient could’ve sneezed that baby out. It’s not that big a deal.

No big deal? Not to you anyway. You’re not the one at risk of losing your nursing license. If something had happened I’m the one who’d be up on the stand!

Good point, you can write it up; but, it’s not like there’s much anyone can do about Frazier, he’s burned out. Ever since, Merci-Corp transformed our maternity ward into the Daisy Hill Puppy Farm we’ve become more of an assembly line then a hospital.

I’ve got a feeling this is just the tip of the ice berg.

You know it. I’ve heard rumors that Merci-Corp wants to sell us to United Medical, the biggest health care chain in the U.S., Kim’s eyes widened, her hazel irises gave off a smoldering glow. "If that happens we’ll have wealth care not health care. We might as well kiss affordable premiums good-bye. Speaking of which, have you had any luck getting artificial insemination covered?"

Paige gulped. She had forgotten she had told Kim she had looked into the expensive treatments that were outside their employer’s coverage and completely beyond her economic reach.

No they won’t budge a nickel. Imagine 10,000 bucks a treatment- even if it doesn’t take. It’ll cost a small fortune not to mention how much it costs to raise a child, Paige sighed.

Well you can take one of mine, Kim joked. Believe me when they’re teenagers you’re happy to be rid of them.

Paige didn’t know what to say. As a nurse working in a maternity ward, the subject of having kids should have been as familiar as passing out cake at a birthday party; yet whenever a co-worker mentioned the word baby, Paige winced as the serving reached her plate.

I’ll never complain if I have another baby. I swear I’ll never ask for anything else, Paige vowed to herself as she bit her lower lip.

The universe knew Paige’s wish. It had been heard many times over the past several years and had since grown from a tiny seed into a tangled network of vines that had invaded every corner of her mind.

###

That night, after her husband and daughter were long asleep, Paige lay awake after a fitful nightmare. In her dream, someone had come into Jessica’s room and stolen the baby. Paige searched frantically for the newborn. A cloaked figure had emerged holding a dagger; and when Paige tried to scream, no sound would come out. Her mouth opened to call for help, but her voice was sucked into a backdraft that slammed her throat shut. Paige woke up gasping, her chest heaving until she could catch her breath.

Careful not to wake her husband, she slipped out of bed. The red numbers on the digital clock read 2:44. When she got to the kitchen, she turned on the light, then found what she was looking for. Inside the refrigerator, on a neatly-stacked shelf, a bottle of Zinfandel rested on its side. Paige grabbed the bottle, opened it, and poured the blush liquid into a glass. This one’s for you, Michelle. Paige waved the drink for an imaginary clink with the air. After a few big gulps, she filled the glass again, downed it, and filled it one more time before heading back to bed for a dreamless sleep.

Chapter Two

The Birth of a Nurse

Some people are born under blue skies; blessed with clarity, they dive into crystalline waters. Others come through a pervading mist, a heavy fog that prevents them from dipping even a little toe. Then there are those like Paige, born during a thundershower, joyful for the soaking rain. Even as the lightning flashed, she knew the deluge had come to prepare her soul.

It was 6:45 on a hot Monday morning in July when Katherine and Peter Tobias were on their way to the hospital to have their third child induced. There had been a heat wave across New York City, and even at this early hour humidity made the air sticky and thick.

I can’t believe it! Now we’re going to be late for our appointment, goddammit! Peter swerved around the traffic to get through the yellow light. "That son of a bitch knew I’d get stuck in the crosswalk. Why couldn’t you just move up? " he shouted to the unhearing driver. Peter leaned on the horn, showing no mercy for those still asleep in nearby apartments.

Kathy pushed back her stringy brown hair to keep it from falling in her eyes. She sat in the front seat of the car, pale thin arms clinging to her overnight bag. Inside were the usual: clean underwear, socks, slippers, and the personal effects that would make her stay in the hospital more comfortable. Down toward the bottom of the bag was the yellow outfit she had carefully chosen for her new baby’s homecoming. Tucked all the way behind everything else, a pink layette was hidden, just in case she got lucky.

Friends and family teased, calling her older boys Irish twins; born eleven months apart, both Paul and Johnny were currently the same age until the following month, when Paul would turn two. Now, whenever she was asked what she was having, everyone joked that she would have triplets—three boys in three years of marriage. Breaking her streak was out of the question.

Peter, watch the car in front of you. You’re too close! Kathy cried out, letting go of the bag and bracing herself against the dashboard. The car screeched to a stop.

Do you want to drive this car? Because if you think you can do better than me, I’ll pull over right now and let you drive, Peter lashed out. Why did you take so long? More hair spray or something? Now we’re gonna be late.

Kathy gnawed at her bottom lip. At one time she had been an attractive woman, but after years of Peter’s harrowing insults Kathy had become haggard.

Only ten minutes from home, the hospital seemed like days away. Car rides alone with Peter were always the worst because she was his captive audience—and the butt of his frequent outbursts. Even in her tender state, this day would be no different.

Before they met, Kathy had dated several men, but until Peter, none had presented her with the beauty and temperament of a thoroughbred. His dark black hair and steel-blue eyes made him a handsome catch, but his quick temper and flashes of anger had scared most women away. Kathy pitied Peter. Underneath his tirades she recognized the frightened boy who had lost his own mother as she was giving birth to his youngest sister.

Don’t be ridiculous. I wasn’t fixing my hair. Johnny needed to be fed before we left. I couldn’t just leave him screaming.

Your mother knows how to feed a baby.

I was just trying to help.

Help? It would help if you didn’t shoot babies out your barrel like some sawed-off shotgun. Peter reminded her of the incident that prior year when she had gone into labor and had almost given birth in the car on the way to the hospital. If you hadn’t delivered Johnny so quickly, we wouldn’t have to go through all this right now.

Why do you always have to bring up the past? I couldn’t help it that my water broke in your precious car. Kathy knew better than to reason with him, especially while he was driving; but, like a bear defending her cub, she spat out the words she knew would enrage him.

It still stinks in here. Peter scrunched up his nose; his face reddened.

"Well, we don’t have to do this. We could just turn around and go home and wait until I go into labor. Then maybe I will give birth in your precious car, Kathy chided. How would you like that?"

Shut the hell up, will you? Peter came to a screeching stop in front of the hospital. I’ll meet you upstairs, he said as Kathy stepped out while the car idled.

Awkwardly Kathy lumbered toward the hospital. She swung the overnight bag over her shoulder and waddled through the entryway. Inside, the admitting clerk greeted her with paperwork.

As Kathy signed the last of the documents, Peter walked in through the front door. All the women turned to see whom this man with movie-star good looks had come for. With Kathy in a wheelchair, they went up in the elevator to the maternity ward. The doors opened onto a large vestibule, where an attendant took them over to the front desk, which was decorated with pink and blue laminate. A nurse dressed in a