Ann Patchett - State of Wonder

“I think you were having a dream.” The flight attendant pulled back, giving Marina a bigger picture. How early must she have gotten up this morning in order to put on that much mascara? “Would you like a glass of water?”

Marina nodded. The trick of Lariam was to figure out which part was the dream and which part was her waking life: Vogel she knew, Anders and the lab. It was the plane that smacked of nightmares.

“I don’t like to fly myself,” the suited man told her and held up his Bloody Mary. “I medicate.”

“I don’t mind flying,” Marina said. There was something she had meant to tell Anders.

“It certainly seemed like you mind it,” the man said. Maybe he was concerned, or bored, or inappropriately friendly, or midwestern friendly. Nothing was clear. She took the glass of water that was handed to her and drank it down.

“I have bad dreams,” Marina said, and then she added, “on planes. I won’t fall asleep again.”

The man looked at her skeptically. After all, they were in this together now, seatmates. “Well, if you do, should I wake you up or just let you go?”

Marina thought about it. Either way it was a loss. She didn’t want to scream in front of him and she didn’t want him shaking her arm either. The intimacy of sleeping next to strangers, much less twitching and making noises, was unbearable. “Let me go,” she said, and turned her shoulders away from him.

She had been going to tell Anders about Dr. Swenson. It was a funny business, the subconscious mind, thinking that it could rewrite history. It would never have occurred to her to tell him what had happened when he was alive, and now that he was dead she was certain she should have. The great, lumbering guilt that slept inside of her at every moment of her life had shifted, stretched. Wasn’t it logical that guilt should awaken guilt? Marina Singh had had an accident a long time ago, and after that she had removed herself from the obstetrics and gynecology program. She had never told her mother, who thought that her daughter had had an illogical change of heart late in her training, or Mr. Fox, who never knew her to be anything other than a pharmacologist. The people who did know the details of what had happened, Josh Su, the friends she had at the time, one by one she found a way not to know them anymore. She no longer knew Dr. Swenson. With a great deal of concentrated effort she had found the means to stop repeating the story to herself. She no longer traced the events through the map of her memory, studying the various places where she had been free to make different choices.

Marina Singh had been the chief resident and Dr. Swenson was the attending. On this particular night, or as the review board had called it, the night in question, she was working at the County Receiving Hospital in Baltimore. It was a busy night but not the worst. Sometime after midnight a woman came in who said she’d been in labor for three hours. She had already had two children and she said she hadn’t been in any hurry to come to the hospital.

“How are you feeling now?” the flight attendant asked.

“I’m fine,” Marina said. Her eyes were dry and she concentrated on keeping them open.

“Well, don’t feel embarrassed. This nice man here woke you up

in time.”

The nice man smiled again at Marina. Something in that smile implied that he was sheltering a small flame of hope that there would be a reward for his good deed.

“Some people’s seatmates aren’t so thoughtful,” the flight attendant said. She was lingering. There wasn’t much to do in first class, not enough people to take care of. “They let them snore and scream and carry on until you can hear them in the rear lavatory.”

“I’m fine now,” Marina said again, and she turned her face to the window, wondering if there was an empty seat at the back of the plane.

She tried to separate what had happened that night from her deposition. She tried to place herself back at the actual event instead of the endless and exhaustive retelling of that event. The patient was twenty-eight, African-American. Her hair was straightened and pulled back. She was tall, broad shouldered, enormously pregnant. Marina was surprised to remember how much she liked the woman. If the patient had been afraid she never showed it. She talked about her other children in between her contractions and sometimes through them: two girls, and now they were having their boy. Marina paged Dr. Swenson and told her the patient’s contractions were four minutes apart and she hadn’t begun dilating. The infant’s heart rate was unstable. Marina told Dr. Swenson that unless the situation improved they would need to do a cesarean.

And Dr. Swenson said, she was very clear on this, that Marina was to wait. She was not to do the section without her.

“Can you see anything down there?” asked the man in the suit.

“No,” Marina said.

“I don’t know how you can stand it. Me, I can’t do the window seat. If it’s all they’ve got I pull the blind. I tell myself we’re in a bus. I used to not be able to fly at all and I went to a class where they taught us to hypnotize ourselves into thinking we were on a bus. It works as long as I have a drink. Do you want a drink?”

Marina shook her head.

“Part of the paper?”

Marina looked at him. He was pale with high red cheeks, a fellow traveler who wanted her to ask him why he was flying to Miami and if that was his final destination. He wanted her to tell him she was going on to South America so that he could be impressed and ask her what she planned on doing there, and she would do none of that. She would do nothing for him.

She had done C-sections before but on that night she was told to wait and monitor and call back in one hour if there was no improvement. The fetal heart rate dropped and climbed, dropped and climbed, and still the patient wasn’t dilated. Marina paged Dr. Swenson the second time, and she waited and waited but there was no call back. When she looked at the clock she realized that only forty-five minutes had passed, not an hour. The rules were intractable. She had not followed the rules. It was exactly the thing Marina had always admired about Dr. Swenson until she was the one trying to get her on the phone. The patient was a talker, and they had time to talk. She said she was exhausted but that it wasn’t so much the labor. She said her two-year-old had kept her up all night the night before with an earache. Her husband had dropped her off in front of the hospital. He was driving their girls out to his mother’s and that was two hours away. Two hours out and two hours back but at the rate she was going he’d be there for the birth so she said she didn’t mind waiting. She wanted him there. He had missed the first two, circumstances, she said, not his fault. Her voice was strong, louder than it needed to be in the small room. “You always forget what childbirth is like,” she said, “but I don’t remember it being this hard.” Then she laughed a little and said, “That’s the whole point, right? You don’t remember, because if you did remember no one would ever have kids again and then what would happen? That would be the end of everything.” It was one thirty. It was two. It was three. No calls were returned. Marina delivered two other babies while the woman waited and both of the births were so easy they hadn’t needed a doctor at all. Women for the most part knew how to push out an infant. Even when they didn’t know there was no stopping them. Marina went back to check on the woman again. The doctor was terrified, the patient was patient. Back in the days when Marina played this film in her head every hour, waking and sleeping, this was the part she watched most carefully. She slowed down the tape to a crawl. She looked at every frame separately. She was not terrified that the patient would die or that she would lose the baby, she was terrified that she was doing something wrong in the eyes of Dr. Swenson. She was thinking that if she had followed instructions and waited another fifteen minutes to call the first time then none of this would be happening. Surely she had learned her lesson now. Surely Dr. Swenson was almost there. The nurses understood all of this. Even as they were prepping the patient for surgery and calling the anesthesiologist to wake him up they were saying, We’re just getting things ready for Dr. Swenson so she can walk right in. Marina should have called another doctor but she never even thought of it. She had stretched the time out too far trying to cover herself. If she hadn’t waited so long, if she hadn’t waited until everything was crashing and there was no other choice but to go ahead, she would have taken more time.