Paying in Time

By

The bed wouldn’t stop moving. I would just start to drift off when it would wheeze into action, the bottom lowering down, the top rising. I tried to pretend like it was something nice and relaxing, like an undulating cloud underneath me, but it wasn’t. The movement itself soon became less annoying than the fact that I was always tensely anticipating it, trying to count the seconds until it would move again. My panic grew with each hour that I didn’t sleep. My tightly swaddled newborn was sleeping soundly, and I knew that wouldn’t last much longer. But I still couldn’t sleep. I finally asked a nurse “Can this bed stop moving?” “No, no, it needs to do that,” she said. “Blood clots.”

I had made choices that brought me here, to this moving bed. I had chosen to work a part-time job without health insurance, in order to have time to write. I paid $600 a month (after subsidies) for insurance through New York’s health exchange plan. I was not poor enough for cheaper insurance, nor employed enough for real insurance. By the time I realized that insurance purchased through the state’s health exchange is only taken at city hospitals, I was pregnant and needed prenatal care and it was too late to unwind any of those choices.

And so I found myself at a hospital where, because they knew you didn’t have money, you paid instead in time.

 

“Just go pee in this cup,” the woman at the front desk said when I went in for my first appointment.

“Oh, I know I’m pregnant.”

“Doesn’t matter—you have to start at the start.”

I peed in a cup.

An hour and a half later, a woman called me to a private room.

“So your pregnancy test was positive,” she said. I nodded. I knew that already. “And do you want keep the pregnancy?” I did. I was getting somewhere. She took out a little manual machine and stamped a plastic card with raised letters, spelling my name and birth date. “Don’t lose this,” she said.

I sat in the waiting room for three more hours. Every half hour, two men would come around, pushing a cart with snacks for purchase. “Water, tea, chips, sandwiches,” they intoned. I didn’t have any cash, and couldn’t figure out the logistics of getting it. It wouldn’t be worth it if I missed the next step on my journey. My empty stomach turned. Throwing up would be bad, too; if I was in the bathroom, I might miss the next step, and once you missed a step, it seemed like you went once more to the back of the line. Finally, I was taken to another room by a social worker, who asked a long list of questions: Was I experiencing domestic violence? No. HIV positive? No. Was someone using my immigration status to threaten and/or coerce me? No.

No, no, no. Nothing bad was happening to me. Nothing bad had ever happened to me.

A nurse came immediately into the room of sad questions to get me for the next part of the process without me having to return to the waiting room, a minor miracle. She said to the social worker questioning me: She speak English?

“Yes,” I said, startled. It was a question I’d never been asked, and would only hear asked about me within the walls of this hospital. It is the only place where I’ve been assumed to be something other than white.

Seven hours after I entered, I was able to leave the first prenatal appointment, carefully holding the most important slip of paper: the date and time of my next appointment.

 

I knew that slip of paper was important because I’d been a lawyer in Brooklyn Family Court. The hospital reminded me of family court: the waiting, the inefficiencies, the long lines of exhausted people. The fact that white faces were rare, and almost always belonged to people who worked there. And, the appointment slips. If you didn’t bring your slip of paper back to family court—a tiny, unofficial-looking square with a handwritten date and time on it—you were likely to get a court officer who would shrug, tell you he didn’t know if the judge would have time. Only the most diligent would get seen.

I could be diligent. I could follow the rules. I could get an A in prenatal care. I stored my appointment slips and hospital ID card carefully. At my next appointments, I was never even one minute late, which often meant arriving at the building an hour before the appointment time in order to stand in the long, winding line for the elevator.

I had seen a young Black couple at one of my appointments where the father had tried to come in the room and been shooed away. “We just see her,” the nurse had said. They’d looked startled, but he’d turned without protest to sit in the waiting room chair.

But the ultrasound—surely that would be different.

It wasn’t. The nurse told Colin, my husband, “You sit out here,” before taking me back. We were having a girl. There were thirty minutes where I knew that, but he didn’t. They came and got him at the very end, moving the wand over my stomach to show him a few brief glimpses of her ghostly image on the screen.

Later that day I called a friend, a nurse in Seattle, to tell her that we knew it was a girl. I mentioned, casually, that Colin hadn’t been there. “They told him to sit outside?” she said, outraged and baffled.

“Yeah. I mean…” I trailed off. I never know what is just substandard and what is outrageous when it comes to healthcare practices. I wasn’t going to find a job with health insurance now, halfway through my pregnancy.

My due date came and passed uneventfully. I was supposed to go in every other day for ultrasounds to check my amniotic fluid. At each one, after hours of waiting, they’d do an ultrasound and proclaim that all looked well, and then give me the slip to come back the day after next. My days off from the appointments felt like such a blessing. I was so big, and the waiting room chairs were so small.

Ten days out from my due date, the nurse said, cheerfully, “Well, you can’t stay pregnant forever.” And she gave me the slip—a full-size, 8 x 11 inch sheet of paper that said across the top: Appointment for an Induction. September 6, 10 a.m.

Then, I lost that sheet of paper.

 

I still don’t know where it went. I expected, for a long time, to find it one day in a forgotten folder, or slipped under the couch. On the night of September 5, I still hadn’t felt a single contraction, and I was tearing the house apart looking for it.

“It’s not like they’re not going to let you give birth because you didn’t find the paper,” my husband said, baffled at my panic.

“No,” I said. “But they’ll make me wait.”

They did. We arrived at 10 a.m.— exactly on time—but the process of finding my records to see if I really was, as I claimed, forty-one and a half weeks pregnant, took hours. A non-emergency patient without a slip of paper was the lowest priority.

When the induction finally started, it, too, happened in fits and starts. They gave me a dose of pills to start contractions. The contractions started. But no one ever came to give me the second dose. The contractions petered out, meaning the process had to start over again. Start at the start.

That whole long night, with contractions too infrequent to feel like they were getting anything done, but too regular to sleep well, the Regina Spektor song that plays at the start of Orange Is the New Black went through my head: and you’ve got… ti—iiii—ime. I stared at the white ceiling, and thought about that song.

The next morning, I heard the word I’d expected to hear: “Pitocin.” And I said back the word “epidural.” I knew, particularly in Brooklyn, this was not the “right” way to give birth. Pitocin was an enemy, and staff who wanted to get your baby out quickly were worse. I did not actually feel this way, though. I wanted to get it done.

In exactly one way, I need to give the hospital credit: the epidural arrived right away, probably only twenty minutes after I’d requested it. I don’t know why. It was twenty-four hours after I’d first entered the hospital, but still. Before the epidural kicked in, I felt less like a human and more like a sweaty piece of meat, tortured by ineffective contractions. As soon as the medicine  hit, I felt calm, cool, euphoric. I got an hour of sleep. I also had a very diligent nurse who would appear at my bed unbidden and craaaaank the pitocin level up, and who checked on me without fail every twenty minutes or so—a level of attentiveness that made me desperately grateful. I could see, but not feel, the contractions growing bigger on the piece of paper. I’m sure my daughter would have been born on a later date without her efforts. She would be the villain of many people’s birth stories, but she is the hero of mine.

 

Most birth stories end with the baby being put on the mother’s chest right away. Instead, my husband held her for an hour in the corner while I got stitched up very slowly. I was too out of it, feeling both like I was floating and underwater, to say anything. I remember feeling desperate to see our baby and hold her, but I was just too tired to talk. By the time she was handed to me, her initial wakefulness had passed, and she was asleep.

Then, after we’d made a few calls to family and been transferred to a tiny postpartum recovery room divided with a curtain, they told my husband it was time to leave.

Leave? Our plan had been to have him do the first night of parenting while I passed out, exhausted from my long, meandering induction. “I was going to… stay?” he said. One sympathetic nurse tried to get approval from some higher-up to let him stay. She returned, shaking her head. He would not be allowed.

Something broke in me then. I couldn’t stop crying. All the things I’d been able to do before I’d given birth—maneuver, be diligent, follow the rules, put in the time—seemed impossible now. I remember a physical sensation of crashing, like I could actually feel my hormone levels falling.

“Are these tears of joy?” one concerned young resident asked me.

“No… I just didn’t realize… didn’t realize… that he’d have to…” I couldn’t even get out the word “leave.”

“I can’t even stand,” I said to Colin, wide-eyed, after she’d left. That was true. I had just been helped to the bathroom by a nurse, where I’d tried not to look at the soaked pads of blood. I was going to be left alone to care for our infant, when I could not care for myself.

I don’t remember seeing anyone else after the nurse who’d said that the bed couldn’t stop moving. An alarm started blaring in my head: I need to get out I need to get out I need to get out. The lack of sleep, the long birth, the slow hours, the awfulness of this place: a place built to serve only the poor, in a city that hates its poor. A place no one would ever choose to be. The contempt the place exuded for the people inside it felt physical, hanging in the air like humidity.

Gingerly, I got out of bed around 3 a.m. and pulled off the flowered hospital gown, which I’d sweated through, and rummaged around the bag to pull on leggings and a maternity shirt. If I couldn’t get out, I could at least wear clothes that didn’t mark me as being inside this place.

 

When the morning finally came, there was something to do: a mandatory parenting class. A sign posted above my bed told me that I wouldn’t be discharged without attending this class. Discharge was my focus, my salvation. I was sweating through the shirt and leggings that I’d changed into, a cold sweat from both exhaustion and fear. I arrived at the classroom early, sweaty, and crazed, my newborn next to me in a wheeled bassinet. Every other woman who walked in was wearing the regulation gown and brown non-slip socks. “Are you the teacher?” one asked me. “No, no,” I said with a little laugh, gesturing at my baby. “I’m…” I didn’t finish the sentence with any one of the phrases: “just like you.” Or “one of you.” I was the only white woman in the room. I also seemed to be the only woman who was completely losing it.

Stilted actors in videos told us to not put pillows in our baby’s cribs, to not shake our babies, to breastfeed our babies. Whenever I mention this class to someone who did not give birth in a city hospital, they are surprised. Oh, they say. We didn’t have that! As if it’s a coincidence, something their hospital overlooked. It doesn’t occur to them that only a place that serves poor, BIPOC patients would have a mandatory class implying that its patients are too stupid to parent.

I wanted to comply, still, with what I was being told to do. Compliance was my only tool, my survival skill. I would make the nurses like me, and therefore I would get more help.

But the nurses had been clearly given a mandate to push the importance of breastfeeding, and breastfeeding wasn’t going well. My daughter arched her back away from me and screamed when I tried to feed her. Nurses spoke to me sharply, like I was a misbehaving child. Colin managed to wheedle a bottle of formula out of one of the kinder ones before he again was kicked out for the next night. My daughter took two ounces of the formula happily, before drifting off in my arms.

And then, having been awake for nearly forty hours, I hid the rest of the bottle under the bed.

I knew that wasn’t allowed. I knew that formula went bad if it was left unrefrigerated. I’d been stripped down to an animal trying to hoard food for its young. Without Colin, I didn’t know if I could get any more formula, and without formula, I couldn’t stop my baby from crying.

I’m embarrassed about how quickly I got to this state of mind, beyond reason or thought. The inside of my own brain felt the way I imagined people felt after weeks of torture or months of solitary confinement, not after just a day and a half. Why hadn’t I just asked Colin to pick up some formula and bring it back in the morning? Why hadn’t I just said something like, “Sorry, that’s not working for me” when I’d been told that I had to keep trying to breastfeed my screaming, resisting baby? Why had I not, in all those hours, told a single person to go fuck themselves? All of these ideas seem obvious in retrospect, but none occurred to me then.

 

On the day we were supposed to leave, there were computer problems, and computer problems meant we couldn’t leave. I was too out of it to remember now whether it was three hours or five that we were kept in the room, Colin periodically poking his head out into the hall to try to spring us free.

In the months after I was there, I read everything I could find about the hospital. I felt vindicated as I read the complaint in a federal lawsuit, filed ten years before I’d given birth, calling the place “a chamber of filth, decay, indifference and danger.”

I read about women who had died there. Beverly Stevens, who died at age thirty-eight of complications from her ectopic pregnancy, after the hospital had missed it and sent her home. Yvonna Harvell, who had died, along with her baby, in 2015. Both Black women, who had tried to tell doctors and nurses that something was wrong, and who had been ignored.

I read the most about Esmin Green, a forty-nine-year-old woman who, after sitting for twenty-four hours in the psychiatric waiting room, collapsed and died from a blood clot that had formed in her leg. She’d been physically healthy. The length of the wait killed her. The place that made people pay for their care in time had made her pay for no help with all the time she had.

I wondered if the reason my bed had moved all night was because the hospital had responded to Green’s death with the idea that they needed to do more to prevent blood clots, and not that they needed to treat their patients like they were people.

In the months after I had my baby, I found myself in lots of conversations with college-educated white women about our births. Many of them, despite living within a few miles of the hospital I gave birth at, have never heard of it. “Oh, I don’t know that one!” they’ll say. In those moments, I will have a moment of strange gratitude that I went there, that I got some tiny inkling of what it would be like to live a life other than the one I have.

 

When we were finally allowed to leave the hospital, a jovial security guard checked our names, unlocked the large swinging doors and said “Congrats, guys! When are we going to see you again… a year, year and a half?”

I just stared at him. The doors slowly creaked open and we walked out into an early evening sunset, our daughter in her stroller. Unlike the other mothers there, I was able to walk out the doors of that hospital, and back into a world that would treat me like I matter.

***

Rumpus original art by Briana Finegan.


Sarah Jaffe is a freelance writer whose work has been published in Slate, Catapult, Bklyner, and Mutha Magazine. She also works as an attorney for children in foster care. She lives in Brooklyn with her husband and three-year-old daughter. More from this author →