Ellen answered her phone on the third ring. “Hi, how is it?” she said. She knew it was Gina without looking at the screen. Ellen would have picked up sooner, but she’d tossed her cell into her bottom desk drawer when she’d first arrived at the clinic at four in the morning, turning off the building’s security alarm and letting herself in hours before the workday technically started. She’d jumped at the ringing in the still-silent office and had to fish it back out. She could never sleep when Gina was out of town.
“I’m halfway between Belfast and Blue Hill,” Gina said. It was almost ten in the morning where she was. Her voice was tight. “The snow is coming down hard.”
Ellen could picture the road, and from the timbre of the other woman’s voice, she could picture Gina’s knuckles white on the steering wheel. She had a moment of vertigo-inducing doubling: she was sitting in a desk chair in a clinic in the city, but she could also so easily picture the swirl of snow. She thought, Get the fuck off the phone if it’s so bad, then, but she didn’t say that, because she could tell Gina was already freaking and didn’t need any more of that energy. Instead Ellen shut her eyes and tried to remember the exact turns in that stretch of the road, tried to will the snowflakes to be beautiful and not terrifying and to project that calm into her voice.
“How is the road itself?” Ellen asked. “Is it icy? Is the snow sticking?”
“No. The road isn’t that bad, actually, I’m just going very, very slowly because it’s so hard to see.”
“Can you follow a plow or a truck?”
“There’s no one else out here,” Gina said. She really did sound terrible.
“Okay. Well, at least the road is okay. And you’re driving towards the coast, towards towns with more money, which means the road is going to get better, better built and better maintained.” Ellen was just making stuff up, but she knew that was what Gina called her for. Ellen was the kind of person who you called when you needed someone to make stuff up that would make you feel better.
“Right. Good. Okay,” Gina said. Then she started to talk about everything else that was scaring her. The snow, but more than that, the entire homebirth that Sarah-Beth and Leslie had planned, the reason why she was driving to their hometown in the middle of January in the first place. The distance between their house and the closest hospital. The midwife’s two-wheel-drive car. The supplies that, she had just found out, midwives weren’t allowed to carry in Maine. “What kind of bullshit is that, anyway, that you aren’t allowed to carry Methergine outside of the hospital?” Gina said. “Do they think we’re going to start doing kitchen-counter abortions with it? What if there’s a postpartum hemorrhage? And what if Sarah-Beth needs an emergency C-section but we can’t get to the hospital because of the snow?”
“It’ll be okay,” Ellen said, though her own stomach was knotting with every sentence. “Don’t panic about stuff that hasn’t happened yet. These are the things you’re always scared about with every birth. And most of the time everything is totally fine, would be fine even if no one was there at all. You’ve been the doula for plenty of home births. What’s the difference this time? Just the snow. Just that one thing. Nothing else has gotten more dangerous. Plus Sarah-Beth is a midwife. Not that she’ll be able to help in her own birth, but she knows what she’s doing, risk-wise. She’s making her own choices.”
“You’re right. Okay,” she said. Through the phone line Ellen could hear Gina breathe in, and back out. When she spoke next her tone had shifted to one with increased clarity and a slightly lower pitch. She wasn’t venting any more. She was managing. “You’re doing seizure watch tonight, right? Last night was Michael?”
“Yup. We’ve got it.”
“Okay. Thank you. I’m going to focus on driving now.”
“Good,” Ellen said. “I love you.”
“Love you too.” She hung up.
Ellen kept the phone to her ear for another moment, trying to keep manifesting her mental image of calm: snow falling but not sticking yet, the tires of the rental car catching the pavement nice and easy. She’d wanted to say, Text me when you get there. But Gina was going to two other women who needed her, who would be expecting her, who would know to call someone if she didn’t make it in time.
Ellen tucked the phone back into her desk drawer, but then felt like it was too far away, so she shoved it into the top of her boot.
She busied herself with the stack of patient records on her desk. She’d just cleaned out the paper box a day or two ago; how was it so full again? She signed papers without reading them, forms for physical therapy, forms for approving diabetic supplies, lancets and test strips, continue with current standing orders, sign sign sign, fax. Then she pulled out the records she’d requested and now should really read, stacks of medical histories too thick for binder clips, held together loosely with oversized rubber bands instead. A patient who told her he had no medical problems had, per his previous doctor, had a stent placed two years earlier. What was so wrong with all of them, her, the patients, the systems, that this was how she found that out, by wading through paperwork after several months of being his medical provider? Did he think, after the stent was placed, That went well, I guess it’s better now, no need to tell my next provider about it? That it was no longer a “problem”? What was wrong with how she asked patients questions, anyway, with how she did—or in this case didn’t—examine them, that she hadn’t figured this out before now? She went through his previous lab results with a highlighter and a pen, his previous medications, formulations tried and failed, the field notes of the ongoing experiment that was Western medicine vs. Mr. Jones.
Her coworkers started coming in and saying good morning, and she was startled, both because she’d been alone in the clinic for hours, and because it was still, after all this time, technically morning. “Hey.” She swiveled her chair towards a colleague, held up the stack of papers. “Mr. Jones who swore he had no chronic medical problems had a stent and two myocardial infarctions.”
The coworker laughed. “Typical,” he said. “I mean, what’s a problem, really.”
“Right,” Ellen said. “I should put ‘Optimist’ on his chronic conditions list.”
Her phone buzzed and she jumped, grabbed it. It was a text from Gina’s husband Josh, confirming that Ellen was coming over for seizure watch that night. Ellen read the message, replied, then shoved the phone back into her boot.
The front doors of the community health center opened and from nine until noon she saw patients every fifteen minutes. Good morning, what can I do for you today, Good morning, what brings you in today, Hello, how have you been? Every time, she made a point to add, early on: I’m expecting an important phone call from a colleague, so I just want to apologize in advance if I have to step out. Gina was kind of a colleague, she thought. It was kind of work.
Another text buzzed in. I got here safely. Of course Gina texted her.
* * *
Gina’s husband Josh had seizures, but only in his sleep, his brain firing uncontrollably a few times every year as he switched between REM cycles. He couldn’t be alone at night as a result, so if Gina ever left town, someone had to be around Josh at night. Often, it was Ellen, who slept on their couch with a baby monitor, ready to give him meds if he seized. The fact that this only happened to Josh in his sleep was both a blessing and a curse. It meant he could still drive, but that napping was a hazard he could not afford. He had to be especially careful not to nod off on long plane rides, pinching himself or listening to bad loud music to stay awake.
“You’re like a shark,” Ellen said after he let her into the apartment that evening, “who can’t stop swimming, or it’ll die. Or like Tony Stark in Iron Man, whose arc reactor is simultaneously keeping him alive and slowly poisoning him with palladium.”
“Or just like a normal human being, whose pursuit of basic needs is a nightly act of biologic fulfillment, except on those few occasions when my own brain tries to kill me.”
“That’s dark.”
He shrugged. He was worried about Gina and the snow, too.
They ate takeout directly out of paper cartons on the coffee table. Josh and Ellen didn’t spend that much time together without Gina, but enough so that it wasn’t weird when they did. They read their books and Josh put on a series of records. He drank a beer, and Ellen used their kettle to make herself tea. Ellen wanted a beer, too, but she didn’t drink anymore when she was on seizure watch. She flipped through one of Gina’s science magazines. Self-destructive microbe species can commit ecological suicide, the headline read. Certain microbes make their environments unliveably toxic and wipe themselves out.
Relatable, Ellen thought.
Ellen never went back to their hometown anymore, but she was glad Gina did and brought back the news, glad that she, Ellen, could be with Josh and make it easier for Gina to go anywhere at all. Ellen wanted to hear about how Sarah-Beth was doing. She missed Sarah-Beth, and was excited for her even if she shared Gina’s homebirth nerves.
Sarah-Beth and her wife Leslie had always planned for Sarah-Beth to have a homebirth. The last time Ellen had seen Sarah-Beth, she’d just had her second miscarriage, and they’d been drinking the least festive margaritas Ellen had ever had, which was saying something. Sarah-Beth’s voice was bitter as she’d talked. “I’m a gold-star girl. Did you know that?” she’d said suddenly. “I’m thirty years old and I’ve never slept with a man. I thought my body would encounter sperm for the first time and boom, pregnant. But no. Or it does and then I can’t stay pregnant. I don’t understand.” She’d started crying.
Ellen had handed her a cocktail napkin. “Hey, hey,” she’d said. “I thought you wanted your margarita unsalted.”
Sarah-Beth had laughed through her tears. “I just want you to know, Ellen, that I’ve never thought you were an asshole. Don’t listen to what anyone else says. You’re just awkward as fuck.”
Who says I’m an asshole? Ellen thought but did not say.
That was two years ago, before Sarah-Beth had stopped talking to her, too.
Now Ellen set her book down on the couch next to her. A margarita sounded good, even an unsalted, sad one. Or any one of the beers that she had unwillingly counted in their fridge: four, on the bottom shelf in the back. She checked the weather report for back home. Snow was still coming down.
* * *
The one time Josh had a seizure while Ellen was staying over, it was one-thirty in the morning. Gina was away at a bachelorette party. Ellen had been drinking, and it took her longer than it should have to respond. She’d thought it would be okay to have a few drinks with Josh that evening. It wasn’t like she was at work. Then after he went to bed, she couldn’t sleep, so she got up and had a few more.
When Josh seized, she wasn’t sure if, or for how long, she’d been asleep. Didn’t know, at first, what she was hearing. She was on the floor, not the couch, when she became aware that something was happening, something outside of her own head. She was supposed to set a timer when he started to seize, but she forgot, and she had no idea how long the seizure—because it was a seizure, she knew that now—had been going on. Had she never turned on the monitor? She stumbled into their bedroom.
Gina had warned Ellen that the hardest part of taking care of Josh during a seizure was physically wrestling him into place in order to give him ten milligrams of diazepam. Ellen was strong, she could do that, fine. What she wasn’t prepared for was how violent it felt. Josh bleated and thrashed while Ellen pinned his legs down. This wasn’t a hospital bed with anonymous sheets and a railing that Ellen could operate with familiar, clinical remove. It was Gina and Josh’s apartment, their bed, with one of Gina’s dumb tapestries from college hanging on the wall. The room revolved around her and Ellen cried with her mouth open and she didn’t check the dosage until after she’d already administered it.
Josh stopped seizing as Ellen called 911. Then a minute later—that fast? she wasn’t sure, she had the spins—Ellen let six paramedics into the apartment.
Josh was surprisingly cogent. Gina had warned Ellen that he would be, warned her he’d seem totally fine and not to believe him. Josh’s postictal states, that period between the seizure subsiding and returning to his normal self, were famously misleading. Once he had insisted on buying a bunch of records right after a seizure and then, six hours later, had found the pile and asked what idiot had bought such bad records. The paramedics kept looking at Ellen, not Josh, and Ellen struggled to look sober while trying to explain the situation. “He has nocturnal epilepsy,” she said. “He had a seizure. I already gave him diazepam.”
“You’re his wife?”
“No, I’m a friend who stays over in case this happens—in case he has a seizure. I’m a nurse practitioner.”
“So you’re his nurse?” asked the same paramedic. He was the one in charge. Or maybe he was just the tallest. She thought there had been six of them, but suddenly she only saw five, and they were all staring at her.
“I’m his wife’s best friend,” Ellen said. “I stay here while she’s out of town in case he has a seizure. I’m also a nurse practitioner. I already gave him ten milligrams of diazepam.” She thought maybe she was repeating herself.
They turned to Josh. “Can you tell us your name, sir?”
“Joshua.”
“What month is it?”
“January.”
“Do you know what happened?”
“It does seem likely that I had a seizure. That’s usually why there are suddenly paramedics in my bedroom.”
“Who is this woman over here?”
“That’s Ellen.”
“Who is she?”
“She’s… she’s just Ellen.”
“Do you know why we’re here?”
Josh rolled his eyes in a way that was reassuringly Josh-like and not mid-seizure-like. “I supposed you’ve all come over to have a jam session. Let’s get out the amps,” he said.
The paramedics all looked at Ellen. “He’s very sarcastic,” she said. “That’s normal.”
“Josh-o, Joshy, Josh-y-oh, my man,” said one of the paramedics, and both Josh and Ellen winced. “Who’s the president?”
“Barack Obama.”
They were all quiet.
“Right?” Josh said.
“Josh,” Ellen said from the corner. “Prime numbers.”
“2, 3, 5, 7, 11, 13, 17.”
“Who’s the president?”
“Barack Obama.”
The paramedics shuffled. One of them turned to Ellen. “Ma’am, do you feel comfortable if we don’t transport him to the hospital and leave him here with you? You think he’s okay?”
“Yeah, that’s fine,” Ellen said. “I think he’s okay.” They picked up their gear and filed out of the apartment.
Ellen sat cross-legged at the bottom of the bed, a discrete distance away from where Josh leaned against the headboard. She wondered if it was an intrusion for her to be sitting on the bed at all. Maybe it was good that she was drunk.
“I didn’t bite my tongue that badly,” he said, moving his mouth experimentally. Then his face reassembled stubbornness. “Who’s the president?” he asked.
Ellen just looked at him.
“Look, I can tell I keep whiffing that question. Who is it?”
“I don’t think I’m supposed to tell you, I think I’m supposed to wait until it comes back to you to make sure your brain is doing everything right.”
“Come on. Just tell me.”
Outside, the streetlights shone against the blinds. “It’s Trump,” she said.
He looked at her, then flopped back against the pillows. “Fuck. Right. Well. That’s sobering.”
This was the thing that they laughed about, eventually, later. It was nowhere near morning yet. He’d never had a seizure this early in the night before, and Ellen wasn’t supposed to let him go back to sleep, but it was barely 2am., and she was so tired. Ellen kept him awake for an hour by asking him to explain how synthesizers worked. Then she let him go back to sleep.
He seized again within forty-five minutes. He bit his tongue badly that time, and blood poured over his face. Ellen gave him the only dose of diazepam that was left—was he even allowed to have two doses in one night? Had she done that math right?—and she called 911 again. This time Ellen told the paramedics that something was really wrong, that he never had two seizures in a single night, though of course, he’d never been allowed to go back to sleep after a seizure, either, though she didn’t say that part. She swept Josh and Gina’s entire medicine cabinet into her backpack, not trusting herself to read the labels, and followed them into the ambulance.
At the hospital, the nurses asked Josh again who the president was and checked his blood sugar for the fifth time. “Barack Obama,” Josh said. He looked sad. He could tell he was getting it wrong.
Ellen nodded off in the visitor’s chair next to Josh’s hospital bed while they monitored him. As she slowly sobered up, she got more horrified. Suddenly, she wasn’t sure: had he had two seizures, or three? She remembered how slow she’d been to rouse. How she hadn’t even been sure how many paramedics were in the room. She vomited in the medical waste bin in the corner of the hospital bay and the nurses had all glared at her and checked Josh’s blood alcohol level (normal) again.
Ellen couldn’t stop remembering the horrible sounds Josh had made while he was seizing, how it had felt, in the moment, like she was hurting him.
After Josh had been discharged from the hospital and Gina had come home, Ellen didn’t talk to them for three weeks, because she was pretty sure she had nearly killed Josh.
* * *
Now Ellen made it through the night with her herbal tea, but she barely slept. In the morning she moved around Gina and Josh’s apartment shakily. It was getting harder and harder to sleep on their couch, and she’d been up half of the night. She made coffee for her and Josh and pretended to be okay. She checked the weather again to see how the snowstorm back home was developing.
Two hours into her workday, between her 10:45 and 11am patients, Ellen got a text from Gina. Looks like I’m delivering a baby, she said. We’re snowed in, the midwife is snowed in, Sarah is 7 cm dilated and her water just broke. Ellen called her immediately, but Gina didn’t pick up and didn’t send any more texts.
Then Ellen had an idea that she immediately regretted, not because it was a bad idea, but because she didn’t want to do it, and having thought it, she really should do it. She picked up her phone and typed a name into the contacts with her thumb. Horribly, she had not deleted his number.
He picked up on the fourth ring. “Hello?”
“Hey, Matt,” she said. “It’s Ellen!”
There was a long pause.
“How’s it going?” Ellen said.
More silence. Then he said, “Are you in a program? On step nine? Are you step-nining me?”
She laughed. He didn’t. “No,” she said. “Um. Do you still live in Sedgewick? And do you still have a plow?”
There was silence on the other end of the line.
“I’m asking because Sarah-Beth is about to have a home birth in Blue Hill, not that far from you? And they’re snowed in? And so is their midwife? And maybe, you could plow them all out.”
Ellen’s medical assistant came around the corner and handed her a filled-out intake form. She mouthed room four at Ellen with large accompanying hand signals including four fingers and some okay signs before disappearing back into the main area of the clinic. When Matt spoke next his voice was flat. “You’re calling me because you want me to go out in a blizzard and plow people out as a favor.”
“Yep. That’s the long and short of it.” She laughed again but she was not really trying this time and it sounded awful.
“Text me the address,” he said. “But I’m not doing it for you. And you know, I felt better about this when I thought you were step-nining me.” He hung up.
Ellen took what she mentally thought of as three deep yoga breaths, which would be more helpful if she actually did yoga, then jumped up and down a few times like a human Etch A Sketch. She looked at the intake form her assistant had just handed her. Under “chief concern today” her next patient had written “anxiety.” Ellen texted Sarah-Beth’s address to Matt, then texted Gina to say he would be over to plow them out shortly. Then she went in to see her patient.
Ellen was just finishing her afternoon patients when her phone buzzed. It was Gina. The plow guy came and things have slowed down and the midwife says she’s coming.
Ellen wanted to ask her if the plow guy had gotten fat or if he mentioned whether or not he had a girlfriend, but she knew, she knew, this was not the time.
A few hours later Ellen texted, is there a baby yet?
No, no baby yet. In transition.
* * *
Ellen started going to meetings after the night Josh seized, but the meetings were for adult children of alcoholics. She didn’t talk about why she was really there. In the absence of actual stories about actual alcoholic parents, Ellen told stories that could have come from a patient report. Every time she showed up, strangers—a possible thing in this big city—introduced themselves, shook her hand, welcomed her, told her to keep coming back. “You’re lucky you started coming so young,” the older ones said, though already in her thirties, Ellen didn’t feel young.
“It’s just something I’ve been thinking about,” she’d say back. “You know, the patterns you get from your families of origin. I’m a healthcare worker. I’m here more as a preventive maintenance thing. I’m lucky that I’ve never had a problem myself, but I want to make sure I understand the role alcohol has played in my family and in my life.”
She didn’t tell them why she’d left home in the first place. She didn’t tell them that she sometimes had three, four, five drinks alone at night.
She didn’t tell them that she wasn’t even sure how many drinks she’d had the night she might not have heard her best friend’s husband have a seizure. She didn’t tell them that she’d been close to blacking out the time she injected him with benzodiazepines before even checking the dose.
* * *
Ellen stayed three hours late at work finishing her notes and when she finally walked outside it was dark already. She walked by a dive bar that she and Gina used to frequent, back when they first moved to this city, before Gina and Josh got married, before Ellen had passed her boards. Ellen had been burning her bridges slower then. She hadn’t yet gotten to what Sarah-Beth, when they were still talking, referred to as her ramming speed. She hadn’t wrecked her mother’s car yet. Hadn’t hooked up with Matt’s brother over that same bad New Year’s back home. Everyone makes mistakes, Gina said. Besides, you’ve never hurt me, and I judge people by how they are with me, not by what other people say about them. Gina trusted her. Ellen looked through the bar window and chewed her right pinky nail hard enough that she could taste blood from the cuticle. Ellen had been telling herself for a while, now, that she could stop drinking without anyone knowing. She was a grown woman. A healthcare professional. Just today, she’d had three office visits with patients she’d counseled on their substance use. Motivational interviewing. Stages of change. She was willing to do the work as long as no one had to know. She turned away from the window and kept walking, quickly, to Gina and Josh’s apartment.
At three in the morning that night, having finally dozed off with the help of melatonin gummies and still more herbal tea, Ellen jerked awake. She was on her feet, every startle response engaged, her heart pounding. But no, it wasn’t Josh, it wasn’t a seizure, it was only her phone that had made a sound. She’d gotten a text from Gina: a picture of Sarah-Beth, Leslie, and a new baby. Everyone looked whole and tiredly happy. Slowly, Ellen sank back down onto the couch. HURRAY, she texted back. The thing was done and everyone looked okay.
But it hadn’t been okay. Gina would tell her, later, how it went. She would tell her that the midwife arrived late, just twenty minutes before Sarah-Beth delivered, and that the midwife’s assistant never made it at all. That Sarah-Beth had a separation of the placenta and lost a liter of blood while the midwife pounded her abdomen with her fist, trying to get her uterus to contract without Methergine. That Gina had to resuscitate the baby.
Gina would tell Ellen all this later while they stared at each other from opposite ends of her kitchen table. Ellen would tell Gina that she had done everything right.
“Be careful,” Gina would say, taking even but shallow breaths as she laid out the story, methodically and removed, like someone marking out lengths of rope. “I will cry if you are too nice to me right now.”
After, when the baby was breathing and Sarah-Beth was no longer bleeding out and it had been determined that everyone was going to survive, Gina had fished the clots out of the tub and carried twenty gallons of bloody water into the woods. Then she had done three loads of laundry.
“There was a moment,” Gina would tell Ellen several days from now. “When I was bagging the baby, trying to give her enough air but trying also not to overinflate her lungs. I was so tired, and I just thought, I would rather be anywhere but here. I wasn’t scared any more. I was done, and I was gone. And I didn’t stop bagging the baby, but you could tell. And when I looked up, Sarah-Beth was looking right at me, and I knew she’d seen, that at the worst moment, I had left them.”
And when Gina tells Ellen this, two days from now, Ellen will start to say, That’s crazy. Ellen will start to say, She was bleeding out after twelve hours of labor in a blizzard and you had a neonatal resuscitation mask on her newborn; I’m absolutely sure she didn’t see into your quote-unquote seditious soul and judge you for it. Ellen will start to say, Sure, but you were still doing all of the things. You did everything right. Hell, they let you give the baby her middle name! But she wouldn’t say this, because it wouldn’t really matter. It wouldn’t really matter, and they both would know it. What would matter was Gina’s story, her shaken belief in herself, and the way in which that doubt had already calcified in her brain.
But that night, knowing only that the baby had been born, holding her phone in her hand with the photo still open, Ellen didn’t know any of this yet. She looked at the picture of the two exhausted mothers and the new baby, waiting for her heart rate to slow back down again. She thought about Matt, disappointed that she was not calling to make amends. About Josh, on the other side of the wall from her, courting death in his respite from the conscious mind. About Sarah-Beth, a midwife, who knew full well what birth entailed, struggling so hard to get pregnant anyway, like an engineer stepping in front of her own train. And she thought about what she, Ellen, would do next. That maybe this time she would finally tell Gina the truth when she got home, the truth about the problem Ellen was starting to understand that she had, even if that meant Gina would stop trusting her.
Margaret Adams’s writing has appeared in over two dozen publications, including The Best Small Fictions 2019, Threepenny Review, Joyland Magazine, and The Pinch Journal. She lives in Vermont.