Human Remains Read online

  "No!" Joan called, gripping the metal edge of the shower door. "Joan, unlock the door for him. Please! Pull down your skirt. I'll follow you with the twins." Her babies' need for survival trumped her modesty.

  "No, no, no, NO!"

  "Joan, unlock the door!" I bellowed, as I pumped on her second baby's chest. "He can breathe for this baby! He can check on the first baby!"

  Joan tried to drag her skirt back over her thighs. But even as she did so, blood squirted out of her vagina, swiftly followed by the brown-red mass of placenta.

  Which meant that she was no longer providing oxygen to this baby, but we were also no longer tied to Joan. I could let Ryan in.

  I scrambled to my feet. The floor was slippery with fluid. My feet skidded, but I managed to scoop up both babies and use my quads to push myself up without squishing either twin. At least all the liquid decreased the coefficient of friction as I carefully towed the placenta across the floor by the umbilical cords.

  Joan lifted Might I out of my hand. I hesitated, but I didn't fight her. I needed a hand free.

  I unlocked the door, breathing through my mouth. "I need two breaths."

  I wanted out of this bloody hellhole. I wanted to put Might II on a clean, flat surface, like the dining room table, instead of cupping her in both my hands, but I'd start with the breaths.

  Ryan managed to press the door open two inches while I belatedly backed out of his way. His eyes widened at my Carrie-like appearance before his gaze shifted behind me.

  My elbow bumped into something soft.

  Joan. She'd squeezed between the sink and the door. She was no longer holding her first baby.

  I started to yell before I spotted the bundle of Might I, complete with a bloody umbilical stump, in the sink. A pair of used nail scissors rested on the counter. While I goggled, Joan reached for her second twin.

  "Don't!"

  My hands clutched Might II, but my hindbrain realized that Joan wasn't snatching her baby away. Her deep brown hands aimed for Might II's head, tilting the chin upward while pushing the forehead down.

  Joan opened her mouth over the baby's nose and mouth and exhaled once.

  The baby lay nestled in my two hands as she did mouth to mouth.

  She was saving her own baby's life, calmer than I'd ever seen a woman who'd just given birth, let alone given birth to premature twins, after the death of her husband. She was tough.

  "Now stop. I'm going to do compressions." I moved Might II to the floor towel, which was bloody and askew but better than nothing. I encircled her teensy chest and started pumping.

  "Hope." Ryan's voice. I had my back to the door, but I knew he was trying to reach us.

  I heard Joan hip-check the wood. "No, Mister Ryan."

  "Joan, I can't run two codes!" I yelled, while the 911 operator burbled in the background.

  Ryan started to answer the operator, which gave Joan the edge to slam the door and lock it on him.

  "No! I need more breaths!" Joan ignored me, bending over the baby in the sink.

  I gave the breaths myself. Might II's skin was already cold. I could see her tiny chest move with my exhalation.

  I could pop her lung if I wasn't careful. I was probably breathing too hard out of stress. Premies have very stiff lungs. That's why we try to delay delivery as long as possible and give them steroids before they're born.

  I touched Might II's brachial artery. No pulse. I restarted compressions.

  But this baby had never taken a breath. I'd never felt her heart beat. She might have died in utero.

  Might I was more crucial now.

  If I had to choose, I chose Might I.

  It sounds horrible, but that's triage. It's the battlefield. The first twin, the stronger twin, the one with the heartbeat and working lungs— that was the one I'd have to focus on. She had microcephaly, but at least that wasn't DEADoceaphaly.

  Joan lifted Might I from the sink and held her firstborn to her chest. I couldn't see anything from down on the ground. "Is she breathing?"

  Joan didn't answer me.

  "Is she BREATHING?"

  Chapter 30

  No response, except that Joan bundled Might I so tightly, she might smother her.

  "Joan! Let me see!"

  I craned my neck, keeping up the compressions on Might II, but my attention was laser-focused on Might I.

  "Ryan! I need you."

  The door shook, with some squeaking noises, and then it thrust open. Ryan tossed a disposable pie plate in the garbage—he'd folded it and used it to finagle the lock—while talking on the phone. "Up the stairs. The elevator's really slow. Unless you're going to have trouble with the stretcher." His voice died as he took in the full-blown scene: me doing CPR on Might II on the floor, surrounded by blood, amniotic fluid, umbilical cords, and placenta; Joan half-naked with her first twin.

  Points for not fainting.

  Joan screamed and tried to shield her nether regions with Might I. Her skirt covered most of her, but obviously not enough.

  I called, "Ryan, please take over CPR here. I need Twin 1."

  He whipped his head away from Joan, closed his eyes, and swallowed. I could see his Adam's apple bob up and down. I was asking a lot of a civilian. Most of them couldn't even stay coherent on a 911 call.

  "Ryan, please."

  He looked at me with those dark eyes, the ones that made me melt, the ones that made me scream, the ones that made me swear to be a better person. His face was wooden.

  Maybe he couldn't deal. The blood alone would send most people screaming into the hallway.

  Ryan set his still-squawking phone on the sink ledge and dropped to the ground on his knees, ready to do CPR on Might II.

  Tears stung my eyes.

  That's my man. He always comes through.

  I showed him how to landmark, and he started compressions. "After every six compressions, give two breaths." Not as good as 3:1, but better than before. "I'll be back to help."

  He didn't have gloves. He'd never done CPR on a human before, let alone on a premature newborn, but I had to get to Might I.

  "Joan, if she's not breathing, she needs mouth to mouth and CPR. She's the one who's more likely to—" Live, I almost said, and caught myself in time—"benefit."

  Ryan said, after giving a breath to Might II, "Please, Mrs. Acayo. Immaculate Joan." He said her name beautifully, like music. Ryan sings in his church choir. "'The whole creation groans'"—breath, breath—"'and suffers the pains'"—breath, breath—"'of childbirth together.'"

  He was quoting, probably from the Bible. Even though he was a guy who'd never seen childbirth, he emitted a calm energy.

  Me, screaming and pounding on the baby's chest and calling out orders—that was technically correct, and I knew how to save a baby's life better than anyone here, but Ryan was reaching her heart.

  She lowered Might I toward him. I intercepted her.

  Joan's legs buckled, and Ryan lunged toward her, temporarily abandoning Might II so that he could lower Joan on the toilet.

  Meanwhile, I stared at Might I. Who was not breathing.

  Her face was frozen in place.

  When I pulled back the towel, her little chest wasn't moving.

  "Shit," I said, and I was on my knees, laying Might I on the ground. I was giving a breath, because this was a respiratory arrest, God damn it. If we could get any air in her, her heart should start beating again.

  Might I's skin was warmer than her sister's. Only by a few degrees, but I'd take it.

  Baby, breeeeeeeeeeathe.

  Breeeeeeeeeeathe.

  When I put my fingers to her arm, I cried out. "I can feel her heart!" She had a pulse.

  A slight, slow one, compared to the usual newborn pulse, but she had one.

  Joan made a noise deep in her throat.

  I ignored it. I had to count. If the heart rate was under 60 beats per minute, I'd start CPR.

  It took me a moment to find the second hand on my watch, I was so messed up. B
ut then I had it, faster than one per second.

  Ryan got on his knees beside me, struggling to find the pulse in his twin.

  I told him, "Start CPR!" I was not optimistic about his twin.

  I counted the beats on Might I. Eighty beats. Not great—almost two thirds normal—but not needing chest compressions. Just breaths.

  I concentrated on Might I. On lifting her head up gently. On covering her nose and mouth when I gave her two more breaths.

  The 911 operator was calling out in a tinny voice from the speaker on Ryan's abandoned phone. I called, in case she could hear me, "Twin 1 has a pulse again."

  I gave three more breaths, and then I thought I felt Might I move. She was with us.

  Someone hammered on the door. The paramedics had arrived. Now we could do proper neonatal resuscitation.

  And then I'd go to the hospital myself. Not only to accompany the Acayo family, but to register as a patient and request two tests on me:

  1. Zisa.

  2. Pregnancy.

  Chapter 31

  WEDNESDAY

  I tiptoed into Joan's hospital room after dawn.

  She lay alone in her bed. No babies, and her roommate's bed was empty.

  My throat tightened. I blinked.

  Joan curled on her side, toward the dim light shining through the white horizontal slats. I was glad that she'd gotten a room with a window.

  She was breathing so quietly, I couldn't hear her, but her chest rose and fell. Under her thin, white blanket, I could tell that her belly was smaller today. Vacant.

  My eyes stung, and not only because I hadn't slept all night.

  My mother had given me a square wicker basket full of apples and oranges. I placed it as quietly as possible on the bedside table, nudging aside a black laptop to make room. Joan might not feel like eating, but Mom had insisted that the nurses "and maybe even the doctors!" would appreciate it.

  I spun toward the door. My boot heel squeaked on the tile, and Joan's sleep-roughened voice said, "Doctor Hope."

  I faced her, agonized. "I'm so sorry, Joan."

  She held out her arms. She enveloped me in her warm, spicy scent and kissed my forehead. "You did your best, Doctor Hope. You and Ryan, that fine man of yours. I can never thank you enough."

  "But your babies—" Might I was in the NICU, and Might II …

  "I know." Her eyes glimmered with tears, but she didn't allow them to fall. "My littlest girl is with God now. I'm going to call her Hope."

  I started. It was an honour, and yet a creepy one. I tried to look appreciative.

  "You can help me name my big girl."

  Her "big girl's" eyes flared in my brain. I remembered Might I's miniature body, the skin so thin that it was transparent, showing the red tissue underneath. I remembered the feel of her learning to breathe again. The odds were never in her favour, but this girl was a fighter. Like her mother.

  "Do you have to go to work now, Dr. Hope?"

  She looked so lonely, I lied, "Oh, I can stay a bit." I perched on the edge of a chair at her beside. There weren't any decorations in her room, only a bed, white walls, and this padded cream vinyl chair for visitors.

  "Thank you. I would normally be surrounded by family at home, but the flights are too expensive, and … " She hesitated while I nodded vigorously. I wouldn't spend money on a plane ticket as a pregnant wife of an academic with no funding. She added, "Lawrence was worried about infection."

  Might II's small, still face replayed in my mind. I squeezed my eyes shut. "Of course. Everyone is worried about Zisa nowadays."

  "Not only Zisa, Doctor Hope. His father told him about a truck driver from Burundi who was vomiting blood and bleeding from his mouth and nose—"

  My entire body seized up. "Ebola? But that was only in Liberia and Sierra Leone, right?" I don't know much about African geography, but I do know that we managed to contain Ebola's attack on West Africa. Uganda's on the east side.

  Joan clucked her tongue. "No, not Ebola. Everyone thought he had Marburg, and they were afraid of touching him. Even the ambulance drivers did not want to take him. They said they didn't have the proper protective equipment. The truck driver was trying to walk, but he was so weak, he had to stop by the side of the road because he had diarrhea as well as vomiting."

  Wow. I kind of didn't want to know that. I suppose it was written across my face, so she added, "They did get him to hospital eventually. He had Rift Valley disease."

  Hemorrhagic fever is so rare in Canada, all I knew was a) Ebola, and b) Marburg. I'd never heard of Rift Valley disease before Stephen Weaver's poster, but now I couldn't get away from it. I know it's a psychological coincidence that you can stumble across something obscure and end up seeing it everywhere. I even know the name for it, the Baader-Meinhof Phenomenon. Still, what were the chances that the Acayos came from a region that was attacked by the same virus Stephen Weaver was studying?

  On the other hand, Zisa came from Uganda, too, and I wouldn't blame Lawrence for Zisa. Mother Africa contained a motherlode of diseases.

  I tried to stick to the facts. "Doesn't Rift Valley usually affect animals and get spread through mosquitoes? Dr. Stephen Weaver has a picture on his wall, so I looked it up."

  Joan closed her sunken eyes for a moment. "Yes, Rift Valley disease is mostly a disease of animals. Most people who get infected don't get very sick, but Lawrence said that one percent of them get hemorrhagic fever. They start bleeding everywhere. Not only do they have bloody vomit and stool, but blood comes out of their gums, their noses, their skin, and their injection sites."

  Eesh. I couldn't recall how we'd gotten on to this cheerful topic, but it reminded me how little I knew about medicine. Rift Valley disease sounded like a weird combination of Zisa (spread by mosquitoes, and most people don't even know they have the infection because it's so mild) and Ebola (epic exsanguination that only a vampire could love).

  "Lawrence's father knows three men who went blind from this disease during the last epidemic. Another little girl started seizing in church. They had to carry her out. The virus had affected her brain. She survived, but she still has trouble talking, and she walks with a limp."

  "That's horrible!" A fresh surge of guilt welled up in my chest. I should be on the front lines, fighting pathogens, instead of cowering in a lab. Then I caught myself. You combat disease in a lab, too, perhaps even more effectively, because you attack it at its source. "Well, at least Stephen Weaver is working hard on Rift Valley disease."

  Joan pressed her hand against her post-partum belly. The extra flesh folded in over her hand. "Yes. I am grateful for that. He spoke to me and Lawrence about it, although I explained that I'd never seen a case. You know, Doctor Hope, I didn't agree with Lawrence about staying in Canada. I wanted to see my parents and my brothers and sisters. That truck driver was in Kabale, about 200 miles from the capital city of Kampala. The farmers, the herders, and the veterinarians who handle the animals are infected before the city people. It was unlikely that I'd get the disease. Lawrence was adamant that I shouldn't take the risk. He said, 'You can't tame a mosquito. I'm waiting for the first report of Rift Valley disease from Kampala. I don't want it to be you.'"

  "That's a good point." I'd always wanted to go to Africa, but I can't say this was making me book my first ticket.

  She crossed her arms over her breasts, which seemed swollen under her hospital gown, although I tried not to look. First I noticed Summer's bosom, and now Joan's. Probably that wasn't what Anne of Green Gables meant when she talked about "bosom friends." Joan said, "Lawrence was very protective of me. He didn't trust the government. He said the first case was officially diagnosed on the fourth of March, and the government sent a rapid response team that included six students from the Health Club at the university. Lawrence understood why they were sending them. They would be young and eager, and we would need as many people as possible, but to send young people with almost no training into an epidemic … "

  "Are they okay?" I had a
mental image of six students charging into the fray, wearing lab coats and gas masks, only to be carried out in coffins.

  She nodded. "Lawrence was keeping in touch with them. He even helped one of them publish a blog about his experiences on a health care network site."

  "That was good of him." I smiled.

  "He was a good man." She took a deep breath and covered her eyes for a moment, but when she lifted her hands away, she still didn't cry. "My girls wanted to come meet him. That's why they came early. They didn't want to miss him. They want justice, like their mother."

  Weirder and weirder. "Um, I don't know if babies or fetuses can decide—"

  She kept talking over me. "One of the women from my church came to visit me. She asked if she could bring me anything, and I said yes, Lawrence's laptop." She pointed to the black case beside the fruit basket. "I didn't trust anyone else to go through it, Doctor Hope. Only you."

  I swallowed. I both did and I didn't want to pry through his computer. "Why don't you do it yourself, Joan? You're his wife. You knew him the best."

  She closed her eyes and shook her head. After a moment, she said, "I'm afraid."

  She had never struck me as fearful. Not when she was crashing the lab meeting in the wake of her husband's death. And certainly not when she was delivering and saving two premature babies. She was one of the strongest women I'd ever met. I licked my lips. "What are you afraid of ?"

  "I'm afraid of what I might find. Perhaps we could do it together."

  "Okay," I said. This was a lot easier than trying to resuscitate twins. "I can stay for ten more minutes. Let me text one of my colleagues." I chose Summer, for obvious reasons.

  I'm at OHSC with Joan Acayo. She delivered twins last night, and one of them died. I'll be at the lab soon, but please tell Tom not to worry. I can stay late tonight.

  She answered right away: OMG! Take your time. Take the day off.

  Meanwhile, Joan had booted up the laptop.

  I opened his Internet browser and clicked on History, which offered me an option for recently-closed windows. Amongst the boring scientific stuff, I found a motherlode of site listings.

  free-white-girl-porn videos