Even the Darkest Night

Chapter 1

The Dark at the End of the Tunnel

Our anesthesiologist, Dr. Oana Maties, probably didn’t know why she dreamed of death the night before our twins were born. Nor, wisely, did she tell us beforehand. But there was something in the way she lingered a beat too long on the one small part of her consent paperwork—Lindsey’s consent to receive donated blood. Maybe that didn’t reach my consciousness, at least not right away, but it set off a subtle alarm bell, an annoyance almost. Geez, I thought, I’ve done anesthesia for hundreds of cesarean sections and never focused on blood this much.

As an academic anesthesiologist and intensive care physician, a physician who takes care of patients in the operating rooms and Intensive Care Unit at the University of California, San Francisco (UCSF), I’ve had versions of that talk with my own patients thousands of times. The thick stack of preoperative paperwork had become second nature to me in my own practice. Her perseveration was subtle, but unmistakable all the same. The paperwork was completed in a matter of minutes, but what lingered was my colleague’s pause as she hovered over that medical release, the soft catch of concern in her voice, the undercurrent of foreboding.

A premonition of death is a very unusual thing for any doctor to admit, let alone an anesthesiologist at an elite academic university. It’s squishy. Imprecise. Inconvenient. Unquantifiable against the backdrop of science that underpins our practice. Our belief in the knowable, the provable, the demonstrable is kind of a funny crutch that we use, an object of faith that allows us to do the things we do to patients, the risks we take. She couldn’t have known this routine operation would be complicated; that my wife, Lindsey, would nearly die, bleeding so much and so quickly that her body would go into shock, not able to support enough blood pressure to remain conscious. None of us knew. And yet Dr. Maties paused there.

Lindsey had had a textbook pregnancy, which is very surprising because she was thirty-nine years old and carrying twins that were conceived via IVF after five and a half years of seeing countless doctors and specialists. The chances of her having a normal pregnancy after IVF was only about 20 percent, and that was for a singleton, not twins; plus, after all the failed cycles we’d had, who knew? In fact, her own obstetrician was scanning her chart toward the end of her pregnancy, asking what exactly the problem had been for those five and a half years when we couldn’t conceive. As a fellow physician, I knew she wasn’t so much asking what the diagnosis was (as with the majority of infertility cases, our formal diagnosis was “unexplained subfertility,” and we would never have a clear answer about what was actually “wrong”); rather, it was a rare moment of candor in which she was essentially saying out loud, I can’t believe you are this far along without any complications.

Lindsey ended up carrying our twins to almost forty weeks. Thirty-six weeks is considered to be full term for twins; by thirty weeks, doctors usually induce birth. But the twins’ conception was so heavily medicalized, her pregnancy was so filled with tests, procedures, and ultrasounds, that I am sure a part of her wanted the birth to be less like that. By the time we went to the hospital, on the morning of August 27, 2020, deep into the pandemic culture of shutdowns and social isolation, still months before the vaccine would give us some relief, it was almost painful for me to look at Lindsey because her belly was so huge. Even she would laugh and agree with this statement. She’s five foot three with a petite frame, and from behind you couldn’t even tell she was pregnant. I once heard someone standing behind her in line at the grocery store gasp when Lindsey turned around, “Oh my God, she’s pregnant!” The twins would end up being almost six and a half pounds each, a staggering combined thirteen pounds of baby on that tiny frame.

In the inky blue hours of August 27, 2020, just before sunrise, Lindsey woke me up gently to tell me that she felt she needed to go to the hospital. It had been too long, she said, and she didn’t feel like she should be pregnant anymore. It was just a gut instinct, she said. We had walked five miles the day before along Crissy Field, one of the most beautiful open spaces in the city, under the splendor of the Golden Gate Bridge, the burnished red arches overhead, San Francisco Bay lapping beside us, the surfers daring to ride the waves in that notoriously complicated cove. Women smiled at her. I caught men eyeing her, even at almost forty weeks. She’s just one of those women.

So there I was, at five in the morning, still groggy from sleep, still unsure what all was happening, still maybe buried in denial that these babies were coming at all, when Lindsey told me her mom, Ayn (pronounced “Ann”), was already driving into San Francisco, where we lived, from Marin County, where Lindsey grew up. Ayn would be our “lay doula,” the only non-medical person allowed to be with us in the hospital at the pre-vaccine height of the pandemic.

As Lindsey was telling me all of this, I recall thinking she was beautiful and that I should have felt like the luckiest guy in the world, overwhelmed with anticipation and excitement to meet our babies, for whom we had not just waited but also endured and suffered for so long. While I remember thinking that, I felt nothing—nothing for her, nothing for our unborn babies—and I’m not sure I realized it at the time. All the words and expressions that conjure up my state in that moment—empty, hollow, a robot—now sound clichéd and tired, but they were deeply true. I was a shell. I had spent most of my life “compartmentalizing,” mentally separating hard or unpleasant things from my everyday internal dialogue, both because of my career and my own complicated childhood, but this had reached its zenith in the last nine months. I hoped no one had noticed, but I was checked out and disengaged from Lindsey and the entire pregnancy. In that moment, though, the reality of what was to come was just beginning to set in. All my mechanisms that kept my life orderly, that shielded me from uncertainty, from pain I didn’t even know I had, would be dismantled, and I would find myself adrift—and I wouldn’t even see it coming.

I don’t recall what I was thinking as we drove to the hospital that morning to give birth. The three of us were huddled in Ayn’s Volvo station wagon in the dark, early hours of the morning. The fact that I don’t remember what I was thinking as I was about to meet my babies is telling in its own right: I’m always cogitating, thinking about next steps, obstacles, and work-arounds.

Our labor experience was a thirty-six-hour hellscape of sleep deprivation, confusion, and failure. Nothing seemed to stimulate Lindsey to have contractions, and one of the babies was moving around so much that the monitors, necessary to track fetal heart rate as a proxy for the babies’ well-being, simply couldn’t track her. The physicians and nurses spent literally hours at a time, all day and all night, adjusting this, moving that, trying to keep Baby B on the monitor, keeping us awake and miserable, and all the while, nary a contraction nor any sign of labor occurred. As our second day was turning to night, Ayn napped on the daybed under the long stretch of windows facing Oakland and the East Bay. The smell of smoke was just beginning to permeate the hospital; it would be another week until the Tubbs fire in Santa Rosa would cause the daytime sky to turn an eerie orange, something so bizarre news outlets throughout the world reported on it.

But for now, it strangely felt like we were camping and Ayn had come over to join us at the campfire, even as the trio of medical professionals huddled in the corner of the room tried to figure out next steps for Lindsey’s induction. Ayn had birthed Lindsey’s sister at home, unmedicated, in less than two hours. Lindsey was born in five hours. Ayn was a bit crunchy, an earth mom, favoring tinctures, whole foods as medicine, and yoga over antibiotics or even Tylenol. We’d often clash, me rolling my eyes at her severely unscientific approach to nearly everything. I’d rib her pretty hard about what I’d call “elephant placenta” (her favorite garlic and echinacea blend, which she swore by during flu season) or her faith in astrology over the scientific method as a way to make sense of the world. So imagine my shock when, in the middle of the hemming and hawing about next steps, she said, with the clarity of a phonograph needle scratching into silence, “I think we need to be talking about a C-section.”