Small Great Things (46 page)

When the judge calls order, we all face forward again, riveted by that giant poster of the dead infant. One of the jurors bursts into tears and it takes two others to calm her, and then, Judge Thunder calls a recess.

Beside me, Kennedy exhales. “Oh, shit,” she says.

F
IFTEEN MINUTES LATER,
everyone but Brittany and Turk Bauer has returned to the courtroom. And yet their absence is almost even more visible, as if the negative space is a constant reminder of why we had to break in the first place. Odette leads the medical examiner through a series of photographs of the baby's body, from every angle possible. She has him explain the different test results, what was standard, what was deviant from the norm. Finally, she asks, “Were you able to determine the cause of death for Davis Bauer?”

Dr. Binnie nods. “For Davis Bauer, the cause of death was hypoglycemia, leading to hypoglycemic seizure, leading to respiratory and then cardiac arrest. In other words, low blood sugar made the infant seize, stop breathing, and that in turn stopped his heart. The method of death was asphyxiation. And the manner was undetermined.”

“Undetermined? Does that mean the defendant's actions had nothing to do with the baby's death?” Odette asks.

“On the contrary. It just means that it was not patently clear whether this was a violent or a natural death.”

“How did you go about researching that?”

“I read the medical records, of course, as well as a police report that provided information.”

“Such as?”

“Mr. Bauer told the police that Ruth Jefferson was aggressively beating on his son's chest. The bruising we found on the sternum could support that allegation.”

“Was there anything else in the police report that led you to fill out the report the way you did?”

“According to multiple accounts, there was an indication that the defendant did not take any resuscitative efforts until other personnel came into the room.”

“Why was that important to the autopsy results?”

“It goes to the manner of death,” Dr. Binnie says. “I don't know how long that infant was in respiratory distress. If the respiratory failure had been alleviated sooner, it's possible that the cardiac arrest would never have occurred.” He looks at the jury. “Had the defendant acted, it's possible that none of us would be sitting here.”

“Your witness,” Odette says.

Kennedy rises. “Doctor, was there anything in the police report that indicated there was foul play or intentional trauma to this infant?”

“I already mentioned the bruising to the sternum…”

“Yes, you did. But isn't it possible that the bruising might also be consistent with vigorous, medically necessary CPR?”

“It is,” he concedes.

“Is it possible that there might be other scenarios—other than foul play—that might have led to the death of this baby?”

“It's possible.”

Kennedy asks him to review the neonatal screening results she entered into evidence earlier. “Doctor, would you mind taking a look at exhibit forty-two?”

He takes the file and thumbs through it.

“Can you tell the jury what you're looking at?”

He glances up. “Davis Bauer's newborn screening results.”

“Did you have access to this information while you were performing your autopsy?”

“I did not.”

“You work at the state lab where these tests were performed, don't you?”

“Yes.”

“Can you explain the highlighted section on page one?”

“It's a test for a fatty acid oxidation disorder called MCADD. The results were abnormal.”

“Meaning what?”

“The state would return these results to the hospital nursery, and the doctor would have been immediately notified.”

“Do infants with MCADD show symptoms from birth?”

“No,” the medical examiner says. “No. That's one of the reasons the state of Connecticut screens for it.”

“Dr. Binnie,” Kennedy says, “you were aware of the fact that the infant's mother had gestational diabetes, and that the baby had low blood sugar, correct?”

“Yes.”

“You stated earlier that the diabetes was what caused the hypoglycemia in the newborn, didn't you?”

“Yes, that was my conclusion at the time of the autopsy.”

“Isn't it also possible that hypoglycemia might be caused by MCADD?”

He nods. “Yes.”

“Isn't it possible that a newborn's listlessness and lethargy and poor appetite might be caused by MCADD?” Kennedy asks.

“Yes,” he admits.

“And an enlarged heart—is it potentially a side effect not only of maternal gestational diabetes…but also of this particular metabolic disorder?”

“Yes.”

“Dr. Binnie, did you learn from the hospital records that Davis Bauer had MCADD?”

“No.”

“Had these results come in in a timely manner, would you have used them to determine the cause of death and manner of death in your autopsy results?”

“Of course,” he says.

“What happens to an infant who has the disorder yet has gone undiagnosed?”

“They are often clinically asymptomatic until something happens to cause metabolic decompensation.”

“Like what?”

“An illness. An infection.” He clears his throat. “Fasting.”

“Fasting?” Kennedy repeats. “Like the kind of fasting done prior to a baby's circumcision?”

“Yes.”

“What happens to a baby who is undiagnosed with MCADD, and who suffers one of these acute episodes?”

“You might see seizures, vomiting, lethargy, hypoglycemia…coma,” the doctor says. “In about twenty percent of cases, the infant can die.”

Kennedy walks toward the jury box and turns so that her back is facing them, so that she is watching the witness with them. “Doctor, if Davis Bauer had MCADD, and if no one at the hospital knew it, and if the medical protocol was to have him fast three hours prior to his circumcision like any other infant
without
the disorder,
and
if an acute metabolic episode occurred in his little body—isn't there a chance Davis Bauer would be dead even if Ruth Jefferson had performed every conceivable medical intervention?”

The medical examiner looks at me, his gray eyes soft with an apology. “Yes,” he admits.

Oh my God. Oh my God.
The energy in court has changed. The gallery is so quiet I can hear the rustle of clothing, the murmur of possibility. Turk and Brittany Bauer are still gone, and in their absence, hope blooms.

Howard, beside me, breathes a single word. “Day-umm.”

“Nothing further, Your Honor,” Kennedy says, and she walks back to the defense table, winking at me.
I told you so.

M
Y CONFIDENCE IS
short-lived. “I'd like to redirect,” Odette says, and she gets up before Dr. Binnie can be dismissed. “Doctor, let's say that this abnormal result had come into the nursery in a timely fashion. What would have happened?”

“There are some abnormal results that require a letter to be sent to the parents in due course—suggesting genetic counseling,” the medical examiner says. “But this one—it's a red flag, one any neonatologist would consider emergent. The baby would be monitored closely and tested to confirm the diagnosis. Sometimes we send the family to a metabolic treatment center.”

“Isn't it true, Doctor, that many children with MCADD are not formally diagnosed for weeks? Or months?”

“Yes,” he says. “It depends on how quickly we can get the parents in for a confirmation.”

“A
confirmation,
” she repeats. “Then an abnormal result on the newborn screening is not a final diagnosis.”

“No.”

“Did Davis Bauer ever come in for more testing?”

“No,” Dr. Binnie says. “He didn't have the chance.”

“So you cannot say, beyond a reasonable medical doubt, that Davis Bauer had MCADD.”

He hesitates. “No.”

“And you cannot say, beyond a reasonable medical doubt, that Davis Bauer died of a metabolic disorder.”

“Not entirely.”

“And in fact, the defendant and her legal team might be grasping at straws to try to throw some shade in another direction, any direction that doesn't point to Ruth Jefferson intentionally harming an innocent newborn first by withholding treatment and then by reacting so forcefully she left bruises on his tiny body?”

“Objection!” Kennedy roars.

“I'll withdraw,” Odette says, but the damage is done. Because the last words that jury has heard may as well be bullets, shooting my optimism out of the sky.

T
HAT NIGHT
E
DISON
is silent on the way home. He tells me he has a headache, and almost as soon as we have walked in the door and I'm starting supper, he comes back through the living room with his coat on and tells me he is going out to clear his head. I don't stop him. How can I? How can I say anything that will erase whatever he's been through, sitting behind me every day so far like a shadow, listening to someone try to make me into someone he never believed I could be?

I eat by myself, but really, I just pick at the food. I cover the rest with tinfoil and sit at the kitchen table waiting for Edison. I tell myself I will eat when he returns.

But an hour passes. Two. When it is after midnight and he does not come back and will not answer my texts, I put my head down on the pillow of my arms.

I find myself thinking about the Kangaroo Suite, at the hospital. It's a room with an unofficial name that has a mural of the marsupial on the inside. It's where we put the mothers who have lost their babies.

I have always hated that term—
lost
—to be honest. Those mothers, they know just where their infants are. They would in fact do anything,
give
anything, even their own lives, to get them back.

In the Kangaroo Suite, we let the parents spend time with an infant who has died for as long as they'd like. I'm sure Turk and Brittany Bauer were put in there with Davis. It's a corner room, next to the charge nurse's office, intentionally set aside from other labor and delivery rooms, as if grief is a communicable disease.

This isolation means that the parents don't have to walk past all the other rooms with healthy babies and mothers in them. They don't have to hear the cries of newborns coming into the world, when their own child has left it.

In the Kangaroo Suite, we put the birthing mothers who knew, thanks to ultrasounds, that their babies would be born in a way that was incompatible with life. Or the mothers who had to terminate late, because of some gross anomaly. Or the ones who delivered normally, and who—to their great shock—lived both the greatest moment of their lives and the worst within hours of each other.

If I was a nurse who was assigned to a patient whose baby died, I'd do handprints of the baby in plaster. Or hair samples. I had professional photographers I could call, who knew how to take a picture of the deceased and touch it up so that it looked beautiful and vibrant and alive. I'd put together a memory box, so that when the parents left the hospital, it was not empty-handed.

The last patient I had who had used the Kangaroo Suite was a woman named Jiao. Her husband was getting a master's degree at Yale and she was an architect. For her entire pregnancy, she had too much amniotic fluid, and would come in weekly to have an amniocentesis to check the baby, and to siphon off fluid. One night I took four liters of fluid off her, to give you a sense. And obviously that's not normal; that's not healthy. I asked her doctor what she thought it was—was the baby missing an esophagus possibly? A baby in utero normally ingests amniotic fluid, yet clearly if that much was accumulating, the baby wasn't swallowing it. But the ultrasounds were normal, and no one could convince Jiao that this was a problem. She was certain the baby was going to be fine.

One day she came in and the baby had hydrops—fluid collection under his skin. She stayed with us for a week, and then her doctor tried to induce, but the baby couldn't tolerate it. Jiao had a C-section. The baby had pulmonary hypoplasia—the lungs just didn't function. He died in her arms quickly after birth, puffy, swollen, as if he were jointed of marshmallows.

Jiao was put in the Kangaroo Suite, and like many mothers who had to come to terms with the fact that their babies had not survived, she was robotic, numb. But unlike other mothers, she did not cry, and she refused to see the baby. It was as if she had this image in her mind for a perfect little boy, and she could not reconcile anything less than that. Her husband tried to get her to hold the baby; her mother tried to get her to hold the baby; her doctor tried to get her to hold the baby. Finally, when she was on her eighth hour of catatonia, I wrapped the baby in warm blankets and put a tiny hat on his head. I carried him back into Jiao's room. “Jiao,” I said, “would you like to help me give him a bath?”

Jiao didn't respond. I looked at her husband, her poor husband, who nodded, encouraging.

I filled a basin with warm water and took a stack of wipes. Gently, at the foot of Jiao's bed, I unwrapped her baby. I dipped a cloth in warm water and ran it over her baby's sausage legs, his blue arms. I wiped his swollen face, his stiff fingers.

Then I handed Jiao a damp cloth. I pressed it into her palm.

I don't know if the water shocked her into awareness, or if it was the baby. But with my hand guiding her she washed every fold and curve of her baby. She wrapped him in the blanket. She held him to her breast. Finally, with a sob that sounded like she was tearing a piece of herself away, she offered the body of her child back to me.

I managed to hold it together while I carried her infant out of the Kangaroo Suite. And then, as she collapsed in her husband's arms, I lost it. I just lost it. I sobbed over that baby the whole way to the morgue, and when I got there, I couldn't let him go any easier than his mother had.