Chapter 2: Inconceivable

It was the following Tuesday and I had a particularly grueling day ahead of me. I had several surgeries to perform and decided to arrive at the hospital early to make sure I had everything in order before I started it. I left Bella sleeping in bed, wanting more than anything to stay with her, my arms wrapped around her, safe and warm. But, alas, reality would not allow that, so I left for work, hoping I would be able to return to her at a decent hour.

"Dr. Masen, Michael Brake's surgery is scheduled for nine." Karen, my surgical nurse reminded me as I stopped by nurses' station on my way to finishing rounds.

"Thank you. I will meet you in his room in fifteen minutes. Just let me finish these charts." I completed my notations on the files of my current patients then walked down the hall to Michael's room where he and his family were waiting.

"Hello, Mr. and Mr. Brake, Michael." I smiled as I shook his parents' hands.

"Michael, how are you feeling today?" I asked as I took a seat at the foot of his bed. He was a six-year old boy with a severe heart murmur that was not correcting itself as he developed, it was getting worse. After several years of watching it, his parents, pediatrician and I had opted to move forward with surgery to correct it.

Michael's mother responded for him. "He's good, just tired of being in the hospital. We are all ready to get this over with and bring him home," while smoothing the hair on his forehead.

I turned back to the boy. "Michael, like we talked about, you are going to go to sleep for a little while. But there is nothing to worry about because I will be with you the whole time. When you wake up you will be sore in your chest and you won't feel very good. But, in a week or so, you will be up and moving around with your brother and sister." I explained to him. He nodded his head as he looked at his parents for comfort. They smiled back at him lovingly.

"Okay, if you don't have any other questions, Karen will be right in to get him prepped and we will get going."

"Thank you Dr. Masen." Mr. Brake responded as I walked out.

As I passed by the nurses' station, Karen was sitting at the computer terminal. "Karen, Michael is ready for prep whenever you are through."

"Thanks, I'll be right in." I walked to the surgical locker room to change into scrubs and prepare for the surgery. Before every surgery, I had a moment of panic, of doubt in my abilities. Mothers and fathers trust me with their child's heart, their life. What if I am too hasty with a cut? Or my hand isn't steady? The entire time I am disinfecting I run through scenarios of how it could go wrong, but the moment I walk through those stainless steel double doors into operating room, all doubt is removed. I have trained years for this and I am ready.

Today is no different. I go through my mental battery and then enter the room. On cue, one of the other surgical nurses hit play on the iPod and the cool, soothing sounds of Claire De Lune fill the room. Michael was already under anesthesia. If this had been a less routine surgery, such as a valve replacement, I may have been accompanied by my Chief Resident, Dr. Oates. But, it was a fairly common procedure so I was flying solo.

I began the surgery and everything was going smoothly. I had entered Michaels' chest cavity laparoscopic, which dramatically decreased his recovery time, when the phone in the operating room rang. A nurse, one I wasn't familiar with, went over to answer it.

"Mr. Masen, an Alice Whitlock is on the phone for you." The young nurse said as she covered the receiver with her hand.

"Could you tell her I will need to call her back. I am not at a point where I can step away." She relayed the information into the phone and paused for a response. I continued with the procedure. Why would Alice be calling me in the middle of surgery?

"Dr. Masen," she hesitated, "she says it's an emergency, in regards to your wife," concern evident in her voice. I was quickly becoming panic stricken, unsure of what to do. I had to complete this procedure. My instruments were inside my patience chest cavity, already manipulating his small, fragile heart. I could see the hole in the heart wall on the monitor.

"Dr. Masen?" The nurse said again.

"Please ask Mrs. Whitlock if she can hold for a moment until I can step away. Karen, could you please page Dr. Oates to see if he is available to take over?" Karen nodded her head and went to another phone on the back wall while the nurse spoke with Alice. I tried my best to clear my thoughts while I proceeded.

The phone by Karen rang and she answered it. "Yes, Dr. Oates, Dr. Masen has an emergency with his wife and cannot proceed. He needs immediate relief if you are available." She paused and out of the corner of my eye I saw her nod her head. "Yes, sir, I will let him know," and she hung up the phone.

"Dr. Oates will be scrubbing-in in two minutes." Karen relayed. I looked towards the other nurse, at the other side the room, waiting patiently. "Please tell Mrs. Whitlock that I will call her back in five minutes. Thank you." I said lowering my eyes back to my patient and fighting all urges to run out of the room as fast as I could to be with my Bella.

Just as he said, Dr. Oates arrived and was by my side within four minutes. He took the laparoscopic equipment from me. "Go, Dr. Masen, go see to your wife."

"Thank you Dr. Oates." I said with a sigh of relief. I was already peeling my first layer of scrubs off as I passed into the prep room. I immediately picked up the phone and dialed Alice's cell number.

"Oh Edward, thank God!" The panic was palpable in Alice's soprano voice. "You need to get to Northwestern Memorial Hospital right now! I didn't know what else to do and she's in so much pain, and the blood, it happened so quickly..." She was speaking so fast I could barely make out the words.

"Alice! Alice! Slow down. I don't understand, what happened so quickly?" It took all my strength to keep my voice controlled and somewhat calm.

She took a deep breath and blew it out into the receiver. "Bella's in labor." As the words filtered through my ears to my brain, I was certain that I heard them wrong.

"What?! She's just barely twenty weeks!" But, before I gave her time to answer, "Don't say anymore, I'm on my way. I'll be there in ten minutes." I slammed the receiver down on to the wall cradle and ran out of the room towards the locker room. My legs couldn't carry me fast enough as the weight and implications of the news came crashing down around me.

Her doctor would find a way to stop it, there were plenty of drugs that they could be used to stop the contractions; it would be okay. Maybe she would be on bed rest for the rest of the pregnancy, but that's okay. I could take some time off of work if I had to and I'm sure that Rose and Alice would help out…

Don't panic Edward; she doesn't need that right now.

I continued repeating that mantra in my head as I wove through traffic on Fullerton Parkway to route forty-one, on my way to Northwestern. Thankfully traffic was light since it was mid-morning. I pulled into the first parking space I could find, not caring if it was illegal or not, pushed through the front entrance glass doors and ran to the stair case. The maternity wing was on the fourth floor.

I forcefully pushed the heavy metal door open on the fourth floor, hearing it bang behind me. I rounded the corner and saw Alice crouched on the floor outside of a door.

"Alice!" I called out as I ran towards her. She slowly stood up, her eyes circled with red and worry.

"Oh Edward, thank God you're here." She threw her arms around my neck as I held her in comfort, but wanting nothing more than to see my wife. "I didn't know what to do. The resident OB/GYN is in with her right now."

"Alice you did fine. I'm glad you brought her right here." I replied while releasing her and already pushing past her into the room. The curtain was pulled around her bed.

"Edward?" I heard her soft, pained voice call out.

I pushed the curtain to the side and saw the doctor in with her performing an exam. A drape was over her legs, which were in stirrups. I rushed to her side, grabbing her hand.

"Hi love." I murmured against her forehead as I kissed it. The doctor looked up, and I recognized her. "Hello Dr. Masen."

"Hello Dr. Jones." I replied, noticing a confused look on Bella's face. I returned my attention to her to explain, "Susan and I went to med school together. You're in good hands." I attempted a smile, but was not entirely successful as I felt a tight line form on my mouth.

"Well, I'm sure that your wife's primary OB/GYN will want to see her as well. I will let her know the situation." Susan replied as she pulled her gloves off.

"What is the situation?" I asked in a barely calm voice as I saw Bella's face scrunch up in pain, assumingly from a contraction. I placed my hand over hers in reassurance as she breathed through it. She was so strong.

The doctor lifted Bella's feet from the stirrups, pulled a section of the bed back out and placed her legs on them, covering her with the sheet. "Bella is in premature labor. She is almost fully dilated. My best guess at this point is that she has an incomplete cervix."

"What does that mean?" Bella asked with a scared expression as she squeezed my hand. I attempted to sooth her, pushing her hair back from her beautiful face, as I tried not to panic. I knew exactly what an incomplete cervix was, and it was not good, terrible actually.

"What is means is that your cervix was not strong enough to hold the weight of the baby as it grew. Therefore, once it reached the point of too much weight, it simply fails and dilates. Once that happens there is very little we can do to prevent the birth from occurring." Susan said solemnly.

"What do you mean?" Bella shrieked as I tried my best to hold back the tears that were tearing at the inside of my eyes. We were going to lose the baby and there was nothing that could be done about it, but I couldn't be the one to tell her that.

"It means that your baby is most likely going to be born today, and unfortunately, does not have a high survival rate at nineteen and a half weeks. Its lungs are almost certainly not fully developed yet. If, by some chance they are developed enough, we can put the baby on life-support, a machine to aid in its breathing, but even then the chances of survival are very slim." She said as placed her hands on Bella's legs in comfort. "We have a very good NICU unit here and will do everything in our power to help the baby once it arrives." I had been in her shoes before, telling a patient and their parents that there was nothing we could do to save them, that it was hopeless. It was an awful, wretched feeling.

I took my hand and covered my eyes, the pain that was surfacing was excruciating. How could this be happening? She had done everything right in her pregnancy. But, being a physician, I already knew the answer to my heart's questions. There was nothing that we could have done to prevent this, not unless we knew she was predisposed to it, and even then it would have been difficult.

"Edward! What does she mean? That the baby is going to die?" Bella was in near hysterics now. She didn't allow me time to answer as she turned back to Dr. Jones.

"Can't you give me something to stop the contractions and sew me up or something to keep the baby in?" Tears were streaming down her face and all I could do was stroke her hair. I felt so helpless, but at the same time like I might collapse from the agony, the hopeless reality.

Dr. Jones looked up at me and I nodded my head lightly in understanding, then she left the room to allow us some time. I pulled a chair up and took Bella's hands firmly in mine. She was almost hyperventilating she was so upset. "Bella, love, you need to take deep breaths. Passing out from lack of oxygen will not make you feel better." I said while stroking her forehead and arm.

She looked at me with the most gut-wrenching gaze, "But maybe then I would wake up and know that this is all a nightmare, some horrible dream." She started to sob again. I stood up and sat on the edge of the bed, leaning over to drape my body over hers, hoping to protect her from the pain that I knew would only get worse. She clung to me in desperation, her nails digging into my shoulders. We lay there for several minutes, both attempting to comfort one another, as I heard her breathing finally calm.

I heard the door open and sat up to see her regular OB/GYN walk in. "Dr. Bradley," I nodded at the middle-aged woman. "Hello Bella, Edward." She answered solemnly as she placed her hand on Bella's leg to come around to the other side of her bed. "Dr. Jones has filled me in so far. She said she is fairly certain that the culprit of the pre-term labor is an incomplete cervix, but I would like to do my own exam if that is okay to make certain that I concur with her diagnosis." She spoke softly and evenly to both Bella and me. I nodded my head in agreement. Maybe by some off hand chance Dr. Jones was wrong. Bella looked at me with questioning eyes and I simply nodded my head to let her know that I thought it was a good idea.

As I slid off of the bed into the chair, Bella gripped my hand hard in pain. "Bella, you are having a contraction now." The doctor said as she looked at the monitor. "It looks like they have been quite irregular." Bella let out of puff of relief as it passed.

"I honestly haven't been paying attention. Before we got here, my friend Alice was timing them and they were about five minutes apart. But it has seemed like they are more stretched out now." As Bella spoke, the doctor slid the section of the bed away again and pulled the stirrups out. She placed Bella's feet in them and adjusted the sheet. As she began her exam, Bella winced in discomfort. "I'm sorry this is so uncomfortable. Your cervix hasn't moved down yet." As she completed the exam, she got a grim look on her face. She readjusted Bella's legs on the bed and covered her up.

We both stared at her expectantly, hoping that by some miracle this wasn't our worse nightmare. She looked up, her eyes shifting between us, "I'm very sorry to say that Dr. Jones' prognosis was correct. You have an incomplete cervix that is complete dilated. I can feel the amniotic sac pushing through already." She let out a sigh. "You're only option at this point is to deliver the baby and hope for the best."

Bella let out an agonizing cry as she turned towards me. I had never heard of a baby born at twenty weeks surviving much past a few days. If, by some miracle it did, it most likely would have mental and physical disabilities for the rest of its life. I felt the tears run down my face as our sentence was issued, the weight of it heavier than if a truck had fallen on me. The pain surfacing so quickly it took the air out of my lungs, constricting and contorting my insides like an opportunistic parasite. After a few moments to collect myself, I asked, "How long do we have until the baby arrives? You said her contractions were sporadic."

"As soon as I break her water, the baby will come out. It is so small, most likely weighing less than five hundred grams that she probably will not even need to push. Before I do that, you two need to decide what steps you are willing to take to keep the baby alive if it is a live birth, which honestly, a very small percentage are at this point. The actual birth is too traumatic for them. If he or she is a live birth, the statistics are eleven to fifteen percent survival rate."

Bella looked at me with an abhorring gaze, the pain flickering through her always comforting and warm eyes was more than I could stand. I knew what she was thinking. How could we decide what we would do to save our baby, my answer was, anything! I knew that without a doubt. "Dr. Bradley, could you give my wife and I just a few moments to discuss all of this. It's happening so fast."

"Yes, of course. I will be in the hall when you are ready." She drew the curtain to the side and walked out. I turned my attention back to Bella.

She drew in a slow breath, on the exhale she said, "We don't really have any choices, do we?" Her voice was so small and weak. Since I had known Bella, she had been my rock, the one with strength and courage. Now, when she needed me the most, I felt as though I had nothing to offer in comfort. That alone caused me as much pain as what was occurring. She was right - we didn't have any choices. If the baby was born alive, we would fight to keep it with us, if it was not…I couldn't even finish the thought.

"No, love…you are right, we don't have any choices." We both fell silent and prayed for the life of our soon to be born child.

Even when my cardiologist had told me my only option was a transplant, when I had very little hope to live, nor did I want to without Bella's love, I had not been this scared. Time had become our executioner, never wanting it to stop and cease inching forward so badly, but it progressed at double time, delving us directly into our own personal hell.

I went outside to fill Alice in on what was happening and asked her to go home. There was nothing that she could do at this point and Bella would certainly need her once she was discharged. She came in quickly and said goodbye, trying desperately to hold back her tears for our sakes.

The doctor came in and broke her water. The next few hours went by in a blur of disbelief and gut-wrenching agony. Nothing was clear other than the pain and sorrow we felt. Just as she had predicted, the baby came out immediately without any effort from Bella. Her tiny form was not even granted the blessing of one breath of air into her underdeveloped lungs. Her broken little body couldn't survive the journey out of her mother. For some inconceivable reason the loss seemed infinitesimally easier if we were able to start dealing with immediately instead of spending days in the NICU watching our child fight for its life only for it to inevitably be lost.

Bella cried out as she held out baby girl to her chest. All I could do think was – how naïve I was to think nothing could hurt worse than losing my parents - and yet this was exponentially worse.

In the aftermath, I lay in the hospital bed with Bella. My entire being felt numb, completely void of everything I had taken for granted a few short hours ago. All I wanted to do was comfort my wife, but I didn't know how. The images of the last few hours were blurs, all except the pain that had taken up permanent residence on my love's features, and the face of our sweet baby girl, Olivia. Bella's beautiful brown eyes had taken on a glazed look of blankness from what we had just suffered. It didn't seem fair that someone as sweet, caring and wonderful as my wife should ever have to survive a loss of this nature.

Parents of my patients have told me that the idea of losing their child was so incomprehensible, that they would rather take their own life than to out-live their own offspring. It isn't the correct way of the world - parents are supposed to leave this world first. I wonder if it makes a difference if that child never even had a chance at life? Our baby girl was still a pure, untarnished being with every possibility still ahead of her… I guess I will never know.

Bella stayed in the hospital for another day, I slept on the cot next to her, holding her hand throughout the night. She woke up several times screaming in agony, asking me to tell her it was all a nightmare. Edward, tell me I dreamed it all, tell me Olivia is okay! But then she let her hand trail down to feel her nearly flat stomach and the lack-of-life encased in her flesh, and knew the truth.

When we came home, I had spent the rest of the week with her. The days and nights merged together as our friends did their best to provide us with some level of comfort. I was reminded over and over again that I too had experienced the loss, not just Bella, and that I shouldn't be expected to shoulder the full weight of her grief. But, I didn't mind. I was put on this earth to love my wife and right now, that was all I wanted to do. The idea of it got me through each second, then each minute, until another day finally passed.

Bella called her parents to let them know the news. I heard her on the phone with Renee.

Her voice was becoming elevated and very upset. "Why didn't you think that was something I needed to know Mom? Maybe they could have done something to prevent this." She paused as she took a breath and wiped a tear from her eye. "Yes, I realize it was a long time ago and you were able to have me after, but really Mom, how selfish could you be?" I was studying her face in concern.

Had Renee and Charlie experienced the same tragedy and if so, why didn't they feel the need to ever tell Bella? Had the child been born alive? What did the doctor's do to prevent it back then? Now, there were a few different procedures that could be done to help prevent it if you know the woman is at risk. "Fine, I'll talk to you later. Bye." She closed the phone shut and turned to me with disbelieving eyes. I walked over and swiftly embraced her, holding her tight to my chest.

By the following Monday I had to return to work. A part of me was relieved to have a change, to put my mind towards something other than grieving, but most of me felt terrible for feeling that way. Bella was in a near catatonic state the majority of the time. Her eyes were open but she saw nothing. She walked in and out of the kitchen not eating anything. She hadn't even cried since the first day we came home. She assured me she just needed time.

I had never felt so helpless in my life. I am a physician; my job is to fix human bodies. But this, the emotional wreckage the likes of which I never dreamed could exist, haunting our every thought and move, this I was at a loss with. I had only had my heart for a little over a year and yet somehow it felt more broken and weak than the first, with its illnesses and malformations, ever did. How can we possibly fix this - for there is no surgery or medical procedure that can begin to repair this level of damage?