The surgeon holds out a gloved hand, palm up, and says, “scalpel.” He makes a smooth, long, incision across my wife’s belly, below the umbilicus, and above the pubic hair. Skin spreads. The thin layer of fat glistens yellow. Small red dots appear along the edges of the skin. One spot blossoms larger, and blood trickles into the incision. The surgical assistant touches the spot with the electrocautery pen, and there’s a tiny blue buzz, and a small puff of smoke. The incense of burned blood.
The latex gloves have smears of red, but not enough to make them slippery. The exact and silent movements of the surgeon and assistant become more urgent. They dissect and tug. Grip and cut. Down through the muscles of the abdominal wall, grasping, stretching, and digging quickly, down to the hard purple muscle of the uterus. Then there’s a pause, followed by a low transverse cut, and a gush of clear fluid that sloshes out across table. The room is quiet, save the slurping sound of the surgeon’s hand plunging into the belly, up to the wrist.
The surgeon gropes around, blindly finds the head, and then pulls upwards, wrestling the baby out through the wound.
Sally is in a bed in the recovery room. I’m standing next to her. They’ve taken the baby somewhere. Dr. Gage pulls the curtain open, and the guides in the aluminum track make a clicking, clattering sound. He’s taken off his OR hat, and his forehead has a red arc across it. His green scrubs have dark sweat stains under his arms.
“I checked on the baby,” he says “Congratulations. She’s beautiful. She seems healthy, had great APGAR scores.” He pauses. “She has two small heart murmurs – probably a small VSD and a patent ductus.”
Sally and I are both medical people, so we understand – two small holes in the heart.
I take a deep breath. Maybe it won’t be too bad. The VSD may close on its own. Same with a patent ductus.
Sally turns her head a few degrees to the side, keeping her eyes on Dr. Gage.
“We’ll get an ultrasound of the heart,” he says. “Make sure.” His voice is gentle and clear.
“And?” Sally says.
“She has Down syndrome.”
Sally shrieks. Fists at her side, neck veins bulging, she takes a big gasp of air, and screams again.
Sally’s wailing fills the room. Her face is ugly and red. Cracked lips open wide.
My heart beats fast. I lean down, and place my forehead next to hers, hairline to hairline.
She continues wailing.
I keep my head touching her head. Her screaming is full throttle.
Her gasps for air become more frequent.
I close my eyes.
A nurse brings the baby into the recovery room, to feed.
“Do you want to hold her?” the nurse says.
I shake my head.
Sally reaches out. “Hello, Sarah.” Sally’s voice is musical, and hoarse from the screaming.
Sally grabs the bottom edge of her gown, pulls it up, and tucks it under her chin. Her breasts are swollen and heavy, with faint blue veins visible through the pale skin. “Let’s see how we do,” she says.
The nurse watches as Sally grasps her breast.
“Farther back from the nipple,” the nurse says. “Sarah needs to get a big mouthful.”
Sally holds Sarah close, and brushes the baby’s cheek against her nipple.
Sarah opens her mouth wide, like she’s yawning, and Sally pulls her into her body.
“Like a pro,” the nurse says.
I let out a pent-up breath.
Sally looks down at Sarah. In oil paintings of the Madonna and Child, the light is soft, and the shadows softer, and breastfeeding looks peaceful and quiet; it suffuses a radiant calm. But surrounded by the pastel stripes of this too-bright cubicle, this meeting of saliva and skin, milk and tongue, is a slurping, grunting, air-whistling-through-the-nostrils affair. And it’s a cold bright light that shines down on this baby.
It will be twenty-two years before I cry for my daughter like Sally did. It happens while I’m at a writers’ conference working on this book. I’m in a workshop taught by Nick Flynn, a writer I have long admired. He assigns an exercise in which we cut our manuscript into chunks of text – actual paper and scissors – and rearrange them. The empty spaces are supposed to open up our minds. At first, it seems precious – gimmicky. But Nick’s writing is so brave and clear, I decide to give it a try: see if it works.
We’re at The Atlantic Center for the Arts, in New Smyrna Beach, Florida. About two miles inland, the Center is a small cluster of buildings, all redwood siding and angled rooflines jutting into the sky. The buildings seem to float in a sea of plant life – the spiky fans of palmetto palms, wild magnolias, scrub oaks and Spanish moss. The illusion is enhanced by the weathered wooden walkways between buildings. Without the waist-high railings one might expect, they look like piers, jutting into the lush green foliage.
Our workshop meets in a small and narrow library, with two walls of books, and two walls of windows. For this exercise Nick has arranged for us to use one of the artists’ studios. It’s a large open room with a concrete floor, natural light, and five long tables splattered with paint, giving the place a Jackson Pollock feel.
I start out calmly enough, laying out two rows of blank paper, stark and white against the reds and blues and yellows of my workspace. I glance around, and my classmates are all busy cutting and taping. I enjoy the summer-camp feel of the activity – the absorption of scissors and tape.
I cut several paragraphs free, and spread them out onto the pages. They look like chunky fortune cookie slips. So much white space and so few words. I glance at my classmates’ work. They have more pieces of text, and they are all busy moving the pieces around, rearranging them. My pages look bare. I turn to Nick, who is pinning pieces of a poem onto a wall. “Can we use pictures?”
He turns. “Sure. Whatever helps.” Turns back to his work.
I go to the computer center, and print off pictures of the things I’ve been writing about. Three portraits of John Langdon Down, the “father of Down syndrome.” He’s wearing a frock coat and a black bowtie. Two photographs of Jerome Lejeune, the scientist who first discovered the extra twenty-first chromosome that causes Down syndrome.
I print out the karyotype that Sarah’s geneticist gave me after she was born. It’s an eight-by-ten photograph of her chromosomes all lined up two-by-two, except for the twenty-first chromosome – it has three. I print a snapshot of Sarah, dressed up as a wicked princess for Halloween. Another photograph of Sarah, 22 years old, living in a group home. She’s sitting between two framed movie posters – one with Gene Kelly, Debbie Reynolds, and Donald O’Connor skipping forward in yellow slickers, umbrellas twirling – Singing in the Rain. In the other, Audrey Hepburn poses in a slinky black dress, neck encircled with diamonds and a tabby cat, black gloves all the way up to the elbows – Breakfast at Tiffany’s.
I place these pictures on the near-blank pages, and step back from the table. Stare at the pages. Try to let the process work. I lean forward to jot a note to myself in blue ink on the white page. Stare some more.
The picture of Sarah’s chromosomes entirely fills the page. I lean down and write, “This picture looks so big. So real.” I look over at a snapshot of Sarah. It looks so small there, askew in the corner of an empty page. It hits me that from the day she was born, I’ve seen a diagnosis instead of a daughter. This strikes me like a bolt of lightning splitting a tree. I feel as if something in my chest has been riven – my aorta torn away from my heart, or my trachea ripped free from my lungs. I do not know my daughter.
I feel tears coming. I leave, pushing thorough the door of the studio, and out into the sun. I make it partway down the unrailed walkway. But this feeling in my chest is too big to control. I jump down into the bushes, pushing alongside a building, the branches scratching my face, vines catching my feet, crying, and sobbing, till I come to deck, a bare platform without railings. I stop and wail. I am undone. Unhinged. Bereft. I hear my howls swirling out of my body and into the air. The shrieking finally slows to sobs. I become aware again of the sand under my feet, and the thicket I’ve stumbled into. I take a gulp of air. The breeze is soft against my face. The trees sway gently.
“Are you okay?” I hear someone call from the walkway, a disembodied voice coming through the tangle of plants.
“Yes,” I call back. I take a deep breath. “I’m fine.”
“Yes,” I say. “Thanks.” I hold my breath. I don’t want anyone to see me.
I hear a few footsteps on the wooden pier, and then a door in the building I’m standing next to open, and then close. Fuck. I’ve been wailing right outside someone’s workshop.
I blow my nose on my fingers, and sling the snot into the bushes. I wipe my fingers on the cuffs of my jeans. Wipe my face and cheeks with my shirtsleeve. I feel empty inside. Clean.
I push through the bushes back to the walkway. No one is there. Good. I climb up onto the walkway. Find a bathroom. Splash my face. Dry it.
The studio is empty: they must’ve gone back to the library. At my table, I stare at the photograph of Sarah, and gently straighten it on its page, glad that it’s not too late. My daughter will forgive me. It’s the way she is.
I walk back to the library. The group is sitting around the table. Nick looks up.
Thought we’d lost you,” he says. “Did you go to make more copies?”
“No,” I say, gesturing outside. “I was needing to cry.”
He looks at me and nods, as to say, “that sometimes happens.”
I feel calm and expectant, like that glittering moment right after a thunderstorm, when the trees and sidewalks and streets have all been scoured clean, and new. I’ve been given a second chance.
At lunch, Nick walks up with his plate and silverware. “Can I join you?”
“Mary Gaitskill’s workshop heard you.”
I wince. “Sorry.”
Nick waves it away. “She thought it was an animal caught in a trap.”
“Not far off,” I say.
“You’re in the middle of it.” He takes my shoulder and gently shakes it. He smiles. I feel as if he is welcoming me into a new place.
“Yup,” I say. It’s Sarah’s shorthand way of summing up a complicated truth. I am eager to get home. Get to know my daughter.
Paul Austin’s first book, a memoir, came out in 2009 “Something For the Pain: One Doctor’s Account of Life and Death in the ER” (W.W. Norton) and received a starred review by Library Journal. The Boston Globe called it “a stunning account of the chaos of the emergency room.” He has attended the Bread Loaf Writer’s Conference as a contributor, a waiter, a scholar, and a fellow. His fiction and nonfiction have been published in Discover Magazine, The Florida Review, The Gettysburg Review, Creative Nonfiction, Ascent Magazine, The Southeast Review, and turnrow. “Cry Like My Wife” is an excerpt from Paul’s upcoming book, Beautiful Eyes, which will be published in late 2013 or early 2014, by W.W. Norton.
 The names of family members are unchanged. All other names are changed to protect their privacy. Dialogue is recreated as accurately as memory will allow.