West of the Rotunda

This was Sid’s toughest. It’s the last you’ll read, but there were more dead babies.

Jack was taking time to line up his shot. Sid and Jack had been playing pool once a week for the last year and Jack was getting better. But it still wasn’t really even. Sid knew the game.

Jack missed.

Late in his career now, it was okay to play pool one night a week and drink beer. Sid hadn’t delivered babies for ten years, so he couldn’t get an unexpected call on their second pitcher. Delivering babies, something he had loved, was in Sid’s past.

And his clinic days were scheduled, and he didn’t have to take call. Sid was winding down.

And there wouldn’t be any coroner calls. He’d dropped that when he quit the big clinic in town. So now, he could shoot pool.

They had started with straight pool, since Sid thought that’s how a beginner should start. But Sid had made the mistake of setting 100 as the end of the game. When Jack was down by 40 balls, it was a testament of his character that he still put his all into every shot. Jack’s character helped him learn that lesson well. The score can be a distraction. There can be many.

As Sid rose for his shot, he noticed the couple up at the bar. But it was his turn, so he looked at the table and addressed the situation. Drop the three-ball soft, left English and then it’s the seven, and stop for the eight. They had moved to eight ball.

Sid missed.

When he missed, he often cussed. But he always thought about why he had missed. It can be the stance, the stroke, but this time it was the aiming. That had always been his strength. He could know the spot, see it and hit it. But lately, he’d noticed how unfocused he had become. Discipline.

As Sid looked down at the floor, walking back to the chair and beer, he saw the couple again. He recognized the woman. She was no longer a girl.

Amber was a quiet girl with a big belly. Sid always found pregnant women attractive. It was not a sexual thing, at least he didn’t think so. He hoped not.

It helped that her mother was in the room. And her sister. Amber hung her hair across her face. She looked at him sideways, like he was a passing lecher, and she needed some distance. He hoped that wasn’t his demeanor, but he was never sure how folks see him. Attractive is dangerous. He had to clear his mind and get back to business.

Sid found out they had just moved up here. No dad involved. But these ladies’ bonds seemed strong. Amber’s mom seemed to like him. That was reassuring.

Sid listened to the dates, the story. Her last menstrual period put her at about twenty-four weeks. She’d felt movement “quickening”.  Sid’s calculated due date coincided with their expectations. She had not had an ultrasound. Did they want one? Did they have insurance? They were applying for Medicaid. He was okay with that, though many local doctors hated Medicaid reimbursement. It paid just half what regular insurance pays. Sid just liked delivering babies, even with all the mess and irregularities. He felt sharp when doing it.

Sid decided he didn’t need to do a vaginal exam. All the tests should have been done by the doc down south and he could get the records. They had signed for that, so all looked good. This seemed to ease the tension in the room, not probing her privates. Schedule the follow up and do the regular. Just pay attention for problems.  

But she was young. Young moms can have problems. He’d dealt with those with preeclampsia, early labor, bleeding, early rupture of membranes. None of these were just for young moms, Sid knew. It was just the work of delivering babies. Amber and her pregnancy would deal the cards. Sid had learned a long time ago to the play the hand dealt.

Maybe that’s why he had resolved to investigate all child deaths carefully. An unanswered question doesn’t tell you anything. Answers, even painful ones, can give peace, at least some sense of it. And not investigating left unanswered questions. So, he had decided.

Or maybe it had been advice. The doc who had been the coroner for three years of his four year term decided to leave town, he’d handed over to Sid his two volumes of the three volume “Pathological Investigations” and his small wisdom.

He only offered two pieces of advice. “The single car accident with no explanation is best left as an accident. If there’s clear evidence otherwise, then you got to go with it, but I usually called it an accident.”

Sid hadn’t yet experienced the guy who drove down through two fences, no braking and drown in his pickup in the swollen river after 6 shots at the small-town bar. Or the old guy who burned up in his car spinning his tires till they burst into flame to get back on the road, but never trying to get out. Sid hadn’t experienced any of this coroner shit yet.

“Oh yeah, the other,” the departing coroner had advised. “Get an autopsy on all SIDS. Don’t just call them and not investigate.”

None of this was in his mind as he left the small rural clinic and headed back to Paradise in the ’54 Chevy. The sun was low and below the trees. Sid was not thinking about Amber, or dead bodies or investigations, none of that shit, just the road ahead.

Amber kept her appointments. That was one on the tests. Sometimes she was with her mom, sometimes the sister, toward the end she’d come into the room alone.

The records had come. It was all adding up. Things should be fine.

The last weeks Sid always asked them to come in weekly. It was how he had been trained. Things need to be done and bad things can happen late. But these last visits included a vaginal exam, to check the cervix and see how the baby was lining up. Sid had sensed Amber’s reticence in her early visit. But she was alone in the room here at 36 weeks with her pants off and a paper sheet over her legs. Did she trust him?

He measured her belly, felt the babe. Doppler heartbeat. Head down, facing to her left, lined up. Sid turned and got the gloves on with his back to her. “I need to check the cervix.” He said.

“I know.” She said. She was lying flat on the exam table.

He brought the lubricant tube with him, having done this so many times before. He stood to her side and raised her legs under the paper sheet. Then held his gloved fingers up and squeezed the gel onto them. He moved them back and forth to make sure all was smooth. Sid placed the lubricant tube next to Amber on the exam table and brought his right gelled fingers under the paper. He placed his left hand on the fundus, holding the baby, the object of this examination. Sid’s gloved slippery fingers felt her labia and parted them gently. Then he pressed in.

When he felt her cervix, he looked at her. She looked back.  It was firm, hard, closed. He could barely feel the baby’s head. He looked at Amber with his hand in her vagina.

“Your cervix has not softened, and the baby is still high.” Sid said as he slowly withdrew his hand. She exhaled.

They did this four more times.

Then Amber had a baby. A healthy baby boy she named River.

Jack had almost laughed at Sid’s miss. But then Jack was faced with his own situation. He went to work as Sid sat with his back to the bar. He was sitting there, knowing it was Amber up there.

Sid thought she had been a good mother. She had nursed, kept the appointments, though they were now living in a hamlet 40 miles away. Amber’s mom had come to the first visit. It looked like breast feeding was working. It was winter and these were tough appointments to keep. Sid was proud of this young mom.

Early on in his coroner job, Sid had decided childhood deaths needed better investigation in his state. His was the only state in the nation without a review panel over all child deaths. He’d read the reports, the CDC recommendations. But there was no way he could get a panel of experts in this small county, so he called on some folks that already met monthly to review child abuse referrals. He asked for their participation to review child deaths and they agreed.

And he went to training. It was all pretty redundant for him, but he thought he should. Sid was like that. He did what he thought should be done.

The call came in the middle of morning clinic. The hospital had a dead baby, and they needed the coroner. Sid ran across the street. It had snowed the night before, but it was wet pavement now. The ER doc had done everything, but when they had noticed rigor in the lower extremities, they’d called it. It was River.

Sid had to take a breath. “Where’s the family?”

“They are all in the family room. They got here with the ambulance.”

Sid looked at the ER Doc. He’d known him for a long time. Sid almost cried. But he could not do that now. Sid looked up at him and said, “I delivered this baby.” He wondered if he had missed something. Mainly, he just wondered. But he knew what he had to do.

The family room was a shit-show. Amber was sobbing, screaming, the mother and the sister were doing their best. Sid walked in, no longer their family doctor, but now the coroner assigned to investigate deaths. This could not go well.

Amber was still in her nightgown. Her face was puffy from her crying and screaming as she bounced between the two, neither able to console her. There seemed to be some others in the room, but Sid only recognized the three.

All turned toward Sid as he entered.

Amber came up to him screaming “Why” or “How” or something, Sid could not fully understand. Her round puffy creased face was barely recognizable in its torment.

As she screamed at him, she bent forward, and her sagging, breast-feeding mother’s breasts swung below her in the loose nightgown. Amber’s mother must have caught Sid’s glance. She grabbed Amber, her tortured daughter and swaddled her in a blanket. She held her daughter’s face in her hands and spoke to her forcefully, face to face. Amber stopped screaming and listened to her mother. Then she turned to Sid, her doctor.

 Sid gave his speech.

I am so sorry. River has died. I am here now not as your doctor but as the county corner to investigate this death….

The room sobered. Was it coroner or investigate, Sid never knew. The words sobered the room. It is a sober endeavor.

“I need to ask you some questions.” He said to Amber. He looked at her mom and sister. Mom then looked at the others in the room. They politely filed out and then it was just Sid and the three.

Amber was still choking on sobs. Mom and sis were quiet. “I need to know what happened.”

Jack had missed and now Sid rose. He didn’t look toward the bar. He still had his two balls to deal with, then the eight, but Jack had dropped a couple and only had one stripe left. Sid realized he could lose this game. And Jack had left him down at the end with only a long shot. And a tough one. There are a couple ways to play this. Shoot to win or shoot not to lose. Sid chalked and pondered.

It had been hard out in their wintery town. Amber had been tending bar before the baby. She’d stayed home with him for the last few weeks, but her mom had encouraged her to go out. She’d watch him. Amber should take care of herself. She’d gone to the bar.

Did you drink?

Yeah.

When did you get home?

It wasn’t late.

Mom offered. “I kept the fire going and River was asleep. She got home about eleven.”

Amber nodded.

How much did you drink?

She shook her head. “I don’t know. Maybe too much. I hadn’t had any while I was pregnant. It hit me kind of.” She was looking down, talking soft.

Sid turned elsewhere. “Is your bed really soft?”

No, not soft at all.

Did River nurse when you came home?

I think so. She looked at her mom.

Mom looked at me. “I think she just got in bed. She was real tired. She might have nursed him in bed there after I left.”

River was sleeping in the bed all while you were there? Sid asked mom.

Yeah, he was quiet. He fussed once and I held him, but then put him back down. He was jus fine, didn’t need changing. She was only gone for maybe three or four hours.

Sid felt a picture forming. But you have to see the whole thing.

So, Amber, do you remember nursing when you got in bed?

Amber looked at Sid blankly, like the question had no meaning. She looked down at the hospital carpet. “I think so.” Softly.

Did he wake up again during the night?

I don’t think so.

When did you wake up?

It was about nine or ten in the morning. She’s still looking down.

What did you notice?

I just got up. He was quiet.

What did you do?

I went to the bathroom and then got some water. But he was so quiet. I went to him. Amber looked at Sid fierce, her face contorting back into the screams and sobs, but she held on.

I went to him.

And her face melted more into that screaming sobbing round wet ball and her mother hugged her and Sid looked up at the ceiling.

He told them what he had to do. Sid would go out to the snowy hamlet to investigate the scene. And an autopsy would be done to determine the cause of death. And then he would issue his report.

He told them this. They agreed to his investigation. They too, wanted to know just why.

He had to cancel the rest of his scheduled patients. Not because he had to do a delivery. That always got some forgiveness. Investigating deaths wasn’t offered to scheduled patients as an excuse for his absence. They didn’t understand.

The snow was two feet high on the roadsides out there. He followed Amber and her mom down the icy path to the trailer. It was still warm, though they’d been gone hours. “Neighbors must have fed the stove.” Mom offered.

The place was small but neat. Lots of people in this county live in trailers. Some do well, some don’t. This looked like a good home. And the bed was firm, just a thin pad on a plywood base.

He told them again of the process, the investigation, then the report. Sid told them he would share it with them when it was done.

The pathologist that was available was just south. He was an older, very experienced guy, and a good investigator. About a week later he called Sid on another clinic day. He summarized what the official report would say. There were no physical findings to explain River’s death. But the blood alcohol test on the baby was positive, at a level that the pathologist speculated that the mother’s blood alcohol must have been very high. “She must have breast fed him when her level was quite high for the infant to have this level. I’ve never seen this before.”

He concluded that the cause of death was “Overlying”. This means that the mother has smothered her child accidentally. He surmised it was due to her level of intoxication.

And so, Sid filled out the death certificate. He called Amber, but she never came into the clinic to talk to him. They never spoke about the findings. Sid worried about her.

Sid made that tough long shot but left himself bad and missed the next. Now he had to pee. He left Jack to finish the game. Sid resigned, he would win, or he would lose and sitting there watching wouldn’t change anything. The full bladder was urgent. Sid got up and went to the bathroom. He finished and zipped and as he came out, he saw Amber walking down the steps toward the exit.

Sid hurried after her. He called, “Amber?” She turned.

Sid saw she had aged. Whenever he noticed this in others, he reminded himself of his own years. Her face did not do any melting, like it had so long ago. It stayed hers. But she conveyed recognition. She knew who he was. She might have known up there on the barstool as he was losing this stupid game he weekly played.

Yes, she said.

I just wondered how you are doing.

She looked down quickly, then back up to meet him. Just fine. I’m Okay.

Then she turned and walked away.

Cause of Death: Overlying

Manner of Death: Accidental

This doesn’t mean you won’t have to read about more, the ones in the middle…You should.

Sid wondered just why the prosecutor wanted him to come up to the courthouse. The message had come a couple days before, so he cleared out a couple of the early afternoon slots. Was he in trouble?

He parked the old ’54 Chevy in the lot. The Hilux had rusted away, but he still used it for dump runs. When he struggled with buying a new truck Martha had looked at him with wonder. “What have you always wanted?”

A new 4WD Toyota would be cool and practical. But he’d remembered the old 1953 Chevy his grandmother had. Four speed gearbox, steady engine. He’d told her he wanted it when he’d helped her move from the old place into town.

“But Jason said he wants it.” The truck was worn but in really good shape overall.

Jason was his cousin’s husband. “He’ll take good care of it. You should give it to him It’s a beauty. He’ll take good care.”

Then, on a later visit, he’d seen the truck gliding through the little Eastern Oregon hamlet. The side was caved in and the muffler blasting. It was beat to shit.

“Gramma, did you give that truck to Jason?”

“No, Honey. I sold it to a guy here in town. He was going to use it to get wood. I didn’t want there to be no bad blood between you two.”

A gem trashed to preserve nothing. Sid knew this sentiment, this insidious peacemaking.

But he’d found an old truck and fixed it up and now, in his later years of practice, he had some pride in it. It glowed in the lot.

He’d even taken it on coroner calls. Folks recognized him rolling up. Sometimes, at least. Once on the highway east of town, called to a motor vehicle death, he’d passed around the line of cars a deputy was holding. Sid could see the frown from a distance as he rolled up. “You’re supposed to stay in line.” The deputy had barked at him.

Sid smiled and looked down. “Sorry, but I’m the coroner.”

The deputy smiled back and said to come on.

As he strode up to the steps, he was again wondering just what mistake he had made.

The prosecutor met him in the hall. “Good, you’re here. We’re all here.” He said to a young woman who went into a room behind him.

“What’s this about?”

“I haven’t had time to brief you on this.” He held a folder. “We’re meeting with a family who had a child die a few years back. It seems the child’s death was declared a natural death by the coroner at the time, but they have found that such was not the case. I apologize I couldn’t get these documents to you earlier to review, but the medical records are all here.”

Sid looked at the manila folder. It was thin. That’s good. “What’s going on here?”

The prosecutor took a deep breath and launched in. “They have legitimate grievance. We are trying to assure them such an injustice would not happen again.”

“Injustice?”

The prosecutor handed Sid the folder. “Why don’t you look through this. When you’re done, come on in.” He went through the door and Sid opened the folder.

The top sheets were an autopsy report for a 9-month-old child from the big city in a neighboring state. They described the cause of death as injury to internal organs from blunt trauma. The manner of death was listed as homicide.

The next few pages described the hospital course for the infant before the autopsy was needed. Sid scanned them, knowing the pathways taken.

There were police reports after that, usual observations, nothing glaring.

The last page was the official death certificate. So familiar, he had done so many of these. But the coroner had put ‘pneumonia” as the cause of death, and “natural” as the manner of death. Sid couldn’t clearly read the coroner’s signature, but he knew of this guy.

This county had elected doctors to be coroners forever. That’s why he was currently serving. But doctors aren’t always honest, Sid knew. And Sid knew more.

This doctor had left town under a cloud. He had been a member of a prominent conservative church, but his sexual orientation was not accepted by their dogma. Sid just knew rumors of this history. But here’s his name, and here’s this death certificate.

Sid went into the room.

There was a big Formica table and about ten people seated around it. Sid only knew the prosecutor and two others. They were an older couple he had seen in the clinic with some of their many children. He knew them to be of the same faith as the former coroner, the fugitive doctor.

“And this is Doctor Hawthorne, our county coroner.” The prosecutor intoned.

Sid nodded to the couple. He knew them from clinic visits.

The prosecutor continued. “You have read the reports. This family is here today to get our assurances that such a miscarriage of justice will never happen again.”

Sid didn’t speak. They needed to.

The story came out. The day care providers were trusted church members. The coroner also was of their faith, though, they acknowledged, he had lapsed. They believed what they had been told. But then when autopsy results were revealed…. Tears flowed. They felt a deep wound.

And so did Sid.

But inside he felt some relief. It was not his fuck up. He slowly grasped just who was around this table. There was probably an agent from the county’s insurance company and at least a lawyer or two representing their interests. And since this had occurred in the city, Sid imagined some lawyers from them were here. He looked down at the folder. He looked across at the sad couple.

The baby was dead.

“I wish I could assure you.” He placed the folder on the Formica.

“I have done my best to insure good investigations of childhood deaths. I have instituted child death investigations in this county. Whenever a child dies, the death is reviewed by a panel. Our state is the only state in the union that does not have a statewide review, but we do this here in our county. I cannot assure you that such will be the case in the future. The county coroner is an elected position. The voters will make this call. I am so sorry for this. I wish it had been done differently.”

Sid left the basement room and got into the 54 Chevy pickup. He sat a bit before turning the key and stomping the starter button.

The next day he found the phone number of the former coroner.

It was a brief conversation.

That night he replaced the coil on the old pickup in his cold garage. He tried to keep things running. It brought him peace.