The Last All-Nighter

THE LAST ALL-NIGHTER 

                                                           By David L. Elkind

I’ve had six all-nighters in my life. The common expression is that I “pulled” an all-nighter, as if I pulled some cord which caused me to stay up all night. My first all-nighter took place at the end of my first semester of college. Soon after I had finished my last exam I was sitting in my dorm’s dining hall having lunch, which was beef with vegetables and a thick sauce. A classmate sitting next to me started picking at my food and asked, “What’s this? It looks disgusting.” After being awake for about 30 hours I had lost any inhibitions about my behavior. “If you’re so interested in it why don’t you wear it,“ I said as I poured it on him. This led to a brief food fight. As we walked away to shower I heard a female student say, “I hate those boys.”

My next two all-nighters took place about a decade later. I was working as a young lawyer on a project in Houston. Because the project was time sensitive I finished the work with two consecutive all-nighters. We were working at a Houston law firm’s offices.

After I had already been awake for about 36 hours, I went to the firm’s library to do some research on the second night. When I got there I learned that the library had the eerie sound of noise proofing. It was already strange being there alone.  With nothing to absorb the noise, the sound proofing had a discordant tone, harsh and jarring well beyond its volume. The combination of the odd sounds and my fatigue made me feel discomfited, as if I was hallucinating. I couldn’t stay there. I quickly left the library and went back to my office.

When I got back to the hotel at about 6:15 a.m. after the second all-nighter I told the desk clerk to wake me at 8 a.m. I still can hear him laughing. Somehow I got to the airport in time to take the flight home.     

My last three all-nighters accompanied the births of my three daughters. There are several points of your children’s lives that are special. I don’t think that any compares with the joy of meeting them for the first time.

Staying up all night for the birth of my first two daughters made sense. Because we belonged to an HMO we had to use their hospital for childbirth, which was 40 miles from our home. Once we were told that my wife, Sarah, was in labor, it made sense to stay at the hospital rather than driving 40 miles home and then 40 miles back to the hospital again. Both births took place many hours after we got to the hospital.

During the first two births I remember being intimidated by the anesthesiologist, an older Eastern European woman who had a gruff demeanor and wasn’t shy about ordering me out of the room while she administered the anesthesia. She acted like what my father used to call a battle-axe: aggressive, overbearing and forceful. The hospital also was a teaching hospital. They were equipped to handle any problems that arose but there were no amenities.

The dominant characteristic that I remember was steel. Cold steel everywhere, with no plants or flowers. Everything was functional with a lack of warmth. Labor took place in a large room with multiple women present. It was sterile and unwelcoming. During the second birth Sarah was in a labor room with a woman from Jamaica who would whine every couple of minutes, “Oh, Jesus.” I had Sarah look into my eyes as I said, “Pay no attention to that woman.” My first daughter was born at 3:39 p.m. and the second girl was born nearly three years later at 1:06 p.m. I remember crying with joy as I held each baby for the first time.

My third daughter, Jenny, was born four years after the second daughter. Her birth was particularly memorable. By then we had traditional insurance that let us choose which doctors would be involved with the birth and where the birth would take place. We chose a hospital only a half mile from our house. It had a much softer look, with plants everywhere and some flowers in vases. Labor and delivery took place in the same private room. Everything oozed warmth.   

I remember how hot it was during that time, in early April. The temperature rose to the high 80’s and I turned the air conditioning on at the house two months earlier than normal.   When we got to the hospital at about 2:30 a.m., the doctor determined that Sarah’s cervix was dilated six centimeters. A cervix is supposed to dilate to ten centimeters to allow the passage of the baby’s head into the vagina as part of the childbirth process. Sarah was well on her way to giving birth. But she was in intense pain from the cervical dilation and wanted an epidural.

An epidural provides a band of numbness from the belly button to the upper legs. The doctor told me he was concerned that an epidural at this point could be problematic because he was worried that it would slow Sarah’s rate of contractions. He was about fifty and had an arrogant demeanor. He spoke to me as if commanding me rather than discussing it with me. I didn’t care.

I could see how much pain Sarah was enduring and she repeatedly asked for an epidural.  It  didn’t matter to me that the doctor was an experienced physician twenty years older than me. I wasn’t intimidated by him. I was about six inches taller than him and my tee shirt revealed my musculature. I decided to take charge of the situation and I wasn’t going to negotiate. “She wants an epidural and you’re going to give her one,” I said in an even but sharp tone. I moved to within a few inches of him and I scowled as I looked down on him. He looked shocked at my abruptness but then nodded. It was a nod of concession rather than agreement. He looked intimidated. That wasn’t my goal. I just wanted Sarah to be more comfortable.  

The rate of dilation of Sarah’s cervix slowed to the point of being almost imperceptible after she received the epidural. More than two hours later she still wasn’t at 7 centimeters. “I think I’ll give her a shot of Pitocin to help stimulate more contractions,” the doctor said to me. Pitocin is a hormone that strengthens labor contractions. The tone of the doctor’s voice sent me a mixed message. At one level he was trying to assert himself, as if my conduct demanding an epidural for Sarah had removed his doctor’s cloak of invincibility. Yet he also seemed as if he was seeking my approval.

I realized that I needed him to be confident and lead . “That sounds great, “ I said. “Thank you. I’m glad you’re in charge.” His face noticeably relaxed. Mission accomplished. A nurse hooked a device onto Sarah that measured her contractions. The stronger the contractions, the higher the lines rose. Before the Pitocin the lines showing the contractions had risen a modest amount when Sarah had a contraction. Once she had the Pitocin the numbers almost leaped off the monitor. Sarah was having intense contractions but feeling no pain.

That was the calm before the storm. Once her dilation reached 9 centimeters I was told that when she reached 10 centimeters, full dilation, Sarah would be in transition, the stage where dilation is over and the body starts getting ready to push the baby into the world. At this point Sarah would have strong contractions every two to three minutes. The epidural had almost worn off. Soon her pain would be intense.

I realized then that we had made a major mistake. Before our first two daughters’ birth we had taken Lamaze classes. They taught breathing techniques and relaxation methods to help Sarah cope with labor. I remember that when our first daughter was born Sarah started to lose it as she reached transition. I gently grabbed her head and pulled it to within two inches of my face and initiated a breathing pattern that she immediately imitated. That got here through a very difficult time.

I don’t know why we hadn’t attended Lamaze classes this time but we hadn’t. When Sarah reached transition she was in obvious pain. I decided to “take one for the team.” I extended my arm to her and she repeatedly dug her fingernails into the top of my hand. I wished then that they had given me a painkiller because when she dug her fingernails into my hand it hurt like hell, but I had no choice but to take it.

What finally saved me was when the doctor came in to deliver the baby. Soon Sarah was pushing with all of her might. Jenny came out looking a little bluish on her hands and feet and near her lips with blood and a waxy goo on her skin. Some of her skin was mottled with spots. She looked a little bruised, and as I looked at her carefully she seemed a little bluer than her sisters had been.

Babies are given an Apgar score at one and five minutes following birth. The test measures the baby’s apparent health, looking at a variety of factors. The highest number is 10, and the hope is that the baby’s score is at least 7.

The nurse said that Jenny’s first Apgar score was 5. That was a low number and indicated that there may have been a problem at birth, which could have led to a low oxygen level.  I’ve usually been calm during difficult situations, but I felt a wave of fear take hold of my body.  

The nurse looked worried and momentarily hesitated, as if she was unsure what to do. She was young and I wondered how often she had confronted a similar situation. She looked lost. I realized that I had to step up and take over. I didn’t hesitate.

“Give her to me,” I said. The nurse hesitated. “Please give her to me,” I said. The language was softer but my tone was no-nonsense. The nurse quickly looked around nervously.  There were no doctors to play the bad cop and tell me no. She gently passed Jenny to me.

I immediately took off my shirt and brought Jenny to my chest. I held her against my heart, which was pounding. I don’t remember the songs, but I sang to her nonstop. I bounced her up and down gently. I prayed silently.

At five minutes the nurse took Jenny back. She checked Jenny’s color, heart rate, reflexes, muscle tone and respiration.

She smiled. “She’s a 10,” she said. “Nice work.” I took Jenny back. I burst into tears, but they were tears of joy and gratitude. I’m not a narcissist but I was proud of myself. This was the biggest crisis of my life and I had taken charge and passed the test. That was the last time that I was ever nervous. Each time that a difficult situation has arisen since then I’ve told myself that it was nothing significant and I’ve calmly resolved it. After Jenny’s crisis nothing else could be nearly as important.

I can approximate the dates of my first three all-nighters. I know the exact dates of the last three. The final one was more than 32 years ago. The last three dates have more in common than being the dates of my daughters’ births. They were the three happiest days of my life. The all-nighters were time well-spent.

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