Caffeine has become one of Russell's prevailing desires since he began his residency. His feet stick to the cold floorboards as he pads towards the darkened kitchen. A fresh pot of coffee is waiting, courtesy of the Brewomatic Fay gave him when he matched at his first choice of hospitals.

He drinks a cup while perched at the counter, a barrier between the living room and the kitchen. They've been here for several months now, but the apartment still looks as if they just moved in. On his rare days off, he is too tired to unpack or decorate any further. Boxes are scattered everywhere like undetonated bombs. Empty walls wait for picture frames, which lean against each other by the sofa.

Only the second bedroom remains an uncluttered oasis. Sometimes he falls asleep in there, right in the middle of the floor, instead of painting or ripping out the wall-to-wall carpeting, attempting to fix it all up before the baby is due.

After his daily run around Elm Park and a shower, Russell drives over to the hospital. This route has become so familiar—past the edge of the city's dilapidated downtown and a state mental facility—he could probably do it and sleep at the same time.

More coffee is required for a level of alertness that can be sustained for most of the day. So he always allows enough time for a stop at The Bean, sandwiched in between the hospital and a car wash.

Even though it is barely what you could call morning, a long line of nurses, doctors, and lab technicians snakes out the door. As Russell gets closer to the front counter, he can hear the familiar sound of music he doesn't know anything about and the three Bean employees discussing the Pennant race.

"I cannot believe they actually won last night," the guy with Red Sox tattooed on his arms says as he froths milk. "I had to keep leaving the room I was so tense."

"We're in Game fucking Seven, babe," the sexy one with dyed-orange hair looks up from toasting a bagel. "Unfuckingbelievable."

"Dude, don't get too excited, it's the Red Sox," the tattooed guy turns to face her.

"Why do you always have to be such a complete downer?" the short, stocky one at the cash register asks.

"Yeah, dude, we're going to kick some serious Yankee ass tonight," the sexy one adds.

"See, that is the kind of attitude we don't need," the tattooed guy shouts at them. "Blind optimism is going to ruin it for them."

In some ways, this is Russell's favorite part of the day. Waiting in line is like overhearing their own private party. The customers are merely some side project they need to take care of for a minute before resuming their real mission: talking to each other. Russell always takes a little too long to put his wallet away or grab napkins he doesn't need, just to be in there a little longer. They make him feel homesick for another time in his life.

This month, Russell's rotation is on the labor and delivery floor and already he has assisted with the birth of about two dozen babies. At first he loved it so much, he wished he could switch his residency from internal medicine to obstetrics, until the premature twins. One lived a few hours, the other three days.

It turns out to be a fairly uneventful day: standard issue birth followed by a Caesarean. Even though he's seen about ten C-sections, he still feels like he's going to be sick when they push the newborn out from between the stretched-out folds of the woman's abdomen. The entire afternoon is taken up with a seminar on medical ethics, a requirement for all first year residents. It is a battle to stay awake. Since starting medical school, fatigue has engulfed him like a heavy coat he can never take off.

It is completely dark outside by the time the seminar finishes. For dinner, Russell buys a damp tuna sandwich and more coffee from a cart by the gift shop, then heads to the doctor's lounge to call his wife.

"I cried during yoga today," Fay says instead of 'hello'.

"When did you start doing yoga?" he asks without thinking. His alleged inability to pay attention to her life is high on the list of accusations against him.

"Two weeks ago. With Allison."

Russell has no idea who Allison is. "Oh," he tries to bluff.

"You met her," she sighs. "She was at our house on Friday."

"Oh yeah," Russell remembers being startled to see someone in their apartment. Except for occasional UPS deliveries and a plumber when the toilet overflowed, no one had been over.

"The teacher told us to remember that we're bigger than the baby."

"That's true," Russell has no idea what she's talking about. But asking for an explanation will lead to a fight so he just says he'll check in later.

Everything seems to make Fay cry now. Russell can't figure out if it's moving to a new city or being pregnant that is the cause. She was less than happy about leaving New York, let alone ending up here where everyone seems to be in some type of social service program. The shopping plazas, fast food restaurants, convenience store parking lots are all filled with day releasers and substance abusers, killing time before their support group starts. Most nights Russell comes home to find his wife weeping in front of "Roseanne" reruns, hunched over a vat of macaroni and cheese. And once again yesterday morning, Russell woke up alone in bed. He found her on the sofa, looking out the window and sobbing. When he asked what was wrong, Fay said she felt like she was on a conveyer belt that was moving away from everything recognizable.

Tomorrow she'll leave early for New York. She's still the arts editor at a women's magazine there, on the condition that she come back for monthly staff meetings. It's hard to remember what she was like when they lived in the City, constantly going to gallery openings, private screenings, and preview performances. Any evenings at home were spent hosting long, loud dinner parties, empty wine bottles crowding the edge of the kitchen sink the next morning.

An orderly saunters in, nods "hello" to Russell and lands next to him on the couch. He turns on the TV and pulls out his nail clippers. Someone told Russell that he was suspended last year for some missing medication, so Russell mostly avoids him. Especially since he finished writing a horror movie that he keeps hassling Russell to read.

A few more people trickle in as the game comes on. No one says much while the players line up for the National Anthem. Then Russell gets called out for a patient —a pregnant teenage girl who has been in twice before. Russell had carefully explained each time that they were just Braxton Hicks contractions, not the real thing. She waits for a room assignment with her stunned boyfriend, doubling over every few minutes.

"I can't believe I thought those other things were labor," she says when they get her into a room. "God, this really fucking hurts."

Her boyfriend is glassy-eyed and pale, looking like he might pass out at any moment. "Maybe try that breathing shit," he mumbles.

Russell attaches a fetal monitor around her belly. "Do you want something to make you more comfortable?"

"Anything, I'll take anything," her face contorts as she has another contraction. "I don't think I can do this."

"You can, I know you can," Russell tries to sound reassuring.

After consulting with the supervisor and ordering an epidural for the girl, he checks the board by the nurses' station. Most of the delivery rooms are occupied. Nighttime brings babies, the nurses are always saying, especially if there's a full moon.

A number from one to ten is written next to each name in black magic marker, the nurses' rating system for the patients' screams. In 613 there's a 10. Even though her door is closed, you can hear her out in the hallway. "Somebody help me. Somebody kill me." Over and over.

Inside the room, The Screamer has her head burrowed deep in the folds of a pillow, her body twisted into a question mark. A man standing over her starts kneading her back.

"Don't touch me!" she swats his hands away. Russell learned right away not to assume people's relationships with each other, but this guy is definitely the husband.

A chart dangles at the end of the bed with Tina Bailey written across the top. "Hi Tina. I'm Russell, a resident, and I just need to give you a pelvic exam."

She rolls over, pointing her finger at Russell. "I'm not letting some medical student shove his hands up me, you understand. If I need an exam, Dr. Melfitch will do it. Not you."

Dr. Melfitch is at home, having dinner with her family in one of those sprawling homes along Elm Park that Russell runs past each morning. You're not even allowed to call until her patients are at least six centimeters dilated.

"Would you be more comfortable with a woman? I can get someone else to do it."

"I don't think you heard me. I WANT DR. MELFITCH."

"Tina, honey," her husband pleads softly.

"No talking!" the finger points at him now, his face drooping slightly like a slapped beagle. He smiles weakly and shrugs. "What can you do?" he whispers to Russell.

Looking over the chart again, Russell tries to think of some way to get this woman to let him do it. He decides to find the supervisor, even though he doesn't like to be bothered with things the first years should be able to do by themselves, like pelvics.

Then Russell looks in on a woman who is being induced. Although she's been hooked up to an IV of Pitocin for several hours, still nothing is happening. She shouts at the TV set when Trot Nixon hits a home run. The Red Sox are ahead 4-0 in the top of the third. "Maybe this is a good luck baby," her male companion kisses her. Everything he is wearing says Red Sox on it, including the foam finger he keeps waving around. A Red Sox onesie is laid out on a stool, waiting to be filled by their newborn. He videotapes everything, including Russell doing a pelvic. "Homemade porn," he winks.

It is nine p.m. and Russell has been inside for fourteen hours straight. It seems like there are days on end that he doesn't even breathe natural air, except for occasional forays to The Bean. He checks the board again. Two new admits need to be hooked up to monitors. When he's finished with those, he examines a woman who wants an epidural and more pillows. Next door, another one asks if she can have a cheeseburger, instead of the bucket of ice chips by her bed. Then the supervisor asks him to help prep a woman for a C-section.

Afterwards, Russell heads for the soda machine at the end of the hallway. As he fishes some coins out of his pocket, he pictures Fay watching the game in their living room, a blue pilled blanket wrapped around her, the wind rattling through windows that won't close all the way.

During his break a few weeks ago, Russell came upon his wife in a diner by herself. He stood out on the sidewalk for awhile, watching her inspect the menu and order something to eat. Then he walked away, looking back over his shoulder to make sure she didn't see him. The sunlight glaring off the windows made her look especially forlorn, unkempt hair framing the edges of her sallow face.

The woman who is being induced is still not making any progress. Her partner has the foam finger on his head now. Russell stalls long enough in their room to watch Bernie Williams single home Derek Jeter, making it 5-3 in the bottom of the eighth. Yankee Stadium erupts as Matsui steps up to the plate. The Red Sox manager visits the mound, but sticks with Pedro. "For fuck's sake, take him out," the father says. Then Matsui hits a double, putting runners on second and third for Jorge Posada, who ties the score with a double. The foam finger is thrown to the ground as the father grips the ends of his hair and shouts, "You stupid asshole!"

"FUCK!" the woman slams her hand on the side of the bed.

"You two should really try to get some rest," Russell says but they ignore him. He passes Dr. Melfitch in the hallway. Dorsal fin, the other residents call her. Russell can never quite look her in the eye, staring at his feet or a distant object whenever he is in her presence, anything to avoid being noticed and pummeled with hard questions.

The teenage girl has fallen asleep hooked up to the epidural, her boyfriend passed out in the chair next to her. The Screamer is still going at it. Then the supervisor finds him. "Everyone is all set right now. If you want some shuteye, now's your chance."

Russell gets to the doctors lounge just in time to see the Red Sox lose. Mariano Rivera collapses on the pitcher's mound, hugging it tightly. The Yankees pile over him, then lift him up and carry him around.

Lying back on the sofa, Russell pulls out the ultrasound picture tucked inside his wallet. This fuzzy black and white image of a tiny skeleton's arm will become his first child in just a few months. At home, a large pile of baby books is stacked up on the floor by his side of the bed. Fay refuses to look at them. Her doctor told Russell that once she feels the fetus moving inside of her, things would change. "Her maternal instinct will kick right in," she'd said when Russell called to discuss Fay. "Moodiness is just a part of pregnancy. Make sure she's getting enough rest. I'm sure it will clear up soon."

Russell falls asleep clutching the thin strip of paper. Then someone is calling his name, shaking his arm. It takes a moment for the supervisor's face to really come into focus.

"That girl—the really young one—she's freaking out," he says. "The epidural wore off and she was almost ready to push but then she started hyperventilating. I'm just about to do a delivery, so you gotta go deal with her."

It feels like he's only slept for five minutes but it's actually been almost three hours. Russell stands up too quickly and, for a moment, feels like he's going to fall over. But the moment passes and he hurries to the girl's room. She is screaming every time she has a contraction. A nurse Russell doesn't recognize rubs the girl's back.

"Stop," her boyfriend pleads. "Baby, you have to stop yelling." But she keeps doing it, so he walks away from the bed and slumps over in a chair.

Russell leans down and gets really close to the girl's face. Her eyes are shut tight as she howls like a wild animal caught in a steel trap. "I want you to breathe with me okay?"

"Please make it stop, please," she moans, opening her eyes. "Help me." She reaches out and grabs at Russell.

"Listen to me, okay. Just listen," he takes her hand. "Close your eyes and do exactly what I tell you." He checks the monitor. Another contraction is coming. "Okay, inhale, inhale. Now hold it, hold it. Okay, now breathe out." The girl whimpers but manages to do it. Russell gets her to breathe deeply during her next contraction, and then the next one. He stays crouched by her, inhaling and exhaling for almost fifteen minutes before she calms down.

"Okay, come over here," he calls to the boyfriend. "You have to breathe with her just like I did, okay. And don't stop."

The boyfriend shuffles over while Russell does a pelvic. "She's fully dilated, 100% effaced," he calls out to the nurse. She gets the supervisor while Russell and the boyfriend help the girl get up on all fours.

"I'm gonna puke," she says seconds before throwing up onto the floor.

"What the fuck is wrong with her now?" the boyfriend shouts at Russell.

"It's just the stomach expanding because the pressure of the baby isn't on it anymore," he explains.

The door slaps open and the supervisor comes in, slipping on plastic gloves, the nurse following close behind. The supervisor glides over on a stool to face the girl's backside.

"Okay Mom," he looks up at the monitor. "Now push! Push where my hand is."

Sweat pours down the girl's face as she tries to follow the instructions. "Okay, bear down hard again," he calls out. "Russell, come over here." Russell grabs another stool and sits next to him. Blood spills down the girl's legs.

"I wanna be on my back," she says. They help her turn over, limbs and sheets moving together. Her boyfriend holds one leg while the nurse holds the other and wipes at her face with a washcloth. The girl pushes again and a round tuft of blackness comes into view.

"Excellent, I can see the head," he calls out to her. "You're doing great, Mom. Now, push again."

The head comes halfway out, then shoulders are visible as she pushes again. "Ease the baby out now," he says to Russell, guiding his hands around the slippery, rubbery body. It comes sliding out with the next contraction.

Then everything happens quickly. Russell holds the limp head in his hands while the supervisor swabs out the mouth and ties off the umbilical cord.

"Is it over, is it over?" the girl cries out. "Please God, is it over?"

"You have a baby girl," the supervisor announces as the infant screams.

"Oh my fucking God," the boyfriend hugs his girlfriend. "I fucking love you."

The nurse does the Apgar test, calling out numbers to the supervisor, then weighs her and measures the head and body. Then she wraps the baby in a blanket and places her on the girl's stomach. The new parents sob as they inspect their tiny daughter.

"She's so fuckin' hairy," the boyfriend laughs.

"Shut up, she's so fuckin' beautiful," the girl has that worn-out, ecstatic post-birth look. "Will you take a picture of us?" her boyfriend hands Russell a disposable camera.

"Okay, now its time to deliver the placenta," the supervisor calls out to the girl.

After taking their picture, Russell throws out his gloves and scrubs his hands in the sink. "You were really good with her," the nurse whispers to him. "I didn't think she'd be able to do it. But you calmed her down."

No longer needed in here, Russell checks in on the induction once again, but still nothing is happening. Another few hours of this and she'll have to have a C-section. At least they are both finally asleep. A woman in slippers and a bathrobe paces the hallway dragging an IV, her companion holding onto her arm. The orderly is mopping the floor in the Screamer's room, which has been vacated. Russell finds an empty room and sleeps for the last two hours of his shift.

 

 

It is still dark when Russell wakes up. Outside the hospital, he gulps in the fresh air. The Bean is just opening up so he decides to get a cup for the drive home. He waits while the sexy one with dyed-orange hair unlocks the door.

"Sorry," she fumbles with the top lock. "I just put the coffee on," she finally gets it open. "It'll be a few minutes."

Russell sits on a stool, enjoying not doing anything, watching her rush around behind the counter. "Who is this?" he says, referring to the music. He's observed with envy when other customers ask the same question.

"Mekons, their second album," she shouts out from the back closet. "You into their early stuff too?"

Russell has never even heard of them. "Yeah," he mumbles. "Sucks about the game," he tries instead.

"I know," she breezes back, tying a stained apron around slender hips. "Fucking Pedro. David—you know that guy with the tattoos, he's going to be like suicidal today," she checks the coffee. "You're kinda early."

"Just finished an overnight."

"What do you do?" she puts some muffins on a platter by the window.

"First year resident. On the maternity ward right now."

"You mean like delivering babies and shit?"

Russell nods. The coffee maker exhales loudly.

"That is so awesome," she fills the steel pitchers with milk, cream, two percent, and soy. "I wish I was doing something real like that. I can't wait to get the fuck out of here."

The stool creaks slightly as Russell feels a sudden panic at the thought of not seeing her every day. "Are you leaving?" he starts to stand.

The next thing he knows, he is lying on the wooden floor with his legs draped over the stool, splayed out next to him. There is a sharp pain in the back of his head.

"Oh my God, you scared the shit out of me," she is kneeling beside him, smooth fingers on his forehead.

"What happened?"

"You like passed out or something," she studies his face. "You fell like totally hard. God, are you okay?" She smells like faded deodorant and body oil. It seems likely that she didn't shower yet today, maybe not even yesterday. She is one of those people who are more attractive when you look at them quickly and don't linger too long on any one thing. Still, he wishes she would kiss him.

"I think so," Russell reaches for the back of his head. No blood, but a huge welt.

"You want some ice?"

He sits up. "That's all right."

She helps him to his feet, her hands on his arms. Then she picks the stool up. "You better sit down."

Russell follows her orders. "I guess I'm still getting used to working nights."

"I don't know how you can deliver a baby on no sleep," she gives Russell a weird look and he realizes that he's staring at her. "You sure you're okay?"

"I'm fine, really," he looks away quickly. "I should get going though."

She goes behind the counter and pours coffee into a large container, then brings it over to him. "Here, this is on the house," she nods at his wedding ring. "Someone will look after you when you get home, right? "

Russell starts to explain that Fay is out of town, but if she were at home, she still couldn't look after him. That she never asks about work or really anything, now that he thinks of it. That he can't remember the last time she even touched him, sleeping curled away from him, flinching if their skin comes into contact. Clearly, this woman doesn't care about all that. She's just passing the time before her shift ends. Instead, he thanks her, dumps some milk in his coffee and heads off to the parking lot.

An almost sunrise creeps across the charcoal gray sky as he turns onto Carlton Street. On his way out of the hospital earlier, Russell made his usual stop at the nursery. It's his favorite room, twenty plastic containers with wrapped-up newborns inside and the only place that doesn't reek of ammonia. The teenage girl's boyfriend was leaning over his brand-new infant, stroking her forehead, while a nurse washed her off.

"Everything is so fuckin' little," he whispered to Russell. "You can barely even tell she's got fingernails. I just hope I don't break her," his voice wavered. He was still wearing the leather jacket he had on when they arrived.

"You won't. Just enjoy her."

"Thanks for everything, man," the boyfriend gently punched Russell's fist.

Belmont Ave. runs right into Highland. Rising up over the hill, the 7-11 across the street from their apartment building comes into view. Russell keeps going. Everything on their street is still closed: the liquor store, Mexican restaurant, even the laundromat. Elm Park is empty except for a few runners that Russell recognizes from his morning runs. He drives along for awhile until he comes to a lake and turns onto the gravel road that runs beside it.

When the road dead-ends, Russell gets out of the car and stands by the edge of the motionless water. Here, away from the city, the leaves still hold onto their bright red and orange color. He picks up a rock and throws it at a log floating in the distance. Missing it completely, he throws another one and another. Out in the middle, wild geese lift off the water. They swirl around for a few moments before forming a large V. Even though they are several hundred feet away, their loud honking reverberates across the lake.