In this short story Prajna reflects on medical trauma as experienced with her twin daughters and the over-used expression “just in case.” Sit meditates on the importance of sitting with challenging decisions and the necessity of following one’s own voice and intuition.  

It is a Tuesday night. A sliver of the moon sits still in the chilly night sky. I turn into the driveway of our big yellow house on California Avenue with a car full of lumber to complete an accessibility project for my twin daughters Abby and Libby. Libby’s nurse is leaving. Abby and Libby are in bed listening to a book on tape. I’m unloading my car when my phone chimes. It is Abby using her talk-to-text. “Mom, you need to come inside right away.” I feel my heart jump a beat and my protective mothering instincts kick into high gear. She never sends messages like this. 

Abby and Libby were born three months early after a series of relentless medical interventions. I showed early signs of labor at twenty-six weeks and after a brief exam was flown in a helicopter to Stanford hospital for emergency intercession with the experts. Years later, I discovered a video of an ultra sound taken shortly before their premature birth that shows they were as healthy as twins can be. The doctors intervened just in case. Twenty-three years later, Abby and Libby continue to navigate the world with severe brain injuries. 

Leaving my car wide open, I run inside. It’s quiet. No crying. The silence is alarming. I call for Abby and go directly to her room. She isn’t there. I make my way to Libby’s room and see Abby’s petite silhouette in Libby’s dimly lit bathroom. 

“What are you doing in here?” 

“I had to use the toilet.” She pauses, her speech slurred. “Mom, I fell but I’m o.k. I tripped on Libby’s wheelchair.” 

I turn up the light and scan the scene. I see bloody toilet tissue spread around the floor and blood on her pajama top. My eyes travel up towards her face. One of her front teeth is completely missing and the other is chipped. I scan the room for her missing teeth and find them wadded in bloody tissue in the trash. Maybe Abby thought if she hid the evidence, we could pretend that none of this ever happened? Abby has low vision and blind spots, this isn’t her first fall. 

In the blur of immediate trauma, I steady Abby’s walk on the way to the living room and lay her down with a cold wash cloth and rescue remedy. It feels like the whole house is holding its breath–waiting for the inevitable wailing that follows the shock of a traumatic experience. 

Unsure of what to do, I google, “what to do when an adult tooth is knocked out?” It informs me: Don’t panic. Clean the area. Rinse the tooth in milk or a saline solution. Don’t touch the root. Attempt to place the tooth back in the mouth. If done within an hour, the tooth may be able to reconnect as the root is still alive. Abby shakes and screams when I attempt to put her tooth in place. Bad idea. 

I call an emergency dentist but we don’t have time to get to him. He tells me to call 911. A fire truck and ambulance sirens full blast are at our house within minutes. As the squads enter the door, the outbreath happens. The entire house is wailing at once. The medics would like to take her to the emergency room to see what can be done. “They’re not taking me!” Abby roars. She writhes with the strength of a tiger in full panic. From many medical interventions throughout her life, Abby has post-traumatic stress and she is fully triggered. 

Knowing full well that Abby won’t be riding in the ambulance, I drive her myself. The place is packed, every seat is taken. The receptionist tells me there is a two hour wait. I explain the critical nature of the situation and plead to move forward in the line. A good hour passes before our names are called. There is not an orthodontist on site, but a doctor is willing to attempt to reinsert the tooth. Several staff members and myself try to hold Abby in place for the doctor to do it. Bad idea. She bites, pushes, and kicks with muffled screams. I’m sure it feels like she’s being strapped down. I can’t take it. 

“Stop. This isn’t working. Our time is up. Leave her alone.” 

I feel defeated and like I’m an accomplice to a crime. Abby is re-traumatized. What made me think the ER could help her? I thought they could put the tooth in and save the day. A perfect stranger forcing someone to do something they are not ready for or cannot manage is never a good idea. Trauma is inescapable. 

“We’re going home,” I console Abby and massage her trembling legs. 

The nurse balks, “We can’t release you until the Doctor says so and she takes her medication.” 

“What? Medication for what?” 

“He has a prescription for Abby. An antibiotic for infection.” 

“She doesn’t have an infection.” 

Just in case.” 

There it is again. Just in case. I sign a refusal statement, take a firm hold of Abby’s hand and head home. 

Almost a year later, after multiple dental appointments and failed proceedings by well-intentioned dentists, Abby is still missing her front teeth. She wants a bridge. She talks about it allthe time. She obsesses over her favorite dental hygienist and wears her hair in a bun just like her. She watches YouTube videos of kids receiving laughing gas. She mentally rehearses her success. She’s confident. All the while, she feels people staring at her. She nibbles on her lip in an effort to self soothe. When the moment comes to sit in the dentist chair, her trauma response takes over. Nobody can get near her mouth to get anything done. 

Just in case” is a statement I hear more often than not in traditional western medicine. It’s a clause that leads to a standard protocol of medical behaviors to protect against negligence. I have heard and seen many instances in which this approach to medical intervention has harmed more than helped. Why take a medication or use a treatment with a potentially harmful outcome when nothing is wrong? 

When I went to the hospital twenty-three years ago on what ended up being Abby and Libby’s birthday, the Doctor on duty asked about the birth of my first child. I boasted it was as easy as making pumpkin pie. I’ll never understand why an alarming medical drama ensued. Without engaging a full pre-natal examination, the doctor declared they were not equipped to handle the birth of these babies ifit should occur now. I would be transferred to Stanford hospital immediately by helicopter, just in case. 

I entered a dream space, lost my voice and my footing. I became a passenger in an unfamiliar terrain. No one was allowed to accompany me in the helicopter. I was alone with strangers traveling through clouds. The weekend staff on duty never got a clear picture of what was happening in utero with my babies. They failed to uncover the facts that may have precluded an emergency c-section. Rushing something to happen is never a good idea.