You came into our life twice. First as an idea — on a normal Tuesday morning in late September, you materialized as a pink line on the pregnancy test I had ordered months earlier, after the third miscarriage, and squirreled away in the laundry room like some awful talisman whose powers could be dampened underneath layers of stuff: detergent, batteries, measuring tapes, Halloween costumes for the dog. Then, you were nothing more than a detectable level of human chorionic gonadotropin: inert and pure proposition.

The second time, you came with all fierceness; hammer and tongs.

On Friday night, Zack and I went out to dinner. I ate some bread and butter at the beautiful restaurant, as it was the only thing that appealed to the nausea that had stirred up every day inside me for nine months. The bread was sourdough, tangy and tart, and I almost threw up. After dinner we walked home, watched an episode of Arrested Development in bed, and went to sleep. Or rather, Zack went to sleep and I wiggled around in bed with what were becoming real contractions. Did they hurt? Yes. Was this it?

I went to the bathroom around midnight and saw a little bit of mucusy blood, and immediately called the hospital, which told me to come on over. I woke Zack up. I hadn’t bothered to pack a bag yet, so I put everything I could think of into a grocery tote and waddled to the front door, and then, the car.

When we got to the triage unit, the receptionist clicked her tongue. “Should have gotten here earlier,” she said. “Four other couples just came in the last 15 minutes. Full moon tonight, end of the month, you know.” I didn’t know. We followed her to the last door on the right, past the rooms where I had spent days earlier in my pregnancy, hooked up to IVs to help combat the nausea and refill my body with liquids. Every room looked the same: a sliding glass door, pastel curtains, too many chairs, an ultrasound machine, IV drips stacked on top of each other, cabinets labeled TOCO and BANDS and SANITARY.

Zack sat down next to the bed while I changed into the hospital-issued gown. I gave a urine sample, and two startlingly young medical professionals, a doctor and a nurse, came in to ask how I was feeling. “You’re talking through your contractions, which is a sign that they’re not too strong yet,” the doctor, who looked like she was 14 years old, said. I felt like punching her.

Instead, I nodded when she said we could go home, that I was only dilated one centimeter and that I should try to sleep and come back on Sunday morning for my scheduled induction. “Or before that, if you feel like you need to.”

I took her words as a challenge. Watch me, I thought. I’ll make it to Sunday. We went home that Saturday, at four in the morning.

Pain was nothing to me; it bothered other people but could not penetrate my lizard skin any longer.

I never did see the sun come up that day, and I didn’t go back to sleep either. Instead, I laid in bed until the contractions became unbearable — I bore them in the bathtub, then on the yoga ball in the living room in front of episodes of Call the Midwife. Zack texted while I was scrolling through Twitter in the tub, doing anything that would take my mind off of the contractions. “What are your real opinions about the guys coming over for soccer?” he wrote. I apologized three times and told him I wasn’t up for having his friends in the house to watch a game. “At this point the contractions are frequent enough that I feel really sick,” I wrote. “So sorry.”

There was a lot to be sorry about that weekend: no sleep, the glass of wine I didn’t order at dinner, the internal need I had to prove that I was strong (which meant certain things did actually hurt me). I was sorry in the sense that I was apologetic: I’m sorry you can’t have your friends over for one last Liverpool game before the baby comes. I’m sorry we are opening our lives up like this. I’m sorry the first three didn’t make it. I’m sorry, I’m sorry, I am so, so, so sorry.

I couldn’t make it to Sunday. I’m sorry. I called the hospital at 11 that morning, wanting permission, which they gave to me. “The contractions are three minutes apart,” I said, which was sort of true. “I can’t talk through them,” definitely true. Zack talked to the advice nurse while my next contraction came, and I held fingers up at him: How severe was the pain, how long did the contractions last, how real was this baby on a scale of one to 10. That last one was just in my head. “Come on in,” the nurse said.

We started walking toward the car for round two, when Zack paused, looking at his phone. “Can we stop by FedEx on the way to the hospital?” he asked. “We need that part for the bassinet.” We had bought a bassinet secondhand. It was a fancy one, but was missing the plug that would power it to rock the baby back and forth, giving us the sleep we already knew we would so desperately need. I answered him with a “no” at first, then, “Fine, let’s stop, just let’s get there and do this and be on our way.”

FedEx turned out not to be exactly on the way, but also not not on the way, and when we pulled into the parking lot, the contractions were so sharp that they literally took my breath away. Zack walked briskly through the automatic doors and, I would later learn, told the people who worked there that his wife was in labor in the parking lot and could they please help him locate the missing bassinet piece immediately.

In the front seat of the car, I turned on the seat warmer and the audiobook I was listening to, the memoir of Elizabeth Smart. I couldn’t really focus because I was wrestling through my contractions, riding them like a ship in stormy seas, waves cresting and flowing while Elizabeth Smart rode on a bus from Salt Lake City to San Diego with her captors. I groaned deeply, gutturally, thinking of how I would tell my friends about this moment: “And then I labored for half an hour in a FedEx parking lot,” I would say nonchalantly, because I could handle pain. I had already handled three miscarriages, an interminably nauseous pregnancy, and multiple hospitalizations for dehydration. Pain was nothing to me; it bothered other people but could not penetrate my lizard skin any longer.

I’m in the front. They are finding it, Zack texted.

OK, I texted back. Then, what felt like an eon later, ETA? Finally, I’m in serious pain.

He was in the driver’s seat a minute after that last text. No one at FedEx could find the bassinet part. I could tell that Zack was annoyed, not at me, but with the situation, the whole thing, the inability to do the one thing that he was supposed to be able to have control over.

The contractions were coming harder and stronger. We pulled away from FedEx and, 10 minutes later, were in the hospital parking lot. I don’t remember the drive.

We checked in again at the same place we had been 12 hours earlier. The woman who checked us in ushered us into a new room, where I grimaced through contractions that felt like they were crushing my internal organs. I couldn’t talk through these, and could barely talk around them. Zack offered his hand, which I squeezed until it turned purple and small in my own. Two nurses came in, looking like mother and daughter, and said they were going to check me. I steeled myself for a bad report: no progress, perhaps, or half a centimeter. It was 1:30 on Saturday afternoon, and I had been in labor for 16 hours.

“Get ready for this baby,” the older nurse smiled at me. “You’re eight centimeters!” Zack and I stared at each other, then at her. “Holy shit!” I said. “Holy shit!” Zack was still staring. “So does that mean…?” I trailed off. I didn’t know what that meant, other than the fact that I was in a lot of pain, having made it to eight centimeters without any pain relief. It also meant that, apparently, this baby was making progress. Perhaps, one day, he would even come.

Quickly, I called my parents, who had spent the night in Santa Cruz and were now stuck in traffic on the freeway, hoping to make it to us in San Francisco before the baby was born. Even more quickly, the nurses wheeled me to the delivery room, where they recommended I skip an epidural. “You probably won’t even need it — this baby is coming quickly!”

It felt like someone was squeezing my insides, tighter and tighter, wringing me out completely just in time for a new squeeze to begin.

The nurse asked me how my pain level was. What was a 10? I had to save 10 for something, right? I was in labor, yes, but what if I was in labor and someone was cutting off my leg without anesthesia? That would be a 10, so this couldn’t be.

The world I lived in had shrunk to this room and this window, and for a few minutes the moon curved against the top of the sky.

I made the next several decisions with this immediacy — in order, perhaps, to impress some floating entity, some ghostly amalgamation of the nurse, Zack, my future self, the entire medical staff at the hospital, so they all would know how tough I was and how much I could handle. No epidural, no problem. I didn’t need it. This baby was on his way.

Turns out, the baby was very much not on his way, at least, not as soon as it had seemed. Two hours passed, then three, and I had tried both a Fentanyl drip and nitrous oxide, neither of which made an ounce of difference in the sheer pain I was experiencing.

I continued to breathe through every contraction as if each was a particularly intense yoga posture, until someone finally brought up the idea, again, of an epidural. This time I accepted after pausing a beat: Even in the middle of labor, I did not want to seem too desperate. The contractions were worse than any pain I’d ever before experienced, each one pinching and kneading at my insides in a ceaseless churn. There was hardly any breathing between them — as soon as one ended the next one was there.

A nurse came in with a man in scrubs. “This is Jack,” the nurse said. He was of medium height, with black hair, and looked almost exactly like Jianyu from The Good Place, a show that Zack and I had binged early on in the pregnancy.

“Hey,” said Jack. He even sounded like Jianyu, I marveled, as he explained, slowly, how the epidural would work. I nodded along as if I was interested in anything he said when all that was passing through my mind was white-hot words of anger at this doctor who had the magic drugs, but had not yet put them in me. I made a thumbs up sign when he asked if I was ready, and the nurses arranged me in a C-shape, hunched around a stack of pillows.

“The pain should start to get better in 15 minutes or so,” he said. “That would be nermal.” He pronounced “normal” like “nermal,” like the name of the annoying kitten Garfield hated in the cartoon strip. “What wouldn’t be nermal is if you are still in pain in about 45 minutes.”

It wasn’t nermal. After 45 minutes passed the only thing I noticed was that the pain had gotten worse with every passing contraction. It felt like someone was squeezing my insides, tighter and tighter, wringing me out completely just in time for a new squeeze to begin.

In the labor room, the nurse asked me how my pain level was. “Probably an eight,” I said, even as alarm bells went off in my head. What was a 10? I had to save 10 for something, right? I was in labor, yes, but what if I was in labor and someone was cutting off my leg without anesthesia? That would be a 10, so this couldn’t be. I was doubting myself, doubting everything. The nurse looked at me. “I’m concerned that your pain isn’t getting better. Let’s get Jack back in here.”

Jack didn’t come back for another half hour, and when he did, he treated me like a science project. “Okay, hmm. Sometimes the needle doesn’t go into the right place. In about 10 percent of epidurals, they don’t take the first time.” I was tired of the numbers: 10 percent of epidurals don’t work, five percent of pregnancies cause nausea that lasts all 40 weeks. One percent of those who get pregnant experience three miscarriages or more. Six to eight percent get gestational diabetes. One percent have polyhydramnios, or too much amniotic fluid.

I won the Math Olympics in third grade, but my relationship with numbers has been bad ever since.

Jack tried again, and this time, the epidural worked, or, as he would say, it was nermal, and the next four hours were glorious. I texted everyone I knew. Friends visited with Indian food, the first thing I wanted to eat after delivering. Our nurse talked about the house that she and her husband were building out in the East Bay. Someone gave me a catheter, and someone else broke my water, which, it turns out, there was a lot of. I ran a 100 degree fever and was put on antibiotics.

Hours passed until the nurse put her fingers inside of me. “You’re fully dilated! We can start pushing!” It was 10:30pm now, and we were 25 hours into labor. I still didn’t believe there would be a baby, but that didn’t mean I wouldn’t do my best to keep up the charade. “Okay!”

Jack returned just before I started pushing. “How’s that epidural?” It was weak. I wanted more. Someone, somewhere told me that I could have more, of course, it was my decision, but if they kept the epidural going I wouldn’t really be able to feel the contractions to push, and didn’t I want to be able to feel them so that I knew when to push?

And for the same reason I didn’t tell anyone about my unfavorable reactions to certain medications, and the same reason I hardly let myself take any anti-nausea medication during the pregnancy, and the same mysterious reason any of us do anything to pretend we are okay when we are not, I said of course I wanted to know when to push, let’s turn that epidural off.

“I can’t do this,” I cried. It wasn’t a statement. The words were not words, they were bricks, and they built a wall that kept the baby inside.

At first it was fine, and I was fine, for an hour, and then two, and I pushed with all my might. I pushed in threes, 10 seconds apiece, for each contraction, and then after two hours I asked if I could push four times per contraction, and they said that would be fine, so I pushed in fours, laying on my back on the hospital bed, the epidural wearing off, Zack holding up one of my legs and my mom holding the other, the nurse counting to 10, telling me to squeeze my abs like I was doing a sit-up.

It had gotten very dark outside and very quiet inside, so all I saw were the lights on the construction equipment outside the window, and all I heard was my own exhalation and the count, one-two-three-four-five-six-seven-eight-nine-10. Then I’d rest and start again. The world I lived in had shrunk to this room and this window, and for a few minutes the moon curved against the top of the sky.

After two and a half hours of this non-stop pushing, a new doctor came in — a small, brusque brunette. “Hi,” she said, “So, we might need to start thinking about interventions.”

What was an intervention? Was I getting a C-section? She looked past me when I asked. “Not yet. We would start with forceps or a vacuum.”

This all seemed so fast. She explained the relative merits of both options, and in my right mind, I told her that I did not feel equipped to make a decision between the two, and could she please tell me what she would suggest. All the while, I kept pushing. She waited and talked to me between contractions.

Who was it that thought someone in the throes of labor could make any kind of rational decision? Why do we even prize rationality? I flashed back to a college philosophy class: John Locke said that moral laws were rationally discernible. In his later work, though, Locke suggested that we actually make moral decisions based on the pursuit of pleasure and the avoidance of pain. Which is it?

Forceps, it turns out, are not small salad tongs that slip delicately in and softly grasp the baby’s head. They felt like five irons ramming their way down my vaginal canal. By this time, I had been pushing for four hours, and for the past 90 minutes the epidural had worn off completely. The pain was worse than anything I had ever felt, and the (alleged) baby was still not making much progress.

The small doctor was in the room, and so was another, along with a team of NICU doctors also standing by, which, I learned, was standard procedure any time forceps were involved. When the small doctor put the forceps in, I grunted and grimaced as the pain built, became exquisite, and would not be breathed down. The forceps strained against my insides, the (alleged) baby was still not coming, and it was radiating hot pain through my entire body.

“I can’t do this,” I cried. It wasn’t a statement. The words were not words, they were bricks, and they built a wall that kept the baby inside. “I cannot, cannot, cannot,” I said, and the other doctor, not the small one but her tall colleague, smiled kindly at me and said that I was doing this, and I was doing great, and then the baby was out. The baby was out.

They put him, the baby, gray and limp and swollen, on my chest. He was silent and did not move, and felt like a fish, weighty and substantial, and possibly dead. This memory makes me heave with breath now, but it may not have even been real: Both Zack and my mom insist that no one actually put the baby on my chest, that they took him immediately from where he was born, and where Zack cut the cord, straight to the incubator, where they started working on him right away and bypassed me.

Perhaps. I still feel him on my chest.

They were going to have to decide, soon, whether the baby needed brain cooling, because he had suffered hypoxic-ischemic encephalopathy. We had to wait for Neurology because it was the Sunday of Memorial Day weekend. I was now 100 years old.

The doctors around me were quiet, and so was everything else. The quiet made me sick to my stomach. “Will he be okay?” I demanded, but it was like asking for a genie to appear. My son had been born white, blue, and gray, all the colors that are the opposite of life, and I wanted to know when he would turn pink.

I thought, suddenly, of the beginning of A Portrait of the Artist as a Young Man: “Once upon a time, and a very good time it was, there was a moocow coming down along the road and this moocow that was down along the road met a nicens little boy named baby tuckoo…”

I had never liked Joyce but my body was keening for baby tuckoo, and I would be the moocow. I would be the moocow, I would meet the nicens little boy, I would take home the nicens little boy and feed him and give him a name and give him a bath, and I would be the moocow.

Hours passed. Millennia passed, worlds were born and died, stars were born and exploded. God created the universe and divided the day from the night, but they were only minutes.

Whether the doctors rolled the baby over to me before they took him to the NICU is another fuzzy point. My mind has several voices on this. At some point someone told me he might survive. My labor nurse told me he would, and I loved her for it, even if it was a lie. The doctors took hours to stitch me up — days, even — and I was an old woman by the time they finished.

Someone wheeled me to him after all of this, and I touched his chest. There is a photo of this so I cannot deny it. He was covered in leads and had a hat on his head with a hole cut through the top, like Joe Pesci in Home Alone, so that the leads could connect seamlessly from his head to the machine that monitored his brain waves. He hardly moved. The doctor carried a piece of paper that said APGAR 1.

They were going to have to decide, soon, whether the baby needed brain cooling, because he had suffered hypoxic-ischemic encephalopathy. Brain cells die when they lose oxygen like his had, so taking steps to cool the brain would help to keep some of those cells alive. We had to wait for Neurology to arrive to decide if they needed to put the baby on a cold blanket to keep those cells alive, whether they would keep him on the blanket for three days. We had to wait for Neurology because it was the Sunday of Memorial Day weekend. I was now 100 years old.

Someone wheeled me to my room. Someone gave me an Ambien. Someone changed me into a clean hospital gown. I was reminded of John 21:18:

When you were younger you dressed yourself and went where you wanted; but when you are old you will stretch out your hands, and someone else will dress you and lead you where you do not want to go.

I woke after two hours of sleep to the news that Neurology didn’t think the baby needed brain cooling. He was still not responding well to reflex tests, but he was better than he had been hours before. APGAR 4. I woke up swollen, my stomach feeling like a deflated balloon, face and ankles puffy from the fluid pumped into me throughout delivery, eyes crusted over from dried tears, hemorrhoids from four hours of pushing.

Someone wheeled me down the hall to NICU, where the baby was laying in his bed, surrounded by my in-laws and doctors and nurses and, blessedly, Zack. Everyone but he and I left the room, and Neurology told us that things were looking better, things were looking good, even — that the baby’s lack of Moro reflex was still concerning, but he might still be just fine, and was just traumatized from birth.

So am I, I wanted to say, but the earth had shifted slightly on its axis and I somehow knew that my body mattered very little in this new rotation.

Seven pounds and six ounces of flesh and organs and bones — and my whole heart.

Our friends came by, one smiled reassuringly, and one cried, and I needed the one who cried. There were other babies in the NICU, and that registered with me in a strange way, that one baby had a room all to himself, which was decorated. There was a crib, family photos, name badge, and a big poster with number of days he had been in the NICU. He lived there.

Halfway through that day, the baby’s Moro reflex looked good. Good! And that night, it even looked normal. I held my son in the dark and silent NICU, looking out over San Francisco, a city I have always felt immense ambivalence about. I nursed my son, gave him the tiniest bit of honeyed colostrum he could eke out of my body. We were doing something together, my baby and I.

“What’s his name?” the doctors asked immediately after he was born. I was used to being coy when people asked, because we didn’t want to tell. The baby’s name was the last name of the family in Zack’s favorite book, and it was the only word that made sense after the miscarriages. The name was a betrayal of fate.

I looked at my mom. “This isn’t how I wanted you to find out,” I said. Then, to the doctor, “Chance.”

Here is what Chance had when he was born: jaundice, cerebral hypoxia, blue eyes, long fingers, hair in the shape of a monk’s tonsure, the prayers of my grandmother’s Bible study, seven pounds and six ounces of flesh and organs and bones—and my whole heart.

Now, my heart sleeps and cries and poops and smiles and wakes up crying in the middle of the night. Now, I sometimes get annoyed at my heart. Life has gone on, and when he is still, I still sometimes look at him and want to move into the space between his caruncle and his eyeball. I want to breathe in every one of his exhales so that none of his breath goes anywhere except directly into me.

This is how you came to us. Once in a mute pink line, and then again, with all your fierceness.