What our hands hear

On holding on, and letting go

Content warning: a portion of this piece refers to the life and death of Adriana Smith, a Black nurse and mother who was declared brain dead at eight weeks pregnant but was kept on life support for over one hundred days in order to continue gestating her pregnancy. My deepest condolences go to to the family and friends of Smith not only for her preventable and premature loss, but the incomprehensible violence enacted upon her and them in its wake. If you find yourself called to contribute to her family’s expenses a verified Gofundme can be found here.

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I hear the bump, then the cry from the other room; little footsteps follow. I turn to meet Hanif, who is running toward me. “I got a boo boo” he cries, his mouth downturned into an exaggerated pout. He holds out his fingers. “Kiss it.”

Ilan chuckles from the couch across the room as I bend over to bring my mouth to Hanif’s hands. “Imagine having kisses heal every hurt you ever have,” he remarks.

It’s a thought I’ve had myself, many times. It’s a thought I’ve heard spoken by someone else even more times. I’m pretty sure, in fact, that I’ve heard this sentiment as the punch line of a stand-up comedian’s joke more than once. “Kissing a boo boo to make it better” seems to be one of those widespread, cross-cultural kinds of parenting instincts, but one I don’t think I’ve ever heard be spoken of with anything other than a sort of wry amusement. This time, though, maybe for the first time, when Ilan calls attention to it now, I don’t simply chuckle back. Now, this time, maybe for the first time, I actually hear the question. I take a moment. I consider it. I do exactly what Illy is asking, which is to imagine. I think of stubbing my toe or hitting my elbow, the initial burst of extreme and irrational outrage at the pain it elicits in me. I think of Andy’s loud “fuck!” whenever he bangs his head (often, because he is 6 foot 5). I think about the time I stood up right under an opened cabinet door, or the time toddler Josie reared back in protest when I was brushing her hair and I thought she broke my jaw, the way I started crying, the way fear coursed through my body. I think about my teens, wondering when exactly their stubbed toes or banged elbows, bumped heads or broken nails stopped being things they brought to me and instead managed themselves, with the same sort of outburst Andy and I have, walking away on their own while sucking on the banged thumb or rubbing their own heads. I wonder about the last time I looked into their eyes and touched their cheeks and kissed their faces and held them close in those moments. I thought about what it would be like to wrap my arms around Andy when he bumps his head. I thought about what would happen if, instead of continuing to do the dishes when I stubbed my toe, Andy stopped, shut the water off, cooed at me the way I do Hanif when he is hurt.

It sounds ridiculous. And yet. Even just visualizing it fills me with a soft, liquid warmth.

“Actually, I can imagine it,” I say.

*****

Hanif is my hand holder. He holds my hand when he’s falling asleep. He sticks his arm out at any angle, no matter how uncomfortable, if we’re stuck in traffic and he is losing his ability to cope. Whatever dysregulation he may be experiencing, if nursing is inaccessible to him, his instinct is to ask for a hand to hold. One afternoon last week he was protesting being stuck in the stroller our whole long walk home from the park (“I need to run!” he kept insisting, even though it was decidedly naptime), but once I reached a hand out and held his, stroking the dimple knuckles, tracing the little moons of dirt under his nails, he calmed down and eventually fell asleep. For the rest of the walk, until I finally, sure he was deeply asleep, let go of his hand, I received smiles from every passerby. “That is so cute,” a teenaged boy said aloud to the girl with whom he was walking. “God bless,” an elderly woman told me. It did not matter who the person was; there was not a single pedestrian that did not smile. We were a walking oxytocin molecule, lighting up coziness in everyone we passed.

It makes sense. Hand holding is a literal expression of our intertwining as human beings. It reduces stress and anxiety in our body so profoundly¹ that simply imagining holding someone’s hand is enough to buffer the intensity of those feelings.² This is true across the lifespan, from infancy to adults. And although hand holding is most helpful when it’s with someone you love, its stress mitigating affects are even observable when you’re holding the hand of a stranger.³

When researchers began studying hand-holding, it was assumed the practice mediated stress by increasing our ability for emotional regulation, a task controlled by the prefrontal cortex of our brain. This is the part of our brain responsible for managing our attention, inhibition, emotions, and self awareness. It’s the rationalizing part of the brain — the part that will remind you that a threat is imagined or perceived rather than actual and existential when you’re watching a horror film, for example. The support of another’s hand, it was initially reasoned, must help us more effectively access these “higher” parts of the brain and thereby tame our more primal fear networks.

But that’s not, as it turns out, what happens when we hold hands. Instead, hand-holding lessens activity in the prefrontal cortex. It seems it’s not that the support of someone’s hand amplifies our ability to rationalize. It doesn’t help us access our “higher selves” or more effectively use our executive functioning capacities. It’s that the support of someone’s hand allows us to better access our neuropsychological baseline. It’s that the support of someone’s hand allows us to be ourselves without so much effort.

It’s not an addition, it’s a return.

Needing to rationalize our feelings — needing to activate our prefrontal cortex to cope or rationalize or understand what is happening to us — is metabolically costly. Knowing we are not alone allows our brain to slow down, to spend less effort and energy regulating. James Coan, one of the researchers to whose work I’m referring here, calls this “social baseline theory:” the idea that our baseline, what is normal and expected for our brains, is connection and interdependence.⁴ This is the argument of social baseline theory: it’s not adding support that gives us our brain the tools to cope. It’s that not having support forces us to expend energy compensating for the lack. Having to figure out the world and regulate our emotions alone is the violation; we are, as it turns out, most at rest in ourselves when we are together.

*****

This week we learned that Adriana Smith, who was officially declared brain dead back in February but has been artificially kept alive by Emory University Hospital, had been delivered, via surgery, of the baby hospital staff had desecrated her corpse to gestate. Smith’s story originally broke in May, when she had already been on life support for nearly 3 months. The hospital had justified the decision to keep her alive, despite her family’s wishes, by citing Georgia law banning abortions after fetal cardiac activity can be detected (roughly six weeks into pregnancy). They argued that to take Smith off life support could be interpreted as effectively performing an abortion, and was therefore illegal. (It did not matter that a number of Georgia lawmakers, including the attorney general stated this was a misinterpretation of the law; Emory refused to be made legally vulnerable just in case). Smith was just 8 weeks pregnant at the time of her death, her embryo the size of a green olive. The day before she died, she — a nurse herself — had presented to the hospital with debilitating headaches but was, as it all too often the case with Black women in this country, dismissed without the imaging that could have detected the blood clots in her brain and saved her life.

Smith’s case isn’t the first of its kind. A 2021 review in the American Journal of Obstetrics and Gynecology found 35 cases of pregnancies that were artificially continued after a diagnosis of brain death; 27 resulted in the extractions of fetuses, 50% of which survived (the biggest predictor in that survival was, unsurprisingly, whether or not the gestating person was over or under 24 weeks gestation’ — considered the technical age of fetal “viability” — when they were declared brain dead).⁵ In one particularly visible case in 2014, John Peter Smith hospital in Texas refused to take Marlise Muñoz, a 33-year old and 14 week pregnant paramedic, off of life support despite her own explicit directives and the wishes of her family. The hospital, like Emory, claimed their hands were legally tied by Texas’ Advance Directives Act, which states that physicians may not withdraw or withhold life-sustaining treatment from a pregnant patient. (Again, they claimed this despite Texas lawmakers asserting this was not the intent of the law.) Her husband, Erick Muñoz , also a paramedic, sued the hospital for "cruel and obscene mutilation of a corpse.” He won. It took two months.

Life support in the case of brain death is, in fact, a cruelty to all involved. Keeping a body forcibly alive requires constant intervention: not just mechanical ventilation but hormonal and steroid therapies, feeding tubes, constant surveillance, antibiotics to fight the inevitable infections, nurses to tend to the inevitable deterioration. Many people had to collude in this grotesque charade, a fact which haunts me: this is what happens when we sever “care” away from an ethics of love. Muñoz described being forced to hear the cracking of his beloved wife’s bones when her limbs were moved, to witness her body increasingly smell of death, to look into “soulless” eyes he did not recognize, day after day. April Newkirk, Adriana’s mother, described the experience as “torture.” “I see my daughter breathing,” she told journalists, “but she’s not there.” This is to say nothing of the literal human being forced to gestate inside a body emptied of any of the feedback a parent normally provides. In pregnancy we mother through the waves of our body, training a new nervous system how to be, how to ebb and flow. I do not know what it means to grow without hearing a parents’ voice or experiencing their fear or pain or joy, their anticipation or their relief. Without oxytocin spreading through their body like the warmth of the sun. Without the trembles of their tears or their eruption of laughter. Without the intertwining that is at root of who we are. I do not know what it means to be a human knit together in a body without human experience. I do know it is a cruelty to act without asking the question, to reduce what we do for each other when we are one into forced breath pumped in and out of lungs.

When the news of Adriana Smith first broke in May, social media was a flurry of outrage. Many described this is as yet another case of medical experimentation on Black women’s bodies. The words “human incubator” appeared frequently. People, not surprisingly, often referenced The Handmaid’s Tale. Who will pay for this? they asked. Will the family have to pay for this? It takes roughly $7500 per day to keep a dead body technically alive. Smith was kept alive for approximately 120. People asked, how are hospitals not allowed to use life support measures to harvest organs for donation but allowed to force life support on an unconsenting family to use a Black woman’s organs? The posts said butchery. The posts said barbaric. They said Incubator Depraved Experiment Horror Film Inhumane. They called what was happening Terrorism. They called it Gilead. They called it A Nightmare.

For a few days, these words dominated my social media timeline. And then, they disappeared. Adriana Smith was still being kept alive. The days were still continuing. Her baby was still growing. The situation was the same. Paused. Waiting. But people had moved on, now captivated by other unrelenting horrors unleashed upon us by the powers that be: other things to protest, other things to fear, other things to make content about. Until this week, when it was reported that Smith’s extremely premature son, Chance⁶, had been extracted from her body, and that she would be, finally, put to rest. Then the same words came back.

It was an excavation.

It was a fetal removal during autopsy.

Ghastly Experiment Torture Incubator incubator incubator incubator. Incubator.

To reduce a human body into chemical levels and physical processes that can be manufactured by medication and machines is unequivocally dehumanizing.

I struggle with how narratives can do the same.

Adriana Smith didn’t consent to doctors using her body to continue gestating her son.

She also didn’t consent to becoming content.

I’ve thought about this before, of course; the world as it stands gives us plenty of examples of people being made into lessons about and illustrations of the brutality of the state. I have often struggled with the tensions between wanting to inform, to draw connections, to spell out how systems are at the root of most harm, and reducing an entire human into the singular act of what has been done to them. I wrote about it at length last summer, when Sonya Massey was murdered:

I find her obituary. Here, are the names of her parents, her siblings, her children, the grandparents that came and left before. She loved to do hair, it says. She loved to spend time with her family.

I cannot type into the search bar, how did she choose the names of her children? I cannot type into the search bar, How did her parents choose hers? What stories live there, in those decisions, in those hopes, in those remembrances? The search bar can tell me the weather the day she was born (a low of 50, a high of 63) but it cannot tell me what kind of birthday cake she liked or what she wished when she blew out the candles.

That whole self belongs to those who knew her, not me, and that is how it should be, I continued last July. But if I am destined to read a story about her, I wish it were one she wrote. I cannot help but wonder, if she knew that someday everyone would know her name, what would she want us to know?

What would Adriana Smith, mother, nurse want us to know about her three decades on this earth? Unlike when I have googled many other names in the past, asking, what is left here that is theirs? there is almost nothing to be found of her. I don’t know any of her likes or her dislikes, how her friends remember her, if she had a hobby. The record that exists is simply her, dead-but-not-dead, dead-but-housing-someone-who-is-alive. The record that is exists is what the rest of us think about it. She has been held in-between in something we have created that is her and yet not her. All I can find is what has been done to her, and the lessons the rest of us see in it. All I can find is her as a stand-in for the intersectional horrors of the American project.

But she is not just a stand in. She is not just a lesson, a horror movie, a fictional novel, a nightmare, an example of history repeating itself, a ghastly experiment. She is not an incubator.

She is her.

She was her.

Fuck.

How do we tell these stories about each other without erasing our sacredness, our irreplaceability? What does it actually mean to keep each other alive — in life, and in death?

There is something about Adriana Smith’s story, the prolonged and suspended animation of her body, that feels too tender, to me, for takeaways. Perhaps it is because I am someone who spends a lot of time briefly touching, almost imperceptibly, the spaces between here and there, and because knowing the feeling of those spaces makes the idea of being forcibly held between them without crossing into one or the other too painful to bear. Perhaps it is because I am someone who knows, intimately, how much we are made up of one another, and because the institutional violence of keeping Smith’s body alive in order to preserve an 8-week old embryo is such a profound perversion of this fact that it elicits a pure, animal echo of grief in me that defies words.

Or perhaps it is simply that when I imagine what it is to be a human being gestating inside a corpse, all I hear is quiet.

*****

In 2014, when I was in midwifery school, I posted a selfie of my torso in a dirty hospital mirror, green shirt under blue scrubs, hands cupped around the phone. The post was about my necklace: a wooden moth given to me by my sister. But at the end of my caption about my necklace I wrote, “PS: These are hands that catch babies!"

The idea that my hands could transform into those of a midwife, at that point, still felt surreal. My own midwife's hands were embedded in my brain, having stared at her lovely nail beds in between the contractions of my precipitous second labor. My nail beds are scraggly. I have never gotten past my teenager habit of picking at them. I don't get manicures, ever: I do not enjoy them, I hate the smell of nail polish, and I simply don’t have time. I do not have the long graceful fingers of a pianist. My palms have callouses from lifting. My hands are just hands, uncurated and unlovely. And in 2014 they were hands that had spent most of their time on this earth turning pages and scribbling words. My fingers had made a keyboard click with satisfying crispness as I turned a phrase, but I still wasn't convinced they were capable of doing any of the things I'd decided they needed to learn: reading a baby's position through skin and muscle and fluid, suturing a perineum, dislodging a shoulder dystocia, stopping a hemorrhage. But they had, at the point at which I wrote about my moth necklace, caught about fifteen babies, and in so doing, they had become almost unrecognizable to me.

I still, at this time, thought of midwifery skills as just that: skills. The task of decoding a baby's position through skin and muscle and fluid was to my mind a series of four actions — named, like most things I was learning, for a dead white man. Leopold’s Manuevers. It was a practice my brain had to learn and force my hands to do. Suturing, resolving a shoulder dystocia, stopping a hemorrhage: all of them algorithms I needed my executive functioning brain to memorize and then send as instructions my hands could bear out. A matter of will, mastery, control. But I think there was some small part of the person who wrote that post and said PS These are hands that catch babies! who was beginning to comprehend that this was an at best inadequate and at worst erroneous understanding. Although I wouldn’t have been able to articulate it at the time, I was beginning to sense how becoming a midwife was more than professionalization, more than memorizing procedures and instructions and carrying them out, more than using a brain to assert dominance over not only one’s own body, but the physiology of birth. What I was beginning to sense was that my hands were ceasing to belong to me at all, at least in the way we conventionally understand ownership of our bodies, that they were becoming more conduit than anything else. I was beginning to sense the way midwifery was going to force me to confront every misconception I had about the singularity of bodies, the singularity of the world we inhabited, and about the authority any of us had over any of it.

A couple of years ago I held a baby at a postpartum visit, chattering to her about her experiences in the wide world in the weeks since her birth. As I asked her some rhetorical question or another, then listened to her babbles, observing her face, her mother exclaimed, “Robina! You’re making the same face you made when you were feeling my belly during prenatals!” I’d laughed, then, but she’d continued, “No, really! I always loved watching you when you tried to feel her position because you always cocked your head to the side and looked up, not down at my belly, as if you were trying to hear something in the distance.”

“I was trying to hear something in the distance,” I replied. “Trying to figure out a baby’s position always feels more like listening to me than feeling.”

Hands are like that: they don’t just help us discern through touch myriad stimuli of the world — the differences between the warmth of a smooth, sun-baked stone or the softness of fur or the coldness of snow — but help us hear each other. Studies have shown that, more than any other isolated body part, people can recognize each other’s emotions simply by visualizing their hands.⁷ In other studies, people have been able to accurately discern feelings of anger, disgust, fear, happiness, sadness, sympathy, love, and gratitude when communicated via touch by someone they have never met, even without being able to see or hear them.⁸

This is what I didn’t know back in 2014: my hands were going to come to transcend what I had come to understand as their purpose, their function, their role. I did not know that resolving a shoulder dystocia would be less about the brilliance and discipline of my brain and the way it could understand and impose skills onto my hands but about the opposite, that it would be about relaxing the grip my brain had on my hands so that they could listen and understand what the baby was telling me themselves. I did not know that I would have to loosen, to soften; that “managing” a shoulder dystocia would be less about rigid adherence to something pre-scripted and more about suspending my brain’s disbelief and listening to what my hands knew without thinking. I did not know, then, that what I would need was to allow all those centers of executive functioning to slow down to a barely humming whir, so that I could return to the place where I was always-already made up of someone else.

*****

In May I witnessed three babies being born, each of them different, each of them born into different family structures and neighborhoods and stories, but each of them born into the hands of their mothers while the sun shined through the windows. One of them did not breathe, not in the seconds after birth, and not in the minutes either. Her birth was not long, nor traumatic in any way. Her heart rate never wavered in labor. But she came out still, her skin pale, her eyes closed. Her mother had given birth standing, and so I loaned her my hands as support as she lifted the slippery baby to her chest, our fingers so close they may have well been intertwined. So close my hands could have been hers; so close I hoped they were barely perceptible, that they were in fact perceived simply as her own. As quickly as they were there, they left again. She held her baby close, heart to heart. I stood up from where I had been perched below her while I was awaiting the birth, observed the baby’s pale face and closed eyes and limp body. I gently asked her mother — my client, a woman I have cared for in three pregnancies, whose husband often sends me political memes that make me laugh out loud, whose son tenderly touched a scrape on my own son’s face during a prenatal visit once, whose own mother is a midwife — if she wanted to offer the baby some breath. She did. The baby responded with a slight grimace, but nothing more. I asked if it was okay if I tried to offer some myself. I did. Another slight grimace, but no breath. No cry. I did the things I always do. I asked my assistant, Jessica, to place the doppler on the baby’s chest, because I knew, because my hands heard it, because my gut felt it, that we would hear a strong heartbeat thumping and I hoped it would reassure everyone. I adjusted the baby’s body to try to get the breath I offered through her airway, first on my client’s body, and then, when I couldn’t quite manage to get her in the right position, on the resuscitation board. I helped her mother perch on the end of the bed next to the board, still connected to her daughter via umbilical cord. I encouraged her mother to talk to her. My hands eased air into her body and I made each breath an invitation. The baby became slightly more pink, slightly more toned. She grimaced and twitched. I could feel her responding to each breath I gave her. But still, she did not breathe. Still, she stayed quiet. Her eyes did not open.

I was standing in my client’s bedroom. The dark blue paint, the poster of the forest, the cat under the bed, the music wafting in from the bathroom, my client’s husband’s socks balled up and thrown into the corner (ten minutes earlier, anticipating a rush of blood and fluid, I had to said to him as he stood behind her, supporting her hips you might want to take off your socks). My client, her long brown hair up on her head, her naked body glistening with sweat, her cheeks rosy with the force of the universe. I was there, with it all, with them all. They spoke to me. I spoke back. And also I was somewhere else, some third space, where it was just me and the baby. I was asking a question. I was asking it of her, and I was asking it of the universe. I was listening for answers. There were no blue walls or posters or cats or socks. There was no sun shining through the window; or maybe all there was was sun, washing everything else out. There was a hush as holy as a cathedral, a still like the air in a minaret before someone enters to call out the adhan, a suspension like the moment before a key is turned in a lock. Look, I’ll show you: there was a world out there, a world of smooth, sun-baked stone and the softness of fur and the coldness of snow and the warmth of a hand in your own, but also a world of brutality and extraction, a world being burned, a world of melting ice caps and forests on fire. Look: there was a world, and it could be terrible. There was a world, and it could be beautiful. There was a world, and it could be. I turned my head toward that wide, expectant distance to listen.

“Is she okay?” my client asked.

“She is okay,” I said. “Look —”

There was not really any reason, not any logical reason, not any algorithmic reason to do what I did next but I had heard enough to try. I lifted the baby off the board. I placed her back on her mother’s chest. Her mother stroked her back. Her mother kissed her face. The baby opened her mouth and cried.

1

Coan JA, Schaefer HS, Davidson RJ. “Lending a Hand: Social Regulation of the Neural Response to Threat.” Psychol Sci. 2006;17(12):1032–9. doi: 10.1111/j.1467-9280.2006.01832.x

Feldman R, Singer M, Zagoory O. “Touch attenuates infants’ physiological reactivity to stress.” Devel Sci. 2010;13(2):271–8.

Graff TC, Fitzgerald JR, Luke SG, Birmingham WC. “Spousal emotional support and relationship quality buffers pupillary response to horror movies.” PLoS One. 2021 Sep 15;16(9):e0256823. doi: 10.1371/journal.pone.0256823.

2. Jakubiak BK, Feeney BC. “Keep in touch: The effects of imagined touch support on stress and exploration.” J Exp Soc Psychol. 2016;65:59–67

3. Coan et al 2006; See also: Coan JA, Beckes L, Gonzalez MZ, Maresh EL, Brown CL, Hasselmo K. “Relationship status and perceived support in the social regulation of neural responses to threat.” Soc Cogn Affect Neurosci. 2017 Oct 1;12(10):1574-1583. doi: 10.1093/scan/nsx091.

4. Coan JA, Sbarra DA. “Social Baseline Theory: The Social Regulation of Risk and Effort.” Curr Opin Psychol. 2015 Feb;1:87-91. doi: 10.1016/j.copsyc.2014.12.021.

5. Dodaro MG, Seidenari A, Marino IR, Berghella V, Bellussi F. Brain death in pregnancy: a systematic review focusing on perinatal outcomes. Am J Obstet Gynecol. 2021 May;224(5):445-469. doi: 10.1016/j.ajog.2021.01.033.

6. We do not know much of Chance’s prognosis or the precipitating factor in his surgical birth. We do not even know his exact gestational age. His weight — which I have seen reported by turn as one pound and eight or one pound thirteen ounces — is roughly consistent with an extremely preterm baby of under 28 weeks but likely over 26 weeks, which also lines up to Adriana Smith being 8 weeks in February. Babies this age have roughly a 90% survival rate but often require long NICU stays. They require respiratory support, which may or may not mean being on a ventilator. They are usually fed intravenously because their digestive system is too immature to absorb nutrients. They have difficulty regulating their blood pressure, body temperature, and blood sugar levels, and often develop intraventricular hemorrhage (bleeding in the brain), necrotizing enterocolitis (infection and failure of the intestines and bowels ), patent ductus arteriosus (the failure of the ductus arteriosus fails to close after birth, which can affect how blood flows through the baby’s lungs), retinopathy (damage to the retina of the eye), and sepsis. In other words, Chase will likely require a level of intervention not entirely unlike what his mother’s body required in order for him to continue gestating after she died. In the average extremely preterm baby, cerebral palsy, chronic lung disease, developmental delays, digestive problems, and vision or hearing loss are common long term sequelae. We do not know what long-term developmental, psychological, or physiological sequelae are associated with gestating for five months in a body that is technically dead.

7. Blythe E, Garrido L, Longo MR. Emotion is perceived accurately from isolated body parts, especially hands. Cognition. 2023 Jan;230:105260. doi: 10.1016/j.cognition.2022.105260.

8. Hertenstein MJ, Holmes R, McCullough M, Keltner D. The communication of emotion via touch. Emotion. 2009 Aug;9(4):566-73. doi: 10.1037/a0016108.