Compound Presentation

Anne Falkowski

I was good during labor. Real good. Drugless. Soundless. I never uttered anything. Not the gut sounds, or the sip sounds, or the out breath. Even when the midwife shouted her advice. Told me to make noise. To help my baby come out. The baby I wanted more than my own life. She had been in me so long. Longer than the thirty years I’d been alive. Floating. Carrying her. I will always carry her.  

I uttered nothing when contractions squeezed the bowels of me sending me to soft moss and bone bits, where ancient ones laid their craggy hands on me. I did what needed to be done, which I had done before, but never knew, on my backbone with swollen legs spread open, knees bent and some meat colored hospital socks on my feet. As a nurse wiped the shit away I offered my baby the sides of me. To kick off. To gain momentum.

When Emily came out, they said she punched through my vagina, my portal, and tore me from crotch to asshole with her miniature left fist and shoulder.

They called her a compound presentation.

My mind registered the furrowed eyebrows of the midwife and the pursed lips of the nurses as concern. Hospital pads, underneath my legs, soaked up the warm blood streaming out of me.

My daughter’s father smiled down. “You did so good,” His first concern for me. He can’t help it. It’s his reflex.

My voice found. “Bring her to me. Bring her to me. Now. Now. Now.”

A syringe full of Pitocin pierced my butt cheek.

“It’s to contract the uterus.” The midwife’s lips were moving lumps behind her surgical mask. “We need to stop you from bleeding out.”

I remembered thinking…Good Idea.


Sixteen-year-old Emily sits upright on the examination table in the office of a pediatric neurologist. The doctor is in his late thirties, and he leans against a radiator, one slim leg twining around the another. Every sentence he utters is of absolute certainty. His wiry fingers cut through the forced air. I judge him to be a man who points at people. Instead he brings his hands to his forehead and fondles his own frontal lobe. I wear outdated jeans and a faded turtleneck. I wish I’d thought to armor in clothes that didn’t out me as a stay-at-home-mom.

The pediatric neurologist asks Emily a series of questions. He laughs at her answers. I can’t determine his sincerity. Fear traces my jaw bone. It’s eight in the morning. I insisted he see my daughter first thing. On top of being pissed at this doctor, I’m furious that my husband can’t be here to help. He’s stuck at a desk, writing code for the insurance company that will hopefully pay for this cluster fuck of medical care.

We’re here because Emily’s twitching. Her head, neck, and shoulders jerk every few seconds. She can’t hold a glass or a fork with food on it. The water spills, the fork flies, and the noodles land on the table. With each twitch, she’s momentarily neckless. A stick figure with no control of her arms.

For five days, the twitch has been nonstop.

“Don’t be alarmed.” The nurse reassured me earlier this week over the phone. “It’s a side effect. The doctor says to stop the medication. The tics should soon go away.”

A week ago, this doctor prescribed Topamax, an anti-seizure medication, for her headaches which had gotten so bad they were causing her to sometimes pee her pants. He assured me this medicine was used all the time.

“I gave her the same dose I would give a baby.” He spoke as if simple words were all we could filter.

Five days ago, Emily stopped the Topamax. If anything, her tics had gotten worse.

“Look at her.” If on cue, Emily’s shoulders jump. The tissue paper underneath her thighs crinkle.

“Something’s wrong.” My voice so high, I don’t recognize it.  I stare at the doctor and then at Emily.  

“In addition to twitching, she’s doing this tapping thing.”

My brilliant and beautiful first born. Drumming her fingers on anything with a surface. Tables, the arms of chairs, her legs, the dashboard of my van as I pushed the speedometer over the limit to get to the office, ensuring she will be seen right away.

She keeps repeating the phrase, Story of my life.

“Emily, I’m sorry this is happening to you.”

“Story of my life,” her chewed off fingernails tap the base of her throat.

“You must be scared.” I steady my voice.    

“Story of my life…story of my life.”

One for each twitch.


Not only has the Topamax caused Emily to tic and repeat phrases, its brought out an obsession with Michael Ross, the Connecticut serial killer who raped and murdered fourteen girls.

“Did you know his lawyer almost got disbarred for advocating against the death penalty for him?” Her head snaps back towards the wall behind her. When it returns, huge-pupiled eyes stare down the folded-legged doctor.

Emily hasn’t showered in days. One day earlier, she buzzed off all her hair. She wears her father’s sweatpants which barely stay up on her petite frame. Under a baggy sweatshirt, her braless breasts hang, moving against their will, each time she twitches.  

“Did you know Michael Ross masturbated so much in jail that his hands were blistered repeatedly and scabbed over?”

The doctor uncrosses his legs. His shoulders rise into points and he gets an “Aha” look in his eyes. He thinks we are both unreliable.  

“This is a psych issue.” he says to me and not her. “Let’s admit her,” he says to the other male doctor he brought in for a second opinion.

I want to scream. It’s the fucking Topamax! You did this!

My daughter’s head bounces like a jackhammer.

“She wasn’t like this six days ago.” The back of my throat burns. He only met Emily a week ago. Couldn’t he see the obvious?

“It’s got to be the medicine.” I’m begging.

He scribbles on Emily’s chart.

He’s done.  

The knot of his navy tie is a perfect cinch under his throat.

“Your daughter needs a psych evaluation.”

I look down. I see my daughter’s face in his black polished shoes.


Almost ten pounds with skin the color of a newborn pig. The black hair on her head longer than her fingers. Her nails already in need of a trim. Corn silk covered her tiny earlobes. Furry creature. I stroked her. I pet her. I smelled her baby head.                        

My breasts swelled to reach her. My eager hands hiked her greasy body to my aching chest. My uterus cinched under her suckle.

Home from the hospital, each week she grew stronger. To break from her dutiful sucking, she lifted her head and gazed at me. As soon as I smiled, she returned back to my breast with slurp sounds. Using the hand that punched her way out of me, she drummed my neck or slapped my skin like a fever.


An ambulance made a magic appearance, backing up to the front doors of the office. The engine ran while two male orderlies placed Emily on a stretcher and loaded her five-foot-one body into the back. They were bringing my daughter one building over to Adolescent Mental Health. Arriving in an ambulance is the only way they’ll admit her.

“Don’t worry Mom,” said the more talkative one, “we won’t run the siren.”

I’m directed to an empty waiting room down the hall. On an overhead TV, a Disney mermaid moves her mouth in song underneath locks of red. No one thought to turn on the sound. Later, I learn that two social workers will repeatedly ask my daughter, “What happened? Tell us everything. Something must have happened to make you so sick. We need to know every detail. To help you. To help you get rid of your twitch.”

When they finally speak with me, their hands are lightly folded, not allowing me privy to the already begun psychiatric diagnosis.

“What’s Emily like?”

“Nice,” I answer. “Smart. Sweet.”

“Really?” They lift their eyebrows and unfurl their hands to smooth out trendy skirts. Both are young, maybe a year or two out of grad school. The one with blond hair pushes her thick framed glasses back up the bridge of her nose.

“Really.” I say.

“What do you know about the boy who raped her?” Their eyes don’t waiver.

“I don’t know anything. I’m finding out now. Just like you.”

“You understand we can’t give you details.” They nod their heads together, waiting for my reaction.

I want to say: I don’t understand! Can’t you see I birthed her? What do either of you know about being a mother?

My head moves up and down making a yes.  

Later I will go to the bathroom and throw up.

The heavy wooden door mutes me.

The mermaid belts a soundless tune.  

The social workers soften their faces.


Before Emily was conceived, I experienced eight years of infertility. More than a quarter of my life. Near the end of those eight years, I found myself in my work’s parking lot, unable to open my car’s door.  

Just bring your stupid hand to the door handle.  

Instead of lifting, my hand clamped down. Once I made the decision to call in sick, my hand worked again.

I got myself an appointment with a therapist. It took months before I decided to mention I was sexually assaulted at thirteen.

“It happened while walking home from choir practice. There were three of them. They were a grade ahead of me.

Late afternoon folded into the soft palm of night. Front porch lights punctured the onset of dark. Clay-colored leaves crunched under their boots. Behind me, they made snort sounds. Each one not quite a man, but had grown beyond boy.

“You never thought about mentioning this?”

It was our tenth appointment.

“It happened so long ago. I’m over it.” My fingers picked invisible lint off my pants. A noise machine hissed in the hallway.  

“They came at me from behind. Even though there were three of them, I felt like I was being taken by one animal.” My hand brushed my cheek. Sometimes gravel still stings my face. One boy flipped me over. Another pinned down my shoulders with his knees. Breath left my body. Three boy heads, wild with excitement, peered over me. I closed my eyes.

Multiple hands pressed down, underneath my bra, the waistband of my jeans, and inside my underwear. Fat fingers kneaded my breasts and dug into my vagina.

I tried to scream, but nothing…

Instead I kicked them. Blood poured from one boy’s nostril.

There was something satisfying and unreal about the glossy red trickle.

A screen-door banged. Porch lights flickered. Knees, hands, and penises retreated. Bodies moved fast. There were the teeth of a zipper. The sound of spit. A wet lump landed on my face. Three boys took off in the direction they came from. Eventually the crushing of leaves trailed away.

“I’m not even sure it happened. Maybe I made it up.” My fingers flicked fake lint onto the carpeted floor. Let’s talk about my fucked-up memory instead of what happened. Let’s talk about anything else.

The surface areas of my lungs began to pucker. I clamored for air. I have asthma but only when I’m sick. The therapist reached into her purse and pulled out a yellow inhaler.

“Here,” she held it out. “Use this.”

I took a hit, closed my lips in an effort to trap the medicine, familiar with its bitter taste. Opening my mouth, a tiny puff of mist escaped.


Emily’s been home from the adolescent psych ward for a few weeks. The word dissociative sits on my tongue. I want to catch what’s left of her. She’s uncatchable. I move and speak slowly, careful not to scatter what remains.

There’s a YouTube video on connective tissue. It’s this soft gelatinous matter that surrounds and protects all our muscles and organs. It looks like chicken fat. The proper term for it is fascia. When we get sick, our fascia dehydrates, breaks down, or contracts. Without it, our organs and muscles have no support to hold them in place. What had once held my daughter in place was infected. Invisible to the human eye, but I see it. I’d touch it if she let me. Nothing else can break now. My job is to protect what’s left. To be her connective tissue until she can regrow her own.

In a taped interview, Michael Ross said he looked into the eyes of the last girl he raped and killed the moment before she took her final breath. He said he became so overwhelmed with a love and forgiveness intrinsic to the universe that he made the decision to stop raping and killing. Years later he would beg for the death penalty, which he eventually received by lethal injection. He said he looked forward to his own peace.

My therapist told me I couldn’t get pregnant because my nervous system operates as if the world was unsafe. My body won’t believe it could protect anything precious.

“What did you do after the assault?” Her tone gentle.

“I picked pebbles out of my hands, knees, and face. I went home.”

“What did your parents do?”

“They called the police.”

“What did the police do?”

I rolled my eyes.

“Nothing. They said it was my word against theirs.” For the next five years, I saw those boys at school every day. I wanted to make the whole thing to disappear.

“And?” my therapist asked.

“That’s how it went down. I never spoke about it.”


I didn’t make a sound when Emily was born. Not during contractions when both of my thighs cramped at the same time and the midwife leaned the full weight of her elbows into my hamstrings to bring them back to normal. I didn’t make a sound when transition came, the pain so great, I threw up into a pink kidney-shaped dish. I didn’t make a sound when I bore down and pushed, nor when Emily’s tightly bound fist punched its way through me. I spoke no words when the doctor sewed the layers of my perineum back together and the midwife stood next to him, holding surgical thread in her gloved hands. Instead, I imagined the strand steadied between her teeth. Silence is a language without tongues. Its a surface area. As essential as the smooth muscles of lungs are to the act of breathing. Silence swims us back to the pockets of soft landings and the vastness of canyons.


Emily stops talking about the serial killer Michael Ross. She left him behind with Ivy League doctors, barely adult women social workers, and the polished floors of a children’s hospital. My politics are liberal. It surprises me I’m for the death penalty. There are reasons mothers don’t decide the fate of their child’s perpetrator.

She’s still twitching. It’s relentless and I see it like I see light and shadow. Her father says ignore it. Don’t give her tics any energy. It won’t help to wear my anxieties. I keep moving, eating, drinking, talking, and running in the cold. My daily acts are spastic and without buffer. Her new doctors, the ones not affiliated with the hospital, use words like trauma, PTSD, and dissociative. Real or imagined, fixed or unfixed, I never grow used to any of it.

It’s late when we decide to try a movie, go out in the world. Emily still needs to remain in the dark. Being in daylight among strangers is too much. We pour over movies, trying to find one that’s not triggering, which is a joke because everything is. I look at her and she looks at me and we are both triggered. A reminder she was violated. A reminder to me I didn’t know. A reminder to her I didn’t protect her. Each time we look at each other, we breathe in the other’s fear.

“I need a break from you,” she says. “From all of this.”

“I want to go back to the hospital,” she says.

“I know, but that’s not an option,” I say.      


Breastfeeding gets off to a rocky start. I blame the hospital. After delivery, they gave Emily a bottle while I was being sewn up. I specifically asked them not to. In capital letters. The request was on my intake form. At home, I bring her hungry mouth to my engorged breasts and try to get a latch on. My milk won’t let down. I break out in a full body sweat. I rock her. She cries and turns her head in fits of anger and misunderstanding.

“Hush…” I say. “We will figure this out.”  

When my milk finally does let down, it’s my heart breaking open and a pureness only found in a newborn. Our nervous systems move together without ever touching.


We’re the only ones in the movie besides an elderly couple. The backs of their silver heads jut up from faraway seats. The movie is almost three hours long. When the credits finally roll, it’s close to midnight. In the hallway, soda and popcorn machines hum. Rolling hotdogs have disappeared from their trays. The halls are dark except for a path of recessed floor lights.

We exit through the front doors. My van is a good distance away. The parking lot is vacant except for one car which two men stand in front of. The taller one smokes a cigarette. They look in our direction. To get to my van, we have to pass them. I squeeze the keys in my fist.

A trail of smoke curls under the eye of a parking light. A current runs through the guts of me. My skin feels no separation from the night.

“Come on Emily,” Speaking under my breath. “Let’s walk this way.”

I grab her hand and pull to the right. My legs stay upright but I’m aware of a rubbery quality. If I let them, they would buckle.

I can run if I have to. Not Emily. Since the hospital, she only wears her father’s clothing, including his size twelve shoes. Engulfed in middle-aged men’s casual attire, she’s my ghost daughter. Feminine features loom under her hood. Her black pupils are tree rings in the dark. In the dimly lit parking lot, Emily appears bloodless and translucent. No longer capable of fight or flight. The daughter I knew went missing. There will be no kicking off of sturdy sides or greeting the world with a fist pump.  

“You can’t keep anyone safe,” my therapist told me all those years ago and a few months before I finally got pregnant. My body eventually felt safe enough to trust my eggs to be implanted. “You can’t control what happens to you or anyone else. You can only manage what happens afterward. You were a child left alone in your own head and you blamed yourself. You won’t be that kind of Mom.”

I am that kind of Mom.

I glance over at Emily whose caught in a series of twitches. Each spastic movement is proof I should have known. I should have seen the signs. The debilitating migraines and peeing her pants. She complained of always being tired.

I am that kind of Mom. My daughter has no broken skin, torn and bloodied clothing, eating disorder, or promiscuity. She doesn’t use alcohol or drugs. Her coping strategies don’t resemble mine.

Like so many mothers, I repeat the sin of not seeing. By the time I noticed my blind spot, it was too late. If I could, I would chew off my own arms to change it.

The two men stare.


 I will fucking kill them.

Pulling my daughter’s arm, I drag her towards the van. They follow.

Emily slows down. I yank her until she winces.

One of them opens his mouth and utters something.

Neither one of us will remember what he says.

I hit a button on my keys. Headlights flash and my horn bleats.

My daughter stops. I feel her wanting to turn and give an answer

“GET IN THE FUCKING CAR!” The harshness of my voice shocks me.

If I could, I’d slap her.

Emily jumps into her seat and shuts the passenger door. I push a button. All locks click down. Fingers belonging to me guide the key into the ignition and turn it. My running shoe steps hard on the gas. The van’s tires burn as they squeal.  

We don’t look back to see what we ran from or gage the narrowness of our escape. Safe on the main road, my limbs begin to tremble. The soft glow of stars have gone empty under the hands of man-made light. We cannot escape violence. We cannot control fear, love or even the stars at night.

I shake with the love of a mother.

“Mom, you’re fucking crazy,” Emily twitches. Her fingers tap my left arm. It occurs to me that my daughter’s strange movements are now her new language.

“I think something bad was going to happen.” My tongue moves like thick cream.  

“Me too,” Emily says.  “But I don’t want to talk about it.”

She stares straight ahead. I turn my head to look at her. I could stare at her forever. My oldest daughter. Trauma nests inside trauma. A compound presentation. It’s late but not too late. Our shared silence is the milky breath between us.


Anne Falkowski has been writing for the past three years under the guidance of Lidia Yuknavitch, best-selling author. Previous works have been published at The Coachella Review, Entropy, and Change Seven. In 2018, she completed her memoir, Namaste Fat Girl, and is seeking agent representation. She is currently at work on her novel, Butterfly Girls, a psychological thriller.