Page 2 of Ruthless Grace

“Inhale for four, Cassia,” Dante says, his low baritone thick with a panicked, hyper-protective edge I have never heard from him in my entire life. “Exhale for six. Per favore, just do the pattern the class taught us⁠—”

“If you count to four in my ear one more time, Dante,” Cassia gasps, her teeth grinding together as another contraction tears through her, “I swear to God you are sleeping in the guardhouse until this child is in college. Cazzo!”

“Cassia, mia vita, you need to breathe— just take the epidural, please⁠—”

“I am breathing!” she snaps, squeezing his hand so hard I hear his leather watchband groan. “And I told you I didn’t want the epidural! I read three medical journals on this! An epidural slows down the second stage of labor and makes the baby lethargic!”

“The baby wouldn’t be lethargic,” Dante shoots back, glaring at me over the sterile blue drapes. “Gia, tell her! Tell her she’s allowed to take the drugs!”

“I am the Chief Financial Officer of this family,” Cassia wheezes, glaring right back at her husband. “I do not make sub-optimal medical decisions based on temporary pain!”

“You’re screaming in my ear!”

“Then cover your ears, Don Santoro!”

“Both of you, shut up,” I say, stepping between her elevated knees and adjusting the overhead surgical lamp. The harsh, white light pools over the drapes. “Dante, stop coaching her like she’s an enforcer in a tactical drill. Cassia, your stubborn forensic logic is adorable, but you’re crowning. Give me a real push on the next wave.”

Cassia glares at me, then lets out a ragged exhale as the contraction peaks. “Fine.”

I reach out, my gloved fingers touching Cassia’s abdomen, feeling the rock-hard tension of her uterus. The fetal heart rate monitor mounted on the wall beeps in a steady, rapid rhythm. 140... 138... 135...

Then, without warning, the rhythm shatters.

110... 95... 82...

The alarm on the monitor shrieks, a high-pitched, electronic warning that cuts through the arctic room like a serrated blade.

“Deceleration!” the anesthesiologist barks from the head of the bed. “Fetal bradycardia. Heart rate is dropping fast!”

Dante’s head snaps toward the monitor, his eyes flaring with sudden, terrifying panic. “Gia! What’s happening?”

Inside my chest, the ghost wakes up.

The memory surfaces whole. A Sunday dinner in our dining room, the smell of Nonna’s ragù, my Papa passing the bread before his palm went to his chest and he hit the tile floor. My knees on the cold marble, counting compressions, working with flawless, desperate hands, calling time of death in my calm doctor voice so my brothers could survive hearing it. His heart, I had told them. It was his heart.

The tox screens came back long after the funeral flowers had died, and proved I was wrong. He had been poisoned right at our table. I was in the room. I was the expert. And I missed it.

Don’t fail them again, the voice in my head whispers, cold and venomous. Your hands couldn’t save your father on that dining room floor. Don’t let Dante’s child die on this table.

My heart slams against my ribs, a sudden, suffocating wave of adrenaline threatening to drown me. My thumbs twitch inside my gloves, a microscopic tremor of terror.

No. I slam the door on the panic. I bury the daughter who failed her father and bring Dr. Santoro to the front.

“Dante, shut up and hold her shoulders,” I command, my voice dropping so low and sharp it slices through the shrieking alarm. “Cassia, look at me. Look at my eyes.”

Cassia’s wide, terrified gaze locks onto mine.

“The cord is wrapped,” I say, my hands moving with blind, instinctual precision beneath the drapes. I slide two gloved fingers past the pubic bone, feeling the smooth, rubbery coil of the umbilical cord pinched tight against the baby’s neck. “She’s hooked on her shoulder. I’m going to unloop her. I need you to push with everything you have on three. Do you hear me?”

Cassia nods once, her jaw set.

“One,” I call out, my fingers hooking gently around the slippery cord, maneuvering it over a tiny, miniature ear.

“Two...”

I ease the loop over the soft crown of the baby’s head, relieving the pressure on her neck.

“Push!”