She sat on the raised hospital bed, knees propped up as close to her chin as she could get them, belly swollen with 34 weeks' worth of pregnancy. Her husband slumped in the recliner next to her, nodding off and oblivious to the chaos in the room. Her four-year-old son fiddled with the buttons at the foot of her bed, which, according to the nurse, had been unplugged a half hour ago precisely because of the child's constant readjustments. Her two-year-old daughter struggled, strapped into a chipped and stained umbrella stroller, releasing piercing, unpredictable, intermittent screams that caused everyone - except for the semiconscious father - to jump every time. The dull roar of this young family was audible around the corner at the nurses station, even over the laboring moans and newborn cries of the other patients in the Birthing Center.

Though her adult status had been established by motherhood at 18, her face was pale and open enough to have allowed unnoticed passage through the hallways of a junior high school. She was in the hospital for a Non-Stress Test following irregular, preterm contractions. The test was uneventful from her stomach inward, but was characterized by the uncontrolled impulses of children taking advantage of their mother's physical restriction by medical equipment and their father's mental restriction by heroin withdrawal. In a rare quiet moment, the nurse asked, "How have you been feeling, emotionally?"

The girl murmured something about having a history of Bipolar Disorder and addiction to pain pills, and currently being off her psychiatric medications, though she was being treated with methadone for the addiction. "It's been hard. Really hard. Sometimes I think I can't live my life for one more day." The word suicide came up, though only in hushed, indirect tones.

The combination of the desultory presence of the husband, the unkempt and unhappy appearance of the children, and the lethargic and sad posture of the mother led the nurse to call for an emergency psychiatric evaluation. "I've never had to ask for this on this floor before," came the intense and somewhat baffled voice over the phone, "because most of the women we see are optimistic and happy. Or at least on pain medication. But I'm afraid to let this girl go home." The nurse, also, was not able to overcome years of training in political correctness; we know we're supposed to refer to a female over 18 as woman but the aching vulnerability of this particular female insisted that she is still girl.

Using free food and television as bribery and babysitter, the husband and children relocated to the waiting room and, with luck, avoid major incident during the next few unsupervised minutes. Once alone, the mother-to-be dug hungrily into her tray of french fries and cafeteria chicken, then laid her head back on the pillow and sighed, deeply and with knowledge that this respite, this quiet, was temporary. "I didn't know I was pregnant," she said. "I know that sounds stupid, especially since I've had two others. I knew, with them, right away. I knew as soon as I got pregnant, and I got cleaned up. And I stayed clean, right through the pregnancies. I even breastfed them. I love my babies."

She sighed again, and paused for a while. "But, somehow, this time, I just didn't know. I still bled sometimes, and I didn't get sick like before. And I guess I was using heavier, probably. But only when the kids were at school. Only when they were sleeping. I love them."

The next silence was long enough to require a question or two to encourage more information. "I was using. They told me I was six months along when I found out. I stopped right away, and it almost killed me. So I'm on methadone, and off my bipolar meds, and now I don't know what's going to happen. They tell me this baby is healthy, physically. But I just don't know about the mental effects. The emotional problems. It was too late. I'm so scared for this baby. I screwed up so bad this time. I don't know what to do."

"No," she said, later. "No, I would never actually commit suicide. I know that it would put my kids in such a horrible lifestyle, and I know they love me and they know I love them. I'll stay here for them. And I would never hurt myself while pregnant. This baby has already been through enough because of me."

"But I think about it sometimes. I think about how hard my life is, and I think about just laying down and letting it all go. I can't tell whether I care too much, or if I just don't care at all anymore."

Arrangements were made, to get her back on non-teratogenic medications to control her mood swings and anxiety attacks, to organize transportation to see a therapist, to set her up with free food and medical care for herself and her children. Arrangements were made, to provide follow-up care, to assist in getting her husband into rehab for the next few weeks before the new baby comes, to notify her mother that they need more help in the three-room apartment that the little family already fills to the straining point. Arrangements were made, to load them all into a taxicab and send them home, because we have reached the limits of help that we can offer and she doesn't want to be in a hospital just yet.

"I need to tuck my kids in at night," she whispers. "They still need me. Someone has to take care of them."

It is unclear, though, who is taking care of her.