The Reluctant Midwife (25 page)

“By God, that was slick! Thanks for coming out, Hester!” the farmer expresses his appreciation. Then in a much quieter tone, “I can't pay you anything now, but you know I'm good for it.” The vet doesn't show his disappointment, but hearing Patience talk, I know they have bills to pay too, the mortgage on the Hesters' large farm, for one.

“That's okay, I know how tight cash money is. You'll get it to me when you can, or we'll work out a trade.”

Back in the Ford, we all sit up front, me sandwiched between the two men. I smile in the dark. Patience was right. I'm glad I came. Seeing a birth when I have no responsibility is uplifting. Linus is dead. He has left this earthly home for a new one, but three fuzzy new lambs are born. Life is a circle, renewing itself, one way or another.

It's almost midnight as we drive home and there's a light snow, big white flakes coming down from the west. Hypnotized, I watch them dance in the headlights. It's so peaceful; twice I fall asleep and when I wake I find my head on Blum's shoulder. The second time, his arm is around me.

Finally, we bump across the wooden bridge and into the yard.

“Better check the stock before bed,” the vet says as he turns off the engine.

The minute Blum opens the passenger-side door I know something is wrong.

What alarms me as I stand outside the Hesters' stone house is the sound of Danny crying from his dark bedroom upstairs while the light is still on in Patience's room. “I'll see what's going on.” I enter the kitchen and take the stairs two at a time while the men head for the barn.

“Patience?”

“I'm sorry. I'm so sorry.”

I push open the door.
What in heaven's name?
My first thought is that someone has spilled paint on the bed, but that's absurd. Patience is lying in a pool of her own blood, and the red spreads down the sheets to the floor.

Tears run down the midwife's white face and she speaks slowly as if drugged.

“I shouldn't have done it. . . . I was having bad stomach pains and thought it was because I was constipated so I convinced myself maybe I could have a bowel movement in the commode if I squatted and strained. When I got up, the blood came and I realized the pains weren't from being blocked up. Oh, Becky, I'm so scared!” She lets out a sob, just as Daniel enters.

“God in heaven!” His face turns gray. “Fucking hell. Fucking hell,” he curses, looking around at all the red, as upset as the time
we found him in the ditch saying he'd killed his wife. “Oh, Patience, honey.” He collapses next to the bed, kneeling in the blood and taking his wife's face in his hands.

Blum now stands in the doorway wiping Danny's tears, but when he takes in the scene, he whips around so the child can't see. It's not easy to estimate the amount of blood when it's spread all over the place, but from all the surgeries I've assisted with, it looks like a couple of pints. The human body I remember contains eight to ten. If she loses much more, she'll go into shock.

I put my hand on her uterus. It's rock hard but there's a baby inside, so old Mrs. Potts's hemorrhage tincture can't help us. “Daniel, quit blubbering and let's find out what's going on. Can you take her blood pressure?” I fly downstairs, grab my medical kit, and return, flinging the cuff and stethoscope across the bed.

“Patience, listen to me. Take slow, deep breaths. I'll do a vaginal exam and see if we have time to get to Torrington.” I'm surprised to hear myself speak with such authority. I almost sound like a midwife.

“Oh, Becky. The pain. It's here all the time and it just gets worse with contractions. I feel like I'm going to rip apart.”

“I know, Patience.” I suck in a big breath and blow out through my lips. “I know. But breathe. Breathe like this. In . . . Out . . . In . . . Out.” I demonstrate and she copies while I sit down on a corner of the wet bed, warm with Patience's life fluid, and pull my red rubber gloves over my shaking hands.

“Blood pressure, seventy-six over fifty. Pulse one twenty,” Daniel spits out. He's quit crying and wipes his face and nose with a clean corner of the sheet.

I slide my fingers into Patience's vagina and another blossom of blood spurts out. Blum now stands at the door again, but without Danny. Somehow, he's gotten the child quieted and back in bed, probably gave him a cookie.

“I'm abrupting. I know I am. The placenta is shearing off,” Patience whispers. “I've already lost two babies this way.” Another twisting pain comes and she stops to get through it, sweat beading on her brow. The contractions are two minutes apart.

“Only four centimeters dilated,” I report to the group.

“Shit,” says Daniel. “I was hoping for eight or ten.”

“Check our baby. Check the heartbeat.” That's Patience. She's weak but still with us, the infant her chief concern.

“Do you think we can make it to Torrington?” Daniel turns to me. “The snow's really coming down now, but I could put chains on.”

I take Dr. Blum's stethoscope, place the silver headpiece over my brow, and lean down to listen to the fetal heart rate. At first I hear nothing and hold up my hand to quiet the room. Then from underneath Patience's rapid pulse, I catch a slower
tick tick
and tap the air with my finger to show them the rate. Daniel looks at his watch.

“Eighty,” he announces. “Too slow?” Patience starts crying again.

“Oh, save my baby, Becky. I'll push now! I can push! I don't care if my cervix rips.” She sits up in bed and another half cup of blood spurts out of her.

“What's it supposed to be!” Daniel yells at me.

“One hundred and twenty to one hundred and sixty.”

Patience begins to breathe as if she's been running, gulping for air. “Daniel, turn up the light. It's getting dark,” she cries and then collapses back on the bed. He reaches over, his face almost as white as hers, and takes her pulse again.

“One eighty, maybe. I can barely feel it.”

“Time to go,” Hester says, pulling himself together. “We have to cut. We have to do a cesarean section. Here, Blum, give me a hand. We'll move Patience down to the kitchen. The bottle of ether is in the hall closet. Becky get the table ready and pull it away from the stove. Ether is flammable. Then build up the fire and put on a pot of water.”

“Daddy?” It's little Danny calling from his room.

“Not now, honey. Go to sleep. Mommy's sick and we have to take care of her. Be a good little boy.”

“Daniel, can you do this? Patience is your wife,” I question. “Maybe I should do the surgery. I don't want to, but I think I could. I've seen the operation so many times.
She's your wife, Daniel
.”

“We don't have time to argue, Becky. She's going into shock. Just do as I say. How different can a woman be from a horse or a cow? I'm a veterinarian surgeon.
A surgeon
. The question is, can
you
do the anesthesia? That will be critical. Can you do the ether?”

“I have an anesthesia certificate from Walter Reed and I've done anesthesia for Dr. Blum.” I whip around and fly down the stairs. (He's right! We don't have time to discuss things.)

Within minutes, I've laid out Blum's old surgical instruments, which fortunately were still wrapped in sterile cloth from a year ago. Patience is stretched out flat on the kitchen table and tied down with whatever we can find, apron strings, Daniel's and Blum's belts, and the long peach scarf that I wore to the ball.

It's important that Patience not be able to move when she enters the excitable phase of the ether administration. I take a paper cone and sprinkle the anesthetic on it, not too much and not too little. This is familiar territory to me and I know how many drops from
experience. Patience is still unconscious and still losing blood, not cupfuls, but in a slow trickle. There's a trail of it down the stairs and across the oak floorboards.

Hester has scrubbed with soap and warm water from the reservoir on the side of the cookstove, and so has Dr. Blum, though god only knows what good he will be. Maybe Daniel plans to have him hold a retractor.

As soon as Patience is under, I nod to the doctors. Daniel stands with his scalpel above his wife's belly and I can see that he really has no idea where to cut, side to side or up and down.

“On a woman you start midline about three inches above the umbilicus and go straight through for another three toward the pubis,” Blum shocks us with his unused voice, a rusty pulley in a well.

Daniel holds the scalpel out to him. “Please, man, I'm begging you. You do it. I know you can! Save my wife. Save our baby if it's not too late.”

Patience moans and I give her a little more ether. “Daniel, cut! Or Blum! Someone cut now!” I command. “This baby can be out in five minutes.” It's then that I see something I could never have imagined. Blum steps up and takes over. With one swift movement he slices through Patience's pale skin.

“Scissors,” he commands, but I'm already holding them out. He snips through the abdominal muscles, then opens the tough peritoneum with his hands and the shiny pink womb lays exposed like a giant egg.

“Scalpel.” Delicately, he makes a hole in the uterus. More blood clots and fluid spurt out, spilling over the sheet and onto the floor. Blum enlarges the hole, then dips his right hand deep into the Patience's body, feeling for the fetal head. He grapples this way and that, like a man digging for gold, but then changes course.

Daniel just stands there, but I'm already holding out a warmed baby blanket, waiting for an infant that I'm sure will be floppy, but pray will still be alive. Finally, Isaac gets ahold of the feet, delivers the infant as a breech, and plops the limp, bloody baby into my hands. It's over in only four minutes.

It's funny how fast you can move if you have to. I hold the tiny infant against my chest and run for the parlor, where before we started the surgery I had built up the fire in the heater stove and laid a blanket and some supplies on the sofa. “Breathe, baby. Breathe.” I talk to the tiny girl as I scoot across the slippery kitchen floor. Not only is she depressed from the anesthetic, but also weak and pale from blood loss, like a balloon that's lost air.

The first thing I do is place her on the flannel blanket, then I go to work. In the other room, I can hear Blum saying something to Daniel as he delivers the placenta and begins to quickly suture the uterus back together again.

I dry the infant and rub it all over. There's a pulse, but no reaction to stimulation, no startle, no cry. She just lays there, floppy as a Raggedy Ann doll. “Come on, baby. You are
not
going to die. I've had enough death for one week!” I try Patience's trick, the Breath of Life, and blow on the infant's umbilicus. Still nothing!

Finally, I take the Asepto, suction her airway, and place my mouth over hers. Three quick, light puffs as Patience once showed me. Not too hard—you can damage the delicate lungs. Three puffs
and then wait five seconds and then try again. Finally, the baby lets out a cry. I am so grateful I cry with her.

“Okay, little one! Okay, baby. Keep breathing.” I rub her thin skin all over with a dry towel as she turns from blue to pink, but her troubles aren't over. When I stop stimulating her, she stops breathing.

Now I know what we have to do. Keep touching her. Keep talking to her. I don't care how long it takes. I'll sit up all night if I have to.

“Becky? The baby?” That's Daniel calling from the kitchen, and I step back through the door.

“A little girl.” I move closer to watch the end of the surgery. “She had trouble getting started and looks about three pounds, but has good muscle tone, good reflexes, and good color. Now we just have to keep her warm and keep stimulating her so she won't forget to breathe. How's Patience?” As I talk I keep patting the bottom of the little bundle in my arms.

“Weak, but she'll make it. Infection is what we'll have to worry about.” The two doctors close Patience's skin, their four hands working together like dancers who've danced this dance before, the curved needles swooping back and forth across the midwife's alabaster body.

Dr. Hester clips the suture and holds the skin closed, Blum does the stitching, as slick and competent as I remember. Finally, they're done. They cleanse the skin one more time, then lay on two layers of cotton wool.

“Here, Daniel. Why don't you sit down by the stove and hold your baby? The anesthesia will be wearing off soon and we'll have to control Patience's pain with laudanum. Dr. Blum and I can finish the dressing.”

I look at Patience so still and white, but I'm already thinking
about her recovery. We must get fluids into her as soon as possible and then good food, chicken broth, and liver. What she needs is blood, but blood transfusions are still experimental, and even if they were available there's no hospital nearby that could give them.

Patience moans and flips her head back and forth. She twists her mouth around like she tastes something bad, but these are all good signs that she's coming around.

“Patience, it's Becky.” I place my hands on each side of her face. “You're okay. You're okay, my friend. You're okay and so is the baby.”

Daniel comes over with the newborn in his arms and pushes a wooden chair in close so he can sit down. There are tears streaming down his face and I'll admit, my face is wet too. He holds the baby a little higher, as the mother's eyes flutter open. “Look, my love. We did it. It's a miracle. She lives. Thank god! She lives.”

The crisis is over, but now the hard work begins. The first night, the three of us, Daniel, Blum, and I, sit up together as if prayer could keep the baby and mother alive. First, we transfer Patience to the sofa while she's still under the influence of the opium, and then we take turns rubbing cooking oil on the infant's skin and keeping her warm. If ever she turns blue or stops breathing we double our efforts. Only once do I have to breathe for her as I did right after her birth.

As we hold our vigil, I watch Dr. Blum, still shocked at how he returned to himself when we needed him. He doesn't say anything, just sits there, silent as usual, but he's present, and when I hand him the baby so that I can catch a few winks he takes her gently and begins the massage.

A quarter of the midwife's life fluid is on the bed upstairs and another quarter on the kitchen floor, so I'm determined not to let Patience lose any more and now I can be liberal with Mrs. Potts's hemorrhage tincture. I thought maybe Dr. Blum would ask me what's in it, but once the emergency was over he went back to his old silent self.

The main thing with Patience is to keep the uterus firm and to hydrate her. We start with the herbal mixture, blended with honey and warm water. Water. Water. Water. Tea and water. By morning she's still weak but alive and we begin with warm milk. Daniel goes out in the hall and telephones the Reverend in Hazel Patch.

Right after breakfast, the troops arrive, first Preacher Miller, quiet and serious, and his wife, Mildred, a bundle of energy. She throws off her long coat and rolls up the sleeves of her white blouse. She's even brought her own flowered apron.

“Oh, my. Oh, my,” Mrs. Miller sighs. “You should have called us last night. We would have circled you with love the minute we heard. And Dr. Blum did the surgery? That's what you said? Praise Jesus, our prayers are working. You know we hold him in the light every Sunday. Just think, not even a year ago he was like a child.” She's all smiles and gives the doctor a hug. He smiles too, but just barely and doesn't hug back.

“Now, honey, tell us what you want us to do. I can stay all day and all night, and there will be several others here as well. I suppose half of Liberty knows by now if the telephone operator is her usual self.”

I give her the worst job. “We are all so tired, can you clean up the blood?” Mrs. Miller doesn't hesitate. While the preacher tends the stock and splits more firewood, she takes my red rubber gloves and a bucket of water and goes right to work, starting in the kitchen and then the stairs and then the Hesters' bedroom. By evening you wouldn't know that the tidy home had been the scene of a near tragedy.

“The baby?” Patience asks, and I know that she's back. Then she notices Danny standing next to her, patting her hand. “Oh, Danny. Mama's so glad to see you. I missed you.”

“Uncle Isaac gives me cookies.”

Dr. Blum rises from the rocker where he has been tenderly massaging the baby and holds her out to her mother, but when Patience reaches out, she drops back in pain.

“Don't sit up yet,” I admonish. “Do you want to try to breastfeed? I can help you get started.”

“For sure!” Patience smiles, and it's as if the sun has come out at the end of a long, rainy day.