Obstetrix(27)

“He needs albuterol,” I said. “Do you have albuterol?” Sarah unlocked the medications and I explained to him how to use the inhaler. “What triggered this?” I asked him.

“I don’t know,” he said.

“What were you doing when you started having trouble breathing?”

“Cleaning the chicken barn,” he said. “We were doing life instruction and the boys my age work with the chickens.”

I turned to Sarah. “He’s probably allergic to something in the barn. Chicken feathers, maybe. He needs to not clean the chicken barn.”

“I can advise his mother, she can talk to his father, and his father can bring your concern to Pastor. But he’s twelve, and the twelve-year-old boys clean the chicken barn as part of life instruction.”

“Did he just—” I turned to the boy. “Did you just turn twelve?”

“Yes, ma’am. Yes, Doctor. On Monday.”

“Have you had asthma attacks before?”

“I get wheezy sometimes, but not like this.”

“Tell Pastor John that if he wants this boy to turn thirteen he should find him some job that isn’t the chicken barn, and young man, if you’re going into the chicken barn you need to at least wear a high-grade filter mask like an N95 the whole time you’re in there. Not just a dust mask like we wore sanding earlier this week, a filter mask.”

“The inhaler helped a lot,” he said.

“If you overuse an inhaler it will stop working. Keep that in your pocket in case you need it, but you can’t just expose yourself to a major allergen that triggers a reaction and rely on your inhaler to save you, because one day it won’t.”

Later that same day, I saw someone who’d gotten a “thrashing”—not Turkey, someone else. It was one of the adult women, not pregnant, who’d been hit with a narrow implement like a switch on her thighs and buttocks hard enough to draw blood. One of her wounds was oozing and she was concerned—reasonably enough—about infection. She’d started using a topical antibiotic but only in the last day; I gave her a stronger one and told her to come right back if it got any worse.

Back in my real life, when adult patients came in with marks like this, it was usually from consensual BDSM activities. Children with marks from beatings merited an automatic call to CPS; adults required some sort of conversation. Women who had them consensually were always relieved that I, a respectable middle-aged medical professional, was familiar with the concept of kink. I actually had a handout I’d made that I gave patients like this, going through safety concerns specific to pregnancy (for example, choking is never safe, but you really need to knock it off when you’re pregnant since your air is your baby’s air and your baby didn’t consent). It had a bit at the bottom saying, Sometimes intimate-partner violence starts during pregnancy, and consensually kinky relationships are not immune from abuse and then went through the usual warning signs of an abusive relationship with some additions like ignores your limits/boundaries, and disregards safewords.

After the woman with the whip marks was gone, I told Sarah I needed to go to the bathroom and sat on the toilet, leaning my head against the wall. I felt guilty about not asking more questions, and told myself, This woman isn’t my patient, I didn’t agree to any of this, I need to just cooperate as best I can and be ready for any opportunity I have to get out.

If she can’t leave either, then I can help her by escaping.

Even if she could leave, possibly I could help her, along with all the children here, by escaping. I was having a hot flash, and I turned on the sink to run cold water over my hands. I imagined a SWAT team coming to arrest Sarah, Brandon, Pastor John, and Ethan. Since this was a fantasy, I imagined Emma and Janet meekly surrendering, Joy ecstatically seeking proper care, Bethany weeping with delight over an armload of books.

“Are you almost done in there?” Sarah called. “We have another patient.”

I washed my hands properly, dried them, and came out of the bathroom. Looked over the patient, who was one of the older women. “How can I help you today?” I asked.

On Fridays, I sat with Emma, Janet, Natalie, and Heather and stitched. I learned how to darn socks so they wouldn’t give anyone a blister. I listened to Heather and Emma trade gossip until Natalie coughed disapprovingly. I learned the names of people’s children and got Sarah’s personal history. I’d noticed that when men and women went anywhere together, generally it was married couples, so I’d figured Brandon had to be her husband, but they really lacked that “married couple” vibe. Courtesy of bits and pieces from Emma, I learned that Sarah had originally joined the cult with a different spouse, a guy named Jeremy. He’d been part of the group that originally came to Harvest, along with their two children, but he’d left six months later, taking their children with him, and apparently he’d run away with Brandon’s wife. Pastor John had announced that both Sarah’s marriage to Jeremy and Brandon’s marriage to his former wife were invalid now and had instructed Sarah and Brandon to marry each other and “be fruitful.” So far, however, no fruit had resulted, and Emma was pretty sure that this was because Brandon was “stubborn,” but Heather thought it was just that Sarah was old. Sarah was almost forty, which is in that gray area for fertility that I privately call the Murphy Zone, after Murphy’s Law. If you want to get pregnant, you’ll probably have trouble; if you don’t want to get pregnant and take chances, you are 100 percent going to find yourself knocked up. So it really could be either.