Obstetrix(37)

I could sabotage the woodworking equipment. I thought about those woodworking lessons with my father that had petered out before we got to power tools, and how I didn’t know enough about the equipment to know how to sabotage a safety feature, and how even if I could work out what to do, I could wind up maiming one of the teenage boys, who were woodworking novices and more likely to have an accident.

Back to that first idea. Could I convince some man that he was having a stroke or a heart attack? Could I convince Sarah, and Pastor John?

I mean, ideally I’d make Pastor John think he was having a heart attack. He had never visited the clinic; if he did, I could try convincing him that he had cancer. Melanoma, probably, since that’s something I could plausibly spot even if he was actually in for something else.

But it probably wouldn’t be Pastor John. The odds that I’d have someone else turn up with a panic attack were also not great, because surely my best chance at seeing a panic attack would have been in the days right after Holly’s beating. (Panic attacks frequently cause chest pain and shortness of breath; it wouldn’t be hard to convince someone having a panic attack that they were having a heart attack.) If someone turned up with a migraine, I might be able to convince them it was a stroke, but if they’d had migraines before that felt similar, they probably wouldn’t believe me.

I tried to think through the other ways this could go wrong. If someone did have a medical emergency, the cult might still not take them anywhere—they might take them into the community house and pray over them. And if I’d lied about it being an emergency, the prayer would even “work.” If they did decide they had to seek care, probably because the person with the emergency was sufficiently high status, they’d probably put them in the van and drive them to the hospital, not call an ambulance, and there’s no way they’d bring me along, although they might bring Sarah. If I put my note on the person heading to the hospital, I had no way of ensuring it was found. And no way of ensuring it wasn’t found by one of the cult members, who would certainly know I’d written the note.

What would they do to me, at that point? No one wants you to get a thrashing, Doctor. The noise of Holly’s beating still echoed in my ears, sometimes.

Was it worth the risk?

I thought it might be worth the risk. But I’d need someone—one of the adult men, specifically—to turn up with a plausible emergency to put that plan into action.



* * *



JASON CAME TO THE clinic to discuss Bethany’s desire for “apprenticeship.” I could tell from looking at him that his knee was getting worse, not better, and when he settled into the folding chair Sarah brought out, his brow was furrowed.

“Bethany says she wants to apprentice with you,” he said, speaking more to me than to Sarah. “Pastor said I should talk to you about it.” He paused, then went on before I could reply. “I like the idea. She’s a bright kid.”

“And as the community grows, it will be good to have more women who can attend births,” Sarah added. “We are to become a refuge for the faithful, after all.”

“Right,” Jason said. He looked a little listless. “Anyway, it’s fine with me, so long as she stays out of the way, and doesn’t ask questions that bother your patients.”

“Can you let her know that if I ask her to leave, she needs to do it without delay?” I asked.

“Oh, you shouldn’t have any problems with that,” Jason said. “She’s a good, obedient girl.”

“What does Brother Ethan think?” Sarah asked.

There was a flicker of pain or anger in Jason’s face, smoothed away to blankness so quickly I wasn’t entirely sure if I’d imagined it. “Once they’re married, it’ll be his decision about whether she can continue. But I think he knows how important it is for there to be women trained to help with births.”

“So you haven’t talked with him about it?”

“Pastor might have, I don’t know.”

“All right,” Sarah said, with a slightly perplexed smile. “It won’t do any harm to let her start learning, even if Brother Ethan decides she should have other priorities.”

“That’s right,” Jason said. He stood up, wincing a little as he straightened his leg. “I’ll let her know she can start coming this afternoon.”

Her father’s approval gained, Bethany started turning up, bright-eyed and enthusiastic, every Monday, Thursday, and Saturday, as well as coming for part of the evening if we were sitting with a woman in labor.

There had been several births since I’d arrived. All the babies had come out without major problems so far, so my ability to do a field-hospital-style cesarean section was still untested. There’d been one woman who tore badly enough that she’d probably have had an easier time healing from a C-section; I’d stitched her up as carefully as I could, and told Sarah that this woman absolutely needed to rest as much as possible, her husband was not allowed to have sex with her until I explicitly lifted the restriction, and that I didn’t care if she stood up on Sunday and blasphemed the Holy Spirit, absolutely no corporal punishment until she was entirely healed.

My fears about Bethany being freaked out by childbirth were so far unwarranted. Her first week, a woman named Vanessa did have a significant birth complication, shoulder dystocia. Usually, once the woman births the baby’s head, the rest of the body slides out without any additional difficulty; the head is usually the biggest part, and in general, if a baby is just going to refuse to come out, it’s the whole baby that gets stuck. In shoulder dystocia, the head comes out but the shoulders get stuck. This is arguably the only complication of childbirth where you’re better off at home, since once the baby’s head is out, it’s too late to do a C-section anyway. Home births don’t involve epidurals, and if a woman hasn’t had medications that keep her from moving freely, you can do the Gaskin maneuver, where you have her get on all fours. I had to use a couple other tricks to get this baby out, but we got her out by the end, and afterward, as Sarah bathed the baby and gave it back to Vanessa while I checked over the placenta, I thought she had the self-satisfied smile of a kidnapper who now felt entirely justified in her kidnapping.