Obstetrix(42)

Joy was definitely in labor. “Do you think we should do the steroid shot for her?” Sarah asked. “Hold off delivery for a day?”

That might not be optimal for the escape. I can’t think about that now; I have to think about the patient in front of me.

Joy grabbed my hand. “We can’t wait,” she said. “I think you need to get this baby out of me, and I think you need to do it now,” she said. “God put it on my heart”—she broke off with a groan of pain—“God put it on my heart that this baby needs to be born tonight. Tonight.”

Sarah looked at me.

“Maternal instincts are a powerful indicator,” I said. This was not actually clinically true, and I hoped it did not come back to bite me. “We’re going to need an ultrasound to look at fetal positioning, though, given Joy’s uterus.”

“You said tonight, right, Joy?” Sarah said. “It’s just after midnight, there’s a whole lot of night left.” She rolled the ultrasound machine over. The baby was still transverse, which was not surprising. But the heartbeat looked nice and strong, and I actually had a pretty good feeling about lung development. This baby was almost term.

“Okay,” I said. “Okay. I can perform the C-section tonight. Sarah, are you doing the surgical assisting?”

“We have someone else for the surgical assisting. Brother Mike.”

“How did no one tell me this before?” I snapped. “Guess you’d better get him in here, then.” Sarah ran to the door and actually ran out to find Mike, leaving me briefly alone with Joy.

I leaned down and whispered, “Are you sure about this?”

She whispered back, “Make it last as long as you can. If you can take my whole goddamn uterus out and burn it, so much the better.”

Sarah was back, Mike in tow, Bethany at his heels. “Howdy, Doc,” he said.

Joy visibly jerked when she saw Bethany. “I don’t want the child here,” she said.

Bethany’s face visibly fell, but I leapt to agree. “Bethany, this is a surgery; you can’t be here for a surgery, not yet. When you’re fourteen—” I issued the promise recklessly. “We’ll train you for surgical assisting and you can be at surgeries once you’re fourteen.” I could feel Joy relax slightly beside me. “For now, Brother Mike, get into scrubs. There’s a bathroom over there. While you’re scrubbing up, tell me what your actual experience is.” Mike turned out to be trained as a veterinary assistant, so normally he did this on literal farm animals, but at least he probably wouldn’t faint at the sight of blood. “Are you even going to know what the instruments are called when they’re for humans and not for cows?”

“Oh, yeah,” Mike said. “They’re mostly called the same things. I checked.”

I decided that if anything went wrong, I was going to try to throw the blame on Mike. Sarah got out masks, gloves, laid out autoclaved surgical instruments. Up at the meal hall I could hear a bell tolling. “What’s that for?”

“A prayer vigil to welcome Pastor’s first grandson,” Sarah said.

I looked at Joy, who didn’t seem alarmed, so probably that was part of the plan. Sarah pulled out the anesthetics and I set to work delivering the largest and longest-lasting dose of spinal anesthesia I could do.



* * *



I HAVE DONE OVER a thousand C-sections in my career as an ob-gyn. I’ve overseen many more vaginal deliveries. (I’ve done exactly zero of those, personally—the woman delivers the baby, with a normal childbirth. The doctor’s just there to catch. And I’ve never given birth myself.) I have performed hysterectomies, rectocele repairs, tubal ligations, oophorectomies.

Those didn’t prepare me for this. Even my rotation in Haiti did not prepare me for this. Well, that’s not entirely fair, because obviously I brought my normal skill set to this horrifying, absurd situation. What I drew on more, though, was the time back during my residency when I and two surgical residents, near the end of a very long shift, went down the rabbit hole of Leonid Ivanovich Rogozov, a doctor on an Antarctic expedition in 1961 who removed his own appendix under local anesthetic. We’d all found it fascinating and had argued about which surgical tasks we might reasonably walk a non-doctor through, if any, and whether we could use a camera to better effect than Rogozov’s mirrors. (He had set up mirrors, but gave up on using them partway through and did the surgery by touch.)

Operating in a makeshift operating theater with a surgical assistant who’d only ever practiced on animals: a piece of cake compared to doing your own appendectomy. They hadn’t skimped on the lighting, so I could see what I was doing. Joy closed her eyes tight, doing her best impression of a woman under general anesthetic.

The table—such as it was—was the wrong height, and my back started cramping almost immediately. No matter how well Bethany had sanitized this room, she was a child, and we weren’t in a hospital; Joy’s infection risk was going to be appalling.

The baby was a boy, small but breathing on his own. In addition to Mike the vet tech, Janet had been standing by, ready to take charge of the baby. I didn’t ask what pediatric training she’d had—that wasn’t my problem, and I needed to focus on Joy.

Normally, a C-section takes about forty-five minutes, if nothing goes wrong; it’s stitching that takes the most time. But even aside from Joy’s directive to make the surgery take as long as possible, I was working under strange and stressful circumstances. I’d counted instruments and sponges before starting, and I counted them all four times before I closed. I’d never done a surgery with a retained surgical item, and this would be a very bad time to start.