Obstetrix(43)

The thing about making surgery take longer is that it also makes infection risk higher. Fortunately, once the fascia is closed, that risk drops precipitously and there’s still quite a lot to do. I started by closing the fascia with a lot of attention to perfect hemostasis, trying to fix every last capillary. Once that was done, I deliberately slowed down even more. “This is taking a lot longer than it does when you repair a tear,” Sarah remarked.

Joy’s eyes screwed shut even tighter, but she didn’t need to worry; I reached for my “training the new residents” voice. “A recent study found that the best suturing technique for perineal injuries is continuous, nonlocking sutures. That means something like a running stitch. Whereas with cesarean surgery, I like my scars to be perfect, and the simple interrupted suture, like I am performing here, is one of the best ways to provide a small, minimally noticeable scar. The running stitch does take less time, which is kind of a nice bonus for everyone, but the main reason I use it on perineal tears is that it results in significantly less pain for the patient.” Lecturing slowed me down even more, so as I continued working, I lectured Sarah and Mike on things to watch for that might indicate trouble or complications, and I had them give her some pain medication so that she wouldn’t get slammed with surgical pain the instant the spinal wore off. Joy didn’t object, which I hoped meant she wasn’t required to be clearheaded for the plan to come off.

I’d finished closing Joy but was still lecturing Sarah and Mike when David burst in.

“Where’s the baby?” he shouted. “Where’s my son?”

“Sister Janet took him,” Sarah said. “I assumed—didn’t she bring him back to your place? He’s fine, he’s healthy. She was—she was going to bathe him. She couldn’t do that here.” She gestured to the clinic-turned-field-hospital, at the harsh lights and the tight space.

I sat down, still in my scrubs, on a chair that had been pushed into the corner. I had not realized that the plan had included taking Joy’s child. That seemed risky. Riskier. Next to me, Joy stirred. Normally—in a hospital—patients who’d just had a C-section were taken off to recovery to be monitored by nurses as the anesthesia wore off, but obviously that wasn’t going to happen here. Joy whimpered a little.

“He must be somewhere,” Sarah was saying.

“I’m telling you, he’s gone. We can’t find Janet, either.”

Joy opened her eyes.

“You have a healthy son,” I told her. “How do you feel?”

“Where’s my baby?” Joy whispered.

“He’s doing great,” I said, hoping this was true and hoping that Joy remembered the plan, if this had been part of the plan. “Do you want to see your husband?”

She shook her head. “I want to see my baby,” she said. “Oh. It hurts. What did you do to me? It hurts.”

“Sarah,” I said, interrupting the conversation. “Give Joy another five milligrams of morphine, please.”

“Joy?” David said, coming around to bend down over her. “Where’s my son?”

“How is Joy going to know the answer to that question?” I said, trying to put myself between them. “She’s been a surgical patient for most of the last two hours.”

“Get out of the way,” David growled at me.

I pulled myself straight. “You need to leave my patient alone. I don’t care if she’s your wife.”

“David?” Joy said. “Where’s the baby? What happened? Where is he?”

There was a long silence, and then David turned on his heel. “We’ll find them,” he said. “They can’t have gone far.”

I stepped outside. The night was nearly over, and the compound was full of activity. There’d been a prayer vigil and sleepy children who’d spilled out of the community building were now being herded back in. Holly was hurrying past me with her head down. “What’s going on?” I called to her, and she looked up at me, her face distracted.

“Brother Jason and Sister Emma are missing,” she said. “Along with their children. And no one knows where Sister Janet took Sister Joy’s baby.”

Pastor John was unlocking the building where they kept the vehicles. “The minivan’s still here,” I heard him call. “And the truck. The Gator’s gone.”

“I’ll get the keys,” David snarled, and ran up to the community building. He was back a minute later, shouting for Brandon. Apparently he’d used the minivan for the feed pickup today because the pickup wasn’t running, and the keys were still in his pocket, instead of in the cabinet. There was a spray of gravel as David whipped the minivan out of the garage. “Brother Ethan—”

“Yes, of course,” Ethan said. He climbed in, his rifle across his lap, and the minivan roared away up the driveway into the dark.

Sarah came out of the clinic, white-faced. “Go sit with Sister Joy,” she said to me.

In the clinic, Sarah had shut off the bright lights. The sheets around Joy were still stained with her blood—even a surgery that goes well produces a certain amount of blood. Joy was asleep; Sarah had given her a pillow for her head. The second bed in the clinic had been folded up and shoved into one of the closets to make more space for the surgery. I brought it back out and made it up, thinking that when Joy roused I could move her over to the clean, unbloodied bed.