Maxence came back. “The stove has a fire in it, so I put water on to boil. I should have sterilized towels in a few minutes.”
Dree dug through her backpack and handed him her few rudimentary surgical instruments, including two clamps and a pair of medical scissors. “Boil these, too. Keep them in a sterile towel.
Dree counted between the mother’s contractions, and they were about a minute apart. She and Batsa caught a glance at each other over the woman’s heaving abdomen, and he had obviously been timing them too. He held the woman’s hand in both of his and murmured to her.
Maxence came back, holding steaming towels. “I twisted them out as well as I could. They’re still pretty hot.”
Dree asked him, “You didn’t burn yourself, did you?”
“No, I have about an inch of calluses on my palms and fingers.”
Dree shoved her sleeve up her arm and checked the temperature of the towels. Warmth rose from the thin cloths, but in just a few minutes they wouldn’t be too hot if the baby landed on them, not that Dree intended to drop it. She spread the towels on the bed beneath the woman, just as she screamed and strained again.
Batsa murmured soothingly to her again, but he muttered to Dree, “She’s calling me curse words in Nepali I’ve never heard before.”
The top of the baby’s head appeared.
Dree said, “Crowning.”
Batsa said, “Hopefully, the baby will be face up. Support the head, and then you’ll get one shoulder and then the other. Just tilt the baby up, and the rest of it will come right out. It’s best to lay a baby directly on the mother’s abdomen, but I’m not sure what to do with a preemie.”
Dree nodded. “That’s what we did at the hospital.”
Batsa said, “My cousin was our OB. She said that women have been giving birth for all of time. She’s against medical intervention.”
Dree chanted what they had been told in nursing school and doctors had told her when she worked in the hospital. “Before 1900, almost all babies were born at home. It’s only been since 1969 that most babies have been born in hospitals. We can do this. She can do this.”
Dree prayed they could do this. She also knew the statistics of women and babies dying before 1900, and they were wretched.
With the woman’s next push, the baby’s head became visible, and the rest of the birth proceeded as Batsa had described within a few minutes.
The baby was tiny, though, so very tiny, where she lay on her mother’s stomach. She was hardly longer than Dree’s hand. Her pitiful cry was too soft, not the lusty wail of a full-term newborn. A fine layer of down covered her dark red skin.
Dree used one of the cloths Max had sterilized to wipe blood and mucus off the baby’s face and then covered the child with another cloth that felt just the slightest bit warmer than her body temperature, leaving room around her face for her to breathe. “You’re okay,” she whispered to the mewling infant. “You’re okay, baby girl.”
The baby wasn’t okay. She was far, far too small to survive.
Eighty percent died, Alfonso had said.
Batsa shook his head. “She is smaller than my third-born, who was just under four pounds and in an isolette in the NICU for a month.”
“There isn’t a NICU here.” Dree’s eyes stung with tears.
Maxence growled, “We need one of Alfonso’s damned micro-clinics right here, right now, not a year from now.”
The older woman said something else.
Batsa, the baby’s mother, and the other woman at the bedside said something harsh back to her. The woman looked angry instead of chastised.
Batsa said, “The mother-in-law has asked why the baby has fur. I’ve explained that it’s because she was born too early and it will disappear, but she said something superstitious. I am concerned about the child’s safety.”
Dree asked him, “Where’s the nearest larger town with a hospital?”
“It’s still Chandannath, I would think. Where are my maps?” He started digging through his backpack on the floor, throwing paper with notes and clothes onto the cement floor.
Isaak was plastered against the front door of the house, his hands spread on the thick wood like he was keeping the monsters of the afternoon out. “We’ve been riding the motorcycles for weeks. It has to be twelve or fourteen hours away.”
Batsa said, “We’ve been making a loop around Chandannath. There might be a road straight back down. I just need to find—”
He retrieved a folded paper from his backpack and pressed the wide sheet onto the floor. Thick black and blue marker streaks colored the roads on the map.
Using one finger, he traced lines until he found what he was looking for. “There’s a direct route. We could be back in Chandannath in less than three hours, but we don’t have a car.”
Isaak peeled himself off the door. “We can take the baby to the hospital on the motorcycles. Batsa and I can carry some of the baby’s relatives on the backs of ours.”
The mother cried out again, though not as loudly. She arched her back, and Dree caught the baby’s placenta. She held the placenta aloft before clamping off the umbilical cord, cleaning the area with super-premium vodka from Isaak’s flask, and cutting between the two clamps with the instruments Max had sterilized.
Dree stripped off her gloves. “The reason we put premature babies in incubators is to keep them warm. Premature babies lose heat, and they die of hypothermia in minutes. That’s why I covered her with a warm towel on her mother’s tummy. We’re in the Himalayas in December. It’s freaking freezing outside. There’s no way any baby would survive a motorcycle ride of even two minutes in this weather, let alone over two hours.”
Maxence said, “I can hold her. We can put her under my leather motorcycle jacket.”
His skin was warm, as she’d discovered a few nights before. “We have those hand-warmer packs Father Moses sent from Paris, too. We can pack those around her. And he sent that shiny space blanket. That thing reflects heat, and it’s waterproof. It must be windproof.”
Dree started digging through her backpack, throwing materials on the floor. “And we can use the pashmina the lady gave me between the baby and the hand warmers. We can fashion an incubator around her and you.”
Isaak walked over and crouched beside her. “That’s ingenious.”
Dree laid out the supplies. “That’s how we country folk do it. If you don’t have a thing you need, you make do. You wear it out, use it up, repurpose it, and make one out of spare parts. If we had time, I’d quilt all these things into a little isolette for her and make it pretty. I’m thinking some nice applique with a touch of turkey-trot red cotton for the home and hearth, and for luck.”
Isaak smiled at her, a spark lighting in his blue eyes. “It’s like a wearable incubator.”
She twisted around from her work. “Batsa, explain to them what we want to try and how risky it is. Tell them it might not work, and the baby might not survive the trip.”
Batsa explained to the family about their plan to get the baby to the hospital.
The mother was nodding and crying.
The mother-in-law must have said something negative because the other woman started berating her and then turned and said something insistent to Batsa.
Batsa translated, “This woman is our new mother’s oldest sister, and thus she makes decisions for their family. She will go with the baby to the hospital until the mother can recover and arrive. They’re very aware of how few tiny preemies survive.”
Dree started ripping open hand-warmer packs and told Maxence, “Strip.”
Maxence hadn’t bothered to put on his leather pants before they’d made the emergency ride over to deliver the baby, so he did that, and then he stripped down to his tee-shirt. He laid down on the floor.
Dree scooped the baby up with the warm towel, dried her off, and wrapped her in the lovely pashmina like a tiny little burrito, careful to fold a tiny hood over the baby’s head but not her face.
In
the pashmina’s outside layer, Dree inserted the hand-warmer packs, which were already getting toasty to the touch. She tied the space blanket around Maxence’s waist and shoulder, fashioning it into a shiny baby sling.
Isaak watched her construction closely. “Insulation, warming gels, and then an outer protective layer. Got it.”
Maxence carefully zipped his black leather motorcycle jacket around himself and the baby while Dree, Batsa, and Isaak yanked on their outerwear, and they started walking out to the bikes.
“I can’t believe you fit her inside your jacket,” Dree said to Max. “I didn’t think there was room.”
He whispered, “I’m not breathing much because I don’t want to squish her. Let’s get to the hospital as soon as we can.”
The afternoon sun was wan but strong enough to warm Dree’s ski suit. Shadows slithered from the mountains into the valley.
Batsa took point, as always, because he had memorized the map and could read the signs.
Isaak bundled the older sister onto the back of his bike and wrapped her arms around his waist, showing her how to lean with him when he turned. The woman’s expanded eyes looked frightened, but she was nodding vehemently.
Maxence mounted up behind Dree. “This isn’t safe. We should have a car seat or whatever they do for motorcycles.”
“I know, but it’s her only shot. If we find a truck going that way, we’ll hijack them.”
He nodded. “Excellent idea. I have an innate knack for piracy.”
They jammed their helmets on and buckled them.
They left a note for Father Booker and Alfonso at the house where they had set up the clinic.
Dree gunned the motorcycle, riding as fast as she thought might be safe. She crouched low over the handlebars like she was riding a racehorse for speed, but she wanted to stay upright so her body could act as a windbreak for the baby between them.
Usually, while they were riding together, Maxence wrapped both his arms around her waist or braced them on either side of her, but that day he held onto her with one hand and the baby with his other arm.
The three motorcycles sped through the afternoon as the shadows lengthened, every turn feeling fraught with danger. Dree could have sworn she didn’t breathe until they pulled up to the covered awning at the regional hospital.
The three motorcycles stopped in a row. Maxence dismounted the bike and walked directly toward the doors of the ER.
Dree started to follow him, but the older sister nearly fell off the back of Isaak’s bike, grumbling something in Nepali. Dree caught her arm before she face-planted on the frozen asphalt.
Batsa translated to Isaak, “She says she will die a thousand deaths on the wheel of karma and Lord Shiva will dance and destroy the universe before she gets back on that motorcycle, but she is very grateful you brought her here.”
Dree chased Maxence through the doors. Batsa, Isaak, and the baby’s aunt were right on her heels.
Maxence was unzipping his coat and calling out, “Emergency! We have an emergency!”
Batsa caught up to him and began calling out in Nepali.
A woman wearing a dark blue sari and a long white lab coat ran up to them. “I am a doctor. What is your emergency?”
Maxence was having trouble getting the pashmina-wrapped bundle out of the knotted space blanket under his jacket.
Dree reached between his arms and retrieved the tiny infant. “Premature birth, perhaps twenty-eight weeks gestation. We’re not sure. She seems to be more than a kilogram but less than two. She was born in one of the small villages, and it seemed better to try to get her here instead of treating her up there.”
The doctor took the baby from Dree’s arms and spread the folds of the pashmina away from her tiny face.
Dree saw the baby’s mouth open in a yawn or an instinct to suckle and nearly collapsed with relief.
The doctor started walking, her long white coat fluttering in her wake, and their entire company followed. “Our neonatal unit is this way. What is this warm under the shawl?”
Batsa said, “Dree Clark, who is a registered nurse practitioner, put hand warmers in the pashmina to keep her warm.”
The doctor nodded, flaring her already enormous eyes. “That is very good, yes. You did a good job, Nurse Dree.”
Batsa said, “Your English is very good. Did you study in the United States or the UK?”
“I did a Masters in Molecular Biology at the University of Iowa.”
Batsa said, “I am living in Iowa City for the past twenty years! Did you try India Café?”
Her head bobbled. “I thought it was excellent, but I went to Masala Cuisine more because I am pure vegetarian. Here we are at the NICU.”
A NICU specialist bustled over. “What do we have?”
Dree talked medicine with them, explaining the circumstances of the baby’s birth and the relationship of the baby’s aunt, who stepped forward and took over the conversation while the neonatologist placed the baby in an incubator and took her vitals.
After a few moments that felt like forever, the doctor looked up at Dree and said, “You got her here in time, and she is warm. Her vitals are very good for a baby who is one and a half kilograms. We will do our best for her.” She called out something in Nepali, and nurses bustled over to take charge.
The mother’s oldest sister stayed with the baby, and Maxence guided Dree back into the hallway because she felt like she couldn’t even breathe.
After they had walked away a good fifty feet, Dree’s knees gave out, and she crumpled.
Maxence caught her before her knees banged on the ceramic tile and whisked her up in his arms. “You did it. She’s alive, and she’s in good condition for a preemie.”
Dree tucked her face into Maxence’s neck, and to her utter chagrin, began to sob. “I don’t want her to die.”
His strong arms cradled her. “You did all you could. If you hadn’t been there, she wouldn’t have any chance at all.”
“I don’t think I can head back to the village just yet. Maybe if we can find some tea, or maybe if you drove the motorcycle. I’m just exhausted, and I don’t even know what I’m doing.”
He whispered in his deep voice, “Let’s stay here in Chandannath for the night. It’s beginning to get dark out there. I don’t want to drive a motorcycle on those twisty roads above the cliffs in the dark.”
“But Father Booker and Alfonso—”
“We already had the campsite set up before we left. They’ve got two motorcycles, a fire pit ready to go, and three tents. They each have the opportunity to sleep alone in a tent tonight. I think if we go back, they’ll be mad at us.”
Dree nodded into his neck. His sandpaper stubble scraped her nose and forehead. She just wanted to sleep in his arms again.
Chapter Fifteen
Jumla, Again
Dree
Maxence settled Dree on the motorcycle behind him. She held onto his muscular waist and leaned her helmet against his back. She wasn’t trying to tempt him or herself, but holding onto his body with both arms comforted her. She rubbed her gloved palm over the black leather of his jacket, trying to distract herself from worry over the tiny baby they’d taken to the hospital.
When they got to the inn they’d stayed at their first night in Jumla and wrenched off their helmets, Maxence must have caught a glimpse of her tear-streaked face because he grabbed her hand and pressed it between both of his, saying, “You did the most anyone could have done.”
“I should give you that cross necklace back. Angels can work miracles. I think I did something stupid that cost a baby her life today.”
“That baby didn’t stand a chance if we hadn’t tried something. We’ll check on her tomorrow morning before we head back to the village. But no matter what happens, you gave her a shot, even if it’s only a slim chance. She was very small. Her little limbs were just skin-covered bird bones. She didn’t have a twenty percent chance of surviving up there. She had no chance at all.”
&nb
sp; “When Batsa said that about the mother-in-law, all I could think was to get that baby out of the house.”
“That’s yet another reason, and you’re right.”
They went inside and found the same three available rooms and eager innkeepers who appreciated wintertime guests.
Isaak grinned and stretched his arms as they checked in. “A real bed all to myself with a warm shower? I have died and gone to Heaven.”
Maxence swiped his credit card and paid for the rooms and meals, even though the innkeepers were willing to bargain again and let them have the rooms for only the price of supper.
When Dree asked Max about it, he said, “I’m unwilling to surrender to the relentlessness of poverty today. Perhaps saving one baby’s life has inspired me to fight on, at least for tonight.”
Dree didn’t feel it.
The innkeeper’s wife made supper for them. They sat at a table in the tiny lobby.
The plant in the corner was still dead.
The world was caving in on Dree. No matter how hard she worked, she couldn’t save anyone. She’d come up with one harebrained scheme to wrap a few random items around a neonate and drive her for hours on a motorcycle.
Dree had probably killed the baby.
She hated herself. She was a stupid, undertrained nurse who thought she was MacGyver.
Maxence’s knee and lower leg pressed against hers throughout the meal, though he didn’t seem to notice it.
She did. The warmth and pressure reminded her that Max thought they hadn’t done something lethally stupid, even though she suspected he was wrong.
Isaak and Batsa sat across from them in a booth and ate steadily. The hard, wooden seat was bruising her tailbone.
Batsa had stayed at the hospital a little longer to help if he could, and then he’d caught up with them.
He told them that yes, when he’d left, the baby was still alive. “They were pleased with her suckling response, and she had eaten two ounces of neonatal formula all by herself, not with a feeding tube. That is a very good sign. My premature daughter did not eat for herself for a week in the NICU.”
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