by Sarah Moss
‘I’m, Miss Eastman, the nurse, and here is Dr. Moberley. We’re going to help you. We need to have a look at you now, see how you’re doing.’
Miss Eastman turns the girl onto her back, lifts her skirt and gently parts the knees. The patient has no underwear and has not washed in some time. A tuft of dark hair is already visible in the vaginal opening. Ally looks up. The patient’s eyes are closed and her mouth slack. In the grimy wrist, the pulse is weak and slow. Three days in labour, and she can’t be more than sixteen. The face is thin and pointed, the legs like twigs below the swollen abdomen. And Ally’s heart drops, because even in this foreshortened position the thighs are visibly bowed. Rickets. Probable pelvic distortion. Cephalopelvic disproportion: the foetal skull may simply not fit through the patient’s pelvic ring. Damn. She rests a hand on the belly while it hardens again. Nurse Eastman, without being asked, passes her the Pinard. She listens and hears the drumming of blood, the march of a different beat within the patient’s body. The child, for now, lives. The mother is failing. They have perhaps ten minutes, Ally, thinks, maybe fifteen, to work between the beats of those two hearts, to keep all the human music in the room playing. Her and Miss Eastman. Starting now.
The patient is too weak to stay on all fours. Miss Eastman tries to support her while Ally pushes her fingers around the child’s head to find the jammed shoulders. They sway the girl back and forth but nothing happens, nothing frees. Ninety seconds gone. Ally sees the map of the pelvis in her head. A mechanical problem. An engineering problem.
‘On her back.’
Miss Eastman raises her eyebrows but complies. Ally takes a knee.
‘Copy me.’
Miss Eastman takes the other and they push back against the patient’s abdomen, extending the sacrum. Ally sees the skull jammed against the pelvic bones, the angles all wrong. Not fundal pressure. She pushes hard on the pubic bone, rocks it. Sometimes the head can spring free but not this time, not now. Another moan and every muscle in the girl’s body gripping, tightening, forcing the child deeper into a cave with no way out. Not unless Ally makes the child’s head smaller or the mother’s pelvis larger. She holds out her hand for the Pinard and hears the small music slow, almost stop, and reluctantly resume some seconds after the contraction passes. Miss Eastman, her fingers on the patient’s wrist, bites her lip, shakes her head and feels for a carotid pulse instead. Five minutes, Ally thinks, five minutes and we’ll lose both of them.
‘Get the instrument box,’ she says.
‘Craniotomy?’
Perforate the skull, mash the brain with scissors, crush the bone so the child can be pulled free. She’s seen it done.
‘No. Symphysiotomy. It’s possible to spring the pelvis.’
Not a complex procedure. She remembers Dr. Burnet. All you need, ladies, is a catheter, a strong scalpel and stronger nerves, and you can manage without the catheter.
‘Glass catheter, please, and then a number four scalpel.’
A minute and a half. No time for analgesia. The patient is conscious enough to whimper as the blade goes in.
The child is limp and does not breathe, but the cord is still pulsing, the two hearts still working from one set of lungs, as she passes him to Miss Eastman. There is so much blood that it is hard to assess the mother’s trauma. She needs to deliver the placenta, now. Ally ties and cuts the cord, ending the baby’s oxygen supply, and works on her patient.
‘When you can, Miss Eastman, morphia please.’
Afterwards, Miss Eastman goes back and forth, attending to the mother and child while Ally works through the clinic, her blood singing with elation. The girl, Nellie Tillman, is sore and exhausted but has taken tea and the bread and butter Ally had brought for her own lunch and has fed her new son. The baby, whose first cry wasn’t heard until Ally was binding his mother’s hips to stabilise the spliced pelvis, has looked at the world and apparently, for now, decided to stay, making underwater movements and turning a strange gaze on the new element, air. His chances of surviving childhood are not good, worsened by his mother’s extreme youth and single state. Nellie is not well placed to recover from an obstructed labour, and even after the hospital stay that Miss Eastman has arranged may not avoid infection in Ally’s layers of careful stitching. She may never be able to walk far, may find standing at mill or factory work impossibly painful, especially if—especially as—she cannot take several weeks’ rest. But even so, Ally thinks while she listens to tubercular chests and weighs children who appear several years younger than their mothers say they are, while she hears a heart murmur that would indicate the avoidance of exertion in a person who had any means of survival without exertion, even so, because of what she did, because of her training and her knowledge, there are two people alive now who were all but dead before lunch.
The rain must have stopped sometime during the afternoon, but the handle wets her gloves as she closes the heavy door of May’s Centre and locks it behind her. Puddles gleam in the gaslight. Ally buttons her pocket over her purse and glances behind her as she sets off; this is not a place where she would advise a well-to-do woman to walk alone after dark. She is tired. She remembers the smell of earth and water after rain in Cornwall. Here, there is still smoke on the air and at the back of her throat, and the streetlights show a sky washed brown. It is not reasonable to think in Cornwall that the climate is too damp and the land too wet and in Manchester that there is too much smoke and soot; one must be somewhere. She tugs at her cuffs and walks faster. She could take the omnibus, she thinks, for Mamma need never know and it would mean she could reach the grocer before the shopkeepers are cross because they are about to close and there is only tripe left. It would not be unreasonable, to take the omnibus with such an aim, as it would be from laziness, though it would probably not occur to Mamma do to such a thing. She will walk past the stop, she decides, and take the bus if one comes; Mamma will be angry if there is no supper and only disappointed if she learns that Ally has taken a bus instead of walking. Her throats tightens at the thought of Mamma’s anger, and then again in irritation with herself for caring so much. She remembers herself holding the scalpel, herself remembering to protect the urethra, to deliver the child down over the perineum as the seconds flickered away. Herself controlling her patient’s bleeding with death at her shoulder as she worked. She should have outgrown the fear of Mamma. But has not.
She rounds the corner. There is a bus. It is not raining so very hard, she thinks. If she has money to spare for bus tickets, it could be given to a hungry family, to any Mamma’s charities, rather than used to spare a healthy and well-fed woman a walk of barely two miles. It is not as if her day’s work has been physically demanding. The bus moves off, and Ally quickens her pace through the puddles and the dusk.
The house stands unlit, the gate shadowed by the privet hedge. The sky seems darker here and there is half a moon in the taller beech tree and the suggestion of moonlight on the wet grass. The gate has swollen in the rain and is stiff; her footsteps crash on the gravel path. She fumbles for her key, inside her purse inside her coat pocket, with cold hands, and has to peer to find the keyhole. This is the day’s lowest point, she reminds herself, the return to a chill dark house and the need to begin again, to clean and prepare a meal, when it feels as if the day’s work is done. There are women all over the city who have been standing in a factory all day and are now returning to the needs of their husbands and children; she has no business complaining of a house that is too large and empty. Leaving the door open for the sake of the light from the street, she feels for the matches in the niche at the bottom of the stairs, a niche where Papa used to keep a great vase painted with peacock feathers and now there is only dust soft under her fingertips. She lights the lantern and then sees that there was a fat letter on the doormat and that she has walked on it, left a wet brown footprint smudging the ink on the front and crossing the pale blue stamp. Japanese Empire, Five Sen, and a whit
e chrysanthemum, her Falmouth address crossed out for redirection. He thinks she is still there, still sleeping in his bed and waking each morning to the sight of his garden. Or at least he did think that, six weeks ago when the letter was posted. Later, she thinks. It is important that there should be food ready when Mamma comes home.
The potatoes are soft to the knife and the cabbage has brightened in the pan. She drains them through the old colander from which one handle has been lost, leaning over the sink to feel the steam curl around her face. She is real, she has a body, hands that feel the pain of the hot pan and cold skin on which steam condenses. She has a letter in her pocket, and a ring on her finger. She saved two lives today. She takes a plate down from the rack where she left it to dry last night and pulls the lid off the flour jar. Liver is to be dredged with seasoned flour before frying, and although Mamma regards seasoning as unnecessary it is Ally’s view that omitting this step altogether would have an unappetising result. The flour must be damp and does not pour onto the plate, so Ally shakes the jar and half of it, a good pound of flour, falls in a squared lump and explodes on the floor. She’s hardly started to clear it up when she hears Mamma’s key in the lock and can only wait, kneeling on the flour in her blue dress, for Mamma to find what she has done.
What possible reason can you find for such behaviour, Alethea? For such waste? Do you not know, can you not think, what demands are made on my time and energies during the day that I should return to this disorder in my own house? I do not know how your husband can bear your carelessness and wasteful habits, it is no wonder he has gone away. I suppose it is asking too much that you should clear up this mess. Do not imagine, Alethea, that your true motives go unseen. Do not imagine that I will wait upon you as the servants in my sister’s house have done, as I suppose you must have required your husband to do. Until he left you. Clean the floor, please, Alethea. And then get to your bed. I cannot bear further messing in my kitchen and a night’s fasting will do neither of us any harm.
Mamma’s skirts, always cut high because of places she goes and the roads and floors she walks, swing above the floor and the kitchen door closes behind her. No slamming, not in this house, no throwing or shouting, no hand raised in anger. Only words.
Words and a candle flame offered on her tenth birthday. Show me how you can bear pain, Alethea. Show me how you can choose to endure.
Lying hands at her sides with her skirts lifted for Mamma and Dr. Henry to apply blisters. The best cure for weak nerves, Alethea. Pray refrain from that hysterical gasping.
Before she knows what she is doing she finds herself at the stove, her sleeve rolled back as Mamma once rolled it for her. She lifts one of the lids. She extends her arm. She watches the skin turn red and then white. There is a faint odour of roast meat.
There is not enough pain.
She wants the end now.
She is too old for this.
THE LENGTH OF A DINNER PARTY
It is probably as well that he can see only his head and shoulders in the mirror. He suspects that the rest of him looks ridiculous to eyes accustomed to the kosode and hakama, to the fall of woven cloth cut to the neatness of the male form. He loosens his tie, a garment with no purpose whatsoever. When did British men start to wear bows around their necks?
There is a murmur from the bottom of the stairs where the Senhouses are already waiting for him, he in a black evening suit so much like Tom’s that they could have been cut and sewn at the same time from the same cloth. Every man there will be wearing the same thing. She wears a gown with large yellow flowers on a white ground, one of those puffs over her behind and her breasts cantilevered up and pushed together to make a line of cleavage above the tasselled yellow trim around the edge of her bodice. A length of yellow silk lies across the back of the skirt, looped around her elbows as if it had slipped from her shoulders. Her hair, a paler blonde than Ally’s, is braided and twisted around her head and small white flowers nestle in the swirls. She’s pretty enough, but most of all she looks uncomfortable, artificial.
‘You are looking very beautiful this evening, Mrs. Senhouse. Your shawl is of local manufacture?’
There are white chrysanthemums embroidered on the silk. Ally might like such a thing, in grey or a light blue.
‘Indeed so, Mr. Cavendish. There are now several shops where they understand the requirements of European dress.’
Senhouse holds his wife’s evening cloak for her. ‘Come, Cavendish. The Ambassador values punctuality.’
He is pleased to see that there are no jinrikishas at the gate. He would have thought the evening too cold for Mrs. Senhouse to walk, certainly in her finery, but her heeled silk slippers tap a staccato rhythm to her conversation with her husband. He walks behind them. The sky is clear and the stars winter-bright. The stars must have different names here, and maybe the constellations themselves are differently ordered, taking the form of flowers or temples rather than agricultural implements and animals. Until recently, Makoto told him, there was no word for ‘animal’ in Japanese; living things were divided into categories of movement. There were creeping things—lizards, woodlice, some small mammals—and flying things, which included butterflies and bats as well as birds. Things that leap and run, and also a category of furred beasts. There is nothing natural, nothing innate, about taxonomies. He wonders what other aspects of being in the world might be wholly different in Japanese. There are, plainly, men and women, but it is less clear that the categories of children and adults are as distinct as at home. Japanese medicine is different and perhaps the very definition of health is questionable. The quick and the dead, ghosts. There are samurai and farmers, a distinction at least until recently much more rigid than its British equivalent. There are fox owners. He thinks of the jinrikisha men, beasts of burden, and the shape-shifting foxes. If the idea of animals is recent, what about the idea of humans?
He almost treads on Mrs. Senhouse’s skirt. Her face turns to him, white under the hood of her cape.
‘And what do you think, Mr. Cavendish?’
The pavement is wide enough now for him to walk beside them.
‘I beg your pardon?’
‘Ah, you were thinking of home, I dare say. We were discussing the possibility of having a Christmas tree, and perhaps giving a dinner. There are several bachelors here, you know, and I do not like to think of them gathering only in some bar or club to mark the birth of Christ.’
‘Mrs. Senhouse comes of a large family,’ says Mr. Senhouse. ‘She always feels the need for a crowd at Christmastime.’
Christmas. He had forgotten about Christmas. There are—he counts—five weeks yet. Almost six. With a little luck, time for the post. Silk shawls, he thinks, for Ally and Mother, easy to wrap and hard to damage on the way. Perhaps also for Mrs. Dunne, since they are likely cheap enough.
‘Mrs. Senhouse, before I leave for Kyoto could you be so kind as to find a moment to show me the shops of which you spoke? You remind me that I have been remiss in my shopping.’
Her laughter tinkles in the quiet street. They will hear her behind the paper screens, around the firepits and the red lanterns. Foreign laughter.
‘You need a gift for your wife. Of course, Mr. Cavendish, it will be my pleasure. Tell me, what is her taste, her favourite colours, her complexion?’
The double doors of the ambassador’s residence are wide open, and lanterns hanging in the porch send a dancing light down the stone steps. The ambassador is an aficionado of Japanese gardens and has had the box hedges and lavender taken out and replaced with black bamboo which waves and rustles by the path. Tom remembers the temple on the island, and the unseen bear. He remembers his lights, shining out now over dark waters. He follows Mrs. Senhouse’s cloak up the steps, its beads glistening like raindrops in the lamplight.
There are place cards. Mrs. Senhouse says that the ambassador’s wife, who is much younger than the ambassador, spends days
before each party working on precedent and placement, her task infinitely complicated by the changes of the last twenty years. Sometimes she will be entertaining a prince in whose youth streets were closed so that the populace might not glimpse his face when he walked out, along with an industrialist whose grandfather worked the land, not to mention the European nobility who are visiting Japan in increasing numbers and then itinerant Americans who may be the sons of eminent professors taking a kind of Grand Tour or ne’er do wells in permanent exile, or indeed in some cases both. There are always more men than women, partly because the enthusiasm for modernity of the best Japanese families stops short at asking their wives and daughters to dine in public, to dance and speak to foreign men, and partly because of professional men like Tom who travel alone. He must not mind, must not take it personally, if he finds himself seated beside another man. Dear Lady Alexandra has such a time with these things! He does not mind, for the card beside his own says, in Lady Alexandra’s own italic hand, Professor William Baxter. Professor of European History at the University of Tokyo, he thinks and the author, if he is not mistaken, of The Land of Cherry Blossom: Japan in Our Own Time.
He is among the first to sit down, glad to escape the wife of an American missionary who has a great deal to say on the subject of girls’ schools in Japan. At exact intervals down the tables are glass bowls half filled with water, in which float flat pink candles and the heads of miniature water lilies. He won’t reach over and stir up a tornado with his soup spoon, see if the candles set the lilies on fire before everything sinks. He watches as a lady further up the table is settled into her chair by a man in a clerical collar. The vicar pulls out a chair, supports the woman’s elbow as she approaches the table, eases the chair under her and stands back respectful as she arranges her skirt. He must ask Ally about the puffed up skirts, the way they seem to fold when the wearer sits and open out as she rises. Some kind of concertina arrangement. He counts the silver arrayed on the white damask cloth: soup, entrée, fish, meat and pudding, and a crystal glass for each course. In the Kiso valley, Makoto’s family will be sitting by firelight on the floor around a table holding one rice-bowl and one tea-bowl for each person.
