Grace’s mother had died during childbirth with Grace, of a PPH, a post-partum haemorrhage, where the uterus fails to contract following birth, leaving the placental bed bleeding freely into the uterine cavity. Like an inverted uterus, it’s one of the few true emergencies of childbirth. Mostly now a PPH could be avoided or averted but when Grace was born, there were none of the drugs that could make a uterus contract. They did the best they could to stop the bleeding. In her mother’s case, it hadn’t been enough.
Over drinks one night when they were still medical students, Grace’s friend Janis Kennedy had suggested that if Grace wanted to be an obstetrician she would need to face her emotions about her mother’s death.
Janis was into facing her emotions at that stage. She was specialising in psychiatry, fascinated by what the mind could do. “Otherwise, you’ll be no use to patients.”
“Oh please,” Grace had said. “I have no feelings. I might have been there but I was hardly conscious of it.” Grace hadn’t had children then, hadn’t understood anything about birth and mothering. She ate the glacé cherry that came with her drink and stared flatly at her friend.
“You probably blame yourself at some level,” Janis said. Janis was thin as a rail with neat brown hair and eyes that appeared to see deeply into a person. Tools of the trade, she’d told Grace when Grace had said as much.
“I do not,” Grace said. “And just because you’re my friend doesn’t mean you can practise on me.”
“What did your father do after your mother died?” Janis said.
“I have no idea,” Grace replied curtly. “He wasn’t around. I’ve never met him.”
“You’ve never met him?”
“No,” Grace said. “Iris, my grandmother, knows who he is, or thinks she does. He didn’t want anything to do with me.”
“So you don’t want anything to do with him?” Janis said.
“That’s about it,” Grace said. “It’s possible he’s a doctor. He was studying medicine with my mother.”
“Wow,” Janis said. “You’re a psychiatrist’s dream in terms of issues. You might meet your father.”
“Unlikely,” Grace said. “There are a lot of doctors in the world. And I have no intention of seeking him out. Ever.”
Grace looked at her patient now, mustering her confidence. Margaret Cameri had enough doubts for both of them. She nodded vigorously that she understood what Grace had said, but she looked terrified. “Where’s the baby?” she whispered.
Just then Alice walked in. Thank God, Grace wanted to say. Alice was much better with patients than Grace, who always set out the risks too precisely. “He’s fine,” Alice said. “A great big boy who surprised us all. Now he’s out there with Dad in the other room and they’re getting acquainted nicely. They’ll be there when you wake up and you can give him a feed.”
“The others?” Margaret said.
Grace was about to say what others when Alice said, “. . . are on their way into the hospital with your mum, remember? And they’re okay too. Everyone’s fine.”
Within minutes Margaret was asleep and the anaesthetist was doing the crossword. We don’t do that here, Grace wanted to say but didn’t. Tomorrow she’d talk to his boss.
Grace wasn’t in the mood for teaching but she showed Andrew Martin what to do because that’s what you did. You showed the next generation, passed on the skills you could only learn by doing. This would probably be the only inverted uterus Andrew would see during training. He’d have read about it but the real thing was rare. This was the second Grace had managed in ten years, the third she’d seen.
Grace had loved anatomy, had found the cold science of the dead oddly peaceful. In medical school, she’d taken extra tutorials and everyone thought she’d be a surgeon. But few women were accepted into surgery in the sixties and Grace wasn’t offered a place. She remembered the interview panel’s feedback. A red-faced gastroenterologist told her they couldn’t give out positions that didn’t pay off. “Before you know it, you’ll be married and having kids and we’ll have wasted our time with you.” She’d opted for obstetrics, happy medicine as someone had called it, but this was the part she did well, the cutting and manipulating. As obstetricians, she and David were opposites, he the warm fuzzy doctor, she the skilled surgeon. And yet, he probably operated more than Grace. Gender, he’d told her, can’t quite get away from it.
With Margaret Cameri fully under, Grace guided Andrew as he grasped the fundus, the top of the uterus, between his thumb and fingers and began to push it back gently. “The Johnson method,” Andrew said. She could see sweat beading on his forehead. It was hard work and he’d surely be nervous. Grace herself was nervous.
“You’re doing well,” she said. “Fingers towards the posterior fornix.” He worked to force the uterus back up the birth canal and through the pelvis, stopping every few minutes to check with Grace. “And now,” she said, “slowly make a fist and continue to push towards the umbilicus.”
Andrew was nodding, starting to relax a little. “I can feel it. It’s about like putting your hand in someone else’s boxing glove.”
“Not an analogy I’d use with a new mother, but yes, you have the idea.”
When they’d finished and the bleeding had stopped, Grace told Alice to make sure she watched Margaret Cameri carefully. She paged Frank to thank him and let him know he could turn around and go back to wherever he was coming from and told Andrew not to hesitate to call if there were problems. “You did well, recognising this. Go tell the husband his wife is fine.” Grace always made sure the trainees got some of the good jobs as well as the hard ones. It hadn’t been her experience as a registrar and she vowed she’d never do that to someone else.
She was on her way out when Alice came running across the car park after her. “What’s wrong?” Grace said, thinking Margaret Cameri might have started bleeding again.
“No, it’s another patient—private. I need someone to authorise peth.”
“Who’s her doc?”
“Clive Markwell.” Markwell was a senior consultant at the hospital, a “dong and tong” man, as David referred to them, happiest when he could knock patients unconscious and pull their babies out with forceps.
“Why can’t you ring Dr. Markwell?”
“I did. He said no pain relief.”
“Why?”
Alice looked at her carefully. “I can only assume.”
“Assume what?”
“The girl’s sixteen and unmarried. Baby’s going up for adoption.”
“And unmarried,” Grace repeated. Alice nodded. “This is 1978. Tell me he’s not punishing her.” Alice was silent.
“Okay, let’s go back in.” Grace dropped her car keys into her bag and tossed the bag to Alice.
The girl was the one who’d come down in early labour from the hostel and was on the ward when Grace had left earlier in the evening. The Sisters of Charity who ran the hospital also ran several homes for unwed mothers, including the largest one, St. Mark’s, which was on the hospital campus, high on the hill above the hospital itself. When Grace had been a medical student, they were admitting a couple of girls in labour every week from St. Mark’s. Grace had never been inside but from the outside it looked like a haunted house, dark stone walls and shuttered windows. She always felt a little sorry for the girls from up there.
When they came back onto the ward, Grace could hear the girl’s screams from the desk. “What’s she had?”
“Nothing,” Alice said.
“Not even nitrous?”
Alice shook her head. “He said not.”
“Nothing?” Grace said. She looked along the hallway.
She was reluctant to go in and examine the girl but could see Alice was in a dilemma. “She’s having a tough time. How old did you say she is?”
“Sixteen. Baby’s persistent OP. She’s getting pre
tty crazy, Grace.” Occiput posterior, where the baby’s back remained facing towards the mother’s back. It made for a painful labour and sometimes a difficult delivery. And Alice had an uncanny knack of knowing when a woman had reached the edge of coping.
“Jesus,” Grace said. “How could he do that?” Grace took her bag back from Alice and left it at the desk and walked down to the delivery room with Alice behind her.
“Name?” Grace said quietly. Alice told her.
Jan Michaels was lying on her side, gripping the top rail of the bed. She was a big girl carrying a big baby. When she looked up, Grace thought of Tolkien as a puppy, completely helpless and dependent on them for survival. The girl’s eyes were wide with fear.
Grace took the girl’s hand. “Jan, how are you feeling? I’m Grace Hogan, one of the doctors here.”
“I’m all right,” she said in a tiny voice. “It hurts.”
“Your back?” The girl nodded weakly. “Well, I’ll see what I can do to organise some pain relief,” Grace said. She patted the girl’s hand and nodded to Alice on the way out.
Grace went to the tiny office off the ward desk, rehearsing what she’d say before she phoned Clive Markwell at home. With another doctor, it would be more straightforward.
“Markwell,” he answered on the third ring. She could hear a radio or television in the background.
“Clive.” Grace made herself use his Christian name. “Grace Hogan. I just happened to be on the ward,” she said, not wanting to tell him Alice had come to her, “and one of your patients needs something for pain. I’m going to give her some gas and a shot of peth.”
He asked her the patient’s name. She told him. “She doesn’t want anything,” Markwell said. He was chewing as he spoke.
“She does now. She’s a mess.”
“Have you examined her?”
“I popped in when I heard the racket she’s making. I really think we need to help her now to avoid a larger problem later. You know how it can go. She’s still OP.”
“I’ll drop by later and see how she’s going,” Markwell said. “I saw her earlier. She’s got a long day ahead of her. Still a bit frisky when I saw her.” Markwell owned horses and used his observations of their mating and gestation in his descriptions of women. Some liked the comparison, felt it located human birth in nature where it belonged. Others, including Grace, found it objectionable.
“Maybe you ought to come in and have a look at her if you don’t trust me to—”
“I know what the patient needs,” he said, “and I’d thank you to remember that.” He hung up.
Alice was right. He was punishing the girl, for having sex, for getting pregnant, for being a girl, he was punishing her. Grace felt angry but also anxious. If she acted against his direct advice, she put herself at risk. On the other hand, he was denying a young girl pain relief to teach her a lesson. And somehow, to Grace, it was worse that he was denying the girl pain relief when she was giving the baby up. Surely their job, hers and the other doctors’, was to make this experience as painless as possible. The girl was sixteen years old.
On her way back to the delivery room, Grace passed Margaret Cameri’s room. The family was there now, the father telling the other children in a soft, deep voice about their new baby brother, holding the infant in his big hands, the grandmother stroking Margaret Cameri’s forehead. They were perfect, just as they were, Grace thought, any domestic trouble stilled, any unhappiness banished, just for this moment. New life was indeed a miracle. Sometimes, Grace thought, but not always, hearing another cry from the delivery room farther along the hall.
Alice was holding the girl’s hand and stroking her brow. “Okay, Jan, we’re going to give you a mask to breathe into that will help on the contractions,” Grace said, “and an injection to dull the pain.” To Alice, she said, “Give her nitrous as needed and fifty milligrams peth two-hourly.”
“How’d you talk him round?” Alice said as she went to draw up the drugs.
“Some docs will only listen to docs. Call me if there are any problems. And mark me as the attending.” Alice looked at her. “It’ll be fine,” she said. “Dr. Markwell will be in by nine.”
“By then it will be over,” Alice said. “We’re doing better now. But the pain relief will be a big help.” Just then the girl had another contraction, bellowing like a cow through it. “That’s the way, darling,” Alice said. “We’re nearly there. Help’s on the way.”
Grace smiled. “Good. Call me if you need me.”
Grace left the hospital and drove home through Auchenflower and Milton, Neil Diamond’s Hot August Night blaring out of David’s five-hundred-dollar car stereo. Grace sang along to “I Am . . . I Said,” blithely at first. He had a warm voice, Neil Diamond, but lonely too, at its core. It soothed Grace for some reason. She stopped singing and let out a sigh. Nights like this, called into the hospital late, an emergency she might or might not handle, that was the thing you never knew, she wondered how long she could keep it up. Sometimes she felt as if at any moment, something might give way. The kids needed more not less as they grew older—she’d thought it would be easier now that they were all out of nappies but it was just that their needs were different—and work was like a bottomless pit. They never told you that in medical school. She was tired all the time, tired to her bones. And every now and then, you had an emergency like Margaret Cameri where what you did made the difference between life and death. It didn’t matter if you were tired, if the kids needed you, if you had no one to lean on. You had to be there and make sure your patient’s care was the best you could do. It was more than difficult. Sometimes, it was terrifying.
She crept back into the house just before five, Tolkien having heard the car, wandering out to greet her sleepily, realising she wasn’t David, and flopping back down in a sulk. She checked the children again. Henry was in the same position, bedclothes flung again, so she covered him. Phil was sleeping quietly now. Grace crept into her and David’s room, took off her clothes, spooned her body behind David’s. Sleep was the last thing on her mind now. “Did I wake you?” she said softly, and then again, a bit more loudly.
“What? No, that’s all right. Everything okay?”
“Yeah.” She snuggled closer, kissed the back of his neck, ran her fingers down his chest and belly.
“Now?” he said sleepily. “It’s the middle of the night.”
“It’s morning,” she said, reaching into his boxers, finding his penis already hardening. “Truth to power my friend.” He turned around and kissed her gently, his breath sour and oddly exciting. She kissed him back, full on the mouth, and felt his body waking up, his strong arms around her. She ran her fingers through his hair; it needed a cut. David kissed her neck, breasts, and belly and started to move down but she took his head in her hands and brought it up to her face. “Let’s just fuck,” she said softly. She only swore in relation to sex. He’d liked it when they were first together but now she thought it made him slightly embarrassed, as if she was middle-aged and wearing teenage clothes.
“You sure?” he said, reaching his hand down.
“Yes,” she said, irritated. She was too wired for slow sex. Emergencies always left her like this. She loved and hated the rush. David absorbed stress, calmed any situation, including Grace.
She wanted to be on top—story of my life, he used to say. She moved her hips in time with his but lost the rhythm again and again and finally stopped moving, felt the power of his thrusts deep inside. He came quickly, moaning softly, opening and closing his eyes.
Afterwards she lay on his shoulder and cried. Hey, he said gently, as if she was a child again, and he was Iris comforting her in some major loss, a tooth, a girl who’d left the class, the end of holidays. Hey. David was like Iris in that way. He always knew exactly what was needed, even when Grace herself didn’t know.
By the time she emerged from the showe
r, David had made coffee and they sat out the back watching the morning sky take shape. She could hear kookaburras singing together in the distance and a butcher-bird over towards Iris’s place in full song. Middle of winter and the birds were everywhere. Grace loved that about Brisbane. In Canada, it’s what she’d missed most, the birds. There were birds in Banff but they were far less brash, more reserved. You had to really listen for them.
David was wearing checked shorts and a white T-shirt with his old wool cardigan over the top, his blond curls a soft wet mess now, his face more vulnerable without his glasses. She told him about the case.
“Did you tell Andrew he shouldn’t have used the Pit?” he asked. Pitocin was needed in a post-partum haemorrhage to make a floppy uterus contract quickly and stop bleeding. But in Margaret Cameri’s case, it made the uterus harder to manipulate. Relaxants had been needed.
“I told him afterwards,” Grace said. “I thought he did well to realise it wasn’t right and call me in.”
“How come you let him off but not others?”
“Like who?”
“Me?”
“Well, if you made a mistake like that I’d be worried. You ought to know better. He’s a trainee.”
In Falling Snow Page 5
