She lay flat on the bed, and I loosened her dressing gown. She had no idea who I was but the memory of doctors, and my appearance in a tie and white collar, echoed something within her and she accepted that being undressed like this was no cause for distress. Her blood pressure was so low it was almost unrecordable. “Sore?” I asked her, trying to keep my language as simple as possible. She made a wincing expression and passed her hand back and forward over her stretch marks. It seemed suddenly incredible that this son and daughter were once inside her womb, that her womb, having sponsored their lives, was now hastening her death. Pulling down her pajama trousers, I saw blood pooling in the pad, slick clots of crimson.
From a pack of vials in my suitcase I drew up some morphine, and injected it under the skin of her belly. The injection site was inches away from the tumor that was eating away at her womb, stiffening the organs of her abdomen and killing her as surely as if she had slit open her veins. As I stood watching her for a moment she closed her eyes and began to doze. On the wall above her head was a poster print of Jesus, with a bleeding heart and a Hollywood beard. Stacks of videocassettes were piled along the skirting boards. There was an open night bag, like the ones expectant mothers keep, stocked with talcum powder, cigarettes and spare nighties. “We keep it there in case she has to go into hospital,” explained her son.
“Should we sit down next door and have a chat?”
They nodded, and together we moved back through to the living room leaving Mrs. Stafford lying on her bed.
“I know you’ve not met me before, and I’ve just met your mum, but I can see on her records that she has a cancer, and we know she’s bleeding from that cancer.”
“Aye,” said her daughter, nodding. “They gave her weeks to live, and that was months ago.”
“Well, she’s losing a lot of blood, and we could do one of two things. We could send her into hospital for a transfusion, or we could keep her here, and see what happens …”
Her son and daughter looked at one another, until the son broke gaze and turned to look out the window.
“… and what might happen is that the bleeding stops, and she rallies, and things go back to the way they have been. Or what might happen is that she keeps on bleeding and fades away.”
“How long has she got?” the daughter asked.
“I wish I knew, but …” I hesitated for a moment, then met her eyes, “… she could die tonight.”
“Just leave her here,” her daughter said decisively.
“Alright,” I said, and a few moments passed. “I’ll come back in three or four hours to see how she’s getting on.”
Before I left I wrote up notes in the district nurses’ folder by the bedside, and helped her daughter change the pad. As I was pulling up her underwear I saw that the new one was already scarlet with fresh blood.
IT WAS THREE in the morning before I could come back. At the door I was met by her granddaughter who, in her haste to get to me, tripped and fell forward, butting her head against the glass. “The priest’s in,” she gasped as she opened the door to me. She was heavily pregnant.
I stopped at the doorway, holding my case, wondering if my expression was serious and pious enough for a meeting with a priest over a deathbed. I felt a spasm of guilt that it was my warning – “she could die tonight” – that had brought him out in this weather. There were ten people in the room including the priest: a tall, well-built man in his late forties or early fifties – better nourished as a child than his parishioners. He nodded to me from the foot of the bed. From my doorway glance I could see that Mrs. Stafford had already drunk the blood of Christ, taken the viaticum of last rites, and now lay propped up on pillows.
I waited just outside the doorway. On the sofa behind me I could see that the folder I had written in was lying open; the whole family had been poring over it, as if over tea leaves. The prayers went on for ten, fifteen minutes more. And then there was a bustle, and one by one Mrs. Stafford’s son and daughter, her granddaughter and several grandsons, began to leave the room. “Evening, Father,” I said to the priest as he nudged past me on the way out of the room.
“Evening, Doctor,” he said, clapping me on the shoulder and giving me a quick, businesslike smile. “It’s fine work you’re doing.” Before I could offer, “You too,” he was already gone.
I entered the room; Mrs. Stafford opened her eyes and I took her hand, wondering if she recognized me at all. “I met you earlier,” I said, “I’m the doctor.” She grunted an acknowledgment, closed her eyes again and laid her head back on the pillow. This time her pulse was faster, and I couldn’t find her blood pressure at all. Her hands and feet were just as cool as they were earlier. “She says she feels cold,” her daughter added, coming in from the living room behind me. “We’ve got the electric blanket on, but …”
I undid her dressing gown again and began to gently press on her belly. She uttered a low moan, and I drew up another vial of morphine and again injected it into the skin of her abdomen. “Have you had to change the pads many more times?” I asked, looking over my shoulder at her daughter.
“Aye, twice since you were here last. But maybe it’s slowing.” I pulled up the elastic on her pajama trousers and looked down on the clots of blood that slipped out of her like leeches.
“I’ll come back before finishing my shift around breakfast time,” I said. “Try to get some sleep.”
WHEN I RETURNED to the Stafford house it was just before eight. The garbage trucks were out, and the rain was easing. It took a while for the door to be answered.
“Well, she’s still breathing,” was the first thing her daughter said, stepping aside to let me in. “But only just,” added the granddaughter, sitting back and stroking the tense, swollen skin of her belly. “She’s said nothing since you left.”
Her son was asleep on the sofa, snoring. His slippers were placed neatly beside the Pekingese ashtray. The television was still on, but muted. I pushed open the door to the bedroom for the third time that night. Her face seemed to have even less color in it, despite the natural light now falling in through the window. “Did the bleeding stop?” I asked, “I mean, have you had to change many more pads?”
“Just the one after you left,” her granddaughter said, “I’ve not needed to since. Is that a good sign?”
“Sometimes,” I said.
Her pulse was even thinner than before – I could barely feel it. Her breath was deep, sighing and sporadic. Her eyes were half-lidded, and gray crusts of spittle had gathered at the angles of her mouth. The creases of her wrinkles seemed smoother, and the tone of her skin had yellowed from wax to something more like old vellum. I was standing holding her wrist, feeling for her pulse, when she made a long, rattling sigh, then fell silent. I stood still for a few moments, out of respect, before glancing down at my wristwatch to count. One minute passed, then two.
“That’s it, isn’t it?” her daughter asked.
“Yes,” I said. “She’s gone.”
And she began to sob, but silently, showing only in the shudder of her shoulders and the way she rocked on her chair. Her own daughter put an arm around her shoulders, and pulled her close.
16
AFTERBIRTH: EAT IT, BURN IT, BURY IT UNDER A TREE
One can see what custom can do, and Pindar, in my
opinion, was right when he called it “king of all.”
Herodotus, The Histories
AT FIRST GLANCE umbilical cords seem to come from the sea: opalescent and rubbery like jellyfish fronds or stems of kelp. Their contours are torqued in a triple helix of blood vessels, twinned arteries spiraled around a single vein. The purplish blood vessels braid themselves through grayish jelly composed of a substance used in only one other place in the body: the refractive humors of the eye. They look soft and delicate but are tougher than appearances suggest; for nine months they have to tether a baby to life.
The wrinkle-faced, bunch-fisted girl I had just delivered was already squalling, and I dried h
er with a towel and held her down beneath the level of her mother’s hips for a moment. The placenta was still inside her mother’s pelvis – in these first moments I wanted to let blood run from it down into the baby’s body. I put my fingers again on the cord, feeling the pulse of her tiny heart fluttering within it like a trapped moth. “Is everything alright?” asked her father. He looked stunned by sleeplessness and the agonies of labor that he had just witnessed his wife going through.
“Fine,” I said, “absolutely fine.” As I watched the girl, my fingers on her cord, the pulse in it thinned out and then stopped – a reaction to the coolness of the air and the higher oxygen levels in her blood now that she was breathing for herself. Inside her liver and around her heart other blood vessels were closing off in synchrony. These are “shunts” that during her time in the womb had diverted blood around the developing lungs and liver. Other vessels for carrying blood to and from the lungs were at the same time opening up – it was thanks to them that her blood was reddening with the flush of oxygen. A hole in her heart, necessary for circulation while she was inside the womb, was closing over. Her umbilical arteries were closing too, narrowing from their origins deep in her pelvis running out toward her umbilicus. It was because of this concert of changes that her bluish, waxy face was pinking up. Only when the pulsing of the cord had stopped did I place plastic clips across it.
The midwife handed me some scissors, scored and blunted from their many passages through the sterilizer, and once again I marveled at how a substance seemingly so fragile can be so hard to cut; I had to hack at it as if at a hawser. For the delivery of the baby the mother had been on all fours, but as I handed her daughter up to her she heaved herself onto her back, pulling the baby onto her breast with an astonished gasp. As mother, father and baby dissolved into a universe of three the midwife and I looked down at the business end. This wasn’t over yet.
The “third stage” of labor is unexpected for many, as if the show should be over with the birth of a child. But a storm of hormones and chemistry was shearing the placenta from its mooring against the womb lining. If contraction occurs too slowly, the blood can go on pouring from the raw surface of the womb – a “postpartum hemorrhage.” I pushed my hand gently, but firmly, onto the mother’s slackening abdomen, to feel if the womb was shrinking down. It was.
With a pair of steel tongs I pulled gently on the cord. The baby was already at her mother’s breast: as she sucked, hormones hastening the let-down of milk also caused the mother’s womb to tighten. As I turned the tongs, the cord blenched against their steel – the arteries and vein within were already ghosts of their once vigorous selves. Then, as I pulled, the cord suddenly widened the way a tree trunk does just before its roots spiral into the earth. The “afterbirth,” a violet clot of blood, slithered from the mother’s body onto the bed.
It was heavy – over half a kilogram – almost round and about an inch thick. Since early in the pregnancy it’d had to carry oxygen, sugar and nutrients toward the developing fetus, as well as carrying carbon dioxide, urea and other by-products back toward the mother. The pressure pulse of this remarkable exchange had been driven by the baby’s developing heart. The blood of mother and baby don’t mix, but the capillaries belonging to each are brought together so closely that it’s as if a million tiny hands locked fingers across the placental divide. Da Vinci noticed this distinction over five hundred years ago, when many of his contemporaries still believed that babies grew by consuming their mother’s menstrual blood. Da Vinci’s placental drawings betray a familiarity with the afterbirth of the sheep; it’s thought he only saw one cadaver of a woman who died in pregnancy. He wasn’t alone: European men through the centuries seem to have had more familiarity with sheep placentas than those of their own children. Even the scientists’ word for the placental membrane, amnion, is taken from the Greek for “lamb.”
Most of the elements of our anatomy are robust enough to see us through four or five decades at least before they start to fail, but an organ that need last only eight or nine months shows just how fragile human tissue can be. I’ve seen placentas turn brittle and gray, either because of the toxins they’ve been exposed to or from the relentless deep-fry nature of the Scottish diet. The worst are the placentas of heavy smokers, clotted with knots, yellow and hard as ambergris.
This placenta was clean though, and I spread it out on a steel tray. The gossamer remnants of the amniotic sac were fused into the placenta itself, and I couldn’t find any rips. “Membranes intact,” I said to the midwife, before taking it by the stump and hoisting it awkwardly into a plastic bucket. I clipped on an orange lid as if sealing a pot of paint, then carried it through to the waste room on the ward. From being the center of this baby’s world, essential for life and growth, it was now part of the anonymous stack of placentas and umbilical cords that had been delivered that day, and that later tomorrow would be burned in the furnace beneath the hospital’s smokestack. What was nourishing the baby only that morning would tomorrow be smoke floating over the city.
THE GREEK “OMPHALOS” comes from the same root as the Latin “umbilicus”: both carry the sense of being at the center either of the body or the world. For the Greeks the Omphalos, a stone at the Delphic Oracle, was considered the geographic center of the earth. Around the time that people were making pilgrimages to Delphi, the Greek traveler and historian Herodotus wrote about the way different customs were prevalent across different parts of the ancient world:
One might recall, for example, an anecdote of Darius. When he was king of Persia, he summoned the Greeks who happened to be present at his court, and asked them what they would take to eat the dead bodies of their fathers. They replied that they would not do it for any money in the world. Later, in the presence of the Greeks, and through an interpreter, so that they could understand what was said, he asked some Indians of the tribe called Callatiae, who do in fact eat their parents’ dead bodies, what they would take to burn them. They uttered a cry of horror and forbade him to mention such a dreadful thing.
For Herodotus, custom was everything, and for the past few decades in the West our custom has been to burn placentas with the soiled dressings, diseased organs and contaminated needles in the hospital incinerator.
Just as Darius’s Greeks were horrified at the prospect of eating their fathers, and the Callatiae of India were horrified at the dishonor of not eating them, the practice of eating placentas arouses fierce emotions, both for and against. Placentas are a rich source of progesterone, the hormone that maintains pregnancy, and a crash in body progesterone has been proposed as a trigger for “baby blues” – the disturbance in mood after childbirth that often cedes to postpartum depression. Eating the afterbirth is a common habit among carnivores, as well as omnivores like chimpanzees – our closest relatives. It could be that the practice is not just about nutrition, but about letting an exhausted mother come down gently from her progesterone-high.
There is only one reference in the Old Testament to the afterbirth, and it’s about breaking taboos: in Deuteronomy 28, verse 57, a woman is given permission to eat the ordinarily prohibited placenta because her city is under siege. But in other cultures around the Mediterranean rim a new mother was traditionally encouraged to eat afterbirth in order to help her milk come through, and to reduce after pains as her womb contracted back down to its normal size.
From Morocco to Moravia to Java, women have eaten the placentas of their own children, or those of other women, in order to improve their fertility, while in Hungary the ashes of a burnt placenta were fed in secret to men in order to reduce their fertility. (This isn’t as daft as it sounds: female sex hormones can sometimes aid female fertility, while at the same time inhibiting sperm production if taken by men.) During the Tang dynasty in China, around the seventh century CE, the placenta of a live-born girl was advocated in a spell to transform oneself into a young girl.*
The spell book was called Collection of 10,000 Feats of Magic.
The egg
s of the earliest vertebrates evolved to grow bathed in seawater, and by developing a womb full of amniotic fluid, we mammals have evolved a way of carrying a sea inside us. That the membranes in the womb have a close connection with the sea seems to have been recognized since earliest times: those membranes, the caul, have often been considered protective against drowning. In the cultures of the British Isles, a baby who emerged still wrapped in its caul was destined to be a strong swimmer, and would be possessed of good fortune. Charles Dickens’s David Copperfield starts out his autobiography with a discomfiting discussion of how his own caul was put up for sale to the highest bidder for just this reason:
I was born with a caul, which was advertised for sale, in the newspapers, at the low price of fifteen guineas. Whether sea-going people were short of money about that time, or were short of faith and preferred cork jackets, I don’t know; all I know is, that there was but one solitary bidding.
As far apart as Japan and Iceland the traditional method of disposing of a placenta was not to inter it beneath a tree, but to bury it under your house. In Japan a priest would choose the location of the burial place, whereas in Iceland it would be buried in such a position that the mother’s first steps in the morning, as she rose from bed, would stride across it. Another old Chinese text advised burying the placenta and cord deep in the ground “with earth piled up over it carefully, in order that the child may be ensured a long life. If it is devoured by a swine or dog, the child loses its intellect; if insects or ants eat it, the child becomes scrofulous; if crows or magpies swallow it, the child will have an abrupt or violent death; if it is cast into the fire, the child incurs running sores.”
The Russians traditionally saw the placenta and umbilical cord as sacred; Orthodox Christians dedicated it in particular to the Virgin Mary, the governess of fertility. Following delivery, the afterbirth would be laid out for a time on the local church altar, where it was believed to influence the fertility of other women in the community, before being buried.
Adventures in Human Being Page 16
