by Melissa Yi
Bastard said, “I need you to look after Casey.” He didn’t sound really angry, more like he felt like he had to stand his ground. But that could be dangerous, too.
“I will,” said Tucker. “Just let me get this little one settled first.”
Bastard lifted his gun up. It was pointing at the ceiling, not at Tucker and Isaiah, but I gasped.
My mouth was still gaping open when Bastard aimed the gun at me. I pressed my lips together, and suddenly I understood the term “right between the eyes.” It was almost like I could feel a bullet punching a third eye between my eyebrows.
Bastard said, “No funny business,”
“No funny business,” I agreed. My dreams of sprinting out the door collapsed.
Bastard nodded agreement and shoved the delivery cart backwards to allow Tucker and Isaiah out of the bathroom. Bastard was still lined up with a good sight of both the bathroom door and the incubator, so even though theoretically he now had to split his attention between two different sets of people, I had no doubt he could perforate all of us before we all got out of gunshot range.
“Oh,” said Manouchka. “It feels…”
I turned back to her, and she was hunkering down now, like she was hovering over a squat toilet, except it was the placenta squeezing out of her vagina and hitting the floor.
“Oh. Jesus,” said Bastard.
“I’ve got it!” I said, scooping up the still-warm placenta. Normally, we throw it in a sterile, stainless steel bowl, but Tucker hadn’t brought me one, just the clamps and scissors now scattered on the floor.
Maybe it was only in my mind, but the placenta filling my hands felt like it was pulsating with a rich warmth.
“That stinks,” said Bastard, and he didn’t sound too good.
I wanted to say to him, You know what stinks? You potentially killing all of us. That smells worse than amniotic fluid. Now I thought back on my innocent self, from an hour ago, worrying about mild odours in the birthing room. I wanted to yell at that Hope, those were the good times! When you were free and no one pointed a gun at your head! Laissez les bons temps rouler!
But I knew what was bothering him. I can’t even describe the wet, earthy, amniotic smell of a placenta. Really heavy and dense, especially inches from your face. I’ve examined placentas before—one obstetrician likes to inspect them and makes sure there are no missing bits, and if the baby is post-dates, sometimes you see calcifications, like the placenta is getting elderly. It’s always kind of fun to play with the ruptured amniotic sac where the baby used to live.
Normally, I’d do a cord blood gas, sticking a needle into one of the umbilical arteries and sending off the blood to prove that the baby got enough oxygen at birth. There are a lot of lawsuits in OB. Everyone wants the perfect baby, and disabled infants are expensive. Solution: sue the doctor.
But you need to send an arterial blood gas right away. I don’t know exactly how fast, but a nurse or orderly always runs off in a panic. By the time we escaped from this hellmouth, any blood gas would be useless. Maybe I should just forget about the blood gas. If Manouchka sued us, I’d deal with it then. Lawsuits were for the living.
On the other hand, drawing blood might distract him. Especially since he hated blood and wombs. And a needle in hand could double as a weapon, if it had to. So I said, “Could I send a blood sample to the lab?”
“No one’s going nowhere,” said Bastard. He aimed his gun at Manouchka for a second before he trained it back on me.
Right. I was not going to brave a bullet over a blood gas. So now I didn’t need the placenta anymore.
My first instinct was to dump it in the toilet, but that seemed sacrilegious and might plug up the plumbing. This placenta was a good double handful for me, smaller than a soccer ball, but still sizeable and dripping blood besides. St. Joe’s pipes probably have trouble handling some bowel movements, let alone a placenta.
Bastard made a small noise, and I realized that the placenta might come in handy. He hated blood.
Maybe I could lob it in his face, like a bomb of hemoglobin.
Bastard’s hand shook slightly on the trigger, and I dismissed that thought, too. If I pushed him too far, he’d shoot us.
Still, I didn’t want to sling it in the garbage. It seemed as blasphemous as a toilet, even though I think hospitals do throw out placentas, unless the moms want to take them home.
So I tossed the placenta into the sink. It made a wet, smacking sound and blood spattered, spraying the white ceramic walls of the sink, the stainless steel faucet and a bit of the white wall as well.
Gah. So much for my germ phobia.
Bastard made a gagging noise and took a step back.
“Sorry,” I lied. I turned back to Manouchka. “Are you okay?” For some reason, the chorus from Michael Jackson’s “Smooth Criminal” reverberated in my head, but I tried to block it out. I really wanted to finish up with her and help Tucker with Isaiah.
She pointed to her crotch, and Bastard said, “Aww, God” and faded two more steps away from the doorway. Which gave us a little breathing room, but brought him closer to Tucker and Isaiah.
I had to finish up with Manouchka. Fast.
I said, “May I examine you?”
She sat back on her bum and spread her legs apart, revealing the clotted blood between them.
CHAPTER 21
Okay.
I’d just finished mentally making fun of Bastard for flinching, but I’m no expert at repairing birth lacerations.
I haven’t seen that many, and the whole process seems kind of mysterious. The doctor picks up some dissolving suture, and the next thing you know, he’s dipping a curved needle into the woman’s vagina.
And maybe it wasn’t a vaginal tear. Maybe her uterus was hemorrhaging. I’d have to get a good look, and ideally a good feel, to be sure.
“You okay, Tucker?” I called out.
“Yes,” he said. “I intubated and suctioned him. He’s coming around.”
“Good job,” I said, even though I was slightly jealous that he’d gotten to intubate a newborn. I’ve never done that.
Manouchka clutched at my hands. “My baby. My baby is okay?”
“Yes,” I said. “Dr. Tucker’s taking good care of him. Now let’s take care of you. I just have to change my gloves, because these ones aren’t sterile anymore.”
Even as I was talking, I couldn’t help dwelling on the fact that Tucker got the cool interventions and I got the uterus. That might sound like I’m hating on women, but the chances of intubating a newborn at a community hospital like St. Joe’s are minuscule. We do rotate through neonatal care later in residency, but even so. I could sew up fifty vaginas before I so much as glimpsed a distressed baby, and even then, the other residents might shove me aside while they pulled the superhero moves.
I shook myself. There’s no use keeping score when you’re staring into the maw of death. I was losing it.
I turned back to Manouchka. “Could I get you into a bed?” I gestured to the wall blocking us from the bed next to Tucker, in the main room. “I want to keep you clean. And you’re shivering.” It was true. Her legs trembled, which is not uncommon, from the effort of labour, but her arms shook, too.
She looked sick. Not seizure-like, necessarily, but exhausted.
She hesitated before she made eye contact with me and jerked her chin. “He’s there.”
I glanced up. Bastard had only taken about three steps outside the bathroom door, so he was still standing guard on us in the bathroom, yet maintaining his direct line to monitor Tucker and Isaiah at the incubator. He blockaded all of us from the main door.
As if sensing our eyes, Bastard rotated his head toward us. “What’s the hold-up, ladies?” he said, making me want to smack him. Again. Still.
“She’s bleeding,” I said.
“Well, fix it!” he said, but his throat convulsed as he swallowed.
Yep. Squeamish.
How could I use this against him?
/> Nothing came to mind, except that a bed sounded better and better for Manouchka. Not only was it cleaner and warmer than the frozen bathroom floor, but it brought us closer to her baby and Tucker, as well as the resuscitation cart.
In the meantime, though, I scooped the scissors and both pairs of forceps off the floor. They were dirty, but I couldn’t just leave them there for us to slip on and stab ourselves.
“What’s that?” said Bastard.
I showed him. The scissors were obviously bloody enough for him to spot from the hallway, and he said, “Jesus.”
“We might need these,” I said.
“For what?” he said, and I couldn’t answer him, exactly.
A Kelly forceps is about as long as my forearm, mildly curved at the end to hold on to whatever you need, but each of the two “arms” is narrower than a skinny French fry. They’re like metal fingers, really, designed to reach someplace so high or deep or narrow, your fingers can’t make it. You can squeeze the handle part together when you reach the area you want, locking and clamping your tissue in place.
I’ve used them to separate muscle fibres when I’m inserting a chest tube. Obstetricians can use them to clamp the umbilical cords, as we had, although we usually apply opaque white plastic clips on the cord. Or we’ll use the forceps to reach inside a vagina, uterus, or other segment of the abdominal cavity.
The metal clattered together as I bundled the instruments in my palm.
The scissors were more hefty than the dainty pairs you find on a fine instrument tray. The first time I cut an umbilical cord, I was surprised by how...chewy it was. You need a fair amount of force to first cut and then drive through that rope of tissue. Honestly, cutting the cord reminded me of the time my grandfather made me eat a pig’s ear at a Chinese restaurant. My teeth just bounced and bounced off the cartilage before I managed to chew it into fine enough bits, swallow it, and swear to myself, Never again.
Anyway, I stooped and wrapped the instruments up in the formerly sterile green towel Tucker had thrown on the floor. I told Bastard, “They have to be autoclaved.”
That part was true. You have to sterilize them before another patient will use them.
“What does that mean?” said Bastard.
“We have to clean them for the next patient. We don’t want to give anyone HIV or hepatitis, right?” I looked him straight in the eye, willing him to connect the dots that the next woman could be Casey, or his sister, or his mother.
His lips seemed to move under the material of the burqa, almost in a silent snarl, before he backed away from us.
I tucked the bundle under my arm and used my other arm to help Manouchka off the floor. Her legs buckled once, but she grabbed on to me and levered herself into a standing position, even though I thought she looked a bit pale, under her melanin. She just didn’t want to show weakness in front of Bastard. Probably a good policy.
“You’ll be closer to Isaiah this way,” I said, smiling and trying to distract her.
She frowned at me.
It took me a second to figure out why. “Isaiah. Your baby. I’m sorry, that’s what I was calling him in my head. I mean your son.”
She nodded and leaned her weight on me. We took a few shuffling steps.
She was a trooper, all right. I’ve never given birth in my life, let alone on my hands and knees, with a gun in my face. I squeezed her arm against my side—I didn’t have a free hand because of the instruments—and said, “You’re very brave.”
She kept her head up, looking toward the incubator instead of me. I was just noise.
After a few steps, something on the ground caught my eye.
I spied a few spots of blood, smaller than a dime, but fresh blood. Not June’s.
Manouchka was hemorrhaging.
CHAPTER 22
“Move it,” said Bastard.
I pointed silently to the floor. Since we’d paused, a few more drops of blood dripped on the ground, directly below Manouchka. Now that I looked closer, I could make out blood tracking down her legs.
“Jesus,” said Bastard, recoiling, even though he was at least three feet away from us, and June’s blood was already smeared into the main room’s beige tile floor.
What, like assassinating people was supposed to stay neat ’n’ tidy?
Manouchka ignored him. She leaned on my arm. Somehow, it felt Biblical, like she was weary and in need of shelter. Which she wasn’t going to get anytime soon.
I helped her toward the bed. It was only maybe ten feet away, but it felt longer, because of her fatigue and Bastard reluctantly moving out of our path. Unfortunately, he migrated toward Tucker and Isaiah, and I felt her tense just before she said, in French, “My baby.”
Bébé sounds an awful lot like baby, so Bastard had no trouble translating that one. “Don’t worry,” he said. “I ain’t touching your nigger baby.”
Her head reared back like a dragon about to exhale flames upon him.
I smoldered, too, but my hand flexed a warning on her arm. He was still the man with the gun.
“How’s the baby, Tucker?” I called, trying to sidetrack Manouchka as well as get a status update.
On cue, Isaiah uttered a weak, warbling cry.
“Great! His Apgar’s 7 now. That’s a lot better. He really pinked up.”
Manouchka started toward the incubator, and I debated for a second if I should ask her to lie down first. I sympathized with her need to see her son. However, fainting in the middle of the room wouldn’t do us any good.
“Maybe you could lie down and Tucker will bring him to you?” I suggested, but she lunged toward the incubator and said, “My baby. David.”
Oh. I guessed it wasn’t going to be Isaiah, then. Too bad. I kind of liked it.
She swayed like she was about to topple, and I nearly dropped the cloth-wrapped forceps and scissors out from under my arm. I lobbed them under the bed instead so I could grab her with both hands, from behind.
In the meantime, to my astonishment, Bastard had instinctively reached out to catch her.
I hugged her from behind with one knee between her legs, but Bastard clutched her from the front and side, so they were almost face to face and surprisingly intimate.
It reminded me of a much happier time when two campers had yelled “Sandwich!” at me before squishing me between them. Hard.
Basically, Bastard and I were making a Manouchka sandwich.
He was much taller than her, by at least eight inches, I’d say, and he stared down at her for a second with an unreadable expression on his face before she shoved him away and repeated, “Mon bébé.”
She seemed strong enough, so I took a step back myself.
Bastard let her go. He clicked his tongue and made a point of grasping his gun, but mercifully said nothing.
Tucker was already wrapping baby David up in a blanket, so he turned around, holding him aloft like he was the star ornament for the Christmas tree. “He’s fine. See?”
Whatever hostility Bastard was working up ebbed with the sight of the newborn baby mewling in the air. We all sighed in relief.
“David,” she said. She hadn’t cried, but I could feel the tears in her voice, and it made me shudder inside, where Bastard couldn’t see.
“Lie down, and I’ll bring him to you. Special delivery, right to your lap. Okay?” Tucker grinned at her from underneath his matted hair, darkened by sweat. His French was tinged with more English than usual. He was secretly losing it, too. He was just a better actor than me. Good to know that he wasn’t used to suctioning newborn tracheas every day.
Manouchka stumbled toward the bed, falling toward the dirty instruments.
I hauled her upright by grabbing her gown from behind, so it wouldn’t be as personal as holding her by the waist. Then I knocked the instruments a foot under the bed with a solid kick. I know that’s unsanitary, but so was the blood she was dripping on the floor, and they were her own instruments. I’d get them later. For now, I needed to sew up her cooc
hie.
When she drew her legs up into the bed, I helped her lift the leg nearest to me and gaped at the streaks of blood on her inner thighs. It was a bit like Carrie, only X-Rated.
“It’s that bad?” she said, and I tried to recover the inscrutable Asian card I’d missed out on at birth.
“No, no problem. I just need to, ah, give you a massage to help control the bleeding.” I still had the same gloves on, but I didn’t need sterile gloves for the external massage.
I braced her hip with my left hand and reached for the soft expanse of her abdomen with my right. Then I started grinding on her uterus through the skin of her belly like I was trying to knead a lump of floppy dough.
Usually, after you give birth, the uterus recognizes that the baby is gone and starts shrinking back down to size. Nursing the baby helps release oxytocin, which contracts the uterus too. But since we’d whipped David away, he hadn’t really had a chance to nurse, and she’d started bleeding.
“What are you doing? I want my baby.” She started to squeeze away from me.
“Your uterus is too, um, big. Loose,” I added in English. I was startling to struggle with my French worse than Tucker. “I need to massage it. That way, it will close up again and you’ll stop bleeding.”
“Is it dangerous?”
“It can be,” I said, not wanting to lie, but I couldn’t figure out how to sugarcoat it.
Tucker to the rescue. “Most women do well with the massage,” he said, winding around to the head of the bed and smiling down at her from the office end. “Do you want to see your son, David?”
She fixed her eyes on David and opened her arms, so Tucker successfully distracted her while I mentally ticked off the post-partum hemorrhage algorithm.
One. Two large bore IV’s. She didn’t have any. I could try to put one in, and Tucker definitely could, but only if the nurse had left the venipuncture kit in the room. In the emerg, most rooms are stocked with equipment, but I’ve also seen nurses carry a small blue basket of needles, gauze, Opsite dressings, and tape from room to room. I wasn’t sure which way OB swung.
Two. Group and screen her blood. They may have done that when she arrived, or as part of her prenatal blood work. Either we’ve documented the mom’s blood type, or draw it immediately. Unfortunately, boxed into this cage, I didn’t have access to her record, but maybe I could ask the intercom when I got a hand free. Again, Bastard would probably block them if they actually tried to deliver her blood, but if we needed to cross-match her some units, we’d have to start now.
