The Pull of the Stars

by Emma Donoghue

  Always on their feet, these Dublin mothers, scrimping and dishing up for their misters and chisellers, living off the scraps left on plates and gallons of weak black tea. The slums in which they somehow managed to stay alive were as pertinent as pulse or respiratory rate, it seemed to me, but only medical observations were permitted on a chart. So instead of poverty, I’d write malnourishment or debility. As code for too many pregnancies, I might put anaemia, heart strain, bad back, brittle bones, varicose veins, low spirits, incontinence, fistula, torn cervix, or uterine prolapse. There was a saying I’d heard from several patients that struck a chill into my bones: She doesn’t love him unless she gives him twelve. In other countries, women might take discreet measures to avoid this, but in Ireland, such things were not only illegal but unmentionable.

  Concentrate, Julia. I said the phrase in my head to scare myself: Acting ward sister.

  Let Eileen Devine go; I had to bend all my efforts to the living now.

  One always checked the sickest patient first, so I went around the skeletal frame of Eileen Devine’s empty cot and took down the chart on the left. Good morning, Mrs. Noonan.

  The mother of seven didn’t stir. Ita Noonan had been wheeled in six days ago without the grippe’s characteristic cough, but feverish; head, back, and joints as sore as if she’d been knocked down by a bus, she’d said. That was when she could still speak coherently.

  She’d told us all about her job at the shell-filling factory, where her fingers had been yellowed by handling the TNT. She’d return to it as soon as she was over this flu, despite what she referred to lightly as her gammy leg. (The right was swollen to twice the width of the left since her last birth; it was hard and chill, the skin chalky and nonpitting. Ita Noonan was supposed to stay off it—keep it elevated, in fact—but sure how could she do that during the working day?) Once she was delivered in January, she’d return to the shell factory again for the grand wages and the cheap meals too; she’d have her eldest girl bring the baby in for feeds, she assured us. Mr. Noonan had been jobless ever since the lockout, when the bosses had broken the workers’ union; he’d tried to join the British army but was turned away for having a hernia (even though his pal with a withered arm had kept his jacket on and been accepted), so he went around with a barrel organ now. Ita Noonan chafed to know how her kids were getting on; visitors weren’t allowed in because of the influenza, and her husband wasn’t one for writing. Oh, she was full of chat and jokes and strong views too; she went off on a rant about the Rising in ’16, how her Canary Girl crew—all loyal to His Majesty—hadn’t missed a day and had filled eight hundred shells that week.

  But yesterday her breathing had turned noisier and her temperature had swooped up, jumbling her mind. Despite Sister Luke giving her high doses of aspirin, she’d spiked a fever twice last night, I read, hitting 103.7 and then 104.9.

  I tried to slip the thermometer under Ita Noonan’s tongue without waking her, but she roused, so I yanked it out before her remaining teeth could clamp together. Every nurse made that mistake once, had a patient spitting glass and mercury.

  The woman blinked her pale blue eyes as if she’d never seen this room before, and writhed against the tapes binding the hot poultice to her chest. The shawl slid off her head; her thin hair cropped inches from the scalp stood up, the prickles of a hedgehog.

  It’s Nurse Power, Mrs. Noonan. I see you’ve had a haircut.

  Delia Garrett muttered, Sister Luke put it in a paper bag.

  Some of the older nurses maintained that cutting a fever patient’s hair had a cooling effect and that if you cut it, it would grow back after, whereas if it fell out on its own, as often happened with this flu, it’d never return. Superstition, but I didn’t think it worth a quarrel with the night nurse.

  Delia Garrett touched her fingertips to her own elegant head and said, If it never comes back and the poor creature’s left as bald as an egg, I suppose she can have a hairpiece made of it.

  Let me just take your temperature, Mrs. Noonan.

  I loosened the collar of the woman’s nightdress. A thermometer under the arm needed two minutes rather than one and gave a reading one degree lower, but at least there was no risk of the patient biting the glass. On a chain Ita Noonan wore a tin crucifix, I noticed, no bigger than the top joint of my finger. People were all for holy things these days—talismans against terror. I tucked the thermometer into her humid armpit. There we go.

  A little breathless, Ita Noonan answered randomly: Rashers!

  That’s right.

  I knew never to dispute a point with a delirious patient.

  Could she be hungry for her breakfast? Unlikely, in her state; patients with serious flu cases had no appetite. Haggard at thirty-three years old, pale but for those flame-red cheeks, her belly a hard hill. Eleven previous deliveries, it said on Ita Noonan’s chart, seven children still living, and this twelfth birth not expected for another two and a half months. (Since Mrs. Noonan had been able to tell us nothing about when she might have conceived or when she’d felt the quickening, Sister Finnigan had had to make a stab at the due date based on the height of the uterus.)

  My job wasn’t to cure all Ita Noonan’s ills but to bring her safe through this particular calamity, I reminded myself, to push her little boat back into the current of what I imagined to be her barely bearable life.

  I placed my first two fingers on the skin between tendon and bone on the thumb side of her wrist. With my left hand, I pulled out the heavy disk of my watch. I counted twenty-three beats in fifteen seconds and multiplied by four. Pulse rate 95, at the upper end of normal; I jotted it down in minute letters. (Wartime policy, to save paper.) The rhythm was Regularly irregular, I noted, which was typical during a fever. Pulse force normal, a small mercy.

  I drew out the thermometer from under Ita Noonan’s arm; its glass dragged at her tired skin. The mercury stood at 101, the equivalent of 102 taken orally, which was not too alarming, but temperatures were generally at their lowest in the early morning, and hers would climb again. I penciled the point on the graph. Many an illness had a characteristic line of exposure, incubation, invasion, defervescence, convalescence—the silhouette of a familiar mountain range.

  Ita Noonan turned confiding now. She wheezed, said in her thick inner-city accent: In the wardrobe, with the cardinal!

  Mm. Just lie quiet, we’ll take care of everything.

  We? I remembered I was on my own today.

  Ita Noonan’s chest strained to rise and fall, her breasts two windfalls rotting on dropped branches. Six breaths in fifteen seconds. I multiplied and wrote down Respirations 24. That was still rather high. Mild nasal flaring.

  She beckoned me closer with her gaudy stained fingers. I leaned in and got a whiff of linseed from her poultice and something else…a bad tooth?

  Ita Noonan whispered: There’s a baby.

  I wasn’t sure how old her youngest was; some of these women were unlucky enough to produce two in a year. You’ve a little one at home?

  But she was pointing down, secretive, not quite touching the drum under her sweat-dampened nightdress or even looking at it.

  Oh yes, another one on the way, I agreed, but not for a good long while yet.

  Her eyes were sunken; was she dehydrated? I lifted down the kettle to make her some beef tea. In this cramped space, we had only a pair of spirit lamps for cooking, so on one of them we kept a kettle always simmering, and on the other a wide pan for sterilising, in the absence of an autoclave to steam things clean. I picked up the jug of cold boiled water and poured some into the beef tea so it wouldn’t scald Ita Noonan. I put the lidded cup into her hands and waited to make sure that in her confusion, she remembered how to suck from the hole.

  A hard shake to the thermometer drove the mercury down into its glass bulb. I dipped it in the basin of carbolic, then rinsed it and put it back in my bib.

  Delia Garrett slapped down her magazine and let out an angry cough behind her polished fingernails. I want to get
home to my little girls.

  I took one of her plump wrists and counted the beats, my eyes on the silver-framed family portrait on the miniature bedside table. (Patients’ effects were meant to be kept in the drawer, for hygiene, but we knew when to turn a blind eye.) Who’s looking after them while your husband’s at the office?

  She swallowed a sob. An older lady up the avenue, but they don’t like her and I hardly blame them.

  Pulse rate nothing out of the ordinary, the rhythm just a little syncopated. No need for the thermometer because her skin was the same temperature as mine. What concerned me was the pressure of her blood against my fingers. Pulse force bounding, I wrote down. Hard to tell how much was due to her agitation.

  I observed her respiratory rate now.

  Isn’t it a mercy you’ve only a light dose, Mrs. Garrett? I was the same myself back in September.

  I was trying to distract her because one never let a patient know one was counting her breaths or self-consciousness would alter the rhythm. Respirations 20, I wrote.

  Delia Garrett narrowed her pretty eyes. What’s your name—your Christian name?

  It was against protocol to share any personal information; Sister Finnigan taught us to maintain gravitas by staying aloof. If you let patients become familiar, they’ll respect you less.

  But these were strange times and this was my ward, and if I had to run it today, I’d do it my way. Not that it felt as if I were running anything, exactly; just coping, hour by hour.

  So I found myself saying, It’s Julia, as it happens.

  A rare smile from Delia Garrett. I like that. So did they jam you in a storeroom, Julia Power, between a dying woman and one who’s off her head?

  I found myself warming to the wealthy Protestant for all her obstreperousness. I shook my head. I was nursed at home, by my brother, actually. But when you’re expecting, this flu can lead to…complications.

  (I didn’t want to spook her by listing them: miscarriage, premature labour, stillbirth, even maternal death.)

  Any headache this morning?

  A bit of pounding, Delia Garrett admitted with a surly look.

  Where?

  She swept her hands from her bosom up to her ears as if brushing away flies.

  Problems with your vision at all?

  Delia Garrett blew out air. What’s there to look at in here?

  I nodded at her magazine.

  I can’t settle to reading; I just like the photographs.

  She sounded so young then.

  Is the baby giving you a lot of bother—kicking and such?

  She shook her head and covered a splutter. It’s just the cough and the aching all over.

  Perhaps you’ll get another note from Mr. Garrett today.

  Her lovely features darkened. Where’s the sense in forbidding our families to visit when the whole city’s riddled with this grippe anyway?

  I shrugged. Hospital rules.

  (Though I suspected it wasn’t so much about quarantining our patients as sparing our skeleton crew the extra trouble.)

  But if you’re the acting sister today, you must have authority to give me a cough mixture and let me out of here, especially since the baby’s not coming till Christmas!

  Unlike our poorer patients, Delia Garrett knew exactly when she was due; her family physician had confirmed the pregnancy back in April.

  I’m sorry, Mrs. Garrett, but only a doctor can discharge you.

  Her mouth twisted into a knot.

  Should I spell out the risks? Which would be worse for her thumping blood, the frustration of feeling confined for no good reason or the anxiety of knowing that there were grave reasons?

  Listen, you’re doing yourself harm by getting worked up. It’s bad for you and the baby. Your pulse force—

  How to explain hypertension to a woman with no more than a ladylike education?

  —the force with which the blood rushes through the vessels, it’s considerably higher than we like it to be.

  Her lower lip stuck out. Isn’t force a good thing?

  Well. Think of turning a tap up too high.

  (The Garretts would probably have hot water laid on day and night, whereas most of my patients had to lug babies down three or four flights to the cold trickle of the courtyard tap.)

  She sobered. Oh.

  So the best thing you can do to get home as soon as possible is keep as quiet and cheerful as you can.

  Delia Garrett flopped back on the pillows.

  All right?

  When will I get some breakfast? I’ve been awake for hours and I’m weak.

  Appetite is a splendid sign. They’re understaffed in the kitchens, but I’m sure the trolley will be up before long. For now, do you need the lavatory?

  She shook her head. Sister Luke brought me already.

  I scanned the chart for bowel movements. None yet; the flu often caused the pipes to seize up. I fetched the castor oil from the cupboard and poured a spoonful. To keep you regular, I told her.

  Delia Garrett screwed up her face at the taste but swallowed it.

  I turned to the other cot. Mrs. Noonan?

  The befogged woman didn’t look up, even.

  Would you care for the lavatory now?

  Ita Noonan didn’t resist as I lifted the humid blanket and got her out of bed. Clutching my arm, she staggered to the door into the passage. Dizzy? I wondered. Along with the red face, that could mean dehydration. I reminded myself to check how much of her beef tea she’d managed to drink.

  I felt a twinge in my side as Ita Noonan leaned harder. Any nurse who denied having a bit of a bad back after a few years on the job was a liar, though any nurse who griped about it had a poor chance of staying the course.

  Once I had her sitting down on the lavatory, I left the stall and waited for the tinkle. Surely even when her mind was wandering, her body would remember what to do?

  What a peculiar job nursing was. Strangers to our patients but—by necessity—on the most intimate terms for a while. Then unlikely ever to see them again.

  I heard a rip of newsprint and the soft friction as Ita Noonan wiped herself.

  I went back in. There now.

  I pulled down her rucked nightdress to cover the winding rivers of veins on her one bloated leg in its elastic stocking and her skinny one in ordinary black.

  Ita Noonan’s eyes in the mirror were vague as I washed her hands. Come here till I tell you, she murmured hoarsely.

  Mm?

  Acting the maggot something fierce.

  I wondered who she could be thinking of.

  Back in the ward, I got Ita Noonan into bed with the blankets pulled up to her chest. I wrapped a shawl around her shoulders, but she scraped it off. The lidded cup still felt half full as I set it to her lips. Drink up, Mrs. Noonan, it’ll do you good.

  She slurped it.

  Two breakfast trays sat side by side on the ward sister’s tiny desk, protruding over its edges. (My desk today.) I checked the kitchen’s paper slips and gave Delia Garrett her plate.

  A wail went up when she lifted the tin lid. Not rice pudding and stewed apple again!

  No caviar today, then?

  That won half a smile.

  And here’s yours, Mrs. Noonan…

  If I could persuade her to take something, it might bolster her strength a little. I straightened her legs, the huge, swollen one (very carefully) and the ordinary one. I set the tray down in her lap. And some lovely hot tea, if you prefer that to the beef?

  Though I could tell the tea was lukewarm already, and far from lovely; given the price of tea leaves these days, the cooks had to brew it as transparent as dishwater.

  Ita Noonan leaned towards me and confided in a ragged whisper, The boss man’s out with the rossies.

  Really?

  She might be thinking of Mr. Noonan, I supposed. Though boss man seemed an odd epithet for a fellow pushing a barrel organ around town to support a sick wife and seven children. Was there almost a relish in delirium,
I wondered, at getting to say exactly what floated through one’s head?

  Delia Garrett leaned out of bed to ogle Ita Noonan’s tilted plate. Why can’t I have a fry-up?

  Nothing fatty or salty, remember, because of your blood pressure.

  She snorted at that.

  I perched on Ita Noonan’s cot—there was no room to fit a chair between this one and the next—and cut one of the sausages into small bites. What would Sister Finnigan say if she could see me break her rule about sitting on a bed? She was gliding about upstairs, too busy catching babies to tell me the thousand things I needed to know and had never thought to ask.

  Look, lovely scrambled eggs.

  I put a forkful of the nasty yellow stuff—obviously powdered—to Ita Noonan’s lips.

  She let it in. Once she realised this was a fork I was setting in her hand, she gripped it and went to work. Wheezing a little, pausing to strain for breath between bites.

  I found my eyes brooding over the empty cot in the middle. The nail on which Eileen Devine’s chart had hung was loose, I remembered. I stood up now to ease it out of the wall. I pulled on the chain of my watch and weighed the warm metal disk in my palm. Turning away so neither woman would notice what I was doing, I set the point of the nail to my watch’s shiny back and scratched an only slightly misshapen full moon among the other marks, this one for the late Eileen Devine.

  I’d formed this habit the first time a patient died on me. Swollen-eyed, at twenty-one, I’d needed to record what had happened in some private way. A newborn’s prospects were always uncertain, but in this hospital we prided ourselves on losing as few mothers as possible, so there really weren’t that many circles marked on my watch. Most of them were from this autumn.

  I replaced the nail in the wall. Back to work. Every ward had intervals of peace between rushes; the key was to snatch these opportunities to catch up. I boiled rubber gloves and nailbrushes in a bag in a saucepan. I crossed to the opposite wall and studied the contents of the shallow ward cupboard, acting competent, if not feeling it. All these years, I’d been expected to set my judgement aside and obey my ward sister; such an odd sensation, today, to have no one telling me what to do. A measure of excitement to it, but a choking feeling too. I went to fill in requisitions at the desk. Since the war, one never knew what would be in short supply, so all one could do was ask politely. I didn’t bother requesting cotton pads and swabs, as they’d disappeared for the duration. Some supplies had been back-ordered for weeks already, I found from Sister Finnigan’s list.