The Pull of the Stars

by Emma Donoghue

  Thanks, Bridie.

  I made a little gesture for her to put the book back before she noticed the more disturbing sections: malpresentations, anomalies, obstetrical surgeries.

  Mary O’Rahilly was stumbling back and forth around the bed, blinded by fright.

  Puritans who thought ignorance was the shield of purity—they made me angry. I said to her, Your mother should really have explained. Didn’t she bring you into the world this way? I’ve seen it happen dozens—no, hundreds of times—and it’s a beautiful sight.

  (Trying not to think of all the ways it could go wrong. Of the young blonde I’d encountered in my first month here who’d laboured for three days before the doctor had pried out her eleven-pounder by caesarean section; she’d died of the infected wound.)

  Mary O’Rahilly’s voice was barely there: Mammy passed when I was eleven.

  I regretted what I’d said about her mother. I’m so sorry. Was it…

  Having my last brother, or trying to.

  Her voice was very low, as if it were a secret, and a shameful one, rather than the most ordinary tragedy ever told. Even if this girl was ignorant of the mechanics of birth, she knew the fundamental fact about it: the risk.

  I supposed that was why I found myself telling her, My mother went the same way.

  They were all looking at me now, these three women.

  Mary O’Rahilly seemed almost comforted. Did she?

  I said, In our case, I was four, and the baby did live.

  Bridie was watching me, her eyes crinkling in sympathy.

  Mary O’Rahilly sketched a cross, touching her forehead, shoulders, and breastbone, before resuming her walk.

  I felt as if I were adrift in a leaking boat with these strangers, waiting out a storm.

  A grunt burst out of Delia Garrett. My bowels—I need to move them, Nurse, but I know it won’t come!

  I looked at her hard. I’d been so focused on the newcomer, it had completely slipped my mind that constipation could be an early hint of labour. But Delia Garrett wasn’t due for almost eight weeks, I argued with myself. This being her third go, surely she’d recognise those pangs?

  Except that she was so reluctant to stay in hospital, she’d be likely to deny any hint that she might be slipping into that state. And wasn’t this flu becoming infamous for expelling babies before their time?

  She let out a volley of coughs.

  Tell me, Mrs. Garrett, when you get the urge, does your whole middle tighten up?

  Like a drum!

  That was another sign.

  I laid her down on her back with her knees drawn up a little and began palpating. The baby’s bum was up, head down; that was good. Bridie, the horn?

  Delia Garrett tried to sit up, eyes wild. You’re not prodding me with that thing.

  It won’t hurt.

  I can’t bear anything pressing on me right now.

  Very well, I can use my ear.

  So I set my cheek against her bump and asked her to take a deep breath.

  I tell you I’m desperate for the lavatory!

  I really don’t think it’s that, Mrs. Garrett, but you can try a bedpan.

  Bridie rushed to fetch one.

  I put my ear back to the hot, stretched skin. I found a pulse…but I could tell without counting that it was too slow to be anything but Delia Garrett’s.

  Her cough resounded in my head.

  Let me try a different spot…

  But the young woman kept thrashing about and protesting that I was pressing too hard, and I couldn’t make out the pattering beat I was seeking, the foetal rhythm that should be almost twice as a fast as its mother’s.

  Please, Mrs. Garrett, don’t move for a minute.

  It hurts to stay flat on my back!

  I spoke lullingly, as if to a spooked horse: I understand.

  Delia Garrett’s voice went shrill: How could you, a spinster?

  Bridie’s eyes widened and met mine.

  I smiled and shook my head to show I hadn’t taken it personally. Labouring women often turned cranky as things came to the crunch; in fact, it was a useful sign.

  Delia Garrett’s face screwed up again and she began to moan.

  I noted the time.

  Waiting for her pang to finish, I checked on Ita Noonan, who was still scarlet-faced and dozing.

  Between their two cots, Mary O’Rahilly paced like a ghost, three steps towards the window, three steps back, trying to keep out of the way.

  Mrs. O’Rahilly, how are you doing?

  All right. Could I sit a bit, maybe?

  Certainly, whatever you like.

  I went around her to Ita Noonan and gently pulled up the woman’s lip to insert a thermometer under her tongue; she didn’t stir.

  Back to kneel on Delia Garrett’s bed, because I knew there was one more bit of proof I needed: Was the head fixed in the pelvis yet or still floating?

  Hold steady on your back for just a minute more, please, Mrs. Garrett.

  Facing her glossy bump, I moved my right hand into Pawlic’s grip, taking hold just above the pubic bone, sinking my fingers in as if around a huge apple, and gently trying to shift the small skull from side to—

  Argh!

  Delia Garrett kneed me away violently.

  I rubbed my bruised rib, calculating. The head hadn’t budged at all under my fingers, so, yes, this woman was in labour, two months early.

  Bridie pointed.

  Mrs. Noonan had let the thermometer drop out of her mouth, and it had fallen onto her blanket.

  Pick it up for me, would you, Bridie? Quick, before it cools.

  She scuttled between the two cots.

  Show me?

  Bridie put the thermometer up to my face, vertically.

  Flat! So I can read the figures.

  She turned it.

  I read the number: 105.8. Climbing again.

  Check she still has some whiskey in her cup, would you?

  Bridie reported: Plenty.

  You could try ice-cold cloths on the back of her neck, then.

  She hurried to do that.

  I tugged lightly on Delia Garrett’s drawers and said, These have to come off.

  She huffed but lifted her hips so I could slide them down.

  Let your knees fall apart, would you, just for a minute?

  I didn’t even need to touch her. The pubic curls were crusted with red, what we called bloody show, the surest sign.

  Behind me, Bridie let out a gasp of shock, but it was covered up by Delia Garrett’s groan.

  I closed her legs and pulled out my watch; barely five minutes since the last pang. This was all going much too fast. Born at thirty-two weeks would mean severely premature. All we could do with those babies was keep them in the warm box upstairs for the week, send them home wrapped in cotton wool with an eyedropper for feeding, and cross our fingers—especially if they were boys, notoriously weaker—that they’d somehow live through the first year.

  My most urgent task was to look after the mother, I reminded myself. To keep Delia Garrett’s blood pressure from going through the roof.

  I took her wrist now. Under the pads of my fingertips, her pulse leapt, a river in spate. I plumped her pillows. Sit up and lie back on these, dear.

  Blinking, she did.

  Bridie was still standing there with the thermometer, openmouthed.

  I asked her to disinfect it just to get her over to the sink. I followed her and murmured in her ear, You know what part of a nurse is the most important?

  Bridie looked blank. Her hands? Her feet?

  I pointed to my face and made it serene. If a nurse looks worried, patients will worry. So guard your face.

  She nodded, absorbing that.

  I went back to Delia Garrett. I believe you’re on your way, dear.

  Fear in her voice, for the first time. I can’t be! She’s supposed to be a Christmas baby.

  As lightly as I could, I said, Well, she seems to believe she’s a Halloween one.r />
  Ah, no!

  I turned to see Bridie with an appalled face, one hand trickling scarlet. I demanded, What have you done?

  She cringed. Sorry, I set the thing, I put it down in the hot pot, but it must have hit something—so I took it out again—

  I’d meant her to dip the thermometer in the basin of carbolic. What kind of eejit didn’t know that boiling water would crack a delicate glass bulb?

  But I bit my tongue. I could hardly expect this young woman to pick up the basics of nursing in a couple of hours.

  Excuse me a minute, Mrs. Garrett.

  She buried her face in the pillow and moaned.

  I crossed the room, took Bridie’s hand, and shook it a little over the bubbling water till she released the shards. I dried the bleeding finger on a sterile cloth and gave the cut a dab with a styptic pencil from my apron to seal it up so she wouldn’t go off dripping scarlet like a murderess in a play.

  There you go. Now, could you run upstairs to the maternity ward and find Sister Finnigan? Tell her I have a precipitate premature labour—

  Damn it, Bridie would never hold on to those unfamiliar words.

  A rapid premature labour, I said instead.

  (Would I be better off taking the time to write a note?)

  Tell Sister Finnigan that Mrs. Garrett’s pangs are less than five minutes apart and we need a doctor. If the lady one isn’t in yet, then anyone else at all. Will you remember?

  Bridie echoed in a thrilled voice: Rapid, five minutes, any doctor.

  She scurried off.

  I called after her, Don’t actually run.

  Delia Garrett grunted crossly. I keep telling you, I need to go.

  I reached for the bedpan Bridie had brought over.

  Not that!

  You have to rest and conserve your strength, Mrs. Garrett.

  (What I was thinking was, what if her baby dropped out in the passage or in the toilet?)

  Mutinous, she allowed me to pull her nightdress up and get the bedpan under her, but as I’d expected, nothing came out. I said, While I have you here, let me clean you.

  She didn’t object, just shut her eyes as she crouched miserably on the pan. I gave her soft parts a thorough going-over first with soap and water, then with warm, dilute disinfectant, to get rid of the germs that could infiltrate her or contaminate the baby as it came out.

  As the next pang took Delia Garrett, she hung her head and let out a guttural sound that turned into a racking cough. Something for the pain, Nurse Julia?

  I’m sure when the doctor comes—

  Now!

  I’m afraid nurses don’t have authority to order medicine.

  Then what bloody use are you?

  I had no answer for that.

  Let’s get you lying down now, Mrs. Garrett. On your left, that helps.

  (If the labouring woman turned on her right, the uterus might compress the vena cava and reduce blood flow to her heart.)

  I urged, Take long breaths.

  I took a clean cloth from the packet and dipped it in boiling water. When it had cooled enough, I wrung it out, folded it smaller, and went over to where Delia Garrett lay on her side. Slide your knees up towards your chest for me, so your rear’s sticking out?

  She grumbled but did it.

  Here’s a hot compress, I said, then pressed the cloth to her perineum.

  A sob.

  That pressure behind, that’ll be the baby’s head you’re feeling.

  Make it stop!

  I wondered, For how many millennia have women been vainly asking that?

  No, no, I assured her, it means you don’t have long to go.

  (And where, oh, where was the blasted lady doctor?)

  In the middle bed, young Mary O’Rahilly was coiled around her own slow, unceasing pains. A little damp across the forehead, her hair a black oil slick; dark underneath the eyes. Birth was such a roll of the dice, I thought; labour could keep a woman in painful limbo for days on end or strike her as hard and fast as lightning.

  I simply couldn’t give hands-on care to two women at once, and Delia Garrett’s need was more urgent. But when Mary O’Rahilly straightened again, I asked softly, Was that a bad one, Mrs. O’Rahilly?

  A hapless shrug, as if the seventeen-year-old were unqualified to measure what was being done to her. She let out a series of small coughs.

  When Bridie Sweeney gets back, I’ll have her make you more hot lemonade.

  Delia Garrett cried out.

  I kept pressing on the hot compress with one hand, and I checked my watch with the other. Her pains were close to three minutes apart now. I fingered the silver disk as if I could smooth away the terrible scratches. I pushed it back into my bib pocket.

  Delia Garrett wailed, It wasn’t like this the other times, Nurse Julia. Can’t you give me something?

  And why was I not allowed to do that in a pinch when half the protocols had been thrown out the window?

  Instead, I threw the compress into the waste bucket and got behind her. Let’s see if this helps, Mrs. Garrett. Up on your hands and knees?

  She grunted angrily but heaved herself into a cow-like position. With the heels of my hands, I pressed hard on her two sitz bones, pushing the very base of her pelvis forward.

  Oh, oh!

  I hoped that meant I was taking the edge off the pain.

  For the next contraction, three minutes later, I tried thumbing the last few vertebrae on both sides of her spine, but that did nothing for her. I switched to the dimples of Venus at the base of her back; I set my knuckles into them and leaned hard.

  Any better?

  Delia Garrett sounded preoccupied: A bit.

  These tricks of counterpressure weren’t in any manual, just passed down, midwife to midwife, though the more stern of our profession didn’t approve of anything done to relieve pains they considered natural and productive. But I was firmly in favour of whatever helped a woman keep up her strength and get through.

  In the silence, Delia Garrett sank back against the pillows and pulled her nightgown down. Her eyes were shut as she muttered, I didn’t want this baby.

  A sound of footsteps behind me. I could see by Bridie’s face that she’d caught that.

  I took Delia Garrett’s hot hand with its manicured nails. It’s natural enough.

  Two seemed plenty, she confided. Or if my little girls could have had more time…it’s not that I wasn’t willing to have a third, only not so very soon. Am I dreadful?

  Not at all, Mrs. Garrett.

  Now I think I’m being punished.

  None of that! Rest and breathe.

  And Bridie was by her side, gripping her other hand. Doctor’s coming.

  Oh, oh! A wave took Delia Garrett.

  In the next respite, I got the woman on her side and had Bridie cup her right hand around Delia Garrett’s right hip and set her left flat on the small of the back. I started the rotation. Like pedaling a bicycle, see?

  Bridie asked, Is it?

  It baffled me that this young woman seemed to lack experience of the most ordinary things—bicycles and thermometers and unborn babies. Still, she was so grateful for everything from skin lotion to ashy tea. And how quickly she got the knack of whatever I taught her.

  Delia Garrett ordered, Don’t stop.

  I left Bridie to continue the pelvic tilts and went to check on the other two.

  Fiery-faced, Ita Noonan was tossing and turning. I was at a loss as to how to quench this fever without our usual standbys, aspirin and quinine.

  Mrs. O’Rahilly, how’re you doing?

  The young woman shivered and shrugged.

  Her pangs were still twenty minutes apart, according to my notes. I suggested, Have a sleep if you think you could drop off.

  I doubt it.

  Maybe walk a bit more, then?

  Mary O’Rahilly turned her face to the pillow to muffle her cough. She clambered out and started pacing around the bed again, a lioness in a too-small cage.

&
nbsp; Delia Garrett let out a long groan. Can I start the bloody pushing?

  Panic flapped in my chest. Do you feel the urge to bear down?

  She snapped, I just want to get this over with.

  Then please wait a little longer, till the doctor comes.

  A mutinous silence. Delia Garrett said, I believe I’m leaking.

  I checked. Hard to tell amniotic fluid from the water that had dripped from the compress, but I took her word for it.

  Just then a boyish stranger in a black suit swept in and introduced himself as Dr. MacAuliffe, a general surgeon.

  My heart sank. He looked no more than twenty-five. These inexperienced doctors rarely knew one end of a woman from the other.

  He wanted to do an internal, of course. At least he wasn’t slapdash about hygiene; he asked for boiled rubber gloves. He had a brief conversation with Delia Garrett while I fetched a paper packet and then unwrapped it for him. He soaped and nailbrushed his hands and snapped on the gloves.

  I got Delia Garrett’s thighs up at a right angle to her back, her bottom sticking out over the edge of the bed, to give the doctor more room to work.

  When he began, she yowled.

  MacAuliffe said, Well, now, madam—

  (He’d clearly judged from her southside accent that she should be addressed that way rather than as missus.)

  You’re coming along very nicely indeed.

  That was vague.

  He tugged the gloves off.

  I gestured to Bridie to put them in the bucket of items to be sterilised.

  Fully dilated, Doctor? I murmured.

  Ah, so it seems.

  I gritted my teeth. Couldn’t he tell? If he was wrong and the rim of the cervix was still in the way, and Delia Garrett pushed hard enough to make it swell up and block the passage…

  MacAuliffe told her, Just take your ease and let Nurse Power look after you.

  Her cough was a harsh bark.

  I asked, May I give Mrs. Garrett something to make her more comfortable, Doctor?

  Really, at this late point in the proceedings, it seems hardly—

  And to calm her down, I urged. Dr. Prendergast’s been worried about her elevated pulse force.

  That had a visible effect, because Prendergast was his senior. MacAuliffe said, Chloroform, then, I suppose, the usual dose.

  I should have asked him about Mary O’Rahilly next, but I was reluctant, somehow. Young doctors had a tendency to treat nature the way one would a lazy horse—with a crack of the whip. They particularly distrusted primigravidae, who had no record of being able to give birth unaided. Especially if the strain on a labouring woman was exacerbated by an illness such as the flu, a young general surgeon such as MacAuliffe might well panic at the delay, order a manual dilation, then go in with forceps. Despite how long the seventeen-year-old had been enduring her pains, the last thing I wanted was for this pup to start brandishing tools that could harm as easily as help.