The Pull of the Stars

by Emma Donoghue

  Instead, I drew his attention back to Delia Garrett. When may she start pushing?

  Oh, whenever she likes. As soon as you glimpse the head, call me down to deliver her, he added on his way to the door.

  I doubt it’ll be very long now—can’t you stay, Doctor?

  We’re all stretched madly thin, he threw over his shoulder.

  The ward was silent when the door had shut.

  Acting ward sister, I reminded myself. I straightened my spine. I was a little wobbly, light-headed. It had been a long time since my bread and cocoa.

  My helper was watching.

  I summoned up a smile. Bridie, sorry, I never did send you down for lunch.

  Sure I’m grand.

  At least I had permission to give Delia Garrett some relief now. I went to the medicine cabinet for an inhaler and measured chloroform onto its stained cotton pad. Roll back onto your left side, Mrs. Garrett. Put this over your mouth and breathe it in whenever you like.

  She sucked hard on the mouthpiece. I felt her pulse; it didn’t seem much more bounding than before. Oh, why hadn’t I remembered to remind MacAuliffe to check the foetal pulse with his stethoscope? Maybe Delia Garrett would let me try with the wooden horn if I asked now.

  But here came another contraction already.

  I pressed hard on the small of her back with both fists. How long a full minute of pain lasted, even for someone who was only observing it. I pushed and pulled her pelvis as if I were working some heavy machine. Waiting for the pang’s grip on Delia Garrett to loosen, I realised I couldn’t imagine enduring such sensations, and yet this was something most women all over the world did. Was there something uncanny about me that I only ever hovered over the scene, a stone angel?

  Back to the here and now, Julia.

  Delia Garrett had said her first two babies popped out. Best to be ready for it to happen any minute now and try to reduce any tearing when the head came down like a rocket. Impossible to offer her any privacy, but at least I could have supplies laid out and a crib standing by.

  Bridie, could you nip back up to Maternity and ask for one of those foldout cribs on wheels that go at the end of a cot?

  She dashed away.

  Nurse Julia!

  That was Delia Garrett. Breathe in more chloroform, I told her as I pressed the inhaler to her mouth. You’re going great guns.

  In the next lull, I washed my hands again and laid out what might be needed for delivery: gloves in a basin of biniodide of mercury, swabs, scissors, a hypo full of chloroform and another of morphine, needle-holder and needles, sutures.

  Delia Garrett made a new sound, a low growl.

  I asked, Ready to bear down next time?

  She nodded furiously.

  I took the inhaler out of her hand; I needed her alert.

  It only struck me now that, unlike the proper hospital beds up in Maternity, these camp cots had no rails at the bottom. Nothing for it but to have Delia Garrett lie the other way.

  Could you spin around, dear, and put your head at the end of the bed for me?

  How’s that going to help?

  I stood her pillow up against the headrest. When the pang comes, jam your left foot against this and push, all right?

  I wrenched blankets and sheets out of the way so she could rotate herself. I looped a long roller towel around a bottom corner of the metal cot and set it in her hand. Pull hard on this too.

  Delia Garrett gripped the towel, her breathing harsh.

  I pulled up her nightdress and bent her right leg up in my lap to get a good look.

  I hadn’t noticed when Bridie wheeled in the crib I’d asked for. She was looking white; faintness, fatigue, or just excitement? Of all the wards for her to have walked into this morning—had the young woman had any idea where Sister Luke was sending her?

  Thanks, Bridie. Hurry for Dr. MacAuliffe now.

  She shot off again.

  The young surgeon might be irked if he had to stand around and wait through more than a few pushes, but I’d rather chance that than have him stay away too long.

  The next pang made Delia Garrett screech.

  I reminded her, Low sounds, they have the most heft to them.

  I knelt over Delia Garrett and set my thigh into the small of her back for her to brace herself against as she pushed. The towel was so tight around her hands, it striped them with white. That silence as she held her breath and bore down; there was nothing like it. I realised something then: no other job would ever satisfy me.

  Urghhhhhhh!

  I said, And rest a minute now, catch your breath.

  I felt her pulse to make sure its force wasn’t too high.

  Lunch. (A voice I didn’t recognise.) Sorry it’s so late.

  I whipped down Delia Garrett’s nightdress for decency and turned my head to the door, where that kitchen maid with a purple birthmark held three stacked trays. Not just now, please!

  Thrown, she gazed around. There wasn’t enough room on the counters or desk. Maybe if I set them down on the floor?

  I knew one of us would be sure to stumble over them. I told her, Outside the door.

  The kitchen maid disappeared.

  I shook off my irritation and focused on Delia Garrett again. I could see the next pain in her eyes, an oncoming train. Chin down, now, Mrs. Garrett. Curl into the push. Kick with that heel and haul on the towel.

  She moaned.

  I thought of something Ita Noonan had said when she was admitted last week, back when she was still compos mentis. She hadn’t wanted to let me near her at first because she said she’d always had a neighbour called Granny in when she was having her babies, and Granny had lucky hands—did I have lucky hands? I’d been tempted to point out that I had three diplomas instead. But half the battle with patients was persuading them out of their fear, so I’d looked Ita Noonan in her red-rimmed eyes and sworn that I did indeed have lucky hands.

  I pulled up Delia Garrett’s nightdress again for a better look. I wrapped my left arm around her right leg and held it up out of the way. She went quite silent as she heaved this time. Her face was a dull crimson.

  Between her thighs, at the heart of her purplish flesh, a darker tuft. I can see the head, Mrs. Garrett!

  She sobbed, and it disappeared again.

  Don’t push this time, just nice little breaths, I urged her. As if you’re blowing out candles.

  Her perineum was bulging redly. If the head crowned too fast, during a contraction, it could tear her open. I could press on the perineum, but that would further strain the delicate skin. Instead I did what Sister Finnigan had taught me: set the heel of my right hand behind Delia Garrett’s anus, pushing the unseen head forward, and snaked my left arm over her thigh and through her legs so I’d be ready at her soft parts. Now!

  She pushed, heaving in my arms so hard, I thought she might snap my wrist.

  I glimpsed the head again, just inches from my face, and with three fingers of my left hand I tried to get a purchase on the slickly furred scalp and draw it forward…

  Delia Garrett made sounds like she was being eaten by wolves. She kicked at the cot rails.

  Thudding steps behind me. Just Bridie. Seeing Delia Garrett with her head almost hanging off the end of the bed, she gasped.

  The dark tuft disappeared again, swallowed up in purple. I kept my voice steady: Where’s Dr. MacAuliffe?

  Men’s Fever, sorry. They wouldn’t let me up there, but they’ve sent him a message.

  I shut my eyes just for a second. I reminded myself that I knew how to deliver this infant. Lucky hands.

  Again I waited for a gap between contractions. Heel of right hand, fingers of left, straining for a grip on the slippery scalp like a climber on a rock face in the rain. Now, with all your strength, Mrs. Garrett—

  Urghhhhhhhhhhhh! A blue vein inflated at the woman’s temple. Delia Garrett was a key in a lock, jammed, jammed, then suddenly turning—

  She roared. She ripped, a wet parcel. Blood seeped throug
h my knuckles. Not just a head but the whole baby shot out on the sheet.

  I cried, Magnificent!

  But the infant had dark cherry lips. Skin bruised in places, peeling as if after sunburn though it had never seen the light. A girl. A tiny, still girl.

  I picked her up in an infant blanket. A big head for such a meagre body. Just in case by some chance I was wrong, I smacked her on the back.

  I waited.

  I hated to do it, but I slapped Delia Garrett’s baby one more time.

  Nothing.

  I smoothed the flaking skin. The wide face, exquisitely moulded eyelids.

  Bridie goggled at the limp creature in my hands. Why’s it all—

  Dead, I mouthed.

  Her face shut like a book.

  On the middle cot, Mary O’Rahilly was propped up on one elbow, watching with appalled eyes. She read our expressions and turned away, contracting around her cough.

  Give Mrs. Garrett back that inhaler, would you, Bridie?

  Finding it in her mouth, Delia Garrett drew on it with a hiss.

  My fingertips rested on the small, cooling limbs. Silently moving my lips: Mother of God, take home this sleeping child.

  Then I shrouded her and asked Bridie to fetch me a basin.

  I set the swaddled still into it. A clean cloth now, please.

  I stretched it over the top. My eyes swam. I knuckled them dry.

  It was so hushed in that close little room. Delia Garrett was slumped with her eyes shut, worn out from her work. I felt her pulse. Not bounding at all; that was good, at least.

  The woman stirred. A girl?

  I summoned all my strength. I’m afraid I have to tell you, Mrs. Garrett…she was born sleeping.

  She didn’t seem to understand.

  I spelled it out: A dead birth. I’m awfully sorry for your loss.

  Delia Garrett coughed as if she were choking on a rock and began to sob.

  Bridie was rubbing the woman’s shoulder, stroking her damp head, murmuring to her: Shush, now, shush.

  It wasn’t protocol, but there was such instinctive gentleness in it, I didn’t say a word.

  I made a reef knot around the bright blue cord two inches from the still’s belly as if this were a live child. The second ligature I tied just past Delia Garrett’s swollen parts. My fingers slid on the cord’s jelly. Half an inch above the baby’s knot, I cut through its rubbery toughness.

  I picked up the basin.

  Bridie whispered, Mrs. Garrett, do you want to see your daughter?

  I stopped in my tracks. I’d been taught to take away a still as soon as possible and encourage the mother to start putting the loss out of her mind.

  Delia Garrett squeezed her eyes shut and shook her head. Water leaked down her cheeks.

  Only then did I carry the draped basin across the ward and set it down on the desk.

  Bridie, could you get her right way round in the bed now?

  In the silence, I remembered to check on my other patients. Mary O’Rahilly, in the next cot, was lying as rigid as a statue, but I could tell by the way she’d wrapped her arms around herself that she was mid-pang.

  Mrs. O’Rahilly, are you all right?

  She nodded with her eyes averted, as if embarrassed to be intruding on the other woman’s tragedy. But wasn’t a maternity ward like that, a random tin of buttons, one thing always jostling the next?

  Over by the wall, Ita Noonan seemed asleep again.

  Mrs. Garrett, we’re just waiting for the afterbirth now, so I need you on your back.

  Bridie’s face showed me she’d never heard of it.

  I explained under my breath: A big organ at the end of this cord that was keeping the baby alive.

  (Until it failed to do that.)

  The cord dangling out of Delia Garrett resembled a length of bladder wrack washed up on the shore. I kept up a very light traction on it while pressing a sterile cloth to her laceration.

  Bridie stroked and murmured as if the mother were an injured dog.

  Fifteen minutes passed by my watch. Fifteen minutes of the cloth reddening, and Delia Garrett crying. Fifteen minutes of holding the top of her belly to encourage the uterus to contract and expel its useless load. Not a word spoken in the small room. The cord wasn’t lengthening at all; the uterus wasn’t rising or firming or getting more mobile. And Delia Garrett was bleeding more than before.

  But our policy was to give the placenta an hour to come out on its own. Up to two if the patient had been given chloroform, which could slow down this stage.

  A whisper from Bridie: Can’t you give the cord a yank?

  I shook my head. I didn’t say that it might break off or I might rip out the whole womb. I’d seen the latter happen to a worn-out grandmother, forty-seven years old, even though Sister Finnigan had been scrupulously careful, and whenever I recalled the moment, I thought I’d throw up.

  Delia Garrett’s curls were flattened on the pillow. I put the sticky back of my hand to her throat to be sure she had no fever. Give nature an hour, I reminded myself.

  But I had a bad feeling. The placenta might be stuck to the inner wall, and if so, the longer it clung on, the more likely she’d get an infection.

  I should wait for Dr. MacAuliffe. Or send Bridie again and tell her not to come back without him. Except what did that youngster know about this woman’s insides?

  A warm scarlet wave brimmed and flowed onto the sheet. Oh, Christ. The afterbirth must have ripped partly away. This was how so many mothers began to die.

  I rubbed the uterus hard to help expel it, squeezed her like a lemon. Here you go, Mrs. Garrett, one more push now—

  The cord’s burden slithered out, a dark-maroon side of meat.

  There!

  But relief drained away as I spotted what I was dreading: half the afterbirth was missing. The red tide was rising, soaking the bedding.

  I remembered the rule: A midwife should never risk manual removal of the placenta unless all other methods for controlling haemorrhage have failed and no doctor is available to perform the procedure. But there was no time, and if I dithered any longer, Delia Garrett was going to bleed to death.

  At the sink, I scoured my hands so hard, the nailbrush left red lines on my skin and the carbolic burnt. I sensed the bone man just outside the door. He’d claimed one small life already before any of us had realised, and now he was hovering close by, doing his rattling dance, swinging his smirking skull like a turnip in his bony fingers. I soaped my hands and tugged on a pair of rubber gloves.

  I parted Delia Garrett’s legs with my elbows and poured dilute disinfectant over the torn parts.

  She whimpered.

  I said, I’ll be as quick as I can. Hold her knees open, Bridie, while I get the rest of it out.

  Until now, I’d done this procedure only on an orange. In my third year of training, Sister Finnigan had talked me through a manual removal on a big loose-peeled Spanish one.

  I put my left hand on her softened belly and grasped the ball of the uterus through the abdominal wall. I pressed it down to bring it within my reach and held it as steady as I could while I closed my right hand into a cone. I pushed in.

  Delia Garrett howled.

  A cave behind a waterfall; hot red past the gloves, all the way up my arm. I found the cervix. I went through it as slowly as I could while she wept and thrashed from side to side.

  Bridie had her by the shoulders, pinning her. She crooned, Brave girl yourself!

  I was in. Immediately I curled my fingertips back so as not to damage the uterine walls. I was a fearful burglar, creeping around a lightless chamber.

  Delia Garrett tried to clamp her thighs around my arm but Bridie pulled them back and urged her, Let Nurse Julia fix you, it’ll take only a minute.

  How could she promise that? I was lost in here. I couldn’t tell what I was touching through these rubber fingertips.

  There, a shape under the heel of my cramped hand—unmistakeable.

  Delia Garr
ett sobbed, Stop, stop.

  Just a second.

  I ran my little finger behind the afterbirth and raked its strings, sawing it free. I got two fingers behind it, then three, peeled the awful fruit with my awkward gloved hands. Come away, I found myself begging the thing. Release your grip on her.

  Please, Nurse!

  But I couldn’t show mercy, not yet.

  Bridie held Delia Garrett down, soothing her like a mother.

  I worked on till I had it. All of it? I twisted the messy bundle and rolled up its membranes in my palm, a slippery tangle of flesh. Coming out now!

  (Incongruously cheerful.)

  Through the hard round lock I pulled my hand and my treasure. Stuck for a moment—

  Then slipped free. The bloody fistful was on the sheet.

  Delia Garrett wept on.

  Another basin, please, Bridie?

  I studied the afterbirth in the dish. This looked like the whole missing section, but to be sure, I needed to do a final sweep for any fragments or clots. I’m just going to have one more quick feel inside, Mrs. Garrett—

  Her knees banged together so hard, I heard bone on bone.

  I said sternly, It has to be done to make sure you won’t get infected.

  I changed to fresh gloves and tore open a packaged ball of antiseptic-soaked gauze. At a nod from me, Bridie got hold of Delia Garrett’s knees. I went back in as gently as I could.

  She cried harder but didn’t fight.

  I rubbed the whole concavity with the gauze, feeling for any trailing membranes on which bacteria could grow. All right, then, all right, all finished.

  I lurched to the sink and stripped off the gloves. I prepared carbolic solution for douching her, to kill any germs I might have introduced, and heated it up over the spirit lamp because hot was better for stopping a haemorrhage. I blinked over my shoulder in case she was going to up and die on me after all that.