The Pull of the Stars

by Emma Donoghue

  What on earth does that mean?

  Bridie took a breath to speak.

  I threw her a look.

  She said, I was upstairs just now, and I couldn’t find Dr. Lynn.

  The first policeman’s shoulders sagged. Well. When she comes in next, tell her she’s obliged to present herself—to turn herself in at Dublin Castle, as a matter of urgency.

  I said, Certainly, Constable.

  Head skewed around at the end of the mattress, Mary O’Rahilly had been watching this scene play out with fearful eyes. But now a pang seized her; she hauled on her looped towel and let out a long groan.

  The policemen fled.

  This time I lifted up her right foot and set it against my hip as she pushed. No sign of any progress.

  When I got a chance, again over by the sink, I asked Bridie in a whisper: Did you make that up, about not being able to find Dr. Lynn?

  Bridie’s mouth was mischievous. Not exactly. They said she was in surgery and they’d get a message to her.

  Mary O’Rahilly cried out again.

  I hurried back. I palpated her abdomen and used the ear trumpet to check that the foetal heartbeat was still pattering away. She’d been working for—I checked my watch—more than an hour and a quarter now, and the head didn’t feel to my hands as if it had descended an inch. What could be blocking the way?

  Such confidence in Bridie’s light blue eyes, turned towards me as if I knew everything, as if all things were possible to me and my lucky hands.

  The bladder. Mary O’Rahilly hadn’t emptied it on my shift.

  Bridie, a bedpan, right away, please.

  I persuaded the girl to lean up on one hip and got the thing under her. You need to pass water to make room in there, Mrs. O’Rahilly. Try to release it. Even a drop.

  She sobbed and coughed. There’s nothing there.

  I wondered if the foetus’s head was blocking the urethra, preventing liquid from flowing.

  I told her, I’m going to let it out for you.

  (Such a simple description of a tricky procedure. Yet in the absence of a doctor, I had to try it.)

  I got Mary O’Rahilly lying down on her left again. Then I dashed to the sink to scrub my hands and find a sterile catheter as well as a bottle of carbolic solution.

  Mary O’Rahilly had her chin on her chest, her teeth bared. She heaved, eyes bulging.

  When the pang was over, I told her, You’re doing grand.

  She gasped when I poured the cold disinfectant over her privates.

  I mouthed at Bridie: Hold her.

  Bridie set her hands on the young woman’s ankles.

  Mrs. O’Rahilly, stay very still for a minute, please…

  I’d inserted a catheter before, but not often, and never into a woman being wracked by labour.

  This will sting, I told her, but only for a moment.

  Her face screwed up. Somehow I found the opening and slid the greased end in, half an inch. She let out a sharp cry.

  But what if everything was pressed out of shape by the small skull—what if I punctured the bladder? I closed my eyes, took a breath. I fed the catheter up into—

  Urine the colour of weak tea shot all over my apron. Quickly I aimed my end of the catheter into the dry bedpan.

  Bridie cried, You did it!

  Mary O’Rahilly was pissing like a soldier now, like a horse, like a mountain spring. When the flow trailed off, I pulled out the tube and Bridie carried the bedpan to the sink.

  I swiped the dark hair out of Mary O’Rahilly’s eyes and told her with more conviction than I felt, That should help.

  She nodded weakly.

  Time went by, and it didn’t help. Nothing helped.

  I considered an enema but decided that she’d been eating so little, there was probably nothing in her bowels. The pangs kept coming every three minutes, a clockwork torture. For all Mary O’Rahilly’s efforts, nothing in her great taut bump seemed to be descending. Could the head be stuck at the pelvic brim? Nothing was changing except that the young woman was getting limper and paler.

  I tried to clear my muddy mind and remember exactly what I’d been taught about obstructed labour. The cause could be passage, passenger, or powers—maybe Mary O’Rahilly’s pelvis was too small or misshapen, or the foetus’s head was too big or had a bad angle of presentation, or the mother was too worn out to expel the foetus on her own.

  Please let this not be a case for forceps. They saved lives, but the mothers and babies I’d seen mangled…

  I felt Mary O’Rahilly’s forehead—no fever. But when I took her pulse, it was over a hundred, and thready.

  Panic rose in me. Between the flu and the strain of labour, she was going into shock.

  Intravenous saline.

  I told Bridie, Stay with her.

  From the sterile trays on the high shelf I snatched a long needle, a tube, and rubber bulb syringe. I filled a bowl to the two-pint mark with hot water from the pan, measured the salt in, then brought it down to blood temperature by adding some cold.

  When I tied a catgut ligature above Mary O’Rahilly’s right elbow and tightened it until a sky-blue vein stood out, she barely seemed to notice. Obedient to the next contraction, she gripped the roller towel and pushed her stockinged feet against the bare rails. (The pillow had fallen to the floor, but I couldn’t reach it.)

  I injected the warm saline and pumped it into her as fast as I could.

  Holding her wrist, I counted for fifteen seconds and multiplied by four. Pulse dropping towards ninety already; good. Was the force any stronger, though?

  What are you doing, Nurse Power?

  It was Dr. MacAuliffe in his smart black suit.

  Blast it. I needed Dr. Lynn, with all her experience in lying-in wards. Unless she’d been arrested already—could she have walked right into the men in blue?

  I said, I’ve given Mrs. O’Rahilly saline for shock.

  I yanked the cannula out of her arm and put a clean bandage over the site. Press just there, would you, Bridie?

  Why is she the wrong way around? MacAuliffe wanted to know.

  So she can push against the rails with her feet.

  He was soaping and scrubbing at the sink already. I gave him a pair of sterile gloves.

  With his right hand inside Mary O’Rahilly, MacAuliffe waited for her next pang and pressed hard with his left on the top of the uterus.

  She let out a long groan.

  I gnawed my lip. One couldn’t simply pop a baby out of its mother, and it might damage them both if one tried. I’d seen wombs perforated or turned inside out by rough handling. But to say so would be insubordination.

  You say she’s been trying for a full hour and three-quarters, Nurse? The head should be much lower than this.

  I resisted the urge to say, That’s why I called for a doctor.

  Hm, said MacAuliffe. Clearly some disproportion.

  The word I always dreaded to hear—a mismatch between a narrow woman and a big-skulled foetus.

  He went on: I estimate the occipitofrontal diameter to be four to five inches and the pelvic outlet rather less than four, but I can’t be sure without taking thorough measurements with a Skutsch’s pelvimeter, and that would probably require general anesthesia.

  This girl might pass out at any minute, and he wanted to put her to sleep so he could fiddle with instruments and formulas to determine the exact ratio of the problem?

  MacAuliffe went on, But all in all, I believe it’s time to intervene surgically.

  I stared, thinking, What, here, in a makeshift fever ward with barely inches to spare between the cots?

  He murmured, The mortality rate for caesareans is so high, I’d rather try a symphysiotomy. Or actually, better still, a pubiotomy.

  My heart sank. These operations to widen the pelvis were common in Irish hospitals because they didn’t scar the uterus and limit future childbearing. Pubiotomy did have one advantage over a caesarean: it was less likely to kill Mary O’Rahilly even if it w
as performed under local anesthetic only on a camp cot by a young general surgeon who’d learnt it from a diagram. But it would mean two and a half weeks of her lying here with her legs bound together afterwards, and it could very well do her damage; I’d heard stories of patients left limping, leaking, or in pain permanently.

  I tried to think of how to phrase my objections.

  Mary O’Rahilly pushed and groaned, but quietly, as if trying not to draw attention to herself.

  MacAuliffe leaned into the girl’s sight line and said, I’m going to numb the area and deliver you now, Mrs. Rahilly. A simple little procedure that means you’ll have no further trouble having this baby or his little brothers and sisters to come.

  She blinked up at him in fright.

  Shouldn’t the man warn her that he was about to saw her pubic bone in half?

  Shouldn’t I?

  I pleaded, Dr. MacAuliffe—

  Message for you, Nurse Power.

  I spun around to find that junior nurse from before panting in the doorway. What is it?

  Dr. Lynn says, have you tried Walcher’s?

  Vol-curse? I didn’t understand the nonsense syllables. Then they resolved into German and made sense.

  I asked MacAuliffe, almost stuttering in my rush, What about Walcher’s position, Doctor—can’t that open the pelvis a little and draw the head down?

  He pursed his lips, irritated. Perhaps, but at this point—

  The junior added, Oh, and you’re wanted urgently in Men’s Fever, Dr. MacAuliffe.

  I seized my chance. I said in my humblest tone, Why don’t I try her in Walcher’s while you’re gone just to see if it might help at all before the surgery?

  Mary O’Rahilly’s eyes shifted between us.

  The young surgeon sighed. Well, I’ll need to get hold of a hand-cranked wire saw, anyway. But do get her prepared, won’t you?

  The moment he was gone, instead of shaving, washing, and disinfecting Mary O’Rahilly for a pubiotomy, I pulled Jellett’s Midwifery from the shelf. I thumbed through the book, but my hands were shaking so much I couldn’t find the page describing Walcher’s position; I had to look under W in the index.

  Rarely used supine dorsal recumbent…it could encourage the pelvis to widen by half an inch, I read. Employ for no more than two to four uterine contractions or a quarter of an hour. Because it hurt the woman so much? Dr. Jellett didn’t say.

  The instructions for positioning called for a surgical table or at least a hospital bed that could be winched up at either end. I had a cheap, low cot.

  But it was open at the foot and there was room for her legs to dangle, so all I had to do was raise it.

  Let’s get you standing up for a minute, Mrs. O’Rahilly.

  She resisted; she sagged; she wailed in my arms.

  I said in a level voice, Bridie, could you look in that bottom cupboard and get out the bedrests—

  Which of them?

  (She was already there.)

  All of them. Stick them under the end of this mattress to make it as high as you can.

  Bridie couldn’t possibly have understood what I was up to, but she didn’t ask anything else, only wrenched up the mattress and fitted the wedges on top of each other on the bed frame like a puzzle.

  Another pang seized Mary O’Rahilly. I held her under the armpits as she cried, crouched, and sagged. I knew I should take her pulse to see if she was going into shock again, but I didn’t have a hand free.

  I told Bridie, That’s it.

  Or, rather, it would have to be, since there were no more bedrests.

  She let the mattress fall. It was tilted up now, as if there’d been an earthquake. The sheets were loose but she pulled them straight.

  Lucky that Mary O’Rahilly was so tiny; this mad arrangement would never have worked with a tall woman. I said, Let’s get her bottom on the end of the bed and her legs hanging right off.

  Bridie stared but then helped me move the young woman into place.

  Finding her hips lifted higher than her head, her back arched, helpless as a pinned insect under her huge bump, Mary O’Rahilly wailed, No!

  Trust me, I told her. The weight of your own legs will help open you up to let the baby down, to let it out.

  (That made it sound as if Mary O’Rahilly was the captor, but wasn’t she a prisoner too?)

  Oh, oh, but the pain’s coming—

  She let out a scream loud enough to be heard all down the passage. She sobbed, couldn’t catch her breath. I’ll snap in two!

  I was a torturer, breaking this girl on the wheel. No more than two to four uterine contractions. Did that mean I should give up after two? Three? Four? Wait for MacAuliffe to arrive with his saw to do his necessary butchery?

  You’ll be all right, Mrs. O’Rahilly.

  But there was no relief for this girl, no respite. She was a canoeist shooting the rapids; nothing stood between her and her fate. The air in the narrow ward seemed to prickle with static.

  Hold her so she doesn’t slip, Bridie.

  I ducked and squatted between Mary O’Rahilly’s dangling feet. I fixed my eyes on the violent red flower of her privates. Your strongest push this time, Mrs. O’Rahilly. Now!

  As she growled and heaved, a dark disk revealed itself just for a moment.

  I told her, I saw the head! One more big effort. Third time’s the charm.

  Collapsed, she barely breathed the words: I can’t.

  You can, you’re splendid.

  Then I had a wild idea and stood up. Your baby’s head’s right there. If you felt it…

  Red in the face, Mary O’Rahilly writhed and panted.

  I seized her right hand, to be ready.

  Her pain stalked around her, doubled back, waited, hit.

  Push!

  But this time I pulled her hand around her bump, between her splayed thighs. Not hygienic, but maybe just what she needed. As soon as I glimpsed the black circle I pressed her fingers to it.

  Mary O’Rahilly’s face went stark with surprise.

  In the brief lull, I straightened up. A shilling-size bit of the head was still visible.

  She gasped. I felt hair.

  I said, The same black hair as yours.

  Now the baby was crowning, I could free Mary O’Rahilly from Walcher’s position. I lifted her right leg up and set the flat of her foot against my belly.

  Bedrests out, Bridie.

  She tugged them away.

  The mattress jerked back down and Mary O’Rahilly with it. I thrust one of the wedges behind her head and helped her up until she was semi-inclined.

  Will I put them back—

  Leave them, Bridie! Just hold her other leg for me.

  She ran around the bed and lifted Mary O’Rahilly’s left foot.

  Shrinking back against the wall, in the cot on the left, Honor White was transfixed.

  Here it comes, Mrs. O’Rahilly.

  She held her breath and shoved so hard with her feet, I staggered backwards.

  A conical head, gummy with blood, facing sideways, straight across the room.

  Bridie cried, Janey mac!

  Half in, half out; always a weird moment, between worlds. The colour was good but I couldn’t tell anything more. I said, The head’s here. Nearly over, Mrs. O’Rahilly.

  As I spoke I was checking for the cord. So as not to introduce germs, I didn’t use a finger, only tipped the tiny face towards the mother’s spine and…yes, there was the cord, wound around the neck. In this position, the cord might keep the body roped inside, or it might get compressed, which would starve the baby of blood; either way, I had to free it. At least it was only looped around once. I hauled on the cord till it was long enough to pull over the small skull.

  A hasty physician would grab the head now and deliver the body himself, but I’d been taught better. Watch and wait.

  On the next pang, I said: Come on, now, bring out your baby!

  Mary O’Rahilly went quite purple.

  The most extraordin
ary thing, one that I’d seen so many times and never tired of seeing: the pointed head turned down like a swimmer’s and the infant dived out into my hands. Alive.

  Bridie laughed as if she were at a magic show.

  As I wiped its nose and mouth, it was mewing already, breath animating the wet flesh. A girl. Her legs were skinny, her privates dark and swollen.

  Well done yourself, Mrs. O’Rahilly. You have a fine girl.

  Mary O’Rahilly let out something between a cough and a laugh. Maybe she couldn’t believe the impossible job was done. Or that girl was the word for her minute daughter now, never again for her seventeen-year-old self.

  While I waited for the thick blue cord to stop pulsing, I checked the baby for the basics—all her fingers and toes, no tongue-tie or sunken fontanelle, no imperforate anus or clicky hips. (Almost every infant did come out perfect, even from women who bore all the stigmata of poverty, as if nature designed babies to take as much as they needed, no matter the cost to the mothers.) No signs of asphyxia despite those hours jammed against the pelvic bone. No sign that the mother’s illness had done the baby any harm.

  The cord delivered its last blood and was still now. I laid the tiny girl facedown on her mother’s softened belly so I’d have my hands free. Mary O’Rahilly’s fingers crept down to touch the sticky skin.

  I tied ligatures around the cord in two places, then scissored through it. I wrapped the baby in a clean cloth and gave her to Bridie to hold.

  The redhead was flushed, exuberant. Oh, but that was something, Julia.

  Mary O’Rahilly begged: Show me?

  Bridie held the girl low enough for Mary O’Rahilly to get a good look.

  Before the mother could ask, I said, They come out with slightly pointy skulls if they’ve had a long journey, but it rounds out in a few days.

  Mary O’Rahilly nodded blissfully. She had a splash of red in her left eye where she’d burst a blood vessel by pushing, I saw now.

  Honor White spoke up in an asthmatic voice from the bed on the left: The one that gives most trouble, the mother loves double.

  I stared.

  She added, ’Tis a saying.

  Maybe from her part of the country; I’d never heard it. I thought of the trouble, in several senses, that Honor White’s first baby must have brought her, and all the further trouble ahead of her.