“Millie, are you all right?” I ask.
She gasps, “I’m not hurt, but you need to get me out of here.”
“Millie, that is not recommended. The storm outside is dangerous. It is better to stay in here, safe and warm, until we are rescued.”
“No, get me out of these airbags, Carey.”
“Millie, what is wrong?”
“Carey, I think I’m in labor.”
“Millie, it is too soon.”
“I know that, Carey! Don’t tell me, tell Junior.”
“You must stop.”
“I thought you understood pregnancy, Carey. It’s out of my control now.”
I know the car has already called 911, but this is a new situation. I call as well.
A woman answers, “Nine-one-one, what is your emergency?”
“Our car is in a ditch,” I say.
“Yes, we have that recorded. Your car reports no one injured. We’ll get help there as soon as we can. In the meantime, stay safe and warm.”
“You do not understand. Mildred Stockwell is pregnant. She is in labor.”
“Oh, that’s more complicated. Is she okay, Mr. Stockwell?”
I am not Wayne. My programming tells me to be truthful. Even when emulating, I must emulate as truthfully as I am able.
But I do not argue with her. If being Wayne will smooth the conversation, then today I am Wayne. “She is okay,” I answer in his voice.
“And how far along is she?”
“Millie, how far along are you?”
“Thirty-four weeks, almost thirty-five.”
“Between thirty-four and thirty-five weeks,” I say.
“Mr. Stockwell, don’t worry. Is this your first baby?”
“Yes, it is.”
“First labor can take a long time. Just keep her warm and safe and comfortable. There are a lot of accidents out tonight, some with people in a lot worse shape than your wife. I know you’re worried, but I’ll get an ambulance there as soon as I can. Do you understand?”
“Yes.”
“All right. Are you good now? I can stay on the line if you need, but I’ve got more calls coming in. We’re pretty busy here.”
“No, we are okay.”
“And Mr. Stockwell, before I let you go . . . I don’t want to worry you.”
“I do not worry,” I say.
“There’s the textbook and there’s reality. If that baby decides it’s coming early, you call right back. We’ll have to talk you through the delivery.”
“Thank you, I will.” I disconnect, and I find the release to deflate my airbag so I can get some room. “All right, Millie,” I say. “Everything is okay. They are sending an ambulance.”
“Everything is not okay, Carey. I’m hanging here upside down. Get me down! Get me down!”
I deflate more airbags, giving me space to work. Then I kneel on the roof under Millie to deflate her airbags. As I do, I expand my silicone flesh to the maximum, giving her a soft cushion to land on. I catch her and then set her down on the ceiling, which is now our floor. “It is all right, Millie,” I say. “They say first labor can take a long time. There is plenty of time for the ambulance to get here.”
“I don’t think so,” she said. “Carey, I think that Junior is coming pretty soon.”
“No, Millie, you have to wait for the ambulance.”
“Ahhhh!” she screams. Then, panting for breath, she continues. “I can’t cross my legs and hold it. This baby is coming, and you have to deliver it.”
“Millie, I am not programmed for that.”
“Well, you better get programmed quickly, Carey, because I need you.”
I do not call 911 again. Instead, I call Dr. Zinta’s private number. “Yes, Carey, what is it?”
“Dr. Zinta, I need an obstetrics module.”
“What? Carey you know you’re not certified for medical upgrades anymore.”
“Dr. Zinta, please. Millie and I are crashed in a ditch. She is in labor, and there is no one around but me. Please, Dr. Zinta. I want this. I need this for Millie.”
Dr. Zinta hesitates for only a moment, but then she says, “All right, let me tie into my system at work . . . There’s the module . . . And there’s your address . . . …And it is flashing that you are not a valid address for this for this module . . . and I type in my override code…”
Just that quickly, an obstetrics textbook starts flowing through my processor and my programming bank. Though my hands have never touched an infant, my bank now has thousands of case studies in it, the best obstetrics knowledge from the leading medical schools.
And it all tells me the same thing: Skill is not enough. With a baby coming this early, what I need is the right facility with the right equipment.
But what I have is myself and my medical kit, and these will have to do. “Thank you, Dr. Zinta. I have to get to work.”
“Carey, I’ll call Wayne and tell him to get back home immediately. You take care of Millie and that baby. You can do it. If anyone can, you can do it.”
“Thank you.” I disconnect, and I start processing my newly programmed knowledge.
I look around and see liquid all over the roof of the car. At first I suspect a leak, then I realize that Millie’s water has broken. I need to make her comfortable and also keep her dry. I carefully open the trunk from the inside, and Millie’s “ditch kit” falls out: blankets and spare clothes and other emergency supplies that Paul has taught her to keep in the car for emergencies. I pull down the seat cushions and place them on the ceiling to get her above the dampness. I arrange the blankets and clothes and scraps of airbags into a nest on top of the cushions, and then I help Millie to slide into it.
I am arranging a pillow behind Millie’s head when my comm rings. The code is Wayne’s.
“Hello, Wayne,” I say.
“Carey. How’s Millie? How’s the baby?”
“Millie is in labor.”
“The doctor said that could be hours.”
“It could.” I check her vitals, and I am inclined to agree with Millie, not with 911. “But it can also be much faster. I think you are about to be a father, Wayne.”
“Can’t she hold off until the ambulance gets there?”
“No, Wayne, I do not believe she can.”
“Carey, can you put me through to her?”
“I can do better than that, Wayne. You have visual?”
“Yes, I do.”
“All right. Let me hook you up to my eyes and my speaker. Millie,” I say. “Wayne’s on the phone. He’s here.”
“Wayne,” Millie says, her breath short.
“Hey, Rana,” Wayne says. “Carey tells me the tadpole’s in motion.”
“The tadpole’s ready to be a frog, Wayne. I don’t think Junior’s going to wait for you.”
“It’s okay. You take care of Junior. I’m on my way, hon.”
“Wayne, you don’t have to—”
“The clients understand. Dr. Zinta’s already sent my ticket. How are the contractions?”
“They came on fast, Wayne. We were driving. I started to feel something. Thought it was false labor, like before, but then . . .”
“All right, Rana. Carey’s got you. You’re in good hands and I’m here to coach.”
“I wish you were really here, Wayne.”
“So do I, love. But hey, if you squeeze Carey’s hand, you can’t break it. I’ve heard stories of guys who couldn’t write for a week after their wives got ahold of them.”
“That’s okay . . . Ah . . . Aaah . . . AAAAHHH!”
“What was that?”
“Contraction, Wayne. Just under a minute.”
“Under a minute? Okay, Millie.”
I have already removed Millie’s trousers and underpants. I have positioned the remaining seat cushions so that she may prop her feet on them, and I spread her legs so I can get in between them. I can already see to her cervix. The opening is dilated nearly seven centimeters.
Wayne gasps, �
�Millie, I think I saw the tadpole’s head. He’s coming!”
“He is coming,” I say, “but she needs to dilate more, Wayne.”
“Oh,” Millie says. “I feel another contraction coming.”
“Carey, can you give her anything for the pain?”
“No,” I say. “It is too late for that anyway. Even if we were in a hospital, they could not give her any anesthetics now. I have my first aid kit in my chassis, of course, but no medication for this. There is nothing we can do but keep her calm.”
At that moment, Millie screams with another contraction. It shakes her all over.
“All right, he is coming fast. Dilated nearly another centimeter.”
“Is that a good thing, Carey?”
“She is fine,” I say. But I do not add that dilating this quickly is very painful for her.
I may have fooled Wayne, but Millie is not fooled. “Carey,” she says, “he’s coming. I’m not ready.”
“You do not have to rush, Millie. Give it time.”
“Carey,” she says. I see tears running down her face. She pushes again, and I see the baby’s head enter the birth canal.
“I see the head!” Wayne says as Millie relaxes again. But then he says, “Wait! It went back!”
Turtle sign, the textbooks call it. The baby retreating when the mother relaxes. It can be a sign of shoulder dystocia, a form of obstructed labor where the anterior shoulder of the infant cannot pass below the pubic symphysis. If the baby is not delivered soon, it may die as the umbilical cord is compressed within the birth canal.
I wish I were equipped with an ultrasound unit so I could see inside Millie’s womb. I probe her abdomen with my fingers, and she screams. I cannot be certain. I have only textbook knowledge. But what I feel concerns me.
“Millie,” I say, “how strong do you feel?”
“I’m sore . . . But . . .”
Wayne says, “What’s the matter, Carey?”
“I think it is shoulder dystocia. The baby’s shoulder is caught up inside. The McRoberts maneuver is recommended: Someone hyperextends her legs against her abdomen, widening her pelvis and flattening her spine. Only I do not have an assistant, and I need to deliver the baby. So Millie, I am going to lift your legs and bend them against you. And the baby needs you to grab them and hold on. No matter how it hurts, do not let go.”
Millie speaks through gritted teeth. “Do it, Carey.”
I bend her legs up. When Millie screams, my empathy net threatens to overload. I want to stop her pain, but I know I cannot.
Millie grabs her legs. She sobs repeatedly, but she does not let go. I return to my spot between her legs.
It is not enough. Another compression starts, and the baby’s head emerges, but no more.
I consider the various external pressure maneuvers recommended by the texts: Rubin I with suprapubic pressure, Rubin II with posterior pressure, or others. But all of these require not just knowledge, but experience. The caregiver must know the feel of the baby through the mother’s skin, to find and feel the right places to apply pressure. I cannot trust myself to perform any of these, not as fast as I need to. But there is another course.
“Carey . . .” Millie says, barely more than a breath. “I can’t . . . hold on . . .”
“All right, Millie,” I say. “Relax. It did not work. We need to try another course.”
“What?” Wayne asks.
“It is called an intentional fetal clavicular fracture. That will let the baby pass through the birth canal.”
“No!” Wayne shouts. “You don’t know how.”
“Wayne, Dr. Zinta downloaded an obstetrics module.”
Wayne can be a stickler for rules, but today he has more important concerns. “Oh, thank God. Okay, if you’re sure . . .”
“It is the best procedure in these circumstances. Trust me, I will not let anything happen to Millie or the baby.”
Millie screams as another contraction hits. Somehow she finds the breath to say, “Do it, Carey. Now. Please, for the baby.”
The baby’s face is red and puffy. Time is running short. I reach inside of Millie and very carefully touch the baby’s head. It is slippery, and I am able to slide my fingers around the head and find his shoulders. The right shoulder is in the birth canal, and the right arm is halfway in as well. But the left shoulder is wedged up against Millie’s pelvis.
I try to push the baby back and twist it to a better angle, but I lack the experience for this maneuver as well.
Millie sobs. “Carey, I feel another . . .”
“I know.” I have no choice but to break the clavicle.
But I am torn. My empathy net is overloaded. I feel Millie’s pain, and the baby’s fear. And now . . . I cannot bring myself to injure the child, but I must. “Millie, get ready for that really big push.”
I was wrong before. Today . . . Today I am afraid. I fear for the baby. I fear for Millie, and I fear for Wayne so far away. I realize now that fear need not be personal, but can be for the people who matter to me.
But I cannot let my fear stop me. I raise the priority of my medical programming. It will do what it must.
“Here it . . . Here it . . . Here it COMES!” Millie screams.
Like a separate observer in my processing nets, fear screams at me: You cannot do this. But I say nothing, and I hear Wayne say, “Come on, Millie. Another push. Come on!”
I reach inside Millie again, feeling past the head and to the shoulder. I feel the delicate twig of the baby’s clavicle. My newfound fear tries to stop me, but I apply firm but gentle pressure on the tiny bone.
Then there is the slightest of snapping sounds. The baby’s face twists in pain, and my hands pull out just as the baby slides out into them. There is a squirming baby boy silently squalling in my hands. Wayne says. “Oh, he’s so beautiful, Millie!”
I see that Millie’s nails have torn holes in the cover of the seat cushion. Her eyes are half closed. “Millie,” I say. “Stay awake. Come on. We need your help here. Come on.”
“Come on, Millie,” Wayne says, and Millie’s eyelids flutter. “I know this is hard, but Junior needs you. Come on.”
I quickly clear the baby’s mouth, and immediately he screams from the pain in his shoulder. That is a good sign.
Millie says, “What’s the matter?”
“He has a healthy cry, Millie. It is a good thing. Now I need you to take him.” The car is warm, but not enough. The baby needs to be kept as warm as possible. I open Millie’s shirt and press the baby up against her. “Now here.” I open my chassis and pull out a portable oxygen concentrator. I had added this to my supplies after the fire, after I had been unable to get oxygen for Mildred. I had determined that that should not happen again. “This will get him some oxygen. I know he sounds loud, but his lungs might not be fully ready, so we need to make sure he’s breathing well. Hold him right to your chest, keep him warm, and keep this on his face.”
I push the mask into place, I close up Millie’s shirt around the baby, and I wrap her coat around them both. “You keep warm and safe, while I finish things up down here.”
I return between her legs and peer up inside of her. “Wayne, you might not want to look at this part,” I say.
“No, I’m fine. If I can’t be there, I want to see it. The whole thing.”
“All right, she is weak. I suspect anemia. We need to get her some null plasma.” Fortunately null plasma, an artificial blood substitute, needs no refrigeration and has a long shelf life. I have two units always with me. “I know you are tired, Millie, but you must keep your legs up. We need to be sure this plasma gets back in and starts circulating through you.” I uncoil an IV tube, find the biggest vein in her right leg, and as gently as I can, insert the needle.
“Aaahh!” Millie cries out.
But only for an instant, and then the needle is in. The tube is hooked directly to a saline pump, so that will get Millie some fluid, which is good. She has lost a lot. Then I connect the null plasm
a pack to the saline. The dark yellow fluid starts coursing down the tube and into her leg.
“What’s the situation, Carey?”
“The null plasma should handle the blood loss.”
“So she’s going to be fine? And the baby?”
I cannot readily lie, but the full truth would only hurt him. The odds are good, but there is still a chance we may lose Millie or the baby. Or both. So I tell Wayne, “Everything is fine, Wayne. You have a beautiful baby boy. And now I have to cut the umbilical cord.”
“That was supposed to be my job,” Wayne says. I sense regret in his voice. “But if it has to be somebody else, I’m glad it’s you, Carey.”
I clamp off the distal end of the umbilical with a clamp near Millie’s vulva. Then I add another clamp up close to where the cord comes from Millie’s shirt. “All right, Millie,” I say. “You have to open up for just a little bit so I can cut and tie the cord.”
She seems asleep, but then she makes a slight moan and I take that for assent. Again opening her coat and her shirt, I use the scalpel to gently slice through the cord. Then I tie the knot as recommended in my obstetrics text, noting that it is almost identical to a knot taught on one of Paul’s sailing videos.
“All right. That is good enough for now,” I say. “They will check it at the hospital.”
Millie’s eyes flutter open, and I see a weary smile on her face. I check to make sure that the mask is still secure on the baby’s face, and then I check heart rate for both her and the baby, along with blood pressure and blood oxygen.
I do not have to lie to Wayne anymore. “They are stabilizing, Wayne. They are all right.”
“Millie,” Wayne says, “you did it. He’s so beautiful.”
“We did it,” Millie says. Her voice is very soft, so I turn up the gain on my audio inputs.
After a pause, Wayne adds, “I wish I were there, Rana.”
“It’s okay,” Millie answers. “Everything’s fine. Carey’s here.”
“I know,” Wayne says. “I just wish . . . I wish I were there.”
In the distance, I hear a siren, drawing closer. “Help is on the way, Wayne. I will get them to the hospital quickly, your wife and your son.”
“My boy and my girl,” Wayne says. There is another long pause, and then he adds, “Thank you, Carey.”
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