Without Borders

by Amanda Heger

  “Yes, but it is only a few people. And this is the first time they carried a gun.” Marisol held her arms out again, and Annie wrapped her friend in a tight hug.

  “Is your brother okay?” she asked when Marisol’s sniffles dried up.

  Marisol clamped her lips together, but a small laugh still escaped between her tears. “I did not know your tampons were electric. Those were not on the packing list.”

  The corners of Annie’s mouth tugged up, despite the terror and embarrassment still swirling inside her. “But you don’t think he’s really hurt or anything, right? Should I go check on him?”

  “Only his pride, mi Anita. Give him some time to recover.”

  Over her friend’s shoulder, Felipe stood motionless, his arms crossed tightly against his chest and the rifle slung over his shoulder. Everything about him screamed stay away.

  Around them, Phillip and Juan repacked bags, plucking gauze pads and vials from the dirt. Annie took a deep breath and squatted next to her things, dividing them into four piles. Then two long lines. She merged them all into one and reached for her backpack.

  “What are you doing?” Marisol raised an eyebrow.

  “Packing,” Annie said. “It makes me feel better.”

  “Oh yes. Your anal probl—”

  “¿Vamos?” Juan’s voice was quiet.

  Annie moved faster, trying to keep her mind and her belongings in order. “Will we take the boat all the way to the truck?” she asked, trying to shake torn blades of grass off a shirt. Even now, fifteen minutes after the boys had disappeared into the woods, her hands still trembled.

  “What do you mean?” Marisol asked.

  “We’re going back, right? So we can make a police report or something?” And maybe I can call my dad about an emergency flight home.

  Her friend shook her head and looped an arm around Annie’s shoulders. “We will keep going. It will be fine. You will see.”

  Day Ten

  The midwife fluttered around Felipe in a panic, pelting him with detail after detail about her patient’s progressing labor. Her face grew redder with every syllable, and she ran her sausage fingers up and down her stomach as she spoke. Around them, waiting patients stirred and mumbled, staring at the dirt beneath their feet. Felipe knew they were only pretending not to listen.

  He put a hand on the woman’s fleshy forearm. “I will come as soon as I can get my things together,” he said. “You stay with her.”

  She scurried out of the clinic, glancing over her shoulder every few steps, as if to be sure Felipe was packing up his things to follow her. She paused in the doorway and turned to face him. “It is my daughter.” Both her eyes and the pitch of her Spanish pleaded with him. “Please hurry.”

  Felipe gave her a single nod and scoped out the line of patients. Four people waited, none of them bleeding, broken, or teetering on the brink of death. “I am very sorry, but there is an emergency. If you leave your names here, I will come to your homes tonight.”

  He paused, anticipating an outcry. He knew some of these people had been waiting for days to see him, maybe even months—since the last time his team visited. But they all nodded and patted him on the back as he passed by. One man even promised to say a prayer for the baby’s safe delivery, and gratitude filled Felipe’s chest.

  “Where is Marisol?” He dropped his supply bag on the bench next to Annie. She’d taken up residence there during the clinic, first as she handed out nets and then to entertain the children who came to stare and ask her questions. The kids froze and stared at him with scowls and narrowed eyes.

  “Can you move that please?” Annie asked.

  He lifted the bag over his shoulder. A smattering of scuffed metal jacks and a blue rubber ball clunked to the floor with the movement. “Sorry,” he said to the children. “It is important. Where is she?”

  Annie cleared her throat and looked pointedly toward the door. “I think she and Phillip went off somewhere…”

  Of course. “I need help. Do you want to see a childbirth?”

  She was on her feet and at his side in half a second, leaving the kids alone to their game of jacks. “Obviously. Also, about yesterday—”

  He waved her off. There was no time. “This will be a complicated birth. I am not sure what will happen.” A flash of doubt ran through him. The mother, or the baby, or maybe both could die. And Annie would be forced to watch. “If you do not want—”

  “I want.” She flipped open the notebook and held her pen over a blank page. “Tell me what’s going on.”

  As they zipped along the path between the houses, Felipe told her everything he knew—the patient was young and pregnant for the first time. She wasn’t due for another four weeks, but her water broke that morning. And the midwife was certain the baby was breech. He told Annie how he would first try to turn the baby inside the mother’s womb and what he would do if the baby refused to move.

  He didn’t tell her he’d never delivered a baby outside of a hospital.

  “How do you know the baby’s breech?” she asked.

  “The midwife told me.”

  “Yeah, but how does she know? I’m assuming there aren’t any ultrasound machines out here.”

  “It is possible to tell. I will show you.”

  Her face lit with excitement, but the smile slid from Annie’s face as they stopped in front of the midwife’s house. Ten people gathered on the overgrown front lawn, their hushed voices unable to drown out the screams coming from within.

  “Buenas,” he said.

  The crowd descended on him like a flock of vultures on a carcass.

  “She is in much pain,” one woman whispered to him in a mix of Miskito and Spanish.

  A man with a scraggly beard shook his head. “This sounds very bad.”

  The voices followed Felipe to the house, and by the time he and Annie reached the entrance, his heart thumped so hard he could feel his pulse in his toes.

  “Buenas.” He pushed back the length of fabric over the door frame. A scream slashed through the air, and beside him Annie’s eyes widened. “Are you sure you want to stay?” he asked.

  • • •

  “Yes.” The word came out in a squeak, but Annie lifted her chin and tried to slow her breathing. “I want to stay.”

  “Okay. Come.”

  She followed him into the house. A rotund man with hound dog jowls greeted them in the front room. He clapped Felipe on the back and ushered them in. A barrage of hushed Spanish passed between the men, and Annie didn’t even try to follow. She shifted her weight and clicked her pen as the screams echoed off the thin walls. Each cry wound her insides further, and by the time Felipe pried himself away from the man, Annie’s whole body was a rubber band, pulled tightly enough to snap in half with the next scream.

  “Okay?” Felipe asked.

  “Sure.” She pushed a breath out between her teeth and followed him to a second room, separated from the rest of the house by thin plywood walls. A single, narrow window provided the only source of light, and the air inside the tiny room was at least fifteen degrees hotter than the rest of the house. Beads of sweat sprung up on every inch of Annie’s skin, rolling over the preexisting layer of perspiration and dirt.

  On the floor, a girl about her age panted, her face screwed up in pain. Sweat plastered her thick black hair to her forehead. Beside her, a woman twice as round as the man in the front room stared at Annie as if she were an alien species.

  “Felipe? Are you sure it’s okay that I’m here?”

  “It is fine. This is the midwife of the village. And this—” he nodded toward the girl on the floor, “is her daughter, Angela. So there is some extra nervousness.” He turned to the woman and rattled off more Spanish. She stood, wrapping him in a hug. He squeezed the woman, then knelt next to her pregnant daughter.

  “What do you want me to do?” Annie asked, kneeling beside him.

  He took her hands in his and placed them on Angela’s stomach. “Here.” He pressed her
fingers into the girl’s abdomen until they hit something hard and smooth. “This is the baby’s head.”

  “Wow.” Annie kept pressing, even after he let go, searching for more body parts. She found what she suspected was an elbow, and her stomach jumped into her throat. “This is so cool. You’re going to flip the baby over?”

  “We will try. But first you must stop pushing her stomach.” For the first time in days, he gave her one of those grins, the ones that brought out his dimple and turned her insides to mush.

  “Sorry.”

  Three hours, dozens of contractions, and two buckets of sweat later, Angela was fully dilated, and all Felipe’s attempts to turn the baby had failed. Resignation hung from the midwife’s cheeks, and even Annie’s earlier excitement was melting amid the humidity and failure.

  “What now?” she asked.

  “We will prepare for the breech birth.” He sighed and peeled off his gloves. “Go to the front room and ask the man to give you blankets.”

  “How do you say blankets?” She pulled the neck of her t-shirt from her sticky skin and licked her dry lips. Salt lingered on her tongue, making her even thirstier.

  Felipe glanced up from his supply bag, his features creased and heavy with worry. “Mantas.”

  Stepping into the main part of the house felt like slipping into a cool bath. She’d forgotten how much hotter it was in that tiny bedroom. But the man was gone. Even the plastic chair where he’d sat earlier was missing. Her eyes darted around the room, taking in the hammock hanging in one corner and a single framed photograph sitting on a cracked table near the front door.

  The girl in the photo was around ten with bright, playful eyes and a smile that stretched from ear to ear. It was miles from the pained grimaces Annie had seen in the back room, but the crooked nose told her it was Angela.

  Angela. Blankets.

  Annie jolted, shaking her head clear. It’d been hours since she’d had anything to eat or drink, and fog muddled her brain. “¿Hola?” she called out, her tongue tacky and dry in her mouth. She stuck her head outside the door, letting the fresh air cool the sweat on her cheeks.

  “Hola,” the man said, eyes wide and hopeful. He sat outside among the crowd, which had doubled in size since they’d arrived. “¿Bebé?”

  “Uh, no.” Annie shook her head. “No baby. I need mantas?”

  The man turned to the crowd. “Mantas.” The people rushed from the yard, and Annie stared after them, her stomach knotting. Where are they going? Maybe I said the wrong word. Shit. Did I tell them the baby died? Shit, shit, shit.

  But two minutes later, the blankets rolled in. One after another, the villagers returned, their arms loaded with cloth. When Annie had a pile so high she could barely see around it, she stumbled into the house.

  “Espera.”

  She turned, shifting her weight to keep the blankets from tumbling to the ground. “I think this is enough.” She hoped her expression and the massive stack in her arms would make her meaning clear.

  The man slapped a damp cloth on her neck and stuffed a piece of sweet, ripe mango in her mouth. The juice ran down her chin, and she closed her eyes, savoring the liquid on her tongue as she chewed.

  “Gracias.”

  He gave her a smile and shuffled outside as the sugar roared through Annie’s system and cleared her head. She jogged to the room with her mound of blankets and tore back the curtain. “Here. It took a little while because—”

  The coppery scent of blood mixed with the harsh odor of antiseptic, and Annie froze in horror. Felipe knelt in front of Angela, slicing her open with a shiny scalpel. He’d told her this was what he’d have to do. And she’d heard of episiotomies before, but seeing it in person was not the same. At all.

  Her knees wobbled, and a blanket fell off the top of the pile. From across the room, the midwife glowered at her, then barked at Felipe in Spanish.

  He didn’t look up from his work. “Annie, are you okay? If you need to go, it is fine.”

  She swallowed her fear and set the blankets beside him. “I’m good.”

  “Okay.” He dropped the scalpel next to a giant syringe and nodded toward Angela. The girl’s cheeks and nose blazed red, and her eyes were swollen and bloodshot. Silent tears rolled down her cheeks. “I need her to squat. Stand behind her and hold her up.”

  Annie rushed to the girl as Felipe translated the request. She hooked her arms under Angela’s armpits, and both of them groaned as she struggled to move. It took three attempts and one hefty push from Angela’s mother, but Annie planted her feet and heaved the girl into a squat.

  “What now?” Annie panted and wiped her forehead on her sleeve, still supporting Angela from behind.

  “Now we push.” Felipe looked at her. Blood and sweat stained the front of his shirt. “On the next contraction, Angela will push. You will have to hold her steady. Yes?”

  She nodded. He spoke to Angela in a hushed voice, and the girl whimpered and squirmed. Annie’s fingers slid and slipped as she tried to keep hold of her sweat-laden skin.

  “Empuje, empuje,” Felipe and the midwife chanted.

  The world erupted.

  Angela grunted and groaned. Her body weight shifted as she pushed, throwing Annie off balance. Her foot skidded in something wet as she scrambled for leverage, but she refused to let herself look down. Don’t want to know. Annie jerked the girl upright and joined in the chant, adrenaline surging through her.

  And for a minute, the world calmed again.

  “We have one leg.” Felipe said. “On the next contraction, I will try to bring down the other.”

  Annie peered over Angela’s shoulder. One tiny, bloody foot dangled from between her legs. “Wow.” The girl’s sobs shook Annie’s body. “Hey,” she whispered. “It’s okay. It’s okay.” She couldn’t find the right Spanish words to soothe the girl’s tears, but she hoped her tone would be enough to offer some comfort.

  “Ready?”

  It took Annie a beat to realize Felipe was speaking to her. “Yeah. How do I say good job?”

  “Bien hecho.”

  Angela writhed and grumbled, sliding dangerously close to the floor. The midwife’s shouts echoed off the bare, unfinished walls as Annie tugged her upright. Plopping down could mean crushing that tiny little foot.

  She wrangled the girl into the squat and the chanting began again. “Empuja, empuja.”

  “Bien hecho,” Annie said between pushes, but she doubted Angela could hear anything over her own pants and curses and screams. Each shout reverberated through Annie’s chest, sharpening the fear growing inside her. And as Felipe delivered the baby’s other leg, for the first time, the full weight of what was happening hit her squarely in the chest.

  This girl could die. In my arms.

  Panic boiled inside her, but Annie blew at the hairs clinging to her forehead and pushed it away. Angela’s body tensed against her, and soon the room was caught in the midst of another contraction, leaving no room for anything but focus.

  Three pushes later, Felipe managed to deliver the baby’s arms. The girl’s mother squatted between Angela’s legs and wrapped the half-born infant in one of the many blankets Annie had procured from the neighbors. Angela leaned over and rested her weight against her mother, giving Annie a brief reprieve.

  She shook out her arms and legs, long numbed by the constant tension in her muscles and the pressure—both physical and emotional—of supporting Angela’s weight. Her back ached, and the metallic taste of blood invaded her nose and mouth.

  Angela leaned into Annie’s arms, ready to push again.

  And again.

  The girl strained and cried out, and it took everything Annie had to keep her upright. Felipe and the midwife swapped positions with every contraction, taking turns at easing the infant into the world. But with every push, Felipe’s face darkened and the midwife’s voice grew shriller as she half cried, half encouraged her daughter.

  Annie had no idea how long it had been since they’d arriv
ed in this dim hut, but every second that passed with those legs and arms dangling outside the womb made her heart ache.

  In a rare moment between contractions, Felipe and the midwife began arguing. They pointed and stomped and shook their hands as the words flew between them.

  Angela sagged in Annie’s arms, pale and sweaty.

  “What’s going on?” Annie asked.

  For a moment, the arguing stopped and they both stared silently at Annie.

  The girl’s mother pointed and nodded at her, shrieking in Spanish, but Annie didn’t understand a word of it.

  Felipe held up a hand. “We are having some trouble delivering the baby’s head.”

  The midwife yelled and pointed again, and before Annie could ask what she was saying, the woman stood and nudged her out of the way with her rotund mid-section. She looped her arms through Angela’s and took the girl’s weight.

  Annie stumbled, her muscles too tired to change position. She squeaked to something that resembled standing, but her back refused to straighten. Felipe looked at her, eyes flashing with fear.

  “We need you to deliver the baby,” he said.

  • • •

  Felipe watched the redness seep out of Annie’s cheeks.

  “What? Why?” she demanded.

  As he rewrapped the infant’s lower half in a fresh blanket, fear overtook him. Everything could go wrong. In one fell swoop, he could lose the mother and the baby, and Annie. “Your hands are thinner than mine. Thinner than hers.” He nodded at the midwife. The woman was right. There was no other option.

  Annie’s mouth fell open, and her body shifted as if she were ready to charge through the door and never return.

  “Please,” he said. “I will tell you exactly what to do. I think—”

  She knelt beside him. “What do I do?”

  Above them Angela squirmed, and her mother shushed the girl, rocking her from side to side. “Rest for a minute,” she whispered in low, mournful Spanish.

  “Get some gloves out of the bag.”

  Annie darted to the supplies, and she pulled on the latex. He gave her the quickest, most basic explanation he could find, but amid the exhaustion and strain of the moment, his words were half English, half Spanish.