An Irish Country Welcome

by Patrick Taylor

  He saw her relax a little. “Thanks, Doctor Laverty.”

  He could barely hear her but said sotto voce to Bill, “For God’s sake lower your voice, Bill. You’re scaring her to death.”

  Bill shook his head and blew his breath through semi-closed lips.

  “Puuush.”

  Barry flinched as the scissors cut through the perineum. There was little bleeding, but he could detect blood’s coppery smell. God, how he hoped Sue would not have to endure that.

  “You’re doing very well, Mildred,” Barry said. “Won’t be long now.”

  The baby’s right buttock appeared in its entirety. There was only a scant amount of vernix caseosa, the sebaceous white substance that coats every newborn’s skin, because the glands that produce it were immature.

  Bill continued to teach his student, but in fairness he did lower his voice. “Michael, now we have to be patient and do nothing until we can see the umbilicus.”

  At least as Sue was the wife of a colleague, she’d have no students in attendance.

  One more push and buttocks, thighs, and umbilicus appeared. Bill first pulled down one leg then the other, as well as a loop of umbilical cord. The baby’s legs flopped down between the mother’s buttocks. Its lower back faced up to the ceiling.

  Barry saw, as was usual in breech deliveries of boys, that the scrotum was swollen. He said, “You’re having a boy,” but she did not reply because the next contraction was starting.

  The shoulder blades appeared, and Bill reached into the birth canal under the baby. “Praise be,” he said, “the arms have not extended past the head. Good work, Joan. They’re folded across the chest and I can flip them out so there’s no risk that they’ll interfere with the delivery of the head.”

  Bill turned toward the hall. “Rahul, we won’t need a general, but in about three minutes I’d like you to give her some intravenous Pentothal. Sebastian, come in too. I’ll need you then to suck out the baby’s nasopharynx.”

  Joan, now freed from trying to prevent the baby extending its arms inside Mildred’s womb, left her patient’s side and returned with the suction device. The three-inch cylindrical plastic bottle had two narrow tubes at opposite sides of the top. One stretched from close to the bottom of the bottle out through the lid and ended in a red rubber tip. That was the baby’s end. The rubber was kinder than plastic to babies’ tissues. The other tube barely entered the bottle, so that when Sebastian put its far end in his mouth to suck, he was in no danger of inhaling anything. “Here you are,” she said before returning to her place.

  Even though Bill had looked disbelieving when he’d been asked to lower his voice, he spoke now so only Barry and Michael could hear. “I mustn’t rush, but as the head enters the pelvis, it will nip the cord and cut off the baby’s blood and hence oxygen supply. We’ve four minutes to get the baby able to breathe for itself. Barry, start clock-watching.”

  Barry shot his cuff to expose his Timex watch and took note of the time.

  “Right. We’ll wait for one more contraction and the baby’s hanging weight will get the head into and most of the way through the pelvis.”

  Barry could picture this, and although he knew it would not happen, he had a horrid mental image of the smaller head slipping through and the baby landing in the bucket positioned at the end of the table. He told himself not to be silly.

  As if reading Barry’s mind, Bill held his hands cupped beneath the baby’s bottom. He said, “We’ll know when that’s happened when I can see the hairs on the nape of the neck. Rahul, please give her the Pentothal as soon as the next contraction’s over.”

  “Right,” said the anaesthetist. “She’ll be awake again five to ten minutes after I’ve given the drug.”

  Barry said, “Mildred, Doctor Bannerjee’s going to put you to sleep for about five minutes very soon. It’s another way of making the delivery easier on your wee one.”

  She nodded and managed a weak smile.

  Amazing, Barry thought, how maternal instinct means that for a mother no sacrifice is too great on behalf of her baby. He wondered about paternal instinct, if there was such a thing, and in particular how it might—or might not—affect him.

  “Thanks, Rahul,” Bill said, still speaking softly, “and for your information, Michael, premature babies’ heads are very fragile, and I want a completely controlled delivery of this one’s. An involuntary push would make it pop out in what we call a ‘champagne cork’ delivery. God knows what damage the compression and sudden decompression might do. That’s why she’s getting the Pentothal.” He raised his voice for the patient’s benefit. “And the plus is with the head blocking the cord, no drugs can enter the chissler’s circulation.”

  That was kind. Ever since the thalidomide crisis of the late ’50s linking maternal ingestion of the drug with foetal deformities, pregnant women were terrified of taking any medication.

  Barry asked, “Did you hear that, Mildred?”

  “Only the last bit, but I’m glad to hear it and—oh-oh—”

  “Puush. Puuush.”

  Barry was tiring and braced himself to withstand the pressure of Mildred’s foot by leaning on the edge of the table.

  The minute the contraction ended, Doctor Bannerjee said, “A little jag,” followed shortly after by, “Now, please count backward from one hundred.”

  “One hundred, ninety-nine…” She stopped counting by ninety-one.

  “She’s out.”

  “Thanks, Rahul.”

  To Barry’s delight, he saw the hairs on the nape of the baby’s neck. It seemed like the longest three minutes of his life since the end of the last contraction, but now Bill could complete the delivery of the head.

  And the four-minute clock was running.

  Bill used his right hand to grasp the baby by his ankles and exerted gentle outward and upward traction that did not allow the baby’s body to pass the horizontal. Allowing the arms to dangle, he brought more of the head into view. Meanwhile, his left hand controlled its descent.

  One minute. Barry willed the uterus to contract.

  Two minutes. Come on. Come on.

  Three minutes.

  “Right, Sebastian, suction. I can see the mouth.”

  Yes. Yes. The tightness in Barry’s chest began to ease.

  “It’s like Paddy’s market in here with all of us,” Sebastian said as he knelt, put the tube in the baby’s mouth, and started to suck the end of his tube.

  Barry, for a second, was irritated by Sebastian’s flippancy, but in fairness the man had been out in the hall, quite detached from the drama.

  “Now,” Bill said, “we’ve all the time in the world. Finished sucking, Sebastian?”

  Before Sebastian could reply, the little boy gave vent to his annoyance at being removed from a warm, dark womb to a world of noise and coldness. His yelling was harsh and frequent, even though his head was still to be delivered.

  “Finished? It would certainly seem so.”

  Barry realized his laughter was more from the relief of tension than at any great wittiness by Sebastian, and more to the point, the louder the boy cried, the more he would open up his lungs with each inhalation. He was surprised that Mildred didn’t immediately awake from her drug-induced sleep to respond to his cries.

  “Then, Sebastian, please take over holding the ankles. Do not allow the body to begin to become any more vertical. That would put the neck vessels at risk, Michael, and I’m going to need both hands to put on forceps. They’ll make delivery of the head more controllable and will also protect it from pressure.” He lifted one shiny half of a set of forceps and slipped the concave blade between the side of Mildred’s pelvis and the baby’s head, repeated that on the opposite side, and locked the handles. “Joan, let me know when a contraction is starting.”

  Bill wasn’t using the forceps to tug the baby out, as was their usual function. Instead, by exerting pressure against what was being expelled, he ensured the slow and controlled delivery of the head. Two con
tractions later the little boy was completely out, attached to his mother by only the umbilical cord.

  Sebastian continued to hold the tiny baby aloft until the cord had stopped pulsating and Bill had clamped and cut it. The maternal end lengthened, accompanied by a small gush of blood.

  Joan said, “The uterus has shrunk and is very firm.”

  “Thanks, Joan. See to the baby now, please.”

  Sebastian handed the boy to Joan, who immediately wrapped him in a blanket.

  Barry knew the uterine shrinking was an indication that the placenta had separated from the uterine wall. As Mildred had not woken up yet, she could not help by pushing, so Bill used his left hand above the pubic symphysis to ensure that the uterus remained in place and pulled on the cord with his right. In seconds, the placenta, looking like a small slab of raw calf’s liver, lay on the rubber sheet.

  Bill quickly inspected it. “It’s all there.”

  Good, Barry thought. If bits of the placenta remained inside the uterus, they would prevent Mildred’s uterus from remaining properly contracted. It was that contraction which effectively shut down the maternal blood vessels supplying the placental site. If that failed, severe postpartum haemorrhage would ensue.

  Bill asked, “How’s your patient, Rahul?”

  “She’s awake and knows where she is.”

  “Thanks. Now, I’ve some sewing to do, so, Sebastian, please relieve Barry as a foot support while I sew up the episiotomy.”

  Barry and Sebastian changed places. The stiff back that Barry had ignored during the birth sent him a reminder and he grunted.

  “Now, Barry, there’s a syringe on a shelf behind me filled with ergometrine.”

  The drug provoked strong uterine contraction and, as a further safeguard against haemorrhage, it was undoubtedly important. But was no one going to tell Mildred she had a baby boy? The ergometrine could wait. Barry called to Mildred, “Your lovely wee boy’s here. I’ve only got a quick look at him, but he’s got all his fingers and toes. I’ve just to give you a jag and then I’ll come and tell you all about him.”

  “I’m very glad til hear that he’s got all his bits and pieces. And another wee lad? That’s great, Ken’ll be tickled pink. Me? I don’t care as long as they’re healthy.” And he heard her chuckling. Now it was time for that ergometrine. Barry picked up the syringe.

  “Please give intramuscularly.”

  Barry shook his head. “You may be a specialist and me only a GP, Bill. We’ve been friends since school, so as a friend”—and Barry smiled as he spoke softly—“don’t try to teach your granny to suck eggs.”

  Bill had the courtesy to laugh. “Fair enough. I know I can be a bit thoughtless, but you do know the pressure I’ve been under since we got started here.”

  Barry nodded and said, “Wee jag in your leg, Mildred.”

  “Right.”

  Barry gave the injection.

  “After you’ve had a word with Mum, nip off and let the father know. He’ll have to wait to see his son until the little lad’s in the incubator.”

  “Will do.” Barry went and half-sat on the edge of the table. “So, Mummy, how are you feeling?” He took her pulse.

  “I’m main glad til be rid of them pains, so I am. It says in Genesis, ‘In sorrow thou shalt bring forth children.’ I think it must have been a man wrote that. I was never unhappy, but it hurts like blazes. Good thing you can’t really remember pain.”

  She wasn’t the first recently delivered patient to tell him that. He was sure it would be the same for Sue, but he did not envy her labour, even though the profession had quite effective means of pain relief.

  She looked him in the eye. “Never mind me. What about the wee lad? I know I had til be put out, but I missed his first cries. I’ll never forget his big brother’s.”

  “Number two was announcing himself to the world in no uncertain terms even before he was all the way out. Doctor Howard did a great job. Breeches are tricky, but it was a very smooth delivery. I’m sure your wee lad came through it perfectly. As soon as the midwife has him cleaned up, she’ll let you see him.”

  “I can hardly wait.” She looked down. “And I want til thank you, Doctor Laverty. The wee midwife was very good at helping me, but you brung me comfort. Thank you, sir.”

  “And I’ve brought you something else,” Joan said. “If you could help Mildred sit up, Doctor?”

  “Here you are, Mother,” said Joan. “He’s perfect.”

  The boy was completely swaddled in a blanket and wore a white roll of tube-gauze, knotted at one end as a hat, to help prevent heat loss.

  Mildred, eyes glistening, held out her arms and cuddled her sleeping son and made crooning noises in her throat. “You’re beautiful, my little son. And you’re going to grow up into a big strong boy. You are. Just look at his wee rosebud mouth.”

  Joan smiled. “I know you’d like to keep him a bit longer, but I’m sorry. I have to get him into the incubator in the ambulance at once so we can keep him warm and supplied with oxygen too. When I’ve seen to him and left him with Doctor Bannerjee, who’ll examine him more thoroughly, I’ll come back, and I’ll get you ready to go with your son.”

  Mildred handed her boy back. Her gaze never left him as Joan walked away. “Mammy’s coming soon, son. Soon.”

  Barry smiled. “He is beautiful.” He patted Mildred’s shoulder. “Now I’ll leave you in peace and pop up and tell Ken. I’ll keep in touch with the hospital while you’re there, see how the pair of you are getting on. And we’ll be here for you both when you get home.”

  “Thanks again, sir. For everything.”

  Barry turned to where Bill was finishing sewing up the episiotomy.

  Mildred’s legs were still supported by Sebastian and Michael.

  Bill snipped a stitch. “I heard that, Barry, and I know you of old. I have your home phone number. I’ll give you a call in the next day or two and let you know what’s happening.”

  “Thanks, Bill. I’d appreciate that.”

  “Go on with you.” He carried on with his work. “And Daddy can have a wee peek at his new offspring, but only a wee peek. Preemies are very prone to infections.”

  “I’ll tell Ken.”

  Barry walked away. He felt at peace. The happiness spread by a new mother was infectious. He looked forward to the birth of his first in January as he headed upstairs to where Ken was sitting on a wooden chair in what must be Angus’s bedroom. Angus was fast asleep in his cot.

  Ken leapt to his feet. His eyes were wide. “Well? Well? I heard the bairn’s cries.”

  Barry smiled. “Mildred’s fine and you’ve a lovely wee boy.” Who, Barry thought, has made it through a difficult delivery, but who is not out of the woods—yet. This was not the time for that discussion.

  Ken’s eyes sparkled. “Another wee boy? He’ll be a pal for Angus. Can I see him?”

  “Just for a minute. He is premature, you know.”

  “Aye. Right enough.”

  “He’s in an incubator in the ambulance. Run on down. I’ll keep an eye to Angus.”

  Ken glanced at his sleeping son and whispered, “You’ve got a wee brother, Angus Anderson.” Ken thrust out his hand and Barry shook it. “Thanks, Doc,” he said, and left.

  Barry sat in Ken’s chair and took some deep breaths. Thank the Lord for the flying squad. He and Sebastian could not have managed on their own, and what could have been a disastrous situation had been turned into a semi-triumph by the skill of fellow professionals. And it had been decent of Bill to say he’d keep Barry posted. While there were many wonderful aspects of rural general practice, not being able to follow more complicated cases was frustrating.

  He shifted in his chair, rubbed his sore back, and thought of his tumult of feelings during the delivery—from concern, to outright fear as Bill had begun, to relief when the neck hairs had appeared, to a feeling of triumph at hearing the wee one’s first cry. And if that was how he had felt as a trained physician, how was Sue going to
feel during her own labour? And, he thought, how will I feel? A little shudder shook Barry. He had to be brave for her and stop letting her sense how he couldn’t help worry for her. Because if a little knowledge was a dangerous thing, a lot of knowledge could be terrifying.

  25

  Launched His Frail Boat on the Rough Sea

  “Oh, shut up, Max.” Barry looked up from where he sat in an armchair reading Mario Puzo’s The Godfather. “Bloody dog,” but he smiled as he said it. By some sixth sense, the springer always detected Sue’s approach well before Barry heard her car.

  Max charged through to the kitchen, thrashing his tail and panting.

  Tigger, the stray tabby Barry and Sue had rescued from a winter gale, looked up from where she had been sleeping in front of the unlit fire, first at Max and then at Barry. She yawned, arched her back, and licked her backside to show that she had little time for excitable dogs.

  Barry smiled. Tigger knew felines were the superior species.

  He heard the kitchen door open and Max’s barking rise in crescendo until Sue said, “Come on, silly. Settle down.” He preceded her by backing into the living/dining room, tail going so hard his behind swung from side to side.

  Barry stood, wanting to hug and kiss his wife, but she made a beeline for the dining room table and unloaded her armful of exercise books. “Welcome home,” he said. “How was your day?”

  She shrugged, came to him, and kissed him firmly. “Hectic. My class is still settling in. But I’ll live. I do so enjoy teaching and being with the children.” She sat on the settee and patted the seat beside her. “Not long until we’ll have one of our own.”

  Barry joined her.

  “What time did you get up?”

  “Eleven. Sebastian and I had to go out at two to see a six-year-old with mumps. Only child. Mum and Dad at panic stations. Not all country patients are considerate of their doctor’s sleep. Poor little thing hadn’t been immunized.” That was not going to happen to young Laverty.