‘I’m going to listen to the foetal heartbeat. I’ll make do with my stethoscope,’ she said to Kam, who immediately translated. Jenny was strengthened by his voice and by his presence not far away. She went to work more steadily now, letting her training take over.
‘The FHR is slow, under a hundred. I would have thought tachycardia would be indicative of a problem, but the bradycardia is a worry anyway if it goes on for more than ten minutes. I’ll check again later. Can you ask how long since she had a contraction?’
The patient was getting agitated and the women had to hold her shoulders down until Jen gently pushed them away and helped the girl sit up. She cursed herself for not knowing the language but she kept her arm around the girl and patted her shoulder, smoothing back the sweaty, tangled hair from her exhausted face.
‘No contraction for half an hour and before that very weak,’ Kam said. ‘Is the patient all right? Is that her crying out?’
‘Yes. What’s she saying? What does she want?’
‘She wants her husband,’ Kam translated, his voice sounding very dubious.
‘What’s the man’s name?’ Jen demanded.
‘Abdullah.’
Jen repeated it and her patient grabbed her hands and looked pleadingly into Jen’s face, repeating the name and pointing to herself.
‘Why can’t he come in?’ Jen asked Kam.
The answer was brief.
‘Custom!’
‘Oh, spare me,’ Jen said. ‘You tell him he’s a modern man, a leader, and it’s up to him to start and set new customs for his people. What sort of leader is he that he bows to ancient ways at a time like this? OK, some of them are good, but others must be tossed out. Say it any way you like, but tell that man to get his butt in here to reassure this poor woman. He needn’t stay—in fact, I doubt he’d be much help during a Caesar—but she’s so distressed she needs to see him and she needs to see him now.’
While Kam’s voice rose and fell outside, Jen finished her examination. The contractions must have lost force early in the latent phase for the cervix hadn’t reached four centimetres dilatation. After twenty hours this poor young girl was still in the first stage of labour.
Jen’s admittedly basic physical examination suggested it was a problem with the girl’s pelvis, the bones failing to open wide enough to allow the baby’s descent.
Then voices at the doorway and a flutter of rearranging of scarves among the women suggested Kam might have persuaded the chief to enter the tent to see his wife.
Jen rearranged the rugs and clothing over the girl’s belly and again pushed her limp hair back from her face.
A deep voice spoke and the women scattered like pigeons in a square, then a huge man appeared.
‘I have got my butt in here!’ he said, in a deep, guttural voice, and Jenny had to smile.
‘How long would you have gone on letting my colleague translate?’ she asked as he strode towards them, his eyes on his young wife on the bed.
‘Perhaps for the whole time,’ he said, ‘for why would you believe you needed someone to translate?’
He knelt beside the bed and began to speak very gently to his wife, and once again the language sounded like poetry.
Jen let the two of them talk for a few minutes then she knelt on the other side.
‘I brought my colleague in case you wouldn’t come in, then he would have had to explain to your wife what we need to do. The labour has gone on too long. I think perhaps because your wife’s pelvis won’t allow the baby through.’
She pointed to her own pelvic region and used her hands to show how the pelvic bones usually opened.
‘I think the baby is now getting distressed, and as you can see, your wife is exhausted. I would like to do a Caesarean and deliver the baby that way. You know what it means?’
‘You cut her open and take out the baby. Will she live, my wife?’
Jen could have hugged him. So often people thought first of the child—would it live?—but this man must dearly love his wife for her to be the most important issue in his mind.
‘She will, but she will have to take it easy for a few days—she should move her legs and walk a little but not move around too much or strain herself, just until the scars, both internal and external, heal. I can come back and see her every day if you wish.’
The man nodded then began to speak to his wife, who looked at him with her lovely eyes brimming tears, while her two hands clung to one of his.
He shook his head, and though Jen knew Kam could probably hear the conversation, he knew better than to interrupt whatever was passing between the two of them.
‘She wants me to stay,’ the big man said, looking pale himself now, as if he’d rather be facing a thousand fighting tribesmen than be present at his baby’s birth.
‘Men do it all the time in the West,’ she told him. ‘Even with a Caesarean birth. We can hang up a rug so you can sit at your wife’s head and not have to see the operation. I will give her an anaesthetic so she won’t know you’re there, but I know you will honour your word. And if you are there, we can hand the newborn baby to you, and you can cut the umbilical cord if you wish, so you are part of this great occasion and will be the first to hold your child.’
The man took a deep breath, looked down at his pale child bride and nodded.
‘I will do it,’ he said, and began to give orders so the women came scurrying back, and in no time there was a rug hung above the woman’s waist.
‘I need my colleague to assist me,’ Jen told the leader. ‘It will be easier and safer if he is here. He can remain behind the rug with you, giving your wife the anaesthetic and oxygen to ensure she and the baby are all right. I will also need water and some clean cloth and something to wrap the baby in when it is born.’
More orders, then Kam appeared in the doorway. He took in the situation in a glance and made his way to the head of the makeshift bed and knelt on the other side of patient’s head.
‘I’m doing the anaesthetic?’
A smile for Jenny’s benefit. She was thankful for it, aware her heart was racing with what ifs.
What if she botched the operation and the baby died?
The woman died?
‘It’s ether—you can use it?’ Jen said, handing him a bottle and a swab to pour some drops onto. ‘She might feel nauseous after this anaesthetic,’ she explained to the chief, ‘but it is all we have.’
Jen rummaged around in her bag and produced the small canister of oxygen she’d dug up from a corner of her room and passed this with a mask and tubing to Kam. She set out the instruments she’d need—scalpel, retractors and small clamps being the most important. She didn’t have any obstetric forceps but felt she could manage with her hands, although that might mean her patient would have a larger scar than was strictly necessary.
All these things rattled around in her head as she mentally rehearsed what she was about to do. Then, as a woman put down a basin of water and a pile of spotless-looking cloths beside her, Jen washed and soaped her hands, dried them and pulled on gloves.
The woman Jen had taken to be the midwife remained beside her and Jen was glad she had someone on hand to take the baby and see to it while she finished the operation.
‘Ready,’ she said to Kam.
‘I’ll tell you when,’ he said, and although she couldn’t see him, she knew he’d be pressing the ether-sprinkled pad to the patient’s nose and counting slowly down.
‘Ready,’ he said, and Jen began, swabbing then cutting through the skin and outer flesh through the uterine wall, keeping the incisions as small as possible, feeling for the baby’s head then gently easing him out—for it was a him.
‘You have a fine son,’ she said, handing it to the waiting woman, who used a tiny straw to suction out his nose and mouth. ‘In a minute, when we know he’s breathing real air and turning pink, you can hold him. Do you want to cut the cord?’
A strangled ‘No’ was the answer, so Jen cut and knotted it then m
otioned to the woman to pass the baby to his father.
The woman hung back so Jen took the baby, now a satisfactory pink, his eyes wide open as if to take in all he could of this new world. She held him close for a moment and thought of all that might have been, but the past was gone and with it other dreams and plans and happiness. This was now, and a new life was just beginning. She dropped a kiss on the cloth swaddled around the little head, then leaned around the rug to hand him to the man who sat there, still holding his wife’s unresponsive hand.
Keeping his promise.
An honourable man.
He took the tiny child, a look of wonder akin to disbelief on his bearded face and tears in his dark eyes, but though he held the child, he turned his attention back to his unconscious wife. The deep love he felt for her was almost palpable.
Jen delivered the placenta and sewed up the wounds she’d made, checking for any signs of bleeding as she went.
‘I’m putting a dressing on her now,’ Jen said to Kam, knowing he would be watching the woman’s eyes for signs of returning consciousness. ‘Let’s see how clever you were at judging dosage.’
‘If you knew how long it was since I used ether,’ he grumbled. ‘In fact, I don’t know that I’ve ever used it.’
‘Everyone can use it,’ Jen reminded him. ‘Didn’t dentists use it for a long time in the past?’
‘She’s coming round,’ Kam said, and his voice told her how relieved he was. ‘Have you any pain relief we can give her? The wound will hurt like hell.’
‘She will forget her pain when she sees her son,’ the chief said, but Jen wasn’t so sure.
‘I’ve got some tablets I will leave for her,’ Jen said, speaking to the chief again. ‘Do you have access to ice, or is that a stupid question?’
‘We have power in the village and refrigerators. I can get ice,’ he said, so Jen explained how wrapping ice in towels and holding it against the stomach might help reduce the pain.
‘And make her take the painkillers—she can still breastfeed her baby without them affecting her milk.’
One look at Kam’s face was enough to tell her that this was not the kind of conversation this desert chief was used to, but the man was holding up very well, mainly because most of his attention was back on the tiny being in his arms, who was wriggling now and then and gazing up at his bearded father as if taking in every detail of the man who held him.
The patient stirred and groaned, and Jenny wondered if she should give her something stronger than an oral analgesic until the maltreated parts of her body settled down, but then her husband bent towards her, tilting the baby so she could see his face, and wonder overtook the pain.
She reached out a tentative finger and touched a tightly clenched fist, then she looked up at her husband, the question—is he really ours?—obvious in her eyes.
Kam slipped away and Jen roughly washed her instruments, wrapped them in a clean cloth so she could take them home to sterilise them and moved towards the door, leaving the pair to examine their miracle together.
‘Have you asked about Hamid?’ she asked, joining Kam outside the doorway.
‘They will get him when we are ready to leave,’ Kam said, but something in his voice made her turn and look into his face.
‘You don’t believe him?’
‘Oh, I believe him, it’s the “when we are ready to leave” part that bothers me,’ he said. ‘Do you think that man will let you go when his wife still needs care? Do you know what it would have taken for a man like him to be present at the birth of his child? He is going against thousands of years of tradition, which tells me he must love her very, very much. Do you think he’s not going to worry about her recovery? Not want a trained person taking care of her?’
‘But I can’t stay,’ Jen protested. ‘And he promised.’
Kam touched her arm, no doubt to calm her, although she was feeling far from calm.
‘It wasn’t he who promised,’ Kam reminded her, ‘but his lieutenant. Desert people are very wary about making promises because their word is their bond. So they will avoid giving it. They will procrastinate as long as possible or seek an out. In this man’s case, the out is his lieutenant. He’s the one who gave his word.’
‘Well, it was that or shoot me, I suppose,’ Jen said, and although she spoke lightly, she was feeling a great deal of disquiet.
‘Don’t worry,’ Kam said. ‘I’ll find the man who promised and talk to him. He is obviously trusted by his chief that he was sent on the mission, so he must be important to the tribe. What if you write out exactly what must be done for your patient—when to give her painkillers and how many, when to check the dressing and change it if necessary? Have you enough dressings and antiseptic to leave some for them? I’ll check the chief reads English as well as he speaks it and if not will translate your instructions. We’ll set everything up then tell them we can come back—when? A week?’
Jenny thought about it, her imagination providing lists of things that could go wrong for the young mother.
‘I don’t know, Kam,’ she finally said, and must have sounded so despairing he put his arm around her and gave her a hug. She nestled gratefully against him, drawing strength from his body. ‘Not a week certainly. Imagine if infection set in!’
Comforting, that’s what it was, to have his arm around her shoulders, and if it started little tremors of desire at the same time—well, she didn’t have to acknowledge that part.
What she had to do was concentrate on the problem.
‘It didn’t take us that long to get here. What if we take Hamid back tonight and I promise to come over again each night to check on her?’
Kam gave a long, theatrical sigh.
‘So much for kissing in the moonlight,’ he said, squeezing her a little closer.
‘That was never going to happen,’ Jenny told him. ‘I’d come to my senses just before the messenger arrived. As you said, this can go nowhere, so why…?’
She shrugged away the rest of the explanation and eased away from him before he felt the tremors in her body. Only this time they weren’t just tremors of desire, they were tremors of disappointment as well.
But Kam must have felt something, for he moved away as quickly as if she’d pushed him.
‘I’ll find our guide,’ he said, and disappeared into the shadows.
CHAPTER SEVEN
THE guide returned but his face was grim. He spoke to Kam, and now it was his turn to look grim.
And angry!
‘Apparently the chief says we cannot go,’ he translated, but something in his tone told Jen that wasn’t right.
Although it wasn’t hard to guess what bothered him.
‘ We cannot go?’ she repeated, with just enough emphasis on the first word for him to understand she’d guessed the things he hadn’t said.
‘The chief wants you to stay. I have offered, and explained I can do whatever is necessary for the woman should things change. I said I could work through the midwife here, but the chief wants you.’
‘And Hamid?’
‘Our guide says Hamid is waiting for us—he has him safe.’
‘Then you could take Hamid back and run the testing for a while. The two nurses know what to do—all you’d have to do is check the slides and put out the medication. I’ll stay for another day and—’
Kam couldn’t believe she’d be stupid enough to suggest such a thing, and his anger at her, and at the situation, made his abrupt ‘No!’ sound far too loud, too aggressive, too explosive.
‘One goes, we all go,’ he insisted. ‘You’ve said you’ll return. Why should your word be any less believable than theirs?’
Useless question. He knew why. For centuries these people—his people—had trusted no one but their own, often with good reason as waves of raiders and conquerors had swept across their lands.
He spoke to their guide, who was adamant Jenny could not leave the camp, although he seemed shamed to have to say that.
�
�Well, she needs to sleep. At least show us to somewhere we can sleep, and we want the boy with us—that was your promise.’
Their guide nodded and led the way to a small cave, hollowed out over the centuries by the nomads as shelter and home during their summer stays in the mountains. Inside, lit by the dim light of a tallow lamp, the little boy already lay asleep, the photos clutched tightly in his hands.
Jenny squatted beside him and watched him as he slept, then she looked up at Kam and smiled.
‘So we’ve saved two children today,’ she said softly, and in the words he heard an echo of the child she hadn’t saved. That she could be so—so brave—about this situation affected him deeply, sparking anger deep inside.
‘Saved him? Don’t you realise the situation? We’re far from saved, and neither is Hamid, and now we’re at the mercy of the chief.’
Jen shook her head.
‘Do you really believe he’ll harm us?’ she said, and Kam couldn’t tell a lie.
‘No, not harm us, but he could keep us here indefinitely.’
‘Not us—me,’ Jen argued. ‘You can go, the guide will take you back, you and Hamid, which will stop Akbar’s self-destruction, and it will mean the testing can go on.’
‘Forget the testing!’ Kam all but yelled the words, remembering the sleeping child and stopping himself just in time. ‘And forget about me going back and leaving you here, that is just not going to happen.’
But even as he spoke, he knew he had to do something. For a start, if Arun didn’t hear from him for twenty-four hours, he would start to worry. The way the country was, they’d both known that Kam going out into the far reaches of it had been the most dangerous job, for if he was recognised by anyone against the hereditary regime, he could be captured or even killed.
And here, should someone recognise him, he’d make the perfect kidnap victim, held to ransom to finance the struggle going on between the tribes.
They had to get away.
Tonight!
‘Did you write out the list of what to do for your patient?’ he asked Jen.
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