The Book of the Unnamed Midwife

by Meg Elison

  This is a work of fiction. Names, characters, organizations, places, events, and incidents are either products of the author’s imagination or are used fictitiously.

  Text copyright © 2014, 2016 by Meg Elison

  All rights reserved.

  No part of this book may be reproduced, or stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without express written permission of the publisher.

  Published by 47North, Seattle

  www.apub.com

  Amazon, the Amazon logo, and 47North are trademarks of Amazon.com, Inc., or its affiliates.

  ISBN-13: 9781503939110

  ISBN-10: 1503939111

  Cover design by Christian Fuenfhausen

  This book would not have been possible without the support of my tribe.

  Inestimable thanks are due to my writer friends, who tolerated rewrites and impertinent questions. Everyone from the SCWP that one summer that changed us all had a hand in this, and I thank you. Writers not from there—Stephanie, Ash, and Avery—I thank you from the bottom of my inky heart. You are all midwives to the story.

  I must thank Robin, the real midwife, for her factual information and for truly terrifying pictures of medical oddities.

  I must thank Devin, who never feigns interest when he doesn’t feel it, but focuses like a laser when invested in a project.

  I must thank my mom, who gave me an idea like a flaming torch in a dark corner of this book before she had read even a line.

  I must thank Di, who was the test this book had to pass.

  First and last, best and always, I must thank my husband, John. My first reader, my best critic, my companion in all things; this work is dedicated to you.

  CONTENTS

  PROLOGUE

  CHAPTER 1

  CHAPTER 2

  CHAPTER 3

  CHAPTER 4

  CHAPTER 5

  CHAPTER 6

  CHAPTER 7

  CHAPTER 8

  CHAPTER 9

  CHAPTER 10

  CHAPTER 11

  CHAPTER 12

  CHAPTER 13

  EPILOGUE

  ABOUT THE AUTHOR

  PROLOGUE

  Mother Ina tapped her fingers on her hollow wooden belly. It tied around her shoulders and the small of her back and sloped out in front, making the curve of a nine-month pregnancy. Mother Ina was very old, too old to really be pregnant. Her hair was white and so short that her black scalp showed through, shining. She tapped again, her thin fingers drumming so that the hollow sound echoed through the room. She clicked against the wood with her fingernails rhythmically until the scribes looked up at her.

  Six boys, all around the age of puberty. Their faces were hairless, and their eyes were bright in the morning light. The schoolroom was older even than Ina herself. Parts of the building had collapsed. The biggest spaces had once been gyms and theaters and auditoriums, but over the years they’d sagged and then fallen, weighted with rain or snow. The long corridors of offices stood empty. Squirrels nested in the file cabinets, and the branches of trees grew in through the windows.

  Ina’s village used only three schoolrooms. These were swept and kept up. Blackboards and wooden desks. The hardest things to mend were the glass windows. Some of the more skilled craftsmen had learned to pull good windows out of other buildings and reuse them, but they were never the right size. The classrooms still got sunlight, but much of it came through old sheets of plastic and acrylic. The light was enough.

  The scribes had good pens. They had been trained since babyhood with walnut ink and berry ink until they were old enough to be trusted with the precious ink taken from squids or cuttlefish. Fishing them was deep business, expensive and time-consuming. Each boy had a stack of straight-cut hemp paper and a glass jar of the blue-black ink. Each boy had a stylus and a narrow squared nib. Each had been taught perfect, even script and how to line out a page and work carefully, conserving.

  Tap, tap, tap went Mother Ina’s fingers on her wooden baby belly.

  “Are you boys all ready?”

  They gave her their silent attention. It was their signal.

  “Good. You boys were chosen for a special project this year. You’ve all copied from the Book of the Unnamed Midwife before?”

  Nods.

  She walked to the large wooden desk behind her and pulled a light cloth away. Beneath it lay nineteen leather-bound books of varying size and thickness. Some were very worn. One showed the bloat and wrinkle of water exposure. Scrapes on the leather were visible on every side. The boys craned to look, but kept their seats.

  Mother Ina picked up one volume with a gentle hand, and the boys could see another chamois cloth underneath the books. She held the volume up for them to see. In the bottom corner of the front cover, a year was stamped in gold.

  The boys knew how old the Book of the Unnamed Midwife was; they had all studied it, and the stories had been told all their lives. This book was four years older than what they knew.

  “The Book of the Unnamed Midwife is actually these nineteen journals,” she began. “What we have taught to you boys is called the canon. It holds the story of the dying. The Book of the Dying is very hard to read, and terrible things happen in it. Some of you might cry or feel sick. That’s ok. I felt sick, too, when I came to read it. Almost all the mothers did. You boys are just as strong as we are, and you might feel it, too.

  “You have all learned the hives and the Book of Honus. The Book of the Dreamless Ones is what you’ll finish with when your training is complete.” She gestured back to the stacks of books on the desk. “These are the rest of her story. The canon is short, but the whole story is longer, and messier. Each year, a group of scribes is chosen to recopy the entire cycle. This year that group is you.”

  There was excitement in the room. The boys felt pride at having been chosen and were fairly bursting to know that there was more to this book than what they had been taught. Their faces twitched like the whiskers of rabbits. But they had been trained their whole lives to be silent and obedient to the mothers, and so the room was a quiet hum.

  Mother Ina was pleased.

  “You’ll begin today. These are the originals. The people trust us that much. So we must be worthy of that trust. That means washing your hands frequently. Senders will bring warmed water and clean towels. That also means we’re going to have to close the shutters. Paper this old cannot be exposed to sunlight all day. We will work extra carefully and preserve these books. Won’t we?”

  As one, they answered. “Yes, Mother Ina.”

  She nodded. “Get into pairs. Each scribe must start his own copy, but you will share and help each other care for the book.”

  She walked the first volume over to a pair of boys who had quickly pushed their desks together. They waited with their palms down on the wood. She put the book on the table and their eyes dropped to it. When she opened the cover, a loose leaf of hemp paper sat on top of the pages.

  “You may begin.”

  CHAPTER 1

  Book of the Unnamed Midwife

  Volume One

  The Book of the Dying

  15 January

  Patient that I was seeing earlier this week with the fever thing was transferred out. Team of guys with all the protocol bells and whistles. Heard there were a couple of cases on the same floor, but I didn’t hang out with anyone this weekend, so I didn’t hear. Was supposed to meet Karen for drinks, but all she does is complain. She should just dump him and get it over with. Hate the sound of his name, especially when she’s drunk. Gerry = shit. I got it = we all got it.

  30 January

  More fever patient
s, but almost all women. For a while they were saying it was some kind of widespread food poisoning thing but >>> Dallas, so it’s not just us. Jack’s been in the lab with it for days, and I’ve been sleeping in the call room and barely seen him. Exhausted. Worked doubles all this week, half the nurses are sick. Haven’t attended a delivery in ten days. Fever 1, babies 0. Losing team.

  31 January

  Called Laura in Conn. Talked shop. Miss her and told her to kiss her kids for me. Sounds like I feel. Asked her about how they’re doing. Small town = better odds, but the odds sound bad even there. Starting to freak out. WTF is going on?

  2 February

  Shit I missed deliveries, but not like this.

  Don’t even know what to say about the rate of infection. Can’t even put the rate of stillbirth or basically stillbirth into words. What. The. Fuck. Whole hospital under quarantine, but what good is that? Got texts from over at the Mission clinic from Pilar, and she says the homeless have got it just as bad. Out in the street. Fucking everywhere, but the lab has nothing.

  4 February

  CDC is all over SF. News is terrible. What they were showing from New York can’t really be happening. BART stopped running. Not like I’m going anywhere, but damn. Preachers outside with megaphones. Hate to wish them death while so many are dying, but better them than every neonate.

  Jack says it’s autoimmune. Almost wish I hadn’t asked, he looked so scared when he said it. Think that was more because he doesn’t know. No antibiotic. No interferon. No anti-inflammatory, no sedative, no emetic, nothing. Nothing touches this once it starts. We’re all wrapped in plastic, but it doesn’t seem to matter. Marianne went down with it two days ago. Shirley’s looking like shit, so they sent her home. Dr. Kaufmann just DFO’d in the middle of a consult. Wake up and hear the shouting, the sound of flatlining.

  6 February

  Feel like shit. Fever 1, me 0.

  7 February

  Know I’m getting sick, but no one gives a single solitary fuck. Everyone is sick. Jack came and sat down with me, felt my fever. Looked like he wanted to die. Said that some men are recovering, but not women and not children. Told me that the fever skyrocketed in pregnant women, and we were at one hundred percent fetal mortality in delivery, nearly as high maternal death. Fell asleep with him holding me. Don’t think I can work tomorrow.

  Don’t think it will matter.

  In the days when the world had not yet fallen, the screaming of sirens was constant. The structures that still held were the ones designed to cope with emergency and disaster, but none of them could work indefinitely. Desperation moved block by block, and people fought and fled.

  They died of the plague, and they died of proximity to each other. When there weren’t enough people in charge of keeping the lights on, the cities went dark. When the sirens quit, the rules gave out. Some people had been waiting their whole lives to live lawlessly, and they were the first to take to the streets. Some people knew that would happen; they knew better than to open their doors when they heard cries of help. Others didn’t. What disease cannot do, people accomplish with astonishing ease.

  She awoke in the hospital, on a cot in the nurse’s break room. There was no chart on her bed, and her name tag was missing. The woman knew who she was and where she was, but everything else was gone.

  Her mouth and throat felt like she hadn’t had a drink of water in days. It took her a while to get her bearings. She tried light switches and stared at machines that wouldn’t turn on, stupefied by their disobedience. She stopped at the first body she saw, checking for a pulse. She stopped at the second and the third before she got the idea. She ran out of the building, blundering into an emergency exit. No alarm sounded.

  The sun was bright and bouncing off the fog that had just begun to rise over the bay. She walked in stark and rising panic out the door and over the blocks between the hospital and her apartment. She saw no one. No buses ran, no cars moved on the streets. The stoplights were dark. She remembered treating plague victims, hearing impossible rumors. She remembered her friends dying before she got sick. She knew what had happened, but it still made no sense to her.

  She made it to her apartment and stripped off her scrubs. They were dirty, always dirty after a shift with blood and amniotic fluid and urine and everything the body can leak. These were stiff with filth, and she couldn’t remember how long she had been in them. She got out of her bra and underwear and climbed into the shower, trying to think straight. The water shot out of the showerhead ice-cold, and she frantically clawed at the knob to warm it up. The water lost pressure, then stopped running. She pushed and pulled, twisted every direction. She tried the tap in the sink. Nothing came.

  Cold and naked, she walked to her kitchen. The bananas were black, and the bread was green. She found a box of crackers and sat on the couch. She hit the button on the remote to try her TV, but it didn’t turn on. She sat staring at it anyway, shoveling crackers until the salt was too much.

  In the warm fridge, she found a bottle of Gatorade and drained it, standing there with bare feet.

  She walked out of the kitchen and stood in her living room. Her apartment was mostly below ground level, and weak sunlight came streaming down from the long, skinny windows above. She stood dumbly, looking at the floor, the silence pressing in on her ears.

  “What the fuck? What the fuck?”

  The question repeated quietly for a long time. The answer did not come.

  She put on a pair of panties and an old T-shirt and climbed into bed. She burrowed down into her own smell, the most familiar and comforting place in the world, and she refused to think. She slept for nearly a day. It was an hour or two before dawn when he woke her. He was in bed with her, his weight pushing down on the edges of the mattress and shifting her side to side. She stirred for a second and thought it was Jack, come home to her. She sat up, smiling, the whole thing forgotten for that one golden second before full consciousness took hold.

  He pushed her back down by her shoulders, and he was breathing hard. She knew everything at once, every awful thing.

  Everyone was dead. This was not Jack. She was alone.

  He let go of one shoulder to reach down and unzip. He moved the hand holding her down to her neck and pushed the crotch of her panties to one side with the other. He was crushing her throat, using his weight above her to keep her from rising or getting her breath. She kicked once, twice, and her ankles caught in her sheet. She knew that was wasted effort. She was clawing at his face with her hands, and he barely seemed to notice. She couldn’t see him in the semidarkness. He was a shape, a weight, an intrusion she couldn’t do anything about.

  He pushed against her, trying to force his way in. She turned her hips, pulling them back, twisting right and left, drawing her knees together. He swore and wrestled with her, pushing her legs back with his knees and leaning down more heavily on her neck. Her vision was darkness and explosions as she gasped. She let go of his face and felt how weak her arms were getting as they fell. She bucked with her whole body, trying to twist sideways, get her knees under her. He felt her flexing and struggling like a cat and worked with her suddenly, turning her over on her belly and pushing down on the middle of her back.

  He switched his legs to be outside hers in one jump, came down hard on her, and pushed against her again. She felt his breath on the back of her neck and his half erection frustrating him. He pushed his uselessness against her dry, closed lips. He took his hands off her back to reach down to her ass to force her cheeks apart.

  As soon as his weight was off her, she clawed desperately to her nightstand. She ripped the drawer open to the stop and banged her wrist against the side of it, reaching in. Her right hand found her pocketknife. She thumbed it open and flicked it full while he tried to pull her thighs back toward him. She pushed off the nightstand and knocked it over. Half facing him, she swiped the knife in a full arc at arm’s length, still not really seeing. Shaking with panic and still bleary-eyed from choking, she miss
ed what she’d aimed for and caught his chin, slicing it open.

  His hands flew to the wound. She could see a little of the whiteness of him with his face and hands together in the darkness. He made a strangled sound and swung at her suddenly with his right hand, punching her on her cheekbone. The punch only glanced, but her head still rocked back with it. He saw it and reached for her with both hands, his chin dribbling blood in a thin line. With both his hands down, she struck out again with the knife, and this time she did not miss. The hook of the blade caught in his neck, and she pulled it savagely across him with her shoulder stretched at a wide angle. The knife cut through the skin, catching and ripping as she yanked it. His hands flew to his neck, and she saw his blood, black in the low light, pumping out over his fingers.

  He gurgled. She watched.

  When he was no longer attacking her, her training took over. She pushed him back and applied pressure to his hands with her own. She thought about tying up the wound with a sheet as the blood washed over her hands and his together in rhythm. His face was all round black holes, staring up at her. The dark blood rushed out of him, staining her bed. She was covered in it. Her knife had fallen to the floor. She thought about her phone, realizing she had knocked it across the room when she’d sent the nightstand tipping over. Then she remembered it was useless.

  She looked back at him, and the coursing of blood was getting weaker. His arms were growing slack, and his choking sounds were fading. She pushed harder against the wound and remembered how he had held her down, just like this.

  It was over quickly. His hands relaxed and slid away from his neck. She let go when he did, watched him go limp all over. She saw the gap in his throat, a ragged trench that leaked out slow blackness.

  Her feet tangled when she tried to get out of the bed, and she fell out of it instead. She tried to stand, and her knee found her still-open knife on the floor. It made a tiny cut in her skin, and she mechanically walked into the bathroom and found the peroxide in the cabinet by feel. She opened the white cap of the brown bottle and poured it out over the tiny cut in her knee until the bottle was empty. The bubbling, cold liquid ran down her leg on to the tile floor.