He nodded and pushed a package across the table. “Here’s some doxycycline. Sorry it took so long. We’ve had some ideas for your synthetic rubber, but no luck yet.”
“Wonderful!” she exclaimed, bending down to give him a little hug and plant a kiss on his cheek. Standing and tucking the package under her arm, she asked, “Do you know how pure it is so we’ll know how to dose?”
“About ninety-five percent pure. The other five percent shouldn’t be toxic.”
“Great.” She looked over at Narita, “And, um, it looks like you’ve brought in another of your friends with cataracts?”
“Yes,” Geller said, introducing Narita. “Her cataracts aren’t severe… She’s not blind yet, but she’s starting to have a lot of trouble. Is it okay to treat her cataracts before she’s completely blind?”
“Oh yes. Unfortunately, Daussie’s not here. She’s calling on a patient in town and I don’t know when she’ll be back.”
“I, um… I was hoping to have you treat my friend Narita.”
Looking surprised, Eva said, “Oh, sorry, I can’t do them.”
“You can’t?” Geller said, frowning and letting his eyes travel to the package under Eva’s arm, reminding her of what he’d done for her.
“Oh, sorry. We’re having a misunderstanding. Daussie’s the only one who treats cataracts. She’s the one who figured out how to do it. I myself don’t actually know how. No one else knows how to do it yet. I do have a nephew that Daussie’s going to teach. She won’t be the only one much longer.”
“But… you treated me.”
“Oh no. Daussie treated you. I was there, but she’s the one that fixed your eyes. She treated all your friends as well. She’s really quite good at it.”
Geller’s eyes widened. He’d wondered why Daussie had pushed so hard to treat the last three patients he brought in. Why didn’t she tell me she was the only one who could do it? Oh… She probably didn’t want to tell me Eva doesn’t know how, he realized. He pictured one of his grandchildren trying to cover for him if he’d forgotten how to prepare a dye. “Okay,” he said, “Narita and I’ll come back another day.” And I’ll apologize to Daussie when we do, he thought.
***
Daussie followed the urchin down the narrow alley, glancing about in some dismay. She’d heard people speak of this blighted neighborhood, but never been here herself. The homes were built of scrap and junk. The trash collectors obviously didn’t visit this area. Great heaps of garbage were piled here and there.
It’s hard to believe we don’t get more cases of disease from this area, she thought. Then she wondered whether people with diseases in that quarter simply died without seeking help from the tavern. “How did you know to come get us for your mom?” she asked Pippa, the little girl who’d come to the tavern to get help.
“Midwife said to get a healer from the tavern,” the child responded, as if that were an entirely sufficient answer. She turned into one of the hovels and held the door, “In here.”
Daussie bent to step inside, then wished she’d taken a deep breath before she did. A sour smell permeated everything.
An underfed, sweaty pregnant teenager was lying on a straw mattress. She looked miserable.
Daussie immediately recognized the midwife sitting on the mattress and rubbing the girl’s back. She’d been the midwife of the woman Kazy’d taken care of for childbed fever. Daussie’s eyes immediately went to the midwife’s hands. With relief, Daussie saw the woman’s nails were short and clean. Her hands looked like they’d been recently washed.
Daussie knew Kazy’d tried to teach the woman about sepsis and the importance of cleanliness. Even though Kazy’d been able to use her talent to convince the woman that what Kazy taught her was true, that didn’t mean the woman would have understood what Kazy told her. However, when Daussie’s eyes found a bag she thought the woman carried to deliveries she was pleased to see it looked clean as well. Daussie asked, “How long has she been in labor?”
Tiredly, the midwife said, “A day and a half.”
If the midwife’s exhausted, Daussie thought, her patient must be in far worse condition. Another woman sat in a chair beside the bed looking pinched and dismayed. “You’re her mother?” Daussie said nodding at the girl on the bed.
The woman attempted to speak, croaked, then cleared her throat and managed to say “Yes.”
She looked like she was already mourning the death of her daughter and grandchild. And not greatly cheered to have another teenager show up to help with her daughter’s difficulty.
Giving her something to do might be helpful, Daussie thought. She swept the tiny room with her eyes, then spoke to the woman, “Cleanliness is extremely important during a difficult childbirth. If you could clean the room and find some clean cloth for the baby to be born onto, that would be very helpful.”
The woman looked around herself, appearing somewhat surprised by what she saw. Standing, she said, “I’ll do my best.” She started for a corner where Daussie saw a broom.
Daussie turned to the midwife. “Husband?” she mouthed, her eyes going to the girl on the pallet.
The midwife minutely shook her head. “Ran away,” she mouthed in return.
Daussie asked the midwife’s opinion of what was happening with the birth.
The woman shrugged, “Laboring without progress.”
Daussie sent in her ghirit, relieved to find the baby still had a heartbeat, though it wasn’t the strongest Daussie had ever detected. A check of the mother found her undernourished but without other health issues evident. A contraction began, but as the midwife had described, it made no progress. Why? Daussie wondered.
“You gonna check her?” the midwife asked.
I don’t need to, Daussie thought, but knew that was the wrong answer. She sighed, “Let me wash my hands.”
The midwife pointed out a basin that had a scrap of soap next to it. After Daussie threw out the water in the basin, the midwife pointed to a bucket. Daussie poured some fresh water into the basin, then washed her hands.
The midwife told little Pippa to refill the bucket, leaving Daussie to wonder how long a trip it would be to get clean water.
And whether the water would actually be clean.
Daussie tried to position herself so she blocked the midwife’s view of her manual examination of the patient’s birth canal. She’d intended to only pretend to do an examination, since it wouldn’t teach her anything she didn’t already know and—despite the handwashing—would introduce additional bacteria.
However, the midwife adroitly maneuvered herself to a new position so she could watch.
Daussie positioned her hand at the entrance of the birth canal, then, feeling terrible about it, she ported a tiny droplet of pepper extract into the midwife’s nose. By the time the woman completed a healthy couple of sneezes, Daussie had “finished her exam” and was patting the midwife on the back.
Daussie stopped to think about the situation. She knew it was called “obstructed labor” and was more common in younger mothers whose pelvises hadn’t grown to their full width. This could lead to a situation in which the passage through the pelvis could simply be too narrow for the baby’s head. A quick question confirmed the girl was only thirteen. A glance showed hips that appeared narrow.
Daussie sent in her ghirit again. The baby’s head was larger than the bony passage it had engaged but not really entered. Cesarean section, she thought, that’s what the ancients would do. Unfortunately, Daussie knew that in current times an obstructed labor usually resulted in the death of both mother and child. Cesarean or “C-sections,” were only performed when the mother was so close to death she couldn’t fight whoever cut her open. It was done in desperation, in the usually futile hope of saving the child.
But not with any hope of saving the mother.
There’s nothing I can do, Daussie realized.
She stood and turned to the midwife, “The bony opening of her birth canal’s too small for the ba
by’s head.” she said.
The midwife nodded, obviously having come to that conclusion already. Which was why she’d called for help.
“I’m going back to the tavern to ask my mother if she has any suggestions.”
The midwife’s gaze hardened.
Daussie could tell the woman didn’t think Eva’d have anything to offer. She expected she’d be left alone to endure the long hours remaining until her patient and the baby were dead. Nonetheless, the woman nodded as if she accepted the task as her grim duty.
As she made her way back to the tavern, Daussie viewed with great dread being sent back to sit with the midwife and the girl until the girl’s inexorable death.
~~~
“Do you know of anything we can do?” Daussie asked her mother after explaining the situation. She sounded plaintive even to herself.
Eva slowly shook her head.
“So, um…” Daussie said, waiting for Eva to sentence her to return and sit with the girl until she died, but unwilling to volunteer.
“So,” Eva said a little impatiently, “have a look in the book on obstetrics. I don’t know everything.”
~~~
Daussie waited until her mother finished with a patient, then said, “The book recommends a C-section.”
Eva chewed her lip thoughtfully, “Does it describe how to do one?”
“Um, yeah.” Daussie described the incision in the skin and through the muscles of the abdominal wall. “You have to be sure you’re avoiding the intestines and the bladder, which should be easier for us because of our ghirits. Then you cut through the wall of the uterus, in an area where you won’t cut into the placenta and cause a lot of bleeding. Um…” Daussie glanced at the ceiling, thinking, “take out the baby, tie off and cut the umbilical cord, take out the placenta, then sew everything back up.”
Eva rolled her eyes, “Sounds simple.”
Daussie stared at her mother for a moment, “I doubt it would be.”
“So do I. It probably was simple for the ancients, they got to learn how to do it from someone who’d done hundreds of them. We’d be trying to do it without any guidance except dry words in a book.” Eva got a distant look. “I suppose we’d have the advantage that you could use your talent to cut through the layers on the way down to the baby, easily avoiding accidental incisions into important structures. Tarc could cauterize the bleeders.” Eva shook her head, “But we wouldn’t have the sterile gloves and gowns the ancients used. I don’t like the thought of our trying to sew the uterus back shut. We’d be working deep in the abdomen and our instruments aren’t long enough to reliably do that without touching something in the wound with our fingers and contaminating it with our bacteria.”
“We could wash our hands with alcohol before…” Daussie said tentatively, “And give her lots of sulfa.”
Eva sighed, her shoulders drooping. “I suppose we should try it. If we don’t, she and her baby are going to die for sure, right?”
Daussie nodded.
“And the book didn’t have any other suggestions?”
Daussie frowned. “They mentioned cutting the pubic symphysis. A…” she glanced uncertainly at her mother, not certain how to pronounce it, “‘symphysiotomy.’”
“Oh,” Eva tilted her head curiously. “The place where the pubic bones join together at the front of the pelvis, right?”
Daussie nodded.
“Were there any pictures? I thought the symphysis naturally separated at the end of pregnancy. Mine did, but maybe that doesn’t happen in everyone.”
“Only a picture of the symphysis. Not much explanation about how the surgery might be done. Apparently, it was considered a primitive strategy and only used in poor countries.”
“Was the girl’s symphysis separated or still together?”
Daussie thought back to when she was using her ghirit to determine the relative sizes of the baby’s head and the bony birth canal. “I’m pretty sure it was still together.”
Eva gave her an excited look, “You could cut the symphysis without making an incision! It’d be much safer.”
Daussie frowned, “The ancients didn’t seem to think symphysiotomy was a very good operation. They thought a C-section was a lot better.”
“Yeah, well, they could do C-sections with little risk of infection back then. What were the problems with cutting the symphysis?”
“Sometimes they’d injure the bladder or urethra. They’re right next to it.”
“You should be able to avoid those.”
Daussie winced, “What if they just tear when the bones separate?”
“Hmm, I guess you should be sure to separate the bladder and urethra from one side of the pubis so they don’t get pulled on when the bones separate.”
Daussie ventured one more objection, “Sometimes the symphysis didn’t grow back together very well after the delivery.”
Eva made a face, “Yeah, for a couple of months after you were born I had some pain at the symphysis and in the back of the pelvis where the SI joints shifted. I wore a binder to try to help them grow back together. Even if that fails,” she looked Daussie in the eye, “I think it sounds way safer than a C-section with our current technology. I’d take it over a cesarean any day.” She grinned at Daussie, “Think of us as living in a poor country.”
“So, should I get Tarc to help me bring her back here in the little wagon?”
Eva looked around the clinic where several patients were still in the process of being seen. “How many patients were waiting downstairs when you came in?”
“Quite a few.”
“Why don’t you and Jadyn go out and do a symphysiotomy? If labor still doesn’t progress, send Jadyn back to get Tarc and the wagon.” She shook her head, “We’d have to try a C-section then, but I surely hope it doesn’t come to that.”
Daussie felt panic welling up inside of her, “But… I’ve never…”
Eva patted her daughter on the shoulder, “Neither has anyone else.” Sounding completely confident in Daussie’s abilities, she said, “You can do it.”
When Daussie continued staring wide-eyed at her mother, Eva gathered her into a hug. A feeling of peaceful confidence floated over Daussie. Eva pushed her away, “If you can’t do it, no one else can either. Just do the best you can.”
Knowing that Eva had instilled Daussie’s serene sense of competence didn’t make the feeling go away. After contemplating this for a few moments Daussie decided she was glad she felt confident.
~~~
As she and Jadyn rode back to the girl’s shanty, Daussie reflected that she wished she could instill confidence in Jadyn the way Eva had given it to her. Jadyn might be older than she was, but she was frantically anxious because this would be the first time she’d blocked pain or put someone to sleep without Kazy or Eva there to back her up. “What if it doesn’t work?” she asked for the fifth time.
“It will,” Daussie said confidently. “And, if it doesn’t, I’ll just cut the symphysis with her awake. It probably won’t hurt much compared to what she’s gone through in a day and a half of labor.”
Jadyn closed her eyes for a moment, then opened them looking resolved. “I’ll do it. There’s no reason I shouldn’t be able to.”
Daussie thought Jadyn was mostly talking to herself. Physician, heal thyself, she thought. She said, “We’re here.” Climbing off her horse, she said, “Let’s hope this works.”
The midwife looked up hopefully when Daussie came in, but when only Jadyn followed, the woman looked as if she were steeling herself against failure.
Their patient looked even more exhausted, if that were possible.
Daussie quickly sent in her ghirit and confirmed that the girl’s symphysis hadn’t separated. The baby’s heart was still beating. Turning to the midwife, she said, “My mother suggested we try relaxing the bones of her pelvis to see if that can provide enough room for the baby to pass.”
“‘Relaxing the bones of her pelvis,’” the woman quoted di
sbelievingly. “And how do you think you’re going to do that?”
Seeing the patient looking fearfully up at her, Daussie felt terribly guilty. She realized she hadn’t actually talked to the girl when she’d been there before. She sat down on the edge of the bed and said, “Hello. I’m Daussie. I was here before, and I’m sorry I didn’t introduce myself then. Eva, the healer at the Hyllis Tavern sent me to try to help you deliver your baby. What’s your name?”
The girl stared at Daussie for another moment, then in a small voice she tiredly said, “Deborah.”
“Okay, Deborah,” Daussie said, nodding at the telepath, “Jadyn here, is going to do a special massage of your head and neck. One that’ll make you relax so you won’t feel much pain when I tug on the bones of your pelvis. Eva says that if I do a special kind of manipulation, the bones might loosen up enough to make room for your baby to come out, okay?”
Deborah gave a little nod. Not a hopeful one, more the kind of nod you gave when you thought there were no other choices.
The kind of nod you gave when you thought your life was over so it was worth taking extreme risks.
Daussie and Jadyn urged the girl onto her back.
Jadyn made a show of massaging the girl’s scalp. Daussie saw her flinch momentarily when her fingers sank into the girl’s greasy hair, but her expression firmed and she went on with the massage anyway.
Daussie began stroking and rubbing her hands over the bones of the girl’s pelvis and hips while her ghirit started to explore the region of the symphysis. The girl’s urethra was slightly off-center to the right. She looked up and saw that Jadyn had Deborah asleep. Daussie’s first step was to make a series of small disc-shaped ports that cut the urethra and bladder loose from the left pubic bone. She checked her work, then set up a large disk that would cut through the symphysis itself.
Glancing up at the patient and Jadyn, she verified the girl looked peaceful. Jadyn gave her a nod confirming the girl was asleep. Daussie triggered the disc and the symphysis suddenly separated.
But only by a few millimeters.
Daussie stared, trying to keep the horror out of her eyes. It’s supposed to be a couple of centimeters! Getting a grip on herself, she sent her ghirit through the symphysis to make sure she’d cut all the dense fibrous tissue that held the bones together.
Hyllis Family 06 - Sisters Page 26