The Pull of the Stars

by Emma Donoghue

  But the circle on Honor White’s bottom sheet didn’t have that sharp tang of urine. Mild, almost milky.

  I checked her chart and confirmed that she wasn’t due till the end of November. Damn and blast it; another premature labour. What I found myself thinking, selfishly and childishly, was Could we not be let to sit still for five minutes?

  I think your waters have broken, Mrs. White.

  She clamped her eyes shut and wrung her rosary beads.

  Not another! Delia Garrett heaved onto her side and pulled the pillow over her head.

  I wished we had anywhere else to put the grieving mother but this room.

  I told Honor White, You’re a few weeks earlier than expected, but don’t worry.

  I felt her abdomen. The foetus’s bottom was at the top, as it should be. But instead of finding the hard arc of the spine, my fingers sank into a hollow before they reached the head. The foetus was faceup. This was common enough in late pregnancy, and the awkward positioning might explain why Honor White’s amniotic sac had broken already. Hopefully it would revolve to facedown before it was time to push. Otherwise it could mean a long, painful back labour, a bad rip, maybe even (if worse came to worst) forceps…

  I got out the ear trumpet and moved it around till I found the faint but lively beat low down on her right flank.

  I told her, You’re progressing nicely now the waters have broken. I’m just going to wash my hands and see what the story is before we change your bed.

  I put Honor White on a bedpan first to make sure her bowels and bladder were empty. Then I got her to lie back in her soaked sheets. She opened her legs without a murmur.

  I was feeling to make sure the cord hadn’t prolapsed, because sometimes a loop came out first and could get pinched by the skull. But to my astonishment Honor White was wide open already; my gloved fingers could detect only a thin lip of cervix. I felt awful for not having checked her before.

  Have you been having pangs, Mrs. White?

  She nodded and coughed.

  Where, in your back?

  Another nod.

  For how long?

  A while.

  You should have said.

  Her face was stone.

  So! You’re well on the road now.

  Nearly ready to push, I would have added if her foetus had been facing her spine.

  Usually in this situation, the doctor would give the mother a draught of morphia and we’d cross our fingers that her contractions would turn the foetus while she was asleep, but Honor White would refuse the drug, and in any case, there just wasn’t time.

  For a breech birth (wrong way up), I might have tried to persuade the tiny passenger to flip over by pressing the abdomen, but for this presentation, it was best to use gravity. I got Honor White out of bed and sat her on a chair. Lean forward, please, Mrs. White. Hands on your knees.

  Bridie helped me put a fresh nightdress on her and then we stripped and made the bed, working smoothly together.

  Out of the corner of my eye, I saw Honor White hold her breath and redden.

  No bearing down yet, Mrs. White!

  She let out her breath in a splutter of coughing.

  I told her, It’s the angle your baby’s at, the head’s pressing so, it tricks you into thinking you’re ready.

  She stifled a groan.

  Bridie bundled up the wet sheets for the laundry.

  I asked, Once you’ve dropped that down the chute, could you find Dr. Lynn and tell her Mrs. White has a persistent posterior presentation and she’s almost fully dilated?

  I saw Bridie mutter the phrase to herself silently, trying to memorise it.

  Just say posterior.

  She nodded and rushed off.

  Now that I was looking out for it, I could see the tightening in Honor White’s face when the next pang came. She let out a cough so ragged, I passed her the sputum cup. She hawked up something dark.

  Mary O’Rahilly spoke up, eyes shiny with concern: If you don’t mind my saying, Mrs. White, I found the chloroform such a help.

  No answer.

  Would you not take an inhaler for a minute to soothe your cough, even? Save your strength for the pushing?

  But the woman shook her head savagely.

  She worried me, this one. I’d been assuming that Honor White was simply the stoic type, but perhaps she was putting herself through this labour in a spirit of grim penance for what the nuns called her second lapse, her second offence. I’d occasionally been called in to see a woman who’d been labouring away at home quite unsupported, and it often went badly, even after my arrival; it was as if the isolation had sapped her spirit. That wasn’t only the unwed either. One wife near fifty was so embarrassed to find herself in that condition again at her age that she hadn’t told a soul, not even her husband—she’d been wheeled into this hospital with a tiny live foot sticking out of her, and Sister Finnigan and I had spent a long hard night saving them both.

  Now, Mrs. White, I said, stand up and lean on the bed and rock your hips, would you?

  She blinked.

  Come on, it’s to get your baby into the right position.

  She obeyed, facing the wall and swaying backwards and forwards in a slow, incongruous dance.

  The O’Rahilly baby let out a goatish wail in her crib.

  I picked her up and showed Mary O’Rahilly how to change the nappy.

  Green slime!

  That’s how it comes out at first, I told her.

  Disgusting, she said fondly.

  What are you and Mr. O’Rahilly thinking of calling your daughter?

  Maybe Eunice, for my aunt.

  Lovely, I lied.

  Afterward we got little Eunice on the breast again.

  Bridie had come in silently and was rubbing Honor White’s back. The woman paid her no attention but didn’t rebuff her either. Bridie reported, Her legs are shaking something awful.

  Honor White grunted. Can’t I just lie down and push?

  Not quite yet, sorry.

  (Feeling her bump for any hint of the foetus revolving yet.)

  I told her, The doctor should be here very shortly.

  (Please, God, let Dr. Lynn arrive in time for this delivery. What if the skull got jammed and everything swelled, and there was nothing I could do to rescue mother and child from each other, from their joint and private hell?)

  Delia Garrett had her magazine out as a shield for her eyes.

  Mrs. White, I said, let’s try you on the bed on hands and knees.

  Like a dog? Mary O’Rahilly asked, mildly outraged on her neighbour’s behalf.

  But Honor White climbed onto the mattress, leaning on Bridie’s skinny arm. She rocked back and forth in a kind of fury. Oh, oh, I need to—

  Let me check you again. Stay right where you are.

  I scrubbed and gloved and lotioned. I felt inside her and there was no trace of the cervix at all.

  Please!

  Even if the foetus was still facing upwards, I couldn’t say no to this overwhelming urge of hers. As long as the back of the skull was leading and the chin was well tucked in, it should be possible to deliver now, shouldn’t it?

  All right, time to lie down on your left and push.

  (I was praying for one of those last-minute miracles that nature sometimes worked—the foetus finally, suddenly, gloriously corkscrewing into place, then into the light.)

  Honor White dropped down heavily, head to the wall, a martyr of old.

  I crooned, Good woman yourself.

  Temperature no higher; pulse just a little too fast, and thready. I was about to listen to the foetal heartbeat for any sign of distress when her next pang made her start to groan.

  Chin down, I said, hold your breath, and give a fine strong push.

  I saw all her muscles harden and the strain move right through her.

  Feel free to make noise, Mrs. White.

  She stared past me.

  I looped a towel around the top rail for her to pull on. She was
the wrong way round to be able to brace her feet on anything but I didn’t want to move her now. This primitive little storeroom!

  A squeak as Bridie wheeled in a second baby crib. She murmured, For when it’s needed.

  Honor White hissed through her teeth, God be with me, God help me, God save me.

  A red puddle was forming around her hip. Old brown blood coming out during labour was quite usual, but this was very bright.

  Her eyes followed mine to the scarlet. She wheezed, Am I dying?

  I said, Oh, birth’s a messy business.

  But by the time Dr. Lynn bustled in, Honor White’s bleeding was distinctly heavier.

  I gave a rapid report.

  Thirty-six weeks, said the doctor, that’s only a week from early term, so the lungs should be well developed, at least. And most stargazers do come out on their own.

  Stargazers?

  That was Bridie.

  I explained over my shoulder: Born faceup, looking towards the sky.

  Dr. Lynn muttered, No, it’s the mother’s pulse force that concerns me, and the haemorrhage. Most likely the afterbirth’s come away already.

  Honor White bore the internal exam wordlessly.

  At the sink after, scouring her hands again, Dr. Lynn said, You’ve done splendidly, Mrs. White, but we’re going to get your baby out without further delay. Forceps, please, Nurse.

  My stomach clenched. I asked, French or English?

  French.

  The long ones. That told me the bad news: the head wasn’t very far down the passage yet.

  Bridie was all agog, but I hadn’t time to explain.

  I fetched a pair of long Andersons, with their handle grips and finger ring, as well as carbolic solution, a scalpel, ligatures, scissors, cloths, a needle, and thread. I filled a syringe with cocaine hydrochloride.

  I’d seen women left botched by forceps, their infants with skulls dented or mashed, sometimes spastic for life. Don’t think about that.

  Dr. Lynn was asking Honor White to lie on her back.

  She cried, Wait!

  She gripped the towel and pushed, a vein standing out at her temple.

  The doctor asked, Ready now?

  Honor White nodded. Her cough sounded sharp enough to crack a rib.

  Local anesthetic, Doctor, as she won’t take chloroform?

  Dr. Lynn accepted the syringe of cocaine hydrochloride and injected it into Honor White’s soft parts while I held her legs.

  Once the area was numbed, the doctor made the snip. Working fast, before the oncoming pang, she slid the first flat branch of the forceps all the way up and alongside the foetus’s skull. Then the next.

  Honor White cried out then.

  Blood ran even faster; I wondered how the doctor could see what she was doing in this gaudy mess. That was the paradox of forceps—if they didn’t get the baby out right away, they could worsen a haemorrhage.

  Faster, faster.

  Dr. Lynn clicked the handles together at the midpoint and locked them.

  Honor White writhed and coughed as pain struck her like lightning.

  I helped her up a little so she could catch her breath and wiped the catarrh from her lips.

  Dr. Lynn murmured to herself, Easy does it.

  Gripping the awful tongs, she worked on. I wedged myself behind Honor White, holding her as still as I could as she leaked more and more scarlet across the sheets.

  Holy Jesus, Honor White said, gasping.

  Dr. Lynn straightened up and gave me a preoccupied shake of the head. Ah, not quite within reach yet.

  She slid the forceps out in one piece and rested them on the tray. Perhaps ergotoxine to strengthen the contractions? But it’s so unpredictable…

  I’d never heard Dr. Lynn dither. Awkward, I looked away and busied myself taking Honor White’s pulse. Twenty-six in fifteen seconds, so a heart rate of one hundred and four. What worried me wasn’t the speed but the lack of force, a feeble music under my fingers.

  I bent lower to hear what the patient was whispering: For though I should walk in the midst of the shadow of death, I will fear no evil, for thou art with me.

  When I put the back of my hand to her grey cheek, it was clammy with sweat. Are you nauseated, Mrs. White?

  I thought she nodded but I couldn’t be sure. Her pressure’s dropping, Doctor.

  (She might lose consciousness at any moment.)

  Dr. Lynn stared; for once she seemed at a loss. In that case, she said, I doubt saline will be enough. Mrs. White needs blood, but the hospital’s stocks are awfully low. I wonder, would there be any walking donors in the building?

  Donors on the hoof, that was the jocular phrase. My mind cleared and I told her, We nurses are all on the register. I’ll do it.

  Oh, but—

  I’m right here. You wouldn’t even need to do a cross match, my type is O.

  The universal blood donor; that made the doctor’s face brighten.

  I hurried to get the sterile kit from the top shelf.

  Behind me I heard Honor White cough shrilly as the next pang pulled her back into the eye of the storm.

  The doctor told her, Keep pushing if you’re able.

  Honor White groaned as she bore down. The bed was a sea of red.

  I readied my left arm by whirling it a dozen times.

  Bridie watched as if witnessing some arcane ritual.

  I checked the other patients. Mary O’Rahilly was somehow sleeping through all this, but Delia Garrett asked, What on earth—

  Just transfusing some blood, I said as glibly as if it were something I did every day.

  No room for a chair by her cot, so I perched on the edge and unbuttoned my cuff with my trembling right hand. I wasn’t afraid, only thrilled at the prospect of giving exactly what was needed.

  Dr. Lynn said loudly, Mrs. White, I’m going to put a pint of Nurse Power’s blood into you.

  No response. Was she sliding beyond our reach?

  I took her pulse again. It’s climbed to one hundred and fifteen, Doctor.

  (Her heart was pumping faster to compensate for the fact that she was bleeding to death.)

  Bridie, said the doctor, a glass of water for Nurse Power.

  I almost barked, Don’t waste time. But I was a patient now, so I held my tongue.

  The doctor would need my artery for fresher blood and stronger flow to help her pump it faster into the sinking woman. So I offered her the thumb side of my wrist, hoping she had the knack of locating the deep radial pulse.

  Dr. Lynn refused it. No, no, those little arteries hurt like the devil, and there’s the risk of leakage and embolisms.

  I really don’t mind—

  You’re too necessary to risk your health, Nurse. Besides, I read an article that said vein to vein, assisted by gravity, will do in a pinch.

  In a pinch; was that where we were now? And had the doctor never actually tried this vein-to-vein technique before?

  She slid her warm hand into the crook of my elbow. When she found the best vein, she bounced on it a few times.

  I looked away and drained the glass of water Bridie was holding out; oddly enough, I was squeamish when it came to anything piercing my own skin.

  Dr. Lynn took only two goes to get the needle in, which wasn’t half bad for a physician. A dark line of blood filled the tube, and she turned the stopcock before it could spill. Rapidly, she bandaged the apparatus onto my arm.

  But Honor White’s head was falling back; her eyelids closed. Were we too late? Another contraction seized her now, ghastly to watch—an unseen monster shaking her limp body on a crimson bier.

  I said, Do it!

  Dr. Lynn was calmly attaching my tubing to the other metal syringe. She tied Honor White’s arm to make the veins stand out, but they were flat as string.

  With my right hand I took the pulse on the woman’s other wrist—up to a hundred and twenty now, and so faint.

  The doctor still couldn’t find a vein on the dying woman.

  Heat
? My voice came out almost angry. Bridie, dip a clean cloth in the pot of hot water, would you?

  Dr. Lynn murmured, I almost have the bugger.

  But for all the probing and prodding, Honor White’s veins kept rolling under the doctor’s fingers.

  When Bridie brought over the hot cloth, I snatched it myself, despite my impediments. I flapped it in the air two or three times to release some steam so it wouldn’t burn Honor White, then folded it over and pressed it along her inner arm.

  Can you, Nurse Power? Dr. Lynn offered me the handle of the syringe.

  Even in the hurry, I respected her for knowing that this was a moment when all her study and experience was no match for a nurse’s.

  I grabbed the syringe and pulled the hot cloth off Honor White’s arm. There, on the pink-flushed skin, was a little blue line—a creek in a canyon. I beat out a rhythm on it with my fingertip: Stay alive, Mrs. White. The wary blood vessel rose a little, just enough, and I slid the needle in.

  Dr. Lynn took over promptly, bandaging the tube onto the slumped patient so it wouldn’t slip out.

  Stand up, she urged me.

  I leapt off the cot.

  As soon as she opened the stopcock, my blood began to flow down the tube. The doctor seized my left hand and set it on her own shoulder to keep it high; my elbow locked. She pressed my flesh above the needle so hard I almost cried out. She squeezed my arm, milking me of life.

  Hearing some commotion in the corridor, I jerked; could that be the police come back, still hunting Dr. Lynn?

  Either she hadn’t heard anything or she had nerves of steel. A captain in the rebel army, I remembered. Bullets whizzing past her like hail.

  Dr. Lynn murmured, Now, I can’t be sure how much I’m taking, Nurse Power, so do speak up at once if you feel faint.

  With my other hand I gripped the head of the bed, just in case. Let it not clot; we hadn’t a minute to change a clogged tube or decant my blood and add sodium citrate to keep it liquid. Flow, flow, red waterfall, keep flowing into this woman. Don’t let us have to cut this infant out of her. Mother and child doing their best to walk in the midst of the shadow of death.

  Could I see a slight flush rising in Honor White’s chalky face?

  Suddenly the woman blinked up at me.

  You’re all right, dear, I assured her.

  (Not true yet; a hope in the form of a lie.)