The Pull of the Stars(54)

Blast it. I needed Dr. Lynn, with all her experience in lying-in wards. Unless she’d been arrested already—could she have walked right into the men in blue?

I said, I’ve given Mrs. O’Rahilly saline for shock.

I yanked the cannula out of her arm and put a clean bandage over the site. Press just there, would you, Bridie?

Why is she the wrong way around? MacAuliffe wanted to know.

So she can push against the rails with her feet.

He was soaping and scrubbing at the sink already. I gave him a pair of sterile gloves.

With his right hand inside Mary O’Rahilly, MacAuliffe waited for her next pang and pressed hard with his left on the top of the uterus.

She let out a long groan.

I gnawed my lip. One couldn’t simply pop a baby out of its mother, and it might damage them both if one tried. I’d seen wombs perforated or turned inside out by rough handling. But to say so would be insubordination.

You say she’s been trying for a full hour and three-quarters, Nurse? The head should be much lower than this.

I resisted the urge to say, That’s why I called for a doctor.

Hm, said MacAuliffe. Clearly some disproportion.

The word I always dreaded to hear—a mismatch between a narrow woman and a big-skulled foetus.

He went on: I estimate the occipitofrontal diameter to be four to five inches and the pelvic outlet rather less than four, but I can’t be sure without taking thorough measurements with a Skutsch’s pelvimeter, and that would probably require general anesthesia.

This girl might pass out at any minute, and he wanted to put her to sleep so he could fiddle with instruments and formulas to determine the exact ratio of the problem?

MacAuliffe went on, But all in all, I believe it’s time to intervene surgically.

I stared, thinking, What, here, in a makeshift fever ward with barely inches to spare between the cots?

He murmured, The mortality rate for caesareans is so high, I’d rather try a symphysiotomy. Or actually, better still, a pubiotomy.

My heart sank. These operations to widen the pelvis were common in Irish hospitals because they didn’t scar the uterus and limit future childbearing. Pubiotomy did have one advantage over a caesarean: it was less likely to kill Mary O’Rahilly even if it was performed under local anesthetic only on a camp cot by a young general surgeon who’d learnt it from a diagram. But it would mean two and a half weeks of her lying here with her legs bound together afterwards, and it could very well do her damage; I’d heard stories of patients left limping, leaking, or in pain permanently.

I tried to think of how to phrase my objections.

Mary O’Rahilly pushed and groaned, but quietly, as if trying not to draw attention to herself.

MacAuliffe leaned into the girl’s sight line and said, I’m going to numb the area and deliver you now, Mrs. Rahilly. A simple little procedure that means you’ll have no further trouble having this baby or his little brothers and sisters to come.

She blinked up at him in fright.

Shouldn’t the man warn her that he was about to saw her pubic bone in half?

Shouldn’t I?

I pleaded, Dr. MacAuliffe—

Message for you, Nurse Power.

I spun around to find that junior nurse from before panting in the doorway. What is it?

Dr. Lynn says, have you tried Walcher’s?

Vol-curse? I didn’t understand the nonsense syllables. Then they resolved into German and made sense.

I asked MacAuliffe, almost stuttering in my rush, What about Walcher’s position, Doctor—can’t that open the pelvis a little and draw the head down?

He pursed his lips, irritated. Perhaps, but at this point—

The junior added, Oh, and you’re wanted urgently in Men’s Fever, Dr. MacAuliffe.

I seized my chance. I said in my humblest tone, Why don’t I try her in Walcher’s while you’re gone just to see if it might help at all before the surgery?

Mary O’Rahilly’s eyes shifted between us.

The young surgeon sighed. Well, I’ll need to get hold of a hand-cranked wire saw, anyway. But do get her prepared, won’t you?

The moment he was gone, instead of shaving, washing, and disinfecting Mary O’Rahilly for a pubiotomy, I pulled Jellett’s Midwifery from the shelf. I thumbed through the book, but my hands were shaking so much I couldn’t find the page describing Walcher’s position; I had to look under W in the index.

Rarely used supine dorsal recumbent…it could encourage the pelvis to widen by half an inch, I read. Employ for no more than two to four uterine contractions or a quarter of an hour. Because it hurt the woman so much? Dr. Jellett didn’t say.

The instructions for positioning called for a surgical table or at least a hospital bed that could be winched up at either end. I had a cheap, low cot.

But it was open at the foot and there was room for her legs to dangle, so all I had to do was raise it.

Let’s get you standing up for a minute, Mrs. O’Rahilly.

She resisted; she sagged; she wailed in my arms.

I said in a level voice, Bridie, could you look in that bottom cupboard and get out the bedrests—

Which of them?

(She was already there.)

All of them. Stick them under the end of this mattress to make it as high as you can.

Bridie couldn’t possibly have understood what I was up to, but she didn’t ask anything else, only wrenched up the mattress and fitted the wedges on top of each other on the bed frame like a puzzle.