The flying squad was a backup for unexpectedly complicated home deliveries. Once Miss Hagerty had phoned, the Royal Maternity Hospital would have dispatched an ambulance with a crew of specialists and midwives, blood if Hester was to need a transfusion, and oxygen-supplied incubators for the wee ones.
“Trouble is,” O’Reilly said, “even if they’re on the way, they might not get through.”
“Why not?”
“You’ll see.”
O’Reilly concentrated on the road ahead. Already he’d driven along a series of country roads, each more twisty and narrow than the last. They were going up into the Ballybucklebo Hills, past Sonny and Maggie’s house.
The land’s rolling contours were lit by the silver glow of a waning moon and Venus shining like a diamond solitaire. He craned forward to look up. The Milky Way seemed like a long smudge of chalk on a damp blackboard. Orion hung sideways, low in the eastern sky. From a distant hillcrest, the stark branches of a huge sycamore curled in silhouette.
As the car rounded a bend, O’Reilly saw a man outlined by the headlight beams. He was waving them down. O’Reilly slowed and parked behind Miss Hagerty’s Morris Minor and a Massey-Harris tractor.
The car’s lights and engine died, but the night was made bright by the tractor’s beams.
O’Reilly and Barry were getting out as the man yelled above the roar of the tractor’s engine. “Doctors, I’m main glad to see yiz, so I am.”
“Doctor Laverty,” O’Reilly bellowed, “this is Freddy Patton.”
Barry nodded at the man.
“We’ll have to go the rest of the way on the tractor,” Freddy called. “After all the rain, the dip in the lane’s flooded, so it is. I’ll be back in a wee minute, Doctor.” He drove out onto the road and turned left.
There was a wider place fifty yards away where Freddy Patton could turn the massive vehicle. O’Reilly listened to the notes of gears being changed, and he waited as the red taillights moved away and then the twin headlight beams drew nearer.
“Let’s get the bags,” O’Reilly said.
“Right.”
O’Reilly opened the boot and grabbed the heavier of the two bags; Barry took the other. The air bore diesel exhaust and the scent of burning turf coming from the Pattons’ farmhouse. The Massey-Harris grumbled to a halt. O’Reilly bellowed, “Have you room for two, Freddy?”
“Aye,” Freddy called, with his hand cupped round his mouth to make a megaphone. “One of yiz can fit in the cab, t’other’ll have to hang on behind, so they will.”
“Never worry. Into the cab, Barry. Take this bag too.” O’Reilly clambered up behind the driver, stood on the tractor’s body, held onto Freddy’s shoulders, and roared, “Damn the torpedoes. Full steam ahead.” From force of habit he mentally cited his source. Rear Admiral David Farragut apparently uttered those words during the American Civil War battle of Mobile Bay.
With the engine rumbling and filling O’Reilly’s nose with exhaust fumes, the tractor jolted along a lane so narrow that he had to keep ducking and dodging to avoid being scraped by the branches of the hawthorn hedge. The wind nipped at his cheeks.
The lights of the farmhouse beckoned, then vanished as the tractor headed into a hollow where O’Reilly could see the oily waters of a small lake disappearing through both hedges and stretching for a good ten yards ahead. He’d told Barry the flying squad might have trouble getting through. There was no “might” about it. He, Barry, and Miss Hagerty were going to have to manage.
The tractor’s huge, ribbed, rear tyres drove through the flood, and soon the machine was climbing from the hollow. They rumbled into the well-lit barnyard.
“Get yiz down, Doctors. I’ll bring the bags, so I will,” Freddy said. “And mind yourselves. It’s slippy, so it is.”
Barry dismounted and headed for the house.
O’Reilly jumped down and his boot skidded. He had to twist violently to keep his balance. “Bugger it,” he roared, as something ripped in his back. His left lumbrical, the big muscle that runs alongside the spine, was knotted in spasm. “Holy thundering Mother of Jay—” He sucked in his breath and scrunched his eyes shut as his left hand sought the sore spot. He blew out his breath through pursed lips, arched his back, and felt the knotting ease a little—but not enough. It would be impossible for him to bend over a labouring woman to deliver her babies.
Barry would have to manage.
Despite his pain, O’Reilly smiled. He already knew from earlier experience that Barry was a gifted accoucheur. Indeed sometimes he wondered why his assistant hadn’t decided to specialise in obstetrics. Tonight, particularly with twins to be dealt with and himself hors de combat, he was grateful the young man had not. He’d make a fine partner. No doubt about it.
O’Reilly hirpled across the yard to where Freddy held the door open. He was a very tall, thin man, angular, balding, with sunken cheeks the colour of ripe tomatoes.
“Come on, on in, Doc.” Freddy closed the door behind O’Reilly. “Your man Doctor Laverty’s gone upstairs to Hester and Miss Hagerty, so he has. He took them big bags with him.” He held out a hand. “Gimme your coat.”
After the open-air ride along the farm lane, O’Reilly was grateful for the warmth coming from the range at the far side of the kitchen. He winced as he managed to shrug out of his coat.
“Bad back?” Freddy enquired.
“Aye. I wrenched it getting off the tractor.”
“Boys-a-boys, but that can smart, you know.” He frowned, then cocked his head to one side. “I’ve some powerful horse liniment. Will I get you a wee taste?”
O’Reilly shook his head. “Hester’s in your bedroom?” He knew the house of old.
“Aye.”
“I’ll find her.”
“Go ahead, Doc. I’ll take a look at wee Jimmy. He’s dead excited, so he is, that he’s going to be the twins’ big brother. I got him over about half an hour ago, and I have him asleep in his room. Then I’ll have a wee cup of tea in my hand, like.”
* * *
It took O’Reilly longer to climb the stairs than he’d anticipated. Each step sent twinges through his back. Twice he had to rest and rub his back. It felt like the time he’d cracked a couple of ribs playing rugby.
He heard panting, a woman’s loud grunting, Barry speaking, then a high-pitched wailing. That must mean twin one had been delivered.
O’Reilly stood quietly in the doorway. His nostrils were filled with the acrid smell of amniotic fluid jostling for attention with the reek of disinfectant.
Barry, wearing a rubber apron and bloody rubber gloves, was handing a tiny baby to Miss Hagerty. The little one’s reedy cries came in short bursts. While Miss Hagerty cleaned the newborn, Barry stood at Hester’s side, talking to her and examining her belly.
“That’s a boy. Miss Hagerty’ll show you him in a minute. The other one’s coming head first, so it shouldn’t be long.”
Barry kept a hand on Hester’s tummy as he waited for the next contraction.
Miss Hagerty bundled up the newborn and put him into a blanket-lined drawer taken from a dressing table. A second, similarly prepared, jury-rigged cot waited for twin two. “I’ll bring him over in just a wee minute, Hester,” she said, “but I need to listen to the other one’s heart.” She lifted a foetal stethoscope from where it sat on the dressing table between a jar of Pond’s face cream and a tin of talcum powder. Miss Hagerty put the wide end on Hester’s bulging belly, bent over, and laid her ear on the flat circular end. O’Reilly saw her eyes widen. She looked straight at Barry. “Ninety-six,” she said quietly.
O’Reilly grimaced. It should have been 144 beats per minute. That baby was in distress from lack of oxygen. He overrode his temptation, ricked back be damned, to intervene. Hadn’t he been thinking moments ago that his young colleague was very good at obstetrics?
Barry turned and saw O’Reilly. “Fingal—”
“You carry on.”
Barry hesitated, pointed a finger at his own br
eastbone, and mouthed, “Me?”
O’Reilly smiled and nodded. Come on, Barry, he thought. You’re right to be scared, but I know you’ll do fine.
Barry shrugged. “Open the forceps pack, please.” He began to examine his patient vaginally. “Checking the other twin, Hester.”
O’Reilly laid the pack on a small bedside table and moved the table to where it would be handy for Barry. As O’Reilly opened the pack, he silently cursed Hester’s stubbornness in leaving the hospital despite medical advice. She was perfectly within her rights to have done so, but now was the time she and her premature babies needed a fully equipped facility. “Ready, Barry,” he said.
“The heart rate’s down to eighty.” Miss Hagerty spoke softly.
Barry swallowed and squared his shoulders. “Doctor O’Reilly … Miss Hagerty … can you bring Mrs. Patton across the bed, buttocks over the edge, and each one of you support a leg?”
He turned to Hester. “Mrs. Patton, I’m sorry. I’m going to have to give your baby a hand to get born. It’s going to be uncomfortable.”
As the midwife and O’Reilly positioned the patient, he felt the spasms start in his back. He gritted his teeth, tried to ignore the pain, and willed his young assistant to get a move on.
28
Willing to Pull His Weight
Barry’s hand trembled. He’d only ever done three forceps deliveries when he was training, all of those under supervision in a teaching hospital. He wished O’Reilly was in charge.
“The heart rate’s sixty,” Miss Hagerty said.
Barry gritted his teeth. He was sorry he’d not been able to put in a nerve block to numb the entire birth canal, but by the time he’d scrubbed his hands and put on his gloves, the first baby was nearly born. Nor had he time now. The second twin’s heart could stop at any second so there was no time for a block, but he’d risk the minutes it would take to inject some local anaesthetic before he cut a wide episiotomy. “Just a jag, Hester.”
She flinched as the needle went in and Barry injected. He waited for the local to take effect.
When he had examined Hester moments earlier, he’d found that the widest part of the baby’s head had entered the pelvis, a precondition for a forceps delivery of a premature baby. Not only was the head engaged, it was also properly positioned, with the baby’s chin well tucked into its chest and the back of its skull, the occiput, facing the mother’s front.
“Heart rate’s forty-eight,” Miss Hagerty said.
Barry had to ignore the fact that the slowing of the heart was due to oxygen lack, but it was lack—not total deprivation. If the heart stopped and the oxygen supply to the little brain failed, he’d have four minutes before the baby would suffer irreparable brain damage, and not long after that it would die. The temptation was to rush. His mentor in the Royal Maternity had had a great Latin expression for situations like this. Festina lente. Make haste slowly.
He took heavy scissors. The imminence of the act he must perform stilled his tremor for the moment. He made the incision. It would give him extra room in which to work.
“We’re ready, Barry,” O’Reilly said. His voice was steady with no hint of the urgency Barry knew the far more experienced O’Reilly must be feeling. Barry started to sweat, pulled in a very deep breath, closed his eyes, opened them, and saw the trembling in his hand was worse.
He pursed his lips, clenched his fist, and when he opened it to pick up the right forceps blade, the tremor had stopped. He felt the metal cold through his glove. The heavy handle, grooved to allow a firm grip, ended in a lock that would be fitted to the second half of the instrument once it also had been inserted. Past the lock, the blade was curved out to one side to fit around the contours of the baby’s skull and shaped in a fore-and-aft direction to accommodate the direction of the birth canal. It looked like an enormous spoon, except that most of the bowl had been removed, leaving only a rim of metal around the circumference. A set of Wrigley’s obstetrical forceps was simply a pair of tongs. The blades were for grasping the object to be moved, and the handles for pulling.
“Eighty,” said Miss Hagerty.
Better, but still too slow. Barry knew what he must do, but the thought of it made him queasy. Both halves of the forceps must be inserted into the birth canal to fit snugly around the baby’s head. The blades were unfeeling steel, impervious to any hurt. The canal was tearable flesh, and the premature, soft little head could easily be damaged.
Barry glanced at O’Reilly, who supported Hester’s right leg. The big man’s lips were drawn back in a rictus, as if he was in pain. But there was no time to worry about that. Barry moved to stand between the patient’s legs, with his back to O’Reilly.
“I’m going to start, Hester,” he said. “You’ll feel a fair bit of pressure.” Barry slipped his four right fingers into the vaginal opening, feeling the warmth on his knuckles and the firmness of the head beneath his fingertips. As gently as he could, he advanced his fingers between head and canal until the base of his upcocked thumb rested against Hester’s pubic bone.
He heard her moaning.
“Sorry,” he said, knowing he was going to have to hurt her more. In his left hand, he held the right blade of the instrument vertically at the opening, then positioned the tip between the baby’s head and his fingers, which were protecting the mother’s soft tissues.
“She’s not contracting at the moment?”
“No, and the heart rate’s sixty,” Miss Hagerty said.
Festina lente. Barry stifled the temptation to rush and perhaps bungle things. Gradually he allowed the weight of the blade to carry the instrument down and forward so that it slid deeply inside and fitted snugly around the head.
Hester groaned and tried to squirm. Barry heard O’Reilly gasp, glanced round, and saw the big man’s eyes were screwed tightly shut and the veins in his neck standing out.
“You all right, Fingal?”
“Fine.” O’Reilly growled. “And you’re … doing … fine.”
Grateful for the encouragement, Barry repeated the manoeuvres with the left blade, and with both inserted it was simple to engage the two halves of the lock by bringing the handles tightly together. Some of the tension ebbed from Barry. He’d inserted the forceps by feel. If he’d not positioned them correctly, the lock would not have been closable and he would have had to remove the instrument and start all over again.
And time was moving on.
He looked at Miss Hagerty. “I’m ready. Can you get her to push with the next contraction?”
“Aye.”
Barry waited until he heard Miss Hagerty saying, “Push, Hester dear. Puuuuush.”
Now the contracting uterus and Hester’s efforts were acting on the baby, moving it down deeply into the canal. To these efforts, Barry added traction with the forceps. At first he exerted pressure downward. He had to keep the baby’s chin tucked in until it had negotiated the curve of the pelvic canal before beginning to ascend. He saw the vaginal opening distended by a dark circle about two inches in diameter. Twin two had dark hair.
“All right, Hester. Take a rest,” Miss Hagerty said.
Barry had to steel himself to hold the forceps steady until the next contraction started. The three minutes before Miss Hagerty’s exhortation “Puuuush” seemed like an eternity.
He pulled the forceps toward himself, and more of the head appeared. As the expulsive forces of the uterine contractions combined with Hester’s pushing caused the baby to extend its neck, Barry directed his pull upward. Then he stopped and held the instrument still. He wanted the baby’s head to come out slowly. Letting it appear with a rush could rip the mother despite the episiotomy and by sudden decompression damage the little brain.
Slowly, slowly, a wrinkled forehead appeared, then the bridge of the nose, the mouth. Barry used the little finger of his left hand to clear mucus. Cry, he thought, holding his breath. Cry, please cry, and in obedience the baby gulped and gave a tiny reedy wail.
Barry exhaled. Now th
e head was delivered, he removed the blades of the forceps, rapidly set them on the table, and guided little girl Patton into the world. It was a matter of moments to doubly clamp, then cut, the umbilical cord.
“It’s a girl,” he said.
Simultaneously he heard Hester’s “Thank you, Doctor,” sounding as if she was speaking through tears, and O’Reilly telling Miss Hagerty to move the patient back onto the bed.
Barry stepped back to let O’Reilly swing Hester in a quarter circle so she could lower her legs onto the rubber-sheeted bed. For that, Barry was grateful because now that Miss Hagerty’s hands were free, he could give the little girl to her.
That would in turn allow him to take care of the delivery of the afterbirths and sew up the episiotomy while O’Reilly and Miss Hagerty saw to the babies.
Barry inhaled deeply. When moments earlier the baby’s heart had kept slowing, he had wondered what had happened to his own heart rate. It was probably back to normal now, but certainly it must have exceeded a hundred then. His hands were clammy from sweating inside the gloves, and Barry reckoned that anyone with his lack of experience would have had sweaty palms too. Proper training was what allowed his senior obstetrical colleagues to approach difficult deliveries with the same confidence that Barry would have had when examining a sore throat.
Yet despite the stress, if he asked himself how he felt after the forceps delivery of premature twins, his answer would be “Good. Damn good.”
* * *
Barry snipped the last stitch. “All done, Hester.”
“Thank you, Doctor Laverty.”
He straightened and offered up silent thanks that he’d had no difficulty delivering the placentas, nor had there been any haemorrhage. Periodic reports from Miss Hagerty as he’d been suturing had reassured him that both babies were doing well. Don’t get a swollen head, Barry Laverty, he told himself, but he could take pride from having successfully delivered twins, the second one with forceps. It was a good feeling, a gratifying feeling, and more satisfying than dealing with the coughs, sniffles, and sprains he saw every day. Barry stood and stripped off his gloves.