“Gloves and gown, quick!” Hemlatha shouted. “C-section tray here. Wake up, all of you! Do you not want to save her? Hurry! Hurry! Hurry!” She repeated this in Amharic—“Tolo, tolo, tolo!”—in case English wasn't getting through.
The authority of her words kept them from retreating into the shock that had paralyzed them. “And you nurses standing around all starched and useless,” Hemlatha said, as she pulled on a sterile gown and donned fresh gloves (there wasn't time to wash), “couldn't you have said something to him? Matron?” Matron looked to the floor.
“How long ago did the fetal heart sounds stop? What was the fetal heart rate?”
“It happened too quickly. We—”
“Oh, shut up, Stone. One of you give me a straight answer. Otherwise all of you shut up. Pressure now?”
“Barely sixty.”
“Where's the blood? Am I dealing with deaf as well as dumb people? Answer me?”
The hospital had no blood bank, just a pint or two if one were lucky, kept in a refrigerator. Patients’ families were reluctant to give blood. Hema once pressed a husband to give blood for his wife, and he'd refused outright. When she suggested that his wife would surely give blood for him if the tables were turned, he said, “You don't know my wife. She's waiting for me to die to take my cows and property.” Time and again, she and Ghosh and Stone and Matron would donate their own blood and prevail on some of the nurses to do the same. At least once a year Ghosh would take his car and round up members of his cricket team to give blood.
“Has no one thought about blood?” Hema said again. “All of you who aren't needed here, go at once and give blood. This is one of our own, for God's sake. Go, now. No, not you Stone! Get gloved, man, for goodness’ sake. Make yourself useful. What was the fetal heart rate?”
The probationer kept her eyes focused on the chart, terrified at the idea of giving blood and not daring to look up. And she knew that no one had listened for a fetal heart. They'd been too preoccupied with the mother. The probationer drew a line through her “C-section indicated” entry, sensing that it reflected badly on Matron. It was no consolation to see Dr. Stone standing frozen, eyes downcast, like a dog who'd disobeyed its master, every instinct telling it to slink away but knowing that the slightest movement would only bring more punishment.
Hema saw that Sister Mary Joseph's Praise's face was losing all color, the eyelids lowered to quarter mast, the hooded gaze now unfocused, a look that was so often a precursor to death.
“Pressure?”
“Can't find it …”
“Doesn't matter, pour in blood, splash some iodine here, let's go!” With that she ripped open the sterile tray, grabbed the scalpel, and slashed through the skin—no time for sterility even—a vertical cut below the navel. Hema still couldn't believe what she was doing, or whom she was cutting.
She half expected Sister Mary Joseph Praise to sit up in protest.
Instead she heard the thud of a body falling and turned in time to see Matron crumpled on the floor.
CHAPTER 8
Missing People
CUSTODY OF THE BODY” was the first thing out of Matron's mouth when she revived. She'd passed out for probably fewer than five seconds; everyone was in the same position, but now staring down at her. The probationer ran over to help. Despite Hema's protests, Matron clawed and kneed her way onto the anesthetist's stool, shouting, “I'm not leaving!” They were too busy to argue.
She sat near the board that tethered Sister Mary Joseph Praise's arm, blood finally running from a bottle into a vein. Matron reached for that hand, bending over it, studying Sister Mary Joseph Praise's fingers. She didn't want to look at what the doctors were doing, their red gloves reaching in Sister's belly. Matron still felt light-headed.
As she massaged Sister's fingers to still the shaking in her own, the words came to Matron unbidden: “Instruments of God.” Sister Mary Joseph Praise had beautiful fingers, slender and soft, each a delicate sculpture. Even at rest they spoke of fine motor skills. Matron's by contrast were doughy white, the knuckles large and red as if someone had taken a ruler to them; the knobby excrescencies on the fingers spoke of nothing but age and toil and the caustic soaps and scrubbings which were the first tools of her profession; the fire burst of wrinkles on her palms spoke of her love for the Ethiopian soil and her willingness to plant and weed and dig alongside Gebrew. He was guard, gardener, odd-job man, and priest, and he believed Matron had no business dirtying her hands.
Matron felt her body shaking. Lord, you can take me, she thought. But wait till they're done because I don't want to distract them again. How she longed for a cup of coffee made from their own plant grown on Missing soil. She loved the gritty feel of the stone-ground bean against her teeth, and the way it rolled down the throat like lead shot. The Italians had left behind their passion for macchiato and espresso so that every café in Addis served these beverages. Matron had no use for any of that. Missing coffee, brewed traditionally, that's what sustained her through the day, and what she needed right now.
Tears tracked down into the crevices at the angles of her mouth. One of my Cherished Own, she thought; the daughter I can never have, now with child … So many times at Missing, Matron had become privy to an unspeakable secret revealed by catastrophic illness. Impending death had a way of unexpectedly unearthing the past so that it came together with the present in an unholy coupling. But Lord, she cried out silently, You could have spared us this. Spared her!
As she stroked the younger woman's skin, Matron thought of the impulse that had made Sister Mary Joseph Praise choose to hide her body under a nun's habit or under scrub suit and mask. It hadn't worked; her covering exaggerated what little flesh was exposed. When a face was so lovely, lips so full, even a veil couldn't block its sensuality.
A few years after Sister Mary Joseph Praise's arrival, Matron thought that the two of them should give up the white habit. The Ethiopian government had closed down an American mission school in Debre Zeit for proselytizing. Matron was in the business of running a hospital, not converting souls; she decided it might be politically smart to forgo nun's habit. But when she'd seen Sister Mary Joseph Praise leaving Operating Theater 3 in a skirt and blouse, Matron wanted to run out and cover her with a sheet. W. W. Gonafer, Missing's laboratory technician, standing next to Matron, had also seen Sister Mary Joseph Praise walk by in mufti. He'd frozen like a setter pointing to quail, a flush creeping from his collar to the roots of his hair, as if lust were a companion fluid to blood. Matron had decided then that nuns at Missing should remain in habit.
A sudden exclamation that could have been from Hema or from Thomas Stone startled Matron, brought her back to the present. She jerked her head up, and before she could stop herself, she looked … What she saw made her shudder and feel as if she'd keel over again. She dropped her head down between her shoulders, closed her eyes, and forced her mind to find another focus …
Matron had no saint whom she modeled herself after, someone to call on at these times. To think of St. Catherine of Siena drinking the pus of invalids—oh! how that disgusted her. Matron thought of such displays as a particular Continental weakness, and she was impatient with celestial billing and cooing, bleeding palms and stigmata. And as for St. Teresa of Avila … why, she didn't have anything against Teresa. She didn't grudge Sister Mary Joseph Praise her adulation of Teresa. But secretly she agreed with Dr. Ghosh, the internal medicine physician at Missing, that St. Teresa's famous visions and ecstasies were probably nothing but forms of hysteria. Ghosh had shown Matron photographs that Charcot, the famous French neurologist, had taken of his patients with hysteria at the Salpêtrière hospital in Paris. Charcot believed that these delusions sprung from a woman's uterus—hystera in Greek. His patients, who were all women, stood in smiling poses—provocative poses, Matron thought—that Charcot had labeled “Crucifixion” and “Beatitude.” How could anyone smile in the face of paralysis or blindness? La belle indifférence was what Charcot called this phen
omenon.
If Sister Mary Joseph Praise had visions, she wasn't one to speak about them. Some mornings, Sister Mary Joseph Praise had looked sleepless, her bright cheeks, her floating carriage, suggesting her feet strained to remain earthbound. Perhaps that explained her equanimity while working shoulder to shoulder with Thomas Stone, a man who for all his talents gave little encouragement to those who labored with him.
Matron's faith was more pragmatic. She'd found in herself a calling to help. Who needed help more than the sick and the suffering, more so here than in Yorkshire? That was why she came to Ethiopia a lifetime ago. The few photographs, mementos, books, and certificates Matron brought with her had over the years been pilfered or mislaid. She never worried over this—one Bible, after all, would do just as well as the next. The essentials were also easily replaceable: her sewing kit, her water-colors, her clothes.
But she'd come to value the intangibles: the position she had grown to in the city where she was “Matron” to everyone, even to herself; the resourcefulness she'd discovered that allowed her to make a cozy hospital—an East African Eden, as she thought of it—grow out of a disorganized jumble of rudimentary buildings; and the core group of doctors whom she'd recruited and who by long association had evolved into her Cherished Own. The umbilical cord that had connected her to the Society of Holy Child Order, to the Sudan Interior Mission, had shriveled and fallen off. They were all now self-exiled prisoners at Missing— she and her Cherished Own.
Missing Hospital wasn't its name, of course, and now and then Matron tried to correct people, teach them to say “Mi-shun” instead of “Missing.” But in truth that year it wasn't even Missing; it was either Basel Memorial or Baden Memorial—she had to consult the paper taped to her desk to be sure—named after a generous church in either Switzerland or Germany. The Baptists of Houston were big donors, but they weren't at all concerned about naming the hospital. Dr. Ghosh liked to say that the hospital had as many forms as a Hindu god. “On any given day, only Matron knows which hospital we work in, and if we are walking into the Tennessee Baptist outpatient clinic, or the Texas Methodist outpatient clinic, so how can you blame me for being late— I have to get out of bed and go find my place of work. Oh, Matron, there you are!” Prisoners they all were, Matron thought, smiling despite herself; Missing People who could hardly choose their cell mates. But even for Ghosh, who was without doubt one of the strangest of God's creations, Matron felt a maternal affection. And the parallel anxiety that comes with such an impish child.
MATRON SIGHED and was surprised to hear words tumble out of her mouth, and she felt the others in the operating theater staring at her. Only then did she realize that her lips had been busy shaping prayers. Since turning fifty, Matron had noticed such dissonances and disconnections between her thought and action; they were becoming common. For example, at inopportune moments her mind busied itself pasting images into a mental scrapbook. Why? When would she ever have occasion to recall all these memories? At a testimonial dinner? On her deathbed? At the pearly gates? She'd long ago stopped thinking literally about such matters. Her father, a miner who had lost himself in alcohol and the darkness of the tunnels, had loved the words “pearly gates.” On his tongue it sounded like the name of a blowsy woman, one of many that had come between him and his conjugal duties.
Still, Matron was sure of one thing: the image she witnessed when she'd inadvertently looked up a short while before, that was one she'd never ever forget. What happened was this: the sun had suddenly freed itself from behind a cloud, and by some accident of elevation and season presented itself directly on the ground-glass window of Operating Theater 3. Lambent and white, it had bounced off the walls, reflected off glass, metal, and tile, and there it was just when Hema or Stone or whoever it was made a loud exclamation, which was what had made Matron look up. That was when Matron saw them all bent over like hyenas over carrion, peering into Sister Mary Joseph Praise's open abdomen and its scandalous contents. She saw the light nosing its way between elbow and hip. Then the sunbeam fell directly on Sister Mary Joseph Praise's gravid uterus, which bulged out of the bloody wound like an obscenity on a saint's tongue. A blue-black collection of blood—a hematoma— stretched the broad ligament of the uterus, and it glowed in the light like the Host. Matron felt that this had been the sun's intent all along— to find the unborn. We have seen each other anew. We are unmasked. Yes, it was the kind of event that might be termed a “miracle”—except that nothing happened; the laws of nature weren't suspended (which Matron felt was the sine qua non for miracles). But it was as if the twins’ place in the firmament as well as in the earthly order of things had been secured for them even before they were born; she knew that nothing—not even the familiar scent of eucalyptus, or the sight of its leaves thrust into a nostril, or the drumroll of rain on corrugated tin roof, or the visceral odor of a freshly opened abdomen—could ever be the same again.
CHAPTER 9
Where Duty Lies
HEMA WIELDED HER SCALPEL like a woman on fire. No time to tie off bleeders, and, in any case, very little bleeding along the way—not a good sign. She opened the glistening peritoneum and quickly positioned retractors to hold the wound edges back. The uterus bulged out of the wound. Then, before her eyes, it seemed to swell and turn luminous … She stood frozen, until she realized it was because the sun had suddenly struck the frosted window and lit up the table. In all her years operating at Missing, she couldn't remember that happening before.
Just as Hema feared, there was a lateral tear in the uterus. Blood had filled the broad ligament on one side. That meant that once she got the babies out, shed have to do an emergency hysterectomy, no easy task in pregnancy, what with the uterine arteries being tortuous, thickened, and carrying half a liter of blood a minute. Not to mention the massive blood clot shimmering in the light, growing before her eyes and gloating at her like a smiling Buddha, as if to say, Hema, I have completely distorted the anatomy, dissection is going to be bloody difficult, and your landmarks will all be gone. But come on in anyway, why don't you?
Hema believed in numerology; next to one's name, nothing was as important as numbers. What is it about this day? she asked herself. It's the twentieth day of the ninth month. No fours or sevens in there … Airplane almost crashes, a child breaks his leg … I crack a Frenchman's nuts … What more, I say, what more?
She rapped Stone's knuckles with a scissors. “Stop!” He was fumbling with an oozing vessel when she needed him to retract.
She incised the uterus and tried to deliver the twin who sat higher in the uterus but was nevertheless head down, upside down. This twin would have been the second to come out had delivery proceeded through the birth canal, but now it would be the firstborn. But strangely, this twin, hand jammed against its cheek, wouldn't budge.
She extended the uterine wound.
She suctioned the infant's mouth.
She drew a sharp breath that inverted her mask against her lips because she could see the problem.
The babies were joined at the head. A short, fleshy tube passed from the crown of one to the other, a tube that was narrower and of a darker hue than the umbilical cords. They were tethered together, but there was a fatal tear in this stalk, a jagged opening caused no doubt by Stone's fishing with the basiotribe. And from this rent, what little blood the two infants possessed was pumping out.
Please God, she thought, let this be only a blood vessel, and a minor one at that. Let there be no brain or meninges or ventricle or cerebral artery or cerebrospinal fluid or whatnot in it. She spoke aloud to Stone now, to the room, to God, and to the twins whose lives, if they survived, might be irrevocably affected by this decision: “They could have seizures the minute I cut this. One twin could bleed out and the other overfill with blood. They could get meningitis …”
This was a technique surgeons used when difficult decisions had to be made: think aloud for your assistant because it might help clarify the issues for yourself. And theoretically it gave t
he assistant time to point out her faulty reasoning, though she wasn't about to take an opinion from the man responsible for this blunder. A careful decision was needed so as not to blunder again. It was often the second mistake that came in the haste to correct the first mistake that did the patient in.
“No choice,” she said. “I have to cut.” She put clamps across the stalk where it emerged from each infant's scalp. She invoked Lord Shiva's name, held her breath, and cut above each clamp, bracing herself for something terrible.
Nothing happened.
She tied off the stumps. She cut the umbilical cord and easily pulled out the first infant, a male. She handed it to the gowned and gloved probationer who stood nearby. This baby had been spared his father's probings. Then she pulled out the other infant—again a boy, an identical twin, whose scalp was bloodied from Stone's knife and whose skull would have been crushed had she not arrived.
Both infants were tiny, three pounds at best. Clearly less than full term. A month premature, perhaps more. Neither infant cried.
Distracted now by heavy oozing from Sister Mary Joseph Praise's soggy, friable uterus, Hema turned back from infants to the mother.
“What is her BP?” Hema asked, peering over the drapes, first at Nurse Asqual, and then at Sister Mary Joseph Praise's face. The anesthetist, the whites of her eyes showing like saucers, shook her head. Beautiful Sister Mary Joseph Praise's face now looked bloated and lifeless. “More blood! For God's sake. Pour it in!” Hema shouted.
As she toiled in the now deflated cavity of the belly, Hemlatha remembered that when she'd handed over the second baby to the probationer, she had been surprised to find the probationer still standing there, holding the first, a blank look on her face. But Hema had no time to worry about that. Once the babies were out, her duty as an obstetrician was to turn completely to Sister Mary Joseph Praise; her duty was to the mother.