John Sayles - A Moment in the Sun

“I want you to breathe somewhat rapidly in between the cramps,” he tells Jessie. “Rapidly but not deeply. If you start to get dizzy, slow your breathing down.”

“It’s coming, isn’t it?”

He doesn’t want to get her hopes up, not at her age, not when it is this early. His first delivery, the one that soured him on obstetrics, was a girl about Jessie’s age. She was long overdue, her mother said, but had had no contractions and now was sick with a fever.

The baby was very large and beginning to decompose. He insisted on the curtain that time, insisted that the mother and the aunt and the girl’s best friend stay on the other side of it to comfort her while he worked. There was enough swelling that neither the blunthook nor the cephalotribe were of any use, no way to insert them without further damaging the vagina. He was forced to use the trephine perforator, asking the women to sing a hymn to distract from the sound of it, and then hook in and yank the tiny body out with a crochet. At least it came out in one piece.

So many possibilities, so many pitfalls.

“You’re going to have to help me,” Dr. Lunceford says to his daughter. “Do you think you can do that? You have to be very brave.”

“I’m only a girl,” says Jessie in a very small voice.

“You have been married, you have been widowed, you have been exiled.” It is the first time he has ever said the word aloud. “You only have to do what all women do.”

“I’m not ready.”

“I’m sorry. It won’t wait.”

They speak very little these days. Yolanda pleads with him to forgive Jessie and he maintains that their acceptance of her, living with her and what they all know to be true of her condition, is forgiveness enough.

This time she cries out louder, and Dr. Lunceford has a momentary twinge of concern for their neighbors on the fifth floor. Their neighbors who engage in screaming matches twice a week.

A tiny knob of skull is pushing through now.

“Aaron?” calls Yolanda from the kitchen.

“Is it clean?”

“As clean as I can make it.”

“Take some of my handwash, the antiseptic,” he calls, “and wipe the inside with it.”

Jessie is huffing now, balling handfuls of the bedsheet in her fists, pushing down hard enough with her feet that her buttocks raise off the bed from time to time.

“It shouldn’t be coming now, should it?” she says to him when she can catch her breath. “I’m not ready.”

“We won’t know anything till it reveals itself,” he says. It is not true. He knows it will be undersized, discolored, the digestive tract not finished, the lungs prone to atelectasis, susceptible to infection — if it is viable at all. “You just have to concentrate on helping it come out. When the next cramp happens I want you to try to breathe in and make your chest and stomach rise up. You’ve been clamping down.”

“It hurts so much.”

“The pain will be there no matter what you do, Jessie. But if you lift up with your stomach it will allow the baby to come out.”

He is careful to call it a baby and not a fetus. Dr. Osler once presented a lecture that concerned nothing but Terminology and the Patient — when the lay terms should be employed, when a bit of scientific Latin was not amiss to either obscure a harsh reality or impress a skeptic. But in his mind this is no baby.

The membrane on the cervix is appropriately thin, and it has opened to nearly five centimeters. Dr. Lunceford’s pitiful collection of instruments, just sterilized, is laid out beside him on a clean towel. He will have to cut and sew, there is no way to avoid it, with the attendant risk of sepsis. He wonders what the midwives do, women with their herbs and potions and folklore. That so many of their charges, mother and child, survive, is either a testament to their common sense or to the inherent hardiness of the species. That something so vital to our existence should require the ministration of others—

“Ah, ah, ah, ah!” cries Jessie.

“Lift your stomach—”

“ Do something! Give me something!” she shouts at him, red-faced, furious in her agony.

Dr. Lunceford flushes as he stifles his first response. This is the consequence, he thinks, of her own actions. And then anger, at his own arrogance, at Nature itself for contriving to allow his sweet little girl to hurt like this.

“When we get it out,” he says to her soothingly. “We just need to get it out and then I can give you something.”

The veins on Jessie’s temples stand out as she strains, crying out each time she exhales, but he sees that she is trying, chest and stomach pushed up spastically with each convulsion.

“That’s my girl,” he says. “That’s my Jessie.”

“Aaron?” calls Yolanda from the kitchen. Her voice wavers, he can hear that she is crying.

“Feed the firebox,” he says. “But keep the door to the warming compartment open.”

She had nightmares, Yolanda, for years after the birth, waking in a sweat and then insisting on going into the children’s rooms to be sure they were both still breathing.

“Daddy!” Jessie calls. “I feel it moving!”

Another contraction grips her, her little face contorted with pain, Dr. Lunceford holding tightly to her ankles to keep her on the bed and it is fully crowned now, purplish with fluid-slimed hair on top of it. Not breech, thinks Dr. Lunceford thankfully. Not transverse.

Jessie slumps back into the mattress, wheezing for breath, and he quickly injects cocaine solution into the perineum. This late in the procedure there is little chance of it passing into the fetus. He lifts the scalpel, stretching the cervix away from the cranium with his other hand, counting. He wants to give the drug time to dull the nerves, but to cut before the next contraction. Just a little nick, enough so it won’t tear.

“We’re halfway there, Jessie. A little sting now—”

He slices, less than an inch, and immediately she spasms and there is blood and amniotic fluid and the nose and mouth are pushed out, a vertex presentation, and he reaches under and quickly clears its tiny mouth with his little finger.

“A couple more, Jessie,” he urges. “Push from your diaphragm. Remem-ber your singing lessons.”

He misses her playing. He never thought too much of it in Wilmington, something the women liked to occupy themselves with and Jessie apparently a prodigy, but here, in these dingy rented rooms, he feels its absence. He hears Yolanda in the doorway again.

“The shoebox,” he says.

“That I keep my jewelry in?”

“Empty it out and line it with cotton batting. There’s some in my bag.”

He hears her move away. His eye falls on the forceps lying beside the bloodied scalpel. No, he thinks. We’re past that. Jessie starts to growl, the growl raising in pitch till she is shouting, one long agonized howl and she is pushing from her diaphragm as he asked and more of it is revealed and he is able to hook his index finger in and get a purchase on something, perhaps beneath an arm, and when Jessie goes slack this time she is weeping, her shoulders shaking and her head rolling from side to side on the pillows.

“I can’t, Daddy. I can’t anymore.”

“You would be surprised,” he says, “at how strong, at how will ful my daughter Jessie is. Come on now — one more big push when it comes—”

Her scream this time is not the noise a girl makes. She strains and contorts her face and mucous blows out of her nose and Dr. Lunceford pulls gently and it is free, tiny thing and fluid and blood and black meconium and the cord exactly where you want it to be, the cord purple and red and blue and with the faintest of vibrations, a pulse, when he squeezes it with his fingers.