Ann Patchett - State of Wonder

From the other side of the room the baby was crying now and the husband, still fixed to his wife’s hand, craned his head towards the sound. “Tap the Ketamine,” Dr. Swenson said. “There’s no point in her waking up now.” Marina suctioned out the belly again and set to work on the heavy stitches, a procedure as delicate as closing a Thanksgiving turkey with kitchen twine. The nurse, so much braver than one would have imagined, moved her shoehorns back knowledgeably while Marina reassembled everything she had taken apart: the uterus sewn, the bladder placed back on top.

“This is a good man,” Dr. Swenson said, nodding to the husband. “He stayed right with her. You don’t see that. They like to go fishing. Sometimes when they hear it was a son they’ll come in for a look, but that’s about it.”

“Maybe it’s their first,” Marina said.

Dr. Swenson shook her head. “I should know that. I can’t remember.”

Marina was making her last knot when the baby was returned. She slid the Ketamine out of the woman’s arm and lay the baby there in its place, though the mother, who was just barely flicking her eyelids, did nothing to hold it. It was a good looking baby, two furry eyebrows and a rounded mouth, swaddled in striped yellow cloth. He gave half a cry and half a yawn and everyone seemed to find this charming.

Marina was stiff coming up off her knees. “See?” Dr. Swenson said, pointing. “It’s hard enough for you.”

Marina nodded, taking off her gloves, and looked at the blood on her arms, the blood on her dress, the tidal pool of blood in which she had been sitting. “Good Lord,” she said. She looked in the bag for a blood-pressure cuff.

Dr. Swenson shook her head. “You don’t realize how much blood there is when you have all those other people waiting there to sop it up for you. This is a perfectly reasonable amount. You wait and see, she’ll be fine. They’ll both be fine.”

The nurse came over and covered the woman with another blanket. “It would be good if we could just move her to someplace that was dry,” Marina said. “I can’t leave her lying in all of that.”

“There are certain things we cannot expect the Lakashi to do,” Dr. Swenson said. “They cannot perform cesarean sections. That is a matter of training and equipment. They do know that a sick woman should not be left to lie on a sodden blanket, and they know perfectly well how to clean up. You will come back tonight and check on your patients, Dr. Singh, and come back again to check on them tomorrow. You’ll see how well they manage without you.”

The woman who had been nursing a baby when they arrived had handed that one off and was now nursing the new one while his mother slept on the floor. The father came to Marina, who was putting the contents of the used surgical kit back in her bag, and very lightly slapped her back and arms with his open hands. Then the others came over, all except the woman nursing and the woman sleeping, and did the same. The two children hit her legs and the old man reached to slap her ears. Marina in turn pounded the back of her nurse who had never flinched or turned her head during the surgery and in return the woman gently slapped Marina’s face with the back of her hand.

“Come now,” Dr. Swenson said. “Once you get started with this it can go on for hours. You’ll come home with more bruises than Easter.”

It took some navigation to get Dr. Swenson down the ladder but there were so many Lakashi waiting for her at the bottom with their arms stretched up that they would have simply caught her had she fallen and borne her aloft all the way back to the lab. She gave herself a few minutes to catch her breath and while they waited a crowd assembled. Clearly the news of their success had spread. The natives made a thick ring around Marina and Dr. Swenson, chattering and clapping their hands together once Dr. Swenson made it clear they were to keep their hands to themselves.

“Everyone is admiring you,” Dr. Swenson told Marina in a raised voice.

Marina laughed. There was a woman behind her holding on to her braid, staking out the territory as her own. “You’re just projecting. You have no idea what they’re saying.”

“I know their happiness. I may not know the details of every sentence but believe me, there are many ways to listen and I’ve been listening to these people for a long time.” The crowd was moving forward and the two doctors moved with them. “They think you will replace me,” Dr. Swenson said to her, “the way I replaced Dr. Rapp. Benoit told them you were the one who killed the snake to save Easter and that you brought the snake back for them. Now they’ve seen you cut out a child and keep the mother alive. That’s a heady business around here.”

“They didn’t see that,” Marina said.

“They most certainly did,” Dr. Swenson said, and lifted up her hand towards the sky. “They were in the trees. The entire surgical theater was full.”

Marina looked around at the faces of all the beaming Lakashi. What would have happened if the woman hadn’t lived? If the child were dead? “I didn’t look up,” she said.

“Just as well, too much pressure. You did a fine job. I could tell you were a student of mine. You made a classic T-incision. You kept the opening in the uterus small. You have very steady hands, Dr. Singh. You are exactly the person I want when I deliver.”

What a thought, delivering the child of the person who taught her to deliver children. “I won’t be here when you deliver,” Marina said, and took comfort in the knowledge. “How far along are you?”

“Just over twenty-six weeks.”

“No, no,” she said. “That’s not even possible. Who were you planning on delivering the baby?”

“The midwife. I’ll be honest, I had envisioned an experience as close to the Lakashi’s as possible, but as time goes by I’m thinking more about the need for a section. I’m doubting that my pelvis will spread. Chewing the Martins does nothing to reverse the aging of one’s bones. I’m going to need a section and there’s no one else here I’d trust for that.”

“Then you’ll go to Manaus.”

“A woman my age can’t go to the hospital to have a baby. There would be too many questions.”

“I would have to think a woman your age couldn’t avoid going to the hospital.” Marina looked at Dr. Swenson and seeing that she wasn’t listening began again. “Even if I was going to be here, and trust me, I’m not, you don’t know what kind of complications you might have. You’re breaking ground here, you can’t just expect to have the baby on your desk. You just saw me perform my first surgery in over thirteen years. That hardly qualifies me to deal with anything that could come up.”

“But you could. I saw you work. At some point I realized I should have made better plans for this inevitability but now you’re here. You’re a surgeon, Dr. Singh, and all the pharmacology in the world isn’t going to change that.” She shook her head. “Pharmacology should be reserved for doctors who have no interpersonal skills or doctors with uncontrolled tremors who are prone to making mistakes. You never did tell me why you changed your course of study.”

Some members of the crowd around them had begun to sing and some others to tap their tongues against their palates, making a noise of cheerful wailing. The children cleared the path ahead like a pack of hungry goats, snatching up every leaf and twig, ripping out vines, knocking down spider webs with a stick, until the trail was as neat as anything found in a national park. “You never told me why you changed yours,” Marina said.

“I had no choice. I saw the work that needed to be done and I had to do it myself. You can’t draw the world a map to this place and have everyone come running in, trampling the Rapps, killing off the martinets, displacing the tribe. By the time they understood what they were doing, it would all be dead. The conditions for this particular ecosystem have yet to be replicated. Eventually, yes, but for the time being if it is going to happen it’s going to happen here. For years my study was strictly academic. I wanted to record the role of Martins in fertility. I had no desire to synthesize a compound. I’ve never believed the women of the world are entitled to leave every one of their options open for a lifetime. I believe it less now that I am pregnant. Give me your hand, Dr. Singh, this leg is killing me. Yes. We can walk a little slower than the rest of them.” With that the Lakashi, who had at times an uncanny ability to understand English, cut their pace in half. “But when I discovered the link to malaria all of that changed. No scientist could be on the threshold of a vaccination for malaria and not make an attempt at it. I’ve been very careful about the people I’ve brought here. They are all extremely committed, respectful. I wouldn’t have any of them take out my appendix, but as far as the drug’s development is concerned they have made remarkable progress.”