Abraham Verghese - Cutting for Stone

Matron came closer. Stone's eyes were not bloodshot and he didn't reek of spirits. No, he was unhinged by Sister Mary Joseph Praise's condition, and rightly so. As Matron turned her attention from Stone to Sister Mary Joseph Praise, she nevertheless felt a ghost of satisfaction: at last the man had bared his soul, displayed his feelings for his assistant.

Matron ignored Stone's ramblings about volvulus or ileus or pancreatitis or tuberculous peritonitis. “Let's go to the theater,” she said, and when they were there, she said, “Lay her on the operating table.”

He set her down and Matron saw a sight she had seen seven years before: blood soaked Sister Mary Joseph Praise's dress in the region of her pubis. Matron's mind raced back to Sister Mary Joseph Praise's first arrival from Aden, and how blood on her habit then had caused similar concern. Matron had never asked the nineteen-year-old, point-blank, what caused the bleeding. The irregularity of the stain on that occasion had invited the observer to read meaning in its shape. Matron's imagination had constructed so many scenarios to explain that mystery. In the ensuing years, memory had changed the event from mysterious to mystical.

Which was why Matron now glanced at Sister Mary Joseph Praise's palms and breast as Stone laid her down, as if she half expected to see bleeding stigmata, as if that first mystery had grown into this second mystery. But no, the only blood was at the vulva. Lots of blood. With dark clots. And bright red rivulets that ran down the thighs. Matron had no doubt, as blood dripped to the floor: this time it was secular bleeding.

Matron seated herself between Sister Mary Joseph Praise's legs, willfully ignoring the stomach swelling that loomed in front of her. The labia were engorged and blue, and when Matron slid her gloved finger in, she found the cervix fully dilated.

Of blood there was much too much. She swabbed and dabbed and pulled down on the posterior vaginal wall for a better view. When a piteous sigh emerged from her patient's lungs, Matron almost dropped the speculum. Matron's chest was pounding, her hands shaking. She leaned forward, tilted her head again to peer in. There, like a rock at the bottom of a mud pit, a stone of the heart, was a baby's head.

“Lord, she's,” Matron said, when she could finally speak, gasping at the sacrilegious word that threatened to choke her and which her mouth could no longer contain, “pregnant.”

Every observer I later talked to remembers this moment in Theater 3, when the air stood still, when the loud clock across from the table froze and a long, silent pause followed.

“Impossible!” said Stone, for the second time that day, and even though it was incorrect and hardly the thing to say, it allowed them all to breathe again.

But Matron knew she was right.

She would have to deliver this baby. Dr. K. Hemlatha—Hema to all of them—was out of station.

Matron had delivered hundreds of babies. She reminded herself of this now to try and keep herself from panic.

But how was she to push away not just her qualms but her confusion? One of her own, a bride of Christ—pregnant! It was unthinkable. Her mind refused to digest this. And yet the evidence—an infant's skull— was there, right before her eyes.

The same thought distracted the scrub nurse, the barefoot orderly, and Sister Asqual, who was the nurse anesthetist. It caused them to trip over one another and knock down an intravenous drip as they scurried around the table, readying the patient. Only the probationer, who was mortified that she had failed that morning to recognize this crisis when she visited Sister Mary Joseph Praise, didn't stop to wonder how Sister Mary Joseph Praise got pregnant.

Matron's heart felt as if it might gallop right out of her chest. “Lord, what worse circumstance can you construct for a delivery? A pregnancy that's a mortal sin. A mother-to-be who is like my own daughter. Massive bleeding, ghostly pallor …” And all this when Hema, Missing's only gynecologist, not only the best in the country, but the best Matron had ever seen, was away.

Bachelli up in the Piazza was marginally competent in obstetrics but unreliable after two in the afternoon, and his Eritrean mistress was deeply suspicious of him leaving on “house calls.” Jean Tran, the half-French, half-Vietnamese fellow in Casa Popolare, did a bit of everything and smiled a lot. But assuming they could be reached, it would still be a while before either man would come.

No, Matron had to do this herself. She had to forget the implications of the pregnancy. She had to breathe, concentrate. She had to conduct a normal delivery.

But that afternoon and evening, normal would elude them.

STONE STOOD BY, his mouth open, looking to Matron for direction, while Matron sat facing the vulva, waiting for the baby to descend. Stone alternately crossed his hands in front of him and then dropped them by his sides. He could see Sister Mary Joseph Praise's pallor increasing. And when Nurse Asqual in a panicked voice called out the blood pressure— “systolic of eighty palpable”—Stone wobbled as if he might faint.

Despite uterine contractions which Matron could feel through the belly and see in Sister Mary Joseph Praise's contorted face, and despite the fact that the cervix was wide open, nothing happened. A baby's head high up in the birth canal with the cervix flattened like a gasket around it always reminded Matron of the shaved scalp of a bishop. But this bishop was staying put. And meanwhile, such bleeding! A dark and messy pool had formed on the table and tidal eddies of blood came out of the vagina. Blood was to delivery rooms and operating theaters what feces were to tripe factories, but even so it seemed to Matron that this was a lot of blood coming out.

“Dr. Stone,” Matron said, her lips quivering. A bewildered Stone wondered why she was calling on him.

“Dr. Stone,” she said again. For Matron, Sound Nursing Sense meant a nurse knowing her limits. For God's sake, she needs a Cesarean section. But she didn't say those words because with Stone it could have the opposite effect. Instead, her voice low, her head drooping, Matron pushed down on her thighs to bring herself to her feet and to vacate her spot between Sister Mary Joseph Praise's legs.

“Dr. Stone. Your patient,” she said to the man who everyone believed to be my father, putting in his hands not only the life of a woman that he chose to love, but our two lives—mine and my brother's—which he chose to hate.

WHEN SISTER MARY JOSEPH PRAISE felt the herald cramps of labor, Dr. Kalpana Hemlatha, the woman I would come to call my mother, was five hundred miles away and ten thousand feet in the air. Off the starboard wing of the plane Hema had a beautiful view of Bab al-Mandab—the Gate of Tears—so named because of the innumerable ships that had wrecked in that narrow strait that separated Yemen and the rest of Arabia from Africa. At this latitude, Africa was just the Horn: Ethiopia, Djibouti, and Somalia. Hema traced the Gate of Tears as it widened from a hairline crack to become the Red Sea, spooling north to the horizon.

As a schoolgirl studying geography in Madras, India, Hema had to mark where coal and wool were produced on a map of the British Isles. Africa figured in the curriculum as a playground for Portugal, Britain, and France, and a place for Livingstone to find the spectacular falls he named after Queen Victoria, and for Stanley to find Livingstone. In future years, as my brother, Shiva, and I made the journey with Hema, she would teach us the practical geography she had taught herself. She'd point down to the Red Sea and say, “Imagine that ribbon of water running up like a slit in a skirt, separating Saudi Arabia from Sudan, then farther up keeping Jordan away from Egypt. I think God meant to snap the Arabian Peninsula free of Africa. And why not? What do the people on this side have in common with the people on the other side?”