Abraham Verghese - Cutting for Stone

The probationer recorded in the chart the arrival of Dr. Hemlatha. She chastised herself for not thinking of the gloves.

Hemlatha spread her own legs. Her feet were swollen from the long flight. She flexed her toes against the straps of her sandals and pawed the ground to get good purchase on the bloody floor. With the fingers of her left hand she spread the labia. Then, with a motion made simple by countless repetitions, her right hand pulled down on the posterior rim, opening the birth canal to view.

“Rama, Rama, this is a bloody Stone Age utensil,” Hemlatha shouted as she carefully disengaged first one half and then the other half of the skull crusher, slipping them over and then off the baby's ears. When the bloody instrument was free, she looked at it with distaste and flung it aside.

Matron felt relief. Whatever happened, at least now a real obstetrician was in charge. She couldn't help but note how Hemlatha and Stone had reversed roles: Hema was now the shouter and the flinger.

Matron offered the history that Sister Mary Joseph Praise had been in severe pain, great spasms of it, and then the pains had suddenly ceased and she'd seemed almost lucid, talking … but now she had deteriorated again.

“My God,” Hema said, knowing that in nature pains don't cease till a baby is out, “it sounds like a uterine rupture.” It would explain all the blood on the floor. Placenta previa—a placenta plastered over the exit to the womb—was another possibility. Neither possibility was good. “When did you stop hearing the fetal heart sounds?” No one replied.

“Pressure?”

“Sixty by palpation,” the nurse anesthetist said, after a pause, as if she expected someone else to volunteer the number that she was responsible for.

Hema peered around Sister Mary Joseph Praise's swollen belly to fix Nurse Asqual with a withering look. “Are you waiting for it to get to zero before you breathe for her? Put in a tracheal tube. Connect it to the hand bellows. If she wakes, give her some intravenous pethidine. Tell me when you're done. Where's Ghosh? Have you sent for him?” Nurse Asqual busied herself, grateful for step-by-step instruction because her mind had seized.

“And who has gone for blood? What! Nobody? Am I dealing with idiots here? Go! Run! Run!” Two people charged for the door. “Round up anyone and everyone to give blood. We need lots of blood!”

Hema insinuated two fingers of her right hand around the fetal skull. With her other hand she pushed down on Sister Mary Joseph Praise's belly. She peeked over the rise of the abdomen at Sister's face; it had gone gray, grayer than Stone's.

Nurse Asqual, her hands shaking, managed to insert the tracheal tube. With every squeeze of the air bag, Sister's engorged breasts heaved up.

Hema's hands were like extensions of her eyes as she explored the space that she thought of as the portal to her work; fingers inside took their soundings, helped by the hand on the outside. She closed her eyes, the better to receive what her fingertips conveyed about the pelvic width, the baby's position. “What have we here … ?” she said aloud. Indeed, the baby was head down, but what was this? Another skull?

“Good God, Stone?” Hemlatha said, snatching her hand out as if she'd touched a hot coal.

Stone looked on, not understanding, but afraid to ask. She fixed her gaze on Stone, her face taut, waiting for a reply, any reply, and prepared to shout it down when it came.

“Better out than in?” Stone mumbled, thinking she meant his skull-crushing attempts.

“Damn it, Thomas Stone, don't quote me your idiot book. Do you think this is a joke?” Stone, who didn't at all see this as a joke, who in fact saw that everything Hema was doing was something he could have and should have done, turned crimson. Hema turned back to probe once more that calamitous space in Sister Mary Joseph Praise's body where two lives were in jeopardy. Her words were like body blows directed at Stone.

“One prenatal visit? Could you have let me see her for at least one prenatal visit? I'd have canceled my trip. Look at the soup we are in! Miracle, my foot. Completely avoidable … completely avoidable “ the last two words delivered like lashes.

Stone stood as if in front of the headmistress. Hema seemed to expect him to speak and so he stammered, “I didn't know!”

Hemlatha's jaw dropped. She stared at him. There was a part of her that was incredulous at the idea of Stone impregnating Sister Mary Joseph Praise—who could imagine that? But the cynicism of the obstetrician who has seen everything crept back in. “You're thinking virgin birth, Dr. Stone? Immaculate conception?” She came around the table. “In that case, guess what, Mr. Expedient Operator? This is better than the manger in Bethlehem. This virgin is having twins!” She paused to let it sink in. “For goodness’ sake, couldn't you have done a Cesarean section?” Her singsong intonation rose at the end, leaving the words “Cesarean section” hanging over Stone's head.

“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.