John Irving - The Cider House Rules

The harangue that developed at the railroad station over the arrival of the body Homer would call Clara gave Homer his first experience with eclamptic convulsions -or puerperal convulsions, as they were called in Wilbur Larch's days at the Boston Lying-in. At the exact moment that Dr. Larch was at the railroad station arguing with the stationm aster about the release Form for the unfortunate Clara, Homer Wells was at St. Cloud's trying to locate, exactly, the inferior thyroid vein on body number two. Although he didn't know it, lie had a good excuse for having, momentarily, lost his way; body number two was wholly shopworn, and many things were hard to locate within it. He would have consulted his Gray's in another minute or two, but just then Nurse Edna burst upon him-shrieking (as she always did when she saw Homer with body number two; it was as if she'd caught him up to something with Melony).

'Oh, Homer!' she cried, but she couldn't speak; she flapped her arms in an agitated, chickenlike fashion before she managed to point Homer in the direction of the dispensary. He ran there as quickly as he could, finding a woman lying on the dispensary floor-her eyes staring so wildly and so steadily unseeing that at first he mistook her for the body he knew Dr. Larch was trying to liberate from the stationmaster. Then the woman began to move, and Homer Wells knew she was quite close to becoming a cadaver; the convulsions began with a twitching in her face, but they spread rapidly through all the muscles of the frame. Her face, which had been flushed, turned a shiny blue-black; her heels struck the floor with such force that both her shoes flew off-{166}Homer saw instantly that her ankles werer'Kugely swollen. Her jaws were set; her mouth and chin were wet with a frothy spittle, laced with blood because she'd bitten her tongue-which was at least preferable to her swallowing it. Her respiration was hardworking; she expelled air with a hiss, and the spray splashed Homer's face with a violence he'd not felt since he stood back from the bank and watched therWinkles being swept away.

'Eclampsia,' Homer Wells said to Nurse Edna. It derives from the Greek; Dr. Larch had told him that the word refers to the flashes of light a patient sees at the onset of the puerperal convulsions. With any sensible prenatal care, Homer knew, eclampsia was usually avoidable. There was an easily detected rise in blood pressure, the presence of albumin in the urine, swelling of the feet and hands, headaches, vomiting, and of course those spots and flashes in the eyes. Bed rest, diet, reduction of fluid intake, and free catharsis usually worked; but if they didn't, the bringing on of premature labor almost always prevented the convulsions and often produced a living baby.

But the patients Dr. Larch saw were not women who sought or even understood prenatal care. This patient was very last-minute-even by the standards of Dr. Larch's practice.

'Doctor Larch is at the railroad station,' Homer told Nurse Edna calmly. 'Someone has to get him. You and Nurse Angela should stay to help me.'

In lifting the woman and carrying her to the delivery room, Homer felt the woman's moist, cold skin and was reminded of body number one and body number two (the latter, he recalled, had been left on the examining table in the room now used for his anatomical studies, near the boys' division kitchen). In the last century, Homer Wells knew, a doctor would have given this patient an ether anesthesia and would have dilated the mouth of the wornb to effect a forcible delivery-a method that usually caused the patient's death.{167}

At the Boston Lying-in Wilbur Larch had learned to fortify the heart muscle with doses of digitalis, which helped prevent the development of fluid in the lungs. Homer listened to the woman's watery breathing and realized he might be too late, even if he correctly remembered the procedure. He knew that one had to be conservative with eclampsia; if he was forced to deliver the woman prematurely, he must allow the labor to develop as naturally as possible. The woman just then moaned; her head and heels whacked the operating table in unison, her pregnant belly seemed to levitate-and one of her arms, without will, without purposeful direction, flew up and hit Homer in the face.

He knew that sometimes a woman had only one puerperal convulsion; it was recorded that a few patients had survived as many as a hundred. What Homer didn't know, of course, was whether he was observing this woman's second convulsion or her ninetieth.

When Nurse Edna returned to the delivery room with Nurse Angela, Homer instructed the nurses to administer morphine to the patient; Homer himself injected some magnesium sulphate into a vein, to lower blood pressure at least temporarily. In the interval between her last and what Homer knew would be her next convulsion, he asked Nurse Edna to take a urine sample from the woman and he asked Nurse Angt:la to examine the specimen for traces of albumin. He asked the woman to tell him how many convulsions she had already suffered but although the woman was coherent and could even answer questions intelligently, she couldn't pinpioint the number of convulsions. Typically, she remembered nothing of the convulsions themselves-only their onset and their draining aftereffects. She estimated she was at least a month away from expecting her baby.

At the onset of her next convulsion, Homer gave the woman a light ether sedation, hoping he might reduce the violence of the fit. This fit was different in character from the last, though Homer doubted it was any less {168}violent; the woman's motion was slower, but-if anything -more powerful. Homer lay across her chest, but her body abruptly jack-knifed-lifting him off the operating table. In the next interval, while the woman was still relaxed under the ether sedation, Homer's investigations showed him that the neck of the patient's womb was not shortened, its mouth was not dilated; labor hadn't begun. He contemplated beginning it, prayed that he wouldn't have to make this decision, wondered why it was taking so long to find Dr. Larch.

An orphan with a bad cold had been assigned to locate Larch at the railroad station; he returned with a thick rivulet of snot in each nostril and strung across one cheek, like a welt from a whiplash. His name (Nurse Angela's, of course) was Curly Day, and he wetly announced that Dr. Larch had boarded the train to Three Mile Falls-in order to chase down and capture the body that the stationmaster (in a pique of perversity prompted by religious outrage) had forwarded to the next stop. The stationmaster had simply refused to accept the cadaver. Larch, in a rage now surpassing the stationmaster's, had taken the next train after it.

'Oh-oh,' Nurse Edna said.

Homer gave his patient her first dose of digitalis; he would repeat this periodically until he could see its effects on the woman's heartbeat. While he waited with the woman for her next seizure, he asked her if she had decided to put her baby up for adoption, or if she had come to St. Cloud's only because it was the nearest hospital -in short, was this a baby she very much wanted, or one she didn't want?

'You mean it's going to die?' the woman asked.

He gave her Dr. Larch's best 'Of course not!' kind of smile; but what he thought was that it was likely the baby would die if he didn't deliver it soon, and likely the woman would die if he rushed the delivery.

The woman said she had hitchhiked to St. Cloud's because there was no one in her life to bring her, and that {169}she didn't want to keep the baby-but that she wanted it, very much, to live.

'Right,' Homer said, as if this decision would have been his own.

'You seem kinda young,' the woman said. I'm not going to die, am I?' she asked.

'That's right, you're not,' said Homer Wells, using Dr. Larch's smile again; it at least made him look older.