State of Wonder (33 page)

“You’re very quiet,” Dr. Swenson said. “I thought you would have so much to talk about while we walked. Everyone back at the lab this morning was anxious to discuss your feelings.”

“I’m trying to remember how to deliver a baby,” Marina said.

“The brain is a storage shed. You put experience in there and it waits for you. Don’t worry. You’ll find it in time.” With these nearly encouraging words they reached their destination. Had the Lakashi lived in a city, this particular hut would have been located in the outskirts of the farthest suburb. It was for the native who wanted privacy, who wanted a view of the river without a view of his neighbors. They knew it was the right house by the pitifully weak screaming that emanated from it. The man and the duffel bag bounded up the ladder ahead of them and was gone.

Dr. Swenson looked behind him, gauging the logistics. “When I think of finishing this project and going back to the States the thing I picture is a staircase. I suppose if I were more ambitious in my daydreams I would think of elevators and escalators, but I don’t. All I want is a nice set of stairs with a banister. You are my witness, Dr. Singh. If I make it out of this country alive I will never climb another ladder again.”

At seventy-three it was hardly a shocking oath to swear. Marina considered the length of Dr. Swenson’s arms and legs against the width of her circumference. It did not seem possible. “Is there any way for me to help?”

“Not unless you strap me to your back. I believe I can go up but the coming down concerns me. I don’t want to get stuck up there and wind up having to give birth in this hut myself.”

“No,” Marina said, though the thought of going up there alone was not without problems.

Dr. Swenson rubbed at her temples. “What do we know for certain, Dr. Singh? I am a seventy-three-year-old woman who is pregnant and short. But women who are older and shorter and more pregnant than I have made it up and down these ladders every day of their lives, including the day of their delivery.”

The T-shirted man leaned over the floor and looked at them with expectation. “Vir! Vir!” he said.

“Oh good,” Dr. Swenson said. “He has a little Portuguese. He says we should come.” She looked up again. “I suppose we should.”

“We also know for certain that none of those women was having her first child at seventy-three,” Marina said. “They had a lifetime of experience in climbing the ladders, pregnant or not. They were used to it.”

Dr. Swenson turned to her and nodded her approval. “Well said, and I admire your willingness to argue against your own best interests. Now stay one step behind me and prepare yourself to be an ox. You are very strong, aren’t you?”

“Very,” she said. And so they climbed, Marina stretching her long arms around her professor, her hands just beneath Dr. Swenson’s hands, her strong thighs beneath Dr. Swenson’s thighs, and up they went towards the wretched weeping and the husband’s calls of “Agora.”
Now!

Benoit had been sent ahead with instructions that the family should have waiting a large quantity of water that had been twice boiled and twice strained, and the first thing they saw were the buckets, which were not clean themselves, sitting in a row. Benoit, who had avoided Marina since the incident with the snake, was nowhere in evidence. The woman lay on the floor in a pile of blankets and both the woman and the blankets were so wet they looked like they’d been dredged up from the river. Spreading across the floorboards beneath her was a dark, soaking stain. Their guide was kneeling beside his wife, holding her hand, rearranging her wet hair with his fingers while the other members of the household went about their business. An elderly man with no shirt stretched out in a hammock while two small children, a boy and a girl, pushed him back and forth, laughing ecstatically every time he swung away. Three women, one with a baby on her breast, were tying strings of red peppers together while a man in the corner sharpened a knife. When Dr. Swenson arrived at the top of the ladder she was panting and they all snapped up their heads in attention. She pointed to a wooden crate and one of the younger women ran to bring it to her. She sat down and was offered a gourd full of water which she accepted. Even the woman on the blankets quieted herself to acknowledge the honor she had been shown. To think that Dr. Swenson had come to her house!

Marina didn’t know if she should first attend to the patient or the doctor, when in fact she wasn’t sure she had the skills to help either one of them. “There’s the bag,” Dr. Swenson said, and gave a nod towards the floor. “You’ll find what you need. I’ll tell you, I’m impressed to have managed this.” She covered her heart with her hand. “I haven’t gone up a ladder since this whole ordeal began.”

Marina unzipped the bag and ran her hand in circles inside, heartsick to see how little she had to work with. There was a bar of soap in a box, no scrub brush, some packaged, disinfected towels, packaged gloves, a prepackaged surgical kit, some various medications that rolled around the bottom of the case looking paltry. There were two silver shoehorns with their ends bent back. Marina held them up. “What are these?”

“Shoehorns!” Dr. Swenson reported happily. “Rodrigo got a whole box of them once years ago. They make brilliant retractors.”

Marina put the shoehorns in her lap and bowed her head. “How can I sterilize them?”

“How can you sterilize anything? You can’t, Dr. Singh. This is what it is. Go ahead and wash up in the first bucket,” Dr. Swenson said. “I’m catching my breath.”

The water in the first bucket was tepid and Marina ground the soap into her skin over and over again, wondering how it was possible that she was where she was, that what was about to happen was in fact happening. Surely she had participated fully in every step it took to get to this place, agreeing whenever she had meant to decline, but still, it wasn’t such a long time ago that she was back at Vogel charting lipids and Anders was alive. She was trying to dig out the dirt from underneath her fingernails when the woman on the blanket let out such a cry she jumped. What Marina needed was to deputize a nurse, someone had to open the packages. She called to one of the three women, jerking her head until the woman reluctantly laid down her peppers and came over. Marina handed her the soap and did a pantomime of washing and opening the packages while the woman stared at her as if Marina had lost her mind. She wondered if she would have to act out every stage of the surgery, but now she was getting ahead of herself. No one had said there would be a surgery. Dr. Swenson had situated her crate next to the woman on the blankets. Marina came over with her nurse who continued to scowl at the bother of it all until Dr. Swenson made eye contact with her and the eye contact settled her at once.

Marina pulled on her gloves, got down on her knees. When the woman on the blankets looked at her, Marina pointed to herself, “Marina,” she said. The woman gave her a weak nod in return and said a name no one could hear. Having made the introductions, Marina soaped the woman’s genitals and thighs, bent up her knees and showed the nurse how to hold them. “It would be nice to have a clean blanket to put her on.”

“If you had a clean blanket you would want a sterile one, and a sterile blanket makes you think you can’t do anything without a table and a light, and from the table and the light it is a very short step to needing a fetal heart monitor. I know this. Check and see how dilated she is.”

Again, Marina looked at the woman as she slid in her hand to check the cervix. There was enough room for a well placed baby of normal size to make an easy exit and Marina felt a great wave of relief come over her. “She’s wide open.” She moved her hand around, feeling for the baby. As it happened, the basic construction of the female body had not changed since she had done this last. Having the patient on the floor made no difference: there was the baby, though she was quite certain that was not the baby’s head she was feeling. “It’s breech,” she said. It wouldn’t have been her first choice but she could manage it. “I’m going to have to try and turn it.”

Dr. Swenson shook her head. “That takes forever, causes a great deal of pain, and half the time it doesn’t work anyway. We’ll do a section.”

Marina removed her hand from the woman. “What do you mean it takes forever? Where do we have to go?”

From her perch on the wooden box Dr. Swenson dismissed the suggestion out of hand. “There’s no point in putting her through all of that if in the end you’ll have to do the section anyway.”

Marina sat back on her heels. “The point is we don’t have anything approaching sterile conditions. The chance of her dying from a postoperative infection is enough to indicate that turning the baby is worth a try. I don’t have a nurse to help me with a surgery, I don’t have an anesthesiologist.”

“Do you think we keep an anesthesiologist around here?”

“What do you have?” Marina pulled off a glove and poked through the bag.

“Ketamine. And don’t go throwing gloves away. This isn’t Johns Hopkins.”

“Ketamine? Are we planning on sending her out to a disco later? Who in the world uses Ketamine?”

“Here’s the news, Dr. Singh, you get what you get, and I was lucky to get that.”

“I’m going to try and turn the baby,” Marina said.

“You’re not,” Dr. Swenson said. “It is enough that I had to go up that godforsaken ladder. I would appreciate it if you did not make me get down on the floor as well. Even if it were possible to take my leg out of the equation, I have edema in my hands.” Dr. Swenson held up her hands for exhibition. Her fingers were swollen out straight and the skin was pulled tight. Ten little sausages.

“Dear God, when did that happen?” Marina reached up for a hand and Dr. Swenson jerked it away.

“I would have a difficult time with the scalpel. I have a difficult time with a pencil. All that said, either you are going to do the cesarean or I am. Those are the choices.”

“What is your blood pressure?” Marina asked.

“I am not your patient,” Dr. Swenson said. “You would do well to keep your attention on what is in front of you.”

The man in the gray T-shirt looked from Dr. Swenson to Dr. Singh, holding his wife’s hand. Clearly, their disagreement concerned him. It did not concern his wife, who took the opportunity to close her eyes for the two minutes she had between contractions. Had someone asked Marina whose opinion was more valuable on the question of whether or not to proceed with a cesarean—the former head of obstetrics and gynecological surgery at Johns Hopkins who had not touched the patient, or the obstetrics and gynecological surgery dropout who was touching her first patient in thirteen years—Marina would cast her lot with the former. Still, being the latter, she was sure she was right, and equally sure she wasn’t about to physically prevent her mentor from taking over the case. That left her one option. “Tell me how to use the Ketamine,” she said.

The Ketamine was put in a syringe, which, once the needle had been inserted into the vein, was taped to the inner arm so that it could be slowly tapped in as needed, and with that tapping the patient ceased to whimper. Marina washed and dried the woman’s belly, straightened out her legs, and, putting on clean gloves, showed her nurse how to hold the skin taut. She had her nurse’s attention now. The woman was wide-eyed and still while Marina slid the scalpel into the skin. Once she felt the knife insert, it occurred to her that this was not her first surgery after so many years. It wasn’t a week ago she had cut through the snake. The subcutaneous fat welled up through the line of the incision like clotted cream dotted with the first bright beads of blood.

That cut, which passed without a sound save a small gasp from the husband, drew the sudden attention of everyone in the hut. Even the old man pulled himself out of the hammock and brought the two children over to see. The other two women, and the man with the knife, all gathered round for the show, leaning forward and pushing a little to get the best view. Marina felt someone’s knees against her back. “This isn’t helping,” she said.

Her nurse, hands steady on either side of the incision, barked out an order, and the circle immediately took one big step back.

“Now we’re looking for the fascia,” Dr. Swenson said. “I didn’t bring my glasses. Do you see it there, under the fat?”

“I’ve got it,” Marina said. She took the nurse’s hands and put a shoehorn in each one. She dug the horns into the incision and showed the woman how to pull. There was the uterus. Despite the drowning flood of adrenaline she recognized it all—bowel and bladder, it was perfectly familiar. Why was that so surprising? She had given up her profession, not her knowledge. Marina, half blinded by her own sweat, turned her face to Dr. Swenson who picked a shirt up off the floor and wiped her down. Dr. Swenson then leaned forward and blotted off the face of the nurse, who was wrestling mightily to keep the cavity open wide with her shoehorns.

“Now take the bladder down,” Dr. Swenson said. “Don’t nick it. You see the bladder, don’t you?”

“I do,” Marina said. It was a miracle to see anything without direct light. She cut into the uterus carefully, avoiding everything that was not meant to be cut, and the blood boiled up into the cistern of the belly. Blood, combined with the great slosh of amniotic fluid, made a dark and raging ocean Marina could not get past. The hot liquid broke over the floor and pooled beneath the doctor and her patient. “How in the hell do you do this without suction?”

“There’s a bulb in the bag,” Dr. Swenson said.

“I need another set of hands.”