Bryson City Tales (35 page)

“Excuse us, folks,” Sally declared as she took me by the arm and escorted me to a door on the back wall. “We've got some work to do.” As we approached the bedroom door, the midwife stepped out and introduced herself. Elizabeth looked to be in her eighties, small, lanky, and leathery—a true granny midwife. She whispered, “Thanks for coming. You're not a minute too soon! The baby's heartbeat is starting to get slow and irregular. We don't have much time.”

“Mrs. Stillwell, wouldn't it be a good idea if the paramedics came inside?”

She looked apoplectic. She still whispered, but now in a more agitated tone of voice. “No way! Absolutely not!” was her emphatic response. “It was hard enough to convince the family to let me call
you.
”

“The Shoaps have a phone?” I asked, surprised.

“No, of course not. I have a radiophone that the sheriff dispatcher can patch into the phone system. Now we'd better hurry!”

We entered a small bedroom. There was barely enough room for a small bed and a chest of drawers. The woman was lying on her side, moaning. She didn't acknowledge my arrival. A man, sitting alongside and stroking her hair, stood up and faced me.

“Let me be real honest,” he stated bluntly. “You're not wanted here. Not real sure we trust your type. Elizabeth here says you can save my baby's life. I'd be obliged if you did. This here is Isabella and I'm Donnie.” He turned back to his wife and sat down on a small wooden chair by the bed.

“Isabella,” I said, “I'm Dr. Larimore. Would it be OK if I checked your baby?” She nodded, then began to grimace as another contraction began. I reached over to palpate her abdomen. During the quick exam I had time to offer a quick prayer.
Lord, guide my hands. Give me wisdom. Protect this
small baby. I know children are special to you. Great Physician,
be with us.

The baby felt headfirst and was big—my guess, somewhere in the vicinity of nine pounds, maybe more! As the contraction intensified I could see the sweat glistening on Isabella's brow, reflecting the lantern light coming from atop the chest of drawers. Her husband looked genuinely worried.

As the contraction waned I warmed the head of my stethoscope in my hands. Then I placed it on Isabella's abdomen. What I heard caused a knot in my stomach. The baby's heart rate was about one beat every one to two seconds—I guessed about forty beats per minute, the normal was more than 120 beats per minute—but was beginning to speed up.

“Mrs. Stillwell, heart rate's about forty. We've got to move fast. Let's get some oxygen started. I'm calling the paramedics to come in.”

Elizabeth gave me a concerned look, but without comment she quickly set up the oxygen and placed the mask on Isabella's face.

As she was doing this I opened the door. “Pastor!”

He leaped from his seat and ran over to me.

“I need you to do two things and do them now.”

He glared at me.

“Get
out there and get my paramedics. Tell them I want them ready to receive this baby. Let them know the baby is in trouble.”

He nodded and started to turn.

“One more thing!”

He turned back to me.

“When you get back, I need you and everyone here to pray for this baby and for Isabella.”

He smiled, ever so slightly. “Be obliged.”

“Pastor, one more thing.”

I paused. He furrowed his brows, listening intently.

My voice softened, almost quivering, “Pastor, will you all pray for me, too?”

He reached out to place his hand on my forearm and gave it a squeeze. “Yep.”

I quickly returned to the bedroom. We moved Isabella to the end of the bed and positioned her on her back. I had Mrs. Stillwell hold one leg and Sally held the other. Now sweat was beading on my forehead. I heard Don and Billy entering the cabin.

“Doc, you OK?” Don called from behind the closed door.

“Don, just set up for a resuscitation.”

“You need us in there?”

“No room now. Just set up, OK?”

“OK!”

I put on sterile gloves and began to examine Isabella again. The birth canal was filled with an enormous head. Fortunately the cervix was completely dilated. Then I checked for the position of the baby's head.

“Drat,” I muttered. “Elizabeth, she's OP!” This was
not
good news. The baby was in the same nose-up position my son had been in before he was born.

Elizabeth was listening to the baby's heart rate. “Doc, heart rate's in the thirties.”

I felt panic starting to build. The child was in immediate danger.

“Elizabeth, can you open the forceps for me?”

“Isabella and Donnie,” I continued, “I'm going to gently place some forceps around the baby's head. They will protect the head in the birth canal and will help me deliver the baby.”

I was well trained in forceps deliveries, and I quickly applied the instrument. After double-checking the position of the forceps to be sure the application was correct, I waited. In just a few seconds the next contraction began. With it I began to pull and pull. The baby didn't budge. It felt stuck.

I tried gently pushing the baby back up the birth canal. Doing so would sometimes allow the head to flex and present a smaller diameter to the birth outlet or perhaps allow me to rotate the head to the normal OA position, which would then make birth easier and faster. In this case, once again the head didn't budge.

Then I quickly tried to rotate the head. I knew the odds of this being successful were nearly zero, but it was worth a try. But to no avail.

“Doctor, the heart rate's in the twenties!” exclaimed Elizabeth.

I suddenly felt nauseated. “Let's roll her back on her side.”

Within seconds of getting Isabella off her back, the baby's heart rate soared into the fifties and then to one hundred beats per minute. “Much better!” I said, almost to myself. Still, the normal baby's heart rate at this stage of labor should be 120 to 160 beats per minute. We were in big, big trouble. I was thinking as fast as I could—and praying even faster.

Then a thought occurred to me. When I trained in England, where most of the maternity care and deliveries are done by midwives, we did deliveries in the side-lying position—but not forceps deliveries. I remembered one of the British midwives teaching me how to deliver OP women in the knee-chest position. She said that this position allowed gravity to pull the baby down, against the abdominal wall, which would allow the head to flex and either allow the baby to rotate or to be delivered more easily.

“Elizabeth,” I queried, “did you try the knee-chest position?”

“Yes, Doctor, but it didn't seem to help.”

“Well, maybe it will if I also use the forceps.”

“Good idea,” she confirmed.

I quickly explained to Isabella and Donnie what we were going to try, while Elizabeth and Sally arranged the pillows in the middle of the bed. We then helped Isabella roll over into a knee-chest position, with her chest resting on the pillows.

Now
I
was the one who was completely befuddled. I had used forceps many, many times—but always with the woman being on her back. This position was 180 degrees different. Now I had to think and act in the exact opposite way from how I usually did. I quickly lubricated and applied the forceps. I could see Donnie's shocked look. I was hoping his shock was over seeing the stainless steel hardware protruding from his wife's birth canal and not over my profusely sweating forehead, the look of terror in my eyes, and my lips mouthing a silent prayer,
Lord, guide my
hands. Guide the head. Protect this baby!

Isabella began to moan as the contraction intensified. I double-checked the position of the forceps.

Elizabeth reported, “Heart rate's in the twenties and falling.”

It was now or never. I began to pull, but for some reason—maybe instinct, maybe intuition, but most likely God's leading—thought better of it. Instead I gently pushed the head and it moved, ever so imperceptibly,
up
the birth canal. This was a good sign, for it meant that the head might be flexing and turning to a better position.

Then I tried gently rotating the forceps, and, to my amazement, the baby's head quickly and easily turned. Then in an instant the head began to progress down the birth canal.

I quickly removed the forceps. Isabella was straining with all of her might. Elizabeth was massaging her back and shoulders and coaching Isabella's pushing. Donnie just stared at us all.

Sweat was dripping off my forehead and the tip of my nose, but I couldn't stop to wipe it off. I was using my hands to maintain the baby's head in flexion. As I pushed to do this and as Isabella pushed, the head began to show and then in an instant the baby was out of the birth canal.

“A little boy!” I shouted. I could hear, in unison, in the common room, “A little boy!” followed by shouts of “Hallelujah!” and “Praise Jesus!”

I was quickly clamping and cutting the umbilical cord.

“Elizabeth, can you take over?” I asked as I bolted from the bedroom to the paramedics with a floppy, blue, unresponsive baby. I didn't wait for the answer.

Don and Billy had set up a baby warmer on the kitchen table. They had brought in a couple of battery-powered lanterns and had the resuscitation equipment ready to go. They had also instructed the family that they must stay away from the table as we worked.

“Heart rate's less than thirty, Doc. No spontaneous respirations!” shouted Don as I vigorously dried and stimulated the baby.

I suctioned out the mouth and pharynx. Still no response.

“Start CPR?” exclaimed Don.

“Wait a second,” I burst out, as I grabbed the baby's legs around the ankles and then with my other hand slapped the blue bottoms of the feet. The baby instinctively pulled up his legs and let loose with the sweetest shriek I had ever heard.

“Pulse is 120,” cried Billy, whose fingers were feeling the pulse at the base of the umbilical cord.

I quickly examined the baby. He was now beautiful and pinking up just fine. He was perfect!

Elizabeth appeared at my side. “Isabella's OK, Doc. Placenta delivered without a problem. I've given her an injection of Pitocin, and there is no bleeding. How are you?”

“We're OK, we're OK!”
I exclaimed as my eyes filled with tears. “Isn't he beautiful, Mrs. Stillwell?”

“He is, he is!”

Elizabeth took over, doing what she did naturally, what she had done hundreds of times before. She swaddled the baby and held him to her chest, singing a lullaby. We all simply watched. It was all I could do to choke back sobs of relief. As I watched and dabbed the tears from my eyes, I prayed,
Lord, thank you
for your grace and for your guidance. Thank you for this beautiful
baby. Thank you for protecting me and him!

“I think Isabella and Donnie would like to see their baby. OK?” Elizabeth looked at me.

“You bet,” I nodded.

She turned to the bedroom and then stopped. She slowly turned back to me.

“Doc. Why don't you?” She held out the baby to me.

Her thoughtfulness and graciousness overwhelmed me.

“May I?” I asked with tearful eyes.

“Yes, of course.” Elizabeth smiled. So did I. As she handed the baby to me, she softly said, “Feels to me like about a nine and a half pounder, Doc.”

Isabella was sitting up in bed, looking no worse for the wear. Donnie was sitting on the bed beside her, stroking her hair. When the midwife and I entered, they both turned toward the door. Isabella held her hands out. I placed the baby in her arms and then stepped back to watch this new family bond. After a few moments Donnie stood up and walked around the bed toward us.

“Mrs. Stillwell, thanks for everything.”

“Donnie, I'm so glad everything came out OK.”

He then turned to me and dropped his head. “Doc, I want to apologize for my words when you came here. May have been a bit harsh. But the family hasn't had very good dealings with doctors—'cept for Dr. Pat. She's about as good as they come.” He paused, seemingly struggling for words. “But I appreciate you helping Mrs. Stillwell out here.”

He paused for a second. Then he raised his head to look into my eyes. “Thanks for saving my baby's life.”

My eyes filled with tears that tumbled down my cheeks. He stepped toward me and gave me a big bear hug. I hugged him back. When he stepped away, I was speechless. We both smiled.

I left Donnie and Isabella to enjoy their new baby. The common room was abuzz with conversation and somehow seemed brighter. Maybe another lantern or two was lit. Maybe it was the new life that had just entered the world.

The pastor approached. “I've never had a doc ask for prayer. Appreciate it. Appreciate being a part of your work. Mind if we say a prayer now?”

“Nope,” I replied, “that would be mighty fine.”

We all held hands in a big circle. Don on my left, Billy on my right. We were all joined in a circle—the paramedics, a mountain family and pastor, a wise old granny midwife, and a young physician—growing in experience and in spirit. The pastor thanked the Lord for the new life, for the safe delivery. Silently I was thanking the Lord for this unexpected privilege of standing in this circle of life, the stinging words of “you're not wanted here” melting into a chorus of praise.

chapter thirty

THE SHOWDOWN

Rick and I were just finishing up our last patients on a beautiful spring morning. Mitch had come in from the hospital and was in his office with the door closed. The voices behind the door were uncomfortably loud. Rick and I looked at each other. He shrugged and turned his attention to his paperwork. I tried to ignore the voices and finish my chart work.

Suddenly the door to the office flew open and out bounded a red-faced Ken Mathieson. As he saw us sitting there, he screeched to a halt and drew up to his full five-foot eight-inch frame. His eyes narrowed, and he pointed a finger at us, as if aiming down the barrel of a rifle. “You boys are trouble. Trouble, I say!”