Georg Letham (59 page)

An analogy, to make this clear. A plum pit that can slip lengthwise through the narrow neck of a bottle and out again will have a great deal of trouble getting out of the bottle in a crosswise orientation. And here
there was just as little hope that the baby's body, lying transversely with its legs by its head, one bulky, shapeless mass, could safely pass through the natural birth canal. Never. Rather, it would tear the poor mother's viscera to pieces, and even now the screams, the almost continuous hypertonic contractions without any time for recovery, were only too understandable. For the baby's head, much too far to one side, was pulling at and grinding against the tender internal organs. It was causing contusions, internal wounds, hemorrhages. Even the woman's most bloodcurdling screams would make sense to someone who knew what was going on inside her. A warm bath may work wonders for a nervous, oversensitive lady whose baby is in the proper position, but here it was as useless as a shot of morphine. Unless all one wanted to do was to give the two of them a painless end, both mother and child. That I could not do. No doctor could.

The conservative school of obstetrics cherished in the bosom of our university faculty for a century had always recommended as the first recourse that the baby's body be shifted with the greatest care from the transverse lie to the correct one, the longitudinal lie, bringing the head away from the side and downward, if possible without surgical intervention. I, an experimental bacteriologist, attempted this now. I would work only on the outside, on the abdominal wall, where I saw streaky horizontal striae attesting to earlier pregnancies; if at all possible, my hand would not even touch the exposed internal organs. If this was successful, the delivery could take its course in a normal fashion, with the head first.

Then the mother would not be infected by my bacteriologist's hands; but only then.

Turning the baby's body from its transverse lie onto its head in the mother's womb was without a doubt the simplest and gentlest intervention
if
it could be done by simple dislocation, from outside. Usually the baby's head lies somewhat closer to the mother's pelvic inlet, that is, somewhat farther down, than the baby's bottom. The mother must therefore be positioned so as to be resting on the same side as the baby's head in order for the delivery to take its natural course.

I asked the matron and a young but competent nurse, her factotum, to give me a hand. We put two beds together on their long sides with a crossbrace and then tried to reposition the mother. Though I was not the strongest person in the world since my illness, I undertook to lift the woman from her single bed. I carried her in my arms to the double bed and established the desired position. Her cries of pain had not stopped. As her blotchy, sweaty face lay on my chest, I felt her frantic, hissing gasps on my throat. She was doing her best to keep from screaming.

Finally she was in the position we wanted. She was immobile. But not relaxed. She should not, could not relax, she had to help. Much as we might have liked to, we could not administer a narcotic that would have anesthetized, sedated, paralyzed her, she had to help us with the delivery by bearing down with all her strength.

Even in normal births it is not easy to get a mother-to-be to deliberately increase her own pain by bearing down to contract the abdominal muscles and squeeze the baby's head deeper through the sore, tender lower abdomen. And how much more difficult it was in this case! But I had so much power over this woman who was almost unconscious with brute suffering that she did her best. I helped the process along methodically with my hand on the outside of her belly.

The baby does not lie directly beneath the skin and the muscular sheath; it is surrounded by amniotic fluid within the womb. Often, when one thinks one has grasped the head, it slips away again like a fish in water, and the stronger the contractions become, the denser and tighter the muscular wall of the uterus becomes and the more difficult it is for a hand to correct the baby's wrong lie by pushing vigorously from the outside. The things I tried! The maneuvers I attempted, the torment I caused! At last we seemed to have succeeded. The woman was on her side on the bed, holding on to a support with both hands; her beautiful reddish hair shone, spread out on the damp pillows. Every so often she reached out for me, but then she controlled herself to keep from annoying me, making an effort to stifle her screams.

When everything was taken care of, I put her cold hand back where it belonged, squeezed it, and at the same time counted her pulse on the radial artery. It was somewhat elevated but fortunately gave no cause for concern. Then I checked the baby's heart sounds by placing my late friend's stethoscope on the outside of his widow's abdominal wall. The unborn baby's heart was clearly perceptible, pounding like a kettledrum. I counted 140 to 142 beats per minute. The young resident (he was wearing his old, no longer entirely clean white coat and his presence here was not to my liking, but what could I do) was very concerned about this high rate, the pulse rate of healthy adults being no more than sixty-eight or seventy per minute. I had to inform him that an unborn child's pulse rate is twice that. His polite but incredulous smile told me what a good thing it was that I had not entrusted the delivery to him. For he was as innocent as a Capuchin monk.

A slight improvement in the woman's condition seemed to be at hand. Her haggard cheeks were losing their blotchy flush, her breath
was not so spasmodic, and her screams were dwindling to deep, prolonged groans. The muscles in her meager arms were tense: she held on and held out.

I am unable to describe how very happy this slight seeming improvement made me. The woman wanted to say something, she gestured, and when I bent down, she asked me–to send word to her five children in the city? No, Georg Letham, you poor excuse for a psychologist–she asked me to look after the little dog that was shut up in the guest room she had been occupying and was surely suffering from hunger and thirst and loneliness.

All my life I have been vulnerable, ultimately, to sentimental impulses. And I succumbed to them now. First I searched for the woman's bag, finding it under her clothes on the reclining chair, and opened the clasp to look for the key to her room.

A strange feeling came over me as I found, along with small bills, a tortoiseshell comb, coins, handkerchiefs, lipstick, compacts, the key, and other odds and ends, my friend's passport and the telegrams to whose composition and dispatch I myself had been a witness not long before. I put everything back, smiled confidently at the woman, took the key, and went out into the corridor. March was waiting for me, feverish with worry and impatience. “She's doing better, bosom buddy, much better!” I called out to him. I hurried as quickly as I could through the rambling building to the wing where the guest room was located. I could already hear the little dog's melancholy whine like a repeated question.

But at the same time my ears, so inordinately keen since my illness, picked up unmistakable sounds of distress from the woman once more: not the feral shrieking of the first hypertonic contractions, but twice
as dreadful to me in the subdued, weakened form signifying surrender to despair.

I threw the room key at the feet of a young assistant nurse who appeared in the corridor just then, shouted a few incoherent words at her. It hardly mattered whether she understood them or not. I had to go back.

On the way I reproached myself most bitterly for having left the sickroom. But had it been so inexcusable? I, who had always wanted, who had needed, to take upon myself what was most difficult, had felt the desire to be part of something lighter, more human for once. To go to an animal that had been left by itself, that was half dead from hunger and thirst, to show it all the acts of kindness that an animal lover can (I had begun to love animals, and did I ever!)–was that such a crime? It seemed so.

In that brief interval, the woman's condition had worsened a great deal. She no longer lay compliantly on her side, but on her back, her legs propped on the bar that we had provided. She was moaning and crying out, feebly, but so heart-wrenchingly that no ear could have borne it, even one much less keen than mine.

The matron too was white as a sheet, and the good-natured resident shook like a leaf when the woman in her anguish suddenly lurched upward, sat up on the shuddering bed, got to her feet, hammered with both fists on her spherical belly, and then let herself fall face-first back onto the bed with all her weight, as though to destroy the child inside her with the force of her fall–and herself, too. Only with the greatest effort was it possible to bring her to reason, at least for a short time–and this effort consisted chiefly of a potent injection of morphine and atropine. Dangerous or not. It had to be. Her pupils dilated immediately
from the effect of the atropine, which was stronger than the pupil-constricting effect of the morphine.

Now she gradually stopped screaming, but pointed to her belly with both hands. I examined it very gently. The uterus was visibly contracted beneath the thin, brownish, striated skin, with no sign of wanting to relax completely.

Suddenly a greenish liquid poured out of her, the amniotic fluid began to be expelled. The amnion, the amniotic sac, had ruptured. What to do? Act fast? Yes, but how? Was there any way to help? There had to be. The delivery could not proceed naturally. Do nothing, just put my hands in my lap? In hers? Bring in the chaplain, who was knocking on the door, impatiently now, and demanding to baptize the child in the womb with an injection of holy water? The matron was in favor of this. The hospital director, an excellent administrator but an extremely mediocre and unresponsive physician, also arrived, to make matters worse. All of them assailed me loudly with advice, worries, senseless talk. Were they sorry they had put a convict in charge of the delivery? It was too late for that. They were shouting so confusedly that the woman herself was inaudible now.

I do not know how I found the strength to get them out of the room, all but the matron and the young assistant nurse who had followed me with the key from the corridor. Her face, in its chaste, unspoiled austerity, gave me a certain confidence in her moral steadfastness (which proved itself). The air was stifling. We tore open the window. One had to be able to breathe before making grave decisions affecting the life and death of two people.

A colossal cloudburst was now hammering down on the city. The air, with a smell of burning sulfur, was a lead weight in the lungs.

There was a rumbling like the bottom notes of an organ in the branches of a tall jacaranda. Some of the ubiquitous vulture-like nocturnal birds, startled, rose from it, their dripping wings stretched out horizontally.

Back to the bed, which was soiled by the greenish, disagreeable-looking, but odorless, fluid. I placed the stethoscope on the rock-hard, yellowish abdomen, pointing upward like a gently shining dome.

The baby's heart sounds? They were subdued. The pulse rate was decreasing. It had fallen from 140 to 110.

A bad sign. A terrible danger signal. We had to make haste, or all would be lost.

The air that evening was so humid that our shirts and coats stuck to us as though they had just been pulled out of water. The heat took our breath away. It was like wearing a helmet made of lead, a diving helmet. But this was no time to be thinking about personal discomforts.

All that mattered was the prepping for the unavoidable intervention.

Luckily the room had running water. And outside the windows, water was pouring down as though the sluices of heaven had opened.

The first preparatory procedure consisted of the disinfection of my hands and arms up to the elbows and the equally careful and meticulous aseptic prepping of the woman now half conscious and writhing in contractions. This disinfection could be entrusted to the trained matron and her very skillful, intelligent assistant.

The second preparatory procedure was the induction of deep anesthesia. If I wanted to turn the baby in the womb, the uterus and abdominal musculature had to be as relaxed as possible. The mother could
not suffer any more pain. She simply could not take any more. Human feeling and medical duty were one.

This anesthesia I would in good conscience much rather have entrusted to my friend March–who had spent many hours anesthetizing monkeys and dogs down in the laboratory and possessed a natural, inborn gift for this difficult task–than to anyone else, than to Carolus, say, who soon withdrew. He could not watch such things. Thus I called to March, telling him to scrub thoroughly as I was doing and then begin the anesthesia. While I scrubbed, the assistant nurse went down to the hospital pharmacy for an anesthesia mask and the necessary quantity of anesthetic, a mixture of chloroform and ether in alcohol.

The storm had abated momentarily. It was quiet outside after the rumbling of the hurricane-like thunderstorm. Now there was more trouble. The electric light was beginning to flicker ominously. There had been similar disruptions every so often since the death of the Swedish power-plant director. What could we do? There was no time to think. The mother, who was only whimpering now, was looking more critical every minute. She was deteriorating. She was slipping away. I had to operate, even if darkness reigned as before the creation of the world, when all was a black chaos.

I barked at March. Why hadn't he begun the anesthesia? “Get going! Mask on! Administer the mixture one drop at a time, faster or slower as needed. Grab the lower jaw with your left hand and pull it forward! Then the tongue will come along and won't lie on top of the laryngeal inlet, so respiration will be free; monitor her breathing, breath by breath! Keep your left index finger on her pulse and count off the breaths till I say stop. Wait! Have you checked for false teeth?” March had forgotten this, and why would he have thought of it? Dogs and
monkeys do not have dentures to slip down their throats in deep anesthesia and choke them. “False teeth! Oh, come off it!” objected March, normally so clever and quick on the uptake. “Get that stupid look off your face, you idiot!” I cried. “Open her mouth, and do it right! Like that, yes, and have a look!” “Stop shouting,” March responded resentfully, but he obeyed. (Her teeth were real.)