An Irish Country Welcome Page 23

  Barry rose. “Thanks, Kinky. Come on, Sebastian. Give me a hand with the maternity bags. Fingal, the pair of us saw her two weeks ago, so she’d be thirty-four weeks today. She was meant to be coming in for an antenatal checkup. I was just going to brief you, Emer. She might still have a breech presentation. We’d better get moving.”

  O’Reilly put down his pipe. “Premature breech? If she’s in labour, get onto the flying squad at once.”

  “Will do.”

  “So,” Sebastian said as Barry steered the Imp out of Number One Main’s back lane and onto the Belfast to Bangor Road, “what do you reckon?”

  “I hope to God it’s false labour. Prematurity’s bad enough. We’ve got time for a little teaching—do you know the neonatal survival rates?”

  “Depends on the birth weight. Under two pounds, it’s one in thirty. At three pounds, one in three, and at four pounds, three out of four. But that’s in uncomplicated deliveries. If hers is still a breech, the odds are not nearly so good because of the risks during the delivery.”

  “Correct.” Barry had no difficulty making a left turn from the main Belfast to Bangor Road onto the country byway that led to the six-house terrace of cottages where the Andersons lived. Although the railway had, in 1952, sold up what had once been subsidized housing for its workers, everyone still called them “the railway cottages.”

  “Home is no place for a couple of GPs to be conducting the delivery of a premature breech. We’ll leave our maternity bags in the car until we’re sure she’s in labour and delivery is imminent.” He parked in front of a neat redbrick, two-storey, slate-roofed house. The railway track was one hundred yards away and Barry smelled the diesel as the single motorized car, known to the locals as “the covered wagon,” rattled by on its way to Bangor. He grabbed his doctor’s bag.

  Ken Anderson answered the door. He was a big, heavyset man. “Thank God youse’ve come. And dead quick too. Come on on in. She’s in our bedroom.” He led the way up a narrow staircase, calling, “We’re coming up, dear.” He pushed a cream-painted door open. “In thonder. I’ll wait downstairs with wee Angus.”

  Barry led Sebastian into a small, neat room where Mildred lay propped up on pillows in a double bed. The eiderdown and blanket had been turned back and she was only covered by a sheet. She tried to smile, but instead clenched her teeth and held her stomach with both hands.

  Barry fervently hoped she was only having Braxton Hicks contractions, named after the English doctor who first described them in 1872. All pregnant women experienced them, and certainly Sue, now in her twenty-second week, had had a few. They did not presage imminent delivery.

  “Sorry about that,” she said, and did manage a smile.

  “I’m asking Doctor Carson to help you, Mildred.”

  “Dead on. You was real nice til me last time, sir.”

  Sebastian nodded, looked embarrassed, and finally asked, “Um, can you tell me what’s been happening this morning?”

  She nodded. “Och, I’ve been getting the odd twinge for a month or two now. I paid no heed, but about five o’clock this morning I got a real humdinger. Woke me up, so it did.” She pursed her lips. “I didn’t want til panic. Sure, hadn’t I had a few like that the last time I was up the spout that meant nothing and, anyroad, youse doctors need your sleep.”

  Barry saw Sebastian smile.

  “They kept coming about every twenty minutes until about sixish, but since then they’ve been coming every ten or less. I reckoned this was the real McCoy so a couple of hours later I asked Ken to send for you—” She inhaled deeply, bit her lower lip, and grabbed her tummy.

  Barry didn’t like the sound of that. He glanced at his watch to gauge the timing of the next pain.

  “And then he phoned the stationmaster to get the day off so he could stay home and look after wee Angus.”

  “He did the right thing,” Barry said, although he often wished that country patients weren’t quite so considerate of their doctors. If she’d called at six, she’d be safely at the Royal by now.

  “Yes, he did,” Sebastian said, and when the pain had passed continued, “Have your waters broken?”

  “Not at all.”

  “Good. Now, I’d like to examine your tummy.” He folded back the sheet to be level with her pubic hair. “Just like last time I’m going to tell Doctor Laverty what I find.”

  “Fair enough.”

  “Uterus proper size, singleton, longitudinal lie, back on the left, and I’m pretty sure the breech is engaged. That means it’s dropped into your pelvis, Mildred.”

  Not good, Barry thought. He handed Sebastian a Pinard foetal stethoscope.

  After fifteen seconds, Sebastian said, “One hundred and forty-four.”

  The baby was not in any distress—yet.

  “I’d like to wash my hands, please.”

  “I’m sorry, Doctor. The privy’s outside. These here cottages was built in 1865. Ask Kenneth to get you a towel from the hot press and use the sink in the kitchen.”

  Sebastian left.

  “Did you understand what Doctor Carson said?”

  “Aye. Well enough. There’s still only one babby, and it’s got its bottom in my pelvis. If I am in labour, it’s very early—six weeks early—and it’s still a breech.” She sighed and little tears slipped down her cheeks. Barry, and to hell with his not having a chaperone, put his arm round her shoulders and said in a soft voice, “Don’t worry. It’s going to be all right.” And it might, but inside he was none too sanguine.

  She did not reply.

  Sebastian reappeared, took a pair of rubber gloves from Barry’s bag, and pulled them on.

  “Oooooh.” Mildred’s teeth showed over her lower lip.

  It had been only six minutes since the start of the last contraction. Barry had taken Mildred’s hand in his right. As the contraction waxed and waned so did the pressure on Barry’s fingers. At its peak, Barry had pulled out a linen hanky and wiped the sweat off her brow. When this one, lasting almost two minutes, had passed, Sebastian said, “Mildred, can you pull the sheet down a bit, bend up your knees, and part your legs?”

  After his examination, Sebastian stripped off his gloves and pulled up the sheet. “The cervix is about seven centimetres dilated.”

  Barry, despite his disappointment, kept an expressionless face. Labour was already well advanced. Widening and thinning of the neck of the womb were sure signs.

  “The membranes are still intact. The breech is engaged and has descended deeply into the pelvis and I’m pretty sure it’s a frank breech.”

  That at least was a promising sign. Of the three types of breech presentation, frank was the least difficult to deliver and associated with the fewest complications. In a complete breech, the baby was in a cross-legged position, in “footling,” one leg or both legs would be flexed, below the breech. With a frank breech, at least both legs were extended and the feet above the head. But if labour started four hours ago, this baby was coming quickly.

  “Oh my God, that’s desperate, so it is.” Mildred’s tears still flowed but were interrupted by another contraction.

  Sebastian said, “Do you have a telephone, Mildred?”

  She sniffed. “No, but Joyce Devlin, next door on our left, she does.”

  “I’ll go,” Barry said, “We need to get you to Royal Maternity as soon as we can.” He left Sebastian explaining how a specially equipped ambulance and staff would be dispatched at once and should be here in about thirty minutes.

  As Barry headed next door he remembered being taught about “the flying squad,” probably named for a special unit of the London police formed in 1919. The Belfast obstetric one was still operating in 1969 because a full 20 percent of deliveries still took place in patients’ homes. While the aim was to get the patient to the hospital, the team was able to, if necessary, carry out any obstetrical procedure short of Caesarian section. As he knocked on the door, he sighed. The flying squad could surely handle Mildred’s premature breech.

/>   * * *

  While Sebastian and Ken were arranging a hospital bag for Mildred and bringing her down to the living/dining room, ready for immediate transport if that were to be possible, Barry held young Angus against his chest, very aware of the little lad’s clean baby smell, a combination of warm milk and talcum powder. Jogging him up and down in an effort to stop the wee one crying wasn’t working. Barry’s “Rock-a-bye Baby,” sung off-key, had not been a great success either. It struck Barry forcibly how little he knew about the care of small children and he was again reminded that when it came to having children, anything could go wrong.

  “Well, Master Anderson, I think I’d better hurry up and learn about babies,” he said. Even as he said it, he could feel an uncomfortable shiver walk up his spine. He wasn’t superstitious, was he? And yet even alluding to a happy outcome for Sue’s pregnancy felt like tempting Providence somehow. Finding a rattle on the table beside him, he shook it tentatively at Angus. The baby cried all the harder.

  “Oh, aye, he’s afeared of thon thing. I don’t know why we still have it,” said Ken Anderson as he came into the room, looking harried and exhausted. Until Sue’s pregnancy Barry’d never fully understood the emotional toll pregnancy could take on expectant mothers—and fathers. He certainly was beginning to.

  Mildred was supported by Sebastian and Ken. They soon had her teed up on the sofa under a tartan rug.

  Angus set up a steady chant of, “Want Mammy. Want Mammy,” and with his little fists he pounded Barry’s chest.

  “Here, I’ll take him,” Ken said, and stretched out his arms.

  “Want Mammy.”

  Ken carried the little boy over to Mildred, who cuddled her son for a few minutes before grimacing and handing him back.

  “I’ll take him upstairs. Doctor Carson’s explained what’s going til happen. Angus’s too young til understand, and if the hospital doctors have til deliver Mildred here it’s going til get crowded.”

  The nee-naw sounds of an approaching ambulance drew close then stopped.

  “I’ll go,” Sebastian said, returning soon after, accompanied by some of the flying squad team.

  The leader, Doctor Bill Howard, had been at Campbell College with Barry and Jack Mills. “Hello, Barry.” Bill had been no stickler for formality. “Sebastian explained about the space in here. I’ve left the gas-passer and midwife back in the ambulance until we see if we’re going to need them.”

  “That makes sense. Sebastian’s looking after Mrs. Anderson. He’ll fill you in.” He turned to Mildred. “Mildred, this is Doctor Howard and—”

  “Michael Doak, final-year medical student,” a dark-haired man in a short white jacket said, “from Royal Maternity.”

  She nodded at them. “Pleased til meet youse.”

  It took a very short time for Sebastian to give the necessary clinical details.

  “Thank you.”

  “Mike, nip out and ask Joan to bring in a sterile glove pack. Is your kitchen that way?”

  Mildred nodded.

  Bill disappeared and came back holding his hands in front of his face, water dripping from his elbows. The navy-blue-uniformed midwife held open a sterile pack from which Bill removed a green towel, dried his hands, and put on rubber gloves.

  He reported his findings. “I can just see the buttocks, so delivery is imminent. We’ll not be taking you and your baby to the Royal Maternity until it’s over.”

  “Oh my God.”

  “It’s all right, Mildred,” Barry said. “Doctor Howard is the specialist you’d have been seeing at the hospital. Instead he’s come to you, and Doctor Carson and I’ll be here too.”

  “I can’t tell the state of the cervix because I can’t get my fingers past the breech. But bums, particularly premature ones, are narrower than the head, and can slip through a partially dilated cervix. Unless we can wait until the anterior buttock is born, it’s hard to be certain about the cervix.”

  Barry wondered why Bill was explaining all this within earshot of an already worried woman.

  “You may feel like pushing, dear,” Bill said. “Do not, I repeat, do not, until we’re ready.”

  “I won’t, Doctor.”

  Barry heard a tremor in Mildred’s voice.

  Dear? Do not? Barry shook his head. “Try not to” would have been kinder. During his trial experience of obstetrics in the Waveney Hospital a few years ago he had noted a certain lack of humanity creeping into his work. He had thought it came from rarely seeing patients more than a few times, and it was one of the reasons he had returned to GP work.

  “Joan. Michael. You both know what we need to do. Joan, why don’t you bring in the rubber sheet and a bucket first.”

  Barry wondered where Bill intended to conduct the delivery. Certainly not on the couch.

  He went to the dining table. “Solid oak. Ideal. Barry. Sebastian. Give me a hand.”

  Together they cleared it, putting items on kitchen shelves.

  Joan came back, carrying a red rubber sheet and a stainless-steel bucket.

  Bill spread the sheet on the tabletop and tucked the end into the bucket, which was placed at the end of the table.

  Joan arranged two cushions at the head end of the table.

  “Now,” said Bill, “Michael and I are going to help you up on the table, Mildred.”

  “Here”—Barry pulled over a low pouffe—“use that as a step.”

  Between them, Bill and Michael helped Mildred up.

  “Oh God. My waters has just broke.”

  Barry’s nose was assailed by the smell of amniotic fluid and he heard splashing in the bucket.

  While this was going on the midwife and anaesthetist had brought in the squad’s instrument bags. He had returned to the ambulance and she had been setting out the instruments on green sterile towels on convenient surfaces. She hung the strap of a rubber apron round Bill’s neck and tied the waist ties behind his back.

  “I’m ready to deliver your wee one, and the first thing I’m going to do is freeze your behind, so we’ll have to move you down the table.”

  Barry inhaled and told himself not to worry. He’d just told Mildred that Bill was a specialist, and perhaps Barry could try to make up for the man’s cold, purely technical approach. He said, “The freezing really helps, Mildred, and it’s just two tiny jags.”

  “I know,” she said. “I had that there block with my first one too.”

  Once that was done, and Barry knew Mildred was as comfortable as possible, he was going to have a front-row seat at the delivery of a premature breech.

  24

  The Nearest-Run Thing You Ever Saw

  “Bring your bottom to the end of the table.”

  “Yes, Doctor.” With the midwife’s help, Mildred inched her way down the length of her dining room table.

  “Barry. Mike. Give Mildred a hip to rest her feet on. They may not be stirrups, but they’ll do in a pinch.” Bill stood between them and loaded a syringe with a long needle from a rubber-capped bottle of Xylocaine held by Joan. “I’m putting in a pudendal block,” he said as he guided the needle past the baby to the right side of the patient’s vagina. “The pudendal nerve runs just past the ischial spine near the knobby bit of your backside that you sit on. There’s one side done. Now the other.”

  As he worked, Mildred had another contraction.

  Barry hoped its pain would distract her from the sting of the injection needle.

  “Nearly set. Sebastian. Nip out and ask Doctor Bannerjee to join us. I don’t think we’re going to need a general anaesthetic, but better to be safe.”

  A minute later, a barely accented voice called from the hall, “Looks a bit crowded in there. Doctor Carson and I, and the portable machine, will wait in the hall until you need us.”

  Bill called out, “Thanks, Rahul.” He turned to the midwife. “Will you stand to Mildred’s right, Joan, encourage her to push with contractions when I ask you to, and once the buttocks are born, keep one hand on the fundus to exert
pressure there to try to stop the arms extending.” For the student’s benefit, Bill said, “If the arms do extend past the head, they increase the difficulty of effecting a simple delivery.”

  Joan took her place. “Contraction starting. Try not to push yet, Mildred. Pant. Pant.”

  Barry, his nose still filled with smell of amniotic fluid, heard her huffing and puffing.

  “Keep it up, Mildred,” said Joan. “You’re doing fine.”

  Bill, standing between the patient’s legs, moved to her left. “Barry, can you see the baby’s anterior buttock?”

  Barry leant forward. “There’s a little buttock and the left edge of the natal cleft clearly visible. So, even if Mildred doesn’t push, the uterine contraction will still move the wee one on?”

  “Correct. Now, dear, your next contraction is the start of the time to push.”

  That “dear” again. Thank the Lord Harith Lamki was looking after Sue. He was a man who did not patronize his patients.

  Every time Mildred had a contraction, she pushed down with her foot on Barry’s hip, and presumably Michael’s. Barry could see her grimace. Every time, Joan, one hand on the uterine fundus, encouraged Mildred with “Hold your breath and puuuush. Puuush. You’re doing great.” And every time Mildred ran out of breath, she exhaled explosively and dragged in deep lungsful of air.

  Barry heard the repeated words of encouragement, the strangled grunts, and occasional cries of the patient. The left buttock was born. Now it was the turn of the right one. Barry watched its gradual progress, a combination of coming farther and farther out while ascending toward the maternal pubis.

  “Episiotomy with the next contraction,” Bill said. “It’ll straighten the birth canal and lessen the pressures on a softer than usual head.”

  All right, so Michael had to be instructed, but Barry had seen Mildred’s eyes widen, how she clapped a hand to her mouth, tensed up. Enough. He said to her, “Doctor Howard is right, and that’s why he’s doing this to protect your wee one. All preemies’ heads are a little”—in fact at thirty-four weeks a lot, but why distress her?—“softer than babies born at term.”