Doctors (45 page)

He himself could not take his eyes from the face of the brother with whom he had never been able to speak.

Goodbye, Howie, he said in his thoughts. If there is some supernatural way you can possibly know me, then you’ll understand that I’ve done this because … I love you.

The funeral, like Howie’s life, was restricted to the four of them. Even Judy did not attend. For it was Rosie’s wish that “the family should be alone together one last time.”

Seth stood impassive at the graveside as he listened to the cemetery’s Unitarian minister eulogize his brother’s goodness. The only thing that brought him comfort was the fleeting references to Howie’s being “laid to rest” and “now at peace.”

In the limousine ride from the cemetery, Rosie consoled herself by endlessly repeating what the doctors—who tried in vain to wake her Howie—had said.

“At least, thank God, he didn’t suffer. It was painless. His heart just stopped. There was nothing anyone could have done.”

Judy was waiting in front of the Lazarus market. She offered her condolences to Rosie and Nat, both of whom nodded in mute appreciation and, arm in arm, walked toward the back door.

Seth and Judy were alone.

“How do you feel?” she asked.

He was going to tell her fine. But suddenly a deluge of guilt overwhelmed him and he murmured, “Oh, Judy, what have I done? What have I done?”

They were working in different hospitals for their next rotation, so Barney and Bennett rarely saw each other except for
the occasional midnight foul-shooting contest, in which the score now stood at 2,568 to 2,560 in Barney’s favor.

But early one morning, as Barney was completing a three-mile jog, he caught sight of Bennett going crazy—like Gene Kelly in
Singin’ in the Rain
—madly leap-frogging over parking meters along Avenue Louis Pasteur. Barney sprinted to catch up.

“Hey, Landsmann, have you blown your mind?” he puffed.

Ignoring the question, Bennett blurted ecstatically, “I’ve done it, Livingston. I’ve just delivered a real live baby.”

“Hey, no shit.” Barney smiled and held out his hand. “Congratulations. Only eleven to go and you can graduate.”

“I’ll do a million more with pleasure. Can you imagine what it’s like, Barn, to reach into that bloody goo and pull out a tiny human being!”

“You mean you got to do the actual delivery?”

“I really lucked out. It was five
A.M.
The resident was doing an emergency operation, the intern had been up all night transfusing a bleeder and told me to go ahead and do it on my own.”

“Great!”

“Of course,” Bennett continued, “the guy might have been slightly influenced by the fact that the mother was a welfare patient from Roxbury. But anyway, I did it—although I have to admit that the nurses gave me a little help. And the woman herself had been through it all before. But you’ll never believe what happened next.”

“Landsmann, from you I’d believe anything.” Barney grinned.

“Well, then, dig this—the woman looked up at me and said that though this was her ninth kid, it was the first ever delivered by what she flatteringly referred to as a ‘gen–u–ine spade doctor.’ So she insisted on giving her my name.”

“
Her
—it’s a girl?”

Bennett shrugged joyfully. “Can I help it if there’s now an eight-pound little lady in the Beth Israel maternity ward called ‘Bennetta Landsmann Jackson’?”

“She even got the Landsmann part, too? Lucky you didn’t mention Abraham Lincoln.”

“To tell the truth, I did. But she’s already got a kid with that name.”

“How’s the labor coming, Laura?”

Attending obstetrician Walter Hewlett had peeked into the labor room to see how Laura was coming with her patient, Marion Fels, a thirty-six-year-old prima gravida.

“Contractions four to five minutes apart, cervix about six centimeters dilatated, eighty percent effaced—minus three station.”

“Scared?”

“No, I’m all right.”

She was lying, of course.

Laura was sure of the information she was conveying, which explained exactly the position of the baby in Marion’s birth canal. But she was far from being all right.

They had already determined that it would be a cephalic presentation—i.e., that, like ninety-five percent of all babies, Marion’s would be arriving head first. But the information she had just given Hewlett suggested that they were not likely to see the baby crown for at least two hours.

And she was terrified that Hewlett might go off to find a quiet bed and try for a little shut-eye.

“Listen, Laura,” he said, “it’s obvious we’ve got plenty of time. I’m going to step out …”

That’s okay, Laura thought to herself, you always go to the same place in the parking lot to light up a cigarette.

But then she heard the end of his sentence.

“… and get something to eat. I’ve just
got
to go to Blue Hill Avenue and get a corned beef sandwich with a big half-sour.”

Blue Hill Avenue?
she thought. That’s
miles
from here! For God’s sake, Walter, you can’t leave me alone like this. I know there are nurses around but I’m the only doctor—and I’m not even a doctor.

“Think you can hold the fort?” Hewlett smiled.

She was determined not to chicken out. “Sure, Doctor, no problem,” she said, wondering where she got the strength—much less the breath—to utter such a falsehood.

“Great,” said Hewlett. “Can I get you anything?”

She shook her head. “Thanks.” All the while thinking, you could get me a qualified obstetrician.

“How are you feeling?” asked the head nurse.

“Fine, thank you,” Laura replied.

“I was asking Miss Fels, Dr. Castellano,” she retorted.

“Oh,” said Laura, trying to hide her embarrassment.

“I’m okay,” the patient answered.

The head nurse smiled. “If you need anything, just holler.”

“Can’t you do something about these damned contractions?”

“Stay loose, Marion,” Laura interposed, “we’ll be able to give you some medication very soon.”

“Yes,” the head nurse confirmed, “we’ve got you scheduled for a saddle block.”

Florence Nightingale withdrew her smirking face from the doorway. Laura thought to herself, Isn’t it wonderful to be getting such support from the teammates of my gender, who resent my wearing a white coat instead of a white hat. Please, Walter, eat that damn sandwich before this woman is fully dilatated!

She tried to regain the patient’s confidence by taking her blood pressure and then checking her cervix, which—to her alarm—had dilatated to nearly eight centimeters. The labor was progressing more rapidly than anyone had expected.

As soon as the patient’s contraction ended, Laura asked her gently, “Did I hear her call you ‘Miss’?”

Marion smiled wanly and replied with some difficulty. “Yeah. I didn’t want to marry him—mainly because he was married to someone else. Still, I’m not getting any younger and I wanted to have a kid before it was too late.”

“What do you do?” Laura asked.

“Work for
The Globe.
I was so busy being successful that I didn’t take a look at the biological clock. Are you married, Doctor?”

“Please call me Laura. And the answer’s ‘Not yet.’ ”

Suddenly Marion blurted, “Quick, Laura, your hand!”

As Marion moaned and squeezed her hand tightly, Laura murmured, “Relax. Try to breathe normally. It’ll be over soon.”

When she caught her breath, Marion inquired, “How much more of this till I get my baby?”

“Not much,” Laura replied reassuringly, inwardly praying that Walter was already speeding back along the Fenway. “I’ll just check you again.”

To her consternation she discovered that the cervix was fully dilatated and the baby was at the
plus two
station.

Christ, it was first down with goal to go! She rang for the nurse.

“This is it,” Laura whispered to Marion.

“Thank God, these contractions are starting to kill me.”

A squad of nurses bustled in and began to wheel the mother-to-be to the delivery room. In a split second Marion was gone.

Suddenly a voice behind Laura whispered unctuously, “Hadn’t you better scrub up?”

Shit, it was the friendly head nurse.

“Yes, of course,” she responded in a state of mounting
panic. “Uh—when Dr. Hewlett comes back, be sure and tell him where I am.”

“Of course, Doctor.”

Laura sprinted down the hall, stopped at the sink outside the delivery room, and began to scrub.

All the while she struggled to control the rapid beating of her heart.

She pushed open the door and entered the O.R., where a second nurse was waiting to help her into a sterile gown and gloves.

From a distance she could hear Marion groan with pain.

“Where’s the anesthesiologist?” she asked. “He’s supposed to be giving her a saddle block.”

“Nico’s just been called on a Code Blue. He may be quite a while.”

Oh God, Laura thought to herself,
I
ought to call him back on a Code Blue—’cause I don’t think I can keep breathing on my own. And I
know
I can’t do the anesthesia on my own.

She stood motionless, trying to remember what a real obstetrician would do in a situation like this. He would administer a pudendal. She had observed a few of those procedures, but had never actually done one.

Now she had no choice—Laura took a deep breath and walked into the brighter lights that flooded the operating room.

Then suddenly the miracle occurred. To her astonishment she was no longer shaking. She found herself moving calmly toward the table, where Marion’s legs had been strapped into the stirrups for delivery, her abdomen draped with sterile towels and sheets. The head nurse stood nearby at a small table on which she had tidily arranged the surgical instruments.

Laura rapidly rehearsed all the instructions she had memorized. First and foremost, do not hasten delivery or you might cause serious damage to the mother and child.

Depress the perineum to stretch it and let the newborn’s head clear the opening of the vagina.

From beyond her field of vision, Laura heard one of the nurses cry, “Look, the baby’s crowning.”

With an icy calm Laura instructed the Head Nurse to fill a syringe with ten cc’s of Xylocaine.

As she was waiting, she inserted her left hand past the baby’s head and felt for Marion’s ischial spine. Then, with her finger on the pudendal nerve, she asked for a “trumpet,” a metal tube that she inserted to guide her eight-inch needle.
Taking the syringe with her other hand, she put it through the trumpet till she felt the tissue at the side wall of the vagina. She then withdrew the needle slightly to be sure there was no blood. And finally injected the painkiller.

At that moment Marion had another excruciating contraction.

“Shit,” she gasped. “The goddamn drug’s not working!”

Laura answered in what she hoped would be reassuring tones. “Xylocaine needs about two or three minutes to take effect, Marion.”

Indeed, less than five minutes later, all was well—for Marion, at least. Laura was able to perform an episiotomy. With a pair of straight Mayo’s scissors she made a three-inch cut from the base of the vagina toward the rectum to facilitate the baby’s grand entrance.

And Marion did not experience the slightest twinge.

Yet now things seemed less clear. A torrent of blood and mucus was pouring everywhere. But somehow Laura’s hands found the infant and she gently helped it clear. Its face and chin—and then the neck.

Functioning like an airplane on automatic pilot, Laura carefully rotated the infant and disengaged its shoulders from the mother’s pelvic inlet.

Slowly (
every movement must be slow
, she kept reminding herself) she turned the baby so that its face pointed downward. Now the second shoulder was free. The rest would be a cinch. But
don’t hurry, Laura, goddammit.
Your heart can go as fast as it wants, but keep removing the baby gradually and gently.

An instant later she was holding an entire infant in her hands. At least it would look like one when all the vernix, blood, mucus, and other matter were washed off. Christ, it was slippery. What if I drop it? No, I’m holding it the right way—by the back of its heels. Then someone cried—or was it a wail? In any case it was the first utterance of the newest arrival to the world.

Laura looked at the gravy-coated being she was appropriately holding like a chicken and called out, “It’s a girl. Marion, you’ve got a girl!”

She placed the baby on her mother’s stomach, as the nurses wrapped it in warm towels. As soon as the cord ceased to pulsate Laura clamped it, cut it, and tied it.

Just then a tall, stoop-shouldered doctor in an ill-fitting white coat entered the room. It was Nico, the anesthesia resident. “I’m sorry, Laura. But a code’s a code. Shall we get this show on the road?”

“Sorry, Nico,” Laura said with a breeziness born of relief, “I’m afraid the show’s over.”

“What did you use for anesthesia?”

“I did a pudendal.”

“Yourself?”

“No, my fairy godmother helped.”

Nico looked at the mother communing peacefully with her new baby, then glanced at Laura.

“Hey, Castellano, not bad.”

He took a final glance at her patient and then about-faced to return to his code.

Laura started to sleepwalk toward the exit.

“Wait, Doctor,” she heard the head nurse cry out. “Don’t forget the placenta.” Laura returned to the table and, like an automaton, awaited the arrival of the afterbirth, and closed the episiotomy cut with chromic catgut.

Finally, she checked Marion’s general condition. The bleeding was slight. There were no lacerations or cervical damage.

“You’re okay, Marion,” she murmured.

To which the ecstatic mother replied, “You’re okay yourself, Laura. Thanks.”

Even after they had wheeled her patient out, Laura stood alone in the empty operating room, her feelings of relief now changing to pride. And then to jealousy. Marion really had things in the right perspective.

It suddenly seemed to Laura that for a woman the greatest joy was to hold a baby in her arms.