Signs for Lost Children Sarah Moss (best way to read books .TXT) 📖

Miss Eastman turns the girl onto her back, lifts her skirt and gently parts the knees. The patient has no underwear and has not washed in some time. A tuft of dark hair is already visible in the vaginal opening. Ally looks up. The patient’s eyes are closed and her mouth slack. In the grimy wrist, the pulse is weak and slow. Three days in labour, and she can’t be more than sixteen. The face is thin and pointed, the legs like twigs below the swollen abdomen. And Ally’s heart drops, because even in this foreshortened position the thighs are visibly bowed. Rickets. Probable pelvic distortion. Cephalopelvic disproportion: the foetal skull may simply not fit through the patient’s pelvic ring. Damn. She rests a hand on the belly while it hardens again. Nurse Eastman, without being asked, passes her the Pinard. She listens and hears the drumming of blood, the march of a different beat within the patient’s body. The child, for now, lives. The mother is failing. They have perhaps ten minutes, Ally, thinks, maybe fifteen, to work between the beats of those two hearts, to keep all the human music in the room playing. Her and Miss Eastman. Starting now.

The patient is too weak to stay on all fours. Miss Eastman tries to support her while Ally pushes her fingers around the child’s head to find the jammed shoulders. They sway the girl back and forth but nothing happens, nothing frees. Ninety seconds gone. Ally sees the map of the pelvis in her head. A mechanical problem. An engineering problem.

‘On her back.’

Miss Eastman raises her eyebrows but complies. Ally takes a knee.

‘Copy me.’

Miss Eastman takes the other and they push back against the patient’s abdomen, extending the sacrum. Ally sees the skull jammed against the pelvic bones, the angles all wrong. Not fundal pressure. She pushes hard on the pubic bone, rocks it. Sometimes the head can spring free but not this time, not now. Another moan and every muscle in the girl’s body gripping, tightening, forcing the child deeper into a cave with no way out. Not unless Ally makes the child’s head smaller or the mother’s pelvis larger. She holds out her hand for the Pinard and hears the small music slow, almost stop, and reluctantly resume some seconds after the contraction passes. Miss Eastman, her fingers on the patient’s wrist, bites her lip, shakes her head and feels for a carotid pulse instead. Five minutes, Ally thinks, five minutes and we’ll lose both of them.

‘Get the instrument box,’ she says.

‘Craniotomy?’

Perforate the skull, mash the brain with scissors, crush the bone so the child can be pulled free. She’s seen it done.

‘No. Symphysiotomy. It’s possible to spring the pelvis.’

Not a complex procedure. She remembers Dr. Burnet. All you need, ladies, is a catheter, a strong scalpel and stronger nerves, and you can manage without the catheter.

‘Glass catheter, please, and then a number four scalpel.’

A minute and a half. No time for analgesia. The patient is conscious enough to whimper as the blade goes in.

The child is limp and does not breathe, but the cord is still pulsing, the two hearts still working from one set of lungs, as she passes him to Miss Eastman. There is so much blood that it is hard to assess the mother’s trauma. She needs to deliver the placenta, now. Ally ties and cuts the cord, ending the baby’s oxygen supply, and works on her patient.

‘When you can, Miss Eastman, morphia please.’

Afterwards, Miss Eastman goes back and forth, attending to the mother and child while Ally works through the clinic, her blood singing with elation. The girl, Nellie Tillman, is sore and exhausted but has taken tea and the bread and butter Ally had brought for her own lunch and has fed her new son. The baby, whose first cry wasn’t heard until Ally was binding his mother’s hips to stabilise the spliced pelvis, has looked at the world and apparently, for now, decided to stay, making underwater movements and turning a strange gaze on the new element, air. His chances of surviving childhood are not good, worsened by his mother’s extreme youth and single state. Nellie is not well placed to recover from an obstructed labour, and even after the hospital stay that Miss Eastman has arranged may not avoid infection in Ally’s layers of careful stitching. She may never be able to walk far, may find standing at mill or factory work impossibly painful, especially if—especially as—she cannot take several weeks’ rest. But even so, Ally thinks while she listens to tubercular chests and weighs children who appear several years younger than their mothers say they are, while she hears a heart murmur that would indicate the avoidance of exertion in a person who had any means of survival without exertion, even so, because of what she did, because of her training and her knowledge, there are two people alive now who were all but dead before lunch.

The rain must have stopped sometime during the afternoon, but the handle wets her gloves as she closes the heavy door of May’s Centre and locks it behind her. Puddles gleam in the gaslight. Ally buttons her pocket over her purse and glances behind her as she sets off; this is not a place where she would advise a well-to-do woman to walk alone after dark. She is tired. She remembers the smell of earth and water after rain in Cornwall. Here, there is still smoke on the air and at the back of her throat, and the streetlights show a sky washed brown. It is not reasonable to think in Cornwall that the climate is too damp and the land too wet and in Manchester that there is too much smoke and soot; one must be somewhere. She tugs at her cuffs and walks faster. She could take the omnibus, she thinks, for Mamma need never know and it would mean she could reach the grocer before