Hema believed in numerology; next to one's name, nothing was as important as numbers. What is it about this day? she asked herself. It's the twentieth day of the ninth month. No fours or sevens in there … Airplane almost crashes, a child breaks his leg … I crack a Frenchman's nuts … What more, I say, what more?
She rapped Stone's knuckles with a scissors. “Stop!” He was fumbling with an oozing vessel when she needed him to retract.
She incised the uterus and tried to deliver the twin who sat higher in the uterus but was nevertheless head down, upside down. This twin would have been the second to come out had delivery proceeded through the birth canal, but now it would be the firstborn. But strangely, this twin, hand jammed against its cheek, wouldn't budge.
She extended the uterine wound.
She suctioned the infant's mouth.
She drew a sharp breath that inverted her mask against her lips because she could see the problem.
The babies were joined at the head. A short, fleshy tube passed from the crown of one to the other, a tube that was narrower and of a darker hue than the umbilical cords. They were tethered together, but there was a fatal tear in this stalk, a jagged opening caused no doubt by Stone's fishing with the basiotribe. And from this rent, what little blood the two infants possessed was pumping out.
Please God, she thought, let this be only a blood vessel, and a minor one at that. Let there be no brain or meninges or ventricle or cerebral artery or cerebrospinal fluid or whatnot in it. She spoke aloud to Stone now, to the room, to God, and to the twins whose lives, if they survived, might be irrevocably affected by this decision: “They could have seizures the minute I cut this. One twin could bleed out and the other overfill with blood. They could get meningitis …”
This was a technique surgeons used when difficult decisions had to be made: think aloud for your assistant because it might help clarify the issues for yourself. And theoretically it gave the assistant time to point out her faulty reasoning, though she wasn't about to take an opinion from the man responsible for this blunder. A careful decision was needed so as not to blunder again. It was often the second mistake that came in the haste to correct the first mistake that did the patient in.
“No choice,” she said. “I have to cut.” She put clamps across the stalk where it emerged from each infant's scalp. She invoked Lord Shiva's name, held her breath, and cut above each clamp, bracing herself for something terrible.
Nothing happened.
She tied off the stumps. She cut the umbilical cord and easily pulled out the first infant, a male. She handed it to the gowned and gloved probationer who stood nearby. This baby had been spared his father's probings. Then she pulled out the other infant—again a boy, an identical twin, whose scalp was bloodied from Stone's knife and whose skull would have been crushed had she not arrived.
Both infants were tiny, three pounds at best. Clearly less than full term. A month premature, perhaps more. Neither infant cried.
Distracted now by heavy oozing from Sister Mary Joseph Praise's soggy, friable uterus, Hema turned back from infants to the mother.
“What is her BP?” Hema asked, peering over the drapes, first at Nurse Asqual, and then at Sister Mary Joseph Praise's face. The anesthetist, the whites of her eyes showing like saucers, shook her head. Beautiful Sister Mary Joseph Praise's face now looked bloated and lifeless. “More blood! For God's sake. Pour it in!” Hema shouted.
As she toiled in the now deflated cavity of the belly, Hemlatha remembered that when she'd handed over the second baby to the probationer, she had been surprised to find the probationer still standing there, holding the first, a blank look on her face. But Hema had no time to worry about that. Once the babies were out, her duty as an obstetrician was to turn completely to Sister Mary Joseph Praise; her duty was to the mother.
10. Dance of Shiva
WE TWO UNNAMED BABIES, newly arrived, were without breath. If most newborns meet life outside the womb with a V V shrill, piercing wail, ours was the saddest of all songs: the stillborn's song of silence. Our arms weren't clamped to our breasts; our hands did not make fists. Instead, we were limp and floppy like two wounded flounders.
The legend of our birth is this: identical twins born of a nun who died in childbirth, father unknown, possibly yet inconceivably Thomas Stone. The legend grew, ripened with age, and, in the retelling, new details came to light. But looking back after fifty years, I see that there are still particulars missing.
After labor stalled, I dragged my brother back into the womb and out of harm's way as lances and spears came at him through our only natural exit. The attack ceased. Then I remember—and I believe I do—the muffled voices, the tugging and sawing outside. As the rescuers neared us, I recall the blinding glare and strong fingers pulling at me. The shattering of the darkness and the silence, the deafening racket outside was so great that I almost missed the moment when we were physically separated, when the cord connecting my head to Shiva's fell away. The shock of that parting lingers. Even now, what I think about the most isn't that I lay there without breathing, immobile in the copper basin, born to the world, yet not alive—instead, I recall only the parting from Shiva. But, to return to the legend:
The probationer unloaded the two stillborns into a copper basin used to hold placentas. She carried the basin to the window. She made a notation in the delivery chart: Japanese twins connected by the head but now disconnected. In her eagerness to be useful, she completely forgot her ABC's: Airway, Breathing, and Circulation. Instead, she thought of what she had read the previous night about jaundice of the newborn and the helpful role of sunlight. Shed memorized that passage. She wished she had read about Japanese twins (the word “Siamese” eluded her) or asphyxiated babies, but the fact was she hadn't; shed read about jaundice. But then, as she set the basin down, she realized that for sunlight to work, the babies had to be alive, which these weren't. Her sorrow and shame made her confusion worse. She turned away.
The twins lay face-to-face, feeling the basin's galvanic touch against their skin. In the chart the probationer used the words “white asphyxia” to describe their deathly pallor.
The sun, which had stage-lit the room moments before, now honed in on the basin.
The copper glowed orange. Its molecules became agitated. Its prana rose into the infants’ translucent skin and passed into their doughy flesh.
HEMLATHA DISSECTED the broad ligaments, then clamped the uter ine arteries, praying that she wouldn't accidentally clamp the ureters and shut down the kidneys in that bloody mess. “Quick, quick, quick!” She was tempted to smack Stone on the forehead instead of on the knuckles. “Retract properly, man!”
She followed his gaze to Sister Mary Joseph Praise's head, which bobbed like a rag doll's as the anesthetist tugged at her arm to find another vein. Matron, teary and lost in her grief, stroked Sister Mary Joseph Praise's other hand.
When Hema finally delivered the uterus, clamps and all, into a basin, she saw no pulsations in the abdominal aorta. Her hands, steady till now, shook as she loaded a syringe with Adrenalin and attached a three-and-a-half-inch needle to it. She lifted Sister Mary Joseph Praise's left breast, hesitated for a moment, invoked God's name again, then plunged the needle between the ribs and into the heart. She pulled the plunger back, and a mushroom of heart blood appeared in the syringe. Whenever I've had to resort to adrenaline to the heart it has never worked, Hema said to herself. Not once. Maybe I do it as a way to signal to myself that the patient is dead. But surely it must have worked, somewhere, with someone. Why else was it taught to us?