Then he sat by her, and waited, until Hank opened up the door and told him they’d finished everything he’d asked and there was no more reason to tarry.
“So ’s time,” said Hank. “Get doctoring.”
It was just past noon when Andrew Waggoner cut into Lou-Ellen Tavish. They had laid her out on a clean sheet on the table, pots of steaming boiled water next to her and Andrew’s surgical kit laid out on a stool beside her. He had set his mirror between her legs, which had been strapped apart, one to each table-leg. Her breathing was slow and steady, as a result of the morphine he’d given her. Next to the mirror was the ivory speculum, fresh out of the boiling water. He lifted it, because he did not intend to cut yet, and brought it to her vagina. The speculum had two pieces: a conical wedge, which fit perfectly inside the cylinder. If things were as they should be, the first step of this operation would be to insert that between the patient’s labia, gently forcing it open. Then he would remove the wedge, and have a two-inch diameter tube through which to operate.
But Andrew set the speculum back down as fast as he’d lifted it. He bent forward, positioning the mirror to get a better look.
“What’s a matter?” asked Hank, who was standing with his brothers and sisters and cousins at the agreed-upon distance of ten feet. “Your arm hurtin’?”
Norma, the only one allowed close, leaned in closer to look herself. “What’s it?”
Andrew touched the labia with finger and thumb. “Look,” he said, drawing them apart. Between the pink flesh was a yellowish membrane, stretching the length of Lou-Ellen Tavish’s vagina. “There’s no opening. Or rather—there’s an opening, but something is covering it.” Andrew prodded it. It made a crackling noise, as though it were part calcified. “It’s as though her hymen regenerated somehow.”
“Hymen?”
“Maidenhead.”
Norma nodded. “Ah. The child skin. That don’t come back once you’ve lain with a—”
“No, it doesn’t,” said Andrew. “I’m going to need a scalpel.”
Norma didn’t know what that was, so Andrew took it and showed her: “Scalpel,” he said. “For next time I ask. Now I need you to get around there and spread the—” he was about to say labia, but again, just showed her: “These.”
Norma leaned over and did as she was told. Lou-Ellen made a soft whimpering noise, as Andrew leaned in, positioned the mirror, and set the blade of his scalpel against the tissue.
“Need somethin’ else?” asked Norma finally.
“No,” said Andrew, “I’m fine.”
Which finally was true enough. His hand did not shake at all as he pressed the tip of the blade into the strange yellow tissue.
Although the scalpel was keen, it took surprising force to break through the membrane. It became fibrous once the scalpel breached the brittle surface, and Andrew had to saw at it.
But once that pierced, Andrew did not have to complete the incision. It was like breaking a seal on an overturned jug; once the scalpel pierced all the way through, the pressure from a thick flow of brownish liquid tore it the rest of the way open. It splashed up Andrew’s arm, stained the sheet to the edge of the table, and filled the dish of the mirror with a foul broth.
Loo shrieked, and her back arched, and the table-legs creaked as she tried in vain to draw her knees together. Andrew lurched back, pulling away just in time to avoid slicing her thigh with the scalpel. Norma moved as well, to take hold of Lou-Ellen’s shoulders, hold her down and try to comfort her best she could.
Andrew took a breath. If his patient were genuinely pregnant, this might be explained as amniotic fluid, but Loo was not, and this was not. It was something strange.
And it smelled…
The smell was a cousin to the stench Lou-Ellen had left in the cabin. It could be a sign of infection, just that, Andrew thought. But it reminded him of something else, that skirted at the edge of memory. He sniffed at his hand, which was covered in the mucous-thick liquid, trying to recall—and as he did, he chanced to look closely at it. It was not, he saw, entirely pure—suspended in it were tiny dark objects of various shapes. They might have been insects, or pieces of insects.
You have a patient, he reminded himself. See to her.
Lou-Ellen was still screaming but she had slowed her struggling enough that Andrew could get close again. The sheet was soaked now, with glistening puddles here and there. Andrew shook off his hand, and reached in to pick up the mirror, clean it off and begin again, this time sliding the speculum into the open space to see what he could see. Which would be a problem, Andrew realized, because in her struggles she’d knocked the speculum to the ground. It would have to be sterilized. He shook his head as he started to pour the juices out of the mirror’s bowl. Then he looked at it more closely.
At its deepest point, the bowl held about a quarter-inch of the liquid. And it, like the stuff on his hand, was impure. But the particulate that had gathered there was bigger. Andrew held it in the full sunlight and squinted. Was there something like a hand in it? No bigger than a man’s fingernail? Wispy effluvium trailed in the murky liquid, making it impossible to tell.
“Does anyone here have a jar?” he asked. “A clean jar I mean?”
“Sure,” said Norma. “In the root cellar there’s plenty.” She turned to one of the children, and ordered her to fetch a couple.
Andrew set the mirror down carefully. He motioned with his splinted arm to the ground, where the speculum lay. “That will have to be washed,” he said. “Clean it with boiling water and alcohol.”
Norma stayed with Loo, so it was Hank who bent to pick it up. He, and the rest of them, had drawn closer. Any closer, and they’d be blocking out his light. “Wash your own hands first,” said Andrew. “Don’t want Loo to get sick. Not now she’s through the worst of it.”
“Worst of it?” It was Norma. “You mean you’re done?”
Andrew looked back down at the bowl—the grotesque pieces of tissue—the strange shapes they made in the liquid. “Maybe. I don’t think I had much to do. Looks like whatever was in her died on its own. There are pieces of it in this.” He held the mirror out so Norma could see. Her eyebrows raised and her nostrils flared as she sniffed it. “I’d call it a miscarriage if I didn’t know better. As it stands, I’ll still take a look inside. See what troubles this awful sickness has caused her.”
“But you think she’s better,” said Norma. Loo did indeed seem better. The morphine, still in her blood, was back to work now that the panic was over.
Andrew gave a smile he hoped was reassuring. “We’ll see,” he said.
“All done,” said Hank, and handed Andrew the speculum. Andrew took it, and dribbled some of the alcohol on it and through it for good measure. Then he bent back down. “All right, Norma. Same as before.”
Norma reached down and pulled the labia apart, and Andrew leaned closer to insert the speculum. He barely touched it to the girl, however, before the second eruption. This time, Andrew didn’t lurch back, because this time, the fluid coming out was something that his surgeon’s reflexes understood.
This time, it was blood. Lou-Ellen Tavish was haemorrhaging.
Andrew had encountered this circumstance four times in his career as a physician. Three of the women who had bled out in the afterbirth had died. The last of those was Maryanne Leonard.
The fourth survived—because the French hospital where she was being seen employed a surgeon who had studied blood typing with Landsteiner and knew enough to pick the correct plasma for transfusion.