"Okay. Push now."
"I can't," Karen screamed. "It's too much."
"Don't worry. You'll make it." She cut a minuscule episiotomy with surgical scissors. Blood flowed on the sheets.
"Breathe like this, sweetheart," David said, panting and puff-ing like a dog.
"I can't," she screamed, her entire body convulsing. She fell back, exhausted.
"That was good," Fletcher said calmly. "The head's almost through, so one more time ought to do it. Wait until I tell you, then push as hard as you can."
"I can't."
"You will."
The contraction came. David lifted her up and forward by the shoulders.
"Push," Fletcher cried. "Now!"
"He's tearing me up!" Her voice became a straining animal grunt. David cried out, "I see its head!" His voice, ringing in her ear, sounded so full of love and wonder that she began to cry.
Dr. Fletcher gently cradled the head in her hand. "Not yet. Stop straining. The shoulders are next. Coordinate it with the next contraction."
While Dr. Fletcher held the unbreathing baby in her hand, Nurse Dyer battled with sponge and gauze to keep other bodily fluids away from the newborn.
The baby rotated about, cradled firmly in Fletcher's grasp. Another contraction loomed. "Push now!" she said.
"Come on, honey," David cried. "Push!"
Wordlessly, Karen leaned forward with David's aid and pushed as hard as she could. This time was easier than the last. David's voice was near tears.
"There she is! It's a girl! God, Karen, she's beautiful."
"Eleven-oh-seven A.M.," Fletcher said, glancing at her watch. Dyer made a quick note of the time. The little purple-red, blood-smeared, vernix-coated figure rested in Dr. Fletcher's hands. She gently ran a finger through the baby's mouth to remove the mucus plug. Dyer used a tiny suction bulb to do the same to the infant's nose. Fletcher ten-derly transferred the newborn to the belly of her mother. She took her first breath. Intrigued by the change in proce-dure, she tested her new equipment with a healthy, hearty wail. Her parents wept with joy seasoned with not a little exhaus-tion. Dr. Fletcher gripped the swollen grape-purple corkscrew of umbilical, gently holding tension on it to guide the afterbirth farther out with each uterine contraction. At the same time, the baby received added blood from the placenta, topping off her circulatory system.
Nurse Dyer registered the baby's Apgar score-a nine in her first minute. That was nearly perfect, since out of superstition nurses rarely gave babies a ten. Only the newborns of pedia-tricians ever received the top mark, and only then because the doctor would worry if her own child were not pronounced perfect. Dyer put down the clipboard to mop the doctor's sweaty brow. That done, she turned her attention back to the baby, placing erythromycin drops in her eyes.
"Now, Karen," Fletcher said calmly, "in births such as yours, the placenta doesn't all come out, so I'm going to go in to get the last of it after you've expelled the main part." They heard none of what she said. The couple watched the pulsations of the umbilical cord, mesmerized. They gazed at the squalling child on Karen's stomach. It turned from purple to a radiant shade of ruddy pink.
A series of contractions expelled the afterbirth into a shal-low tray held in place by Fletcher. The cord collapsed, lost its candy-swirled shape and shiny gloss. Taking her cue, Fletcher used a yellow plastic clip to seal off the umbilical as close to the baby's navel as possible. Nurse Dyer handed the husband a pair of scissors.
"Would you like to do the honors?"
Crying, he took the scissors and allowed her to guide his hand within an inch of the clip. A quick snip severed the cord. Blood pulsed out, dark red, further collapsing the cord into something that resembled a limp crimson noodle. Fletcher put the tray aside.
Nurse Dyer gently snatched the infant away from Karen, tak-ing it to a scale for weighing. She measured the circumfer-ence of the baby's head, her length, and fastened an ID tag on her wrist.
"Six pounds, eight point four ounces," Dyer called out. "Nine-teen point five inches." Karen wept happily at the news, taking her baby back to hold her.
"Doctor?" David asked, remembering something from his classes. "Shouldn't you count the veins?" Dr. Fletcher smiled and reached over for the tray. David watched with curiosity, splitting his attention between the doc-tor, his wife, and his new daughter. She picked up the end of the umbilical, nipped it between two fingers, and spread the edges back to examine the interior.
"All three are there," she said simply. "Nice to know you're checking every detail." David let go a relieved breath. His hand squeezed firmly the weak one it held. He was not sure what the danger was, but he knew that three veins was good, two veins bad. Karen had not even noticed the exchange. She gazed lovingly, exhaustedly, joyfully, at the little person on her stomach.
"You may give her a drink if you wish." Nurse Dyer smiled with a warm tenderness. Carefully, she helped Karen lift the tiny bundle to her left breast, showing her the way to cradle the head and neck. Karen held the child in one arm. David stuffed pillows behind her to raise her into a sitting position. Dyer cleaned the new mother's nipple, which Karen offered to the baby's cheek. Feeling the stimulation, the tiny light blond head rotated, sensitive lips searching. In a matter of seconds, her mouth found a new source of nourishment and happily began to feed. The room fell silent for a moment.
"Pardon the intrusion," Dr. Fletcher said, picking up a hyst-eroscope. "As I suspected, I've got some cleaning up to do. Don't mind me." She took only a few moments to examine Karen and remove a few bits of tissue that had remained at the surgical attachment points of the transplant operation. Karen hardly noticed. David pulled a Canon camera from beneath his hospital garb and shot half the roll. After a few minutes, Dyer announced that nursing time was up and that the baby needed to be cleaned. She poured an inch or two of tepid water into a bright yellow tub and placed it on the table next to the bed. Urging David to observe carefully, she inserted a finger alongside Karen's nipple to break the baby's suction. The baby began to cry, jerking her arms and legs, her eyes tightly shut. With a sponge almost as big as the baby, Nurse Dyer softly dabbed away the blood, leaving just enough of the waxy coat-ing of vernix to keep the newborn's skin from drying out.
"Now," the nurse announced, patting the child dry with a bright white towel, "you both need a rest, and so does she." She put the baby in a Plexiglas tray under a warming lamp. David watched Nurse Dyer lay a small green bottle of oxy-gen next to the baby, a tiny little mask placed about two inches away from her ruddy, drowsy face. "Where's she going?"
"They'll both be moved to the postpartum room. They need to sleep, and so do you. Kiss your wife good night and go home and rest."
He looked at Dr. Fletcher. She nodded in agreement.
"Sweetheart?" he said. "Will you be all right?"
Karen Chandler smiled at her husband. Tears of joy began to well up in her soft grey eyes. Her chestnut hair, wet with sweat, hung in near-black tangles across the pillow. Blood smeared her abdomen, her belly still large and soft from the ordeal.
She was the most beautiful woman in the world.
David stretched across the bed to hold her for a moment. They wept those misty-eyed tears that survivors of great ad-ventures weep. They murmured the phrases new parents speak that seem to them so momentous and emotional at the time.
"We have a baby," she said.
"A daughter," he said.
"She's beautiful."
"So are you, my love."
Nurse Dyer wheeled the baby out of the room. The little one had already fallen asleep.