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Page 42
Page 42
Erin fell to her knees beside the couch. “Marcie! Baby! Tell me what to do!”
“I don’t know,” she groaned breathlessly. “I don’t know….”
Erin heard an engine and ran to the door, not sure who she wanted to see there most. When Aiden leaped out of his car, she yelled, “Aiden, hurry! It’s Marcie!”
He backtracked briefly to get a bag out of the back that Erin had never even realized he kept there. She breathed a sigh of relief to recognize what was probably a doctor’s emergency medical bag. “Why didn’t you call me?” he asked as he jogged toward the door.
“Annalee,” she said. “With a gun.”
He stopped short. “Where is she now? Gone?”
“In a manner of speaking. I knocked her out,” Erin said. “Or killed her. I hit her in the head with the bear repellent bottle. After I squirted her in the eyes. She’s in the bedroom.”
Aiden grinned suddenly, but proceeded quickly. He went immediately to Marcie, going down on one knee at the side of the couch. “Hey,” he said. “Easy does it, I’m here. What’s going on?”
Wide-eyed and terrified, Marcie breathlessly said, “He’s not supposed to be born like this, Aiden. But I think he wants to be.”
“Sometimes we have to work with what we’ve got, kiddo. How long ago did your water break?”
“Half hour? Forty minutes?” She groaned deep and low as another contraction gripped her. “The doctor said he’ll die! Aiden, he’s going to die! Take him out the right way! I can handle it—just don’t let him—”
“Easy, easy, he’s not going to die. We’re going to do everything right—just take some deep breaths and try to calm down. How many weeks here?”
“Thirty-five,” she said.
“Good job.” Aiden stood up and motioned Erin to stay with Marcie. “Time those contractions and absolutely no pushing. No matter what.”
Aiden knew he had a lot to deal with even before he had a chance to take a closer look at the patient. For starters, he knew this was supposed to be a breech baby scheduled for a C-section; usually the breech baby didn’t provide enough pressure to rupture membranes…unless that baby had dropped and was on its way out. The bloody fluids staining her pants and the sheer force of the contractions spelled out an emergency delivery was imminent. He opened his bag and withdrew a pair of latex gloves, then put them on. It was not, however, so he could examine his patient.
Gloves donned, he ran into the bedroom and pressed two fingers to Annalee’s carotid artery. Steady pulse. He grabbed her by the ankles and dragged her unceremoniously through the small cabin and out onto the deck. He wasn’t about to get any of her blood or body fluids on his hands; Annalee was high risk and he knew his hands would soon be plunging into Marcie’s birth canal. He left Annalee on the deck, closed and locked the doors. He stripped off and tossed the latex gloves. He then locked the other cabin door and went again to Marcie’s side.
“They’re coming fast, Aiden,” Erin said. “She’s had two since you left.”
“Thanks, honey. Marcie, I’m going to carry you to the bedroom, to the bed. Don’t strain. Let me do the work. Erin—get two or three large trash bags and towels. Bring them to me along with my bag.” Then he bent to lift Marcie. He smiled down into her eyes. “Trust me—we’re going to get through this.”
“Sure,” she said in a weak breath. “Sure.” Then she started to sob.
“It’s going to be okay.” He laid her gently on the bed. “We need to get your britches off, kiddo. Have to take a look.” He was already tugging them down when Erin quickly reappeared. “Towels,” he said to Erin. “Lots of towels. And get the phone, please.”
When Marcie was stripped from the waist down, Aiden took a glance at her pelvic floor. He didn’t see anything yet and was grateful. He really wanted to wash his hands, but the washing he could accomplish in as much time as he felt he had wasn’t likely to do enough good anyway. He reached into his bag for new gloves. “Okay, sweetheart, bend and spread your knees for me. Let’s see where we are.”
Marcie obliged and Aiden was on one knee, his one hand on her belly, the other gently moving into her birth canal. What he thought was, Holy fuck! What he said was, “There we go, nice and easy. Pant for me, Marcie.” Then he took his stethoscope from the bag and said, “Quiet for me, please…” He listened, and while it wasn’t the best equipment to get a fetal heart rate, it sufficed—the baby was not yet in distress. “Good. It’s all good.” All the while thinking, Bad, this is all bad.
When Erin brought him what he requested, he placed a large bath towel on top of a spread-out trash bag and asked Marcie to lift a bit so he could slide it under her. “See what I did there?” he said to Erin. “I’m probably going to ask you to do that for me again in a little while—towel on top of the plastic.”
“I don’t care about the bedspread,” she said.
“That’s not the concern. There’s lots of blood and fluid involved in a birth and it can get overwhelming—obscure the field of birth. Easier to keep it as clean as possible. Now dial 911, press the speaker button and put the phone over here on the bedside table for me. Then get me—Do you have rubbing alcohol?”
“No,” she said, doing as he asked.
“Okay, bring the bottle of scotch. And I need string or twine or, failing that, shoelaces. And a bowl—medium-size bowl.”
“Huh?” she asked, putting down the phone.
He looked at her, trying to keep his expression from being panicked or scary. “Please, honey. We move quickly now.”
“Right,” she said, dashing off.
The emergency operator answered and he said, “Aiden Riordan here, I’m a physician—obstetrician. I’m going to need emergency medical transport. Airlift, if that’s an option. We’ll need access to a neonatal intensive care unit.”
“What’s your situation, Doctor?” the operator asked.
“I have a woman in advanced labor with a breech presentation, thirty-five-week gravida one para zero, eight centimeters, membranes ruptured. I’m going to have to deliver. What’s your ETA?”
“I’m showing your location at 400 Moonlight Road, Doctor. Is that correct?”
Erin was back and she nodded. “Correct,” he said. “It’s right on top of the mountain in a nice big clearing. What are you sending? Bus? Helicopter?”
“I’ll let you know in a minute…. Please stay on the line….”
“Whatever,” he muttered. “Marcie, I want you to take nice, slow, deep breaths. I’ll breathe with you. Erin, get a basin or pan of lukewarm water and some washcloths. Where’s that string? I need a couple of lengths about six inches long—there’s a scissors in the bag. What are the chances you have a turkey baster?”
“Zero,” she said. “Why?”
“I don’t have everything I need in the bag—suction for one thing. But I can manage.”
The phone came alive again. “We’re sending helicopter medical transport from Redding, Dr. Riordan. ETA about thirty minutes.”
“Be sure they’re prepared to transport a preemie. Thirty minutes puts us over the line to get her to surgery.”
“Can I put someone on the line to walk you through it, Doctor?” the emergency operator asked.
He chuckled in spite of himself. “Very kind of you, thank you. I’ve got it. Can you send sheriff’s department support? Humboldt County Sheriff’s Department?”
“You’re located in Trinity, Doctor…”
“No worries—just give ’em a call, will you, please. Let them know that a woman they’ve been looking for is here. Annalee Kovacevic. I’m sure they’ll appreciate it.”
“Can you spell that for me, Doctor?”
“I cannot, I’m busy at the moment…”
“Is that the woman delivering, Doctor?”
“Nope. Ms. Kovacevic is waiting on the patio, I believe. The patient is Marcie Buchanan and she’s—” He stopped talking as Marcie let out a cry of pain followed by a loud grunt. Aiden checked her and he was seeing the backside of a rather small baby boy. Thank God she was early and the baby small. It improved their chances. “She’s ready,” he finished. And at that point, he was done with the emergency operator. He poured a little scotch in the bowl and dropped in his scissors and scalpel to sterilize the instruments. He’d perform an episiotomy if necessary; the scissors was to cut the cord, unless their transport made it first.
“Erin,” he said. “Dampen a facecloth and stay at Marcie’s head for now. Mop her brow, give moral support.” Then to Marcie he said, “Listen to me now—we’re going deliver the baby and—”
Marcie let out another passionate yell, bearing down in spite of herself.
“Stop, stop, stop,” he said. “Get control and listen to me. You have to work with me! I know it hurts, but everything depends on this! Marcie!” She cried out again and in desperation Aiden said, “Erin! Can you help? We need to work together!”
The contraction let up, and Erin, sitting up on the bed by her sister’s head, wiped Marcie’s brow and then turned her face so she could look in her eyes. “Marcie, look at me,” she said. “Listen to me. Aiden needs your complete cooperation to deliver this baby. It’s critical, Marcie. Hang on to my hands and listen to Aiden. Breathe deep and listen to Aiden.”
“Will the baby be all right?” Marcie asked, a sob in her voice.
“He will be all right. We’ll get through this,” Aiden said. “Work with me. You’ve got to work with me. No pushing yet.”
“I…have…to…”
“Gimme a second,” Aiden said. “Pant, if that helps. Get control. Erin—coach her. Pant like a dog. Try that.”
“It hurts,” Marcie said. “God, it hurts.”
“Yeah,” Aiden said. “But you’re there.” And as he said that, he watched the buttocks of the baby, back up, thighs tucked underneath. “Marcie. Erin. You really have to listen to me. This is critical. When I say push, you push. When I say stop, you stop.”
Erin gripped her sister’s hand. She stared hard into Marcie’s eyes. “We will…we can. Can’t we, Marcie?”
Breathless, she said, “Yes. Yes. Please make it be all right.”
“It’s going to be all right,” Aiden said. “Now, Marcie. Push now…”
The baby had to deliver himself all the way up to the umbilicus without any manipulation or interference—that was the safest way. It was actually hard to watch; to remain uninvolved.
“Good,” he said. “Rest a second.”
It wasn’t going to take long; the baby was small and would come fast. The butt was out.
“Once more, Marcie—push when you’re ready…”
She was so ready for that. She pushed and Aiden could see thighs and knees. “Stop pushing. Pant. Hold back.” He ran two fingers up the baby’s thigh to the underside of the knee, applied pressure, the knee bent and the right leg delivered. He did the same on the left side and both legs were out. He supported the baby around the hips; to grab the baby around the belly could cause internal damage to the organs. With his thumb on the sacrum, his hands around the hip bones, he slowly rotated the baby downward until the first shoulder appeared.
“Arrrgggghhhh…” Marcie growled.
“Don’t push! Don’t push! Don’t push,” he instructed.
The baby at this point was without oxygen and it was time to move quickly, but he had to be in charge and couldn’t have the mother’s natural urge to deliver trip them up. Aiden quickly moved two fingers up along the arm, applied pressure to the inside of the elbow to deliver the arm. He slowly rotated the baby in the other direction, repeated the maneuver to deliver the second arm.
This was the most dangerous part of the breech delivery—delivering the head. It had to be done carefully. He supported the baby’s underbelly with his left hand, buttocks up. “Marcie, do NOT push. Erin, I need you.” He moved a hand to Marcie’s pelvis. “In a second I’m going to ask you to press down right here.” He slid two fingers of his right hand inside the birth canal, slipped them around the baby’s neck in search of a cord. Luck was with him—no cord loops. He found the baby’s maxilla and pressed down, tilting the baby’s chin toward his chest.
“Erin, push down…Marcie, push the baby out. Now. Now. Now.”
And the baby slipped out. He was limp. Sluggish and worn-out and he’d been without oxygen, but not for a dangerous length of time. Aiden had a hand on his chest, flipped him over and stroked his back for a second. He was just about to turn him right side up and suck the mucus from him with his own mouth when there was a cough, sputter and lusty cry. Also, in the distant background, the sound of rotor blades.
“Nicely done, Marcie,” he said. “Erin, lay a towel across Marcie. Let’s clean this boy off, dry him and warm him. That’s what he really needs right now.”
Marcie was crying and reaching for him before there was a towel in place. “Oh, God, oh, God, oh, God,” she cried.
Aiden covered the baby to keep him warm, but then he tied off the umbilicus. He could hear the chopper; he wasn’t going to deal with the placenta. If the placenta delivered spontaneously, they’d take care of it.