In my agitation I ignored his defiance. It was enough that he cooperated. My thoughts were elsewhere. When I had almost finished disinfecting my arms, I ran through my plan of action again in my mind.
The young nurse to my left. The old matron to my right. Each would hold one of the mother's knees. A sterilized drape over her lower abdomen.
One of my hands working inside the mother, the other hand on the drape helping from outside.
Both hands always working together. Neither by itself.
Turning the baby from its transverse lie onto its rump by these manipulations would be a last attempt to bring about a normal longitudinal lie.
If it failed, the woman was lost.
But I was sure of my business. I still had the self-confidence to trust in my ability to perform this intervention, which in its rudiments was very simple and which I had executed at the clinic more than once.
Which
hand should I use to turn the baby, that is, which hand should I use to go inside the mother's womb, the right or the left? Which should help from outside? My best hand was my right. My late friend Walter's best hand had been his left. In my place he would have preferred his left, just as I favored my right. But this makes no difference in operative
obstetrics. One always turns the baby using the hand corresponding to the side of the mother where the baby's feet are. In the case of the left occipital transverse lie (the baby's feet on the right, rump on the left), using the right hand. This position, the left occipital transverse lie, was what my late friend's widow presented with, and thus I had to go in using my right hand.
Without drying my dripping hands, in order to keep them sterile, I moved to the bed.
The woman, with fresh drapes underneath her, was already breathing under the anesthesia. Good. March counted her respirations carefullyâthey were regular, if somewhat rapid. I put my ear over the mother's belly, taking care not to touch it. I wanted to know what the baby's heart sounds were like before I began. My hearing was keen and I imagined I could pick them up without direct contact.
But I had not counted on the thunderous drumming of another heavy squall beating down on the hill and the hospital, shaking the entire building to its foundations, even the posts of the bed on which the woman lay.
No matter. The turning had to be done, the normal lie had to be produced.
On with it, no more hesitation.
Calm, self-control, logical thinking, precise movements, the utmost gentleness and care even with the most intense effort. Heads up! Stay calm! Not a single abrupt movement. Not a single unconsidered maneuver.
The drapes were finally all in place, the two assistants stood by me, doing what they should. The woman was breathing deeply and regularly.
March had counted to nearly a hundredâhe thought he had to enumerate every breath.
I let him be. This was not the time to be giving him a long lesson. Besides, the counting gave me a yardstick for elapsed time during the intervention, which had to be kept to an absolute minimum.
I took a good deep breath and drew my head up from between my shoulders, where it had hunched due to the great strain of determination that many operating physicians feel before any major intervention. But as I extended my right hand and let my left hand slide over the smooth, cool, damp drape on the woman's abdomen, the last of my abnormal excitation left me. I was as lucid as I had ever been.
I nestled the four fingers of my right hand together as much as I could and pressed the thumb into my palm, so that my hand would take up as little space as possible. Then I carefully slid my fingertips forward, the soft, warm flesh again clinging tightly to my hand, and reached the inside of the womb, that is, the transitional zone separating the external sexual organs from the internal ones. In a sudden contraction, the uterus snapped at me like a fish snapping at a lure. Then the tension relaxed. At this point, to my relief, I already felt what I had expected to feel: a broad, smooth surface with a faceted ridge in the middle, no doubt the baby's back and spine.
The light above my deeply bowed head was flickering, going out momentarily. This did not disturb me.
Completing an operation of which one is technical master affords a feeling of happiness like that of an athlete who has set a record. It is a turbulent, but very intense happiness.
But now I became uncertain, and I paused. I became alarmed. The numbers that the faithful March had been counting off were coming
more and more slowly and hesitantly, and he suddenly screeched: “She's dying! She's dying!” In a flash I removed my hand and ran around the two beds placed side by side to where the woman's head was, used my left hand to tear off the anesthesia mask, which was coated with saliva and chloroform mixture, and saw what the trouble was.
The woman was not dying. On the contrary, she was regaining consciousness. Hence the apnea, the tachycardia. Suddenly she raised her swollen, velvety eyelids, and the large, bloodshot eyes that rested on me held an expression of returning consciousness. “Go on! Go on! Keep it up!” I cried softly but very urgently to March. Stay calm! Stay calm! I hurried back to where I had been. “Give her a few more minutes! And we'll have it! Go!”
It took perhaps half a minute until the anesthesia was deep enough for the operation to continue. But this half minute of waiting made me very impatient. Even before the intervention, the baby's heart sounds had not been the best. For this was a vulnerable preterm baby, at least a month premature. Things must be wound up as quickly as possible in such a case. But I had to wait. No anesthesia, no intervention. So I stood and waited. My hands were tired. My right hand in particular was sagging, as though paralyzed, from working inside the contracted womb.
Very inappropriately, I thought of this child's departed father. I saw Walter on his deathbed. I saw him saying good-bye to his wife. I saw him making the sign of the cross with his left hand in his last lucid moments. I thought now that the anesthesia was deep enough for me to resume the intervention that I had had to break off so abruptly. There
was no time for another careful disinfection. The process takes ten to fifteen minutes. But if I spent that much time disinfecting myself, the baby would have long since suffocated and the woman have bled to death. However, I had kept the hand I needed, the “inside” hand, clean.
This time I did not set to work with the same joy and courage. Taking great care not to inflict an internal injury, I slipped my left hand inside while my outside hand, the right one, on top of the drape, supported the maneuvers of the operating left hand. Something was holding me up. I felt as though I had rushed out of the house forgetting the most important thing, had wanted to turn around at the bottom of the stairs and go back but had not been able to, and was now going farther and farther in the wrong direction on the street, putting my patient at even greater risk. But what I had forgotten did not come to me! It simply was not there.
The drape slipped suddenly and my right hand was lying directly on the woman's damp, cool, velvety-smooth abdomen.
At last my left hand, folded up to be as small and narrow as I could make it, had reached the inside of the uterus. A sudden contraction, beginning at the top and intensifying as it moved down, clutched at my hand. It is an indescribable feeling to be surrounded by the bleeding, quivering, grasping, vibrating flesh of another body. It is paralyzing. One fights it, one wants to act, to move, to find and seize the baby's foot once and for all. Wait! Stay calm! Be patient!
The anesthesia took its normal course. The breaths that March continued to count off, functioning as a clock for me, had long since passed three hundred and were approaching four hundred; the intervention had thus been going on for well over ten minutes. But my left hand
remained as though paralyzed, even when the grip of the clenched uterus had loosened and I should have made haste to finish my work. I didn't know my way around in this hot cavity. Everything was strange to me here. I knew nothing. Except that the blood was draining from my head. I felt about uncertainly in the strange interior, as someone in a dark room where he has never been before might stumble, fall, bump into sharp corners. But the place was not strange to meâhow could it be! I had explored the terrain no more than five minutes before and found it normal; the baby's back in the expected place, head and rump where they were supposed to be. Could everything have shifted so much in that short time that it now seemed strange and incomprehensible? Where was the back? Where the tips of my index and middle fingers had felt the subtle but clearly perceptible faceted prominence of the baby's spine, now I found a soft body surface with no longitudinal bone. Tiny little bones ran transversely, evidently the rib cage, or was it a soft, unresisting mass, the baby's belly? Where I had felt the foot earlier, now I found the fine, articulated bones and fleshy forms of a hand. Where was I? Had the world shifted on its axis? I stopped. A new contraction was beginning. I had to break off. Rooting about in the dark was senseless and life-threatening. I stood silently. My heart was pounding in my throat, behind my eyes.
March had been watching all my movements and my face with his hostile expression. Suddenly he burst out with the puzzling words, “Which hand?” I stared at him. How did he know that all I had found was the baby's hand, not the foot that I needed? I didn't understand him. He smiled with defiant derision. I looked at him dumbfoundedly, and when the woman suddenly groaned under the anesthesia, I groaned too. I said earlier that I sometimes imitated the emotions of others in
moments of despair. And I had reason enough for despair. My groans were now really and truly from the heart.
Now I understood March's question. All was lost! The second time I had not, as would have been proper, gone in with my right hand, which could have finished the job without difficulty and which I had prudently kept sterile by taking care not to use it to touch the anesthesia mask and so forth. Instead I had used my left hand, the unclean, unsuitable, wrong hand, to go inside the woman entrusted to my care, the hand that was not capable of doing the job, or only with the greatest effort, the hand that was contaminated with countless microorganisms.
That was how it was. Those were the facts. I will not and cannot describe what went through my mind. Nor can I reconstruct the logic that finally brought me to a decision. The decision had to be made: Quit? Go on? And if “go on,” should I take the wrong hand out again and insert the correct hand, my right? But now my right hand had been on the skin of the woman's abdomen and had not been sterile for a good while. There was even less time for disinfection now than there had been before. It was a matter of seconds, not minutes. One question after another. Thinking instead of acting!
I was not a doctor now! My medical certificate had been revoked, almost a year back! I was a convict on the island of C. Tolerated. The recipient of unearned confidence, a fraud, nothing more. Nothing more. A wife murderer. No, much more, something very serious, and
that
was the significance of the resentful and contemptuous expression on the face of my friend March! I had abused my friend Walter's poor wife once already, abused this woman who had truly been battered by fate by experimenting on her without her knowledge, against her will, and now I was doing it again! Never had a conscience been so belatedly
heard from. Why? Why? And an infectious, clumsy, half-paralyzed hand in an exposed pelvic region!
What's done is done. In all my life I had never felt so shattered. Incapable of doing anything, deciding anything. I closed my eyes.
But then I rallied myself. I had to meet my fate. Things had to be done. No one was going to act for me, so I would act as best I could.
The baby's body moved under my hands. A shudder ran through it. Was the tiny creature trying to take its first breath? It would never be able to while it was inside. With this premature breath the baby would inhale the surrounding amniotic fluid and inevitably choke.
A baby's first breaths are not restricted to the rib cage, the windpipe, and so on. The entire little body tenses up, mobilizes all its strength in its urge to live, to act. No, that's not the way! Not like that! Not like that!
I changed hands. Better to save
one
life if both, mother and child, were at risk. I would save the child. For the child it was irrelevant what microorganisms my hand was covered with. Anything was better than doing nothing and knowingly, despairingly, losing both mother and child.
I
had never really known my mother. I had never had to lose children of my own. Fate had ordained that this mother and this child be placed in my care. At this truly frightful moment I did not think of myself. I forced myself not to feel the terrible burden of my conscience.
My fingertips would do the thinking, I would be guided by my exquisite sense of touch alone. No past. No dickering with the fate that had given me such rotten treatment. No shifting the blame onto my father, who was on my mind at that moment as the one among my betters who had always overcome all difficulties for as long as I had known him.
Thus I proceeded. In with my right hand! Again, and even more gently and cautiously than the first time.
Immediately I had the baby's back and spine before me again. Good! I slid farther down, now to the side, now at an angle and upward, and took hold of a piece of the thigh just below the baby's bottom.
Now my right hand, effectively supported by the left, outside hand, could slide down the meager leg. To the ankle. This I grasped with great gentleness so that my hand took up as little space as possible, the foot clamped between my index finger on the dorsum and my middle finger on the anklebone.