The Reluctant Midwife (5 page)

“Well, all's well that ends well,” Stenger intones as he opens the glass door to his store and then says brightly out of habit, “Come again, Miss Myers.”

On the way out of town I make a point of going past the church to see the soup line. There are dozens of fellows, mostly white with a few colored mixed in, and I'm happy to see that the African Methodist Episcopal and the Saved by Faith Baptists have joined forces and serve all races.

I study the men as we drive by: thin, hollows under their eyes, cheeks sunken in, clothes greasy and torn, and I wonder where their women are. Staying with the children and kin, I imagine. But the men must leave home and keep on looking for work. They can't stop. Whatever it takes, just like me, they must find work.

The Joes in the line turn to stare at our vehicle, and one tall fellow in overalls waves with the stump of an arm. That's Holly Wetsel, I realize. One-Arm Wetsel! The doc saved his life a few years ago when men from the sawmill carried Holly to the clinic in the back of a pickup. He'd run his hand through the roller and crushed it so badly it couldn't be saved. Isaac amputated the torn stump and stopped the bleeding, while I provided the anesthesia. He didn't charge a cent for the surgery. That's how he was . . . generous when you didn't expect it, but otherwise a skinflint.

As we pass the church, Isaac turns. His face doesn't change, still the blank stare, but there's a shift of the head in what looks like a nod. Maybe he's thanking the men in the soup line. . . . I take a deep breath. Not likely.

“Thanks for coming with me, Becky,” Patience says as we bump in her Olds down Salt Lick Road. “It's a lot more fun to have a pal at a delivery and also safer if something goes wrong.” I'm bracing my feet against the floorboards wondering how I got into this.

Thinking it over, there wasn't much choice. Blum and I were at the Hesters' returning their push mower when Patience got a call and the person on the phone mentioned blood. Then when Patience asked me to come with her to the delivery, what was I going to say?
“No thanks, I'm busy?”
She clearly thought I'd be happy to attend, as if assisting a woman in labor was a big honor.

Daniel gently led the doctor off to the barn. “Come on, old buddy. I got something to show you. We'll leave the birthing to the ladies.”

“I get so tired sometimes,” Patience goes on as she expertly bounces around another hole in the gravel road. “But since Mrs. Potts died, I'm the only midwife in Union County. . . .”

“When we get there, can you sort through the birth satchel and resterilize the scissors and whatever else we'll need? I just had a delivery yesterday and didn't get around to it. This is Thelma Booth's fourth child. She's been calling me every few days with one thing and another.”

Patience takes a sharp left and passes a wooden sign that reads
HAZEL PATCH
.

“You know about Hazel Patch? That's where Reverend Miller and his Negro followers live. It's a village of about a hundred folks who migrated up from the southern part of the state to work the Baylor Mine, until the cave-in in '24, when seventeen of their men were killed, seventeen men and two boys.

“They say you could hear the trapped men calling for help, but no one could get to them through the boulders. They screamed for a week and then the cries got weaker, and then they stopped. Those who weren't killed won't go underground again, no matter what, and now make a living as subsistence farmers.

“I spent a lot of time in mining camps,” Patience goes on. “Did I ever tell you? I was married to a union organizer for the UMWA, the United Mine Workers of America. The camp we're going to today isn't unionized. It's abysmal. The houses are little more than the shacks that the hoboes build under the bridge in town.”

She takes another sharp turn and follows a narrow gravel road along a bubbling creek where the water is a shocking golden color and the rocks are covered with orange slime that comes from acid runoff out of the mines.

“I worked at Scotts Run as a public health nurse when I first came to West Virginia,” I tell her. “Up there, even some of the nonunionized camps had nice schools and churches and a clinic with a doctor, but that was over ten years ago.”

“That's the way it should be. Unions, just by their presence, stand for improved living and working conditions, but now that the economy has fallen apart, the coal barons can do anything they want. They know the men won't strike. It's not like there are a lot of jobs to choose from and they're lucky they have one.”

As we continue into the hollow, I see shacks perched on the hillside and a company store, but nowhere a clinic or school. Miners,
wearing metal hats with lights on them, their faces so black you can only see their eyes, are just coming out of a massive dark hole. Some of them lift their heads as we pass, but only one fellow waves.

“You remember Thelma?”

“I saw her at my Women and Infants' Clinic, years ago. Had to explain everything to her twice; she's a little slow.”

Patience takes another sharp turn and we pull up in front of a plain wooden miner's house, all one story. I'm surprised, in such dismal circumstances, to see that the trim around the windows is painted a sea green, with a matching sea-green door. Purple pansies bloom in green window boxes in an attempt to bring cheer to an otherwise gray world.

“Miss Patience!” cry three freckle-faced kids sitting on the porch. “Miss Patience! The midwife! Ma, the midwife is here.” You'd think she was Santa Claus.

“Okay, baby dolls, you calm down!” A very pregnant redhead, with an angelic freckled face comes to the door.

“Come in. Come in. Why, Nurse Becky, I didn't know you were in town. I'll make us some tea.”

“Thelma! What are you doing out of bed?” Patience squeals. She rushes forward, pushing the children aside. Fresh blood is visible on the insides of the woman's calves and stains her worn pink house slippers.

“For god's sake, you're bleeding, Thelma! Becky, can you bring in the birth satchel? I'll get her back to the bedroom. You children stay here. Where's your father?”

“He's working in the mine, down under,” the oldest boy, around eight, answers. “Might do a double if he can. We need the money.” Patience sighs and propels Thelma down a narrow hall.

“Will Ma be okay?” the boy says, turning to me. “That's a lot of blood.”

“The midwife and I will take good care of her,” I hedge.

“Will she be okay?” he asks again.

A cloud, like a hand, has moved over the sun.

When I step into the small bedroom with Patience's birth satchel, Thelma is lying on her side, crossways on the sagging iron bed, folding clean laundry, and singing to herself.
“Happy days are here again. The skies above are clear again. So let's sing a song of cheer. Happy days are here again.”

“Thelma, I want to check the baby's heartbeat. Can you roll on your back?” Patience asks sweetly, though by her expression anyone—but Thelma—could tell she's angry. “Do you know when you last felt the baby kick?”

“Probably last night. No, maybe yesterday. It's been quiet today.”

The midwife holds out her hand and I know what she wants: the metal stethoscope. Her lips are drawn thin and tight. For all we know this baby could already be dead. Mrs. Booth is so clueless, it's possible.

“It's okay, Thelma. It's okay,” I whisper in her ear as Patience moves the stethoscope up and down and then across the bulging mountain of abdomen. The air in the room gets thicker as the minutes go by, and I remember that the last time I went to a delivery with Patience
she only had a Pinard stethoscope, a wooden hornlike tube. She must have inherited this new metal one from the late Mrs. Potts, the colored midwife who in years past delivered half of Union County.

Finally, Patience pushes her drooping wire-rim glasses up and begins to tap her finger in the air while staring at the gold timepiece she wears on a ribbon around her neck, and I know by watching her that the fetal heart rate is normal. We both take a deep breath and Patience breaks into a smile.

“Your baby is fine, Thelma. Nice and strong. But why are you bleeding?” She turns to me. “It might just be bloody show.”

“That's a lot of blood,” I note. The mother rolls on her side and goes back to folding the laundry, as if our conversation doesn't concern her.

I study our patient. “
Happy days are here again . . .”
She has a pensive, faraway look in her eyes, and Patience and I each place our hands on Thelma's abdomen at the same time. Her uterus is rock hard. We wait for her singing to stop and the uterus relaxes.

“She's singing through the contractions,” Patience whispers, then she nods her head toward the door.

“What do you think?” she asks me as we stand in the narrow dark hallway.

I hesitate, not sure if Patience knows the medical terms, but then remember she's studied the whole of Delee's
Principles and Practice of Obstetrics
, a medical text that her mentor, the midwife Mrs. Kelly left her. Bitsy, her young assistant, had also studied it when they used to attend births together.

“It could be an abruption,” I offer. “Have you ever seen one?”

“Yes.” Patience's face grows gray. “But she's not in severe pain. Usually, in abruptions there's terrible pain, so most likely it's a placenta previa with the placenta at the edge of the cervix or, God forbid, completely over it.”

“Do you think we could get her in the car and make it to the hospital in Torrington?” I ask.

“Maybe. If she's only a few centimeters, we might try, but it's three hours to the hospital so I guess I have to check her. It's her fourth and we might not make it.”

We both know that doing a vaginal exam in a situation like this is dangerous and not just because the West Virginia Midwifery Statute of 1925 forbids it. Patience could accidently poke a hole in the placenta and that would cause a life-threatening hemorrhage.

“Thelma.” Patience tries to get the mother's attention. “I need to check you. I will be very careful, but you mustn't move or squirm around.” She pulls on her sterilized red rubber gloves and holds out two fingers. “Oil,” she says and I pour a little from the brown bottle she carries in her bag.
Happy days are here again
.

I hold my breath and watch Patience's face as she slowly moves her fingers into the vagina.

“Seven centimeters,” she finally says. “Completely thinned out and the head well engaged.” Then her eyes widen. She mumbles a curse and removes her fingers, as a handful of blood leaks out on the bed. “A partial previa. I can feel the placenta where it's come loose on the left side, about an inch of it. I think we need to get her out of bed.”

“Out of bed?” (This seems unusual and if I didn't have so much respect for Patience, I'd think she was crazy.)

“There's no way we can get a mother of three, who's already seven centimeters to the hospital in time. So it's better to get the baby out quickly. Also the pressure of the head on the edge of the placenta might slow down the blood loss.”

“You mean like a tamponade? Dr. Blum told me about this.”

“I don't know the word
tamponade
,” she whispers back, “but it's like when you put pressure on a wound.”

Once on her feet, Thelma begins to sway and to sing again, but she's almost yelling the words with each contraction.
“Happy days are here again! Happy days are here again!”

I run down the hall to the kitchen, throw the midwife's scissors for cutting the cord in a pot of water on the cookstove, then run back again and straighten the bed. “Happy days are here again!” I didn't know such a pretty woman could yell so loud, but at least she's not screaming like so many women do. The contractions are only two minutes apart and the bleeding has slowed.

I get rid of the unfolded laundry, run down the hall a second time, grab the pot of hot water, and set it on a towel on the bedroom dresser where it can cool. “
Happy days are here
. . . Ugggggggh!” It's more of a growl than a groan and I nervously point to the bed, asking Patience with my eyes if it's time for the patient to lie down.

The midwife shakes her head no. “Here, Thelma, do like me.” Both women squat on the wooden floor. In between contractions, there's the
drip, drip, drip
of red and I wipe it up.

“Be ready for anything,” Patience whispers. “The baby may come out floppy if there's been too much blood loss. . . .” I begin to shake inside, and to quiet my nerves try to take deep breaths.

“What?” the mother cries. “What about my baby? Is it okay?” Patience reaches for her stethoscope and listens for a brief moment.

“The baby's fine,” she reassures and that may be so, or possibly not. She didn't spend a lot of time listening. “Now bear down like you mean it!”

“Oil,” she orders again and I pour a little of the oily golden liquid on her fingers. She wipes it around the woman's vagina and two pushes later the head is out. “Wait! Blow!” There's a rubbery cord around the baby's neck. She eases it off and the baby drops
into Patience's clever hands. She holds the blood-covered, dark-haired, wailing infant out to me and when she reaches out her chubby little arms, I almost choke up. It's as if light has burst my tired heart open. I don't know how else to say it. Light.