was forbidden for males of any stripe, even doctors, to look at any part of a woman in this part of the world, especially where he’d have to look to deliver a baby. But with all the local midwives dead, he was the only show in town. The Doctors Unlimited folks in Washington, D.C., had explained that it would be a death sentence for him and his patients to be caught. But the D.U. staff had believed—correctly—that local women would risk it anyway.
Crazy thing, that. Women wanting to have a fighting chance at surviving childbirth. What were they thinking? He snorted sarcastically as he turned up the propane heater. Without proper care, one in three women in this part of the world died in childbirth or soon after from complications. Doctors Unlimited and other aid organizations had spent the past several decades training midwives, and the mortality rate had dropped to rates commensurate with the West. Until this past winter and the midwife massacre.
He commenced meticulously scrubbing his hands and forearms over a bucket of water so cold it made his fingernails turn blue. How in the hell was he supposed to work under these conditions?
A muttered argument ensued behind him, and Katie announced, “The girl doesn’t want you to examine her or help unless things go badly.”
“And how am I supposed to know things are going badly if I can’t look at my patient?” he snapped.
She sighed. “They want you to tell me what to look for.”
“That’s absurd. You have no medical training whatsoever.”
“That’s what I told them. She’s adamant, though. And embarrassed.”
“But I’m a doctor—”
“And she’s a young, terrified girl who cannot read or write and will be beaten to death by her husband if he catches her here.”
“Then why did she come?” he demanded, low and angry.
Katie came over to stand directly in front of him. Her eyes were huge and beseeching as she looked up at him. “Because she’s more scared of her baby dying than of dying herself.”
He stared down at her, seared by the zeal in her eyes. He grumbled, “This sucks.”
“Welcome to life as a female a thousand years ago.”
He just shook his head. “The first thing to do is see if the baby’s presenting headfirst. You’ll have to use a speculum and a flashlight since it’s so dark in here.” The lone lantern was barely bright enough to read by, let alone perform surgery by.
Katie gulped and headed for the laboring girl, who was moaning again. He glanced at his watch. Contractions were under two minutes apart. “Do you know what a speculum is?” he asked.
“Every woman who’s ever had an ob-gyn exam knows what one is,” Katie replied frostily.
His lips twitched with humor, and he was glad her back was turned to him. “How far is she dilated?” he asked.
“There’s about a silver-dollar-sized opening,” Katie reported a moment later. “What does a head look like?”
“Like a wet, hairy balloon pressed against the cervix.”
“Then we’ve got a problem. I’m seeing pink skin. And it’s kind of pointy. Maybe bony. Like, umm, a baby bottom?”
“Breech presentation,” he bit out. “You’re going to have to talk our reluctant patient into letting me help.”
But Mama was having no part of it. It was outrageous that he had to stand there and do nothing when he could be attempting to turn the baby before it entered the birth canal. Although given how small Mom was, that would be a dicey proposition at best. He really needed to consider a C-section sooner rather than later.
“Tell her I want to discuss a C-section.”
Nope. Abruptly hysterical Mama was having none of that. Grandma wasn’t keen on the idea, either—something about not being able to hide the evidence of a doctor helping her granddaughter.
This was no way to practice medicine.
The tension in the tiny space mounted over the next hour as the girl’s labor progressed and her moans turned into sharp cries of pain. “Don’t let her push!” he ordered. “At all costs, she mustn’t push.”
The cries turned into screams muffled by a pillow the grandmother pressed over the girl’s mouth. God, this is barbaric.
“I can set an epidural. Give her painkillers. At least let me put a heart monitor on the baby,” he all but begged.
“I’m sorry, Alex. She’s not budging.”
“Katie,” he ground out urgently. “Find a way. Make her understand that she and her baby are in grave danger. This is why she came to me. Let me do my job!”
His impotent fury mounted as the girl’s screams turned into long, keening moans indicative of exhaustion and delirium. He didn’t need anyone to tell him the patient was no longer progressing in her delivery. Katie finally turned to the grandmother and said something sharp.
“Okay, Alex. Grandma says to ignore her granddaughter and come help.”
Thank God. As he expected, the girl was so far gone into the agony of a difficult birth that she barely noticed him working frantically to shift her baby into some sort of birthable position.
“I need her to push with the next contraction.”
Katie stood by the girl’s head, translating his instructions, although he doubted the mother was paying the slightest attention at this point. The girl’s body heaved of its own volition, and he went to work. He pulled the baby’s slippery ankles clear and hung on desperately until the next contraction. The girl screamed, one long continuous keen of agony as he all but tore the child from her body. It was that or risk the child suffocating in the birth canal.
“It’s a boy.” He suctioned the baby’s nostrils and rubbed the child vigorously. Finally, the infant drew a shuddering breath and let out a wail. Not as lusty as Alex would have liked, but the kid was alive. He cut the cord and thrust the child at Grandma to wrap up and warm up. He had bigger problems at the moment.
This girl was too narrow-hipped and too damned young to be having babies, and the delivery had torn the crap out of her. She was bleeding heavily, and one supply he and Katie had not been able to haul in had been refrigerated whole blood.
He went to work fast, racing against time. The mother’s screams quieted. Not that he wasn’t causing her intense pain. She was merely bleeding out. Dying.
“Tell her to fight,” he ordered.
Katie leaned down to speak in the girl’s ear.
“Say it like you mean it,” he growled.
Katie raised her voice and began demanding that the girl open her eyes. That she live for her son. And while Katie tiraded like a drill sergeant, he fought like hell, his hands flying to stem the worst bleeders. It took a full five minutes to avert disaster, and nearly a half hour to stabilize the girl. Once the meatball work was done, he settled down to the slower and
