A Breath of Snow and Ashes - Diana Gabaldon [642]
I moved my stethoscope over the tiny chest, ear pressed to it, listening intently. It was my best stethoscope, a model from the nineteenth century called a Pinard—a bell with a flattened disc at one end, to which I pressed my ear. I had one carved of wood; this one was made of pewter; Brianna had sand-cast it for me.
In fact, though, the murmur was so distinct that I felt as though I barely needed a stethoscope. Not a click or a misplaced beat, not a too-long pause or a leaky swish—there were any number of unusual sounds a heart could make, and auscultation was the first step of diagnosis. Atrial defects, ventral defects, malformed valves—all have specific murmurs, some occurring between beats, some blending with the heart sounds.
When the ductus arteriosus fails to close, it’s said to be “patent”—open. A patent ductus arteriosus makes a continuous shushing murmur, soft, but audible with a little concentration, particularly in the supraclavicular and cervical regions.
For the hundredth time in two days, I bent close, ear pressed to the Pinard as I moved it over Amanda’s neck and chest, hoping against hope that the sound would have disappeared.
It hadn’t.
“Turn your head, lovey, yes, that’s right. . . .” I breathed, delicately turning her head away from me, Pinard pressed to the side of her neck. It was hard to get the stethoscope close to her fat little neck . . . there. The murmur increased. Amanda made a little breathy noise that sounded like a giggle. I brought her head back the other way—the sound decreased.
“Oh, bloody hell,” I said softly, so as not to scare her. I put down the Pinard and picked her up, cradling her against my shoulder. We were alone; Brianna had gone up to my room for a nap, and everyone else was out.
I carried her to the surgery window and looked out; it was a beautiful day in the mountain spring. The wrens were nesting under the eaves again; I could hear them above me, rustling round with sticks, conversing in small, clear chirps.
“Bird,” I said, my lips close to her tiny seashell of an ear. “Noisy bird.” She squirmed lazily, and farted in reply.
“Right,” I said, smiling despite myself. I held her out a little, so I could look into her face—lovely, perfect—but not as fat as it had been when she was born a week before.
It was perfectly normal for babies to lose a little weight at first, I told myself. It was.
A patent ductus arteriosus may have no symptoms, beyond that odd, continuous murmur. But it may. A bad one deprives the child of needed oxygen; the main symptoms are pulmonary—wheezing; rapid, shallow breathing; bad color—and failure to thrive, because of the energy burned up in the effort to get enough oxygen.
“Just let Grannie have a little listen again,” I said, laying her down on the quilt I’d spread over the surgery table. She gurgled and kicked as I picked up the Pinard and placed it on her chest again, moving it over neck, shoulder, arm . . .
“Oh, Jesus,” I whispered, closing my eyes. “Don’t let it be bad.” But the sound of the murmur seemed to grow louder, drowning my prayers.
I opened my eyes to see Brianna, standing in the doorway.
“I KNEW THERE was something wrong,” she said steadily, wiping Mandy’s bottom with a damp rag before rediapering her. “She doesn’t nurse like Jemmy did. She acts hungry, but she’ll only nurse for a few minutes before she falls asleep. Then she wakes up and fusses again a few minutes later.”
She sat down and offered Mandy a breast, as though in illustration of the difficulty. Sure enough, the baby latched on with every evidence of starvation. As she nursed, I picked up one of the tiny fists, unfolding her fingers. The minute nails were faintly tinged with blue.
“So,” Brianna said calmly, “what happens now?”
“I don’t know.” This was the usual answer in most cases,