State of Wonder - Ann Patchett [130]
“Dear God, when did that happen?” Marina reached up for a hand and Dr. Swenson jerked it away.
“I would have a difficult time with the scalpel. I have a difficult time with a pencil. All that said, either you are going to do the cesarean or I am. Those are the choices.”
“What is your blood pressure?” Marina asked.
“I am not your patient,” Dr. Swenson said. “You would do well to keep your attention on what is in front of you.”
The man in the gray T-shirt looked from Dr. Swenson to Dr. Singh, holding his wife’s hand. Clearly, their disagreement concerned him. It did not concern his wife, who took the opportunity to close her eyes for the two minutes she had between contractions. Had someone asked Marina whose opinion was more valuable on the question of whether or not to proceed with a cesarean—the former head of obstetrics and gynecological surgery at Johns Hopkins who had not touched the patient, or the obstetrics and gynecological surgery dropout who was touching her first patient in thirteen years—Marina would cast her lot with the former. Still, being the latter, she was sure she was right, and equally sure she wasn’t about to physically prevent her mentor from taking over the case. That left her one option. “Tell me how to use the Ketamine,” she said.
The Ketamine was put in a syringe, which, once the needle had been inserted into the vein, was taped to the inner arm so that it could be slowly tapped in as needed, and with that tapping the patient ceased to whimper. Marina washed and dried the woman’s belly, straightened out her legs, and, putting on clean gloves, showed her nurse how to hold the skin taut. She had her nurse’s attention now. The woman was wide-eyed and still while Marina slid the scalpel into the skin. Once she felt the knife insert, it occurred to her that this was not her first surgery after so many years. It wasn’t a week ago she had cut through the snake. The subcutaneous fat welled up through the line of the incision like clotted cream dotted with the first bright beads of blood.
That cut, which passed without a sound save a small gasp from the husband, drew the sudden attention of everyone in the hut. Even the old man pulled himself out of the hammock and brought the two children over to see. The other two women, and the man with the knife, all gathered round for the show, leaning forward and pushing a little to get the best view. Marina felt someone’s knees against her back. “This isn’t helping,” she said.
Her nurse, hands steady on either side of the incision, barked out an order, and the circle immediately took one big step back.
“Now we’re looking for the fascia,” Dr. Swenson said. “I didn’t bring my glasses. Do you see it there, under the fat?”
“I’ve got it,” Marina said. She took the nurse’s hands and put a shoehorn in each one. She dug the horns into the incision and showed the woman how to pull. There was the uterus. Despite the drowning flood of adrenaline she recognized it all—bowel and bladder, it was perfectly familiar. Why was that so surprising? She had given up her profession, not her knowledge. Marina, half blinded by her own sweat, turned her face to Dr. Swenson who picked a shirt up off the floor and wiped her down. Dr. Swenson then leaned forward and blotted off the face of the nurse, who was wrestling mightily to keep the cavity open wide with her shoehorns.
“Now take the bladder down,” Dr. Swenson said. “Don’t nick it. You see the bladder, don’t you?”
“I do,” Marina said. It was a miracle to see anything without direct light. She cut into the uterus carefully, avoiding everything that was not meant to be cut, and the blood boiled up into the cistern of the belly. Blood, combined with the great slosh of amniotic fluid, made a dark and raging ocean Marina could not get past. The hot liquid broke over the floor and pooled beneath the doctor and her patient. “How in the hell do you do this without suction?