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GHOST MUSCLE		10/28/92 * 05:12	BOU.DOC 

Through the narrow window, the New Orleans dawn is orange and rose. I'm tapping away, alone and wide awake for once. Delivery has been quiet since an hour ago when Laskin, Boy, slid effortlessly through his mother's birth canal as if on a toboggan run. Not so last night at around ten when Joel Nash and I performed three deliveries, two hitchless, the last one outlet forceps, in a single athletic hour. When that third baby decided not to be born, we paged Jennifer Sandler, but she was busy in OR with the attending, Gus Grant. Joel and I were on our own.

Joel's my fellow fourth-year subintern, along with Steve Tsintolas. Joel would be a doctor by now if he weren't on a full ride with Uncle Sam. In his second year, Army shanghaied him to Saudi where he did nothing, from what he says, except learn to make all kinds of macrobiotically acceptable foods. He's a nonlacto-ovovegetarian, and though born Baptist is a self-proclaimed Buddhist. He looks like a cross between Colonel Sanders and Yoko Ono. He has Yoko's features and her hair except blond, but he has the colonel's smile and twinkly blue eyes.

Last night he briefly attempted a vacuum-assisted delivery. This is a procedure in which a device like a sterile plunger attached to a pump is planted on the baby's head. To put it crudely, one draws the unwilling infant onto the great, peopled stage of life with something resembling a Hoover Convertible. The problem is the suction doesn't always hold, and when it does, the baby isn't always pleased. Like last night. The baby's head was barely crowning with each contraction, then disappearing again, in a most provocative manner. Joel gingerly applied the rubber bell, but as soon as I turned on the pump, the kid's pulse dropped to seventy. We removed the cup and the baby's heart rate came right back up. Joel was slower to recover, having turned as pale as one of those slabs of tofu he eats with soy and chopped scallion.

Just then the dreaded Dr. Grant arrived from surgery, took one look at Joel, and sat him in the corner. I had the forceps in my hand, and I was too worried about what I was going to do with them to care about the boss. Joel always has time to worry about Grant because Joel's a white southerner, while Grant's an African-American southerner. Grant turned his impatient eyes on us, his lips twisting with dissatisfaction before we could even tell him what had happened, and Joel quaked like a schoolboy. I didn't care. I'm a Yankee.

There were no more decelerations once we got the vacuum off, but there also wasn't much progress with the mother's pushes. We had an asynclitism, which is when the baby's head hits the floor of the birth canal at the wrong angle. I held the left forceps blade in my palm like a violin bow, then guided it into position with my right glove. That was only about as hard as reaching into the trunk of a car packed tight for a camping trip and finding a jar of peanut butter. Then I placed the spoon of the right blade in front of the baby's other ear. This was tougher, more like going back into the trunk in the dark and coming up with two slices of unsquashed bread. Luckily the mom, Judy, who was only twenty-four but was having her third, did all she could to help me. She said I was doing just fine. Once it was clear her baby wasn't in distress, she even asked Joel if he was feeling better. I thought that was a nice gesture.

Her introitus was distended like the mouth of a fish, not soft the way you'd expect. Between contractions the baby's head jammed up against her perineum so tight I could feel the ridge of the eyebrows. To my amazement, I closed the forceps. Grant checked their placement, then I started the gentlest traction Charity Hospital has ever witnessed. I wasn't moving that baby at all, just standing there sweating, all my chest muscles in a knot. The head started to move, slowly, and lined up all right. I knew where the baby was, even though I couldn't see it. I could sense it pivoting in there. Grant whispered that I should have done an episiotomy and that I'd better do one now. Kate held the forceps while I gave Judy a shot of lidocaine and then, under Grant's guidance, carefully made the cut.

I took the forceps again, but I still wanted to let the baby come out by itself. I bent my knees to get the gentlest angle of leverage, and tried not to let Grant see that I wasn't doing anything. I leaned over the invisible baby and prayed to it to hurry up. With the next contraction the head came all the way clear, facing down toward Judy's bottom. I thought I'd done it. Then Judy's perineum snapped shut around that baby's neck, as if there were a ghost between her legs trying to strangle it.

I froze. The baby wasn't breathing yet, was still on the umbilical cord, but for a endless second I forgot that. The next contraction didn't arrive. Grant opened the forceps and carefully removed them from the baby's head. Then he pried the handles out of my numb hands, while I tried with telepathy to help Judy figure out in what direction to make the baby go. Grant lifted Judy's feet out of the stirrups and guided her knees up and apart. The whole room closed in. Joel and Kate were telling Judy, Push! Push! I could hardly hear them. Judy, the baby, and I, we were all waiting to be born together, the baby from Judy, Judy from time, me from that silent place where I stood.

Another inch of the baby's neck appeared and my ears opened. Grant placed Judy's feet back in the stirrups. The left shoulder worked free. Kate and Grant came in closer and I made a basket of my hands and forearms. The baby's right shoulder popped clear, and with a squirt the whole creature followed. She lay in my hands and on my arms, her hair matted, her nose chafed and flat. I saw the red pucker of her pudendum and realized that I'd known all along that she was a girl, though there was no way I could have known.

Grant took her from me. Kate clamped and cut the umbilical cord. I stood still. Joel was back on his feet, and he and Grant worked on the baby. Kate cleaned up Judy and told me to sit down.

On his way out, Grant said I'd done fine. That was all. No wonder Joel's scared of him.


Excerpted from the book LOVE Enter by Paul Kafka, 
reprinted by permission of Houghton Mifflin Company.
Copyright (c) 1993 by Paul Kafka.

All rights reserved, including the right of reproduction
in whole or in part in any form.

mende@het.brown.edu