The hospital was an anonymous four-story building, the color of charity. Inside was a rabbit warren of cubicles designed to diagnose sickness, alleviate it, cure it or sometimes bury it. It was a medical supermarket, and there was something there for everyone.
It was four A.M., the hour of quiet death or fitful sleep. A time for the hospital staff to have a respite before girding for the battles of another day.
The obstetrical team in Operating Room 4 was in trouble. What had started out as a routine delivery had suddenly turned into an emergency. Up until the actual delivery of the baby of Mrs. Karl Czinski, everything had been normal. Mrs. Czinski was a healthy woman in her prime, with wide peasant hips that were an obstetrician’s dream. Accelerated contractions had begun, and things were moving along according to schedule.
“Breech delivery,” Dr. Wilson, the obstetrician, announced. The words caused no alarm. Although only three percent of births are breech deliveries—the lower part of the infant emerging first—they are usually handled with ease. There are three types of breech deliveries: spontaneous, where no help is required; assisted, where the obstetrician lends nature a hand; and a complete “breakup,” where the baby is wedged in the mother’s womb.
Dr. Wilson noted with satisfaction that this was going to be a spontaneous delivery, the simplest kind. He watched the baby’s feet emerge, followed by two small legs. There was another contraction from the mother, and the baby’s thighs appeared.
“We’re almost there,” Dr. Wilson said encouragingly. “Bear down once more.”
Mrs. Czinski did. Nothing happened.
He frowned. “Try again. Harder.”
Nothing.
Dr. Wilson placed his hands on the baby’s legs and tugged, very gently. There was no movement. He squeezed his hand past the baby, through the narrow passage into the uterus, and began to explore. Beads of perspiration appeared on his forehead. The maternity nurse moved close to him and mopped his brow.
“We’ve got a problem,” Dr. Wilson said, in a low voice.
Mrs. Czinski heard. “What’s wrong?” she asked.
“Everything’s fine.” Dr. Wilson reached in farther, gently trying to push the infant downward. It would not budge. He could feel the umbilical cord compressed between the baby’s body and the maternal pelvis, cutting off the baby’s air supply.
“Fetoscope!”
The maternity nurse reached for the instrument and applied it to the mother’s belly, listening for the baby’s heartbeat. “It’s down to thirty,” she reported. “And there’s marked arrhythmia.”
Dr. Wilson’s fingers were inside the mother’s body, like remote antennae of his brain, probing, searching.
“I’m losing the fetal heartbeat—” There was alarm in the maternity nurse’s voice. “It’s negative!”
They had a dying baby inside the womb. There was still a slim chance that the baby could be revived if they could get it out in time. They had a maximum of four minutes to deliver it, clear its lungs and get its tiny heart beating again. After four minutes, brain damage would be massive and irreversible.
“Clock it,” Dr. Wilson ordered.
Everyone in the room instinctively glanced up as the electric clock on the wall clicked to the twelve o’clock position, and the large red second hand began making its first sweep.
The delivery team went to work. An emergency respiratory tank was wheeled to the table while Dr. Wilson tried to dislodge the infant from the pelvic floor. He began the Bracht maneuver, trying to shift the infant around, twisting its shoulders so that it could clear the vaginal opening. It was useless.
A student nurse, participating in her first delivery, felt suddenly ill. She hurried out of the room.
Outside the door of the operating room stood Karl Czinski, nervously kneading his hat in his large, calloused hands. This was the happiest day of his life. He was a carpenter, a simple man who believed in early marriage and large families. This child would be their first, and it was all he could do to contain his excitement. He loved his wife very much, and he knew that without her he would be lost. He was thinking about his wife as the student nurse came rushing out of the delivery room, and he called to her, “How is she?”