Cutting for Stone

all these years— Matron thought the young nun realized that she was now the patient to be operated on and that the odds were against her.

“Perhaps she felt she deserved to die,” Matron said, guessing at my mother's thoughts. “If faith and grace were meant to balance the sinful nature of all humans, hers had been insufficient, and so what she felt was shame. Still she must have believed, even with all her imperfections, that God loved her and forgiveness awaited her in His abode, if not on earth.”

Matron wondered if it scared my mother that she might die in Africa, a continent away from her birthplace. Perhaps deep in her— perhaps deep in every being—there lingers a desire to bring the circle of life back to its starting point, which in her case was Cochin.

Then Matron heard my mother clearly whisper “Miserere mei, Deus” before sound left her. Matron carried her through the rest of the psalm in Latin, serving as her voice box while Sister Mary Joseph Praise's lips moved: “… Behold, I was shapen in iniquity; and in sin did my mother conceive me … Purge me with hyssop, and I shall be clean: wash me, and I shall be whiter than snow …”

When she finished, Matron said the shroud was back. The light was slipping away from her world.

“PICK UP THE STOOL, Stone,” Hema barked. “And you,” Hema said, snapping her fingers at the probationer, “get your hands out of your pockets.”

Stone set the stool upright just as Hemlatha eased down onto it. The key bunch Hema had fished out to open her house was now tucked into the waist of her sari, and it jingled as she settled herself. Under the theater lights the diamond in her nose sparkled. Strands of loose hair fell over her ears and in front of her eyes; through pursed lips she blew these wayward locks aside. She squared her shoulders, squared them to the horror and the unloveliness of what was before her. In that gesture she slipped off the mantle of the traveler and put on that of the obstetrician. The task ahead, however difficult, dangerous, or unpleasant, was hers and hers alone.

Hema felt herself gasping for air. Her lungs would need a week to acclimatize. Shed come from sea level in Madras to an operating room 8,202 feet above sea level, not counting the stool on which she sat. Her nostrils flared with each inhalation, like a thoroughbred after the quarter mile.

But her breathlessness came also from what was before her eyes. Gebrew hadn't lost his mind or imbibed too much talla; hed been telling the truth. The everyday miracle of conception had taken place in the one place it should not have: in Sister Mary Joseph Praise's womb. Yes, Sister Mary Joseph Praise was pregnant, had been for months before Hema left for India! And not just pregnant, but now in extremis. And the father?

Who else? She glanced at Stone's gray face.

But why not? she thought. Why should I be surprised? “The incidence of cancer of the cervix,” she remembered her professor saying, “is highest in prostitutes, and almost zero in nuns. Why almost zero and not zero? Because nuns are not born nuns! Because not all nuns were chaste before they became nuns! Because not all nuns are celibate!” That's neither here nor there, Hema admonished herself, while she thrust her hands into gloves that Matron produced.

The probationer recorded in the chart the arrival of Dr. Hemlatha. She chastised herself for not thinking of the gloves.

Hemlatha spread her own legs. Her feet were swollen from the long flight. She flexed her toes against the straps of her sandals and pawed the ground to get good purchase on the bloody floor. With the fingers of her left hand she spread the labia. Then, with a motion made simple by countless repetitions, her right hand pulled down on the posterior rim, opening the birth canal to view.

“Rama, Rama, this is a bloody Stone Age utensil,” Hemlatha shouted as she carefully disengaged first one half and then the other half of the skull crusher, slipping them over and then off the baby's ears. When the bloody instrument was free, she looked at it with distaste and flung it aside.

Matron felt relief. Whatever happened, at least now a real obstetrician was in charge. She couldn't help but note how Hemlatha and Stone had reversed roles: Hema was now the shouter and the flinger.

Matron offered the history that Sister Mary Joseph Praise had been in severe pain, great spasms of it, and then the pains had suddenly ceased and she'd seemed almost lucid, talking … but now she had deteriorated again.

“My God,” Hema said, knowing that in nature pains don't cease till a baby is out, “it sounds like a uterine rupture.” It would explain all the blood on the floor. Placenta previa—a placenta plastered over the exit to the womb—was another possibility. Neither possibility was good. “When did you stop hearing the fetal heart sounds?” No one replied.

“Pressure?”

“Sixty by palpation,” the nurse anesthetist said, after a pause, as if she expected someone else to volunteer the number that she was responsible for.

Hema peered around Sister Mary Joseph Praise's swollen belly to fix Nurse Asqual with a withering look. “Are you waiting for it to get to zero before you breathe for her? Put in a tracheal tube. Connect it to the hand bellows. If she wakes, give her some intravenous pethidine. Tell me when you're done. Where's Ghosh? Have you sent for him?” Nurse Asqual busied herself, grateful for step-by-step instruction because her mind had seized.

“And who has gone for blood? What! Nobody? Am I dealing with idiots here? Go! Run! Run!” Two people charged for the door. “Round up anyone and everyone to give blood. We need lots of blood!”

Hema insinuated two fingers of her right hand around the fetal skull. With her other hand she pushed down on Sister Mary Joseph Praise's belly. She peeked over the rise of the abdomen at Sister's face; it had gone gray, grayer than Stone's.

Nurse Asqual, her hands shaking, managed to insert the tracheal tube. With every squeeze of the air bag, Sister's engorged breasts heaved up.

Hema's hands were like extensions of her eyes as she explored the space that she thought of as the portal to her work; fingers inside took their soundings, helped by the hand on the outside. She closed her eyes, the better to receive what her fingertips conveyed about the pelvic width, the baby's position. “What have we here … ?” she said aloud. Indeed, the baby was head down, but what was this? Another skull?

“Good God, Stone?” Hemlatha said, snatching her hand out as if she'd touched a hot coal.

Stone looked on, not understanding, but afraid to ask. She fixed her gaze on Stone, her face taut, waiting for a reply, any reply, and prepared to shout it down when it came.

“Better out than in?” Stone mumbled, thinking she meant his skull-crushing attempts.

“Damn it, Thomas Stone, don't quote me your idiot book. Do you think this is a joke?” Stone, who didn't at all see this as a joke, who in fact saw that everything Hema was doing was something he could have and should have done, turned crimson. Hema turned back to probe once more that calamitous space in Sister Mary Joseph Praise's body where two lives were in jeopardy. Her words were like body blows directed at Stone.

“One prenatal visit? Could you have let me see her for at least one prenatal visit? I'd have canceled my trip. Look at the soup we are in! Miracle, my foot. Completely avoidable … completely avoidable“ the last two words delivered like lashes.

Stone stood as if in front of the headmistress. Hema seemed to expect him to speak and so he stammered, “I didn't know!”

Hemlatha's jaw dropped. She stared at him. There was a part of her that was incredulous at the idea of Stone impregnating Sister Mary Joseph Praise—who could imagine that? But the cynicism of the obstetrician who has seen everything crept back in. “You're thinking virgin birth, Dr. Stone? Immaculate conception?” She came around the table. “In that case, guess what, Mr. Expedient Operator? This is better than the manger in Bethlehem. This virgin is having twins!” She paused to let it sink in. “For goodness’ sake, couldn't you have done a Cesarean section?” Her singsong intonation rose at the end, leaving the words “Cesarean section” hanging over Stone's head.

“Gloves and gown, quick!” Hemlatha shouted. “C-section tray here. Wake up, all of you! Do you not want to save her? Hurry! Hurry! Hurry!” She repeated this in Amharic—“Tolo, tolo, tolo!”—in case English wasn't getting through.

The authority of her words kept them from retreating into the shock that had paralyzed them. “And you