Cutting for Stone

Distracted now by heavy oozing from Sister Mary Joseph Praise's soggy, friable uterus, Hema turned back from infants to the mother.

“What is her BP?” Hema asked, peering over the drapes, first at Nurse Asqual, and then at Sister Mary Joseph Praise's face. The anesthetist, the whites of her eyes showing like saucers, shook her head. Beautiful Sister Mary Joseph Praise's face now looked bloated and lifeless. “More blood! For God's sake. Pour it in!” Hema shouted.

As she toiled in the now deflated cavity of the belly, Hemlatha remembered that when she'd handed over the second baby to the probationer, she had been surprised to find the probationer still standing there, holding the first, a blank look on her face. But Hema had no time to worry about that. Once the babies were out, her duty as an obstetrician was to turn completely to Sister Mary Joseph Praise; her duty was to the mother.

10. Dance of Shiva

WE TWO UNNAMED BABIES, newly arrived, were without breath. If most newborns meet life outside the womb with a V V shrill, piercing wail, ours was the saddest of all songs: the stillborn's song of silence. Our arms weren't clamped to our breasts; our hands did not make fists. Instead, we were limp and floppy like two wounded flounders.

The legend of our birth is this: identical twins born of a nun who died in childbirth, father unknown, possibly yet inconceivably Thomas Stone. The legend grew, ripened with age, and, in the retelling, new details came to light. But looking back after fifty years, I see that there are still particulars missing.

After labor stalled, I dragged my brother back into the womb and out of harm's way as lances and spears came at him through our only natural exit. The attack ceased. Then I remember—and I believe I do—the muffled voices, the tugging and sawing outside. As the rescuers neared us, I recall the blinding glare and strong fingers pulling at me. The shattering of the darkness and the silence, the deafening racket outside was so great that I almost missed the moment when we were physically separated, when the cord connecting my head to Shiva's fell away. The shock of that parting lingers. Even now, what I think about the most isn't that I lay there without breathing, immobile in the copper basin, born to the world, yet not alive—instead, I recall only the parting from Shiva. But, to return to the legend:

The probationer unloaded the two stillborns into a copper basin used to hold placentas. She carried the basin to the window. She made a notation in the delivery chart: Japanese twins connected by the head but now disconnected. In her eagerness to be useful, she completely forgot her ABC's: Airway, Breathing, and Circulation. Instead, she thought of what she had read the previous night about jaundice of the newborn and the helpful role of sunlight. Shed memorized that passage. She wished she had read about Japanese twins (the word “Siamese” eluded her) or asphyxiated babies, but the fact was she hadn't; shed read about jaundice. But then, as she set the basin down, she realized that for sunlight to work, the babies had to be alive, which these weren't. Her sorrow and shame made her confusion worse. She turned away.

The twins lay face-to-face, feeling the basin's galvanic touch against their skin. In the chart the probationer used the words “white asphyxia” to describe their deathly pallor.

The sun, which had stage-lit the room moments before, now honed in on the basin.

The copper glowed orange. Its molecules became agitated. Its prana rose into the infants’ translucent skin and passed into their doughy flesh.

HEMLATHA DISSECTED the broad ligaments, then clamped the uter ine arteries, praying that she wouldn't accidentally clamp the ureters and shut down the kidneys in that bloody mess. “Quick, quick, quick!” She was tempted to smack Stone on the forehead instead of on the knuckles. “Retract properly, man!”

She followed his gaze to Sister Mary Joseph Praise's head, which bobbed like a rag doll's as the anesthetist tugged at her arm to find another vein. Matron, teary and lost in her grief, stroked Sister Mary Joseph Praise's other hand.

When Hema finally delivered the uterus, clamps and all, into a basin, she saw no pulsations in the abdominal aorta. Her hands, steady till now, shook as she loaded a syringe with Adrenalin and attached a three-and-a-half- inch needle to it. She lifted Sister Mary Joseph Praise's left breast, hesitated for a moment, invoked God's name again, then plunged the needle between the ribs and into the heart. She pulled the plunger back, and a mushroom of heart blood appeared in the syringe. Whenever I've had to resort to adrenaline to the heart it has never worked, Hema said to herself. Not once. Maybe I do it as a way to signal to myself that the patient is dead. But surely it must have worked, somewhere, with someone. Why else was it taught to us?

Hemlatha prided herself on being methodical in an emergency, keeping her cool. But she stifled a sob now as she waited, her right hand buried in Sister Mary Joseph Praise's abdomen, palm down, just over the spine, waiting for a throb in the aorta, a slap to register in her fingers. She couldn't forget that this was dear Sister's heart she was trying to jump-start, and whose life was slipping away. They'd shared the bond of two Indian women in a foreign land. The bond extended back to the Government General Hospital in Madras, India, even though they hadn't known each other there. To share a geography and a landscape of memory made them sisters, a family. And Hema could see her sister's hands turning blue, the nail beds dusky, and the skin turning dull. It was the hand of a corpse, and holding it was Matron, her head bowed as if she were asleep.

Hema waited longer than she might have under normal circumstances. It was some time before she could bring herself to say, her voice breaking, “No more. We have lost her.”

IT WAS DURING this hiatus of activity in the room that the firstborn, the one who'd been spared a skull puncture, signaled its presence. It rapped its hands on the copper basin. It brought its left heel down to produce a muffled gong. Now that it had come wholly forth from a dying womb, it reached both arms skyward and then to its right, to its brother. Here I be, it announced. Forget the shoulds and coulds and might haves and hows and whys. I am sympathetic to the situation, the circumstance, and in due course we can explore the details, and, in any case, Birth and Copulation, and Death—that's all the facts when you come down to brass tacks … I've been born, and once is enough. Help my brother. Look! Here! Come at once! Help him.

Hemlatha ran over at this summons, saying “Shiva, Shiva,” invoking the name of her personal deity, the God whom others thought of as the Destroyer, but who she believed was also the Transformer, the one who could make something good come out of something terrible. Later she would say that she'd assumed the worst about the twins. One of them had his head bloodied, and then there was the matter of her dividing the fleshy tube that connected them, and God knows how much distress they'd been in before she cut them free of the womb. But she'd also assumed that Matron or the probationer or both would be reviving the infants while she worked on the mother, though she recalled seeing Matron seated and immobile.

The probationer was mortified at the sound of a baby that had come alive right behind her back, confounding her most basic clinical assumptions. The child was no longer white, but pink, and not jaundiced. The other infant was a robin's egg blue, and it was still and unmoving as if it were the discarded chrysalis from which the crying baby had emerged. Matron, hearing that newborn cry, jumped off her stool. Her glance let the probationer know she was a hopeless case. Hemlatha went to work on the twin that was unmoving while Matron hastened to clean up the living one.

THE BREATHING TWIN gazed out from the copper vessel. Its puffy newborn eyes surveyed the room, trying to make sense of its surroundings.

There stood the man everyone took to be the father, a tall, sinewy white man, looking lost in his own theater. The father's hands were preternaturally pale from the talc that lingered on them after he'd stripped off his gloves. His fingers were clasped together in a posture shared by surgeons, priests, and penitents. His blue eyes were set deep in the orbits under a ledge of a brow which could make him look intense, but on this day made him look dull. From the shadows sprung the great ax blade of a nose, a nose that was sharp, in keeping with his profession. His lips were thin and straight as if drawn with a ruler. Indeed, the face was all straight lines and sharp