The Midwife of Hope River (4 page)

5

Mastitis

The weather has turned warm again, blue sky dotted with innocent white clouds, the smell of leaves rotting, a last shower of gold from the big oak out front, but there's something wrong with Moonlight. When I went out to milk her last night, one of her teats was as tight and red as a German sausage. I suspect the problem is an infection brought on by an injury or, more likely, from my not milking her on time, letting her bag get too tight and full, but I don't know much about cattle.

Consumed with guilt, I've been going out with hot water and rags to wrap around her udders every few hours. She seems to like the warm compresses but hates it when I try to milk her. Still, it's the only thing I know to do. A breast infection hurts like the holy devil. I should know; I had mastitis a few times myself when I was a wet nurse.

 

First, to get the milk flowing, I pull on the teats that aren't quite so tender. It's what I tell my mothers when they have a red, tender breast: “Nurse on the good side first, rest, drink fluids, apply warm compresses. Keep the breasts empty, and leave the nipples open to the air.” Good food also helps and sometimes cabbage leaves, but I can't figure out how to tie cabbage leaves on the cow's udders, so I skip that part. Meanwhile, I lay my head against the side of my beautiful black-and-white bovine, and my eyes fill with tears.
I am so sorry, Moonlight.

 

This morning, finding my cow with her head hanging low, I get up my nerve, hike down the road to the neighboring farm, and ask Mr. Maddock what I should do. Maddock is a stern-faced old bugger who always wears a black felt hat and never waves when I pass, despite the fact that I've lived here two years. I was hoping he might be out in his fields mending fence or cutting brush, but I have to go up to the house.

“She's stopped eating and doesn't even look up when I come in the barn,” I tell him through the screen door. Maddock doesn't invite me in, though a stiff wind is blowing and I have to keep brushing my hair from my face. “She just looks at me with big eyes and moans. I'm milking her six times a day, even getting up at night and using warm compresses. Can you think of anything else I could do?”

Maddock owns four or five Holsteins; I've seen them in his field. He pulls on his coarse black wool jacket, steps out on the porch, and yanks down his broad-brimmed headpiece. “You could ask the new vet; maybe he'd have some salve.” He scratches his chin through his gray-speckled beard. “He doesn't live far. You can walk around Salt Lick Road to his farm on Titus Hollow or just hike over the top of Hope Ridge on the old Indian trail that goes through the woods. His place backs up to yours on the other side. Either way, you'd be there in an hour.”

Behind the weathered man, in the parlor, sitting by a kerosene lamp on a table, Mrs. Maddock, a pale woman with her silver-and-gold hair twisted up in a bun, sits knitting. She doesn't get up or come to the door. I catch her eye and smile. She doesn't smile back. There are books on shelves behind her and a display of framed needlework on the walls. Ordinarily, women in Appalachia would invite you in, but Mrs. Maddock, who looks, from her books and artwork, like an interesting person, must not approve of me, a woman without a man living alone just up the road. She turns her head and goes back to her knitting.

 

House Call

The hike over Hope Ridge, through a thick forest of stunted spruce growing out of flat sheets of granite, takes longer than I'd expected. Just when I decide that maybe I'm lost, I smell coal smoke and see, through the trees, a stone house with a white barn down in the hollow. The two-story dwelling, situated in a long narrow valley, appears to have been built a hundred years ago. Three horses graze in the pasture.

It's a picture-book place but so quiet that it occurs to me, for the first time, that I don't know the veterinarian by sight or even his name, and the closer I get, the more I begin to fear that this trip may be wasted. He could be out on a call or, now that I think of it, probably has an office in Liberty or Delmont.

A pileated woodpecker laughs from the top of a bare sycamore and I can hear a vehicle winding along Salt Lick, a pickup, maybe the mail carrier. As I work my way down the hill through the stubby yellow grass and outcroppings of rock, I sight a man dressed in coveralls, next to the barn, wearing black rubber boots and hammering on a piece of metal.
Clang. Clang. Clang.
He has a strong back; a tall fellow, maybe six feet, his light brown hair receding. Around forty, I think; I'd expected the vet to be someone much older.

A rock about the size of a cottontail rabbit catches under my foot and begins to roll downhill straight toward him. “Look out!” I yell.

He steps aside and watches as it lands near his feet. “Where'd you come from?”

“I'm sorry, I should have called out. My name is Patience Murphy.” I've been using this name since Mrs. Kelly and I came to Union County, and by now it rolls off my tongue like honey.

“I'm the midwife from over Hope Mountain.” I'm not sure why I tell him I'm
the midwife.
Maybe I feel it gives me some kind of legitimacy. “I have a cow with a red swollen teat, and Mr. Maddock, my neighbor, told me you might help.”

“A house call is five dollars. You could have used the telephone and saved yourself some trouble.” He looks me over, head to toe, and I'm suddenly aware of the sight I must be. Usually when I go into town or make a social call, I spruce up, wear a dress and hose (if I have any), but today I'd come in my work boots, the trousers I wore when I worked at Westinghouse, and a heavy men's red-and-black-plaid jacket that Mrs. Kelly and I bought secondhand, before we exiled ourselves to these outer lands.

That's how I think of it, as though I've been banished from civilization, all because of what happened in Logan County at Blair Mountain. Some would say I should forget it. The feds can't still be looking for me after all this time.

I pull my long, straight hair away from my face and continue my plea for help. “I was hoping you could just give me some advice. I've been milking Moonlight every six hours the last few days and using warm compresses, but one of her teats is swollen and painful and now she's not eating. If you have any salve, I could work in trade.”

One corner of the man's mouth turns up, and he raises his eyebrows as if he thinks my work wouldn't be worth much.

“Dr. Hester!” A woman, wearing a flowered apron, leans out the back door. “Phone call.”

The vet lays down his hammer and strolls toward the house. “Wait,” he commands.

I take a deep breath and let it out slowly, looking around. I'm not sure what I expected, but some kind of neighborly welcome would have been nice. Maybe I should have come by the road and dressed like a woman. I find an empty bucket and turn it over for a seat, wishing I'd just stayed at home.

While I kill time, I survey my surroundings. The open door of the barn reveals an old tractor, and the smell of hay and manure drifts through the yard. Parked in the drive is a newer-model black Ford covered with dust and mud. The woman watches me out the kitchen window; his wife, I suppose. I nod, and she ducks back from the glass.

When Hester returns, approaching from the side, I jump up. He walks softly with a little limp, like maybe he has a sore knee.

“Let's go.” He's carrying a small bag and a wooden box and has a canvas jacket thrown over his shoulder.

I frown. “I can walk home.”

He's already hurrying toward the vehicle. “I'm not taking you home. We're going to Clover Bottom to deliver a foal.” I hear by his clipped accent that he's not from Appalachia. No drawl or nasal twang like many of the natives.

“Clover Bottom? That's over eight miles.”

“Afterward I'll see what I can do for your cow.”

“But I don't have the five dollars . . .”

“If I need you for an assistant, this can be your payback. Do you have small hands?” I stare down at my work-roughened mitts. They're narrow with long fingers, not especially dainty but good for the work I do. I observe his wide hands in leather driving gloves.

“They're smaller than yours. But what if you don't need me?”

“Then you've wasted your afternoon and you'll still owe me for the home visit.”

I climb into the Ford. What else was I planning for the afternoon, anyway? Not much. I have a few hours before Moonlight needs milking. Maybe this excursion will be interesting. As strange as it sounds, I've never seen anything born but humans. Not even kittens.

“So where were you trained?” Hester asks, making an effort to be civil as we bump over Salt Lick, where the creek runs clean and clear over the rocks.

“Pittsburgh,” I lie, knowing he means at what
midwifery school.
It isn't a complete fib. I
did
apprentice a little with Mrs. Kelly when we lived there. “For two years,” I add, hoping that will be the end of it.

“I went to University of Pennsylvania.”

La-di-da!
I say to myself. But I ask in an interested voice, “What made you want to be a vet?”

I expect him to answer, “I like animals” or “My father was a vet.”

We hit a big pothole and jolt up in the air. “I volunteered for the Great War early in 1917, fresh off the farm, only in my twenties, and was assigned to be a driver and take care of the livestock. It was hell for the horses. They stumbled through mud and rain to bring us supplies, food, water, and ammunition. I watched them die of exhaustion, broken bones, bloody wounds, and tetanus. There was nothing we could do. They should never have been there. Modern weapons made them sitting ducks. Eight million died in combat . . . Eight million beautiful horses. Most people don't know that.” He has a strong jaw with a big nose, a manly face but not overly handsome. He flashes me a look out of gray eyes, yellow around the middle. Then he lets out his air and drums on the steering wheel.

“Seeing them suffer was almost worse than seeing men die. At least the soldiers, whether they volunteered or were drafted, knew why they were sacrificing. The horses had no idea, and it was sheer terror for them. They gave up their lives for a cause but never knew what the cause was. In the end, I forgot the cause too. Maybe war is always that way.”

He says all this as the terrible sights and sounds roll like a picture show in the back of his mind and I watch the side of his face as he talks. If he served in the military in 1917–1918, he'd be about my age. I'm just beginning to warm up to him when he changes the subject.

“So you're the midwife that thought the MacIntosh infant was stillborn.” One corner of his mouth twitches up like he thinks this is funny.

My breath is knocked out of me. “Yes.”

How dare he ask such a question? It's easy to make judgments when you aren't in the birthing room. He wasn't the one who knelt by Katherine's bed and frantically searched over her abdomen with the fetoscope for that quiet
tick-tick.
He wasn't the one who'd had to call tall, silent Dr. Blum and ask for a second opinion. He wasn't the one who had choked back her own tears as she told the parents that their long-awaited baby was dead.

Hester glances over, waiting for a response, but my jaw is clamped shut and we drive the rest of the way in silence, across the stone bridge over Hope River, down Main and through town.

 

Liberty is a small settlement of some two thousand souls that looks like a village that comes with a wind-up train set. Main Street is populated with two-story shops and a water tower next to the wooden train station. There's a bank on one corner, a pharmacy, and a courthouse. There's the engine and coal cars waiting on the tracks that runs along the Hope River. No stoplights, just a stop sign at the corner of Chestnut and Main. It takes about five minutes to traverse the whole town.

Out into the country again, following Route 92 and the B&O Railroad tracks, Hester breaks the quiet. “Did I say something wrong?”

I pull my gold timepiece out from under my wool jacket and flip it open. “It's already three. I'm a little worried about Moonlight.”

“I'll get you home well before dark.”

“No, I mean Moonlight, my cow.” I'm still not looking at him. “That's her name. I've been trying to keep her udders empty by milking at least every four hours.”

“I'll drive you,” the vet says again, and I don't know if that means he'll get me home in time, or he doesn't think it matters. It matters to me . . . and to Moonlight.

6

Foal

At the bottom of a hill a few miles the other side of Clover Bottom, we make a right turn at the small yellow train depot, cross the tracks, and follow a streambed into a hollow. The road ends at a large barn with peeling red paint. Inside I can hear a mare whinny and snort, whinny and snort. The vet winces. It's the same way I feel when I arrive at a pregnant woman's home and hear her scream.

Mr. Hester jumps out of the car and heads for the open barn door. “Bring my bag and the birth box, will you?” he yells back. “In the trunk.” As the able assistant, I find the black leather satchel he stowed in the backseat and the wooden box with a hinged lid in the trunk, then trip along after him. In the dim barn, a dappled gray mare lies in the straw, her eyes wide with terror, and I instantly want to comfort her, tell her it will be all right.

Hester shakes hands with a farmer whose thick red hair sticks up as though he's been on an all-night bender, then kneels at the horse's side and says something to the animal that I can't hear. The farmer hands me a bucket of warm soapy water and a clean white feed sack. “You the new helper?” he asks. “Ain't seen a woman veterinarian before.”

“Thanks,” I say, taking the vessel, remembering that I'm dressed for the part in my heavy plaid jacket and pants. If I'm playing the vet assistant I better act like one, so I find a place out of the way, set the bucket down, and open the birth box to see what's in it. Behind me the horse screams again and stands up. Something's hanging out of her birth canal, a leg maybe, covered with membrane.

“How long has she been this way?” Hester asks.

“Four hours. She won't settle. It's her first. I tried to help her, but she kicked me away.” He holds out his arm, pushes up his flannel shirtsleeve, and shows us a large purple bruise.

Hester hangs up his coat and takes off his upper clothing down to his wool undervest, then motions for me to bring over the bucket. “You better scrub too. There's supposed to be two feet.” That's all he says, as if I know what this means.

When's he's done washing thoroughly, he slathers his arms and hands with soap again and waits. I set the bucket down, take off my jacket, roll up the sleeves of my work shirt, start washing like he did, and wonder what I've gotten myself into.

The mare is lying down again, groaning and straining, but nothing's coming out. “We're going to have to go in for the other leg,” the vet explains. “Let me get her to stand. Then I want you to pull down on the limb that's dangling while I reach in.” I nod and do what he tells me. For ten minutes he fools around while the mare strains, and I see that with each contraction his brow beads with sweat as if he's in pain. Sometimes a muscle in his face twitches, but other than that there's no way to tell. Finally he withdraws. “I can't get it. Will you try? Your arm and hand are smaller.” He spreads his fingers, which would play an octave and a half on the piano: big, powerful mitts, good for many things but not for mucking around in an animal's vagina, not even a horse's.

“What should I do?” I whisper. We both face away from the farmer, who stands respectfully back by the barn doors. “Go in like I did and see if you can find the other hoof. I can just touch it. If you can get in a little farther, you should be able to hook your fingers around and bring it down.”

I soap up again, this time past my elbow, and slowly wiggle my way inside, doing as he says. Between contractions I wait and it does hurt a little, but not badly. There's no point trying to go farther while the mare bears down. I'm surprised when I find the second foot where he says and smile; then, following his instructions, I carefully manipulate it toward the opening.

At last both legs hang out. Hester takes them in his big hands and pulls, while the mare pushes. There's no whinnying now. She's all business, feeling her efforts accomplishing something. I've seen this before with my own patients. A mother who appears exhausted from an obstructed labor will revive and find strength when a malpresentation is resolved.

I stand next to the vet, my arms at my sides, amazed that with steady traction the legs emerge and then the head with the membrane still covering it. Suddenly, without warning, the whole mass swivels and plops out on me, my glasses fall off, and I collapse into the straw. The mare lies down too, her hard labor over, and looks behind her at the baby horse in my lap. She sniffs her offspring, who lifts his head with the amniotic sac still covering it.

Without asking I begin to peel the membrane off the little face, then look up at Mr. Hester for approval. He nods okay and hands me a towel to work with. The colt opens his eyes and I blow on him, the same way I blow on a baby if it doesn't breathe right away. The breath of life, I call it, and the little horse gasps from the cold air the same as a newborn human baby does.

Hester is already finished washing up and is inspecting the farmer's arm. “It's a nasty one,” he says of the bruise. I feel around in the hay for my specs, squirm out from under the seventy-pound chunk of new life, and give the little one and his mama some time to get to know each other. How like a human mother she is! Nuzzling her newborn, eyes shining with love, sniffing it, licking it.

“Nice colt,” I say to the men as I wash my hands. There's nothing to be done about my wet trousers.

“It's a
filly,
” the vet corrects. I snap my mouth shut, feeling foolish, and go out to the car.

 

Milk Stone

Twenty minutes later, motoring toward home over the stone bridge that crosses the wide and rocky Hope River, I'm still embarrassed about my mistake in calling the filly a colt but also elated from the experience of witnessing new life. It doesn't matter if it's a horse or a human, I decide, it's still amazing. If I believed, I'd call it God's miracle.

“Thank you for taking me with you,” I say humbly. “I've never seen anything born before, except a human. Are they always that way? Or was that an especially hard delivery?”

“No, it wasn't especially hard.
I've
never seen a human born. Seen all kinds of animals . . . but . . .” He changes the subject. “Every now and then I need an assistant for the hard deliveries. I'm the only vet in the county now, and my practice is new. Some of the farmers are helpful, and some I wish would just go back in the house. Mr. Hicks was okay, not as nervous as some.

“Horses are like people, all different. Each will react to foaling in her own way. Mares that haven't foaled before can foal late; then you worry about the size. Also, mares that are nervous struggle more and impede the process.” He's lecturing now, almost as if I'm a student.

“Just like women in labor,” I comment. “Turn here.” I direct him down Raccoon Lick to Wild Rose Road.

As we pull into the yard, the vet looks around. “I haven't been up here before.”

I take out my timepiece; it's been four and a half hours since Moonlight was milked. “The barn is in back, but we better wash up.”

 

“Sorry the water's cold,” I murmur. We're in the kitchen, and I ladle almost cool water from the hot-water reservoir on the side of the cookstove. There are only coals left, and the house is growing chilly. “When the fire's going, the water's nice and warm.”

Mr. Hester shrugs and turns to stare through the doorway into my living room. He takes in the piano, the books, the framed paintings on the wall. I realize that he's the first male to stand in this house since the men from the church brought the piano two years ago.

 

In the barn he's all business, goes right to Moonlight.

“See what I mean? It's a breast infection, isn't it?” I comment. Then correct myself. “A teat infection, I mean.”

Hester doesn't answer. He takes a thermometer out of his box and sticks it into my cow's rectum. Moonlight barely reacts, just looks back once, her head hanging low. Gently he washes the whole udder with soap and water, then squeezes some kind of salve on his hands and palpates the red, swollen teat. The cow moans and he sees how it hurts her, but he keeps on with his examination.

I hand over the milk bucket, and he wraps his index finger and thumb around the red, swollen teat, then squeezes down with the other three fingers, careful not to force the milk uphill into the bag. I wince when blood squirts into the bucket.

The vet stops and examines the sick teat again. “The straw looks clean. Are you routinely washing your hands with soap and water before you milk?”

“Yes.” What I want to say is “What do you take me for, a dummy?” but I bite my tongue. No need to be disagreeable.

The vet gently compresses the bloody teat, up and down, side to side, searching for something. First one side, then the other. I watch his hands, wondering what he's looking for.

“I think she has an obstruction, not simple mastitis. It might be a milk stone.”

He reaches into his satchel, selects a small metal box with sterilized instruments, pulls out a scalpel, and before I can say
no
makes a slit down the side of Moonlight's sore teat. This time she almost kicks him, but he's ready for her and ducks away. When she settles, he takes a long pair of curved tweezers and pulls out a white object about the size of a pea. He hands the instrument back, then gets out suture and gauze and begins to blot the oozing red as he sews up the incision in my poor cow's teat.

“That's a milk stone, probably what caused the infection in the first place,” he says as he works. “I could feel it in there. I'm surprised you didn't.”

I tighten my mouth. “I've never heard of a milk stone. I wouldn't have known to look for one.”

“That's why you call a vet,” he says, and I feel my face flush.

“I did call a vet.”

“Keep your shirt on. Just next time get me sooner.”

“Not everyone has the money to call a veterinarian for the least little thing. Not everyone has a phone.” That shuts him up.

He stops for a second and stares at me. “Hemostat.” He picks up the instrument he just used and holds it out for me to see. “Needle driver.” He picks up another one. “Forceps.” He shows me the rest. “Retractor. Scissors. Scalpel . . . Do you do any stitching in your line of work?”

I'm surprised at his interest. “Some, not often. I'm good at getting babies out without tears, and I've never had to do an episiotomy. I know how, though.”

“Here.” He hands me a needle holder and a curved needle. “You can have these. I have several. Old Doc Collins, from Liberty, gave them to me when I bought his practice. They might help if you have a deep laceration. I'll show you how to use them someday.” He stands and stretches his back, looking around. “Don't forget, you owe me one more trip as an assistant.”

I stare down at the shiny silver needle holder. “Thank you,” I mumble, then jerk up. “What do you mean one more trip? I thought I'd paid for Moonlight's visit by helping you with the foal. I did my job and more, bouncing around in your dusty old car.”

(Actually, I'd enjoyed myself. I don't get to see a baby horse born every day, even if I did get covered with amniotic fluid and slime. Still, he irritates me.)

“Yeah, but I had to do surgery on your cow's teat, and surgery costs more. It might even be
two
more trips.” Again the one corner of his mouth twitches.
Is he joking?
I can't tell.

“Well, you'd have to come around Hope Ridge to get me, and sometimes I'm away at a birth . . . it would be hit and miss, and remember, I don't have a phone.”

“Yeah, you told me that. Don't you need one in your line of work?”

“You're not getting the picture. I'd love one. It would help a lot, but the co-op electric and phone lines haven't come out Raccoon Lick yet. None of my neighbors care about a telephone or electricity, and I couldn't afford to pay extra to get the poles and line set just for me. I'm not a rich veterinarian. I don't think there
are
rich midwives.”

“Not many rich vets either,” he says. The dig doesn't faze him. “I guess neither of us do it for money.” We walk back toward the house and I let him into the kitchen so he can wash again. Against my better judgment I ask if he would like tea. It seems only neighborly, but I'm relieved when he says he has to get going. I'm not used to company, and when you're as old and cranky as I am, you don't miss it.

“Thank you for helping with the foal,” he responds, reaching out his hand. I shake it like he's a banker or lawyer. I'm surprised that it's so warm and folds over mine like a quilt on a snowy day. I've never felt a hand so warm, except Mrs. Kelly's.

“Thank you too,” I mumble, not looking at him. “Is it okay to still milk Moonlight, with the stitches and all?”

“Yeah, but use Bag Balm to make your hands slip.” He looks around the kitchen to see if I have any, and I point out the distinctive bright green can with the image of red clover and a cow on the lid. “You can take the stitches out in two weeks when she's healed. Keep her bag empty. I'd continue to milk her every four hours. How much does she give, anyway?”