The Outlander Series 7-Book Bundle (691 page)

35

Laminaria

Safely returned from Brownsville, I took firm steps to resume normal life. And among these was a visit to Marsali, who had returned from her refuge with the McGillivrays. I’d seen Fergus, who had assured me that she was well recovered from her injuries and feeling well—but I needed to see for myself.

The homestead was in good order, I saw, but showing certain signs of dilapidation; a few shingles had blown off the roof, one corner of the stoop was sagging, and the oiled parchment over the single window had split partway up, the flaw hastily mended with rag stuffed through the hole. Small things, but things that should be dealt with before the snow came—and it was coming; I could feel the touch of it in the air, the brilliant blue sky of late autumn fading into the hazy gray of oncoming winter.

No one rushed out to meet me, but I knew they were home; there was a cloud of smoke and sparks from the chimney, and I thought tartly that at least Fergus seemed able to provide enough wood for the hearth. I called out a cheery “hallooo!” and pushed open the door.

I had the feeling at once. I didn’t trust most of my feelings at the moment, but that one went bone-deep. It’s the feeling you have, as a doctor, when you walk into an examination room and
know
that something’s very wrong. Before you ask the first question, before you’ve taken the first vital sign. It doesn’t happen often, and you’d rather it never did—but there it is. You know, and there’s no way round it.

It was the children that told me, as much as anything else. Marsali sat by the window, sewing, the two girls playing quietly close by her feet. Germain—uncharacteristically indoors—sat swinging his legs at the table, frowning at a ragged but treasured picture book Jamie had brought him from Cross Creek. They knew, too.

Marsali looked up when I came in, and I saw her face tighten in shock at sight of mine—though it was much better than it had been.

“I’m fine,” I said briskly, stopping her exclamation. “Only bruises. How are you, though?”

I set down my bag and cupped my hands round her face, turning it gently to the light. One cheek and ear were badly bruised, and there was a fading knot on her forehead—but she wasn’t cut, and her eyes looked back at me, clear and healthy. A good color to her skin, no jaundice, no faint scent of kidney dysfunction.

She’s all right. It’s the baby,
I thought, and dropped my hands to her middle without asking. My heart felt cold as I cupped the bulge and lifted gently. I nearly bit my tongue in surprise when a small knee shifted in answer to my touch.

I was terribly heartened at that; I had thought the child might be dead. A quick glance at Marsali’s face muted my relief. She was strained between hope and fear, hoping that I would tell her that what she knew to be true wasn’t.

“Has the baby moved very much, these last few days?” I asked, keeping my voice calm as I went about fetching out my stethoscope. I’d had it made by a pewtersmith in Wilmington—a small bell with a flat end piece; primitive, but effective.

“Not so much as he did,” Marsali answered, leaning back to let me listen to her stomach. “But they don’t, do they, when they’re nearly ready to come? Joanie lay like the de—like a millstone, all the night before the waters broke.”

“Well, yes, often they do do that,” I agreed, ignoring what she’d nearly said. “Resting up, I suppose.” She smiled in response, but the smile vanished like a snowflake on a griddle as I leaned close and put my ear to the flattened end of the flared metal tube, the wide, bell-shaped opening over her stomach.

It took some time to pick up the heartbeat, and when I did, it was unusually slow. It was also skipping beats; the hair on my arms rippled with gooseflesh when I heard it.

I went on with the examination, asking questions, making small jokes, pausing to answer questions from the other children, who were crowding round, stepping on each other’s feet and getting in the way—and all the time, my mind was racing, envisioning possibilities, all bad.

The child
was
moving—but wrong. Heartbeat was there—but wrong. Everything about that belly felt
wrong
to me. What was it, though? Umbilical cord around the neck was thoroughly possible, and quite dangerous.

I pushed the smock further back, trying for a better listen, and saw the heavy bruising—ugly splotches of healing green and yellow, a few still with deep red-black centers that bloomed like deadly roses over the curve of her belly. My teeth sank into my lip at sight of them; they’d kicked her, the bastards. A wonder she hadn’t miscarried on the spot.

Anger swelled suddenly under my breastbone, a huge, solid thing, pushing hard enough to burst it.

Was she bleeding at all? No. No pain, bar tenderness from the bruises. No cramping. No contractions. Her blood pressure seemed normal, so far as I could tell.

A cord accident was still possible—likely, even. But it could be a partially detached placenta, bleeding into the uterus. A ruptured uterus? Or something rarer—a dead twin, an abnormal growth … The only thing I knew for sure was that the child needed to be delivered into the air-breathing world, and as soon as possible.

“Where’s Fergus?” I said, still speaking calmly.

“I dinna ken,” she said, matching my tone of absolute calm. “He’s no been home since the day before yesterday. Dinna put that in your mouth,
a chuisle.
” She lifted a hand toward Félicité, who was gnawing a candle stub, but couldn’t reach her.

“Hasn’t he? Well, we’ll find him.” I removed the candle stub; Félicité made no protest, aware that something was going on, but not knowing what. In search of reassurance, she seized her mother’s leg and began determinedly trying to climb up into Marsali’s nonexistent lap.

“No,
bébé,
” Germain said, and clasped his sister round the waist, dragging her backward. “You come with me,
a piuthar.
Want milkie?” he added, coaxing. “We’ll go to the springhoose, aye?”

“Want Mama!” Félicité windmilled arms and legs, trying to escape, but Germain hoisted her fat little body into his arms.

“You wee lassies come with me,” he said firmly, and trundled awkwardly out the door, Félicité grunting and squirming in his grasp, Joanie scampering at his heels—pausing at the door to look back at Marsali, her big brown eyes wide and scared.

“Go on then,
a muirninn,
” Marsali called, smiling. “Take them to see Mrs. Bug. It will be all right.

“He’s a sweet lad, Germain,” Marsali murmured, folding her hands across her belly as the smile faded.

“Very sweet,” I agreed. “Marsali—”

“I know,” she said simply. “Might this one live, d’ye think?” She passed a hand gently over her belly, looking down.

I wasn’t at all sure, but the child
was
alive for the moment. I hesitated, turning over possibilities in my mind. Anything I did would entail hideous risk—to her, the child, or both.

Why had I not come sooner? I berated myself for taking Jamie’s and then Fergus’s word that she was all right, but there was no time for self-reproach—and it might not have mattered, either.

“Can you walk?” I asked. “We’ll need to go to the Big House.”

“Aye, of course.” She rose carefully, holding to my arm. She looked around the cabin, as though memorizing all its homely details, then gave me a sharp, clear glance. “We’ll talk on the way.”

There were options, most of them horrifying to contemplate. If there was danger of a placental abruption, I
could
do an emergency cesarean and possibly save the child—but Marsali would die. To deliver the child slowly, via induction of labor, was to risk the child, but was much safer for Marsali. Of course—and I kept this thought to myself—induction of labor raised the risk of hemorrhage. If that happened …

I could perhaps stop the bleeding and save Marsali—but would be unable to help the infant, who would likely also be in distress. There
was
the ether … a tempting thought, but I reluctantly put it aside. It
was
ether—but I’d not used it, had no clear idea of its concentration or effectiveness, nor did I have anything like an anesthetist’s training that would allow me to calculate its effects in such a dicey situation as dangerous childbirth. For a minor operation, I could go slowly, judge the patient’s respiration, and simply back off if things seemed to be going wrong. If I were in the middle of a cesarean section and things went pear-shaped, there was no way out.

Marsali seemed preternaturally calm, as though she were listening to what was going on inside rather than to my explanations and speculations. As we came near the Big House, though, we met Young Ian, coming down the hillside with a clutch of dead rabbits, dangling by their ears, and she sharpened to attention.

“Ho, cousin! How is it, then?” he asked cheerfully.

“I need Fergus, Ian,” she said without preliminary. “Can ye find him?”

The smile faded from his face as he took in Marsali’s paleness, and my support of her.

“Christ, the bairn’s coming? But why—” He glanced up the pathway behind us, clearly wondering why we had left Marsali’s cabin.

“Go and find Fergus, Ian,” I cut in.
“Now.”

“Oh.” He swallowed, suddenly looking quite young. “Oh. Aye. I will. Directly!” He began to bound off, then whirled back and thrust the rabbits into my hand. Then he leapt off the path and tore down the hillside, rocketing between trees and vaulting fallen logs. Rollo, not wishing to be left out of anything, flashed past in a gray blur and hurtled down the hillside after his master like a falling rock.

“Don’t worry,” I said, patting Marsali’s arm. “They’ll find him.”

“Oh, aye,” she said, looking after them. “If they shouldna find him in time, though …”

“They will,” I said firmly. “Come on.”

I sent Lizzie to find Brianna and Malva Christie—I thought I might well need more hands—and sent Marsali to the kitchen to rest with Mrs. Bug, while I readied the surgery. Fresh bedding and pillows, spread on my examination table. A bed would be better, but I needed to have my equipment to hand.

And the equipment itself: the surgical instruments, carefully hidden beneath a clean towel; the ether mask, lined with fresh thick gauze; the dropping bottle—could I trust Malva to administer the ether, if I had to perform emergency surgery? I thought perhaps I could; the girl was very young, and quite untrained, but she had a remarkable coolness about her, and I knew she wasn’t squeamish. I filled the dropping bottle, averting my face from the sweet, thick scent that drifted from the liquid, and put a small twist of cotton in the spout, to keep the ether from evaporating and gassing us all—or catching fire. I glanced hastily at the hearth, but the fire was out.

What if labor was prolonged and then things went wrong—if I had to do this at night, by candlelight? I couldn’t; ether was hideously inflammable. I shoved away the mental picture of myself performing an emergency cesarean section in the pitch-dark, by feel.

“If you have a moment to spare, this would be a bloody good time to have a look-in,” I muttered, addressing this remark collectively to Saints Bride, Raymond, and Margaret of Antioch, all presumably patrons of childbirth and expectant mothers, plus any guardian angels—mine, Marsali’s, or the child’s—who might be hovering about in the offing.