Chapter Thirty-Eight

A week later, Jacob and Luo Jun sat together in the small office in the back of the store eating lunch when someone pounded on the shop’s front door. Jacob’s brows met.

“You put up the ‘Closed’ sign, didn’t you?” he asked the tailor.

“Of course,” Jun said. He pushed back from the desk and started to rise. “I’ll send them off.”

“I’ll do it,” Jacob said. “Probably some miner who can’t read the sign. Just don’t eat all the cookies while I’m gone.” Jun mimed falling face-first into the tin of gingersnaps Lyddie had brought over the previous day, and Jacob laughed.

His laughter died in his throat when he stepped onto the main floor and saw Frank waving frantically at him through the front window. He sprinted the last few yards to the door and nearly ripped it off its hinges before remembering they always bolted it when they broke for lunch. His hands fumbled with the lock.

“Is it Eleanor?” he asked when he finally wrenched the door open.

Frank nodded, his face grim. “Her pains started two days ago, and the midwife says she can’t get the baby out.” He swallowed hard. “She told me to fetch Doc Titus, but Eleanor wanted me to come straight for you. Said she wouldn’t let any doctor touch her but you.”

A line of cold sweat broke out along Jacob’s hairline. “Did you say two days?”

Frank nodded again.

“Dear God.” Jacob clutched the doorframe.

“Uncle Jacob?” Frank said. “Is it as bad as it sounds?” His voice had risen higher than usual, making him sound much younger than his twenty-two years.

Jacob could only nod.

A sob escaped Frank’s throat. “Is the baby gonna die?”

Jacob opened his mouth to lie, but he met Frank’s eyes and couldn’t follow through. This wasn’t just Eleanor’s baby they were discussing: It was Frank’s niece or nephew. Jacob laid a hand on his shoulder.

“An experienced midwife like Clara calling for a doctor is a very bad sign,” he said. He almost gagged on the words. He couldn’t bear the thought of losing Eleanor’s baby any more than he suspected Frank could. To say nothing of Eleanor herself.

Frank let out another sob, ripped a handkerchief out of his pocket, and buried his face in it. His shoulders shook. Jacob wanted to join him, but he couldn’t afford sorrow just now. Eleanor needed him.

“Come on, son,” he said. “Let’s get out there.”

He dragged Frank into the shop to get him out of the chilly November air while he dashed to the office to tell Luo Jun.

“Could you stop at my house after closing and take Grace to Mrs. Williams? She lives in the green house two doors down from me.”

Jun promised he would and handed Jacob his physician’s bag and a small pail of carbolic acid from behind the desk. Jacob had kept them there since Andrew’s accident. He didn’t like the idea of leaving someone bleeding again while he fetched it from home. And he’d used more of the carbolic acid on Andrew than he’d expected, so when he resupplied, he bought an entire pail. Jacob opened the bag, double-checked that he had chloroform and laudanum, and snapped it shut again.

“Thank you,” he said to Jun and turned to leave the office.

Jun grabbed his elbow, and Jacob turned back to face him. The tailor held his gaze for a moment then said, “Good luck.”

Jacob thanked him and dashed back out to the main floor and Frank.

******

Eleanor burst into tears when Jacob dashed into her and Andrew’s bedroom an hour and a half later. He was sure he was still wild-eyed from his harrowing ride to the ranch. Frank had brought Andrew’s enormous horse for Jacob to ride back to the ranch, and they’d pushed the horses to a run the entire way. Jacob spent most of the ride clinging to the saddle horn and praying he’d live long enough to aid Eleanor.

Now, as he rushed to Eleanor’s side, the fear from the ride gave way to the terror of seeing his dearest friend lying so pale against her pillows. His heartbeat thrummed in his ears so loudly he could barely hear her when she spoke.

“Jacob, has my baby died?” she said, sobbing. She grasped Jacob’s hand in a surprisingly strong grip. Andrew stared imploringly at him from a seat on the other side of the bed. Mary hovered behind him, tears streaming down her face. Jacob glanced up at Clara, who jerked her head toward the door.

“I don’t know, Eleanor,” Jacob said. He smoothed a sweaty lock of hair off her pale forehead. “Let me speak with the midwife, and then I’ll be right back, and we’ll figure out what’s happening. All right?”

Eleanor nodded and wiped her eyes with the back of one hand.

Clara and Jacob stepped into the hallway and closed the bedroom door behind them.

“Tell me everything,” he said.

As Clara detailed the progression—or, rather, lack thereof—of Eleanor’s labor, Jacob immediately recognized the signs of obstructed labor from his reading. After eighteen unsuccessful hours, Clara had broken Eleanor’s water, hoping that would move things along so she could extract the baby with forceps like she had Declan.

“But she isn’t contracting strongly enough for the baby to move far enough along to pull him out with regular forceps,” Clara said. “And she cannot persist in this state. You have to perform a craniotomy, Doctor Lewis.”

Jacob placed a hand on the wall and squeezed his eyes shut. He couldn’t give in to sorrow. Right now, he had to pull himself together so he could step back into that bedroom and break his best friend’s heart. And his nephew’s. Not to mention Will and Mary, who had been so excitedly anticipating the arrival of their first grandchild. He drew in a deep, steadying breath and looked Clara in the eyes again.

“Are you certain the child has passed?”

“No.” Clara dropped her own gaze now and sniffled. “But it’s less likely the baby is still alive than it is that Eleanor will die if we don’t do something.”

Jacob’s eyes widened. “You’re saying there’s a chance the child is alive?”

Clara looked back up, her eyes widening, too. “Yes, but weren’t you listening, Doctor Lewis? Eleanor will die if we don’t stop this labor.”

An odd mixture of elation and doubt settled over Jacob. He felt both giddy and terrified. “I can stop this labor,” he said. “And if the baby is still alive, I can save them both.”

Clara took a step backward. “You’re not suggesting a surgical measure, are you?”

“A cesarean section is the obvious solution,” Jacob said. He ran a hand through his hair. His mind swirled, trying to conjure the diagrams and information from his textbooks. “If done properly, both mother and child can survive the procedure.”

Clara sighed. “Doctor Lewis, I must object. In my twenty-five years as a midwife, I’ve seen two doctors attempt the procedure, and in both cases the mother died of sepsis.”

Jacob smirked. “That’s because those doctors hadn’t read Doctor Lister’s work.” He turned and called down the hallway for Lyddie. He’d dashed past her and Will in the parlor on his way into the house. Lyddie rushed to his side.

“Clear the table,” he said. “And gather up all the lamps you can. I’ll need a lot of light.”

Lyddie, who had helped him prep for simple surgeries in his office in Washington dozens of times, hesitated.

“Are you certain, Papa? Perhaps we should call for Doctor Titus.”

He gazed down at her and saw the past three years reflected in her eyes. His panic, his moodiness, his sheer… impotence. That childlike confidence she’d always had that her father could fix anything was gone, replaced by doubt. He could see it in crease of her brow, the downturn of her mouth. It enraged him. He wanted to smash something, to display his vitality through a show of sheer brutal strength. But that wouldn’t fix Eleanor’s predicament.

So he took a deep breath, and he smiled.

He ruffled Lyddie’s hair, just like he did when she was a small child.

“Don’t worry, sweetheart,” he said. “Papa’s got this well in hand. Now go prep that table.”

Lyddie hugged him tightly around the waist and then scampered down the hall, shouting to Will to gather up all the lamps.

“You don’t have to assist,” Jacob told Clara. “Lydia knows what to do. But if you could keep the rest of the family distracted and out of the way, I would be much obliged.”

Clara nodded and opened the door to the bedroom.

Jacob smiled at Eleanor and Andrew when he stepped back into the bedroom.

“I think we have an option,” he said, “but, Eleanor, with your permission, I need to examine you.”

Eleanor nodded, her face tight. Andrew echoed her.

“Can you save the baby?” Andrew asked.

“That’s what I’m going to find out,” Jacob said.

He dug his stethoscope out, approached the bed, and grabbed the blanket that covered Eleanor from belly to ankles. She wore only an old shirt of Andrew’s, leaving her entire lower half exposed. Out of respect for her modesty, he lowered the blanket only to just below her belly. A contraction passed as he did this, and her abdominal muscles contracted, though, like Clara had said, not nearly as strongly as they needed to. Eleanor panted through it, and when it passed, Jacob placed the stethoscope on her belly.

Listening to a baby in utero was difficult in the best of circumstances, and this was certainly not the best of circumstances. Eleanor’s breathing came hard, and Andrew kept making cooing sounds to her. Jacob waved to them both for silence, though only Andrew was able to comply. But Jacob thought he could make out a heartbeat, though perhaps not as strong a heartbeat as he would have preferred.

“I think the baby’s still alive,” he said.

Eleanor, Andrew, and Mary all burst into a fresh round of tears. Jacob held up a hand to temper their relief.

“But he won’t be much longer if we don’t do something.” He pulled the blanket back over Eleanor’s belly and took her hand. “We have an option, but it’s risky.”

Eleanor and Andrew exchanged a look.

“Tell us about it,” Andrew said.

“There’s a procedure called a cesarean section,” Jacob said. “It’s the surgical delivery of a baby that’s stuck, like yours is.”

Eleanor nodded, but Andrew grimaced.

“Feels so barbaric,” he said.

“Less barbaric than the alternatives,” Jacob said.

“Which are?” Andrew said.

“Number one is a craniotomy in which I would use my forceps to,” he swallowed hard, “crush the baby’s skull so I can pull him out.”

Eleanor sobbed, and Andrew wrapped his arms around her.

“Number two is we do nothing and Eleanor and the baby both almost certainly die,” Jacob finished.

Andrew looked up at Jacob, his nostrils flaring.

“Have you no decency?” he shouted. “How can you say that to her at a time like this?”

Jacob knew the boy wasn’t upset with him. Andrew was enraged at the medical condition that had left his wife in this position. And quite possibly with himself for giving her the baby that put her here. He kept his voice gentle.

“Because she deserves to know the truth. As do you.” He pulled a handkerchief from his pocket and leaned down to wipe some of the tears from Eleanor’s face. She met his gaze and stared into his eyes for several long moments. He stared back, unblinking.

“Don’t be afraid,” she said. “I know you can save my baby and me.” She took his hand and squeezed it before turning to Andrew. “I want the surgery.”

Andrew closed his eyes and nodded. “All right, then.” He looked up at Jacob. “What do we need to do?”

“Just give me a few minutes to help Lyddie prepare the table,” Jacob said. “Then you can help by carrying her over to it.”

Jacob leaned over and kissed Eleanor’s forehead before leaving the bedroom to check on Lyddie and Will’s progress.

In the hallway with the bedroom door firmly closed behind him, he took several gulping breaths. The old, familiar panic tried to grip him. Something clattered on the other side of the house, and he jumped, his heart rate inching higher.

“Sorry!” Will’s voice rang out from the dining room. “I didn’t hit you, did I?”

Lyddie responded too quietly for Jacob to make out what she said. He bit hard on his lower lip, using the pain to ground himself. He was in Andrew’s house, not a field hospital. The patient was a pregnant woman, not a young boy who never should have been in harm’s way. His older brother was only two rooms away. He was safe, he was safe, he was safe.

Thanking God the Minié ball was still tucked away in his desk drawer at home, he took one more deep breath and strode down the hallway.

Lyddie, Frank, and Will had cleared the table and covered it with several layers of clean, white sheets. All along the sideboard sat nearly a dozen lamps and lanterns. Lyddie had even set out a silver tray on an end table for him to lay out his surgical tools. Not that he had many. But for what he was about to attempt, all he really needed was a scalpel and sutures.

“I’ve fetched some rags and a hand mirror as well,” Lyddie said, sidling up to him.

Jacob nodded and through his shakiness managed to smile at his daughter. “We haven’t worked together in, what? Seven, eight years? And you haven’t forgotten a thing.”

Lyddie smiled back. “I had an excellent teacher.” She squeezed his hand. “I’m proud of you.”

“Don’t say that until we know the outcome.”

“I’m proud of you anyway. Whatever the outcome may be.” She hugged him and then shooed him down the hall to retrieve Eleanor.

Eleanor had gone through another contraction while Jacob checked on the table. She was nearly as white as the sheet when Andrew gently laid her on the table and Lyddie slipped a small pillow under her head and covered her with another sheet.

“Lyddie will assist me,” Jacob said, addressing the family and Clara. “The rest of you can wait in the parlor. I’ll let you know when we’re finished.”

Will, Mary, Frank, and Andrew all nodded, but Clara stepped forward.

“Doctor Lewis, if it’s all right with you, I’d like to assist. I don’t know much about surgery, but I know my way around newborn babies.”

Jacob nodded. “I’d appreciate that, thank you.”

Still next to the table and clutching Eleanor’s hand, Andrew leaned over and kissed her forehead. He whispered something Jacob could not hear, and Eleanor reached up and patted his cheek.

“The baby and I will see you soon,” she said.

Andrew nodded and stepped away from the table. He took Mary and Frank each by an arm and said, “Come on. Let’s let Uncle Jacob get to it.”

“I’ll be right there,” Will said. When the dining-room door closed behind the rest of the family, Will turned to Jacob and placed his hands on his shoulders. He peered into his eyes.

“Steady as she goes, Younger Brother. I’ll have a brandy waiting for you when you’re finished.” He squeezed Jacob’s shoulders and left the room, closing the door behind him. Jacob hated the finality of the gesture but was glad that Andrew had a dining-room door rather than the more open floor plan of Jacob’s own house. It would afford them some privacy for the procedure.

Lyddie handed him and Clara each an apron. She must have stolen them from the kitchen because the ties were barely long enough to go around his waist, and it stopped several inches short of his knees. At least Eleanor didn’t favor ruffled aprons.

He turned to Lyddie and Clara. “You ladies ready?”

They both nodded.