Chapter 39: Chapter Thirty-Nine

Jacob closed his eyes and reviewed the procedure in his mind, briefly visualizing each step. He didn’t like performing a procedure from memory that he’d never attempted and only watched twice more than two decades ago. But there were no other options. Eleanor’s choices were either him or death, and she’d chosen him.

“All right,” he said. “Lyddie, you administer the chloroform and monitor Eleanor’s breathing. Clara, you’ll be my second set of hands.” He approached the table and stood next to Eleanor’s head. Resting a hand on her forehead, he gazed down at her.

“Lyddie’s going to give you some medicine to make you go to sleep,” he said. “I promise you won’t feel any pain.”

Eleanor nodded, and when he began to step away, she grabbed his wrist.

“I know you can do this,” she said. Her voice and her gaze were earnest and trusting. “I know you can save my baby.”

Jacob’s eyes blurred, but he smiled at her. “I plan to save you both,” he said. He kissed her forehead and stepped to the end of the table to mix up some carbolic solution. He, Lyddie, and Clara all dipped their hands in it per Dr. Lister’s procedure, and then Jacob used it to cleanse his surgical tools.

“Ready?” he asked Lyddie. She nodded and placed a mask over Eleanor’s mouth and nose.

“Just breathe normally,” she told Eleanor. With a steady hand, she dripped chloroform onto the mask from a small bottle. Within a few minutes, Eleanor’s eyes fluttered, then closed. Her belly seized in another contraction, and Jacob had to wait it out before he could begin his incision. His stomach churned along with her, and he closed his eyes, forcing himself to stay in the moment.

“Make sure she’s good and out,” he said.

“Don’t worry, Papa,” Lyddie said. “I won’t let her twitch under your knife.”

The statement should have jolted him back to the war, but something in Lyddie’s tone soothed him. Her presence reminded him of surgeries performed in his own office in Washington, with no gunshots or cannon fire so close they made his ears ring. He wiggled his toes in his boots, enjoying the free movement that came from not having feet so swollen he would need someone to cut his shoes off later.

“She’s ready,” Lyddie said.

Jacob closed his eyes, took a deep, cleansing breath, and drew back the sheet covering Eleanor’s swollen belly. He hadn’t performed surgery of any sort for more than three years. His hands shook, and he hesitated reaching for his scalpel.

“Sometime today, please, Papa,” Lyddie said, her tone loving but firm.

He grabbed the scalpel. He gripped it so tightly his knuckles turned white, but it stopped the shaking. He took another deep breath, let it out, and touched the blade to Eleanor’s skin.

“Once I open the abdominal wall, I’ll need your help holding the incision open while I make my incision in the uterus,” Jacob said to Clara. “Then we should be able to pull the baby out.”

“I’ll be ready,” Clara said.

Jacob pressed the scalpel against Eleanor’s belly, and the sharp instrument sliced neatly and easily into her skin and through the layer of fat beneath. He counted slowly under his breath as he made the incision, keeping time to ensure he cut neither too quickly nor too slowly. The cold, metallic scent of blood filled his nostrils, and he swallowed hard. He briefly squeezed his eyes shut and fought back memories.

“Tell me when you’re ready for me,” Clara said, snapping him back to the present.

“Hold here, please.” He indicated the edges of the six-inch-long incision.

Without flinching, Clara grasped the edges of the incision with her bare fingers, holding Eleanor’s flesh open so Jacob could cut through the abdominal wall and reach the uterus.

“How’s her breathing?” he asked Lyddie.

“Nice and steady.” Lyddie sprinkled another few drops of chloroform onto the mask covering the lower half of Eleanor’s face.

Jacob grabbed a cloth from the table and dabbed away some blood.

“Lyddie, are you able to direct the light for me while still monitoring her?” he said.

“Of course,” Lyddie said. She came to Jacob’s side of the table and grabbed the hand mirror. She caught the reflection of one of the lamps and directed the beam of light directly into Eleanor’s open abdomen.

Jacob took yet another deep breath. This was the tricky part. He had to slice through Eleanor’s uterus, opening the womb with one incision but not stabbing the scalpel through so deeply he cut the baby. He pressed the scalpel to the exposed organ and cut, thanking the heavens that Clara had broken Eleanor’s water the day before. If she hadn’t, there would have been a gush of amniotic fluid that would have obscured his view and made everything slippery.

“Are you able to hold the uterus open, too?” he asked Clara.

“I think so,” the midwife said. She chuckled. “What I’d give for three or four more hands right now.”

Thanks to Lyddie’s light, Jacob could see the baby, its head directed down through Eleanor’s pelvis. He wiped his bloody, sweaty hands on another rag and reached ever so carefully into his best friend’s body. He caught the baby’s head and gently guided it up and out of the incision. The tiny child was bloody and wet, but Jacob noticed the thick shock of black hair covering its head.

“Man alive, I’ve got the baby,” he said, too loudly given how close Lyddie and Clara were. “Well, partly.” He glanced up at Lyddie. “I’m ok without the light now. Check the chloroform.”

Lyddie set the mirror down and returned to the head of the table, where she sprinkled a few more drops of chloroform on the mask.

“She’s still doing fine,” she said.

Delivering the rest of the baby proved trickier than the head. He didn’t dare enlarge his incisions—there was enough blood coming out of the small vessels as it was—but he couldn’t yank the child out in one motion, either. He stared at the tiny head gently cupped in his hands and thought for a moment.

“Push up there, gently,” he said to Clara, gesturing with one hand to the upper part of Eleanor’s belly. “Maybe we can squeeze him out.”

With Clara pushing on Eleanor’s belly, Jacob maneuvered the baby back and forth, easing out first one shoulder, then the other. Finally, with both shoulders free, he lifted the child out of Eleanor’s body and into his own arms.

“A boy,” he said. He broke into a huge grin and beamed at Lyddie, who had tears in her eyes. He gazed down at the tiny purple face and his heart dropped. “He isn’t breathing,” he said. He turned the baby over and patted his back. He could feel the tiny heart fluttering beneath his hand, but the child still didn’t draw a breath. He cranked his hand back, ready to give the child a good hard smack on the behind, when Clara snatched the baby from him. She pried open the tiny lips and jammed a finger deep into the baby’s mouth. With a single motion, she swept a glob of mucus from the child’s throat and flung it to the floor. The baby drew a loud, rattling breath and let out a wail. Jacob wanted to sink to the floor and weep, but he still had a patient lying open on the table.

“I’ll take care of this little one,” Clara said. “You take care of Eleanor.” With one hand, she tossed Jacob a spool of thread. He caught it and unwound a length, snipped it with scissors from the end table, and tied off the umbilical cord. Cutting it neatly, he returned his attention to the incisions to remove the placenta. It came free surprisingly easily, and he pulled it out through the incisions.

“Don’t worry, Eleanor,” he whispered. “Your baby’s safe. Let’s get you patched up.” The sooner he could get her sewed up and off the chloroform, the better. Anesthesia was a miracle, but he didn’t like leaving patients under its effects longer than he had to.

“You’re both doing just fine, Papa,” Lyddie said. “Her breathing is still good and steady.”

Jacob smiled and wanted to say something significant to his daughter, to express his gratitude for her presence and unwavering support, but someone started pounding hard on the door.

“Uncle Jacob! Uncle Jacob!” Andrew’s muffled voice carried through the door. “Is it a boy or a girl? Is Eleanor all right? Can I come in?”

“Lydia, would you address that, please?” Jacob said.

She laughed, checked Eleanor’s chloroform, opened the dining-room door a crack, and peeked through.

“It’s a boy,” she said. Andrew whooped and repeated her news to the rest of the family in the parlor. They all broke out in cheers. “We’re still cleaning him and Eleanor up. Give us a few more minutes.” She closed the door again and returned to the head of the table.

A few more minutes turned in to a half hour as Jacob dealt with the incisions. There was nothing he could do about the uterine incision: He wouldn’t be able to remove internal sutures there without opening Eleanor up again. It would have to heal on its own. Leaving an incision open unsettled him, but there was nothing he could do. He took his time carefully stitching the external incision along Eleanor’s abdomen.

“I’m afraid you’ll have quite a scar,” he said to Eleanor’s unconscious form. “But something tells me you won’t mind.” When he finished the sutures, he cleaned the incision with the carbolic acid solution, covered it with putty, and wrapped a bandage around all of it.

“Should I let her come round?” Lyddie asked.

“Not quite yet.”

He stepped into the kitchen and rinsed the blood from his hands at the pump. Clara was still there with the baby. Clean and swaddled in a blanket, the boy had fallen asleep.

Clara smiled at Jacob and headed for the door, but he caught her arm.

“Thank you,” he said. “When he didn’t start breathing, I didn’t know what to do. You saved his life.”

A shadow crossed Clara’s face, and she dropped her eyes to the baby. “Only after I asked you to take it from him.”

Jacob blinked. “What in the name of the Almighty are you talkin’ about?”

Clara looked back up, her eyes welling. “The craniotomy.” She turned her face to the kitchen window as if she couldn’t bear to look at either the baby or the surgeon who had saved him.

“Oh. That.” Jacob stepped toward her. “You could just as easily have been right. And my surgery wouldn’t have done him any good if you hadn’t been here to clear his airway.”

Clara shrugged. “Just a little trick I know.”

“A damn important one. And one I won’t soon be forgetting.” Jacob squeezed her shoulder. “We all do the best we can with the knowledge we have. And yours saved a life today.”

“Thank you, Doctor.” Clara wiped her eyes with the back of one hand. “Yours did too.”

Jacob followed Clara into the dining room and extracted a hypodermic syringe and a small, clear bottle from his bag. He filled the syringe with liquid from the bottle and injected it into Eleanor’s arm.

“Morphine,” Lyddie said. “Good idea.”

Jacob nodded. He didn’t want to think about how much pain Eleanor would be in when she awoke if he didn’t give her something for it. She’d probably be miserable enough coming out of the chloroform. He pulled the sheet over her bandaged belly and moved to the head of the table to check her breathing himself.

He studied his friend, dark hair swirled around her head, eyes closed, half her face still concealed by the chloroform mask. Shaky with relief and joy, he patted her cheek affectionately.

“I think we made it,” he said in a whisper. He lifted his gaze and smiled at Lyddie. “Let her wake up. And let Andrew in here before he breaks down the door.”

Lyddie removed the mask from Eleanor’s face and cracked open a window to pull in some fresh air. She tucked the mask into Jacob’s bag and opened the door.

Andrew knocked her over when he burst into the room and plowed straight for the table where his wife lay, still unconscious. He threw a quick “Sorry, Lyddie,” over his shoulder and bent over Eleanor and stroked her hair. Jacob hurried to shove some of the bloody rags into a corner where, hopefully, Andrew wouldn’t see them. More than once he’d had a family member panic seeing the detritus of surgery. He pulled off his apron and flung it, bloody side down, onto the rag pile.

“Why isn’t she awake?” Andrew said.

“It can take a little while to wake up from chloroform,” Jacob said. “And she’s probably going to feel terrible when she does. I thought it might help to have you here.” He smiled. “Would you like to see your son?”

Andrew nodded, apparently unable to speak. His eyes were wagon wheels, and his color was only slightly better than Eleanor’s. Jacob was glad he’d bought some smelling salts on his last trip to the druggist. He nodded to Clara, and she handed the little bundle to Andrew.

“Make sure you support his head,” she said. “He won’t be able to hold it up on his own for a few months yet.”

Jacob’s eyes welled as he watched his nephew gaze down into the pink face of his newborn son. He glanced at Lyddie, trying to remember her that small. So small, yet surprisingly heavy the first time he held her. Andrew was brave, holding his newborn while standing. Jacob had needed a full month before he’d felt comfortable holding his baby that high off the ground. He'd bought extra chairs just to be sure he’d always have a place to sit down when he held the baby.

“Look how much hair he has,” Andrew said. Grinning, he looked up at Jacob, and tears filled his eyes. “Thank you, Uncle Jacob,” he said. He cleared his throat, and when he spoke again, his voice was gravelly. “I actually can’t thank you enough. For a moment there, I was afraid they’d… that I’d lose…” He cut off and bent forward so his forehead was touching his son’s.

Jacob placed a hand on his shoulder. “No thanks necessary, son.” He squeezed Andrew’s shoulder. “So you know what you’re going to call him?”

Andrew lifted his head. His eyes and nose were red. He shook his head.

“Ellie thought it was bad luck, coming up with a name before he was born.” One corner of his mouth turned up. “Truth be told, I think she was hoping for a girl.”

“I expect she won’t care once she sees him,” Clara said. “Now why don’t we take him to meet the rest of the family?”

When Clara and Andrew disappeared with the baby, Jacob grabbed a chair and dropped into it. Exhaustion and the full realization of what he’d just done crashed down on him the instant he sat. He rested his elbows on his knees, leaned forward, and buried his face in his hands. His entire body trembled, and he didn’t try to stop the tears from flowing.

“I did it,” he whispered. “I did it.”

Something nudged his shoulder, and he looked up through blurry eyes to see Lyddie, smiling at him from a chair she had dragged alongside his. Tears streamed down her face too.

“I knew you could do it,” she said. “I’m so proud of you, Papa.”