After the rain of Christmas Eve, the weather remained dry until the Ides of March, when the sky blackened, thunder grumbled and a few patchy storms fell among the crags of the high Sierra. At El Zopilote, however, the thirst of the dusty pine seedlings was no more than tantalized by a brief sprinkle which dried within the hour. Over Ajoya, as I could tell by looking westward under the dark billow of low clouds, the sun was still shining.
Two days later I left for Ajoya, accompanied by a boy named Amado, whose father had loaned me two mules. These we were taking to Ajoya to pick up a visiting group of American high school students. Around two o’clock in the afternoon, as we neared Güillapa, we passed Chano’s wife, who was washing clothes on a rock in the river. She greeted us warmly. Nearby her naked children were bathing, their slender, golden bodies more precious than jewels, gleaming and flashing in the sunlight. Laughing and shouting, they waved as we rode by.
Half a mile downstream, as we approached the point where, on the far side of the river, the wooded arroyo leads to Cipriano’s house, I explained to Amado that it was down this very arroyo that on Christmas Day we had carried the bodies of Nasario’s sons. No sooner had the words left my mouth than, to my amazement, a swarm of people emerged from the woods, moving toward us down the arroyo. It was like deja vu. And sure enough, in the middle of the group I soon spotted a stretcher. There, also, a little downstream, was the Power Wagon, waiting. I spurred my mule into the river to cross over to the stretcher bearers, and as I did so, I heard the shout of Jasmín Flores, one of our young American volunteers, hailing me, “David! David!”
We converged on the Power Wagon at the same time. Streaming sweat, Cipriano and his son, Isidro, lowered the stretcher from their shoulders. In it lay Isidro’s wife, Pancha, who had delivered a baby girl at 3:00 A.M., the first of twins. By mid morning, she had not delivered the second and the midwife, finding the baby transversely situated in the womb, had sent to the Ajoya Clinic for help. Mark Kinder, one of our volunteers who has worked in an ambulance corps in the States, drove the Power Wagon. It was a hard trip. Three times the 4-wheel drive wagon got stuck in sand bogs and had to be winched out. Also, crossing the rocky river bed, the battery broke loose and fell into the fan, chopping a section off of it. Mark succeeded in rewiring the remaining cells and getting the vehicle started again, At last, they had arrived at Güillapa. They found Pancha in good condition. Although there was still a fair chance that the second twin would be delivered normally, our volunteers had decided it was safer to take her back to Ajoya. Roberto, a local apprentice medic, volunteered to ride my mule the rest of the way for me and I accompanied the mother in the Power Wagon.
In Ajoya things went slowly. Pancha’s labor pains remained weak and spaced at long intervals until the following morning, when they became more severe and frequent. The baby was still transverse in the womb, and at about 3:00 P.M., the bulge of the amniotic sac appeared at the opening of the birth canal. I perforated the sac and exposed what we had feared—the biggest dread of the backwoods midwife—the baby’s hand. The small pink hand moved this way and that, as if testing the outer atmosphere. I reinserted the baby’s hand back into the womb and, with the help of a village midwife, tried, gently, to turn the baby. Without success. I was leery of using much force for fear of precipitating a hemorrhage which might demand an immediate Caesarean, a procedure which was beyond our capacities. The mother’s pains were subsiding again and we decided to make a run for the hospital in Mazatlán. Mark packed medicines and instruments in case the baby’s position should change and it could be delivered en route. At about 5:00 P.M., we took off—Pancha, her husband, her mother and I, together with a 13 year-old boy named Saul, who had a tumor of the jawbone, of which I wanted to get better X-rays than our equipment could provide. The one day old twin we left at the clinic, where the mother of one of our patients agreed to breastfeed it, having left her own four month old baby at home.
The trip was difficult. Pancha cried out in agony every time the truck lurched. We had to proceed very slowly for the bumps in the rough road precipitated such violent uterine contractions that I feared these might cause a fatal rupture. Isidro knelt at his wife’s side, trying to stabilize the jolting cot in the back of the vehicle. Several times I stopped to climb back and examine the state of the mother and the child in her womb. Isidro asked me over and over again if I thought the baby was still alive. Each time I told him yes, he breathed a soft “Gracias a Diós”. I marveled at how essential the life of this second, still unborn twin, already was to him. He seemed to be nearly as anxious about it as about the life of his wife, Pancha.
At last we arrived at the Hospital Civil in Mazatlán. There were no doctors on duty, but the nurse telephoned and they came very quickly, both the Director, a kindly middle-aged pediatrician, and the chief resident, a young obstetrician. The obstetrician examined Pancha and decided to try to “invert” the child and remove it through the birth canal, rather than to perform a Caesarean. His confidence was reassuring and he was so friendly that I felt no reluctance to ask him if I could observe the procedure. He cheerfully agreed. We changed into gowns and masks and scrubbed, while the nurses prepped the mother; then we went into the operating room. The Director, also masked, came along to observe. After starting an I.V., the young doctor expertly gave Pancha a spinal block. Meanwhile, the baby’s hand had again presented. It had good color and even grasped at the forceps which clamped off the umbilical cord of the first twin. The young resident reinserted the hand and, reaching in up to his elbow, fished for the infant’s legs. On finding them, he drew them out of the birth canal. The hips followed. It was a boy. There, the baby hung up. The cervix was in spasm and, try as he could, the young doctor could not get his fingers through to catch the baby’s shoulders or mouth. Time was precious now, for the pressure of the birth canal on the umbilical cord interfered with the oxygenation of the baby’s blood. The nurses applied larger and larger doses of nervous system depressants in an attempt to relax the contracted cervix. The young doctor twisted and turned the infant in vain and finally, in desperation, began to pull on it, forcefully. The sweat ran down his face and dripped from the end of his nose. He twisted and tugged harder. Finally he succeeded in slipping through his fingers and hooking the baby’s right arm, which he tried to manipulate down through the birth canal. The Director advised him as to how to turn and lift the body, but still the infant remained stuck. The desperate young resident gave too strong a tug at the infant’s arm. There was a faint snap of bone, accompanied by a gasp of horror on the part of the doctor. It made me recall how, when I was first learning to pull teeth, I sometimes had become flustered with an extra obdurate molar, applied too much force, and broken the crown off the roots.
There was the sickening snap, then the sense of failure, of inadequacy, which follow. I felt sorry for the baby, but I felt, perhaps, even sorrier for the young doctor. He had done no more than try his hardest. I regretted that the Director and I were watching. The Director simply said, “Broke?”, and the young doctor nodded and kept working. Now it was easier to extract the child’s arm and, while the Director was scrubbing up to lend a hand, the baby’s shoulders and, finally the head, emerged. By now the baby was limp. The cord was cut quickly and the nurses began to aspirate the mucous from the baby’s mouth and to flick its backside, but the baby did not begin to breathe. A tube with oxygen was run into the baby’s nose, but to no avail. At this point the Director stepped in, listened for a heartbeat, and then began to give the child mouth to mouth respiration. In the meantime the young resident manually removed the two placentas from Pancha, who was nearly unconscious from so much medication. After applying mouth to mouth respiration for about a minute and a half, the Director listened again to the infant’s heart, then handed the stethoscope to me. I listened. Irregular and barely audible, the beat was still there.
The Director shook his head, a look of sadness in his gentle eyes. “It’s hopeless,” he said. “The respiratory failure is due to the depressants given the mother to relax the cervix. What a shame! Such a big, healthy looking baby for a twin!” He stood there looking down at the dying baby and said, with finality, “Too bad!”
But the child’s heart was still beating, if barely, and its color was not all that bad. I thought of Isidro, the father, sitting in the hall, the anxious look in his weathered eyes, his humble voice asking again, “Is the baby still alive?”
“Do you mind,” I asked hesitantly, “if I continue giving mouth to mouth respiration for a moment longer?”
“Go ahead,” replied the Director, “but you’re wasting your time.”
Using the mask I wore to filter my breath, I bent over the limp body and began to breathe for it, at the same time willing—willing life into it. After about two minutes, I paused and listened to the baby’s heart. “Still there!” I said to the Director, who stood by, watching. The baby still showed no signs of breathing.
“The baby is done for,” said the Director, a slight irritation in his voice, as if my amateur attempts were an insult to his judgment.
“He is probably right,” I said to myself. “Furthermore, I am intruding. He has been patient enough to allow me to go this far. I should respect his judgment.” Yet I muttered, “I’ll try a little while yet,” and bent once again over the limp infant. The Director left the operating room and was soon followed by the young resident. A moment later, Pancha was wheeled out by the nurses. I remained in the operating room alone with the infant, lending it my breath and my will. Every few moments, I monitored its heartbeat and paused long enough to see if there was any attempt by the infant to breathe on its own. There was none. But little by little, the heartbeat grew stronger, the baby’s color richer. “Live:” I demanded, as if its life were my own.
But I was also fraught with doubts. If the baby survived, might it not have permanent brain damage from the long period without oxygen? Did it not already have a broken arm and who knows what internal injuries as a result of the traumatic birth process? Was it in any way needed in this world? Its parents already had six other children, one of which, born but two days before, would receive but half its mother’s milk if this little boy survived. What a fool I was to invite the ill feelings of the hospital staff by questioning their death sentence on the child. They were probably right anyway, if not from one point of view, from another . . . yet the baby was alive! A potential soul. A potential human being. Outside in the hall, I would meet Isidro asking, “The baby?” What joy it will give him to learn it is a boy . . . if he lives: Human life has never been a question of wisdom, but of passion. We live and we will to live, not with our mind, but with our entire body and soul, with our 50 million years of evolution, with our blood:
“Live!” I begged the child. “LIVE!” And I poured my breath and spirit into his.
After ten minutes, the baby’s lungs jerked once . . but only once. I continued to breathe for him. At fifteen minutes, he took one deep breath . . . one only. At twenty, he began to breathe on his own. I stood by, marveling, my hand on his head, unwilling to remove it lest it, somehow, be an umbilical link between my soul and his. No father could have experienced more joy or more love. “You are alive! You breathe! And you are my doing!” I felt as if I had just painted the Mona Lisa.
The Director reappeared, in his street clothes and ready to leave. “Well,” he said flatly, on finding me still standing over the infant.
“Look!” I said.
The Director drew close and stared at the small, heaving chest.
“Oh,” he said. “It really looks like it might live.” There was a touch of something near to resentment in his voice. He could not have been human if there were not.
The door opened again and the young doctor came in, also in his street clothes. Without looking around, he began to screw closed the valves of the oxygen tanks from which a tube led to the tiny nose of the infant.
“You’d better hold off on that,” said the Director. “The baby’s begun to breathe."
“But I already filled out a certificate that he was dead!” exclaimed the young resident, then suddenly burst into an embarrassed smile. The smile lasted but a moment and was traded for a very firm expression, mask-like, self-controlled. I felt that he, too, resented my intrusion and was, at the same time perhaps, shocked at his own resentment. He had injured the baby in birth. He had brought it into the world broken and imperfect. If he had not willed its death as such, its death (as he supposed) had in a way been a relief. Babies are sometimes born dead, even in the hands of the greatest obstetricians . . . but they’re not alive with broken arms. When other doctors should see such a baby in the ward, its pathetic arm in traction, what would they say? . . . Such thoughts are not the noblest . . . but they are the most human. We all know them well! I was not surprised that the young doctor, who had been so confident, who had been so friendly to me as an intruder, did not even come to look closely at the child. A moment later he politely said, “Buenas noches,” and left.
My joy at having extended my life into the child’s suddenly was wrought with a sense of doubt and guilt. It is a huge burden to have sentenced life on one so young. I felt like a fool who had played God, had breathed Life into clay—and erred. I said meekly to the Director, “I guess I’ve created a lot of new problems . . .”
The Director looked at me with his sad kindly eyes and said, a little patronizingly, “That’s all right, in this place we have problems all the time.” When the nurses re-entered, he told them to take the child below and keep it on oxygen until it fully regained consciousness. As if listening, the baby opened its eyes. The Director and I shook hands, and he went home. I asked one of the nurses for a ribbon to tie off the umbilical cord, from which the clamp still dangled . . .
I found Isidro and Pancha’s mother waiting in the hall. He had been told that his wife was fine but that the baby had never breathed. He had been given no further report and had assumed the little boy was dead. When I told him the contrary, his face lit up. “¡Gracias a Diós!” he exclaimed. “Was it the effect of medicines that brought him back to life?”
I shook my head. “No,” I said, “to the contrary.” I did not go into more detail.
We left for an all night pharmacy to fill a prescription the young doctor had made out for Pancha. An hour later when we returned we found Pancha in good condition, exhausted but content with the new baby at her side. She moved and the infant awoke and began to cry. What a great sound!
As the back window had fallen out of my Jeep camper on the rough roads, I did not want to leave it alone. Isidro and Pancha’s mother chose to stay in the hospital, so Saúl and I decided to sleep in the Jeep next to the hospital. We had no sooner pulled into the quieter end of the lot, however, then the police appeared and ran us out. So we drove outside the city and slept near the beach.
Next morning I took Saul for X-rays and then to the office of Dr. Guzman, a very capable surgeon in whose opinion I have increasing confidence. It was afternoon by the time we returned to the Hospital Civil. There, a young intern told us that Pancha was doing well, but that the baby had died at nine that morning. I asked him what had happened. He shrugged his shoulders and said that the baby had appeared to be doing well and then, from one moment to the next, he had just stopped breathing.
I looked at my hands and said, “Oh.” And yet I wonder . . .
At least I am no longer responsible . . . to that one.