Improbable though this seemed, K the mechanic seemed to have everything under control, but she asked Rosie to stay anyway.
“Early,” K explained. “She schedule C-section in hospital next month but she not make it.”
A scheduled hospital caesarian delivery somewhere this rural and remote struck Rosie as nearly as improbable as an auto mechanic delivering a premature baby. “Why did she have a C-section scheduled?”
“She have scarlet fever when she was child.” K delivered from the patient’s clenched fist a damp, crumpled envelope from which Rosie extracted a letter, faded and ancient and, besides all that, in a script she could not name, never mind decipher. The patient paused between contractions to look very proud.
“She have scarlet fever and then two-week walk to city to see doctor. Probably her family have some little money. Doctor took picture, looked her heart, wrote down some note for if she pregnant. She lucky. But then she labor early.”
Was Rosie here to treat mother or baby? “How early?”
“Maybe thirty-two week.”
Rosie looked around. It wasn’t just that she saw no NICU incubators, no mechanical ventilators, no bili lights. It’s that asking about them seemed absurd. Surely if they had a neonatal cardiopulmonary monitor, they’d also have sheets and actual beds? “And the letter? What does it say?”
K shrugged and made soothing sounds at the patient as the baby crowned. “Cannot read all. And very short. But damage. Lesions. You know?”
Rosie at once did and did not know. She’d never seen heart disease caused by rheumatic fever—they were so careful with strep these days, and it was so easily treated—but patients with the sort of damage it caused were generally advised against pregnancy, the stress of not just labor but the pregnancy itself too great on compromised heart valves. That ship having clearly sailed, the only tack left was to wait and see who needed help afterward: mother with a too-weak heart or baby with too-weak lungs. Rosie stood and held her hand while the patient pushed and cried and waited, panted, pushed, and cried, while K eased out the head, turning gently, then the shoulders, no hesitation, the rest of the baby rushing out wet and slick as an otter, the baby crying, the new mama crying, even Rosie tearing up a little. It had been a long time since she’d been on this end—either end really—of labor and delivery, and she was jet-lagged and overwhelmed. And relieved. The baby was very small, too small, but pink, crying—if not loudly, if not lots, at least a bit. K swaddled him in a scrap of heretofore T-shirt that read EAST LAKE HIGH BEACH WEEK 2009: SURF THIS! and laid him in his mama’s arms, right up against her scarred heart. The patient was euphoric, weepy-grateful. K and Rosie too and the other waiting, watchful patients on their wooden platforms all around them. All was miracle and celebration. Through the haze of this wonder, Rosie gazed over the throngs of people still waiting and decided to leave the coda of this case in the car mechanic’s apparently multitalented hands.
Then, in a language Rosie had never heard before in her life but understood as if it were her mother tongue, the patient wheezed that she could not breathe. Her inhalations became short then gasping all in a seeming moment. Her face went gray, her eyes then her head rolled back, and it was K who had the presence of mind to grab the baby as he tumbled from her slackened arm.
Rosie listened to her lungs and heard wet, like a conch shell, though in this case she heard not water, not waves, but crackles like a campfire of wet wood: rales. Pulmonary edema. The patient was drowning. Was there a ventilator? She supposed a mask would do for the moment.
“Oxygen,” she said to K.
But K shook her head. “Have mask,” and she looked proud at that but, “and one tank oxygen but empty. Request more three month ago but not arrive yet.”
Rosie took that in. The rest of the patient’s skin was going gray. Sputum, pink with foreboding, frothed at her mouth and nose. Rosie would have to treat the heart and hope that allowed the lungs to do their job as well. She knew but nonetheless asked, hoped, prayed, Hail Mary’d: “Echocardiogram?”
K shook her head again.