There was a would-be grandmother present; she spoke Lithuanian to the woman in labor. To Dr. Larch shespoke a strange language of gestures, which suggested to him that the would-be grandmother was feebleminded. She indicated that a large mole on her face was either a source of hysterical pleasure or hysterical pain-Larch couldn't tell which; perhaps she simply wanted him to remove it, either before or after he delivered the baby. She found several ways to exhibit the mole-once by holding a spoon under it, as if it were about to fall; once capping it with a teacup and revealing it suddenly, as if it were a surprise or a kind of magician's trick. But the zeal she brought to each revelation of the mole suggested to Wilbur Larch that the old woman simply forgot that she had already shown him her mole. {63}

When the husband returned with the ice, he trod on the cat, which voiced its disapproval in tones that made Wilbur Larch think the child was being born. Larch was grateful not to have to use the forceps; it was a short, safe, loud delivery, following which the husband refused to wash the baby. The grandmother offered, but Larch feared that her combination of excitement and feeblemindedness would cause an accident. Indicating (as well as he could, without the benefit of Lithuanian) that the child should be washed in warm water and soap-but not boiled in the pot on the stove, and not held head down under the coldwater tap-Larch turned his attention to the afterbirth, which refused to come away. The way the patient kept bleeding, Larch knew he would soon be faced with serious hemorrhage.

He begged the husband to hack him some ice-the strong fellow had brought a whole block, borrowing the ice company's tongs for this purpose and standing in the kitchen with the tongs on his shoulder in a menacing fashion. The block of ice could cool the uteri of several bleeding patients; to apply it whole, to a single patient, would likely crush the uterus, if not the patient. At this moment the grandmother lost her grip on the soapy child and dropped it among the dishes soaking in the coldwater sink; this happened the instant that the husband again trod upon the cat.

Seizing the moment, when he saw that the grandmother and the husband were distracted, Larch grasped the top of his patient's uterus through her abdominal wall and squeezed hard. The woman screamed and grabbed his hands; the grandmother, abandoning the baby among the dishes, tackled Larch at the waist and bit him between the shoulder blades. The husband retrieved the child from the sink with one hand, but he raised the ice tongs over Larch with the other. Whereupon, lucky Wilbur Larch felt the placenta separate. When he calmly pointed to its appearance, the grandmother and the husband seemed more in awe of it 64 than of the child. After washing the baby himself and giving the mother some ergot, he bowed a wordless goodbye. Leaving the apartment, he was surprised to hear a commotion almost the instant he closed the door: the grandmother, the iced patient, the husband-all shouting in Lithuanian-and the baby giving forceful voice to its first family quarrel. It was as if the delivery, and Dr. Larch's entire appearance, had been only a brief interruption to a life of unintelligible turmoil.

Larch navigated the dark stairs and groped his way outside; he stepped on a rotting head of lettuce, which gave under his foot with the disquieting softness of a newborn baby's skull. This time he did not confuse the cat's terrible yowl with the sounds a child can make. He looked up in time to see the object flying through the window of the Lithuanian apartment. He was in time to dodge it. It had clearly been hurled at him, and Larch wondered what particular, perhaps Lithuanian, offense he had caused these poor people. Larch was shocked to see that the object thrown from the window-and now dead on the ground at his feet-was the cat. But he was not that shocked; for a passing second, he feared it might have been the child. He had been told by his professor of obstetrics at Harvard that 'the tensile strength of the newborn' was 'a marvel,' but Larch knew that the tensile strength of a cat was also considerable and he noted that the beast had failed to survive its fall.

'Here in St. Cloud's,' Dr. Larch would write, 'I am constantly grateful for the South End of Boston.' He meant he was grateful for its children and for the feeling they gave him: that the act of bringing them into this world was perhaps the safest phase of their journey. Larch also appreciated the blunt reminder given him by the prostitutes in the South End. They recalled for him the painful gift of Mrs. Eames. He could not see the prostitutes without imagining their bacteria under the microscope. And he could not imagine those bacteria without feeling the need for the giddy warmth of 65 ether-just a sniff; just a light dose (and a light doze). He was not a drinking man, Dr. Larch, and he had no taste for tobacco. But now and then he provided his sagging spirits with an ether frolic.

One night, when Wilbur was dozing in the South End Branch of the Boston Lying-in, he was informed by one of the doctors that there was an emergency arrival, and that it was his turn. Although she had lost a lot of weight and all of her youthfulness since Larch had last seen her, he had no trouble recognizing Mrs. Eames. She was so frightened, and in such intense pain, that she had difficulty catching her breath, and more trouble telling the nurse-receptionist her name.

'Rhymes with screams,' said Dr. Larch helpfully.

If Mrs. Eames recognized him right away, she didn't let on. She was cold to the touch, her pulse was very fast, and her abdomen was as hard and white as the knuckles of a tight fist; Larch could detect no signs of labor, and he couldn't hear the heartbeats of the fetus, which Larch couldn't help imagining as having features similar to Mrs. Eames's sullen teen-age daughter. How old would she be now? he wondered. Still about his own age -that much he had time to remember before attending to his diagnosis of Mrs. Eames: hemorrhage within the abdomen. He operated as soon as the house officer could locate the necessary donors for the transfusion.

'Missus Eames?' he asked her softly, still seeking some recognition from her.

'How's your father, Wilbur?' she asked him, just before he operated.

Her abdomen was full of blood; he sponged away, looking for the source, and saw that the hemorrhage issued from a six-inch rupture in the back of the uterus. Larch performed a Caesarean section and delivered a stillborn child-the pinched, scornful face of which forcibly reminded him of the cigar-smoking daughter. He wondered why Mrs. Eames had come here alone. {66}

To this point in the operation, young Larch felt in charge. Despite his memories of the woman opened up before him-and his memories of her transmitted disease, which he was only recently rid of-he felt he was handling a fairly manageable emergency. But when he tried to sew up Mrs. Eames's uterus, his stitches simply pulled through the tissue, which he noticed was the texture of a soft cheese-imagine trying to put stitches in Muenster! He had no choice then; he had to remove the uterus. After all the transfusions, Larch was surprised that Mrs. Eames's condition seemed pretty good.

He conferred with a senior surgeon in the morning. At the Boston Lying-in it was standard that an obstetrician's background was surgical-Larch had interned in surgery at Mass General-and the senior surgeon shared young Larch's bafflement with the disintegrating consistency of Mrs. Eames's uterus. Even the rupture was a puzzle. There was no scar of a previous Caesarean section that could have given way; the placenta could not have weakened the wall of the uterus because the afterbirth had been on the other side of the uterus from the tear. There had been no tumor.