From the novel Providence, VA

Here’s an excerpt from my book Providence, VA. My heroine is Sammy Reisinger, a 17-year old violin prodigy from a wealthy New Jersey family. She has inherited a priceless Cremonese violin from her grandfather and is schooled in the classics. Becoming enamored with traditional Appalachian music, she decides to visit the venerable Old Fiddlers Convention in Southwest Virginia. While there performing, tragedy strikes, leaving her seemingly trapped and orphaned in the tiny community of Providence, VA. Sammy decides that to earn her keep, she will assist the local midwife and learn the profession herself. Emily, her mentor, is sick and cannot assist in this delivery, so Sammy must go alone.

In this scene, she has ridden Jackson, her horse, into the town of Fries to collect any personal effects of Quint, her host, who was recently murdered.  

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After doing chores in the morning, Sammy decided to return in the afternoon to Fries to see if there were any personal effects of Quint’s still at the pharmacy. After lunch, she saddled Jackson and strapped on her midwife’s bag. It was a cool day with lazy, puffy clouds overhead.

She found a woman named Helen Nuckolls staffing the store. Nuckolls told her that she’d worked for Quint briefly years earlier, and that Annie Mullins had asked her to be there temporarily until longer-term plans could be devised.

Angie handed Sammy Quint’s spare reading glasses, a silver cup, a pocket knife, and some change. As Sammy was preparing to depart, a man came running into the store, shouting for her.

“Ms. Sammy, Ms. Sammy, please you must help! My wife is going to have the baby!”

“Calm down. I remember when Emily and I called at your house a few weeks ago, but I can’t remember your name.”

“It’s Emilio Vasquez. Please come!” He grabbed her by the sleeve of her sweatshirt and walked her outside. “You must come right away. My wife is in pain and I think she’s having problems.”

“Let me go and get Emily,” Sammy suggested.

Walking towards his moped, Vasquez said, “I already went there. Ms. Emily is very sick. She said she wouldn’t be able to come. She wanted you to assist.”

“Are you sure your wife is having problems? As I recall, her due date is still a couple of weeks away.”

“Yes, please come. She’s in a lot of pain.”

He turned the key and kicked the kick-starter and the little machine came to life. Sammy untied Jackson’s reins and hoisted herself atop him. Vasquez sped northwards on Ivanhoe Road, then turned on Winding Road towards Stevens Creek. Sammy trotted Jackson and occasionally ran him, but she couldn’t remember exactly how far away they lived and didn’t know how hard she could push Jackson. Every few minutes, Vasquez stopped to wait for her. Each road they took was smaller and more remote than the one before.

Finally, they arrived at the Vasquez house, a tiny wood-frame structure surrounded by forests. He parked the moped and ran to her. “Please hurry.”

Sammy grabbed her midwife’s bag and trotted inside, leaving Vasquez to tie up Jackson. The expectant mother was in a fetal position on her living room floor, with their three girls playing with dolls near her.

“Hi, Mrs. Vasquez, I’m Sammy Reisinger, Emily Ayres’ assistant. Emily is sick today but I’m here to help you. How are you doing?”

The dark-haired Hispanic woman rolled over towards her. “I’m in a lot of pain.” She was wearing a loose-fitting yellow T-shirt that said, “Bebé a bordo,” and navy-blue sweat pants, stretched to the limit.

“Are you having contractions?”

“Yes. I don’t know how often.”

“Can you get up? Would you like to go to your bedroom?”

“I’ll try.” Sammy helped her as Emilio walked inside and helped as well.

“Remind me of your name.”

“Estella,” she said, with a Spanish intonation.

“Okay, Estella, I’ll do the best I can.”

Emilio and Sammy placed the pregnant woman on her bed. Sammy noticed a large figurine of Jesus of Nazareth tacked to the wall above the bed. Emilio genuflected towards it. Sammy removed the fetoscope from her bag and warmed the sensor in her hand. “I’m going to listen and see how the baby’s doing.”

She lifted Estella’s shirt and placed the diaphragm on her distended belly and began to listen. She couldn’t hear any heartbeat. She moved the diaphragm from place to place, but couldn’t hear anything except the faint sound of blood movement. She took the diaphragm and placed it between Estella’s breasts and listened for her heart, simply to reassure herself that the fetoscope was working. Sure enough, she heard Estella’s heart clearly and distinctively, although it was beating rapidly.

“We may have a problem,” she said sadly.

“What is it?” asked Emilio.

 “I’m not hearing the baby’s heartbeat.” Sammy felt Estella’s belly. It felt full, balloon-like. “I don’t feel the baby’s body or head distinctly. Roll to your side and let me listen again.”

Estella began to moan. “I’m having more contractions.”

“Do you remember how long since the last ones?”

“I don’t know. When Emilio wasn’t here, I was trying to keep track, but the children were fussy and I couldn’t concentrate. Owww! Owww!”

“Let me check your cervix.” Sammy removed the cloth tape measure from her bag. “Only four centimeters. I’m afraid this is not good.”

“What’s wrong?” asked Estella.

“I don’t know of any other way of saying this. I think your baby is dead,” Sammy said sadly.

“¡Dios mío!”

“How will we know?” Estella queried.

“I don’t really know,” admitted Sammy, now sweating herself. “I’ve never seen a fetus die in utero.” Sammy placed her hands again on Estella’s belly.

“Owww! That really hurts!”

“I’m sorry! I don’t mean to hurt you, but I’m not sure what’s going on. Emily gave me a handbook. Let me let you rest for a moment and I’ll see what I can find out.” She began thumbing through her book. She tried to ignore the sobs and heartbroken cries of the couple. One of the children in the living room began screaming. “I’m going to step outside and see about the children.” Sammy went into the living room and held the youngest, a girl of about two years. She had on a shirt but no pants or underwear. There was a dark spot on the shag carpeting where one of the girls, likely this one, had urinated. The room smelled awful.

Sammy took the girl in her arms and held her tight. “Settle down, please, oh please.” The girl gradually began to calm down and stop crying. Sammy said to all three girls, “Please behave yourselves. Your mother needs you to be good. I need to get back to her and try to help her.”

She walked back inside. Estella was crying; Emilio was crying as well. Estella wiped her face with her shirt and said, “We understand that this baby is dead. We mourn for him. I am ready for him to leave my body.”

“Estella, I don’t mean to scare you, because I really don’t know exactly what I’m doing, but our problems have only begun.”

“What do you mean?” asked Emilio.

“When a baby is bring born, the baby does much of the work. Your baby is dead, so he cannot help. Your cervix isn’t dilated enough. So the baby is acting like a plug for the blood your body is feeding into the uterine cavity. I need to look at your cervix again.” It was still constricted, about five centimeters. “I’m going to try to stretch it.” She put her index and ring fingers of both hands together and pushed them inside, then began to spread them.

“Ow!” the woman screamed. “Owww! Please stop.”

Sammy persisted.

“Owww! Dear God!”

Sammy removed her fingers and a burst of bloody fluid flowed from the cavity. “What’s that?” asked Emilio.

“I think the placenta has been abrupted. The placental lining has separated from the uterus. Her body is trying to expel the fetus and the placenta. I’m going back in again.”

“Owww! My God!”

The children cried from the other room.

Sammy stretched the cervix as much as she could bear, hearing the woman scream. Then she said, “I’m going to let you rest for a moment. Then we have to begin again. I’m going to give you some cotton root bark to help see if we can induce your body into labor.” She went into the kitchen and found some water which she poured into a glass. She mixed a few drops of the fluid in her tiny vial in it. She returned and forced Estella to drink half of it. “In ten minutes, I’ll need you to drink the rest.”

She pulled Emilio aside and said, “Estella’s body is trying to feed blood into the placenta. But the placenta has probably detached. So the blood is pooling in the uterine cavity. There is no way to stop the bleeding. She is only 5-6 cm dilated, so the dead fetus can’t be expelled. I’m guessing she is losing a half-cup of blood every minute. We’ve got to get the dead fetus out or she will die.”

“What do we do?”

“I don’t know. I’m not a surgeon, so I can’t simply slit her belly and pull the fetus out like a cesarean section. I’m sure she’d die if I did. So I need to keep stretching her cervix.”

She returned to Estella and feeding her the remaining cotton root bark solution. She removed her sweatshirt as she explained what she needed to do. “I’m going to keep stretching and you need to keep pushing.” They worked for another 45 minutes or so, both sweating profusely in the cool room.

The woman screamed in agony. “Este dolor me esta matando.”

Sammy turned to Emilio and asked what she said. “The pain is killing her.”

They had made little progress when Sammy noticed that Estella was beginning to go in and out of consciousness. “Work with me, Estella! Don’t leave me!”

Estella drifted out of consciousness again. Emilio yelled, “¡Pelea por tu vida!”

Sammy became panicky. Indecision wracked her brain as she struggled with what to do. “Keep her talking, Emilio. Keep her awake!”

“Her hands are getting cold. She’s shivering,” Emilio whispered.

 She noticed Estella’s lips were turning purple. Sammy realized that Estella was bleeding to death. Sammy had no forceps, but she knew the fetus needed to be extracted. She squeezed her right hand inside Estella’s uterus. She felt the fetus’ head, but found nothing to grab. She pushed the head back, hoping to extend her hand inside further. Estella awoke from her light-headedness and she screamed. Sammy pulled out her hand, empty. Emilio was wracked with vicarious agony.

“¡Mi esposa, mi querida esposa!”

Sammy took a moment to gather her thoughts. Every scenario she could envision had little chance of success. She could do nothing, and Estella would surely die. She could slit her belly and do a C-section, but she had no knowledge of how and few tools to repair the cut. She could slice the inner wall of the birth canal, with likely the same result. But whatever decision she was going to make, she needed to make it quickly!

She reached into her bag and withdrew a sheathed scalpel. “I’m going to slit her birth canal,” she told Emilio.

Emilio heard her and recoiled in horror, but Estella didn’t. She was unconscious. Sammy made a slit about 1” deep at two o-clock and another at ten o-clock. She reached inside with her right hand and grabbed the dead fetus under its chin, reaching with the fingertips of her index and ring fingers. As gently as she could, she slid her hand and the fetus back through the enlarged canal and into the outside world. Blood spewed everywhere, both from the uterus and the surgical cuts. The fetus was blue and lifeless. It was a boy. She cut its cord and set it at the foot of the bed.

She looked to her bag for a needle and thread to suture the wound. When she looked, Estella’s face was ashen and comatose, wide-eyed and frozen in a rictus of distress. Emilio was crying. Sammy reached for Estella’s neck to see if should could detect a pulse from the jugular vein. Nothing. She looked at Emilio and said, “She’s gone. She’s dead. I’m so sorry.”

The children walked inside and saw Emilio crying over their dead mother. The two year old saw the blood and the fetus, and screamed. The children ran to their mother and hugged her lifeless body. Emilio said to the corpse, “Adiós mi amor.” 

“I am sorry, so, so sorry,” Sammy said painfully. “I wish I had known what to do. Her death is my fault.”