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  “So who’s going to actually deliver the baby?”

  “Her grandmother. She’s delivered more babies than I have. I know she delivered Maria’s first two. Oh, and just last week she delivered her neighbor’s baby.” He shrugged. “Lady’s got a lot of experience, and she resents anybody barging in who doesn’t belong there. In Irene’s opinion, we do not belong there.”

  “Then she’s a midwife,” Juliette stated, relieved that someone with experience and knowledge was taking over.

  “Of sorts. I mean she’s not trained or anything like that. She’s just always available to do something she’s been doing for sixty years.”

  Sixty years? That alarmed Juliette. “How old is she?”

  “Not sure, since she doesn’t go to doctors or hospitals, and we don’t have her records. But I’m guessing she’s somewhere around eighty, give or take a few years.”

  “Eighty and still delivering babies? Why do you allow that, Damien? You’re the doctor in this village. Shouldn’t you have some say in the medical concerns of the people who live here?”

  “Normally, I do. But when it comes to childbirth, the women here gang up on me and keep me at a distance. It’s their tradition to rally around their mothers in labor and see to the delivery. They’ve been doing it for more years than the two of us combined have been here on this earth. So who am I to intrude?”

  Juliette pushed her hair back from her face. Tonight, it wasn’t banded up in a ponytail. “Do you think they’d mind if I looked in?”

  “As another woman, or as a doctor?”

  “Why can’t I be both?”

  Damien laughed. “You really can’t be that naive, can you?”

  “What do you mean by that?”

  “These people practiced their folk medicine long before anything remotely modern came in and took over, and so many of the older ones still hold on to their old ways. They’ll tolerate us when they need us, but otherwise they’ll resist the hell out of what we try to offer them because they consider that an insult. People trust what they know, and resist anything new to them. The fine art of healing is included in that.”

  From somewhere behind the wall to her right, the quiet voices of people chattering were beginning to grow louder, and Juliette wondered if that was a sign of imminent birth. The ladies in the room with Maria were getting excited. She could almost picture them huddling around the bed, talking, as Maria was assuming the position to deliver. All so casual. “Well, resistance or not, I’m going to go take a peek.”

  “Or you could sit down with me here, have a nice refresco—” Damien held up a glass of blended fruit and ice in salute “—and wait.”

  “Or you could go back home and go to bed, since I’m here now,” she suggested. “George said you pulled thirty-six hours straight, so I think you need the sleep more than I do.”

  “I appreciate the offer, but I think I’ll stay since I’ve been with Maria through this entire pregnancy. And she did ask me, specifically, if I would check the baby after it’s born.” He held his refresco out to her. “Papaya and passion fruit. Really good. Want a sip?”

  What she wanted was to go deliver a baby, but seeing as how that wasn’t going to happen, she still wanted to get into Maria’s bedroom and watch what was going on. Hitching her rucksack higher onto her shoulder, she passed by Damien, whose feet were now propped up on the chair opposite him, and headed on back through the kitchen. “I’ll let you know if it’s a boy or girl,” she said before she stepped into the back hall.

  “It’s a boy,” he called after her.

  “You did some testing to find out?” Juliette asked, clearly surprised that he’d go to such lengths for someone who wanted as little medical intervention as possible.

  “No tests. Just a guess. And I’m usually pretty good at guessing. Got my last five deliveries right. No reason to break that winning streak now.”

  “You’re that confident, are you?”

  In answer, he picked up his refresco, took a sip, then said, “Yep!”

  Damn, he was sexy, sitting there in all his casual, cocky glory. She really didn’t want to think that of him, and maybe her guard was let down because she was so tired but, God help her, she was beginning to like Damien. Not enough to fall for him, in spite of his somewhat unusual charm, but enough to tolerate his ways.

  “Can I come in?” she asked, pushing open Maria’s bedroom door.

  The women in the room all turned to look at her—all but the oldest one, who was seated at the end of the bed, obviously ready to deliver a baby. “Who are you?” one of the women asked.

  “Juliette Allen. El doctor Juliette Allen.”

  “No doctor needed here,” the woman at the end of the bed said quite sternly.

  “That’s what el doctor Damien told me, so I’m not here as a doctor. I’m just here to watch. And if you need someone else to help...”

  “Irene needs no help,” another one of the women informed her.

  Juliette sighed. If Damien were here, he’d be enjoying this rejection. “I won’t get in the way.”

  “Don’t get in the way somewhere else,” Irene, Maria’s grandmother, said. “Maria doesn’t need a stranger here.”

  Struggling to be patient, Juliette smiled, and backed her way over to the door, where she stopped and simply stood, without saying another word. Apparently that was good enough for the women, as they turned their attention back to Maria, who was bearing down in a hard push.

  “Push harder,” Irene encouraged her.

  “I can’t,” the pregnant woman moaned. “Can’t push. Can’t...breathe. Getting too tired.”

  When Juliette heard this, she was instantly on alert. “Maybe reposition her,” she suggested. “Get her head up a little higher. More like she’s sitting rather than laying.”

  Her suggestion was greeted with frowns from everyone in the room. “My grandmother knows how high she’s supposed to sit,” one of the younger women said, her voice curt.

  Before Juliette could respond, a scream from Maria ripped through the room. “I can’t do this!” she cried. “The baby’s not coming.”

  This was more than Juliette could take, and she pushed her way through the crowd in the room and went straight to Irene’s side to bend down and take a look. But what she saw was no progression toward birth. No crowning whatsoever. “How long has she been in heavy labor?” Juliette asked the woman.

  “Not long enough,” the woman responded belligerently.

  “I mean in hours. How long in hours?”

  “About one,” one of the women called out.

  “And it’s been heavy like this since the beginning?” Contractions coming almost one after another.

  “She always has her babies fast,” Irene conceded. “But I think this one is taking too long. I’m worried I don’t see the baby’s head yet.”

  “Can I take a look?” Juliette asked, slinging her rucksack down onto the floor, then opening it up to grab out a blood pressure cuff. Damn, she wished she was back in her clinic, where she could hook up a fetal monitor, because her greatest fear right now was that the baby was in distress and she had no way to observe it.

  “Maria’s having trouble. So if you could move over and let me get a look at her...”

  Irene hesitated for a moment, then nodded and moved aside. “You can help her?”

  “I’m going to try,” Juliette said, taking her position at the end of the bed. “Could you hold back the sheets for me, so I’ve got a little more room to maneuver?” It wasn’t really necessary, but she wanted to include Irene since she was such a vital part of childbirth here in Bombacopsis, and all the women in the village respected her. There was no way Juliette wanted to dismiss Irene and diminish her in the eyes of all the people who trusted her. “And also make sure Maria stays in position?”


  Irene agreed readily, and moved into her place next to Juliette, where she did everything Juliette asked.

  “It’s good we have you here,” the old woman finally said, after Juliette had completed her initial exam. “El doctor Damien is good enough, but this should be left up to a woman.”

  Juliette smiled, hoping that this might be the beginning of the village accepting something they’d never before seen—a female doctor.

  “Did I hear my name mentioned?” Damien asked, poking his head through the door.

  “Just in that the ladies here believe this is no place for a man,” Juliette returned. Then continued, “But I do need some help, in spite of that.”

  “What’s going on?” he asked, stepping fully into the room.

  “We have an obstructed labor in progress,” Juliette called over the increasing noise of the women surrounding her. “In spite of Maria’s strong contractions, her labor isn’t progressing.”

  Juliette pumped up her blood pressure cuff and tried to hear the dull thudding of Maria’s heartbeat after she placed the bell of her stethoscope underneath the cuff. “Her blood pressure is high,” she called out. “As best as I can tell.” Then she felt Maria’s belly, pressed down on it to determine the position of the baby. “Baby’s in normal position. But not progressing down the birth canal.”

  “She needs to push again,” Irene shouted over the crowd.

  “Pushing’s not going to help now,” Juliette explained. “The baby’s ready to come. But it’s not, and trying to push now is only going to make things worse. Put the baby at some risk.”

  The noise of the women was growing louder, deafening, fraying Juliette’s already frayed nerves. Maria was in trouble, she needed Damien to help her with this and she couldn’t even communicate with him, the ladies were so loud. Pressure mounting. Maria moaning even louder. Ladies getting frantic. More pressure—

  “Damien!” she finally yelled. “Can we get these people out of here? I can’t do what I need to do with everybody hovering over me, shouting the way they are.” She was trying her best to shut out all the confusion going on around her, but alarm for Maria’s lack of pushing out the baby was making everybody crazy, including her. “We’ve got a problem going on, and I can’t do what I need to do with everyone hovering over me.” Her own anxiety for Maria and her baby was increasing.

  “Give me a couple of seconds,” Damien called back to her.

  She couldn’t see him, as the door was at such an angle it wasn’t in her line of sight. But she felt reassured just having him in the room. She felt even more reassured when each of the women started to leave the room. Whatever Damien was saying to them was working, and she was glad for that as Maria had turned a pasty white and was slowly sinking into total exhaustion.

  “What have we got?” Damien asked, once all the ladies, with the exception of Irene, had exited.

  “Nothing. Absolutely nothing.”

  “Her contractions?” Damien approached the bed and took Maria’s pulse.

  “Strong and almost continuous. The baby should be coming out now, and I’m getting worried that it’s not.”

  He nodded, and immediately tore into the rucksack he was carrying, producing, in just a matter of seconds, a scalpel, a sterile drape, forceps and a handheld suction device. “Six minutes,” he said, as he grabbed a bottle of sterile wash and pulled the sheet off Maria’s belly.

  “What?” Juliette asked him.

  “I can do an emergency C-section in six minutes from the time I get her sedated. Faster, if I have to. So, stand on the opposite side of me, and let’s get this thing done.” Then, to Maria, “Maria! Can you hear me? It’s el doctor Damien, and I’m going to get your baby out of you right now. But I’m going to have to make a little cut in your belly to do so.” He looked over at Juliette. “How long will it take you to get an IV going?”

  “Not long,” she said, immediately plowing through her medical rucksack to find the necessary equipment. Tubing, needle, IV drip solution. “What are we going to put in it?”

  “I’ve got ketamine.”

  “Ketamine?” she asked. “You didn’t mention that in your drug list.”

  “Because it’s hard for me to come by and I put the little bit I do have back for emergencies.”

  Resourceful, she thought. Ketamine was a valuable property. “Well, a low-dose application of ketamine will work, since this baby’s going to be out of her before the ketamine can cross the blood barrier,” she said, as she readied to stick the IV catheter in Maria’s arm. In no time at all, the IV was started, and Juliette handed Irene the bag of drip solution to hold above the head of the bed so the medication would run down into Maria’s vein, while she piggy-backed on a pouch of ketamine. As soon as the medications were both in place, Juliette opened up the port to let them pass through the tubing into Maria’s body. It took only a couple of minutes for the anesthetization of Maria Salas to commence. “Ready?” she finally asked Damien, noting that he’d prepped the incision site whilst she started the IV.

  “Put a clock on it,” he said, poised to make the first incision through Maria’s abdomen.

  Juliette did, and Damien was right. Six minutes and ten seconds into the procedure and he was handing over a brand-new baby for her to check. “A boy,” she said.

  “I was right,” Damien said, grinning. “And he’s a big one. I’m guessing nine or ten pounds.”

  “Closer to ten,” Juliette said, as she turned her attention to baby Salas while Damien finished up with Maria. First she did the normal suctioning—mouth, nose. Then she took a towel and wrapped it around the baby, poking him gently, trying to get him to cry.

  “Is he OK?” Damien asked, looking over at Juliette for a moment.

  “Well, I don’t have any equipment to do a proper evaluation, but he’s breathing and his heart is beating.”

  “But he’s not crying?” Damien asked.

  “Not yet.”

  “Pinch him gently. Just a little one to see what you get.” Damien grabbed up a pre-threaded suture and began to stitch up Maria’s incision. But he took a second to look over at Juliette as she gave the baby a slight tweak on the bottom of his left foot. And got no response.

  So she switched to tickling. Tickled a little spot on the baby’s upper arm and ran her fingers down his arm lightly to his wrist, then waited for a second when he didn’t respond, and tried it again. This time, baby Salas sucked in a lungful of air and let out with a royal scream.

  “Good work,” Damien said, without looking up at Juliette.

  “How’s Maria?”

  “Hanging in there.”

  “Want me to finish closing for you?” she asked, handing the baby over to Manuela—Maria’s sister—who’d snuck back into the room to be by her sister’s side.

  “No, I’m good. But what you can do is go outside and tell someone in the yard to run over to the hospital and fetch a stretcher. Then round up some volunteers to carry Maria over once I get through here.”

  “You OK?” Juliette asked before she left the room.

  He finally looked up at Juliette, his brown eyes twinkling and his smile spreading from ear to ear. “I just delivered a baby. That always makes me OK.”

  * * *

  “We do good work together,” Damien commented as he and Juliette walked back to the hospital, arm in arm in the dark, leaning heavily on one another. He was tired. Almost too tired to function. But Maria and the baby were probably being settled into the hospital by now, so he had to take one more look at them before he dragged himself back to his hut for what was left of the night.

  “It was a pretty slick delivery,” Juliette admitted. “My first C-section since I assisted in one during my residency. Then later, in my clinic, I referred all my pregnancies to the obstetrics department.”

  “Well, aroun
d here you get to do it all. Bandage a stubbed toe, remove an infected appendix, treat malaria, remedy a bad heartburn. You know, jack-of-all-trades.”

  “So, I know you’re a surgeon, but did you learn these other things in your training, or do you just learn as you go?”

  Truthfully, it had been a culture shock coming here. No matter where he’d worked prior to this, he’d always surrounded himself with a security blanket in that he’d kept strictly to his general surgery, never wandering very far from it. Then this, where he had to wander in all different directions.

  “It’s been a huge learning curve. And yeah, a lot of it I do make up as I go. But the people here are patient with me.”

  “Do you consult outsiders? You know, friends or colleagues from your old days?”

  “Not so much. We don’t have great access to the outside world. Although, if I need to know something bad enough, I’ll go into Cima de la Montaña and scare up an internet connection.” They walked on by his hut, where he took a wistful glance at the front door, wishing he was back in there right now, sleeping peacefully in his uncomfortable bed. “And I did have several of my medical references shipped down to me, so I’ve always got those to fall back on, even though they’re pretty outdated.”

  “Well, if there’s ever anything you want me to look up for you, let me know and I’ll do it when I go back to San José, then I’ll get the answer back to you next time I come.”

  “Are you really coming back?” he asked her. “I mean, your first day has been pretty tough so far, and I haven’t exactly been welcoming.” That was putting it mildly. He’d been downright awful, which he regretted as Juliette was a real trooper. She’d come here first thing this morning, pitched right in and done everything that needed to be done. More, actually. She’d spotted the problem in Maria’s labor, and the way she had assisted with the C-section was downright amazing!

  “Have you been trying to get rid of me? Is that why you’ve been so rude? Because I thought you needed someone else here.”

  They entered the hospital where, down the hall in the ward, George Perkins was settling Maria Salas into bed. Irene, her grandmother, had seated herself in a chair next to the bed and was holding the baby. Maria’s husband, Alvaro, was standing at the foot of the bed along with five other people Damien assumed were relatives or close friends. “I do need someone here. I just wasn’t expecting...you.”