The Christmas Surprise Read online

  ‘Ssssh,’ he said, face strained. ‘They’re saying she’s not well … Célestine.’

  ‘Not well how?’ said Rosie. ‘She’s only eight months along.’

  ‘They’re not sure about that.’

  ‘Faustine’s a doctor though, right?’

  Stephen shook his head.

  ‘She’s had first-aid training, we all did, but no, she’s a regional manager. She’s got administrative skills.’

  ‘But it’s called Médecins Sans Frontières.’

  ‘Yes, that’s right. But you wouldn’t waste a doctor on managing everybody else, would you?’

  Rosie’s brow furrowed as Faustine disappeared into the hut.

  ‘Well, I should go in,’ she said.

  ‘You haven’t been invited,’ pointed out Stephen.

  ‘No, but I want to take a look at her anyway.’

  ‘I suppose you could, though I’m sure she’s fine.’

  ‘I’m not,’ said Rosie. ‘How old is she?’

  Faustine came hurrying back out of the hut, pulling out her phone. She was swearing.

  ‘What’s up?’ said Stephen.

  ‘There’s something wrong,’ said Faustine. ‘It’s been wrong for a while. And the nearest team is eight hours away. I’m only meant to be here to hand over money and sign some paperwork …’

  ‘Can I see her?’ said Rosie.

  ‘Are you a doctor?’ said Faustine rudely.

  ‘I’m an emergency nurse,’ said Rosie, forcefully rather than apologetically as she usually did. ‘But if that’s no use …’

  Faustine backed down.

  ‘Please,’ she said.

  Inside the hut it was incredibly dark and hot, with a warm, sinister scent: smoke, with something underlying it. There were very few possessions – a couple of tin plates – and an older man and woman sat looking frightened by a small fire, which made the room suffocating. They looked up at Rosie with fear in their eyes.

  Rosie moved towards the bed. On it was a young girl – very young. She was barely developed, not fully grown, and her frightened eyes were enormous in her heart-shaped face, her stomach painfully distended but not huge.

  ‘Célestine?’ Rosie said, quietly and calmly, and knelt down next to her. The girl nodded. Rosie cursed and wished she hadn’t spent all her French lessons up the back of the class with her great mate Trix making ‘hee haw hee haw’ noises.

  Faustine was there behind her, however.

  ‘Can you say I’m here to help her?’ said Rosie, and Faustine translated immediately. Rosie felt Célestine’s forehead. She was burning up.

  ‘Oh Lord,’ said Rosie and felt down between the girl’s legs. As she’d suspected, there was a moist patch on the sheet.

  ‘Have you got a medical kit in the car?’ she said. ‘Also, I have to scrub up.’

  Faustine brought in a large box that had been under the front seat, and Rosie did the best she could with the disinfectant wipes and boiled water on offer.

  ‘I think she’s got puerperal fever,’ she said urgently. ‘I’ve seen it before. She needs to be in hospital. Her waters have broken but her labour hasn’t started and she’s got an infection. How pregnant is she really?’

  Faustine asked the older couple – Célestine’s parents – who indicated various measures.

  ‘Ask the girl,’ said Rosie crossly. ‘And tell her we need to know; we absolutely need to know exactly. It’s going to make all the difference.’

  Faustine spoke to Célestine gravely, then counted back on her fingers, checking quickly with the parents.

  ‘Oh, that explains it,’ she said finally.

  ‘What?’ said Rosie, who was palpating Célestine’s stomach, trying to feel the baby move.

  ‘She told her parents it was when her betrothed came home in the winter time, but it wasn’t. It was the festival when the warriors arrived in the village. This baby is very late, not early.’

  ‘Crap,’ said Rosie. ‘Right. Okay. OKAY!’ For she had felt a flutter under her hand, a tiny movement that told her what she needed to know: this baby was alive.

  She looked at Célestine’s face.

  ‘How long has she felt so bad?’

  ‘Three days,’ translated back Faustine, and Rosie swallowed in disbelief.

  ‘Where’s the nearest hospital? This baby needs to come out now. Every second we delay, we’re increasing the risks – these are real risks. Is there a helicopter?’

  Faustine snorted.

  ‘No.’

  ‘Well we need to drive her somewhere, then. Where’s the nearest hospital?’

  ‘She will be in far more danger in the hospital,’ said Faustine. ‘It’s a haven of infection. It’s not safe. We were going to take her to the mission hospital, but it’s an overnight drive back towards the city.’

  ‘But she needs drugs, monitoring …’ Rosie pulled back the sheet on the girl’s narrow hips. ‘I don’t think she can even give birth. She needs a Caesarean.’

  Faustine looked and nodded.

  ‘I’ll radio in to our nearest field team. They’re working in a refugee camp …’

  ‘Well they need to be here,’ said Rosie.

  She took out a cool disinfected towel and rubbed it on Célestine’s head, then went outside to think.

  ‘What is it?’ said Stephen, who was pacing in the shade, the children making passes at his stick.

  ‘She needs to give birth,’ said Rosie. ‘She’s got an infection, and if we don’t get the baby out it will kill them both.’

  ‘Can you do it?’

  ‘I can try and induce it.’ She looked at Stephen. ‘But she’s far too young to have a baby, you know. It’s going to be a difficult birth. She really needs a section, and I definitely couldn’t do that. Or not without killing her; there’s no anaesthetic. CHRIST.’

  Stephen looked at her.

  ‘Oh God,’ he said. ‘Oh God, I can’t believe I brought you out to this.’

  Rosie shrugged and shook her head.

  ‘Well let’s just try and think that it would be even worse if I wasn’t here …’

  Faustine came running out. Her face was calm, but very pale.

  ‘She’s fitting.’

  ‘Oh crap,’ said Rosie. ‘This baby can’t wait. It can’t. How far away are the field team?’

  ‘Eight hours,’ said Faustine.

  Rosie swore.

  ‘She hasn’t got eight hours. I’ve seen this before.’

  Both the others nodded.

  ‘Unpack me a pair of gloves,’ said Rosie. ‘Faustine, I’ll need you.’

  Célestine’s parents, who had already lost both their sons, sat looking carefully ahead, too numbed by fate to do anything else. Rosie pulled on the gloves and got Faustine to try and cool the girl with stream water – Stephen fetched it – though it was not as clean as she would have liked. She set a pot to boil on the fire, then, very carefully, gave the girl a ‘sweep’: a gentle stimulation of the ovaries to try and bring on labour. Now that her waters had gone, the baby really needed to be delivered or risk even more infection. And round here, everything you touched was infection.

  Célestine moaned and clutched at the thin cotton covering her. Faustine murmured to her comfortingly in French and mopped her brow. Rosie had found a stethoscope in the medical bag but could tell too from touch that the baby was alive. For now.

  Suddenly a great wrench went through the girl and she cried out.

  ‘Yes,’ said Rosie. ‘Yes. That’s labour starting.’ She looked at the girl’s face in pity. ‘And it’s not messing about.’

  All through the day and on into the night, Célestine laboured in the boiling heat, her cries faint as Rosie did her best to hold on to her. The group doctor was talking her through it on the radio, but she remembered most of it from her training, and from delivering Edison’s sister at Christmas time, although that seemed now incredibly far away; a different era, almost, in a clean room, with a doctor present and a healthy, motivated mother. Cé
lestine on the other hand was unresisting, her eyes cloudy.

  As they went on through the night, still with no sign of the back-up team – their jeep had broken down on the way and there was no prospect of replacement parts, it seemed – everyone dozed in broken jerks here and there whilst Stephen brewed tea and more villagers arrived, their faces grave, with offerings of food.

  By three o’clock, Rosie felt incredibly filthy and delirious with tiredness; she couldn’t imagine what Célestine was going through. Célestine’s eyes flickered occasionally; she was in a strange world of her own, a world of animal noises and deep disconnection. She could not answer a basic question. And she was not dilating, not properly.

  The group doctor was asking Rosie with some urgency if she could possibly perform a section, and she was telling him with absolute clarity that she could not, practically, morally, ethically or without some risk of killing both mother and child. The group doctor pointed out that she was likely to do that by doing nothing, and Rosie squeezed her eyes tight shut and wiped her grimy forehead and looked at Stephen, who looked back, neither of them knowing what was right and what they should do.

  Eventually, twenty-four hours after Célestine had gone into labour, they heard the most welcome noise ever: the sound of a heavy four-wheel-drive car turning into the village. Rosie jumped up as the team thundered towards the hut, her heart pounding with relief, but as the three sober-looking people came in – two men, one local, one French, and a woman – one look at their faces told her everything she needed to know.

  She offered to leave, let them perform their duties, but as she did so, Célestine roused briefly, made a little noise, and grasped Rosie’s sleeve with weak fingers. The doctor nodded and Rosie sat back down.

  ‘Hush,’ she said to the girl, mopping her brow gently, trying to bring her temperature down. The truck had ice, which she tried to feed Célestine, stroking her, cooing to her, using words that weren’t of any language but the international sound of one human being attempting to comfort another.

  The team prepped as quickly as they were able, and one of the men approached with a gas mask, ready to administer a general anaesthetic. Célestine turned her face away, and Rosie, with gentle coaxing, attempted to get the mask on her. There was a bit of a muddle – a strangulated yell, an arm flailing out briefly, the French doctor swearing – then, suddenly, Célestine turned towards Rosie, looked at her once – a sharp, entirely clear, direct look that Rosie would never forget – and said huskily, very slowly, ‘Bébé … vive.’

  Then slowly, almost happily, her eyes drooped and then closed, so that she looked for all the world like a baby going to sleep. She exhaled once, a long, ragged sound, and then, as they all froze watching, her grip on Rosie’s hand unfurled and she lay still.

  Her mother, in the corner of the hut, sank to the floor with a howl. Faustine immediately went to take her out. As Rosie stood there, numb, the doctors continued as if nothing had happened.

  ‘You’re going to …’

  They looked at her.

  ‘You can clear out now if you like; this will have to be quick,’ said one of them in broken English.

  Rosie stumbled out of the hut, into the arms of an anxious, waiting Stephen.

  ‘What?’ he said, but she could only shake her head, too shocked to speak.

  One of the children led them down a long path towards a waterfall, where the water tipped and spilled over boulders, frothing at the bottom. Neither of them said a word as they stripped down to their underwear and got into the water.

  The swift current blasted off the sweat and the muck and woke Rosie out of her stupor. She let herself be completely consumed by the flow and the cleanliness. Finally, feeling cool for the first time since she’d arrived, she stood upright on two stones. Then she burst into tears.

  Stephen came towards her.

  ‘Ssssh,’ he said, taking her in his arms, his chest glistening with spray. ‘You were magnificent! You did brilliantly!’

  ‘I couldn’t help her,’ said Rosie. ‘I couldn’t help her.’

  ‘Of course you did,’ he said in surprise. ‘You did everything right, Rosie. Everything. You kept her going until the medics got here.’

  ‘I shouldn’t have started labour,’ said Rosie. ‘I should have just waited.’

  Stephen shook his head.

  ‘Don’t be ridiculous, she was already very sick,’ he said. ‘There’s no way she’d have lasted that long. No way. They would have been too late, Rosie.’

  Rosie choked back tears.

  ‘She was only a child.’

  ‘It’s different here,’ said Stephen. ‘And I don’t mean different because it’s Africa. I mean because it’s deep bush. Deep in the country. You help where you can, you comfort where you can, and you don’t panic. And you didn’t panic. When the time came, you did everything right.’

  Rosie was still coming to terms with what had happened. She had seen people die before, of course, in A&E. From horrible, pointless things. But not from something so preventable.

  Stephen held her tightly close to him.

  ‘Come on,’ he said. ‘We’ll go and get some sleep. You did your best darling. That’s all you can do. I was very proud of you.’

  She looked up at him and swallowed.

  ‘I just want …’

  ‘I know,’ said Stephen. ‘I know. You want everything to be fixed, you want everything to be fine. But that’s the first lesson you learn out here: you do what you can.’

  He swallowed.

  ‘I learned the hard way too.’

  They picked their way back up the path to the little cluster of huts in the sandy clearing. As they grew closer, they heard it. At first Rosie thought it wasn’t possible. Or that it was somebody else’s; the village was full of children. But as they approached the dingy little hut, it became clear from the huge crowd of people outside it that the mewling noise was coming from within.

  Faustine beckoned them over. Her face, with its clear skin and fine dark brows, was an exhausted mask. Rosie noticed the smell of blood immediately and looked up, full of foreboding.

  Faustine shrugged.

  ‘Without you they would both have died.’

  Rosie gasped. Already Célestine’s body had been removed. Sand was being swept across the floor. Sitting in the corner was a woman Rosie had not seen before; a heavy-set older woman who nonetheless was breastfeeding a tiny infant. And there too, with the same numb look of shock they had worn for the last two days, were Célestine’s parents: stoic, resigned, as if a life in which your children died before you was absolutely normal. Rosie felt her heart begin to break.

  She approached the child. It was a little boy. He had been cleaned up and had finished feeding; the woman happily handed him over for Rosie to have a look. She put him up on the bed to check him over. He responded well to stimulus; his pupils contracted well; there was no jaundice. But she noticed that his right arm did not shoot up when he was dropped gently backwards, as she would expect. She tried it again and again, and looked more closely at the arm. The tiny fingers, with their perfect little nails, did not grasp on to hers as the left hand did without any trouble at all. The hand – he was a very pale coffee colour – was lighter than the other, with a bluish tinge all the way up to the elbow.

  ‘Faustine!’ called Rosie. Outside, the doctors were smoking and chatting to a middle-aged man who had appeared and was gesticulating with some importance. ‘Can you send one of the doctors over?’

  The local doctor came over and followed her in. She showed him what she’d noticed and he screwed up his face and gathered the others.

  ‘They were about to check the baby again,’ said Faustine defensively. ‘They were clearing up after the mother.’

  ‘I realise that,’ said Rosie patiently. ‘I just want everyone to take a look.’

  Now there were the first stirrings of life in the grandparents. The man came over to examine the baby with them. His face looked concerned. A loud debate
started that Rosie could not follow, but at one point the baby started crying again. The wet nurse took him back and someone brought her a plate of food, which she ate with her free hand. Stephen ushered Rosie out of the hut and over to where a canvas tent had been set up for them. Inside, four comfortable-looking camp beds had been unpacked. Suddenly all Rosie wanted to do was lie down and sleep.

  Stephen sat next to her on one of the beds.

  ‘What’s wrong with the baby?’ he said, straight out, holding her gaze intently. Rosie thought he must be very tired too.

  ‘Um, it’s hard to tell,’ she said. ‘His neurological impulses all seem fine; his pupils are responding, his grasp, all of that; he seems very smart and alert. But his right arm is a problem. It’s possible he was lying badly in the womb, that it’s got damaged in some way. It may have developed that way, or they may have been in such a rush to get him out they damaged him somehow. But his arm is limp and I don’t think … I don’t think it’s a temporary thing. I don’t think it’s ever going to work.’

  Stephen swallowed. She still didn’t understand, not in the slightest, the intense look on his face.

  ‘I mean, he’ll probably be all right with one arm … It’s a shame it’s his right, if he’s right-handed, but people can compensate a lot.’

  ‘Not here,’ said Stephen shortly.

  A small child came in and offered them two cups of tea, which they took with thanks, even though it tasted very odd to Rosie. But just to drink something warm and wet was very comforting. Her eyelids were starting to droop.

  ‘Oh,’ she said, wearily. In her head, she had an idea that the MSF people would take him, would know what to do with him, or, he would be subsumed into village life, raised collectively with the other children, playing joyfully in the sand, sitting in long rows at lessons …

  ‘So—’

  They were interrupted by the middle-aged man Rosie had noticed before, the one with the air of self-importance. He wore a very smart robe over a businessman’s shirt with a white collar and beckoned them to come.

  Stephen glanced at Rosie and they followed the man back to the hut. Outside, Faustine was hovering, looking worried. Célestine’s parents were standing stiffly, the baby fast asleep in his grandfather’s arms.