The man sitting on a stool in front of me, in Impressionist blue adorned with a spattering of red, only the black of the skin between his mask and his hat living tissue - covered by a face shield; the rest is paper gown and latex glove and boot covers to the knees - he does not panic. He is calm, voice a steady reassurance. "Pitocin wide open. Give me some fundal massage." Eyes flicker to the patient's face. "You're fine. You're just bleeding more than I like. We have to make your uterus clamp down." And clamp down it does. The flow of blood stops, leaving curtains to clot in strings, wiped away by moistened rags, its final rivulets stemmed with quick swipes of a needle, catgut or dissolvable suture, knots tied with an elegant two-handed throw.
Birth is not a pretty thing, O Best Beloved. Babies come out covered in vernix and looking like someone's rolled them in semi-melted butter; they are bloody and wet and wriggling and terribly difficult to hold on to. We had several patients with meconium today; thick green fluid roiling out of the uterus, staining baby and placenta and cord and turning blood to a sickly mud-coloured goo. Patients bleed, red, bright, under brilliant lights that pick out the undertones. This, O Best Beloved, is a red that defines red. I have never seen a colour that is so completely the essence of its description, and only the blood of birth is that living, defining hue. We deliver babies through push after push, skin splitting at times, wiping fecal matter away to keep the field clean, the slow crowning appearance making them cone-headed and bizarrely malformed at first glance.
Today I unslung an umbilical cord from a baby's shoulder where it was stretched bandolier-tight, a tiny guerrilla just hatched from its womb. I made my first unaided laceration repair and tied with a two-handed throw that may not have been elegant but at least it was not too clumsy. I scooped meconium-stained placenta into a bucket; I pinned down a squalling infant and sliced off its foreskin with a scalpel - that makes three, and only a few more that need to be supervised. I broke out the ultrasound machine and missed lecture because of it, but the patients come first. I am the doctor on call. I broke it out again to do a limited ultrasound: head-spine-hand-leg-your baby's waving at you! and a woman went away reassured.
Today has been bloody and full of excrement, both babies' and mothers' and the usual excrement piled high in any institution. But I have knee waders, and that is good. It is 2:25 AM. I am hoping for half an hour of sleep. Perhaps I should go find it.