Birth

Lesson-7

Birth

By A.J. Cronin

Birth Introduction

"Birth" is a scene from "The Citadel" that follows Andrew Manson, who has recently graduated from medical school. It is the storey of how, despite having a difficult relationship with his girlfriend Christine, the newly graduated medical practitioner assisted in the birth of Joe and Susan's child.

Birth Summary

The lesson starts with Joe walking towards his house after an argument with his girlfriend Christine. When he gets home around midnight, he finds Joe Morgan waiting for him outside his house. Joe and Susan were expecting their first child. When Joe arrives, he tells Andrew that he is too nervous to go inside, so Andrew walks in alone. He realises that he still has some time. Susan's mother, who is wise but tense right now, offers him tea. He starts thinking about his girlfriend while sipping his tea. He recalls how his friends are also struggling in their relationships.

On the other hand, he believes that marriage is supposed to be a happy and peaceful experience. As a result, he finds himself in a quandary. Susan's mother expresses her concern for the child due to the complexities of the situation. The procedure results in the birth of a lifeless child. He is unsure whether to address the child or the mother, who is unconscious at the moment, so he chooses to look after Susan first. He injected her with a few medications, and when he saw that her heart was regaining strength, he turned to the child. It was a small boy in excellent condition. He suddenly remembered that there was a problem with limited oxygen supply, so he told the nurse to get hot and cold water.

The nurse, who was initially hesitant, got him what he needed, and he juggled the child in both hot and cold water at the same time. Despite his efforts, the child remained lifeless. While everyone else had given up hope, he continued with the procedures. Finally, the child heaved and came to. Everyone was shocked when his body no longer remained motionless. While holding the child, the nurse muttered prayers. Susan was still unconscious, and her grandmother was praying as well. Andrew left, exhausted, while informing Joe that everything is fine. His heart was full as he walked home around five o'clock in the morning, knowing he had accomplished something meaningful in his life.

Birth Lesson Explanation

THOUGH it was nearly midnight when Andrew reached Bryngower, he found Joe Morgan waiting for him, walking up and down with short steps between the closed surgery and the entrance to the house. At the sight of him the burly driller’s face expressed relief.

• Surgery- a place where a doctor, dentist or other medical practitioner treats or advises patients
• Burly- (a person) large and strong; heavily built
• Driller- someone who works at the drilling controls on the rig floor

When Andrew arrived home around twelve o'clock at night, he noticed Joe Morgan climbing up and down the stairs between his small clinic and the entrance to his house. Joe breathed a sigh of relief when he saw Andrew, the heavy driller.

“Eh, Doctor, I’m glad to see you. I been back and forward here this last hour. The missus wants ye —before time, too.” Andrew, abruptly recalled from the contemplation of his own affairs, told Morgan to wait. He went into the house for his bag, then together they set out for Number 12 Blaina Terrace. The night air was cool and deep with quiet mystery. Usually so perceptive, Andrew now felt dull and listless. He had no premonition that this night call would prove unusual, still less that it would influence his whole future in Blaenelly. The two men walked in silence until they reached the door of Number 12, then Joe drew up short “I’ll not come in,” he said, and his voice showed signs of strain. “But, man, I know ye’ll do well for us.”

• Ye- an old written form of the word ‘the’
• Contemplation- deep reflective thought
• Abruptly- suddenly and unexpectedly
• Perceptive- having or showing sensitive insight
• Listless- lacking energy or enthusiasm
• Premonition- a strong feeling that something is about to happen, especially something unpleasant

Joe Morgan expressed his delight at seeing Doctor Andrew. He informs Andrew that he has been waiting for him for about an hour. Joe's wife requires Andrew to examine her even before her child is born. She is in a critical situation. When Andrew heard this, he had a flashback to an unpleasant night he had with his girlfriend Christine, but without further wasting any time, he told Joe to wait outside while he went to get his bag. When he emerged, they both started walking towards Number 12 Blaina Terrace, where Joe's wife lived. It was a cool night, and the streets were quiet, adding to the mystery. Andrew, who is normally full of life and spirit, was deafeningly quiet and drained of energy. Andrew had no idea what the night had in store for him or how it would impact his life in Blaenelly. They walked silently until they arrived at Number 12. As soon as they arrived, Joe informed Andrew that he had no intention of coming in, but he expressed complete trust in Andrew. Joe's voice was tense and strained.

Inside, a narrow stair led up to a small bedroom, clean but poorly furnished, and lit only by an oil lamp. Here Mrs Morgan’s mother, a tall, grey-haired woman of nearly seventy, and the stout, elderly midwife waited beside the patient, watching Andrew’s expression as he moved about the room.

• Stout- (of a person) rather fat or heavy build
• Midwife- a person, typically a woman, who is trained to assist women in childbirth

Andrew entered the gate by himself. He climbed the stairs, which were narrow in width, and entered a bedroom. The bedroom was not extravagant or luxurious, but it was clean. Inside the room was Joe Morgan's mother-in-law, a woman in her seventies with taller-than-average stature and grey hair, as well as a plump midwife to assist with the childbirth. The midwife was also in her eighties. They sat next to Mrs Morgan, waiting for Andrew.

“Let me make you a cup of tea, Doctor, bach,” said the former quickly, after a few moments. Andrew smiled faintly. He saw that the old woman, wise in experience, realised there must be a period of waiting that she was afraid he would leave the case, saying he would return later. “Don’t fret, mother, I’ll not run away.”

• Bach- used as a term of endearment, often after a personal name
• Smiled faintly- smiling with less energy or a smile that lacks spirit
• Fret- be constantly or visibly anxious; worry

Mrs Morgan's mother, the sweet old lady, offered Andrew a cup of tea. She addressed Andrew as "bach," a term used to express affection. Recognizing that the elderly lady might be concerned about him leaving during the waiting period, he gave her a gentle smile and assured her that he would not leave. Andrew realised she was wise and experienced because she anticipated the period of waiting and was concerned about him leaving.

Down in the kitchen he drank the tea which she gave him. Overwrought as he was, he knew he could not snatch even an hour’s sleep if he went home. He knew, too, that the case here would demand all his attention. A queer lethargy of spirit came upon him. He decided to remain until everything was over.

• Overwrought- in a state of anxiety; tired
• Snatch- manage to take (here)
• Queer- strange; odd
• Lethargy- lack of energy and enthusiasm

In the kitchen downstairs, he sipped his tea. Though he was mentally and physically exhausted from the unpleasant meeting with Christine, he knew that going home would make it impossible for him to get even an hour's worth of sleep. Despite the fact that he was new to his line of work or practise, he was aware that the situation was critical and demanded his full attention. Surprisingly, he felt somewhat active and decided to remain at the place until his duty was completed.

An hour later he went upstairs again, noted the progress made, came down once more, sat by the kitchen fire. It was still, except for the rustle of a cinder in the grate and the slow tick-tock of the wall clock. No, there was another sound —the beat of Morgan’s footsteps as he paced in the street outside. The old woman opposite him sat in her black dress, quite motionless, her eyes strangely alive and wise, probing, never leaving his face

• Rustle- make a soft, muffled crackling sound
• Cinder- a small piece of partly burnt coal or wood that has stopped giving off flames but still has combustible matter in it
• Probing- inquiring closely

After nearly an hour, he went upstairs to check on Mrs Morgan. When he returned, he sat near the kitchen fire. It was late at night, and everything was quiet. The only sounds were the ticking of the clock, Joe's footsteps from outside, and the almost extinguished piece of coal. Mrs Morgan's mother sat in front of him in the kitchen, wearing a black dress. She kept looking at him with her wise eyes that were filled with hope.

His thoughts were heavy, muddled. The episode he had witnessed at Cardiff station still obsessed him morbidly. He thought of Bramwell, foolishly devoted to a woman who deceived him sordidly, of Edward Page, bound to the shrewish Blodwen, of Denny, living unhappily, apart from his wife. His reason told him that all these marriages were dismal failures. It was a conclusion which, in his present state, made him wince. He wished to consider marriage as an idyllic state; yes, he could not otherwise consider it with the image of Christine before him. Her eyes, shining towards him, admitted no other conclusion. It was the conflict between his level, doubting mind and his overflowing heart which left him resentful and confused. He let his chin sink upon his chest, stretched out his legs, stared broodingly into the fire. He remained like this so long, and his thoughts were so filled with Christine, that he started when the old woman opposite suddenly addressed him. Her meditation had pursued a different course.

• Muddled- not arranged in order; untidy
• Morbidly- (with reference to a disturbing or unpleasant interest or activity) in an abnormal and unhealthy manner
• Sordidly- meanly selfish, self-seeking
• Shrewish- (of a woman) bad-tempered or aggressively assertive
• Dismal- causing a mood of gloom or depression
• Wince- make a slight involuntary grimace or shrinking movement of the body out of pain or distress
• Idyllic- like an idyll; extremely happy, peaceful, or picturesque
• Resentful- feeling or expressing bitterness or indignation at having been treated unfairly
• Broodingly- preoccupied with depressing, morbid, or painful memories or thoughts

Clearly, the previous unpleasant encounters with Christine had taken their toll on his mind. He was still haunted by the incident at Cardiff railway station. He began to consider his friends and acquaintances who had had bad love and marriage experiences. He remembered Bramwell, the woman he loved who had cheated on him. He was thinking about Edward Page's relationship with a domineering woman named Blodwen. He reflected on Denny's unhappiness in living apart from his wife. All of this led him to a cringe-inducing conclusion. He wanted to believe that marriage was a happy institution, one that guaranteed peace and companionship. With Christine's gleaming eyes in his mind, he had no reason to believe otherwise. He was undoubtedly in the midst of a conflict, with his mind, heart, and soul all in disagreement. As a result, he rested his chin on his chest and drew his legs out while staring at the fireplace. He sat motionless for a few moments, his thoughts still on Christine, until the old lady broke her silence. She was preoccupied with something else.

“Susan said not to give her the chloroform if it would harm the baby. She’s awful set upon this child, Doctor, bach.” Her old eyes warmed at a sudden thought. She added in a low tone: “Ay, we all are, I fancy.” He collected himself with an effort. “It won’t do any harm, the anaesthetic,” he said kindly. “They’ll be all right.”

• awful – very

Susan was worried, according to the old lady, because of the complicated situation. She even refused anaesthesia if it would harm the baby. She told him how much she cared about the child. The elderly lady corrects herself and states that they are all invested in the child. While she said this, her eyes were filled with warmth. The doctor, who was preoccupied with another set of concerns, somehow cleared his mind and assured the elderly lady that the anaesthetic would not harm either of them.

Here the nurse’s voice was heard calling from the top landing. Andrew glanced at the clock, which now showed half-past three. He rose and went up to the bedroom. He perceived that he might now begin his work.

They were startled to hear the midwife's voice calling out to them. Andrew noticed that it was already 3.30 p.m. and decided to start the procedure. As a result, he stood up to go upstairs to his bedroom.

An hour elapsed. It was a long, harsh struggle. Then, as the first streaks of dawn strayed past the broken edges of the blind, the child was born, lifeless

• Blind- a screen for a window, especially one on a roller or made of slats

It took him nearly an hour to complete the surgery. It was a difficult one. The Morgan child was born as the first rays of sunlight came in through the window's corner. Unfortunately, the child was cold and motionless.

As he gazed at the still form a shiver of horror passed over Andrew. After all that he had promised! His face, heated with his own exertions, chilled suddenly. He hesitated, torn between his desire to attempt to resuscitate the child, and his obligation towards the mother, who was herself in a desperate state. The dilemma was so urgent he did not solve it consciously. Blindly, instinctively, he gave the child to the nurse and turned his attention to Susan Morgan who now lay collapsed, almost pulseless, and not yet out of the ether, upon her side. His haste was desperate, a frantic race against her ebbing strength. It took him only an instant to smash a glass ampule and inject the medicine. Then he flung down the hypodermic syringe and worked unsparingly to restore the flaccid woman. After a few minutes of feverish effort, her heart strengthened; he saw that he might safely leave her. He swung round, in his shirt sleeves, his hair sticking to his damp brow.

• Resuscitate- revive someone from the unconsciousness
• Ether- used as an anaesthetic
• Haste- excessive speed or urgency of movement or action; hurry
• Frantic- conducted in a hurried, excited, and disorganized way
• Ebbing- (of an emotion or quality) gradually decrease
• Hypodermic- relating to the region immediately beneath the skin
• Unsparingly- generous
• Flaccid- lifeless

A shiver ran down his spine as he continued to stare at the lifeless child. While his face was heated from his efforts, a wave of coldness engulfed him. He was heartbroken. Furthermore, he was perplexed; he couldn't decide whether to address the still-born or the depressed mother. He was unable to make a conscious decision. As a result, he addressed the mother first while handing the child over to the nurse. Susan was also unconscious as the effects of the anaesthesia persisted. He worked tirelessly to pull her out of her predicament, even as her strength deteriorated. He quickly broke the glass of the medicine to fill the syringe and inject it into her. He worked tirelessly to bring her back to normal. He returned his attention to the child after a brief moment of relief that she was safe and that her body was regaining strength. His sweaty hair was all over his face, but he didn't waste any time.

“Where’s the child?” The midwife made a frightened gesture. She had placed it beneath the bed. In a flash Andrew knelt down. Fishing amongst the sodden newspapers below the bed, he pulled out the child. A boy, perfectly formed. The limp, warm body was white and soft as tallow. The cord, hastily slashed, lay like a broken stem. The skin was of a lovely texture, smooth and tender. The head lolled on the thin neck. The limbs seemed boneless.

• Sodden- saturated with liquid, especially water; soaked through
• Tallow- the hard fat of animals melted and used to make soap, candles etc.
• Hastily- with excessive speed or urgency; hurriedly
• Slashed- slit
• Lolled- hang loosely

Andrew rushed over to the midwife and inquired about the child. The midwife became concerned and inquired as to the whereabouts of the child. She'd hidden it under the bed. Andrew took the child out without wasting any time. It was a boy who was in good shape and had flawless skin. His skin was extremely soft and his body was warm. The head hung loosely on his frail neck, and the cord hung from his body as well. Because his bones were so soft, his limbs felt boneless.

Still kneeling, Andrew stared at the child with a haggard frown. The whiteness meant only one thing: asphyxia, pallida, and his mind, unnaturally tense, raced back to a case he once had seen in the Samaritan, to the treatment that had been used. Instantly he was on his feet. “Get me hot water and cold water,” he threw out to the nurse. “And basins too. Quick! Quick!” “But, Doctor—” she faltered, her eyes on the pallid body of the child. “Quick!” he shouted.

• Haggard- looking exhausted and unwell, especially from fatigue, worry, or suffering
• Asphyxia- a condition arising when the body is deprived of oxygen, causing unconsciousness or death; suffocation
• Pallida – suffocation or unconscious condition caused by lack of oxygen and excess of carbon dioxide in the blood, accompanied by paleness of the skin, weak pulse, and loss of reflexes
• Faltered- lose strength or momentum
• Pallid- (of a person’s face) pale, typically because of poor health

Andrew glared at the child as he bent to take the child out from beneath the bed. He looked at him and wondered why he was so white. He knew it had to be an oxygen deficiency because he had seen a similar case in Samaritan. He concentrated on the method of treatment. He immediately stood up and told the nurse to bring in hot and cold water in separate tubs. The nurse hesitated because she thought her efforts were useless at the time, but the doctor hurried her along and shouted at her to get it done right away.

Snatching a blanket, he laid the child upon it and began the special method of respiration. The basins arrived, the ewer, the big iron kettle. Frantically he splashed cold water into one basin; into the other he mixed water as hot as his hand could bear. Then, like some crazy juggler, he hurried the child between the two, now plunging it into the icy, now into the steaming bath.

• Ewer- a large jug with a wide mouth, formerly used for carrying water
• Plunging- falling steeply

Andrew grabbed a blanket and laid the child on it while performing the unusual respiration method while she went to take what he told her to. When the nurse arrived with the necessary items, he began the procedure right away. He put cold water alone in one basin and hot water at the temperature he could stand in the other. The next thing he knew, he was dipping the child in those basins one by one. He carried on doing it.

Fifteen minutes passed. Sweat was now running into Andrew’s eyes, blinding him. One of his sleeves hung down, dripping. His breath came pantingly. But no breath came from the lax body of the child.

He completed the procedure in about fifteen minutes. He was exhausted and drenched in sweat to the point of being blinded. One of his sleeves became wet after being unfolded. He took a deep breath. Despite his efforts, the child was still lifeless.

A desperate sense of defeat pressed on him, a raging hopelessness. He felt the midwife watching him in stark consternation, while there, pressed back against the wall where she had all the time remained —her hand pressed to her throat, uttering no sound, her eyes burning upon him —was the old woman. He remembered her longing for a grandchild, as great as had been her daughter’s longing for this child. All dashed away now; futile, beyond remedy…

• Stark- complete
• Consternation- a feeling of anxiety or dismay, typically at something unexcited

He felt he had failed, and all hope seemed to be fading around him. He could feel the nurse's disheartened gaze on him. On the other hand, there was the old lady who couldn't say anything. Her gaze was constantly drawn to him. He remembered how desperately she desired a grandchild. Furthermore, he remembered how her daughter had been waiting for one. It was all a waste of time now.

The floor was now a draggled mess. Stumbling over a sopping towel, Andrew almost dropped the child, which was now wet and slippery in his hands, like a strange, white fish. “For mercy’s sake, Doctor,” whimpered the midwife. “It’s stillborn.”

• Draggled- dirty or wet, typically from being trailed through mud or water
• Stumbling- tripping or losing balance while walking; moving with difficulty
• Sopping- saturated with liquid; wet through
• Whimpered- say something in a low, feeble voice that expresses fear, pain, or unhappiness

The floor was extremely wet and filthy as a result of the ongoing struggle. The doctor was on the possibility of slipping on the towel and losing control of the child. The child was also drenched, and he was compared to a white fish. The midwife then begged the doctor to stop because the child was stillborn.

And then, as by a miracle, the pigmy chest, which his hands enclosed, gave a short, convulsive heave, another… and another… Andrew turned giddy. The sense of life, springing beneath his fingers after all that unavailing striving, was so exquisite it almost made him faint. He redoubled his efforts feverishly. The child was gasping now, deeper and deeper. A bubble of mucus came from one tiny nostril, a joyful iridescent bubble. The limbs were no longer boneless. The head no longer lay back spinelessly. The blanched skin was slowly turning pink. Then, exquisitely, came the child’s cry.

• Pigmy- little (here)
• Convulsive- violent; uncontrollable
• Heave- produce a sigh
• Giddy- weak
• Unavailing- achieving little
• Iridescent- showing luminous colours that seem to change when seen from different angles

The little chest, which was encased in Andrew's hands, took a breath as if by miracle. He kept heaving, making Andrew weak in the knees. He almost passed out from the sensation of the baby's breathing on his fingers. He immediately worked twice as hard to revive him until the child breathed deeply. As he exhaled, a bubble of mucus formed from his tiny nose, his pale skin turned pink, and his body no longer felt lifeless. The next thing he knew, he was crying.

“Dear Father in heaven,” the nurse sobbed hysterically. “It’s come —it’s come alive.” Andrew handed her the child. He felt weak and dazed. About him the room lay in a shuddering litter: blankets, towels, basins, soiled instruments, the hypodermic syringe impaled by its point in the linoleum, the ewer knocked over, the kettle on its side in a puddle of water. Upon the huddled bed the mother still dreamed her way quietly through the anaesthetic. The old woman still stood against the wall. But her hands were together, her lips moved without sound. She was praying.

While tears streamed down her cheeks, the nurse muttered the words of prayer. Andrew felt extremely weak and tired as he handed her the child. The room was obviously a complete mess by this point. All of the equipment, including blankets, towels, basins, soiled instruments, the hypodermic syringe, the ewer, and the kettle, was filthy. The anaesthesia was still having an effect on the mother as she lay still on the bed. Susan's mother remained motionless in one spot, her lips moving in prayer.

Mechanically Andrew wrung out his sleeve, pulled on his jacket. “I’ll fetch my bag later, nurse.” He went downstairs, through the kitchen into the scullery. His lips were dry. At the scullery he took a long drink of water. He reached for his hat and coat. Outside he found Joe standing on the pavement with a tense, expectant face. “All right, Joe,” he said thickly. “Both all right.” It was quite light. Nearly five o’clock. A few miners were already in the streets: the first of the night shift moving out. As Andrew walked with them, spent and slow, his footfalls echoing with the others under the morning sky, he kept thinking blindly, oblivious to all other work he had done in Blaenelly, “I’ve done something; oh, God! I’ve done something real at last.

• Scullery- a small kitchen or room at the back of a house used for washing dishes and other dirty household work

Andrew rolled up his sleeve and put on his jacket, informing the nurse that he would pick up his bag later. He then went downstairs to a small room through the kitchen and grabbed a large glass of water. He put on his coat and hat and went outside. He approached Joe outside and assured him that everything was fine. It was around five o'clock in the morning, and there wasn't much light. He was accompanied by a few miners who had just finished their night shift as he walked back to his house. He had only one thought as their footsteps echoed. His heart was bursting with pride at the realisation that he had finally accomplished something.

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