Birth

BIRTH

By A.J. Cronin

INTRODUCTION

“Birth" is an excerpt from "The Citadel" that revolves around Andrew Manson who just graduated from medical school. It is an account of how the newly graduated medical practitioner helped in bringing Joe and Susan’s child into this world despite going through a tough time with his girlfriend Christine.

Summary 

The story starts with a doctor Andrew Manson who has passed out of medical college and is in a relationship with Christine. She was a school teacher. Andrew had a heated argument with his beloved as he was very outspoken and later on realized this. As soon as he reached his home, Joe was waiting for him anxiously. They were about to have their first child after 20 years of a long marriage. Though it was late at night, he was still ready to perform his duty. When Joe and Andrew reached Morgan’s house, he found that Susan was in severe condition and a midwife was helping her out. He also took his time to understand the case. He wants to focus on the patient and so he diversifies his mind and thinks about his other friends who were also having disturbed relations with their partners.  After that, he put aside all the things and just wanted to focus on Susan Morgan as she lay under anesthesia. Early in the morning, she delivered a child and soon the doctor noticed that it was lifeless. After a long hour of struggle, he was shocked. Soon he saw that the mother was left unconscious and both of them needed urgent treatment. Now, he was left with the choice as to whom he should attend first. He chose the mother as she was left unconscious and he injected some medicines. As soon as she gained some strength, Andrew now ordered the nurse to bring some hot and cold water. Andrew scrutinized the child who was pale and lifeless. At first, he was not able to detect that the case was of asphyxia and the child has low oxygen levels in his blood. If he could he can give up on the child, but he did not and with his sheer determination he juggled up the child in hot and cold water. He knew that it was very important for the couple. He again started by rubbing a towel on the back of the child and also tried to fill some air. After a long hour of battle, the little child gave a motion and started breathing. As soon as the child started crying, Andrew heaved a sigh of relief and he felt that he had done something big that day. He soon told Joe that all is well. He told everything related to the complications of the operation to the Morgans and left the house with great satisfaction and feeling that he has done a great job.

Birth Lesson Explanation

THOUGH it was nearly midnight when Andrew reached Bryn Gower, 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.

Word meaning -

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 reached his house at around twelve at night, he caught the sight of Joe Morgan climbing up and then down the stairs between his small clinic and the entrance to his house.

On seeing Andrew, the heavily built driller, Joe heaved a sigh of relief.

“Eh, Doctor, I’m glad to see you. I have 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 than 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 you'll do well for us.”

Word meaning -

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 how pleased he was to see Doctor Andrew. He tells Andrew how he has been waiting there for him for about an hour now. Joe’s wife needs Andrew to examine her even before the time of her child’s birth. She is in a critical situation. On hearing this, Andrew had a sudden flashback of the unpleasant night he had with his girlfriend Christine but without wasting further time, he told Joe to wait outside while he got his bag. When he came out, they both began walking towards Number 12 Blaine Terrace, where Joe’s wife was. It was a cool night and the streets were silent which made it mysterious. Andrew, who generally is full of life and spirit, was silent and lacked energy. Andrew had no idea what the night had in store for him and that it was going to influence his life in Blaenelly. They both walked silently till they reached Number 12. As soon as they reached, Joe revealed to Andrew that he does not intend on coming in but he showed full confidence in Andrew. Joe’s voice was tense and under pressure.

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.

Word meaning -

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 alone. He took the stairs which were of rather a small width and reached a bedroom. The bedroom was not lavish or luxurious, but, it was neat. Inside the room was Joe Morgan’s mother-in-law, a woman of around seventy with larger than the average height and grey hair along with a plump midwife to assist the childbirth. The midwife was also of elderly age. They both sat beside 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, realized 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.”

Word meaning -

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

The sweet old lady (Mrs. Morgan’s mother) offered Andrew a cup of tea. She addressed Andrew as “bach” which is used while displaying affection. Realizing that the old lady might be worried about him leaving during the waiting period, he gave her a gentle smile and comforted her by assuring her that he will not go away. The fact that she anticipated the period of waiting and was worried about him running away made Andrew realize that she was wise and had plenty of experience.

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

Word meaning -

Overwrought- in a state of anxiety; tired

Snatch- manage to take (here)

Queer- strange; odd

Lethargy- lack of energy and enthusiasm

He sipped the tea in the kitchen downstairs. Though he was mentally and physically exhausted because of the unpleasant meeting with Christine, he knew it was impossible for him to even get an hour’s worth of sleep if he went home. Although new in his line of practice, he was aware that the situation was critical and called for his attentiveness. Strangely, he felt a bit active and decided to stay at the place till his duty was fulfilled.

An hour later he went upstairs again, noted the progress made, came down once more, and sat by the kitchen fire. It was still, except for the rustle of 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.

Word meaning -

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 the combustible matter in it

Probing- inquiring closely

He went upstairs after almost an hour to check upon Mrs. Morgan. He sat near the kitchen fire upon coming back. It was that time of the night when everything was still. The only sounds that came were of the ticking clock, Joe’s footsteps from the outside and from the almost extinguished piece of coal. While he sat in the kitchen, Mrs. Morgan’s mother sat in front of him wearing her black dress. She looked at him constantly 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.

Word meaning -

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 earlier unpleasant moments with Christine had taken a toll on his mind. He was still being haunted by the incident that took place at Cardiff station. He began thinking of his friends and acquaintances who have had bad experiences in love and marriage. He thought of Bramwell, the woman he loved who had cheated on him. He contemplated upon the relationship of Edward Page, who was committed to a dominating woman named Blodwen. He reflected upon how Denny is living away from his wife not-so-happily. All of this brought him to an inference that made him cringe. He wished to believe that the institution of marriage was a cheerful one, one that guaranteed peace and companionship. He also had no other reason to believe otherwise with Christine’s shining eyes in his mind. He was undoubtedly facing a conflict with all his mind, heart and soul in disagreement. He thus rested his chin on his chest and pulled out his legs while he glanced at the fireplace. He sat still for a few moments, his mind was still preoccupied with Christine until the old lady broke her silence. She was thinking about 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 anesthetic,” he said kindly. “They’ll be all right.”

Word meaning -

awful – very

The old lady tells the doctor how worried Susan was on account of this complicated situation. She even refused to have anesthesia if it were to affect the baby. She told him how invested she was in the child. The old lady corrects herself and says that all of them are invested in the child. Her eyes were filled with warmth while she said this. The doctor, preoccupied with another set of worries, somehow cleared his mind and assured the old lady that the anesthetic would do no harm to 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.

Suddenly, they heard the voice of the midwife calling upon them. Andrew saw that it was already 3.30 and that he shall begin with the procedure. Thus, he got up to go to the bedroom upstairs.

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

Word meaning -

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

It took him almost an hour to perform the surgery. It was a rather tough one. While the first rays of daylight came inside from the corner of the window, the Morgan child was born. Unfortunately, the child was cold and still.

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

Word meaning -

Resuscitate- revive someone from the unconsciousness

Ether- used as an anesthetic

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

As he continued to look at the lifeless child, a shiver passed down his spine. While his face was heated because of the efforts he put in, a wave of coldness held him. He was devastated. Moreover, he was confused; he couldn’t get himself to choose between addressing the still-born or the miserable mother. He could not make the decision consciously. So, he intuitively addressed the mother first while giving the child to the nurse. Susan lay unconscious too as the effects of the anesthesia still persisted. He put in all his efforts to bring her out of the desperate state even while her strength continued to weaken. He instantly broke the medicine’s glass to fill the syringe and inject it into her. He worked tirelessly to bring her to her senses. After a moment, when he was assured that she was safe and her body was beginning to regain its strength, he turned his attention to the child. His hair was all over his sweaty face but he did not waste another moment.

“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.

Word meaning -

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 hastened and asked the midwife about the child. The midwife got anxious and asked him where the child was. She had kept it under the bed. Without wasting another moment, Andrew took the child out. It was a boy in perfect shape and with flawless skin. His body was warm and his skin was extremely soft. The head hung loosely on his weak neck and the cord was hanging too, from his body. His limbs felt boneless because the bones were so soft.

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.

Word meaning -

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 the 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

Still bent to take the child out from beneath the bed, Andrew glared at the child. He observed him and thought about the reason he was so white. He knew it could only be a case of oxygen deprivation because he had seen a similar case in Samaritan. He focused on the treatment that was used. He instantly stood up and instructed the nurse to bring in hot water and cold water in separate tubs. The nurse hesitated because for the moment, she thought the efforts were useless but the doctor hastened and shouted at her to get it done instantly.

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.

Word meaning -

Ewer- a large jug with a wide mouth, formerly used for carrying water

Plunging- falling steeply

While she had gone to take what he told her to, Andrew grabbed a blanket and laid the child on it while he performed the unique respiration method. The nurse arrived with the necessary items and he began the procedure instantly. In one basin, he put cold water alone and in the other, he put hot water at the temperature he could bear. The next moment, he was seen dipping the child in those basins, one after another. He continued 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 did the procedure for about fifteen minutes. He was extremely tired and filled with sweat so much that it blinded him. One of his sleeves got unfolded and wet with water. He breathed heavily. Despite all his effort, the child still lay lifeless.

A desperate sense of defeat pressed on him, 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…

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

He felt that he had failed and suddenly, all his hope was beginning to fade. He could feel the nurse gazing upon him, disheartened. On the other hand, there was the old woman, who couldn’t utter a word. Her eyes were constantly fixated upon him. He instantly remembered how badly she wanted a grandchild. Moreover, he remembered how her daughter was waiting for one. It was all a waste 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.”

Word meaning -
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

After the continued struggle, the floor was extremely wet and dirty. The doctor almost slipped on the towel and he was just about to lose hold of the child. The child was also wet and he is being compared to a white fish. The midwife then pleaded before the doctor and told him to stop as the child is 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.

Word meaning -
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

Just as it was a miracle, the little chest which was enclosed in Andrew’s hands, took a breath. He continued heaving, leaving Andrew weak in his knees. The feeling of the little one’s breathing on his fingers almost made him faint. Instantly, he worked on reviving him with double the efforts until the child breathed deeply. As he gasped, a bubble formed by the mucus was formed from his tiny nose, his pale skin turned pink and his body no longer felt like it was lifeless. The next instant, he started 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, and the kettle on its side in a puddle of water. Upon the huddled bed, the mother still dreamed her way quietly through the anesthetic. The old woman still stood against the wall. But her hands were together, her lips moved without sound. She was praying.

The nurse muttered the words of prayer while tears rolled down her eyes. As Andrew handed her the child, he felt extremely weak and tired. The room was obviously a mess by this time. All the equipment, including blankets, towels, basins, soiled instruments, the hypodermic syringe, the ewer and the kettle were all in a terrible state. The mother lay still on the bed, the anesthesia still had its effect. Susan’s mother stood still in one place, constantly moving her lips 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.

Word meaning -

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

Andrew unfolded his sleeve and put on his jacket while informing the nurse that he will take his bag later. He then went into a small room through the kitchen downstairs and grabbed a large glass of water. He took his coat and hat and headed outside. He met Joe outside and told him that everything was fine. It was around five in the morning and there was not too much light. While walking towards his home, he was accompanied by a few miners who had just completed their night shift. As their footsteps echoed, he had only one thing in mind. His heart was full of the thought that he finally accomplished something.