Mrs. O’Rahilly, are you all right?

She nodded with her eyes averted, as if embarrassed to be intruding on the other woman’s tragedy. But wasn’t a maternity ward like that, a random tin of buttons, one thing always jostling the next?

Over by the wall, Ita Noonan seemed asleep again.

Mrs. Garrett, we’re just waiting for the afterbirth now, so I need you on your back.

Bridie’s face showed me she’d never heard of it.

I explained under my breath: A big organ at the end of this cord that was keeping the baby alive.

(Until it failed to do that.)

The cord dangling out of Delia Garrett resembled a length of bladder wrack washed up on the shore. I kept up a very light traction on it while pressing a sterile cloth to her laceration.

Bridie stroked and murmured as if the mother were an injured dog.

Fifteen minutes passed by my watch. Fifteen minutes of the cloth reddening, and Delia Garrett crying. Fifteen minutes of holding the top of her belly to encourage the uterus to contract and expel its useless load. Not a word spoken in the small room. The cord wasn’t lengthening at all; the uterus wasn’t rising or firming or getting more mobile. And Delia Garrett was bleeding more than before.

But our policy was to give the placenta an hour to come out on its own. Up to two if the patient had been given chloroform, which could slow down this stage.

A whisper from Bridie: Can’t you give the cord a yank?

I shook my head. I didn’t say that it might break off or I might rip out the whole womb. I’d seen the latter happen to a worn-out grandmother, forty-seven years old, even though Sister Finnigan had been scrupulously careful, and whenever I recalled the moment, I thought I’d throw up.

Delia Garrett’s curls were flattened on the pillow. I put the sticky back of my hand to her throat to be sure she had no fever. Give nature an hour, I reminded myself.

But I had a bad feeling. The placenta might be stuck to the inner wall, and if so, the longer it clung on, the more likely she’d get an infection.

I should wait for Dr. MacAuliffe. Or send Bridie again and tell her not to come back without him. Except what did that youngster know about this woman’s insides?

A warm scarlet wave brimmed and flowed onto the sheet. Oh, Christ. The afterbirth must have ripped partly away. This was how so many mothers began to die.

I rubbed the uterus hard to help expel it, squeezed her like a lemon. Here you go, Mrs. Garrett, one more push now—

The cord’s burden slithered out, a dark-maroon side of meat.

There!

But relief drained away as I spotted what I was dreading: half the afterbirth was missing. The red tide was rising, soaking the bedding.

I remembered the rule: A midwife should never risk manual removal of the placenta unless all other methods for controlling haemorrhage have failed and no doctor is available to perform the procedure. But there was no time, and if I dithered any longer, Delia Garrett was going to bleed to death.

At the sink, I scoured my hands so hard, the nailbrush left red lines on my skin and the carbolic burnt. I sensed the bone man just outside the door. He’d claimed one small life already before any of us had realised, and now he was hovering close by, doing his rattling dance, swinging his smirking skull like a turnip in his bony fingers. I soaped my hands and tugged on a pair of rubber gloves.

I parted Delia Garrett’s legs with my elbows and poured dilute disinfectant over the torn parts.

She whimpered.

I said, I’ll be as quick as I can. Hold her knees open, Bridie, while I get the rest of it out.

Until now, I’d done this procedure only on an orange. In my third year of training, Sister Finnigan had talked me through a manual removal on a big loose-peeled Spanish one.

I put my left hand on her softened belly and grasped the ball of the uterus through the abdominal wall. I pressed it down to bring it within my reach and held it as steady as I could while I closed my right hand into a cone. I pushed in.

Delia Garrett howled.

A cave behind a waterfall; hot red past the gloves, all the way up my arm. I found the cervix. I went through it as slowly as I could while she wept and thrashed from side to side.

Bridie had her by the shoulders, pinning her. She crooned, Brave girl yourself!

I was in. Immediately I curled my fingertips back so as not to damage the uterine walls. I was a fearful burglar, creeping around a lightless chamber.

Delia Garrett tried to clamp her thighs around my arm but Bridie pulled them back and urged her, Let Nurse Julia fix you, it’ll take only a minute.

How could she promise that? I was lost in here. I couldn’t tell what I was touching through these rubber fingertips.

There, a shape under the heel of my cramped hand—unmistakeable.

Delia Garrett sobbed, Stop, stop.

Just a second.

I ran my little finger behind the afterbirth and raked its strings, sawing it free. I got two fingers behind it, then three, peeled the awful fruit with my awkward gloved hands. Come away, I found myself begging the thing. Release your grip on her.

Please, Nurse!

But I couldn’t show mercy, not yet.

Bridie held Delia Garrett down, soothing her like a mother.

I worked on till I had it. All of it? I twisted the messy bundle and rolled up its membranes in my palm, a slippery tangle of flesh. Coming out now!

(Incongruously cheerful.)

Through the hard round lock I pulled my hand and my treasure. Stuck for a moment—

Then slipped free. The bloody fistful was on the sheet.

Delia Garrett wept on.

Another basin, please, Bridie?

I studied the afterbirth in the dish. This looked like the whole missing section, but to be sure, I needed to do a final sweep for any fragments or clots. I’m just going to have one more quick feel inside, Mrs. Garrett—

Her knees banged together so hard, I heard bone on bone.

I said sternly, It has to be done to make sure you won’t get infected.

I changed to fresh gloves and tore open a packaged ball of antiseptic-soaked gauze. At a nod from me, Bridie got hold of Delia Garrett’s knees. I went back in as gently as I could.

She cried harder but didn’t fight.

I rubbed the whole concavity with the gauze, feeling for any trailing membranes on which bacteria could grow. All right, then, all right, all finished.

I lurched to the sink and stripped off the gloves. I prepared carbolic solution for douching her, to kill any germs I might have introduced, and heated it up over the spirit lamp because hot was better for stopping a haemorrhage. I blinked over my shoulder in case she was going to up and die on me after all that.

Bridie was crouched on the cot, holding the woman’s hand, whispering.

I took down a sterile bulb syringe. The rubbery bulge, with its limp tubes, always reminded me of a red spider that had lost all but two legs. I tested the temperature of the solution by dripping it on the inside of my wrist, then filled a large jar. Fresh gloves.

The bleeding seemed to have slowed. Now, Mrs. Garrett, this will wash you out nicely.

I dropped the syringe’s sinker into the jar and fed the glass nozzle inside her cervix. I squeezed the bulb to pump the liquid in while I massaged her rumpled belly with my other hand. Pinkish water flooded back out of her, across the sheets, soaking my apron and Bridie’s.

At last, the unmistakeable feel of the womb contracting under my palm. The bleeding was stopping. I wouldn’t need to dose her with ergot or plug her with a tin’s worth of gauze. This was over, and I hadn’t lost the mother.