“Just tell her to breathe.”

“What do you call this?” The woman puffed up her cheeks and blew out two sarcastic breaths.

I could hit her with a hammer, Sara thought. That would do the trick.

“For God’s sake, tell that woman to zip it!” The voice came from the next bed, occupied by an old man with pneumonia. He finished his plea with a spasm of wet coughing.

“Marie, I really need you to work with me here,” Sara said. “You’re upsetting the other patients. And there’s really nothing I can do at this point. We just have to let nature take its course.”

“Sara?” Jenny had come up behind her. Her brown hair was askew, lacquered to her forehead with sweat. “A woman’s come in. She’s pretty far along.”

“Just a second.” Sara gave Marie a firm look: No more nonsense. “Are we clear on this?”

“Fine,” the woman huffed. “Have it your way.”

Sara followed Jenny to admissions, where the new woman lay on a gurney, her husband standing beside her, holding her hand. She was older than the patients Sara was used to seeing, maybe forty, with a drawn, hard face and crowded teeth. Shocks of gray ran through her long, damp hair. Sara quickly read her chart.

“Mrs. Jiménez, I’m Dr. Wilson. You’re thirty-six weeks along, is that correct?”

“I’m not sure. About that.”

“How long have you been bleeding?”

“A few days. Just spotting, but then this morning it got worse and I started to hurt.”

“I told her she should have come sooner,” her husband explained. He was a large man in dark blue coveralls; his hands were big as bear paws. “I was at work.”

Sara checked the woman’s heart rate and blood pressure, then drew up the gown and placed her hands on her belly, gently pressing. The woman winced in pain. Sara moved her hands lower, touching here and there, searching for the site of the abruption. That was when she noticed the two boys, young teenagers, sitting off to the side. She exchanged a look with the man but said nothing.

“We have a birthright certificate,” the man said nervously.

“Let’s not worry about that now.” From the pocket of her coat, Sara withdrew the fetoscope and pressed the silver disk against the woman’s abdomen, holding up a hand for silence. A strong, swishing click filled her ears. She recorded the baby’s heart rate on the chart, 118 bpm—a little low, but nothing too concerning yet.

“Okay, Jenny, let’s get her into the OR.” She turned to the woman’s husband. “Mr. Jiménez —”

“Carlos. That’s my first name.”

“Carlos, everything’s going to be fine. But you’ll want your children to wait here.”

The placenta had separated from the uterine wall; that’s where the blood was coming from. The tear might clot on its own, but the fact that the baby was in a breech position complicated matters for a vaginal delivery, and at thirty-six weeks, Sara saw no reason to wait. In the hall outside the OR, she explained what she intended to do.

“We could hold off,” she told the woman’s husband, “but I don’t think that’s wise. The baby might not be getting enough oxygen.”

“Can I stay with her?”

“Not for this.” She took the man by the arm and looked him in the eye. “I’ll take care of her. Trust me, there’ll be lots for you to do later.”

Sara called for the anesthetic and a warmer while she and Jenny washed up and put on their gowns. Jenny cleaned the woman’s belly and pubic area with iodine and bound her to the table. Sara rolled lights into place, snapped on her gloves, and poured the anesthetic into a small dish. Using forceps, she dipped a sponge into the brown liquid, then placed this into the compartment of the breathing mask.

“Okay, Mrs. Jiménez,” she said, “I’m going put this on your face now. It will smell a little strange.”

The woman looked at her with helpless terror. “Is this going to hurt?”

Sara smiled to reassure her. “Believe me, you won’t care. And when you wake up, your baby will be here.” She positioned the breather on the woman’s face. “Just take slow, even breaths.”

The woman was out like a light. Sara rolled the tray of instruments, still warm from the boiler, into place and drew up her mask. With a scalpel she cut a transverse incision at the top of the woman’s pubic bone, then a second to open the uterus. The baby appeared, coiled head-down in the amniotic sac, its fluid tinged pink with blood. Sara carefully punctured the sac and reached inside with forceps.