Dr Macleod had been staring at the scan for almost ten minutes before Dr Symonds said, ‘Well? What are we going to do with it?’ After a moment’s hesitation, she added, ‘Sir?’
Dr Macleod took a deep breath and then slowly let it out, in the same way he did when he was about to tell a mother that her baby was stillborn.
‘To be absolutely honest with you, Caroline, I don’t have the first idea. Will it survive once we’ve taken it out of her? Can it survive? And if it does survive – which Heaven help us I pray for its own sake that it doesn’t – what kind of a life can it expect?’
Dr Bhaduri had been examining the scan over Dr Macleod’s shoulder. ‘It’s difficult to tell if it’s male or female.’
‘It’s difficult to tell if it’s even human,’ said Dr Macleod. ‘Well, of course it must be, because it’s been conceived inside this poor woman’s womb. It seems to have a brain, and a spinal column, but its body is severely underdeveloped. And all these limbs. I think the question of its gender hardly comes into it. It’s never going to have to decide whether to wear trousers or a skirt, is it?’
He paused and said, ‘Sorry. That was flippant. But I’ve never come across anything like this in all my twenty-seven years of practice, and I’ve come across some dreadfully deformed foetuses in my time, I can tell you. Compared to this, conjoined twins were a doddle.’
Duncan, the anaesthetist, pushed his way in through the double swing doors. He was bald and his belly strained against his tight white surgical jacket so that he looked more like a chef. ‘She’s all prepped for you, doctor.’
Dr Macleod took one last look at the scan, and then stood up. ‘Very well. Let’s meet this unfortunate little creature face to face, shall we?’
They followed Duncan into the theatre, where Chiasoka was lying on the operating table covered by a light green sheet. One of the centre’s more experienced midwives was standing on the opposite side of the table, next to the 4K surgical display screen. A young nurse was counting the instruments that Dr Macleod would be using for the C-section.
As Dr Macleod came in, the midwife lifted the sheet and folded it back to expose Chiasoka’s swollen stomach. He said, ‘Thank you, Glenda,’ and gave her a smile, although it was the queasy smile of a man who is deeply reluctant to do what his professional duty demands of him. He tugged up his surgical mask and was relieved that he could now keep his grim expression to himself.
‘Vital signs all within normal parameters,’ said Duncan, sitting down beside his monitors. ‘Blood pressure 90 over 60, temperature 37, pulse 75. Sixteen breaths per minute.’
On the table next to his instruments, Dr Macleod saw that a large stainless-steel kidney dish was waiting for the foetus, once he had removed it. Hardly a foetus, he thought. But what else can I call it?
‘Let’s get this over with, shall we?’ he said, and beckoned Drs Bhaduri and Symonds to come and stand on either side of him. Usually he liked to have music playing while he operated, Debussy’s La Mer, but today he wanted absolute silence, apart from the beeping of the heart monitor. The nurse handed him a No. 10 scalpel and he deftly made the first horizontal incision into Chiasoka’s abdomen. Blood ran down on either side, which the nurse quickly swabbed. Next he cut open the thin glistening tissue of her uterus.
Dr Bhaduri inserted retractors into the incision to open it wide and to hold it open so that Dr Macleod could reach inside and lift out the foetus.
‘Oh, Jesus,’ whispered Dr Symonds, behind her mask.
Normally, when they opened up the womb, they were presented with the top of the baby’s head, and then with its face, its eyes squinched tight. All they could see inside Chiasoka was a mess of tubes, like a bowlful of thick cannelloni, although some of the tubes appeared to have rows of small nobbles on them, which could have been rudimentary fingers.
Of course, Dr Macleod had already seen these tubes, or tentacles, or whatever they were, in the ultrasound scan, and he had studied them closely. That didn’t diminish his disgust and his horror when they came bulging out of the bloodied incision in Chiasoka’s abdomen, because it was obvious by the way in which they slid over each other, winding and unwinding, that they were very much alive.
Dr Symonds turned away, went over to the corner of the operating theatre and retched. Duncan opened and closed his mouth, but he was speechless, and Glenda the midwife and the nurse stood stunned, even though Dr Macleod had shown them the scans and warned all of them beforehand that the foetus was ‘catastrophically deformed, with supernumerary limbs, among other defects’.
While the scans were detailed, they were just stills. It was the way that the tubes were writhing and struggling that appalled them most of all.
Dr Bhaduri looked at Dr Macleod, his chestnut-coloured eyes wide over his surgical mask. ‘What do we do now, sir?’
‘The first thing we do is get it out of her. Then… then I don’t know what. Duncan, how are her vitals?’
‘Her pulse is a little quicker and her blood pressure’s down, but there’s nothing to panic about. Except for that bellyful of calamari she’s got there. I mean – bugger me.’
While Dr Bhaduri stretched open the incision as wide as possible, Dr Macleod slid his hand into Chiasoka’s womb and took hold of the foetus as gently as he could, although it wriggled furiously as soon as he tried to get a grip on it. He could feel that the tentacles were jointed, with thin stick-like bones inside them, like frogs’ legs. So – deformed as they were – they were limbs.
‘Come on,’ he breathed, behind his mask. ‘Come on out, you little monster.’
He had to tug harder and harder, because the foetus seemed to be resisting every effort to extract it. He would manage to pull it out six or seven centimetres, and then it would immediately slither back into the incision. After this had happened three times, he buried the fingers of his right hand deep between its squirming tentacles so that he could use all his strength to drag it out. It clung on for a few moments, but then Dr Macleod gave it one final wrench, and it slopped out on to the sheet between Chiasoka’s thighs, bloody and slippery with amniotic fluid, and still angrily writhing.
It continued to writhe for a few more seconds as Dr Macleod clamped and cut its umbilical cord. He was panting with effort. Over the years he had performed scores of grisly operations, but the feeling of this foetus’s tentacles flopping against his hands caused him to bring up a mouthful of acidic bile, which he had to swallow. Dr Symonds was still standing in the corner of the theatre with her back turned, while both Glenda and the nurse had turned away too, and Duncan was staring at the foetus in disbelief.
‘Dr Bhaduri,’ said Dr Macleod. ‘Oxytocin.’ This was a hormone injection, which would help Chiasoka to expel the placenta. Dr Bhaduri picked up the hypodermic and lifted the sheet so that he could inject it into Chiasoka’s thigh, but he couldn’t bring himself to look at the foetus and his hands were trembling uncontrollably.
‘I-I...’ he began. ‘I’m sorry, doctor. I don’t believe I can—’
Dr Macleod said, ‘It’s all right. Let me do it.’
He reached across and gently took the syringe out of Dr Bhaduri’s hand. To his relief, the foetus’s tentacles had stopped their furious writhing and were slowly untangling themselves. Dear God, he thought, please let this creature be dying. But as the tentacles unfolded, they gradually revealed a white oval shape in their centre, still glossy with slime and streaked with blood. It was a shape that hadn’t shown up clearly in the ultrasound, because the tentacles or limbs or whatever they were had been wrapped all around it, effectively masking it. It had registered only as a mass of tissue, like a tumour, but because it had appeared to be connected to a small deformed spine, Dr Macleod had assumed that it was the foetus’s brain.
Now that the tentacles had fallen away though, he could clearly see that it was a distorted human head, with a face. The tentacles were growing out of the back of the head, and from its neck, two bulging balloons of thin skin protruded, semi-transparent and laced with red capillaries. These balloons were rhythmically inflating and deflating, like lungs, and Dr Macleod could only assume that they were lungs.
Beneath the lungs, there was a rudimentary body, no bigger than a child’s glove, with tiny male genitals and floppy, undeveloped legs.
Dr Macleod had seen some freakish foetuses – foetuses deformed by drugs or alcohol or genetic abnormalities. But the face of this creature chilled him to the core. It was beautiful, like a cherub. He had rarely seen a newborn child look so perfect. Its eyes were closed as if it were peacefully sleeping. Its bow-shaped lips were slightly parted as it breathed. And yet, by any definition, it was a monster. He couldn’t believe that it not only existed, but that it was still alive.
‘What are we going to do with it?’ said Dr Bhaduri. ‘It’s …it’s… I have never seen anything like it. Its face.’
Dr Macleod snapped himself back to reality. He lifted the sheet that covered Chiasoka’s thigh and injected the oxytocin. He had to think of her welfare above everything. The oxytocin would stimulate her to release the placenta, and then he would try to remove it from her uterus by controlled cord traction. That would lessen the risk of infection.
‘Her blood pressure’s dropping,’ said Duncan. ‘Heart rate’s okay though.’
Glenda the midwife said, ‘The thing, doctor. The foetus. Look – it’s having trouble breathing.’
She was right. The foetus had started to snuffle, twitching its head from side to side, and Dr Macleod could see that its nostrils were blocked with mucus. Its tentacles had started to twitch again too, so that its head was joggled up and down.
If this had been anything like a normal birth, he would have told the nurse to use an aspirator and clear out its nasal passages immediately, but now he hesitated. Despite its angelic face, perhaps it would be kinder to let this poor creature suffocate. In fact, he was already thinking about a massive dose of morphine to finish it off.
It spluttered and choked, and then to Dr Macleod’s horror, it opened its eyes. Clear, sapphire-blue eyes stared at him in the same way that all babies stared at him when they were first born. Who are you, and what am I doing here?
Glenda looked across at him, biting her lip. ‘I know what you’re thinking, sir. I’m thinking the same.’
Dr Symonds had turned around and come slowly back to the operating table. Her face, usually flushed, looked as pale as if she had powdered it in cornflour.
‘It’s so beautiful,’ she whispered. ‘How can anything so horrible be so beautiful?’
The foetus continued to snuffle, and Dr Macleod could see by the way its balloon-like lungs were only half inflating that it was having more and more difficulty breathing.
‘I don’t even understand how it can still be alive,’ he said. He wished that it would stop staring at him, as if it were appealing to him to save it. I can’t breathe, doctor. Please, I’m begging you – I can’t breathe.
‘I’m not God, but my feeling is that we could do no greater kindness to this unfortunate child than to allow him to pass away, with or without our intervention.’
He was aware that he had called the foetus a child, and that he had also called it ‘him’, but he had found it impossible to say ‘it’ when the child was staring at him like that.
‘What do we all think?’ he said. ‘Are we in agreement?’
‘Yes,’ said Dr Bhaduri; and ‘Yes,’ said Dr Symonds. Glenda the midwife nodded.
‘Nurse, would you fetch me 200 milligrams of morphine, please,’ said Dr Macleod. Then with great care, he lifted the tangled foetus off the operating table. It couldn’t have weighed more than three or four pounds. Its bony tentacles wriggled a little, and it was whining for breath, and even when he set it down in the stainless-steel kidney dish, it continued to stare at him with those unblinking blue eyes.
‘I’m sorry,’ he told it, even though he knew that it couldn’t understand him.
But then it took a clogged-up breath and started to cry.