THE MATRIARCH
By Jeff Robinson

“Dr. Hansen,” said the nurse, “I think that package you’ve been asking about just arrived in this afternoon’s priority mail.”

Gregory Hansen, one of the more respected OB/GYN specialists in the Hillsbury Medical Center, interrupted his review of the Collins’ baby sonograms, stood and hurriedly took the cardboard envelope from his administrative assistant. Without so much as a word, he ripped open the seam of the package and removed a stack of a dozen Xeroxed pages and began examining them.

Glaring at him, Ruth Parrish, his office manager and staff nurse, folded her arms sternly and scolded him.

“This isn’t more research on that Rutherford woman, is it? Didn’t she forbid you to dig into her medical history?”

Without looking up, Dr. Hansen muttered, “She can’t stop me. As her personal physician, I’m authorized to evaluate any factors that might have an effect on her health, her pregnancy, or the potential health of her baby.”

“But that doesn’t include searching historical birth and death records for her family in New England going back… what is it…more than two hundred years?”

Pulling out one sheet and holding it up, he answered, “Actually, it’s closer to two hundred and eighty years. Look, I have documentation going back ten generations now and they all show the same thing.”

“But, Greg,” she said, reaching out and taking the sheet of paper he held out to her. “Listen to me.”

Dr. Hansen stopped and lowered the other pages in his hands. Ruth only called him by his first name when she was serious and wanted his full attention. By addressing him with such familiarity she reminded him of the nearly two decades they had worked together.

“This isn’t going to change anything,” she said. “I was here the last time when you explained to Mary Rutherford that her pregnancy involved more than the usual risk. She didn’t listen then and this isn’t going to change her mind.” Ruth waved the blurry Xeroxed printout in her hand. “She’s got to be the most determined woman I have ever met and you scrounging around into her personal history without her permission is just going to make her even madder at you than she already is.”

Gently taking the single page back from Ruth, Gregory sighed and nodded. It was true.

Mary Rutherford was one of the most remarkable and intimidating women he had ever dealt with. She wasn’t loud, or haughty, or condescending, or anything like that. But the way she carried herself and they way she spoke set her apart from ordinary people. She had a commanding presence that set him back whenever she entered his offices. But it was her eyes that affected him the most. She was physically quite beautiful. Her long jet black hair made her look younger than her years, and contrasted with her eyes, her blue-grey eyes, eyes that had an endless depth to them and made her seem ageless in a haunting way. Whenever she looked at him those eyes pieced him like an insect on a bug collector’s examining board. They held him transfixed in a way that made it hard for him to speak. Even after she left his office, the memory of her eyes lingered and held him in awe.

While only forty-two, Mary Rutherford radiated an authority of proud, aristocratic “old-money” like no one else he had ever met. The only child of a wealthy New England couple, Mary had grown up pampered and spoiled in ways even richest people only dreamed of. Yet Mary showed no signs of being spoiled. She was highly educated, confident, and well-spoken. Moreover, she obviously did not take her inherited fortunes for granted. From what he’d heard about her, she guarded her wealth as jealously as if she had earned very penny herself. Why with her money, she could have afforded the best specialists in the country, yet she had sought help at this small, middle-class clinic, simply because it was close by… to save a little money, he supposed.

“Look,” said Gregory, almost pleading. “You don’t understand. When Mary Rutherford told me her mother died in childbirth, I was concerned that there might be some family history of birth complications.”

“I know,” said Ruth. “I was there. And when you inquired about her grandmother, she declined to reply.”

“And that made me suspicious,” said Gregory nodding. “So I looked up birth records in online medical records and found that her mother, grandmother, and great grandmother also died giving birth.”

“Suspicious?” asked Ruth. “What do you mean? You think she is hiding something?”

“No… “Stammered Dr. Hansen. “I mean… it just made me worried and curious. So I dug a little deeper and checked back as far as computer records would go. As I suspected the same phenomenon occurred, every generation. Women in her family always seem to die giving birth.”

Gesturing at the records in Dr. Hansen’s hands, she added, “It looks like you’ve gone back a lot further than that.” Then scowling, she said, “So you think she’s hiding this from you? That’s absurd. Have you ever considered that maybe she’s just a very private person who doesn’t want other people scrutinizing her private family records.”

“I know… and I don’t think she’s hiding anything. In fact, most people can’t even name their great grandparents. I’ll even admit that she doesn’t probably doesn’t even know these details. It’s just that these records indicate she has a family history of childbirth fatalities that has consistently reoccurred over at least the last ten generations. Have you any idea what the odds are of that? I actually had to look up a formula to figure it out but, mathematically, it just can’t happen by accident. There must be some medical condition, like a latent heart or kidney problems or undetected aneurisms that are so stressed by pregnancy that childbirth is almost always fatal for women in her family".

Dropping the papers on his desk, Gregory Hansen closed his eyes. “I knew I should have trusted my instincts. When she couldn’t conceive normally, I should have stopped when traditional methods didn’t result in a viable pregnancy.”

“Now don’t go sexist on me, Gregory,” admonished Ruth. “She’s single and never married, but if she wants a child, she’s entitled to try.”

Dr. Hansen frowned. “It’s not that. At first, I was only worried about her age. After forty, the risks of birth defects go up tremendously. But when artificial insemination didn’t work, I shouldn’t have let her take fertility drugs. Not at her age… and especially not with a medical history like this.”

“But she did conceive, Greg. Besides, it’s not like you had an option,” countered Ruth. “If you hadn’t given her the medications, any of a dozen others doctors in this township would have taken her business.”

“I know, I know. But I should have done something sooner.” Dr. Hansen lowered his head and closed his eyes.

“Like what?” asked Ruth. “She never even came back after the pregnancy tests came back positive. In any case, it’s too late to terminate her pregnancy, now. She’s already past 33 weeks. - seven and a half months.”

“That’s the whole point. You see, there’s another trend that all these medical histories show.” He pushed the papers a few inches forward toward her. “Mary Rutherford’s maternal ancestors also have a history of premature childbirth. They almost always deliver their babies about six weeks early.” Ruth Parrish’s eyebrows furrowed and then her eyes grew wide as she did the calculation in her head.

Before either of them could say another word, there was a knock on the door of Dr. Hansen’s office. Another nurse on the clinic staff stuck her head in and said, “I’m sorry to bother the two of you, but we have an emergency. Hill-Gen just admitted Mary Rutherford. She’s gone into labor early and there appear to be some sort of … complications. They want you there stat.”

Without comment Dr. Hansen and Nurse Parrish hurried out of the clinic, taking Dr. Hansen’s car to the emergency room of Hillsbury General Hospital, a mere mile down the road.

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Dr. Hansen had delivered so many babies at Hillsbury General over the years at so many strange hours of the day that he drove to the hospital almost without conscious thought. His mind was focused on Mary Rutherford and the imminent risk she now faced. Parking near the physicians’ entrance, he took an elevator up to the maternity ward forgetting about Ruth who followed him diligently. His mind was completely preoccupied with Mary Rutherford as he speculated what the complications might be.

As the elevator doors opened at the floor where the maternity ward and OB/GYN department were located, Gregory Hansen hurried over to the nurse’s station and demanded Mary’s chart.

Noting her location, he quickly scanned the details and headed to her room. Upon entering, he noted two other Hill General resident physicians already present. The older one was a senior staff member, named Carlyle; the younger was an intern who had recently joined the hospital, but Gregory could not recall his name. Mary Rutherford lay in bed obviously in pain from ongoing labor pains.

“Ah, Dr. Hansen,” said the Dr. Carlyle, “I’m glad you got here so quickly.” Nodding at the chart in Gregory’s hands, the older doctor added. “You see the problem that has been developing? I was just explaining the situation to Ms. Rutherford.”

“Don’t let me interrupt then,” said Gregory. “Please continue.”

Struggling to breath, Mary Rutherford raised herself up on one elbow and interrupted, saying, “It doesn’t really matter, since as I’ve already explained, I am not consenting to the procedures you have recommended.” She collapsed back onto the bed gasping for air once more.

Dr. Carlyle glared at Mary and stepped away from the bed, motioning for Gregory to join him. Ruth Parrish stayed with Mary and took her hand to comfort her. “This woman is insufferable,” whispered Carlyle. “Both she and her baby are both at risk, but when I mentioned a C-section as a delivery option, she nearly bit my head off.”

“Yes, I would have guessed that,” said Dr. Hansen. “She has not been the most cooperative patient. What do you see as the greatest problem?” he asked candidly. “It’s a tossup,” gestured Carlyle helplessly. “She is in labor and is fully dilated, but she’s been having intermittent seizures and convulsions. She’s even passed out twice for short periods of time, but I haven’t been able to perform any tests. I suspect neurological problems or perhaps even potential imbalance of her electrolytes, but she’s refused to submit to any tests and I haven’t been able to pinpoint the cause for her distress or confirm even the most cursory diagnosis. I only managed to get a stethoscope on her briefly before she pushed me away, but I confirmed that the heartbeat of the fetus is irregular and is likely in great distress as well.

“Unless we can get her to submit to tests, I fear that both the mother’s life and that of her unborn child are both at risk.”

Putting his hand on Dr. Carlyle’s shoulder, Gregory said, “Let me talk to her. Maybe I can explain the situation to her.”

“Good luck,” muttered Dr. Carlyle. Then, glancing once more at Mary, he shook his head and headed back out into the hall.

Walking over to the bedside, Gregory looked first at Mary, who appeared to be resting quietly for the moment, and then at Ruth, who still held Mary’s hand. Ruth shook her head and her lower lip tightened in a brief grimace of sadness.

Before he could say anything, Mary opened her eyes and stared with angry impatience at him.

“Give us a moment,” said Gregory to Ruth. “I want to speak to Mary alone.”

Ruth patted Mary’s hand and nodded. As she left, she the look she flashed at Gregory confirmed her despair.

Pausing, Gregory tried to choose his words carefully.

“You know you’re making this much harder on yourself than you need to,” he said. “If you’d just let us do our jobs, we could make things safer for both you and your child.

The look of anger and barely controlled rage that Mary threw at him, nearly made him take a step back.

“You don’t know what you are talking about,” she hissed at him through gritted teeth. “Just leave me alone and let nature take its course.”

“That is exactly what I don’t want to happen,” he replied. “I’ve done considerable research into your family history and, if nature takes its course, you’ll likely die.”

A momentary look of doubt washed across Mary’s face before it was quickly replaced with the firm resolve that was her trademark. Her cold steel grey eyes were steady and hard, despite the sweat on her brow and her pale complexion.

“What is it that you think you know?” she demanded in a shallow whisper.

“I know that if we don’t take immediate measures, your child will be born prematurely and you may die in childbirth as you mother and grandmother and all the women of your maternal line have died for as long as we have records.”

Mary closed her eyes and grimaced against another contraction. As the wave of pain passed, she let her head drop back on the pillow behind her and said, “Then you do know… something at least.”

Taking short breaths, she gathered herself and said, “What you don’t realize, however, is that it must be this way. It has always been this way. I cannot allow you to interfere. This is how things must be.”

“But if we don’t do something immediately, he said, “Then you could very well die.”

“I know,” said Mary sternly. “And that is what I mean. That is precisely what must happen. That is why I cannot let you intervene.”

For a moment Gregory was sure he had misunderstood. He started to rephrase his last comment, but Mary cut him off once more.

Reaching out, she gasped his hand and squeezed so hard that he winced.

“Don’t. I understood you perfectly. Now understand me. I know I will die and you have to promise me that you won’t do anything to prevent it. Understand? This is how it must be.”

Collapsing once more, she said. “This is the way, it has always been.”

Then she released his hand and her eyes rolled back in her head, as her body shuddered and shivered with another seizure.

Stepping back, he beckoned to Ruth who stood out in the hallway. The nurse hurried to the bedside and together they attended to Mary as best as they could. The seizure lasted only a minute and, as quickly as it had started, it passed, leaving Mary limp and helpless in its wake.

Gregory took her wrist and checked her pulse. It was weak and thread, irregular. The signs were bad and her condition was obviously worsening. He knew it was within his authority to treat her, even against her wishes, if he deemed her incompetent to make a sound judgment, but his pending decision was apparently obvious since Mary reached out once more and took his hand.

While her eyes were still steady and clear, she was clearly weaker and there would be little time to act if he delayed at all.

“Don’t,” she pleaded softly. “Please listen to me. I meant what I said before. It’s always been this way. It has to end this way. It has always happened like this for as far back as I can remember.”

“What do you mean remember?” asked Gregory. “You mean from stories your father told you?”

“No,” she replied. “I remember. In order to be born I always have to die.”

Gregory’s eyebrows furrowed. She was obviously hallucinating. Confused he asked, “What do you mean you must die?”

Impatience flared in her eyes, before the softened once more. “I mean that in order for the child to be born, I must die. If I don’t die, I don’t know what will happen to me. It has always been this way. When I give birth, the child is always a girl, and I always die, and then I awaken in the baby’s body.”

Grimacing with another contraction, she said through gritted teeth. “It has always been this way… for as long as I can remember… so many, many times”

Gregory suddenly realized what she was saying, but it was ludicrous. Mary must be hallucinating badly to make such a claim.

“Please,” she begged, clearly reading his disbelief. “Promise me you won’t intervene. Promise me, please. I don’t know how much longer I can hold on. Even if you don’t believe me, then just respect the last wishes of a dying patient.”

Gregory started to object and then stopped himself. Regardless of whether he believed her claim, he did have a professional obligation to respect the medical wishes of his patients. As much as he disagreed with her choice, it was, after all, her choice and not his.

Taking her hand in his, he nodded and said, “All right, Mary. I promise.”

Gasping loudly, she collapsed back onto the bed free of pain for the moment.

After a long silence, Gregory asked, “So how far back do you remember?” pretending to believe her to comfort her.

“Beyond counting,” she replied in slow shallow breaths. “Further back than you can imagine… before electric lights, before cities, before writing, before farming… “In my earliest memories,” she said. “There were no lights at night to disturb the darkness, except for the fires we used to cook. The only lights were the moon and stars. We were hunters and killed game using spears. There wasn’t woven cloth yet, so we all wore furs.”

Sighing deeply, trying to catch her breath. “For a time,” she said wearily, “some worshipped me as a goddess.” Her voice tapered off and turned into a low moan as contractions began once more.

Gregory did not grasp what she had said until later. At the time, he did not give Mary’s comments much credence at all. His focus was on saving her and her baby.

Mary did not speak again. The strain of the final stages of childbirth consumed the last of her strength and for reasons unknown, at the time, she passed away just as the babies were born.

A side effect of the fertility drugs was that Mary had conceived and given birth to identical twin girls.

Strangely, though, the twin girls did not cry. However, as Ruth and he held the infants side-by-side, they looked at one another with uncanny clarity, quite unlike any newborns he had even seen. Then, in unison, they turned their heads and stared at Dr. Hansen with the same hauntingly steel grey eyes of their late mother.

 

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