Featured Article » Fiction

Modern Medicine

Written by Kerryn Offord

1632, near Puerto Real, Andalusia

Juan Antonio de Aguilera was sitting trying to read while he waited to hear sounds from above. He glanced across the room at his father, who looked a lot more relaxed than he felt. He put down the book he wasn't managing to read and glanced up toward the bedroom above.

"The baby will come in its own good time," Antonio Diego de Aguilera said.

"But it shouldn't take this long, surely?"

His father shrugged. "María is the most experienced midwife in Puerto Real. With her in charge, what can go wrong?"

The words had barely left his mouth when they heard a baby's cry from above. Antonio smiled smugly. "What did I tell you?"

Juan rose to his feet and started for the stairs. He fully expected the midwife to call him in shortly. What he wasn't expecting was his mother swinging open the door and shouting, "Call for the doctor." Then she looked at Juan, and his stomach fell. Something was wrong, badly wrong.

Juan pushed his way into the bedroom, then stopped. The midwife was massaging Magdalida's nether region and there was blood everywhere.

Juan must have uttered something because the midwife turned to face him. "I can't stop the bleeding," she explained softly. "Nothing I have done has worked."

Juan pushed past her and reached for Magdalida. He ran gentle hands over her face.

She reached out for the hand and guided it to the baby feeding hungrily at her breast. "We have a son," she said.

Juan had to strain to hear. He ran the back of his forefinger gently across his son's face, while trying to ignore the sharp winces that flashed across Magdalida's face. He held her close.

"I want to call him Eduardo, after my papa," she whispered.

Juan looked into her dulling eyes. "Eduardo it will be."

February 1635, Cadiz

Juana de Silva wouldn't normally willingly cross the threshold of Luisa de la Vega's home, let alone drag her granddaughter along with her. However, her good friend, Anna María, wanted Juana to meet her goddaughter, Catalina de Mendoza. It was just unfortunate that the most timely opportunity to inspect the possible candidate for Juan's hand—one of the regular social gatherings arranged to introduce young girls to polite society—should be meeting at Luisa's home.

Juana smiled at the sight of her granddaughter playing with some of the other girls under Catalina's supervision. "She is a most delightful girl," she told Anna María.

"And well connected, even if she is only a minor twig on the Mendoza family tree."

"She has a good dowry?" Juana asked, concentrating on important matters.

"Well, I can't really say it is a good dowry, as Mendoza dowries go, but two villages aren't to be sneezed at."

"And she does seem to be getting on well with Isabel."

Anna María smiled. "Then it is agreed? We arrange for Catalina to meet Juan."

"Yes." Juan was still resisting the idea of providing his children with a new mother, but at least he might make the effort to look at the girl.

"I must show you what my husband sent back from Venice."

The strident tones emitted by Luisa caught Juana's attention. "I wonder what the old witch's husband has paid too much for this time?" she asked her friend.

Beside her, Anna María giggled. "Something extremely rare and expensive, no doubt. I must go to Catalina. You'll write when you've made arrangements?"

Juana nodded, and together they gathered their respective charges and dutifully trailed behind Luisa de la Vega.

Luisa led everyone to an elaborate display cabinet. "This is my most prized possession. My husband was most fortunate in being able to purchase it at considerable expense on his recent trip to Venice." She stepped away to let everyone see.

Juana's granddaughter jumped up, waving a doll. "You've got a Barbie just like mine!"

Juana knew she should reprimand Isabel for speaking without being spoken to, but the horror and embarrassment visible on the faces of Luisa and her cohorts kept her smugly silent while Isabel showed off her doll, which was exactly the same as Luisa's—although considerably more bedraggled.

"Where did you get that?" an outraged Luisa demanded, reaching for the doll in Isabel's hands.

Frightened by Luisa, Isabel rushed to her grandmother. Juana wrapped her arms around the trembling child and faced Luisa. "It's one my youngest son, Alfredo, gave to her."

Luisa pointed an accusing finger at Juana. "You let a child play with a priceless up-time artifact?"

Juana gently stroked Isabel's hair and smiled serenely at Luisa. "Only the ones that had already been well played with."

Isabel turned and, from the safety of her grandmamma's arms, carefully counted off on her fingers the various Barbies and Barbie accessories she had. Juana was impressed at how well her seven-year-old granddaughter remembered what she had been given. She didn't miss one.

"But none of the ones Isabel plays with are in anything like that good condition," Juana said. "No, the 'mint in box' ones like that are kept locked in a cabinet."

"I'm not allowed to play with them." Isabel pouted.

Juana sighed in silent relief when Isabel stopped talking. It wouldn't have done for her to tell everyone that the cabinet in question was in one of the attics. She glanced over at Anna María. Now might be a good time to take their leave. She jerked her head suggestively toward the door and Anna María nodded.

A month later

The planned meeting at San Sebastian's had not been the success Juana had hoped for. Catalina had indicated interest in Juan, but the ungrateful idiot hadn't reciprocated. Instead, he had pushed his way through the crowds in the Street of the Arch after services in his rush to get back to his wretched flying machine, leaving his poor mother to make excuses for his inexcusable behavior.

"It's not right," Juana de Silva protested to her husband later that evening. "Isabel and Eduardo need a mother, and Juan refuses to even consider remarrying."

"My love—Magdalida died in his arms," her less-than-sympathetic husband said.

"It is nothing but foolishness. God needed Magdalida more than Juan and the children did."

Antonio Diego de Aguilera shook his head. "You'll never convince Juan of that. He maintains that he will never expose another woman to that risk again."

Juana snorted. He might be her most favored son, but Juan was still only a man. She couldn't see him keeping that promise forever. However, it was an obstacle . . . just when she'd found an ideal candidate. Catalina de Mendoza was a modest girl of good family and fortune. "Isabel and Eduardo lost both parents when Magdalida died. Juan has buried himself in his flying machines instead of caring about them. Something must be done to convince him to provide them with a loving mother."

"What do you suggest? Father González has already spoken to him, with no effect."

"Priests! What good is a priest? No, what is needed is someone who can convince Juan that what happened to Magdalida is unlikely to happen again."

"One of the up-timers?" Antonio suggested.

"Dr. Nichols would be ideal. Even Juan must have heard of the famous Moor."

"I fear Dr. Nichols is unlikely to be interested in coming to Andalusia," Antonio said. "I'm sure he is much too busy practicing his profession in Grantville."

"What about one of the other doctors?"

Antonio shook his head. "I don't think we could interest an up-time trained doctor to come to Puerto Real. However, Fredo has spoken of the new doctors being trained in Grantville and at Jena. I could write to him and ask him to find someone suitable."

Juana sighed. "Ask him to find an up-timer who has trained as a doctor if he possibly can."

"Of course," Antonio said as he wrote a short note to himself. "Anyway, where is Juan?"

"Where do you think? Chancing his life playing with that devil-spawned machine." Juana shook her head in disgust at the risks Juan was taking. "If God had meant man to fly he would have given him wings."

Meanwhile . . .

"Hold her steady," Juan told the student piloting the airship.

He glanced forward, toward the landing field, where dozens of men were waiting on the ground to grab the handling ropes that dangled from the Pepino. "When you cross the fence, reduce power," he instructed the student.

Fernando López de Pérez nodded to indicate he'd heard the instructions and aimed for the men assembling on the landing field.

They were coming in nicely when Juan felt the first telltale signs of a cross-wind hitting the Pepino. "Apply power," he screamed.

Juan willed Fernando to react, to apply power so that the Pepino would gain lift from its forward momentum, and achieve the safety of altitude. Instead, Fernando cut the throttle back, causing the Pepino to sink closer to the ground.

To Juan's horror, men on the ground grabbed at the handling ropes. He knew there was no way so few men could stop the wind carrying the Pepino away, and leaned over the edge of the gondola to shout at them to let go. Then the full force of the cross-wind hit the Pepino, and sent it sideways. Juan was almost tipped from the gondola as the gas-bag tried to fold under the force of the wind. The airship was blown, careering out of control, toward the trees at the edge of the cleared landing field.

Time passed slowly for Juan as the trees grew closer. From the moment the Pepino hit them, time moved too quickly. He was thrown from the gondola and fell through the branches to the ground. On the ground, staring up at the Pepino entangled in the tree above, his final thought before he blacked out was "Don't let it burn."

Early April, 1635, Grantville, USE

John "Sully" Sullivan guided his mother to the dining room table where his wife and three children were already seated.

After settling her, he took his seat and surveyed his sons and daughter across the empty expanse of the table. John Junior, Jack as he preferred to be called, was as usual, all attentive; Linda was busy tending to her nails; and the youngest, Jacob, was, as he always seemed to be doing these days, feeding his face. "Your mother and I have some good news, and some bad news. Which do you want to hear first?"

"The good news," Jack said.

John glanced over at his wife, but Annamarie shook her head indicating that he had the floor. "Your mother and I have accepted an offer of employment that will allow us to put Jack and Linda through med school, and send Jacob to the university of his choice."

Jacob, always the first to pick-up on points one would prefer were missed, piped up. "Where are these jobs?"

"We will be working for Alfredo de Aguilera's family," Annamarie said.

"But he comes from Spain, and the Spanish are our enemies," Linda protested.

"We're actually at peace," Jack corrected.

John dived in before the kids started squabbling . . . again. "That's enough, you two. Yes, we're currently at peace with Spain, and the contract your mother and I have accepted was too good to turn down. Besides, it'll be easy for us, since your mom insisted that we all keep up our Spanish even if we can no longer visit her family."

"But I'm supposed to be entering the medical program next year," Linda protested.

"I'll be renting my place and moving in here to look after you, Linda. It'll be just us two girls together," Dorothy Sullivan said.

John knew his daughter well enough to read the horror she was busy concealing. "Or, of course, you could come to Spain with us."

Linda visibly shuddered at that suggestion. "No. Staying with Grandma will be okay."

"Which just leaves Jacob, who will be going to Spain with your mother and me."

"Leave Grantville?" Jacob asked. "But I don't want to. Why can't I stay here with Grandma too, Dad?"

"Because I said so," John said. "Besides, you never know. You might enjoy it."

"But all my friends are in Grantville," Jacob protested.

"You never had trouble making friends when we visited your mom's family in Puerto Rico, so you shouldn't have any trouble making new friends in Spain," John told him. He and Annamarie had already decided that Jacob was coming with them, come hell or high water. There was no way they were leaving him behind, given the group of undesirables he'd been mixing with lately.

May, near Puerto Real, Andalusia

"The bones look to have set properly," Sebastian Ferrer said as he gently ran his hands over Juan's leg.

Juan glared at the man in the brown habit and white belt of a Franciscan lay brother. "And what would you do if they weren't properly set? Break them and try again?" Juan thought he was being sarcastic, but the gentle nod from the heavyset man was anything but reassuring.

"You don't really expect me to believe you'd break my bones if they weren't healing properly?" he demanded.

"I wouldn't enjoy doing it," Sebastian said.

Juan raised his brows. The mauling he'd suffered at the bonesetter's hands when his leg was set gave the lie to that. He was positive the man had smiled all through the procedure.

"The alternative would be that you are left crippled for life because the bones don't heal properly."

Juan looked at his left leg, finally free of its splints. He reached down to scratch the itch that had suddenly started. He had to concede that point. Nobody wanted to be crippled for life. However, it was purely academic, as the man seemed happy with his handiwork. "How long before I can walk again?"

"You could get up right now, with a little help." Sebastian lifted Juan's legs off the bed and carefully set his feet on the floor. "Give me your arms."

Juan reached out, and suddenly he was pulled to his feet.

"We'll just walk to the door and back this time. If someone will take your other side?"

With a servant standing to his left and the bonesetter to his right, Juan slowly shuffled to the door and back. He fell onto his bed and lay down, exhausted after walking a massive twenty feet. "How long before I'm fit?"

"If you don't force the pace and hurt yourself again, maybe six or seven weeks."

Juan winced. "Another six or seven weeks?"

"Maybe eight," Sebastian said.

Mid-May 1635

Annamarie Sullivan leaned on the starboard gunwale of the De Fortuijree and stared at the city in the distance. She'd always wanted to visit Cadiz, and there the city was, just across the bay from where their ship was anchored.

"Is that where we're going?" Jacob asked, tugging on her jacket and pointing across the ship.

Annamarie turned her back on Cadiz and looked across the ship toward Puerto Real. "Yes, that's Puerto Real. The de Aguilera's live somewhere past the city."

Jacob kicked out at one of the strategically placed sand-filled fire-buckets on the deck. "Dad said we were going to be traveling through pirate-infested waters."

"Dad was right. The English Channel is pirate infested.

"But we didn't even see another ship."

She reached out and laid a hand on his shoulder. "Poor thing, nothing exciting ever happens to you, does it?"

Jacob shook off the hand, and glared at her. She grinned at his offended look and offered him the crook of her arm. "Come on. It looks like your father might have all our stuff on the lighter."

"Are you going to use the ladder again, Mom?" The hint of a grin started to displace the scowl on Jacob's face.

Annamarie looked across the deck to the other passengers preparing to disembark using a bosun's chair. "They do look ready to be outraged again, don't they?"

Jacob produced a full-blown smile as he nodded.

"Well then, who are we to disappoint them? I'll follow you and your father down the ladder, just like I did when we stopped over at Amsterdam."

****

Alfonso, the de Aguilera major-domo, stood on the dock watching people disembark from the De Fortuijree, a Dutch armed-merchant of eighty lasts. He was looking for the Americans Alfredo de Aguilera had recruited. He almost missed the female, until he saw her ignore the bosun's chair and climb down the ladder to the lighter below. She looked Spanish, which was why he hadn't thought her to be one of the Americans. However, no Spanish lady would ever climb down a ladder, especially not with sailors waiting below.

Once he'd identified the woman, the rest of the Sullivan family were easy to find. The husband was darker-skinned than his wife, suggesting a life spent working in the sun. Alfonso shuddered at so little care taken of one's complexion. Why, people might mistake him for a peasant. He lowered his telescope and snapped his fingers hopefully.

When nothing happened he looked over his shoulder, and released a sigh. The quality of help was deplorable. "Get up, you lazy clots. The up-timers will soon be here."

Alfonso knew his people, so he didn't rely on just words to get the two peasants moving. He managed to give each of them a solid kick in the rump before they could avoid him. "Hurry up; I want the horses here before they reach the dock." While Sancho and Pedro hurried off Alfonso prepared to greet his employer's newest employees.

"Allow me," he said as he offered the señora a helping hand off the lighter. A surprisingly strong hand gripped his hand and the woman jumped onto the dock.

"Thank you," Annamarie said. "I'm Doctor Sullivan. You wouldn't happen to be here to meet us, would you?"

"Your husband is also Doctor Sullivan?" Alfonso asked, hoping that maybe the up-timers allowed the wives of doctors to use the honorific.

"No, just me."

Alfonso hoped he was able to conceal his horror. A female doctor? How was this blasphemy possible? More importantly, how would the local Franciscan order, which was waiting hopefully for someone to teach them the up-time medicine, going to cope with being instructed by a female?

****

While Jacob got to know the spirited pony he was allocated, John and Annamarie examined the two horses provided for them. One was a stallion, the other a mare. "I think you should take the stallion," John suggested.

"You thinking about your hip?"

It was nearly seventeen years since he'd been invalided out of the US Army after breaking his hip in a parachuting accident, He'd mostly recovered, but . . . "Nah. It's doing the thinking for me. The mare looks nice and quiet."

John helped Annamarie up onto the nearly sixteen-hand stallion before mounting the smaller mare. He was adjusting his stirrup leathers when there was a clatter of hooves and squeals from Jacob's pony. He looked across to see the animal rearing. A glance at the ironmongery in the pony's mouth suggested the source of the problem. Obviously Jacob had forgotten that he wasn't on his old pony, using his normal mouthpiece, and he'd done something to upset the animal. Then Annamarie's stallion decided anything the pony could do, he could do better. Annamarie was caught with her feet out of her stirrups—probably because they had been too long and she was shortening them. But she had her legs clamped tightly around the animal's chest and a hand gripping the saddle just under the pommel, while she used her free hand to bring the animal under control. The whole family had just about been born in the saddle, so he had absolute confidence in both Jacob's and Annamarie's ability to control their mounts, but he didn't want his mount joining in on the fun.

"I hope you aren't planning on joining in," he said to the mare's head.

The mare's ears twitched at his voice and she turned her head as if to glare at him. He could swear she was expressing disgust at the very idea. When Jacob and Annamarie had their mounts back on the ground and under control, he shortened his reins and gripped a little tighter with his calves. That didn't excite the mare to move, so he told her to move out. That didn't excite any action either, and John was thinking he might have to actually kick her to get her moving when the others started to move. John's mare decided she wanted to stick with her herd and followed them. John shrugged philosophically. Maybe the mare was going to be a bit too gentle a ride.

Outside the city, he edged up alongside Alfonso to find out more about the clinic they were supposed to be running.

"There might be problems with the Franciscans," Alfonso said.

"Why?" John asked. They'd been assured back in Grantville that there would be no problem with the Franciscans. In fact, they'd been told by Alfredo de Aguilera that the Franciscans were very open to new knowledge.

"I don't know how they'll take being taught the new medicine by a female."

John smiled. So that was the problem. "Don't worry. I'll be in charge of training, while Annamarie deals with treating patients."

"But your good wife said that you weren't a doctor," Alfonso said, obviously confused.

"I'm not, but I spent nearly twelve years as an Army Special Forces Medic. I've got a lot of experience training people."

"Why are they building a cathedral in the middle of nowhere?" Annamarie interrupted, pointing to a large structure in the distance.

"That is not a cathedral, Dr. Sullivan," Alfonso said. "That is His Excellency's new airship hangar."

"Airship hangar?" John stood in his stirrups to get a marginally better view. In the distance, he could see an enormous structure surrounded by scaffolding. In his travels, he'd seen the airship hangars at Moffett Field and the Zeppelin hangar in Rio de Janeiro, and, well, this one looked like it was going to be that kind of big. He settled back in his saddle and turned to Alfonso. "Someone's making an airship that big?" he asked, gesturing at the structure under construction.

"His Excellency, Don Juan Manuel Pérez de Guzman y Silva, believes that airships could provide a means of moving the treasures of the new world home to Spain without risk of piracy."

"Hence the size." John nodded. If one stopped to think about it, that was reasonable. Certainly, there was no way any normal pirate could intercept an airship. "We were told that Don Juan de Aguilera was injured when his airship crashed into trees." He pointed toward the hangar. "Does that mean we're close to our destination?"

"Just over the next hill, Señor Sullivan."

****

John knew enough to take "over the next hill" with a large pinch of salt, so he wasn't surprised that it was another twenty minutes before they topped a hill overlooking the sprawling white-washed walls and terracotta roof complex that was the de Aguilera hacienda.

They were led through an olive grove to the stables, where they dismounted. Then, while their mounts were led away, they and their baggage followed Alfonso to their temporary quarters.

"If you would like to tidy up, I will inform Doña Juana that you have arrived." He paused to look pointedly at their clothes. "She will wish to see you immediately.

John waited until Alfonso had left before turning to his family. "I guess that means we better wash up and put on our Sunday best before we're called in to meet our boss."

"Do I have to?" Jacob asked.

"Yes, you do," Annamarie said. "Find where the servants have put your good clothes and then wash and change."

****

Doña Juana dusted her hands nervously over her gown. It was of the latest fashion, being black, but not an ordinary black. It was a true black. The fine silk overdress was dyed with the wondrous dyes being made in Grantville. Who would have thought that Alfredo, usually so feckless Alfredo, would think of sending back dyes from Grantville?

She heard footsteps in the hall and hurried over to the settee she'd had placed so the light from the window was behind her, and fell onto the seats she'd had placed for the up-timers on who so much depended. She wanted to be able to see their every expression clearly during the interview.

Juana noticed the female first. Señora Sullivan was—or at least she looked—Spanish. She was wearing a tailored white blouse with beautiful embroidery, and a full length skirt in a black at least as good as her own dress. The males were dressed in black trousers and white shirts. She studied the boy, and silently complimented the woman on her ability to turn her son out looking so clean and tidy. Juana knew how hard that could be. "I wish to talk to your parents now. Follow Alfonso. He will take you to the kitchen, where, no doubt, the cook will have something for you to eat," she told Jacob.

The bright smile that elicited from Jacob told Juana that up-timer children were not that much different. Certainly, at his age, her sons had always been concerned with their stomachs.

"Doctor Sullivan," Doña Juana de Silva addressed John. "My eldest son . . ."

"I'm sorry, Doña Juana , but you are mistaken," John hastily interrupted. "I'm a nurse, my wife here—Annamarie—is the doctor."

Juana turned her eyes onto the Señora Sullivan. "You are truly a doctor?"

"I'm one of the new Doctors of Osteopathy, Doña Juana. I was a nurse up-time, and I trained as a doctor at Grantville and Jena after the Ring of Fire."

Juana smiled. It couldn't be better. A male doctor wouldn't understand her problem. "That is close enough," Juana said. "My eldest son . . ."

"I understand he was involved in a serious accident," Annamarie interrupted.

Juana waved her hand in dismissal. "A few broken bones and some bruising. Nothing of consequence. No, Juan's accident isn't what I wish to talk to you about."

"Broken bones and bruising can have long term consequences," John said, massaging his hip.

Doña Juana glared John into silence. "Juan has had the attentions of the best of medicants. Certainly we have paid enough to restore four chapels for his care. No, this is much more important. My Juan is a widower. A widower with young children, and he refuses to think of remarrying."

"How long has he been a widower?" Annamarie asked.

Juana smiled. Yes, the woman understood the problem. A quick glance took in the confusion on the face of the doctor's husband. Clearly, as a mere male, he had no idea. "Over three years. His Magdalida died giving little Eduardo life." She patted her suddenly teary eyes with a scrap of heavily embroidered linen. "The poor boy and his older sister need the influence of a mother, but Juan refuses to even think of remarrying." She blew her nose into the handkerchief. "Magdalida died in his arms, you see. She bled to death. There was nothing either the midwife or doctor could do.

"Since Magdalida's death, my son has refused to consider marrying and putting another woman at risk of dying like that again." Juana stared at Annamarie. "I want you to persuade him that your modern medicine will prevent it happening again, and it is safe for him to remarry."

****

John stamped around the room in frustration. "How the heck do we reassure a guy that a woman won't die in childbirth? And what happens if we can't convince him it's safe to remarry?"

"Stop fretting, John." Annamarie laid a hand on his shoulder. "What're the most likely reasons for fatal postpartum hemorrhaging?"

"The doctor fouled up, or failure to pass all of the placenta."

Annamarie nodded. "And given that the birth was supervised by an experienced midwife, I'd discount physician induced trauma being the problem. Which leaves us with . . ."

"Part of the placenta being left behind," John finished the sentence.

"Very good, John, and do we know how to deal with that?"

John nodded. "Sure, a D&C. But how do we convince a down-timer that curettage to remove the bit left behind would have saved his wife?"

"We don't," Annamarie said. "There is no way a hidalgo is going to listen to an unsolicited explanation of how we could have saved his wife's life."

"So what are you suggesting we do?"

"We're just going to have to demonstrate how all-powerful modern medicine is."

John snorted. He knew Annamarie believed in the all-powerful nature of modern medicine about as much as he did—which wasn't much at all.

"More realistically," Annamarie said, "you're just going to have to do such a good job teaching whoever the Franciscans send for training that people start talking about how good the new medicine is."

"And what will you be doing?" John asked.

"I'll concentrate on the midwives. If nothing else, the knowledge ought to stop another woman bleeding to death in childbirth."

A week later

Don Juan sat upon his quietest mare on a hill above the scene of his accident and looked down upon the duke of Medina Sidonia's airfield. The Richard Peeke—the duke's new semi-rigid airship—was being guided out of its hangar on the rail system he had pioneered with the Pepino. Once the airship was clear of the hangar, it was released to fly under its own power.

The Richard Peeke was more than three times the size of the Pepino and had something like ten times the power in its two up-time engines. Under the control of its pilot, no doubt that ham-fisted fool, Don Fernando López de Pérez, the Richard Peeke took to the air and gracefully flew over Puerto Real before returning to the waiting mass of men in the middle of the airfield.

"Don Fernando has developed into a fine pilot," Alfonso observed.

"He could hardly have developed into a worse one," Juan snapped.

They stared at the airship in silence until it was moved back into its hangar. Then Juan sent Alfonso a wry smile. "I've been left behind. They don't need me any longer, and there is no longer a place for me in His Grace's plans." He stuck his clenched fist against his thigh in frustration. "I spent more than the estate could really afford developing the Pepino, and now I have nothing to show for it."

"You still have the Pepino."

Juan snorted. "His Grace's agent has thanked me for letting them have the Pepino as a training vehicle. You think I can now ask for it back?"

Alfonso winced and shook his head.

"That's what I thought." Juan kneed his mare into motion and pulled her head around toward home. He nearly cantered home, but the pain in his body quickly had him slowing down to a gentle trot. That was the ultimate humiliation. Not only was he reduced to riding a mare, he couldn't even travel above a trot. He wondered if the American doctor had anything to reduce the pain.

****

"I can't see any problems," Annamarie reassured the young woman she'd been called in to examine. She sent what she hoped was a reassuring smile toward the midwife who'd insisted on being present.

"I told you so," the middle-aged midwife said.

"Yes, María," the patient said. "But the Señora is a doctor, an up-time doctor, and it is good to hear what she has to say."

María glared at Annamarie and stormed out.

"I'm sorry about María. She takes my husband insisting on you examining me personally," Ursula Lorenzo said.

"She probably thinks you no longer have confidence in her abilities. I'll talk to her, and see if I can get her to understand that I'm not trying to take over your care."

"Thank you," Ursula said.

****

The huffy midwife, obviously building up a head of steam, intercepted Annamarie on the front steps as she left the house. "You aren't wanted here. I can look after Señora Lorenzo myself."

"Señora, I'm here to help you, not take over your patient," Annamarie said.

"You already have the señor insisting that the up-time doctor examine his wife. How is that supposed to help me?"

"He's just a husband thinking a university degree is worth more than experience," Annamarie said. "In a straightforward case like Señora Lorenzo's, I'm not needed. However, if something goes wrong, such as in a case like that of Señora Amellera, I have knowledge that could help."

María snorted. "Not even that puffed up Englishman with his medical degree from Padua could save Señora Amellera. What makes you, a graduate of the jumped-up University of Jena, think you could have done better?"

"Was part of the placenta missing?"

The midwife made a sign to ward off the devil. "How did you know that?"

Annamarie pulled the cross she wore on a chain around her neck out from under her blouse and showed it to María to reassure her that she wasn't an agent of the devil. "It's a process of elimination. According to her mother-in-law, Señora Amellera died of blood loss after giving birth. Either the problem was part of the placenta not being delivered, or you don't know how to do your job. And nothing I've seen or heard suggests you don't know how to do your job."

"Of course I know how to do my job. Nobody in Andalusia has delivered more babies than me."

"Well, that only leaves part of the placenta not being delivered as an explanation for the bleeding." Annamarie was hopeful that her judicious lying would reduce María's belligerence.

"Nothing I did would get the body to push out the last piece of placenta." María folded her arms and glared. "And now I suppose you're going to tell me that you could have removed the last piece of placenta and saved Magdalida?"

Rather than just answer, Annamarie dug into her medical bag and bought out a curette. "I'd use one of these to scrape the remaining bits off the uterus."

María took the ten-inch-long nickel-plated-steel screwdriver-like implement with a half-inch wide open-loop head and turned it over and over in her hands. "This," she demanded, holding it up, "was all I would have needed to save Magdalida's life?"

Annamarie winced at the flash of obvious pain passing across María's face. "If you'll let me, I can teach you when and how to use it."

María handed the curette back. "What's it going to cost me?"

...