Examination by [livejournal.com profile] surgicalsteel

Apr. 20th, 2009 01:07 pm
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Cross-posted from [livejournal.com profile] surgsteelfic. :^) More tennis ball lobbing.

Ivrineth began as a character that Mélamírë's spouse used to threaten her with when she tried to escape strict bed rest toward the latter stages of what would be considered today to be a high-risk pregnancy; this draft is under lock and key in the vaults of the Mirdain for the time being while I continue to develop the Pandë!verse.

Steel has fleshed out this character's back story which made me squee vigorously. Here in her "Examination," we meet Ivrineth.

So without further adieu, here's Steel:

This is I suppose a sequel of sorts to Pandemonium's The Good Broideress, which was her birthday present for me. In that story, a mortal surgeon and an elven smith meet for the first time when the smith has an injury which requires treatment. In this one, the smith returns for medical care of a different sort. Occurs almost immediately after Serindë's return to Minas Tirith following the cessation of hostilities with Mordor.

Warnings for Serindë's usual bad language. ;)

Serindë fumed as she limped back to her office. The hot soak last night had certainly helped with some of the soreness, but she still ached, and getting up well before dawn to make rounds hadn’t helped, and then having the damn Chief Physician screeching at her in Sardos’ office about the surgeons raiding his supplies and his funds to take care of their patients had been nearly the final straw.

“Which ones shall I not care for, then?” she’d fired back, and had remarked that two of his cousins were in the wards for the most seriously injured and asked whether she should apologize for managing to get so many wounded off of the battlefield alive. When Sardos tried to placate both of them with ‘I’m sure that no one meant,’ Serindë had responded by calling both of them names that the Chief Physician likely wouldn’t understand – but Sardos would. Not for nothing had Sardos been partnered with a Dol Amroth man for over thirty years.

And she fumed.

And sat down behind her desk, pulled off her boots, threw the left one at the door to help calm herself somewhat, and then began going through the reports on her desk. I am not going to fucking feel guilty because we managed to save more men than anyone expected. I am not going to let that little thenluis make me feel like I’ve done something wrong, she thought.

Eight hundred wounded from the army that had gone to the Black Gates. Another seventy from the army in Anórien. And this on top of four hundred survivors from the Siege and a hideous number of dead from that day because the streets had been clogged with all manner of debris, making it difficult to get the wounded up to definitive care. Had she commandeered wards normally used by the physicians and the midwives? Yes. Had she arranged for extra cots in every damned space she could find? Yes. Had she had a choice?

Bandage materials – damn, it was going to make someone angry, but Hador had found a warehouse full of fine cotton and linen in the Second Circle and she’d told him yes, take the supplies, and she wasn’t going to let herself feel guilty for looting. She needed those supplies.

The polite knock on the door sounded all too much like the manner in which Sardos usually knocked, and so she was snarling even as she limped over to the door. “I’m not fucking apologizing, Fish, so you can save your…” Serindë stopped midsentence as she opened the door. “Fuck a duck,” she muttered.

The woman laughed, and then pointed at Serindë’s hand-printed sign on her door. “‘Death worse than fate?’” she said.

Serindë racked her brain for a moment, trying to remember – she’d gotten two names for the elven smith back before the Siege, and she wasn’t entirely certain which one she was supposed to use. “I can explain, Istyanis,” she began, settling on the woman’s title.

“Given my family, I can hardly help but understand the joke,” the woman replied with a grin.

Serindë swallowed at that, remembering the maker’s mark on the needles she’d received just before heading off to war. Anyone using the Fëanorian star as a personal mark would definitely understand that some fates truly were horrific, and deaths worse than those?

“I generally have to make references to Túrin Turambar that most of the apprentices don’t understand,” Serindë said. “Thick-headed, uninterested in history… it’s a pleasure to have someone understand the joke! Damnitall, where are my manners, please come in,” she said, standing aside and allowing her guest to enter and snatching up her boot from where it lay on the floor. “A fit of temper,” she said with a shrug, waving her hand around the office. “Please, have a seat!”

The Istyanis walked over to the window seat, peering out the window. “Your view…” she began.

“One of the best parts of this position,” Serindë said. Noting the slightly greenish cast to her guest’s complexion, she rummaged around in her cabinets and found the tin with the ginger biscuits and the teapot. “Ginger’s usually easy on the stomach, I find, and helped me with an unsettled stomach innumerable times when I carried my children,” she said, and then seated herself to pull on her boots.

“Your foot – were you injured?”

Serindë shook her head. “That’s a childhood injury,” she said. “Ossё’s wrath hit Dol Amroth when I was nine, and a horse-cart ran over my foot. That’s how I ended up in Minas Tirith to begin with – it’s not actually my city, you see,” she added with a wink. “Dol Amroth is my city – you wouldn’t approve of their defenses, either. Built to protect us from Ossё’s wrath rather than Sauron’s.” Serindë stopped at the other woman’s raised eyebrow, changing to another tack. “Minas Tirith never quite felt as much like home to me as Dol Amroth – but it’s where I live and practice my profession now. The man who occupied these offices when I was brought here with the other evacuees, he recognized something in me. And so here I am. That’s ginger tea with lemon,” she concluded. “But if you’d prefer something else, Istyanis?”

“I’d prefer that you call me Mélamírё, as I asked you to,” Mélamírё replied.

“Mélamírё, then,” Serindë said, feeling her lips twitch upwards. “Oh, I must thank you for the needles! Trust me when I tell you they were put to very good use more than once – and at least now when someone tries to make off with them, I can very easily identify which are mine and which the other party stole from someone else.” As Mélamírë’s raised her eyebrow again, Serindë continued, “But I suspect you’re not here to listen to me complain about apprentices – what does bring you here?”

“I hoped you might recommend a midwife,” Mélamírё began.

“Oh, of course – I’m sorry, I didn’t mean to interrupt,” Serindë said. “I have one in mind – I’d trust her to care for myself, actually, she’s quite good, and I’m certain she’d be happier to practice her specialty again, rather than helping us bandage up gangrenous limbs. I can go and find her for you – or if you’d prefer, I could examine you myself today, make certain things are proceeding normally, and then send her up to the Citadel later?”

“I don’t mean to impose,” Mélamírё said.

Serindë flipped one hand in the air. “No imposition. I did my share of midwifery in Bree, much to my horror. Over twenty years there, and before she died, the town midwife was a woman with filthy hands and a terrible manner with patients. My conscience wouldn’t let me say ‘no’ to any woman who asked me to attend them instead – and goodness knows I’m lucky that she didn’t attend me…” she stopped for a moment, wondering what might have happened if that evil-minded woman had delivered any of her children.

“I’d almost forgotten that you mentioned a son,” Mélamírё said, and Serindë had almost forgotten it, too.

“A healer himself, now,” Serindë said, “And my daughter’s a Ranger. And you should at least allow me to check your arm again.”

“I suppose I still ought to listen to my healer’s wisdom,” Mélamírё said, shrugging out of her tunic and extending her left arm.

“Fish took out your sutures, did he?” Serindë said, examining the scar. “I’m sorry I wasn’t here to do it myself – I was off doing things that weren’t particularly wise, but were quite effective…” she trailed off, humming as she examined the reddened scar that had once been a particularly nasty laceration.

“The Warden told me that you took charge of the healers accompanying the army,” Mélamírё said, the tone of her voice rising slightly at the end of the sentence, turning a statement into a question.

“I did,” Serindë said, feeling herself grinning, and before she quite realized it, she was babbling about Eagles and battlefield mud and using whichever son of Elrond’s blood she’d used to replenish Sam’s. “Good, strong needles come in quite handy with scalp lacerations. People seem to think they’re such a minor thing, but you can bleed to death from them, you know…” And it was easy enough once she’d started with the arm and the collarbone that actually seemed to have almost fully healed to slide into a very quick examination of breasts and belly – the elven smith had had the characteristic changes in her breasts in March, but there hadn’t been a noticeable swelling of the abdomen then, and she hadn’t argued when Serindë had suggested three months. That should make her about five months now, but if Serindë remembered correctly, elvish pregnancies lasted longer, which should mean the children developed more slowly. If they developed at the exact same rate as mortal children, the heads would never make it out of the pelvis, and yet…

“Is something wrong?” Mélamírё asked, a somewhat alarmed look crossing her face.

“No – no, I’m sure it’s nothing wrong. You seem just a bit larger than I would have… let me go and get Ivrineth,” Serindë said.

Halfway down the hallway, she realized that she’d probably needlessly alarmed Mélamírё, and that she could have dismissed her worst fear by simply asking if Mélamírё had felt her baby move. She was far enough along that even as a first time mother, she should have noticed movement. Serindë’s worst fear – well, she wasn’t even certain if hydatidiform mole occurred in elves. It was mercifully rare in mortals, but if she had that, she wouldn’t have felt movement, and if she’d felt movement…

Wonderful way to fuck with someone’s mind, Serindë, leave the room when you’re sounding out of your depth and you could’ve sent an apprentice after Ivrineth, and she’s probably panicking. You know that panic.

It fortunately did not take long for Serindë to arrive at Ivrineth’s office and to explain to the other woman that she had need of a midwife for an elven woman in her office and shamefacedly admit that she’d likely sent the other woman into a panic.

“You owe me gumbo for this,” Ivrineth said, snatching up a small listening tube. “You might at least have listened for the babe’s heartbeat before you came running for me in a panic.”

“My listening tube was stolen twenty years ago and I still haven’t found an adequate replacement. And you still owe me jambalaya for that section in January,” Serindë said as they began walking back to the Chief Surgeon’s office.

“True enough,” Ivrineth said with a laugh. “When did you get back from Ithilien?”

“Two days ago,” Serindë said. “And you from Dol Amroth?”

“Couple of weeks,” Ivrineth said. “We got the word that the City was safe to return to, and the Warden was sending messengers begging anyone and everyone who’d left to come back – but if I never see another mangled extremity, it’ll be too soon. They slammed the City hard, didn’t they?”

Serindë nodded. “Dol Amroth?” she asked.

“Safe enough. Corsairs passed us right by, nearly as I can tell, more interested in going straight upriver – they’d have dealt with us later, I don’t doubt… Gracious, Serindë, don’t you ever get tired of that joke?” Ivrineth asked, pointing at Serindë’s sign as they reached the door of her office.

“Never,” Serindë said with a grin, and pushed open the door. Mélamírё had moved into the window seat, and Serindë couldn’t blame her for that – the eastward view was spectacular, and looking down to the workmen in the First Circle starting to pick up rubble might have served as a distraction. “Ivrineth, this is Istyanis Náryen, a smith and engineer, and she’s been in Minas Tirith helping look after our siege engines. Istyanis, Mistress Ivrineth – one of our most skilled midwives…”

“You flatter me,” Ivrineth said with a grin.

“Years of assisting helped – she was one of our best assistants in the post-operative wards when the late Steward threw me out of Minas Tirith,” Serindë said. “Imagine my delight upon my return, that someone finally managed to convince her to complete her apprenticeship and become a midwife – I’d have been happier if she’d become a surgeon, mind you…” she stopped at Ivrineth’s blush, and then tried to find a way to more delicately explain why she’d bolted out of the room. “I first met the Istyanis in March – she had a fairly deep forearm laceration which required repair, and I noticed then that she was pregnant. I’d thought three months at the time from the changes in areolar pigmentation, but I think she might be a bit further along than I thought…”

“I don’t suppose there’s any chance the dates are wrong?” Ivrineth said, and then half to herself, “No, elves are supposed to know when…”

“I – I am not entirely certain when I conceived,” Mélamírё said quietly from the window. That revelation had Serindë and Ivrineth exchange a quick look with raised eyebrows. “I did not realize I was pregnant when I left Rivendell. I didn’t realize it until it was too late to turn back, in fact.”

“What made you suspect?” Ivrineth asked.

“I bled,” Mélamírё said. “Only a small amount, but I should not have been bleeding. I thought something must be wrong, and so I… I should have known, I should have been able to sense the fёa of my child, or so I have always been told.”

That was what Serindë had always heard as well, but surprisingly, Ivrineth didn’t seem terribly concerned by that. “Your husband is an elf as well?” Ivrineth asked, and at Mélamírë’s affirmative nod, she raised her eyebrows just a fraction. Questions and answers followed about usual length of menstrual cycles and what the earliest and latest dates of conception might possibly be, and had she noticed fatigue, nausea, breast tenderness, vaginal discharge.

“I think Serindë’s likely right about the dates, which is what I expected,” Ivrineth said. “If I might…?” she said, extending a hand to Mélamírë’s abdomen, gently probing, and Serindë knew she was trying to determine what the fundal height was, if Serindë had perhaps been wrong on that.

“We’ll just have a listen,” Ivrineth said, setting her listening tube to the elven woman’s abdomen. “For all that she’s not a midwife, Serindë’s altogether too good at the basics. She’s one of those people that the more popular apprentices pointed at and mocked for being a pet of the masters back in her day, nose always in her books is what the Warden always says…” she stopped, crinkling her eyebrows together, and then moved the listening tube. “That’s not terribly common,” she said, half to herself.

Serindë had always thought of elves as being either cool and reserved, like most of the ones she’d met in Rivendell; or more interested in their own pleasure than anything else, like those that still sometimes came into the Old Port. But at that statement, a look of naked panic appeared on Mélamírë’s face – one that Serindë understood all too well, remembering that awful morning when she’d known something was not right and Níniel was born. She couldn’t help but take the elven woman’s hand in her own to try and extend her some comfort as Mélamírë snapped at Ivrineth, “What’s not terribly common?”

“Twins,” Ivrineth said, raising her head from the listening tube and gesturing that Serindë should listen for herself. “Do twins run in your family, Istyanis? They’re more common among mortals in families that have them…”

“Yes, I had great-uncles who were twins…”

Serindë shut out Ivrineth’s babble for a moment, shut out Mélamírë’s responses, and focused on listening through that tube. There was the slow, deep background thump that was Mélamírë’s own heartbeat, muffled by the distance between chest and abdomen, and there was the more rapid, high-pitched drumming that was one child’s heartbeat, and a slightly different rhythm, also rapid and high-pitched, almost like two snare drums that were slightly off from one another’s beats.

“Twins,” Serindë said. “And good strong heartbeats in both of them.” The sudden tightening on her hand reminded her that she’d never let Mélamírë’s hand go, and she looked up to see frank relief on the other woman’s face. “So things are well.”

“That they are,” Ivrineth said, “But you, Istyanis, are far too thin – and I know the City was under Siege, but it’s not any longer, and we need to get nourishment into you and your babies. Shame that spicy foods tend to cause heartburn, Serindë owes me gumbo…”

“I’d never have time to make the roux in time for dinner, and you still owe me jambalaya,” Serindë protested.

“I rather like spicy foods,” Mélamírё said, and a wistful look crossed her face as she uttered the single word, “Curries…”

Well, that confirmed what Serindë had suspected from the stud in Mélamírë’s nose – she’d definitely spent time in the East. “I don’t know that we can manage curry – haven’t the faintest clue how to make it, although I tasted it once in Umbar,” Serindë said. “But if you’re of a mind – Ivrineth, I never had a problem with spicy foods during my pregnancies, and sweet sanity, look at her face; she’s probably craving something spicy. I’ll put together a gumbo when I’ve got time to make the roux…”

Ivrineth took the unspoken thought and took Mélamírë’s hand. “You just come with me, we’ll get some good Dol Amroth cooking into you – was it Náryen that Serindë said your name was?”

“Please call me Mélamírё,” was the response as the two women left Serindë’s office, the much older elven woman still looking more than a bit bewildered, the younger mortal woman looking every bit as competent and confident as Serindë knew she was.

One problem handled, Serindë thought, and then turned her attention back to the damned budgets and supply lists and casualty lists, and wished vainly that all her problems might be this easily solved.


AUTHOR’S NOTES: Firstly, my thanks to [livejournal.com profile] pandemonium_213 for allowing me to borrow from her canon, for her picking of nits, and for linguistic assistance on the word ‘thenluis,’ which is meant to be the Sindarin/Dol Amroth slang equivalent of the Spanish insult ‘pendejo.’

Fundal height is one method used to ‘date’ a pregnancy, i.e. to determine roughly how many weeks pregnant a woman is. The uterine fundus (the top) usually reached the umbilicus (navel) at about 20 weeks (roughly four and a half months) and usually continues to increase in height by about 1 cm per week thereafter. A fetal heartbeat can be detected using an unamplified stethoscope at about 19-20 weeks, so this is another way of confirming that a woman’s reached about the mid-point of her pregnancy.

The fundal height might be greater than expected for a number of reasons – some of them happier than others. Multiple gestation (twins or more) would cause the fundal height to be ‘abnormal.’ Uterine fibroids can also do this, and would pose a higher risk of miscarriage and maternal hemorrhage. Renal agenesis, or the kidneys failing to form, can do this as well.

One of the more tragic causes of the fundus being higher than usual is the group of conditions known as gestational trophoblastic disease. The most benign of these conditions is called hydatidiform mole. In this condition, a normal fetus doesn’t develop – instead, something like a tumor develops from placental tissue. It’s suspected when a woman has abnormal bleeding and is ‘large for dates.’ Suspicion these days would be heightened by an abnormally high hCG level (the hormone that pregnancy tests look for) and confirmed by ultrasound (there’s a characteristic ‘cluster of grapes’ appearance). Between 5 and 10% of these become invasive cancers (choriocarcinoma). The initial treatment is dilation and curettage (removing as much of the abnormal tissue as possible), possibly followed by hysterectomy. The estimated incidence is about one in 1500 pregnancies.
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