My shoulders ached, and so did my hips and knees, from kneeling on the dirt floor so long, but I felt it dimly, an irrelevant observation. I had one hand in her vagina, the other on her belly, probing through the wall of skin and muscle, feeling for some pattern in the tangle of tiny limbs. Susannah’s sweat was slick and hot under my hands—that was good, the wetness helped me feel movements …. The contraction came on with a force that smashed my fingers between skull and pelvis and made Susannah scream and me bite my lip not to.

Such force, in a woman who’d already given birth three times, should have shot the baby out like a greased pig. It hadn’t, and now I was sure what was wrong.

“The twins are tangled together,” I said, as calmly as I could. I pressed her stomach and felt movement—one twin, at least, was still alive. I was drenched with sweat and my mouth was dry. Someone had set a cup of water near me; I hadn’t noticed. I picked it up and drank, to get enough moisture to say what had to be said next.

“Susannah,” I said, leaning forward to look into her eyes. “The babies can’t get out. I can’t get them out. If we keep doing this, they’ll die—and you might die, too.” Easily. I took a deep breath; her hand had come down to rest on mine, atop her rigid belly.

“Wait,” she whispered, and clenched my hand as we all rode the next contraction. When it relaxed, she was panting, but squeezed my hand lightly and let go. “What … else?” she said, between gasps.

“I can cut you open and take the babies out,” I said. “It will be awful and it will be painful, but—”

“It can’t be worse’n this,” she said, and then did laugh, hoarse as a crow. I lowered my head and rested my forehead for a moment against her belly, controlling my own emotions, preparing myself. “Will I die, then?” she said, her voice quite matter-of-fact.

“Very likely,” I said, straightening up and matching her tone. I wiped a sleeve across my face and shoved the loose hair out of my eyes. “But it might save the babies. I’ll do my best.”

She nodded, and clutched my shoulder fiercely as the next contraction came on.

“Save ’em,” she said, as soon as it passed, and dropped her head, breathing like a winded horse.

The energy of emergency flooded me and I stood up, looking about the cabin for the first time. It was tiny and sparsely furnished, with one bedstead and a pallet rolled up at the foot. A table and benches—and a cauldron on the fire, steaming, thank God. And much to my surprise, Jamie, calmly unrolling the bundle that held my surgical knives on the table.

“Where did you come from?” I said. And added, glancing round the cabin, “Where’s Mr. Cloudtree?”