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She had a sense of calm-during-emergency that John immediately recognized. His profession, like hers, required a balance of detachment and caring that allowed them to be effective.

“I’m afraid the situation is critical,” Mrs. Caswell said without preamble. “We’re facing two problems, either of which by itself would be dangerous. Together . . . the outcome isn’t hopeful.”

“For the baby?” Reina asked.

“For either of them.”

Reina was standing close enough to John that he could feel her jolt at the news.

“The babe is lying sideways in the womb,” Mrs. Caswell said, “instead of head- or feetfirst. To make matters worse, the placenta is blocking the way, and must be removed or—”

“Placenta?” John asked.

“It’s a vital organ that sustains the baby in the womb and is expelled after birth.” The midwife paused, considering the best way to explain. “Think of trying to push a chest of drawers through a narrow doorway. If you turn it sideways, it can’t pass through at all. Now imagine someone has covered the doorway with a heavy curtain. If you try to pull or cut the curtain away . . . in other words, if we damage the placenta . . . it will cause uncontrollable bleeding. The only option is a surgical delivery. A cut through the stomach, called a caesarean section. In these cases, I recommend a surgeon, Dr. Oakes.”

“What hospital is he affiliated with?” Reina asked.

Mrs. Caswell shook her head. “He has a private practice. But he has experience with this procedure.”

“How many patients survive the caesarean section?” John asked. As she hesitated to reply, he prompted, “On average.”

“No more than one in five women,” the midwife admitted. “But if Tuppence doesn’t have it, there’s no chance for either her or the baby. I’ve explained the situation to her, but she won’t let me send for the doctor.”

“I’ll speak with her,” Reina said, and started toward the bedroom.

“Where is Dr. Oakes?” John asked Mrs. Caswell, tugging the small notebook and pencil stub out of his coat pocket.

“Number 22 Frith Street, next to the apothecary.”

Reina stopped and turned to face John. “Wait. You can’t bring him here without Tuppence’s consent.”

John gave her a narrow glance. “What other choice is there?”

“Whatever choice Tuppence makes.”

“We’re not going to let her die, regardless of what she decides.”

“It’s more complicated than that.”

Fighting to bridle his impatience, John tucked the notebook back in his pocket. Time was running out, and she was setting obstacles in his path. “No,” he said, “it’s not. It comes down to a simple issue of life or death.” As Reina tried to reply, his hand lifted in a staying gesture. “I’m not one for nuance or sophisticated reasoning. All I know is, Tuppence needs a doctor.” He turned to the midwife. “Is there anything you can do to buy time for her while I’m gone?”

The midwife considered the question uneasily. “I could give her some medicine to slow the contractions. Tincture of cramp bark or even extract of opium . . . but there’s a risk of worsening the bleeding.”

“Do what you can,” he said.

Looking troubled, Mrs. Caswell nodded and returned to the bedroom.

Reina waited until the door had closed before speaking coolly. “I know you want to take action. But the decision isn’t yours to make.”

“We don’t have time for a meeting,” John said over his shoulder, heading to the door.

“Stay right there.” Her voice was quiet, but it stung like the flick of a whip.

No one else on earth could have made him stop at that moment. Gritting his teeth, he swiveled to meet her steady gaze.

“Tuppence has been forced at every turn,” Reina said. “Forced during the attack, forced to abandon her entire life and go to prison, forced to carry the child of a man who brutalized her, and now . . . she may be forced to have a male doctor operate on her. At what point is she allowed to choose what she wants?”

“Not the point where she chooses death.”