Ernest Hemingway faced two deadlines in June 1928.
One involved his unborn child. Hemingway's second wife, Pauline, was eight months pregnant.
The other involved his current manuscript.
As yet untitled, Hemingway had begun his story several months before in Paris. In it, a laconic, almost numb World War I ambulance driver is wounded. He begins an affair with a nurse in a Milan hospital. Soon the nurse is pregnant.
By June Hemingway wasn't sure how the novel, already being considered for serialization, would end.
But both deadlines would be met -- not in Paris, or in Milan -- but in Kansas City in the summer of 1928. This was the city where Hemingway became a journalist as a teen-ager a decade earlier and to which he would return from time to time for brief stays, even as he became a writer of almost unprecedented fame.
The book was published in 1929, 70 years ago, under the title A Farewell to Arms. The novel, perhaps Hemingway's most celebrated and examined, achieves an emotional climax with the difficult labor and the Caesarean delivery of the nurse Catherine Barkley's stillborn child.
Then Catherine dies.
Evidence suggests that Hemingway assembled the book's opening and middle passages from a smorgasboard of historical events and personal experiences. But the arrival of the author's real-life child, Patrick, apparently proved vivid to Hemingway, who weeks later incorporated an anxious delivery room drama into his novel's conclusion.
On June 28, 1928, Patrick Hemingway was delivered by Caesarean section at old Research Hospital.
Pauline had been in labor 18 hours. Her husband, who had missed the birth of his first son in 1923 while on assignment for the Toronto Star, may well have been riveted by the experience.
"Obviously, if my mother hadn't undergone that business here in Kansas City, my father wouldn't have written with as much detail and insight as he did," Patrick Hemingway said during a recent Kansas City visit.
Michael Reynolds, Hemingway biographer, goes further.
In Hemingway: The American Homecoming, the third volume in his five-book series on the author, Reynolds maintains that two events in 1928 prompted and ended A Farewell to Arms: an accident in Paris in March, when a falling bathroom skylight left a deep cut in Hemingway's forehead, and his son's Caesarean delivery that June.
The falling skylight roused Hemingway out of a writing block. It also, Reynolds said, seemed to spur him to confront the trauma he experienced driving an American Red Cross ambulance during World War I. Hemingway had been circling this material in his fiction and journalism for several years.
The birth of his son, meanwhile, gave Hemingway a conclusion to the book, as well as the verisimilitude the writer so prized.
"Down below, under the light, the doctor was sewing up the great long, forcep-spread, thick-edged, wound," Frederic Henry narrates in Chapter 41 of the novel. " ... I do not think I could have watched them cut, but I watched the wound closed into a high welted ridge with quick skillful-looking stitches like a cobbler's, and was glad."
The detailed description of the procedure suggests that Hemingway witnessed Patrick's birth.
Through close analysis of the novel and other materials, Reynolds also has concluded that before Hemingway arrived in Kansas City, he had not decided on any particular ending for the novel.
"Hemingway tended to avoid planning ahead, saying that it would ruin the story for him," Reynolds said.
The book originally might have ended with Henry's plunge into the Tagliamento River in Italy, as he tried to escape troops preparing to shoot him as a spy.
But the nature of Patrick's arrival probably changed that, Reynolds said.
"I still believe," Reynolds said, "that Pauline's operation was what triggered the ending."
`All those things'
The Hemingways arrived in Kansas City on June 14, 1928, because they wanted to have the child here.
The author's distractions were many. On June 15 he visited the Republican National Convention, then under way at Kansas City's convention hall.
There were visits to Don Carlos Guffey, the Kansas City obstetrician they chose to deliver the child. There were letters to answer from Hemingway friends in Paris as well as Maxwell Perkins, Hemingway's editor in New York.
Yet Hemingway continued thinking and writing about northern Italy during the autumn of 1917, keeping his focus on Frederic and Catherine.
"What I find incredible is all those things happening just when he really whipped that book into shape," Patrick said. "It just shows you that when people are really good, they can concentrate and get the work done no matter what the circumstances."
After Patrick's birth, the Hemingways stayed in Kansas City until mother and son were strong enough to travel. They left for her family's home in Piggott, Ark., on or around July 20.
During the preceding 35 days, Hemingway wrote the bulk of the novel's Book 3. That section details Frederic Henry's flight during the Italian retreat following the late October, 1917 breakthrough of Austrian and German troops at Caporetto, on the Isonzo River northwest of Venice.
"This narrative is often cited as the most compelling section of the novel," Reynolds said.
Hemingway awoke every morning to a warm and humid Kansas City. Then he sat down and summoned forth a cool autumn rain in northern Italy in 1917.
He achieved this through research -- checking maps and war histories -- and the distillation of personal experience.
One peril of reading Hemingway is just how close the arc of his life parallels those of his more memorable characters. The temptation is to read Hemingway fiction as pure biography.
The line between novel and memoir especially blurs in A Farewell to Arms. Hemingway, who himself drove an ambulance in Italy, was both wounded and in love with a hospital nurse in 1918.
But as Reynolds points out, Hemingway was no Frederic Henry.
A Farewell to Arms begins in 1915. The book's opening pages include Frederic's famous description of the marching soldiers whose loads of ammunition bundled beneath their capes make them appear "as though they were six months gone with child."
Hemingway never saw Italy until 1918. Nor had he experienced the battles Frederic describes or seen the terrain of Book 3.
Yet the events he invented while living in Kansas City were so realistic that Mussolini's Italian fascist government banned A Farewell to Arms in Italy.
Every step in the retreat, Reynolds said, is "incredibly accurate in its details, down to the specific weather, the various routes taken and the condition of the roads."
While Hemingway throughout the 1920s schooled himself in the events of the war, it's also likely that the author continued his research of the Italian retreat as late as June 1928.
"Somewhere in Kansas City he got some help," Reynolds said. "I would almost put money on it that he visited at The Star."
Then Patrick arrived.
Hemingway, a doctor's son, knew about Caesarean sections. During the almost seven months he worked as a cub reporter at The Kansas City Star, in 1917 and 1918, part of his beat was General Hospital.
Yet his interest in obstretrics may have deepened after the war.
When he returned from Italy with his wounded leg, he spent his convalescence in his family's Oak Park, Ill., home. Hemingway read everything in his father's office. That included his father's copies of the American Medical Association journal.
That publication in 1918 and 1919 was full of articles on amputation, shock, traumatic neuroses and other miseries associated with the war.
There also were 35 papers on childbirth, as counted by Charles R. King, then a physician in the University of Kansas obstetrics and gynecology department, for a 1989 article in Obstetrics & Gynecology.
These included articles on stillbirth, birth trauma, nitrous oxide anesthesia for childbirth and hemorrhage as a cause of maternal death.
Of particular interest was a paper detailing the operative techniques and complications of Caesarean sections. The article was written by Joseph B. Delee, a Chicago obstretrician trained at the same medical college as Hemingway's father.
Today Patrick Hemingway remains unsure why his father didn't ask his own father -- Clarence Hemingway -- to deliver him. Clarence Hemingway delivered all six of his own children and in 1914 began listing obstetrics as his specialty.
"It was a touchy subject," Patrick Hemingway said. "It's an interesting family thing that I don't know the ins and outs of."
Kansas City relatives, meanwhile, may have suggested Guffey, an obstetrician thought to have performed the first Caesarean section in Kansas City.
Guffey, the first chairman of gynecology and obstetrics at the University of Kansas medicine school, also was an arts devotee. His Roanoke district neighbors included painter Thomas Hart Benton. Guffey also had a fondness for collecting fine editions of modern literature.
Such considerations may have helped Hemingway get into Pauline Hemingway's operating room on June 28.
"They finally had to open up Pauline up like a picador's horse to lift out Patrick," Hemingway wrote to a friend a month later. "It is a different feeling seeing tripas (insides) of a friend rather than those of a horse to whom you have never been introduced."
By July 4, when Hemingway paused to write his mother and father, Patrick was thriving.
"He is very big strong and healthy," he wrote. "He is too big in fact as he nearly killed his mother. They had to do a cesaerian (sic) finally and I have been very worried about Pauline since but today her temperature is down to 99 and 8/10s and the gas distention is subsiding. She has suffered terribly."
About two weeks later, the Hemingways left for Piggott, Ark. Hemingway soon turned around and headed to Wyoming, where he began to compose the novel's ending.
Today a deluxe edition of A Farewell to Arms is held by the University of Missouri-Kansas City. Hemingway signed the book for Guffey, adding "with much admiration and grateful remembrance of a Caeserean(sic) that was beautifully done and turned out splendidly."
Patrick Hemingway never discussed with his father the precise role his birth played in the book's creation.
"I didn't know enough to ever ask him," the younger Hemingway said. "I should have.
"The best story I remember was later on, after my parents were divorced," Hemingway added. "Somehow my dad didn't remember my birthday, and my mother reminded him.
"He said, `Well, I always thought of it as more of an occasion for you than for him.' "
To reach Brian Burnes, history reporter for The Star, call (816) 234-7804 or send e-mail to firstname.lastname@example.org