She knew at once

When Bloom recalls the death of his infant son in Calypso, he twice thinks that the experienced midwife ("Lots of babies she must have helped into the world") could tell at once that the infant would not survive: "She knew from the first poor little Rudy wouldn't live. Well, God is good, sir. She knew at once." How, one wonders, could she have known that? And can readers share in her omniscience by learning what killed Rudy? Two chapters later, the novel offers a clue to the first question: Rudy's skin looked purple. With no diagnostic testing or autopsy having been performed, the second question cannot be answered definitively. But the addition of another clue—in Ithaca, we learn that Rudy died eleven days after birth—suggests that he may have died of a congenital cardiac defect known as Hypoplastic Left Heart Syndrome (HLHS).

 Bruce Hardy and John Hunt 2021

Diagrams of a normal heart (left), in which high-oxygen blood (red) is pumped to the body and low-oxygen blood (blue) recovered from the body is pumped to the lungs, and an HLHS heart (right), in which the two kinds of blood mix in the single functioning ventricle. Source: Moss & Adams: Heart Disease in Infants, Children, and Adolescents (Philadelphia, 2022).

Blood flow problems in an HLHS heart, showing blood pumped from the right ventricle to the lungs, with some of it entering the aorta via the ductus arteriosus and going to the rest of the body. Source:

Blood flow after the Norwood procedure has reconstructed the diminutive asending aorta, joined it to the trunk of the pulmonary artery, and installed one of two kinds of shunt to carry blood to the lungs. Source:

Results of the Glenn procedure, in which blood from the upper body is routed directly to the lungs via the pulmonary artery, bypassing the heart and freeing the right ventricle to pump blood only to the body. Source:

Results of the Fontan procedure, in which blood from the lower body is routed directly to the lungs via the pulmonary artery, letting the right ventricle pump only high-oxygen blood to the body. Source: