Kitabı oku: «The Honourable Midwife», sayfa 2

CHAPTER TWO

‘DR CROFT, we’ve got Rebecca in transition and almost ready to push,’ said Bronwyn. She was an efficient, thin and rather cool brunette, married with a school-aged son and daughter.

‘Right.’

Pete took a deep breath, switched his focus quickly. Little Lucy McNichol was looking good now, better than he’d dared to hope. She was small, just over three pounds on the old scale, but after that initial, frightening hitch with her breathing, she seemed reasonably strong, and she’d even taken the breast.

Nell had said she thought the gestational age might be closer to thirty-five or thirty-six weeks, not the thirty-three he’d been working on. Patsy might have mistaken bleeding at the beginning of the pregnancy for a period, and he’d dated the baby on that basis. With the spread and position of the fibroids retarding growth, the ultrasound scan at seventeen weeks hadn’t contradicted those dates.

But now here was Rebecca Childer about to give birth, and Bronwyn thought her dates might be wrong in the other direction. With no accurate date of LMP—last menstrual period—and no ultrasound measurements, they were working purely on the measurement from pelvic bone to top of uterus.

‘Don’t be surprised if you get called back up here,’ he told Nell, as she stripped off gloves and mask and prepared to head back down to A and E. ‘We have another iffy pregnancy on hand.’

‘I’ll be back up here anyway as soon as I can, just to make sure Lucy’s doing as well as we think,’ she said. ‘I did hear a faint murmur over her heart, did I tell you? But, of course, that’s very common. I’ll let it go as long as her stats are good.’

‘It’s your call. She looked good to me, too.’

‘See you in a while.’ Nell went towards the lift.

‘Rebecca, how are you doing here?’ Pete asked his new patient, as he entered Delivery Room Two.

She didn’t answer, just gave him a hostile look which he shrugged off. If he hadn’t asked about her state, the look would have been just as grim. In the grip of a powerful contraction, she wasn’t enjoying herself at the moment.

As soon as the contraction was over, he gave her a manual exam. It wasn’t routine policy to do so in this department, but Rebecca wanted a progress report. He listened to the baby. Heartbeat was fine. Dilatation was almost complete. The head was nice and low, but small. He agreed with Bronwyn. This wasn’t a thirty-seven-weeker.

‘Have we got extra staff?’ he muttered to her.

‘Vanessa Gunn is coming in,’ Bronwyn answered. ‘Emma will go into Special Care, with back-up from Sue North in post-partum. We’ll juggle it.’

Rebecca moaned. ‘I’m not ready for this. Nobody said it would be this bad.’

‘You’re doing really well, Rebecca,’ Bronwyn told her.

‘Don’t give me that garbage…’

Pete listened to the heart again, and found that the rate was perceptibly slower. ‘Get Dr Cassidy up here again,’ he told Bronwyn. ‘We might not need her, but if we do, I don’t want to wait.’

‘What about Emma?’

‘Her, too, as long as the post-partum staff have got Lucy’s care covered.’

Rebecca groaned, half sat up and opened her legs. The head was already crowning, propelled forward by the action of the uterus. Contractions were coming without a pause in between. Rebecca strained again. They’d have a baby very soon…

‘OK,’ Nell said. ‘She’s stable. She’s good.’

Like Patsy, Rebecca had delivered a tiny girl, whom she’d named Alethea. It was an old-fashioned name, but it was pretty, Emma thought. She clung to this thought—that the baby’s name was pretty, that the baby was pretty—because the little creature had problems at the moment.

She’d needed intubation and she was on a respirator. It had taken Nell, Emma and Pete an hour to get her stabilised enough to move her to Special Care, and Nell, who’d actually thought that was ‘nice and fast’ under the circumstances, was still working over her with a severe frown on her face.

Pete had left to check on Patsy McNichol.

‘Oxygen saturation’s gone up,’ Nell said. ‘I like her heart rate. I like how quickly we got this done. I like most things.’

‘That’s good.’

‘For the moment. And I’m hoping we’ll get her off the respirator within the next couple of days.’

‘What’s worrying you, Nell?’ Emma said. She knew her friend well enough to realise there was something.

‘I don’t know.’ She shook her head, as if to clear swimming-pool water from her ears. ‘I think I’m hearing a murmur again.’

‘Lucy had one, too.’

‘I know. They’re so common in babies, especially early babies, and mostly they mean nothing. With Lucy, I wasn’t so concerned. Her dates were better, even though she was almost as small. A small baby delivered within a few weeks of term is almost always better off than a larger one delivered earlier.’

‘And this one wasn’t large, in any case.’

‘I know. Which worries me, too, because I don’t know why.’ Nell listened to the heartbeat again. ‘I don’t know whether to be concerned about this baby’s murmur either,’ she said. ‘Certainly want to get the rest of her stronger before we start worrying about her heart. Hey, Alethea? Do you support that plan, darling? You don’t want a whole lot more mucking around, do you?’

Her voice was soft and cooing as she addressed the motionless baby. Then she straightened and spoke to Emma again.

‘All indications are that the heart is working fine at the moment,’ she said. ‘If it wasn’t, her numbers wouldn’t look so good. If I keep hearing this, though, or if it changes, I’m going to do a couple of tests. Let me know if there are any indications that her heart isn’t doing its job.’

‘She’s premature…’ Emma said.

‘I’m guessing thirty-three or thirty-four weeks.’

‘So…Patent ductus arteriosus is a fairly common condition in premmies, isn’t it? Treatable, too.’

Emma knew that in a normal foetal heart, the ductus arteriosus was open. In a full-term baby, this vessel closed automatically at birth, as part of the heart’s almost miraculous shift from foetal circulation to the circulation pattern it sustains throughout its life. A premmie baby’s heart can’t always manage this shift on its own, however, and if the ductus remains open beyond early infancy, permanent heart damage could result. Fortunately, the condition could be monitored and treated if necessary.

‘If it’s that, and if the PDA doesn’t close on its own, there’s a drug we can use to encourage it,’ Nell agreed. ‘It doesn’t always work, and that’ll mean surgery.’

‘In Sydney.’

‘A few years ago, we’d have had no hope of handling a baby like this in Glenfallon at all, with or without the need for surgery. Even now, I wonder if we should be starting to look at arranging medivac transport.’

‘We’re a level two unit.’ Emma was a little defensive. ‘I’ve handled several thirty-four-weekers, and even a couple of younger ones whose mothers had their dates wrong, like this one did.’

‘Yes, I’m not kicking her out of here yet, am I, Alethea? There are no real danger signs, and it would be great if we could get her strong and well ourselves…but I still think Sydney’s on the cards.’

‘There’s no point in having the facilities to handle premmies here if we don’t use them to maximum potential,’ Emma said. ‘Thirty-four weeks is the cut-off, I know, but personally I’m trained to a higher level than that.’

‘True. And people get better at it if they practise. There are going to be a few of us practising on this baby.’

‘Don’t put it like that, Nell, as if she’s an anatomical model.’

‘Oh, I’m not. I’m not. You know I’m not. I’m just nervous. That thumb-pricking feeling that something’s not right, despite all the things that clearly are.’

‘The way you were worried about that little girl who was revived after she fell in her pool?’

‘She was Pete’s patient, too.’

‘This one was dropped into his lap,’ Emma pointed out, although why she felt this instinct to leap to Pete’s defence, she didn’t know. ‘He’d never seen her before.’

‘The man has trouble with the women in his life, doesn’t he?’ Nell commented lightly. ‘Whether they’re patients or family.’

Emma bit back a comment which she might regret. Was Nell implying Pete’s troubles were his fault? Again, she felt a need to protect him and to leap to his defence, which she didn’t understand. He was extremely competent and very intelligent. He worked hard, he cared and he had the right priorities. Just because he’d been living in her house, that didn’t mean he needed her nurturing. What was wrong with her today?

‘Let’s take this one across to the unit,’ Nell added.

It took them another hour to get the baby settled in Glenfallon’s tiny special care unit, which was simply a small, closed-off room with thick, almost soundproof windows opening onto the rest of the maternity unit. It was most often staffed by the midwives rostered for post-partum care.

Lucy was already there, in the care of Sue North now, but she’d probably go home with her mother in a few days’ time, if her condition continued to be this good and she began to feed properly. Alethea’s arrival would necessitate the juggling of staff so that Emma and a roster of two or three other experienced nurses could provide her with the acute care she’d need at first, round the clock.

In the meantime, Nell was staying.

‘I hope my department’s quiet,’ she said. ‘No doubt I’ll hear the yelling soon enough if it isn’t! We can let the dad come in and see Lucy now.’

Brian McNichol had been shepherded aside as soon as Patsy had been taken into the operating theatre. He’d probably been fed several gallons of tea by now. Emma had lost track of time. Where was Patsy? Still in Recovery? After her general anaesthesia and the extent of her bleeding, she’d probably be kept there for longer than usual. Had her husband been able to see her yet?

‘I’ll track him down,’ she said.

‘Rebecca Childer, too. She might need some encouragement. She seemed a little frightened about what to expect, and inclined to suggest it was all up to the nurses. Or her mother!’

‘We’ll work on that. I’ll hunt up some pamphlets on premmies, and talk to her and her mother as well, try and get her involved right from the beginning.’

Emma went back to the nurses’ station on the labour and delivery side of the unit, and found an unnatural level of quiet. No patients.

‘Just had a phone call from a first-timer in query early labour, but it sounded to me like a false alarm,’ Bronwyn summarised, lifting her head from the paperwork she was catching up on. ‘She’s not due for a couple of weeks. She wants to come in, but I expect we’ll be sending her home again. Pete Croft is chugging coffee in the kitchen if you want a progress report on Mrs McNichol.’

‘Oh, I do!’ Emma said. ‘And I’m hunting for the dad.’

‘I sent him off for breakfast. He was wandering around like a ghost.’

‘Dr Cassidy says Rebecca can see her baby now. Have you moved her to her room?’

‘Yes, half an hour ago,’ Bronwyn answered. ‘And her mother’s with her. I’ll take Brian McNichol round to Special Care as soon as he gets back from breakfast.’

As Bronwyn had said, Emma found Pete in the kitchen.

He’d evidently ‘chugged’ his coffee to good effect, and was holding his mug beneath the wall-mounted urn to fill it for a second time—or possibly a third—when Emma entered the room. He took a gulp of it black, then shuddered, grabbed the milk carton and splashed in a generous amount, before bringing the mug to his lips again.

Only then did he turn and see her standing there, and she had to quickly hide the awareness she suspected had been showing in her face. ‘Emma…’ he said, coming back to the present from what looked like a million miles away.

‘I was wondering…Mrs McNichol?’ she asked, before the beat of awkwardness could lengthen.

‘She lost a lot of blood,’ Pete answered. ‘Not enough to need a transfusion, but she’s on a fast drip and I’ll be watching her iron levels over the next few months. Thank goodness the baby started breathing when she did!’

‘What’s your sense about Alethea Childer?’ Emma asked.

‘I wanted to ask you that, actually, since you’ve been with her all the way through. How much did she weigh?’

‘Twelve-fifty grams.’

‘And we estimated thirty-three weeks gestation!’ He pressed his lips together, and she couldn’t help watching as they softened again when he continued to speak. ‘That’s small, even for the dates.’

‘I know.’ An average baby should have weighed several hundred grams more. ‘And Dr Cassidy doesn’t know why.’

‘Bothering her?’

‘Yes. She picked up a heart murmur as well, which she’s not sure about yet.’

‘Lucy McNichol has one, too.’

‘This time she thinks it may be more significant, but so far the heart is doing the job with no problems, so we’re hanging fire.’

‘Right.’ Pete shut his eyes for a moment, then opened them again. A tiny muscle twitched just above one cheekbone. ‘I guess I’m not all that surprised. Has the staffing been sorted?’

Emma nodded. ‘Yes, looks like it. Sue North knows what she’s doing. I’m in there, too, and they’ll juggled the roster. We’re all used to stretching when we have to.’

‘It may not be for long, if we end up sending Alethea Childer somewhere else.’

‘You don’t want to?’

‘Funny, but, no, I don’t.’ He gave an upside-down smile. His eyes had those creases around them again. ‘You’d think I might be keen to get this one off my hands. But she dropped on us out of the blue, and for some reason I don’t want to lose her again to another hospital just as quickly. Rebecca’s young. She has no confidence, and she’s not ready for this.’

‘She seems a little detached at this stage, like she might leave everything to us and just stay away.’

‘Maybe that explains why I’m feeling possessive.’

He leaned back against the kitchen countertop, with one elbow resting on it. The movement made his shirt tighten across his strong chest. The fluorescent light overhead sculpted shadows on the side of his face.

‘I feel like the baby belongs here,’ he went on. ‘And that we can do what we need to for her, with Nell on board. Unless that heart murmur turns out to be significant and she needs surgery. That, we couldn’t handle. That would mean Sydney or Melbourne.’

He took another gulp of his coffee, punctuating the heaviness of the statement. The movement firmed his mouth and stretched the planes of his cheeks a little.

‘If it’s an open ductus, the operation itself isn’t that complex any more, is it?’ Emma asked.

‘In relative terms, I guess. It’s a closed-heart procedure.’

‘They don’t have to open the heart itself.’ Emma understood this.

‘And no heart-lung machine required,’ Pete confirmed. ‘Start to finish, less than an hour. They make an opening in the left side of her chest, tie off the PDA and divide it. It’s about the width of a piece of string.’

‘Oh, huge!’ she drawled.

‘As I said, simple is relative. It would still need to be done in a major children’s hospital, by a paediatric surgeon. And what parent wants to think of a baby as small as Alethea in surgery when she’s just a few days old, no matter how skilled those guys are?’

‘I know.’ Emma leaned against the fridge and rubbed an aching calf with the side of her shoe. ‘Nell has hopes the murmur doesn’t mean anything. The baby’s oxygen saturation is up in the high nineties.’

‘That’s great! Are you heading back to Special Care now?’ He tipped out the rest of his coffee, rinsed the mug and rested it upside down on the sink.

‘Yes, I just wanted to catch up with you and make sure everything was still in hand on this side of the unit.’

‘Come on, then,’ he said.

He slipped past her and she followed in his wake at once. They walked along the U-shaped corridor together in a comfortable silence, and found Nell scribbling notes on Alethea’s chart, while Lucy slept peacefully. Both babies looked like tiny red frogs in the white expanse of their special, warmed humidicribs.

‘I’m heading off,’ Nell said, capping her pen. ‘I’ll be back in a couple of hours. Or sooner if you need me, Emma. If that oxygen sat rate drops, if the heart rate changes, you know what I’m looking for. Pete, she’s not as strong as you hoped. And there may—may—be a heart problem.’

‘Yes.’ He nodded. ‘Emma told me. You’re going to wait before doing any tests?’

‘Yes, as long as her levels are this good, but I want to talk to the mother about whether to send her to a higher level unit even if she doesn’t need surgery. There may be other problems. I just have that feeling, despite what the machines are saying. And this is a stretch for us.’

‘I know, Nell, but if there’s nothing specific, and if the mother is already too detached to get properly—’

‘Look, I’m not saying it’s an easy decision,’ she cut in. ‘There are pros and cons.’

‘There are always those.’

She ignored him. ‘We have to consider the downside of transporting a fragile baby, for a start. And you’re right. Taking a premmie away from a mother whose bonding is already tenuous could cause its own problems. But let’s think about it,’ she urged, her eyes bright. ‘Let’s get it right.’

She left without giving him time to reply, and Emma saw his jaw set.

Anger, or determination?

She wasn’t sure.

She didn’t think Pete was the kind of doctor who’d make up his mind and then stick to his guns out of ego and pride. She’d only ever seen him put the interests of his patients first. But she knew he was under pressure at the moment in his personal life, and there were pulls in both directions for Alethea.

Pete looked again at the baby and at the fluctuating red figures on the monitor, and Emma couldn’t help doing the same. The heart rate, respiration and oxygen saturation all showed up on screen at a glance. The baby’s nappy was as small and flat as an envelope. The little hat covered the whole of her tiny head, and her face looked as crumpled and ancient and inscrutable as that of an Eastern mystic.

‘Should we start trying for a bed in Sydney or Melbourne straight away?’ Pete muttered. He might have been talking to himself. ‘On paper, we’ve got the facilities and the staff. I’m glad I called in Nell.’

‘She’s good,’ Emma agreed.

So was he. Thorough and caring and imaginative in his approach. He wasn’t afraid to try something new, or to go out on a limb.

He was way out on a precarious one right at this moment, putting Rebecca’s chance to bond with her baby on a par with the baby’s potential need for a higher level of care. On the other hand, skin-to-skin human contact had been shown in repeated studies to be as physically important to a premmie’s development as oxygen, medication and specialist expertise.

He looked up.

‘Sorry. I’m still e-mailing you. Only verbally this time.’ He grinned, and there was a warm glint in his brown eyes that she responded to at once with a laugh.

‘Are you?’

‘That doesn’t make sense,’ he conceded. ‘But it was nice, Emma. Did I say that?’

‘You said it was a slice of paradise. My house. In your card, I mean.’ Emma cleared her throat. ‘You didn’t specifically mention the e-mails.’

She felt absurdly self-conscious beneath the warm wash of his words. In the confined space, they were standing closer than she felt comfortable with. It was ridiculous to be so aware of him, to feel this sense of closeness and this sense of knowing him, which was based on such a thin foundation.

‘Well, the e-mails were good,’ he said. ‘They helped.’

Emma blurted, ‘Is it Claire? Is that why you’re looking so stressed?’ Then could have cut out her tongue. He’d said nothing to encourage her to ask such a personal question. It was all coming from her.

He sighed, then muttered, ‘Yes, of course it’s Claire.’

‘I’m sorry, you don’t have to—’

‘I thought that we were in the home stretch.’ His mouth tightened and turned down. He spoke in a low, rapid way, and didn’t look at her. ‘We had decisions made and arrangements worked out. I thought. But Claire’s thrown that to the four winds, and I would have done so even if she hadn’t, because of the way she’s been behaving. I don’t know what’s wrong with her.’

He stopped, and looked up suddenly, with a ravaged expression that struck Emma to the heart. She felt the same need to touch him that had tingled in her fingers before. The same need to smooth out those creases around his eyes and softly stroke the brown skin at the back of his neck, to press his lips with her fingertips until they relaxed, and to tell him everything would be all right.

‘Oh, Pete!’ she said. It was heartfelt, but so inadequate.

‘I haven’t talked to anyone about this.’ His eyes were narrowed, and glittered with fatigue. ‘I don’t know why I’m talking to you.’ He gave a short laugh. ‘Because you’re listening, I guess. Because you asked. You were here at the right moment, basically. The wrong moment, perhaps.’

‘I shouldn’t have asked. I’m sorry.’

‘No, it was fine. Only now I’m not offering you much choice about listening to a far more detailed reply than you wanted.’

‘I-it’s fine, Pete,’ she stammered, echoing the same word he’d used—safe and vague. ‘I’m happy—that is, I want to listen. If it’s a help.’

‘I’m petitioning for sole custody. Please, don’t talk to anyone about this!’

‘As if I would!’

He glanced around to check that the door was closed and that they were fully alone.