Kitabı oku: «Cinderella And The Surgeon / Miracle Baby For The Midwife»

CHAPTER ONE

ESTHER MCDONALD RUBBED her eyes for the twentieth time as she made her way to work. She’d hoped the walk along the footpath next to the Thames would have woken her up a little, but it clearly wasn’t working.

She’d pulled an extra shift last night working until midnight at another hospital in London. Anything to help pull in some extra cash. She already planned to text the agency again today to see if they had anything else for her.

It wasn’t that her own job wasn’t well paid. It was and she loved working in the neonatal ICU at the Queen Victoria. But right now she needed every penny she could get. So that meant working every shift available.

She was lucky. Because she was dual-trained she could work as a nurse or a midwife, which meant she had multiple opportunities for extra shifts. Usually she could pick up shifts at short notice for the A&E department in the Queen Victoria on her scheduled days off. But the duty manager had noticed how often she’d been working and had passed comment more than once. So, Esther had registered with an agency as well.

She filed through the main doors of the hospital along with a whole host of other staff heading for the early shift. She was worried about a tiny preemie she’d been looking after for the last few days in ICU. Billy, the twenty-four-weeker with a heart defect, had seemed even more fragile than normal yesterday afternoon when she’d left. His young mother hadn’t left his side since he’d been born a few days earlier and was looking sicker and sicker herself. Esther just hoped the ‘wonder’ doc they’d all been talking about had finally managed to turn up to assess the little guy. Billy needed surgery that only a few neonatal cardiac surgeons could do. Trouble was, this guy had been over in France operating on another baby, so Billy had been left waiting.

She tugged her pale blue scrubs over her head and pulled her hair back into a ponytail, catching a quick glance of herself in the changing room mirror. Ugh. She looked awful. The quick sweep of make-up she’d stuck on her face this morning couldn’t hide the dark circles under her eyes.

As she headed to the stairs her stomach grumbled loudly. She’d been so tired she hadn’t had time to make breakfast this morning. She’d have to try and sweet-talk her colleagues into letting her take first break. One of the Queen Victoria’s freshly baked scones would easily fill the huge gap in her stomach. She smiled at the thought of it.

‘Morning,’ she said in her best bright voice as she entered the NICU, stowing her bag and washing her hands. She got a little buzz every time she walked through the door. It was everything, the lighting, the sounds, the staff and patients—even the smell. She’d done her nurse training in Edinburgh and came down to London to also complete her midwifery training. Only a few specialist centres offered the shortened eighteen-month training these days and she’d been delighted to join the programme at the Queen Victoria, joining in with an already partly trained direct entry midwifery programme. She’d made some of the best friends she’d ever had—and even though some of them had gone to other parts of the world now, they were all still in touch.

The midwifery training had been a revelation for her. Esther had always imagined she’d end up as a community midwife, but from the first second she’d set foot in the NICU, she’d known that’s where her heart lay. There was something about the vulnerability of these tiny babies. The role of often being their safe-guarder in the first few days of their lives. The little bits of progress she could see every day.

Of course, there could often be heartbreak. Her job was as much to take care of the families as it was to take care of the babies. But there was something so special about helping a preterm baby latch on to their mother for the first time. Or watching them become more aware of the world around them. Or seeing their reactions to lights or voices. Now she was here, she couldn’t imagine working any place else.

One of the other midwives stood up and put her bag over her shoulder.

Esther glanced at the chart. ‘How’s Billy doing?’ She checked the whiteboard, making sure she’d been assigned her favourite patient again today. Yip. Perfect. Billy, and a thirty-six-weeker in the next crib who’d been born to a diabetic mother in the early hours of the morning. That little one was likely just being monitored for a few hours to keep an eye on blood sugars.

Ruth, the other midwife, sighed. ‘You look tired.’

‘I am. Weird. Extra shifts never usually bother me.’ Esther stretched out her back. ‘You know how things are. Win the lottery and give me a share and I promise I won’t work an extra shift again. Until then, I’ll take all I can get.’

Ruth shot her a look and started the handover. ‘Billy hasn’t had a good night. His sats dropped, his feeding tube dislodged and X-ray haven’t been able to get back up to ensure the new one is in the correct place. Hence, his feeds haven’t started again.’

Esther shook her head. She knew exactly how important it was to ensure the nasogastric feeding tube had gone into the stomach and not a baby’s lungs. No feeding could commence until it was confirmed.

‘I’ll call them again. If Callum’s working I’m sure he can get someone up here now.’

Ruth smiled. ‘Perfect. He always listens to you.’

She scanned the rest of the charts. ‘Anything else?’

Ruth nodded. ‘Billy’s cardiac surgeon is supposed to arrive today. No idea when, but all his tests have been completed, so hopefully the surgeon will just be able to check them all, listen to his chest and schedule the surgery.’

Esther nodded. Please let it be today.

‘By the way,’ said Ruth as she handed Esther another chart. ‘He’s supposed to be a duke or something.’

Esther had already started scanning the other chart. The other baby was Laura, thirty-six weeks, born via emergency caesarean section to a Type 1 diabetic mother. Laura’s blood sugar levels had been erratic for a few hours after delivery. That could happen with babies born to diabetic mothers, and it wasn’t unusual for a baby to have close monitoring for just a few hours. Laura’s levels had stabilised in the last hour, so Esther would just do a few more checks, then get her back to her mother’s bedside.

She looked up and wrinkled her nose. ‘What did you just say?’

Ruth laughed. ‘I said the new surgeon. He’s a prince or a duke or something.’

Esther shrugged. ‘And what difference does that make? Is that why he’s late? He’s too busy with his—’ she held up her fingers ‘—other duties.’ She frowned as she picked up some nearby equipment. ‘Better not be why he’s keeping my baby waiting.’

Ruth shook her head as she picked up her bag to leave. ‘Lighten up. Maybe this new guy is single.’ Ruth sighed and gave Esther a look that made her want to run a million miles away. Pity. Esther hated that. She hated anyone feeling sorry for the poor little Scots girl. ‘All I’m saying is that maybe there’s more to life than work, that’s all.’ Ruth gave a shrug and walked over to the door. Then she turned back with a smile and wagged her finger at Esther. ‘And make sure you’re on your best behaviour. Don’t have our new guest surgeon meeting Crabbie Rabbie instead of super midwife Esther.’

Esther looked around for something to throw but Ruth had ducked out the door too early. She shook her head as she walked over to do her checks on her babies and parents.

She’d earned the nickname within a few months of getting here as a student midwife. Because she’d already been qualified as a nurse, she’d caught a few shifts in the wards while completing her midwifery course. Truth was, Esther was never at her best on night shift. That whole ‘turn your life upside down for a few days’ thing just messed with her body and brain and tended to make her a little cranky—or crabbit as they called it in Scotland.

She’d clashed with one of the junior doctors one night on the ward when he’d continually tried to re-site an IV on an elderly patient, rather than come and ask for help. Once she’d realised he’d had four attempts he hadn’t fared well.

The whole ward had heard him getting a dressing-down, her Scottish accent getting thicker by the minute as she got angrier and angrier.

It had been 25 January. Robert Burns Day in Scotland—named after their national poet. This doctor had known that and had walked away muttering, ‘Oh, calm down, Crabbie Rabbie,’ much to her fury, and the rest of the staff’s delight.

She’d never managed to shake it off—even though she mostly kept her temper in check these days.

One of the other staff on shift wandered over. ‘Problems?’

She shook her head. ‘All stable. I’ve chased up the x-ray for Billy, just waiting for them to appear. I’m going to take Laura back along to the maternity ward. Her blood sugars are fine and she’s starting to grizzle. Must be due a feed.’

‘Okay, do that, and then go for first break. You look as if you need it. I’ll keep an eye on Billy.’

She laughed and put one hand on her hip. ‘I must be looking bad if you’re sending me on first break.’

‘Go before I change my mind.’

Esther rechecked Billy’s obs and chatted with his mum for a few minutes, making sure everything was meticulously recorded and phoning down to Callum again to chase up the x-ray. Then she gathered what she needed for Laura and threw her bag over her shoulder. Ten minutes later, Laura was back at her mother’s bedside and happily feeding.

Esther stretched out her back as she headed to the canteen. It didn’t normally bother her but today it was aching. Maybe all the extra shifts were taking a toll on her. The smell of freshly baked scones hit her as soon as she walked through the canteen doors. Two minutes later she had a large coffee and an even larger scone with butter and jam before her.

She glanced around the canteen. She couldn’t spot Carly or Chloe, the friends that she normally sat with. There was a group of other nurses that she knew, but a seat in the far corner of the room was practically crying out her name. She was too tired to be sociable.

She moved quickly and slid into the seat before anyone else claimed it. Most of the seats were hard-backed and sat around the circular tables in the canteen. But there were a few, slightly more comfortable chairs a little further away—obviously left over from a ward refurb a few years ago.

The scone was gone in minutes and as she sipped her coffee she closed her eyes for just a moment. The door nearest her opened with a bang and a large crowd of people walked in, all talking and laughing at the tops of their voices.

She gritted her teeth. Just five minutes of peace. That’s all she wanted. She shifted uncomfortably on the chair, pulling her scrub top from her skin. It seemed unusually warm in here.

The noise continued. Esther watched through half-shut eyes. There was a guy at the centre of it all. Handsome, in a TV doctor kind of way. Tall, broad-shouldered, with dark rumpled hair. The rest of the people around him seemed to be hanging on his every word, occasionally throwing in a word of their own as if they hoped to garner some approval. Maybe he was some kind of TV doc?

‘This place is a hospital, not a blooming circus,’ she muttered.

She checked the clock on the canteen wall. Five minutes. She had another five minutes left of break time. Esther usually never bothered with timings. Most days she grabbed some food, bolted it down and went straight back to the NICU. But she couldn’t believe how tired she felt—it was unusual for her, she did extra shifts frequently and never felt like this—so, for once, she settled back into the chair. For once, she would take her full break.

‘Esther, Esther!’

The voice came out of nowhere. Esther jerked awake. Liz, the admin assistant from NICU, was shaking her shoulder. ‘Wake up.’

Esther sprang from her seat, knocking the still-full coffee cup that had been balanced on the edge of her chair, splashing coffee up the legs of her scrubs and sending Liz jumping backwards.

‘Oh no,’ she groaned. She gave herself a shake and glanced at the clock on the wall. She was more than fifteen minutes late.

Liz pulled a face. ‘Abi told me to come and find you. The surgeon’s arrived. He’s reviewing Billy right now.’

Esther stared down at the rapidly spreading stain on the lino beneath her feet. ‘Leave it,’ Liz said, waving her hand. ‘I’ll get it. You just go.’

Esther put her hand on Liz’s arm. ‘Thanks, Liz. I’m so sorry. I’ll make it up to you.’

She dashed back down the corridor towards NICU, crashing through the doors and heading straight to the sink to wash her hands. Abi was standing in the middle of a crowd of strangers that must include the new surgeon; she raised her eyebrows and said in a louder than normal voice, ‘Oh, good, Billy’s midwife is here. She’ll be able to update you.’

Esther dried her hands and moved over quickly, making her way through the crowd. ‘Hi there, I’m Esther McDonald.’ She looked around trying to decide which one of the many bodies wearing white coats must belong to the surgeon. All she knew was he was male. Abi handed over Billy’s chart and Esther could see from a glance that he’d had his chest x-ray and his tube feeding had restarted while she’d been gone. She breathed a sigh of relief.

‘You’re the midwife?’

The deep voice was practically at her ear and she jumped, stumbling over her own feet.

She spun around. Mr Imposing was standing in her personal space, his arms folded across his chest, looking her up and down in a disapproving manner. Okay, so the NICU probably wasn’t big enough for all these people, which could explain the space thing. And the massive splatter of coffee all over her scrub trousers probably wasn’t helping her appearance.

But right now she could smell his clean aftershave and see into those toffee-coloured eyes.

‘Weren’t you the nurse who was sleeping in the canteen?’

She could feel the blood rush to her face and all the hairs on her body prickle in indignation. Who did this guy think he was, sweeping in here with his giant entourage?

Nope. No way.

‘I’m sure you know that we limit visitors to NICU. Maybe other NICUs relax rules for you and your entourage, but the Queen Victoria doesn’t.’

She started to count in her head just how many people were in his little gang. She’d reached twelve when his deep voice sounded right in front of her again.

‘Isn’t this a teaching hospital? Famous the world over for its training programmes?’ There was a mocking tone in his voice.

Esther had been around long enough to recognise an arrogant doctor. As a nurse, and a midwife, she’d met more than her fair share—both male and female.

She hated anyone being dismissive with her. And she didn’t stand for it. More than once she’d used her Scottish accent to the best of her ability to give someone short shrift.

There was something about her accent that generally made people take a step back—particularly when she was angry. If this guy didn’t watch out, he’d soon find out exactly who Esther McDonald was. She’d barely had a chance to look this guy up. All she knew was he was one of a few specialist surgeons who could do the procedure that Billy needed.

She mirrored his stance and folded her arms, tilting her chin towards him as she put a fake smile on her face. ‘Maybe you’d like to introduce yourself and let me know why you think your needs are more important than the needs of the very special babies we have in here?’

She could do sarcasm too.

He inhaled deeply, almost like he wanted to show her just how broad his chest was. But Esther had never been easily intimidated by anyone. ‘I’m Harry Beaumont. I’m here to do the surgery on your patient.’

She raised her eyebrows and nodded. ‘Ah, so you’re here to do the surgery on Billy.’ She pointed one finger at him. ‘In that case, you can stay. Everyone else can wait outside. Unless you’ve brought your own anaesthetist with you.’ She shrugged. ‘If you have, then he, or she, can stay too.’

Eleven other faces exchanged anxious glances, so Esther turned her head a few times as she spoke. ‘The babies in here are just too susceptible to infection to have this many people around. Visitors are strictly limited, for good reason.’ She looked at them all. ‘As I don’t know who any of you are—and to be honest, I’m a bit funny about letting people I don’t know into my NICU too—I’m just going to assume that you’re all either medical professionals or trainees, therefore I don’t need to explain the principles of infection control to you, so you’ll all completely understand that this amount of people is overkill—’ she turned her head back towards Harry ‘—even for a surgeon.’

She’d spoken quite a lot, but knew entirely that all the emphasis was on the things she hadn’t said, but had left implied.

There was a tic at the side of Harry’s jaw. He was mad. She didn’t care. She wanted to tug at her scrub top again. NICUs were always really warm, but this amount of people in close proximity was making her sweat. But tugging at the top would mean she’d have to unfold her arms and that would be a sign of weakness. So not happening.

It was the longest pause. Harry gave the tiniest nod of his head. ‘Francesca, will you stay with me, please? The rest of you, if you wait outside we’ll find a teaching area where I can explain things in due course.’

Francesca was a petite redhead who was grinning conspiratorially at Esther. She let the rest of the entourage leave, then asked, ‘Can I see Billy’s films? I’d like to review them before we examine him.’

‘Of course,’ said Esther, gesturing for both of them to follow her to the nearest computer screen. ‘Have you been assigned temporary log-in credentials?’

‘I have,’ said Harry, moving over next to her and tapping his details in.

It only took a few moments for a scowl to come over his face. ‘I sent a list of tests to be completed for Billy before I got here. Some are missing.’

‘They are?’ Esther moved closer, checking the screen. She’d checked before she’d gone off shift yesterday when there were just a few still to be completed. Ruth had said the rest had been done. What was missing?

She turned to Harry. ‘What is it that you’re looking for?’

‘His bloods. From this morning.’

Of course. ‘I’m sure they were done—they’ve probably not been reported on yet. Don’t worry, I can phone the lab and put a rush on them.’

Harry straightened and gave her an incredulous glance. ‘What do you mean you’re “sure they were done”? You mean you don’t actually know? And why wasn’t there already a rush put on them?’

She stiffened. He was speaking to her as if she was incompetent. Of course she should know if Billy’s bloods had been done or not. But the specialist phlebotomist would have been here while Esther was on her break. If she hadn’t been late back, she might have had a chance to check…

She kept her face blank. Her back was aching. ‘The orders for the bloods were put in last night. At that point, you hadn’t told us when you were coming, or let us know if you’d secured theatre time for Billy. If you had, there would have been a rush put on his bloods.’

She moved over to the desk to pick up the phone. Every word he’d said had annoyed her. But what irked most was that they felt true.

What was wrong with her? She prided herself on being meticulous at work. It wasn’t like she’d made any kind of mistake but…in her brain it almost felt like that. Double-checking things was second nature to her.

‘I’m used to working with professionals. I guess the standards here are not what I’m used to.’

‘Excuse me?’ She couldn’t help herself. There was no way she going to let anyone accuse her of being unprofessional. It was the biggest slight that someone could say to a nurse or midwife.

But it seemed that Harry was off on a rant. He kept his voice low, so that no one else in the unit could hear. ‘Why does Billy still have a feeding tube in situ? In order for Francesca to anaesthetise him, she needs to ensure his stomach is empty. His feeding should have stopped a few hours ago.’

Now Esther wanted to shout at him, but just at that moment a voice answered at the end of the phone. ‘Lab,’ came the weary response.

Something inside Esther panged. Whoever was working there was obviously every bit as tired as she was. ‘It’s Esther from NICU. Can I chase bloods for a baby that’s going to Theatre?’

There was a sigh and murmur of consent. She replaced the receiver and turned to face Francesca, completely ignoring Mr Entourage. She wasn’t even prepared to use his name right now.

‘If you refresh the screen in around five minutes Billy’s bloods will be available. One of the machines was down for a few hours this morning but it’s back up and running now. Billy’s bloods had already been in the system. They’re just waiting for his clotting factor.’

Francesca gave a nod. ‘Perfect.’

Esther looked at Harry’s screen. He was looking at the cardiac echo that had been taken yesterday. Billy needed his surgery, badly.

She moved alongside Harry. ‘I have many skills, Mr Beaumont, but mind reading isn’t one of them. Like I said earlier, if you’d given us notice of Billy’s procedure, then we’d have made sure his feeds were stopped in good time. As it was, his tube dislodged last night and had to be replaced. Billy already had a few hours without sustenance, while his tube was re-sited and then checked. His feed only started again in the last hour.’ She braced herself and turned her head towards him. ‘And for me, unprofessional is a surgeon sweeping into a NICU with an entourage of twelve people with no regard for the patients or parents who are already in a stressful environment. For a surgeon with your apparent experience, I’d expect better.’

Harry was trying his absolute best to keep his temper in check, but this midwife was trying his patience in every possible way. It didn’t help that she had a cheek to be angry at him, or that when she was clearly annoyed she spoke so quickly he had to concentrate to make out a single word that she said. Her Scottish accent was fierce. A bit like she was.

By rights she should probably have fiery red hair to match. But she didn’t. She had dark hair that was up in a ponytail, and her skin looked as though it had once been tanned but was now strangely pale. He couldn’t possibly ignore the dark circles under her blue eyes, or the dirty scrubs she was wearing. He wasn’t quite sure what all this meant—apart from the fact she was looking after the baby he was due to take to Theatre.

Harry had spent his life in and out of NICUs across the world due to his surgical speciality. There weren’t many people that wanted to work on such tiny hearts and veins—particularly when the tissues were so fragile and these little lives could literally be on a knife edge.

What the staff in the NICU at the Queen Victoria clearly didn’t know was that he was the new visiting surgeon, which meant that, where possible, babies with heart conditions would be brought here for him to operate on. For those who were too sick to travel any distance, he would still go to them. But having a semi-permanent base with a team around him would be good. He’d hoped to find professional colleagues he could trust and rely on. But first impressions of this midwife weren’t exactly good.

There was no way he wanted her watching Billy postsurgery.

But what annoyed him most of all was the way she’d quickly and determinedly told him to get his staff out of ‘her’ NICU.

And she’d been right. They always tried to reduce the amount of close contacts that prem babies had. It was important. Their immune systems were often not fully developed, and most humans were walking petri dishes.

People could be carrying bugs for days without any signs or symptoms. Something that caused a mere sniffle in an adult could be deadly to a premature baby. It might be a teaching hospital but even he wouldn’t expect any NICU to let in that many students and trainees. He’d been in such a hurry to get in here and see his patient, and been so swept away by the enthusiasm of the staff at his side, that he hadn’t stopped to think. And Harry didn’t make mistakes like that. So being called on it was embarrassing.

‘You must have known Billy was going to Theatre today,’ he said briskly to the midwife.

She gave him a weary look that told him she was getting very bored by all this. ‘I hoped you might show your face today. I hoped that Billy wouldn’t have to wait another day for surgery. I was told that you were supposed to turn up today, but no one knew when. I look after both baby and mum, and if you’d communicated a little better, there was also the chance I could have prepared mum more for his surgery today.’

She put her hands at the back of both hips, leaned backwards and winced as if she’d touched something painful.

‘Blood results are in,’ said Francesca in a manner that could only be described as deliberately distracting. It was clear she was trying to break the tension between them. ‘His blood gases are a little lower than I would have liked. But not anything I wouldn’t have expected.’ Francesca gave a little sigh and Harry felt a rush of sympathy for her. They’d worked together for a long time. She was a great anaesthetist. It took great skill to manage these tiny babies in Theatre and he depended on her completely. Francesca’s chair scraped on the ground as she stood up. ‘I need to sound his chest. Let me wash up first.’

He followed her over to the sink in the treatment room, completely sidestepping Esther and washing his hands too. He needed to prioritise this baby, not the midwife who looked as if she could currently fall asleep on her feet.

As he stepped back his arm brushed against hers and she jerked away. But not before he noticed how hot she was. ‘Do you have some kind of infection?’

She looked shocked. ‘What?’

‘You’re burning up. What’s your temperature?’ His arm swept out across all the cribs in the NICU. ‘If you have anything respiratory you’re putting the lives of all these babies at risk.’

‘I don’t have anything respiratory,’ she snapped. ‘My chest is clear as a bell.’

For one strange second he realised that her words had made him look exactly at her breasts hidden under her scrubs. He turned back to Francesca. ‘We should see this baby on our own.’

Esther stepped into his path. ‘No, you won’t. I know Jill, his mum, best. She needs support. She trusts me.’

Harry glared at her and she held up her hands. ‘Okay, I won’t touch Billy, right now. I’ll run down to A&E when you’re done and get a clean bill of health. But you don’t see him without me.’

Harry pressed his lips together, stopping himself from just getting into a pointless argument. ‘Only speak to mum, then,’ he reiterated.

She gave an exasperated nod and held out her hand. ‘This way.’

Harry and Francesca followed her over to the left-hand side of the unit to where a young woman sat staring at her baby lying in the crib and rocking backwards and forward in the nursing chair. Harry had dealt with lots of anxious parents. NICUs were the most intimidating places on earth. Parents frequently felt everything was out of their control, and he was used to comforting and supporting parents who were overwhelmed with helplessness and focused on every word that was said to them. This mother was young. Her lank hair was pulled back from her face. It looked as if it hadn’t been washed for a while and from first appearance he actually wondered when she’d last eaten. Now he understood just why Esther was being so protective of Billy’s mum. It was clear she didn’t have many support systems in place.

‘Jill, this is Harry Beaumont. He’s the surgeon that’s going to do the surgery on Billy.’

Harry crouched down so he was level with Jill. She’d sat forward but hadn’t stood up. He gave her a broad smile. ‘It’s a pleasure to meet you, Jill. I’m here to take a look at Billy. I’m hoping we’ll be able to take him for surgery later today. Do you mind if I examine him?’

Jill paused for a few moments as her eyes filled with tears, then she gave a tiny nod. ‘Of course.’

She was terrified. He got that. Harry used some of the NICU hand sanitiser before opening the crib to examine Billy, while Francesca introduced herself as Billy’s anaesthetist. He could tell straight away that Esther completely understood, and after a few moments, he could see the tension in Jill’s shoulders start to dissolve as he spoke to Billy in a calm, quiet voice as he examined him.

‘Hi, Billy, I’m here to see how you’re doing. Let’s have a little listen to your heart and lungs.’ He took his time, listening carefully, then checking his oxygen sats, his feeding tube and his colour. Babies this small frequently had skin that was almost translucent. Their circulatory systems—and particularly Billy’s—weren’t functioning quite right, and they often couldn’t regulate their temperatures. Operating and anaesthetising these babies carried huge risks. He gave Francesca a nod as he moved his stethoscope back to Billy’s chest. ‘Want to take a listen?’

She nodded and moved alongside him. There was no point her touching Billy too when she really just needed to listen to his heart and lungs. So, she listened through Harry’s stethoscope, nudging him to move it on occasion.

Harry could sense Esther watching them curiously. She wouldn’t know they’d done this a dozen times before. As Francesca finished her examination it struck him how similar Esther and Jill looked. Exhausted and tired. He could understand it for the mother. But for a member of staff—it wasn’t good enough.

Francesca gave him a nod and he removed his stethoscope and pulled a chair over next to Jill and spent the next few minutes explaining Billy’s surgery to her in simple terms. He brought out some notes that he’d prepared earlier. He always gave the parents of the babies he operated on some clear notes that they could refer to later. Experience had taught him that although parents listened, anxiety meant that they didn’t always remember or understand what they’d been told.

He could feel Esther’s eyes on him the whole time. He would expect the midwife assigned to this child to listen to his explanation. It would mean that she could reiterate anything to the mum at a later date. But somehow, today, it irked him. And he couldn’t quite understand why.

‘Do you have any questions?’ he checked with Jill. She shook her head and he gave her a small nod. ‘If you think of anything later I’ll still be available to answer any questions. I’m going to organise some theatre time now. I hope to take Billy later this afternoon. We’ll stop his feeding for the next few hours, and I’d expect the surgery to last around six hours. You can come down to Theatre if you want while Billy goes to sleep, and I’ll come and find you as soon as we’re finished to update on how things have gone. Okay?’

Jill gave a nod.

‘I’m just going to have a chat with your midwife, and then I’ll talk to you in a while and get you to sign the consent forms.’

He smiled and walked back over to the nurses’ station with Francesca and Esther. Francesca sat down and started making some notes. Esther turned to look at him. ‘You aren’t doing the consent form now?’

He shook his head. ‘No. I’ve given her a lot to process. I want to give her a bit of time to think about everything I’ve told her before I get her to sign the consent form. She might have more questions later.’

Esther gave a brief nod.

He narrowed his gaze. Was she actually listening? He glanced at the board he’d noticed yesterday. It was a shift rota for staff.

The next few days would be vital for Billy. It was important that whoever was looking after him was at the top of their game. Esther’s name was on the rota for tomorrow. He couldn’t let that go.

‘You’re tired. No, scrap that, you’re exhausted. And I think you’re sick. I don’t think you should be at work and I certainly don’t think you should be assigned to Billy. For the next few days he’s going to need someone who’s alert and on their game.’ He paused for the briefest second, because he knew what he was about to say wasn’t exactly nice. ‘And to be honest, I’m not convinced that’s you. I want another midwife assigned to Billy.’

‘What?’ Well, that had certainly gotten her attention.

‘I’m sorry. But I can’t take the risk of performing this surgery and having his postoperative care compromised.’

‘How dare you!’ she hissed at him. She glanced down. ‘What? Because I have a little coffee spilled on my scrubs and I haven’t had a chance to get changed yet, and because I dared to close my eyes in the hospital canteen, you’ve decided I’m not fit to do my job? Just who do you think you are?’

He cringed. He hadn’t exactly said those words but it was certainly how he’d felt. ‘I think you’re sick,’ he said quickly. ‘I think you might need to be checked over, and have a few days’ rest.’ He could see a couple of other staff members looking their way—as if they’d picked up that something was wrong. The last thing he wanted when he was taking up a position here was to cause a ruckus with the staff.

‘My priority is my patient,’ he said quietly but firmly.

‘And mine isn’t?’ He could tell she was mad.

That wasn’t what he meant, even though he’d clearly just implied it. But then again, did he really want this midwife looking after his patient if she wasn’t at the top of her game?

Francesca glared at him from over her computer. Oh no. That didn’t usually happen. Francesca normally had his back.

He took a deep breath. ‘Esther, I have to call things the way I see it. I think you’re running a temp and maybe need to take some time off. You agreed you’d go down to A&E and get checked over. Why don’t you do that and we’ll take it from there.’ It was a compromise. But it was the best he could do right now.

She kept her face entirely straight and pulled up a few things on the computer and grabbed the chart from the base of Billy’s crib.

‘Here, Mr Beaumont. I’d like you to check my work. Here’s all the orders I made for Billy on my shifts for the last few days. Here’s all my nursing notes. Here’s every temp, blood pressure, pulse and respiratory rate. Here’s his medications I’ve administered, and his feeding. Here’s his skin care chart. Here’s his colour chart. Here’s how many times I’ve sounded his chest to ensure that it remains clear. Here is exactly how many times he’s had a wet or dirty nappy.’ She pulled up a final chart. ‘And here’s how many times I’ve had to chase doctors, other departments, test results…all to ensure Billy’s care is up to my standards.’ She held herself very still, but there was the tiniest tremble in her voice. ‘I want you to take the time to look at what I’ve done. Because I record everything, meticulously.’ She emphasized the word, then gave a wave of her hand. ‘And once you’ve done that, I can pull up all the same information for his mother, and you can check my recordings for Jill too.’ She paused for a few seconds as he glanced over what she’d handed him. ‘Unfortunately I’m not on shift twenty-four hours a day, so I’ve only given you what I’ve done for Billy. Hospitals have emergencies, as I’m sure you’re aware. Blood machines break down. Feeding tubes dislodge and can’t be safely used again until there’s been an x-ray that’s been checked by a physician. I’m not responsible for other people’s time constraints.’

He was checking. She was right. He couldn’t deny it. Her recording was meticulous. Some of the best he’d ever seen, and he’d been in a lot of NICU units.

She’d felt warm to the touch earlier, but as she’d moved closer as she spoke to him he couldn’t hear any sign of a wheeze or rasp in her breathing. Every person was different. Maybe she didn’t have an infection. Maybe he was overreacting. It could be that her body temperature just ran at the top end of normal. It happened.

What was clear was he couldn’t tell her why he’d overreacted. He couldn’t tell her that deep down there was an underlying paranoia about his patients and their welfare.

Before he could blink she’d stepped right up in front of him, her accent thick but perfectly legible. ‘You know, Harry, I’m actually glad that you’re here. Because even though you’re an insufferably arrogant fool, I know how much Billy needs this surgery. And I put him first. Always. But I’m only going to say this once. Don’t ever talk to me like that again and don’t ever question my professionalism or my competency at work.’ She put both hands on her hips. ‘I wish you luck with Billy’s surgery today, but after that, I hope I never have to see your sorry ass in here again.’ And with that, she turned on her heel and walked away, leaving Harry feeling about as welcome as a thorn in a space suit.

Francesca tutted and gave him a sarcastic smile. ‘Well done, Harry. First day on a new job and you’ve made friends.’ She picked up her bag. ‘And to be honest,’ she said in a low voice as she walked past. ‘Against her? I don’t fancy your chances at all.’

CHAPTER TWO

THE SIGNS HAD been there but she’d been too busy to pick them up—looking after Jill, worrying about her mum. Esther cursed herself all the way down the stairs towards A&E. She hated the fact that it took that pompous prince, duke or whatever he claimed to be to point them out before the penny had finally dropped for her.

Abi had told her to go on down for the check while she took care of Billy but Esther already knew exactly what was wrong with her. She’d ducked into the treatment room and took her own temperature. Yip. She was burning up. She grabbed some paracetamol from her handbag. She had to start somewhere.

Rob, one of the advanced nurse practitioners, was at the nurses’ station in the middle of the A&E department. He took one look. ‘You okay?’

She shook her head. ‘I think I’ve got an upper UTI. Can I borrow you for five minutes?’

He nodded. ‘Sure.’ Then he smiled and handed her a specimen bottle. ‘Let’s get you sorted.’

It took a little more than five minutes because Rob liked to be thorough. Once he heard her past history of having kidney problems as a child, leaving her prone to upper urinary tract infections, he gave a little nod, dipsticked her urine, rechecked her temp and listened to her symptoms of fatigue and an aching lower back.

‘You couldn’t come down earlier?’

She sighed. ‘I’d felt a bit tired but my back only started aching this morning and the new neonatal cardiac surgeon arrived today so I’ve been flat out dealing with him too.’

He gave her a nod and scribbled some notes. ‘What normally works best?’

She told him the name of the antibiotic that normally resolved her infections and he scribbled a prescription, then went to one of the cupboards and pulled out a bottle, signing a form to record it. ‘Okay, so I won’t make you trek to the pharmacy. But I’m still sending your sample away to make sure you’re on the right antibiotic. Results should be on the system tomorrow. I’m working then—will I give you a call?’

Esther gave a grateful nod. The computer system in the Queen Victoria meant that no staff could access their own records or results—no matter how tempting it was. ‘Perfect. Thanks, Rob.’

‘Any time. Not many perks to being in the NHS. We’ve got to look after our own. Are you going to take some time off?’

‘Me?’ She smiled and shook her head. ‘As soon as I start taking these, they usually work fast. This time tomorrow I’ll start to feel better. I’ll just take some paracetamol until then.’

He gave a nod. ‘Fine, but let me know if there’s anything else you need.’

‘An assassination attempt on a visiting surgeon, maybe?’

Rob looked up in surprise. ‘He’s annoyed Crabbie Rabbie? Wow, he’s brave.’

She waved her hand. ‘Don’t worry. I’ve told him how much I love him already. Hopefully he’ll do his surgery, fix my baby and leave.’

She gave Rob a nod and disappeared out the cubicle and back along the corridor. In a way she was happy. This had obviously been working on her for the last few days. At least now she knew why she was so unnaturally tired. It was sort of a relief to know that after a few days of antibiotics she’d be back to herself again.

As she pushed open the door, the manager of the A&E department was heading towards her. Shirley had her hands full, so Esther held the door for her.

She gave her a grin. ‘Lifesaver, thanks.’

‘No probs.’

Something flitted across Shirley’s face. ‘Hey, don’t suppose you could cover a shift on Thursday?’

Esther glanced at the pill bottle she’d just pushed into the pocket of her uniform. Thursday. Three days away. It was her next scheduled day off and she was bound to be feeling better by then. ‘Sure.’ She nodded.

‘Great,’ Shirley shouted over her shoulder as she continued to speed down the corridor.

Harry was doing his absolute best not to try and cause trouble. Only because Francesca had torn a few strips off him.

‘You were way out of line yesterday,’ she said quietly as they met the next morning.

‘How was I out of line? I don’t want some flaky member of staff caring for my baby.’

‘Your baby?’ Francesca raised her eyebrows.

He sighed. ‘You know what I mean. If I operate on them, they’re all my babies.’

‘Don’t try the mushy stuff with me. You’re being harsh. So, she spilt coffee and didn’t have time to change. Who hasn’t? Half the times I was called to a cardiac arrest, I went with half my lunch down me.’

‘Did you sleep in the hospital canteen too?’

Francesca shrugged. ‘Sometimes. If I’d been up all night on call, I might grab five minutes when I had to. Can you really say that you’ve never done that?’

He took in a deep breath and gave a conciliatory shrug too. ‘Okay, I might have.’

Francesca gave him a hard stare. ‘I’m just saying. This is the first time you’ve operated here. I’d try not to get on the wrong side of everyone you might come across if you’re going to be a visiting surgeon.’

‘Now who’s being harsh?’

Francesca started pulling up some results on a nearby computer. ‘Anyway. I would tread carefully. I’ve heard she’s got a nickname.’

‘A nickname?’

Francesca nodded and smiled. ‘Yep. Crabbie Rabbie.’

‘What?’ Harry frowned.

‘Something to do with Scotland’s national bard?’

‘I know who Rabbie Burns is.’

‘Well, apparently she got the nickname just after she arrived. Something to do with her strong accent and the fact she takes no prisoners with people she thinks are annoying.’

‘Are you trying to tell me something?’

‘Just that I think you’ve clearly just put yourself into the annoying category.’

He shook his head. ‘Oh, thanks for that.’ The door to the NICU opened and the day staff filed in, Esther among them.

Her dark hair was swept up in an elaborate plait. She still looked tired but maybe she’d put a little more make-up on, because there was more colour in her cheeks than there had been yesterday. She was wearing a different colour of scrubs today. Bright pink. He’d noticed the staff in the NICU wore different colours—sometimes even with child-friendly designs. The brighter colour made her not look quite so washed out.

It was odd. On any other day—with any other member of staff—he might actually have admitted that he thought she was quite attractive. But he didn’t have time for that. Harry didn’t usually date anyone from work. Too many complications. And he and Esther hadn’t exactly got off to a good start.

He wanted to ask if she was fit to work. He wanted to ask if she still had a temperature. He knew he wasn’t entitled to. Staff in NICUs were extremely familiar with the dangers of exposing babies to potential infections. He shouldn’t second-guess anyone.

Francesca tapped his arm. ‘Okay, I’m off to see another baby.’ She shot him another look. ‘Now, behave. Play nicely.’

He shook his head as she walked out the door.

Esther had raged last night as she’d tried to get to sleep. It was ridiculous. All day all she’d wanted to do was sleep, but actually put her in comfy pyjamas and give her her own bed and she lay there blinking and plotting horrible futures for that annoying surgeon. The man had even stolen her sleep from her.

She ignored the fact it was noisy outside, the pipes creaked, the radiators hissed and upstairs seemed to be having a party again. Her back might have ached a little too, and she’d needed to pee on numerous occasions. It was funny how when you finally got a diagnosis your body practically slapped you on the face with it. But no, it was none of those things that prevented her from sleeping; it was definitely smug Harry Beaumont with his entourage and unflattering words.

She burned from a few of the things he’d said to her. But most of all was his threat to ask for another midwife to be assigned to Billy. She was pretty sure that the charge nurse for the unit would give him short shrift. Oona was from Northern Ireland, and was much more like Esther in temperament than she cared to admit. She wouldn’t take kindly to some visiting surgeon dictating what happened in her NICU.

But as Esther walked through the door of NICU she could see Harry sitting at the nurses’ station. It was 6:50 in the morning and clearly her worst day in the world was just about to start.

It didn’t help that he was looking like Dr Delicious in his pale blue shirt that was a little damp around the collar. He’d obviously just showered and was currently charming the few staff around him; they were laughing and joking.

She braced herself, waiting for someone to tell her she couldn’t look after the little boy she’d spent the last few days tending to. Her eyes hesitantly went to the board. Esther McDonald was written next to Billy Rudd and Akshita Patel. She let out a sigh of relief and went straight over to hear the report.

Somehow she just knew that every single step of the way Harry’s eyes were watching. What was he waiting for?

She pointedly ignored him. Billy’s surgery had apparently gone well, which was a relief. She hurried over to his crib to get a look at him for herself, making sure she gave Jill a hug first.

His colour was different—straight away. Some people might not have found it obvious, but Esther was an experienced NICU member of staff and had always noticed the slight dusky tinge to Billy’s skin. Today, it was gone. His skin still had the translucence of a premature baby, but the colour had definitely improved.

She breathed and caught a scent. She tensed. She recognised it from yesterday, some kind of woody undertones. Harry. She was determined not to turn around.

Jill had got up and gone into the small kitchen in NICU to make herself a cup of tea.

‘Things went well?’ she asked Harry in an even tone. They might have got off to a bad start but there was no point in being uncivil.

‘Yes, and no,’ he said in a low voice.

‘What do you mean?’

‘I mean, things took a little longer than expected. We ran into some problems. The surgery ended up taking about eight hours.’

Esther turned to face him in shock. She knew how long the surgery should have taken. ‘But…’

He shook his head. ‘It’s all under control. The surgery was successful. Billy will need regular reviews and be carefully monitored for the next few days, but—’ he paused and gave a slow nod of his head before his dark eyes met hers ‘—the next few days will be the most crucial.’

Her skin prickled. He wasn’t saying anything out loud. But it felt like he was accusing her of something.

‘Experience with these babies tells me that if something is going to go wrong, it generally happens in the first forty-eight hours after surgery.’

The time when she was part of the team watching Billy.

She tilted her chin, part of her felt defiant, and part of her felt distinctly annoyed by his unsaid implication.

She glanced at the clock on the wall. She knew when surgery had started yesterday. If it had taken eight hours, it couldn’t have finished until well after midnight. Harry had already been here when she’d come in for her shift. She knew she hadn’t slept last night, but had he?

‘Are you staying close by? You’ve had a quick turnaround.’

She wasn’t even sure where the observation came from, and the instant it came out her mouth she wasn’t entirely comfortable with how it sounded.

But Harry didn’t seem to notice. ‘I’m only a few miles away in Belgravia, but I stayed here last night to keep an eye on Billy.’

‘Oh.’ She nodded. Belgravia. Of course. He was supposed to be some kind of royalty, wasn’t he? Of course that’s where he’d stay. Not like herself, who had to travel nearly an hour each day to get to work.

He pulled something from his pocket, then cleared his throat. ‘I left a note for the NICU nurse last night about all the things I wanted monitored in Billy.’

She glanced at the piece of paper in his hand. ‘I do know how to do postoperative care, Harry. This isn’t my first rodeo, you know.’ There was no way she was touching that list. Her eyes quickly ran down it. It was what they would do for every baby postsurgery, with the exception of one test that could easily be ordered with the rest of the blood work.

She pressed her lips together and tried not to snap. Everything about this guy just seemed to annoy her. Even the way his aftershave seemed to linger in the air between them. ‘I guess when you move around a lot you don’t know what’s normal in each NICU. But you don’t need to worry about the Queen Victoria. We have a reputation of excellence because we’ve earned it.’

Was that too pointed? She didn’t think so. It seemed more factual to her.

He wasn’t wearing a typical doctor white coat and her eyes were drawn to the muscles beneath the pale blue shirt he wore. The shirt was clearly tailored, defining all the parts of him it should. It had short sleeves—just like all doctors were supposed to wear in clinical areas, but the short sleeves drew her attention to his biceps. Some place she definitely didn’t need to look.

‘Point taken,’ said Harry frostily. ‘But I’d still like my post-op instructions followed. I don’t think that’s unreasonable.’

He was still holding the piece of paper towards her. It was like a standoff. She didn’t want to take it. She didn’t. But Jill came out of the kitchen and started walking towards them. The last thing she needed was for Billy’s mum to think there was any kind of issue between the staff looking after her child. Esther reached out and grabbed the paper, stuffing it in her pocket.

‘Fine.’

One of his eyebrows quirked upwards. ‘Fine,’ he agreed before turning and walking away.

She moved quickly, doing her routine checks on Billy, followed by routine checks on the little girl she was taking care of too.

She’d hoped that Harry would take the cue to leave the NICU. Surely he must be tired? Or at the very least have other work to do. But apparently not. He settled in and made himself comfortable in a corner of the NICU, opening up a laptop and sitting next to one of the phones.

The phone calls were brisk. He seemed to consult on a whole host of cases, some in the UK, and some in Europe.

Not that she was listening to what he was doing. Of course not. She just kept hoping that one of those calls would give him an incentive to actually leave the NICU.

Every time she turned around she felt as if she could feel his eyes on her. At first she told herself it was her imagination. But on the few occasions she looked up, they definitely locked gazes, making heat rush into her cheeks.

She chewed the inside of her cheek as she logged in to one of the patient monitoring systems to update her nursing notes on Billy.

There was a little pink flash in the bottom right-hand corner. Someone else was in these notes. That wasn’t too unusual. The lab could be uploading results. Or someone else could be viewing x-rays or ultrasounds. But then the little flash turned blue, and Esther’s temperature turned red.

Now, someone was looking at the nursing notes. Her nursing notes. The ones she hadn’t even written yet. And all of sudden she didn’t have a single doubt who it was.

This guy was checking up on her, and that made her mad. She couldn’t even remember being supervised this much as a student nurse. When she’d come to the Queen Victoria to do her additional midwifery training it had only taken a few shifts for the staff she worked with to realise she was already trained as a nurse and was clearly competent. Of course, labour and deliveries were supervised. But when she was giving out regular medicines and writing up notes, the staff didn’t need to double-check as she already had a professional registration. So this definitely felt like being under the microscope. And she didn’t like it—not one bit.