I thought, I should’ve rung the ambos. I’m not going to make it. Stupid. Stupid. I’d thought my decisions had been rational. Instead, they’d been mad, and what was I going to do? I should’ve rung Nan, at least. Why hadn’t I? We’d passed the School of Dentistry, had crossed the street, and I could see the hospital, all six or seven blocky concrete floors of it, straight ahead of me, then beside me, except that I wasn’t at the entrance.
I could see the sign, red letters on white background, too far ahead. Emergency, the letters said. With a red cross. So close, but I couldn’t get there.
The pain nearly doubled me over. I had to get it out. I had to. Something was bulging out of me, surely. It was happening, and it wasn’t just a problem. It was my baby, and I needed to take care of my baby. I sank to my knees on the damp grass, still holding Olivia, and then onto my side, and told Hamish, who was hovering over me, then squatting beside me, touching my face, starting to cry, “Go tell ... those people up there. Sitting on the ... bench. Tell them your mummy’s having a baby, and she needs help right this minute. Run fast, but watch for ... cars. Be ... careful.”
He ran, and I thought, He’s going to have to cross the entrance to get there. What if he doesn’t stop and look? What if a car doesn’t see him? Please, God, let my babies be all right. I kept Olivia’s hand in a death grip, closed my eyes, heard her crying, wanted to do something about it, and knew I couldn’t. The pain was too much, I was shivering and sweating at the same time, and the grass was prickly, cold, and wet against my skin. I was bleeding, or my water had broken, one or the other, and I hurt. I needed to get my trousers down, and I couldn’t do that, either.
My babies.
2
The Red and the Green
Matiu
My first week at Otago General had been a cracker. I still wasn’t one bit sure my mad shift to the South Island was the right choice, but it was interesting, which tended to loom large in an emergency doc’s job satisfaction. Bird hunting season was finished and wild boar and deer hunting season not yet begun, which meant no hunters excitedly shooting each other in the bum, somehow mistaking a fluorescent orange jacket for a game animal. Still, a tertiary-care hospital got more than its share of trauma, especially of the helicopter-borne variety, besides the usual suspects. Elderly patients with pneumonia, at the end of flu season. Broken bones and overdoses. Fewer drunk holidaymakers than in beachy Tauranga, but more drunk students in this university town, kids who weren’t nearly as clever as they thought they were and paid the price for their miscalculation. An atrial fibrillation, today, that had required shocking, where the patient would go home, and a cardiac arrest where the shocks hadn’t worked, and I’d had to deliver the news to a wife who was suddenly a widow.
Routine, except that in the ED, nothing was ever routine, which was why I did it. That, and incidents like the one I’d been through today.
Five years ago, I’d have sent off the little two-year-old blonde, with her not-abnormally-high fever, her vomiting, and her symptoms of croup, with some baby Paracetamol, even though the mum kept insisting that we “run some tests,” which made the nurse all but roll her eyes.
I almost did send her home, but three things had me thinking twice. First, that the little girl was two. Second, that her wheezing breathing might be croup, and might not. And third, that the family had taken a fun-in-the-sun holiday to Northland last week. I knew that, because I’d thought to ask the question.
And then there was “fourth.” That despite the fact that the little girl was sitting up in Mum’s lap and her temp wasn’t all that high, the mum kept insisting that her baby “wasn’t right.” She seemed sensible, and this was her third child, so I ordered the tests, and when the blood test came back normal, I waited for the urine anyway, even though the little girl was now quietly asleep on the table. No harm in checking.
I didn’t dismiss the tiny trace of blood in the urine, either. Instead, we checked the baby’s temp again and found it was an almost unbelievable 41, and that she wasn’t asleep. She was unconscious. Within minutes, she’d gone from “moderately ill” to “critical,” but she’d done it here, where we could help.
The relief when I got the tube down the tiny throat first time, so she could breathe as her airway swelled, and the look on the mum’s face when the lumbar puncture I’d done came back positive for Group W meningitis. Bacterial, deadly as hell in little ones, and on the rise in Northland. All of which I’d known, because I paid attention to everything, not just things that happened on my patch. That was why the baby ended up in the pediatric ICU instead of at home, and why her parents wouldn’t be burying her. Probably.
That was the worst of emergency medicine, and the best—that you mostly never knew. You diagnosed and treated and sent the patient on—back home, onto a ward, or to the morgue—and you didn’t see them again. But after all this time, there was still the satisfaction that I’d done it right, that I hadn’t taken the easy path, the obvious solution, and that the years and the training had paid off in a life saved and a family that would remain whole. Enough years and training to know that mothers tended to read their kids best, and that to do this job well, you had to shut out the noise and the hurry and listen to your patient, and to your gut.
Doctors weren’t God, as I’d been reminded too many times to count. But sometimes, we got to give him a hand.
Now, I was less than two hours from the end of my shift and two days off in a row, during which time I planned to explore the area and begin to decide whether I could actually become a South Islander, or whether this was some sort of middle-aged-crisis-cum-gap-year that would end in my running back to my familiar, beachy Bay of Plenty surroundings, back to the whanau, back to my comfortable life.
I’d traded shifts with another doc today because he’d had a family thing to do, which meant I’d been locking my front door to come back in to work barely six hours after I’d got home. I was used to my sleep schedule changing, as much as your body ever did get used to it, and after a swim and a feed, I’d be sorted. I’d also be out of here before the Friday-night piss-ups, the fights, and the accidents, and that would be a bonus, this first week.
I’d just finished stitching up a laceration on the hand of a stoical middle-aged bloke who’d had a mishap with some machinery, a situation with which I was completely familiar, and was charting it when I got the call. A woman delivering a baby, around the corner from the Emergency Department. In the grass. With her kids. A nurse and an orderly grabbed a gurney, and I headed out the main doors in the weak winter sun ahead of them at the very fast walk that was the standard ED gait. You didn’t do much ambling along in Emergency.
I didn’t see her at first. Bushes in the way. I saw a tradie, though, a big Samoan in his work boots and fluorescent yellow vest, holding a skinny ginger kid by the hand. A kid with something familiar about him. He was choking back sobs, the freckles standing out on his white face, and the tradie said, “It’s his mum, doc. Back there behind the trees, like, lying on the grass.” He pointed. I still didn’t see the woman, but I saw the crowd that had gathered.
“Show me,” I told the kid, and took his hand. I was going to have to keep track of him as well. He was young, maybe four or five. I asked him, “Ran for help, did you?”
“Yes,” he said, swallowing the hiccupping sob. “My mum said to. I watched for cars. But my baby sister’s there, and she could run in the road. She’s just little.” He was pulling me along like he was taking charge of the situation. Brave enough to conquer his fear, which was the hardest battle of all.
I could see them now. A woman, her long red-gold hair a splash of vivid color against the green grass, one hand somehow hanging onto a toddler who had the same hair. She was a tiny thing in a striped pink-and-black top who broke away, now, and ran toward us. The fast-moving gurney swerved and narrowly missed her, and she threw her arms around her brother, weeping too hard to speak.
The woman, when we got there, had her face practically in
the grass and was panting with a sound I recognized. The effort not to push. It was an effort she was losing, because she was keening along with the panting, but her hand was reaching for something. Reaching for her daughter, calling her name. “Olivia. Come here. Come ... hold my hand.” Practically out of her mind with the pain, and still calling for her little girl.
It all clicked into place. Poppy something. My cousin’s Yank sister-in-law’s new Kiwi sister-in-law, who lived in Dunedin, and whom I’d met a month or so ago up in Tauranga, at the Yank sister-in-law’s wedding.
A convoluted relationship, you’d think, but I remembered this once-removed sister-in-law very well indeed. An extremely pregnant but somehow breakable-looking redhead with a face that was all cheekbones and jawline, freckles on her nose, a warm, wry smile, and big eyes the color of flower pounamu, dark jade with flecks of gold. She’d been wearing a soft pink-and-green dress and a little pink wrap sweater that rode atop the baby bump, along with low heels that she’d kicked off to dance with her dad or her brother or her son or all by herself. Her smile had lit up the room, and she’d been at that wedding without her husband, which had seemed absolutely wrong.
He was traveling, she’d said. Working. If you had a woman like that, though, strong and fragile at the same time, and she was that pregnant and caring for two little kids as well, wouldn’t you do whatever it took to be with her? I’d wondered it, and then I’d let it go, because it hadn’t been my business, even though it had felt like it. Maybe because it had felt like it. And because she hadn’t liked me. Women generally liked me fine, but when she’d looked at me, she’d looked away.
Which was fine. I had detachment. I had it and to spare, normally. It had been commented on, and not in a good way.
I was detached now, anyway. I had to be. I was on my knees beside her, telling the orderly, “Take the kids to Social Services. Tell them what’s happening. They can get it sorted later.”
“Hospital day care,” the nurse corrected me. “It’s for employees, but they can take these two.”
“Right,” I said to the orderly. “Take them there, then. Go.”
The little boy put his skinny arm around the toddler’s shoulders. “Come on, Livvy,” he said. “We have to go wait for Mummy.”
I’d forgotten them already, because they were sorted. I said, “Poppy, I’m the doctor. We’re going to get a blanket under you and take your trousers down.”
She opened her eyes and stared at me, almost but not quite sightlessly. Same green eyes, but not recognizing me, not now. “Help me,” she gasped. “My kids.”
“Kids are taken care of, and I’m here to take care of you.” The nurse already had the blanket in her hands. Together, we got it under Poppy, rolling her onto her side and then back again onto it as she groaned. After that, I told the nurse, “Call for more help,” then got myself gloved up while the nurse took off her shoes and trousers, and there it was. Heaps of blood, because she’d torn badly, and a circle of darkness just visible, because the baby was starting to crown.
“Your baby’s here,” I told Poppy. “Right here. A couple of pushes, and we’ve got it.”
“Are you ... ready to catch it?” she somehow asked.
“I’ve got it,” I said again. “You’re both going to be fine. On the next contraction, we’ll push. You’re almost there.”
If I’d had emotion, it would have been tenderness. Possibly also wonder, that a woman in her state was still talking. I didn’t have emotion, though, because I couldn’t afford it. Poppy gave a heave, breathed, then gave another one, crying out with pain all the while, and the head was there. Dark curls, wet against the scalp. A little face, screwed up tight. A person.
“One more easy push,” I said. “A gentle one, and baby’s here.”
The baby slid into my hands on another agonized moan from her mother. Her little arms and legs were tucked up around herself, and she was a girl. I said, “You have a beautiful daughter. She’s just fine.”
“A ... girl?” Poppy was panting, starting to shake. And bleeding too much. I laid the baby on her belly, and her hands came up instantly to cradle her. The nurse toweled the baby off, and I left the cord for now. I needed to get them both inside right the hell now, because there was more going on here.
The baby opened her eyes. Round, blue, and deep as all the mysteries of the universe. She stared into my face as if she saw all the way into me, even though I knew it wasn’t possible, and for just a second, the world stopped turning. Her hair sprang up in curls now that it was drying, and her skin was pink. She was a little thing, not much fat on her. Early, maybe. And, yes, beautiful. She’d cried once, and now she’d stopped, as if she were happy to be here, held by her mother. As if she knew she was safe.
I shook it off and told the nurse, and the medical student who’d run out to join us, “Let’s get them on the gurney. You—Fletcher—hang onto the baby. Get your hand on her so she doesn’t roll off.” Too much bleeding, and the placenta still inside. Something wrong there, I suspected.
We took her to the ambulance entrance, straight back into the ED, at nearly a run, and Poppy held onto that baby like it was the only thing there was, oblivious to the crowd that had gathered to watch her give birth too publicly, the people who were watching now. Wearing a man’s shirt and no trousers, the crimson blood covering her hands and forearms, seeping into the white blanket that covered her.
There was an ambulance in the bay when we arrived, its back doors just swinging open, a gurney coming out. A man’s voice called from inside its depths, and Poppy turned her head and frowned. A woman lay strapped to the gurney, her acres of shiny, straight blue-black hair spread around her like a scene out of a film, where the glamorous heroine has a frightening but easily survivable accident, and you know you’re nearly at the end.
When Poppy saw her, she raised her head, struggled onto an elbow, and said, “What?” A second gurney came out, with a man on it this time, and she said, “No.”
I paid no attention. We maneuvered past the ambulance, were into the doors of the ED, and then into a room, and she was still saying, “No.” Her hands shaking as they held her daughter, her blood still pooling as I clamped and cut the cord and called for the neonatologist and didn’t deliver the placenta, because I’d been right, and it was adhering to the uterine wall, causing the bleeding. I started the process of making that stop. Another thing that had almost gone wrong, but that I could make right.
Just another day in the Emergency Department. Except that it was nothing like any day before. Or any day after, either.
Friday the thirteenth. The day my life stopped being careful, and stopped being controlled. The day I started to live.
3
One Husband, Slightly Used
Poppy
On another day, this would’ve hurt. Ridiculously. The doctor had his hand and half his forearm buried inside me in a way that would normally make you think of cows in a veterinary program on TV. He was ripping out pieces of placenta, because it was stuck, and “massaging” my uterus from the outside with the other hand, which was nothing anybody was going to be requesting in the spa. This day just kept on giving, I’d have said, if I hadn’t got a baby out of it.
I’m not saying it felt good, but the IV the nurse had started was delivering some painkillers at last, along with medication to stop the bleeding. I was getting a blood transfusion, too, which was either comforting or not, depending on how you looked at it. I was going for “comforting,” because the doctor seemed to know exactly what he was doing. Anyway, compared to when I’d been lying on the grass, with the sensation they called the “ring of fire” burning like the flames of hell, when the baby’s head had been stretching me to the maximum and I’d been trying to hold onto Olivia, dreading the screech of brakes as Hamish ran in front of a car? Compared to all of that, it didn’t hurt a bit, because my kids were safe, and my brand-new baby girl was in capable hands, being taken up to the nursery.
I’d looked at her, t
ouched her, and loved her. How did that happen? It just did. I didn’t even care that somewhere on the ride in, I’d realized that my doctor was, somehow, the impossibly tall-dark-and-Maori-handsome, too-charming-and-knows-it Matiu Te Mana, whose cousin’s sister-in-law had just married my brother, and that later on, I’d probably have feelings about his hand being in my uterus.
Now, he asked me, “Do you have a disposition for the whenua in your birth plan?” The placenta, he meant, and he asked it as if he did this every day. Did he look at all his patients like that, though? His eyes were golden-brown and dark-lashed, and they had so much kindness in them. Like he knew. But he couldn’t.
“Yeh,” I said. On a gasp, because he was right up there inside me. “I ... want it. The ... pieces. The cord.”
The nurse said, “Got it,” and kept wiping off my legs, since everything about me was a bloody mess. I would have closed my eyes, but I looked at Matiu’s face instead. It was helping.
This particular placenta wasn’t going to be beautiful, I thought as he deposited another handful onto the tray, and I didn’t care. My baby’s nourishment would be going back into the earth, a tradition as old as human life on these islands. We’d started the breaking-down process early, that was all.
Max thought the whole idea of burying the whenua was disgusting, though he’d gone along with it in a good-natured sort of way with the other kids, while making it clear that I was a little silly. I’d better not let him look at this latest iteration.
The cold went all the way through my body. I’d been shaking already, and suddenly, it got worse. How could I have forgotten?
The nurse touched my hand and said, “I’ll grab you another warmed blanket in a minute, soon as doctor’s done here.”
Stone Cold Kiwi (New Zealand Ever After Book 2) Page 2
