Entwined

by Elizabeth Marshall

  “OK, I need to do an internal to see how far dilated she is -”

  “You aren’t touching my wife,” Simon growled, “until you tell me what is wrong with her.”

  With an impatient sigh, Graham returned his attention to Simon. “The organ that feeds the baby is called the placenta. It has most likely grown to cover the cervical opening. This means that Corran won’t be able to deliver the baby naturally.”

  “Explain yourself doctor. What does this mean?”

  “That your wife and child will die if I do nothing.”

  “And you are certain of this?” Simon asked.

  “No, but if you will allow me to examine your wife I will be able to tell you.”

  Simon stared at Graham for a few moments, his eyes interrogating the man’s face. “You have my consent. Do whatever you must to save my wife and child.”

  Graham nodded and turned to Kate. “Could you help me remove her leggings, please?” he asked, pulling Corran’s sweatshirt down to cover her swollen belly again. “Please could you unpack one of those sheets, unfold it, and lay it over here?” he finished, gesturing at Corran’s swollen midriff.

  Rose and Graham removed Corran’s leggings and panties, and Kate placed the sheet over Corran. Graham pulled the sheet down, covering Corran’s legs and reached for a pair of gloves. Swiftly pulling them on, he lifted her legs, bent them at the knee, and gently opened them keeping her feet together. He applied some lubricant to the gloves and proceeded with the examination.

  “She’s about an inch and a half dilated, which may explain the amount of blood. Pass me two of those maternity sanitary towels please, Kate?”

  Graham placed the towels between Corran’s legs before closing and straightening them, and pulling the sheet back down to cover her legs. “Rose, please put the leggings and panties into the plastic bag that the sheet came out of.” Rose nodded, doing as he had asked.

  “What should I do with the bag?” Rose asked, “They’re black, so the blood may wash out, but I am not sure that Corran will want to wear them again.”

  “You can put them on the bottom of that trolley over there. Remember we have a ‘clean’ trolley and a ‘dirty’ trolley and that is the ‘dirty’ trolley. The top shelf is for used instruments and the bottom shelf is for anything else,” Graham replied.

  “Will she be alright?” Kate asked, lifting Corran’s hand off the table and holding it.

  “We need to get the baby out.”

  “Can you do that here?” Rose asked.

  “Thanks to your friend’s note, yes I can. I have all the equipment I’m likely to need. There isn’t time to get her to hospital; if I don’t do this now she’ll bleed to death,” he said, with resignation.

  “What do you want us to do?” Kate asked.

  “Just do what I talked you through earlier,” he said, turning to Simon. “Stay with your wife whilst we scrub up.”

  “This soap OK?” Rose asked, pushing the top of the dispenser.

  “That will do fine; it is a good antibacterial soap,” he replied, hastily doing the same. “Kate, remember how I taught you to wash your hands. Copy what Rose and I are doing.”

  Drying their hands, they pulled gloves on and helped each other with their masks and surgical aprons.

  “If you’re done, we need to get on.”

  Rose and Kate followed the man back into the taproom. Corran lay unmoving in an ever-growing pool of blood.

  Simon sat grimly beside her, his hand clutching hers, his eyes showing every ounce of the pain in his heart.

  “She’s lost so much blood,” Rose whispered to Kate.

  “Don’t worry, Rose, we’ll set up an IV and she’ll be fine,” said Graham. “Thanks to Eilidh I know her blood group, and approximately what condition I’d find her in. Simon, please could you move back and give us some room? You can take your place next to Corran shortly, when we are ready.”

  One by one the girls cut Corran’s sweatshirt sleeves from the wrist, over the shoulder to the collar and slid her arms free. They continued to cut the sweatshirt up the sides to the collar, removing the front of the sweatshirt.

  “Are you ready for us to turn her?” Graham asked.

  Rose and Kate looked at each other and Rose replied, “We are.”

  Graham crossed Corran’s ankles, right over left, and placed her right arm across her body. Rose and Graham put their hands under Corran’s hips and shoulders and turned her gently onto her side. Rose pulled the back of Corran’s sweatshirt off the table and dropped it out of sight. Kate slipped a pillow under Corran’s head. Graham bent Corran’s legs up to stop her rolling over onto her front while Kate gently held her shoulders. Rose unhooked Corran’s bra and removed her right arm from the shoulder strap before Graham fitted a blood pressure cuff to Corran’s upper arm and set the machine to take readings every two minutes.

  “Rose, do you remember I showed you how to set up the blood transfusion?”

  “Yeah, sure. Doing that now,” she said, working fast to fit a catheter and hook a bag of blood onto the IV stand.

  “Give that bag a squeeze to get some blood into Corran now please, Rose,” Graham instructed, as Rose released the tourniquet from Corran’s arm. “Can we proceed with the anesthetic? We will start with the local as we discussed,” Graham continued.

  “Sure,” Rose replied, pouring some iodine solution into a kidney bowl and clamping a cotton swab in a pair of forceps before handing them to Graham.

  “Kate, please keep an eye on Corran’s pulse and blood pressure, and let me know if there is any dramatic change.”

  “Will do, Graham.”

  Graham swabbed a large area of Corran’s lower back while Rose unwrapped a syringe and needle. He passed the kidney bowl and forceps back and Rose handed him the syringe and the bottle of local anesthetic. Graham administered the local at several points in Corran’s back while Rose unwrapped another larger syringe and needle.

  Simon watched intently as Rose handed Graham a kidney bowl containing the syringe, needle and another bottle of anesthetic before filling the syringe from the bottle.

  “What is that for?” asked Simon, as Graham proceeded to insert the long needle into Corran’s lower back.

  “It’s a spinal anesthetic,” Graham replied, removing the needle and noting the time. “It will stop Corran feeling any pain. Rose, are you OK to apply the dressing to that?” he asked, returning the syringe to the kidney bowl.

  “No problem,” Rose replied, unwrapping the dressing.

  “I am done.”

  “Great. Let’s get Corran rolled onto her back and deliver this baby.”

  Rose swapped places with Kate to hold Corran’s shoulders while Graham straightened her legs and lifted her right arm over her body, placing it behind her. Graham and Rose gently rolled Corran onto her back and Kate removed Corran’s bra from her left arm, carefully unclipping and replacing the heart beat probe from her index finger. Rose and Kate unwrapped two sheets and covered Corran with them so that they met sideways at her bulging abdomen. Graham checked and unwrapped some instruments and laid them out on a trolley, then removed a pipe from a plastic bag and plugged it into a machine on the floor before switching it on.

  “The suction machine is ready. Right, Rose, a quick recap on what these instruments are and when I am likely to need them. It will also help me make sure that we are ready to start.”

  “I am all ears, Graham,” Rose replied, with clear concentration on her face.

  “OK, scalpel; retractors; Anderson forceps, in case we need them; suction bulb, to clear baby’s mouth and nose; clamps and scissors for the umbilical cord; locking forceps to clamp off any bleeds; long and short nose non-locking forceps; absorbable sutures for closing up. Are you happy with that and what we need to do?”

  “I think so, Graham. Is it OK if I admit that I am a bit scared at this point?” Rose asked in reply.

  “That is perfectly understandable and acceptable. Try to concentrate on helping me and
doing as I ask. If you do that you won’t get distracted by other thoughts. You can do this, you have had the training to do it,” Graham tried to re-assure Rose.

  “You can do this, Rose,” Kate said, forcing a reassuring smile at her friend. “Just think back to all those months you spent working at the hospital.”

  “Yeah, but I never worked in the maternity unit and I’ve certainly never assisted in a surgical procedure before.”

  “Rose, if I didn’t think you could do this you wouldn’t be standing here now. I’d do it alone,” Graham said.

  “You don’t know me, Graham,” Rose replied quietly.

  “I don’t need to. You have already shown me all I need to know.”

  “Just think how proud your Mum and Gran will be,” Kate said.

  “Ladies, we need to do this,” Graham said, and, turning to Simon said, “If you wish to, you may sit here at your wife’s side and hold her hand, but please be ready to move out the way if we need you to.”

  Simon moved forward silently and took his place as instructed. His face looked tired and pale.

  “Ready?” Graham asked. Rose and Kate nodded. Graham checked the time again and said, “The anesthetic has had time to work now. Let’s get on with it. Iodine solution?”

  Rose handed Graham the kidney bowl of iodine solution and the swab in forceps. Lifting the sheet, Graham swabbed Corran’s lower abdomen thoroughly with the iodine solution and handed the kidney bowl to Kate who placed it on the second trolley.

  “Scalpel and cotton pad? Please be ready with the suction tube.”

  Rose handed Graham the scalpel and a cotton pad. Graham made a deep incision across the underside of Corran’s bulging abdomen dabbing away blood as he went. Still clutching her hand, Simon’s eyes followed the man’s hand as it sliced through his wife’s tummy. He flinched, instinctively clenching his free hand to a fist.

  “Suction please, Rose? I can’t see what I am doing here.”

  A slurping sound followed as Rose cleared the wound. “Large retractor please, Rose?” He took the retractor. “Thank you.”

  Simon breathed in deeply as Graham opened the wound.

  “Kate, please could you maintain the tension on this retractor to keep the wound open? Suction again, please Rose.”

  Graham kept working, opening the abdominal wall. “OK, I am ready to open the uterus. Please keep that suction handy, Rose, we will need to clear the amniotic fluid. Here goes.”

  Graham cut through the wall of the uterus; a wave of fluid gushed out of Corran. Rose moved the suction tube from side to side in the wound removing the blood and amniotic fluid.

  “There’s your baby’s head, Simon,” exclaimed Kate, in a nervously excited voice.

  Graham pushed Corran’s abdomen and more of the head became visible.

  “Kate, how are Corran’s pulse and blood pressure?”

  “They look OK, Graham. There have been fluctuations, but no significant spikes or drops,” replied Kate.

  “That is good news,” Graham replied, with some relief coming through in his voice.

  “Do you need the Anderson forceps?” Rose asked.

  “I don’t think so. Corran’s contractions are helping us here.” Graham supported the back of the baby’s head as it emerged from Corran’s body. “Please be ready with that suction bulb… OK, pass me the suction bulb.”

  Graham cleared the fluid from the baby’s nose and mouth and the baby took its first breath and let out a squeaky cry.

  “Rose, can you take the tension on the retractor so that Kate can get that warm towel off the radiator?”

  “Sure. Got it, Kate.”

  Kate rushed away from the table, while Graham hooked his fingers into Corran’s uterus and worked them under the baby around its shoulders and gently eased it out into the world. The baby spluttered and coughed and then a lung-busting cry bellowed from its mouth. “Where’s that towel Kate?”

  “Here, Graham.”

  Graham wrapped the baby in the warm towel. “Please could you hold him for a moment, Kate, while I sort out the umbilical cord? Congratulations, Simon, you have a son. Rose, please pass me the umbilical clamps?”

  Rose handed Graham the clamps, and he swiftly applied them before taking the scissors off Rose and cutting the cord. Graham checked the time.

  “Time of birth, one minute past midnight, December twenty-first,” Graham proclaimed. “Would you like to hold your son while we finish up here, Simon?” he asked, casting Simon a glance.

  Simon nodded as Kate moved toward him and handed him his son.

  “Did you hear that, lass? We have a son,” Simon whispered gently to his wife. “He’s so tiny,” Simon said, letting the baby grasp his little finger. “Why isn’t she waking up?” he asked lifting his eyes to the doctor.

  “She’s lost a lot of blood,” Graham said, gently putting some tension on the umbilical cord.

  Graham glanced up at the IV stand. “The blood bag needs replacing, Rose, would you mind? Best get that done before we deliver the placenta.”

  “Sorry, Graham, I took my eye off it. I’ll get a new bag on quickly. Kate, can you take over on the retractor please?”

  “Got it, Rose.”

  Rose replaced the blood bag on the IV stand, dropping the empty one on the bottom shelf of the ‘dirty’ trolley and swapped the tubes over.

  “I will need the large bowl between Corran’s legs, those long nosed forceps and you back on the suction please Rose.”

  “Ready, Graham. Here are the forceps.”

  “Thanks. Keep that suction going in there.”

  Graham pulled gently on the umbilical cord again, and the large mass of the placenta emerged. Graham grasped the placenta and pulled steadily. Using the forceps he gripped the base of the organ and pulled it away from the uterus wall. It came free and Graham dropped it into the stainless steel bowl between Corran’s legs. His hands worked furiously, mopping the wound with cotton swabs whilst Rose continued moving the suction tube from side to side.

  “The placenta is complete and come away in one piece. Right, let’s start closing up,” Graham said, as he reached over and picked up a couple of pairs of lockable forceps.

  After closing the incision in the uterus, he used a pair of forceps to grip a suture needle held out by Rose. Following a final dab with a new cotton swab and a sweep by Rose with the suction tube, Graham proceeded to stitch up the uterus, his hands shaking slightly with stress and fatigue. Despite this, his stitches were neat and evenly placed. Eventually, Graham nodded in satisfaction, knotting off the final stitch.

  “That’s the uterus closed. Rose, can we irrigate with that squeezy-bottle of sterile water, do a final suction and swab before I close the abdominal wall?”

  Rose washed the closed incision in the uterus, applied suction and swabbed out the wound. Graham picked up another suture, unhooked the retractor and started pulling the abdominal wall closed with forceps, applying stitches at regular intervals. Tying off the last stitch, Graham checked the IV stand and noted that the bag was half full.

  “Rose, I think that we have enough time to close up the wound before you change the blood bag again. We are nearly done here. How are Corran’s vitals, Kate?”

  “No change, Graham. Nice and stable,” Kate replied.

  “That is good news. You alright, Simon?” Graham asked, lifting his head to check on the man.

  Simon nodded, a solemn, rigid nod that told Graham more than any words could have done.

  Graham reached for another suture and turned to Rose, “Are you ready to keep dabbing the wound as I go?”

  “Yeah,” Rose replied, with tiredness coming through in her voice.

  Carefully inserting the needle in the flesh just beneath the skin, Graham continued to close up, dabbing the wound after each stitch. Once the final stitch was tied off Graham cut the suture and his shoulders slumped with exhaustion.

  “Let’s get this wound cleaned up and a dressing on it. Rose, please could you replace th
e blood bag?” Graham said quietly.

  “Sure.”

  Graham cleaned the wound with disinfectant spray and dried it with a sterile wipe before applying the dressing.

  “Is she going to be alright?” Kate asked quietly.

  “We’ll know in a bit,” Graham replied. “She has lost a lot of blood but the section went smoothly and her vitals remained stable. I will give her a shot of antibiotics. We will need to monitor her and perhaps administer some painkillers once the spinal anesthetic wears off; which will be soon enough. The child is going to need feeding. Can one of you sterilize some of those bottles I saw in the kitchen? The formula tins have instructions on the side. I also need someone to clean to her up.”

  “I’ll clean her up,” Rose volunteered.

  “And I’ll get a bottle made,” said Kate.

  Graham nodded. “Just make sure that everything you use has been sterilized,” he said, unwrapping another syringe. After filling the syringe he injected the contents into the top of Corran’s thigh.

  “What is that for?” Simon asked.

  “It’s an anti-D injection. Your wife is rhesus negative. That means she has a negative blood group. If the baby is a positive blood group, this injection will stop your wife forming antibodies, which might cause her problems in subsequent pregnancies.”

  “Subsequent pregnancies?” Simon said with horror. “I don’t think, doctor, that my wife will be having any more pregnancies.”

  Graham smiled gently. “You might feel differently in a few months time – when the memory of today has faded.”

  Simon gave a grunt of disagreement and rocked his child gently in his arms.

  “Our wee lad has my hair,” Simon whispered, lowering his head to Corran’s ear.

  “Rose, once you have finished washing Corran, I will help you get her dressed so that she is as comfortable as can be when she comes around,” Graham said.

  “Can I come in?” Grace whispered, knocking gently on the door.

  “Yes, come in. We’re just about done,” Graham replied.

  “How is she?” Grace asked, quietly.