The Honourable Midwife

by Lilian Darcy

  ‘You have to pin Claire down,’ Jackie said.

  ‘There’s only one way to do that. Through the family court. I’ve tried everything else.’

  Still, he felt in his bones that there was another kind of crisis building—felt it the way you could sometimes feel a late summer storm building in the air, even before you heard the thunder and saw the clouds.

  And if he was right about this vague thing that he couldn’t begin to measure or chart, then he needed to stay on top of his emotions, to stay strong, and in control. He needed, too, to steer clear of distractions and involvements. His sudden awareness of Emma Burns as an attractive, desirable woman since her return from Paris was the last thing he wanted, and the last thing that could be of any help to anyone now.

  ‘I talked to the manager of the child care centre yesterday,’ he told his sister, pulling his focus back with difficulty. ‘They have a couple of part-time staff who’ll take on private babysitting. One’s coming over this afternoon for a talk about what’s involved.’

  ‘That’s great!’

  ‘Well, it feels at the moment like I’m adding another piece of scaffolding to a structure that’s already in danger of total collapse, but at least it will take the pressure off you.’

  ‘I didn’t mean to push, Pete. I’m very willing. It’s just that with Mum and Dad, and also for the girls’ sake…’

  ‘Believe me, everything at the moment is for the girls’ sake,’ he said, hearing the grating harshness in his voice. He took one more gulp of coffee and listened to the noises coming from the other room. ‘Sounds like they’re happy with Tyler and Sarah, so I won’t make a big deal out of saying goodbye to them. I’ll be back after lunch, probably around two or so.’

  Jackie gave him a quick hug and he knew he was rigid in her arms, armoured as if for a battle.

  ‘Have you put on weight, Alethea? You have!’ Emma said.

  It was a tiny amount. Twenty grams. Less than an ounce on the imperial scale. But it was a good sign, all the same.

  ‘You are a cute girl,’ Emma told her.

  Rebecca had visited the baby twice now. The second time, yesterday afternoon, she’d come with her mother, who’d urged her, ‘Sing to her or something, love.’

  ‘She can’t hear, can she?’

  ‘Of course she can!’

  But Rebecca had remained tentative, and hadn’t yet visited today. Emma felt that she’d better coo to the baby instead, so that Alethea would at least come to know the sound of a caring human voice. It wasn’t a hardship for her to do so.

  ‘We are going to get you breathing room air, and get you growing and feeding, and you’ll be home in no time,’ she said.

  Baby Alethea was receiving her mother’s expressed breast-milk through the nasogastric tube now, and this was the best possible nourishment for her. Emma suspected there’d been some heavy lobbying from Rebecca’s mother to encourage her to breast-feed, and it was Mrs Childer who brought the tiny quantities of expressed breast-milk in to the hospital each day.

  Susan Childer had made a couple of oblique references to the fact that Rebecca was having trouble with the pumping process, too, and when Rebecca appeared, at last, just after lunch, looking as hesitant, miserable and fearful as ever, Emma decided to take some action.

  ‘Things are quiet in the unit at the moment, Rebecca,’ she said. ‘And Alethea’s asleep and peaceful. Would you like one of the other nurses to give you some help with the breast pump? Your mum says you’re tearing out your hair.’

  ‘It’s awful!’ the young mother agreed. ‘I hate the whole thing! How can anyone help?’

  ‘Well, I know it seems like a pretty weird thing to be an expert in—’

  ‘You got that right!’ Rebecca rolled her eyes. ‘I don’t want to be!’

  ‘But we do have a couple of midwives on staff who are specially trained in helping new mothers with feeding, including using a pump.’

  ‘I was thinking I’d just ride it out until the milk dries up, and go with bottle-feeding. It’s painful! Mum’s nagging me to death, though.’

  ‘The nipple soreness doesn’t last, although, of course, it’s your decision. Letting the milk dry up can be painful, too, for a few days. Would you like to talk to someone at least?’

  ‘OK. I ’spose so.’

  Not exactly an enthusiastic response, but enough to allow Emma to dial the desk at the nurses’ station and summon Kit McConnell.

  ‘Let’s go somewhere quiet, where no one’s going to disturb us,’ the other midwife told Rebecca, and the young mother allowed herself to be led away, still looking miserable. She glanced at the baby on her way out, opened her mouth, then shook her head, as if deciding there was no point in saying anything to her tiny, sleeping child.

  ‘Let’s hope Kit can help your mum to get better at the pumping stuff, little girl,’ Emma told the baby when Rebecca had gone. ‘Because it’s the best thing for you, and we do so want you to grow for us! Oh, yes, we do, oh, yes we do,’ she crooned, bending over the baby’s special bassinet.

  Then she straightened, a little embarrassed, to focus on Pete standing in the doorway. She smiled at him, felt the heat building in her face and said awkwardly, ‘OK, yes, you caught me out, talking baby talk.’ She raised her hands in mock surrender. ‘No point in mounting a defence. I confess everything!’

  But the baby talk wasn’t the reason she’d flushed. That was all about Pete himself. He didn’t laugh at her lame attempt at humour.

  ‘Don’t get too attached,’ he said.

  His voice was stiff and cool, and his gaze clashed with hers for one violent moment, before sliding away to look at the figures on Alethea’s monitor. He wasn’t wearing a doctor’s white coat, but was dressed casually, the way most doctors dressed in Glenfallon when their schedule included a mix of office hours, hospital visits and private time.

  He wore twill weave pants in a neutral sandy shade, rubber-soled leather loafers and a buttoned, long-sleeved shirt in a low-key abstract pattern. No tie, and there was a pair of sunglasses jutting out of his breast pocket and a stethoscope draped around his neck.

  The casual dress and the cool, distant manner didn’t quite fit together, but they were both effective. He looked both attractive and forbidding, and the sensations and emotions that coiled inside Emma were far too complex and unwarranted.

  ‘It’s always a mistake to get your emotions involved,’ he added.

  ‘She’s doing really well,’ Emma answered obliquely. She ran her hands down the sides of her blue uniform dress, feeling her palms grow damp.

  ‘She’s not yours.’

  ‘I know that, Pete.’

  You care about her, too, she wanted to tell him. I know you do. So isn’t this a little hypocritical?

  But it didn’t take much diagnostic effort on her part to realise that her feelings about baby Alethea weren’t the real issue, and certainly weren’t the most important one.

  Pete regretted everything he’d said the other day. He’d closed off. He was sending out some pretty clear signals that his problems at home were not her business, and that he didn’t want her to trespass into that territory.

  Emma understood.

  She’d almost been expecting it, which was probably why…partly why…she hadn’t tried to talk to him on a personal level since Tuesday.

  That didn’t mean she was happy about it. Something precious had been lost, or perhaps had merely proved an illusion. Face to face, they didn’t have a friendship at all, the way she’d felt they did when she’d been in Paris, and it would be better if she accepted the fact quickly.

  It would be better if her heart was more obedient to the dictates of her head!

  Feeling his stiffness and his distance, she still felt the same instinctive need to step closer, to touch him, to create a connection, skin to skin, which he was blocking today in the way he was speaking.

  ‘How is she, anyway?’ he said, staring down at the baby. ‘Can I see her chart?’

&nb
sp; He reached out without looking at her, and she handed it to him, making sure their fingers didn’t touch. ‘It’s right here.’

  ‘When was Dr Cassidy last here?’

  ‘This morning, pretty early. I’m sure she’ll show up again today.’

  ‘Thorough is one way of putting it, in her case,’ he said. ‘Takes the pressure off me. She’s been great.’

  ‘She’s very good.’

  ‘What about Rebecca?’

  ‘She’s been having a lot of trouble trying to express her milk. Kit McConnell’s spending some time with her, working on positioning the pump and trying to get her more relaxed.’

  ‘Motivation’s the real problem. Rebecca is so ambivalent about motherhood to start with. She’s just too young, and there’s no father in sight and no name been mentioned.’ He began to study the figures on the chart. ‘Numbers are good,’ he said. ‘What’s Dr Cassidy thinking? Has she talked to you?’ He looked at her finally, his eyes narrowed and distant.

  ‘As of this morning, she was still pretty worried,’ Emma said. ‘She can still hear a murmur, even though it seems clear that the heart is pumping oxygenated blood. She’ll send Alethea for tests on Monday, she said, and take it from there.’

  Automatically, she looked down at the baby, who lay on her back with her thin little legs bent and apart, still looking like a frog. With her fine skin and absence of fat, Alethea usually looked quite red—darker than the flush on Emma’s cheeks when she’d first seen Pete in the doorway.

  Now, however, the baby looked pale and a little mottled, and Emma thought immediately, That’s different. That’s a change, even since Pete got here. Her lips are blue.

  She looked at the monitor, and saw a change in the figures there, too.

  ‘Pete,’ she said, and reached out without thinking, to clutch his arm. It was ropy and hard and warm and tickly with hair, its solid bulk such a temptation to cling to.

  For a moment he froze. He looked down at the point of contact between them, and she saw the tight, reluctant look on his face. He didn’t think she was going to mention Claire, did he?

  Emma dropped her hand at once, feeling as if her fingers were burning, and told him, ‘Something’s not right.’

  She realised at once that she’d echoed the words Nell had been muttering at intervals since the baby’s birth. ‘She seemed fine a few minutes ago, Pete, but look at her now! She’s turning blue.’

  He looked, and swore under his breath. ‘What’s happening? What the hell is happening?’ The baby was already looking worse. Drained of colour. Skin mottled with different hues, like a diseased leaf, lips and extremities blue. ‘Is it her heart?’ Pete demanded, clearly not expecting an answer. ‘It has to be. Page Nell, Emma! Is this what she’s been worried about?’

  He flicked the earpieces of his stethoscope into place and grabbed the metal disc that dangled on his chest. Emma reached for the wall phone and stabbed with her forefinger at the two digits that would connect her with the A and E department.

  ‘We need Dr Cassidy in Special Care immediately,’ she said. ‘Is she in the department at the moment?’

  ‘She’s with a patient,’ said a female voice Emma didn’t take the time to try and identify.

  ‘This is urgent,’ she said, not knowing if it was but responding purely to the frown, the tight mouth, the deep concern etched on Pete’s face, and the changing colour of the baby.

  ‘I can pick up that murmur, too,’ he said. ‘It sounds bizarre. Surely this isn’t what Nell’s been in doubt about? It’s clearly not right, and she would have known that at once.’

  ‘It’s new,’ Emma said. ‘The baby hasn’t looked like this before. The pallor and the mottled skin. And her oxygen saturation and respiration and heart rate are all falling. Her heart must be failing in some way that wasn’t apparent before.’

  ‘A heart defect that Nell didn’t pick up? A heart defect made worse if that suspected patent ductus arteriosus is closing now?’ He was talking half to himself. ‘Dear God, are we looking something major? Hypoplastic left heart syndrome? Or…? Let me think. It could be that. There was another case I read about, just a year or so ago…’

  Hypoplastic left heart syndrome was a very serious congenital defect, Emma knew, and invariably fatal without major surgery.

  ‘Is that why she was small, even for her dates?’ Pete was saying. ‘Is that why she’s been looking so good until now, because she’s small enough that the PDA was maintaining adequate circulation? We’ve been medicating her to get it to close so the circulation pattern changed, and now that it’s doing exactly that, we’re in real trouble.’

  ‘Is that possible, Pete?’

  ‘Yes. As far as my knowledge goes.’ He closed his eyes and shook his head. ‘I’m not a heart specialist. I’m pulling this out of six different textbooks and a handful of case studies, and—But if that’s what it is, it’s going to be fatal without surgery, and without medication to keep the ductus arteriosus open until we can get her to—Lord, Sydney? Melbourne? Who does this surgery? Not many people, in this country. Nell will know, and I’ve been holding her back.’

  ‘No, Pete, you haven’t,’ Emma said urgently, the unwanted need to touch him tingling in her hands again. ‘She wanted to hold back, too. She thought the heart was probably fine. Lucy had a murmur, too, and she went home yesterday morning, thriving. Nell is as much aware of the social issues with the mother’s lack of attachment as you are. And she didn’t want to put the baby through unnecessary tests or transport if the heart was already doing its job. It’s—’

  ‘Nell! Thank goodness you got here so fast!’ His exclamation cut off Emma’s attempt to reassure him, and she had to stand back and listen while he outlined what had happened. His phrases were brisk, clear and decisive, but his fists were held tight. ‘It fits the facts,’ he finished. ‘It fits what we know.’

  ‘Yes, it does,’ Nell agreed. She took a moment to think, the wheels in her mind turning almost audibly. ‘If you’re right, we need to treat her with prostaglandin E1, to reverse the closure of the PDA.’

  ‘So we can do that?’ He sounded intensely relieved. ‘Yes,’ he answered himself. ‘If it’ll work.’

  ‘Obviously that’s the only reason the heart has been functioning, fooling us into thinking everything was all right. Can we get the equipment in here to give her an echocardiogram straight away to confirm this? Then we need to get her to Melbourne. There’s a surgeon at Royal Children’s who does the procedure.’

  ‘This can’t wait, Nell.’

  ‘No, it can’t,’ she agreed again. She pressed her hands to her temples, pushing back her dark blonde hair. ‘We’ll start the drug treatment straight away. We’re going to lose her for certain if we don’t. And maybe even if we do. Let me think. Is there a downside that I’m not seeing?’

  ‘I would probably have picked this up in utero if she’d had proper prenatal care,’ Pete said. ‘It should have shown on a routine scan in the second trimester.’

  ‘I would have picked it up,’ Nell retorted. ‘I’d have picked something up, if I’d given her the ECG sooner. I knew all along that something wasn’t right, but with her healthy oxygen levels, I was leaving well enough alone…I didn’t fully consider that it could be something this serious.’

  ‘If we can’t keep that ductus arteriosus open…’

  ‘I know. We can measure her future in hours, or less.’ Nell blinked. ‘I hate this. She’s come so far in other areas in just a few days!’

  ‘And so has Rebecca, I think,’ Emma put in.

  ‘Can we get in touch with the surgeon straight away? They’ll need to get the right team together,’ Pete asked. ‘If anyone’s away…’

  ‘Geoffrey Caldwell is the surgeon we want,’ Nell answered. ‘With Adrian Fitzgerald for the medical side.’

  ‘Cardiologist. I’ve heard of him.’

  ‘They’re both very good, and they’ve dealt with this condition before, as successfully as anyone in the world. We have t
o get her that far first, get a medivac transport organised. Get her to Royal Children’s alive.’

  ‘Yes. That small detail.’

  ‘Emma…?’

  Both doctors turned to her, and the blaze of urgency in Pete’s eyes drained the strength from Emma’s legs. Was she the one who should have picked this up sooner? Could a handful of minutes make a difference to this baby’s life? She hadn’t realised that a patent ductus arteriosus could close so fast, or that it could have such grave consequences in the environment of a malformed heart.

  ‘Prostaglandin E1,’ she said. ‘I’ll chase it up. Is that all we can do?’

  ‘It’s the only thing that really counts,’ Pete said. ‘If we’ve read this right, that is. I’ll get on the phone and start arranging a transport.’

  ‘I’ll get the ECG machine in here,’ Nell said. ‘She should go to Melbourne today, Pete, if it can be managed. Tomorrow at the latest. I need to think how else we can support her until then.’ She pressed her fingers to her temples and closed her eyes.

  Emma heard voices along the corridor, and recognised that they belonged to Kit and Rebecca. She took a deep breath.

  ‘And one of you needs to talk to Rebecca about this,’ she said. ‘I can hear her coming now.’

  CHAPTER FOUR

  ‘YOU are cordially invited to Glenfallon’s newest five star restaurant, Chez Emma, this Sunday at four p.m.,’ read the invitation that Emma had created on her computer, ‘so that I can show off my new French cooking and my French designer gown. Bring an apron, because you’re going to help cook.’

  Emma had delivered the invitations by hand on Friday morning—to Nell Cassidy’s crowded office in the A and E Department, to Kit McConnell’s lap as she sat at the post-partum ward nurses’ station, and to Caroline Archer’s microscope desk in Pathology.