by Sarah Morgan
‘The trace is showing foetal bradycardia,’ Miranda murmured, and Jake gave a decisive nod and turned as Ruth walked into the room.
‘We need to deliver this baby right now and I want it done under general.’
Jake’s swift glance said it all and Ruth hurried off to bleep the anaesthetist and prepare the theatre.
‘What’s happening?’ Gail’s eyes were wide with fear now and tears glistened. ‘Oh, God, it’s all going wrong, isn’t it?’
Her husband stepped forward, his face pale and his eyes darting nervously to Jake, seeking reassurance.
‘Gail, so far the baby is fine.’ Jake’s tone remained calm. ‘But I think there may be a problem with your uterus. I have a suspicion that’s what the pain is. I’m going to have to take you to Theatre. I’m sorry. I know it wasn’t in our plans and I know it will be disappointing for you, but there’s no other way. I don’t want to risk the baby and I know you don’t either.’
‘I don’t want an operation. Not like last time. I’m terrified of epidurals.’ Hanging onto control by a thread, the tears spilled over from Gail’s eyes and Jake took her hand in both of his, his blue eyes kind.
‘I know you’re worried,’ he said quietly, ‘but you have to let me do what has to be done. I need to deliver this baby and I need to do it fast. And we won’t do it under epidural. It will be under general. You’ll be asleep.’
All animosity forgotten, Gail clutched his hand. ‘I’m so scared.’
‘You wouldn’t be human if you weren’t, but let me do the worrying.’ Jake’s voice was firm. ‘I need you to trust me, Gail.’
Miranda swallowed at the kindness and confidence in his voice.
She was hopeless at trusting men and yet at this precise moment she’d trust Jake with her life, she thought to herself, and obviously Gail felt the same way because she gave a wan smile and a nod and reluctantly let go of his hand so that he could leave the room and prepare for the delivery.
Gail’s husband was white with strain and Ruth guided him gently out of the room and showed him where he could wait.
Miranda stayed with Gail in the anaesthetic room, holding her hand until she was unconscious and mercifully oblivious to everything that was going on around her.
Meanwhile, Jake had changed and scrubbed and was waiting in Theatre.
He glanced up as they pushed Gail into the room.
‘Right, folks, let’s work fast.’ He spoke to the anaesthetist. ‘Have we ordered blood?’
‘Six units of whole blood and I’ve requested a full blood count and coagulation studies. She’s got two peripheral lines in and I’ve bleeped the haematology doctor on call.’
‘Tell me when I can start.’
The anaesthetist checked his machines and nodded. ‘Her blood pressure is dropping. She’s bleeding from somewhere. You were right to bring her to Theatre—you’d better start.’
‘Ruth, I want porters ready to fetch that blood and I want the crash trolley in here.’ Jake’s voice was calm, ‘I’m not taking any chances.’
Miranda watched while he swiftly and skilfully opened the abdomen and then made another incision in the fascia.
‘Forceps.’ Without lifting his gaze from the wound, he held out a hand and the theatre nurse immediately handed him forceps followed by scissors which he used to lengthen the incision and separate the muscles of the abdominal wall. Then he made an opening in the peritoneum and carefully examined the uterus.
‘She’s bleeding badly and I can’t see where from—suction, please.’ He held out his hand again and removed the clots. ‘Uterine rupture of any degree is extremely rare,’ he muttered, ‘so why did it have to be on my shift and with a patient who wouldn’t let me near her? OK—that’s looking better. I can see what I’m doing now. Retractor.’
Miranda watched in fascination. She’d never seen a surgeon as slick and fast as Jake. His concentration was absolute, his fingers moving swiftly as he delivered the baby and the placenta.
She found that she was holding her breath and when the baby suddenly started crying there was a collective sigh of relief, but Jake’s gaze didn’t shift from the operation site. His responsibility towards the baby had ended with delivery. Now he was concentrating on the mother.
‘There’s significant blood loss,’ he murmured, lifting the uterus out of the pelvis to determine the extent of the injury. ‘Put 20 units of oxytocin in a litre of saline. I want 60 drops a minute until the uterus contracts. Clamp.’
The nurse handed him the instrument he needed and he moved with swift precision, clamping and ligating bleeding vessels and then using figure-of-eight stitches where necessary. Finally he was satisfied that the bleeding had stopped.
Miranda watched in breathless silence as he drained a haematoma that had formed and then examined the area again. ‘Her previous Caesarean section was stitched with a single layer of sutures—a way of shortening the time in the operating room but it does increase the risk of uterine rupture. I’ll do a double-layer closure this time.’ His eyes still on the wound, he held out a gloved hand. ‘I’m ready to stitch.’
The scrub nurse handed him the correct suture and he set about repairing the tear. ‘More light,’ he requested at one point. ‘I need to see the ureter. Don’t want to be stitching that. Right—clots here. Sponge, please.’
The nurse obliged and Jake carefully removed the clots.
Miranda stepped closer, her curiosity overcoming her reluctance to draw attention to herself. ‘Is her bladder OK?’ She knew that bladder injury was a very real risk but Jake gave a nod of his head.
‘It all looks fine. And no signs of infection so I’m ready to close. The uterus has contracted. Reduce that drip to 20 drops a minute. How’s that baby doing?’ Finally, once he knew the mother was out of danger, he turned his attention to the paediatrician. ‘Give me some good news, Howard.’
The paediatrician smiled. ‘Little girl and doing very well indeed.’
‘Apgar scores?’ Jake’s fingers flew as he stitched with equal measures of speed and skill.
‘Eight, nine and ten.’
Miranda smiled with relief. The Apgar score measured neonatal heart rate, respirations, tone, colour, and reflexes immediately after delivery. Gail’s baby had good scores.
Finally Jake finished and stepped back. ‘All right. Well done, everyone. Thank you very much. Ruth, tell the ward to contact me if there are any signs of infection. Day or night, I want them to phone me. Gail has had a rough enough ride. She doesn’t need any more problems. And we need to redeem the reputation of the medical profession.’
Everything about him was calm and steady, Miranda observed as she watched him strip off his gloves and walk towards the swing doors. Just like the time he’d rescued her from the mountain. He assessed the situation and just did what needed to be done. Panic and Jake Blackwell clearly didn’t go together.
He was an amazing doctor.
But it didn’t take a genius to see that he was angry with her.
And who could blame him?
Dreading the inevitable confrontation, she took her time helping Ruth to clear up Theatre and then waited in the recovery room until Gail was well enough to be transferred to the ward.
It was nearing the end of her shift when she finally returned to the labour ward. There was no sign of Jake.
Weak with relief that she was going to be spared a difficult conversation, at least for the time being, Miranda found Ruth. ‘Is there anything else you want me to do?’
‘Are you joking?’ Ruth gave her a smile. ‘You’ve already worked far longer than you should have done, considering it’s Boxing Day. I’m sure you have places you want to be. Go home.’
Miranda gave a wan smile. ‘I’m fine.’ Exhausted would have been a more appropriate word but she’d grown used to tiredness over the last few months. And there was no denying that the money would be very welcome. ‘I’ll see you tomorrow.’
‘Marvellous. Thank you so much for today. You were my
present from Father Christmas,’ Ruth joked as she checked on the number of delivery packs. ‘I was expecting to struggle through Christmas with no staff, and suddenly they called me out of the blue and said that they had a midwife available.’
‘I was relieved to get work,’ Miranda confessed, running a hand over her bump and pulling a face. ‘I thought you might not want me.’
And then she would have been in trouble because she needed every penny she could save. Pretty soon she wouldn’t be able to work at all…
‘You’re fit and healthy. That’s all that matters. See you tomorrow.’
Miranda grabbed her jumper and jacket and walked slowly to the set of railings where she’d left her bike. She was so tired, she wanted to cry. Her legs ached, her head throbbed and her eyelids drooped. All she wanted was her bed. At least she’d be too tired to notice the grimness of her surroundings, she thought as she walked across the badly lit car park. She doubted she was even going to find the energy to undress.
She’d just stooped to take the lock off her bike when a smooth male voice came from directly behind her.
‘Running away, Miranda?’
Not having expected to see anyone, she gave a cry of alarm and covered her mouth with her hand. ‘Oh—you frightened me.’
It was Jake and he was leaning against the railings, watching her, his handsome face cold and unsmiling.
‘Why?’ His tone was as chilly as the weather. ‘Expecting someone else, perhaps? Your husband?’
Tall and broad-shouldered, his blue eyes glittered dangerously in the darkness and he looked nothing like a respectable consultant. Nothing like the kind, reassuring man she’d seen calming Gail and Lucy earlier.
The anger in his eyes was unmistakable and her heart gave an uncomfortable lurch.
She hadn’t anticipated that he’d be angry when he discovered that she was pregnant, but neither had she anticipated the fact that she’d see him again.
They said that your sins always caught up with you and it seemed as though her sin, although small, was currently biting at her heels.
She should never have gone home with him and she definitely shouldn’t have kissed him.
She ignored the tension in his jaw and the question in his eyes and tried to turn the conversation to safe ground. ‘You were amazing in Theatre.’ She’d hoped that reminding him that they were colleagues would be sufficient to encourage him to back off, but his gaze didn’t shift from hers.
‘I don’t want to talk about work, Miranda.’ His blue eyes were hard. ‘I want to talk about what the hell you were doing, spending the day with me yesterday—kissing me—when you’re pregnant with another man’s baby!’
She didn’t even have enough energy to defend herself.
A freezing gust of wind howled across the car park and a few flakes of snow wafted past her face. She was cold, tired and she still had to cycle the two miles home. The last thing she needed was confrontation. And she didn’t need to think about a kiss that she’d spent one whole night and day trying to forget.
‘Can we talk about this another time?’
‘No.’ His voice was thin. ‘We can’t.’
‘All right.’ She turned to face him, so tired that her own temper started to bubble up. ‘For a start, I didn’t kiss you—you kissed me.’
‘So this is my fault?’
How could she ever have thought he was a nice man? Looming over her now, he looked tough, intimidating and just about as far from nice as it was possible to be.
She was a lousy judge of men, she decided with no small degree of self-derision. Lousy.
‘I didn’t say it was your fault.’
‘Good. Because I may have kissed you but you kissed me right back. What’s your excuse? Are you going to blame the atmosphere? Or the alcohol you didn’t drink? Where was the father of your baby while you were kissing me?!’
‘Damn you, Jake!’ Exhaustion and disappointment made her temper break loose. For a moment she’d thought he was different. Special. ‘You know absolutely nothing about my life! And one kiss doesn’t give you the right to moralise on a subject about which you know nothing!’
She swayed slightly and he swore softly and gripped the tops of her arms with strong hands.
‘Look at you, you’re exhausted! What are you trying to do to yourself, Miranda? Yesterday you were walking on your own in the middle of nowhere in lousy weather and today you’ve just worked a ridiculously long shift. You’re pregnant. You should be looking after yourself and the baby.’
His words were the final straw. She was looking after herself and the baby. She had to because there was no one else to do it.
‘I’m perfectly aware of my responsibilities towards the baby,’ she spat, wriggling her arms out of his grip and glaring at him. ‘That’s why I turn up at work even though I’m exhausted. Not all of us have the luxury of being able to spend our pregnancy lazing around in bed. And my life is none of your business.’
‘You keep making it my business.’ He moved towards her, his blue eyes glittering in his handsome face. ‘It was my business when you tried to half kill yourself on a mountain yesterday and it was my business when you spent the day with me and kissed me. And it was my business today when you were working on my unit.’
She backed away and wrapped her arms around herself to try and stop the shivering. She was going to have to find another job. This was never going to work. Suddenly she just wanted to go home. If the tiny flat that she’d rented could be classed as home. ‘Fine. I made a mistake, walking on the mountains without checking the weather, I admit it. And I admit that I should never have gone home with you, but you wouldn’t take no for an answer and it seemed harmless enough at the time. Obviously it wasn’t, but you know what they say about hindsight.’ She turned and pulled her bike away from the railings. ‘Now, I need to get home.’
‘On that?’ He stared at her bike in disbelief and her answering glance was loaded with derision and disillusionment.
‘Yes, on this. We’re not all the fortunate owners of a Porsche, Mr Blackwell. And now, if you’ll excuse me, I expect we’ll see each other tomorrow.’ Unfortunately. She was tempted to call the agency and ask them to send her somewhere else but she knew that there wasn’t anywhere else. This was the only obstetric unit for miles around. And she wasn’t in a position to move again. She had to think of the baby now. She had to put down roots—make a home for them both.
A feeling of warmth spread through her and a rush of protectiveness. The same feelings she’d had from the moment she’d discovered she was pregnant. Given the circumstances, she probably should have been appalled, but she’d been thrilled and delighted. Excited. Of all the things she regretted in her life, becoming pregnant wasn’t one of them.
‘That’s it?’ He reached out and gripped her handlebars so that she couldn’t go anywhere. ‘That’s all the explanation you’re prepared to give me?’
The warmth inside her faded. ‘What do you want me to say?’ She gripped the bike tightly, trying to ignore the insistent throbbing in her head. ‘That I’m a slut who kisses men even though she’s six months pregnant? There we are—I said it. I behaved badly.’ Her tone was flippant and slightly bitter. ‘I shouldn’t have gone home with you and I shouldn’t have kissed you.’
‘Then why did you?’
‘Because you were pushy and because I—’ She broke off, struggling to explain something that she hadn’t even managed to explain to herself. Why had she gone home with him? ‘It was Christmas Day. I didn’t want to be on my own.’
‘Why would you have been on your own? Did you have a row with your husband?’
Husband? ‘No!’ She didn’t want him thinking that of her. ‘I’m not married.’
‘Partner, then.’
Partner? What a joke. ‘Mr Blackwell.’ She tugged at the bike so that he was forced to let go. ‘I think we should just forget the whole thing now. I’m grateful to you for rescuing me and giving me somewhere nice to spend Christmas
Day. But it’s history. Christmas has a way of doing funny things to people. If you don’t believe me, just think about the increase in suicides and all the people who make utter fools of themselves at office parties. We all go a little mad at Christmas. And now I need to go home.’ Before her aching, exhausted body gave up the ghost and slithered to the ground.
His mouth was set in a grim line. ‘Is he waiting for you?’
Why was he persisting in this line of questioning? ‘Does it matter?’
‘I want to know what sort of man would let his girlfriend climb alone in the mountains in the middle of winter and then let her vanish for a day and a night without calling the police.’
The same sort of man that didn’t care that he’d made a girl pregnant.
Miranda gritted her teeth and gave another shiver. She didn’t want to think about him. He wasn’t worth it. She and the baby didn’t need him. They didn’t need anyone. ‘My life isn’t your business.’
‘You made it my business when you forced me to rescue you from a mountain and when you kissed me back.’ He was glaring right back at her. ‘You can’t cycle home in this weather. Why isn’t he picking you up?’
‘Oh, for goodness’ sake, why do you care? Goodnight, Mr Blackwell.’ She tried to push past him but his powerful, athletic frame blocked her path and he muttered something under his breath and then lifted her bike.
‘Come on, I’ll give you a lift home. Your bike can go on the back of my car. It isn’t the first time.’ He strode across the car park with her bike and she stared after him in a mixture of misery, temper and frustration. And consternation.
She didn’t want him to give her a lift home. She didn’t want to give him the chance to question her further or find out anything about her.
‘Miranda!’ Having fastened her bike, he turned, his glance impatient. ‘Get in the car before you freeze.’
Short of bodily wrestling the bike away from him she had very little choice but to stalk across to him and climb into his car. Again. Her mind was working overtime. She needed to find a way out of this situation and she needed to do it fast. There was no way that he could be allowed to drive her home. It would stimulate more questions that she had no intention of answering.
