‘I’m using propofol,’ he told her.
‘You have propofol?’ General anaesthetic? In a doctor’s bag?
‘I told you, I’m ready for Armageddon here. Fixing my injured sailor wasn’t pretty. I hoped that by getting my kit together I’d pretty much guarantee never to need it again, but here we are.’
She was thinking ahead, not liking what she was thinking. ‘You’ll need intubation.’
‘I will, and that’s where you come in. I have oxygen. I have intubation equipment. I don’t have monitors, of course, so it’ll be up to you to watch her like a hawk. Not that there’s a lot I can do if her breathing fails but...well, let’s just hope.’
He’d started working as he talked, rolling the almost limp dog onto her back, working with soapy water and a razor to shave her abdomen. He used slow, smooth strokes, as if he was trying to calm her rather than prepping for surgery. She wasn’t reacting. The morphine must have kicked in fast, Hannah thought—or else Maisie was so far gone she couldn’t react.
Either way, Josh was moving on, knowing his course.
‘I’ll also need help with the pups if there are any alive,’ he told her. ‘I’ve put towels in the oven, lowest setting with the door open. Claire says the foetal membrane should be removed and the umbilical cord clamped and severed. In a normal birth, the pup’s chest is compressed, expelling fluid from the respiratory tract and stimulating the first breath. That doesn’t work in a Caesarean so it’s over to you. If it’s not breathing then rub hard with clean towels to encourage respiration. Claire says rubbing the hair backwards can help. I also have a suction bulb to clear mucus if you need it.’
Then he hesitated and his voice gentled. ‘Hannah, you do need to be prepared for dead pups, though. Claire says after this time there’s every chance we’ve lost them all. Also, we’re looking at multiple births and there’s only the two of us. I’m sorry, but we need to be harsh and fast in assessment, saving the fittest. You can’t spend time on a pup that doesn’t look viable if the next one I deliver looks like it has a better chance.
She nodded, feeling ill. ‘Got it.’
He’d tugged the table close to the kitchen bench and had already laid out equipment. She checked it fast. ‘You are prepared.’ Deep breath. ‘If I’d known you were here and had this... If Moira had known...’
‘Moira had every chance to ask for help,’ he said, and she heard anger behind his words. ‘She made bad decisions and you’ve been left with the consequences. That’s what happens when people are—’ He stopped, the anger she heard building cut off short. ‘Enough. Are you ready?’
She did another fast visual of the equipment, then headed for the sink.
‘Yes,’ she told him, slipped seamlessly into the professional mode he’d assumed. The howling wind outside, the weird feeling of being in a domestic kitchen rather than a hospital theatre, the shock of the last few hours, even Josh’s crazy apron...they all slipped away.
There was only a doctor, a nurse, and a patient and pups whose lives were in their hands.
She was good.
Professional assessment. Acceptance of limitations of equipment. Of limitations of themselves. Brief questions and then moving on. She helped him set up the IV for fluids without a question, and she moved fast.
She accepted how compromised he was and acted accordingly. The less time Maisie spent under anaesthetic the better her chances, and as for the puppies...they’d be struggling already. He wasn’t going there.
He’d expected to help her with intubation but as he turned to help she motioned him away.
‘Got it.’
Her voice was solid, grounded, practical, and he had a sudden sense that this woman would never promise what she couldn’t deliver.
It was up to him.
Go.
Josh had performed Caesareans during surgical training—of course he had—but that was years ago, and a Caesar on a dog was a very different thing. He found himself thanking his stars that Maisie wasn’t a mini-poodle or a chinchilla. At least a Labrador gave him space.
Claire’s instructions were still echoing, listened to and held. ‘I can stay on the line and talk you through it,’ she’d said. ‘But, honestly, Josh, you’ll need to work too fast to listen.’
One final glance at Hannah, ready with her intubation gear. One final check of Maisie, lying semi-comatose from the combined effect of prolonged labour, shock and drugs.
‘Let’s get you safe, girl.’
And then there was no time to think, only time to follow Claire’s echoing instructions. She’d sent him pictures and they were now burned into his consciousness, almost into his fast-moving fingers.
He made the incision from the bellybutton to the pubis. So far, so good. Now for the foray into the world of Claire’s diagrams and instructions.
A dog’s uterus split into two forks—horns, Claire had called them. Canine reproductive anatomy differed dramatically from that of humans and he thanked his stars he’d taken the time to study those pictures. Maisie’s need had been urgent but going in blind would have been a disaster. Still, he had to work fast.
Carefully he lifted the uterus and incised, just enough to lift the first pup out. This would have been the pup lodged in the birth canal, taking the pressure of the pups behind. One brief look told him it was dead.
He laid the pup in a bowl beside him, his curt nod without looking up a silent communication to Hannah of the outcome.
Next.
The next pup seemed lifeless but not distended. Was there hope? He had no time to assess—that was Hannah’s job. He detached the placenta and handed it over.
The next pup moved in his hand as he lifted it clear and the sensation was like a jolt of adrenaline. He handed it over, but in his peripheral vision he saw the second pup had been laid aside.
Damn.
He wanted more fingers. He wanted more assistants.
He had time for nothing.
When he was sure there were no more pups in the first horn he moved to the next. Another pup. Another movement and he heard the faintest of whimpers. He had no time to react.
Another. Two more.
Done.
Seven.
He had the count solidly in his head, checking and double checking that the placentas were all clear. Leaving one inside could spell disaster.
He had no idea how many pups were alive.
Hannah had kicked a chair to the head of the table and was now sitting down. She was still monitoring Maisie’s breathing, but in the sitting position she’d been able to lay the pups on the towel on her lap. She’d lifted a hand and received each pup in turn, but he had no idea what was happening with them.
He still couldn’t pause to find out. Claire’s instructions were still in his head. He needed to close fast, using subcuticular stitching so as to not interfere with nursing of the pups.
‘Josh...’ Hannah’s voice was urgent. ‘She’s coming round.’
‘Let her wake up,’ he said, inserting the last stitch. ‘I’ll take over. Attend to the pups.’
She scraped back her chair so he could access Maisie’s head to supervise the removal of the intubation tube. The big dog gagged. Josh lifted the tubing clear, then watched as Maisie’s eyes fluttered momentarily—and breathing resumed.
He almost sagged with relief.
But of course he didn’t. When had he ever? He knew this feeling, the sudden drop of adrenaline after lifesaving surgery. He’d learned it was momentary—he needed to brace and then move onto the next thing.
Which was the pups.
‘How many viable?’ he asked.
Hannah had turned to the oven and was gently placing her armload into its warmed interior. He’d made a nest of towels and she was placing them in, one by one.
‘Four,’ she said softly. There were two wee bodies l
aid aside on another towel, another in the bowl. She looked back at them in sadness.
‘Let me see.’ He had an almost overpowering longing for the city hospital he’d trained in, for skilled paediatricians and neonate nurses, for incubators, for at least one staff member for each baby during a multiple delivery.
He checked the three lifeless forms and knew nothing could be done. Gently he laid the first little body with its siblings and folded the towel around them all.
Four out of seven was a miracle all by itself. Aching for more was stupid.
Hannah stood to take over monitoring Maisie, and he knelt by the oven, checking the clamping of umbilical cords, getting rid of the remains of the birth sacs. Getting his head in order.
Four viable pups. One live bitch. It was far more than he’d hoped for.
Finally he stood and faced Hannah.
She looked totally wiped. Her face was as white as a sheet—or whiter.
She was staring down at the towel covering the dead pups, and her body seemed slumped in grief.
Shock must be taking its toll. What she’d gone through, and eight months pregnant herself...
He lifted Maisie down onto a sheet on the floor. The dog was dazed, stilled by the combination of shock and morphine.
‘Stay with her while I organise a bed for her,’ he told Hannah. ‘I have two dog beds but they’re both deemed to be Dudley’s and I don’t want property disputes. She needs a nest of her own, where the puppies can be introduced to her as soon as possible. Claire says sooner—her instinct to nurse has to be allowed to kick in fast.
She nodded, mute, and almost unconsciously he put out a hand and cupped her cheek. ‘Hey,’ he said softly. ‘You did great.’
‘You did greater.’ It was a hiccup of a whisper and he knew she was fighting back tears.
‘Yeah, and I didn’t find a dead great-aunt and nearly get drowned and I’m not eight months pregnant. I performed a Caesarean. All in a day’s work.’
‘You know, I’m very sure it’s not.’ His hand was still on her cheek and she lifted her own hand to cover it. ‘Thank you,’ she whispered.
And, hell, it was all he could do not to take her into his arms and hug her.
Maybe he should. She was shocked, shaking, distressed. Surely any normal human being would have hugged.
But the feel of her hand over his was creating sensations he’d fought for years to overcome. He didn’t need this. Contact? Concern? Closeness?
He lifted her hand away and smiled down into her eyes. Which might have been a mistake as well.
He’d meant his smile to be one of reassurance, a gesture that she didn’t need to touch him, to comfort him.
But she met his gaze and the smile faltered. Her eyes were direct, true.
‘Thank you,’ she whispered, and shifting his gaze seemed a bigger effort than shifting her hand.
‘Moving on,’ he said, suddenly harsh because there were things happening that he didn’t understand—didn’t want. ‘I’ll fetch that bedding. You’re in charge, Nurse.’
She managed a smile back at that, accepting his weird foray into professional titles without a murmur.
‘Certainly,’ she said meekly, but with a trace of a twinkle that warned that in normal circumstances she was anything but meek. ‘Anything you say, Doctor.’
CHAPTER FOUR
IN THE YEARS since the accident, Josh’s half-sister had been amazing, supportive, loving, full of advice as he’d built this place, but grief was always between them. Finally Madison had cracked.
‘I can’t stay here, Josh. I have a job offer in New York. I need a clean break.’
She’d left, but not before leaving most of her gear with him. ‘You have a huge garage. Why would I pay rental on a storage facility?’ So now one side of his garage was packed with boxes, all labelled by his neat-freak sister.
And if his neat-freak sister could see her boxes now she’d have kittens.
He had puppies. Needs must.
Her boxes labelled linen were now empty. He cut the biggest to form a makeshift crate, put it in front of the living-room fire and filled it with Madison’s pink towels.
In the kitchen Hannah was watching over an increasingly wakeful Maisie. He lifted the dog and carried her through to the fire. Hannah followed, and blinked as she saw the pink nest.
‘Hey, how do we know the pups are girls? Sexist stereotyping? Surely this is risking all sorts of neuroses in later life.’
He grinned, his first relaxed grin of the night. Hannah was smiling, too, teasing, and he thought, Wow, the courage of this woman...
‘People who use my garage for storage do so at their peril,’ he told her. ‘My sister, Madison, has a twisted taste in aprons and a sexist choice of bath sheets. We’re stuck with it. Let’s get these babies settled and deal with their psychological trauma later.’
He laid Maisie into the prepared crate, then pushed an armchair up beside it. ‘You’re in charge of supervising,’ he told her. ‘Sit.’
‘Josh—’
‘No argument. Sit.’
She sat.
He returned to the kitchen and double checked the puppies. Four tiny pups, each a miracle in its own right.
The sad little bundle to the side was a tragedy, but compared to what might have been... Don’t go there, he told himself. The last three years had been all about shoving unwanted thoughts aside—needs must to survive.
He carried the living pups into the living room and cautiously set them beside their mother. Maisie stirred and tried to look around at them. She made a huge effort and nosed them with interest, then flopped back down again.
The puppies squirmed against her, nuzzled, instinctively seeking what they needed. And found it.
And as they started to suckle, the tension seemed to ooze from Maisie—and from the two humans watching.
Josh found himself smiling. He glanced down at Hannah and she was smiling too. Mistily.
‘Oh, Josh...’
‘We did good,’ he said, and dropped a hand on her shoulder. It felt okay.
More than okay, he thought suddenly. The feeling of peace... The presence of this woman...
Was suddenly disturbing. This didn’t make sense.
Why was he thinking about peace? This was a crazy night. The storm was still building. The wind was howling around the house and the crashing of the sea was truly scary.
He thought suddenly of Skye and Mick and their three kids on the far side of the island. They’d been resolute in refusing help, but they hadn’t expected the storm to be this bad. This side of the island was slightly sheltered. Theirs...not so much.
But there was nothing he could do now. His truck had rocked with the wind when he’d driven to the bridge, and the track to Skye and Mick’s consisted of little more than sandy ruts. They were on their own.
‘What’s wrong?’ Hannah asked, and he realised she’d been looking up at him in concern. He must have been frowning.
‘Just...indeterminate worrying,’ he told her. ‘Something about a cyclone hovering around my house makes even a grown man uneasy.’
‘Even a grown woman,’ she agreed. ‘Josh, the house on the far side of the island...’
‘Moira told you about the Fordes?’
‘Mick and Skye? I met them once when I was here, walking Maisie,’ she told him. ‘When your house was in darkness and I needed help I thought of them, but the track looked too dodgy.’
‘I saw them earlier today. I asked them to ride the storm out here, but they said they love a good storm.’
‘With kids that age?’
‘Their decision.’ He couldn’t stop his voice sounding harsh. Putting kids’ lives at risk...
Like he had?
‘Hey, earth to Josh,’ Hannah said, and he fought to get his face under control. He’d been
too long answering. Too caught up in the past—again.
‘I guess there’s not a lot we can do about it now,’ she said.
‘Sadly not. Even if we knew they were in trouble, the truck will never make it there in this weather. And as for contacting authorities... Chopper? Boat? Not a hope. There’s no way anyone can reach them until the weather eases. There’s nothing to do but wait.’
‘Right.’ Then she hesitated and then looked...sort of hopeful? ‘Josh, I know this is presumptuous when you’ve been so good already, but would you have what’s needed for... I don’t know...cocoa? Toast?’
Cocoa. Toast.
This was what he needed. Practicalities to drive other thoughts out of his head.
‘When did you last eat?’
‘Breakfast. I thought I’d have something at Moira’s but there’s something about a dead great-aunt that makes food drop down the list of priorities.’
His smile returned. Black humour was almost universal among medics—used as a release. He knew Hannah would be feeling gutted as well as shocked to the core by what had happened, but humour was a defence. He’d seen it time and time again in emergency departments and operating theatres throughout his career, and he knew how much it helped.
It helped now. It helped him.
‘Then cocoa and toast are coming right up,’ he told her. ‘Maybe even something a bit more substantial.’ He hesitated. ‘Give me a few moments, though. I need to turn the kitchen back into a kitchen.’
‘Let me help.’
But again his hand rested on her shoulder, pressing her down.
‘No. Hannah, Maisie’s still drug affected. She has her puppies and they need to be with her, but she might roll. Claire was firm on the need for supervision post-op, so you’re the Maisie Monitor.’
‘But—’
‘No buts.’
‘But Josh, this is your living room. We’ve just...taken over. Maybe you could put us all in the laundry.’
‘Dudley’s in the laundry.’
‘Dudley?’
‘My dog.’
‘Oh, that’s right. I saw him. Josh, it’s his house.’
Pregnant Midwife On His Doorstep Page 4
