A Surgeon, A Midwife - A Family

by Gill Sanderson

  'Because you took me to the conference. And because I wanted to get you a present.'

  He tapped the parcel thoughtfully. 'Why do I suspect that when I open this, I'll get a bit of a shock?'

  'Because you are you and I am me. Come on, aren't you curious?'

  'I'm curious.' He tore open the packet. Inside was something she had toured the shops to buy. And she was pleased with. He held up what she had bought him. 'A pink shirt!'

  'My eyes got tired of looking at all those glistening white shirts that you wear.'

  'But I'm not a pink-shirt man! What will people say if they see me in this?'

  'They'll say, "There's a man in a pink shirt.'" She grinned to herself. 'And he looks cool.'

  'Cool! Surgeons don't look cool!'

  'Start a trend,' she advised. 'A pink shirt will go very well with the dark suits that you wear. You will wear it, won't you?'

  'You bought it for me, so I'll wear it.' He dropped his new present onto the couch. 'Now, I'd better say thank you somehow.'

  He put his arms round her and kissed her. Perhaps just a thank-you kiss at first, but it soon turned into something longer and sweeter. Miranda felt odd, both relaxed and excited. With him was like being happy at home, but it was also like wandering into some new and exciting territory. Whatever it was, she had never felt like this with any man before. When he stopped kissing her, she pulled him back closer, kissed him again.

  And then there was the noise of the door opening downstairs. Annie had come home. 'Guess I'd better go, he said, 'though I'd love to stay.'

  By accident she met him in the corridor next day.

  'How do I look?' he asked. As ever, when she saw him, her heart beat a little faster. In fact, this time it beat much faster. He looked so different. He was wearing her pink shirt! Still the dark suit, still the college tie, but the shirt really stood out.

  'You look great. Really cool. A good start, but there's more progress to be made yet. I think you need to wear a different tie to go with your new look. I'll buy you one.'

  'Miranda!' He looked scandalised. 'We have to take this one step at a time. I happen to like my tie.'

  'We'll see.' She smiled, her eyes dancing. 'Look, I have to get to work.'

  She hadn't expected to see him again so quickly.

  But as she carried out the obs and feeding of the four prem babies in her care, she became more and more worried about the condition of Gracie Johnson. Gracie was being ventilated, and at first all seemed to be going well. But then there was evidence of bradycardia and cyanosis. Her heartbeat slowed, her lips were turning blue. The little girl wasn't getting enough oxygen—but why?

  Miranda checked the endotracheal tube, which was fine. The air supply was there—if the baby could take it. She went in search of a doctor.

  To her surprise, Jack was in the sisters' room, looking through some files. He was wearing a white coat, apparently for a while he was working on the wards. Well, occasionally he did, especially when he was concerned about the welfare of one of the children he had operated on.

  Miranda said, 'I'm concerned about Gracie Johnson. I think she has a pneumothorax.'

  With some doctors she wouldn't have offered a diagnosis herself. But she knew that Jack would respect her as an experienced professional. Of course, he'd check what she thought. But he'd know that she was almost certainly right. 'Let's have a look,' he said.

  They stood together by the incubator. Grade's condition was worsening by the minute. Jack warmed his stethoscope, listened to the tiny chest and nodded to Miranda. 'Decreased breath sounds on the left side. We haven't time to organise an X-ray. We'll do a needle aspiration first and then get a drain in. You'll assist me?'

  'Of course,' said Miranda. 'I have done this before.'

  A pneumothorax. For some reason, air was escaping out of one of the infant's lungs and into the pleural cavity. This reduced the lung's capacity—in time might collapse it. And Gracie needed both lungs to survive.

  This had to be an aseptic procedure. Miranda fetched gloves and gowns for both of them. Then she cleansed the skin and under Jack's supervision infiltrated a local anaesthetic, lignocaine.

  Miranda held the baby still—not that she was capable of much movement now. Jack took a butterfly needle attached to a syringe via a three-way tap. Cautiously, he pushed it into the baby's chest, being ultra-careful not to puncture the lung. There was the faint hiss of air escaping from the pleural cavity. Jack looked up and smiled. The lung would now re-inflate and Gracie could breathe more easily. The emergency was over—but there was more to do.

  Miranda assisted as Jack cut through the intercostal muscle, introduced a drain, sutured it into position and then connected it to a Heimlich valve. Now the pneumothorax could heal itself. Any air escaping from the lung would be drawn out at once by the drain.

  Jack stood back, looked down at his tiny patient and nodded approvingly. There was a much healthier-looking baby.

  'That went well, didn't it?' Miranda asked.

  'It did. You knew what I was thinking, could anticipate what I wanted. I enjoyed working with you, we make a good team.'

  'In all sorts of ways,' said Miranda, mischievously.

  'Very definitely in all sorts of ways. In fact, I was going to suggest—'

  'Morning, Miranda. Morning, big brother, sir.'

  Miranda turned. There was a smiling Toby. 'Don't let me interrupt any important conversation or a clinical procedure,' he went on breezily, his grey eyes twinkling, 'but I could do with a hand in a minute. I'd like to get an IV line into Baby Halsall.'

  'Why does Baby Halsall need an IV line?' Jack asked.

  Toby's answer was prompt. 'Not taking enough food. I want to get some glucose into her. Look, here are the weights.'

  Jack glanced down and nodded. 'Good. Now, Miranda here has got a bit of clearing up here to do and then she can help you. I need to write up some notes.'

  'No hurry. When she's ready. Finish what you're doing, Miranda, and I'll wander around and tell funny stories to the rest of our congregation.'

  The joke was, that's exactly what he did. Out of the corner of her eye Miranda could see him peering into the incubators, occasionally reaching in to tickle or stroke a baby or make sure it was comfortable. And whatever he did, he talked to them. She could hear the drone of his voice, occasionally a word or two. She heard him chatting away to a tiny neonate who couldn't have weighed more than a couple of pounds and smiled.

  Not all nurses or doctors did this. But Miranda believed firmly that talking to children, no matter how premature they might be, helped them to grow and survive. It seemed that Toby felt the same way.

  Eventually she finished writing up her obs on Gracie Johnson and went over to see what he wanted. 'Just hold little Laura while I get this line in. She wriggles and she's slippery. I like my babies to he there and smile at me.'

  'So I've heard,' Miranda said dryly. 'Your bedside manner is renowned.'

  He grinned at her. 'I stand reproved. Now, if you hold her...'

  They worked well together for a while. Quickly, the IV tube was inserted and the drip installed. Little Laura complained at first but then quickly quietened. And as they stood and watched to make sure that all was working correctly, he said, 'I see that my brother Jack is mellowing, turning into a dandy. Have you seen his new pink shirt? I could fancy one myself. I wonder where he got it from.'

  'They've just got them in...' Miranda started, then stopped in confusion.

  She realised Toby was laughing at her. But his eyes were shrewd. 'It's one thing to buy my big brother a shirt,' he said. 'It's quite another to make him wear it. What he needs is the love of a good woman. Now you've got him under control, you've got to keep him that way. You will, won't you?'

  Miranda jumped as from behind them a stern voice said, 'Toby, I'm sure she will keep me under control.'

  She turned and there was Jack, his face as stern as his voice had been. Toby, however, seemed completely unmoved. With a grin he
said, 'I'm very glad to hear that, Jack. We all want you to be happy.'

  Jack sighed and said to Miranda, 'It's always a mistake to work with relatives. Toby, have you finished here?'

  'Now, that's a hint if I ever heard one. Yes, I've finished.' A cheerful Toby walked out of the room.

  When Toby had gone Miranda said tentatively, 'He was only joking, you know. About us. About control. I think he's a good doctor.'

  'He's always joking. I don't mind it at all. And he'd better be a good doctor, otherwise I'd skin him. But I doubt it will be necessary.'

  He pursed his lips, looked down at Laura Halsall and smiled. 'I think we've got things sorted out here,' he said. 'Bleep me if there's another sudden problem, otherwise come and give me a progress report in a couple of hours. I'll have a coffee ready for you.'

  'I'd like that,' she said.

  He stood there a minute in silence then turned to go. Miranda looked at him, the dark suit, the new pink shirt, the face that she had once thought of as craggy—and a great rush of emotion drove through her. Jack Sinclair was everything she could ever have wished for in a man! But was she all he could ever wish for in a woman?

  It was hard, but she forced her attention back to her work. She had a job to do. It would be better to keep her feelings to herself. At least for now.

  She sat in Jack's room and drank his coffee. She thought it was typical of the man—the coffee was superb. She'd watched him make it, so carefully. Whatever Jack did, he needed to do well.

  'I don't know if you've been listening to hospital gossip,' Jack started, 'not that there's much to gossip about. But I wanted to explain why I've got my brother and sister working in the same department as me.'

  'Something about your mother being ill?' Miranda had heard a couple of rumours.

  'She has brain-stem cancer and in time she will die.'

  Miranda winced at this flat statement, tried to cope with the enormity of what he had told her. 'But it must hurt you! It must affect your work!'

  An instant flash of the old Jack. 'Nothing affects my work!' He thought a moment and then went on. 'Toby was in London and Carly was in America when our mother first fell ill. They both gave up their positions and got jobs here. Now they are round at my mother's every spare minute. They've been so good with her. And on the other hand, I think the hospital benefits from them. I don't want anyone to think that they ride on my coat-tails.'

  'Just the opposite! If anything, people think that you work them too hard. Jack, how's your mother now?'

  He smiled. 'She's in a period of remission. She's gone on a cruise, will be away for at least a month. Her body might be slowing down but her brain is as good as ever.'

  'I think it's wonderful, the way the three of you are rallying round.'

  'In some ways we're a very close family. But at times Toby's sense of humour can be...'

  'I like him! We all like him. On the ward he's always his usual cheerful cheeky self and he wakes us all up.'

  'Aren't there times when he should learn not to joke about things?'

  'We can all take it. The nurses and midwives prefer him to some of the glum SHOs who seem to think the world is full of misery.' Miranda looked at Jack thoughtfully. 'You know, I can tell you and Toby are brothers. You look a bit alike but, more than that, your characters are similar.'

  Jack was astonished. 'We're nothing like each other!'

  'Oh, yes, you are. You're both hiding something— the real you. He does it by joking. You do it—used to do it—by pretending to be cold and distant.'

  He was silent for a moment. Then he said, 'You're getting to know me too well.'

  'It's not too well, it's just getting to know you. If you want me to.'

  He didn't answer at first. Instead, he reached across his desk, ran a finger down the side of her cheek. 'I want you to,' he said eventually. 'But much of my life recently I've kept up this attitude. It makes life easier, it makes me a better surgeon. And the way I am, it keeps the neonatal surgical section as one of the best in the country.'

  'You've got to be hard and soft at the same time,' Miranda said, grinning. 'And you can do it.'

  'Perhaps.'

  They sat in silence for a moment, each quite happy just to look at each other. And somehow Miranda knew that he was feeling exactly the same as she was. She felt a great but a simple delight just to be close to him. For a moment no need to speak or to touch. They were together. And there was a communion beyond bodies.

  His phone rang and they both jerked to attention. He looked at it gloomily, but both knew it had to be answered.

  'Hi, Jenny. Good to hear from you... Yes, I'd like that... Yes, in her own time, and you always have first call... Sure, anyone else who wants to come, you know that's always been the case... Thanks!'

  He rang off and smiled broadly at Miranda. 'That was Jenny, your supervisor. As far as possible, she'll let me know when you're working. Then, and only in your own time, you can come and observe me operating. You want to be a scrub nurse, this is the way to learn.'

  'Great!' said Miranda.

  'This is Charlotte Ramsden, my scrub nurse,' Jack said. 'She's been with me for years and now I don't need to ask her for things, she knows what I need before I do myself. Just sit by her. Watch and you'll learn. You can ask questions afterwards.'

  'Right,' said Miranda.

  It was in the operating theatre that she had first seen Jack Sinclair and she remembered the wonder she had felt when she had seen what miracles he could work on those tiny bodies. Now she was not just an onlooker. She was part of the process, not an actual worker yet but a trainee.

  The first baby was wheeled in. Jack looked around the theatre. 'OK, this is Shauna Whitlock,' he said. 'She has hydrocephalus, and as you will know the fluid produced in the four ventricles of the brain, the cerebrospinal fluid, is not being reabsorbed. This causes pressure on the brain. So I am going to drill into her skull, introduce a tube with a one-way valve in it so it can tap the CSF. Then we will run another tube just under the skin, down to the peritoneal cavity, where the CSF can be easily absorbed.'

  Then, without looking, he stretched out his hand and Charlotte placed a scalpel in it.

  Miranda watched, fascinated. She knew Jack now. There was a moment's pause and she noticed the hunched shoulders, the frowning brow. She knew what he was doing, how he was focussing all his attention on the case in front of him. Then he relaxed, made the first cut. Things would be fine now.

  Afterwards they sat in the canteen and talked. 'What did you think?' he asked.

  It was hard to express what she thought. 'There's something I've always been told,' she said slowly, 'but although I've been told it, I've never felt it. Now I can feel it. I think you're a brilliant surgeon. This is no reflection on you, but you're only as good as your team. You, the anaesthetist, even the scrub nurse...they all are important. You can't manage without them.'

  'That's true.'

  'So I want more than ever to be a scrub nurse.'

  'If you get to be as good as Charlotte, you'll never be short of a job.'

  CHAPTER FIVE

  She didn't see much of him the next week. He'd called her into his office, told her he'd have no time to spare as he was so busy.

  She'd walked round his desk, leaned over and kissed him quickly. 'And to show you that you aren't the only busy person in the world—' she grinned '—I'm needed in SCBU right now.'

  She did see him every day, but seldom for more than five minutes. It was hard but she was content—and just a tiny bit pleased when she saw he was suffering as much as she was. One day he said something that both excited her and made her slightly apprehensive, 'This time will pass soon,' he said. 'Then we have to move on. We've got things to decide. We have a future.'

  A future? She wasn't sure she wanted to think of the future. For the moment she wanted to live for the day. There were things about her that she hadn't told him yet. She was scared.

  * * *

  Wednesday was a bad day i
n SCBU. Nurses, midwives, had to be tough, had to take the hard with the joyful. Most of the children they treated managed somehow to survive. Some did not, and on Wednesday two of their precious charges died.

  Miranda had to comfort one of the mothers—though what comfort could there be? And although she got some small pleasure from the thought that she might have helped the mother, if even only a little, it was still dreadfully emotionally draining.

  She desperately wanted to talk to Jack, just to be with him for a few minutes, just to take strength from him. But she knew it would not be right. He needed all his strength for what he was doing. And she had fought battles like this before.

  Then she picked up a call for Jack from Danielle, who phoned to say that things were going well. When Miranda explained that Jack was tied up all week, Danielle recognised Miranda's voice and told her that Wayne was working. She sounded very upbeat and positive, completely different to the first time Miranda had spoken to her.

  'Thanks to Mr Sinclair, I really think things are going to be all right,' said Danielle. She hesitated. 'I don't suppose you'd like to come and visit at all, if you're free? Kylie would love to see you again.'

  Having had such a difficult day, Miranda decided to spend a happy hour or two with Danielle and the children, and accepted. What to take? A small gift might be pleasant but exactly what? In the end she decided on chocolate. Everyone loved chocolate.

  She drove to the estate and parked her car under a lamp. Then she walked to Danielle's flat.

  It turned out to be a comfort, being with Danielle. They chatted, and eventually Miranda spoke about the two deaths in SCBU, to get it off her chest. Danielle understood.

  'I'm so sorry to hear that. When Mr Sinclair told me what was wrong with Kylie, I just couldn't take it in at first. It wasn't right, it wasn't fair. I'd done everything I could to make sure my new baby was all right. Even gave up smoking when I was having Derek. And that was a strain. Like I said, it just wasn't fair.'