by Lucy Daniels
Zoe was still panting when they settled her in one of Animal Ark’s larger kennels. ‘We’ll need to give her time again,’ Mandy explained to Jimmy. ‘I’ve only given her a tiny dose. The injection will help her uterus contract, but she may still prefer to give birth without us watching her every second.’ Zoe wouldn’t be left alone, but they did need to give her some space. As they left the kennel room, both she and Jimmy paused for a moment, peering round the door. Zoe was already lying down. Her tail lifted, and her flank began to bulge as she started to strain again in earnest.
‘Would you mind if I went into the cottage and put the kettle on?’ Mandy asked a couple of minutes later. Zoe seemed to have settled into the labour. She would be safe for a short while with Jimmy. ‘I’ll come back as soon as I’ve made tea.’
Even if Zoe did have her second pup, it could still take a while for the rest of the litter to put in an appearance. She watched Jimmy’s face closely. If he was at all unsure, she wouldn’t leave him, but he seemed happy to be left alone for a few minutes. ‘You do what you need to,’ he told her. ‘I know it’s been a long day. I’m really glad you’re with me.’ He reached out and squeezed her fingers, then turned back to watch Zoe from the doorway. Mandy watched for a moment, then crept out and made her way into the cottage kitchen.
Helen’s car drew up, just as she had put the kettle on. Mandy felt a tiny wave of guilt. She had forgotten to call with an update. If she wasn’t going to operate, Helen could have stayed in bed.
The door opened, and Helen walked in. Despite the lateness of the hour, her hair was neatly tied back, and her uniform was immaculate. ‘Is she still here?’ she asked. Her eyes were sparkling with excitement.
‘They’re in the kennel room,’ Mandy said. ‘Jimmy’s with her. I’ve just given her oxytocin. There’s probably not going to be a caesar.’ She gave an apologetic smile. ‘Sorry I woke you.’
But Helen looked wide awake. She shook her head. ‘Zoe’s giving birth at Animal Ark?’ she said. ‘I wouldn’t miss it for the world!’
Mandy grinned in spite of her exhaustion. Even in the early hours of the morning, Helen brought her enthusiasm to work. ‘You could go out and see how they’re getting on,’ she suggested. ‘I’ll just finish the tea.’ She got a third mug out of the cupboard and lined it up with the others on the bench.
Mandy poured three mugs of tea and was just adding the milk, when Helen rushed in. There was panic in her eyes.
‘Is something wrong?’ Mandy dropped the milk carton on the counter.
Helen seemed breathless. ‘I’m not sure,’ she said. ‘Zoe was licking herself and I thought there was another pup on the way, but she kind of shuddered and stopped. I think there was blood, but she licked it away. Could you check? I don’t like the look of her.’
Mandy’s knees felt weak. She staggered after Helen as she rushed back out to the kennel room. Helen flicked the light switch and the room was flooded with light. To Mandy’s horror the bed behind Zoe was bright red with blood.
‘I’ll get theatre set up.’ Helen didn’t pause for a second.
‘What is it?’ Jimmy’s eyes were stretched wide.
Mandy felt a sick churning, but she made her voice as calm as she could. ‘She shouldn’t be bleeding,’ she said. ‘We’re going to have to open her up.’
She was glad of Helen’s whirlwind efficiency as she stood over Zoe a few minutes later in theatre. Helen had set everything out in record time. Now Zoe was spread-eagled on the operating table, prepped and ready to go. Mandy took a breath as she lifted her scalpel. There shouldn’t have been blood. Something was seriously wrong. Laying her left hand on the skin at the front of the abdomen, she drew the blade along the length of the midline, cutting through the skin. She dissected down to the white line that joined the abdominal muscles together, then clipped through it. Finally, she slid her scissors into the tiny gap and slid them along to open the wound.
The uterus filled the abdomen. It was a frightening purplish-blue colour, instead of healthy pink. Mandy felt the blood drain from her face, but she took a grip on herself. She lengthened the incision further, gently pulling the muscle aside, so she could look at the whole of the womb. There were the four bulges: four good-sized pups. They were all far forward, still high in the abdomen. But Mandy’s eyes were fixed further back. Where the body of the womb should be, there was an ugly blue lump. She would have to get the uterus clear of the abdomen to see it properly.
Mandy’s hands were trembling. She took a deep breath and stood back. She needed them to be steady. Moving forward again, with infinite care, she set swabs round the wound, then worked to externalise the diseased womb. Finally, it was out, and she could see the dilation below the lump where the first pup must have been lying, but there was no way Zoe could have given birth to any more of the puppies. A large tumour had blocked their way out. It was a miracle she’d had even one.
Feeling sicker than ever, Mandy thought back to the ultrasound.
Why didn’t it show up then? It must have grown really fast!
She turned her attention back to the four bulges above the grotesque mass. She must spay Zoe, but she had to get the pups out first. The oxytocin she had given had contracted the muscle of the uterus. Without a way out, there was every chance that the placentas of the remaining puppies would be damaged.
She opened up the first of the bulges and drew out the tiny body. Even if the puppy was fine, it would be anaesthetised; it might not breathe straight away. Handing it to Helen, she reached her fingers in and grasped the hind feet of the second puppy. It took a moment of tugging, but she worked it towards the hole. The uterus was beginning to tear; it was so thin and friable. It wouldn’t matter, she thought in desperation. She was going to remove it anyway. The puppy’s tongue was blue. Removing the amniotic sac from the little face, Mandy cleared the airway, then handed on the little creature to Helen. Next pup. Her hands were shaking. She should have called Rachel. There was no way she could call Jimmy in to help. She and Helen would just have to manage. Third pup. This one too looked alarmingly blue. Fourth.
She checked Zoe’s abdomen. No bleeding. It would be fine for a minute. Laying a clean drape over the wound, she took the third and fourth puppies back from Helen. Helen was working desperately, rubbing the first two pups, holding them, trying to drain any fluid from the tiny lungs. Mandy grabbed a towel and started to rub.
There was no movement.
A minute passed. Two. Three. The tiny tongues were still blue. Though pups three and four were unresponsive, Mandy’s ears strained, hoping for the tiniest noise from Helen’s pups. They worked away, side by side, hoping against hope that there would be movement, that the little chests would begin to lift, that one of the tiny mouths would open. Just let them live. Oh please let them live.
The moment never came. She would have to get on or Zoe would be at risk too. She bit her lip as she handed the tiny bodies to Helen. Helen would work with them as she monitored Zoe’s anaesthetic. There was still hope.
Mandy removed the drape from Zoe’s abdomen, feeling sick. The tumour was huge and the uterus was torn. There was no way she could save it.
She began to tie off the cervix and ovaries, her actions mechanical.
I’ll have to send the lump off for pathology.
It was smooth and round and looked benign, but she needed to be certain it wasn’t cancerous. She checked the rest of the abdomen and the lymph nodes for further lumps. They were clean. The stitching up was always the longest part of a caesarean. Usually the sounds of squealing puppies lightened the room, but this time there was a dreary silence. The click of the anaesthetic valve was the only noise as Zoe breathed in and out.
Half an hour later, Mandy stepped back. A neat line of stitches ran the length of Zoe’s abdomen. Mandy leaned on the white-tiled wall. She had never felt so drained. She looked to Helen, but Helen only shook her head, her mouth crumpled. None of the puppies had made it.
Zoe had lost an awful lot of b
lood too. It would be a while until she was out of the woods. The wall was cold, and Mandy leaned the back of her neck on the tiles, closing her eyes. When she opened them again, the awful scene was still there. Helen was cleaning Zoe’s skin. Zoe was breathing at least.
Helen sent a tentative smile in Mandy’s direction. ‘It wasn’t your fault,’ she said. ‘No-one could have predicted that.’
Mandy swallowed, then pressed her teeth tightly together. Even if Helen was right, it was still awful. The puppies are dead. She was going to have to tell Jimmy. How was she going to tell him? She’d given bad news before, but this – it was Zoe. It was Jimmy. Taking a deep breath, she went to Zoe’s head. The membranes of her gums were paler than they should be. She lifted her eyes to the monitor. Oxygen levels were stable.
She straightened up. ‘I need to go and talk to Jimmy,’ she told Helen.
Helen looked up, another soft smile crossing her face. ‘No problem,’ she said. ‘I’ll finish up here. You can give me a hand to get her into a kennel when you can. She’s staying in, I take it?’
‘She’ll have to,’ Mandy replied. ‘And we should X-ray her chest to make sure there’s no spread up there.’ Her bones felt weary. Normally after a caesarean, the patient would go home straight away, but with the tumour and the blood loss, Zoe would stay here. They’d have to watch the puppy too. Zoe might not be up to feeding it.
There was no way of putting it off. She was going to have to tell Jimmy. Feeling as if her feet were straining through thickening cement, she made her way back through to the waiting room. Jimmy was sitting in one of the chairs, cradling the puppy. He started to his feet as soon as he saw Mandy. His eyes widened, his alarm clear.
‘Mandy?’ His voice was hollow.
Taking a deep breath, Mandy steadied herself. ‘I’m really sorry.’ It was hard to get the words out. She struggled on. ‘There was a tumour in Zoe’s uterus. It was stopping the pups from coming out. I had to spay her.’ She shut her mouth with a snap. The lump in her throat was so huge that she couldn’t talk.
‘The puppies?’ Jimmy’s voice came out in a kind of strangled gasp. Mandy shook her head. She could feel her jaw working as she pushed her teeth together hard. Jimmy looked down at the fluffy white and grey bundle in his hands and very, very carefully placed it back into the box on top of the warming mat. ‘What kind of tumour?’ How huge Jimmy’s eyes were when he was afraid. For a moment, Mandy felt almost detached. ‘Is Zoe okay?’
He needs to know. Get a grip.
‘She’s lost a lot of blood. I don’t know what kind of tumour it was. We’ll get it tested.’ The adrenaline that carried her through surgery was wearing off. Mandy’s whole body was shivery. She could hardly bear to look at Jimmy. He hadn’t moved a muscle. He was standing there: little boy lost. His arms hung at his sides, his hands were clasping into fists, the knuckles white.
For a moment, he squeezed his eyes shut, then opened them again. ‘I’ll have to call the twins,’ he said. He sounded as exhausted as she felt. ‘I told them Zoe was going into labour. They’ll be waiting to hear.’ He pulled the phone from his pocket, then stood there staring at the screen. His eyes were dry.
‘I’ll leave you alone to call,’ Mandy said, watching his face. Should she stay? She didn’t know.
But he managed a smile. ‘Thank you.’ His voice was grateful. She didn’t deserve it. Mandy dug her fingernails into the palms of her hands. For a moment she couldn’t move. Then finding her feet, she spun round and walked through the nearest door.
It was the room with the X-ray developer. There was no other door. She would have to wait in here until he was finished. Knees weak, she sat down in front of the computer. The image of Zoe’s abdomen was still there on the screen, four skeletons, beautifully clear. They looked awfully high up in the abdomen, Mandy thought. She moved her head back. She had been so intent on the puppies: on measuring their skulls. Now she looked at the bigger picture. She hoped there was nothing, but when she looked, the outline was there. There was a round shape where there should have been nothing. The tumour. That was why the puppies were so high in the abdomen. Mandy felt herself go cold.
‘I’m so sorry, Abi. No, there’s nothing Mandy could have done. She’s upset too.’ Jimmy’s voice came through the open door. Mandy looked again at the X-ray. She should have noticed, but she hadn’t. She had given Zoe the oxytocin. There had been no way out for the pups. She had killed them. There was roaring in her ears.
Chapter Nineteen
Through the partly open doorway, she could still hear Jimmy’s voice. Mandy checked the image again. The tumour was obvious. How could she have missed it? Jimmy’s phone call was ending. Mandy could hear him saying his farewells. ‘Zoe will be fine. She’s in good hands.’ Bile rose in her throat. Her hands were shaking. Knees as well. Somehow, she made it to her feet. She was going to have to face him.
There were tears in Jimmy’s eyes. He held his arms out to her and she moved towards him. For him it was a moment of shared pain: no fault perceived. Her actions were automatic. Her head fell onto his broad shoulder. He smelled so good. When he felt her trembling, he held her more tightly. ‘It’s not your fault,’ he said, ‘… not your fault.’ His voice was a murmur: a lullaby. Close as she was, it was as if there was a physical barrier between them.
He doesn’t know.
‘Come into the cottage,’ he said. ‘I’ll make you some tea.’
I killed the puppies.
He led her inside, his hands gentle, sat her down at the familiar table.
Will Zoe die? She’s with Helen: safer that way. Her hands were shaking.
‘I’m sorry,’ he put a mug of tea in front of her, reached out and stroked her hair. ‘I know it’s not a good time, but the twins are worried about Zoe. Could they please come and see her as soon as it’s safe?’
Mandy put her hands round the mug. It was warm, but she couldn’t drink it. The very thought made her feel sick.
‘Of course, they can come whenever you want.’ She owed them far more than that.
What if Zoe dies?
‘I should go back out … Helen …’ Her chair scraped across the floor as she pushed it out. She heard Jimmy’s voice. Registered what he said as if through fog. ‘I’ll call them back. Let them know.’ She fled.
Helen had carried Zoe into a kennel. The living puppy in its box had been put in beside its mum. Zoe’s head lifted. Despite her exhaustion, she was looking into the box, her maternal instincts kicking in.
‘She’s doing well,’ Helen told Mandy. ‘She’s awfully pale, though.’
Between licks of her pup, the husky was panting. Fluids ran into the catheter in her leg. Would the children be frightened, Mandy wondered?
‘You did your best.’ Helen was still sympathetic.
Tears formed in Mandy’s eyes. She didn’t deserve Helen’s compassion. She walked back through into the room with the computer and sat down in front of the screen. The tumour was still there, so clear now she knew what to look for. She closed her eyes, thinking back. She had been so intent on the puppies and the pelvis. Zoe had already had a puppy, ergo the cervix was open. Mandy had felt secure. It was safe to give oxytocin if the cervix was dilated and the puppies weren’t too big. Nine hundred and ninety-nine times out of a thousand, it would be fine just to check the puppies. Not this time.
There were footsteps outside the door. It swung open and Adam came in. ‘Helen said she thought you were in here,’ he said, his voice light. ‘I’ve just had the most awful foaling at Drysdale. First of the season.’ His gaze fell on the screen. ‘Ooh! Puppies. Are they Zoe’s?’ he said, then frowned and bent to study the image more closely. ‘What on earth is that?’ His finger traced round the outline of the tumour.
For a moment, Mandy couldn’t speak. She swallowed. Finally, she managed to form the words. ‘It’s a tumour.’ Her voice was flat. ‘Zoe’s puppies. Zoe’s tumour.’
Adam put his hand on her shoulder. ‘Poor Zoe,’ he said. ‘Is she
all right? Does Jimmy know?’
Mandy shook her head. There was throbbing behind her eyes and she was beginning to shake again. ‘I didn’t see the tumour,’ she said. It was as if she was disconnected from her body. The words began to pour from her. ‘I didn’t see the tumour. She’d already had her first puppy. I measured the skulls and checked the pelvis. I gave her oxytocin.’ Dad’s hand was on her shoulder still. For a long moment, he said nothing, though his fingers were squeezing, trying to reassure.
‘And then?’ His voice remained calm, though it seemed to Mandy that he was making an effort.
‘Then she started to bleed and I opened her up and found the tumour. The puppies died.’ She stopped, pressing her teeth together.
The hand on her shoulder was still there. ‘Zoe?’
‘I spayed her. She lost a lot of blood. She’s in the kennels.’
‘Do you want me to go and check her?’
How practical he was. He always had been. Her parents had always been able to make everything better, but this time there was no way back.
‘I have to tell Jimmy.’ She wanted to cry, but there were no tears.
‘Doesn’t he know?’ Adam asked. There was no censure in the words. It was just a question.
‘He knows I had to spay Zoe and the puppies are dead. He doesn’t know I missed the tumour on the X-ray.’ Mandy could feel herself drooping. How easy it would be to let Dad take over, but she couldn’t. This was something she had to do herself.
Dad squeezed her shoulder again. ‘Better let him know, love. Be honest, but don’t beat yourself up too much. It’s a bizarre case. I’ve never seen anything like it. Lots of vets wouldn’t even have done an X-ray if one pup had already arrived.’
‘I need to X-ray Zoe’s chest,’ said Mandy.
‘Leave that to me.’ He gripped her shoulder one last time. ‘You go and speak to Jimmy,’ he said.
Jimmy was sitting in the waiting room, peering through the window into the darkness. He turned to see who was coming and stretched out his hand when he saw it was Mandy. It was obvious he’d been crying. ‘The twins are on their way,’ he said. ‘They’ll be here in twenty minutes.’
