Midwife's Baby Bump

by Susanne Hampton

  Tristan nodded as he scrubbed and gowned and entered the operating Theatre. Everything had been prepared for the emergency procedure on the newborn infant. The slightly nervous but very eager-looking medical student had also scrubbed in and was waiting in the Theatre, his expression close to that of a deer in headlights.

  ‘Tristan Hamilton, neonatal cardiothoracic surgeon,’ Tristan introduced himself as he checked the sterile surgical tray. He knew that everything would be in order as the Theatre team was second to none in detail and process, but it had been a ritual since medical school and one he never omitted.

  ‘Jon Clarke, third-year med student. I’ve heard so much about you and hope to specialise in paediatric cardiology but I’m keeping my options open.’

  ‘Welcome aboard, Jon,’ Tristan replied, keeping an eye on the doors to the Theatre and the impending arrival of the newborn patient. ‘In a few minutes we will have a neonate, approximately thirty-seven weeks with a transposition of the great arteries. As I’m sure you are aware, the natural history of untreated transposition of the great vessels in the neonate was quite poor but has improved dramatically. Surgical correction has been possible for over fifty years now with an arterial switch procedure that’s considerably lowered mortality rates.

  ‘I’ll be scheduling that surgery within the next two days but we need earlier intervention to ensure immediate survival so shortly I’ll undertake a nonsurgical procedure to create an arterial septal defect, using a balloon catheter. Essentially we will open a small hole in the heart to allow the blue and red blood to mix and provide sufficient oxygen to the newborn.’

  ‘How did you diagnose the condition so quickly?’ Jon asked with interest.

  ‘The mother has been under the care of Dr Nate Hopkins in Sydney. He’d planned the C-section for next week but they travelled here yesterday for some family function and labour ensued. The condition was detected at the twenty-week scan. Thank God she didn’t go into labour somewhere along the Hume Highway or we might not have had the same prognosis for mother or child.’

  Just then the swing doors opened and the tiny child was wheeled in on open bed. Tristan looked up to see Flick standing in scrubs beside the infant. He caught her glance and held it. He couldn’t ignore the look of pain and disappointment in her beautiful blue eyes. But there was no anger. That seemed worse to him. He fought the strongest urge to throw his gloves, gown and surgical cap to the floor and pull her into his arms. But he reminded himself sternly that it was not himself that he was protecting. It was her.

  ‘The vernix has been wiped clear from his abdomen and suction of mouth and nasal cavity done,’ Flick said, as she handed over the care of the baby, wrapped loosely in green sterile sheeting, to the Theatre nurse, then left without looking back.

  Tristan hated that it was over between them and that one night would be all they ever shared, but there was no other way, he reminded himself as he refocused on the tiny child who now needed him. An infant who would be facing a childhood much like his own if this surgery was not successful.

  The radiographer continued the Theatre tutorial for the student. ‘I’m providing the two-dimensional transthoracic echocardiography. Essentially this is live imaging of the child’s heart to allow Dr Hamilton to monitor the catheter’s positioning during the procedure.’

  ‘The procedure can also be of potential benefit in patients with other severe congenital heart defects. I can explain them later if you’d like,’ Tristan added, as he watched the Theatre nurse unwrap the sterile covers and wash the baby’s abdomen with antiseptic solution.

  ‘Today I’ll be using the umbilical vein as an access. This simplifies this procedure dramatically. It can be performed at the bedside in the neonatal intensive care unit but as the infant was down here I chose to do this immediately before the transfer to NICU. I also prefer sedation to general anaesthesia if possible.’

  Jon stepped a little closer. ‘If the condition hadn’t been identified at twenty weeks, due to poor antenatal monitoring, how would you diagnose the condition after birth before it was too late to reverse the condition for the newborn?’

  ‘The symptoms would be detected by the neonatologist or the nursing team. The child would present as unusually quiet, he or she wouldn’t wake, and they would have a low pulse ox test. All the indicators of a congenital heart condition, so I would be called to consult immediately.’

  ‘Ready to go,’ the radiographer announced.

  ‘I’m set too,’ said the paediatric anaesthetist.

  Tristan nodded and began the intricate procedure, talking the medical student through each step. ‘We’re now in the right atrium, as you can see on the echocardiography. I will now thread the catheter into the foreman ovale, the naturally existing hole between the atria that normally closes shortly after birth.’ Tristan watched the screen to ensure the catheter was positioned correctly.

  ‘Now I will inflate the balloon with three to four mils of dilute radiopaque solution to enlarge the foramen ovale enough that it will no longer become sealed. This allows more oxygenated blood to enter the right side of the heart where it can be pumped to the rest of the body. To ensure that there is flow, I am now locking the balloon. I will now carefully but sharply withdraw into the right atrium to create a permanent flow.’

  Tristan continued his explanation of the procedure and repeated the manoeuvre three times before he then deflated the catheter and removed it completely.

  ‘We can monitor the effectiveness directly via the echocardiography,’ he said, pointing to the monitors. ‘But it’s clear there’s been a sharp rise in systemic arterial saturation so we’ve been successful. This little chap will be good to go until we can schedule his major operation in the next two days.’

  Tristan and the medical student stepped away as the nursing team prepared the baby to be transferred to Neonatal Intensive Care. He was pleased that the stunned-deer expression had slowly disappeared from the young man’s face and he appeared more at ease. After agreeing that Jon could scrub in on the arterial switch repair surgery, he invited the student to accompany him to visit with the parents once the mother had been released from Recovery and returned to the maternity unit ward. It was equally important to Tristan that the bedside manner of medical students was developed at the same time as their technical skills.

  Tristan then headed to Neonatal ICU to brief the nursing team before he went back to his office to finalise some paperwork and grab some lunch. He had an afternoon of hospital rounds and consults, so he needed to eat something substantial.

  Flick paced the corridor outside Tristan’s office nervously. She had taken a break after she’d visited a new mother in MMU with Sophia. Flick loved shadowing Sophia and was learning so much about the spectrum of roles within midwifery but that day she felt removed from what was happening. She hadn’t liked the feeling of not being in the moment during the birth. It was what she loved more than anything but that day her mind and her heart were weighed down by what she needed to say to Tristan.

  This was her career and she would not allow Tristan to take that away from her. She would get through her personal issues because she loved what she did. She loved it all—the antenatal care, the birth and the postnatal assistance. She wanted to be a community midwife and spend more time in the field in the future.

  But first she had to speak with Tristan. She had made her decision after two weeks of deliberation. She couldn’t delay it any longer.

  Finally, after taking a deep breath, she knocked on his door.

  ‘Come in,’ Tristan called, trying to swallow a mouthful of his sandwich as he checked his incoming emails, some of them spam from pharmaceutical and medical supply companies.

  Flick’s legs were shaking like leaves in the breeze as she entered his office. She looked across the room at the man who had made love to her on that fateful night and she knew immediately that there was no regret in her heart. No anger. And definitely no blame, as she had willingly invited him into her bed.
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br />   ‘Flick.’ He was stunned and his voice didn’t mask his surprise at seeing her in his office. She looked even more beautiful. She had a glow, he thought as she stood before him in her shapeless hospital scrubs. He knew underneath she had the most gorgeous body but her beauty went so much deeper than that. She had a wonderful, warm spirit and the fact they couldn’t be together ate him up inside.

  It took less than a minute, with Flick standing so close, to realise that his feelings for her were real and that made it so much harder to keep his distance. It tore at him that he couldn’t act on his feelings, to cross the room and kiss away the last three months. As much as he wanted to, he couldn’t let it happen. He needed to stay in control. She deserved so much better than the problems he could bring into her life.

  Resolutely he knew he must deal professionally with whatever hospital matter she had come to discuss and then pretend she had never been within his arms’ reach.

  Flick breathed deeply and hoped she could say what needed to be said without emotion.

  ‘Tristan, there’s something I need to tell you.’

  ‘About Mrs Roberts?’ His tone was austere, just as he knew it needed to be.

  Flick looked at him blankly before she realised he thought she was there about a hospital matter. His voice was cold, and he had no idea there could be anything more between them than a patient’s welfare. That saddened her. She wasn’t sure why she cared but she did.

  ‘No, it’s not about Jane Roberts. It’s about me.’

  Tristan got to his feet, suddenly hoping there was nothing wrong. He was fighting the urge inside him that that was building with every minute to reach out, pull her to him and hold her. And, in a perfect world, never let her go.

  ‘I’m pregnant, Tristan.’ she managed to mouth without a single tear. ‘We’re going to have a baby.’

  CHAPTER TWO

  TRISTAN SLUMPED BACK down on his chair. He was looking at Flick but he didn’t really see her for the longest time. The news she’d delivered brought images rushing back at him. His head was filled with memories of hospitals and surgical wards and cardiologist waiting rooms and sitting on the sidelines of football games he never played but wished he could.

  He saw his own childhood playing out before him and then those images were joined by vivid ones of the surgeries he performed daily on tiny babies in the hope they would live. It was his worst nightmare. She was having his baby and she had no idea there was nothing about that news he would ever celebrate. It brought him no joy. Only an instant mountain of worry.

  Would his unborn child have inherited the congenital heart defect that had made his childhood a nightmare? He couldn’t answer that question. It would be too early to know and it was a high-stakes gamble that Tristan had planned on never taking. Would their child need open heart surgery to live or in utero surgery to survive the pregnancy? He had no answers and it scared him more than he’d thought possible.

  He was speechless. There was no need to ask if the child was his. Although he didn’t know Flick as well as he would like to, he knew her well enough that if she told him that he was the father of her baby, then he was without doubt. She was a woman of integrity and in his heart he knew she was too decent to lie about it. The child’s paternity was never going to be in question. It was his child. Although he wished for everyone’s sake it wasn’t.

  He did the maths quickly and realised that she would be twelve weeks pregnant.

  It would not be too late to end the pregnancy if she chose to do so and he wouldn’t judge her if that was her decision.

  But even with the risks, he would not want to force her hand or even suggest it. It was not his choice.

  There were so many things he wanted to say but he had no idea where to start. He wanted to know if she was feeling okay; if she had great antenatal care organised, which he realised immediately was stupid since she was a midwife; if she had enough money for everything she might need, but none of it would come from his mouth. The ability to verbalise anything had vanished with the sudden announcement and the sinking feeling that had come with it.

  Being a father hadn’t in his plans. Not now, not ever. He was frozen to the spot with a million questions slamming around inside his head. But he needed to put them in some sort of logical order.

  Suddenly he wondered why she had not told him before. Why now? Had she hesitated because she didn’t want him in the baby’s life? Or was it because she hadn’t decided whether she wanted to keep the baby?

  Was this her worst nightmare for very different reasons?

  If she was continuing with the pregnancy, was she keeping the baby or considering adoption? He knew how important it was to not blurt out everything he was thinking. He had to appear calm and in control. That was the way he behaved. He was always able to keep his emotions in check but he needed a few minutes to put his thoughts in some order. He needed to be proactive, not reactive, in this situation but he didn’t know how.

  Flick looked at Tristan sitting behind his desk in silence. There was nothing coming from him. No statements, no acknowledgement, no questions. She was suddenly very embarrassed that she had even come to his office to tell him. She felt like a fool.

  She took a few steps backwards.

  ‘Flick, I…. I don’t know what to say …’

  ‘I understand,’ Flick said, but she really didn’t understand at all. ‘I won’t be bothering you again. There’s no need for anyone at the hospital to know you’re the father and I can manage everything on my own. I don’t need anything from you, Tristan. It was a courtesy call, nothing more.’ Pride had added the last line of her conversation. She wasn’t about to appear needy or desperate for him. Needy and desperate was how her mother always behaved. Begging a man to stay and sacrificing her children along the way.

  Not Flick. She would stand on her own two feet and hold her child’s hand. She had wanted her child’s life to be different from her own and for a father to be a part of it, but that would be Tristan’s choice. He could do as he pleased and it seemed obvious to her from his reaction that it was going to amount to nothing.

  Without saying another word or waiting for Tristan to respond, Flick spun on her heel and left his office, with tears streaming down her face. Her heart was breaking but at least he hadn’t seen her crying, she reminded herself as she rushed into the first bathroom she could find. Morning sickness came any time between waking and lunchtime, and it was now twelve o’clock. So now she had two reasons to heave.

  Tristan raced after her. They needed to sit and talk calmly. Even if she saw it as just a courtesy call, he didn’t. He wanted to offer more. Exactly what that looked like, he didn’t know. But they would work it out. They were two intelligent people who needed to plan their child’s future. Although he had no idea what that future would be and if it would mimic his own, dotted with specialists and hospital stays, corrective open heart surgery or a possible heart transplant, he intended to be there for all of it. The good and the bad.

  But the possible congenital problems didn’t need to be talked about yet. He didn’t want to stress Flick unnecessarily. There were risks in her knowing too. Even though they were slight, there were still risks that anxiety over health issues that might not exist could cause her to lose a potentially healthy baby.

  He needed time to work out the best way forward for all of them. But he also knew that Flick had to be upset at his lack of response. He had to tell her it would be all right. They would work it out.

  Blindly rushing around the first corner near his office in pursuit of Flick, Tristan almost slammed straight into Oliver Evans. He stopped and looked down the length of the empty corridor. She was gone.

  Tristan’s chin dropped. There was no sign of her. Perhaps it was better that way, he mused. It would give him time to work out what to do and cement in his mind if there was any need for Flick to know about his condition. And if there was, then when the appropriate time to tell her would be.

  He wanted to do the right t
hing. Let her know without hesitation that he was there for her and the baby. There was no way that he wanted to freeze again and have her run away. They had so much to sort out. Emotions aside, they also needed to be practical about what lay ahead for all three of them.

  ‘Are you needed somewhere or do you have a minute to come down and speak with one of my patients?’ Oliver asked. ‘I have a twenty-week gestational diagnosis of hypoplastic left heart syndrome. I’d naturally prefer to operate in utero but the parents want to hear about possible postnatal surgical options.’

  Tristan drew in a deep breath before he spoke. ‘Sure, I can see them now.’

  Flick had run off with good reason, but now was not the time to try to reason with her. They needed to sit down somewhere private and talk everything through without an audience.

  He turned back and walked towards to his office with Oliver just as Flick exited the bathroom.

  Oliver was aware that something wasn’t as it should be with his normally composed friend and stopped. ‘I can come back if there’s something important that you need to see to now.’

  ‘No, let’s see your patient. I can deal with my other issue later,’ Flick heard Tristan say, before they headed off down the corridor.

  Flick froze. She felt physically ill hearing their baby referred to as his other issue.

  Her doctor had not referred to her child as an issue when, in a compassionate but matter-of-fact tone, he had delivered the news to her just two weeks before. Tiredness and nausea had sent Flick to the GP for some routine blood tests and the results confirmed that she was pregnant. She had not thought about that possibility, which she realised in hindsight was ridiculous for a midwife. It should have been obvious. But they had used precautions and perhaps trying to block out Tristan for all those months she had blocked out the possibility of anything tying them together.