by Emily Forbes
He could see her chest rising and falling so, although unconscious, she was at least still breathing.
He turned to the woman’s mother as Rick knelt beside the patient and started checking her vital signs.
‘Can you tell me what happened?’ he asked as Rick wrapped a cuff around the woman’s arm to check her blood pressure.
The mother stood in the doorway of the bathroom, wringing her hands. ‘When she went to bed last night she said she wasn’t feeling well. I checked her later and she was sleeping and then this morning I heard her fall. When I came into the bathroom she was having a seizure. I haven’t been able to wake her.’
Her eyes filled with tears and she looked worried. Xander could understand her concern; he was worried too, but he tried not to show it.
Xander squatted down and lifted one of the woman’s eyelids. He shone a torch into her eye and her pupil contracted. He repeated the process on the other eye with the same result. He breathed out and relaxed slightly. She didn’t appear to have sustained a head injury.
‘She’s never had a seizure before?’ he asked. ‘No family history of epilepsy?’
The mother shook her head.
‘BP one-five-four over ninety-nine,’ Rick reported as he clipped an oximeter onto the patient’s finger before taking her temperature.
Damn. Her blood pressure was dangerously high.
‘Not feeling well, how?’ Xander asked the woman’s mother. ‘Nausea? Vomiting? Headaches?’
‘A headache and a stomach ache. I’m not sure if she was nauseous but she hasn’t vomited.’
‘Heart rate ninety-two BPM; oxygen sats ninety-seven per cent.’ Rick passed on more information.
‘Had she been drinking?’ Xander queried.
The mother shook her head. ‘No. She’s been studying for final exams. I thought it was stress but then I heard her get up before I heard a crash. When I went into the bathroom it looked like she was fitting.’
Xander continued his assessment as he listened to the mother. There was oedema in the woman’s hands and feet, the swelling very obvious, given how thin her limbs were. He slid a stethoscope under her T-shirt and listened to her chest. Her breathing was irregular, her heartbeat rapid.
Rick was holding leads in his hand. He was looking at Xander, ready to attach them to their patient. Xander nodded and Rick proceeded to stick the ECG leads on.
Despite the woman’s slim build her abdomen was distended.
Xander palpated her abdomen as he waited for the ECG to record the heart rhythm. It was round and tight with noticeable firmness in the right upper quadrant over the liver. The patient’s temperature was elevated; she had no history of seizures and hadn’t been drinking. He paused, considering the signs.
‘Could she be pregnant?’ he asked.
‘Pregnant? No.’
‘Are you sure?’ The patient was the right age and the signs all fitted. She could be suffering from pre-eclampsia, but only if she was pregnant.
‘Yes. She’s been having her period as far as I know.’
‘ECG is normal,’ Rick said.
Had Xander made the signs fit his diagnosis? He didn’t think so. It made sense.
He still had one hand resting on the woman’s abdomen. He felt something move under his palm and he was almost certain it was a foot or elbow. Which would mean that, despite the mother’s conviction, their patient was pregnant.
He slipped the stethoscope back into his ears and held it to the woman’s abdomen, listening this time for a foetal heartbeat.
He found a heartbeat and counted the beats.
One hundred and thirty-five BPM.
He double-checked the woman’s heart rate.
It was still ninety-two.
He was sure he was right.
‘Can you set up IV glucose?’ he asked Rick. ‘And I’ll also administer precautionary antibiotics. We need to take bloods for liver function and kidney function testing and then I want her in the chopper. She needs an ultrasound and we need to get her to the hospital.’
‘What’s going on?’ the patient’s mother asked.
Xander tightened the tourniquet around the woman’s arm, ready to draw blood, as he spoke to the mother. ‘I think there’s a high possibility that your daughter is pregnant.’ He realised he may be breaking confidentiality but, if he was correct, her condition was life-threatening. ‘It’s probable that she has a condition called pre-eclampsia. If I’m right the only way to resolve it is to deliver the baby. Which means performing an emergency Caesarean. We need to get her to hospital and I need to know, do I have your permission to provide whatever treatment we deem necessary to save her life?’ He saw the colour drain from the mother’s face as she digested his words. She nodded, numbly, as he said, ‘I realise this is a shock and this is all extremely overwhelming but time is of the essence.’
* * *
Chloe stood on the helipad, surrounded by colleagues from the A&E. She heard the thump of the chopper blades and shaded her eyes, watching it approach above the city skyline.
The fire crew slid the door open as it touched down and Chloe’s heart rate accelerated when Xander jumped out. Even though she’d been expecting to see him she couldn’t control her reaction. Every time the sight of him made her buzz with anticipation.
Rick followed Xander out of the chopper and Chloe moved forward with everyone else who had been waiting, and met Xander and Rick halfway.
Xander handed a cooler bag to one of the nurses. ‘I need kidney and liver function tests, please—stat,’ he said before relaying the information he had to the rest of the medical team. Chloe had heard some of it before but the information was limited at best.
‘We have a twenty-two-year-old female. She had a seizure and is now unconscious. BP one-fifty over ninety, but it was higher. Febrile. We’ve administered IV antibiotics.’
An oxygen mask covered the patient’s face and an IV line snaked into her left arm.
‘She’s pregnant,’ Xander continued, ‘and I’m betting on the problem being pre-eclampsia. I think she’s close to term.’
‘You think?’
Xander nodded. ‘Her mother had no knowledge of a pregnancy. We have no antenatal history and an unconscious patient. I did a fundal measurement and the baby seems a healthy size and certainly past thirty-four weeks.’
Chloe was standing at the patient’s feet. From that angle she could see a slightly rounded abdomen, very slight. She certainly didn’t look full term but she looked tall and she was young. Chloe knew strong abdominal muscles could keep a pregnancy disguised for some time, especially a first pregnancy. If Xander was right the baby’s lung development wouldn’t be a concern. But what if he was wrong?
‘She needs an ultrasound scan. We didn’t have time on board, and we need those blood test results. If she’s pregnant you’ll need to deliver the baby.’
‘Raphael Dubois is waiting. He’s one of our obstetricians,’ Chloe told Xander as they pushed the stretcher into the hospital and into the lift that would take them straight to the theatres. ‘Have we got consent to operate?’ she asked as the lift doors closed.
‘Yes. From the mother.’
The doors slid open and Chloe stepped out, pulling the foot of the stretcher with her. Theatre staff crowded around them and the patient was quickly transferred.
The team rapidly disconnected and reconnected monitors and equipment. As the oxygen masks were swapped over Chloe did a double take.
‘Oh, my God. Hannah!’
‘You know her?’ Raphael asked.
Chloe nodded.
‘Are you all right to be the attending midwife?’
‘Yes, I’ll be fine,’ she said. She’d be okay. She could do this. There was no reason why she couldn’t be the attending midwife. She just needed to focus.
Anyway, surely Hannah wasn
’t really pregnant? Surely she and Guy would have shared that news with the family. Xander must have made a mistake.
Unless Guy didn’t know?
Maybe it wasn’t his?
No. She blocked that thought out. If Hannah was pregnant there had to be a logical explanation.
She had no more time to think. She had a job to do.
But although Xander had vanished in the ensuing chaos he hadn’t made a mistake. Hannah was pregnant and close to full term.
‘Liver enzymes are elevated and platelet count is low.’ Hannah’s blood work was back and apparently Xander hadn’t made any mistakes. His diagnosis was spot on. Hannah was suffering from pre-eclampsia and the only way to resolve this condition was to deliver the baby.
Hannah was prepped for surgery and sedated for Raphael to perform a Caesarean section. Within minutes he had delivered a healthy baby boy.
The baby was passed to Chloe to be cleaned and weighed and checked before the paediatrician gave him a more thorough examination.
His one-minute Apgar score was an eight and he weighed six pounds and ten ounces. He certainly looked close to full term, Chloe thought as she wiped him over with warm water.
She searched his face as she gently wiped around his eyes and nose, looking for any trace of her brother in the baby’s features. She knew she was being silly. All babies looked the same. It was an old midwives’ tale that they all looked like their fathers in order to persuade the fathers to bond with them. But was this baby her nephew?
If so, why hadn’t Guy said anything?
The question nagged at her, refusing to go away as she waited for the paediatrician to finish her checks.
She took the baby back, swaddled him and placed him in a crib to be taken to the neonatal ICU for monitoring. The moment she handed over his care to the neonatal team she headed for her locker and pulled out her phone. She left a message for her brother. Regardless of her concerns someone needed to let Guy know where Hannah was.
Chloe had been pacing the floors in A&E since the end of her shift, waiting for Guy. He eventually burst through the automatic doors, still in his fireman’s uniform, his brow furrowed with concern. She saw him scan the waiting area, looking for her, and she walked towards him.
She wrapped her arms around him in a tight hug as he said, ‘What’s happened? Is Hannah all right?’
Chloe’s message had just told him that Hannah had been brought into hospital but that she would be okay, and she asked him to meet her here as soon as possible. She hadn’t mentioned the baby. That information wasn’t something she was comfortable putting into a message.
‘She will be.’
‘Where is she?’ His eyes continued to scan the waiting area as if he thought his girlfriend might be sitting in a chair.
Chloe steered him into a side room, one of the rooms they used when they needed to have a private conversation in A&E. Often those conversations did not go well and she could see Guy looking around nervously. She sat him down. ‘She’s in ICU. She needed surgery.’
‘Surgery? What happened?’ he repeated.
There was no easy way to approach this. Chloe had been racking her brain all afternoon trying to work out how to start this conversation but hadn’t come up with anything subtle or gentle. ‘Did you know she was pregnant?’
‘What? Pregnant? No? Is that why she’s been feeling unwell?’ He paused and then added in a quieter voice, ‘Has she had a miscarriage?’
‘No. She’s had a baby.’
‘What? A baby?’ Guy stared at her. ‘Are you sure?’
‘I’m positive. I was there at the delivery.’ She paused but continued when Guy didn’t ask any further questions. She assumed shock was setting in. ‘Hannah collapsed at home. She had a seizure and was unconscious. She was brought in with the air ambulance. Xander suspected that she was pregnant and suffering from pre-eclampsia. The baby was delivered via C-section.’
‘A baby.’ He sounded incredulous. Not that Chloe could blame him. ‘Is it okay?’
‘He’s perfect.’
‘It’s a boy?’
‘Yes.’
‘And Hannah is okay too?’
Chloe nodded.
She saw Guy’s shoulders relax and he smiled before asking, ‘Can I see them?’
His request surprised her and she wondered why he hadn’t asked any more questions. Perhaps the shock was numbing his brain. He certainly wasn’t questioning the baby’s parentage.
Her mind wandered and her silence obviously had Guy worried. He looked as though he was expecting her to say no.
She nodded again as she handed him a pair of clean scrubs. ‘You can but you need to wash your hands and face first and put these on. You can’t go into the nursery or into ICU covered in dirt. You can leave your uniform in a locker and pick it up later.’
She waited for him to change and then took him to the nursery. The baby was healthy and hadn’t needed to go into the neonatal unit but, even so, she couldn’t let Guy go alone—she needed to vouch for him. She needed to tell the nurses on duty that Guy was the baby’s father, even if she wasn’t certain of that herself.
The nurse congratulated Guy and led them to a row of cribs.
‘This one?’ Guy asked as he gazed down at the baby. He seemed happy if somewhat quiet and stunned.
Chloe nodded.
‘He doesn’t look like a premmie.’
‘He’s not,’ Chloe replied. ‘We think Hannah must have been at least thirty-seven weeks.’
Guy was staring at her. ‘Thirty-seven weeks? How is that possible? I didn’t even know she was pregnant.’
‘Apparently Hannah’s mother didn’t know either. And when I last saw Hannah—what, a month ago?—I didn’t notice anything and she must have been at least seven months pregnant then.’
‘Why would she keep it a secret?’
There was only one reason Chloe could think of and her silence obviously led Guy to the same conclusion but he wasn’t having a bar of it. ‘Don’t say it. He’s definitely mine. Hannah wouldn’t cheat on me.’
Chloe held her tongue. It wasn’t any of her business. If Guy trusted Hannah, if he believed the baby was his—and at this stage Chloe had no reason to think he wasn’t—then that was all that mattered. Which meant there was one other possible explanation.
‘Maybe she didn’t know either,’ Chloe said.
‘How could she not know she was pregnant?’
‘It does happen.’ She thought that was unlikely but not impossible. ‘She’s tall, fit, with good abdominal tone. The baby had room to hide in her abdominal cavity. And,’ she continued, ‘some women continue to experience light bleeding throughout pregnancy, which is a bit of a red herring. Obviously it’s unexpected, so even though Hannah hadn’t been feeling well lately she might not have considered pregnancy as the reason behind it.’
‘You think that’s why she’s been under the weather? Not stress.’
‘I don’t know but it’s possible.’ Unusual but still possible, Chloe thought as she let herself relax. She might have jumped to all the wrong conclusions. The easiest explanation wasn’t always the right one.
‘Do you want to hold him?’ she asked.
‘Can I?’
‘Of course.’ Chloe picked up the baby and handed him to Guy.
‘He’s beautiful.’
Chloe had to agree. He was a gorgeous baby. Not red or wrinkled, not overcooked or underweight. Chloe was sure he was close to full term but his head must not have engaged in Hannah’s pelvis as it was perfectly shaped and had stayed that way because he was delivered via Caesarean section.
Chloe remembered how it felt to hold your own child for the first time. The weight of your own flesh and blood in your arms, the amazing, overwhelming sense of love and awe. The realisation that you would do anything you had to to protect th
em from harm.
Guy had that same look of wonder on his face. He looked so young but at twenty-three he was about the same age as Chloe had been when she’d unexpectedly found herself a parent and she had managed. And she knew Guy would be a good father.
‘Can I see Hannah now?’
Chloe nodded. ‘You go up to ICU. I’ll take care of this little one,’ she said as she held her arms out to take the baby. ‘Hannah’s mum should be there. She will have to wait outside and give you permission to see her. It’s only one family member at a time.’
‘You’re not coming?’
Chloe shook her head. ‘I need to go home. Mum’s got Lily. Will you come past later? Stay for dinner? I think you should have company tonight.’
‘Okay. Thanks. For everything.’
Guy hugged her and headed for the stairwell. Chloe cuddled the baby for a while longer before returning him to his crib and heading for the lift. It had been a long and taxing day and she was looking forward to getting home.
The lift doors opened, revealing one occupant.
Xander.
The sight of him brought her close to tears. She’d had a stressful day and her emotions were running high.
‘Are you okay?’
‘Not really. It’s been a crazy day.’
Her voice wobbled with exhaustion and she really needed a hug. She was tempted to step into his arms but instead she leaned back on the wall of the lift, out of reach of temptation.
‘What’s going on?’ he asked.
‘It turned out that the woman you brought in earlier is my brother’s girlfriend.’
‘The pregnant one?’
Chloe nodded.
‘Did you know she was pregnant?’ Xander asked.
‘No. And neither did Guy.’
‘So is it his baby?’
‘He says it must be.’
‘Do you believe him?’
She knew what he was thinking even though his thoughts remained unspoken. She squashed her sense of slight irritation; she couldn’t get cross with him as she’d had the same thought. ‘It’s not my place not to,’ she said.
