Wish Upon a Star

by Sarah Morgan

  ‘You obviously had a less than perfect experience last time,’ he said quietly, turning his attention back to Gail, ‘and for that I’m sorry. It’s always disappointing when childbirth doesn’t go as nature intended.’

  ‘It was a nightmare. I shouldn’t be here.’ Gail glared at her husband. ‘And I wouldn’t be if your mother hadn’t forced the issue.’

  ‘She didn’t want you having a baby in her kitchen on Boxing Day, love,’ her husband said awkwardly, running a finger around the neck of his jumper as if it was suddenly too tight. Gail tried to struggle to her feet.

  ‘Well, I’m sorry if I’m inconveniencing everybody, but I just want to go home now!’

  Miranda slipped an arm around her shoulders. ‘Please, Gail, just stay and listen to Mr Blackwell. He’ll take a look at you and make some suggestions. We’re asking you to listen, that’s all. No one’s forcing anything on you.’

  ‘I had three babies at home with no problems whatsoever.’ Gail’s voice rose as she looked at Jake. ‘Give me one good reason why I shouldn’t have this one at home.’

  ‘Because having had a Caesarean section last time, you’ll be at slight risk of the scar opening up,’ he said frankly. ‘And with your fifth baby you’re more likely to have other problems, so it’s safer for both of you if you’re in an environment where we’re geared up to help if necessary.’

  ‘Intervene, you mean.’

  Jake picked up the trace and leaned towards Gail. ‘Look at this.’ He ran his finger over the line on the paper. ‘This tells me that your baby’s heart rate was a bit slow here—and again here. I want to keep an eye on that.’

  ‘There are always variations in heart rate,’ Gail said immediately, her gaze challenging. ‘At home they don’t monitor it constantly so you don’t know about it and you don’t worry. And the baby is still fine when it’s born.’

  ‘Sometimes that’s true.’ Jake’s voice was quiet. ‘But are you willing to take that chance? What I’d like to do, with your permission, is ask Miranda to monitor you for a while so that I can get a better look at what’s happening during each contraction.’

  ‘You’re just going to drag me into Theatre at the first opportunity and cut me open!’

  Jake shook his head. ‘If you want to check my records, I have a very low Caesarean section rate compared to the national average,’ he said calmly, ‘but I’m not willing to sacrifice a baby to keep that rate low. I can’t promise you that I won’t perform a Caesarean section if I think it’s necessary, but I can promise you that we’ll make the decision together. If everything goes well, there’s no reason why you can’t just quietly deliver your baby here. It’s not home, that’s true, but it’s a comfortable room and we do our best to make it as relaxing as possible.’

  Gail stared at him and then at her husband, who looked exhausted, stressed and totally out of his depth.

  ‘Oh, hell, I don’t know,’ she muttered under her breath, and then her eyes slid to the trace again and she put a protective hand on her abdomen. ‘You really think that the baby might be in trouble?’

  ‘I don’t know. We need to do some more tests.’

  Gail hesitated and then gave a reluctant nod. ‘All right. I suppose I’ll stay. For now. But I don’t want a stream of staff through here, staring at me or practising on me.’

  ‘There won’t be a stream of staff. Just me. I’m going to be staying with you,’ Miranda assured her, and Gail gave a wan smile.

  ‘I’ve heard that before. We both know that if my labour happens to run past the end of your shift I’ll get someone else,’ she said bitterly. ‘I had three midwives in total last time I had the misfortune to deliver in hospital.’

  ‘Well, that isn’t going to happen this time,’ Miranda said softly, putting a hand on her shoulder. ‘I can promise you that, whatever happens, I will stay until you’ve had this baby.’

  Gail looked at her and gave a disbelieving laugh. ‘It’s Boxing Day. You’re pregnant yourself and you’ve got a family waiting for you. I should think it’s bad enough working, let alone running into overtime.’

  Miranda’s gaze didn’t flicker. ‘I’m staying until you’ve had the baby. Now, if it’s all right with you, I want to put you on the monitor and see what’s happening.’

  Something in the stiff set of her slim shoulders drew Jake’s gaze but there was nothing in her face to reveal what she was thinking. Who was her family? Where was the father of her baby? Suddenly he wished Gail had chosen to be more direct in her questioning. He might have received answers to some of the questions buzzing around his head.

  ‘I’ll be on the unit if you need me.’ He stood up and went back to his office to catch up on some paperwork, but every time he thought he was making headway he was interrupted.

  He saw another patient for Ruth and then called the ward to check on Lucy.

  When he looked up Miranda was standing in the doorway. Her gaze was wary and it was obvious that she would have preferred not to seek his help. ‘Gail’s progressing slowly. I presume you don’t want to accelerate labour with oxytocin?’

  Jake shook his head. ‘There’s some evidence that it increases the risk of rupture. How’s the foetal heart?’

  ‘Showing variable decelerations.’ Miranda handed him a trace. ‘Gail’s complaining of pains, which might just be normal labour pain, of course, but I have a bad feeling about her.’

  Never one to dismiss the instincts of a midwife, Jake looked at her. ‘She had a lower transverse incision, which makes a uterine rupture less likely. And she’s only had one previous Caesarean section.’

  Miranda nodded. ‘That’s all true, I know, but her labour is slowing down and the baby’s heart rate isn’t as I would like it to be. And there’s something about this pain she’s complaining of that worries me. It just doesn’t sound like labour pain.’

  Jake dragged his eyes away from the smooth skin of her cheeks and concentrated his attention on the trace. Instantly he saw the problem. ‘I’ll take another look at her but it certainly isn’t going to be easy to persuade her to allow us to intervene in any shape or form. Is she still as defensive as ever?’

  ‘I don’t think she means to be defensive. She’s just very frightened.’

  ‘There’s often more to a person than meets the eye, isn’t that right, Miranda?’

  She had the grace to blush. ‘Perhaps.’

  ‘You and I are going to talk,’ he said softly, and she straightened her shoulders.

  ‘There’s nothing to talk about.’

  ‘There’s plenty to talk about, but it will keep for now. We need to see to Gail.’

  CHAPTER FOUR

  WHY was it, Miranda wondered as they walked through the labour ward towards Gail’s room, that every time she lowered her guard, it backfired?

  When she’d made the impulsive decision to go back to Jake’s house the day before, it hadn’t occurred to her for even a moment that she’d ever see him again, let alone find herself working side by side with him.

  And now he’d seen that she was pregnant and had jumped to all the wrong conclusions.

  She gave a sigh as she pushed open the door to Gail’s room. Well, she could hardly blame him for that, could she? He didn’t know anything about her circumstances because she hadn’t shared them with him. And she had no intention of sharing them with him.

  It had been a mistake to go back to his house with him the day before. A luxury she should never have allowed herself. She’d been naive to think that she could just enjoy the moment and walk away.

  She pulled herself back to the present and concentrated on supporting Gail, who was listening to Jake.

  ‘I’m not happy with what I’m seeing,’ he said gently. ‘The baby’s heart rate is slow and I’m worried about your scar.’

  Gail stared at him defensively, a sheen of sweat on her brow and her eyes blank with pain. ‘The scar will be fine. I’ve read enough to know that the chances of a uterine rupture are minimal and I’m not having anothe
r Caesarean section. I’d rather take the risk.’

  ‘It’s true that it isn’t common for the uterus to rupture,’ Jake agreed, ‘but in certain circumstances it can happen. And the risk isn’t just to your life, it’s to the baby’s life.’

  Her fear and frustration barely contained, Gail’s eyes filled and she looked away from him. ‘I should have stayed at home,’ she muttered, her voice clogged by the threat of tears. ‘I should never have let them bully me into coming in. Everything would have been fine, then.’

  ‘No, Gail. It wouldn’t have been fine.’ Determined to add her voice to Jake’s, Miranda stepped forward and slid an arm round the woman’s shoulders. ‘I’m a huge advocate of home birth, but this is one baby that never should have been born at home. And I think, deep down, you know that.’

  Gail sniffed. ‘Where are you going to have your baby?’

  ‘Oh…’ Aware of Jake’s glance in her direction, Miranda’s face flamed. ‘I don’t know. I’ve only just moved into the area and I haven’t had time to give it much thought yet.’

  And she couldn’t talk about it in front of Jake. It was too personal. Too intimate.

  Before she could question her further, Gail pulled a face and placed a hand on her abdomen. ‘Ouch! That hurt.’

  ‘Another contraction?’

  ‘It didn’t feel like it.’ The woman’s face was pale and she grimaced again. ‘Oh…’

  ‘It could be the scar.’ Jake stepped forward. ‘I know it’s the last thing you want, but I want to take you into Theatre, Gail. Just to be on the safe side.’

  Miranda caught his gaze and knew instinctively that he was starting to share her bad feeling. ‘She’s only three centimetres dilated,’ she reminded him in a soft voice, and he nodded.

  ‘I know. I want her in Theatre.’

  ‘All right.’

  Gail stared at him. ‘I really don’t know—’

  ‘Gail.’ His voice was urgent as he sat down on the edge of the bed. ‘My job is to deliver a healthy baby from a healthy mother. You’re not letting me do that job. I know it’s hard for you but I’m asking you to trust me.’

  ‘Well, it’s just that I don’t—’ Gail broke off and gasped, one hand on her abdomen. ‘Oh—what is that pain?’

  ‘The trace is showing foetal bradycardia,’ Miranda murmured, and Jake gave a decisive nod and turned as Ruth walked into the room.

  ‘We need to deliver this baby right now and I want it done under general.’

  Jake’s swift glance said it all and Ruth hurried off to bleep the anaesthetist and prepare the theatre.

  ‘What’s happening?’ Gail’s eyes were wide with fear now and tears glistened. ‘Oh, God, it’s all going wrong, isn’t it?’

  Her husband stepped forward, his face pale and his eyes darting nervously to Jake, seeking reassurance.

  ‘Gail, so far the baby is fine.’ Jake’s tone remained calm. ‘But I think there may be a problem with your uterus. I have a suspicion that’s what the pain is. I’m going to have to take you to Theatre. I’m sorry. I know it wasn’t in our plans and I know it will be disappointing for you, but there’s no other way. I don’t want to risk the baby and I know you don’t either.’

  ‘I don’t want an operation. Not like last time. I’m terrified of epidurals.’ Hanging onto control by a thread, the tears spilled over from Gail’s eyes and Jake took her hand in both of his, his blue eyes kind.

  ‘I know you’re worried,’ he said quietly, ‘but you have to let me do what has to be done. I need to deliver this baby and I need to do it fast. And we won’t do it under epidural. It will be under general. You’ll be asleep.’

  All animosity forgotten, Gail clutched his hand. ‘I’m so scared.’

  ‘You wouldn’t be human if you weren’t, but let me do the worrying.’ Jake’s voice was firm. ‘I need you to trust me, Gail.’

  Miranda swallowed at the kindness and confidence in his voice.

  She was hopeless at trusting men and yet at this precise moment she’d trust Jake with her life, she thought to herself, and obviously Gail felt the same way because she gave a wan smile and a nod and reluctantly let go of his hand so that he could leave the room and prepare for the delivery.

  Gail’s husband was white with strain and Ruth guided him gently out of the room and showed him where he could wait.

  Miranda stayed with Gail in the anaesthetic room, holding her hand until she was unconscious and mercifully oblivious to everything that was going on around her.

  Meanwhile, Jake had changed and scrubbed and was waiting in Theatre.

  He glanced up as they pushed Gail into the room.

  ‘Right, folks, let’s work fast.’ He spoke to the anaesthetist. ‘Have we ordered blood?’

  ‘Six units of whole blood and I’ve requested a full blood count and coagulation studies. She’s got two peripheral lines in and I’ve bleeped the haematology doctor on call.’

  ‘Tell me when I can start.’

  The anaesthetist checked his machines and nodded. ‘Her blood pressure is dropping. She’s bleeding from somewhere. You were right to bring her to Theatre—you’d better start.’

  ‘Ruth, I want porters ready to fetch that blood and I want the crash trolley in here.’ Jake’s voice was calm, ‘I’m not taking any chances.’

  Miranda watched while he swiftly and skilfully opened the abdomen and then made another incision in the fascia.

  ‘Forceps.’ Without lifting his gaze from the wound, he held out a hand and the theatre nurse immediately handed him forceps followed by scissors which he used to lengthen the incision and separate the muscles of the abdominal wall. Then he made an opening in the peritoneum and carefully examined the uterus.

  ‘She’s bleeding badly and I can’t see where from—suction, please.’ He held out his hand again and removed the clots. ‘Uterine rupture of any degree is extremely rare,’ he muttered, ‘so why did it have to be on my shift and with a patient who wouldn’t let me near her? OK—that’s looking better. I can see what I’m doing now. Retractor.’

  Miranda watched in fascination. She’d never seen a surgeon as slick and fast as Jake. His concentration was absolute, his fingers moving swiftly as he delivered the baby and the placenta.

  She found that she was holding her breath and when the baby suddenly started crying there was a collective sigh of relief, but Jake’s gaze didn’t shift from the operation site. His responsibility towards the baby had ended with delivery. Now he was concentrating on the mother.

  ‘There’s significant blood loss,’ he murmured, lifting the uterus out of the pelvis to determine the extent of the injury. ‘Put 20 units of oxytocin in a litre of saline. I want 60 drops a minute until the uterus contracts. Clamp.’

  The nurse handed him the instrument he needed and he moved with swift precision, clamping and ligating bleeding vessels and then using figure-of-eight stitches where necessary. Finally he was satisfied that the bleeding had stopped.

  Miranda watched in breathless silence as he drained a haematoma that had formed and then examined the area again. ‘Her previous Caesarean section was stitched with a single layer of sutures—a way of shortening the time in the operating room but it does increase the risk of uterine rupture. I’ll do a double-layer closure this time.’ His eyes still on the wound, he held out a gloved hand. ‘I’m ready to stitch.’

  The scrub nurse handed him the correct suture and he set about repairing the tear. ‘More light,’ he requested at one point. ‘I need to see the ureter. Don’t want to be stitching that. Right—clots here. Sponge, please.’

  The nurse obliged and Jake carefully removed the clots.

  Miranda stepped closer, her curiosity overcoming her reluctance to draw attention to herself. ‘Is her bladder OK?’ She knew that bladder injury was a very real risk but Jake gave a nod of his head.

  ‘It all looks fine. And no signs of infection so I’m ready to close. The uterus has contracted. Reduce that drip to 20 drops a minute. How’s that bab
y doing?’ Finally, once he knew the mother was out of danger, he turned his attention to the paediatrician. ‘Give me some good news, Howard.’

  The paediatrician smiled. ‘Little girl and doing very well indeed.’

  ‘Apgar scores?’ Jake’s fingers flew as he stitched with equal measures of speed and skill.

  ‘Eight, nine and ten.’

  Miranda smiled with relief. The Apgar score measured neonatal heart rate, respirations, tone, colour, and reflexes immediately after delivery. Gail’s baby had good scores.

  Finally Jake finished and stepped back. ‘All right. Well done, everyone. Thank you very much. Ruth, tell the ward to contact me if there are any signs of infection. Day or night, I want them to phone me. Gail has had a rough enough ride. She doesn’t need any more problems. And we need to redeem the reputation of the medical profession.’

  Everything about him was calm and steady, Miranda observed as she watched him strip off his gloves and walk towards the swing doors. Just like the time he’d rescued her from the mountain. He assessed the situation and just did what needed to be done. Panic and Jake Blackwell clearly didn’t go together.

  He was an amazing doctor.

  But it didn’t take a genius to see that he was angry with her.

  And who could blame him?

  Dreading the inevitable confrontation, she took her time helping Ruth to clear up Theatre and then waited in the recovery room until Gail was well enough to be transferred to the ward.

  It was nearing the end of her shift when she finally returned to the labour ward. There was no sign of Jake.

  Weak with relief that she was going to be spared a difficult conversation, at least for the time being, Miranda found Ruth. ‘Is there anything else you want me to do?’

  ‘Are you joking?’ Ruth gave her a smile. ‘You’ve already worked far longer than you should have done, considering it’s Boxing Day. I’m sure you have places you want to be. Go home.’

  Miranda gave a wan smile. ‘I’m fine.’ Exhausted would have been a more appropriate word but she’d grown used to tiredness over the last few months. And there was no denying that the money would be very welcome. ‘I’ll see you tomorrow.’