To Dr Cartwright, A Daughter

by Meredith Webber

  'Without major upheaval?' Jake asked.

  Katy grimaced.

  'Hardly! But it's containable,' she said, remembering the chaos while those renovations were completed, 'especially if it's confined to one ward. The worst problem is changing the plumbing for the en suite bathrooms. Such refinements hadn't been considered when Lake Shore North was built.'

  'Are they necessary in birthing suites?' Jake asked.

  'They give the woman an opportunity to take a warm bath or shower during the first stage of labour,' Rosa replied. 'It helps ease the pain of contractions without recourse to drugs. More and more women are seeking drug-free births, so we want to do all we can to encourage them.'

  Jake glanced at Ron.

  'You have some input?' he asked.

  The younger man grinned.

  'I know my place in this group,' he said. 'One unacceptable suggestion and they're asking me how many pregnancies I've been through.'

  The women chuckled, but Ron was only half-joking. At Lake Shore North there was a move away from specialist attendance at trouble-free births, with the mid-wives delivering most of the babies.

  'However, I have been keeping statistics since I started here six months ago,' he added, 'and, although I wouldn't quote figures outside this room, I'm beginning to believe the literature which claims babies delivered without the use of drugs are more alert and need less intervention after birth.'

  The discussion finished with Katy suggesting she contact the hospital architect about plans and Jake agreeing he'd look at the idea when it had been costed.

  They moved on to the new unit, and Katy felt a rush of affection for her little team when, one by one, they supported the idea and praised the work she'd done on the proposal.

  'I think we should remember that the most important part of the plan is in-service training for the staff,' Jenny reminded them. 'Even if Admin refuse to give the go-ahead, can't we begin to incorporate discussion on the customs of these women into our in-service programme?'

  Jake frowned at her.

  "That's not already being done throughout the hospital?' he asked, and she shook her head.

  'But you said the hospital has a large number of Asian patients and the kitchens are organised. Has no one thought of staff-training?'

  'It's not as big an issue for patients in other departments because they're in for medical reasons or surgical procedures. Geriatrics have been trying to get something organised because they see a number of patients approaching death—which, like childbirth, has certain customs attached to it,' Ron Spencer explained. "The culture clash only occurs when our way of doing things interferes with their traditions.'

  'We've all thought of staff-training,' Helen put in, 'but no one person has the knowledge to draw up a staff-training programme incorporating all the countries involved or all the fields of medicine. It's a one-off project which would require someone working full-time for perhaps six months, contacting experts in medicine from the different backgrounds and asking them to contribute. Considering she has a very demanding job, Katy's done wonders with our small section, but she can't be expected to do any more.'

  Katy turned to Jake and saw he understood the magnitude of the problem. His eyes were grave as he considered Katy for a moment, then he nodded as if he'd come to a decision he wasn't going to share.

  'I'll speak to someone about it,' he said, 'but, in the meantime, circulate the articles Katy's gathered among your staff. The more background knowledge they have, the more tolerant they're likely to be.'

  He leaned forward and stacked his folders into a neat pile, indicating the meeting was almost over. He was assuring them he'd seek approval to set up the unit straight away when there was a light tap on the door. Katy went to answer it and found a hospital volunteer standing outside, almost hidden by a huge arrangement of flowers.

  'You're Katy Turner, aren't you?' the woman asked, and when Katy, too astonished to speak, nodded, she thrust the arrangement into her arms.

  'The delivery man left them at the front desk,' the volunteer explained. 'Must be nice to have someone who loves you that much.'

  Katy felt the blood rushing upward to stain her cheeks. Jake used to send her flowers... Surely not!

  She backed into the room, wishing she could hide the gift, but the sheer size of the bouquet made that impossible. She sneaked a look at Jake and caught the dark shadow of anger on his face, but then it vanished, replaced by a remote mask.

  Jake hadn't sent the flowers!

  She dropped them on her desk, too embarrassed to even think of looking for a card.

  'That's some floral tribute!' Helen remarked as Katy slunk back to her chair.

  'Such lavish attention doesn't look like John's style. Was there a great holiday romance?' Jenny smirked knowingly. She'd gone out with John herself for some time and found his interest in Katy a source of great amusement.

  Katy seized the agenda and made some comment about that being all for the meeting. But she was wondering how Jake had reacted to Jenny's words and she could feel the flowers looming behind her like some floral science fiction monster that grew and grew.

  'Before we finish,' Jake said quickly, 'I've spoken to the head of the interpreting service and arranged for a second female interpreter—so we can take outpatients from this special group fortnightly. However—'

  Whatever he was about to say was swallowed up by the alarm that demanded an immediate response. Katy was the first to the door. She thrust her head into the passageway and saw the blue 'B' flashing on a wall monitor.

  'It's your ward, Helen,' she said quietly, and stood aside to let the medical team respond.

  As Jenny had surmised, the flowers weren't from John. They were from the support group for the sight-impaired she attended, thanking her for her presidency over the last four years. She'd resigned before her holiday, knowing she'd not have the time required to do the job well if she was getting the new unit under way.

  She considered the over-size bouquet and realised Jake would have to continue to assume they were from an admirer—which could work to her advantage! If he thought she had a man in her life, he'd stop the subtle campaign he was waging against her. She stared at the flowers for a minute longer, then carried them out into the passage.

  'Here!' she told a passing wardsman. 'If you're not busy, could you take these up to the geriatric ward for me. Tell Sister to spread them around. Most of the elderly patients love flowers.'

  The man grinned at her.

  'Wrong fellow send them?' he teased, and she found herself blushing—although his guess was as wide of the mark as Jake's had been.

  She returned to her desk and typed up the minutes from the meeting, then prepared a title page for the submission to the hospital board. The resolution of the ward meeting was set in block letters in the middle of the page, with the names of those present underneath it. As she typed 'Jake Cartwright' she remembered the first time she'd typed his name.

  She'd been working in the office of the public hospital at the far end of the lake. It had been a part-time job which helped pay her living expenses while she studied to be a nurse, and as she'd added the final name— his—to the list of new staff members at Lake Shore General she'd looked up to see a pair of blue eyes twinkling down at her.

  'Katy Turner—what a crisp, no-nonsense name!' he'd murmured, reading the name-tag pinned to her white shirt. 'Do you do the guided tours around this place?'

  She'd blushed and stammered and known almost instantly that she was in love. It hadn't come on her slowly, as she'd expected love to come—creeping up like fog off the lake's edge. It had slammed against her with the suddenness of an automobile accident, and she'd felt the juddering shock ricochet through her body.

  Jake Cartwright!

  She studied the name and sighed. She could remember that first meeting so vividly, yet the development of their relationship was hazy. Now, nearly eight years on, it seemed as if they'd been together from that day, yet she knew he'd worke
d impossible hours and she'd studied when she wasn't either typing in the hospital office or waitressing at night.

  Maybe their clashing schedules had made the time they spent together feel more precious, more intense, she decided, unconsciously doodling little daisies around his name. Maybe that was why it seemed, now, as if they had never been apart—back then!

  Until after that special Easter break, when they'd both had four days off. They'd camped near the beach at Freshwater Cove, swimming, fishing, walking, sleeping—and making love! The memory was like a precious jewel, tucked away in Katy's mind—not brought out too often in case use might dim its lustre.

  They'd come back feeling fit and healthy, ready to tackle whatever the new term had to offer. And with such plans! Jake would finish his residency and she would finish her final year at university, then they'd get married.

  She slashed her pen across the daisies. The sense of well-being after the holiday hadn't lasted long. In fact, within a fortnight she'd been feeling tired and sick—her stomach so unsettled she'd bought a pregnancy kit at the chemist and tested herself to make sure that pregnancy wasn't the cause.

  Jake's working hours had been even worse than hers, yet his energy had remained undiminished. Her increasingly frequent refusals to join him in some 'fun' had led to a tetchiness developing between them—the first shadows of disharmony in what had been close to perfection.

  She sighed and turned back to the computer, tapping out a print command to replace the title page she'd ruined.

  The door opened and she looked up to see Jake returning.

  'I had Giardia, you know!' she said, and only realised she'd spoken her thoughts aloud when she saw the look of puzzlement on his face.

  But now the words were said, she decided to continue.

  'Before the accident! When I was sick and you were so convinced I was either faking it or pregnant and neither option pleased you very much.'

  She snatched up the newly printed page, slipped it into a plastic sleeve on the front of the file and shoved the lot across onto his desk. Then she remembered the crisis call and she looked at him again.

  He was frowning, but not at her, and she recognised the look as one he wore when he was inwardly scanning his phenomenal memory banks for some hidden bit of information. He probably hadn't even heard her defiant outburst.

  'What was the emergency?' she asked, her own past misery forgotten as she worried about the cause of Jake's distraction.

  'That woman who was involved in an accident yesterday,' he murmured. Then he looked directly at her and his eyes came into focus once again.

  'Katy, there's a paper in Holstead's Obstetric Text about concealed haemorrhage in abruptio placentae. Could you find it for me while I change the infusion we're giving her?'

  He disappeared through the door while Katy moved towards the bookshelves. She knew enough medicine to know how dangerous it could be for both mother and foetus when the placenta shifted from the uterine wall. Usually the first indication was uterine bleeding, followed by painful contractions.

  Did 'concealed' mean there were no symptoms to guide the medical staff?

  She found the article he wanted and began to read it. Problems with supply of blood to the foetus, elevated intrauterine pressure, blood clotting factors seriously depleted. The condition meant danger for both the mother and the child. Had Jake mentioned the woman's term? Would the baby survive if they had to deliver it?

  He came back into the room as she was wondering and took the book from her without a word.

  'Ah, I thought so!' he muttered to himself, then left the room again before she had time to speak.

  It was late afternoon when he returned, and she noticed that his shirt, in spite of the air-conditioning, was wet with perspiration.

  'Is she okay?' Katy asked, and was pleased when he nodded.

  'And the baby?'

  The question clutched at her heart. Babies had become doubly precious to her since Julia's birth.

  'We've got him in a humidicrib,' he said, slumping down into his chair and resting his head in his hands. 'Is there a counsellor with experience in premature births who can speak to the mother when she's feeling up to it?'

  'Of course!' Katy assured him. 'Helen will take care of that, and will also contact the association for pre-term infants. They're a local group of parents who've had preterm babies. They have volunteers available for either discussion or assistance.'

  She spoke calmly, but her heart was beating out its own anxiety. 'How premature is he?'

  'She thought she was thirty-four weeks, but I'm not so certain. He's less than two thousand grams.'

  Julia had been seventeen hundred grams. A tiny scrap of humanity, she had looked more like a skinned rabbit than a human baby. Katy glanced at Jake, wanting his reassurance that this baby would be all right. But no one could predict his future at the moment, although with new developments in humidicribs, especially in the way of providing warmth and oxygen supplementation, this baby would have a far better chance than Julia had had, even five years ago.

  'Was he delivered vaginally?' she asked.

  He looked up and frowned, as if perturbed by her question.

  'Why are you asking that?' His frown deepened.

  Katy shrugged, aware she'd crossed some imaginary boundary between administration and medicine. Still, he had asked!

  'A Caesar would mean the woman is going to suffer physical discomfort for longer, and is therefore weaker and less able to cope with the stress and grief and uncertainty related to giving birth prematurely,' she said, then she ducked her head and pretended to be busy sorting the pile of papers on her desk.

  'Grief?' It was only one word but it demanded an answer.

  She looked up slowly.

  'When a family has a child 'with problems—even if they are only temporary problems—there is grief for the child they had imagined—the perfect child they thought they were going to have. It doesn't lessen their love for the real baby, but the grief is still there. For a long time counsellors ignored that part of the equation, but, since associations like the pre-term births organisations have been formed, counsellors are accepting what experienced people are telling them.'

  He shook his head and smiled.

  'I did know that,' he murmured. 'We medicos aren't quite the dehumanised beings some people would have you believe. What surprises me is the depth of your involvement, Katy. I know you worked hard on the unit proposal, and I can understand your commitment to that, but this is a different field and you're just as passionate.'

  She was embarrassed by the praise she heard in his voice, but also aware she'd drifted dangerously close to personal issues which had to be avoided at all costs.

  'It's my department,' she said defensively. 'It's natural I should be interested.'

  'Hmm!' He studied her for a moment, his eyes scanning her face as if he might read a different answer on her skin.

  'Well, for your information, Departmental Assistant, she did deliver vaginally. That was what I wanted to check in Holstead. With a concealed haemorrhage the blood has to go somewhere. Usually it escapes into the uterine tissues, causing the uterus to take on a bluish or purplish colour. This condition will resolve itself spontaneously, but Holstead believes vaginal birth will bring a better long-term resolution to the affected tissues. I thought it was worth trying to induce her before operating. Having made that decision, there was a period of very nervous waiting, but it worked in this case.'

  He paused, then looked around the room, another frown beginning to pucker the skin between his eyebrows.

  'What happened to your flowers?' he asked abruptly, and this time it was she who raised one eyebrow. It was a trick which had taken her years to perfect, but it was enough to remind Jake that her personal life was no concern of his.

  She bent over her papers once again, determined to finish her work in time to visit Ward 'B' and the nursery before she left. But it was a pretence. Jake's presence in the room disrupted her tho
ught processes and made the nerves in her skin twitch with awareness. It was impossible to think she could work with him for another thirty-eight days—no matter how busy she might be.

  Impossible!

  She sighed and thought of Julia, and the mortgage on the house, and the down-payment she'd made on the new computer. She sighed again.

  Even more impossible to leave!

  'If you've done sighing, would you mind taking this submission up to the administration office for me? Leave it with your mate Mr Forbes and tell him I'd like him to have a lode at it before the department directors' meeting next Monday.'

  She looked into blue eyes which were regarding her thoughtfully.

  'But you said—' she began.

  'That I'd argue the case for you,' he interrupted. He slid his hand across the desk and touched her on the forearm. 'And I will, Katy, I will. I've already spoken to Mr Forbes and told him how I feel, but it's only fair he gets an opportunity to read through the proposal before it's discussed. He'll also circulate copies to other departments.'

  'They already have copies,' Katy protested mutinously. 'But giving Mr Forbes one this early will give him time to find objections. He'll come prepared with little lists of why the thing's impossible.'

  The blue eyes gleamed with mischief.

  'So we'll have to prepare our own lists,' he said firmly. 'We'll have to go through it word by word and anticipate his objections, then arrange our arguments accordingly.'

  'But that would mean hours and hours of work. We actually have a department to run here, which usually takes all my working hours plus another ten or twelve each week. We'd never get it done!'

  The problem was, she knew he was right. In fact, she couldn't understand why she hadn't thought of it herself. When she'd pushed the crèche past administrative barriers she'd had powerful support, as three department directors had pre-school-aged children and problems with suitable childcare. There'd been no need for an extended campaign.

  Another sigh slipped from her lips. She should have been doing that kind of analysis during her holidays instead of lying on the beach.