‘It seems to me that what you were doing was sitting there muttering to yourself when I arrived but, hey, perhaps Einstein used to do that, too…right before he worked out his theory of relativity.’
‘Tim…’ How could he get angry with someone who was unfailingly cheerful as well as being a good paediatrician?
To his great relief the telephone rang out a strident summons and Josh reached for it with a fervent hope that his colleague hadn’t heard anything incriminating.
‘Yes, Caitlin?’ he said, recognising his receptionist’s voice and silently cursing himself for being disappointed that it wasn’t Dani. After all, it had only been minutes since she’d stalked out of his room after reading him the Riot Act. What would she be wanting to speak about with him?
‘Dani said to tell you that she’s on her way down to A and E. There’s an RTA passenger coming in and she’s seven months pregnant. Apparently, the paramedics radioed ahead to warn that she might need an emergency Caesarean.’
‘Right, Caitlin, can I leave you to mobilise the troops?’ he said briskly while his pulse was still recovering from the simple fact of hearing the wretched woman’s name. It would be far better for everyone if he just concentrated on the matter in hand…an injured woman whose baby might have to fight for its own survival long before its fragile system was ready for the task.
‘I’ll leave you to it,’ Tim said as he levered himself out of the chair. ‘I was only going to ask if I can put your name down for the hospital’s fundraising squash tournament.’
Josh pulled a face but before he could refuse Tim continued. ‘I know this obviously isn’t the right moment for this, so take some time to think about it. You don’t need to make a decision till the end of the week, and the money will be coming to our end of the hospital this time, so it’s in both our best interests to show support.’
‘I’m unlikely to have the time,’ Josh warned over his shoulder as he pulled the door closed and set off along the corridor towards the stairs.
‘It’s more likely that you’re afraid to show off how unfit you are now that you’re getting older,’ Tim taunted, secure in the knowledge that he was all of two years younger, then added slyly, ‘But I’m sure you wouldn’t say no to the new equipment you could buy. As I say, let me know by the end of the week…and good luck with your patient.’
He was going to need more than luck with this one, Josh realised when he took another appalled look at the woman’s injuries, blocking out her feeble moans of distress for the safety of her baby.
‘How long before you’re ready to put her under?’ he demanded, even as he reached out to check the positioning of the foetal monitor and found Dani’s hand there before him.
‘Go and get scrubbing,’ she muttered, almost shouldering him out of the way. ‘Someone from Orthopaedics is on their way, so is a vascular surgeon. And there’s one of the unit’s newest humidicribs warming all ready for the baby, Nadia is ready to special the baby as soon as you get it out, and ICU and Maternity will fight for honours in taking care of Mum.’
If the poor woman left the table alive, he added in bleak silence as he strode out of the room, grateful that Dani seemed to have everything so well organised, and automatically began to scrub at the deep stainless steel sink.
The list of obvious injuries the woman had sustained was impressive, including complex breaks to both legs and a fractured pelvis, but it was the fact that her blood pressure was plummeting in spite of the enormous amounts of fluid they were pumping into her that was causing most concern. With four major blood vessels in the pelvis, it was becoming increasingly likely that at least one of them had significant damage and was haemorrhaging vast quantities that could only be stemmed when her baby was out of the way.
‘That’s if it isn’t a placental abruption that’s causing the blood loss,’ he muttered just as Dani joined him at the sink.
‘There isn’t any evidence of blood loss to indicate that it’s the pregnancy that’s causing the problem,’ she said firmly, almost as if she’d been reading his mind while he’d contemplated the alternatives. ‘That means that if it is placental abruption, the bleeding’s completely contained within the uterus, therefore the intrauterine pressure should be counteracting it to a certain extent.’
She leant forward to use her elbow on the long-lever tap and brushed against his side, sending a shower of sparks right through him and setting every hormone on alert.
‘With all those fractures,’ she continued, apparently totally unaware of the chaos she was causing to his breathing and blood pressure, ‘it’s far more likely to be one of the pelvic blood vessels so you need to get that baby out of there, pronto.’
‘Well, let’s get going, then,’ he snapped, strangely angry that she obviously wasn’t equally affected by his proximity.
She was almost on his heels as he stepped up to the scrub nurse holding out the green cotton gown for him, waiting for him to thrust his arms into the stiff, crumpled-looking sleeves, and she was right at his shoulder when he stepped up to the side of the operating table.
‘Is everybody ready?’ he demanded as the operating field was prepped, concentrating on the clock inside his head that told him the woman’s time was growing shorter with every tick rather than on the clean soapy scent of Dani’s skin that never seemed to be completely covered by the antiseptic smell.
One part of him wanted to do the most direct incision possible to remove the infant as quickly as he could from the one place that should have been a safe refuge. The other part of him knew that, should the mother survive, it would add insult to injury if she lost her baby and was unable to carry another because of his precipitate cutting.
‘Suction,’ he muttered, sending up a brief prayer of thanks as nothing more than amniotic fluid gushed out of the incision. There was no evidence of bleeding into the uterus and the placenta was positioned well out of the way of the incision. He paused just long enough for suction to clear his field before he motioned the instrument away and enlarged the opening.
‘May I?’ Dani asked as he set aside the scalpel, and when he nodded she reached slender hands into the opening and emerged within seconds cradling a slippery head no bigger than an orange. ‘Have you got the clamps ready?’ she asked as she slid her second hand deeper, and he knew that she would be trying to support the weight of the baby’s body…not that it would weigh a great deal at this many weeks gestation. ‘Could you position them as close to the placenta as practicable, then allow the placental blood to drain down into the baby?’ she suggested, and he was glad that his mask covered his expression when a quick grin tugged at the corner of his mouth.
They’d had a conversation about this topic only the other day, debating the benefits to newborns of taking the time to top up their tiny systems with as much blood as possible.
‘So what if it means the placenta and cord end up in two separate pieces?’ she’d argued. ‘Really tiny babies need every bit of blood they can hang onto, so what does it matter if you separate the cord from the placenta in the mother then cut it again closer to the baby when the blood’s had a chance to drain down?’
The fact that he’d been doing just that in nearly every delivery for some time wasn’t something he’d bothered to tell her. He’d been enjoying himself far too much listening to her fighting her corner.
‘And what if the cord blood is needed for other purposes?’ he’d argued, purely for argument’s sake. ‘Researchers are crying out for it for everything from investigations into genetically inherited diseases to ways of persuading bodies to repair their own degenerative conditions.’
‘And there are enough full-term healthy babies being born who could spare those last drops of blood,’ she said with a fervent light in her eyes. ‘Our preemies need it for themselves.’
So, in spite of the fact that it was a more awkward process than immediately cutting the cord close to the baby’s belly, he deliberately positioned the clamps as far away as possible.
&n
bsp; He glanced up briefly, raising one questioning eyebrow as he met those deep blue eyes over the stark white of her disposable mask and was strangely warmed by the way her eyes gleamed back at him with the evidence of an answering smile.
‘Are you ready for me to start injecting dye?’ asked a voice on the other side of the table, and it took a second or two before he could work out what the man was talking about.
‘And for me to get some X-rays taken,’ added another.
‘Go ahead,’ he invited, knowing that the sooner they worked out how many bleeding blood vessels they were dealing with, and how severe the fractures were, the better for their patient’s prognosis. ‘Can you work around me while I finish getting the placenta out?’
The rest of his part of the job would almost have been routine if it hadn’t been for the air of urgency that permeated the room. And it wasn’t just the fact that the monitors were shrilling out warnings every few seconds as the young woman’s pulse rate raced and her blood pressure dropped lower and lower.
Behind him there was an ominous absence of sound from the tiny being that Dani had lifted so competently from its mother’s womb; just the muttered imprecations between midwife and paediatrician while they exhorted the immature lungs to take that first all-important breath.
That first weak, scratchy cry sounded more like a kitten’s mew and coincided exactly with the vascular surgeon’s exclamation of relief that he’d found the damaged artery.
‘Gotcha!’ he gloated just as Josh finally inserted the last suture in the empty uterus and stepped back from the table.
‘I’ll leave her in your hands,’ he said as he stripped off his blood-soaked clothing and prepared to follow the humidicrib to his domain, strangely reluctant to leave the young woman until he knew her fate. But there was nothing further he could do for her—her life was in the hands of other specialists. He needed to concentrate on doing everything he could to make certain that, should she come through this, she would have a healthy baby waiting to greet her.
CHAPTER FOUR
‘THERE’S something wrong with her breathing,’ Dani snapped before they’d even positioned the humidicrib and connected all the travelling leads to the unit’s central monitoring system.
Josh flicked the last switch and the cacophony of bleeps and alarms agreed with her, but he hadn’t needed any of them to tell him that his newest charge was in serious trouble.
‘She’s having to fight for every breath,’ Dani muttered as she double-checked the oxygen supply. ‘Do you think she’s going to need surfactant in her lungs to stop the surfaces sticking?’
He watched the way those tiny ribs were trying to drag air in, and knew from far too much experience that it wasn’t a good sign. Such a tiny body just wouldn’t have enough reserves of strength to keep the muscles working at that pitch for very long, and a shortage of oxygen spelled certain disaster for all the baby’s other systems. The last thing this little scrap needed was brain damage and cardiac arrest.
Unfortunately, there had been no chance to administer corticosteroids to the mother prior to delivery, and as the baby still had some way to go to reach thirty-four weeks, the lungs hadn’t developed far enough to produce their own natural surfactant.
‘There’s a greater risk of brain haemorrhage if she’s struggling like this, isn’t there? Can’t we just raise the pressure of the oxygen a bit to help her?’ The concern on Dani’s face was as acute as if the tiny girl had been her own, and that once more raised warning flags in Josh’s mind.
But it was early days yet, he reminded himself. She’d only been on the unit a matter of days, so there was time for her to learn to distance herself just a little bit, for the sake of her own emotional health.
‘Ordinarily, yes, we could, but with respiratory distress syndrome, if we increase the oxygen pressure to help expand the lungs, we risk rupturing the tissues because they are still so stiff that they can’t stretch and move properly,’ he reminded her, even as he made a silent note to keep an eye on his newest member of staff. The last thing she needed in her first week on the unit was to get too involved with a baby who had so little chance of survival.
If he could make sure that she had as little to do with this patient as possible…
‘And she doesn’t need a pneumothorax on top of everything else,’ Dani agreed grimly, and he was aware that she was watching his every move as he, in turn, double-checked the settings of every piece of equipment.
‘We’ve done everything we can for the moment.’ He risked a glance in her direction and saw the worried pleat between her brows. ‘Dani, to a certain extent the babies have to do the work for themselves. Much of what we do is managing the situation from day to day or, during a crisis, from minute to minute. But we can’t do it all. The baby’s body has to fight to survive, too, and some of them just don’t seem to want to do that. That’s why there’s always a—’
‘Josh? Can you come and put a new line in?’ called a voice from the other side of the unit just as one of the monitors beside him shrilled out another warning.
Momentarily dragged in two directions at once, he suddenly realised that this would be a good moment to let Dani fly solo.
‘Are you happy to put a line in?’ he asked, and saw the brief flash of terror in her eyes that was swiftly replaced by pleasure that he’d asked her to do it, mixed with the determination to make a good job of it.
He sighed softly as she made her way across the room, dragging his covetous gaze away from hips that were surprisingly curvaceous for one so small and forcing himself to focus on the detached sensor that had been the cause of the malfunction.
Dani had always been easy to read, right from her childhood, every emotion showing so clearly in her face that it was impossible for her to tell a lie.
She would probably be horrified to know that he’d been able to tell just how delighted she was to be offered the chance to put that line in without having him breathing down her neck. Not that she should have been surprised. He already knew that she had good technique and that, unless there was a problem, there was no reason why she shouldn’t be able to make a good job of it. After all, she’d managed to do a similar one on her very first day when her nerves must have been at their jumpiest.
No, he didn’t have a problem with her skills as a doctor. His doubts about having her choose this specialty were probably a combination of brotherly concern that she might find the emotional burden of dealing with this environment too stressful and pure selfishness. What else could he call it when it was his own problem with working in the same unit with her that was prompting him to suggest she choose another discipline?
As it was, he was going to have less than six months to prepare himself for the eventuality that, by the time she finished her rotation, she could choose to apply for a permanent post in the unit. If that happened, he was going to have to find some way of giving her the recommendation she deserved for a job in another unit without having to admit why he wasn’t willing to appoint her to his own. That was a tightrope he hoped he’d never have to walk.
Of course, if the next weeks and months were particularly harrowing, she might make her own decision not to stay, but from the expression on her face as she straightened up from successfully threading a hair-fine needle into a vein not much bigger, that wasn’t going to be happening any time soon.
As if she’d felt him watching her, Dani glanced up and met his gaze head on, her blue eyes alight with a blaze of triumph, her whole face wreathed in a smile that was visible even behind the disposable mask.
A tap on the window caught his attention and the speculative expression on Caitlin’s face as she beckoned him across told him she’d caught that exchange of smiles with Dani.
Damn! he thought as he felt a very adolescent blush wash up over his face. The last thing either of them needed was to be the subject of hospital gossip. As it was, only the other members of the interviewing board knew that he’d exempted himself from her interview, and even the
y didn’t know the full details of the relationship between the two of them.
‘Sorry to interrupt,’ Caitlin said slyly when he stuck his head out of the door. ‘But I thought you’d want an update.’
‘Update?’ He honestly hadn’t a clue what his highly efficient secretary was talking about.
‘On the RTA mum you left in surgery?’ she prompted, and he could have kicked himself. Ordinarily, he would have remembered to check intermittently to see how the mother of one of his patients was doing…and Caitlin knew it. It was another strike against him that, with Dani in the unit, he’d completely forgotten about the poor woman he’d left on the operating table hovering between life and death.
‘Tell me the worst,’ he invited, wishing he hadn’t dragged his disposable mask off to dangle against his throat. He could have done with something to hide behind with this woman watching his every move.
‘They’re still trying to get her blood pressure up off the floor, but at least she’s not losing any more. Orthopaedics and Vascular are now arguing over whether she’s strong enough to start some of the pinning and plating to put her back together or whether to wait and take her up to Theatre again tomorrow or the next day, when she’s stronger.’
‘If I were a betting man, I’d put money on Orthopaedics winning that round,’ he said. ‘There’s some major long-bone involvement there, as well as the instability caused by the pelvic fracture. If her body’s going to be fighting, I would have thought that it might just as well be fighting to repair things when they’re all back in roughly the right places. Anyway, thanks for the update and let me know who wins the battle in the OR…I’m glad it’s not my call.’
As for the battle in his unit, so far it looked as if Dani was winning that, hands down. Where he was distracted beyond anything in his life before, she seemed to be having no trouble keeping her eyes and her mind on what she was supposed to be doing.
A wife for the baby doctor Page 5
