The Baby Doctor

by Fiona McArthur

  Outside these hours – Emergencies ONLY Consultations by Appointment

  RFDS Doctor – Every second Monday

  Child Health Nurse – alternate Mondays with RFDS Dentist (as advertised)

  Ophthalmologist (as advertised) Podiatrist, Dietician (as advertised) Optometrist (as advertised) Diabetes Educator (as advertised)

  Women’s Health Doctor (as advertised)

  The last line caught her attention. She needed to talk to the health service administrators about that. About options to go to a female doctor or nurse like women had in the city. Maybe every couple of scheduled visits they could try harder to get a female consultant here. Her heart ached for the woman she’d seen this morning. She pushed open the screen door.

  There were still three patients sitting in the tiny waiting room for the clinic nurse when Sienna arrived five minutes early for her interview appointment.

  The elderly Aboriginal man didn’t look up and the young boy sitting next to him flashed her such a mischievous white-toothed smile in his dark handsome face that Sienna couldn’t help returning it. The third was a blonde-haired young man in his late twenties with a plaster cast on his leg and crutches. He nodded at her with a flashy smile. Sienna nodded back. Handsome bloke.

  She smiled vaguely at them all and ducked back out again to cross the road and walk up to the pub for a cold squash. Alma leaned on the bar and her crinkle-cut face wrinkled into a smile of greeting.

  She filled a glass of squash for Sienna. ‘Did Kyeesha turn up?’ Sienna nodded and thankfully Alma didn’t ask. Just occasionally she surprised Sienna with the boundaries she left intact.

  ‘How’s the detective work going?’

  She’d re-studied all of the patient notes on Sunday night. Nothing had jumped out. Sienna took the glass with a sigh of relief. ‘Slow progress.’ The heat from outside hung around her like a too-heavy pashmina and she lifted the cool glass to her cheek before she took a sip. When she did, the liquid chill ran down her oesophagus with a trickle of pleasure. ‘I don’t like slow.’ As if to make her point she gulped down the entire drink and put it down. ‘I’m waiting for the clinic sister to finish her appointments.’

  ‘Don’t like slow, eh? Never would have guessed.’ Alma looked around. ‘Well, you’ve come to the right place if you want action. In Spinifex we don’t do slow. No siree. This place is jumping.’ Alma used one arm to sweep grandly around the empty bar and the other to fill the water-beaded glass as it sat empty on the polished wood. Small raindrops of condensation raced down the outside as Sienna picked it up again gratefully and felt her lowered mood lift.

  ‘I’m getting used to the crowds.’ Sienna raised her eyebrows and then looked down at her drink with anticipation. ‘The squash is exciting.’

  ‘Reckon you can make your own fun. You looked pretty happy with yourself last night.’

  Sienna used her professional face. ‘It did turn out to be a lovely Sunday.’

  ‘Glad you enjoyed the metropolis of Winton.’ Alma raised her own sparse brows suggestively.

  ‘Oh yes. Beautiful.’

  Alma cackled. ‘Never heard it called that before.’

  Sienna drank this glass at her leisure, savouring it. Then she licked her lips. ‘Seriously. If squash wasn’t so full of sugar I’d drink a gallon of the stuff.’

  ‘A bit of sweet never hurt anyone.’ Alma reached back into the fridge and brought out a fresh cold bottle of the lemon drink. She stacked three ten-ounce glasses inside each other from the rack and put them all on the bar. ‘Take the bottle back across. The girls will have a drink and can take the rest out to the pilot when they go.’

  Sienna stood up. ‘Thanks, Alma. Nice idea.’

  Alma nodded regally. ‘Yep, that’s me. Nice.’ And she snorted and cackled and waved Sienna away.

  This place was crazy. Sienna smiled as she walked, carrying the cold glasses and bottle back down the street. Crazy weather, crazy dust, crazy publican. At least Alma wasn’t miserable.

  Sienna had to step aside as the young man with the broken leg manoeuvred his crutches out the door. Must have had his turn, then. His big smile widened and his voice sounded friendly. ‘You must be the doctor my Maddy’s been working with.’

  ‘Madison. Yes. And you must be Jacob.’

  ‘That’s me. Your sister married Lex Mackay, didn’t she? The Mackays are treated like royalty around here. Can even get a big-city doctor to come to a place like this.’ He paused as he drew level with Sienna, just a touch too close, and instinctively she drew back. Now she didn’t see his good looks. She could see why Douglas hadn’t been impressed. Little big man. Personal-space invader. Too pretty and knew it.

  She shifted to the left. ‘Yes, well, Maddy’s a terrific worker.’

  He shrugged as if he didn’t quite believe Maddy worked hard. Said instead of commenting on Maddy, ‘A doctor staying and working out of a pub seems pretty strange.’

  ‘I’m working down at the police station. In the residence, actually.’ She noticed, oddly, that his eyes seemed to glitter at that, but his voice stayed friendly.

  ‘She didn’t say.’ He paused. Stared off into the distance with a strange smile on his face. ‘Fancy that. Well, hope you find what you’re looking for.’ And he swung away awkwardly with his crutches.

  She watched him go with a tingle of foreboding and tried to unpick what she’d said that had caused the spike of emotion she’d seen sweep his face. She frowned over the slightly unpleasant encounter, but growing no wiser, she walked through the door.

  The screen clanged shut behind her. The waiting room stood empty, with a faint tang of leftover perspiration, and she crossed to where the door to the examination room stood open.

  An older lady, mid-fifties and jolly looking with a first-aid kit under her arm, waved and said as she passed, ‘You must be Dr Wilson. I’m the clinic nurse. The midwife’s in there. Sorry. The butcher cut himself. I need to see how bad. Back soon.’ Then she disappeared. Sienna blinked then peered into the tiny exam room.

  A young woman busied herself tidying the room and packing a bag. Sienna hadn’t thought about how she expected the midwife to look, but eyebrow and nose studs hadn’t been a part of it. There was nothing unusual about that in Sydney or Melbourne, but in Spinifex the ornamentation made her blink. The woman’s blonde hair was worn in a ponytail to one side, and on the other side of her head the dark hair had been shaved to about a centimetre long. Different. And she looked too young to be flying out to be a medical resource person at remote outposts.

  ‘Hi. I’m Chrissy Doolan,’ the young woman said as she invited Sienna into the air-conditioned room. Her eyes skittered to the bottle of lemon squash though she tried to hide it, and Sienna appreciated the publican’s sentiment.

  She put her gifts down on the steel dressing trolley with a metallic clunk and waved her hands. ‘Yours. Compliments of Alma.’ She paused and thought about that as Chrissy cracked it and poured herself a glass. ‘Though possibly, compliments of Blanche Mackay.’

  Chrissy laughed and Sienna saw the flash of her tongue stud. She wondered what Douglas would say if Sienna suggested she should try a tongue stud. The thought made her smile.

  ‘Mrs Mackay is one of our patrons,’ Chrissy said.

  Dear Blanche. ‘Not surprised. She does have remote medical access on her agenda. But I’d better not slow you down. What time does your flight come to pick you up?’

  ‘Anytime after one.’

  ‘Fine. Just a few questions if that’s okay?’

  ‘Sure. The FOG said you’d be keen to talk to me.’ They sat down on either side of the cluttered desk.

  Sienna began. ‘So you would have seen Annette today and baby Eugenie? Did they drop off the questionnaire for me?’

  Chrissy spun in her swivel chair and picked up some folded papers. ‘Yep, here.’

  She handed them over and Sienna put them on the desk in front of her. She’d look later.

  ‘Great, thanks. So, you’re the Fa
mily and Child Health Nurse and you check the milestones for the babies as well as do the antenatal visits between the FOG days?’

  ‘Yes, I am. I hadn’t long started with the RFDS so I remember when Annette came in for the pregnancy test. I know all three of the women involved. It was pretty exciting to have three pregnant women from a small town like this.’

  ‘We’ve considered the camel race festivities might have a hand in that population explosion.’

  ‘Makes sense.’ Chrissy grinned. ‘I did hear it’s a fun event.’

  ‘I’ve learned they play hard around here.’

  Chrissy nodded. ‘It’s a tough life. The remote stations breed amazing people.’

  They both thought about that. ‘So you continued to see all three of the women antenatally in between the FOG’s visits?’

  ‘Yep. The pregnancies were all normal, so apart from the two visits when they saw the FOG, everything was routine until they left at thirty-six weeks to wait for labour. Babies were moving normally, normal growth, normal everything.’ She looked down sadly. ‘Except it wasn’t.’

  Sienna nodded. ‘It’s tough for everyone. I’m hoping to find a cause and try to prevent something like this happening again. I’ve already received a copy of the ladies’ antenatal records, I’m really looking for unusual things that could have happened towards the end of their first and beginning of second trimester. So between ten and fifteen weeks?’

  Chrissy swivelled to look at the calendar on the wall, one with a camel on it. ‘What month would that be?’

  ‘July.’

  Chrissy screwed up her face. ‘I was here. Like what?’

  ‘Toxins, a run of some viral illness, aerial spraying over a water source. That sort of thing.’

  Chrissy tapped her fingers on the desk. ‘Can’t think of anything off hand, but I’m a diary keeper, so I could look it up when I get home. Especially in the early days when everything in this job seemed so new and different.’

  ‘That would be excellent.’ Sienna glanced around the tiny room. ‘Is it still new and different?’ She pictured the waiting room twenty minutes before. ‘You must have a diverse patient load judging by the last three I saw.’

  Chrissy thought about that and reeled off, ‘Yep, diabetes, otitis media and plaster check. Then there’re the swabs and the immunisations and the pregnancy tests, though often the women are too busy to even notice they’re pregnant for a while.’

  ‘Can’t imagine that.’ Then she thought of Maddy and amended the statement. ‘Depends on what else is going on, I suppose.’

  ‘Denial isn’t just a river in Egypt,’ Chrissy said, and they both smiled.

  Sienna thought of Sydney and, before that, trendy Melbourne. ‘Well, not where I come from, anyway. Most women I know test within days and then about three times more before they’re six weeks into the pregnancy.’

  Chrissy nodded seriously and the intelligence and empathy in her eyes made Sienna rethink her initial reaction about the younger woman’s age. ‘I guess it’s back to access. Access to doctors, to chemists. But even if the women out here know they’re pregnant, it’s such a long way to anyone they can talk to, the visits usually stick to less than the recommended ten visits for the first pregnancy and seven or less after that.’

  Not like the city. ‘We’d probably run twelve to fourteen visits for most women.’ Sienna’s thoughts turned to Maddy again. ‘Do you have any pregnant women on your books for Spinifex at the moment?’

  Chrissy screwed up her face as she thought then relaxed. ‘Nope. Not a one, which is funny after having three. There’s not that many young families around and after the flurry in the last month it’s slowed again.’

  Sienna pondered mentioning Maddy and decided not to. ‘And when do they leave to wait for labour?’

  ‘They go to Longreach for the midwives or Charleville, or a Brisbane hospital if they need obstetric care, at thirty-seven weeks at the latest.’ She pulled a face. ‘It must be hard leaving home to wait in a strange place, especially for the Indigenous women who have the extended family around them. Hard for anyone leaving the family while you’re waiting for labour and feeling the most vulnerable. So not surprisingly, some women wait till the last minute. Unfortunately for them, leaving any later than thirty-seven weeks means they have to pay for their own accommodation.’

  ‘I remember that, now. Too late to get to a hospital if you leave when you go into labour.’ She remembered Eve’s experience. ‘They had a breech at the Red Sand centre last year.’

  ‘I heard about that. Glad it wasn’t me.’ Chrissy’s eyes widened at the thought. ‘Luckily, most women are stoic and just go early. And for those who don’t, well, all we can do is deal with what arrives to the best of our ability. If I worried about what could walk in at any of the clinics we run I wouldn’t sleep at night. And the phone’s there for moral and directional support until help can get here.’

  ‘I imagine that’s the frame of mind you’d need.’ Sienna looked around the small room. There wasn’t a lot of equipment backup. ‘I think you do a great job.’

  Chrissy sighed. ‘I wish I could have done something to help Annette and the other ladies. Eugenie is beautiful and we’ll just have to pray that her brain capacity isn’t compromised by her small skull bones.’ She drummed her fingers on the desk and then her face brightened. ‘Is there anything at all I can pass onto my patients to cut down risks of this in the future?’

  ‘It all depends on what the cause is when we find it,’ Sienna said. She refused to say if. ‘I’ve been reading a lot, and there’s research about cytomegalovirus causing microcephaly, but the numbers are very small. Hence the reason for the extra blood tests I ordered for Annette and Eugenie. The other two mothers will have those tests as well. When I get back to Sydney I’ll talk to someone in Health about upping the public awareness campaign,’ Sienna added, ‘but I’ve discovered they have handouts on it already. Do you have some here?’

  Chrissy turned her head slowly to look around. ‘Haven’t seen any, but I’ll get onto it and we’ll order some for all our clinics. Is there an immunisation?’

  ‘Nothing licensed. The paper I read called the only precaution the CMV knowledge vaccine. That simple precautions will hopefully do the trick. I’m thinking you could pass this onto any pregnant women or immunosuppressed people you have in your clinic.’

  ‘That’s what I’m looking for.’

  ‘Pregnant women need to know CMV exists so they can be careful. Second, the recommended three simple precautions are based on the knowledge that toddlers and young children are “hot zones” for CMV.

  ‘The three tips to reduce exposure to the most common sources of CMV involve,’ Sienna ticked them off on her fingers. ‘Not sharing food, drink, straws or eating utensils with young children; so playgroups and preschools are told about this. Not kissing young children on or around the mouth or lips; and washing hands well after changing nappies and wiping runny noses or mouth drool. The study I read talked about bringing the infections down from 46 per cent to 6 per cent in those who were educated about extra hygiene as opposed to the control group. And the group educated on CMV were keen to take up the advice.’

  Chrissy nodded vehemently. ‘I’d think any mother would. Why isn’t this out there more?’

  Sienna didn’t have a good answer for that. ‘I guess there’s so much info for women to hear when they’re pregnant it seems just another frightening possibility.’

  ‘But they’re such simple solutions. You’ve converted me. No more kissing my nieces on the lips.’

  Sienna stood up and smiled. ‘Me, too. Though I’m not planning to be pregnant.’ Then she laughed. ‘I’ll catch up with your clinic nurse when she does her next clinic. I’ve thought of something I want to follow up.’

  ‘No worries.’ Chrissy glanced at the bottle of squash and the glasses. ‘And thank Alma for the drink. The pilot will love her.’

  ‘Will do.’

  When Sienna returned to the p
olice residence she rang her registrar, Cilla, and asked her to find the phone number of the Director of Nuclear Medicine in their Sydney hospital. She’d been going through the causes of microcephaly again and another idea had needed checking.

  Radiation exposure felt like an obscure cause, but she wanted to talk to someone about the possibility. Cilla would get back to her.

  Chapter Twenty-one

  Maddy

  ‘You’ve been keeping secrets again, Madison. You know I don’t like that.’ Jacob wagged his finger at her. He’d been waiting just inside the door.

  Maddy felt the cold trickle of fear along with the chill of the metal crutch against her thigh. She squeezed her satchel against her stomach to form a barrier to protect her baby.

  She’d spent an hour down with the doctor typing up new reports and she only had twenty minutes before she was due at the pub after she came home to make Jacob’s dinner.

  He leaned his weight on his good foot and his backside against the bench behind him. Then the other crutch came up behind her so she couldn’t reverse out.

  Her heart pounded in her chest and she sucked in her belly as much as she could. Had he discovered she was pregnant? Did he want to have sex? Her growing fears for the safety of her baby crystallised into a pure animal terror and she was trying to hide that, too.

  She’d been so stupid to let it get to this point. What if she’d gone into labour and she couldn’t run from him? Had she left it too late? Could he hurt her and the baby in one go? Would he?

  Thoughts tumbled and twisted through her mind as she stood frozen, and when she didn’t reply he tapped her none too gently with the crutch at her back. That woke her up.

  He whispered, ‘No escape from the truth,’ in that mocking, hateful voice she’d grown to dread.

  ‘I’m sorry,’ she said, very quietly. ‘But I don’t know what you mean.’ Warily navigating the tricky waters of his volatile emotions made her eyes dart around as she tried to work out how she could escape, aware again of how urgent it had become.

  His mouth leaned towards her ear as he whispered, ‘Not good enough. Why didn’t you tell me you were working at the police station?’