Doctor on Loan

by Marion Lennox

  But they’d left it too late. Now Liz was lying pale and frightened and tiny, her giant of a husband was wringing his hands in fear and both were looking to her as if she could produce a miracle. She must!

  ‘Can you do a Caesarean here?’ Henry demanded as she entered the room. ‘The Townsville doctors said she’ll never deliver normally. Christie, you must be able to do a Caesarean…’

  ‘Let’s see what’s happening first,’ she told them, her heart sinking. She’d set up a Ventalin drip last night, which had seemed to have stopped Liz’s early contractions, but now…One look as she lifted the sheet over Liz’s tummy told her that these contractions weren’t intending to stop.

  Christie thought back to the scans the Townsville obstetrician had sent her. ‘The baby’s head is almost bigger than the pelvic span at thirty weeks,’ he’d written bluntly. ‘There’s no way he’s coming out the way God meant him to. I’d like her to stay in Townsville now, but she refuses. Make sure she’s well back here by thirty-six weeks.’

  Liz was still only thirty-five weeks but the baby had ideas of his own as to when he was due. Like now!

  Help…

  She checked the CTG and her heart sank further. The baby’s heart rate was fluctuating from 130 down to 100, with a slow recovery phase. Double help…

  ‘Do you want me to fetch Dr Stan?’ Louise asked as Christie timed the contractions. Louise was the island’s most junior nurse, but even she knew that what was happening here spelled serious trouble. The contractions were two minutes apart and quickening.

  ‘No.’ What could her grandfather do except feel angry about his helplessness?

  But what could she do alone? Why on earth had she chosen to practise medicine in such an isolated place?

  At medical school her friends had mocked her. ‘You’ll do nothing but stitch up fishing accidents and call in the air ambulance to evacuate patients,’ they’d told her.

  But they hadn’t understood Briman Island’s pull. A child of brilliant but distant parents, Christie had spent every holiday she could here with her doctor grandparents and she’d known how much the islanders had loved their Dr Stan and Dr Martha. They’d needed them, and for forty years her grandparents had coped with depression, snakebite, fevers…Everything.

  Her grandparents had loved the island, and so had Christie, so when Grandma Martha—or Doc Martha as the islanders had called her—had died, Christie hadn’t hesitated to take her place. After all, Grandpa was just seventy, she’d thought, so they could be partners. He couldn’t work alone.

  As she couldn’t now. Grandpa’s stroke had robbed her of her helpmate, and no one else would come. To practise in such an isolated place…‘You’d have to be mad,’ her friends had said, and right at this minute Christie was inclined to agree.

  Dear heaven…

  With the foetal heartbeat dipping to a hundred, this baby was obviously in the early stages of distress. He wasn’t too bad yet, the heartbeat was strong enough, but if she waited any longer…

  This baby wasn’t waiting until the weather cleared—if she waited any longer and there were further signs of foetal distress she’d be in even worse trouble. To perform a Caesar and then have a flat or distressed baby at the end of it…

  She’d have to do a Caesar, but to do it alone…

  She thought it through, trying to figure out how the Caesars she’d performed in the past could have been done with one doctor.

  Could they?

  She’d have to use a general anaesthetic. She was fighting panic and forcing her frightened mind to think. An epidural was what was best for the patient—especially for a premature baby—but she couldn’t manage a conscious patient, an epidural anaesthetic, the huge incision a Caesarean needed, plus a newborn baby.

  She could hardly cope with it under general anaesthetic—but at least if she gave the initial anaesthetic, maybe they could rig up a mainland phone link so an anaesthetist could talk Mary-anne through the rest of the procedure while she herself operated. Could Grandpa do it?

  No, she thought. It might work, but if he got confused halfway through and gave Mary-anne the wrong instructions or the wrong dosage—No!

  And if the baby needed help?

  It didn’t bear thinking of. All her attention would need to be on Liz. She could hardly stop bleeding and resuscitate a newborn babe at the same time.

  What was the alternative? There wasn’t any, she decided bleakly. This baby wasn’t planning on waiting until the weather cleared and they could get a plane to land. The forecasters were saying two days of high winds. Two days…

  She did a vaginal check, and grimaced. The obstetrician had been right. Liz’s pelvis was so small…

  The baby hadn’t started moving down yet. That was one thing at least. Liz was hardly dilated at all and the baby was still OK. There was no frantic rush, but if she had to operate then she preferred to operate now, before there was one. If the baby’s heart rate faltered there’d be no time to set up the phone links.

  ‘Get Mary-anne from Mr Tallent’s room,’ she told Louise. At least Mary-anne was a midwife. Even trained nurses were thin on the ground on this island. ‘Tell her I need her now. Everything else can wait. You go back onto ward work. Keep up the obs on Mr Tallent, and Mary-anne and I will take over here.’ She needed two more nurses at least, but Mary and Ben still needed attention in the kids’ ward and she couldn’t conjure nurses out of thin air.

  She turned to Liz, took her hand and steadied her own racing heart. She needed to be calm, confident and reassuring to these people—which was the last thing she felt, but needs must. ‘Liz, you realise we need to do a Caesarean. Your little one wants to make it into the world, and he won’t wait for the weather to clear!’

  ‘But…’ Liz faltered. ‘Can you do it on your own?’

  ‘Mary-anne’s a trained midwife,’ Christie told her, still holding onto that smile of reassurance which was a total lie. ‘So there’s no problem. Just lie back and think about baby names.’

  ‘But…’ Liz had obviously been doing pre-natal reading. ‘You can do it with an epidural?’

  ‘I’m afraid I can’t,’ Christie told her. ‘We’ll do it under a general.’

  ‘Oh, no!’ It was a terrified whisper.

  ‘It’ll be fine,’ Christie said strongly, much more strongly than she felt. Please, God…

  It took a while for Mary-anne to arrive. There must problems elsewhere in the hospital, Christie figured as she made her preparations. Mary-anne knew the need was urgent.

  Great! That was all she needed. Both nurses were gone for far too long. Something must have delayed them.

  Please, don’t let Hugo Tallent’s headache be getting worse. A vision of two patients on two operating tables flicked into her exhausted mind, and the vision almost overwhelmed her.

  She blocked it. She couldn’t investigate. There was no time, and triage told her this was her priority. There were two lives at risk here—Liz’s and her baby’s.

  Forcing herself to keep steady and measured, she explained the procedure she intended to use to a terrified Liz and Henry. She sorted her equipment, she set up the humidicrib so it would be warm to receive the baby, and was sorting drugs when the ward door swung open. Thank heaven…

  It wasn’t just Mary-anne, though. It was Mary-anne following a wheelchair, and the wheelchair held Hugo Tallent!

  Why on earth was he here?

  Hugo was dressed—sort of—in a green hospital gown. His leg was out on a support in front of him, a drip stand was attached to the back of the chair and he looked every inch an invalid. Except for his expression. His face held the look of a man who wasn’t letting anything stand in his way. Christie’s gaze turned to Mary-anne, and Mary-anne looked as stunned as she was.

  ‘I couldn’t stop him,’ the nurse said helplessly. She was holding the handles of his wheelchair but Hugo had been propelling himself. ‘He said he needs to see you.’

  Christie took a deep breath. Great! This was all sh
e needed—a nut case as a patient.

  ‘Mr Tallent, I’m busy,’ she told him brusquely, pushing her stray curls back from her forehead and trying not to lose focus. She had so much to concentrate on that she felt dizzy! Somehow, though, she made her voice as stern as she could—doctor supremely unimpressed by recalcitrant patient! ‘This is a private ward, and Mrs Myers is having a baby. Could you, please, return to your room? Now!’

  ‘Mary-anne says you’re attempting a Caesarean on your own.’ He was intent on his own line of thought, and his voice was flat and incisive.

  ‘Yes, but what—?’

  ‘You can’t do it.’

  ‘Of course I can,’ she said bluntly. The last thing she wanted was someone voicing her own uncertainties. ‘Mary-anne’s a trained midwife and—’

  ‘You need an anaesthetist.’

  ‘I don’t have one,’ she snapped. ‘This is none of your business. Will you get back to bed?’

  ‘You do have one,’ he told her, his eyes resting on hers. Despite the incongruity of his appearance, his look was steady, sure and strong, telling her that he spoke the absolute truth. ‘And, no, I won’t go back to bed. I’m a qualified anaesthetist and I’m here to help.’

  Silence.

  More silence and more silence still. It was all Christie could do to breathe.

  An anaesthetist! She had an anaesthetist right here!

  Right up to that moment she hadn’t realised how scared she’d been. She put out a hand and held onto the bed, and suddenly she needed that support to stop herself falling. Her weariness was almost overwhelming.

  ‘You’re an anaesthetist?’ she managed, and her voice actually squeaked.

  ‘Yes.’

  ‘But you’re a—’

  ‘Dope?’ He smiled, his dark eyes creasing into laughter. ‘Agreed. But just because I’m a dope as a sailor, it doesn’t make me a dope as an anaesthetist.’ He looked over at the woman on the bed and, despite his ridiculous dress and invalid appearance, his eyes were warm and infinitely reassuring. It seemed he guessed the young mother’s terror.

  ‘I qualified as a doctor fifteen years ago,’ he told Liz, and there may as well not have been any other person in the room. ‘I’ve been working as an anaesthetist at Royal South Hospital in Brisbane for the last five years. If you or your husband contact my hospital they’ll give you all the professional references you need. Hey—just imagine I’m on temporary loan from the city. Believe it or not, I’m extremely competent.’

  He looked down at his hospital gown and grinned. ‘They say appearance maketh the man, but it’s not always true. I’m very good at giving anaesthetics for Caesareans. I can practically do it with my eyes closed. So how about it, ma’am? Will you let a one-legged, undressed, half-drowned sailor give you an anaesthetic?’

  Christie stared. So did Liz. As Liz’s eyes widened, so did Hugo’s smile. He was still totally focussed on Liz. The most important thing at the moment was to allay her terror, and he knew it.

  ‘I promise you that I’m competent and fit enough to operate,’ he told Liz, still intent on reassurance. ‘I know I’ve just been spectacularly soaked. I have a sore knee and a headache, but for the benefit of Dr Flemming, who I’ll bet is not exactly aching to drill burr holes after she’s performed a single-handed Caesarean, if I had major damage my headache would be worse by now—not fading, as it is. So I’m fine.’ Then, with a sideways smile at Christie—he was reassuring her as well as Liz, Christie realised—he added a rider to Liz and her husband.

  ‘Dr Flemming is capable of giving you the anaesthetic—I have no doubt of that—but, working alone, she’ll need to put you to sleep. She’ll give you a general anaesthetic. Also she’ll have no one to help when the baby’s born. I can give you an epidural so you can watch your little one arrive in the world, and I can be there to assist the baby if there’s a need.’

  ‘But…’ Liz sounded almost as befuddled as Christie. She was clutching her husband’s hand. Another contraction had just passed and she was no longer in control, but she needed to be sure. ‘You don’t look like a doctor.’

  ‘I don’t.’ Hugo flashed another of those magnetic grins. ‘But, to be fair, neither does Dr Flemming. At least I don’t have freckles and I look more than twelve! I’ll admit that in this hospital gown I’m even less respectable from behind than from the front, but you need to ignore appearances here. Concentrate on what’s important.’

  Then he reached to take Liz’s hand, and in that touch Christie knew that he surely was a doctor. With that one touch—and from the look in his eyes—she knew that Hugo had stood at patients’ bedsides a thousand times, and he’d dispensed comfort and reassurance wherever he’d been.

  And somehow, despite his appearance—despite the fact that he looked as if he was about to be operated on rather than operate himself—she knew instinctively that he was all that he’d said he was. And inexplicably she knew that he was good.

  ‘Trust me,’ he said softly to Liz. ‘Yes?’

  ‘Y-yes,’ she said, her voice wavering. She looked at Christie. ‘I…Will you get my baby out?’

  ‘Of course we will,’ Christie told her. There was nothing else to say. ‘There are no problems here, Liz. We’ll take you into Theatre straight away and introduce ourselves to your impatient son.’

  It went like clockwork.

  Christie could hardly believe it. After all her fears…

  They adjusted the operating table to make it as low as possible so Hugo could stay in his wheelchair. It was lucky that Christie was short and Hugo was tall—they could cope okay.

  Whatever—Christie was no longer solely in charge. As they worked, organising equipment, setting up the table and scrubbing, Christie tried to fill Hugo in on Liz’s background, but when they returned to the table Hugo fired off his own swift questions at Liz. Background. General health. Allergies.

  He was double-checking her work, Christie thought with sweeping relief. She’d do that herself if she were him. Double-check all the time…

  ‘Have you given steroids?’ he asked.

  ‘Yes,’ she told him, flushing. ‘Dexamethasone. I gave it yesterday at the first sign of labour.’

  ‘Great.’ And he gave her an assessing stare—the kind she’d had in the past. Anaesthetist wondering just what sort of surgeon he had here…

  She didn’t care, she thought dazedly. He could give her any kind of stare he wanted. He was the answer to her prayers!

  Once started, for the first couple of moments she watched him, but it only took that time to be sure he knew his stuff. He handled the monitors as if born to them. She watched as he filled the first syringe, she listened to the orders he snapped at Mary-anne and finally she relaxed.

  She returned to monitoring the baby and preparing her own equipment as he moved Liz onto her side and skilfully injected the epidural drugs into her spine.

  If a medical council demanded why she’d let an unqualified doctor near her patient she’d have to defend this as a life-or-death decision, she thought, but this man couldn’t be unqualified. He’d done this before, he’d done it recently and he’d done it well.

  So all she had to do was concentrate on her part. To retrieve one baby.

  The epidural was taking hold. As Christie set up a catheter, Hugo was touching Liz’s skin, asking about sensations, watching her face. Her legs were numbing, and slowly the anaesthetic took hold over her abdomen.

  ‘Can you feel this?’ Hugo asked as he touched her swollen tummy, and she shook her head.

  ‘Right.’ He smiled at Christie. ‘Nearly there. Over to you, Dr Flemming. Let’s see what you can do.

  ’Mary-anne set up a sheet to block the incision sight from Liz and Henry, and Christie swiftly prepped Liz’s swollen tummy. Her eyes flicked to Hugo’s. He gave a swift nod and a reassuring smile—the area was completely numbed by now and she could move.

  She took one last flickering glance at the screen showing the baby’s heartbeat. It was dipping to ninety-fi
ve. This baby was as ready now as he ever would be to come into the world. He needed to be born.

  She lifted the scalpel. Now Hugo was on his own—she had eyes only for what she was doing—but maybe he was more competent than she was.

  She took a deep breath, but there was no room for indecision. She had to go in and she had to move fast. She looked up at Hugo, gave him a brief nod in return—and then moved. She made a long, sweeping, transverse incision, just as if she did this three times a day. Ha! She hadn’t done one since she’d come to the island.

  But her basic knowledge was sound. The procedures had been thoroughly instilled into her, and they came back as if by instinct. Thank God! She carefully mobilised the bladder downwards. The uterus lay exposed, stretched to the limit…

  Mary-anne moved in with the sucker as Christie carefully cut the uterine membranes and the amniotic fluid gushed forth. Then the forceps magically landed in her hand. That was Hugo, acting as assistant as well as anaesthetist. He’d seen that she needed them but Mary-anne wasn’t free. There was no time for acknowledgement.

  Where…?

  The tiny head was right where it was meant to be. It was a perfect normal presentation. Thanks be. There wasn’t a hitch.

  Liz could feel nothing and even Henry was holding up well. Christie had seen big men go down in dead faints as they’d watched their wives deliver, but Henry sensed—as they all did—that there was no room for nonsense here. He was talking Liz through what they were doing and she was even answering him in soft murmurs while Christie manoeuvred the forceps around the baby’s head. There was no possibility of Liz doing that if the epidural was the least flawed.

  It wasn’t. There was no pain at all. Carefully, skilfully, Christie brought the baby forward, lifting its head clear and then scooping it out to lie it on his mum’s tummy.

  This was the crucial time. Heavens, the bleeding…The baby…

  But Hugo was there. She wasn’t alone. She could clear away the placenta and tend to the bleeding while Hugo clamped and cut the umbilical cord. She was dimly aware of him clearing the baby’s airway as Mary-anne swabbed and she started to suture the uterus. They were acting together as one, each instinctively knowing what was needed.