Rivals in Practice

by Alison Roberts

  ‘We need you, Jen. Liz has been in second stage labour for over an hour. The baby hasn’t turned and I’m not happy. Liz is exhausted and the foetal heart rate is dropping slightly during contractions.’

  Wendy’s face appeared beside Suzanne’s. ‘Liam’s ECG is showing a few irregularities,’ she informed Jennifer. ‘Can you come?’

  Andrew watched as Jennifer straightened her back. He could see the determination to cope in her face as it settled into a look of grim focus. She must be as tired as he was. She’d worked a full day before being called out to that accident site and she’d coped brilliantly with the unusual stress of major surgery being conducted in her treatment room. It must be years since she’d worked as an anaesthetist and it hadn’t been easy, dealing with a patient in Liam’s critical condition. She had two patients needing urgent attention now and he suspected that others were waiting. That middle-aged couple from the accident for starters. He swung his legs over the edge of the couch. His loose scrub-suit trousers unfolded to cover the bandage on his leg.

  ‘You see to the baby,’ he told Jennifer. ‘I’ll look after Liam.’

  Gratitude for Andrew’s unexpected offer of assistance stayed with Jennifer until she stepped into the maternity suite. Then everything else was forgotten. Elizabeth looked awful. Her face was puffy and her eyes swollen and red. A considerable number of tears had clearly been shed since Jennifer had last seen her patient. She picked up the damp cloth lying on the bedside locker and sponged her patient’s face gently as she absorbed her impression of the young woman’s condition and watched the trace of the foetal monitor.

  ‘You’ve been coping so well, Liz. You’re not having an easy time of it, are you?’

  The response was a strangled sob. Liz was lying on her side, curled up as much as possible. She turned and failed in her attempt to smile at Jennifer. ‘I’ve been trying so hard,’ she said miserably. ‘But I’m so tired now and the pain in my back is getting worse and worse.’ Liz sniffed loudly. ‘I’m just glad Peter’s not here. I never want to see him again. This is all his fault.’ She sniffed noisily again. ‘I’ve decided I don’t want a baby any more. Can’t you make it just go away?’

  Jennifer squeezed her hand before reaching for the face mask that lay abandoned beside the pillow. ‘Have a few good breaths of Entonox and then see if you can lie on your back for me. I need to see what this baby of yours is up to.’

  Jennifer felt her patient’s abdomen carefully before donning gloves for an internal examination. ‘You’re fully dilated, Liz, and the baby’s well down in your pelvis, but there’s a wee way to go yet. Are you still getting strong urges to push?’

  Liz groaned. ‘I can’t push any more. It hurts so much and I’m just too tired. I’m sorry, Jen,’ she sobbed. ‘I feel like such a failure.’

  ‘You’re not a failure at all,’ Jennifer said firmly. ‘I know you wanted to manage this by yourself, love, but I think you’ve tried hard for long enough. It’s time we did something about helping this baby out now.’

  Liz nodded but her eyes were fearful. ‘What are you going to do?’

  ‘I’m going to help the baby out with some forceps.’

  ‘Will it hurt?’

  ‘I’m going to give you some local anaesthetic. This should be a simple and quick procedure and I suspect it will be a lot less painful than these contractions you’re having right now.’

  ‘Let’s get it over with, then.’ The effort to smile was more successful this time. ‘Please?’

  Jennifer returned the smile before catching the midwife’s relieved glance. ‘I’ll need some Kielland forceps, Sue. And draw up 20 mls of one per cent lignocaine. I’ll get scrubbed.’

  Suzanne joined Jennifer at the basin a minute later. ‘Do you want me to catheterise Liz?’

  Jennifer shook her head. She had soaped her hands and was reaching for the scrubbing brush. An opened sterile pack lay nearby, containing a gown, gloves and towel. ‘A urinary catheter is good to avoid urethral bruising if it’s likely to be a difficult delivery, but it’s better to minimise the risk of introducing infection to the bladder if we can and I think we’ll get away without one this time.’ Jennifer picked up the towel to dry her hands. ‘This should be straightforward. Liz is fully dilated, the head’s engaged and there’s no obstruction to delivery. The real indication for a forceps delivery here is that Liz is too exhausted to make any further effort herself and we’re starting to see signs of foetal distress.’

  ‘We’re all set, then.’ Suzanne tied the strings at the back of Jennifer’s gown.

  The procedure was as straightforward as Jennifer had hoped. By the time the pudendal block had taken effect, the local anaesthetic had removed even the severe back pain Liz had been suffering. The specialised Kielland forceps were eased into position and Jennifer exhaled a soft breath of relief as she gently rotated the baby’s head from a posterior to an anterior position. With the contraction Liz supplied immediately afterwards, it was only seconds until the baby was delivered. Suzanne was ready with a soft suction tube and then Jennifer lifted the crying infant onto her mother’s abdomen. Liz already had her hands outstretched to touch her baby for the first time.

  ‘It’s a girl, Liz, and she looks just beautiful.’

  ‘One-minute Apgar score of ten,’ Suzanne reported with satisfaction.

  Jennifer was clamping the umbilical cord. ‘The delivery of the placenta shouldn’t take long, Liz. You’ll get a few more contractions but you may not even feel them. How’s the pain now?’

  ‘What pain?’ Liz was crying again but smiling through her tears. ‘Oh, why isn’t Peter here? Isn’t she gorgeous?’

  ‘You’re not even going to need any stitches,’ Jennifer informed Liz. ‘Which is just as well after all this little one’s put you through.’

  ‘Have you decided on a name?’ Suzanne was leaning over the baby.

  ‘I’ve thought of a lot of new ones in the last few hours.’ Liz grinned. ‘None of them were very complimentary. Maybe we should call her Storm.’

  ‘The storm’s over now.’ Jennifer was basking in the peaceful elation that followed a successful birth. Especially a difficult one. But there was more to her response than professional satisfaction. There was the sheer miracle of watching the introduction of a new life and the deep stirring within her own body that was an unmistakable yearning for a baby of her own. Maybe one day.

  ‘Don’t go all clucky on us.’ Suzanne was watching Jennifer as she softly touched the baby’s cheek. ‘We can’t afford to have two doctors out of action.’

  Jennifer wasn’t altogether surprised that Suzanne had caught up with news of Brian Wallace’s angina attack. The community was a small one and the group of hospital employees a tight band within that community. News travelled fast amongst people with a genuine concern for the well-being of those closest to them.

  ‘Fat chance of that,’ she responded lightly. ‘As if I’d have the time. Or the opportunity.’

  ‘I don’t know about that. What’s this I hear about our visiting surgeon being an old boyfriend of yours?’

  That did surprise Jennifer. When had Suzanne had the chance to get filled in on Andrew’s history? The staff had probably had a good gossip while she had been closeted in the consulting room with the man, stitching up that nasty gash on his leg. The story had obviously been embellished along the way. Jennifer would have thought the night had provided more than enough excitement without some fictional account of her love life at medical school.

  ‘He was never a boyfriend,’ she denied emphatically. ‘Merely an acquaintance.’

  ‘A good-looking one,’ Suzanne said with a grin. ‘And what’s he doing here if he wasn’t planning to visit you?’

  ‘He’s on his honeymoon.’

  ‘Oh! That’s a shame.’ Liz had been following the exchange between the doctor and midwife with considerable interest as she cuddled her baby.

  ‘Where’s his wife, then?’ Suzanne asked suspiciously. ‘I hear she w
asn’t in the camper van.’

  ‘He hasn’t got one.’

  ‘Yes, he has. Tom said he parked it at your place.’

  ‘I’m talking about a wife, not a camper van.’

  ‘How can you have a honeymoon without a wife?’

  ‘I’ve got no idea.’ Jennifer was annoyed by the resurgence of her own curiosity regarding Andrew’s absentee wife. She concentrated on examining the placenta, which had been expelled without Liz even noticing. ‘Why don’t you ask Mr Stephenson about that?’

  ‘I couldn’t do that. Far too personal a question.’ Suzanne threw Jennifer a meaningful glance.

  ‘Neither could I,’ Jennifer said firmly. ‘I haven’t even seen the man for nearly eight years, for heaven’s sake. For all I know it’s wife number three that’s done a runner.’

  ‘Yeah, sure.’ Suzanne’s expression implied that a woman running from Andrew Stephenson was an unlikely scenario. And she’d only had a brief glimpse of the stranger. Jennifer sighed. At least the placenta was intact and she could be happy that the delivery was now completely over. ‘I’ll leave Sue to get you tidied up, Liz. I’d better go and see what else needs doing.’ Jennifer straightened and stretched her back, walking towards the window as she stripped off her gown and gloves. ‘Do you know, I think the rain has stopped? Even the wind is dying down.’

  Finding that Liam’s condition was again stable and being effectively monitored by Andrew, Jennifer finally managed to relieve the nurse aide who had been caring for the other accident victims. Michelle met Jennifer outside their room.

  ‘I don’t think there’s much wrong with them,’ she reported. ‘Mr Hessler has a sore arm and Mrs Hessler is crying a lot, but she doesn’t speak much English.’

  It took Jennifer only a few minutes to reassure herself that the Hesslers hadn’t suffered any serious injuries. Although there was no obvious fracture to Mr Hessler’s arm, Jennifer splinted the painful limb and made arrangements to have him taken to Christchurch the following morning for an X-ray. She left Michelle to settle the couple for the night.

  The responsibility for Liam’s care was being transferred by the time Jennifer had completed a quick check on the other inpatients they now had. Sam McIntosh wasn’t showing any signs of serious damage from his head injury and Edith Turner was resting comfortably with her leg elevated. Mrs Dobson and Lester had both slept through the unusual level of activity in the small hospital. John Bellamy was most in need of Jennifer’s attention and as much reassurance as she felt she could honestly give. He travelled with the emergency evacuation team from Christchurch as they transferred his son to Intensive Care by ambulance. As the vehicle pulled away, Jennifer checked her watch to find it was nearly one a.m.

  ‘Go home and get some sleep,’ Margaret told her firmly. ‘Everything’s under control here and Suzanne and Michelle are both going to stay till morning. We’ll get things cleaned up.’

  ‘I’ll stay, too, if you like,’ Wendy offered.

  ‘No, you go home,’ Jennifer told her. ‘I’ll need you again in the morning.’

  ‘I could certainly use some sleep,’ Wendy admitted. ‘What a night!’

  Jennifer smiled at the staff assembled in the hospital kitchen. She was too tired to help make any inroads into the vast pile of sandwiches Ruby had left for them. ‘You’ve all been wonderful,’ she told her nurses and aides. ‘Thank you. I couldn’t have coped without you all.’

  ‘It could have been a lot worse,’ Wendy commented quietly. ‘We were lucky to have Andrew Stephenson to help.’

  ‘Where is Andrew?’ Jennifer asked. ‘Has he had anything to eat or drink?’

  ‘He said he wasn’t hungry,’ Michelle responded.

  ‘I think he’s getting changed,’ Margaret added. ‘Ruby put all his clothes through the drier.’

  Jennifer left the kitchen as the other women prepared to go home or attend to duties. Suzanne was taking some sandwiches and a pot of tea to Liz. Michelle went with Margaret to begin the clean-up required in the treatment room after the surgery. Jennifer made her way down the now quiet and darkened hallway, looking for Andrew. She needed to thank him and find him somewhere to sleep for the rest of the night.

  The light in the office made his whereabouts easy to discover. Jennifer tapped on the half-open door in case he hadn’t finished dressing. Hearing no response, she entered the room. The scrub suit lay neatly folded on her desk. Andrew was tucking his shirt into jeans. He pulled them closed hurriedly but seemed to have difficulty with the fastening.

  ‘I can’t find my shoes,’ he told Jennifer.

  ‘They may not be dry yet.’ Jennifer couldn’t help watching Andrew fumbling with the snap fastening. The difficulty was being caused by the fact his hands were shaking.

  ‘M-my sweater’s m-missing, t-too.’

  Jennifer stared. Andrew was shivering violently enough to stammer and yet he was looking flushed. He clearly wasn’t well and she remembered the coughing spell he’d had earlier. Jennifer pulled the stethoscope from around her neck.

  ‘Don’t do those shirt buttons up,’ she directed Andrew. ‘I want to listen to your chest. Sit down for a minute.’

  ‘I’m fine.’

  Jennifer gave a fairly pithy response to refute Andrew’s claim and she had the disc of her stethoscope on the front of his chest before he could object further.

  ‘Haven’t you had enough doctoring for one night?’ Andrew asked irritably.

  ‘Be quiet,’ Jennifer commanded. She moved around Andrew to listen to his back. Then she felt his forehead before grasping his wrist to take a pulse rate.

  ‘I thought so,’ she said grimly. ‘You’re sick, Andrew. You’ve got a double pneumonia. You’ve got a tachycardia of 130 and you’re hot enough to fry eggs. I’m going to admit you and start some IV antibiotics.’

  ‘Like hell you are. I’ve had quite enough of this place, thanks. I’m going home.’

  ‘And where is home, precisely?’

  Andrew glared at Jennifer. ‘Wherever I want to make it. I want to get back to my camper van.’

  ‘You’re not leaving here until you’ve got antibiotics on board.’ Jennifer was thinking fast. The camper van was on her property. Surely he wouldn’t be crazy enough to try and drive somewhere else in his current condition. She would at least be able to check on him in the morning and enforce further medical treatment if his condition was any worse. ‘You need a course of tablets—enough to last at least ten days. Also, you’ll have to give me your keys until I’ve checked you over tomorrow.’

  ‘You can’t do that.’

  ‘Yes, I can,’ Jennifer said smugly. ‘Your van’s parked at my house. How do you think you’re going to get there?’

  ‘I’ll call a taxi.’

  ‘We don’t have taxis here.’ Jennifer gave Andrew a very direct look. ‘I’m going to find your shoes and sweater and a large syringe. If you don’t want IV treatment then you’re going to start with a loading intramuscular dose somewhere a lot more painful.’ Her smile twisted with something very close to amusement. ‘Don’t bother doing your jeans up. I’ll be back very soon.’

  Andrew looked mutinous as he sat hunched on the passenger seat of her four-by-four fifteen minutes later.

  ‘A loading dose of tablets would have been quite sufficient,’ he muttered.

  ‘Not in my opinion,’ Jennifer told him airily. ‘And if you’re not considerably better in the morning, you’ll be getting another injection.’ She cast a sideways glance at her passenger. ‘What you really need is a set of chest X-rays and a full blood screen.’

  ‘It’s only bronchitis.’

  ‘Yeah, right!’ Jennifer concentrated on the road as she negotiated still flooded patches. At least the tide had turned and waves were no longer breaking on the road. The rain had diminished to a light drizzle and visibility was good even as she left the streetlights and turned up a valley into the hills, following the road to Long Bay.

  Andrew was silent for long enough to make Jenn
ifer look at him with concern. His eyes were shut and a noticeable sheen of perspiration gleamed on his forehead. She should have insisted on leaving him in the hospital overnight. A camper van was no place for someone as sick as Andrew to sleep.

  The rattle as they crossed the wooden bridge over a wide stream made Andrew’s eyes flicker open. ‘Where the hell are we?’ he demanded.

  ‘My ancestral estate,’ Jennifer replied. The tree-lined driveway wound its way up another hill. ‘It was part of a large farm when I was a child but most of it has been sold off now. We’ve got about twenty acres left but a lot of that is native bush.’

  The house was large and square. An old weatherboard structure with two stories and wide verandahs on both levels. A barn stood at right angles to the house and a series of stable doors closed off half the side facing the driveway. The open area at the end of the stalls was lined with bales of hay and long wall hooks that supported farm equipment and tack. Jennifer’s usual parking spot under the shelter of the loft was occupied by the camper van.

  ‘You’ll have to give me the keys.’

  ‘No way.’ Jennifer climbed out of the vehicle. The front door of the house opened beside them and a young woman in a dressing-gown hurried down the verandah steps.

  ‘How am I supposed to get inside, then?’ Andrew sounded exhausted rather than angry as Jennifer opened the passenger door.

  ‘I’ll unlock the van for you.’ Jennifer’s head turned. ‘Hi, Saskia. Everything all right here?’

  ‘Fine, apart from a few tree branches down. The kids are all sound asleep. I waited up for you.’ Saskia was staring openly at Andrew who was hanging onto the car door as he stood up.

  ‘This is Andrew Stephenson,’ Jennifer told Saskia. The girl nodded.

  ‘Doug told me about him when the van got dropped off.’ Saskia was still staring.

  Having finally hauled himself to his feet, Andrew swayed for a few seconds before lurching towards Jennifer. She caught him, supporting his body as she pulled his arm over her shoulders. ‘Andrew’s not feeling very well,’ she said unnecessarily. ‘Can you take his other arm, Sass? We need to get him inside and into a bed.’