Читать книгу Midwives On-Call - Алисон Робертс - Страница 30

RUBY DOWELL WAS seventeen years old, twenty-two weeks pregnant and terrified. She was Oliver’s first patient at the Victoria.

She was also the reason he’d started so soon. He’d been recruited to replace Harry Eichmann, an obstetrician with an interest in in-utero procedures. Oliver had started the same way, but for him in-utero surgery was more than a side interest. For the last five years he’d been based in the States but he’d travelled the world learning the latest techniques.

The phone call he’d had from Charles Delamere, Victoria’s CEO, had been persuasive, to say the least. ‘Harry’s following a girlfriend to Europe. There’s no one here with your expertise and there’s more and more demand.

‘It’s time you came home. Oliver, right now we have a kid here with a twenty-one-week foetus, and her scans are showing spina bifida. Heinz Zigler, our paediatric neurologist, says the operation has to be done now. He can do the spinal stuff but he doesn’t have the skills to stop the foetus aborting. Oliver, there are more and more of these cases, and we’re offering you a full-time job. If you get here fast, we might save this kid shunts, possible brain damage, a life with limited movement below the waist. Short term, I want you to fight to give this kid a happy ending. Long term we’re happy to fund your research. We’ll cover the costs of whatever extra training you want, any staff you need. We want the best, Oliver, and we’re prepared to pay, but we want you now.’

The offer had been great, but he’d had serious reservations about returning to Melbourne. He’d walked away from his marriage five years ago, and he’d thought he’d stay away. Em had deserved a new life, a chance to start again with someone who’d give her what she needed.

And it seemed his decision had been justified. Seeing her this morning, driving a family wagon, with milk stains on her shoulder, with every sign of being a frazzled young working mum, he’d thought …

Actually, he hadn’t thought. The sight had knocked him sideways and he was still knocked sideways. But he needed to focus on something other than his marriage. After a brief introduction with Charles, he was in the examination room with Ruby Dowell. Teenage mother, pregnant with a baby with spina bifida.

‘At twenty-two weeks we need to get on with this fast,’ Charles had told him. ‘There’s such a short window for meaningful intervention.’

Ruby was lying on the examination couch in a cubicle in the antenatal clinic and, as with all his patients, he took a moment at the start to assess the whole package. Her notes said she was seventeen. She’d been attending clinics in the Victoria’s Teenage Mums-To-Be programme. When the spina bifida had been detected on the scans she’d been offered termination but had declined, although the notes said she intended to give the baby up for adoption after birth. Right now she was dressed in shorts and an oversized T-shirt. Her mouse-blonde, shoulder-length hair was in need of a wash and a good cut. Apart from the bump of her pregnancy she was waif thin, and her eyes were red-rimmed and wide with fear.

She looked like a wild creature trapped in a cage, he thought. Hell, why was she alone? Her notes said she was a single mum, but she should have her mother with her, or a sister, or at least a friend.

It was unthinkable that such a kid was alone. Charles had said that Isla, his daughter and also the Victoria’s head midwife, was in charge of the Teenage Mums-To-Be programme. Why hadn’t she organised to be here, or at least sent a midwife in her place?

But now wasn’t the time to head to the nurses’ station and blast the powers that be for leaving her like this. Now was the time for reassurance.

‘Hey,’ he said, walking into the cubicle but deliberately leaving the screens open. He didn’t need to do a physical examination yet, and he didn’t want that trapped look to stay a moment longer. ‘I’m the baby surgeon, Oliver Evans. I’m an obstetrician who’s specially trained in operating on babies when they’re still needing to stay inside their mums. And you’re Ruby Dowell?’

He hauled a chair up to the bedside and summoned his best reassuring manner. ‘Ruby, I’m here to get to know you, that’s all. Nothing’s happening right now. I’m just here to talk.’

But the terrified look stayed. She actually cringed back on the bed, fear radiating off her in waves. ‘I’m … I’m scared of operations,’ she stuttered. ‘I don’t want to be here.’

But then the screen was pulled back still further. A woman in nursing uniform, baggy tunic over loose pants, was fastening the screen so Ruby could see the nurses’ station at the end of the corridor.

Emily. His wife.

His ex-wife? She’d never asked for a divorce but it had been simply a matter of signing the papers, any time these last five years.

‘I’m scared of operations, too,’ Em said, matter-of-factly, as if she’d been involved in the conversation from the start. ‘I think everyone is. But Dr Evans here is the best baby surgeon in the known universe, I promise. I’ve known him for ever. If it was my baby there’d be no one else I’d want. Dr Evans is great, Ruby. He’s kind, he’s skilled and he’ll give your baby the best chance of survival she can possibly have.’

‘But I told you … I don’t want her.’ Ruby was sobbing now, swiping away tears with the back of her hand. ‘My mum said I should have had an abortion. She would have paid. I don’t know why I didn’t. And now you’re operating on a baby I don’t even want. I just want you all to go away.’

In-utero surgery was fraught at the best of times. It was full of potential dangers for both mother and baby. To operate on a mother who didn’t want her baby to survive …

He didn’t know where to start—but he didn’t need to, because Em simply walked forward, tugged the girl into her arms and held her.

Ruby stiffened. She held herself rigid, but Em’s fingers stroked her hair.

‘Hey, it’s okay, Ruby. We all know how hard this is. Pregnancy’s the pits. You feel so on your own, and you’re especially on your own. You decided not to go ahead with an abortion, going against what your family wanted you to do. That took courage, but there’s only so much courage a girl can be expected to show. That’s why Isla’s been helping you and it’s why I’m here now. I’m your midwife, Ruby. I’ll be with you every step of the way. All the decisions will be yours but I’m right with you. Right now, if you want Dr Evans to go away and come back later, he will. Just say the word.’

She met Oliver’s gaze over Ruby’s shoulder and her message was unmistakable. Back me up.

So Em was this girl’s midwife? Then where the hell had she been when he’d walked in?

Coping with her crashed car, that’s where, and then changing out of her mum clothes into nursing gear. Still, surely she could have made it earlier.

‘We’ve had a drama with a prem birth I had to help with,’ she said, as if he’d voiced his question out loud. She was still holding, still hugging, as Ruby’s sobs went on. ‘That’s why I’m late, Ruby, and I’m sorry. I wanted to be here when you arrived. But I’m here now, and if you decide to proceed with this operation then you’re my number one priority. Do you need some tissues? Dr Evans, hand me some tissues.’

‘You helped with an earlier birth?’ he asked, before he could help himself, and she had the temerity to glare at him.

‘Yep. I had to step in and help the moment I hit the wards. Plus I crashed my car this morning. I crashed my wagon, Ruby, and guess whose gorgeous car I drove into? None other than Dr Evans. It’s his first day on the job and I hit him. It’s a wonder he hasn’t tossed me out of the room already.’

And Ruby’s sobs hiccupped to a halt. She pulled back and looked at Em, then turned and stared at Oliver.

‘She hit your car?’

‘Yes,’ he said. He wouldn’t normally impart personal information to a patient but he guessed what Em was doing, and he could only agree. What Ruby needed was space to settle. He could help with that—even though he had to get personal to give it to her.

‘I have a sixty-four Morgan Plus-4 sports car,’ he said, mournfully, like the end of the world was nigh, which was about how he’d felt when he’d seen the damage—before he’d realised the driver of the other car had been Em. ‘It’s two-tone burgundy with black interior, a gorgeous two-seater. It’s fitted with super sports upgrades, including twin Weber carbs, a Derrington header and a bonnet scoop. It also has chrome wire wheels, a badge bar with twin Lucas fog lamps and a tonneau cover. Oh, and it’s retrofitted with overdrive transmission. Now it’s also fitted with one smashed side—courtesy of your midwife.’

‘Yikes,’ Em said, but she didn’t sound in the least subdued. ‘Twin Weber carbs and a Derrington header, hey? Did I damage all that?’

‘And if you knew how long it took to get those fog lamps …’

‘Whoops. Sorry. But you scratched my car, too.’ But Em was talking at Ruby rather than at him and she still sounded cheerful. Chirpy even.

‘Scratched …’ he muttered, and she grinned.

‘That’s okay. I forgive you. And they’re cars. They’re just things. That’s what insurance is for. Whereas babies aren’t things at all,’ Em continued, leading seamlessly back to the reason they were all there. ‘Ruby, your little girl is a person, not a thing, and she’s far, far more precious. You made the decision to go ahead with this pregnancy. You made the decision early not to choose abortion and you chose it again when the scan showed spina bifida. But you’ve been telling me you think you might have her adopted when she’s born …’

‘I can’t … deal with it.’

‘You don’t have to deal with it,’ Em said soundly. ‘There are lots of parents out there who’ll give their eye teeth to have a baby like yours to love. That’s right, isn’t it, Dr Evans?’

‘I … Yes.’ But her words were like a punch in the gut. That last night … He’d tried to make her see one last time. ‘Em, I can’t. I know adoption’s the only way, but I can’t do it. I can’t guarantee to love a child who’s not our own.’

‘It will be our own.’

‘Em, no.’

It had been their last conversation. He’d turned and walked away from the only woman he’d ever loved and it had nearly killed him. But she’d deserved the family she’d wanted so much. He’d had to give her that chance, and from the evidence he’d seen today, she’d taken it.

But now wasn’t about him. It was all about Ruby. The kid’s terror had been put aside. He had to take advantage of it.

Which meant putting thoughts of Em aside. Putting aside the knowledge that his wife, his ex-wife, presumably—did you need to formally sign papers to accept a marriage was over?—was in the same room.

‘Ruby, you created this little girl,’ he said, as Em continued to hold her. ‘You can have her adopted at birth, but until then you need to look after her. And the staff here have already explained to you—to look after her means an operation now.’

‘But why?’ Ruby demanded, suddenly belligerent. ‘I don’t understand. The kid’s got spina bifida—Dr Zigler showed me on the scans. What difference does it make whether you operate now or operate when it’s born?’

There was fear behind the question. Oliver recognised it. He’d done many in-utero procedures by now, and sometimes one of the hardest things was having the mum understand that the tiny child inside her was an independent being already. Something totally separate from her. This was a child who could be shifted in her uterus, who even at twenty-two weeks could cope with complex surgery and then be resettled, because, no matter how amazing the technology, the womb was still the safest place for her to be.

‘Ruby, you know your baby has spina bifida,’ he said now, gently. Em still had her arm around the girl. He was talking to them both, as he’d normally talk to a woman and her partner, or a woman and her mum or support person. Em had slid naturally into that role. A good midwife sometimes had to, he thought, and Em had always been brilliant at her job. Efficient, kind, skilled and empathic. He’d worked with her once and he’d loved it.

It was totally disconcerting to be working with her again, but he needed to focus on Ruby.

‘You know we’ve picked up the spina bifida on the ultrasound,’ Oliver said matter-of-factly, trying to take the emotion out of the situation. ‘You’ve seen it?’

‘It just looked blurry. I couldn’t figure it out.’

So she didn’t understand. ‘Heinz Zigler’s a great paediatric neurologist,’ Charles had told him. ‘He’s technically brilliant, but communication’s not his strong suit. He’ll do the spinal surgery but everything else—including explanations to the mum—we’re leaving to you.’

So now he needed to explain from the ground up. ‘The scans do look blurry,’ he admitted. ‘I have trouble reading them myself. Fine detail like the nerve exposure around vertebrae needs incredibly specialised knowledge to see, but the radiologists here are superb. They’ve double-checked each other’s work, and Dr Zigler agrees. Everyone’s sure. But would you like me to explain what I think is happening? I don’t talk in fine detail, Ruby. I just see the overview. That’s actually what I do, total patient care, looking after you as well as your baby. I’m an obstetrician and a surgeon who specialises in looking after mums and bubs if bub needs an operation before it’s time for her to be born.’

Silence. Ruby cast him a scared look and subsided. He waited, while Ruby pulled herself together a bit more, while Em handed her a wad of tissues, while both women readied themselves to front what was coming.

‘Heinz says he told you the fine detail,’ he said at last, when he thought Ruby was as ready as she was going to be. ‘But here’s the broad outline. The bones of your baby’s spine—the vertebrae—haven’t formed properly to protect your baby’s spinal cord. The spinal cord holds the nerves that control your baby’s movements. Because those nerves run right through the body, if the cord gets damaged then long term, your baby might not be able to walk. She might not have control of her bladder and bowel. If she has a severe problem she can also end up with a build-up of fluid in her brain. Then she’ll need a shunt, all her life, to drain the excess fluid and relieve pressure.’

Ruby was crying again now, but not sobbing. Em’s arm was around her, holding her close, but Ruby’s attention was held. Her distress was taking second place to her need to know, and she seemed to be taking it in.

‘So,’ she whispered. ‘So?’

‘So the good thing is,’ he said, still gently, ‘that many problems of spina bifida aren’t directly caused by the spina bifida itself. Doctors cleverer than me, like Heinz—did you know he’s top in his field in research?—have worked out that the exposure of the spinal cord to the normal fluid in your womb, the amniotic fluid, is what progressively destroys the exposed nerves during pregnancy. If we can operate now, really early, and cover the exposed cord, then we prevent much of the damage. Your baby’s much more likely to be able to live a normal, happy life.’

‘But not with me,’ Ruby whispered.

That was another issue altogether. Adoption. This was a single mum, a teenager, facing a life apart from the baby she was carrying.

‘You haven’t decided definitely on adoption,’ Em murmured, and the girl shook her head.

‘I can’t think …’

‘And you don’t need to think.’ Em’s hold on her tightened. ‘There’s too much happening now for you to think past what you need to face right now. But, Ruby, regardless of what you decide to do when your baby’s born, regardless of whether you decide you can care for her yourself or if you want to give her to parents who need a baby to love, she’ll still be your daughter. You have the choice now to make a huge difference in your daughter’s life.’

‘You’re … sure she has to have this operation?’ Ruby whispered. ‘I mean … really sure?’

‘We’re sure,’ Oliver told her, suddenly immensely grateful for Em’s presence. Without Em he doubted whether he’d have been able to get past the fear. ‘But the operation’s not without risks.’ He had to say that. There was no way he could let this kid agree to surgery without warning her. ‘Ruby, there are risks to you and risks to your baby. I believe those risks are small but they’re still there.’

‘But … I will make a difference.’

‘Heinz tells me that because the spinal cord exposure is relatively high and very obvious on the ultrasound, then if we leave the operation undone, your daughter will probably spend her life in a wheelchair,’ he said bluntly. ‘And with the amount of exposure … there will be fluid build-up in the brain. She’ll need a shunt and there may even be brain damage.’

‘That’s why Dr Evans has arrived here so fast,’ Em went on smoothly. ‘We haven’t had a specialist in-utero surgeon on staff, but when we saw your ultrasound Dr Zigler knew we had to get the best obstetrician here as fast as we could. That’s who Dr Evans is. The best. So now it’s up to you, Ruby, love. Will you let us operate on your baby?’

‘Heinz and I can close the gap over the cord,’ Oliver told her. ‘There’s probably already a little damage done, but it’s so early that damage should be minimal. What we’ll do is put you to sleep, cut the smallest incision in your tummy as possible—you’ll be left with a scar but I’m very neat.’ He grinned at the girl, knowing a bit of pseudo modesty often worked, and he got a shaky smile in return. ‘Then we’ll gently turn your baby over where she’s lying—with luck we won’t have to take her out. Once her back is exposed Heinz will check everything, tweak things to where they should be, then we’ll close the gap over her spinal cord. We’ll settle her back down again and tuck her in, stitch you up and leave you both to get on with your pregnancy. You’ll need to stay in hospital for about a week, maybe a bit longer, until we’re sure we haven’t pressured bub into coming early, but then everything should proceed as normal.’

‘And she won’t have to be in a wheelchair?’

‘Ruby, we can’t make any promises.’ He caught her hand and held it. Em was still hugging her, and Oliver thought, not for the first time, Em was a wonderful midwife. She knew when to intervene and she knew when to shut up. She also exuded a quiet calm that was a tranquilliser all by itself.

He’d met her ten years ago. He’d been a barely qualified doctor, she’d been a student nurse, but already the confidence she’d engendered in the patients he’d worked with had been impressive. He’d seen her with some terrified teenage mums.

There was no nurse he’d rather have by his side and by the time they’d dated twice he’d known there was no woman he’d rather have with him for ever. Their attraction had been instant, their marriage inevitable.

It was only babies … or lack of babies … that had driven them apart.

The night their son had been stillborn had been the worst night of his life. He’d watched Em’s face contort with an anguish so deep it had seemed endless, and there had been nothing he could do to stop it. He’d been unable to help her. He’d been unable to reach her.

But it was hardly the time to be thinking of that now. It was hardly the time to be thinking of it ever. After five years, they’d moved on.

‘I can’t make any promises,’ he repeated, hauling himself back to the here and now, to the needs of the teenage kid in front of him. ‘The procedure Heinz and I are trained to perform usually has an excellent outcome but there are exceptions. I won’t hide that from you, Ruby. There are risks. There’s a chance of infection, for you as well as your baby. We’ll take every care in the world …’

‘But no guarantees.’

‘No guarantees,’ he agreed. ‘So it’s up to you. This is your daughter, Ruby. It’s up to you to make the choice.’

‘I’m too young to have a daughter.’ It was a wail and Em’s arm tightened around her.

‘That’s where I come in,’ she said solidly, a blanket of comfort and reassurance. ‘You want advice, I’m full of advice. You want a hug, that’s what I’m here for, too.’

‘You can’t be here with me all the time.’

‘I can’t,’ Em agreed. ‘I have my own son and daughter to look after. But I’m here every day during the week, and if I’m needed, I can come in at other times. My mum lives with me so I can usually drop everything and come. I don’t do that for all my mums, but I’ll try for you.’

‘Why?’ Ruby demanded, suspicious.

‘Because you’re special,’ she said soundly. ‘Isn’t that right, Dr Evans? You’re one special woman, and you’re about to have one special daughter.’

But Oliver was hardly listening. Somehow he managed to make a grunt of acquiescence but his mind felt like it was exploding.

I have my own son and daughter to look after.

Somehow … a part of his brain had hoped—assumed?—that she’d stayed … as Em. The Em he’d left five years ago.

She hadn’t. She’d moved on. She was a different woman.

I have my own son and daughter to look after …

‘What do you think, Ruby?’ Em was saying gently. ‘Do you want to go ahead with the operation? Do you want time to think about it?’

‘I don’t have a choice,’ Ruby whispered. ‘My baby … It’s the best thing …’

It was. Oliver watched Ruby’s hand drop to cover the faint bulge of her tummy, the instinctive gesture of protection that was as old as time itself.

And the gesture brought back the wedge that had been driven so deep within his marriage that it had finished it. Em had wanted to adopt, and he’d known he couldn’t love like parents were supposed to love. He was right, he thought bleakly. He’d always been right. What was between Ruby and her baby was what her baby needed. Ruby was this baby’s mum. Adoption was great if there was no choice, but how could an adoptive parent ever love a child as much as this?

He knew he couldn’t and that knowledge had torn his marriage apart.

But Em was watching him now, with those eyes he’d once thought he could drown in. He’d loved her so much, and yet he’d walked away.

And she’d walked, as well.

I have my own son and daughter to look after.

It was nothing to do with him. He’d made his choice five years ago, and Em had obviously made choices, too.

He needed to know what those choices had been.

But now wasn’t the time or the place to ask. All he could do was turn his attention back to Ruby, reassure her as much as possible and then set about working out times and details of the forthcoming surgery.

As they finished, a woman who introduced herself as one of the hospital social workers arrived. It seemed Ruby needed help with housing—as well as everything else, she’d been kicked out of her parents’ house. She was staying in a boarding house near the hospital but she wouldn’t be able to stay there when the baby was born.

There’d be more talk of adoption. More talk of options.

Ruby’s surgery was scheduled for the day after tomorrow, but for now he was redundant. He was free to head to the next mum Charles had asked him to see.

He left, but his head was spinning.

Em was still sitting on the bed, still hugging Ruby. I have my own son and daughter to look after.

Whatever she’d done, it had been her choice. He’d walked away so she’d have that choice.

Why did it hurt so much that she’d taken it?