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He gave a quick nod and Bonnie shot him a smile. ‘In that case, you’re not making it sound like my dream job. Shouldn’t you be giving me the hard sell? And after our first meeting—do you really want to offer it to me at all?’ Jacob Layton wasn’t good at this. He was being too honest.
He groaned again and sat straighter, giving her a grin that sent tingles to her toes. ‘Let me start again. Bonnie Reid—from your extensive experience on your CV we’ve decided you would be a great addition to our team. You’ll know the reputation of Cambridge Royal Maternity Unit. We employ the best obstetricians and midwives and are known as a centre of medical excellence. We have links with Cambridge University and are pioneers in the development and research of many groundbreaking medical techniques. We have a great bunch of staff working in the labour delivery suite. We just need someone who can bring some new organisational skills to the ward.’ He leaned across the table towards her. ‘How’s that for the hard sell?’
She couldn’t pull her eyes away from his. He was closer to her than ever before. She could see every strand of his dark brown hair. See the tiny lines around his eyes. And exactly just how straight and white his teeth were.
He nodded towards her. ‘And yes, I do want to offer it to you. You’re the first person to answer back in about five years.’
Boy, he was handsome. But there was something else. Something so much more than just good looks. Beneath the flecks of gold in his eyes she could see another part of Jacob Layton. There was so much more there than a handsome but grumpy obstetrician. He seemed the single-minded, career-driven type. But what lay beneath the driven exterior?
She returned his smile. ‘That was much better.’
He relaxed back in his chair and she was almost sorry she’d replied. ‘Thank goodness.’ He was so much nicer like this. Why did he act so grumpy around the staff?
She took a deep breath. ‘I want this to work. I want this to work for me and for Freya—my little girl. This is a fresh start. I want to leave everything else behind us.’ She rolled her eyes and gave her head a little shake. ‘And I definitely want to leave men behind. I just want to focus on my new job and getting me and my daughter settled.’
Jacob gave a little nod of acknowledgement as he tapped his fingers on the desk. ‘The reason I asked about your childcare arrangements—if you’re working as ward sister we’d generally expect you to work nine to five. You’d only occasionally be expected to work late shifts if there were staffing issues, and join part of the hospital on-call rota to do weekends.’
Bonnie frowned. ‘How does that work?’
‘All of our ward sisters take turns in covering weekends. You’re not actually there as a member of the team that weekend. You’re covering the management for the whole hospital. Sorting out staffing problems, dealing with any difficult cases or issues across the whole of maternity. It usually works out once every nine weeks.’
Bonnie nodded. ‘That’s understandable. This would make things much easier with my childcare arrangements. Freya will be much happier if I’m working more or less regular hours. I’ll get to put her to bed most nights. And, as I’ve mentioned, Lynn will happily take Freya every weekday before and after school, and for the occasional late night or weekend.’ She gave a visible sigh of relief. ‘I’m happy to do the job—in fact, I’m really excited to be asked.’
He seemed relieved. ‘So you’ll take the job?’ His voice went up a little, as if he was still a bit anxious she might turn down this fabulous opportunity.
She stood up and held out her hand towards him. ‘Of course I will. I’m a little nervous but am sure in a few days it will feel like I’ve been here for weeks. That’s always the way of it, isn’t it?’
He smiled again; this time the relief was definitely reaching right up into his eyes. His hand grasped hers. There it was again.
She hadn’t been mistaken first time around. Coming into contact with Jacob Layton’s hand was doing strange things to her skin receptors—currently it was the dance of a thousand butterflies. Just as well she’d made it clear she was a man-free zone.
‘Perfect. I’ll let Valerie know you’ve accepted. She’ll arrange for a new contract.’ He held open the door for her. ‘Now, let’s go and tell the staff.’
Her stomach did another little flip-flop as she walked through, but she couldn’t work out if that was the thought of telling her new peers about her role, or from the burn coming from Jacob’s hand at the small of her back.
One thing was for sure—CRMU was going to be interesting.
CHAPTER TWO (#ufd082dd1-8363-51f3-802a-d1030bfb054c)
JACOB HADN’T BEEN WRONG. The labour suite was in chaos. And it was all basics.
Bonnie grabbed a ward clerk and made some immediate requests about sorting out case notes, filing things appropriately and keeping the boards up to date. Then she asked for new lists of contact numbers. The one she found on the wall was obviously out of date and, with doctors changing every six months, she didn’t want any problems with pagers in case of emergency.
She spent the next two hours working with various members of staff and patients. After a few hours she was confident in the clinical capabilities of the staff that were on duty. They all wanted to do their jobs and work with patients. They just didn’t want to bother with ‘ward’ stuff. Ordering, stocking, rotas, outpatient appointments, pharmacy prescriptions. It quickly became apparent that her predecessor had dealt with all these things and her quick departure meant there had been no handover.
Bonnie gave a sigh. She’d like to spend all day working with patients too—but that wasn’t the way a ward was run. She started making a ‘to do’ list that she’d have to work her way through.
The other issue was the phones. They rang constantly—often with no one answering. First thing tomorrow she was going to ask about a regular ward clerk for the unit. Just as she finished making a few notes about the off-duty rota the phone rang again.
‘CRMU, Bonnie Reid, can I help you?’
‘Ambulance Control. We need a team on-site at a crash on one of the motorway slip roads. We have a trapped, unconscious pregnant woman. She’s reported to be thirty-four weeks. Ambulance is on its way to pick you up.’
Bonnie put down the phone. First day on the job. You had to be joking. She automatically dialled the page for the on-call obstetrician. Most big maternity units had supplies for emergencies like these. It was just a pity she hadn’t had a chance to find out where they were.
A few seconds later Jacob appeared from his office just as Bonnie was relaying the message to one of the senior midwives. He was holding his page. ‘What have we got?’
She handed over the piece of paper she’d scribbled on. Jacob gestured towards her. ‘Follow me. Equipment is in here. Grab a jacket and a bag.’ He turned to face her. ‘You are coming, aren’t you?’
She hesitated for only the briefest of seconds. ‘If you want me to.’
No. I’m terrified. This sounds like an initiation of fire. It’s my first day, I’ve just agreed to act as temporary sister in one of the most prestigious maternity units in the country and now you want me to be part of the emergency response team.
He acted as if he did this every day, grabbing a jacket with ‘Doctor’ emblazoned across the back and handing her the one with ‘Midwife’. He shot her a smile as he helped her lift the emergency pack onto her shoulders. ‘Let’s go. Leave instructions with Miriam, the senior midwife. She’ll deal with the calls until we get back.’ He walked away, his long strides crossing the corridor quickly, only stopping to wheel a portable incubator to the door.
She could feel the wave of panic lapping around her ankles. There was no way she could let it go any further. She started repeating in her head the list of emergencies that she’d dealt with on her own as a community midwife. She could do this. She could.
Miriam gave her a sympathetic nod as she handed over a few instructions. ‘I’m so glad it’s you and not me,’ she murmured under her breath.
‘What do you mean?’
Miriam rolled her eyes. ‘If you think Dan Daring is harsh on the ward, you should see him at a roadside emergency. The patients love him. The rest of the staff need counselling by the time he’s done.’
‘Let’s go, Bonnie!’ The shout made her jump and she hurried to the exit and into the back of the waiting ambulance. As soon as the doors closed and the sirens switched on they were on their way.
Sitting in the back of the ambulance was more than a little bumpy. She only just managed to avoid practically bouncing onto Jacob’s lap. But he barely noticed. He was holding on to the strap in the back with his eyes fixed on the road ahead.
‘Any more news?’
One of the paramedics turned around. ‘All bad. We’ve just had a report that they think her membranes might have ruptured. She’s still unconscious and trapped. They’re panicking. They think she’s gone into labour.’ He glanced at the clock. ‘We’ll be there in five minutes.’
Bonnie sucked in a breath. A thousand different potential diagnoses were flying through her head. From Jacob’s serious expression he was thinking the same.
When they screeched to a halt Jacob didn’t wait, he just flung open the doors, grabbed the bag and started running.
The first thing that struck her was the smell. Fire, burning metal, petrol and a whole lot more. There were four ambulances already on-site. A few casualties were sitting on the edge of the road. Two children with blood on their faces, a man cradling his arm and an older woman who looked completely shell-shocked. Police had cordoned off part of the motorway but the speed and noise of the cars still passing by was unnerving. Rubbernecking. That was what most of the passing cars were doing. Any minute now there would be another accident on the other side of the motorway. She shuddered and jumped out of the back of the ambulance, trying to spot Jacob’s bright green jacket in amongst the melee of emergency people.
‘Over here.’ A policeman gestured her towards an upended car. She stepped around the pieces of car debris that littered the road. Somewhere, she could hear someone crying. The wails cutting through the rest of the sounds. It was horrible. It was unnerving.
She landed on her knees next to the upturned car. The only thing she could currently see of Jacob was the soles of his feet. His whole body was inside the car, his feet sticking out through the broken passenger-side window. ‘Do you need anything?’ she shouted through the gap.
She adjusted her position to get a better view. Inside the car a pregnant woman was trapped upside down, held precariously in position by her seat belt. It was obvious she was still unconscious, an oxygen mask to her face and a collar around her neck. Jacob was pushing back her coat and gently easing her stretched top over her abdomen. Bonnie didn’t wait for instructions. She fished out a stethoscope and a foetal monitor and stuck her hand through a gap in the broken window where Jacob could grab them.
Even from here she could see the damp patch between the woman’s trousers. It could be two things. It could be urine or it could be amniotic fluid. She was just praying it wasn’t blood. She didn’t even want to consider that—not under these conditions.
After a few minutes of wrestling around Jacob finally spoke. ‘I’ve got a heartbeat—albeit a little quick. But I’ve just felt her contracting and there’s absolutely no way to do any kind of examination.’
He shook his head as Bonnie tried to hand him the nitrazine strips. The best they could do in this situation was rub one against her damp clothes. ‘There’s no point checking. I’m fairly sure her membranes have ruptured. We need to get her out of here now. She’s at risk of uterine or placental rupture. There’s no way I’m delivering this baby upside down.’
Bonnie stood up and shouted over to the fire and rescue colleagues. ‘We need to get this woman out. She’s about to deliver. Can we have some assistance?’
One of them ran over. ‘Sorry, got tied up trying to lift a car off someone’s chest.’
Bonnie gulped. It was chaos all around them and even though the road seemed full of emergency staff, there probably still wasn’t enough.
The fire-and-rescue guy pointed at the collar. ‘She was conscious for only a few seconds after we arrived and had no feeling in her legs. That’s why the collar’s in place. The trauma doc said not to move her. He was waiting for you to arrive.’
She nodded. ‘Well, tell the trauma doc we’re here and she’s in labour. We need assistance to move her as safely as possible now. Can you get us a backboard?’
She pushed her way around the other side of the car. The driver’s door was wedged up against a van that was on its side. It was a struggle to push her arms through and try and wind a blood-pressure cuff around the lady’s arm. ‘Do we have a name?’ she shouted to Jacob.
‘Holly Burns.’
She pressed the button on the machine. Now she’d squeezed around the other side she could see him a little easier. There were deep furrows along his brow; he was clearly worried about this patient and so was she.
‘BP’s low,’ she said quickly as the result displayed.
A number of the fire-and-rescue crew had collected around them, all talking in low voices. ‘Doc, we’re going to have to move the car. We need to cut the patient free and we can’t do it while the van’s in place. You’ll need to come out.’
Jacob didn’t hesitate. ‘I’m going nowhere. This mother and her baby need monitoring every second. Move the car with me in it.’
One of them stepped forwards as Bonnie wriggled out from the other side. She could see clearly why they would need to separate the vehicles. There was no way they could get Holly out on a backboard otherwise. If she had spinal damage they had to do everything possible to try to minimise the movement.
She shook her head and touched the fire-and-rescue chief’s arm. ‘Don’t waste your time arguing with him. He won’t change his mind and it’ll just get ugly. This woman could deliver very soon and her position makes it dangerous for her life and her baby’s.’
She was quite sure this went against every health and safety check imaginable. But she’d seen fire and rescue, paramedic and police services do similar things before. They all made the patient their priority.
She stood back as equipment was positioned and blankets shoved inside the car as Jacob was told to brace himself and his patient.
The car and van were wedged tightly together. The sound of metal ripping apart made her wince. Nothing about this was delicate. Both the car and van were juddering, wheels spinning in the air. It seemed to take for ever before they were finally yanked apart and the fire-and-rescue crew moved in with their cutting equipment.
It only took seconds for them to cut the side from the car. One of the other trauma doctors appeared with the backboard and had a quick confab with Jacob inside about the best way to cut Holly free from her seat belt and support her spine. It was a delicate operation. Twelve pairs of hands ended up all around her, ready to ease her gently onto the spinal board as the seat belt was cut. ‘Hold it,’ said Jacob abruptly. ‘She’s having another contraction. We’ll have to wait a few seconds for it to pass.’
Bonnie swallowed anxiously. Jacob still had the foetal monitor on Holly’s swollen abdomen. She could see the contraction clearly. As an experienced midwife she knew Holly wasn’t in the early stages of labour, even though she was upside down. A thought flicked through her mind—had Holly already been in labour and on her way to the hospital before the crash? Or was this a trauma-induced labour brought on by the crash? One thing was for sure: as soon as they got Holly into the ambulance, they’d better be prepared for a delivery.
As the seat belt was cut and Holly slid onto the backboard Bonnie glanced around. ‘Does anyone know about next of kin?’ she shouted. They were just about to take Holly away from the accident site. There hadn’t been a chance to get all the information they needed.
One of the policemen appeared at her elbow. ‘We’ve sent someone to contact her husband. Are you taking her to CRMU?’
Bonnie nodded. ‘Can you give me her husband’s name and contact details?’
He nodded and scribbled in his notebook, ripping out the page and handing it to her. By the time she turned around Holly was already being loaded onto the ambulance.
Jacob was ruthlessly efficient. The other trauma doctor secured Holly’s head and neck, checking her airway before he left. He was part of the general team from Cambridge Royal. ‘I have to accompany another patient back with a flail chest. I’ll send an orthopod around to the maternity unit.’ Jacob gave him the briefest nod as he attached the monitoring equipment. Bonnie barely got inside as the doors slammed shut and the ambulance started off at breakneck speed.
‘There’s another contraction coming,’ she said as she finished attaching the BP cuff and heart monitor. She helped him slide off Holly’s underwear and covered her abdomen with a blanket.
Jacob’s frown deepened. ‘She’s crowning. This baby is coming out any minute.’
Bonnie turned towards the portable incubator, struggling to stay on her feet as the ambulance rocked from side to side. There had to be rules about this. She was sure they were supposed to be strapped in. But this baby wasn’t waiting for anyone, and what use would two health professionals be at her head or at her side, while a baby slipped out?
She was doing rapid calculations in her head. ‘She’s thirty-four weeks. That’s not too early. Hopefully the baby won’t have any breathing difficulties.’ She switched on the monitoring equipment in the incubator, ensuring it was warm and the oxygen was ready.
It was difficult to take up position in the swaying ambulance. She could only try and lift Holly’s nearest leg, holding it in position to allow Jacob easier access to the presenting head.
She gulped. ‘She’s missing out on the birth of her baby.’ She blinked back tears. ‘I hope she doesn’t miss out on anything else.’
This was awful. Her first delivery for CRMU with a mother that she didn’t even know would wake up. Why was she still unconscious? The trauma doctor had only given her a quick once-over. There hadn’t been time for anything else. A Glasgow Coma Scale chart dangled from a clipboard. As each contraction gripped there were facial twinges—as if she were reacting to some element of the labour pain. Reaction to pain was a crucial part of the head injury assessment. And she was breathing spontaneously. Bonnie tried to focus on the positives. She would hate to think this mother would never get to hold her new baby.
As another contraction gripped Holly’s stomach the head delivered. Jacob had a quick check around the baby’s neck for any sign of a cord. He glanced quickly in Bonnie’s direction. ‘No cord. Presentation is good.’ He gave an audible sigh of relief. ‘Thank goodness.’
One minute later the baby slid into his hands and he quickly handed it over to Bonnie.
A little girl. Just like Freya. A fist squeezed around her heart. She’d heard Freya’s first cries, felt her first little breaths against her chest. Holly was missing all of this.
She quickly gave the pale little baby a rub, stimulating her first noisy breath, followed by some sharp cries. She gave Jacob a quick smile before wrapping the baby in the warming blanket and doing a quick assessment. ‘APGAR six,’ she said as she finished.
It was a little low, but would likely come up before the second check in five minutes. It was certainly better than she’d initially hoped for.
She looked up; they were pulling up in front of the emergency entrance at the maternity unit. Three other staff were waiting for them.
Jacob moved into position as the doors opened and helped lift the incubator down. ‘Take her to the nursery and get a paed doc to check her over.’
Bonnie gave a brief nod and headed down the corridor with one of the nursery midwives by her side. The handover was quick. The little girl was pinking up now and was letting everyone know she wasn’t entirely happy with her entrance to the world.
By the time Bonnie got back to the labour suite, Jacob was consulting with the orthopaedic doctor who’d come over from the main hospital. Holly’s notes had appeared at the desk. Thankfully, she had no significant medical history and her pregnancy seemed to have gone well. Bonnie could see from the whiteboard that Miriam, the senior midwife, was with her.
‘Has she woken up yet?’ She was having trouble getting her head around the fact that Holly had delivered a baby without being conscious. ‘In ten years of midwifery I’ve never seen a woman labour while unconscious.’ She blinked back the tears that threatened to spill over. ‘Does she have some kind of head injury?’
The orthopaedic doctor glanced at Jacob, then leaned over and touched Bonnie’s arm. ‘It actually might not be as bad as first thought. She almost certainly has a head injury but her Glasgow Coma Scale responses are improving. I suspect Holly’s in spinal shock from injuries sustained in the crash. She wouldn’t have felt the intensity of the labour pains even though her body naturally delivered. Jacob and I were just discussing the fact that we think she might actually have been in labour prior to the accident. We’ve checked the ward call log. She hadn’t called into the labour suite and she didn’t have any bags in her car. We’re wondering if she was going home to collect her things.’
Bonnie nodded. She could only remember a few things about spinal shock from her general nurse training. It was usually temporary but could cause loss of sensation and feeling. It certainly sounded better than some of the things she’d been imagining.
Jacob’s voice cut across her thoughts. ‘I take it the little girl is okay?’ He was glaring and it took her a couple of seconds to realise it wasn’t at her—well, not entirely. His eyes were fixed on the orthopaedic doctor’s hand, which was still on Bonnie’s arm.
Was Jacob this territorial around all his staff?
She gave a nod to the orthopod and walked behind the desk to pick up some paper notes. ‘Baby Burns is doing fine. APGAR was eight at five minutes. The paediatrician was checking her as I left.’ She waved the notes at Jacob. ‘I’m just going to write up some midwifery notes for what happened out there. I’ll get the clerk to put Holly and baby Burns into the hospital admission system.’
There was a bang at the bottom of the corridor as the doors were flung open. Both Bonnie and Jacob jumped to their feet. It wasn’t entirely unusual for people to enter the labour suite in a rush. This time, though, there was no pregnant woman—just an extremely anxious man.
‘My wife, Holly, is she here? They said there was a car accident. What happened? Is she okay? Is the baby okay?’
Jacob and the orthopaedic doctor exchanged glances. Jacob gestured towards his office. ‘Mr Burns, why don’t you come into my office and I’ll let you know what has happened?’
The man’s face paled even more and he wobbled. ‘Are they dead?’
Jacob quickly reassured him. ‘No, no, they’re not dead. And you can see them both. Let’s just have a chat first.’ He turned to the orthopaedic doctor. ‘Dr Connelly, will you join us, please?’
