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‘How are you feeling, Patsy?’ Pete asked at once.
‘The contractions are getting stronger. There’s one coming now…’
From Patsy’s reaction, the pain was quite intense. She couldn’t move or speak during its peak, and had to press a thick pad between her legs to deal with the blood. Pete wasn’t happy about how much was still flowing. He abandoned any thought of getting her moved to Canberra or Sydney.
This didn’t mean he was relaxed about the idea of delivering her here. They could be in for some problems after the birth, and dealing with a post-partum haemorrhage could be a nightmare. Thank goodness there were a couple of good doctors he could call on.
‘Let’s get you on your left side with your feet up on a pillow,’ he told his patient, masking the extent of his concern.
She looked pale and drawn. Tired, as if she hadn’t been sleeping well in weeks, which was probably the case. Bed rest wasn’t fun. No physical activity to promote a healthy fatigue at the end of the day, too much time to think and worry. And she was huge, the size due to her fibroids, not the baby.
Pete palpated the uterus, gave her an internal examination and found that the cervix was ripe, already fully effaced and dilated to six centimetres. The baby’s position wasn’t good. Feet and bottom down low, and head lying next to her mother’s heart. The heartbeat was fine, no sign of distress, and that was a plus. But he really didn’t like the bleeding, or his rough impression of the baby’s size. He’d been monitoring this for several weeks, and there’d been steady growth, but the baby was still smaller than it should be for this stage of pregnancy.
‘I’ll be back in a minute,’ he promised Patsy, when he’d finished.
Heading for the phone at the nurses’ station, he almost cannoned into Emma Burns, who had just arrived, and whom he hadn’t seen in the three months he’d been renting her house. She was like a breath of cool, fresh air, scented with spring. She was like her home—bright and pretty and calming.
They smiled at each other.
‘Hi,’ he said. ‘Welcome back.’
‘Thanks.’
A beat of uncomfortable silence hung in the air, and neither of them knew what to say. Pete felt there ought to be something better than what he’d come out with thus far. Something witty or meaningful. Something a little private and personal that encompassed all the complex flavours of the e-mails they’d exchanged.
As if he had time to think about it now!
She’d done something to herself while she’d been away, he noted vaguely. Something good. Hair was different. Eyes. Lips. How she’d done it, he didn’t know. He didn’t even know quite what she’d done, he only knew that it was good.
Straight, dark, glossy tresses, arched brows, glowing brown eyes, soft, happy mouth. And yet he didn’t even have time to say, Wow! You look great, Emma! Although he definitely wanted to.
‘Can you make sure the ob. theatre is fired up and ready to go?’ he said. ‘No one else in there, is there?’
‘No, we’re quiet.’
‘I’m phoning Gian Di Luzio and Nell Cassidy. I’ve a got a patient in there…’ he gestured at Room One with a backward jab of his thumb over his shoulder ‘…who’s making me nervous.’
‘Fill me in,’ she said. She had a lovely voice, clear and steady. ‘I’m not officially on yet, but I’m obviously going to be in on the surgery, right? I think we’ve got another labouring mum coming in, but Bronwyn’s going to handle her.’
‘Yes, I want you in Theatre,’ he answered. ‘And I expect you’ll be moving over to Special Care to look after this baby, if we keep her.’
Emma had spent two years in Sydney, a few years ago, acquiring specialised neonatal nursing qualifications, and staffing was usually juggled to enable her to care for any babies who needed extra attention and skills after birth. There were a couple of other well-qualified nurses to share the load as well.
‘Might we not keep her?’ she asked.
‘I hope we can.’ He hadn’t quite answered her question with the words, but went on to do so in his description of the patient’s history.
Emma’s appearance might have changed in three months—what was it? Her eyes glowed! But he doubted whether her capabilities had. She’d always been good. A team player and able to handle all the different types of people she had to deal with, from nervous new fathers to overworked GPs. She was level-headed, thorough and adept at anticipating problems. He sketched out what she needed to know, using a barrage of medical shorthand which had her nodding and frowning at once.
‘Yes, I see what you mean,’ she said. ‘I can see why you’d want Dr Di Luzio and Dr Cassidy.’
Gian Di Luzio was Glenfallon’s one obstetrician and gynaecologist, and a woman would have to go quite a distance to find another one. Like most parts of rural Australia, Glenfallon was chronically in need of specialists. As a result, there were several GPs in the area who’d obtained extra credentials in various fields to meet demand.
Pete was one of them. He’d returned to Glenfallon at the beginning of the year after two years spent in Sydney, and he was now better qualified than anyone but Gian in delivering babies and dealing with associated areas, but he was by no means too proud to reach out and grab a fully fledged specialist’s extra experience when he needed it. With the twin risks of post-partum haemorrhage and a delicate baby, this was one of those times.
Nell Cassidy was no slouch when it came to extra experience either. She ran the hospital’s accident and emergency department with an iron hand, and no velvet gloves involved. She also oversaw the hospital’s acute-care patients—adults, children and infants. She was extremely bright, unflappable in a crisis and always the very last person to accept that a patient couldn’t be saved.
She’d revived one of Pete’s patients last year—a four-year-old girl, the same age as his daughters now were—after a near-drowning, and she’d kept vigilant when everyone else had been ready to celebrate and relax.
Two days after the incident in the back-yard pool, when Amber Szabo had already started smiling and talking and her parents and hospital staff were talking about her discharge, Dr Cassidy had headed off a major organ shutdown, battled death once again and saved the child.
Now, as far as Pete was concerned, the A and E staff could saddle the woman with any unflattering nickname they liked, but he would defend her with spirit all the way.
They had a full team assembled by seven-twenty. They had type A-positive blood waiting for Patsy, and a neonatal resus trolley equipped and waiting for her baby. They had oxygen and intubation equipment, monitors for heart rate, respiratory rate and blood oxygen saturation, and a barrage of drugs on hand.
They had overhead lights switched on, trays of shiny, sterile equipment lined up, and their patient ready to be wheeled in. The pace had picked up in Labour and Delivery, too. The recently delivered mum had been moved across to the post-partum ward, but they had a new admission to take her place—a young woman of nineteen, who’d had only sporadic prenatal care and no second-trimester sonogram, and was uncertain of her dates. Around eight, eight and a half months gone, she thought.
Thirty-six or thirty-seven weeks? Apparently Bronwyn Jackson wasn’t convinced of this after a manual examination.
‘She feels too small,’ the midwife reported to Pete. ‘By the height of the fundus, I’d say thirty-five weeks, maybe even thirty-four.’
‘Can we try to stop the labour?’ Pete asked.
‘No chance. Fully effaced, half-dilated, contractions every few minutes. This baby’s coming today, and we’ve got the resus trolley on hand.’
‘I’ll get there for the delivery if I can.’
‘The joint is jumping all of a sudden.’
‘Better phone Alison Cairns and tell her she might be needed, too.’ Dr Cairns was good with fragile babies.
The new admission, Rebecca Childer, had been put down as Pete’s patient, although her family was fairly new to Glenfallon, and he’d only ever seen her mother, Susan, for a couple of routine things. He didn’t like having this new, questionable labour hanging over his head when Patsy and her baby were uppermost in his mind.
The baby obviously didn’t want to stay in Patsy’s tumour-filled uterus any longer. He only hoped the little girl would be safe out of there, and in their hands. Should he have sent Patsy to a bigger facility before this? She’d argued against the idea very strongly, but he could have presented it in starker terms.
If we lose this baby, came the insistent thought, how much will I question my own decisions? And where’s Rebecca Childer going to be up to in her labour when I get out of Theatre?
‘Dr Croft looks terrible,’ Emma said quietly to Nell Cassidy.
Although Emma was over a year younger than the A and E specialist, she and Nell had been friends since their school days. More specifically, since the Glenfallon Ladies’ College Senior A netball team’s memorable trip to Sydney about seventeen years ago, for a round of competitions.
Teenage giggles and confessions during the long bus ride had gradually evolved into the more considered honesty and support of adult friendship, and had survived divergent career paths and life experiences, long periods of living in different places and even some significant criticisms of each other’s choices.
Nell knew that Emma considered her too cool and too uncompromising in her approach to her work. Emma knew that Nell would have ‘thrown that parasitical stepmother of yours out months ago’, instead of putting up with the situation until Beryl had left in a huff to go and live with her own daughter earlier that year.
Somehow, however, these differences of opinion didn’t matter. This same honesty now made it possible for the two of them to have a serious, if snatched conversation on an unrelated subject while they waited for their own role in safeguarding the McNichol baby’s first minutes of life.
‘Terrible is a bit harsh,’ Nell said in response to Emma’s comment. ‘He looks tired, definitely. And stressed.’
‘That’s what I meant, Nell. It was sympathetic. I wasn’t accusing him of having a bad hair day and tacky clothes. Is he tired and stressed?’
‘Most people are when their marriage is in the process of doing a slow-motion shatter.’
‘I thought his marriage was over. In his e-mails, he always…Well, in his e-mails, he sounded better than he looks.’
‘These things take time, Emma. But I expect if he’s been talking about his divorce in his e-mails, you know a lot more about it than I do.’
‘I know hardly anything,’ Emma said quickly.
She was sorry she’d made the initial comment to Nell now. She hadn’t meant this to turn into an analysis or a catechism. Having thought of Pete Croft as a kind of penfriend for the past three months, she’d been concerned to see the evidence of stress and problems in his face—problems he’d mentioned to her only in the most oblique way.
Something changed in him when they began the surgery, however. She saw him blink and work the muscles in his face, as if trying to wake them up, and there was a new alertness in his expression, a determination and focus that stripped away the signs of weariness and emotional preoccupation she’d first seen.
Pete was a good-looking man. Somehow, she’d never seen it before. Maybe because he didn’t fit the tall-dark-and-handsome model that most women wanted. He was tall enough, yes, but he wasn’t a giant—just under six feet, nicely built in an athletic way. He wasn’t dark. He did have brown eyes, but they weren’t for drowning in. They were too focused, too intelligent, too ready to be amused and too casually kind.
His skin was typically Australian—fair, a little roughened by the power of the sun, and uneven in tone. On a woman, it would have been disastrous skin, but on a man it was…very male. Rugged and strong and casually attractive.
As Nell had pointed out, he hadn’t been near a razor that morning, and his beard was growing in fast, a red-gold sheen of stubble surrounding firm lips which looked thin when he was absorbed in his work and fuller when he smiled his generous smile.
His hair was cut so you could see that it started as a very dark, rusty gold and went blonder as it grew out, until it settled on sand mixed with straw as its definitive colour. He had little creases at the corners of his eyelids—creases he needed a woman to kiss away with soft, tender lips—and he had a tanned curve of neck at the back which could make that same woman want to stroke it with her fingers, then thread them upwards into the soft prickle of his hair as she sighed against him.
Only not me, Emma thought in sudden panic. Why on earth am I suddenly thinking this way?
‘We’re good to go here, Houston,’ said anaesthetist Harry Ang.
‘One day I am going to kill that man,’ Nell muttered.
It was one of Dr Ang’s harmless quirks that he liked to speak as if this was NASA Mission Control and he was an astronaut about to launch into space. Nell had a limited tolerance for harmless quirks.
Emma didn’t mind Dr Ang—he was a nice guy, and always pleasant to the nurses, which counted for a lot—but she had to suppress a laugh all the same when Pete said, ‘Apollo Thirteen, do you mind if we cut satellite communications for the rest of this mission?’
‘Just trying to raise team morale.’
‘Consider it already more than sufficiently raised, Dr Ang,’ Nell came in. Her tone could have lasered through glass.
Gian Di Luzio ignored the whole thing. He simply asked for a piece of equipment, and the surgery began. Emma and Nell were standing by, waiting for the baby, and Emma found that her focus stayed fixed on Pete. She’d never realised it would feel so intimate to know that he’d lived in her house, and she wondered if he felt in any way the same.
The intimacy had to be even greater, perhaps. He’d slept in her bed. He’d used her dishes. He’d sat on her couch. Her personal possessions had all been packed away, but rooms were personal, too. Air was personal. Grass was personal. He’d breathed her air and trodden her grass.
He had mowed it very neatly, too, just before he’d left. He’d dumped the fresh clippings from the mower in their usual spot beside the compost bin behind her shed, and she’d arrived home to find them still giving off their tangy, summery smell. It had seemed as if Pete must have left just minutes before.
Pete made the incision in Patsy’s abdomen and cut through the outer layers of fat and muscle to reach the uterus. He and Gian had decided on the more conservative midline incision, given the difficult placement of placenta, fibroids and baby.
Gian muttered a couple of suggestions, and Nell stepped close when it was time to lift the baby free. Dr Di Luzio was another very capable doctor, Emma knew, and he’d just become engaged to her fellow midwife and friend, Kit McConnell. The couple were still talking about dates for their wedding, and they’d just agreed to formally adopt his brother’s little girl, Bonnie.
‘Here we go,’ the obstetrician said.
He brought out a blue, slippery bundle of limbs and a tight, immobile little face, beyond the sea of green surgical fabric, and gave the baby girl at once to Nell. Above his mask, Pete looked tense, and the sound they were all waiting for—a baby’s cry—hadn’t happened yet. The lights were bright on Mrs McNichol’s exposed skin, with its rust-coloured splashes of antiseptic, and the seconds seemed to drag.
‘She’s small for dates. Tiny!’ Dr Ang exclaimed.
‘We knew she would be,’ Pete said, his tone clipped. Nell suctioned the baby’s nose and throat out carefully and chafed her chest, but nothing happened. ‘Hoping for better than this, though,’ Pete added.
‘Come on, sweetheart!’ Nell muttered. ‘Don’t scare us like this!’
Working closely beside Nell, Emma clamped and cut the cord. The baby was still limp. Her one-minute Apgar score wouldn’t be all that great. Emma calculated automatically. One for tone, one for colour, zero for respiration…
‘OK, she’s still not breathing. I’m going to bag her, I’m not going to wait,’ Nell said, grabbing the equipment quickly.
She laid the baby in the open tray of the resus trolley beneath the warming lights. Emma managed to slip a stretchy little cap on the baby’s head to keep vital body heat in. The umbilical stump was the most favoured site for IV insertion in a premmie, but sometimes one needed intravenous lines put in through the veins in its scalp.
She hoped she wouldn’t be taking the little hat off again soon for that purpose. A baby at thirty-three weeks shouldn’t need that level of treatment. That fibroid-crowded uterus hadn’t been good for her at all.
‘Got some bleeding here,’ Dr Di Luzio said. ‘Pete, the placenta’s looking very tricky, right across a mass of intramurals. Surprised she got this far with the pregnancy. Not a bit surprised about the size of the baby. Nell?’
‘Going as fast as I can here,’ she answered. She held the manual oxygen bag to the baby’s face, trying to pump air into the tiny lungs and listen with a stethoscope at the same time. Nothing was happening.
‘One more try, then I’m going to intubate,’ she announced. ‘Heart rate’s a little slow and thready, and there’s a bit of a murmur. It may clear up on its own. They often do. Still, we have to get moving on this.’
Already, nearly two minutes had passed since the clamping of the cord, and every second without oxygen was critical. Thank goodness Patsy was unaware of all this!
‘Emma?’ Nell prompted.
‘Yes.’ She had the intubation equipment ready, and the oxygen.
The tube was pitifully small, and it would be an extremely delicate procedure, with the risk of tubing into the stomach instead, creating yet another delay. Nell had her naturally pale face set like a mask as she made her final attempt to squeeze oxygen into the baby’s lungs manually.
‘Come on, darling,’ she repeated, tapping the tiny feet, chafing the chest, looking for the right stimulation.
Normally, her skin complemented her dark blonde hair, but that was all tucked beneath her royal blue disposable cap. She looked as efficient and as cool as a machine, but Emma knew she had a strong, passionate heart beating away underneath.
‘OK, we’ve got her,’ Nell announced at last. ‘No tube, thank goodness. She’s breathing on her own. Yes.’ She watched and listened. ‘Yes! Heart rate is better already. Colour’s improving. She’s picking up quickly now.’
The five-minute Apgar score was the crucial one as a predictor of long-term health and development. Emma added the figures again. One for tone, one for colour, two for respiration…Seven. Eight would have been nice, but if she’d added that extra point, she would have been cheating.
‘Good. Go for it. Got our own problems over here,’ Gian said, in answer to Nell.
‘Houston, we have a—’ Dr Ang began.
‘Shut the hell up, Harry,’ Pete sang at him.
‘Sure. Sure.’
‘Can we tie off this vessel?’ the obstetrician asked.
‘Got it,’ Pete murmured. ‘How’s the placenta looking?’
Emma didn’t have time to look over at the table to see what was happening. She heard Pete’s voice, muttering something else, and Dr Ang confirming that everything looked fine at his end, although the patient’s blood pressure was beginning to drop.
