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‘I apologise again, I reassure you that I’m a professional, you accept it—’ Lucy ticked off the points on her fingers ‘—and we do the ward round before our pregnant mums get discharged with their three-day-old babies.’
His lips quirked at that. So he had a sense of humour. Well, that was a start.
‘Apology accepted, Dr Williams.’ The warmth she’d seen when he’d kissed her was slowly seeping back into his eyes. Not to mention the warmth in the pit of her stomach. Why did he have to have a smile like that? Why couldn’t he have been…well, middle-aged and dull and not the slightest bit sexy?
Not to mention that voice. The slight accent that made her wonder what his voice would sound like in passion…
No. She was not going to start thinking like that about anyone, let alone her new boss. She was a professional. And she was completely focused on her career.
‘Though I prefer to work on first-name terms,’ he said. ‘Call me Nic.’
The slight hint of a long ‘i’, a sensual Italian ‘Nic’ rather than a diffident English ‘Nick’.
She had to get her libido back under control. Fast. Hadn’t she already learned the hard way that it was stupid to follow her hormones instead of her head?
‘Lucy.’ She made it sound as cool and English as she could. Ice maiden. To match her reputation. She held her hand out. ‘And I meant what I said. I’m looking forward to working with you.’
His handshake was firm and cool and professional. So why was her blood fizzing where he’d touched her? And if a handshake did this to her, what would a more intimate…? No. She forced the thought to the back of her mind. ‘Shall we?’
He nodded and they went to join Rosemary and Mal. Just as Rosemary was about to update them on the first patient, Lucy’s bleeper went.
‘Sorry,’ she mouthed, headed for the phone and dialled the number on her bleeper.
‘Lucy Williams—you paged me?’
‘Thanks for ringing back,’ the A and E nurse said. ‘We have a patient with a suspected placental abruption.’ Placental abruption was where part of the placenta became detached from the uterus. It could be dangerous, possibly even fatal to both the mother and the baby. If the bleeding was severe, they’d need to do an emergency delivery.
‘Have you done an ultrasound?’ Lucy asked.
‘A machine’s on its way. Could you take a look at her?’ the nurse asked.
‘I’ll be right down.’ Though it was only courtesy to let her new boss know where she was going. She hated interrupting colleagues when they were with patients, but the only other choice was leaving a message with one of the midwives, and he’d probably think she was sulking and using any excuse to avoid him. She pulled back the curtain just enough to put her head through the gap. ‘Mr Alberici, I’m sorry to interrupt. Could I have a quick word, please?’
‘Of course. Please, excuse me,’ he said to the patient, then came to join Lucy in the middle of the ward. ‘What’s up?’
‘We’ve got a patient with a suspected placental abruption in A and E. They’ve asked me to see her.’
‘I’ll come with you—if it is that, we’ll need her in Theatre pronto. You’ll assist?’
Yeah, he would be a qualified obstetric surgeon. He could have offered to assist her. But, no, he had to take charge. ‘Sure,’ she muttered.
‘I’ll brief Mal and I’ll be right with you,’ he said.
Efficient, courteous—to the patients, if not to her—and drop-dead gorgeous. It was a tempting combination. A dangerous combination.
Stop it, she warned herself. You are not going to think about Nic Alberici like that.
Though in her mind’s eye he wasn’t wearing a formal white silk shirt, teamed with a silk tie and an expensively cut dark grey suit and topped with a white coat. He was wearing that half-open white shirt, tight black trousers, a hat and a domino mask. Sexy as hell. With a smile that promised—
‘Mal’s going to carry on with the rounds and page us if there are any problems,’ Nic said, breaking into her thoughts. ‘I’ll let him know if we go to Theatre.’
She flushed. ‘Right.’
‘I’m not checking up on the quality of your work,’ he added, misinterpreting the reason for her high colour.
‘I didn’t for one moment think you were.’
He sighed. ‘Oh, hell. Look, Lucy, we got off to a bad start. Let’s just forget it and start again, shall we?’
Forget what? That kiss, or what he’d overheard, or the dressing-down he’d started to give her? The second two, she could do, but the memory of the kiss firmly refused to budge.
Even now, she could still feel his lips against hers. Worse, she wanted him to do it again. In a much more private situation…
She’d only just got herself back under control by the time they reached A and E. ‘I’m Lucy Williams—you paged me to look at a patient with suspected placental abruption,’ she said to the receptionist.
‘Yes. Her name’s Mrs Andrews—Liza Andrews. She’s in room two,’ the receptionist replied. ‘Yvonne Roper’s with her.’
‘Thanks.’ Lucy led the way to room two and knocked on the door.
Yvonne answered the knock. ‘Thanks for coming, Dr Williams.’
‘It’s Lucy,’ Lucy responded. ‘Any time. This is Nic Alberici, the new consultant on River. Before we see the patient, what’s the presentation?’
‘She’s in constant pain, her uterus is tender and tense, she’s bleeding slightly—it’s dark red and clotted—and she’s starting to look shocky,’ Yvonne said.
‘Out of proportion to the loss?’ Nic asked.
‘Yes. Her blood pressure’s low.’
He and Lucy exchanged a glance. There were other causes of bleeding in pregnancy, but the symptoms Yvonne had described sounded very like placental abruption.
‘I’m not happy with the foetal heartbeat either,’ Yvonne added. ‘I think the baby’s getting distressed.’
‘Is the scanner here yet?’ Nic asked.
‘No. I’ll chase it up.’
‘Thanks. We’ll go and see her,’ Lucy said. She knocked on the door, walked in and introduced herself and Nic to Mrs Andrews. ‘Yvonne tells me you’re in pain and you’re losing blood. Would you mind if we examined you?’
‘Please. Anything. Just don’t let me lose my baby,’ Liza Andrews whispered brokenly. ‘I’m forty-three. It’s my first baby. We waited so long, and if I lose him…’ She choked. ‘I might not be able to have another.’
‘We’ll do our best,’ Lucy reassured her. ‘There are lots of reasons for bleeding in pregnancy so don’t assume it’s the worst.’ Lucy glanced at the observation chart. ‘Your baby’s heartbeat is still pretty regular, though your blood pressure’s a bit low so we’ll get some blood into you to help. Yvonne, can you cross-match and get me four units of O-neg?’ she asked as the nurse came back in.
‘We’re waiting for the portable scanner to arrive,’ she told Liza, ‘then we’ll be able to check what’s going on a bit better. It might be just that your placenta’s low-lying, what we call placenta praevia, so I’m not going to give you a vaginal examination.’ If it was placenta praevia rather than an abruption, a vaginal exam could cause a catastrophic bleed. ‘But I will give you some oxygen to help you breathe more easily.’ She unhooked the mask from the wall. ‘Just breathe in through this and try to relax.’ She set the output at fifteen litres a minute. ‘OK?’
Liza nodded.
Lucy gently examined the woman’s abdomen.
‘That hurts,’ Liza said, taking the mask off her face.
‘I’m sorry,’ Lucy said. ‘The good news is that your baby’s lying normally.’ She mouthed to Nic, ‘I’m almost certain it’s an abruption.’
Nic nodded and took Liza’s hand. ‘It says here you’re thirty-six weeks.’
Liza’s face screwed up in anguish. ‘And it’s too early for the baby to come!’
‘It’s quite normal for babies to arrive at thirty-seven weeks—so a few days earlier really isn’t as bad as it sounds,’ Nic reassured her, smiling. ‘You’re in the right place.’
‘So my baby’s going to be all right?’
‘We’ll do our best,’ Lucy said, gently settling the oxygen mask back in place. She listened to the baby’s heartbeat and didn’t like what she heard. Nic was watching her face and she gave him a very brief shake of her head to let him know.
Yvonne arrived with the scanner in tow and the units of blood. Lucy quickly set up an intravenous infusion while Nic put the scanner in place.
‘Lucy,’ he said quietly.
She took one look at the screen and her heart sank. The placenta wasn’t low-lying. And as Liza Andrews hadn’t been visibly losing that much blood, the chances were that most of the blood from the abruption was trapped, known as a ‘concealed abruption’.
‘Mrs Andrews, you have what we call placental abruption,’ Lucy said. ‘It means that your placenta’s started to come away from the wall of your womb.’
Liza blenched. ‘Am I going to lose the baby?’
‘Not if we can help it. But it’s too big for me to let you go home again,’ Lucy said. ‘And I don’t want to take any risks with the baby.’
‘I’d like to deliver the baby by Caesarean section,’ Nic said.
‘Now?’ Liza asked, horrified.
‘Now,’ Nic said. They could have given Liza tocolytic drugs to stop the contractions, then medication to help mature the baby’s lungs, but from Liza’s symptoms they knew the abruption was big. The baby needed at least half the placenta to be attached and functioning, so they couldn’t take the risk of leaving it.
‘But—why me? Why now?’
‘We don’t know the causes,’ said Lucy, ‘but it’s more common if you’ve had high blood pressure, you’re an older mum or you have twins or triplets, you’re a smoker or you take cocaine.’
Liza smiled weakly. ‘I’ve never smoked or done drugs. I haven’t even have a glass of wine since I found out I was pregnant, let alone anything else!’
‘That’s good,’ Lucy said, squeezing her hand.
‘Have you been in a car accident or had a fall, or banged your stomach in any way?’ Nic asked.
Liza shook her head. ‘Not that I can remember.’
‘We’ll take some blood for tests to see why it’s happened,’ Lucy said, ‘and to check that your blood’s clotting properly.’ If Liza Andrews had lost a lot of blood, she might have clotting problems after the birth, known as DIC or disseminated intravascular coagulation—around a third of cases did. And she had a much higher risk of a large bleed after delivery, so she might need a transfusion. ‘We might need to give you some drugs to help your uterus contract after the birth.’
Liza nodded.
‘And because your baby’s early, we’ll need to take him—or her—to the special care unit for a little while, to help him with his breathing and feeding. But you’ll be able to see the baby any time you like,’ Nic said.
‘Is there anyone you’d like us to call?’ Lucy asked.
‘My husband’s already on his way in. And my mum.’ Liza’s eyes filled with tears. ‘He wanted to cut the cord.’
‘I’m sorry,’ Nic said. ‘I’ll need to give you a general anaesthetic, so he won’t be allowed in for the delivery. But as soon as the baby arrives, he’ll be able to have a cuddle.’
A tear slid down to pool on the mask. ‘It was all supposed to be so different.’
‘I know,’ Lucy soothed. ‘Though you’re not alone. This happens in around one in fifty pregnancies.’ Not all abruptions were as severe as this one—if the baby wasn’t in distress and the bleed was minor, the mum could often go home if she chose. ‘But you’ll have your baby very soon.’ She just hoped the abruption wasn’t so severe that the baby wasn’t getting enough oxygen—it could suffer brain death or even die.
‘I’d like you to sign a consent form, please,’ Nic said.
‘I’ll call the anaesthetist and get Theatre to prep,’ Lucy said.
On their way up to Theatre, Nic said, ‘You handled that well. It’s a rough situation.’
‘Let’s just hope she doesn’t get renal failure or a bad PPH,’ Lucy said, referring to postpartum haemorrhage, a major bleed after delivery. She couldn’t bring herself to talk about the risks to the baby.
Before she knew it, they were in Theatre and Nic was making the first incision. Lucy couldn’t believe how fast he worked, but she was relieved when she was finally able to lift the baby out. ‘It’s a girl,’ she said.
‘Welcome, bellissima,’ Nic said softly. His eyes crinkled at the corners, betraying the smile behind his surgeon’s mask, and he handed her to Lucy. ‘What’s the Apgar score, Lucy?’ he asked as he delivered the placenta and started stitching—the Apgar score was a check on the baby’s pulse, breathing, whether the skin was pink or blue and the baby’s reaction to suction.
‘First Apgar score of five,’ Lucy said, checking the baby. She gave the baby gentle suction to clear her airways. Her skin wasn’t pink enough either for Lucy’s liking.
‘Second score of seven,’ she reported four minutes later.
The ten-minute score had improved to nine. ‘But this little scrap’s going to up to SCBU—’ the special care baby unit ‘—to warm up for a bit,’ Lucy said.
Nic finished closing. ‘We’ll leave Liza in the recovery team’s capable hands and baby Andrews to SBCU.’ He glanced at the clock. ‘And we’re going to have some lunch.’
Lunch? He wanted to have lunch with her? Her stomach fluttered at the idea of it. Lunch. Sitting opposite him on one of the small cafeteria tables, close enough for their knees to touch…
Way, way too dangerous. ‘Thanks for the offer, but I’d better get back to the ward,’ she said. ‘Finish the rounds—it’s not fair on Mal. One of us ought to go back and you did all the tough work in Theatre, so you deserve the break. I don’t think I’ve ever seen a scalpel move that fast.’
Coward, his eyes said. ‘Maybe Mal needs to feel you trust him enough to finish the rounds on his own.’
And maybe Nic ought to get to know the staff properly before he started throwing his weight about. Just because he’d got the consultant’s job, it didn’t mean he knew everything. She knew Mal far better than he did. She lifted her chin. ‘Maybe I don’t feel he’s ready.’
‘Lunch first,’ Nic said.
‘I really need to get back.’ Liar, a voice in her head taunted. You’d love to have lunch with him. And more.
Given her track record at judging the men in her life, that’d be a very bad move. Anyway, she doubted if he meant that sort of lunch. He was her boss, not her lover.
Despite that kiss.
‘I want to get to know all the team,’ Nic said, ‘and I thought I might as well start with you.’
So he was thinking of her as a doctor, nothing else. Just part of the team. He was going to ask everyone else to lunch, too. He hadn’t singled her out as special. But she still couldn’t help thinking about that kiss. He hadn’t mentioned it, but was he remembering the way it had been between them, that unlooked-for spark at the ball when their mouths had touched?
