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A bright little lady about four feet high and about a hundred years old appeared at his elbow.
‘This way, Doctor.’
He was led to the sink by his elderly helper—who wasn’t acting elderly at all.
There was no time for questions. Joss was holding his scrubbed hands for Marie to slip on his gloves when Amy called him back.
‘We’re in trouble,’ she said briefly, and her face was puckered in concern. She’d cut away the woman’s smock. ‘Hold the stethoscope here, Marie.’ Then, with Marie holding the stethoscope in position over the swollen belly, she held the earpieces for Joss to listen.
His face set in grim lines as he heard what she’d heard. ‘Hell.’ The baby’s heartbeat was faltering. He did a fast examination. The baby’s head was engaged but she’d hardly dilated at all. A forceps delivery was still impossible. Which meant…
A Caesarean.
A Caesarean here?
‘We don’t have identification,’ Amy was saying. ‘Will you…?’
That was the least of their worries, he thought. Operating without consent was a legal minefield, but in an emergency like this he had no choice.
‘Of course I will. But—’
‘We have drugs and equipment for general anaesthetic,’ she finished, moving right on, efficient and entirely professional in her apology. ‘The Bowra doctor does minor surgery here, but I’m afraid epidural is out of the question. I…I don’t have the skills.’
After that one last revealing falter her eyes met his and held firm. They were cool, calm, and once again he thought that she was one in a million in a crisis.
‘What’s your training?’ he started, hesitating at the thought of how impossible it would be to act as anaesthetist and surgeon at the same time—but she was before him there, too.
‘Don’t get the wrong idea. I’m not a doctor,’ she said flatly. ‘I’m a nurse. But I’m qualified in intensive care and I spent years as a theatre nurse. With only one doctor in the district, I’ve performed an emergency general anaesthetic before. That’s why we have the drugs. For emergencies. So if you guide me, I’m prepared to try.’
He stared at her, dumbfounded by her acceptance of such a demand. She was a nurse, offering to do what was a specialist job. This was a specialist job for a qualified doctor!
But she’d said that she could do it. Should he trust her? Or not?
He hardly had a choice. He’d done a brief visual examination on the way here. The baby was still some way away—the head wasn’t near to crowning—and now the baby’s heartbeat was telling its own grim story. If they waited, the baby risked death.
He couldn’t do a Caesarean without an anaesthetic. The woman was unconscious but the shock of an incision would probably wake her.
He needed a doctor to do the anaesthetic, but for him to perform the Caesarean and give the anaesthetic at the same time was impossible.
Amy wasn’t a doctor. And she was offering to do what needed years of medical training.
But… ‘I can do this,’ she said, and her grey eyes were fearless.
He met her gaze and held it.
‘You’re sure?’
‘Yes.’
‘You realise insurance…’
‘Insurance—or the lack of it—is a nightmare for both of us.’ She nodded, a decisive little movement of her head as though she was convincing herself. ‘But I don’t see that we can let that worry us. If we don’t try, the baby dies.’
It went against everything he’d ever been taught. To let a nurse give an anaesthetic…
But she was right. There was no decision to be made.
‘OK. Let’s move.’
It was the strangest operation he’d ever performed. He had a full theatre staff, but the only two under eighty years old were Amy and himself.
Marie stayed on. The old lady had scrubbed and gowned and was handing him implements as needed. Her background wasn’t explained but it was assumed she knew what she was doing, and she handled the surgical tray with the precision of an expert.
And she had back-up. Another woman was sorting implements, moving things in and out of a steriliser. A man stood beside her, ready with a warmed blanket. Every couple of minutes the door opened a fraction and the blanket was replaced with another, so if—when—the baby arrived there’d be warmth. There was a team outside working in tandem, ferrying blankets, hot water, information that there was no chance of helicopter evacuation…
Joss took everything in. He checked the tray of instruments, the steriliser, the anaesthetic. He measured what was needed, then sized Amy up.
‘Ready?’
‘As ready as I’ll ever be.’ Still that rigid control.
He looked at her more closely and saw she was holding herself in a grip of iron. There was fear…
It would help nothing to delay or probe more deeply into her fear, he decided. She’d made a decision that she could do it and she had no choice. There was no choice!
‘Let’s go, then.’
Amy nodded. Silently she held her prepared syringe up so he could check the dose. He nodded in turn and then watched as she inserted it into the IV line.
He watched and waited—saw her eyes move to the monitor, saw her skilfully intubating and inflating the cuff of the endrotracheal tube, saw her eyes lose their fear and become intent on what they were doing.
He felt the patient’s muscles relax under his hand.
She was good, he thought exultantly. Nurse or not, she knew what she was doing, which left him to get on with what he had to do.
He prepped the woman’s swollen abdomen, lifted the scalpel and proceeded to deliver one baby.
CHAPTER TWO
IT WENT like clockwork.
This team might be unusual but their competence was never in question. As he cut through the abdominal layers the old woman called Marie handed over instruments unasked. When Joss did need to ask, her responses were instantaneous.
And Amy’s anaesthetic was first class.
All this was—had to be—ancillary to what he was doing. He was forced to depend on them: his attention was on the job. The anaesthetic was looking fine. All he knew was that he had what he needed and the woman’s heart rate was great.
If only the baby’s heartbeat held…
This was the moment of truth. He looked up to ask, but once again his needs were anticipated. The second of the older women stepped forward to push down on the uterus, giving him leverage as he slid one gloved hand into the incision.
Please…
‘Here it comes.’ He lifted the baby’s head, turning it to the side to prevent it sucking in fluid. ‘Yes!’
It was a perfect little girl.
Joss had only seconds to see that she was fine—the seconds while he scooped the baby free. As soon as she was free of her mother—before he’d even tied off the cord—hands were reaching for her, the sucker was in her mouth and they were removing mucus and freeing her to breathe. These people knew what they were doing! The old man behind Marie ducked in to scoop the infant into the waiting blanket as the elderly nurse cleared her airway.
‘We’ll be fine with her.’ Amy motioned him back to the wound. ‘She’s looking good.’
He had no time to spare for the baby. He turned back to deliver the placenta, to swab and clamp and sew, hoping his geriatric helpers were able to clear the baby’s airway in time.
Amy would supervise. He knew by now that she was a brilliant theatre nurse. She was acting as a competent anaesthetist. Apart from a couple of minor queries about dosage, he’d rarely had to intervene.
And as he began the lengthy repair process to the uterus there came the sound he’d been hoping for. The thin, indignant wail of a healthy baby.
The flattening of its heartbeat must have been stress-induced, he thought thankfully. A long labour and then the impact of the crash could have caused it.
How long had the girl been in labour?
A while, he thought, glancing to where Amy still monitored the intubator. The new mother was as white as death and the wound on her forehead still bled sluggishly. He’d suture it before she woke.
If she woke.
Why was she unconscious?
Hell, he needed technology. He needed to know if there was intracranial bleeding.
‘We can do an ordinary X-ray here,’ Amy said, and his eyes flew to hers. Once again she was thinking in front of him. ‘We have the facilities. It won’t show pressure if there’s a build-up, but it’ll show if there’s a fracture.’
‘Is there no way we can we get outside help?’ He wanted a CT scan. He wanted his big city hospital—badly.
‘Not until this rain eases.’ Outside the window, the rain was still pelting down. ‘Given decent conditions, a helicopter can land on the golf course, but not now. There’s too many hills. The country’s so rough that with visibility like this they’d be in real trouble.’
So they were still on their own.
‘We’ll be OK,’ she said softly as he worked on. Their eyes locked and something passed between them. A bonding. They were in this together…
Joss felt a frown start behind his eyes. He didn’t make contact like this with theatre staff. He didn’t make contact with anyone. But this woman… It was as if she was somehow familiar…
She wasn’t familiar at all. ‘We’re not finished yet. Let’s get this abdominal cavity cleaned and stitched,’ he said, more roughly than he’d intended, and bent back over his work.
Finally the job was done. Under Joss’s guidance, Amy reversed the anaesthetic, concentrating fiercely every step of the way. At last, still rigid with anxiety, she removed the endotracheal tube and the woman took her first ragged breaths.
Amy had done it, and until now she hadn’t known she could. She closed her eyes, and when she opened them again Joss was beside her, his hands on her shoulders and his face concerned.
‘Are you OK?’
‘I… Yes.’ She tried to draw back but his eyes were holding her in place as firmly as his hands were holding her shoulders.
‘Exactly how many anaesthetics have you given in your professional career?’ he demanded, and she gave a rueful smile.
‘Um…one,’ she confessed. ‘A tourist who had penile strangulation. The doctor from Bowra was here seeing someone else when he came in, screaming. I had no choice there either. If I hadn’t given him the anaesthetic he’d have been impotent for life.’
‘But…that’s a really minor anaesthetic.’
‘I know.’ She took a deep breath. ‘And, of course, as you reminded me, the insurance is a nightmare and if anything went wrong I could get sued for millions. So I shouldn’t have done it, nor should I have done this one. But I’ve seen it done and, the way I figured, I didn’t have a choice. Bleating to you about my lack of training wasn’t going to help anything.’
She was amazing, he thought, stunned. Amazing!
‘You were fantastic,’ the woman called Marie said stoutly. ‘To give an anaesthetic like that… She was wonderful, wasn’t she, Doctor?’
Joss looked around at them all. He had four helpers in the room. Three geriatrics and Amy. And he had one live and healthy baby and one young woman whose colour was starting slowly to return to normal.
Because of these people, this baby would live and the unknown woman had been given a fighting chance. Because Amy had been prepared to take a chance, prepared to say to hell with the insurance risk, to hell with the legalities; because these old people had been prepared to shake off their retirement and do whatever they could, then this baby stood a chance of living. Living with a healthy mother.
‘I think you’re all wonderful,’ he told them. He smiled at each of them in turn, but then his gaze returned to Amy’s. And there was that jolt of…something. Something that he didn’t recognise.
Whatever it was, it would have to wait. Now was not the time for questioning. ‘I think you all deserve a medal,’ he said softly. ‘And I think we all deserve a happy ending. Which I think we’ll get.’
He lifted the baby from Marie’s arms and stood looking down at her. The tiny baby girl had wailed once, just to show she could, but she was now snuggled into the warmth of her prepared blanket and her creased eyes were blinking and gazing with wonder at this huge new world.
‘You need your mum,’ Joss said, and as if on cue there was a ragged gasp from the table. And another. Amy’s eyes flew from the baby back to her patient.
‘She’s coming round,’ she said softly. ‘It needs only this to make it perfect.’
The woman was so confused she was almost incoherent, but she was definitely waking.
Joss took her hands, waiting with all the patience in the world for her to recover. When this woman had lost consciousness she’d been in a truck heading out of town. Now she was in hospital—kind of—and she was a mother. It would take some coming to terms with.
‘You’re fine,’ he told her softly, his voice strong and sure, and Amy blinked to hear him. Joss looked decisive and tough but there was nothing tough about the way he spoke. He was gentleness itself. ‘My name is Joss Braden. I’m a doctor and you’re in hospital.’ Of a sort. There was no need to go into details. ‘Your truck crashed. You were in labour—remember?’ And then at her weak nod, he smiled. ‘You’re not in labour any more. You’ve had a baby. The most gorgeous daughter.’
He held the child for her to see.
There was a long, long silence while she took that on board. Finally she seemed to manage it. She stared mutely at the softly wrapped bundle of perfect baby and then tears started trickling down her cheeks.
‘Hey.’ Joss was gentleness itself. One of his elderly nurses saw his need and handed him a tissue to dry her tears. ‘There’s not a lot to cry about. We’re here to take care of you. We had to perform a Caesarean section but everything’s fine.’
Her tears still flowed. Amy watched in silence, as did her three geriatric nurses.
There were more outside. The door was open—just a crack. How many ears were listening out there? Amy wondered and managed a smile. Well, why shouldn’t they listen in to this happy ending? They’d worked as hard as she had, and they deserved it.
‘Can you tell me your name?’ Joss was saying.
‘Charlotte…’ It was a thready whisper.
‘Charlotte who?’
