The Pregnant Midwife

Kirsten had brought a bag of things from home to keep on site and there was a feeling of déjà vu in packing them back into the locker, having emptied it eighteen months ago. She tucked her bathroom bag, small pillow and quilt at the back for those nights when all the checking and cleaning was finished and they were waiting for a call. If she was going to do extra nights in the nursery she might be glad of an hour’s catch-up sleep.

Headquarters had two bedrooms with proper beds, a sofa in the TV room and a fold-up bed that could be erected in the education room. But from past experience she knew there wasn’t usually much chance of sleep.

Most days, the MIRA staff averaged two retrievals per ten-hour shift, with each trip taking between three to five hours. Sometimes it was much longer if the infant was difficult to stabilise before transfer.

Hunter came into the room and Kirsten shoved away her box of emergency muesli bars, relieved she’d finished packing her locker. The sudden awkwardness at his presence made her press back to let him past.

The locker room was tiny and he couldn’t help brushing against her as she shrank almost inside her locker to keep out of his way. Just that minute contact made her stiffen in denial of an attraction she didn’t want to feel.

‘Worried about catching germs, Kirsten?’ he drawled, but didn’t look at her as he put away his jacket. Kirsten gritted her teeth as she backed out of the small space.

‘Don’t be a pain, Hunter.’

There was silence from behind her as she left the room. Great beginning to the first day, she chided herself, but he’d started it. She sensed him follow her out towards the kitchen. They really needed to get professional here and bury the past. She slid her lunch into the fridge and eyed the new vending machines in the kitchen that hadn’t been there last year and grinned. Sweets, chips, Coke and microwave meals—a truly balanced diet for those who wanted it.

One of the male registered nurses from the night shift wandered into the kitchen with an empty coffee-cup, let out a whoop when he saw Kirsten, picked her up and swung her around. ‘Kirsten Wilson. How the hell are you?’ he said, and gave her a big hug. At the look on Hunter’s face Kirsten could either have laughed or cried. She chose the former and hugged Paul Netherby back. Take that, Hunter Morgan, Kirsten thought as the big nurse put her down, but when she turned to see what his reaction was, Hunter had gone.

Suddenly she felt flat, and in denial she became more vivacious.

‘It’s good to see you, Paul. How’s Serena and the baby?’

The man’s face fell. ‘She left me. Not interested in taking her place, are you?’ He looked cautiously hopeful but Kirsten wasn’t fooled.

‘Nobody could take Serena’s place for you. If you’ve hurt that woman, you have some major sucking up to do and you know it.’

Paul hugged her again. ‘I love you, Kirsten Wilson.’ Hunter returned with a dirty coffee-mug and his lip curled as if he’d just swallowed a particularly loathsome insect. Kirsten signed. Paul was oblivious and dragged a stern-faced Kirsten out into the other room. ‘You know me so well,’ he chattered as they left. ‘Come and meet my partner from last night, the delectable Nicky.’

Hunter stood at the sink and stared out the window, but he couldn’t see anything. Lord, he’d had a lucky escape. That woman attracted men like flies and she seemed to lack all moral judgement. Hunter knew about poor Serena Netherby and the flighty Paul, and he’d thought they were almost back together again. And they even had a baby. Netherby was just the sort of low-life Portia, his ex-wife, would have liked, too.

He couldn’t believe Kirsten could be so stupid as to believe anything Netherby said, but obviously they’d had some kind of past relationship to be that friendly.

It was all none of his business and he’d had a lucky escape. It was good to have a calm and safe life again. Now there was no reason he and Kirsten couldn’t be professional about this—she’d always maintained that in the unit.

Ellen wandered into the kitchen to find Hunter gripping a cup, white-knuckled, at the sink.

‘You OK, Hunter? she asked, and he blinked and smiled a perfunctory greeting.

‘Fine.’ He glanced down at the cup in his hand and loosened his fingers. ‘Looks to be good flying weather out there,’ he said, and walked away.

Ellen glanced out the window at the shredded clouds scattered ahead of a thick cumulonimbus front. ‘What planet are you on today?’ she muttered, as she switched the kettle on.

Paul, Nicky and the other night team members had left and Ellen cornered Kirsten to run through the protocols and check routines. All the time Kirsten nodded that she understood, she was aware of Hunter on the sofa as he pretended to read the newspaper. He kept staring at her over the top of the pages, trying to put her off, and if he didn’t stop she’d clock the man with one of the cushions.

She knew he could get up to mischief. It would be just like him to decide to amuse himself at her expense.

Before the battle of wits could escalate, the MIRA phone rang and personal tensions disappeared. Jim took the incoming call from a base hospital on the north coast and they all looked towards the conference phone as Hunter joined in.

A three-hour-old baby boy, Isaac Curtin, had been diagnosed with a large ventricular septal defect (VSD) or hole in the heart. Born in Taree, an hour’s flight north of Sydney, baby Isaac needed to be airlifted to a major centre for care and assessment by a paediatric cardiologist and probable urgent corrective surgery.

Kirsten listened to Jim as he outlined the hospital doctor’s problem, what his needs were and other possibilities, but she could tell they all agreed retrieval was the best option. Jim conferenced the call with Hunter, a paediatric cardiologist and a surgeon in Western Sydney, and Hunter took notes on the recommended treatment for stabilisation by the MIRA team after the decision was made to transfer.

Kirsten’s heart did a little flip-flop of excitement and she couldn’t help savouring the flush of adrenalin for her first retrieval in a year and a half despite the fact she was sharing the trip with Hunter and Ellen. She shrugged. The baby and parents were the important people.

The preparation and flight routine emphasised minimum delay in departure and Kirsten pushed the equipment out onto the roof ahead of the rest as all the sequences returned from memory.

The extra-warm greeting Kirsten received from the tall pilot, Keith, a man not noted for warm greetings, was observed stonily by the two senior staff members as they followed Kirsten into the helicopter. Kirsten rolled her eyes. Hunter probably thought she was having an affair with Keith now. She winked at Keith and watched Hunter’s eyebrows shoot up.

An experienced fixed-wing instructor, as well as helicopter pilot, Keith had flown many times in the past with Kirsten. She’d shared several hilarious picnics with Keith and his wife at the Camden Aero Club before she’d gained her own unrestricted pilot’s licence, and she considered them both good friends. Darned if she’d start feeling uncomfortable around Keith because of Hunter Morgan’s hang-ups.

‘Looks like it’ll be a bumpy ride.’ Keith seemed to derive a certain malicious satisfaction from the forecast and Kirsten grinned back. He hadn’t been able to make her airsick yet.

Stormclouds accumulated off the starboard wing and Kirsten was glad they were in the sturdy Bell 412 helicopter. At least there was plenty of room for the extra staff member and Kirsten didn’t have to stare at Hunter all the way.

Prior to take-off, baby Isaac’s weight and birth date had been fed into the computer and the MIRA program-generated drug sheets produced the correct dosage for every conceivable drug they might need on the retrieval. This double-sided printed sheet was a valuable tool in saving time in drug calculations and dramatically cut the chance of medication error. The team prepared the most likely drugs en route to save more time at the destination hospital.

Ellen ran through the probable scenario of arrival for Kirsten, as if she’d never been on a retrieval or even an aircraft before, and Kirsten listened and nodded. At least Ellen was a distraction from Hunter who was on the other side of the cabin, watching with his arms folded. She wished he’d recheck the portable crib or something because she found his scrutiny hard to ignore.

At last they arrived and Kirsten heaved a sigh of relief. Next time she’d make sure she had the window seat as a distraction.

CHAPTER THREE

AT THE destination hospital, if there was time, the first step was always to meet the parents, then quickly move to assess the patient.

Baby Isaac would become more tired as his in-coordinated heart struggled to achieve what had been so easy inside his mother, and Kirsten knew they’d have to watch out for heart failure.

Isaac’s parents looked very young as they hovered anxiously on the periphery of the medical drama, and Kirsten went over and shook their hands.

‘Hi, I’m Kirsten Wilson and I’m one of the neonatal nurses from Sydney. This must be pretty frightening for you both.’ The young couple nodded and Kirsten smiled. ‘We’re going to keep you updated as we make Isaac as comfortable as we can for the flight. After that we’ll get Isaac and you, Mum, transferred to the major hospital. When you get there, the paediatric cardiologist will talk you through his treatment plan.’

Lily, Isaac’s mum, clutched her boyfriend’s hand tighter. ‘There seems to be so many people here and Isaac looks so small.’

‘I know,’ Kirsten said. ‘But he’s getting the best care so he can have the safest trip we can manage for him. About one baby in a hundred has a heart problem so we’ve done this before.’

Both parents sagged a little with relief at Kirsten’s confidence. ‘We’ll all be with you until we hand Isaac over to the staff at the city hospital so don’t forget to ask questions as you need to.’

Lily nodded and Kirsten rejoined her colleagues. She allowed herself a brief stroke of Isaac’s head as she began to record his respiratory rate, heart rate and oxygen saturation as she looked for signs of cardiac failure. Ellen connected the baby to the MIRA monitors as well as the referring hospital’s equipment to ensure constant monitoring during change-over, and she offered Kirsten the stethoscope to listen to Isaac’s chest. The heart murmur was very clear.

‘What’s your instinct on this baby?’ Hunter spoke quietly in her ear and Kirsten knew he was testing her.

‘He’s breathing faster than he should be so respiration is affected, and he’s sweaty and that’s not a good sign. I’d say he has substantial fluid backing up in his lungs and when I listened to his chest he sounded “wet”.’ She glanced at Hunter. ‘The heart murmur is loud and I’d say it’s a large VSD.’

Ellen, dressed in a lead apron, held Isaac while X-rays were taken, because it was important to see the quality of Isaac’s lungs and any cardiac enlargement. As soon as they were finished, Kirsten did a quick twelve-lead ECG to give Hunter some idea of the electrical conductivity of the sick baby’s heart.

Hunter took the chance while the nurses were busy to explain things to the parents and reassure the base hospital staff on the excellent job they’d done in preparation for the retrieval team. She had to admit that when he wanted to use his charm he was a master at putting people at ease, which helped in situations like this.

She watched him put his arm around Isaac’s mother and clap his father on the back as he congratulated them on their beautiful son. His obvious empathy with frightened parents had a lot to do with the attraction she’d felt for him when they’d first met.

They couldn’t be friends but they should be professional about their differences at least. She could still admire his skill and empathy as a neonatal intensivist.

Hunter returned to the baby and the equipment Kirsten had assembled. He inserted an intravenous cannula in Isaac’s hand and when the newborn grasped Hunter’s finger, they shared a smile across the humidicrib at the wonder of tiny babies.

This was ludicrous, Kirsten thought, and vowed to establish some ‘safe’ camaraderie because moments like this were too special to waste on something that was never meant to be.

The finality of that thought stayed with Kirsten as she turned away to document the time of insertion and the start of the minuscule measured amounts of intravenous fluids.

‘Let’s give him a diuretic to see if we can offload some of this fluid he’s accumulating,’ Hunter said, and Kirsten handed him the preloaded syringe with the ampoule taped to it.

They checked the dosage together and just as Kirsten started to relax, Hunter had another question for her.

‘What else are we looking for?’

Kirsten glanced down at Isaac and the answer came readily. ‘Probably signs of any other abnormalities or indications for other syndromes that this condition can run with.’ The obvious ones were often identifiable by abnormal facial characteristics. She glanced across at Isaac’s dad, and any facial features that might have hinted at a genetic disease were vetoed by the mirror image of father and son. She smiled, and Hunter, following her thoughts, did too. Then they both looked away quickly and Kirsten busied herself by recording what they’d done.

All treatment for the stabilisation of baby Isaac would be diligently recorded, as would any improvement or deterioration in his condition. Later in the week, at the team meetings, all cases would be reviewed and discussed to ensure any improvements in care would be noted and used in the next case.

Within a short while they had achieved the best oxygen saturation and cardiac output they could for Isaac, and all that was left was to fix the cables and tubes, clean up their mess and prepare for transfer.

For Hunter, working with Kirsten was as hard as he’d feared it would be, yet at the same time incredibly easy. The last few months he’d felt he had become adept at completing retrievals with Ellen and the other neonatal nurses, but with Kirsten the clinical component of patient care seemed so much more streamlined.

There was no need to ask for anything. She had either already done it or had what was required ready for him to complete the procedure, as it had always been in Dubai.

And, as it was then, all the time she smiled—at the baby, at the parents, at the referring hospital staff. And at him.

Hunter had forgotten how much joy she shared with those around her. Even in the midst of tension and fear, she was a reassuring light that parents and staff turned to when things seemed blackest, and suddenly there was hope or at least reason in the chaos.

He’d blocked out how many times he’d witnessed her like that in the past and he did not want to go there now, but it was hard not to remember. How ironic that she was happy and he was miserable.

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