Cinderella And The Surgeon / Miracle Baby For The Midwife

She raised her eyebrows and nodded. ‘Ah, so you’re here to do the surgery on Billy.’ She pointed one finger at him. ‘In that case, you can stay. Everyone else can wait outside. Unless you’ve brought your own anaesthetist with you.’ She shrugged. ‘If you have, then he, or she, can stay too.’

Eleven other faces exchanged anxious glances, so Esther turned her head a few times as she spoke. ‘The babies in here are just too susceptible to infection to have this many people around. Visitors are strictly limited, for good reason.’ She looked at them all. ‘As I don’t know who any of you are—and to be honest, I’m a bit funny about letting people I don’t know into my NICU too—I’m just going to assume that you’re all either medical professionals or trainees, therefore I don’t need to explain the principles of infection control to you, so you’ll all completely understand that this amount of people is overkill—’ she turned her head back towards Harry ‘—even for a surgeon.’

She’d spoken quite a lot, but knew entirely that all the emphasis was on the things she hadn’t said, but had left implied.

There was a tic at the side of Harry’s jaw. He was mad. She didn’t care. She wanted to tug at her scrub top again. NICUs were always really warm, but this amount of people in close proximity was making her sweat. But tugging at the top would mean she’d have to unfold her arms and that would be a sign of weakness. So not happening.

It was the longest pause. Harry gave the tiniest nod of his head. ‘Francesca, will you stay with me, please? The rest of you, if you wait outside we’ll find a teaching area where I can explain things in due course.’

Francesca was a petite redhead who was grinning conspiratorially at Esther. She let the rest of the entourage leave, then asked, ‘Can I see Billy’s films? I’d like to review them before we examine him.’

‘Of course,’ said Esther, gesturing for both of them to follow her to the nearest computer screen. ‘Have you been assigned temporary log-in credentials?’

‘I have,’ said Harry, moving over next to her and tapping his details in.

It only took a few moments for a scowl to come over his face. ‘I sent a list of tests to be completed for Billy before I got here. Some are missing.’

‘They are?’ Esther moved closer, checking the screen. She’d checked before she’d gone off shift yesterday when there were just a few still to be completed. Ruth had said the rest had been done. What was missing?

She turned to Harry. ‘What is it that you’re looking for?’

‘His bloods. From this morning.’

Of course. ‘I’m sure they were done—they’ve probably not been reported on yet. Don’t worry, I can phone the lab and put a rush on them.’

Harry straightened and gave her an incredulous glance. ‘What do you mean you’re “sure they were done”? You mean you don’t actually know? And why wasn’t there already a rush put on them?’

She stiffened. He was speaking to her as if she was incompetent. Of course she should know if Billy’s bloods had been done or not. But the specialist phlebotomist would have been here while Esther was on her break. If she hadn’t been late back, she might have had a chance to check…

She kept her face blank. Her back was aching. ‘The orders for the bloods were put in last night. At that point, you hadn’t told us when you were coming, or let us know if you’d secured theatre time for Billy. If you had, there would have been a rush put on his bloods.’

She moved over to the desk to pick up the phone. Every word he’d said had annoyed her. But what irked most was that they felt true.

What was wrong with her? She prided herself on being meticulous at work. It wasn’t like she’d made any kind of mistake but…in her brain it almost felt like that. Double-checking things was second nature to her.

‘I’m used to working with professionals. I guess the standards here are not what I’m used to.’

‘Excuse me?’ She couldn’t help herself. There was no way she going to let anyone accuse her of being unprofessional. It was the biggest slight that someone could say to a nurse or midwife.

But it seemed that Harry was off on a rant. He kept his voice low, so that no one else in the unit could hear. ‘Why does Billy still have a feeding tube in situ? In order for Francesca to anaesthetise him, she needs to ensure his stomach is empty. His feeding should have stopped a few hours ago.’

Now Esther wanted to shout at him, but just at that moment a voice answered at the end of the phone. ‘Lab,’ came the weary response.

Something inside Esther panged. Whoever was working there was obviously every bit as tired as she was. ‘It’s Esther from NICU. Can I chase bloods for a baby that’s going to Theatre?’

There was a sigh and murmur of consent. She replaced the receiver and turned to face Francesca, completely ignoring Mr Entourage. She wasn’t even prepared to use his name right now.

‘If you refresh the screen in around five minutes Billy’s bloods will be available. One of the machines was down for a few hours this morning but it’s back up and running now. Billy’s bloods had already been in the system. They’re just waiting for his clotting factor.’

Francesca gave a nod. ‘Perfect.’

Esther looked at Harry’s screen. He was looking at the cardiac echo that had been taken yesterday. Billy needed his surgery, badly.

She moved alongside Harry. ‘I have many skills, Mr Beaumont, but mind reading isn’t one of them. Like I said earlier, if you’d given us notice of Billy’s procedure, then we’d have made sure his feeds were stopped in good time. As it was, his tube dislodged last night and had to be replaced. Billy already had a few hours without sustenance, while his tube was re-sited and then checked. His feed only started again in the last hour.’ She braced herself and turned her head towards him. ‘And for me, unprofessional is a surgeon sweeping into a NICU with an entourage of twelve people with no regard for the patients or parents who are already in a stressful environment. For a surgeon with your apparent experience, I’d expect better.’

Harry was trying his absolute best to keep his temper in check, but this midwife was trying his patience in every possible way. It didn’t help that she had a cheek to be angry at him, or that when she was clearly annoyed she spoke so quickly he had to concentrate to make out a single word that she said. Her Scottish accent was fierce. A bit like she was.

By rights she should probably have fiery red hair to match. But she didn’t. She had dark hair that was up in a ponytail, and her skin looked as though it had once been tanned but was now strangely pale. He couldn’t possibly ignore the dark circles under her blue eyes, or the dirty scrubs she was wearing. He wasn’t quite sure what all this meant—apart from the fact she was looking after the baby he was due to take to Theatre.

Harry had spent his life in and out of NICUs across the world due to his surgical speciality. There weren’t many people that wanted to work on such tiny hearts and veins—particularly when the tissues were so fragile and these little lives could literally be on a knife edge.

What the staff in the NICU at the Queen Victoria clearly didn’t know was that he was the new visiting surgeon, which meant that, where possible, babies with heart conditions would be brought here for him to operate on. For those who were too sick to travel any distance, he would still go to them. But having a semi-permanent base with a team around him would be good. He’d hoped to find professional colleagues he could trust and rely on. But first impressions of this midwife weren’t exactly good.

There was no way he wanted her watching Billy postsurgery.

But what annoyed him most of all was the way she’d quickly and determinedly told him to get his staff out of ‘her’ NICU.

And she’d been right. They always tried to reduce the amount of close contacts that prem babies had. It was important. Their immune systems were often not fully developed, and most humans were walking petri dishes.

People could be carrying bugs for days without any signs or symptoms. Something that caused a mere sniffle in an adult could be deadly to a premature baby. It might be a teaching hospital but even he wouldn’t expect any NICU to let in that many students and trainees. He’d been in such a hurry to get in here and see his patient, and been so swept away by the enthusiasm of the staff at his side, that he hadn’t stopped to think. And Harry didn’t make mistakes like that. So being called on it was embarrassing.

‘You must have known Billy was going to Theatre today,’ he said briskly to the midwife.

She gave him a weary look that told him she was getting very bored by all this. ‘I hoped you might show your face today. I hoped that Billy wouldn’t have to wait another day for surgery. I was told that you were supposed to turn up today, but no one knew when. I look after both baby and mum, and if you’d communicated a little better, there was also the chance I could have prepared mum more for his surgery today.’

She put her hands at the back of both hips, leaned backwards and winced as if she’d touched something painful.

‘Blood results are in,’ said Francesca in a manner that could only be described as deliberately distracting. It was clear she was trying to break the tension between them. ‘His blood gases are a little lower than I would have liked. But not anything I wouldn’t have expected.’ Francesca gave a little sigh and Harry felt a rush of sympathy for her. They’d worked together for a long time. She was a great anaesthetist. It took great skill to manage these tiny babies in Theatre and he depended on her completely. Francesca’s chair scraped on the ground as she stood up. ‘I need to sound his chest. Let me wash up first.’

He followed her over to the sink in the treatment room, completely sidestepping Esther and washing his hands too. He needed to prioritise this baby, not the midwife who looked as if she could currently fall asleep on her feet.

As he stepped back his arm brushed against hers and she jerked away. But not before he noticed how hot she was. ‘Do you have some kind of infection?’

She looked shocked. ‘What?’

‘You’re burning up. What’s your temperature?’ His arm swept out across all the cribs in the NICU. ‘If you have anything respiratory you’re putting the lives of all these babies at risk.’

‘I don’t have anything respiratory,’ she snapped. ‘My chest is clear as a bell.’

For one strange second he realised that her words had made him look exactly at her breasts hidden under her scrubs. He turned back to Francesca. ‘We should see this baby on our own.’

Esther stepped into his path. ‘No, you won’t. I know Jill, his mum, best. She needs support. She trusts me.’

Harry glared at her and she held up her hands. ‘Okay, I won’t touch Billy, right now. I’ll run down to A&E when you’re done and get a clean bill of health. But you don’t see him without me.’

Harry pressed his lips together, stopping himself from just getting into a pointless argument. ‘Only speak to mum, then,’ he reiterated.

She gave an exasperated nod and held out her hand. ‘This way.’

Harry and Francesca followed her over to the left-hand side of the unit to where a young woman sat staring at her baby lying in the crib and rocking backwards and forward in the nursing chair. Harry had dealt with lots of anxious parents. NICUs were the most intimidating places on earth. Parents frequently felt everything was out of their control, and he was used to comforting and supporting parents who were overwhelmed with helplessness and focused on every word that was said to them. This mother was young. Her lank hair was pulled back from her face. It looked as if it hadn’t been washed for a while and from first appearance he actually wondered when she’d last eaten. Now he understood just why Esther was being so protective of Billy’s mum. It was clear she didn’t have many support systems in place.

‘Jill, this is Harry Beaumont. He’s the surgeon that’s going to do the surgery on Billy.’

Harry crouched down so he was level with Jill. She’d sat forward but hadn’t stood up. He gave her a broad smile. ‘It’s a pleasure to meet you, Jill. I’m here to take a look at Billy. I’m hoping we’ll be able to take him for surgery later today. Do you mind if I examine him?’

Jill paused for a few moments as her eyes filled with tears, then she gave a tiny nod. ‘Of course.’

She was terrified. He got that. Harry used some of the NICU hand sanitiser before opening the crib to examine Billy, while Francesca introduced herself as Billy’s anaesthetist. He could tell straight away that Esther completely understood, and after a few moments, he could see the tension in Jill’s shoulders start to dissolve as he spoke to Billy in a calm, quiet voice as he examined him.

‘Hi, Billy, I’m here to see how you’re doing. Let’s have a little listen to your heart and lungs.’ He took his time, listening carefully, then checking his oxygen sats, his feeding tube and his colour. Babies this small frequently had skin that was almost translucent. Their circulatory systems—and particularly Billy’s—weren’t functioning quite right, and they often couldn’t regulate their temperatures. Operating and anaesthetising these babies carried huge risks. He gave Francesca a nod as he moved his stethoscope back to Billy’s chest. ‘Want to take a listen?’

She nodded and moved alongside him. There was no point her touching Billy too when she really just needed to listen to his heart and lungs. So, she listened through Harry’s stethoscope, nudging him to move it on occasion.

Harry could sense Esther watching them curiously. She wouldn’t know they’d done this a dozen times before. As Francesca finished her examination it struck him how similar Esther and Jill looked. Exhausted and tired. He could understand it for the mother. But for a member of staff—it wasn’t good enough.

Francesca gave him a nod and he removed his stethoscope and pulled a chair over next to Jill and spent the next few minutes explaining Billy’s surgery to her in simple terms. He brought out some notes that he’d prepared earlier. He always gave the parents of the babies he operated on some clear notes that they could refer to later. Experience had taught him that although parents listened, anxiety meant that they didn’t always remember or understand what they’d been told.

He could feel Esther’s eyes on him the whole time. He would expect the midwife assigned to this child to listen to his explanation. It would mean that she could reiterate anything to the mum at a later date. But somehow, today, it irked him. And he couldn’t quite understand why.

‘Do you have any questions?’ he checked with Jill. She shook her head and he gave her a small nod. ‘If you think of anything later I’ll still be available to answer any questions. I’m going to organise some theatre time now. I hope to take Billy later this afternoon. We’ll stop his feeding for the next few hours, and I’d expect the surgery to last around six hours. You can come down to Theatre if you want while Billy goes to sleep, and I’ll come and find you as soon as we’re finished to update on how things have gone. Okay?’

Jill gave a nod.

‘I’m just going to have a chat with your midwife, and then I’ll talk to you in a while and get you to sign the consent forms.’

He smiled and walked back over to the nurses’ station with Francesca and Esther. Francesca sat down and started making some notes. Esther turned to look at him. ‘You aren’t doing the consent form now?’

He shook his head. ‘No. I’ve given her a lot to process. I want to give her a bit of time to think about everything I’ve told her before I get her to sign the consent form. She might have more questions later.’

Esther gave a brief nod.

He narrowed his gaze. Was she actually listening? He glanced at the board he’d noticed yesterday. It was a shift rota for staff.

The next few days would be vital for Billy. It was important that whoever was looking after him was at the top of their game. Esther’s name was on the rota for tomorrow. He couldn’t let that go.

‘You’re tired. No, scrap that, you’re exhausted. And I think you’re sick. I don’t think you should be at work and I certainly don’t think you should be assigned to Billy. For the next few days he’s going to need someone who’s alert and on their game.’ He paused for the briefest second, because he knew what he was about to say wasn’t exactly nice. ‘And to be honest, I’m not convinced that’s you. I want another midwife assigned to Billy.’

‘What?’ Well, that had certainly gotten her attention.

‘I’m sorry. But I can’t take the risk of performing this surgery and having his postoperative care compromised.’

‘How dare you!’ she hissed at him. She glanced down. ‘What? Because I have a little coffee spilled on my scrubs and I haven’t had a chance to get changed yet, and because I dared to close my eyes in the hospital canteen, you’ve decided I’m not fit to do my job? Just who do you think you are?’

He cringed. He hadn’t exactly said those words but it was certainly how he’d felt. ‘I think you’re sick,’ he said quickly. ‘I think you might need to be checked over, and have a few days’ rest.’ He could see a couple of other staff members looking their way—as if they’d picked up that something was wrong. The last thing he wanted when he was taking up a position here was to cause a ruckus with the staff.

‘My priority is my patient,’ he said quietly but firmly.

‘And mine isn’t?’ He could tell she was mad.

That wasn’t what he meant, even though he’d clearly just implied it. But then again, did he really want this midwife looking after his patient if she wasn’t at the top of her game?

Francesca glared at him from over her computer. Oh no. That didn’t usually happen. Francesca normally had his back.

He took a deep breath. ‘Esther, I have to call things the way I see it. I think you’re running a temp and maybe need to take some time off. You agreed you’d go down to A&E and get checked over. Why don’t you do that and we’ll take it from there.’ It was a compromise. But it was the best he could do right now.

She kept her face entirely straight and pulled up a few things on the computer and grabbed the chart from the base of Billy’s crib.

‘Here, Mr Beaumont. I’d like you to check my work. Here’s all the orders I made for Billy on my shifts for the last few days. Here’s all my nursing notes. Here’s every temp, blood pressure, pulse and respiratory rate. Here’s his medications I’ve administered, and his feeding. Here’s his skin care chart. Here’s his colour chart. Here’s how many times I’ve sounded his chest to ensure that it remains clear. Here is exactly how many times he’s had a wet or dirty nappy.’ She pulled up a final chart. ‘And here’s how many times I’ve had to chase doctors, other departments, test results…all to ensure Billy’s care is up to my standards.’ She held herself very still, but there was the tiniest tremble in her voice. ‘I want you to take the time to look at what I’ve done. Because I record everything, meticulously.’ She emphasized the word, then gave a wave of her hand. ‘And once you’ve done that, I can pull up all the same information for his mother, and you can check my recordings for Jill too.’ She paused for a few seconds as he glanced over what she’d handed him. ‘Unfortunately I’m not on shift twenty-four hours a day, so I’ve only given you what I’ve done for Billy. Hospitals have emergencies, as I’m sure you’re aware. Blood machines break down. Feeding tubes dislodge and can’t be safely used again until there’s been an x-ray that’s been checked by a physician. I’m not responsible for other people’s time constraints.’

He was checking. She was right. He couldn’t deny it. Her recording was meticulous. Some of the best he’d ever seen, and he’d been in a lot of NICU units.

She’d felt warm to the touch earlier, but as she’d moved closer as she spoke to him he couldn’t hear any sign of a wheeze or rasp in her breathing. Every person was different. Maybe she didn’t have an infection. Maybe he was overreacting. It could be that her body temperature just ran at the top end of normal. It happened.

What was clear was he couldn’t tell her why he’d overreacted. He couldn’t tell her that deep down there was an underlying paranoia about his patients and their welfare.

Before he could blink she’d stepped right up in front of him, her accent thick but perfectly legible. ‘You know, Harry, I’m actually glad that you’re here. Because even though you’re an insufferably arrogant fool, I know how much Billy needs this surgery. And I put him first. Always. But I’m only going to say this once. Don’t ever talk to me like that again and don’t ever question my professionalism or my competency at work.’ She put both hands on her hips. ‘I wish you luck with Billy’s surgery today, but after that, I hope I never have to see your sorry ass in here again.’ And with that, she turned on her heel and walked away, leaving Harry feeling about as welcome as a thorn in a space suit.

Francesca tutted and gave him a sarcastic smile. ‘Well done, Harry. First day on a new job and you’ve made friends.’ She picked up her bag. ‘And to be honest,’ she said in a low voice as she walked past. ‘Against her? I don’t fancy your chances at all.’

CHAPTER TWO

THE SIGNS HAD been there but she’d been too busy to pick them up—looking after Jill, worrying about her mum. Esther cursed herself all the way down the stairs towards A&E. She hated the fact that it took that pompous prince, duke or whatever he claimed to be to point them out before the penny had finally dropped for her.

Abi had told her to go on down for the check while she took care of Billy but Esther already knew exactly what was wrong with her. She’d ducked into the treatment room and took her own temperature. Yip. She was burning up. She grabbed some paracetamol from her handbag. She had to start somewhere.

Rob, one of the advanced nurse practitioners, was at the nurses’ station in the middle of the A&E department. He took one look. ‘You okay?’

She shook her head. ‘I think I’ve got an upper UTI. Can I borrow you for five minutes?’

He nodded. ‘Sure.’ Then he smiled and handed her a specimen bottle. ‘Let’s get you sorted.’

It took a little more than five minutes because Rob liked to be thorough. Once he heard her past history of having kidney problems as a child, leaving her prone to upper urinary tract infections, he gave a little nod, dipsticked her urine, rechecked her temp and listened to her symptoms of fatigue and an aching lower back.

‘You couldn’t come down earlier?’

She sighed. ‘I’d felt a bit tired but my back only started aching this morning and the new neonatal cardiac surgeon arrived today so I’ve been flat out dealing with him too.’

He gave her a nod and scribbled some notes. ‘What normally works best?’

She told him the name of the antibiotic that normally resolved her infections and he scribbled a prescription, then went to one of the cupboards and pulled out a bottle, signing a form to record it. ‘Okay, so I won’t make you trek to the pharmacy. But I’m still sending your sample away to make sure you’re on the right antibiotic. Results should be on the system tomorrow. I’m working then—will I give you a call?’

Esther gave a grateful nod. The computer system in the Queen Victoria meant that no staff could access their own records or results—no matter how tempting it was. ‘Perfect. Thanks, Rob.’

‘Any time. Not many perks to being in the NHS. We’ve got to look after our own. Are you going to take some time off?’

‘Me?’ She smiled and shook her head. ‘As soon as I start taking these, they usually work fast. This time tomorrow I’ll start to feel better. I’ll just take some paracetamol until then.’

He gave a nod. ‘Fine, but let me know if there’s anything else you need.’