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‘Maybe not tonight,’ Caitlin said. ‘I’ll want to keep an eye on her in the labour ward overnight, in case of postpartum haemorrhage.’
While the baby was being taken away to the special care nursery, accompanied by the paediatric nurse and Andrew, Caitlin finished closing the wound. She felt a trickle of perspiration run down her forehead and was grateful when one of the nurses wiped it away. Once Mrs Roland had woken from the anaesthetic, she would see her and let her know what was happening. She was pleased that her first case had gone well—not that she doubted her ability, but Caitlin knew that sometimes even straightforward cases could suddenly go wrong.
After she had finished in Theatre, she asked one of the nurses to take her to Special Care. She wanted to check on the baby before she spoke to the mother.
She found Andrew bending over the infant, listening to its chest. He looked up at her, his deep brown eyes warm. ‘He’s going to be fine, I think,’ he said. ‘We’ll know better in a few days. You did a good job back there.’
Caitlin looked around the small high-tech unit. It reminded her of the one back in Dublin, but she guessed that there was a uniformity with all hospitals in the Western world. There were five babies in at the moment, with anxious parents sitting by their incubators. Her heart went out to them. It must be so hard to feel so helpless, to know that the life of your child depended on the doctors and nurses.
Having finished examining the baby she had recently delivered, and announcing himself satisfied for the time being, Andrew suggested he show her around.
‘We have around four thousand deliveries a year here,’ he said. ‘We get difficult cases from quite far away. The air ambulance brings mothers and kids in on a regular basis. You might like to go out with the team some time.’
‘I’d love to,’ Caitlin said enthusiastically. ‘I’ve never been on anything like it before. I guess in a country of this size, it happens a lot.’
‘Often enough,’ Andrew said. ‘We take turns being on call for the air ambulance. I’ll rota you in for the same time as me. Okay?’
At Caitlin’s nod he went on. ‘I’ll take you up to Personnel. I know you sent all your paperwork in advance, but there may be one or two pieces they need from you. After that I’ll give you the tour.’
After she’d completed the necessary paperwork, Andrew introduced her to the midwives and doctors she’d be working with. There were too many faces for her to remember everyone’s names straight away, that would take time, but all the staff seemed very welcoming.
Her first afternoon was to be spent in Theatre. One of the senior midwives, a cheerful woman called Linda, took her on a round of the antenatal ward. Andrew left them to it while he went to do his own rounds. After the ward round Linda took Caitlin to the general gynaecology ward and introduced her to the patients she had scheduled for Theatre.
After seeing all the patients on her afternoon’s list, Linda stopped in front of a woman who was perched on the end of the bed and looked as if she was ready to run a mile.
‘This is Mrs Mary Oliphant,’ Linda introduced the woman. ‘She’s in to have her tubes examined. She and her husband have been trying for a baby for a year, and their family doctor thinks she should have her tubes checked before they think about IVF.’
‘Good idea,’ Caitlin said. Mrs Oliphant seemed to relax a little. ‘It’s a very quick procedure,’ Caitlin said. ‘We’ll take you down to the scanning room and pass a catheter through your cervix, squirt some dye and have a look. We don’t even need to anaesthetise you, but we’ll give you a couple of painkillers as it can be uncomfortable. The good news is that you’ll have the results straight away.’
‘And if my tubes are blocked? What then? Does that mean we won’t be able to have children?’ Mary’s lip trembled. ‘We really want a baby.’ A tear slipped down her cheek. ‘I blame myself. I was determined to wait until my career was established before we started a family. But what if I’ve left it too late?’
‘Hey, let’s not get ahead of ourselves,’ Caitlin said soothingly. ‘Let’s do the echovist first and we can talk again then.’ She took her hand. ‘Anyway, you’re not that old.’ She smiled. ‘Although a woman’s fertility does decline markedly after the age of thirty-five, you’re still on the right side of forty. And there is a test we can do which will tell us just how well your ovaries are responding. I’ll take a blood sample today, and I should have the results for you soon. I also suggest that we test your husband. That way, if you need to think about IVF you’ll be ready to go. How does that sound?’
As she spoke a thought slipped into her head. Time was passing for her too. It was quite possible that if she changed her mind about wanting children, she too would find she’d left it too late. It was one thing not to want children, quite another to have the choice taken away. She squeezed the thought to the back of her mind. Why was she suddenly thinking children might be an option in the future, when until now she had been sure children weren’t for her? She forced her attention back to her patient. It was Mary who she had to think about. She deserved her full attention.
Mary smiled, seeming reassured. ‘That sounds great,’ she said. ‘I just want to know so we can decide our next step. Thank you for taking the trouble to talk to me.’
‘Hey, that’s what we’re here for.’ Caitlin smiled. ‘I’ll see you down in the scanning room shortly. First let’s take that blood sample.’
Quickly, Caitlin took a sample of blood from Mrs Oliphant’s arm and passed it to Linda.
As they moved away Linda said, ‘There’s one more lady I’d like you to see. I’ve already spoken to Dr Bedi about her, and he’s interested to know what you think.’ Curious, Caitlin let herself be led across into one of the single rooms. Sitting up in bed, reading a magazine listlessly, was the patient Linda had asked her to see.
‘This is Mrs Levy,’ Linda said, passing her chart to Caitlin. ‘As you can see, she’s twenty-nine weeks pregnant. She was admitted earlier today with an elevated blood pressure of 160 over 100, plus protein in her urine. In her first pregnancy she had to be delivered prematurely because of high blood pressure.’
Caitlin had seen the condition often. It was always a difficult judgement call. On the one hand, there was no treatment and the only sure way of preventing the condition from getting worse was to deliver the baby. However, Mrs Levy was only twenty-eight weeks pregnant and although Caitlin knew that the hospital had the necessary equipment to look after a pre-term baby, there was always a chance that the baby would suffer brain damage or even worse if it was delivered so early.
‘What does Dr Bedi think?’ she asked Linda as they moved away from the patient.
‘He’d prefer us to wait and monitor her closely over the next few days.’
It wasn’t an unreasonable decision, Caitlin knew. Every day the baby stayed safely in the mother’s womb increased its chances of survival.
‘Could we arrange to have Mrs Levy scanned?’ Caitlin asked, making up her mind. ‘I’ll do it myself before Theatre.’ She went back to her patient.
‘You’re probably well aware of our concerns, Mrs Levy. I’m sure they have been discussed with you.’
‘Please call me Patricia. Mrs Levy always makes me think of my mother-in-law.’ She smiled, before the anxious look returned to her eyes. ‘That nice Dr Bedi came to see me and explained everything.’
Did he, now? Caitlin thought, wishing that he had spoken to her before discussing options with the patient. She decided to wait until she had spoken to him and had the scan results before speaking to Patricia again. ‘I’d like to scan you as soon as we can get a scanner up here,’ she told the patient. ‘I’ll see you in a little while, okay? Then we can decide on the best way forward.’
Patricia clutched Caitlin’s hand. ‘I really want this baby,’ she said. ‘They told me it’s a girl and as I have two boys, it will make my family complete.’
Caitlin patted her hand reassuringly. ‘We’ll do our best for you, I promise. In the meantime, the best thing you can do for your baby is try and relax.’
After rounds Linda took Caitlin into the staffroom for a cup of coffee. ‘What do you think so far?’ she asked as she poured them mugs from the pot that had been made earlier.
‘I’m impressed,’ Caitlin admitted. ‘The facilities, at least what I’ve seen so far, are impressive.’
‘I hear from the others that you know Dr Bedi. He’s lovely, don’t you think?’
Caitlin wasn’t quite sure how to answer. What was she supposed to say to that? That, yes, he was gorgeous and that she fancied the pants off him? ‘He seems very nice,’ she said noncommittally.
‘Half the nurses and doctors here are in love with him. The other half are married.’ Linda laughed. ‘Thank goodness I’m in the second half. Otherwise I’d be doomed to have my heart broken, like the rest.’
Caitlin wasn’t used to such frankness and wasn’t sure how to respond. Thankfully, as she was searching frantically for a more neutral subject, Andrew himself appeared.
‘They told me I’d find you here,’ he said, pouring himself a glass of water from the cooler and gulping it greedily. ‘I wondered if you wanted to see the paeds wards before we have lunch. Your theatre list starts at 1.30. Right?’ She eyed him, mentally readjusting her opinion of him in light of what Linda had told her.
Caitlin stood. ‘I’d love to see the children’s ward,’ she said. ‘And meet the staff.’ She finished her coffee and rinsed her cup. ‘Thanks, Linda,’ she said as she followed Andrew out of the staffroom. ‘I’ll see you after Theatre.’
She followed Andrew out of the staffroom.
‘I don’t think we should leave Mrs Levy any longer,’ she said. ‘She’s showing all the signs of pre-eclampsia—raised blood pressure and protein in her urine. If we don’t deliver her and her condition gets worse then there is a chance she’ll start fitting and we’ll lose her. I’m sure neither of us want to be faced with a maternal death.’
Andrew turned and looked at her. ‘The last two scans place her at twenty-eight weeks,’ he said. ‘There’s not been much growth since then.’ He frowned. Caitlin wondered if he was unused to having his opinion challenged. Underneath his easygoing exterior she thought there was a man who, once he had made up his mind, was loath to change it. It was clear in the way the staff acquiesced to him that he was used to being deferred to. On the other hand, so was she. She trusted her instinct, and if she were back in Ireland nobody would have questioned her decision.
‘If we deliver her now, then there is a chance the baby won’t survive,’ he continued. ‘Even another couple of days would give it a better chance.’
Caitlin held her ground. ‘If we wait another couple of days and the mother develops full-blown eclampsia then there’s a good chance that we’ll lose the baby as well as the mother. Is that a risk you’re prepared to take? Because I’m not sure I am.’
They stared at each other, neither willing to give an inch.
‘We should go and speak to the patient at least,’ Caitlin said eventually. ‘We should give her all the facts and let her decide.’
‘Do you think that’s fair?’ Andrew countered. ‘If she decides to go ahead and let us deliver the baby, and the baby dies, she’ll carry that burden always. She’ll always wonder if she made the right decision.’
‘And if she takes your advice and waits, and she and the baby both die, then what about the rest of her family? She has two children under the age of five. Do you think it’s fair to leave them without a mother?’ Caitlin felt her voice catch on the last words as an image of her niece and nephew growing up without their mother flashed across her mind.
Andrew looked at her sharply. ‘Are you sure this isn’t becoming personal, Caitlin?’ he asked softly.
Caitlin gritted her teeth in frustration. She never let her personal feelings or emotions interfere with her professional judgement. But that didn’t mean that she looked on her patients just as obstetric dilemmas—she prided herself on taking all aspects of their lives into account when making a clinical decision. How dared he suggest otherwise? Even if he already thought of her as some sort of pathetic female that needed rescuing. Now he was accusing her of being over-emotional and letting her worry about her sister cloud her judgement. Well, she would soon put him right.
‘Let me make one thing absolutely clear, Dr Bedi. It’s important we understand one another if we are going to be making joint decisions about patients.’ Her voice was cold and clipped, even to her own ears, but she made no attempt to soften her tone. ‘The decisions I make are always—’ she emphasised the last word ‘—made on the basis of what is good for my patient. I never let personal feelings cloud my judgement.’ Aware that she had curled her hands into fists, she made herself relax. What was it about this man which caused her to have such strong reactions?
‘I’m glad to hear it, Dr O’Neill,’ he said calmly. ‘Because if I ever had reason to think you weren’t up to the job, believe you me, regardless of the friendship I have with your family. I wouldn’t hesitate to have you removed from the case. Now, do I make myself clear?’
CHAPTER THREE
STUNNED, Caitlin could only stare open-mouthed at Andrew.
‘Well, now that we understand each other,’ she said stiffly, ‘shall we continue?’ She marched off in what she hoped was the general direction of Paediatrics, not caring whether Andrew was following or not. Of all the insufferable, conceited, big-headed…She was fuming to herself when Andrew caught her arm and stopped her in her tracks.
She glared at him, before seeing the look of apology in his deep brown eyes.
‘I’m sorry,’ he said, ‘that was unforgivable of me.’
‘Yes, it was,’ Caitlin said. Then she softened at his look of genuine remorse. ‘Do you really have doubts about my clinical judgement?’ she asked, puzzled. ‘I know you had me checked out thoroughly before you arranged the job for me.’
‘I did,’ Andrew said. ‘And I don’t have doubts. It’s just…’ He hesitated. ‘Let’s just say that I have my reasons.’
‘Shouldn’t you tell me what they are?’ Caitlin said.
‘There’s no need. I agree we should wait for the scan results before we decide what to do. Okay?’
Caitlin was tempted to press further, but she could tell from the set of his chin that she was unlikely to get anything more from Andrew. But she was a patient woman. Whatever it was, she would find out soon enough.
‘Okay,’ Caitlin said. ‘Now, let’s go and see this paediatric ward of yours.’
After a quick tour of the children’s ward, Caitlin left Andrew checking his patients and made her way to the scanning room where Mrs Oliphant was waiting for her.
‘Hey, how are you doing?’ Caitlin said. Mary just smiled weakly.
Caitlin passed the catheter then turned the monitor towards her patient and pointed to the screen.
‘Look,’ she told the anxious woman. ‘You can see both the ovaries. That’s the left one and there’s the right. And see that little blob there? That’s a follicle with an egg developing inside. So far so good. Everything is normal.’ She withdrew the catheter. ‘You can get dressed now.’
Once Mrs Oliphant was dressed and sitting down, Caitlin turned to her. ‘I’ve also had the blood results back. And they’re consistent with the scan we’ve just done. Your ovaries are looking good. And the embryologists have told me that Richard’s results are also normal. So I’m going to suggest that you go home and keep trying for another six months. If you’re still not pregnant by then, we’ll talk about IVF. But I’ve got a feeling that you won’t need it.’
Mary relaxed and smiled broadly. ‘It’s such a relief to know,’ she said. ‘I can’t tell you how worried I’ve been.’
‘Sometimes,’ Caitlin said gently, ‘I find that once couples relax, nature just takes it course. And if it doesn’t, well, you can come and see me again. But for now I want you and Richard to go home and have plenty of sex.’
She saw a happy and relieved Mary out, and then asked whether the scanner could be taken to the antenatal ward for Mrs Levy’s scan.
Once back on the antenatal ward, Caitlin prepped Patricia’s abdomen with gel, apologising for the cold sensation. Then she placed the wand over her abdomen and turned the screen towards the patient so that she was able to see what Caitlin was seeing.
‘See that over there.’ She pointed to the heart. ‘That’s the baby’s heart. As you can see, it’s beating strongly.’ Patricia looked entranced as Caitlin proceeded to point out arms and legs. The image was so good that she was even able to show Mrs Levy her baby sucking her thumb. ‘And as you’ve been told already, she is a healthy little girl. I put her at about twenty-eight weeks and three days.’
Mrs Levy lay back on the bed, looking thoughtful. ‘It makes it seem more real, seeing her there on the screen.’ She closed her eyes and Caitlin watched as tears slid out from underneath her eyelids. ‘I just don’t know what to do for the best. If only my Jack was here to help me decide.’ Caitlin knew from the notes that Mrs Levy’s husband had been killed in a traffic accident early on in the pregnancy. Her heart went out to the distraught woman. ‘My other two, my boys, they are my first husband’s,’ she went on. ‘We divorced when my youngest was two. I thought that was me. That it would just be me and the boys. And then Jack came along, and that was that. We fell in love and married a few months later.’ She opened her eyes and Caitlin could see the memories brighten her eyes.
Caitlin perched beside her patient on the bed. ‘Go on,’ she said softly.
‘As I say, we got married, once the children had got to know him, and then started trying for a baby. It took a couple of years for me to get pregnant, you know. I was getting close to forty by this time.’ She paused, her eyes misting over. ‘He was so excited, he didn’t have children of his own, never having married before. He was just like a little kid himself. He even went out and bought a crib the day after I took the pregnancy test.’
Caitlin was aware of somebody coming to stand behind her. She glanced over her shoulder to see Andrew. Patricia went on.
‘Then just a couple of months later he was dead.’ She started to cry in earnest. Wordlessly, Andrew passed her some tissues and they waited in silence while she fought for control. Eventually, she blew her nose.
‘So, you see,’ she said once her sobs had subsided, ‘I can’t risk losing this baby. It’s all I have left of Jack.’ She looked from Andrew to Caitlin, her eyes begging them to understand. ‘Dr Bedi knows all this,’ she said quietly. ‘That’s why he said we might be able to risk waiting a day or two.’
‘But,’ Caitlin said gently, ‘you do realise if we wait too long there’s a risk you could develop full-blown eclampsia and might die. What about your other children? They’d be left without a mother.’
‘I don’t want to die,’ Patricia said fiercely. ‘I don’t want to leave my kids, but Dr Bedi says you’ll watch me carefully.’
‘Okay,’ Caitlin agreed reluctantly. ‘We’ll watch and wait. But I’m warning you, if there is the slightest sign of your condition worsening, I’m getting you delivered. Agreed?’ She looked at Andrew for confirmation and was relieved when he nodded.
‘I’ll ask them to call me at home if there’s any change,’ he said.
‘As will I,’ Caitlin added. ‘I’ll do the section myself.’
‘I’d feel so much better if you’ll both be there,’ Mrs Levy said, hope brightening her eyes.
‘But they might have to go ahead and deliver you if I can’t get here in time,’ Caitlin warned.
‘I understand,’ Patricia said. ‘Thank you both for taking care of me and listening.’
Andrew and Caitlin left Patricia to get some rest. A glance at her watch told Caitlin that she was due in Theatre.
‘Did you know all that?’ she asked. ‘Is that the reason you wanted to wait?’
‘Partly,’ Andrew said. ‘At the end of the day I want the same thing you do. A healthy baby and a mother who survives to look after it. But,’ he said, ‘I don’t think we should ever look at patients as if they were simply their medical problems. We need to see them as people, all with different needs requiring different solutions.’ Caitlin bristled. Was he suggesting that she didn’t see her patients as individuals? He had no right to make that assessment of her. But, she admitted to herself, was there just the tiniest bit of truth in it? Was that why she was so drawn to the academic side of her chosen speciality? Because it was easier than dealing with real people and real emotions? He grinned down at her, and Caitlin’s heart gave a curious flip. ‘You and I are on the same side after all.’
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