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‘It will be easier on you and your babies if you’re on all fours,’ he told her. ‘It opens up the birth canal and, even though it may seem uncomfortable, believe me, it will be far better than being on your back. Just try it. Here, I’ll help you.’
He reached for her and she felt the warmth and strength in his hold as his hands guided her into the position he needed to best deliver the babies. He made sure her hands and knees were still resting on the damp jacket, not the bare floor.
‘I’d like to put a cool compress on you. It’s getting warm in here but I’m running out of clothing to give you.’
Even in pain, Claudia smiled at his remark. It was true. He had given his jacket and his shirt. ‘There’s a clean scarf in my bag but it’s very small. You could wet that.’
Patrick reached for her large tan leather bag and dragged it unceremoniously across the metal flooring. He emptied the contents onto the floor, found the small patterned scarf and then noticed the films.
‘Are those films for your obstetrician?’
She turned her head slightly. ‘Yes, he was going to check them and then sign the papers to allow me to fly home to London.’
He pushed the envelope to the side and took her bottle of water and sparingly dampened the scarf. Gently lifting the sweat-dampened curls on the nape of her neck, he rested the tiny compress on her hot skin. There was nothing he could do about whatever showed on the films now. They wouldn’t change anything in the confines of the elevator. He had no idea what the next few minutes would hold but he would be beside her and do whatever he could to keep Claudia and her babies alive.
Feeling his hand on her skin felt so calming and reassuring and Claudia wondered if it was the touch of his skin against hers as much as the makeshift compress. But neither gave relief when the next powerful contraction came and she cried out with the pain.
Her cries tugged at Patrick’s heart. He hated the fact there was nothing he could do. But he needed to focus on delivering both babies or risk losing them all. He wouldn’t let that happen.
Suddenly the first baby began to enter the world. A mass of thick black hair curled like a halo around his perfect tiny face.
‘Just push slowly and think about your breathing,’ he instructed her. ‘We need that to control the baby’s arrival. We don’t want to rush him. You can tear your skin and I want to avoid that.’
The urge to give a giant push was overwhelming but Claudia knew she had to let her breathing slow the pace. She thought of Patrick’s handsome face and tried to follow his instructions. There were a few more contractions and finally Claudia’s first baby was born into Patrick’s waiting hands. He let out a tiny cry as Patrick quickly cleared his mouth of mucous and quickly checked his vital signs.
The baby was small but not so small as to put him in immediate danger by not having access to a humidicrib. Patrick had feared he might have been tinier considering the gestational age and the fact he was a twin. He clamped the cord with a sterile surgical tie before he laid him on the shirt. The baby had endured a harsh entry into the world and the shirt was a far cry from a soft landing but, until his brother was born, there was little Patrick could do for the new arrival. He could not put the child to Claudia’s breast as she needed to remain on all fours until the second baby was delivered.
Another contraction began and the second baby was quickly on its way. Patrick hoped that he would not be faced with a foot. That would mean a breech birth and complications he did not want to contemplate.
That next painful contraction came and Claudia cried out loudly but managed with each following breath to push her second baby head first into the world. And once again into Patrick’s arms, where the baby took his first breath and cried for the first time. Patrick checked the second baby’s vital signs and again was relieved that the delivery had no complications. It had progressed far better than Patrick had imagined.
With beads of perspiration now covering her entire body, Claudia looked over at her two sons and felt a love greater than she’d thought possible.
And a closeness to the man who had delivered them. He was like her knight in shining armour. And she would be indebted to him forever.
Quite apart from being an amazing doctor, Patrick was a wonderful man.
Through the fog of her emotionally drained state, Claudia suddenly suspected her feelings for Patrick ran deeper than simply gratitude for saving them all.
* * *
Patrick remained quiet. There were still two afterbirths and Claudia to consider. Despite the peaceful and contented look she wore, he knew they were not out of the woods yet.
Gently he placed the second baby next to his tiny brother and wrapped the shirt around them both before he carefully helped Claudia from her knees onto her back again. He grabbed her leather bag and made a makeshift pillow for her head. Claudia was past caring about the bag or her own comfort as she watched her tiny sons lying so close to her.
Patrick reached for them. ‘I’m going to rest the babies on you while we wait for the afterbirth.’
While the delivery had been relatively straightforward, Patrick was aware that Claudia’s double birth put her at increased risk of haemorrhage. Gently he placed the two tiny boys into their mother’s arms and he watched as her beautiful face lit up further as she cradled them. Her beauty seemed to be magnified with the boys now securely with her and, with her genes, they would no doubt be very handsome young men.
Within minutes, part of the placenta was delivered but as Patrick examined it he was concerned that it was not intact. Claudia would require a curette in hospital if the remaining placenta wasn’t expelled. But, that aside and despite the surroundings, Claudia had delivered two seemingly healthy boys. Patrick took a deep breath and filled his lungs as he looked at Claudia with a sense of pride for the strength shown by a woman he barely knew.
Then he noticed her face had become a little pale.
‘I sort of feel a little cold now,’ she said softly, as her body began to shiver. ‘It feels odd; I was so hot before. There’s no pain but...’
Patrick noticed her eyes were becoming glassy and she was losing her grip on the boys. There was something very wrong. Quickly he scooped them from her weakening hold and placed them together beside her, still wrapped in his shirt. He felt for her pulse. It was becoming fainter. He looked down to see blood pouring from Claudia and pooling on the jacket underneath her.
It was his worst nightmare—a postpartum haemorrhage.
Claudia had fifty percent more blood in her body because of the pregnancy, which would help, but, with the amount of blood she had already lost on the floor, it would still only buy them a small amount of time. He needed to encourage her uterus to contract, shutting off the open blood vessels. Immediately he began to massage her belly through to her uterus but after a minute he could see there was no difference. She was barely lucid and he needed to administer a synthetic form of the hormone that would naturally assist, but that was on the other side of the closed elevator doors with the paramedics. It wasn’t something he carried in his medical bag. Not now anyway. Once he would have had everything he now needed to save Claudia—but that was a lifetime ago.
‘Claudia—’ he ceased the massage momentarily and patted her hand ‘—I need you to try to feed one of the boys. It will help to stimulate a hormone that will lessen the bleeding. Do you understand?’
‘Uh-huh,’ she muttered while trying to keep her eyes from closing. ‘I feel so light-headed.’
‘That’s the blood loss. I’m going to do everything I can to stop it until help arrives, but again we need to work together. You’ll be on your way to hospital very soon.’
He reached down and gently unwrapped the babies and, picking up the larger of the twins, he lifted Claudia’s tank top and bra and placed him onto her breast. Instinctively the baby latched onto his mother and began to suckle while Patrick continued the massaging.
‘Do you have any names for the boys?’ he asked, trying to keep Claudia focused as he dealt with the medical emergency that was unfolding before his eyes.
She tried to think but the names weren’t there. They were special names and they should have spilled out without any effort but she was befuddled, which wasn’t her. ‘I think...’ She paused momentarily as the names she had chosen now seemed strangely out of reach. She blinked to bring herself back on track. ‘Thomas...and Luca...after each of their great-grandpas.’
‘I think they are strong names for two little fighters. Is this baby Thomas or Luca?’
Claudia smiled down at her son, still attached to her breast but not really sucking successfully. ‘Thomas...but I think he’s tired already and a bit too small.’
‘I think you’re right on both counts.’
‘I’m feeling quite dizzy again.’ She paused as she felt herself wavering and her vision was starting to blur. Fear was mounting again inside her. ‘Am I going to die?’
‘No, you’re going to pull through and raise your two sons until they are grown men.’
Claudia felt weaker by the minute. She knew there was something very serious happening, even though she couldn’t see the blood. ‘If I don’t make it...’
‘You will,’ he argued as he reached for Thomas, who was unable to suckle, and placed him safely on the floor beside his brother, Luca.
She closed her eyes for a moment. She felt too weak to fight. ‘You need to contact my sister, Harriet. Her details are in my phone. She needs to be there for my boys if I can’t be.’
‘Claudia, listen to me. You’re going to make it, but I’m going to have to do something very uncomfortable for you.’
‘What?’ she asked in a worried whisper.
‘I’m going to compress your uterus with my hands. It will further slow the bleeding.’
She nodded but she felt as if she was close to drifting off to sleep. ‘If you have to, then do it.’
‘Try to stay awake,’ he pleaded with her as he attempted to manually compress the uterus with the firm pressure of his hands.
Minutes passed but still the blood was flowing over his hands to the floor beneath her. Claudia needed to be in a hospital and she needed to be there now. This was something more serious than the usual postpartum blood loss.
She was dangerously close to losing consciousness as he gently removed his hands. The manual pressure could not stop the bleeding. Claudia needed surgical intervention if she was to survive. He reached for the films and ripped open the envelope. The films scattered on the floor but, as he grabbed the report, his worst fears were confirmed. Claudia’s placenta had invaded the walls of her uterus. Every part of his body shuddered. It was déjà vu. The prognosis was identical to what he had faced all those years ago. There was no way her obstetrician would have allowed her to board a plane with the condition. Claudia would have delivered her sons in America, whether it had been this day or another.
With a heavy heart, he dropped his gloves and the report to the floor and pulled a barely conscious Claudia into his arms, where he held her while he stroked the faces of the little boys lying on the floor beside them. If help didn’t arrive within a few minutes he would lose Claudia.
And her two tiny babies would never know their beautiful, brave mother.
CHAPTER THREE
AS CLAUDIA’S BODY suddenly fell limp in Patrick’s arms, he heard the doors open behind him and instantly felt a firm grip on his bare shoulder.
‘We’ve got it from here,’ the deep voice said.
Patrick turned his head to see a full medical team rushing towards them. He had never been happier in his life than he was at that moment and, with adrenaline surging through his veins, he immediately began firing instructions at lightning speed. The miracle Claudia needed had arrived at the moment he had run out of options.
‘We’re dealing with a postpartum haemorrhage—she needs Syntocinon immediately and a catheter inserted so that the uterus has a better chance of contracting with an empty bladder. If she doesn’t stabilise she’ll be looking at a transfusion. Forget cross-matching as there may not be time; just start plasma now and have O negative waiting in OR.’
Patrick moved away as the medical team stepped in to begin the treatment he had ordered. Immediately they inserted an IV line, began a plasma transfusion then administered some pain relief and Syntocinon in an attempt to stop Claudia’s bleeding while another two paramedics collected the baby boys and left the elevator with them securely inside portable humidicribs.
‘Any idea why she’s still bleeding?’ the attending doctor asked.
‘Placenta accreta,’ Patrick said as he reached for the films lying on the floor. He kept his voice low so he would not alarm Claudia. ‘I checked the report on the ultrasound films. Only a very small amount of the placenta was delivered and the rest is still firmly entrenched in the uterus wall. If the report is correct, she may be looking at a surgery but a complete hysterectomy should be the surgeon’s last option. I doubt she’s more than late twenties, if that, so she might like to keep her womb.’
‘I’m sure they’ll proceed conservatively if they can.’
Patrick nodded. He had no idea what the future would hold for Claudia and he wanted her to have every choice possible. ‘The boys appear fine but they’ll need a thorough examination with the paediatrician,’ Patrick continued, not taking his eyes from Claudia. ‘One is a little smaller than the other but let’s hope there’s no underlying issues with their premature arrival.’
‘You did a remarkable job, all things considered,’ the paramedics told Patrick as they watched the barely conscious Claudia being lifted onto the gurney and then securely but gently strapped in.
Keeping his attention on Claudia, who was beginning to show signs of being lucid, the doctor added, ‘And you, young lady, are very lucky this man was sharing the elevator. It would not have been this outcome without him, that’s for certain. You and your boys all owe your lives to him.’
Claudia smiled a meek smile and held out her hand in an effort to show her gratitude. Patrick cupped it gently in his own strong hands and smiled back at her then he turned to the attending doctor. ‘I’ll be travelling side-saddle to the hospital if there’s room.’
‘There’s definitely room.’
* * *
For a little over three hours, Patrick divided his time between pacing the corridors outside Recovery and visiting the Neonatal Intensive Care Unit to check on Luca and Thomas. They had given him a consulting coat to cover his bare chest upon arrival at the hospital. Claudia’s dark-haired boys, one with sparkling blue eyes and the other with deep brown like their mother, were doing very well and he felt a deep and very unexpected bond with them. A bond that he hadn’t felt towards anyone, let alone tiny people, for more years than he cared to remember.
But these boys were special, perhaps because he’d delivered them in a crisis, or perhaps because their mother was clearly a very special woman. Perhaps it was both but, whatever was driving him to stay, he knew the three of them were bringing out protective feelings in him. A sense that he was needed and almost as if he belonged there. He should have felt unnerved and wanted to run but he didn’t. That need to protect himself from being hurt was overridden by the need to protect Claudia, Thomas and Luca.
Both boys weighed a little over four pounds, which was a relief. They were still in their humidicribs and being monitored closely but both had passed all the paediatrician’s initial tests and were being gavage fed by the neonatal nurses when Patrick left the nursery and headed back to check on their mother. Her surgery had taken far longer than he had anticipated. He had for a moment contemplated scrubbing in to assist when they’d arrived in Emergency and were rushed around to the OR but he’d immediately thought better of it. A reality check reminded him that his last obstetric surgery had ended his career.
Patrick wanted her to be spared the additional stress and long-term repercussions of the hysterectomy if possible and voiced that again upon arrival. The surgical resident had reassured Patrick that Dr Sally Benton was well respected in the field of gynaecological surgery and that Claudia would be in expert hands. Patrick hoped that the option to give birth again one day in the pretty delivery room with floral wallpaper, midwives and pain relief was not taken away. But, three hours later, he knew the reality of her surgery taking so long meant she had probably undergone a hysterectomy. And she would have to give up on that dream.
‘I’m Sally Benton.’ She pulled her surgical cap free and outstretched her hand.
‘Patrick Spencer,’ he responded as he met her handshake. He looked at the woman before him. She was tall and thin, her short black hair with smatterings of grey framed her pretty face and he suspected she was in her early fifties.
‘Dr Spencer, I assume.’
‘Yes.’
‘I wanted to personally thank you for the medical intervention you provided in the elevator. Miss Monticello is in Recovery now and she certainly wouldn’t be if you hadn’t done such an amazing job delivering her sons and keeping her alive. If you hadn’t been with her today, there would most definitely have been a question mark over their survival.’
Patrick drew a deep breath and chose to ignore the compliment. ‘Was it conservative surgery?’
‘No, unfortunately, Miss Monticello underwent a full hysterectomy to stop the haemorrhaging. She retained her ovaries but her uterus has been removed,’ Dr Benton continued as she took a seat in the corridor and indicated Patrick to do the same. ‘The attending doctor briefed me on your diagnosis of suspected placenta accreta, but the depth of invasion was not first but second grade. I was faced with placenta increta as the chorionic villi had invaded the muscular layer of the uterine wall so I had no option but to remove her womb. She was lucky that it had not spread through the uterine wall to other organs such as the bladder. Let’s just say I’m glad I didn’t have to deal with that; as you would know, even in this day and age, there’s still a six to seven percent mortality rate for that, due to the complications.’
Patrick knew the statistics for death only too well.
‘Thank you, Dr Benton.’
‘Don’t thank me. As I said before, you did the hard work keeping her alive. And she has two wonderful little boys. Perhaps the loss of her womb will not be a complete tragedy.’
Patrick nodded. He wondered how Claudia would react to the need for a hysterectomy.
‘And how are her sons doing?’ the surgeon enquired.
‘Very well,’ Patrick said with a sense of pride that surprised him. ‘They’re handsome young men and a good weight for their gestational age.’
‘Great. Now that’s out of the way and we’ve spoken about our mutual patients, I have a personal question for you,’ Dr Benton continued. ‘How do you know Miss Monticello?’
‘We were just sharing the elevator.’
Her expression revealed her surprise. ‘Well, that’s serendipity for you. I don’t think she could have asked for a better travelling companion. Where do you practice obstetrics?’ Then, without waiting for an answer, she added, ‘Am I right in assuming, with your accent, and because I haven’t heard of you around LA, that your practice is out of state or perhaps abroad?’
Patrick hesitated. He didn’t want to talk about himself but he knew the doctor sitting beside him had every right to enquire. ‘No, I practice here in LA but I’m not in OBGYN.’
‘Really?’ Her brow wrinkled as she considered his response. ‘What’s your field then?’
‘I’m a board certified cosmetic surgeon.’
Once again, she didn’t hide her surprise. ‘I’d never have picked that,’ she said with a grin on her somewhat tired face as she stood up and again offered a handshake. ‘Well, Dr Spencer, if you ever get tired of your current field, you should consider obstetrics. There’s a shortage of experts in the field and you’re very skilled. Your intervention was nothing short of amazing in the conditions you were forced to work in. As I said, Miss Monticello owes her life to you. She will be in her room in another two hours or so. She lost a lot of blood, as you know, so we’ll be monitoring her in Recovery for a little longer than we normally would. But I’m sure she’d be pleased to see you.’
Patrick met her handshake and she smiled before she left him alone.
* * *
Patrick spent the next two hours with Luca and Thomas. He had called his practice and rearranged his schedule. While the boys were being monitored closely he still didn’t want to leave. Not yet anyway. Thomas was in a humidicrib and Luca required additional oxygen to be provided through an oxy-hood so he was in an open bed warmer. The neonatologist felt certain that would only be a temporary measure as both appeared to be healthy and a satisfactory weight for their gestational age. Patrick was aware they had some basic milestones to achieve, both in weight and development, before they would be released; he doubted it would be more than three or four weeks before they would be allowed to leave hospital with their mother.
He went downstairs to the florist and picked the largest floral bouquet they had and two brown bears with blue bows. Claudia had told him she had no one she could reach out to and he knew how that felt only too well. He tried not to think of what he had lost when he’d walked away from his family.
Only now at least Claudia did have two little people to call her family. Still, he knew her room would be devoid of anything to brighten her day and lift her spirits and, after the day she had endured, she deserved a room filled with flowers. And something to remind her of the boys when she was resting and not able to be with them in the neonatal nursery. And when she had to face the reality of the hysterectomy she had undergone without her consent.
The nurse at the station arranged for the flowers to be placed near her bed.
Waiting outside the room twenty minutes later, he couldn’t contain, nor fully understand, the smile that spread across his face and the warmth that surged through his body when he saw her hospital bed being wheeled down the corridor towards him. She was still pale but not as drained as when he had last seen her, and she hadn’t noticed him. In the pit of his stomach he still remembered her limp body collapsing against his and he’d thought the boys had lost their mother.
Patiently he remained outside as she was settled into her room but, as the nurses exited, he tapped on the door that was ajar.
‘Are you up to a visitor?’
‘Patrick?’
‘How did you guess?’ he asked as he quietly entered her room. ‘Perhaps it’s the British accent—there are not a lot of us around these parts so I guess it’s a giveaway.’
‘In this city, it’s a dead giveaway.’ It was more than just his accent, but Claudia couldn’t tell Patrick that it was also his reassuring tone that told her exactly who was at her door. It was the same strong voice that had kept her going when she’d wanted to give up. It was the voice of the man who had saved her and her sons.
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