The Honourable Midwife

‘We’ll work on that. I’ll hunt up some pamphlets on premmies, and talk to her and her mother as well, try and get her involved right from the beginning.’

Emma went back to the nurses’ station on the labour and delivery side of the unit, and found an unnatural level of quiet. No patients.

‘Just had a phone call from a first-timer in query early labour, but it sounded to me like a false alarm,’ Bronwyn summarised, lifting her head from the paperwork she was catching up on. ‘She’s not due for a couple of weeks. She wants to come in, but I expect we’ll be sending her home again. Pete Croft is chugging coffee in the kitchen if you want a progress report on Mrs McNichol.’

‘Oh, I do!’ Emma said. ‘And I’m hunting for the dad.’

‘I sent him off for breakfast. He was wandering around like a ghost.’

‘Dr Cassidy says Rebecca can see her baby now. Have you moved her to her room?’

‘Yes, half an hour ago,’ Bronwyn answered. ‘And her mother’s with her. I’ll take Brian McNichol round to Special Care as soon as he gets back from breakfast.’

As Bronwyn had said, Emma found Pete in the kitchen.

He’d evidently ‘chugged’ his coffee to good effect, and was holding his mug beneath the wall-mounted urn to fill it for a second time—or possibly a third—when Emma entered the room. He took a gulp of it black, then shuddered, grabbed the milk carton and splashed in a generous amount, before bringing the mug to his lips again.

Only then did he turn and see her standing there, and she had to quickly hide the awareness she suspected had been showing in her face. ‘Emma…’ he said, coming back to the present from what looked like a million miles away.

‘I was wondering…Mrs McNichol?’ she asked, before the beat of awkwardness could lengthen.

‘She lost a lot of blood,’ Pete answered. ‘Not enough to need a transfusion, but she’s on a fast drip and I’ll be watching her iron levels over the next few months. Thank goodness the baby started breathing when she did!’

‘What’s your sense about Alethea Childer?’ Emma asked.

‘I wanted to ask you that, actually, since you’ve been with her all the way through. How much did she weigh?’

‘Twelve-fifty grams.’

‘And we estimated thirty-three weeks gestation!’ He pressed his lips together, and she couldn’t help watching as they softened again when he continued to speak. ‘That’s small, even for the dates.’

‘I know.’ An average baby should have weighed several hundred grams more. ‘And Dr Cassidy doesn’t know why.’

‘Bothering her?’

‘Yes. She picked up a heart murmur as well, which she’s not sure about yet.’

‘Lucy McNichol has one, too.’

‘This time she thinks it may be more significant, but so far the heart is doing the job with no problems, so we’re hanging fire.’

‘Right.’ Pete shut his eyes for a moment, then opened them again. A tiny muscle twitched just above one cheekbone. ‘I guess I’m not all that surprised. Has the staffing been sorted?’

Emma nodded. ‘Yes, looks like it. Sue North knows what she’s doing. I’m in there, too, and they’ll juggled the roster. We’re all used to stretching when we have to.’

‘It may not be for long, if we end up sending Alethea Childer somewhere else.’

‘You don’t want to?’

‘Funny, but, no, I don’t.’ He gave an upside-down smile. His eyes had those creases around them again. ‘You’d think I might be keen to get this one off my hands. But she dropped on us out of the blue, and for some reason I don’t want to lose her again to another hospital just as quickly. Rebecca’s young. She has no confidence, and she’s not ready for this.’

‘She seems a little detached at this stage, like she might leave everything to us and just stay away.’

‘Maybe that explains why I’m feeling possessive.’

He leaned back against the kitchen countertop, with one elbow resting on it. The movement made his shirt tighten across his strong chest. The fluorescent light overhead sculpted shadows on the side of his face.

‘I feel like the baby belongs here,’ he went on. ‘And that we can do what we need to for her, with Nell on board. Unless that heart murmur turns out to be significant and she needs surgery. That, we couldn’t handle. That would mean Sydney or Melbourne.’

He took another gulp of his coffee, punctuating the heaviness of the statement. The movement firmed his mouth and stretched the planes of his cheeks a little.

‘If it’s an open ductus, the operation itself isn’t that complex any more, is it?’ Emma asked.

‘In relative terms, I guess. It’s a closed-heart procedure.’

‘They don’t have to open the heart itself.’ Emma understood this.

‘And no heart-lung machine required,’ Pete confirmed. ‘Start to finish, less than an hour. They make an opening in the left side of her chest, tie off the PDA and divide it. It’s about the width of a piece of string.’

‘Oh, huge!’ she drawled.

‘As I said, simple is relative. It would still need to be done in a major children’s hospital, by a paediatric surgeon. And what parent wants to think of a baby as small as Alethea in surgery when she’s just a few days old, no matter how skilled those guys are?’

‘I know.’ Emma leaned against the fridge and rubbed an aching calf with the side of her shoe. ‘Nell has hopes the murmur doesn’t mean anything. The baby’s oxygen saturation is up in the high nineties.’

‘That’s great! Are you heading back to Special Care now?’ He tipped out the rest of his coffee, rinsed the mug and rested it upside down on the sink.

‘Yes, I just wanted to catch up with you and make sure everything was still in hand on this side of the unit.’

‘Come on, then,’ he said.

He slipped past her and she followed in his wake at once. They walked along the U-shaped corridor together in a comfortable silence, and found Nell scribbling notes on Alethea’s chart, while Lucy slept peacefully. Both babies looked like tiny red frogs in the white expanse of their special, warmed humidicribs.

‘I’m heading off,’ Nell said, capping her pen. ‘I’ll be back in a couple of hours. Or sooner if you need me, Emma. If that oxygen sat rate drops, if the heart rate changes, you know what I’m looking for. Pete, she’s not as strong as you hoped. And there may—may—be a heart problem.’

‘Yes.’ He nodded. ‘Emma told me. You’re going to wait before doing any tests?’

‘Yes, as long as her levels are this good, but I want to talk to the mother about whether to send her to a higher level unit even if she doesn’t need surgery. There may be other problems. I just have that feeling, despite what the machines are saying. And this is a stretch for us.’

‘I know, Nell, but if there’s nothing specific, and if the mother is already too detached to get properly—’

‘Look, I’m not saying it’s an easy decision,’ she cut in. ‘There are pros and cons.’

‘There are always those.’

She ignored him. ‘We have to consider the downside of transporting a fragile baby, for a start. And you’re right. Taking a premmie away from a mother whose bonding is already tenuous could cause its own problems. But let’s think about it,’ she urged, her eyes bright. ‘Let’s get it right.’

She left without giving him time to reply, and Emma saw his jaw set.

Anger, or determination?

She wasn’t sure.

She didn’t think Pete was the kind of doctor who’d make up his mind and then stick to his guns out of ego and pride. She’d only ever seen him put the interests of his patients first. But she knew he was under pressure at the moment in his personal life, and there were pulls in both directions for Alethea.

Pete looked again at the baby and at the fluctuating red figures on the monitor, and Emma couldn’t help doing the same. The heart rate, respiration and oxygen saturation all showed up on screen at a glance. The baby’s nappy was as small and flat as an envelope. The little hat covered the whole of her tiny head, and her face looked as crumpled and ancient and inscrutable as that of an Eastern mystic.

‘Should we start trying for a bed in Sydney or Melbourne straight away?’ Pete muttered. He might have been talking to himself. ‘On paper, we’ve got the facilities and the staff. I’m glad I called in Nell.’

‘She’s good,’ Emma agreed.

So was he. Thorough and caring and imaginative in his approach. He wasn’t afraid to try something new, or to go out on a limb.

He was way out on a precarious one right at this moment, putting Rebecca’s chance to bond with her baby on a par with the baby’s potential need for a higher level of care. On the other hand, skin-to-skin human contact had been shown in repeated studies to be as physically important to a premmie’s development as oxygen, medication and specialist expertise.

He looked up.

‘Sorry. I’m still e-mailing you. Only verbally this time.’ He grinned, and there was a warm glint in his brown eyes that she responded to at once with a laugh.

‘Are you?’

‘That doesn’t make sense,’ he conceded. ‘But it was nice, Emma. Did I say that?’

‘You said it was a slice of paradise. My house. In your card, I mean.’ Emma cleared her throat. ‘You didn’t specifically mention the e-mails.’

She felt absurdly self-conscious beneath the warm wash of his words. In the confined space, they were standing closer than she felt comfortable with. It was ridiculous to be so aware of him, to feel this sense of closeness and this sense of knowing him, which was based on such a thin foundation.

‘Well, the e-mails were good,’ he said. ‘They helped.’

Emma blurted, ‘Is it Claire? Is that why you’re looking so stressed?’ Then could have cut out her tongue. He’d said nothing to encourage her to ask such a personal question. It was all coming from her.

He sighed, then muttered, ‘Yes, of course it’s Claire.’

‘I’m sorry, you don’t have to—’

‘I thought that we were in the home stretch.’ His mouth tightened and turned down. He spoke in a low, rapid way, and didn’t look at her. ‘We had decisions made and arrangements worked out. I thought. But Claire’s thrown that to the four winds, and I would have done so even if she hadn’t, because of the way she’s been behaving. I don’t know what’s wrong with her.’

He stopped, and looked up suddenly, with a ravaged expression that struck Emma to the heart. She felt the same need to touch him that had tingled in her fingers before. The same need to smooth out those creases around his eyes and softly stroke the brown skin at the back of his neck, to press his lips with her fingertips until they relaxed, and to tell him everything would be all right.

‘Oh, Pete!’ she said. It was heartfelt, but so inadequate.

‘I haven’t talked to anyone about this.’ His eyes were narrowed, and glittered with fatigue. ‘I don’t know why I’m talking to you.’ He gave a short laugh. ‘Because you’re listening, I guess. Because you asked. You were here at the right moment, basically. The wrong moment, perhaps.’

‘I shouldn’t have asked. I’m sorry.’

‘No, it was fine. Only now I’m not offering you much choice about listening to a far more detailed reply than you wanted.’

‘I-it’s fine, Pete,’ she stammered, echoing the same word he’d used—safe and vague. ‘I’m happy—that is, I want to listen. If it’s a help.’

‘I’m petitioning for sole custody. Please, don’t talk to anyone about this!’

‘As if I would!’

He glanced around to check that the door was closed and that they were fully alone.

‘Couldn’t find a house I liked as much as yours,’ he said quietly. Emma had to step even closer in order to hear him, and came within range of his body heat and his clean male smell. ‘I’ve rushed into it. Had to, because I wanted a home for the girls. It’s part of that new development up on the hill overlooking the river.’

‘It’ll be beautiful when the gardens get going. I’ve driven through it. There are some lovely places.’

‘I know. But right now it’s arid. And I shouldn’t even begin to mind about that, because it’s the least of my problems. I don’t know what’s wrong with Claire,’ he repeated.

‘If you need anything, Pete…’ Emma offered, while wondering if even this token formula was overstepping the bounds. They weren’t friends. They were only colleagues, and he’d recently paid her three months of rent. The fact that they were standing this close didn’t mean anything personal.

‘Might,’ he answered. The single word told her nothing about how he’d received her offer. ‘I’ll let you know.’

‘Please, do.’

He nodded briefly, then looked at both babies’ monitors again, and she watched him literally turn his back on the brief moments of confession. With his back to her, he cleared his throat, massaged his temples with the thumb and middle finger of one hand, squared his shoulders, then turned to her again. ‘Patsy’s out of Recovery and in a private room. She wants to see the baby.’

‘Mary Ellen can organise that. She’s probably with Patsy now, starting to get her mobile.’

‘Keep me posted on any change in how Alethea’s doing. I want to be as involved as I can.’

‘Of course. You and Dr Cassidy are both down as her doctors.’

‘I’d better go. For some strange reason, a lot of other people in this town have the idea I’m their doctor as well!’ His smile was warm and kindled flame in his brown eyes, but Emma saw the effort in it and it soon faded.

Something vital seemed to leave the atmosphere of the room as soon as he’d gone.

CHAPTER THREE

‘AND Dr Cassidy wants to be told the moment there’s any change in her numbers or her appearance or—’

‘OK, so any change at all, basically,’ summarised Jane Cameron, the midwife who was about to take over baby Alethea’s care for this shift.

It was already four o’clock, and Emma was late finishing. She still felt reluctant to go, and didn’t understand why, until Pete Croft appeared in the doorway.

I was hoping he’d show up again, and I didn’t want to leave until I’d seen him, she realised.

‘Still here?’ he asked vaguely, and she nodded, feeling foolish.

‘I’m about to head off,’ she said.

‘What about the mum? Where’s she?’

‘She wanted a same-day discharge.’

‘You mean she’s already gone?’

‘Her mother took her home about half an hour ago. There was no medical reason to say no. Unfortunately.’

‘Yes, we would have liked to keep her here for the baby’s sake.’

‘She was feeling good. No temp. Stomach so flat already you’d hardly know she’d given birth.’

‘What’s the mother like?’ he asked. ‘Rebecca’s mother, I mean. Susan. I’ve only had her in and out of my office for such trivial things that I barely remember her.’

‘She seems very sensible. I gave the instruction sheets about post-partum care to her, not to Rebecca.’

‘Rebecca wouldn’t read them?’

‘Or follow their suggestions if she did, I suspect. Um, Jane, I’m going to head off,’ she added to the other midwife.

‘Yes, go. You’re late already.’

‘Let me take a look at her,’ Pete said, speaking to Jane. He picked up the baby’s notes and glanced through them. ‘Dr Cassidy’s been here again,’ he murmured.

‘See you tomorrow,’ Emma said to no one in particular, and Pete only glanced up for a second as he muttered an acknowledgement of her words.

Emma and Pete saw too much of each other over the next two days, but all of their contact revolved around the two small newborns in Emma’s care, and if there were any small windows for a more personal interlude between them, neither he nor she chose to open those windows up.

Emma was happy to work another long shift on Wednesday, her mood closely tied to baby Alethea’s progress, or lack of it. Patsy McNichol was an almost constant presence while her little Lucy remained in the neonatal annexe, but by Thursday morning the baby girl had begun to feed with consistent strength and appetite, and was looking so good that, in the absence of further problems, she would soon be moved to Patsy’s room, ready for discharge on Friday.

Rebecca Childer had only been seen in the unit once, very briefly on Wednesday morning, since her same-day discharge on Tuesday afternoon. During her visit, she had to be coaxed to talk to her baby and to touch her. She seemed frightened that allowing herself to love the baby might prove too painful, and she seemed frightened of the baby, too—so fragile and tiny and different from the fat, healthy, pink ones she’d seen on television commercials for disposable nappies and baby food.

Alethea was still in a precarious condition, with her respiration the biggest problem at this stage, despite the fact that she’d now come off the respirator and was on a mask. Her breathing alarm went off regularly, because she would simply forget to breathe. Emma usually just tickled her feet to get her started again, but it was an indication that she was fragile.

Nell had ordered a precise and detailed monitoring of every aspect of the baby’s system, including the recording of every millilitre of fluid that went in and out, every nuance of temperature change and oxygen saturation reading.

The heart murmur wasn’t clear or conclusive, and Nell was reluctant to perform tests straight away. Not until Alethea was breathing better. Not until her weight had started to claw its way back to what it had been at birth, after the normal initial loss. Not until the drug they’d given her to close that patent ductus had had a chance to work.

The potential need for transport to Sydney or Melbourne remained Nell’s greatest concern at this stage, and she’d muttered a couple more times in Emma’s hearing, ‘Something’s not right…and yet the figures suggest she’s doing well. Am I borrowing trouble here?’

It was heart-rending to see the difference in size between Alethea and the two healthy babies born in the unit since her own delivery on Tuesday morning. Patsy herself talked about it in poignant terms in relation to her own tiny Lucy.

‘To me those other babies look so huge,’ she said to Emma on Thursday, just before lunchtime. ‘Almost unnatural. Like the offspring of giants. Yet I know that it’s my baby who’s the wrong size. And she’s lost a hundred and fifty grams since she was born. When will she put it back on and start to gain?’

‘Soon,’ Emma promised, because she was promising herself the same thing about both babies. ‘That weight loss is normal. She’s feeding, and that’s great. She’s getting fluid, and she’s getting your antibodies for immunity.’

‘Will I really be able to take her home with me?’

‘We hope so. It’s looking that way.’

Patsy was able to hold her baby easily at least. With Alethea, however, the process was far more of an effort, and Emma had to schedule it into her day in order to fit it in. It had to be done with care, given the equipment to which she was still attached. If Rebecca herself had been here, Emma would have had more time.

But apart from that one uncomfortable visit, Rebecca stayed away.

Her mother was the one to come and see Alethea. She seemed to love the baby very much, but was obviously torn.

‘My daughter should be doing this. Is my coming in just encouraging her to pretend this isn’t happening?’ she said to Emma on Thursday afternoon, and Emma didn’t really have an answer. She was pleased that the baby had someone, and wondered if Mrs Childer would have spent even more time here if she hadn’t been so worried about Rebecca’s lack of interest.

Nell came up to the unit several times a day, poring over the detailed figures noted on Lucy’s and Alethea’s charts. Alethea was passing urine, which meant her kidneys and heart were both doing their jobs. Her feeds came via a nasogastric tube, which she occasionally seemed to be fighting. That wasn’t a bad sign either. Some babies were too weak to fight the discomfort of the tube. She also had an IV line for medication and fluids.

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