Midwife's Baby Bump

CHAPTER ONE

TRISTAN SIPPED HIS coffee as he looked from the window of his third floor office at the Victoria. He had returned from early morning rounds and had an hour before his surgical schedule began.

His mind wandered for a moment back to Flick, just as it had every day for the previous three months. He had hoped that as time passed so would his feelings, but they hadn’t. Ninety-one days and nights had not erased or even paled what they’d shared that one night together. She was different from any woman he had ever met. She was sweet and funny and desirable. Everything he could want in a woman and then some. But he couldn’t be with her, not even for one more night. He was scared that if he caved in to his feelings then he would never want to leave.

Sometimes thoughts of her came to him when he lay down in bed at night, exhausted from a long day’s surgery. Lying on his back on the cool cotton sheets, his arms above his head as he stared into the darkness and thought back to that night. The hum of the ceiling fan gently moved the heavy night air but it didn’t shift his thoughts. Nor his regrets. His mind was consumed with the memory of the hunger and desire they’d had for each other. And he pictured Flick’s beautiful smile. A smile that had lit up the ballroom on that night as they’d sat talking for hours, the sparkle in her eyes as he’d held her in his arms on the dance floor, and the passion that they’d shared in her bed all haunted him before he finally succumbed to sleep. And even in his dreams she would appear some nights.

Dreams that felt so real he could touch the softness of her skin. And taste the sweetness of her mouth.

But Tristan knew that it had had to end before it had begun. He couldn’t pursue a relationship. Flick deserved better. Although they didn’t speak of her future goals and dreams outside her career, her profession made him feel sure one day she would want a family, and a family was the one thing he couldn’t give her.

He looked over at the family photo on his desk. His medical graduation. It had been a day with more meaning to him and his mother and father than to many other graduates. It had been the first step on his journey to becoming a neonatal cardiothoracic surgeon. A journey he had chosen at sixteen when he’d received his heart transplant after spending years wrapped in cotton wool as his name had moved slowly up a waiting list. His mother was beaming in the photograph and his father wore a strained smile. His mother was thrilled that Tristan was alive to live his dream, his father worn down by years of worry.

More study had been ahead but Tristan had never doubted his path and finally he’d qualified. He’d become a heart surgeon who was also a heart transplant recipient and he’d wanted to specialise in neonatal heart surgery.

Tristan was determined to surgically alter the course of seriously ill newborn babies’ lives. Giving them a chance for a regular childhood, something he’d never enjoyed. It was his contact with children with whom he felt a bond and it satisfied his paternal longings. He had decided early in his studies that he would never have a child to call his own. With his medical history and the dire genetic inheritance for any future children, it wasn’t worth the risk.

His thoughts returned to Flick. He had to be cruel to be kind. One day she would meet a man who could provide her with everything she wanted and deserved, and Tristan did not want to stand in the way of her happiness. She might hate him now but keeping his distance would allow her to meet the right man. Someone who could give her a perfect life. But at least he would always have that one night they’d shared. A night he never wanted to forget.

The beeping of his pager brought Tristan back to reality. He looked down at the details then put a call through to the emergency department.

‘Tristan Hamilton. I received your page.’

‘Dr Hamilton, transferring you now to the A and E surgical resident,’ the young female voice replied, before putting him on hold for a moment.

‘Tristan, it’s Dylan Spencer. A patient presented in Cas ten minutes ago in first-stage labour, gestational age approximately thirty-seven weeks. On examination she revealed that she’s been monitored for the congenital heart disease of her unborn son—transposition of the great arteries. I didn’t want to let labour progress without your advice.’

‘Any other history?’ Tristan asked, concern colouring his voice. ‘Who provided the antenatal care?’

‘Her husband says they were notified of TGA at the twenty-week scan and his wife has been under the care of Dr Hopkins, the neonatal cardiologist at Sydney Eastern Memorial.’

‘What are they doing in Melbourne?’

‘Family gathering. Drove down for her aunt’s birthday or something like that.’

Tristan shook his head but did not voice his opinion. Transposition of the great arteries was a life-threatening condition for the baby and travelling so close to term was, in his mind, not the most sensible decision or one that he imagined would have been condoned by their specialist. The patient was fortunate labour had not begun on the journey.

‘I’ll put a call through to Nate Hopkins, but in the meantime please call OR and have them contact the obstetric resident, prep for an emergency C-section and then prepare the adjacent Theatre for a neonate balloon atrial septostomy. You’re right, we can’t allow labour to progress without intervention. The infant may not survive the birth canal.’

Tristan had just ended his call to the Sydney neonatal cardiologist when the scrub nurse arrived at his office door with A and E medical records in hand.

‘Dr Hamilton, here’s the notes for the emergency delivery.’

Tristan was already on his feet and heading towards the door, where he took possession of the medical records and slipped his own notes from the phone call inside.

‘They estimate from the previous ultrasound the baby may be close to six pounds,’ she informed him as they made their way towards the lifts.

‘How’s the mother?’

‘She’s holding up well. The epidural was administered but she’s still somewhere between shock and denial that she’s about to have her baby. Sophia, a community midwife from MMU, is in there with her, along with her student placement, Flick. They’re providing some emotional support while the obstetrician prepares for the C-section.’

Tristan flinched a little when she mentioned Flick. Just the mention of her name brought his still raw feelings rushing to the surface again. He had to pretend their night together hadn’t happened until one day he could forget it actually had. He would never allow himself to fall in love. Not with Flick or any other woman. Up until now that hadn’t been difficult but something about her had got under his skin and was causing him to lose sleep.

The lift doors opened and they both stepped inside.

‘As you instructed, the radiographer and paediatric anaesthetist are scrubbing in in the adjacent Theatre now in preparation for the atrial septostomy.’

They entered the empty lift and headed down to Theatre quickly and in silence as Tristan read the examination observations on the way.

The Theatre nurse met them as the lift doors opened and walked them to the scrub room. ‘Dr Hamilton, the father is waiting to speak with you but I explained that would be after the delivery when you have assessed their son and can provide a more accurate prognosis.’ Her voice was calm yet firm, her years of experience evident. ‘Both parents are aware that major surgery will be needed in the next few days for their son. The paediatric resident discussed the need for the immediate atrial septostomy with Mr Roberts, the child’s father, and obtained signed permission. And by the way, we have a medical student in Theatre to observe today.’

Tristan nodded as he scrubbed and gowned and entered the operating Theatre. Everything had been prepared for the emergency procedure on the newborn infant. The slightly nervous but very eager-looking medical student had also scrubbed in and was waiting in the Theatre, his expression close to that of a deer in headlights.

‘Tristan Hamilton, neonatal cardiothoracic surgeon,’ Tristan introduced himself as he checked the sterile surgical tray. He knew that everything would be in order as the Theatre team was second to none in detail and process, but it had been a ritual since medical school and one he never omitted.

‘Jon Clarke, third-year med student. I’ve heard so much about you and hope to specialise in paediatric cardiology but I’m keeping my options open.’

‘Welcome aboard, Jon,’ Tristan replied, keeping an eye on the doors to the Theatre and the impending arrival of the newborn patient. ‘In a few minutes we will have a neonate, approximately thirty-seven weeks with a transposition of the great arteries. As I’m sure you are aware, the natural history of untreated transposition of the great vessels in the neonate was quite poor but has improved dramatically. Surgical correction has been possible for over fifty years now with an arterial switch procedure that’s considerably lowered mortality rates.

‘I’ll be scheduling that surgery within the next two days but we need earlier intervention to ensure immediate survival so shortly I’ll undertake a nonsurgical procedure to create an arterial septal defect, using a balloon catheter. Essentially we will open a small hole in the heart to allow the blue and red blood to mix and provide sufficient oxygen to the newborn.’

‘How did you diagnose the condition so quickly?’ Jon asked with interest.

‘The mother has been under the care of Dr Nate Hopkins in Sydney. He’d planned the C-section for next week but they travelled here yesterday for some family function and labour ensued. The condition was detected at the twenty-week scan. Thank God she didn’t go into labour somewhere along the Hume Highway or we might not have had the same prognosis for mother or child.’

Just then the swing doors opened and the tiny child was wheeled in on open bed. Tristan looked up to see Flick standing in scrubs beside the infant. He caught her glance and held it. He couldn’t ignore the look of pain and disappointment in her beautiful blue eyes. But there was no anger. That seemed worse to him. He fought the strongest urge to throw his gloves, gown and surgical cap to the floor and pull her into his arms. But he reminded himself sternly that it was not himself that he was protecting. It was her.

‘The vernix has been wiped clear from his abdomen and suction of mouth and nasal cavity done,’ Flick said, as she handed over the care of the baby, wrapped loosely in green sterile sheeting, to the Theatre nurse, then left without looking back.

Tristan hated that it was over between them and that one night would be all they ever shared, but there was no other way, he reminded himself as he refocused on the tiny child who now needed him. An infant who would be facing a childhood much like his own if this surgery was not successful.

The radiographer continued the Theatre tutorial for the student. ‘I’m providing the two-dimensional transthoracic echocardiography. Essentially this is live imaging of the child’s heart to allow Dr Hamilton to monitor the catheter’s positioning during the procedure.’

‘The procedure can also be of potential benefit in patients with other severe congenital heart defects. I can explain them later if you’d like,’ Tristan added, as he watched the Theatre nurse unwrap the sterile covers and wash the baby’s abdomen with antiseptic solution.

‘Today I’ll be using the umbilical vein as an access. This simplifies this procedure dramatically. It can be performed at the bedside in the neonatal intensive care unit but as the infant was down here I chose to do this immediately before the transfer to NICU. I also prefer sedation to general anaesthesia if possible.’

Jon stepped a little closer. ‘If the condition hadn’t been identified at twenty weeks, due to poor antenatal monitoring, how would you diagnose the condition after birth before it was too late to reverse the condition for the newborn?’

‘The symptoms would be detected by the neonatologist or the nursing team. The child would present as unusually quiet, he or she wouldn’t wake, and they would have a low pulse ox test. All the indicators of a congenital heart condition, so I would be called to consult immediately.’

‘Ready to go,’ the radiographer announced.

‘I’m set too,’ said the paediatric anaesthetist.

Tristan nodded and began the intricate procedure, talking the medical student through each step. ‘We’re now in the right atrium, as you can see on the echocardiography. I will now thread the catheter into the foreman ovale, the naturally existing hole between the atria that normally closes shortly after birth.’ Tristan watched the screen to ensure the catheter was positioned correctly.

‘Now I will inflate the balloon with three to four mils of dilute radiopaque solution to enlarge the foramen ovale enough that it will no longer become sealed. This allows more oxygenated blood to enter the right side of the heart where it can be pumped to the rest of the body. To ensure that there is flow, I am now locking the balloon. I will now carefully but sharply withdraw into the right atrium to create a permanent flow.’

Tristan continued his explanation of the procedure and repeated the manoeuvre three times before he then deflated the catheter and removed it completely.

‘We can monitor the effectiveness directly via the echocardiography,’ he said, pointing to the monitors. ‘But it’s clear there’s been a sharp rise in systemic arterial saturation so we’ve been successful. This little chap will be good to go until we can schedule his major operation in the next two days.’

Tristan and the medical student stepped away as the nursing team prepared the baby to be transferred to Neonatal Intensive Care. He was pleased that the stunned-deer expression had slowly disappeared from the young man’s face and he appeared more at ease. After agreeing that Jon could scrub in on the arterial switch repair surgery, he invited the student to accompany him to visit with the parents once the mother had been released from Recovery and returned to the maternity unit ward. It was equally important to Tristan that the bedside manner of medical students was developed at the same time as their technical skills.

Tristan then headed to Neonatal ICU to brief the nursing team before he went back to his office to finalise some paperwork and grab some lunch. He had an afternoon of hospital rounds and consults, so he needed to eat something substantial.

Flick paced the corridor outside Tristan’s office nervously. She had taken a break after she’d visited a new mother in MMU with Sophia. Flick loved shadowing Sophia and was learning so much about the spectrum of roles within midwifery but that day she felt removed from what was happening. She hadn’t liked the feeling of not being in the moment during the birth. It was what she loved more than anything but that day her mind and her heart were weighed down by what she needed to say to Tristan.

This was her career and she would not allow Tristan to take that away from her. She would get through her personal issues because she loved what she did. She loved it all—the antenatal care, the birth and the postnatal assistance. She wanted to be a community midwife and spend more time in the field in the future.

But first she had to speak with Tristan. She had made her decision after two weeks of deliberation. She couldn’t delay it any longer.

Finally, after taking a deep breath, she knocked on his door.

‘Come in,’ Tristan called, trying to swallow a mouthful of his sandwich as he checked his incoming emails, some of them spam from pharmaceutical and medical supply companies.

Flick’s legs were shaking like leaves in the breeze as she entered his office. She looked across the room at the man who had made love to her on that fateful night and she knew immediately that there was no regret in her heart. No anger. And definitely no blame, as she had willingly invited him into her bed.

‘Flick.’ He was stunned and his voice didn’t mask his surprise at seeing her in his office. She looked even more beautiful. She had a glow, he thought as she stood before him in her shapeless hospital scrubs. He knew underneath she had the most gorgeous body but her beauty went so much deeper than that. She had a wonderful, warm spirit and the fact they couldn’t be together ate him up inside.

It took less than a minute, with Flick standing so close, to realise that his feelings for her were real and that made it so much harder to keep his distance. It tore at him that he couldn’t act on his feelings, to cross the room and kiss away the last three months. As much as he wanted to, he couldn’t let it happen. He needed to stay in control. She deserved so much better than the problems he could bring into her life.

Resolutely he knew he must deal professionally with whatever hospital matter she had come to discuss and then pretend she had never been within his arms’ reach.

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