Midwives On-Call At Christmas

‘Bonnie? Can you come and give us a hand? We’ve just been phoned. We’ve got a woman who is thirty-two weeks pregnant with twins coming in by ambulance. They think the babies are in distress.’ Karen, one of the junior midwives, was at the door.

Bonnie clicked the window on the computer to close it and stood up quickly. ‘No problem, Karen.’ She walked out of the office and across to the treatment room to wash her hands and put on an apron. ‘Which room are you preparing?’

Karen glanced over at the whiteboard. ‘Room 3, I think. That’s the biggest. I’ll go and page the on-call obstetrician.’

Bonnie felt her stomach flip over. One of the obstetricians was off sick. There was every chance Jacob would now be on call.

She finished the final checks in the room just as the ambulance crew wheeled the patient in. ‘Hi, Bonnie. This is Eleanor Brooks. She’s thirty-two weeks pregnant with twins. Hasn’t felt well the last few days and fainted in the street around thirty minutes ago.’

Bonnie moved over to the side of the bed and grabbed the edge of the sheet as the paramedic pulled Eleanor over on the patient slide board.

‘Hi, Eleanor, I’m Bonnie, the sister in the labour suite. Let me help you off with your jacket and we’ll see how you’re doing.’

Eleanor gave a nod and shrugged her shoulders out of her jacket, letting Bonnie pull it away as she lay back against the pillows. Her colour was poor and it only took Bonnie a few seconds to wind the blood-pressure cuff around her arm and start to inflate it.

Karen appeared again with the paperwork and spoke in a low voice for a few minutes with the ambulance crew.

‘Eleanor, is there someone I can phone for you?’

Eleanor nodded towards her bag. ‘My mobile is in there. My husband is John, but he works offshore on the rigs. You might not be able to get him. My mum’s number is in there too. She lives in Cambridge.’

Karen glanced in Bonnie’s direction; Bonnie gave her a silent nod. ‘Is your husband up in Aberdeen?’ She was calculating in her head how long it would take to helicopter him back from the rigs to the mainland, and then down to Cambridge. She blinked at the reading on the screen from the BP cuff. Karen’s eyes widened.

‘Have you seen your community midwife lately, Eleanor?’

Eleanor’s blood pressure was unusually high. Any woman with a twin pregnancy was normally monitored quite closely. Eleanor shook her head. ‘I had an appointment last week but she was off sick, and this week I wasn’t feeling well enough to go, so I missed it.’

Karen scribbled a little note on the paperwork. ‘I’ll go and make these calls, chase up the obstetrician and arrange for Eleanor’s notes.’

Bonnie gave a nod. ‘Eleanor, can you tell me how you’ve been feeling this past week?’

‘Awful.’ The one-word answer said everything.

‘Did you call your midwife for some advice?’

Eleanor sighed. Her eyes were half closed; it was obvious she was tired. Her legs and ankles were puffy. Bonnie bent over and gave the skin a gentle squeeze between her fingers, the imprint of her fingers clearly denting the skin.

‘I didn’t want to bother my midwife. I thought I’d feel better in a day or so. Everyone’s had a viral thing lately. I was sure I had the same.’

Eleanor moved uncomfortably, ignoring Bonnie at her ankles and taking a little gasp of breath as she pressed her hand against her right-hand ribs.

‘Eleanor? Are you having pain?’

Eleanor grimaced and nodded. The pain was too high up to be a labour pain, but it could indicate something else. The pain seemed to pass quickly and she relaxed a little. ‘I’ve been tired. Really tired. But that’s normal for twin pregnancies, isn’t it? I’ve been feeling a bit sick too. I’ve had a headache for the last few days. I actually vomited twice yesterday—I’ve never done that before. And usually I’m peeing all the time, now I’m hardly peeing at all.’

Alarm bells were going off in Bonnie’s head. Eleanor was showing some signs of pre-eclampsia. It wasn’t that unusual in twin pregnancies, but Eleanor’s condition seemed to be taking a dangerous turn.

She put her hand on Eleanor’s arm. ‘I know I’ve just got you into bed. But do you think you could manage to give me a urine sample? I know you said you’re hardly peeing right now, but if you could squeeze something out that would be great.’ She hesitated for a second. ‘I’m also going to call the phlebotomist to take some bloods.’

Eleanor gave a little sigh and swung her legs around while Bonnie brought a commode into room. Right now, she didn’t even want Eleanor walking into the separate bathroom. She wanted to monitor her at all times.

Karen came back into the room as Bonnie was helping Eleanor back into bed. She pressed the button on the blood-pressure monitor again. Karen held up some foetal monitors. ‘I thought you might want me to attach these? And Sean is outside.’

Bonnie nodded as she wheeled the commode towards the door. ‘Will you stay here until I get back?’ Karen gave the tiniest nod of her head. They were both aware of the seriousness of the situation.

It only took Bonnie two minutes to dipstick the small sample of urine and put the rest in a collection bottle for the lab.

Once she’d washed her hands she went back outside. But Sean wasn’t alone. He’d been joined at the desk by Jacob.

Her stomach flipped over. This was work. He couldn’t avoid her—no matter how much he tried to.

Sean turned to face her. ‘Can you give me an update?’

Bonnie nodded. Aware that Jacob still wasn’t really looking at her.

‘Eleanor Brooks is thirty-four. She’s thirty-two weeks pregnant with twins. I’ve not seen her notes, but I’m assuming her pregnancy has been unremarkable up until now. She collapsed in the street earlier today. She has upper-right-quadrant pain, pitting oedema in her ankles, her blood pressure is one-sixty over one-ten. Pulse eighty-seven. I’ve just tested her urine and it’s positive for protein.’

She watched as Sean scribbled some notes. ‘There’s more. She’s had a headache the last few days, vomited twice yesterday and she’s been very tired.’

Jacob frowned. ‘Hasn’t she seen a midwife at any point?’

Bonnie felt automatically defensive. ‘She should have. She was last seen three weeks ago. The week after that, her midwife was sick, and last week she felt too unwell to attend. She didn’t call in to speak to the midwife as she thought she just had a virus.’

Jacob started to swear under his breath. ‘This is looking like HELLP syndrome. Do you mind if I come with you, Sean? We might need to do an emergency twin delivery.’

‘Glad of the help,’ Sean said quickly. He handed some blood forms to Bonnie. ‘Can you get these done as an emergency?’

‘No problem.’ She took them as Sean and Jacob walked into the room to assess Eleanor. Five minutes later the ward clerk arrived with the notes and the phlebotomist answered her page. Bonnie flicked through the notes. Nothing untoward. All Eleanor’s previous appointments had shown a healthy developing pregnancy.

The missed appointments were unfortunate. She just wished Eleanor had phoned her midwife when she’d started to feel unwell. Maybe her condition could have been picked up sooner. HELLP was serious. It could be life-threatening for both mother and babies.

Symptoms could be vague but it always started with pre-eclampsia. One of the crucial tests was the blood work and the quickest turnaround time from the lab would be just over an hour. Eleanor was already showing some of the classic signs.

Sean and Jacob came out of the room, both talking in low voices. The phlebotomist arrived, picked up the blood forms and went to collect the samples that would be needed.

‘I think we should prepare and contact the anaesthetist anyway. Give her an ace-inhibitor to try and bring her blood pressure down and don’t leave her alone.’ Those last words were aimed at Bonnie. It was the first time his eyes had connected with hers.

There was something wrong—which was stupid, because she knew that already. But the look in Jacob’s eyes? It was almost blank. As if there had never been anything between them, and there never would be.

Focus. She sucked in her breath. There was a patient to deal with. But as soon as Eleanor’s condition was under control, Bonnie was definitely calling the letting agency.

She’d become too attached to him. They’d become too attached to him, too quickly. It was time to take stock. To take a breath.

She’d made a massive mistake with Robert. She’d married a man she didn’t really love. When it came to men—her previous choice hadn’t been great. Could she really trust her own judgement now?

Her heart was telling her one thing and her head another. It was all too much.

The phlebotomist appeared and waved the blood bottles at them. ‘I’ll take these direct to the lab and ask for the results to be phoned direct.’

Sean gave a nod. ‘Thanks.’ He turned to face Jacob. ‘If I speak to the anaesthetist now are you free to assist in Theatre if required?’

There was silence for a few seconds. The quiet made Bonnie look up. Jacob always responded immediately. He never hesitated over clinical care.

But this time he did. This time he glanced at his watch. She could see him swallow as if a million things were flashing through his brain. ‘I’ll need to make a call to try to delay something else.’

Sean looked just as surprised as Bonnie. ‘No problem. I can always find Isabel. She’s covering the other theatre list today—but we can cancel the routine procedures for an emergency.’

That was right. The other theatre list. The one that Jacob had refused to cover today because he had somewhere else to be. Where exactly was that?

A whole wash of memories flooded over her. Robert. Continually making excuses about where he was going or where he had been. The way he could never look her in the eye when he’d been telling her those lies. Her stomach was in knots. She hated that Jacob was following the same pattern. He could never know how much those memories and associations hurt.

Jacob wasn’t Robert. He would never be Robert. But he was definitely hiding something. It made her question herself. It made her question her judgement. Her choices had been wrong before. It felt as if she could be walking down the same path.

Where on earth was he going? And why was he being so evasive about it?

Jacob waved his hand at Sean. ‘It will be fine. Give me five minutes to make the call. Let’s just try and make sure that if we need to take Eleanor to Theatre there are no delays and we’re ready to go as soon as we get the blood results.’

Sean nodded towards Bonnie. His initial surprise had died away and now he just looked relieved that he didn’t have to go and call Isabel. What was the deal with those two?

‘I’m going to stay close by. Give me a shout if you need anything.’

Bonnie went back to the room to help Karen. It only took a few minutes to administer the blood-pressure drugs and start some IV fluids. Karen continued to monitor the babies and Bonnie set the blood-pressure cuff for every ten minutes.

Eleanor kept her eyes closed, occasionally wincing and touching her right side. It was a clear sign that her liver was affected.

Jacob seemed impatient. He was pacing up and down the corridor, and phoned the lab twice to harass them for the blood results. She’d never seen him quite so on edge.

On one hand, she knew that he was putting the care of Eleanor and her babies first. On the other, it was obvious he was anxious to still keep his other plans.

The anaesthetist, Laura, appeared and did a quick assessment. While Eleanor’s current condition was serious she had no significant history that would cause any Theatre delays.

Laura was already dressed in theatre scrubs and tucked her hair into her hat as the phone rang. Jacob snatched it up, listening carefully before putting it back down. ‘Her blood tests confirm thrombocytopenia and liver dysfunction.’ These, combined with her other symptoms, meant that Eleanor could be at risk of liver rupture, uncontrolled bleeding or cerebral oedema.

‘Let’s go, then,’ said Laura. ‘I’ll meet you in Theatre once you’ve spoken to Eleanor.’

Things moved quickly. Eleanor’s mother arrived with news that her husband was already on the helicopter and had left the oil rig. It would still be hours before he arrived.

Eleanor’s condition was worsening. She was beginning to get drowsy, so once Jacob had explained what was happening and consented her they prepared her for Theatre in a matter of minutes and whisked her down the corridor.

Jacob and Sean disappeared to scrub and Bonnie hurried back to the labour ward.

It was three long hours before she heard anything else.

Sean walked up to the nursing station and pulled his theatre hat off his head. His mussed-up hair and tired eyes said everything. She looked over his shoulder. ‘Where’s Jacob?’

Sean shrugged. ‘As soon as we had stabilised Eleanor and the babies and everyone was happy he disappeared.’

She bit her lip to stop her saying what she actually thought. ‘What about Eleanor and her babies?’

Sean nodded. ‘Two girls. Both in SCBU. Three pounds, four ounces and three pounds, two ounces. Not bad for twins. One had to have a little support breathing and the other was fine.’

‘And Eleanor?’

He sighed. ‘She started bleeding out almost straight away. Her blood pressure plummeted and she had six units of blood and then some platelets. We caught her just in time.’

‘What’s happening now?’

‘She’s stable. Mainly thanks to Jacob. She’s been transferred to ICU. They need to keep a careful watch for organ failure.’

Bonnie sighed. ‘Poor woman. I hope she’s going to be okay. Will you let me know how she is?’

Sean raised his eyebrow. ‘Won’t Jacob tell you?’

Bonnie felt colour rush into her cheeks. ‘What do you mean?’

Sean seemed completely unperturbed. He leaned on the desk towards her, a cheeky grin on his face. ‘You two had a fight? For a few weeks the world of CRMU thought you’d turned Jacob into Prince Charming. But now he’s back to his usual lovely self. I take it Prince Charming has turned into a frog?’

Sean was good-natured. He was only teasing but she felt distinctly uncomfortable. She wagged her finger at him. ‘If I find out you’ve been gossiping about me, Sean, I’ll ban you from our tea room. Don’t think I don’t know who goes in there and eats all the biscuits and sweets.’

Sean pulled back in mock horror. ‘Ouch. Tough sanctions.’ He waved his hand as he started down the corridor. ‘Don’t worry, Bonnie. All your secrets are safe with me.’

She blushed again as one of the other midwives came out of a patient’s room and raised her eyebrows at the comment. She pulled her phone from her pocket. Enough was enough. It was time to make that call to the letting agency.

* * *

‘Mummy, where are we going?’ Freya was looking at the photo on the laptop screen.

Bonnie took a deep breath. ‘We’re going to stay somewhere else, honey. This was only ever temporary. Jacob let us stay for a few weeks until we could find somewhere for ourselves.’

‘But I like it here. I like staying with Jacob.’ Freya stuck her chin out and folded her arms across her chest.

I like staying with Jacob too.

She knelt down in front of Freya. ‘I know that, honey. But we have to find a home of our own.’ She tucked Freya’s hair behind her ear and turned the computer screen around to show her the flat she’d just reserved. ‘It will be fine. Honestly, it’s near to the school and you’ll still get to see all your friends.’

Freya gave a nod and stared at the cases. ‘Will we have a Christmas tree like Jacob’s?’

No. Something tugged at her heartstrings. She didn’t want to leave. She really didn’t want to leave.

Jacob was being secretive. He’d kissed her, but never made any promises. He’d never even asked her and Freya to stay for Christmas. He hadn’t asked them to leave either...in fact, he’d made lots of excuses for them not to leave. But it wasn’t the same.

A distant, secretive man was not what she needed. No matter how much he made her heart flip over. It made her question herself all the time. She needed to protect her heart and her daughter’s. They’d got too attached. Freya’s reaction now just made her even more determined.

Tears were bristling in her eyes. ‘We’ll get another Christmas tree and I promise it will be just as gorgeous as the one we decorated here.’ Bang goes my limited budget.

It was fine. She would make sure it was fine. Anything to keep Freya settled after all the disruption she’d exposed her to. She already had the ridiculously expensive doll and all her accessories that Freya wanted for Christmas. Blowing what little savings she had left on another set of Christmas decorations was an easy sacrifice.

The key turned in the lock and she heard footsteps coming towards the sitting room. Jacob. He opened the door and his face dropped as soon as he saw what they were doing. The flat was clearly visible on the laptop screen in front of them.

‘Bonnie? Freya? What’s going on?’

Bonnie could feel her heart beating against her chest. She hadn’t expected Jacob to come home—not when he’d been avoiding them. She’d planned to write him a note, thanking him for his hospitality, but saying they’d found somewhere to stay and she’d see him at work.

She put her arm around Freya’s shoulders. ‘Oh, Jacob, I didn’t expect to see you. It’s just—’ she held out her hand ‘—I think we might have outstayed our welcome. I’ve found somewhere for us to stay.’ She met his confused gaze. ‘I think it’s time for Freya and I to move on.’

His mouth was slightly agape. He looked shocked. He looked a bit hurt. And everything about this was confusing her.

This was definitely the right thing to do. This was absolutely the right thing to do.

‘I’ll miss you, Jacob.’ Freya’s little voice cut through the silence. ‘Thank you for letting us stay.’

Jacob knelt down opposite her. ‘I’ll miss you too, Freya.’ His voice sounded hoarse. ‘You...and your mother.’ He didn’t look up. He didn’t look at Bonnie at all.

This was it. This was his chance to say something. To tell Bonnie that his feelings were every bit as strong as hers.

That he wanted to kiss her again—just as he had the other night.

That he wanted to spend more time with her and Freya. That he wanted to give this relationship a chance. That this actually was a relationship.

That she wasn’t completely crazy, and he was as crazy about her as she was about him.

She held her breath. Waiting. Waiting. For something. For anything.

But nothing came. Jacob still couldn’t look her in the eye.

‘Freya, go and get your coat and shoes. We need to go to the shops.’ Freya disappeared without a word.

He lifted his head. ‘Why are you leaving? Why are you leaving now?’

It was the way he said the word. She stepped forwards, everything erupting to the surface. ‘We can’t be here any more. Freya’s getting too used to being around you.’ She lifted her eyes. ‘And so am I.’

She gave her head a shake. ‘This was a bad idea. You helped us out, thank you. But I have no idea what’s happening between us, Jacob.’ She held out her hands. ‘I have no idea what this is.’ She took a deep breath. ‘I’ve found somewhere for us to go. We’ll be out of your hair.’

‘You have? Where? Is it one of those ones that you showed me?’ He sounded automatically defensive—as if he were going to tell them not to go.

She shook her head. ‘No, it’s another. It’s small, but in the area of Freya’s school. It will suit us for the next few months until we can find something else.’ She licked her lips. This was horrible. This was awkward.

There was a huge hand currently inside her chest, squeezing her heart hard.

Jacob looked at her again. There was a flash of something behind his eyes, which disappeared almost instantly. He looked down again.

‘What’s going on, Jacob? I know something’s been bothering you the last few days. But you haven’t said anything. You’ve been avoiding me. I thought we could talk about things.’ Her voice was edged with hopefulness that he might actually respond.

He shook his head. ‘There’s nothing.’ His voice was flat.

His dismissal made her mad. ‘Don’t say that. Don’t say it’s nothing. I know it is. Tell me. Tell me what’s going on.’ She was shouting now and she could almost see all his barriers being built up all around him. She bit her lip in anger and tried one last time. ‘I thought we could share things. I told you about my past—and you told me about yours. At least I thought you had.’

She glanced towards the door, worried that Freya would reappear.

He sucked in a deep breath. It made him seem taller, his chest wider and more imposing. ‘Not everything can be shared. Not everything is your business.’ His words were clipped.

‘Then we have to go,’ she said quietly. ‘I can’t be around you, Jacob. I can’t watch my little girl forming a closer attachment to you day by day when I feel as if you can’t be honest with me.’ She picked up her green coat. ‘I’ve been down this road before.’ Her eyes swept down to the floor and she gave a little shake of her head. ‘I thought that this time I could trust my judgement.’ She lifted her head and met his gaze. ‘I guess I was wrong.’

There was silence for a few seconds.

‘I hope you’ll be happy,’ he said quietly.

Something inside her died. That was it. Nothing else.

She’d been wrong. She’d been wrong about her and Jacob. There was nothing between them. A wave of humiliation washed over her.

She’d never felt like such a fool—not even when she’d found Robert in bed with her friend. Everything about this was different. With Robert, there had been no emotional investment left. With Jacob?

This hurt. This hurt so much it felt as if it could kill her.

Freya appeared at the door and she took her hand. ‘Goodbye, Jacob.’ Her voice was trembling. She just hoped he didn’t notice.

She held herself straight and lifted her head before she opened the door and walked outside.

It was definitely time to go.

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