Midwives On-Call At Christmas

* * *

Silence.

You could have heard a proverbial pin drop. Bonnie felt the colour rush to her cheeks and she lifted her hand to her mouth. Oh, no. Why on earth would she say something like that out loud?

It was that darn man. Jacob Layton. It wasn’t bad enough that the handsomest man on the planet had watched her walking down the corridor as if he were undressing her with his eyes. Then he’d started talking to her and everything he’d said had put her back up. Now she’d lost her rag with him. Hardly the best start in a new job.

But Bonnie Reid didn’t take any prisoners. In this life, she meant to start the way she was going to continue. The part of her life where she put up with bad behaviour, indifference and rudeness was over.

Maybe it was the fact he was so good-looking that was unnerving her. If she got any closer she was sure she’d see gold flecks in those intense green eyes. Or maybe it was the fact that no man had even flickered on her radar since she’d walked away from her ex. Certainly not a brown-haired, green-eyed Hollywood-style hunk.

Her insides were cringing. She couldn’t believe what she’d just said. And it was clear from the faces around her that no one else could either.

But what made it all the more excruciating was the fact that the edges of Jacob Layton’s mouth seemed to be turning upwards.

He was laughing at her.

‘Please come with me,’ he said sharply and walked over, ushering her towards an office door with Head Obstetrician emblazoned across it, and away from the gaping mouths.

He closed the door firmly behind them and walked around his desk. ‘Take a seat.’ His voice was firm and she felt a wave of panic sweep over her.

She hadn’t even officially started—was she about to be fired? ‘I’m sorry. I’ve no idea where that came from.’

Her stomach did a little flip-flop. It didn’t matter. It really didn’t matter but she’d just made a fool of herself in front of the resident hunk and her new boss. She’d just told him that her husband had cheated on her. It was hardly a placard that she wanted to wave above her head. She might as well be holding a sign saying ‘I’m plain and boring in bed’.

The humiliation burned her cheeks. Right now she wanted to crawl into a hole.

He fixed on her with those green eyes and she felt her skin prickle under her thin scrubs. At times like this she longed for her thicker white tunic and navy trousers. But scrubs were the order of the day in most labour wards.

He pointed to the chair again. ‘Sit down.’

Her feet were shuffling nervously on the carpet and she couldn’t stop wringing her hands together. Sitting down seemed quite claustrophobic. Particularly with Jacob sitting at the other side of the desk and the door closed behind them.

‘Don’t ever speak to me like that again in front of my colleagues.’ The words were out before she could stop them. And she wasn’t finished. ‘It was unprofessional. If you want to question my clinical capabilities take it up with me privately, or take it up with the director of midwives who employed me.’ She waved her hand. ‘On second thoughts, why don’t you actually wait until you’ve worked with me, before you question my clinical capabilities?’ She stuck her hands on her hips. ‘And maybe I’ll wait until then to question yours.’

Too much. It was too much. Even she knew that. The shocked expression on his face almost made her want to open the door and run back down the corridor.

Definitely not her best start.

She took a deep breath and sat down. ‘Look—’ she started but Jacob lifted his hand.

She froze mid-sentence. This was the way she always got when she was nervous. Her mouth started running away with her, a prime example being what had happened outside.

Jacob ran his hand through his hair. It struck her as an odd act. Usually a sign of someone being tired or frustrated. Jacob Layton didn’t strike her as any of those things.

He lifted his eyes to meet hers. ‘You’re right. I shouldn’t have questioned your capabilities. But let’s start with the basics. Bonnie, I would have preferred it if you could have been here at nine this morning. It would have made our meeting a little easier. Is timing going to be an issue for you?’

She shook her head quickly, wondering if she should be offended by the question. ‘No. Not at all. This morning was a one-off.’

He gave the tiniest nod. ‘I appreciate you just arrived last night, and that you were asked to start at short notice.’ His brow furrowed a little. ‘Do you have adequate arrangements in place for your daughter?’

She straightened her shoulders. He was putting her on edge again. Dr Handsome just seemed to rub her up the wrong way. ‘I hope so. I have a friend who is a registered childminder. She’s agreed to take Freya in the mornings and after school.’

‘What about weekends and night shifts?’

Bonnie felt herself pull back a little. ‘I was told there was no requirement for night shifts—that you had permanent night shift staff here?’ The statement had turned into a question. She had the mildest feeling of panic.

A wave of recognition flickered across his face. ‘What about shift work? Will that cause you a problem?

Now he was really getting her back up. She couldn’t fathom this guy out at all. One minute he was fiercely professional, the next he looked amused by her. As for the sparks that had shot up her arm when they’d touched...

She’d already snapped at this guy once. She didn’t want to do it again. It wasn’t his fault she was tired. It wasn’t his fault that the journey from Scotland had taken much more out of her and Freya than she’d really expected. It wasn’t his fault Freya had been upset this morning, or that the motel room was totally inappropriate for them both. None of this was his fault.

She wanted to respect her boss and get on well with him. He was a bit grumpy, but she’d met worse, and she was sure she could knock it out of him. She’d already embarrassed herself once in front of her boss. It was time for a new tack.

She met his gaze straight on. ‘Jacob, I don’t think you’re actually allowed to ask me questions like that.’

‘Aren’t I?’ He sat back quickly and frowned.

She held up her hands. ‘Would you ask a guy these questions?’ She was so aware it was all about the tone here. It was a serious subject, but she was quite sure he wasn’t even aware of what he was doing. ‘What if I asked you, right now, about childcare arrangements for any kids you might have? Would that seem appropriate to you?’

The recognition dawned quickly on his face. ‘Well...no.’ He put his head in his hands for a second and shook it. When he pulled his head back up he had a sorry smile on his face and shrugged his shoulders. ‘Sorry.’

She gave a little nod of her head. ‘No problem.’

She heard him suck in a breath and his shoulders relaxed a little. ‘I do have a good reason for asking you.’

She raised her eyebrows. ‘You do?’

He nodded slowly. ‘I do.’ He was being serious now. ‘Valerie Glencross, the director of midwifery, suggested we should offer you a promoted post.’

Bonnie sat bolt upright in her chair. It was the last thing she’d expected to hear. ‘She did?’

His gaze connected with hers. ‘She did.’ For a second it felt as if time had frozen. She was looking into the brightest pair of green eyes she’d ever seen. She’d been right. He had little gold flecks in his irises. It made them sparkle. It was making her hold her breath as she realised exactly what kind of an effect they were having on her.

‘She did,’ he reiterated. ‘It seems your CV had already impressed her. I’m guessing that your telephone interview with her went well. She wanted me to meet you and ask if you’d consider being Ward Sister on a temporary basis.’

‘Me?’ Bonnie was more than a little surprised. ‘But you must have senior staff working here already. Wouldn’t it make more sense to have someone take charge who is familiar with the set-up?’

He gave a little laugh. ‘You would think so. Our senior staff are excellent. But none of them have the talent of organisation. Valerie said that before you were a community midwife you were a ward sister. I think she thought it would be good to have a new broom, so to speak. Someone who didn’t have any preconceived ideas about CRMU and could bring some fresh ideas about how things should run.’ He gave a little sigh. ‘Our ward sister Abby has been gone less than two weeks and it’s chaos out there. She left sooner than expected and we obviously didn’t appreciate just how much she kept on top of things.’ He gave his head a little shake. ‘I’m feeling bad. I’m wondering if the stress of the ward was a factor in her pre-eclampsia.’

‘Is she okay?’ It was the first thing that sprang to mind.

He gave a quick nod and Bonnie shot him a smile. ‘In that case, you’re not making it sound like my dream job. Shouldn’t you be giving me the hard sell? And after our first meeting—do you really want to offer it to me at all?’ Jacob Layton wasn’t good at this. He was being too honest.

He groaned again and sat straighter, giving her a grin that sent tingles to her toes. ‘Let me start again. Bonnie Reid—from your extensive experience on your CV we’ve decided you would be a great addition to our team. You’ll know the reputation of Cambridge Royal Maternity Unit. We employ the best obstetricians and midwives and are known as a centre of medical excellence. We have links with Cambridge University and are pioneers in the development and research of many groundbreaking medical techniques. We have a great bunch of staff working in the labour delivery suite. We just need someone who can bring some new organisational skills to the ward.’ He leaned across the table towards her. ‘How’s that for the hard sell?’

She couldn’t pull her eyes away from his. He was closer to her than ever before. She could see every strand of his dark brown hair. See the tiny lines around his eyes. And exactly just how straight and white his teeth were.

He nodded towards her. ‘And yes, I do want to offer it to you. You’re the first person to answer back in about five years.’

Boy, he was handsome. But there was something else. Something so much more than just good looks. Beneath the flecks of gold in his eyes she could see another part of Jacob Layton. There was so much more there than a handsome but grumpy obstetrician. He seemed the single-minded, career-driven type. But what lay beneath the driven exterior?

She returned his smile. ‘That was much better.’

He relaxed back in his chair and she was almost sorry she’d replied. ‘Thank goodness.’ He was so much nicer like this. Why did he act so grumpy around the staff?

She took a deep breath. ‘I want this to work. I want this to work for me and for Freya—my little girl. This is a fresh start. I want to leave everything else behind us.’ She rolled her eyes and gave her head a little shake. ‘And I definitely want to leave men behind. I just want to focus on my new job and getting me and my daughter settled.’

Jacob gave a little nod of acknowledgement as he tapped his fingers on the desk. ‘The reason I asked about your childcare arrangements—if you’re working as ward sister we’d generally expect you to work nine to five. You’d only occasionally be expected to work late shifts if there were staffing issues, and join part of the hospital on-call rota to do weekends.’

Bonnie frowned. ‘How does that work?’

‘All of our ward sisters take turns in covering weekends. You’re not actually there as a member of the team that weekend. You’re covering the management for the whole hospital. Sorting out staffing problems, dealing with any difficult cases or issues across the whole of maternity. It usually works out once every nine weeks.’

Bonnie nodded. ‘That’s understandable. This would make things much easier with my childcare arrangements. Freya will be much happier if I’m working more or less regular hours. I’ll get to put her to bed most nights. And, as I’ve mentioned, Lynn will happily take Freya every weekday before and after school, and for the occasional late night or weekend.’ She gave a visible sigh of relief. ‘I’m happy to do the job—in fact, I’m really excited to be asked.’

He seemed relieved. ‘So you’ll take the job?’ His voice went up a little, as if he was still a bit anxious she might turn down this fabulous opportunity.

She stood up and held out her hand towards him. ‘Of course I will. I’m a little nervous but am sure in a few days it will feel like I’ve been here for weeks. That’s always the way of it, isn’t it?’

He smiled again; this time the relief was definitely reaching right up into his eyes. His hand grasped hers. There it was again.

She hadn’t been mistaken first time around. Coming into contact with Jacob Layton’s hand was doing strange things to her skin receptors—currently it was the dance of a thousand butterflies. Just as well she’d made it clear she was a man-free zone.

‘Perfect. I’ll let Valerie know you’ve accepted. She’ll arrange for a new contract.’ He held open the door for her. ‘Now, let’s go and tell the staff.’

Her stomach did another little flip-flop as she walked through, but she couldn’t work out if that was the thought of telling her new peers about her role, or from the burn coming from Jacob’s hand at the small of her back.

One thing was for sure—CRMU was going to be interesting.

CHAPTER TWO

JACOB HADN’T BEEN WRONG. The labour suite was in chaos. And it was all basics.

Bonnie grabbed a ward clerk and made some immediate requests about sorting out case notes, filing things appropriately and keeping the boards up to date. Then she asked for new lists of contact numbers. The one she found on the wall was obviously out of date and, with doctors changing every six months, she didn’t want any problems with pagers in case of emergency.

She spent the next two hours working with various members of staff and patients. After a few hours she was confident in the clinical capabilities of the staff that were on duty. They all wanted to do their jobs and work with patients. They just didn’t want to bother with ‘ward’ stuff. Ordering, stocking, rotas, outpatient appointments, pharmacy prescriptions. It quickly became apparent that her predecessor had dealt with all these things and her quick departure meant there had been no handover.

Bonnie gave a sigh. She’d like to spend all day working with patients too—but that wasn’t the way a ward was run. She started making a ‘to do’ list that she’d have to work her way through.

The other issue was the phones. They rang constantly—often with no one answering. First thing tomorrow she was going to ask about a regular ward clerk for the unit. Just as she finished making a few notes about the off-duty rota the phone rang again.

‘CRMU, Bonnie Reid, can I help you?’

‘Ambulance Control. We need a team on-site at a crash on one of the motorway slip roads. We have a trapped, unconscious pregnant woman. She’s reported to be thirty-four weeks. Ambulance is on its way to pick you up.’

Bonnie put down the phone. First day on the job. You had to be joking. She automatically dialled the page for the on-call obstetrician. Most big maternity units had supplies for emergencies like these. It was just a pity she hadn’t had a chance to find out where they were.

A few seconds later Jacob appeared from his office just as Bonnie was relaying the message to one of the senior midwives. He was holding his page. ‘What have we got?’

She handed over the piece of paper she’d scribbled on. Jacob gestured towards her. ‘Follow me. Equipment is in here. Grab a jacket and a bag.’ He turned to face her. ‘You are coming, aren’t you?’

She hesitated for only the briefest of seconds. ‘If you want me to.’

No. I’m terrified. This sounds like an initiation of fire. It’s my first day, I’ve just agreed to act as temporary sister in one of the most prestigious maternity units in the country and now you want me to be part of the emergency response team.

He acted as if he did this every day, grabbing a jacket with ‘Doctor’ emblazoned across the back and handing her the one with ‘Midwife’. He shot her a smile as he helped her lift the emergency pack onto her shoulders. ‘Let’s go. Leave instructions with Miriam, the senior midwife. She’ll deal with the calls until we get back.’ He walked away, his long strides crossing the corridor quickly, only stopping to wheel a portable incubator to the door.

She could feel the wave of panic lapping around her ankles. There was no way she could let it go any further. She started repeating in her head the list of emergencies that she’d dealt with on her own as a community midwife. She could do this. She could.

Miriam gave her a sympathetic nod as she handed over a few instructions. ‘I’m so glad it’s you and not me,’ she murmured under her breath.

‘What do you mean?’

Miriam rolled her eyes. ‘If you think Dan Daring is harsh on the ward, you should see him at a roadside emergency. The patients love him. The rest of the staff need counselling by the time he’s done.’

‘Let’s go, Bonnie!’ The shout made her jump and she hurried to the exit and into the back of the waiting ambulance. As soon as the doors closed and the sirens switched on they were on their way.

Sitting in the back of the ambulance was more than a little bumpy. She only just managed to avoid practically bouncing onto Jacob’s lap. But he barely noticed. He was holding on to the strap in the back with his eyes fixed on the road ahead.

‘Any more news?’

One of the paramedics turned around. ‘All bad. We’ve just had a report that they think her membranes might have ruptured. She’s still unconscious and trapped. They’re panicking. They think she’s gone into labour.’ He glanced at the clock. ‘We’ll be there in five minutes.’

Bonnie sucked in a breath. A thousand different potential diagnoses were flying through her head. From Jacob’s serious expression he was thinking the same.

When they screeched to a halt Jacob didn’t wait, he just flung open the doors, grabbed the bag and started running.

The first thing that struck her was the smell. Fire, burning metal, petrol and a whole lot more. There were four ambulances already on-site. A few casualties were sitting on the edge of the road. Two children with blood on their faces, a man cradling his arm and an older woman who looked completely shell-shocked. Police had cordoned off part of the motorway but the speed and noise of the cars still passing by was unnerving. Rubbernecking. That was what most of the passing cars were doing. Any minute now there would be another accident on the other side of the motorway. She shuddered and jumped out of the back of the ambulance, trying to spot Jacob’s bright green jacket in amongst the melee of emergency people.

‘Over here.’ A policeman gestured her towards an upended car. She stepped around the pieces of car debris that littered the road. Somewhere, she could hear someone crying. The wails cutting through the rest of the sounds. It was horrible. It was unnerving.

She landed on her knees next to the upturned car. The only thing she could currently see of Jacob was the soles of his feet. His whole body was inside the car, his feet sticking out through the broken passenger-side window. ‘Do you need anything?’ she shouted through the gap.

She adjusted her position to get a better view. Inside the car a pregnant woman was trapped upside down, held precariously in position by her seat belt. It was obvious she was still unconscious, an oxygen mask to her face and a collar around her neck. Jacob was pushing back her coat and gently easing her stretched top over her abdomen. Bonnie didn’t wait for instructions. She fished out a stethoscope and a foetal monitor and stuck her hand through a gap in the broken window where Jacob could grab them.

Even from here she could see the damp patch between the woman’s trousers. It could be two things. It could be urine or it could be amniotic fluid. She was just praying it wasn’t blood. She didn’t even want to consider that—not under these conditions.

After a few minutes of wrestling around Jacob finally spoke. ‘I’ve got a heartbeat—albeit a little quick. But I’ve just felt her contracting and there’s absolutely no way to do any kind of examination.’

He shook his head as Bonnie tried to hand him the nitrazine strips. The best they could do in this situation was rub one against her damp clothes. ‘There’s no point checking. I’m fairly sure her membranes have ruptured. We need to get her out of here now. She’s at risk of uterine or placental rupture. There’s no way I’m delivering this baby upside down.’

Bonnie stood up and shouted over to the fire and rescue colleagues. ‘We need to get this woman out. She’s about to deliver. Can we have some assistance?’

One of them ran over. ‘Sorry, got tied up trying to lift a car off someone’s chest.’

Bonnie gulped. It was chaos all around them and even though the road seemed full of emergency staff, there probably still wasn’t enough.

The fire-and-rescue guy pointed at the collar. ‘She was conscious for only a few seconds after we arrived and had no feeling in her legs. That’s why the collar’s in place. The trauma doc said not to move her. He was waiting for you to arrive.’

She nodded. ‘Well, tell the trauma doc we’re here and she’s in labour. We need assistance to move her as safely as possible now. Can you get us a backboard?’

She pushed her way around the other side of the car. The driver’s door was wedged up against a van that was on its side. It was a struggle to push her arms through and try and wind a blood-pressure cuff around the lady’s arm. ‘Do we have a name?’ she shouted to Jacob.

‘Holly Burns.’

She pressed the button on the machine. Now she’d squeezed around the other side she could see him a little easier. There were deep furrows along his brow; he was clearly worried about this patient and so was she.

‘BP’s low,’ she said quickly as the result displayed.

A number of the fire-and-rescue crew had collected around them, all talking in low voices. ‘Doc, we’re going to have to move the car. We need to cut the patient free and we can’t do it while the van’s in place. You’ll need to come out.’

Jacob didn’t hesitate. ‘I’m going nowhere. This mother and her baby need monitoring every second. Move the car with me in it.’

One of them stepped forwards as Bonnie wriggled out from the other side. She could see clearly why they would need to separate the vehicles. There was no way they could get Holly out on a backboard otherwise. If she had spinal damage they had to do everything possible to try to minimise the movement.

She shook her head and touched the fire-and-rescue chief’s arm. ‘Don’t waste your time arguing with him. He won’t change his mind and it’ll just get ugly. This woman could deliver very soon and her position makes it dangerous for her life and her baby’s.’

She was quite sure this went against every health and safety check imaginable. But she’d seen fire and rescue, paramedic and police services do similar things before. They all made the patient their priority.

She stood back as equipment was positioned and blankets shoved inside the car as Jacob was told to brace himself and his patient.

The car and van were wedged tightly together. The sound of metal ripping apart made her wince. Nothing about this was delicate. Both the car and van were juddering, wheels spinning in the air. It seemed to take for ever before they were finally yanked apart and the fire-and-rescue crew moved in with their cutting equipment.

It only took seconds for them to cut the side from the car. One of the other trauma doctors appeared with the backboard and had a quick confab with Jacob inside about the best way to cut Holly free from her seat belt and support her spine. It was a delicate operation. Twelve pairs of hands ended up all around her, ready to ease her gently onto the spinal board as the seat belt was cut. ‘Hold it,’ said Jacob abruptly. ‘She’s having another contraction. We’ll have to wait a few seconds for it to pass.’