The Honourable Midwife. Lilian Darcy
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Houston,’ said anaesthetist Harry Ang.
‘One day I am going to kill that man,’ Nell muttered.
It was one of Dr Ang’s harmless quirks that he liked to speak as if this was NASA Mission Control and he was an astronaut about to launch into space. Nell had a limited tolerance for harmless quirks.
Emma didn’t mind Dr Ang—he was a nice guy, and always pleasant to the nurses, which counted for a lot—but she had to suppress a laugh all the same when Pete said, ‘Apollo Thirteen, do you mind if we cut satellite communications for the rest of this mission?’
‘Just trying to raise team morale.’
‘Consider it already more than sufficiently raised, Dr Ang,’ Nell came in. Her tone could have lasered through glass.
Gian Di Luzio ignored the whole thing. He simply asked for a piece of equipment, and the surgery began. Emma and Nell were standing by, waiting for the baby, and Emma found that her focus stayed fixed on Pete. She’d never realised it would feel so intimate to know that he’d lived in her house, and she wondered if he felt in any way the same.
The intimacy had to be even greater, perhaps. He’d slept in her bed. He’d used her dishes. He’d sat on her couch. Her personal possessions had all been packed away, but rooms were personal, too. Air was personal. Grass was personal. He’d breathed her air and trodden her grass.
He had mowed it very neatly, too, just before he’d left. He’d dumped the fresh clippings from the mower in their usual spot beside the compost bin behind her shed, and she’d arrived home to find them still giving off their tangy, summery smell. It had seemed as if Pete must have left just minutes before.
Pete made the incision in Patsy’s abdomen and cut through the outer layers of fat and muscle to reach the uterus. He and Gian had decided on the more conservative midline incision, given the difficult placement of placenta, fibroids and baby.
Gian muttered a couple of suggestions, and Nell stepped close when it was time to lift the baby free. Dr Di Luzio was another very capable doctor, Emma knew, and he’d just become engaged to her fellow midwife and friend, Kit McConnell. The couple were still talking about dates for their wedding, and they’d just agreed to formally adopt his brother’s little girl, Bonnie.
‘Here we go,’ the obstetrician said.
He brought out a blue, slippery bundle of limbs and a tight, immobile little face, beyond the sea of green surgical fabric, and gave the baby girl at once to Nell. Above his mask, Pete looked tense, and the sound they were all waiting for—a baby’s cry—hadn’t happened yet. The lights were bright on Mrs McNichol’s exposed skin, with its rust-coloured splashes of antiseptic, and the seconds seemed to drag.
‘She’s small for dates. Tiny!’ Dr Ang exclaimed.
‘We knew she would be,’ Pete said, his tone clipped. Nell suctioned the baby’s nose and throat out carefully and chafed her chest, but nothing happened. ‘Hoping for better than this, though,’ Pete added.
‘Come on, sweetheart!’ Nell muttered. ‘Don’t scare us like this!’
Working closely beside Nell, Emma clamped and cut the cord. The baby was still limp. Her one-minute Apgar score wouldn’t be all that great. Emma calculated automatically. One for tone, one for colour, zero for respiration…
‘OK, she’s still not breathing. I’m going to bag her, I’m not going to wait,’ Nell said, grabbing the equipment quickly.
She laid the baby in the open tray of the resus trolley beneath the warming lights. Emma managed to slip a stretchy little cap on the baby’s head to keep vital body heat in. The umbilical stump was the most favoured site for IV insertion in a premmie, but sometimes one needed intravenous lines put in through the veins in its scalp.
She hoped she wouldn’t be taking the little hat off again soon for that purpose. A baby at thirty-three weeks shouldn’t need that level of treatment. That fibroid-crowded uterus hadn’t been good for her at all.
‘Got some bleeding here,’ Dr Di Luzio said. ‘Pete, the placenta’s looking very tricky, right across a mass of intramurals. Surprised she got this far with the pregnancy. Not a bit surprised about the size of the baby. Nell?’
‘Going as fast as I can here,’ she answered. She held the manual oxygen bag to the baby’s face, trying to pump air into the tiny lungs and listen with a stethoscope at the same time. Nothing was happening.
‘One more try, then I’m going to intubate,’ she announced. ‘Heart rate’s a little slow and thready, and there’s a bit of a murmur. It may clear up on its own. They often do. Still, we have to get moving on this.’
Already, nearly two minutes had passed since the clamping of the cord, and every second without oxygen was critical. Thank goodness Patsy was unaware of all this!
‘Emma?’ Nell prompted.
‘Yes.’ She had the intubation equipment ready, and the oxygen.
The tube was pitifully small, and it would be an extremely delicate procedure, with the risk of tubing into the stomach instead, creating yet another delay. Nell had her naturally pale face set like a mask as she made her final attempt to squeeze oxygen into the baby’s lungs manually.
‘Come on, darling,’ she repeated, tapping the tiny feet, chafing the chest, looking for the right stimulation.
Normally, her skin complemented her dark blonde hair, but that was all tucked beneath her royal blue disposable cap. She looked as efficient and as cool as a machine, but Emma knew she had a strong, passionate heart beating away underneath.
‘OK, we’ve got her,’ Nell announced at last. ‘No tube, thank goodness. She’s breathing on her own. Yes.’ She watched and listened. ‘Yes! Heart rate is better already. Colour’s improving. She’s picking up quickly now.’
The five-minute Apgar score was the crucial one as a predictor of long-term health and development. Emma added the figures again. One for tone, one for colour, two for respiration…Seven. Eight would have been nice, but if she’d added that extra point, she would have been cheating.
‘Good. Go for it. Got our own problems over here,’ Gian said, in answer to Nell.
‘Houston, we have a—’ Dr Ang began.
‘Shut the hell up, Harry,’ Pete sang at him.
‘Sure. Sure.’
‘Can we tie off this vessel?’ the obstetrician asked.
‘Got it,’ Pete murmured. ‘How’s the placenta looking?’
Emma didn’t have time to look over at the table to see what was happening. She heard Pete’s voice, muttering something else, and Dr Ang confirming that everything looked fine at his end, although the patient’s blood pressure was beginning to drop.
‘OK, placenta’s coming away,’ Gian said. ‘Most of it. Getting a big bleed now.’ His voice was calm, almost lazy, but no one was fooled. ‘Cautery, Mary Ellen. Good. Thanks. Let’s get this closed off.’
There was a hiss, and the acrid smell of burning.
‘Good girl, what a lovely pink colour now! What great breathing!’ Nell said, as if it was the baby’s own success, not hers, and perhaps she was right. She leaned closer, listened once more just to check. ‘You good, darling girl! Now we’ve got it all happening,’ she crooned at the tiny baby, still working quickly as she spoke.
She taped a pulse oximeter to the baby’s hand, checked the fluctuating numbers that appeared on the screen. Climbing. Pink had now begun to radiate outwards from torso to extremities. Emma blinked back tears of relief. Blue was just the wrong colour for a baby, frightening and wrong. Pink was like the sun coming out on a cold, cloudy day, lifting spirits at once.
‘Thank God!’ she whispered.
She saw Pete’s glance