S Bolton - Sacrifice

'We've been trying for three years.' With something between a hiccup and a sob she started to cry. Robert glared at me as though their failure to conceive was entirely my doing and gave his wife the handkerchief he'd had ready in his hand.

I decided to give them a moment. I stood and walked to the window.

It had been raining as I'd driven into Lerwick that morning and the clouds above were low and heavy, the town dark and damp.

Lerwick is a grey stone town on the eastern coast of the main island, a short channel hop from the island of Bressay. Like the rest of the islands' townships, it isn't noted for its architecture: the buildings are simple and functional but rarely beautiful. The traditional choice of building material is local granite with a slate roof. For the most part, two storeys are thought ample by the practical islanders – maybe they worry about high winds blowing roofs away – but in the older parts of town and around the harbour a few three-storey, even four-storey houses can be seen. They seem to represent a rare flash of ambition, or defiance, on the part of the islanders.

Gazing at a rain-washed Lerwick did nothing to improve my mood.

I found myself stifling a yawn. I hadn't slept well. Even when I hadn't been fully awake and out of bed, I'd been restless, my head full of the woman I'd found. I'd seen her, touched her, knew some- thing of what had happened to her. It was appalling… I should be appalled, and I was… but I was angry too. Because I'd wanted to plant snowdrops on Jamie's grave to remind me of the time he tried to eat some. I'd gone out one evening to call him in and found a tiny white flower sticking out of his mouth. He'd looked like an equine flamenco dancer. But now I'd never be able to do that because some sick bastard had chosen our land to bury his dirty work on. And Jamie had been carted off to the knackers' yard.

There was a movement behind me; a fidget. Sarah had stopped crying. I sat down again and turned to her.

'You're only thirty-one. You have a long way to go before you need worry about time running out.' I, on the other hand, was thirty- three. 'There's no guarantee of a baby using IVF. The clinic I'd refer you to has an average success rate of 27 per cent per treatment and, frankly, you're likely to have a below-average expectation of success.'

'Why?' said Robert.

I glanced down at the file again, although I already knew what it said.

'Between you, you're dealing with sub-quality sperm and highly irregular periods. The tests you had on your last visit and the life- style questionnaire you filled in suggest some reasons why that might be.'

Both looked defensive, as though I was about to tell them it was their fault. Well, in a way it was.

'Go on,' said Robert.

'Both of you show deficiencies in certain minerals that are very useful to conception. Sarah, your levels of zinc, selenium and magnesium are very low. You also have a lot of aluminium in your body. Robert, you have low zinc levels too, but what worries me more is a very high level of cadmium.' I paused. 'That's a toxin present in tobacco smoke. You smoke about twenty cigarettes a day. And you drink alcohol most days. You too, Sarah.'

'My father smoked forty a day and drank whisky just about every day of his adult life,' said Robert. 'He had five kids before he was thirty.'

I was losing this couple; but I wasn't about to compromise every- thing I believed in just to give them some false hope today. On the other hand, they might just get pregnant on their first IVF attempt. It was a huge lottery and I could be doing them a great disservice by persuading them to wait.

'What I'd like to suggest is that you forget all about getting pregnant for the next six months and concentrate on becoming as healthy as you possibly can.' I could see Robert about to interrupt. 'Healthy people have the best chance of conceiving, Robert. I'd like to see you give up smoking and both of you to cut out alcohol completely.'

Robert shook his head, as though despairing of my idiocy.

'I know it will be hard,' I went on, 'but if you want a baby, you'll try. Even cutting down will help. Also, I'm going to prescribe a course of supplements to eliminate the various deficiencies you have and I want you both to be tested for a number of infections.'

They weren't going to buy it. They'd come here for sophisticated medical intervention and I was offering them vitamin C.

'Do you really think just that will make much difference?' asked Sarah.

I nodded. 'Yes, I do. I've written everything down.' I handed over a typed sheet to Sarah. 'If you follow this plan, at the end of six months, you'll be much healthier than you are now and the chances of IVF being successful will have substantially increased.' I tried to smile. 'Who knows, you may not even need IVF.'

They stood up, sullenly, like children denied a treat. I wondered if they'd try the plan or just travel to a clinic on the Scottish mainland, where they'd almost certainly be guaranteed a more sympathetic response. Not everyone shared my conviction about the importance of health and nutrition when trying to conceive.

Sarah turned at the door. 'I know you mean well,' she said, 'but we just want a baby so much.'

The sound of their footsteps along the corridor faded away. I opened my top drawer and took out an orange file. The first sheet was the result of a sperm test taken in London twelve months earlier.

Total number of spermatozoa present: 60 million per ml – normal Percentage of sperm alive at one hour: 65% – normal Morphology level: 55% – normal Antibody levels: 22% – normal

And so on, down to the bottom of the page. Everything normal. The name on the top was Duncan Guthrie, my totally normal husband. It was the third test he'd had. The results of the previous two were practically identical. Whatever our problem, it didn't lie with him.

My own notes were underneath. FSH, LH, oestrogen and progesterone levels were all well within the normal ranges. My hormones were OK and, as far as I could tell via a slightly awkward self-examination, everything appeared to be in place.

The Tullys had been my last appointment but I had a ward round in twenty minutes. Immediately afterwards I had to drive north and catch a ferry to the island of Yell for my monthly visit. I'd meet with the island's midwife and hold a clinic for the eight women currently pregnant there.

Getting up, I wandered back over to my office window. The car park was immediately below. Without really thinking I found myself searching for Gifford's silver BMW. Let it go now, he'd said, let the police do their job. He was right, of course. But I still had eighteen minutes to kill.

Back at my desk I accessed the hospital's intranet site. I clicked on a few icons, thought a bit, then clicked on a couple more. For a hospital website it was surprisingly easy to navigate. It wasn't long before I had the file I wanted: a list of every baby born on the islands since records had been computerized.

Stephen Renney believed the woman in my field had been dead for around two years, meaning her baby had to have been born sometime during 2005. If he was right about the strawberry seeds, the birth would most likely have taken place in summer. I high- lighted the section between March and August and pressed print, then collected five printed sheets of A4 and spread them out on my desk.

If she was a local woman and if her labour had been medically managed, then my friend from the field was one of the names in front of me. It would just be a matter of going through the list, checking if each woman were still alive and well.

A normal year on Shetland sees between 200 and 250 births and 2005 had been pretty typical with 227. Of these, 140 had been delivered between March and August. I turned back to my screen and opened up a few individual files, looking for a Caucasian woman between twenty-five and thirty-five years of age. Just about every file I opened fitted the bill. There were a few teenage mothers, one or two older ones who could probably be discounted, two Indian women and one Chinese. Most of the women I was looking at would remain potentials until the patient graft of someone like DS Tulloch proved otherwise.