Alison Roberts - Midwives On-Call

ISLA HAD TRIED to speak with Ruby at the end of the TMTB meeting but she hadn’t been able to get very far. Ruby had merely shrugged in answer to Isla’s questions and given her a look that only teenagers could, a look that said, what would you know?

After the group there had been loads of sandwiches left over and a couple of the girls, Ruby included, had taken up Isla’s suggestion to help themselves as it would only be thrown out, but when Isla had tried to speak with her Ruby had said that she had to go.

Isla didn’t mind being snubbed. She was just very glad that Ruby had turned up and hoped that the promise of pizza might lure her back, if nothing else, and she dropped in on handover the following morning to tell her team the same.

‘If I’m not there and one of you is taking the TMTB group, either ring down to Catering or get some pizza delivered,’ Isla said.

‘Can we bring in a cake?’ Emily asked, and Isla smiled. Trust Emily to want to do more.

‘No, Emily, you’ve already got more than enough on your plate without feeding hungry teenagers.’ Isla shook her head. ‘There’s room in the TMTB budget to ring for pizza or to order from Catering. I do want to have a think about it, though. I can’t stand the idea that these girls might be hungry …’

A bell buzzed and Isla gave her staff a smile. ‘I’ll get it. You carry on with handover.’ But as she walked out of the staffroom the bell buzzed again and Isla quickly crossed the ward, her heart galloping when she saw that it was coming from Donna and that it must be urgent because she wasn’t taking her finger off the bell.

Flick, one of the midwifery students, was, in fact, the one who was pressing the bell.

‘Well done,’ Isla said, because as soon as Isla appeared Flick moved to open a delivery pack.

‘They’re coming …’ Donna sobbed.

‘It’s okay,’ Isla said, pulling on gloves and giving instructions to Emily, who on hearing the urgency of the buzzer had followed Isla in. ‘Fast-page Darcie and the neonatal crash team.’

‘I wanted Tom to be here …’ Donna sobbed.

‘His flight gets in this morning, doesn’t it?’ Isla asked, and Donna went to answer but nature got in first.

‘Something’s coming …’ Donna said, and Isla recognised the fear in Donna’s voice, not just professionally but personally, too, and, just as she had that night with Isabel, she stayed calm.

At least now she knew what to do professionally.

‘It’s okay,’ Isla said. ‘We’re ready for them.’

They were ready, almost. Staff were busy plugging in two Resuscitaires in the side room that Donna had been allocated. Isla could hear footsteps running along the corridor and was grateful for the sound for indeed a baby was coming.

‘Don’t push, Donna,’ Isla said as she felt the baby’s little head. ‘I know that you want to, but let’s just try and slow this down a little.’

Isla wanted to slow things down, not just to minimise any trauma to the tiny baby’s brain but also to ensure there were plenty of staff and equipment ready when this baby made its rapid entrance into the world. Isla met Donna’s gaze. ‘Just breathe,’ Isla said, and a petrified Donna nodded, using all her power to give her baby a few more vital seconds inside her.

Alessi came in then. He was a bit out of breath from running and his hair was soaking and his scrubs were damp—clearly he had been in the shower when his pager had gone off. He stood, watching, but even with Donna doing her best not to push, the next contraction saw the baby delivered into Isla’s hands.

He was tiny but vigorous and very red. He let out a small cry as Alessi quickly cut the cord, took the tiny bundle from Isla and carried him over to the resuscitation table.

‘Twin A,’ Isla said to Darcie, who was running in. ‘Born at seven forty-eight.’

‘So we’re waiting on twin B,’ Darcie said to Donna, who lay back on her pillow and started to cry. Isla glanced over to the Resuscitaire where Alessi was concentrating hard, and so, too, were the rest of the team.

‘What’s happening?’ Donna asked. There was a huge crowd around the cot but it was all very calm and controlled.

‘Looking beautiful!’ came Alessi’s strong voice. ‘He is moving and fighting me, Donna, but I have put down a tube to give him some medicine to his lungs, that’s why you can’t hear him crying. Do you have a name?’

‘Elijah.’

There was a flurry of activity and Isla looked over as the staff started to prepare to move the baby over to NICU. Then Alessi came over and spoke with Donna. ‘He’s doing as well as can be expected,’ Alessi said. ‘We are going to get Elijah over to NICU now, where they are ready for him.’

‘Can I see him?’

‘Briefly,’ Alessi said. ‘Later you will have more time with Elijah but we want him over there now.’

The incubator was wheeled over but Donna’s brief time with her son was soon thwarted as she first folded over and then lay back on the bed. The second twin was coming and Alessi nodded to his team to take the baby up to NICU as Darcie took over the second delivery.

‘Cord’s around the neck,’ Darcie said. ‘Very friable …’ The umbilical cord was so thin and weak that it tore as Darcie tried to loop it over the baby’s head but already the tiny baby was slipping out.

When Isla saw him delivered she was holding her breath, even as she clamped the severed cord. She never made comparisons—in fact Isla did everything she could not to think of that awful night with Isabel whenever a baby was born.

She couldn’t help but compare this morning, though.

He was so tiny and his arms and legs were spindly and his little eyes were fused closed. The difference was that this little one started to put up a fight. Even as Darcie lifted him and handed him straight to a neonatal nurse his arms were flailing and he let out a tiny mewing cry as the nurse took him over to Alessi.

‘Let me hold him,’ Donna called out. ‘Alessi, I want to hold him.’

Alessi didn’t say anything at that point, at least not to Donna. Instead, he spoke to the little boy.

‘Hello, beautiful baby,’ he said, and Isla felt tears prick at the backs of her eyes as Alessi did his best to shut out Donna’s pleas to hold her baby and instead did everything he could to give this little life a chance. ‘Do you have a name for your son?’ Alessi asked.

‘Archie,’ Donna said, and then lay back on the pillow, exhausted and defeated, aching to hold her son but knowing he needed the skill of the medical team now.

Isla did her best to comfort Donna as the team worked on. There was no way to see what was happening. Alessi, the anaesthetist and two neonatal nurses were around the resuscitation cot. They could hear the baby’s fast heart rate on the monitor and Alessi issuing instructions. The mood was markedly more urgent than it had been for Elijah, and Donna started to cry.

‘I just want to hold him,’ Donna said to Isla.

‘I know you do,’ Isla said. ‘But right now he needs to be with the medical team—they’re doing everything they can for him.’

It was an interminable wait, made all the more difficult because Donna’s husband called to say that he had landed. When Donna couldn’t speak Isla took over the call and Alessi glanced up at the calmness in her voice as she introduced herself to the distraught husband.

‘Tom, Donna is exhausted and upset but we’re taking care of her. Elijah was born first and has been taken up to the neonatal intensive care unit, and Archie …’ she glanced over and met Alessi’s sombre gaze ‘… is being worked on by the team now. We hope to get him up to the intensive care unit soon.’ She took a breath. ‘Have you cleared customs? Good, go over to the information desk and explain what’s happening and hopefully they can see you to the front of the taxi queue.’ There was another pause. ‘They’re very premature, Tom. Right now the team are doing their best for your sons.’