Fiona McArthur - The Pregnant Midwife

Kirsten listened to Jim as he outlined the hospital doctor’s problem, what his needs were and other possibilities, but she could tell they all agreed retrieval was the best option. Jim conferenced the call with Hunter, a paediatric cardiologist and a surgeon in Western Sydney, and Hunter took notes on the recommended treatment for stabilisation by the MIRA team after the decision was made to transfer.

Kirsten’s heart did a little flip-flop of excitement and she couldn’t help savouring the flush of adrenalin for her first retrieval in a year and a half despite the fact she was sharing the trip with Hunter and Ellen. She shrugged. The baby and parents were the important people.

The preparation and flight routine emphasised minimum delay in departure and Kirsten pushed the equipment out onto the roof ahead of the rest as all the sequences returned from memory.

The extra-warm greeting Kirsten received from the tall pilot, Keith, a man not noted for warm greetings, was observed stonily by the two senior staff members as they followed Kirsten into the helicopter. Kirsten rolled her eyes. Hunter probably thought she was having an affair with Keith now. She winked at Keith and watched Hunter’s eyebrows shoot up.

An experienced fixed-wing instructor, as well as helicopter pilot, Keith had flown many times in the past with Kirsten. She’d shared several hilarious picnics with Keith and his wife at the Camden Aero Club before she’d gained her own unrestricted pilot’s licence, and she considered them both good friends. Darned if she’d start feeling uncomfortable around Keith because of Hunter Morgan’s hang-ups.

‘Looks like it’ll be a bumpy ride.’ Keith seemed to derive a certain malicious satisfaction from the forecast and Kirsten grinned back. He hadn’t been able to make her airsick yet.

Stormclouds accumulated off the starboard wing and Kirsten was glad they were in the sturdy Bell 412 helicopter. At least there was plenty of room for the extra staff member and Kirsten didn’t have to stare at Hunter all the way.

Prior to take-off, baby Isaac’s weight and birth date had been fed into the computer and the MIRA program-generated drug sheets produced the correct dosage for every conceivable drug they might need on the retrieval. This double-sided printed sheet was a valuable tool in saving time in drug calculations and dramatically cut the chance of medication error. The team prepared the most likely drugs en route to save more time at the destination hospital.

Ellen ran through the probable scenario of arrival for Kirsten, as if she’d never been on a retrieval or even an aircraft before, and Kirsten listened and nodded. At least Ellen was a distraction from Hunter who was on the other side of the cabin, watching with his arms folded. She wished he’d recheck the portable crib or something because she found his scrutiny hard to ignore.

At last they arrived and Kirsten heaved a sigh of relief. Next time she’d make sure she had the window seat as a distraction.

AT THE destination hospital, if there was time, the first step was always to meet the parents, then quickly move to assess the patient.

Baby Isaac would become more tired as his in-coordinated heart struggled to achieve what had been so easy inside his mother, and Kirsten knew they’d have to watch out for heart failure.

Isaac’s parents looked very young as they hovered anxiously on the periphery of the medical drama, and Kirsten went over and shook their hands.

‘Hi, I’m Kirsten Wilson and I’m one of the neonatal nurses from Sydney. This must be pretty frightening for you both.’ The young couple nodded and Kirsten smiled. ‘We’re going to keep you updated as we make Isaac as comfortable as we can for the flight. After that we’ll get Isaac and you, Mum, transferred to the major hospital. When you get there, the paediatric cardiologist will talk you through his treatment plan.’

Lily, Isaac’s mum, clutched her boyfriend’s hand tighter. ‘There seems to be so many people here and Isaac looks so small.’

‘I know,’ Kirsten said. ‘But he’s getting the best care so he can have the safest trip we can manage for him. About one baby in a hundred has a heart problem so we’ve done this before.’

Both parents sagged a little with relief at Kirsten’s confidence. ‘We’ll all be with you until we hand Isaac over to the staff at the city hospital so don’t forget to ask questions as you need to.’

Lily nodded and Kirsten rejoined her colleagues. She allowed herself a brief stroke of Isaac’s head as she began to record his respiratory rate, heart rate and oxygen saturation as she looked for signs of cardiac failure. Ellen connected the baby to the MIRA monitors as well as the referring hospital’s equipment to ensure constant monitoring during change-over, and she offered Kirsten the stethoscope to listen to Isaac’s chest. The heart murmur was very clear.

‘What’s your instinct on this baby?’ Hunter spoke quietly in her ear and Kirsten knew he was testing her.

‘He’s breathing faster than he should be so respiration is affected, and he’s sweaty and that’s not a good sign. I’d say he has substantial fluid backing up in his lungs and when I listened to his chest he sounded “wet”.’ She glanced at Hunter. ‘The heart murmur is loud and I’d say it’s a large VSD.’

Ellen, dressed in a lead apron, held Isaac while X-rays were taken, because it was important to see the quality of Isaac’s lungs and any cardiac enlargement. As soon as they were finished, Kirsten did a quick twelve-lead ECG to give Hunter some idea of the electrical conductivity of the sick baby’s heart.

Hunter took the chance while the nurses were busy to explain things to the parents and reassure the base hospital staff on the excellent job they’d done in preparation for the retrieval team. She had to admit that when he wanted to use his charm he was a master at putting people at ease, which helped in situations like this.

She watched him put his arm around Isaac’s mother and clap his father on the back as he congratulated them on their beautiful son. His obvious empathy with frightened parents had a lot to do with the attraction she’d felt for him when they’d first met.

They couldn’t be friends but they should be professional about their differences at least. She could still admire his skill and empathy as a neonatal intensivist.

Hunter returned to the baby and the equipment Kirsten had assembled. He inserted an intravenous cannula in Isaac’s hand and when the newborn grasped Hunter’s finger, they shared a smile across the humidicrib at the wonder of tiny babies.

This was ludicrous, Kirsten thought, and vowed to establish some ‘safe’ camaraderie because moments like this were too special to waste on something that was never meant to be.

The finality of that thought stayed with Kirsten as she turned away to document the time of insertion and the start of the minuscule measured amounts of intravenous fluids.

‘Let’s give him a diuretic to see if we can offload some of this fluid he’s accumulating,’ Hunter said, and Kirsten handed him the preloaded syringe with the ampoule taped to it.

They checked the dosage together and just as Kirsten started to relax, Hunter had another question for her.

‘What else are we looking for?’

Kirsten glanced down at Isaac and the answer came readily. ‘Probably signs of any other abnormalities or indications for other syndromes that this condition can run with.’ The obvious ones were often identifiable by abnormal facial characteristics. She glanced across at Isaac’s dad, and any facial features that might have hinted at a genetic disease were vetoed by the mirror image of father and son. She smiled, and Hunter, following her thoughts, did too. Then they both looked away quickly and Kirsten busied herself by recording what they’d done.