Alison Roberts - The Doctor's Secret Family

Hannah’s pager sounded as they walked back to Jamie’s room. ‘I’ll leave you to get those bloods away and chase up the results, Will. Keep a close eye on things. If Jamie’s condition deteriorates any further, we’ll need to transfer him to Intensive Care.’

There was a phone on the wall just outside the room Jamie would share with his mother for the next day or two. William emerged just as Hannah finished taking the call her pager message had requested.

‘You don’t look very happy,’ he commented. ‘What’s up?’

‘I have to get up to Theatre. A woman who’s thirty-five weeks pregnant has just come in with a placental separation following an MVA. They’re rushing her up for an emergency Caesar and it seems I’m the most senior paediatrician available at the moment.’ Hannah was already moving swiftly towards the lifts at the end of the wide corridor. Maybe the cause of that premonition had been some instinct that she might be faced with a particularly challenging case. Thanks to Hannah’s determination to excel in everything she did in the run-up to the decision on appointing the department’s new consultant she had a new pressure and a whole new set of nerves to contend with.

‘You’ll be fine.’ William’s confident words floated through the closing lift doors. ‘Peter will be proud of you, you’ll see.’

* * *

Consultant Peter Smiley was living up to his name when he sat down at the table in the cafeteria Hannah was occupying nearly two hours later. It was far too late to be considered part of any normal lunch-break and the huge room was largely deserted.

‘I’ve been hearing great things about you, Dr Campbell.’

Hannah grinned. If that emergency case had been responsible for the nameless fear stalking her earlier then she had managed to prove her instinct very wrong. Her grin faded as she shook her head.

‘I have to admit I was pretty nervous when I got to Theatre. I had no idea how long the baby might have been hypoxic for. I had the feeling that even if the resuscitation was successful the parents might not thank me for it.’ Hannah bit her lip. ‘What are the precise criteria for deciding not to take an aggressive approach? Have you ever done a resus and left parents to cope with bringing up a badly handicapped child, Pete?’

‘It happens.’ Peter nodded. ‘But there are no hard and fast rules. Even when you get a baby born at the limits of viability, like twenty-two to twenty-four weeks’ gestation, it’s tricky. You have to look at the weight and degree of bruising, along with the baby’s condition at birth, the presence or absence of a heartbeat and any efforts to breathe.’

Hannah nodded. ‘This one had an Apgar score of zero initially. White, flaccid, undetectable heartbeat and no spontaneous breathing.’

‘What gestation?’

‘Thirty-five weeks.’

‘How badly injured was the mother?’

‘She had a fractured tib-fib and seat-belt bruising. It was probably the position of the seat belt that caused the placental separation. She’d begun bleeding heavily by the time she reached the emergency department. They did a quick ultrasound and got her straight up to Theatre. The baby was delivered within thirty minutes of her arrival, which was pretty amazing.’

‘I’ll say. They must have had a theatre ready to go.’

‘They were setting up an elective Caesar. The patient had had her epidural and was on the way. I bet she wasn’t too happy about being sent back to the ward for another couple of hours.’

‘No.’ Peter sat back in his chair, his gaze curious. ‘So, what did you do with this flaccid baby?’

‘Put her under the lights and used gentle suction to clear the upper airway. Inflating her lungs with the bag mask initiated a gasp but no spontaneous breathing so I intubated.’

Peter raised his eyebrows. Intubation of a newborn required considerable skill. Clumsy insertion of the tube could damage the upper airways, and over-vigorous inflation could damage the lungs. ‘Any problems?’

‘No. I ventilated at a rate of thirty per minute with a nice gentle pressure but she still didn’t pink up. Heart rate was less than sixty per minute so then I started cardiac massage.’ Hannah’s smile was a little grim. She had thought she was fighting a losing battle at that point. She had encircled the baby’s chest with both hands, positioning her thumbs to exert pressure on the lower half of the tiny sternum and directing the nurse assisting her to deliver one inflation of the lungs to every three to five compressions.

‘Did you need any adrenaline?’

‘I had it drawn up as I cannulated the umbilical vein but then things started to improve.’ Hannah’s smile was much brighter now. ‘The Apgar score at five minutes was 7. She had facial grimaces, gasping respiration, heart rate greater than a hundred, some flexion and she was finally pink!’

Peter smiled at Hannah’s obvious pleasure. ‘Pretty satisfying, then?’

‘You bet. Apgar was 9 at ten minutes. I still wasn’t happy enough with her muscle tone to give her a ten but I’m pretty confident she’ll be OK. It’s hard to know, though, isn’t it?’ Hannah’s brow furrowed. ‘She could have been without oxygen for long enough to have permanent repercussions.’

‘Some people put all sorts of things down to a mild hypoxic insult—anything from hyperactivity to learning problems. But there’s not much in the way of good evidence. Babies can recover remarkably well from what seems like a dire start to life. We’ll keep an eye on this one for the next few days for any sign of neurological compromise but I doubt we’ll find anything. You sound like you managed a difficult case extremely well, Hannah. Well done.’ The consultant’s face creased into a familiar expression of approval. ‘I’m proud of you.’

‘Thanks.’ Hannah returned the fond smile. ‘If I’m good at what I do a lot of credit needs to go to you, you know.’

‘It’s always been a pleasure to work with you, Hannah. A pleasure that I hope will continue for a long time.’

‘So do I.’ Hannah toyed with her almost empty cup of coffee. ‘I’m going to be biting my nails waiting for this consultancy to be decided.’

‘You really want this job, don’t you?’

‘It’s exactly what I want, Pete.’

‘But it’s only a seven-tenths position and you don’t want to do any private practice, do you?’

‘Will that make a difference?’ Hannah asked anxiously. ‘Do you really need someone else in your practice?’

‘I will eventually. I’m not getting any younger, in case you hadn’t noticed.’

Peter was nearly sixty years old but Hannah grinned. ‘I hadn’t. You’ll need to develop some more crinkles, as Livvy calls them.’

‘I’ve got plenty of ‘‘crinkles’’.’ Peter’s face brightened. ‘How is Livvy?’

‘She’s great. She can write her own name now. She drew the most amazing picture yesterday and signed it for me. I think I’ll get it framed.’

‘What’s it a picture of?’

‘Joseph.’

‘That’s your…donkey, yes?’’

Hannah laughed. ‘That’s the one.’

‘It’s a bit difficult remembering all the names of your pets. Every one of those hens has a name, doesn’t it?’

‘Yes. And the goat and cats. We’d love to get a puppy some time as well.’

‘How on earth do you look after them all?’

‘It’s not difficult. And if I get this consultancy I’ll have a bit more time at home so maybe we could think about getting a dog.’

‘Is that why you’re so keen?’

‘Of course not. Having more time with Livvy is the main appeal. On a consultant’s salary I would be paid as much for seven-tenths as I am for this registrar position, which feels like twelve-tenths a lot of the time. Plus I’d be able to stay in Christchurch on a permanent basis. Neither Livvy nor I want to leave our property. I’ve spent years turning that old house into something worth living in and I’d hate to move. We’d never find land so close to town that we could afford now either. The prices for lifestyle blocks have gone through the roof in the last few years.’