The Noble Doctor

by Gill Sanderson

  It was a large room, expensively furnished but now a complete mess. There were clothes, sheets of music, newspapers everywhere. On most surfaces there were cups and saucers, glasses. In the centre of the room was a big leather couch with pillows and sheets in disorder on it. And in the centre of them, as if in a cocoon, there was a tiny creature with long blonde hair and great blue eyes.

  'Are you going to get mad at me, too?' asked Simone. 'Marc is always getting mad at me.'

  'I'm a midwife,' Lucy said again. 'I'm not allowed to get mad at patients. I think I'd better examine you.'

  'I didn't ask for you. I wanted Marc!'

  'Well, you got me. And by the look of this rubbish on the table, you need me.' She pointed to a coffee table where there was a half-empty wine bottle and a smeared glass, a plate which apparently had once held nuts and a couple of opened bottles of pills.

  Marc said, 'Lucy, I thought that perhaps—'

  'Why don't you go in the kitchen and make us all a cup of tea?' said Lucy. It was an order, not a request. 'Stay there and I'll call you when I want you.'

  Simone glared at her. 'You're a bully, do you know that!'

  'I told you, I'm a midwife, trying to do her best for you and your baby. Now, what pills did you take? And when and how many? And how much wine did you drink? Come on, we have to know these things.'

  Lucy had come across mums-to-be like Simone before. There came a stage when gentle coaxing and sympathy just didn't work. Then you let the patient know who was in charge.

  Simone was shocked, obviously not used to being spoken to like this. 'I didn't drink a lot of wine. Half a bottle or something, I just couldn't sleep. Lucy, you don't know what my life is like! I'm miserable all the time and I've got this great belly so I can't get into my clothes and I can't go out and I can't sleep and..'

  'It's a hard life,' said Lucy.

  She picked up the two medicine bottles and looked at the pills. They were mild analgesics and iron tablets.

  Not a lot appeared to have been taken, there were plenty left. 'I asked you how many of these you took.'

  Simone looked sullen. 'I don't know. I took a couple and I wasn't very happy so perhaps I took some more.'

  'You're sure you didn't take anything else?'

  'Yes, I'm sure. Think I'm a fool? I should know what I'm taking.'

  'So you should. Well, even a full bottle wouldn't hurt you too much. So this time we won't get you to a hospital to have your stomach pumped out.'

  That was a vain threat but Lucy hoped that Simone wouldn't know it. Simone looked appalled.

  'I didn't take anything else!'

  'All right, then. Well, let's have a look at you. Where are your records kept? 'The idea these days was that pregnant women should keep their own notes. It was meant to make them feel that they were in charge of their own future and that of their baby. Lucy didn't think that was a good idea in Simone's case.

  Ideally, Lucy should have spent some time talking to Simone, getting to know her, establishing a relationship. But this was the middle of the night and could be an emergency.

  The simplest tests first—pulse, blood pressure. Both within acceptable parameters. Then a quick check for oedema—some swelling in the ankles, none in fingers or face. Good.

  'I need a midflow urine sample, Simone. Go into the bathroom and get me one.'

  With a great sigh Simone flounced out, returned and silently handed Lucy the required sample. Lucy checked for protein, glucose and ketones. All readings acceptable.

  'Now, roll over on your back, pull your nightie up and try to lie flat.'

  Simone did so. Gently, carefully Lucy ran her fingers over the distended abdomen. She was trying to determine the lie, presentation and position of the foetus, and the engagement of the head. Then she used her Pinard stethoscope to listen to the baby's heartbeat.

  She noticed that now she had an audience that was not willing to give way to her, Simone was a lot less distressed than she had indicated to Marc.

  Marc should have known that Simone was acting. He wasn't always the ruthless master of his emotions. He was capable of being fooled—and even of knowing it. He was human after all.

  Lucy wrote down all her findings and then checked them against the entries made by the previous midwives.

  'Things seem fine so far. Now, just lie on your back and pull your legs up.'

  Everything seemed fine. But then Lucy wondered. She palpated Simone's abdomen again and then said, 'OK. Pull your nightie down and cover yourself up. I'm going to have a word with your cousin.'

  She went into the kitchen and shut the door.

  'Well?' Marc asked.

  'False alarm. No need to worry about the pills. They were just iron tablets and a couple of mild analgesics, and she's hardly taken any. She was just bored and since she couldn't sleep decided to wind you up. But there is something. You know she's been playing up with the midwives?'

  'I guess so. Why?'

  Lucy didn't like letting down her own profession. But... 'I think they might have missed something. I think it's possible that she's suffering from unstable lay and she should go to hospital. If I'm right, she's in danger of cord prolapse. She needs ultrasonography and to be seen by an obs consultant.'

  'But are you certain?'

  'Not at all. I'm just being careful. But if I was on the district and found a case like this, I'd get her to the obs consultant urgently. I'm a new midwife and you're a training doctor; we just don't know enough. I do know the chances are dozens to one that it will be a false alarm. But if she stays here there's the remote chance that she might lose the baby.'

  He thought for a moment and then said, 'I will take your advice. Simone must go to hospital—though the last thing I want is to have her in my department. I'll phone and get her admitted to the Castle Hospital— it's the nearest anyway. I'll talk to whoever senior is on duty.' He looked gloomy, 'I suppose I'd better tell her.'

  'I'll tell her if you like, it might come better from me. You just arrange the ambulance.'

  Lucy went back into the living room and said, 'Simone, it's probably nothing but Marc and I think that it's better that you go to hospital to be checked up.'

  'But I feel fine now' she complained.

  'Marc's phoning for an ambulance,' Lucy reiterated. 'Come with me to your bedroom, I'll help you dress and then you can pack a small case so we'll be ready when it arrives.'

  'But I'm not ready! I want to sleep and—'

  'Dress and case! Otherwise you'll have to get into the ambulance like that! I'll tell Marc what we're doing.'

  Now the decision had been taken, Simone was surprisingly co-operative. She dressed quickly, picked the things she would need. Then Marc came into the room.

  'I suppose you've agreed to all this,' Simone grumbled to him. 'It's the last time I phone you for help.'

  Lucy had to turn away and smile when she saw the look of incredulity on his face. But all he said was, 'I'm sure it's all for the best.'

  'You're both going to stay with me, aren't you?' Simone demanded. 'I can't do this on my own.'

  'Only you can have the baby,' Lucy pointed out.

  Marc said, 'We can't presume on Lucy any longer, Simone. I will stay with you until you are settled. But it is the middle of the night. Lucy must go home. Lucy, you must take my car.'

  Lucy shook her head. 'You'll need it and I can always—'

  'Please! It will make me feel considerably better. I have presumed on your goodwill far too much already.' He offered her the car keys.

  He had presumed on her goodwill? That was one way of putting it, she thought. What else had he done to her?

  'All right,' she said, taking the keys. 'If you trust me with it.'

  He winced.

  She left his car outside his flat and pushed the keys through the letterbox.

  There was light just showing in the sky when she got back to her own room. But she slept at once.

  It was almost a joke the next evening. She was in her ro
om, washing her hair, when there was a knock on the door. Lucy thought it must be one of her friends from down the corridor. With her dressing gown half open and a towel around her head, she opened the door. It was Marc. And what made it worse was that two of her friends were walking down the corridor behind him. Both grinned broadly. One raised her eyebrows and winked at Lucy. And so Lucy was in an instant bad temper.

  'I wasn't expecting you!' she said.

  'I am sorry. This is obviously a bad time. May I call back later? I felt I had to speak to you.'

  'Come in if you must,' she said rather flustered. 'But you can't stay long. I'm going out to see my parents.'

  'Of course.' He stepped into her room and she saw that he held a bunch of flowers. He seemed uncomfortable.

  'These are for you,' he said, handing them to her. 'And they come with my deepest thanks. I now realise what an imposition it was, calling on you in the middle of the night. But Simone has that effect on me.'

  'These are very nice. I'll put them in water at once.'

  'Another thing. One should never try to practise medicine on a family member. You were right and I was wrong. Simone does have an unstable lie. She must stay in hospital until the child is born. We—the family—owe you. And we don't know how to repay you.'

  'I'm a midwife, there is nothing to repay.'

  'Well, then, you are entitled to know a little about Simone. That is, if you wish to know.'

  She did want to know. 'Tell me,' she said. 'You can sit on the bed while I dry my hair.'

  So he sat. Then he said, 'Simone came to England to study music. It may be that she is talented but she has never worked hard enough to develop her talent. She had a big argument with her parents, refuses to have anything to do with them. She has her own trust fund and is not reliant on them for money.'

  Now he looked angry, Lucy thought.

  He went on, 'Then a typical story. She got pregnant, said nothing to her family for six months. Then she announced that she didn't love her boyfriend anyway, she had no intention of coming home and could manage her own life. Her father wrote to me as I was the nearest family member and, since Simone had always been fond of me, asked if I could I help in any way. Of course, I said yes.'

  'And you've had nothing but trouble since?'

  'Nothing but trouble. But she's family. Wouldn't you do what you could for your family?'

  'Yes,' said Lucy.

  Marc walked out of the hospital accommodation, managing to do nothing but smile politely at the couple of nurses he met in the corridor. But he was aware of their knowing glances and wondered what Lucy might have told them. Then he relaxed—just a little. He knew Lucy would have told them nothing.

  He needed to be alone. He climbed into his car, drove through the city outskirts and eventually found himself on parkland overlooking the river. He got out of the car, walked down some steps and sat watching the turbulent water racing past. There was a giant oil tanker in the channel, slowly making its way upstream. A couple of yachts tacked nearer shore. And on the far bank he could see the silver pipes and chimneys of the oil refinery.

  He often came here to think. This was where Lucy had first brought him. He gazed down at the black water, stared at the sparking lights across the river. Nothing helped.

  He had thought he was in love with her. It had started, as so many affairs did, just as a quick mutual attraction. But that attraction had developed so quickly, it had seemed to have a life of its own. Neither of them had fully realised it. Then he had stopped it—brutally.

  No way could he take Lucy home to Montreval. He loved the place, wanted to work there. But no way would Lucy be happy there and no way could he bear to see her miserable. Perhaps in time he would meet some French girl who would love to be the Comtesse de Montreval. But he doubted she would make him as happy as Lucy could. He shrugged. He knew what he had to do.

  Of course, Lucy had to meet Marc sometimes. They worked in the same department. She was still in the delivery suite and, as SHO, he was moved from section to section as he was needed. But he still spent a fair amount of time working near her. Mostly it was paperwork, checks of various kinds, and he was on hand if she needed a doctor. So she did come in contact with him. But when they passed in the corridor it would only be a cursory smile or a 'good morning'. And if she saw him drinking coffee or talking in a group, she would keep out of the room.

  'What's between you and Marc Duvallier?' Maria demanded.

  'There's nothing between us.'

  'That's what I mean. All this trouble to be polite, it makes it obvious that there has been something between you—or there's going to be. You're not like it with the other doctors—you're much ruder, and they like it. What has Marc done that you have to be so polite to him?'

  'Nothing,' said Lucy. It seemed hard that her evasion wasn't fooling anybody.

  When they had to work together she saw that he was a really good doctor. Perhaps because he was slightly older, he had a better understanding of the patients than the other SHOs. They were all good at medicine—Dr Bennet wouldn't have had them otherwise—but Marc was good with people too.

  And then came a case they both had an interest in. Astrid Duplessis came in to have her baby. Marc had been the one to keep in touch. He had told Lucy that Kevin was delighted and frightened at the prospect of being a father, that Astrid was happy living with Kevin's parents and that they had been in touch with Astrid's family. Some kind of reconciliation was possible.

  'I told you that love would conquer all,' he said to her with a sad smile.

  'And I didn't believe you. Well, I'm glad to be proved wrong.'

  Astrid was pleased to see her and so was Kevin. 'I'm going to be present at the birth,' he told her. 'Though I'm a bit nervous.'

  'There's usually nothing to worry about,' Lucy said. 'Now, stand up there and hold Astrid's hand.'

  It should be a straightforward delivery. The cervix was now effaced and dilating, no problems so far.

  Lucy checked the outgoing midwife's comments on the partogram; everything seemed to be fine. Well, she would be kept busy; there would be no time to brood over other things.

  'Dr Duvallier will be in shortly,' she told the couple. 'He's got a special interest in this baby. And so have I.'

  'We wouldn't have been together if it wasn't for you two,' Kevin told her. 'If it's a boy, we're going to call it Marc.'

  'That'll be lovely. Now, I'd just like to listen to the baby's heartbeat.' Lucy took her Pinard foetal stethoscope and applied it to Astrid's abdomen and listened for a minute. 'Good and strong,' she said, and filled in the result on the partogram.

  A couple of hours later there was a knock on the door. It was Marc. They smiled at each other in their usual way, polite but blank. 'Just checking my friends,' he said. 'I take it there are no problems?'

  'None at all. We won't need a doctor but stay and chat with them for a while.'

  She had never been more wrong about needing a doctor.

  Things started to go wrong about an hour later. The delivery suite was rather busy so there wasn't another midwife to assist at the birth. No problem. Marc could do it, standing by to take the baby and help if necessary. But she was in charge.

  Astrid pushed. There was the head—rather a large one, Lucy noted. But she said encouragingly, 'Nearly there, Astrid! We have the head!'

  Then she frowned and glanced up at Marc. He had noticed it too. The baby's chin was tight against the perineum—in fact, when Astrid stopped pushing, the head seemed to retract a little. Marc raised his eyebrows questioningly, nodded towards the telephone. Was this an emergency? She was in charge; it was her decision to make.

  This was not the time to worry the mother. Trying to keep her voice level, Lucy said, 'See if there's anyone handy to drop in. Possibly a shoulder dystocia.'

  Marc moved swiftly to the phone, but kept his voice down. Astrid had enough to worry about. It was noticeable how quickly her English had improved; she had no difficulty in understanding.
/>   Encouragingly, Lucy said, 'We need to get you into another position. Slide down the bed, Astrid, and pull your knees up and out.' The lithotomy position. It gave the midwife the best access for an examination.

  Quickly, Lucy administered a local anaesthetic then cut a generous episiostomy, taking great care not to injure the baby's neck. Then she did a vaginal examination. No doubt now; this was a shoulder dystocia. The head could be—had been—born. But the shoulders were too broad to come through.

  She knew that shoulder dystocia was rare—perhaps one in every five hundred births. She had only ever seen one and that had been when she had been a second-year student and had been able to do nothing but watch. Now she was in charge.

  Marc returned, murmured that the senior registrar had been bleeped and was on his way. But they couldn't just wait.

  'I'm going to ease the head down towards the floor,' Lucy told him. 'I'd like you to apply pressure to the anterior shoulder and the fundus.'

  They worked together. A different angle and perhaps the shoulder would slip through. It didn't.

  'Try to rotate the baby?' Marc suggested quietly. 'Bring the posterior shoulder into an anterior position?'

  That was the next thing to try. And that didn't work either.

  Where was the registrar? Lucy wondered. She needed help! But she kept her face smiling and her voice calm.

  'Just a small problem, Astrid,' she said. 'Baby doesn't want to come into the world yet and we're having to persuade him.'

  Now Astrid was realising that something was wrong and she started to panic. There was a great outburst of French. Lucy didn't understand a word but the feelings expressed were obvious.

  Of course, Marc understood. He moved to the top of the bed, stood by Kevin and took one of her hands in his. And he spoke, liquid musical French. Even Lucy felt comforted by the sound.

  It was the voice that did it, Lucy knew. Even at that tense moment she knew that the voice had calmed Astrid, had made her believe that all could be well. A great asset for a doctor.

  Time was passing. Only one thing left to do.

  Lucy eased her hand in behind the baby and felt for the posterior arm. She was able to push the elbow backwards then feel for the forearm. She needed to draw it across the baby's chest. At that moment Mike Donovan came into the room, quickly followed by the delivery suite supervisor.