by Emily Forbes
'What sort of continuing education policy Ross Nightingale has.'
'I'll be running through that with Bill. He's already told us he wants to make sure his employees are looked after, if you choose to stay on. You're welcome to sit in on any of these briefings. In fact, I imagine Bill expects you to.'
'How much input will the staff have in the running of the practice?' Donna was behaving like a schoolchild, thought Lexi a trifle uncharitably, eager to come up with another question to direct a teacher's positive attention onto her. No, that was too harsh, but for someone who'd only minutes ago professed negligible interest in the practice, she'd certainly come to life now. Harmless flirting, Lexi knew. Donna was blissfully happy with her husband and this was simply testament to Tom's effect on women, plural. She should draw solace from that fact: it wasn't just her at risk of making a fool of herself over him.
Tom turned to Pete. 'That really depends on the director of medical services and the practice manager at each clinic.'
'Is your wife is in Pelican Beach with you?'
Lexi almost choked on her drink, and from the look on Tom's face, he was just as startled with Donna's abrupt shift in the topic of conversation.
'Ignore her, Tom,' broke in Pete, 'Donna's just being nosy.'
'No, Pete. I need to know so I can invite them around for a meal. It's called country hospitality.'
'And what about you, Lexi?' Tom had turned to her the moment Pete and Donna had started talking. 'What concerns have you got?'
Had the others noticed how he'd avoided answering Donna's question?
'Nothing I need to discuss at the moment.'
'You need to get some more ammunition, do you?' His ready grin softened his words. 'Not quite ready to come out with all your guns blazing?'
'You seem to know Lexi well, Tom. How did you meet?'
Lexi glared at Donna. She really was on fire tonight with her barrage of personal questions.
'She hasn't told you?' Donna shook her head. 'Then I think that story had better keep for another day.' He glanced around the table at their almost empty glasses. 'If I'm crashing your meeting, at least let me buy a round of drinks. What'll you have?'
'You don't need to do that.' Lexi was torn again, part of her wanting him to stay, part of her uncomfortable with his presence.
'I insist. I'll just charge it to my room.'
Curiosity got the better of her. 'You're staying here?'
Tom nodded. Lexi knew the pub had accommodation but it was fairly basic. Perfectly ok for a night or two but not somewhere she'd choose to stay for a few weeks. But, then, men didn't seem to care as much—if there was a bed and a place to grab a meal, that was all that mattered. And Tom was as easygoing as they came. He used to be, at least, and so far he seemed to have stayed true to form.
Donna obviously thought the same as Lexi. 'So your wife isn't with you, then?'
'Why do you say that?'
'Most wives wouldn't stay in a pub for a few weeks. They'd take the bed and breakfast option in this town.'
'You're right, Elena's in Sydney. She couldn't get away from work.'
'Is she a doctor, too?'
Tom shook his head. 'She's a personal assistant to a lawyer.'
'If she finds she can get away to join you, Lexi's mum runs a B&B—you could book in there for a weekend.'
Lexi couldn't believe it. One minute Donna was trying to push her and Tom together, the next she was suggesting he should stay on her property—with his wife!
'I'll keep that in mind, Donna. Now, about those drinks.' He looked at each of them in turn, waiting for their orders. Did he hold her attention for a fraction longer than the others or was that her over-active imagination? Lexi wasn't sure.
'I'm on call, Tom. I'm fine.' As if to underline her point, her phone rang as she spoke and she excused herself, speaking briefly to the caller before returning to the table to fill in Donna and Pete, Tom having gone to the bar in her absence.
'That was Sam Markham. Seems like Mary's in first-stage labor. They're on their way in and will meet us at the hospital.'
'Does she want us to call the ambulance?'
'Her contractions sound quite strong but she's adamant she'll be ok in the car. It'll be quicker for them to drive rather than wait for the ambulance.'
Tom had returned and must have caught the tail end of her sentence, as he asked, 'What's up?'
'One of Lexi's patients has gone into early labor. She's having twins so Lexi needs Pete to assist her in case they need an anesthetist.'
'Why don't you let me help, Pete? I've got my diploma in anesthetics and it's not like I have any other pressing engagements tonight.' Lexi saw Pete glance at the glasses on the table. Tom saw it, too. 'I've only had one light beer. You might as well make the most of having me around and finish these off.' He leant over the table and deposited the three glasses he was carrying.
'Ok with you Lexi? It's your call.'
Working side by side with Tom was the last thing she wanted at the moment. She'd managed to stay out of his way since he'd arrived, ducking in and out of her office with record speed and infrequency, avoiding the kitchen, encouraging Peggy to suggest to Tom that he tag along with the others for one reason or another. She'd known she couldn't avoid him forever but she'd thought it only fair to give herself a head start in learning to maintain a calm facade around him.
She needed her wits about her, but turning down Tom's offer wouldn't be fair on Pete. It wasn't often they had the option of another doctor with anesthetic skills and it would mean Pete could get home to Cindy.
She nodded. 'We need to get going and make sure Theatre's set up, just in case.' Lexi grabbed her bag, shoving her mobile phone in and digging out her car keys. 'See you guys.' She headed for the door, several steps ahead of Tom, and called back over her shoulder, 'We'll take my car, it'll save time.'
'Where's the fire?' Tom caught up, coming around to the driver's side and holding the door for her, closing it once she was in her seat.
Lexi waited until he was in the passenger seat before answering. 'I want to make sure I'm ready to go when Mary and Sam arrive.' Out the corner of her eye, she watched while Tom buckled his seat belt, wondering whether it had been a mistake to take her car. It was very small and Tom was very close. Too close.
She turned the key in the ignition and reached for the gear lever. Putting the car into gear, her hand brushed his thigh, soft skin contacting the denim of his jeans stretched across his leg. She jumped and the car lurched forward, bunny-hopping out of the parking space.
'Been driving for long?'
'My foot slipped.'
She glanced his way and could see a smile playing on his lips.
'If you say so.' He reached for the CD player, pushing the "play” button. Normally it would irritate her to have someone else take over the music controls but she hardly even noticed, any complaints silenced by the vision of his brown, muscular forearm stretched out beside her. The music started, making her laugh and breaking the tension that was building in the car.
'You might want to choose something else,' she said as the lyrics of a children's song came through the speakers. 'Have a look in the console.'
Tom lifted the lid between the front seats just as Lexi changed gears, and their forearms touched as they met in the center of the car. The engine revved as Lexi let the clutch out too quickly.
'Do you want me to drive?'
She could hear the smile in his voice, the teasing note all too evident, but she avoided looking at him. That would have been far too risky, given that she was having trouble driving even when she was keeping her eyes firmly on the road ahead, so she ignored his comment.
'If it's so urgent we get to the hospital, why didn't you insist Sam and Mary wait for the ambulance and come in with the paramedics?'
'Who?' She wasn't really joking. 'We don't have a permanent ambulance station here and definitely no paramedics. Our ambulance officers are all volunteers.' She was happy to seize
on a neutral— and therefore safe—topic of conversation. 'In the time it would take to contact them and for them to get organized, Sam and Mary could have been well on their way to the hospital. If Mary didn't feel confident about driving in, we would've sent for the ambulance, but it really is quicker, if it's not a medical emergency, to do it this way.' They were almost there—she could see the neon HOSPITAL sign glowing up ahead.
'So you're it?'
'Almost. The ambos are good but it's only a second job for them, so we do seem to get called for anything out of the ordinary.' She flicked her indicator on and slowed down, ready to turn into the car park. 'I don't mind, the work here is certainly more challenging than being a GP in a city practice.'
'Should I read that as a dig at me?'
She accelerated through a break in the traffic and drove through the entrance. 'No. But I would like to ask, do you think Nightingale Clinics really understand the role of country GPs?'
'I think they do. Ross worked in rural New South Wales for ten years, I think he'd have a fair idea of the issues you face.'
Lexi pulled into a car park reserved for doctors, managing not to stall or crash the car or otherwise embarrass herself. She let Tom's reply go unanswered. They were talking about issues that would need to be addressed, but not here, not now.
Opening her door, she got out and motioned for him to join her. 'Follow me.'
Out of the close confines of the car, she could start to feel in control again. Once she was out of his force field, his presence was a little less overwhelming and her self- assurance recovered with each step towards the hospital entrance, the safe, familiar environment helping to calm her nerves. She didn't want to think about why Tom made her nervous—it was much wiser to focus on work.
The after-hours entrance led them almost directly to the maternity suites where they were met by a short, elderly woman with a pleasant round face, wearing no-nonsense shoes and sporting a no- nonsense hairstyle.
'Hi, Greta. Are you expecting Mary Markham tonight?'
'Any minute now, I should think.'
Lexi indicated to Tom by her side. 'This is Dr Tom Edwards, he's working at the practice for a while. He'll be doing any anesthetics for me. Tom, this is Greta, our ward clerk.'
'Dr Edwards.' The elder woman nodded at him, a smile firmly in place. It seemed she, like Donna, had liked Tom the moment she'd seen him. Who could blame her? Lexi had once liked him very much herself, and her body was reminding her of that fact every moment.
'You'll need to come with me to sign some forms for operating privileges here. I assume you haven't already done that.' She didn't wait for an answer. 'If you come with me I'll get you organized while I do the admission.'
Tom glanced at Lexi and she waved him off. 'Greta knows all the policies and procedures. In other words, she runs this place so you'd better do as she says. I'll be back for you in a minute.'
She hurried off towards the delivery suites and the minutes multiplied as she procrastinated. Tom was dangerous. His presence interrupted her concentration, and she could only hope it wouldn't interfere with her ability to do her job. She prided herself on her competence and she owed it to her patients to keep her wits about her. She should have insisted that Pete attend. But it hadn't only been Pete she'd been thinking of when she'd accepted Tom's offer of help. She'd wanted Tom here. Now, contrarily, she hoped Mary wouldn't need his services, then he could leave.
Except he had no transport. For goodness' sake, she admonished herself, stop worrying about Tom and focus on the job. Everything was ready now, they just needed the expectant 4 parents.
The door opened as Tom backed into the room. Lexi was treated to the very appealing site of his derriere, clothed in soft denim, his broad shoulders filling his cotton shirt. He spun around, pushing Mary in a wheelchair. Trailing behind was Sam, clutching an overnight bag. Penny, the midwife, who was carrying a green plastic hospital bowl, closely followed him.
Mary looked exhausted already, not a good sign.
'Hi, Mary, is it harder than you'd thought?'
She nodded in reply and as Lexi crouched down beside her she could smell vomit on her clothes. That green bowl in Penny's hands was there for a reason. 'Not feeling too flash?'
'She was sick twice on the way here and she's complaining of a headache,' Sam said. He was looking a touch unwell, too.
'The contractions are about five minutes apart and strong,' said Penny.
'OK, Mary. Tom and I will help you to stand. We'll pop you on the scales and then get you settled on the bed to take your obs and check your babies.'
Lexi could see Penny open Mary's case notes and get a hospital gown ready as she and Tom helped Mary onto the scales.
Mary was dressed in tracksuit pants and what appeared to be one of her husband's T-shirts. Penny helped her out of her clothes and into a hospital gown before taking her pulse and blood pressure.
'Pulse 82, BP 180 over 13 0.'
'Right. Get the fetal heart rate monitors on and start a trace.' Lexi didn't want to alarm Mary by telling her that her blood pressure was too high. She wanted her as relaxed as possible, for as long as possible. 'Mary, I'm just going to check the babies' positions and then Penny is going to strap a belt around your tummy. Attached to it are the sensors that record the babies' heart rates. Once that's done I'm going to examine you to see how far along this labor is.' The babies were positioned well. 'If you're comfortable there, can you bend your knees up for me?'
Penny attached the monitors and was at the machine, waiting for the first readout. Lexi heard the sound of the babies' hearts as Penny increased the volume. She glanced at the midwife and saw her nod in return. Good, the babies' heart rates were within normal limits. They were OK. Lexi felt, rather than saw, Tom position himself at the bedside. He'd pointed Sam towards the couch for the time being and picked up the sphygmomanometer cuff. He held the cuff up in her direction and Lexi nodded in response to his silent query. She was glad he was prepared to be useful, it wasn't really his role but she had a feeling an extra pair of hands would be required.
'Five centimeters dilated.'
'No change to the BP.' As Tom spoke, Mary's first contraction since she'd come into the room began. Tom mouthed the next word at Lexi. 'Epidural?'
Lexi nodded. She could see Mary's stomach tighten and change shape as the uterine muscles contracted. The babies' heart rates accelerated but remained within the acceptable range. She waited until the contraction passed, wanting to make sure that Mary could concentrate on what she was about to explain to her.
'Mary, Sam. The good news first—the babies are fine, good heart rates and nicely positioned. Your cervix is dilated to five centimeters, Mary. Ten centimeters is fully dilated but there's no way of knowing how long those next five, all-important centimeters will take. The bad news is your blood pressure is higher than we'd like. An epidural will help to lower your blood pressure but it can also slow down labor. Dr Edwards and I would recommend an epidural—it's more important at the moment to get your BP down. We'll monitor the babies to make sure they're ok.'
'I wanted a natural childbirth.'
Sam was at his wife's side now, holding her hand. 'I know, sweetheart, but we also agreed to do what's best for the babies.'
'This is about doing what's best for Mary. The babies are fine at the moment but Mary's high blood pressure is dangerous.' Mary's complexion was turning a definite shade of green. Lexi grabbed the bowl from the bedside cabinet and held it for her as she vomited again. 'Mary, we're going to put a drip in the back of your hand to run some fluids into you, replace what you've lost with vomiting.'
Lexi saw Penny get organized for this and turned her attention back to the expectant parents.
'What are the risks associated with an epidural?'
'There are a few side effects for the mother,' she replied. 'All of them temporary. Things like muscle weakness and loss of sensation. I'd want to give Mary a strong epidural as we need it to be fast acting to lower her
blood pressure, so it's likely that she won't be able to walk around or use her bladder voluntarily until the epidural starts to wear off. As far as complications go, there are no effects on the babies and any maternal complications are extremely rare, the most common being persistent backache or occasional headaches. There's only been one maternal death attributed to an epidural in Australia.'
Sam held Mary's hand and stroked her hair from her forehead as another contraction gripped her. Lexi could see the love and concern he had for his wife written all over his face. He looked like he would gladly take the burden of pain from her. Sam turned to Tom. 'What would you do if it was your wife in this situation?'
Lexi felt a pain in her chest at the thought of Tom supporting his wife through the birth of his child. Had he already done so? Did he have children with...? What had he called his wife at the pub? Helena? Elena? She couldn't help thinking that it could have been her. It almost had been.
Tom didn't hesitate. 'I'd advocate an epidural. In my opinion, the risks associated with high blood pressure far outweigh the risks associated with an epidural.'
'Then there's our answer. Is that all right with you, love?'
Mary nodded. Lexi was sure Mary would have agreed to anything at that point.
Tom took control, not treading on Lexi's professional toes but in a self-assured manner. Lexi had a moment's concern—she was leaving things in his hands without really knowing how competent he was—but watching him scrub and set up for the procedure calmed her fears. His tone was gentle as he spoke to the parents-to-be, taking time to explain the procedure to them both while he prepared to administer the injection. 'After the next contraction passes, I'll set up the epidural. Sam, I need you to sit in front of Mary to support her. Mary, you need to sit on the edge of the bed and bend as far forward as you can, let Sam take your weight. This opens up the space between your vertebrae and makes it easier for me to insert the needle.'