The Pregnant Intern

by Carol Marinelli

  'Well, that was pleasant.'

  Fi's sarcasm didn't go unnoticed as the two women watched Linda depart through the ward doors. 'I'd love to give you a hand, Alice, but I'm snowed under myself. Half the staff are agency this morning. Luckily they all seem excellent nurses, but half my day's going to be spent showing them where things are kept.' She gave an apologetic smile.

  'I'll get there, Fi,' Alice said gloomily, staring at her long list of jobs.

  And she would get there, Alice decided, if her pager didn't go off every five minutes or the nurses didn't keep asking her to write up drug orders that really could have waited.

  'Er, Doctor, I've just started to do Mr Linton's dressing and I think you ought to take a look.' A young nurse Alice didn't recognise hovered nervously.

  With a sigh Alice made her way over to Mr Linton's bedside.

  'It's looking a bit red around the edges,' the nurse commented as she peeled back the sterile drape she had placed over it.

  'I already saw it in the ward round, and it hasn't changed since then,' Alice said, trying to keep her voice even. 'Miss McFarlane's instructions were to start him on IV antibiotics and to clean the wound and apply a dry dressing.'

  'But there's nothing in the notes or on the drug chart.'

  Alice sucked in her cheeks. 'If you'd give me a moment alone, maybe I could get around to writing up some notes and charts.' And, turning on her heel, she brushed through the curtains.

  'Damn,' she cursed through gritted teeth as she sat down at the workstation. Taking her frustration out on the poor agency nurse had made her feel no better. It wasn't the nurse's fault—she was right to be concerned about the wound. If only Josh were around, maybe they could get up to date. Massaging her temples in an effort to quell the throbbing in her head, Alice picked up her pen and started writing.

  'There's a new admission up from A and E,' Fi said brightly, as a trolley carrying an elderly lady whizzed past. 'Apparently Linda wants her clerked straight away so we can commence the IV antibiotics.'

  'Great,' Alice muttered under her breath.

  The patient was a varicose leg ulcer. Mrs Dalton was a diabetic and her poor circulation made her prone to this type of difficulty. Even the smallest wound could create a problem for patients like her, and in this instance her ulcer had shown no improvement, even though she'd had twice-daily visits from the district nurse. Now, despite the nurse's diligence, it had become infected.

  'I'm sorry, Mrs Dalton, I know you've been through this already, but I'm going to need to examine you and ask a few questions.'

  'No worries, love, I know how it all works. Well, I should by now,' she joked, gesturing to the huge pile of old notes Fi had thrust at Alice.

  'How long have you been a diabetic?' Alice asked as she gently lifted the sterile drape with which the nurses had covered the ulcer.

  'Since I was ten.'

  'So no doubt you could tell me a thing or three about it?'

  Mrs Dalton laughed. 'No doubt. You ask away, love, I'm a mine of information. At least you don't think you know it all, not like that madam I saw before. What was her name?'

  Alice took a leaf from Jeremy's book and simply evaded the question. 'It looks very painful.'

  'It is. Sarah, the district nurse, said you might order a needle for me before I have it changed. Normally I don't like taking anything but, 'struth, if you knew what it felt like when they start prodding and poking it. I'm not one for whingeing normally...'

  Alice gave a sympathetic smile. Mrs Dalton had the tough, sun-battered face of a real Aussie battler, and from the brief look she'd had of her notes Mrs Dalton definitely wasn't a 'whinger'—she had put up with a lot from her diabetes.

  'I'll write you up for something strong and the nurses will give it to you before they do your dressing.'

  Even though Mrs Dalton had only come in for dressings and IV antibiotics, Alice still had to examine her patient thoroughly and take a detailed history. Her head was pounding and tiny little dots seemed to be dancing before her eyes as she wrote her notes. By the time she had finished the clock was edging towards twelve and her body, tired before the day had even begun, now ached mercilessly for its bed, yet she still had the rest of the day and night to get through. It was in that instant Alice knew she simply couldn't do it any more. Enough was enough.

  The dots on the page blurred as tears filled her eyes. The sound of Fi's gentle voice came as no surprise.

  'How about we take five in my office?'

  Gulping, Alice nodded gratefully and followed Fi like a child. Fi let her cry for a moment before she spoke.

  'Not having the best day, huh?'

  'How did you guess?' Alice said, half laughing at herself.

  'Well, when the agency nurse said a female doctor had snapped at her, of course I assumed it was Linda. But when the same nurse put it down to hormones I did a double take. We all know Linda hasn't got any.'

  Alice gave a small laugh, then started crying again. 'I've got this terrible headache. I thought it was because I was tired, but now I'm starting to get little spots in front of my eyes.'

  Fi's expression changed abruptly. 'Since when?'

  'Just in the last five minutes or so.'

  Fi's slim delicate hands picked up Alice's. 'Your fingers are swollen—not much, but they definitely are. Have you had your blood pressure checked recently?'

  'I've got an appointment at four. It's not been too great at the best of times.'

  Fi tutted. 'You silly girl,' she said, but not unkindly. 'What on earth are you doing here?'

  'I'm beginning to wonder myself.'

  Fi took over. She disappeared, returning with a blood-pressure machine. Now, let's see what your blood pressure's doing.' She wrapped the cuff around Alice's arm. Feeling it tighten, Alice sat there, resigned. As Fi pumped it up even higher Alice felt in that moment all her dreams evaporate.

  'How high?' she asked when Fi had finished.

  Fi didn't answer straight away. 'I think you ought to ring your obstetrician.'

  'How high, Fi?' Alice demanded, her voice urgent.

  'One hundred and sixty over a hundred.'

  And suddenly work, her internship, the GP rotation all paled into insignificance. Both she and the baby were in real danger.

  'I thought I might find you in here! When you can drag yourself away from your morning coffee, there are a few patients that need to be seen.'

  Alice didn't bother to look up as Linda rattled on. It was Fi who spoke, her voice clear and calm, but Alice recognised the note of urgency health professionals reverted to when there was a real problem. 'Dr Masters isn't feeling well, Miss McFarlane, I've checked her blood pressure and she needs to go to her obstetrician now.''

  Alice heard the subtle shift in tone on the last word.

  Suddenly Linda was all concern. 'Why on earth didn't you say something, Alice?' She came over. 'Who's your obstetrician?'

  'Brett Halliday.'

  Linda nodded. 'I know him well. Look, do you want me to arrange transport to the Women's and Children's?'

  Alice shook her head vehemently 'I'll take a taxi.'

  'Nonsense,' interrupted Fi. 'I'll drive you. I'm due for a lunchbreak. Rowena Sheldon's an associate charge nurse. She can manage for half an hour while I take you.'

  Alice nodded gratefully.

  'That settles it, then,' Linda said efficiently. 'I'll ring Brett and tell him you're on your way. I'll let Jeremy know. Don't worry about a thing.'

  As Alice handed over her pagers to Linda she knew without a shadow of a doubt she wouldn't be back; she wouldn't even be going back to her flat. The next time she came home it would be, God willing, with her baby.

  Alice was infinitely grateful for Brett Halliday's professional unruffled manner. He examined her thoroughly, listening to the baby's heartbeat and checking her urine and blood pressure.

  'You know I'm going to admit you, don't you?' he asked as Alice lay back on his examination couch. His hand was feeling her fundus�
��the top of her uterus—to check the size of the baby. Without waiting for her to answer, he continued, 'Your blood pressure's still up, you've got mild fluid retention and there's protein in your urine. Any one of these can happen, but combined in pregnancy we have to tread cautiously.'

  'It's my fault, isn't it?' she said, fighting back tears, but Brett wasn't about to apportion blame.

  'Pre-eclampsia is also referred to as the disease of theories. No one can pinpoint exactly why certain women develop it. Yes, you've been working hard, and with your blood pressure a bit high, which you know was a concern, but healthy stay-at-home mums also develop it. The important thing now is to bring your blood pressure down and help you get as much rest as possible. Hopefully that will halt the progress of it.'

  'But what if it carries on? What will happen to the baby?'

  'Let's take it a step at a time, shall we? For now we'll get you admitted. The midwives will put you on the CTG monitor at regular intervals to keep an eye on the baby, and I'll arrange an urgent ultrasound and cord studies. If there's any signs the baby's in distress or it isn't receiving adequate nourishment we'll be straight onto it.'

  'But it's too soon. I'm only thirty-four weeks.'

  Brett squeezed her shoulder reassuringly. 'Let's do the ultrasound, shall we?'

  Settled into bed, Alice tried vainly to calm herself down, but to no avail. Everything Brett had said she understood, but she felt as guilty as hell—and not just because she'd continued to work. A little voice inside her warned that this was payback. If she hadn't swanned off for the weekend with Jeremy, hadn't spent the time making energetic love, none of this would have happened. It never entered her head that, had Jeremy not intervened when Marcus had confronted her on Friday, she could have been in exactly this situation, only five days sooner. That lying by the pool, being massaged, fed and pampered by the man she loved, could possibly have kept her blood pressure down.

  Her self-imposed guilt only deepened when Brett returned to her bedside with the ultrasound results.

  'I won't beat around the bush, Alice. The baby's not in any distress but your placenta's not functioning as well as it should, and it's not going to provide adequate nutrition to carry the baby to term.'

  'Which means...'

  'You'll be having the baby sooner rather than later.' He gave her a gentle, reassuring smile. 'We'll see if we can get you to thirty-six weeks. But even if you have the baby now, it's still a good size, though it will mean a stay in special care. We're going to start you on steroids, which will help to develop the baby's lungs. The most important thing you can do for your baby and yourself is to try not to worry. I know I'm asking the impossible but it really is imperative that you try and rest and eat well. Hopefully we can add a few grams to the baby's birth weight. Now, I know you don't want to get in touch with the baby's father, but is there anyone else we can get in to be with you? You should have some support—what about your parents? I'm sure if they were aware of the circumstances they'd be ready to patch things up.'

  Alice shook her head. 'I'm not up to one of my mother's lectures. Honestly, Brett, it really wouldn't help at the moment.'

  'Some friends, then?'

  Alice thought of her loyal friends back in Adelaide. Jess would come at the drop of a hat if she called her, but it was hardly fair. Like herself, Jess was at the end of her internship.

  'There is someone,' she said quietly, thinking of Jeremy. 'He'll probably be here soon.'

  'Good.' Brett uncharacteristically patted her arm. 'Now, I've written you up for some sedatives. Nothing too strong,' he added, noting her alarmed expression. 'And before you ask, no, it won't harm the baby—that's what we're trying to prevent. Remember, we're all batting for the same team here. They'll just help you relax and, as I said before, that's crucial at this stage.' He smiled as a young nurse entered with a plastic medicine cup. Grumbling, Alice swallowed the small pill.

  'Are you going to check under my tongue?'' she asked as Brett stood there, making sure she took it.

  'I'm sure it's not necessary.'

  'Giving you a hard time, is she?' Alice almost started crying again as there in the doorway, paler than usual and slightly breathless, stood Jeremy.

  Brett Halliday obviously recognised him and immediately walked over and shook his hand. 'G'day, there, Jeremy. I was just telling your young intern here to lie back and stop worrying. I hope you're not going to undo all my hard work. She feels bad enough as it is about stopping work.' Brett spoke in a light, jovial manner but again Alice could hear the coded undercurrent that warned all was not well.

  Jeremy obviously heard it too. 'Don't worry, I'm not here to talk shop. I just wanted to see how she was doing.' Walking over to the bed, he looked down at her. 'Linda only just told me. I came as soon as I heard.'

  Alice saw a flash of confusion pass over Brett's usually impassive features, but he didn't say anything and quietly left.

  Once they were alone Jeremy sat gingerly on the bed, picking up her swollen hand. 'What happened?' he asked, his voice thick with concern.

  She so badly wanted to be angry with him, to somehow offload her guilt and blame him for all of this, but, looking into his worried blue eyes, she knew he didn't deserve it. 'I've got pre-eclampsia. My blood pressure's through the roof. And Brett just told me the baby's likely to be born sooner rather than later.'

  'It will be all right,' he said confidently, but it wasn't what she needed to hear. Angrily she pulled her hand away.

  'How would you know?'

  Jeremy gave a helpless shrug. 'Because it has to be,' he said simply. As her face dissolved into a mass of tears he pulled her into his arms, holding her close as she sobbed onto his chest. 'It has to be,' he said again, closing his eyes in a silent prayer.

  CHAPTER SIX

  Alice did her best not to worry. She took the tiny yellow pills and read endless magazines until the words blurred in front of her and she drifted off to sleep. She ate all the meals that were placed in front of her and only got up to go to the toilet and have a brief shower in the morning. She didn't even have to feel guilty about letting them down at work as Josh and Jeremy both told her that her position had been immediately filled by a young overseas doctor named Mai Wing. But, despite the best medical care and the most compliant of patients, nothing was going to prolong this pregnancy beyond thirty-five weeks.

  'You've had a few days' worth of the steroids,' Brett said gently as he broke the news late on Monday evening. 'All the indications are that the baby will do well. Now, as it won't have the last few weeks in utero it won't have laid down any fat reserves so you can expect it to be quite scrawny. Also, he's going to need a lot of small, frequent feeds, which will exhaust him—'

  'It's a boy, then?' Alice asked, jumping on Brett's words.

  'Force of habit,' he assured her, but Alice was convinced now she was having a son.

  'Just wait and see, huh? Now, I know you're keen to have a natural birth and we're going to give you a small trial of labour, but any signs that you or the baby aren't coping and I'll do a Caesarean section without question. You understand that, don't you?'

  Alice nodded.

  'Good. Right, then, I'll see you in the morning. Enjoy your sleep—it's the last good one you'll be getting for a while.'

  Lying back on the pillow, Alice put a shaking hand down to her stomach. 'It's all right, baby, you'll be here beside me tomorrow. Try and rest now.' Closing her eyes, she tried to think positive thoughts to stay calm, sure the baby would pick up on the utter fear she was feeling. She was concentrating so hard on the baby that it took a moment of two to register that someone had come into the room. Opening her eyes, she gave a trembling smile to Jeremy. 'All systems go tomorrow.'

  He heard the break in her voice and in a second he was on the bed beside her.

  'I know you hate me saying it, but things really are going to be fine. You've done very well to get this far.'

  Gulping, she nodded. 'Do you really think so?'

 
'I know so. That extra week will have made all the difference to the baby, you know that as well as I do. It's time now, Alice. At least once it's here you can feed it up. Everything really is going to be all right.'

  Alice lay back on the pillow. He sounded so sure she almost believed him.

  'Now...' He squeezed her hand. 'About tomorrow. I know it's all happened quickly, and I know you want to wait before we make a commitment, but would it help if I was there for you tomorrow?'

  Alice gazed over at him, taking in the deep blue eyes, the full mouth that had touched hers. She wanted him there more than anything, didn't want to do this alone, but it was such a huge thing to ask, such a big step in the direction of commitment.

  Jeremy seemed to read her mind. 'It doesn't have to mean anything's written in stone. I've been to the medical library and borrowed all the trendy labour books.' He held up a bulging carrier bag. 'It's almost old hat to have a husband there these days—I'd be called your "support person". Apparently we're supposed to draw up a list of your wishes and desires throughout labour and if you start to stray from your chosen course I'm supposed to step in.'

  His superior dry teasing tones bought a smile to Alice's lips.

  'Personally I'd be screaming for all the drugs available— perhaps I shouldn't have looked at the pictures.'

  Alice really laughed now. 'It will be a bit more graphic than a few textbooks tomorrow,' she warned.

  'I'll stay at the head end of the bed, I think, shouting instructions from the sidelines, so to speak. That is, if you want me there.' He looked over to her almost shyly, and Alice knew it would have taken a lot for him to ask. She could almost feel the tension in the air as he awaited her decision—it evaporated as she gave a nod.