In Falling Snow

by Mary-Rose MacColl

  But none of it mattered. If Grace had done an internal examination yesterday, she would have confirmed Jennifer Wilson was already in labour and should be admitted. She’d have seen Jennifer was a birth centre patient and transferred her to hospital care. If Grace had referred Jennifer Wilson on, another consultant might have picked it up. If Grace had ordered the twenty-four-hour urine specimen, they might have recognised pre-eclampsia in time. Hindsight is easy, David always said to her, but she felt completely washed out. She’d failed her patient. She’d failed a child.

  Clive Markwell found her in the scrub room. He’d been in one of the other theatres. He’d come in at the end. Grace saw him speaking with the paediatrician. “Dr. Hogan,” he said, the emphasis on the doctor. “I hear you missed this yesterday at clinic.”

  Grace was still shaken. “I’m sorry, Clive. I need to go and tell the father now.”

  He snapped off his gloves and put them in the bin. “Of course you do,” he said. “But mark my words, Doctor. This is another example of your failing to follow protocol. It won’t finish here.”

  “I’m sure you’ll do whatever you think’s best,” Grace said. She bit her bottom lip to keep back tears. She could taste the blood in her mouth. She sucked hard on it.

  She found Craig Wilson in the waiting area. He was slumped in a chair, no idea what she was about to tell him. He stood to greet her, eager.

  “I’m so sorry,” she said. “We did everything we could. We were able to perform a caesarean section and we’re confident your wife is going to be fine. But we were too late, Mr. Wilson. We lost the baby.”

  He fell back onto the chair. Moments passed. He kept beginning to speak and then closing his mouth. He stood and sat and stood again. “Was it a girl or a boy?” he said finally, standing now.

  “It’s a little boy,” Grace said, taking his arm to support him. “He’s in there now and you and Mrs. Wilson might want to . . . There’s a social worker coming up soon. They’ll talk to you about what to do now.”

  “But what happened?” His face was ashen.

  Grace thought of Henry suddenly, when they’d brought him home from the hospital, the two big girls excited they had a brother who’d appeared magically, like a new doll to play with. She felt a hard lump in her chest and pushed it back down. She was supposed to be careful in what she said but she told Craig Wilson as much as she knew. “I think your wife developed pre-eclampsia, a reasonably common complication in late pregnancy, but I think there was a rare further complication, which meant your baby didn’t have enough oxygen during labour. And he died.”

  Craig Wilson stood there, not moving, willing Grace to stay too, as if while they talked he could make what she’d told him not so. She registered the pain on his face and something else too, the beginnings of blame. He kept going to say something and stopping himself, taking a breath, trying again. He didn’t cry. He was too shattered to cry. “A boy,” he said.

  Grace nodded. Her pager went off. “I have to go now.”

  By the next day, Craig Wilson would be asking hard questions. He’d be demanding answers, why they didn’t admit his wife the day before, why they let her remain in the birth centre, why they didn’t move to a caesarean sooner. The hospital would review the death. The coroner might even be involved. Grace didn’t know for sure what they’d find. The only thing she did know was that she’d be there when Jennifer Wilson woke up to tell her that her baby had died.

  Grace went to the desk to pick up the message. She walked slowly, felt the weight of the world on her shoulders. You couldn’t do everything. She knew that. Doctors are fallible. But if only she’d . . . The page was from the antenatal clinic asking if she was coming down. She was the doctor rostered on for the day. Then she remembered. There had been an earlier message for her. The school had called. The school had called when she’d been in the birth centre. “Give me the phone,” she said to the girl on the desk. “What’s the number for Milton State School?”

  “Hi, it’s Grace Hogan here. Someone called me.”

  “Grace Hogan?” The woman sounded vague. “Oh yes, it’s your daughter. She’s had a fall. We couldn’t get you. She’s gone to the hospital.”

  The hospital. Which hospital? “Is she all right? What’s happened?” Phil was the most accident-prone child in the world. Grace felt her heart thumping in her chest.

  “I’ll put you through to the deputy principal. She talked with the ambulance folk.” Ambulance? Grace steadied herself on the counter. What on earth had happened? Grace waited several minutes while they paged the deputy. She almost hung up and drove to the school but they said Phil had gone to the hospital. She needed to know which hospital.

  “Grace, hi, it’s Jenny Nearing. Mia fell from the verandah. I think she was trying to get a ball for one of the littlies who’d thrown it up there. She came down on her back and we weren’t sure it was a good idea to move her.” The woman was speaking too carefully.

  Mia? It was Mia not Phil. “What? How? Where is she?”

  “Royal Children’s. It’s the closest. We couldn’t get you or David. We rang your GP. He said straight to hospital. I thought that was best.”

  “Tell me again. The fall, the nature of the fall.”

  “Maybe twenty feet, onto her back onto the grass.”

  “Skull?”

  “None of the teachers saw how she landed. We don’t think so.”

  “What did the ambulance do on site?” This would give Grace an idea of injury.

  “They confirmed she’s broken her arm.”

  God, Mia, at eight, with a broken arm, and taken to the hospital in an ambulance by herself. Grace forced back tears. At least she’d put her arm down first. Better than her head.

  “Her spine. Spinal injury. Did they think . . .” Grace could hardly form the words.

  “She had movement and feeling and she was conscious.”

  “Okay, okay. I’m on my way. Call the Royal, tell them I’m coming now.”

  “Fine. We did everything right, Grace. Everything we could.”

  “I know you did. I should have . . .” Grace hung up the phone, looked at the clerk. “Call David at the Mater. Tell him to meet me at the Royal Children’s.” The girl was making notes, looking at Grace. She had no idea what Grace was talking about. “Oh for God’s sake, get Alice Jablonsky. She’ll explain.”

  Grace arrived at the Royal Children’s fifteen minutes later, parking in a doctor’s bay and throwing the keys at the gate officer on the way in. She went straight to casualty. There was a long queue at the desk. She took in the clerk, stick-thin, lipsticked, slow. Grace went to the front of the line, said to the woman next in the queue, “I’m sorry. My daughter is eight. She’s been injured and she’s alone.” Grace thought she might cry. “They only just found me.”

  “Of course,” said the woman. “Go ahead.”

  “I’m Dr. Hogan,” Grace said. “My daughter is here, Mia.”

  The clerk looked flatly at Grace and then at the file on her desk, running a polished fingernail down the list. Mouth like a deflated balloon end, a smoker. “We don’t have a Mia Hogan.” She looked past Grace to the next person in the queue.

  “Ravenswood. Mia Ravenswood.”

  “Well, why didn’t you say that in the first place? Mia Ravenswood.” The clerk consulted the next page of the list. Grace saw she was in treatment room seven. “I’ll get a nurse to come out and take you in.”

  “Thank you,” Grace said.

  She went to the waiting area and as soon as the clerk’s attention was taken by the woman who’d let Grace go ahead of her, Grace went through the push doors. It took her several minutes to find room seven, but finally there was Mia, all alone on a gurney, head collar, arm twisted crazily in front. Grace rushed to her daughter, careful not to bump the arm. “Oh honey, I’m sorry. I’m here now. Does it hurt?”

  “H
i, Mummy. A little bit. They gave me magic medicine.”

  “Magic medicine.” Grace saw Mia’s pupils were way too small. Had they morphed her? She was eight and they’d morphed her. Grace might have told them not to do that. She looked at the arm. Fractured ulna, radius, possible shoulder. Grace couldn’t remember how bones were different in children, only that they were.

  Just then she heard David’s voice outside. “I managed to get a Cherry Ripe and a Mars bar but no Kit-Kats. The machine . . . Grace, hey.”

  “David, you’re here! The school said they couldn’t get you.”

  “Mick Dalton called me as soon as he saw Mia. Mick’s here now. He’ll be back soon. Do you remember him? He did paediatrics at the Mater. He was going to go into orthopaedics. Remember? Ended up in paeds. Big career change. Great for us. Couldn’t get better for a fracture.” David was calm, even chirpy. Grace didn’t know if she wanted to hit him or kiss him.

  Grace put her hand on Mia’s forehead, checking her temperature, as if she’d have a fever. She couldn’t believe how casual David was. “Just the forearm?” she asked. “The collar?”

  “It’ll be off soon. They’ve x-rayed. Nothing to worry about. She’ll have a cast for a month or so but that’s it.”

  Grace felt her heart slowing down for the first time since she’d left the operating theatre.

  David picked up Phil and Henry and they had fish and chips at home. Henry drew a big S on Mia’s cast and told her she must have been exposed to white kryptonite. Why white? Grace had asked. She’s lost the power to fly, Henry said. Silly, David added. You should have known that.

  Later, the kids in front of the television upstairs, Grace and David were drinking tea at the kitchen bench. Grace said, “I’m not sure we can keep going like this.”

  “Like what?”

  “Mia today. The school called me. I was in the birth centre. I didn’t even take the call.” Grace remembered Jennifer Wilson suddenly and put the thought away.

  “Well, you can’t stop and drop everything in our line of work. It was just lucky I was in a clinic. And Mia was fine.”

  “She was all alone. In the ambulance.”

  “No, she was with the paramedics. They know how to treat kids. They gave her pain relief and one of them stayed with her until I got there. Lovely guy. I must pen him a note.”

  “But one of us should have been with her. I told the school to call you.”

  “Maybe they don’t have the Mater number. I’ll get Naomi to call it through tomorrow. But it didn’t matter. Mick called. I met Mia at the hospital. It really was all right, Grace.”

  But Grace continued to feel uneasy. What if the attending hadn’t been someone David knew, if he hadn’t got David, if Mia had been all alone in the hospital system? What if the injury had been worse? And while Grace had been in the birth centre initially and then in theatre, she’d forgotten about the call. Sure, they’d had an emergency to contend with. But what mattered more than her own children? She couldn’t bring herself to tell David about Jennifer Wilson. She’d tell him tomorrow. Jennifer would be awake, she realised. Grace had wanted to be there. “I have to go back into the hospital,” she said. “You’re okay to wait here?”

  “Sure, but do you really have to? Mia might want you.”

  “I’ll be back as soon as I can.”

  Jennifer Wilson and her husband were in a private room. The hospital had managed to give them that much. He looked so soft sitting there on the little visitor’s chair holding his wife’s hand. Grace told them how sorry she was. They weren’t even beginning to come to grips with what had happened. Grace knew she shouldn’t tell them she felt responsible but she did say to Jennifer, “I wish I’d known yesterday you were in labour. I should have done more tests.”

  “It’s not your fault,” Jennifer Wilson said. “I wish I’d known too.” Grace found herself biting back tears for about the third time that day.

  She was driving home from the hospital at about ten. Fog had descended over the city and she was listening to Cat Stevens’s “Wild World” on the cassette player.

  Grace had joined the Medical Women’s Society when she was a student. The president was a middle-aged paediatrician, married, no kids. Grace’s was the generation of hope, she’d said to them, the luckiest ever, because things had changed, there would be no stopping women now, they could have everything, a career, children. What a crock it had turned out to be.

  Before Grace left the hospital, Andrew Martin had told her that Jennifer Wilson didn’t want an autopsy. Grace couldn’t blame her for that. Now they weren’t sure whether pre-eclampsia had contributed to the death, Andrew said, but Clive Markwell was going to make a complaint.

  She’d called David then to see how Mia was. She was sleeping peacefully now, he said. Neither Grace nor David mentioned the morning’s appointment with Ian Gibson and when Grace thought of it, it seemed a million years ago. But Ian had said that they needed to bring Henry in. He hadn’t said it was urgent but he hadn’t agreed with Grace that it could wait. He’d wanted her family history. Why would he want that if he wasn’t thinking anything? Grace had done a paediatric term during medical school. Leukaemia, that was the one you dreaded, but Henry wasn’t bruising any more than you’d expect. There was cystic fibrosis and spina bifida, but he didn’t fit the profile for those either. And, at any rate, the inherited conditions weren’t in either family.

  Henry had been the easy baby, that was the thing. Grace didn’t even labour to have him. They’d been in Canada for David to finish his perinatology training. She and the girls were living in Banff for six months while David went back and forth from Edmonton. They were planning to have Henry in the hospital in Banff.

  Grace had just dropped the girls at school. Walking back through town to their condo, she’d slipped and fallen and hit her head hard on the ice. She fell into unconsciousness briefly and then woke and felt what she thought might be blood oozing onto the ice. She imagined it freezing there and her hair sticking to the ground if she tried to get up, then imagined her tongue stuck to an ice cube, then noticed that the side of Mount Rundle looked like a series of faces, Banff’s Mount Rushmore, except the faces wore sunglasses. The blue sky. A single cloud.

  Grace tried to focus. Heavily pregnant and prone on the ice, she knew she shouldn’t move. It was a cold morning and the streets were quiet. She lay there for several minutes more watching her smoking breath until a boy walked by on his way to school. “Are you asleep?” he said, backing away from her, thinking to go around her.

  Somehow Grace managed to convince him to go to the nearest house for help. By the time the ambulance arrived, Grace was in and out of consciousness. She grabbed the paramedic’s shirt. “The girls are at school,” she said. “Tell them to ring Nan Hughes to pick the girls up. Mia and Phil. Their names.” The paramedic, who’d responded by asking her what her name was, what the date was, where she was, told her everything was okay; they were going to lift her one two three, as if he hadn’t heard what she’d said. She grabbed his shirt again. “You’re not hearing me. My daughters are at school. They’re babies. Please.”

  “Nan Hughes,” he said, “I got it, it’s okay, I know Nan. We’ll call the school right away. But for now I need you to keep calm and don’t try to move.” Nan Hughes was the mother of a girl in Phil’s class and a singer. They’d met in the corridor and agreed to have a coffee. Later, Grace had heard her sing at a concert at the Whyte Museum at Christmas. The feeling she could put in a song. Nan was the only person Grace knew in the town. Someone who could sing like that would look after children.

  The next thing she remembered was waking up, David in a chair beside her, talking to someone’s baby in his arms, the smell of a hospital. She remembered thinking how sweet he looked holding a baby, how much she was looking forward to having another baby. Grace closed her eyes and when she woke again, he was still holding a baby but it w
as screaming in his arms now. David had stubble on his chin and looked a mess. “What are you doing here?” she said.

  “Oh Grace, Grace it’s you. You’re back.”

  “Whose baby is that?” she said.

  “This is Henry, Henry our son.” David was crying for some reason. “And he’s pretty keen on getting a feed.”

  “What?” she said. She couldn’t understand. Totally unaware of what she was doing, she took the baby David was holding—whose baby was it?—and placed it at her breast. Immediately, it became focused on feeding. She noticed her breasts were engorged.

  “You had a fall,” David said. “You’ve been unconscious.”

  Grace felt a stab of panic. “You have to pick up the girls. They’re at school.”

  He smiled. “No, they’re still in Banff. One of the other mothers picked them up. They’re staying with her. Everyone’s been wonderful.”

  “Where am I?”

  “Calgary. You had a brain bleed. They delivered Henry to reduce your blood pressure.”

  “I’ve had a caesar?” The baby continued to suck happily as Grace shifted position, sitting up. She looked down at him, and then it hit her. “This is Henry? Henry our son?” David nodded, tears streaming down his face again. And then Grace was crying too. “He’s got your forehead,” she said finally.

  David tried to smile through his tears. “He’s very glad you’re awake too. The nurses keep coming up here from the nursery with bottles of formula. He’s pretty hungry.”