“Blood pressure’s one thirty over eighty-five,” the student midwife said, straightening up and taking the stethoscope out of her ears.
“So, up a tad from one twenty over eighty so still no sign of pre-eclampsia nor any reading too low indicating shock from blood loss. I’m pretty sure it’s only been a small bleed,” Harith said. “Now, Sue, I’m going to examine your tummy.” Harith very gently palpated her belly. “Did that hurt anywhere?”
Sue shook her head as Barry held his breath.
Accidental haemorrhage was often associated with tenderness.
Harith listened with a Pinard stethoscope. “Foetal heart’s at one hundred and forty-four. Perfectly normal.” Harith straightened up and smiled at Sue, then at Barry. “Your baby’s not been hurt, there’s been no more bleeding, and you’re not in labour. All in all, I’d say the outlook’s good.”
Sue gasped and said, “Oh, Barry,” and reached out her hand.
He took the two steps to the bed and grasped it in his. “Thank you, Harith,” she said, and slumped on her pillow.
Barry could feel the meaning of Harith’s words slowly sinking in. The baby was safe. Sue was safe. The anxiety of the last half hour began to seep out of him, leaving him shaken but relieved.
“We’ve already taken blood samples so we can get a baseline value for your haemoglobin level, Sue, but it was fine last week, and I’ll be surprised if it’s fallen. I’m cross-matching two pints of compatible blood and have an intravenous kit in here just in case there’s more bleeding.” He turned to Barry. “Sue’s O Rhesus positive, and there’s no shortage of that group in the bank.”
“And you think it’s a placenta praevia?”
“Every APH is until proven otherwise. So, complete bedrest for five days. Sedation. Repeated haemoglobin measurements, twice daily foetal heart rate and blood pressure measurements and urinalysis to detect any albumin.” He bent over Sue, then straightened. “She’s fast asleep.” But nevertheless, he lowered his voice. “Some foetal conditions are associated with praevia. I don’t think I’ve missed twins, but it can happen.” He glanced again at the sleeping Sue. “We’ll get an X-ray on day five. I’m sorry, Barry, but it will pick up any serious foetal malformation or recent foetal death too…”
Barry flinched. Not now. Not after so long.
“The odds are very much against either, but if—if we do, there’s no point dragging things out. We’ll try for a vaginal delivery there and then.”
Barry glanced again at the sleeping Sue.
“If the X-ray’s normal, we try to get the baby to thirty-eight weeks, which will be next Saturday. The risks of prematurity are practically negligible by then, so I’ll examine her under anaesthesia with everything ready for immediate Caesarean section. Because the only way to establish the location of the placenta is to put my fingers through the cervix and feel for it. That can provoke quite heavy bleeding.”
“I know,” Barry said, and gritted his teeth.
“Unless there is no or only a tiny encroachment of the placenta into the lower uterus we will deliver by section. It’s far safer for mother and child. Occasionally we do return the mother to bed and wait for the spontaneous onset of labour, but I fear Sue’s going to have a section next Saturday.”
Barry nodded. “Last year we had the flying squad out for a premature breech delivery. The mother had a ten-minute Pentothal knockout. When she woke up, she said, ‘I know I had to be put out, but I missed his first cries. I’ll never forget his big brother’s.’ Sue’s going to miss that.”
Harith stroked his chin. “Maybe not. I’ll need to talk to anaesthesia, but we have a gas-passer here who did some residency in the States. Sue had a laparoscopy here last May. It’s the same chap who stunned her then. The Americans are ahead of us in using regional blocks, spinal or epidural for sections. And I’d have to talk to Sue too, but if Dennis agrees and it’s what Sue wants?”
“I think it will be. Thank you.”
“But there’ll be a condition.”
“What?”
“Sue’s going to need all the support she can get. I want you in theatre holding her hand.”
36
From Hope and Fear Set Free
“More coffee, Barry?” Kitty asked.
“Please, and then I’ll have to be running along.” He passed his cup to her.
Fingal, enjoying his after-breakfast pipe, let go a puff of smoke. “I’ll bet you thought today would never come.”
“You’re absolutely right, but it has. At last.” He accepted his full cup. “Thanks, Kitty. You two have been wonderful, having me at Number One for breakfast every day and asking Kinky to make enough for your evening meals to share with me, so I’d not have the added chore of cooking.” He sipped his coffee. “That’s been a very good thing. My skills in the kitchen are, to say the least, limited. Thank you.”
Kitty traced a circle in some spilled sugar on the table. “I feel for you and Sue. Thank goodness it’ll be all over in a couple of hours. It’s the waiting and uncertainty that’s horrible.”
“I know.” Barry nodded. “At least I’ve had my work to keep my mind off things and looking after Max and Tigger before I’ve nipped over to Dundonald every day has kept me occupied too.” He sipped. “But my dear Sue’s had nothing much except reading to keep her mind off things. She said if she’d known how much time she’d be spending in the hospital, she would have taken up knitting.” He smiled at the memory. “But she’s tried to remain cheerful for my sake.” He managed another small smile. “Once she got over the initial shock, each day that passed with no more bleeding, that normal X-ray two days ago, and good old Harith Lamki have all helped.”
Fingal puffed. “And today’s the big day. Sue may not need one but if she does, Caesarean section has come a long way since I did some extra training in Dublin’s Rotunda Maternity Hospital in 1937. It’s a safe routine procedure today thanks to much better anaesthesia, and antibiotics and blood transfusion, if they become necessary.”
“I know. But if the patient is your wife, it’s still a scary prospect.” He finished his coffee.
“Of course, it is,” Fingal said. “There’s a great deal of mythology about it. According to Greek legend, Apollo delivered Aesculapius his son by the operation and Connor McNessa, king of Ulster, did the same for his wife who had drowned.”
Kitty shook her head. “Fingal O’Reilly, you should remember the old adage ‘Sometimes it’s better to keep your mouth shut and let people think you’re an idiot than open it and remove all possible doubt.’ Poor Barry must be worried sick, and you start prattling about interesting legends?”
Fingal looked contrite. “You’re right, Kitty. Sorry, Barry. I didn’t know what to say and resorted to history. But you know Kitty and I are praying for you and Sue and the little one.”
Barry rose. “Never worry, Fingal. It didn’t upset me, and you and Kitty have been wonderful. Thank you. Now, Sue’s to be in theatre in an hour and thirty minutes. I want to sit with her for half an hour before she goes in, so I’ll be off. Thanks again for breakfast. For all the breakfasts this week. They’ve been lifesavers.”
Kitty said, “Our pleasure. Give our love to Sue, and please give us a ring when it’s all over and when, in the words of the classical hospital report, ‘mother and child are doing well.’”
Barry chuckled. “I will, after I’ve phoned Sue’s folks in Broughshane and mine in Ballyholme.”
* * *
Barry sat beside the head of Sue’s bed and held her hand.
She smiled up at him. Her pupils were constricted, the results of the premedication she had been given ten minutes previously: Pethidine 100 mg for its sedative and analgesic effects and scopolamine 0.40 mg for its postoperative anti-nausea effects.
“Won’t be long now,” he said, “and once the anaesthetist has put in the spinal and they’ve taken you through to theatre, I’ll be with you for the whole thing.”
“Thank you, darling.” Her words w
ere slightly slurred. “I love you.”
“And I love you.” Barry bent and kissed her forehead. As he straightened, Harith and an orderly, both dressed in surgical whites, entered, pushing a stretcher trolley.
The obstetrician smiled at Barry before saying, “Time to go, Sue.” He and the orderly brought the trolley alongside her bed. “Can you wriggle over, please?”
Helped by Harith, Sue moved across and was covered with a blanket.
With her doctor at the front, the orderly at the rear, and Barry by her side holding her hand, they set off along the ward until they stopped in front of double spring doors, which Barry pushed open so the trolley could be brought inside. As the orderly put on a surgical mask, Harith pointed to a single door to the left, then began to don his own. “Changing room.”
Barry nodded, squeezed Sue’s hand, bent and kissed her forehead. “Don’t be scared, pet. I’ll see you again very soon.”
Sue and her attendants disappeared through a second set of swing doors and Barry let himself into the changing room. He stood for a moment and took a deep breath. He’d read once that taking in one’s physical surroundings could help you remain calm. He looked around him. Tall grey steel lockers lined one wall. White theatre trousers and shirts and tube-gauze hats were piled on shelves. White ankle-length rubber boots lined one wall. Four easy chairs surrounded a low table in the middle of the room.
Barry had finished changing and putting his clothes in a locker when Harith came in through a door and sat down. “Won’t be long, Barry. Dennis Grant is a slick anaesthetist. He uses a mid-lumbar approach and a fine needle to put in the block so there is never much in the way of post-block headache. Some obstetricians use a local anaesthetic, but it takes quite a while to put in. If there is much bleeding after I’ve examined Sue vaginally, I want to get the section done as quickly as possible.” He squeezed Barry’s shoulder. “Your Sue’s a very brave woman.”
“I’ll take your word about Dennis. I do know about Sue.” Barry swallowed. “I’m not so sure about me. I did manage to live through her laparoscopy last year, but I’m anxious about how I’ll stand up to this. I’ve seen enough surgery, even done a few sections in the Waveney, but when it’s your own wife you’re watching being opened up?”
“You won’t be. You’ll be sitting on Sue’s right and Dennis will have set up a screen between you and the operative field. I’ll give a running commentary so, unless you want to, you won’t actually see anything.”
“Very well.”
“I’m very glad it’s the late twentieth century.”
Barry nodded and offered up a huge silent thank-you, knowing that Sue would not be exposed to practices of the past. “You mean how back in the Stone Age, male midwives thought the bleeding was coming from the placenta itself, not the uterine vessels, and tried to get the placenta out.”
Harith nodded. “Fatal for the babies.”
“And often the mother too,” said Barry. “Back then in Europe the mother’s life was considered to be more valuable, but the Catholic church taught that if the child wasn’t baptized alive, it could not enter heaven.”
Harith nodded. “Good thing we’re past all that.”
The theatre door opened, and a midwife popped her head in. “We’re ready, Harith.”
“Come on then, Barry. Get a mask and put it on.” Harith rose.
Barry did, and followed Harith into the crowded theatre where Sue lay on the table, brightly illuminated by the powerful overhead light. An intravenous line was set up and running saline into a vein in her left arm. Barry knew that at least two pints of compatible blood would be in the blood warmer. His nostrils were assailed by the smell of a powerful antiseptic.
“This is Doctor Laverty, and, Barry, you already know Dennis.”
The anaesthetist waved from where he was sitting at the head of the table beside his anaesthetic machine, there in case Sue needed extra oxygen. “The young lady by the incubator over there is Doctor Betty Rea, our paediatrician.”
She nodded at Barry.
“Behind that mask and already gowned and gloved is Doctor Fred Spence, my assistant.”
Fred paused from painting Sue’s upper thighs and abdomen with a brown antiseptic fluid and arranging green sterile drapes over the operative site and nodded at Barry.
Harith whispered in Barry’s ear, “Fred will immediately start making the incision if I cause bleeding when I do the pelvic examination, because I’ll have to re-scrub and time will be of the essence.”
Barry flinched.
Harith spoke in his normal tones, “Sister Barbara Little, on the right of the table, is scrubbed, and as you can see all the packs are open and ready to go on her instrument table. Midwife Denise Wallace is our circulating nurse. Now I’m off to scrub. Go to your wife. I won’t be long.”
Barry walked round past Dennis to a small circular stool on casters on Sue’s right, near her head. He shook Dennis’s hand. “Good to see you again. You and Sue must be old friends by now. Thanks for looking after her.”
“Any time, my friend.”
Barry looked at Sue. “This is all going to be over very soon, pet. I’ll be here, and Harith will give us a running commentary because we can’t see over where that sterile towel is held up by a barrier. If there’s something Harith says that you don’t understand, just ask me.”
“All right. I think—no, I know I want to understand what’s going on. Harith telling us means he’s seeing me and the baby as real human beings, not a technical surgical problem.” She smiled. “And, besides, it’ll give me something to think about instead of just lying here scared stiff.”
“Me too. It’s the not knowing what’s going on, imagining the worst. And Harith has always been a humane man.” Barry looked to his right. He could see Barbara and her instrument table.
Harith returned and stood to Sue’s left side. “Now, Sue, I’m going to empty your bladder because a full one can get in the way and then examine your tummy and down below. You’ll not feel anything.”
“All right.”
“Usually we put a patient having a pelvic examination up in stirrups, but I just want you to open your legs and flex them.”
Barry knew why. As a student he’d seen a woman like Sue in stirrups bleed profusely. In the time it took to get her properly positioned for surgery she must have lost half a pint of blood.
Sue did as she was asked.
Harith slipped a catheter into the bladder and Barry heard the tinkling of urine into a steel basin held by the circulating nurse.
“Now your tummy.” His hands moved surely. “We know from the X-ray there’s only one baby, lying longitudinally. The foetal heart rate before Fred started prepping you, Sue, was one hundred and forty-four. Now, what I can tell you is that the baby’s head is not engaged and seems to be displaced to the left.”
“What does that mean, Barry?”
“Perhaps something like the afterbirth is keeping it out of the pelvis.”
“I see.”
“I’m passing a speculum because since you haven’t bled since admission there will be no clot to obscure my view.” Harith bent over, peered in, and straightened up. “I can tell you there are no obvious causes for blood loss in here.”
This was certainly looking more and more like placenta praevia. Barry reached down and took Sue’s right hand.
“Now I’m going to examine you pelvically, and I’m going to try to push the baby’s head into the pelvis, but I think I can feel that there’s something between my fingers and its head.”
Barry took a deep breath. That “something” must be the placenta.
“I’m going to proceed with great caution. I can get one finger through your cervix, Sue and—oh-oh, the inside opening is completely covered.”
Harith withdrew his fingers. “Dennis, get a pint started, please.”
Barry smelled blood. Sue was going to need a blood transfusion. He closed his eyes. Please, let the bleeding be light. Please.
&nbs
p; “Please close your legs and unbend your knees, Sue.”
As she did so, Harith spun on his heel, stripping off his gloves. He headed for the scrub sink, saying over his shoulder, “Get going, Fred, and explain as you go along.” His voice was calm, but Barry could hear the urgency.
Dennis tilted the table five degrees head-down into the Trendelenberg position, and Fred said, “Mrs. Laverty, the afterbirth is coming first. I’m going to start the section. Scalpel, Barbara, and then assist, please.”
Dennis rose, went to the blood warmer, came back, and changed the saline for a pint of blood, sat on his stool, and began to monitor Sue’s pulse and blood pressure.
Barbara gave Fred a fifteen-foot strip of nine-inch gauze, specially folded. It would be used for mopping up blood and fluid. As it was used and saturated, it would simply be fed over the edge of the table so it would be easy to find before the wound was finally closed. He said, “I’m making a Pfannenstiel, that’s a bikini incision, Mrs. Laverty. Clamp the bleeders, Barbara, but we’ll not tie them until we’re closing.”
Sue screwed up her eyes and clung onto Barry’s hand.
That transverse incision was quicker to heal and more cosmetically acceptable than one done vertically in the midline.
“Now the fascia, that’s a layer of tough fibrous tissue over the two big up-and-down muscles in the midline of your tummy. Scissors.”
By now, clearly aware that she could feel nothing, Sue had opened her eyes and relaxed her crushing grip.
Barry had relaxed too.
A freshly gowned and gloved Harith stood behind Fred until he gave the scissors back to Barbara and said, “Done.”
“I’ll take over.”
Fred went to the other side of the table and Harith moved in.
“Those muscles Fred mentioned, the rectus abdominis? I’m going to part them.”
Barry pictured Harith’s elbows rising until they were horizontal then moving apart by about eight inches.
“Forceps. Scissors.” Pause. “We’re in.”
Harith had made an incision in the parietal peritoneum, the thin membrane that lines the entire abdominal cavity.
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