Toby hesitated before speaking. ‘Annie, we’re going to be working together. If you’ve got a few minutes to spare, you might like to wander round the gynae ward with me. We can get used to each other’s ways of working. I’ve got just a few things to check and then I’m doing an exchange transfusion. Want to help?’
‘I’d love to,’ Annie said.
It was interesting, working so closely with him. At first his closeness bothered her a little. When they leaned together over an incubator, sometimes she could feel the warmth of his breath. His arms brushed against hers. Their fingers touched when he handed her a sheaf of notes. There was that tingle that she remembered—but, of course, all that was in the past. Now they were colleagues. And he was both a good doctor and a good teacher.
Both leaned over a premature baby, listened to her heart. Toby said nothing, looked at Annie, his eyebrows raised.
‘Heartbeat a bit slow, bradycardia,’ Annie said. ‘But not too slow, so not a tremendously dangerous thing to worry about.’
‘Prescribe extra oxygen and organise a cardiorespiratory monitor,’ Toby said. ‘The nurses will tell us if there’s any change.’ He grinned, and Annie felt warmth surge through her veins. He went on, ‘And I’m going to rub the baby’s feet.’
Annie nodded. Rubbing the baby’s feet was an ancient remedy, but it often worked.
Then they looked at a baby with cyanosis, a slight blueness of the skin. ‘Peripheral, not central,’ Toby decided. ‘No need to worry, but we’ll keep an eye on the condition. Agree?’
‘Absolutely.’
These were both small problems, the kind of thing that cropped up every day. But the next case was more serious. Toby went to the nurses’ room and came back with Nancy Roberts, a middle-aged midwife with a cheerful disposition. They all looked at baby Helen Carter in her incubator. Helen was very yellow—a sure sign of jaundice.
‘Right,’ Toby said to Annie, ‘for the moment you’re in charge. You’ve looked at the notes and you’ve examined the baby. Now justify what you’re going to do.’
‘Me? I came here to watch and help if you needed me.’
‘Call it a learning experience. I’m less frightening than a consultant. Aren’t I, Nancy?’
‘No,’ Nancy said with a giggle.
Annie steadied herself and concentrated. When the SHOs were following the consultant on ward rounds, they would often be asked to present a case. It could be a nerve-racking experience, under the watchful eye of the consultant and a handful of your peers. Especially if you were questioned afterwards. She realised that this practice could be useful.
She looked at the notes again and then said, ‘The baby presented with jaundice, indicating an inability in the liver to deal with the bilirubin produced. At first phototherapy was tried, and for two days the patient has been exposed continually to a light source, stopping only for feeding and care. However, this treatment has proved ineffective and tests show a rising serum bilirubin level. Now we will replace the baby’s blood with fresh, Rhesus negative, ABO compatible blood. This will get rid of excess bilirubin and increase the haemoglobin level.’
‘Good,’ said Toby. ‘Now, I’ve already passed a catheter into the umbilical vein—where does it go?’
‘Through the ductus venosus and into the inferior vena cava.’
‘And I’ve taken a little blood to…’
‘To test for levels of serum bilirubin, haemoglobin and glucose.’
‘So now we…’
‘Remove five mils of the baby’s blood and replace it immediately with five mils of fresh blood. Then carry on in this way until roughly ninety per cent of the baby’s blood has been exchanged.’
‘Right. So start.’
Nancy had already fitted the giving set with the donor blood container and the jar to receive the discarded blood. A three-way tap allowed blood to be both fed into the vein and taken from it. Annie opened the tap—and watched as five mils dripped out. Then she reversed the tap and watched as another five mils was introduced into the baby.
For fifteen minutes they watched, saying nothing, until Toby broke the silence. ‘OK, everything seems to be fine. The really hard work is now going to be done by Nancy here. She’ll stay and watch, she’ll record the times and amounts of blood, she’ll keep an eye on the electrocardiograph and Helen’s temperature.’
‘And if anything at all goes wrong, I’ll page you,’ the midwife said with a smile. ‘But things seem to be progressing properly.’
‘Good. Now Annie and I can sit and sleep while you do all the work.’
‘Always the same,’ Nancy said cheerfully. ‘See you later, Toby, Annie.’
‘You make a point of getting on with the midwives, don’t you?’ Annie asked as they walked out of the ward. ‘You always have the little extra word for them.’
‘They do a good job, the experienced ones know more about childbirth than most doctors. I’ve learned a lot from midwives.’
‘Nothing to do with the fact that most of them are female?’ The minute she had said it, Annie felt rather guilty. It was wrong to keep reminding Toby of his lady-killer reputation. In effect she had arranged a truce with him so why couldn’t she stick to their unspoken agreement? Their affair was over, to be forgotten. From now on they were going to be just friends.
But this time he didn’t seem too upset. ‘I do like females,’ he said evenly, ‘but mostly I like midwives because they do a great job and certainly help to make my job easier.’
‘I’ve met more than a few who know far more than me,’ Annie agreed. ‘But I’m learning. Now, do we need to have a meeting about this new job we’re to do together?’
Toby thought a minute. ‘It’s probably best to wait until John Bennett has told us exactly what he wants. There’s no point in making plans until then.’
‘True,’ Annie said. ‘Well, see you, then. I’ve got these forms to deliver.’ She strode off down the corridor. As she walked she was conscious of just the faintest feeling of regret. She would have liked to have continued her conversation with Toby. Just about the new job, of course.
It would have interested her to know that at that moment Toby was feeling exactly the same way. He watched Annie’s retreating form and thought how much he was looking forward to working with her. Though he didn’t believe for one minute that he could ever be the big brother she had suggested he could be.
As he stood there, lost in thought, his own big brother walked up and stood beside him. Toby guessed that Jack had come to look at the babies he had operated on that morning. In silence, the two of them watched Annie turn a comer and disappear from sight.
‘I gather John Bennett has arranged for you to work with Annie at this new clinic,’ Jack said.
‘So it seems. I’m quite looking forward to it.’
Jack looked serious. ‘You’re not to mess about with her again, Toby. You hurt her before—possibly a lot more than you knew. Perhaps a lot more than you intended.’
‘Perhaps so. Don’t worry, I’ll be the perfect colleague and that’s all.’
‘Good. If Annie works like she’s been doing recently, she’ll do well.’ Jack slapped his brother on the shoulder and then set off down the corridor.
Toby still had a job to do. He walked back into the ward, smiled at Nancy and said, ‘Go and have a break. I’ll check things here and watch Helen for a while.’
‘Toby, I don’t mind staying, honestly. I—’
Toby flapped a hand at her. ‘The best medical advice ever, given to me by a wise midwife long ago: when you get the chance of a sit-down, take it.’
‘OK,’ Nancy said reluctantly, ‘if you really don’t need me. Notes here are all up to date. See you in a bit.’ She walked down the ward.
Toby checked the notes, checked that there were no leakages in the pipes leading into Helen’s umbilicus. All was well. Then he gazed for a moment at the baby they were treating—and his thoughts started to wander again.
He felt—just a bit—that p
eople weren’t being altogether fair on him. He had been genuinely sorry to hurt Annie and he now knew he’d hurt her badly. But he had warned her that their affair could only be a casual one. Why was everyone getting at him now? If he’d let things go on much longer, they could have been much worse. He knew what Annie had started to want. There was no way he could have given it to her.
But still… she was over him. Now he was looking forward to working with her. As a doctor and a friend.
A week later, Annie was more than happy with her work in the new clinic. It was in a prefabricated unit, about fifty yards from the proper obs and gynae wing. In time a permanent building would be erected there—but for the moment the pre-fab would do very well.
The work was more varied than her work at hospital, she was more her own boss. And what was really pleasant, as promised, she had more time to speak to her patients. They became real people instead of passing figures. She was also getting on well with Toby. They met often, not only during the lunch and coffee breaks they sometimes shared. They had their own tiny doctors’ room. And since there wasn’t the crowd of other medical staff that there had been in the main hospital, they spent much of their time talking to each other. She was discovering a new side of Toby, a side that she perhaps had not noticed or appreciated during their ill-fated romance: a man who was as dedicated to medicine as his older brother—but a man who went to some lengths to hide his dedication. She was learning from him.
Most of her cases she could deal with reasonably confidently. But if she was in the slightest doubt, she would talk to Toby. Usually, he would reassure her that she had done the right thing. Once or twice they had agreed to refer a case to the registrar. It was as well to be certain.
That morning she was working alone in the postnatal clinic. She should have been working with a midwife but there wasn’t one available. Annie would just have to manage but she was happy with this. So far she had seen five mums and babies—all were in because the district midwife had thought it might be a good idea if they were seen again after what was usually the final examination at four weeks. If all was well at four weeks after a birth, then the work of the obs and gynae department was done.
So far there had been nothing serious discovered. Three of the cases she had signed off, the slight problems had disappeared and in future they would be seen by their own GP. In two cases Annie had issued prescriptions and asked the mums to come back in a fortnight: one had an episiotomy that was not healing; the other had a baby with a chest infection that just would not go away.
Now it was time for the last of her appointments, a Mrs Myers. The district midwife had noted that Stella Myers seemed to be suffering from mild depression. Annie read through the patient’s notes, concerned that the depression hadn’t yet lifted. After a birth, most women had a few days in which they felt depressed for no particular reason. A few were lucky, their bodies adapted themselves quickly, reverted to the state of health they’d enjoyed before. Other mums had difficulty in coping with the big alteration in their hormones, in the loss—in effect—of thirty per cent of their blood. And there was the sheer impossibility of getting enough sleep. It was an unusual mum who wasn’t still tired. Baby blues was common—though usually not serious. And normally it would pass after four weeks or so.
Stella Myers was a well-dressed, attractive woman in her thirties. She was well made-up, and had obviously had a recent visit to an expensive hairdresser. She had brought Callum, her second baby, and was escorted by her mother. She appeared calm, cool, and very much in control.
But the moment she handed the baby to her mother, she promptly burst into tears. ‘Doctor, I just can’t cope,’ Stella wailed. ‘I can’t sleep. I’m always tired and… it all seems as if it will go on for ever. I’m depressed. You’ve got to give me something.’
‘Don’t take on so, Stella,’ her mother said comfortingly. ‘Here, take this tissue then calm down and in a minute you can tell the doctor all about it.’
Annie poured a glass of water and handed it to Stella. ‘Sit there and do as your mother says,’ she advised with a smile. ‘Try to calm yourself. We’ll have a chat in a minute, but first I’d like to look at your baby.’
‘Thank you, Doctor,’ Stella said. She dabbed at her eyes carefully, making sure that her mascara hadn’t run.
The examination didn’t take long. ‘You’ve got a beautiful, strong, healthy baby here,’ Annie said. ‘I wish all the babies I see were thriving like Callum.’
Stella shook her head. ‘But he cries all the time! Sometimes all through the night.’
Annie resisted the temptation to point out that that’s what some babies did. ‘It can be very wearing,’ she admitted, ‘but in time it will pass. Now, if your mother would like to take Callum into the waiting room for a moment, I’d like to examine you.’
In fact, Stella was in apparently equally good shape. Pulse, BP, heart, all were normal—in fact, better than normal. But it was difficult to take accurate readings as she kept up a constant barrage of complaints about how depressed she was.
‘Well, I think we’ve ruled out any physical problem,’ Annie said. ‘Now let’s have a chat about how you feel.’
‘I feel helpless. My life’s not worth living, and the baby’s too much work and it’s worst first thing in the morning.’
‘I see. Does it get better in the day?’
‘A bit,’ Stella said reluctantly.
Annie nodded, made a note. ‘Now, Stella, I understand that your husband took a fortnight off after the birth.’
There was a set of questions Annie knew to ask. And at the end of them she was in considerable doubt. ‘I think,’ she said eventually, ‘I think that I’d like to consult my colleague, if you don’t mind. To get a second opinion.’
‘If it’s necessary,’ Stella sniffed. And Annie went to look for Toby.
Fortunately Toby had finished seeing his patients. He smiled at Annie, and although she was about to consult him on a medical matter, although they were just two colleagues, for a second she felt a jolt low down in her stomach. She shook herself crossly. She was working!
‘I’ve got a patient who claims to be depressed and I’m just not happy,’ she told him. ‘It’s possible that she’s… well, she’s kidding herself. But it’s well over four weeks since the birth of the baby so we have to consider the possibility that she might be heading towards genuine depression.’
Both of them knew that, if untreated, depression could become more and more severe.
Toby looked interested. ‘So why aren’t you happy?’
‘This woman has got everything a mother ought to need. Her husband is supportive and loving, the house is fine, there are apparently no financial worries. She has her family living close by and they’re also very supportive and there’s quite a lot of them. In fact, her younger sister’s just had a baby too. The family is delighted with two babies. The mother alternates between the two families.’
‘I see. When in the day does she get depressed?’
Annie frowned. ‘She said it was bad in the morning but got a bit better as the day progressed.’
‘And that tells you?’
‘Well, it’s unusual. Most genuinely depressed mums start the day well and get worse.’
‘True. But still… if there is any chance of depression, you could give her a mild tranquilliser.’
Annie shook her head. ‘I don’t want to start her on drugs if I can help it.’
‘I agree.’ Toby thought a moment. ‘What was her reaction to the birth of her sister’s child?’
‘She says she was delighted. And she says that her sister doesn’t suffer as she does.’
‘Right. Mind if I have a word with her?’
‘I’m asking for advice,’ Annie told him. ‘I’ll be happy to learn.’
Toby entered her room and gave the patient and her mother his killer smile. ‘Hello, Mrs Myers. I’m Dr Sinclair. I’m sorry to hear you’re having troubles, and with such a lovely baby too.�
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With slight irritation Annie noted that Stella seemed to cheer up at the sight of Toby. ‘I’m sure you can do something for me, Doctor,’ she said.
Toby nodded. ‘Dr Arnold here has explained that you’re still feeling depressed. But I’m sure we can do something about it. Now, over the past few weeks your body has had enough physical changes, so I don’t think we’ll be giving you any drugs. Not yet anyway. You owe it to yourself and to your baby to get better nature’s way. So I’m going to arrange for you to be visited by a specially trained therapist. She’ll be able to counsel you and go through all your worries. She’ll help you.’
‘But, Doctor, I need something to help me through the day. Perhaps something to calm my nerves and—’
‘You don’t need anything, Mrs Myers, just your own strength of mind and help from the therapist.’
Annie couldn’t help noticing. Toby was still smiling, was still the all helpful doctor. But there was a definite tone in his voice that said that things had gone far enough. And Stella recognised it. ‘Of course, Doctor,’ she said meekly.
‘Then we’ll arrange it at once,’ Toby said.
‘Could it still be genuine depression?’ Annie asked ten minutes later. They were sitting in the doctors’ room, drinking a welcome cup of coffee.
‘If it is, I believe she’s brought it on herself,’ Toby muttered. ‘You can think yourself into being ill, Annie. From what you told me, she appears to have everything she needs and, from what I saw there, she likes to be the centre of attention. And by having a child herself, her sister took that away.’
‘So you think it’s simple jealousy?’
‘It might be jealousy but Mrs Myers would never admit it—even to herself. Especially to herself. She doesn’t even realise it. She’s got no worries, a loving family, a fine baby. Doesn’t she recognise how lucky she is?’
Annie looked at him in surprise. ‘Toby, you’re getting quite upset about her. What’s wrong?’
He shrugged, and she saw the effort he was making to calm down. ‘I’ve seen genuine depression and it’s not fun. I’ve also seen people putting it on like Stella Myers.’
The Doctor's Baby Surprise - An Accent Amour Medical Romance Page 3