‘While I have performed fetoscopic laser surgery on triplets, I will not deny that on quadruplets it will be a slightly more challenging procedure. However, the direct visualisation through the fetoscope will allow us to successfully perform a targeted and focused laser termination of the vascular communications directly responsible for the TTTS and effectively separate the placenta into two components, one for each foetus. With each baby having its own placental mass, and the removal of this communication, there will be an interruption to the transfusion process and we should stabilise the situation so we can advance to a gestational age where the four babies in this situation all have a greater chance of survival. Does anyone have any further questions?’
‘If the parents of the quads did not agree to the surgery, what would the risk be to the other three babies if the recipient baby went into stage five heart failure and died?’
Juliet could see the question came from one of the interns. ‘That’s a very good question. If one foetus was to become non-viable through cardiovascular complication arising from the TTTS, then it would put all three remaining babies at high risk of death, injury or disability. Essentially the fetoscopic laser procedure has taken what was until relatively recently a lethal placental disease and turned it into a manageable condition if detected early.’
The specialist team were all silent. Each nodded their understanding.
‘Just one more question. If the outcome of moving forward with this intervention is pre-term delivery, are you certain that you’re sufficiently prepared for the arrival of four twenty-nine-week gestational babies with a current average weight of less than three pounds?’
Even without hearing the voice or seeing the man, Juliet knew the question had to come from Charlie, who was standing with folded arms at the back of the room. She took a deep breath. But instead of feeling resentment or interference, she appreciated the question. It was fair and one he had every right to ask in that arena and one that others might have been wondering about.
‘Yes, Dr Warren, that’s why we have assembled a multidisciplinary team who can deal with all potential outcomes including pre-term delivery. In addition to Ella, who is Georgina’s midwife, and two anaesthetists, Mr Darrington has already approved the four neonatal intensive care nurses and two neonatologists who are here with us today, and a senior paediatrician, paediatric resident and a paediatric cardiologist, all of whom I assume you will recognise on the day but can’t be at this briefing. In all we will have sixteen in the medical team, three observing and four incubators in Theatre. All of which, God willing, will be under-utilised on the day.’
Surrounded by Theatre staff, many in scrubs, Juliet suspected the imminent laser surgery for his patient became more real in Charlie’s mind, giving rise to his ongoing concerns.
‘Good, I’m not surprised you have it under control, Dr Turner. Let’s hope we don’t need any of it,’ he said, then turned and walked away leaving a tiny grain of doubt in Juliet’s mind.
Juliet never operated with doubt over anything. She needed to manage it immediately.
CHAPTER TEN
‘CHARLIE, MAY I see you for a minute?’ Juliet asked at the same time as she knocked on his open door. She had excused herself from the pre-operative meeting with the medical team and followed him back to his office. ‘I need to ask your advice with regard to a question hanging over Friday’s procedure.’
‘What would that be at the eleventh hour?’
‘It’s hardly the eleventh hour.’
Charlie rolled his eyes as Juliet stepped inside his office and closed the door behind her. Normally she would have shown professional courtesy by involving him in her plans earlier but his initial reservations had ensured that did not happen. She stepped closer to his desk and looked him directly in the eyes. ‘I should have asked for your input around the team. I realise it may have come across as if I’ve gone behind your back and made arrangements with your Assistant Head of Obstetrics with no input from you as the quads’ consulting OBGYN.’
‘What’s done is done,’ he said as he continued rifling through the paperwork on his desk.
Juliet pulled out the chair opposite and sat down. ‘I am sorry about the way I’ve handled this. I’ve been a bit like a bulldozer.’
His gaze lifted from the paperwork and met hers. ‘Perhaps a mini dozer.’
She smiled. ‘I really do appreciate you agreeing to be there in the surgery with me. Not for protocol...just because I need you there.’ As the words slipped over her lips she surprised herself. Juliet never admitted needing anyone. And it wasn’t just to make up for what she had done. She meant it. She actually needed Charlie.
He said nothing for the longest moment, leaving Juliet wondering what he was thinking.
‘Let’s just hope the procedure doesn’t induce an early delivery because all four are too small for my liking.’
‘I agree, that’s why I need your advice around my contingency plan for that occurrence. Do I have everything in place? You’ve delivered more babies at this hospital than I’ve seen in my life and I’m not afraid to say that I feel a little like a fish out of water and I want your advice on how we can best prepare for the worst.’
Over the days since she had arrived, despite their disagreements, she knew Charlie was a great OBGYN. It was his passion for what he believed to be best for his patient that fuelled his stubbornness. Juliet knew he cared over and above and, while she conceded he was not one to take risks, perhaps that would make their collaboration perfect. He could temper her risks, mitigate the strategies and together they could find the best way forward.
‘What is it you want to know?’
‘I want to know if we have sufficient staff on board for starters. And if we don’t, I need you to tell me who’s missing. Oliver has left it up to me, and I would like your input.’
Finally he looked up and spoke earnestly. ‘I think you’re fine with the surgical team. Each and every one is the best that Teddy’s has to offer and I don’t think you want to further crowd the operating room. My concerns would be around the anaesthesia.’
‘Why would that be?’ she asked with her curiosity piqued as she shifted to the edge of her chair.
‘If the laser procedure was to be the catalyst for pre-term delivery of the quads you would be looking at a Caesarean if the babies were to have any chance of surviving. They would be barely twenty-nine weeks’ gestation, and babies that premature would not survive the birth canal. There would not be sufficient time for an epidural to be administered so you’d be forced to use a general.’
‘So we’ll have that option on hand?’
Charlie stood and walked around to the front of the desk, crossed his legs and looked directly at Juliet. ‘I think you should try to avoid general anaesthesia.’
With a frown, Juliet continued the questions. ‘How can we though? You just said yourself that our only option if labour was to commence as a result of the laser surgery was a GA.’
‘No, I said that it would be the only option if we weren’t fully prepared.’
‘So you think we should have an epidural in place for the procedure rather than the local anaesthetic and conscious sedation?’
‘Yes, that way we’ll have both bases covered. It would meet your needs during the fetoscopic procedure, but allow a Caesarean to be performed immediately any signs of distress were detected from any of the babies.’
‘It makes perfect sense.’
‘Glad you agree.’
‘Am I missing anything else?’
‘No, I think we’ve covered it all now.’
They both felt the other trying to meet halfway. It was almost as if the slate had been wiped clean in a very short time by them trying to understand the other. It was starting to resemble a collaboration of minds and skills. And each of them was pleasantly surprised.
‘I know we won’t agree on the procedure,’ she began with her mind back in appreciative colleague mode, ‘but I value your advice. I’ll meet with the anaesthetist tomorrow and brief him on the changes and then let the Abbiatis know. I’m glad we agree on this.’
‘I’m glad too,’ Charlie offered as he suddenly saw Juliet in a very different light. He had seen glimpses over the previous days but only in short bursts, before her need to bring home her opinion took over masking the woman he was seeing clearly again now. Suddenly he felt the defensive armour he had worn close to his chest for two years loosening a little. He had not meant to tell her about losing his wife but the words had just spilled out and he was not sorry. Letting Juliet know about his past seemed natural. In fact everything about being around Juliet suddenly seemed very natural.
‘It’s been a long morning,’ he suddenly announced. ‘And I’m quite hungry as I skipped breakfast. Would you like to join me for lunch?’ He felt as if he was getting to know the real Juliet and it had been a long time since he had wanted to get to know anyone. Her interest in seeking his opinion, despite their opposing stands on the procedure, made him feel as if his advice meant something to her. And she had not pried into his personal life. He had told her about losing his wife and she had left it alone. He appreciated that respect of his unspoken boundaries.
‘That would be lovely, Charlie, but I’m due to collect Bea. Would you mind if she joined us?’
‘Not at all.’
Charlie was already smitten by Bea. She was a tiny version of her mother. Just as bossy, just as beautiful...and just as endearing. Her innocent joy of everything festive was making him see Christmas through her eyes instead of a man who had lost his wife at that same time of the year. The distaste he had held for anything close to celebrating was losing ground under the spell of the tiny decorator with a love of tinsel.
* * *
‘Did you know that Charlie helped me with the tinthel on the windowth?’
‘Did he indeed?’ Juliet asked as she sipped her Earl Grey tea in the downstairs hospital tea room. Juliet did not want to let on she had witnessed Bea ordering Charlie around. It still brought a smile to her face as they sat together having a light lunch. Charlie had suggested they could head into town to have something to eat, but Juliet was well aware that he had a patient in labour and already beginning to dilate and thought better of taking him away. The roads were icy and she knew he would be taking his motorbike and the thought of him racing back in bad weather if the labour turned into a delivery without much notice did not sit well with her.
‘Yeth. He was a very good helper. And he carried the boxthes.’
‘Because you were a very good boss,’ he said, with his eyes laughing. ‘And you can’t carry boxes of tinsel with a broken arm.’
Juliet laughed and looked over at Charlie. He was the most complex man she had ever met. He had so many layers and she wasn’t sure why but when he lowered his guard around Bea in particular she could see how very special he was. Juliet watched him smiling down at her daughter. His affection for her was palpable. And it made Juliet happier than she could have imagined. Not that she was looking for a father for her child, but if she had been Charlie would definitely have been a good choice.
Even Bea knew it.
‘And how exactly did carting tinsel for a four-year-old became your role?’ Juliet asked as she watched Bea happily sipping on her oversized chocolate milkshake. She felt certain the ladies in the tea room had found the largest cup and filled it to the brim. Bea’s little legs were swinging back and forth as she gleefully watched the toy train, driven by a tiny Santa, circling a smaller Christmas tree in the corner of the tea room. Cotton wool covered the base of the tree like freshly fallen snow and it had been sprinkled with silver glitter. Juliet could see her daughter was in complete awe of it all. Juliet finally felt she could relax and exhale over her decision to bring Bea with her to the UK.
‘I wanted to check on Bea’s cast,’ Charlie continued. ‘I know you would have been keeping an eye on it, but I wanted see how my workmanship had stood up to the rigours of a four-year-old. Before I knew it I was recruited to decoration duty.’
‘Be careful, knowing my daughter, she’ll soon have grand plans of taking the tinsel to any part of the hospital that is not looking festive.’
‘Oh, she’s already scoped the entire floor and has plans of hospital-wide decorations!’
As they chatted over roast beef and mustard sandwiches all signs of animosity had abated, and for that Juliet was grateful. She could see that Charlie was a good man, a guarded, opinionated and stubborn one, with an overly cautious nature, but nevertheless a good man with a sad past. They spent a little while comparing the Australian landscape to the Cotswolds and then Charlie unexpectedly excused himself and made his way over to a very pregnant woman.
Juliet watched as he chatted with her for a moment and the two of them returned to the table.
The tall, ash-blonde woman was wearing a very tired smile and said, still chatting to Charlie, ‘I can’t join you but thank you for asking, Charlie. After they make my sandwich, I’ll be heading home. I just finished up a long surgical repair of anomalous pulmonary veins on a newborn. It went well but I need a good sleep. I’m exhausted.’
‘I’m not surprised. You’re pregnant and insist on keeping up a fairly heavy surgical roster. You’ll have to slow down soon,’ he told her. ‘But while you’re waiting for your food, let me introduce you to Dr Juliet Turner and her daughter, Bea. Juliet’s the in-utero specialist brought here from Australia to assist with the quadruplets.’
Sienna approached with her hand extended. ‘Welcome aboard, Juliet. I hope you enjoy your time here.’
‘Thank you,’ Juliet said as she met Sienna’s handshake, immediately liking the other woman.
‘Sienna is Teddy’s neonatal cardiothoracic surgeon,’ Charlie explained. ‘And one of the very best so we’re fortunate to have her.’
‘Said by Teddy’s best OBGYN,’ Charlie’s very tired, very pregnant colleague told Juliet. ‘But I should go... It’s nice to meet you, Juliet. Perhaps we could meet up for coffee soon.’
‘I’d like that, thanks, Sienna.’
‘Mummy, ith that a printh?’ Bea interrupted.
Juliet turned her attention to her daughter. ‘Is what a prince, sweetie?’
‘The man up there,’ Bea said, pointing at the large television screen in the corner of the tea room. ‘Ith he a printh?’
Juliet watched the news coverage and read the footnotes on the screen. ‘Yes, he is a prince. It’s Crown Prince Sebastian Falco of Montanari.’
‘Does he have a printheth?’
‘Not yet, sweetie, but he is engaged to be married and they’re making quite the fuss of him. I suppose if you’re a prince they will make a fuss of everything you do.’
‘Will I ever be a printheth?’
‘You’re already my princess,’ Juliet said as she kissed her cheek.
Sienna suddenly grabbed the seat that Charlie had offered. Juliet noticed she had also suddenly drained of colour.
‘Is everything all right?’ Juliet asked. ‘Would you like some water? You look terribly pale.’
Charlie rushed to the cooler and, taking a bottle of water, undid the cap and passed it to Sienna. ‘Get this into you.’
Juliet didn’t understand what had happened as she watched the woman stare at the screen as if she had seen a ghost. She said nothing as she sipped her drink and then looked away from the screen and into the d
istance.
Charlie’s pager abruptly beeped. ‘I’ve been summoned. Looks like there’s another baby about to enter the world. Will you be all right, Sienna? Should I get Oliver to take a look at you?’
Sienna shook her head. ‘No, I’ll be fine. I’ve suddenly lost my appetite. I really need to go home.’
Juliet walked Sienna to her car, and made sure the other woman was safely on her way. She thought that Charlie was right, that Sienna needed to look at slowing down as her pregnancy progressed. It was obviously taking its toll on her.
* * *
The next day, Juliet managed to meet with the anaesthetist to discuss the change of plans. He agreed that the dual purpose epidural would be the better option and that information would be passed on to the rest of the team. She then headed to Georgina’s room to let her know the change to the preferred anaesthetic and explain the benefits of Charlie’s suggestion of an epidural. The results of the daily scans were emailed through to both Juliet and Charlie and thankfully there had been no change to the TTTS status and Juliet wanted to pass this information on as well.
She checked in at the nurses’ station and was told that Leo had headed home to let the family know the latest update and have a good night’s sleep at Georgina’s insistence. He had spent a few nights at the hospital since his return from New York and she knew he would fuss over her if he stayed that night and not get any rest himself. Juliet knocked on the door and asked if Georgina would like company.
‘If you have time that would be lovely,’ the mother-to-be answered as she invited her to sit for a while. ‘I’ve been here less than a week and I’m going a little stir crazy. I can’t imagine how women confined to bed for months cope.’
‘You do what you have to do, and, believe me, if you were told bed rest for nine months to have healthy babies, you would do it. It’s just a mother’s natural instinct.’
White Christmas For The Single Mom (Christmas Miracles In Maternity #3) Page 11