by Annie O'Neil
“Magnesium sulfate?” she asked as he began speaking in rapid Spanish.
He nodded and handed over the syringe, mouthing, “Four grams in an IV,” as he listened to the response before hanging up and going back to the medicine cupboard.
“Gloves are over there.” Matteo pointed at well-stocked box in the corner.
She snapped on a pair and gave the teen a smile. “Carlita, do you know if you have HIV?”
“I’m okay.”
“Excellent.” At least that wouldn’t be a problem the teen would have to deal with in addition to a newborn.
Matteo cut in, “One of my colleagues—friends—from a local hospital is coming to help. The more hands the better.”
Harriet nodded, swabbing Carlita’s hand after hanging the IV bag on a nearby stand. She gave the teen her best reassuring smile and said, “This won’t hurt too much,” before slipping the needle into her hand after injecting the magnesium sulfate into the IV bag. It wasn’t a cure-all and would take five to ten minutes to be given via infusion pump, but it would help prevent convulsions. Essential if they were to hope for a positive outcome.
“Hydralazine?” Harriet asked when Matteo handed her another syringe.
“Yes. For the blood pressure. We’ll start with ten milligrams and see how she’s doing in ten minutes. Could be it needs to be injected intravenously.”
“Fluid regimen?”
“What happened with the urine test?” Matteo’s eyes scanned the room as if it could answer.
“I didn’t test it.”
Matteo shot her a dark look. Calm. Calm. Be the calm in the storm.
“She’s only just arrived and I don’t know where the dipsticks are.”
His expression softened.
There was some understanding in there. Somewhere. Besides, an emergency birth wasn’t the place for egos. Pure concentration was the only solution.
Matteo began asking Carlita questions in a slow, steady voice as he slipped the blood-pressure sleeve gently along her swollen arm.
Harriet was pleased to realize she was able understand a lot more Spanish than she could speak. At least she wouldn’t be completely in the dark.
“Have you had any seizures?”
“One. That is why I came.”
“You were already in labor?”
“I don’t know.” Her eyes widened with fear. “What is going to happen to my baby?”
“BP is one fifty over ninety-five.” Matteo met Harriet’s eyes with a modicum of relief as he took off the sleeve. If it had been higher—one-seventy over one hundred and ten?—Carlita’s chances of a cerebral hemorrhage would have been increased. As would the likelihood of death for both mother and child.
“Headaches? Blurred vision? How long have your ankles been this swollen?”
Matteo rattled off the questions and Carlita stumbled through her answers as they worked in unison to prepare for delivery. They would need to lower her blood pressure—but not too rapidly, otherwise they risked an acute reduction in the flow of blood and oxygen to the placenta.
“Can you test her reflexes?” Matteo handed Harriet the small instrument as he continued the flow of questions. Abdominal pain? An absence of or reduced urine over the past few hours? Days? They were all clues that, had she been receiving regular prenatal check-ups, would have prevented the severity of her case. Matteo’s face was grim.
“Can you cut off her clothes, please? We need to check the baby.”
“Of course, Doctor.”
Matteo shot her a look. One that was impossible to read. What did he expect? It was hardly the place to call him lover boy. Not that she’d ever, ever call him that.
A sharp rap sounded on the door and a middle-aged man wearing scrubs entered without waiting for a response.
“Matteo.” He gave him a quick nod followed up by a questioning look when he saw Harriet.
“Harriet, this is Dr. Morales, an obstetrician from Hospital de los Porteños. He will help us with the delivery. Carlita? How are you feeling?” Matteo’s attention returned to Carlita, whose eyes suddenly rolled up behind her lids.
“She’s seizing.” Harriet’s words were lost in the flurry of action that followed.
After checking her airway, breathing and circulation, Harriet helped stabilize Carlita’s head and upper body as Dr. Morales administered an additional magnesium sulfate bolus of two grams.
“Do you think we need to use a prophylactic?” Harriet asked. It had been a while since she’d been in a delivery room, but everything she knew was flooding back at a rate of knots.
“Let’s hold off and see how she goes. It could be that her labor has progressed enough that we can deliver,” Dr. Morales replied. “Matteo? How is it looking?”
“She’s already dilated to eight centimeters. Want to wait until ten?”
“I’m not getting much of a read on the baby. Episiotomy?”
Harriet winced when she realized Carlita saw her flinch at the word. An episiotomy would speed things up and with proper anesthetics she wouldn’t feel the cut at all. On top of which, the sooner she had the child, the better. The only way to stop pre-eclampsia from taking both of their lives was delivery of the child.
She took the young woman’s hand in hers and held it tight. Where was Carlita’s family? It must be so frightening to be alone like this.
She looked across at Matteo and Dr. Morales, who were working together like a well-oiled machine. Their exchanges were brief but explanatory. Harriet kept an eye on the obs as they prepped both themselves and Carlita for the delivery, talking her through each step of the journey. Any darkness Matteo’s eyes had carried earlier had lifted, leaving behind the kind, confident doctor she had first met. This was the man she’d heard about for so many years, the one who offered girls a place of refuge, help in a time of critical need.
“It’s okay.” She spoke quietly into Carlita’s ear as they prepared to make the incision. “You’re in good hands.”
* * *
“Here she is!” Matteo gave the infant a swift wipe to clear away any blood and mucus before expertly swaddling her in a light green blanket.
“Look!” He held the tiny infant outstretched in his arms. “We’ve had a baby.”
He’d meant to look at Carlita when he said the words, gave the smile. It was his standard line, but he meant it every time he said it. Especially in cases like this when such a critical medical situation ended with both mother and baby in good shape. Alive. But as he spoke, his body betrayed him and his eyes solidly latched onto Harriet’s.
We’ve had a baby.
Harriet’s lips parted, her eyes widened then clamped tight shut for a moment as if to regroup. No wonder!
The words—usually just a warm welcome for an infant and a “well done” for an exhausted new mother—were suddenly weighted with meaning.
He’d vowed never to have children of his own. It was why this was always the first and last time he held a woman’s child. His fingers suddenly ached to hand the child over. What they’d just been through was a vivid reminder of his vow. Matteo’s sister and her child had died from pre-eclampsia, his sister too frightened by her own pregnancy to seek prenatal treatment. Carlita, he had little doubt, was the same. It was why Casita Verde existed. To try and allow other families’ daughters not to become a statistic, the kind that ended with a funeral.
“Do you want to hold her?”
Harriet’s eyes lit up as Matteo handed the baby across so that she could pass the infant to Carlita.
Something in him softened as he handed over the tiny, wriggling parcel, already complete with a head of thick, dark hair. He shifted his hands away from Harriet’s arms as she took the weight of the baby and again became acutely aware of the connection between them. And not just on a physical level.
She’d more than impressed him today.
Without a thought for herself she had jumped straight in at the deep end, still exhausted from her journey and no doubt wondering where the hell the man who had made love to her with untethered desire had gone. The one who had invited her here and all but cast her aside in the first five minutes.
And here she was, nurturing and supporting someone with utter focus, as if Carlita was the very first new mother in the world. It took a generosity of spirit not everyone possessed. Yes, it was her job. But she did it well. Very well. That much was clear. He added another tick to her list of good qualities.
Harriet ran a finger along the infant’s face, the instinct to nurture coming to the fore before she turned to Carlita.
“Meet your daughter.”
“Do I have to?” Carlita’s pained voice broke the spell.
Harriet looked across at Matteo, unsure what to do. The baby let out a small cry and they all turned to look. Harriet’s arms automatically began an instinctive rocking motion. A lullaby, just audible above the whir of an outdoor generator, came in a low hum from her lips.
“Carlita, mija.” Matteo moved to the opposite side of the bed. “There is no ‘have to’ here. You know that. But I think it might be a good idea.”
“Why?”
He could feel Harriet’s eyes on him. She didn’t really know his style yet and would be seeing first hand how he liked to handle things at Casita Verde.
“I think it is important to say hello,” he began, drawing Carlita’s hand between both of his and giving it a squeeze. “Gracias and adios.” Something he’d never had a chance to say to his sister or her child. And the reason he never cuddled or cooed at an infant. Ten years on it was still too painful. Too raw.
“Thank you?”
“Sí. You are very, very lucky. You almost lost your life today. And your child might have too, but she was smart enough to know you needed to go into labor straight away.” He gave a soft smile. “You haven’t had any prenatal appointments, have you?”
“Not exactly.” Her eyes began darting anxiously around the room.
“There’s no one here to judge you, Carlita. We are here to help you. But what happens now is largely up to you.”
“I know. But she is going to have a good home, so it’s all right! I don’t need to hold her.”
“Which home?” Matteo’s voice intensified. They’d not met Carlita before today and, as far as he knew, she’d not been to the other clinics.
“Here. That’s what you do, right? You’ll find her a nice home and my parents will never have to know.” She began to push herself up, her body and mind still clearly under the light haze of anesthetics.
“No, you don’t, darling.” Harriet pressed a hand on Carlita’s shoulder. “You need rest now. And plenty of it.” She gave her a smile. “How are we going to monitor your blood pressure, your health, if you don’t stay for a while?”
“You’ve got a few days here, mija. Not to mention,” chipped in Dr. Morales, “we’ll need to check your liver for enzymes, thrombocytopenia, hemolytic uremic—”
“Okay!” Carlita waved her hands in the air, desperate for him to stop. “Okay.”
Matteo rose from the side of her bed. “We’ll transfer you to a more comfortable room where you can rest over the next few days and we can keep an eye on you. We will take care of your baby—but as far as your baby is concerned there is no automatic home. No magic queue of parents waiting outside the door.”
Carlita’s eyes widened and instantly filled with tears.
“She won’t go to someone today?”
“No.” He nodded at Harriet, indicating she should hand the baby to Carlita.
“So you have time to say thank you, little one. Thank you for helping to save my life.”
“I was the one who came here!” Carlita protested.
“Because you were in labor. If you hadn’t been...?” Matteo left the question hanging in the air.
Carlita looked at the baby again, lifted her arms then lowered them, nerves getting the better of her.
“What will holding her do?” Carlita sent Matteo a plaintive look.
“Aiie—guapita. Hold her. Just say thank you to la chiquita. If you are old enough to make a baby, you are old enough to say thank you to her for saving your life,” Matteo rebuked the young woman, but with a smile playing on his lips. She was seventeen. Too young and too worldly in equal parts.
He found this moment in the process difficult. He saw it as helping with the parenting he wished his sister had received. And it was so personal. There was no universally accepted way to deal with each and every teen birth. And how to find that perfect balance? Stern, loving, with a healthy dose of arm’s-length understanding?
Carlita looked at her daughter, still being rocked in Harriet’s arms, her wary expression shifting to one of awe. The one that made it worth it. The one that helped them learn.
“Then we will talk about when to call your parents.”
“Que?” There was no mistaking the dismay on Carlita’s face.
“Sí. That’s right. Adoption can’t get underway without approval from a judge and you are going to need their help. I will help, too, but family is important. Now, let’s deal with first things first,” he continued briskly, before she could get too caught up in all the information she’d just received. “What do you think of this little beauty, eh? She has a nice head of hair, no?”
“Sí, Doctor.” Carlita gave him a bashful smile before turning to Harriet to receive the expertly wrapped bundle of baby.
* * *
“What will happen to them?” Harriet had to run a couple of steps to catch up with Matteo as he crossed the courtyard a couple of hours after the baby and Carlita had been settled and they’d said farewell to Dr. Morales.
The sunny, smiling doctor had all but disappeared when they’d left the delivery room. In his stead she saw a man wrestling with something. Balance in a world that would never make sense?
Her question remained unanswered.
“Is that pretty standard?” Harriet tried to match his long, swift strides.
“They’re all different. This is one of the good ones, believe it or not. There will be a bit of a process with the courts to get the child made ready for adoption. Nothing we haven’t dealt with before. It all takes time. Patience.” He snapped the last word as if she’d been hounding him.
Charming! Especially considering all she was doing was trying to work out how things ran, see where she would best fit in for next few weeks.
Out of the way, from the look of things. Rendering this entire journey pointless.
“Shall I just leave you to it, then?” Harriet stopped walking, her voice sounding more confident than she felt. “Now that I’ve played my part in your good deed of the day?”
Where had that come from?
Her fingers automatically went to rub her locket. Pictures of her sister and her parents were in there—a never-ending source of courage. They would’ve been impressed to see her so full of gumption. As well she should be!
Matteo was being cagey. And he wasn’t being fair. She crossed her arms in front of her chest, waiting, watching for Matteo to stop his purposeful striding and pay her the common courtesy she had paid him when he had come to visit St. Nick’s.
A little flush crept onto her cheeks. If you didn’t count spending the best part of two weeks hiding in the patients’ rooms to avoid him. She giggled at her schoolgirl behavior.
“So you think this is all funny, do you?” Matteo wheeled round to face her, green eyes dark with emotion.
The irritation in his voice startled her. She hadn’t meant to offend and certainly didn’t expect this sort of behavior from him. What was going on?
“Of course not.” She stayed silent, arm
s slipping to her sides along with her courage.
He raked a hand through his hair and looked up at the blue sky above them before tipping his head down, eyes meeting hers. “I’m not really rolling out the proverbial welcome carpet as I had intended.”
“Have I done something wrong?”
“No! Absolutely not. It’s just...”
“Just...” she softly encouraged. She needed to know, otherwise there was little point in staying. And in that instant—just imagining picking up her suitcase to leave—she already knew she wanted to stay.
“These situations are complicated.”
“I do work in an orphanage.” She fought the urge to cross her arms. Protect herself. “One filled with dying children, so I’m pretty used to complicated.”
“Of course you are. It’s just...I have a particular way of dealing with the girls. You’re going to see a lot of things that are done very differently.”
“So? I thought the point of my being here was exactly that. To expand my horizons.” She lobbed the words he’d used at her reluctance to leave London straight back at him. If they were going to have this talk? They were going to have this talk.
“What’s so different about what you do anyhow? All I saw was a doctor who saved a teenage girl from dying after safely delivering her child. Then you asked her to acknowledge a few facts about the situation.”
“Sí. Yes, I know what you saw.” He gave her a look that practically screamed, Isn’t it obvious what you’re missing?
Er...no!
“I’m afraid you’re going to have to spell it out for me, Matteo.”
“I’m just not used to being scrutinized.”
“What?” Harriet looked round the courtyard as if hoping to garner some support. “Is that what you feel I’ve been doing? Scrutinizing you? I thought I was just doing what you asked me to do.”
“You did, you were. Are.” The words piled on top of each other as if he was trying to find just the right one.
“Then what is it? What have I done?”
He crossed to her and placed a hand on her shoulder. She shrugged it off. He didn’t get to play nicey-nicey in the throes of this type of conversation.