Mission

by Amy Andrews

  ‘She needs rehydrating and if this baby arrives as flat as I think it will, it’ll need some resuscitation. I need Richard and his bag. Now.’

  John nodded sullenly and left. Richard was back in one minute.

  ‘You got fluid in that bag?’ she asked, barely acknowledging his presence.

  ‘Saline, Haemaccel, Hartman’s.’

  ‘Get a cannula in her. Give her a litre of Hartman’s. Any gloves?’

  Holly was relieved to put the latex protection on. She knew from the briefings there was a high level of STDs among the locals and HIV was also prevalent. She hadn’t wanted to come into contact with the girl’s bodily fluids until she had protected herself.

  She inserted a finger and could feel the baby’s head right there. She was almost at the end. But what kind of shape would the baby be in? Was it still alive? This far down the birth canal a heartbeat was difficult to detect even if she’d had the right equipment.

  An oil lamp gave reasonable light and Holly was glad for Richard’s expertise as he easily slipped an IV in and hooked up some fluids.

  ‘Let’s run it in fully open,’ said Holly. ‘Once she’s had it I want to get her up off her back. Get her squatting and see if we can get the baby moving with a position change.’

  The fluid took fifteen minutes to run through during which time Mila had ten contractions and the baby remained stubbornly unmoved. Richard bunged the peripheral cannula and, with the help of John translating, they encouraged a slightly rallied Mila into a squatting position. Holly encouraged Kia to sit on the low bed behind her daughter and allow Mila to lean back against her between contractions.

  Once Mila had adopted the best pelvic opening position, the head delivered quite quickly, despite Holly’s best efforts to slow it down. The last thing she needed was for Mila’s perineum to tear. How would she stitch it?

  Luckily it didn’t happen. How, Holly would never be able to say because the head was huge! Even badly moulded and looking rather cone shaped it was amazingly big. If this baby wasn’t over four kilos she’d eat her hat.

  As she lay down on the floor to get a closer look, Holly wondered if Mila had gestational diabetes. It would explain the huge baby and, particularly with no ante-natal care, the diabetes would have been largely uncontrolled.

  Holly felt her heart rate settle, knowing they were over the hardest part. Only she was wrong. So wrong. It became quickly apparent that the shoulders were now stuck fast. Holly groaned inwardly. Shoulder dystocia? To think she had been worried about a perineum tear! This was much more dire. Much more fraught with complications.

  She shouldn’t have been that surprised, given the circumference of the head. The shoulders were obviously too broad to descend through the pelvis and the anterior shoulder was probably caught on one of the pelvic bones.

  As far as obstetric emergencies went, this was up there. The cheeks of the baby puffed as a contraction tore through Mila but the baby, which should have just slid out, was stuck fast. Holly knew that the cord was being compressed as each second ticked by compromising the baby’s oxygen supply.

  She found herself yearning for the obstetric services that were on tap at a hospital. The very thing that had frustrated her as a student midwife was the one thing she needed now more than anything else. An obstetrician.

  ‘What’s wrong?’ asked Richard. He had seen the play of emotions on her face and knew something wasn’t good.

  ‘Shoulder dystocia.’

  ‘Oh.’ He may have had limited obstetric experience but he knew enough to know it was a potentially life-threatening condition.

  Luckily Holly had firsthand experience with dystocia. She’d been the only midwife in her student group who had witnessed a dystocia delivery.

  He brought the oil lamp down closer to the action. ‘You can do it, Holly,’ said Richard quietly, and squeezed her arm.

  She looked at him and looked at the faith on his face and she just knew that she’d walk over hot coals to prove him right. So, she wanted an obstetrician. Well, she didn’t have one. She had herself and she had Richard—and she could do this. They could do this.

  ‘Richard, when this baby comes out it’s going to be flat as a tack. I’m going to need you to do the resus while I keep taking care of Mila. OK?’

  ‘OK,’ he said.

  She hadn’t expected such a confident reply and his conviction crystallised her thoughts. She straightened her shoulders. If he wasn’t fazed then neither was she—they could do this.

  Holly inserted a finger to see if she could loosen the shoulder off the shelf the pelvic bone had formed. She prodded and pushed and tried to rotate with no success, and as the seconds ticked by she knew the baby was getting closer to asyphxia. She tried to gently rock the baby’s head, hoping to dislodge it from its position. A bit like easing a cork out of a wine bottle. Still no success. Still the clock ticked.

  An episiotomy was what she needed. A surgical incision into the perineum used to create more room by widening the birth canal.

  ‘What are you thinking?’ Richard asked, watching the concentration puckering her brow.

  ‘That I wished I had the facilities to do an episiotomy.’

  ‘I have suture material,’ he offered.

  Holly hesitated for a second and looked around her at the primitive conditions. ‘It’s too risky. If she haemorrhages from the site she’ll die, and then there’s infection.’ She cast another look around her with the eyes of a nurse and saw potential bacteria sources everywhere.

  She felt overwhelmed suddenly and cast Richard a helpless look. Richard understood how she felt. Working in less than ideal conditions was almost second nature for him, but Holly was used to having a gamut of medical equipment and personnel on hand. He understood how alone it felt to be the one every one was looking to.

  ‘Got a plan B?’ he prompted.

  His calm voice intruded on her helplessness. She looked at him and drew strength from his assuredness. She nodded. She had one more manoeuvre up her sleeve. She had to try and deliver the posterior arm to make room for the opposite shoulder. And if that didn’t work she was going to have to perform the episiotomy and pray it didn’t all go to hell in a hand basket.

  He squeezed her arm encouragingly. She drew strength from his faith and turned back to her task. She took a deep steadying breath and inserted as much of her hand into the vagina as she could. She located the arm she needed, flexing it at the elbow and sweeping it up and across the baby’s chest until it was delivered.

  She didn’t have time to congratulate herself. No time to rejoice. She had to hope she’d created enough room to rotate the body and apply downward pressure so the shoulder could finally be delivered.

  And it worked. The shoulder cleared and she pulled the baby free of the birth canal. She lifted it up, looking at the not-so-little boy, momentarily triumphant before his pale face and silent mouth registered and she passed him hastily to Richard.

  Richard’s hand shook as he accepted the wet newborn. Holly had done her bit now it was his turn. OK. This was not his usual area of expertise but the ABCs still applied.

  ‘Rub him vigorously with a clean cloth. Clear his mouth with your finger. Pinch his nose and sweep downward to remove all the mucus.’

  Holly prattled off the orders as she continued to lie on her side on the floor, tending to Mila. Her eyes hadn’t left her patient. Kia handed Richard a cloth and he did as he was instructed. Still the infant remained unresponsive. He could feel a slow carotid pulse.

  ‘What’s the heart rate?’ she asked, looking at him momentarily, her ears tuned for a cry and becoming more alarmed at not hearing it.

  ‘Forty.’

  Their eyes locked for a second, sharing the seriousness of the situation. ‘Don’t let this baby die now, Richard,’ she said.

  Richard moved into action. Its heart needed to beat faster and he knew he was going to have to initiate some external cardiac massage and give the babe some breaths.

  He lay
the baby on the cloth on the ground and, using the tips of his index and middle fingers, rapidly pushed the centre of the baby’s chest. His injured wrists protested the movement but he ignored them. He puffed some breaths into the baby’s lungs by placing his mouth over the baby’s mouth and nose. Once, twice, three times.

  And then the baby coughed and then he spluttered and finally took a breath. The joyous noise of lusty cries filled the air and everyone in the shelter, everyone in the camp, breathed a collective sigh of relief. He watched as the baby pinked up rapidly, waving its arms around, apparently furious at its traumatic entry into the world.

  He handed the baby boy to Mila, whose sobbing had turned to joy. She took him eagerly despite her exhaustion. Both Mila and her mother were crying, gabbling away at each other and talking to Richard and Holly with huge, broad grins.

  ‘They are thanking you,’ said John, cigarette drooping from his bottom lip.

  She was relieved to see the baby waving his right arm around like nothing had ever happened. A high percentage of babies born with shoulder dystocia ended up with impaired or no movement in their affected arm. All the tugging and twisting and pulling required to get the baby out could stretch and irreparably damage the brachial nerve plexus situated in the baby’s neck.

  Thankfully there had been good outcome achieved tonight. Better than Holly had dared to hope for. But what if the baby had died? She glanced up at a very dispassionate John, his cold eyes watching her through a thin trail of smoke. Would it have been a death sentence for them if the baby had been stillborn?

  Back in their own shelter again, Holly looked at her trembling hands and felt the muscles in her legs turn to jelly. She was shaking all over as she sat down and thrust her hands towards the warmth of the fire. The air was quite cool now and reaction to the events had chilled her even more.

  ‘That was amazing, Holly,’ said Richard, feeling on a real high, momentarily forgetting their situation.

  Holly saw the gleam lighting his black eyes and recognised it instantly. It was the buzz that only witnessing the birth of a baby could give you. She knew that look intimately and it reminded her of the reasons she had become a midwife in the first place. Before the politics and power games of obstetrics had jaded her.

  She only wished she could return it. At the moment she was feeling too…strung out. It had been a huge day. Being taken hostage had been bad enough, but the stress of holding a baby’s life in her hands had been much worse. With the adrenaline rush over, all the what-ifs surfaced. She felt absurdly like crying again and the fire blurred before her eyes.

  ‘You were amazing,’ he said, and smiled at her.

  She blinked rapidly. ‘I was scared out of my mind.’

  She shivered as a cool breeze caressed her bare arms. The pale skin puckered and she rubbed the flesh to warm it.

  Her admission caused him to look at her, and he saw her blank expression and the weariness in every line of her body as she sat hunched by the fire. His old protective instincts stirred. ‘You’re cold,’ he stated.

  ‘A little. I’ll just move closer to the fire,’ she said dismissively because she was too emotionally raw at the moment to take his kindness. Suddenly all she wanted was for him to take her in his arms and kiss her and that made her feel even more wretched, because she didn’t understand why she’d feel like this when there were so many more important things to think about. Like her life.

  He shrugged off his long-sleeved fatigue shirt and draped it over her shoulders.

  ‘I’m all right, Richard,’ she restated in a firm voice. ‘It’s no problem. I’m not cold.’

  The shirt was heavenly. It contained his body heat and his smell and she wanted to bury her face in it. Distant memories were being triggered. How many times had he comforted her when she’d needed it? Held her when she’d been upset. Kissed her better when she’d been hurt? He may have always kept a frustrating emotional distance but he’d never denied her physical closeness.

  Accepting his gift would move her into dangerous waters. She was just managing to keep it together and as much as she was over him their situation was extraordinary and she needed a little human comfort now more than anything. The urge to feel his lips on hers was growing so powerful she could almost taste him.

  ‘I said no, Richard,’ she snapped, and shrugged the shirt off her shoulders so it lay in the dirt behind her.

  ‘Hey. What’s wrong?’ he asked, gently grasping her chin and forcing him to look at her.

  ‘Besides being kidnapped by rebels and dying for a cup of tea and being scared witless that baby was going to die and wanting my mother, you mean?’

  ‘Is there more?’ he asked, trying to make a joke, but he could tell by looking into her eyes that she was tired and fragile.

  ‘Yes, actually, there is. I’m sitting next to a man who has no idea that just taking his shirt off for me makes me want to kiss him so badly I want to scream. But he doesn’t want to kiss me, in fact, he dismisses me outright as just some young little piece of fluff. None of which should matter to me because we’re stuck in the jungle with armed rebel soldiers at every turn, and it’s highly likely I’ll die from a rebel bullet long before sexual frustration claims me, but…there you go…that’s how I feel.’

  Oh, boy! She wasn’t kidding when she said there was more. His gut lurched as her admission about kissing him twisted inside him. If only she new how tempted he was!

  ‘I’m sorry for dismissing you as a young little piece of fluff because what you did tonight was incredible. And for what it’s worth, I do want to kiss you, Holly. Very much. But nothing will change the fact that I’m fifteen years older than you and you want things I can’t give you.’

  ‘And what would you do if I just leant over and kissed you?’

  At the moment he’d probably kiss her right back because she looked so small and fragile and feminine by the firelight, and that appealed to him on levels he hadn’t even known existed. And she’d lain in the dirt tonight and refused to give up when a defenceless life had hung in the balance, and that appealed even more.

  Richard swallowed. ‘It would be a mistake, Holly.’ He hoped he sounded more convincing than he felt.

  The fire seemed to crackle louder between them, the insects outside grew noisier as the silence inside the shelter stretched. To hell with him, she thought, and moved her head, her lips, a little closer to his.

  ‘Holly,’ he warned quietly, when he could feel her breath mingle with his. ‘Don’t do this.’

  All you have to do is move away, Richard,’ she whispered, staring at his lips.

  She was right. All he had to do was get up and move away. Now. Right now. But…he couldn’t. And he needed her to see it was wrong.

  ‘Holly, please. It’s not the time or place.’

  He saw her shut her eyes, and he drew in a deep ragged breath as she moved her body back from his.

  ‘Holly—’

  ‘Don’t, Richard,’ she said quietly, turning her back to him and settling herself on the ground. ‘I’m tired and tomorrow I’m going to be forced at gunpoint to climb another mountain.’

  He touched her shoulder lightly. ‘Holly.’

  She shrugged it away. ‘Don’t touch me.’

  Richard spent the rest of the night dozing, waking frequently, throwing another log on the fire and checking that Holly was OK. He told himself he was too alert, too wary to give in to the black abyss of sleep, but in his gut he knew he was scared. Too scared to sleep lest he should dream the dreams that haunted most of his nights.

  He didn’t want Holly to see his vulnerability. She had to believe he was strong. Invincible. That he could get them out of there. She thought he was a tough guy and that worked to his advantage. If she saw him at his worst, the strung-out mess his nightmares always reduced him to, she might lose faith in his ability to get them out of this alive. And that was to be avoided at all costs.

  Richard was awake at the dawning of their second day of captivity and watche
d as the camp stirred to life. The first rays of sun poked through the canopy heating the moisture-laden air. Even this early, the jungle hissed and steamed around them.

  He glanced at Holly, the early morning light filtering through the slats casting shadows against her skin. She’d rolled on her back and her shirt had ridden up, revealing her flat midriff and delicate waist.

  He stared because he couldn’t help himself. Her small high breasts, outlined in all their perfection by the T-shirt, rose and fell in unison with her respirations. Her mouth had relaxed and looked soft and very kissable.

  He felt a stirring in his groin that by itself wasn’t so unusual at this hour of the morning but had nothing to do with his diurnal rhythms. It was the memory of last night’s kiss or near kiss. He could feel the anticipation, the longing as strongly this morning as he had last night. And even hours later, knowing he had done the right thing, it didn’t lessen the impact.

  Holly stirred and stretched slightly, recoiling instantly and becoming fully awake.

  Her eyes came to rest on Richard sitting propped against the wall looking like hell, and she knew she wasn’t just waking from a really bad dream. She was living it. Fortunately the intense pain in her legs overrode any lingering embarrassment from his rejection last night.

  ‘I can’t move, Richard,’ she groaned. She really started to panic then. No way could she manage more mountain climbing today. Would they shoot her if she couldn’t…wouldn’t? Or would they let her crawl on her hands and knees?

  Richard heard the agony in her voice. He knew how badly her muscles must be hurting today. Luckily for him, part of his job involved strenuous physical tests and pushing himself to the limits of endurance.

  Today’s journey was going to be a particularly horrific form of hell for her. Worse than yesterday. She needed to rest but that wasn’t going to happen, and if they had a good opportunity to escape she would have to run. Run hard. There was nothing for it, she needed to warm her muscles up first.

  ‘Stay where you are,’ he ordered as he crawled to where she lay. He picked up her legs and plonked them across his lap.