The Pregnant Midwife

by Fiona McArthur

  Stormclouds accumulated off the starboard wing and Kirsten was glad they were in the sturdy Bell 412 helicopter. At least there was plenty of room for the extra staff member and Kirsten didn’t have to stare at Hunter all the way.

  Prior to take-off, baby Isaac’s weight and birth date had been fed into the computer and the MIRA program-generated drug sheets produced the correct dosage for every conceivable drug they might need on the retrieval. This double-sided printed sheet was a valuable tool in saving time in drug calculations and dramatically cut the chance of medication error. The team prepared the most likely drugs en route to save more time at the destination hospital.

  Ellen ran through the probable scenario of arrival for Kirsten, as if she’d never been on a retrieval or even an aircraft before, and Kirsten listened and nodded. At least Ellen was a distraction from Hunter who was on the other side of the cabin, watching with his arms folded. She wished he’d recheck the portable crib or something because she found his scrutiny hard to ignore.

  At last they arrived and Kirsten heaved a sigh of relief. Next time she’d make sure she had the window seat as a distraction.

  CHAPTER THREE

  AT THE destination hospital, if there was time, the first step was always to meet the parents, then quickly move to assess the patient.

  Baby Isaac would become more tired as his in-coordinated heart struggled to achieve what had been so easy inside his mother, and Kirsten knew they’d have to watch out for heart failure.

  Isaac’s parents looked very young as they hovered anxiously on the periphery of the medical drama, and Kirsten went over and shook their hands.

  ‘Hi, I’m Kirsten Wilson and I’m one of the neonatal nurses from Sydney. This must be pretty frightening for you both.’ The young couple nodded and Kirsten smiled. ‘We’re going to keep you updated as we make Isaac as comfortable as we can for the flight. After that we’ll get Isaac and you, Mum, transferred to the major hospital. When you get there, the paediatric cardiologist will talk you through his treatment plan.’

  Lily, Isaac’s mum, clutched her boyfriend’s hand tighter. ‘There seems to be so many people here and Isaac looks so small.’

  ‘I know,’ Kirsten said. ‘But he’s getting the best care so he can have the safest trip we can manage for him. About one baby in a hundred has a heart problem so we’ve done this before.’

  Both parents sagged a little with relief at Kirsten’s confidence. ‘We’ll all be with you until we hand Isaac over to the staff at the city hospital so don’t forget to ask questions as you need to.’

  Lily nodded and Kirsten rejoined her colleagues. She allowed herself a brief stroke of Isaac’s head as she began to record his respiratory rate, heart rate and oxygen saturation as she looked for signs of cardiac failure. Ellen connected the baby to the MIRA monitors as well as the referring hospital’s equipment to ensure constant monitoring during change-over, and she offered Kirsten the stethoscope to listen to Isaac’s chest. The heart murmur was very clear.

  ‘What’s your instinct on this baby?’ Hunter spoke quietly in her ear and Kirsten knew he was testing her.

  ‘He’s breathing faster than he should be so respiration is affected, and he’s sweaty and that’s not a good sign. I’d say he has substantial fluid backing up in his lungs and when I listened to his chest he sounded “wet”.’ She glanced at Hunter. ‘The heart murmur is loud and I’d say it’s a large VSD.’

  Ellen, dressed in a lead apron, held Isaac while X-rays were taken, because it was important to see the quality of Isaac’s lungs and any cardiac enlargement. As soon as they were finished, Kirsten did a quick twelve-lead ECG to give Hunter some idea of the electrical conductivity of the sick baby’s heart.

  Hunter took the chance while the nurses were busy to explain things to the parents and reassure the base hospital staff on the excellent job they’d done in preparation for the retrieval team. She had to admit that when he wanted to use his charm he was a master at putting people at ease, which helped in situations like this.

  She watched him put his arm around Isaac’s mother and clap his father on the back as he congratulated them on their beautiful son. His obvious empathy with frightened parents had a lot to do with the attraction she’d felt for him when they’d first met.

  They couldn’t be friends but they should be professional about their differences at least. She could still admire his skill and empathy as a neonatal intensivist.

  Hunter returned to the baby and the equipment Kirsten had assembled. He inserted an intravenous cannula in Isaac’s hand and when the newborn grasped Hunter’s finger, they shared a smile across the humidicrib at the wonder of tiny babies.

  This was ludicrous, Kirsten thought, and vowed to establish some ‘safe’ camaraderie because moments like this were too special to waste on something that was never meant to be.

  The finality of that thought stayed with Kirsten as she turned away to document the time of insertion and the start of the minuscule measured amounts of intravenous fluids.

  ‘Let’s give him a diuretic to see if we can offload some of this fluid he’s accumulating,’ Hunter said, and Kirsten handed him the preloaded syringe with the ampoule taped to it.

  They checked the dosage together and just as Kirsten started to relax, Hunter had another question for her.

  ‘What else are we looking for?’

  Kirsten glanced down at Isaac and the answer came readily. ‘Probably signs of any other abnormalities or indications for other syndromes that this condition can run with.’ The obvious ones were often identifiable by abnormal facial characteristics. She glanced across at Isaac’s dad, and any facial features that might have hinted at a genetic disease were vetoed by the mirror image of father and son. She smiled, and Hunter, following her thoughts, did too. Then they both looked away quickly and Kirsten busied herself by recording what they’d done.

  All treatment for the stabilisation of baby Isaac would be diligently recorded, as would any improvement or deterioration in his condition. Later in the week, at the team meetings, all cases would be reviewed and discussed to ensure any improvements in care would be noted and used in the next case.

  Within a short while they had achieved the best oxygen saturation and cardiac output they could for Isaac, and all that was left was to fix the cables and tubes, clean up their mess and prepare for transfer.

  For Hunter, working with Kirsten was as hard as he’d feared it would be, yet at the same time incredibly easy. The last few months he’d felt he had become adept at completing retrievals with Ellen and the other neonatal nurses, but with Kirsten the clinical component of patient care seemed so much more streamlined.

  There was no need to ask for anything. She had either already done it or had what was required ready for him to complete the procedure, as it had always been in Dubai.

  And, as it was then, all the time she smiled—at the baby, at the parents, at the referring hospital staff. And at him.

  Hunter had forgotten how much joy she shared with those around her. Even in the midst of tension and fear, she was a reassuring light that parents and staff turned to when things seemed blackest, and suddenly there was hope or at least reason in the chaos.

  He’d blocked out how many times he’d witnessed her like that in the past and he did not want to go there now, but it was hard not to remember. How ironic that she was happy and he was miserable.

  ‘Dr Morgan could explain that better,’ he heard her say, and bit back the contradictory comment that jumped to mind. She could explain anything but this was part of the ‘have faith in the great doctor’ theme that he’d noticed she used at times when she didn’t feel she was getting through to parents.

  He stepped into the breach and smiled. ‘Hi, again.’

  ‘I can’t get this blue and pink blood thing, Doc.’ Isaac’s dad, Lionel, shook his head.

  Hunter nodded. ‘Another way to explain Isaac’s hole in the heart is to imagine his heart as a house with four rooms.’ Kirsten blin
ked and stared at him, and that amused Hunter. He’d picked this technique up from the internet.

  ‘Some babies have problems with the doors or one-way valves between the rooms, some have problems with the plumbing or hallways—that’s arteries and veins in the house—and Isaac has a problems with his walls. Specifically his septum—the two internal walls of the larger rooms have a big hole between them.

  ‘Pink blood that’s come back from the lungs with oxygen on board goes to the left ventricle and blue blood that’s had all its oxygen used by the body needs to be pumped to the lungs via the right ventricle.’ He paused and Lionel nodded.

  Hunter went on. ‘His cardiologist will patch the hole and stop the pink blood mixing with the blue blood so that useful oxygen-carrying blood will be pumped around his body.’

  ‘Like a hole in the carburettor of my car that stuffs the mix?’ Hunter and Kirsten smiled.

  ‘Exactly like that.’

  Lily didn’t even try to understand the mechanics and Kirsten noticed she was becoming more agitated as she watched the door. ‘Are you waiting for someone, Lily?’

  Lily’s eyes filled with tears. ‘My mother. I hoped she’d come back but my dad is still angry with us for having a baby and he might not let her come. I wanted to see her before we left.’ She lowered her voice and Kirsten had to strain to hear her. ‘I’m terrified of going in the helicopter but I know Isaac needs me.’

  Kirsten flagged down one of the staff from the nursery with a big can-you-help-me-please smile and arranged for them to phone Lily’s mum. ‘He’s a very lucky little boy to have a mum like you,’ she reassured Lily. ‘We’ll try and get onto your mother for you but I’ll look after you if she can’t make it before we have to leave. You might like the helicopter ride so much you’ll be surprised. At least when you and Isaac come home you’ll know how brave you were to go in the helicopter. You’re doing something no one else can do for him just by being there.’

  Lily smiled weakly and nodded. ‘I hope so.’

  ‘I won’t leave you until someone else is there to look after you,’ Kirsten said, and Lily nodded, relieved.

  They were almost ready to go and unhurriedly, Kirsten gave Lionel final directions to streamline his arrival in the city later that morning.

  Hunter shook hands with the referring hospital’s doctor and glanced across at Kirsten. No wonder Jim had been pleased to see her back. Kirsten was invaluable in this job and Hunter had to rethink any inclination to not make it easy for her.

  It wasn’t in the interests of MIRA to lose such a valuable staff member. But he wasn’t running away this time so he’d better make the effort to establish a more professional relationship with her. They needed some rules and he’d make damn sure she stuck to them.

  On the flight back, baby Isaac was as warm and sweet as they could make him before his surgery, and would be in the best condition possible to start his next phase of treatment.

  Kirsten spent time with Lily and explained about the tests her son would undergo. Lily shuddered at any turbulence during the flight and Hunter and Kirsten took turns to sit with her and divert her mind with what might be happening for Isaac in the next few days.

  ‘What’s an echo?’ Lily asked, as her fear of flying lessened and she began to think ahead. ‘One of the doctors mentioned it and it sounds very strange.’

  Kirsten smiled. ‘Echocardiography is what it sounds like. It’s a device that detects the sound that is reflected from Isaac’s beating heart and echoes the graph it makes onto a computer screen. You can actually see the different colours of the blood as it moves in and out of the heart on the screen so the echocardiogram can show all kinds of heart problems children and grown-ups have.’

  Lily clutched Kirsten’s hand. ‘He’ll have lots of needles, won’t he?’ Lily obviously had a fear of injections, too. ‘Will the echo hurt him?’

  Kirsten looked across at Isaac as he slept in the crib. ‘For the echo, he’ll probably cry because babies don’t like being without clothes, but it’s very similar to the ultrasound you had during pregnancy except it’s over his chest instead of your stomach. He will have needles for other tests, but try and take it all one day at a time.’

  ‘Will we know how bad his heart is affected right away?’

  Kirsten nodded. ‘If your doctor is there for the echo, he’ll be able to tell straight away or as soon as you see him afterwards.’

  Kirsten noticed Ellen staring at her and she stood up. ‘I’ll be back in a minute to give you an idea what happens when we get to the hospital.’

  She crossed the tiny area to the cribs. ‘Did you want me, Ellen?’

  ‘No. Sorry I was staring, I was actually enjoying your explanations.’ The senior sister smiled deprecatingly. ‘I tend to get bogged down in medical jargon but I can see it’s not your problem.’

  Kirsten laughed. ‘I love this bit. Helping the parents understand what all the procedures mean so that they can project more calmness for their babies. I really think the babies pick it up if the mums or dads are scared.’

  Hunter rolled his eyes and Kirsten stared him down. She was sick of his non-verbal innuendos. ‘You used to think so, too, Hunter Morgan, so don’t roll your eyes at me.’

  ‘It’s your hobby-horse.’ Hunter raised his hands in surrender and Ellen stared at them both, finally twigging there was a ‘past’ between them—which explained a lot.

  By the time Isaac was transferred into NICU, Lily was composed and determined to stay that way for her son.

  The three MIRA personnel saw the infant safely connected to the hospital’s monitoring system and then removed their own leads. When hand-over was complete, Hunter saw Kirsten hug Isaac’s mother. How many times had he seen her do that?

  It looked as though she had a new best friend to promise to visit the next day. With a stab of discomfort his mind shied away from the times she’d done and said some of those same things to him.

  Ellen turned to look as well. She grimaced and lowered her voice. ‘She’s good. I was just about sick of Jim singing her praises, but you can’t help but like her. And she’s excellent with the parents. One of the girls is off sick for the rest of the week. I’ll take her shifts and I’ll recommend that Kirsten doesn’t need further supervision.’ She turned away and Hunter followed her. Great, Hunter thought, so there’d only be the two of them! It would be even harder to ignore her.

  Back at headquarters, the window of opportunity for lunch wasn’t ignored because MIRA staff never knew when they’d have time for the next meal.

  Kirsten pulled her sandwiches from the fridge and glanced out the window at the busy car park below. There had been a few moments of awkwardness but all in all the morning with Hunter had progressed fairly smoothly. If there had been any problems working with him in the clinical situation, she would have had to rethink her position here. But while working with Hunter was a challenge, it was satisfying because he knew what he was doing and together they made a formidable team.

  Kirsten heard the chink of money being fed into the machine and turned to see Hunter lift a frozen meal from the slot in the machine.

  ‘I see you’re still a mean cook!’ The words were out before she could stop them, and she thought he was going to freeze her out, like his pre-packed lunch. To her surprise he took her words in the spirit she’d intended.

  ‘Yep.’ He glanced down with a wry grin at the plastic wrapper covering his meal. ‘As long as I read the instructions every time, these turn out perfectly for me.’

  Their eyes met in mutual memories. Hunter’s lack of culinary skills had been the source of amusement between them and some of the more precious times had been when Kirsten had cooked for him in the tiny community kitchen. They both looked away and Kirsten’s appetite suddenly deserted her. She pushed her paper bag back into the fridge and walked past him to leave the room.

  Hunter raised his hand. ‘Just a minute, Kirsten.’

  She stopped and the tension in the room went up a notch. />
  ‘It looks like we’ll be working together often and I’d just like to make several things clear.’

  Kirsten raised her eyebrows. ‘By all means. As in rules, you mean?’

  He stared at a spot over her head. ‘Exactly.’

  ‘Good.’ Kirsten wasted no time. ‘Please, don’t sit with your arms folded and stare at me when I’m trying to listen to someone.’ She was delighted to see him actually shuffle his feet.

  To give him his due, he didn’t dispute it. He even smiled. ‘Granted. I may have done that and, no, it’s not acceptable.’ He met her eyes. ‘What I meant was that we’d be as professional as I know both of us can be because I think that’s the only way this can work.’

  ‘I agree. But what about trust, Hunter?’ He froze and she went on. ‘Do you trust me when I say I’ve given a drug or said I haven’t? How can you trust me professionally when you can’t trust me privately?’

  ‘I trust you professionally and any further discussion of the past is exactly where I want to draw the boundaries. Personal discussions are not on.’

  ‘Surprise me,’ she said dryly. ‘Any more rules?’ When he shook his head she left the room.

  He stared after her and sighed. There was so much about the surface Kirsten he really liked. More than liked. Then there was the other side of her that made him wish he’d never met her. Even watching the way she’d greeted the pilot that morning had raised his blood pressure, and he had no right to even notice how she interacted with other men. Yet every time he turned around she seemed to be in some sort of relationship with another attached male.

  Apparently, women like Kirsten couldn’t help themselves, and that behaviour didn’t bode well for the man who would eventually try to tie her down. He had accepted that he could never be that man but he wished he could figure out how she thought for his own clarity of mind. Or was it just that she was an adventurer in the true sense of the word?

  He’d over-microwaved his food again. While he chewed he couldn’t help remembering the good times they’d shared in Dubai.