She pushed that thought away and tried not to think about it, taking a note of the time on the clock on the wall.
Viv moved automatically into midwife mode, reassuring her patient, even though she didn’t speak the language, and letting Lien or Duc take time to translate everything she said.
It was a stressful situation for everyone in the room. Joe and Lien were calm influences, moving smoothly and easily. They seemed to foresee each other’s actions. It was interesting to watch them work together.
Vivienne took charge. Assessing her patient. Directing her not to push. She attached a monitor to the baby that would alert her to any signs of distress.
‘Okay, folks,’ she said calmly. ‘We’re going to try a change of position. It’s called the McRoberts manoeuvre and it’s used in this condition to try and release the shoulder. What we really want to do is create some space in the pelvis, and we need to move mum and, sometimes, baby to do that.’
She gave Lien a nod, waiting for her to explain to Resta that they were going to help her to lie on her back and move her legs outwards and up towards her chest. As this was a delivery room there was no end on the bed and Vivienne could move easily to try and assist.
She kept her face completely neutral. ‘This entirely depends on the baby’s position. If it’s the anterior shoulder caught under the symphysis pubis, this tends to work.’
‘And if it’s not?’ Duc’s dark eyes met hers. He’d moved behind the patient, supporting her position.
Vivienne kept her voice calm and low. ‘If it’s both shoulders, they’ll be stuck under the pelvis brim and this won’t help. But this is where we start.’
She kept calm. Running through the mental checklist in her head. Waiting to see if the change of position would have any effect on the baby’s ability to be delivered. She was lucky. This baby wasn’t showing signs of distress. Yet.
After a few minutes she shifted to the side of the bed, giving Duc a nod. ‘I’m going to press on the abdomen just above the pubic bone to try and release the shoulder. Can someone explain to Resta and keep reassuring her?’
Duc nodded and spoke in a deep, low voice, his hand gently on the woman’s arm. She could tell that the woman seemed to trust what he was telling her, even though she was clearly exhausted. Viv understood that at this stage all any woman wanted was to deliver her baby and have it safely in her arms.
It was interesting. She was in a room with three doctors, who were all perfectly willing to allow her to take the lead. There were no power struggles in here. Everyone just wanted this baby out safely.
Vivienne kept a careful eye on the clock and the baby monitor. Timing was crucial.
‘Okay, time to try something else, I’m going to do something called the Rubin manoeuvre to try and release the baby’s shoulders.’
She explained carefully, then slid fingers in on either side of the baby’s head, trying a number of techniques, without success.
The baby’s heart rate started to slow. Both mum and baby were tired, and the baby was starting to get distressed.
She was calm and methodical, secretly glad that the heart monitor wasn’t on her instead of the baby because, despite everything, panic was definitely setting in. She wasn’t quite sure how long it would take them to set up a theatre if need be.
‘Okay,’ she said. The baby’s head was still wedged tightly, with very little room for a blade to make an episiotomy. ‘Let’s try mum around on all fours. Let’s see if a further change of position lets things move on.’
In another few minutes she would need to attempt to deliver one of the baby’s arms or give Duc the nod that they needed to head to Theatre. She was running out of options.
Lien explained in a reassuring manner to Resta what they wanted her to try, just as Vivienne sent a little prayer skyward. Joe and Duc helped mum around and baby let out a little grumble at the change of position.
But within a few seconds it was clear it was the right move. Resta was on all fours on the bed. Viv hated the fact she no longer had eye contact with mum, but this was a case of needs must.
Almost instantly she could see a change. ‘Give me a second,’ she said to the others. The baby’s face looked a little more relaxed. ‘I think the shoulder’s been dislodged. Tell Resta to give me a push on her next contraction.’
One minute later the little bundle slid out into her arms. After a few seconds of shocked silence the baby started screaming. Vivienne did a few quick checks. Colour was good. Baby was breathing.
Joe appeared at her side and held out his hands for the baby. Duc helped her clamp and cut the cord, then they helped Resta turn back around to deliver the placenta. Viv caught Joe’s eye. He gave a hopeful nod. When shoulder dystocia had a complicated delivery there could be injuries to the baby’s shoulders and nerves. The baby would need to be observed. But for now he brought the baby over to let mum have a cuddle. ‘Đó là một cô gái,’ he said.
A girl. She recognised the word. Mum looked thrilled. The relief in the room was palpable, all the professionals exchanging glances. Duc shot her a smile and gave a grateful nod of his head as he walked back towards her. ‘Thank goodness you were here,’ he whispered.
Viv looked around the room as she started to tidy up. ‘I’m sure you would have all got there.’ The clenching in her stomach was only just starting to ease.
Lien came over and rubbed Viv’s arm. ‘Thanks so much.’ She glanced at her husband. ‘Sorry for the rude introduction earlier. Joe and I can take it from here. You must be exhausted.’
Viv nodded. ‘I am, but let me finish the notes and a few final checks on mum.’ It didn’t matter how tired she was. She would always make sure her clinical work and her paperwork were completed.
One of the aides brought in some jasmine tea, and Joe did some more checks on the baby. As Vivienne made sure she was satisfied that mum and baby were settled and well cared for, Duc slung an arm around her shoulders.
‘You look as if you haven’t slept in a week. Let’s go. Those jammies are still waiting.’
They walked back out into the cooler night air. Viv stopped for a moment, putting her hands on her hips and arching her aching back.
‘Okay?’ He was right next to her, the warmth from his body crossing the minuscule space between them.
She looked up into his dark eyes. ‘You weren’t joking, were you—when you said you’d no one for obstetrics?’
His dark eyes clouded. He shook his head. ‘No. No one. I don’t know when, or if, our other doctor will be back. This was an area that my mother always took care of—was always on top of. The last few days...’ he looked up the dark night sky ‘...I guess we’ve just been lucky.’
‘You can’t rely on luck, Duc,’ she said quickly. ‘That’s not fair on the staff, or the patients.’
He sighed, and she could literally see the energy sagging out of his body. He’d come into that situation tonight, knowing that performing an unfamiliar surgery could be the difference between life and death for that mum and baby. She hadn’t seen him halt or contemplate refusing. He’d been there. Ready to perform if required.
She turned to face him, their bodies almost touching. ‘What would have happened if you’d needed to do a section?’
He paused for only a second. ‘Then I would have done a section.’ He looked down at her. ‘I’m sure you could have talked me through it.’
Viv’s skin prickled—and not in a good way. ‘But that puts horrible pressure on you, and me.’ She shook her head. ‘This can’t happen again.’
He stepped back and ran his hands through his hair. ‘You think I don’t know that?’ He threw his hands upwards. ‘You think I wasn’t in there absolutely crapping myself?’ He turned his back and took a few steps away from her, his momentary flare of anger starting to dissipate. ‘You think I want any of this, Viv?’
His voice broke
and she stepped forward and took his hands in hers. He kept talking. ‘Of course I don’t. But tonight would have been considered emergency surgery. Whether obstetrics is my area or not, I’m still a general surgeon. I would still be expected to perform emergency surgery as and when required.’
His hands were shaking, and she realised just how scared he had actually been.
‘I don’t want to be here, Viv. I don’t want any of this. But what can I do? The worst part about all this—I don’t even feel myself right now. I can’t be myself. I need to be Khiem and Hoa’s son.’ He had a bit of a wild, panicked look in his eyes. ‘The one who will sort out the hospitals and make sure the patients are looked after. The one who will make sure everything keeps running exactly as it did before—supplying all the same services for patients, even though we’re two doctors down. Maybe I just wave my magic wand and whip them out of thin air? I tried to place an advert and begin the recruitment process yesterday—but apparently there’s some red tape and I need to meet with the lawyer first. How can a hospital run with no doctors?’
He put his hands on his hips and took a few deep breaths, his head downcast. Now she understood the pressure he was truly under. Before, she’d just been thinking about the grief of losing his parents. But it seemed she really should have paid much more attention to his panicked phone call. He raised his head and met her gaze, pressing a hand to his chest. ‘I can’t just be Duc Nguyen, surgeon from Philadelphia. The guy who was just about to sign on a house he’s spent the last six months looking for. The guy who had been tipped that he was going to be offered the next slot on the team at the teaching hospital. I’d even been told to start thinking about recruiting my own team.’ He threw up his hands. ‘This is just not where I thought I would be.’
She reached over and put her hand on his arm, gently bringing it back down. Part of her had always envied Duc and his lovely family life. But now she could see how much pain it had unlocked for him. Maybe her detached way of life was actually easier.
She hadn’t known about the house, or the potential to become a permanent member of the team in Philadelphia. That was huge. He must have done so well. It was clear they were impressed by him. Now she understood exactly how much being here was costing him.
He closed his eyes and spoke quietly. ‘The reading of the will is in a few days and then I’ll find out what my parents’ plans were for this place.’ His face crumpled. ‘They always mentioned they wanted me to take over—and I always told them my heart was in surgery. But we never had a truly serious conversation—not one with plans and lawyers. Our half-hearted discussions took place at the dinner table or between seeing patients when I came back and helped out during the holidays. Now I’m realising how much I don’t know. I guess we just never imagined that something like this would happen.’
He shook his head. ‘Until it did.’ He held out his hands for a few seconds, before walking closer and resting them down on her shoulders.
His head dipped towards hers. And they stood there for a few seconds in the moonlight with their foreheads touching. ‘I’m just glad you’re here, Viv. I couldn’t cope with any of this without you.’
She had so much she wanted to say right now—about the hospital, the responsibilities, the issues that needed to be sorted out straight away. But it wasn’t the time. He didn’t need that right now. What Duc needed right now was his friend.
She reached up and put her hand over his, giving it a squeeze. ‘And you don’t need to.’
They stood for a few more moments, before Duc slung his arm back around her shoulders and they walked back to the bungalow.
As he pushed open the door, he gave her a half-smile. ‘Hey, Viv?’
She was already eyeing her discarded white pyjamas, dying to jump straight back into them. She glanced back at him. ‘What?’
He gave her a weary smile. ‘Welcome to Hanoi.’
CHAPTER FOUR
VIVIENNE HAD WORKED in a lot of places. She generally lasted between six months and a year before moving on. She made friends superficially at each new workplace. She was good at her job and generally had a good feel for people—she naturally knew who to avoid and who to trust. Her instincts had always been sound—except, of course, when it came to men.
Viv seemed to have an inbuilt ability to find the worst man in the room—no matter where she was. Her love life had been one disaster after another. The only guy that had been half-good was Archie, an electrician she’d met when she’d worked in Bristol. Archie had been too good, too nice—even Duc had liked him. But Archie had got too close. He’d tried to support her when she’d tried to trace her birth mum and then found out she was dead. His sympathy had felt overwhelming. His questions about how she was feeling had probed into emotions she wasn’t ready to deal with. It was almost like he had been trying to ‘fix her’—and Viv didn’t need to be fixed by anyone.
So she’d done what she did best, and retreated quickly. Instead, seeking out men who were their own natural disasters, and emotionally unavailable to her, made her life simpler. It made it easier to keep the shell she’d constructed around herself unbroken. Duc was the only person who’d ever been allowed to tap at the surface—the only man she’d ever really trusted. Which was why she was here, trying to get her head around her role within this hospital.
By day three she’d begun to get a feel for the place again. May Mắn Hospital had always been a little different. She’d only been here for short spells, but there was something about this place—it had a little buzz around it that she couldn’t explain. Before, she’d just imagined it was because of the connection to Duc. His parents had always been the heart and soul of the place.
Walking through the corridors, she could almost sense the echo of them. She half expected to turn a corner and walk into either one of them.
Trouble was, the staff had relied on them so much for, well, everything.
Lien seemed to have a good head on her shoulders for the day-to-day running of the hospital. For the general medical patients she was the go-to clinician. But she didn’t know anything about rotas, ordering supplies, or maintenance of the building. Her husband, Joe, helped out at some of the antenatal clinics. He’d worked as a GP back in Scotland, and could do general antenatal care, as well as regular hospital duties. But what was most interesting was the fact he seemed to have a real panache for working with the kids. They seemed to gravitate towards him—even though he still struggled with the language barrier, much the same as she did. It probably helped that he had a young son of his own, but watching her colleagues gave Viv a chance to understand the skills of those around her.
While all that was well and good, she hadn’t found anyone who had the skills she needed as an obstetrician. There was a visiting plastic surgeon, there was Duc, and there was a whole host of part-time nurses working within the hospital.
Trouble was that between Hoa and the other obstetrician there really had been no one else to look after the steady stream of pregnant women who came to the hospital. Viv had learned quickly that not all women in Hanoi presented early enough in their pregnancy to have any kind of antenatal screening.
Viv was lucky. One of her jobs had been on a Scottish island and had required her to have further training in carrying out sonograms. This meant she found herself doing routine sonograms on a whole range of women at different gestations, coming up against a whole host of potential issues.
The truth was, she couldn’t do this on her own. She was a midwife. Not a consultant.
She wandered through the corridors in the midst of another busy day. Duc was sitting at the desk in her father’s office, his head resting on one hand.
‘Knock, knock,’ she said as she walked in.
He looked up. There were dark circles under his eyes. Even though she knew he went to bed at night, it was clear he wasn’t sleeping.
He started to stand up but she shook her head as she
sat in the chair opposite him. ‘Don’t. There’s no emergency. But we need to talk.’
His brow creased. ‘Just don’t tell me you’re leaving.’
She gave a weak smile. ‘Not yet. But you know me. I never hang my hat anywhere for long.’
He opened his mouth as if he was about to respond, then shook his head and held out one hand. ‘So, what’s up?’
She nodded. This was business. It had to be. She could see gaps that she wasn’t comfortable working around.
‘Things need to be clearer. At any other hospital I’ve worked at, we have protocols. A strict set of guidelines that everyone follows for certain events, certain conditions.’ She gave him a weak smile. ‘Thing is, at May Mắn? The protocols were your mum—literally. She knew everything, and everyone just went on her say-so. While that was fine when she was here...’
Duc winced and she cringed at her choice of words, but Viv kept going, this was too important. ‘Now...she’s not. Staff need guidelines to work to. Written-down guidelines. Maybe even stuck-to-the-wall guidelines. Your mother and Dr Tan were their safety net. Not all the nurses are midwives here. Some of them don’t know the first thing about dealing with maternity patients. In lots of cases the care isn’t difficult. They just need specifics. What to do, what to look out for, when to raise the alarm.’ She paused for a second, letting her words sink in.
Part of her was amazed at herself. She never really stayed anywhere long enough to look at procedures and protocols. Last time she’d been here, she’d been just as guilty of using Hoa as her sounding board. But Hoa wasn’t here now, and staff were unsure.
‘This could be relatively simple. There are protocols and guidelines for most things in hospitals the world over. We can choose the ones that work here, and you can get someone to help me translate them. The staff can do short training sessions, and we can put the most important ones in easy, visible places as reminders.’
Just Friends to Just Married? Page 3