KIERAN was on a late the next morning and came in to discover a brief email from Judith. Monday sorted. If anyone else read the message, they wouldn’t have a clue what she was talking about, but Kieran knew exactly what she meant. She’d managed to switch her off-duty day.
Life was looking up.
Until the middle of the afternoon, when Margot buzzed through to him. ‘Kieran, we’ve got a possible emergency section in labour room five. Jude’s with Sara—the mum—at the moment. She asked me to get you.’
‘On my way,’ Kieran said. As soon as he rapped on the door, Judith came out.
‘Sara Cox, aged thirty-three, first baby. No complications during the pregnancy or labour—until now. There was a bit of blood when her membranes ruptured a minute or so back.’
‘Fresh?’
She nodded. ‘And the baby’s showing signs of distress—more than I’d expect. I’m thinking vasa praevia.’
Vasa praevia was a medical emergency. A blood vessel from the placenta or umbilical cord crossed the birth canal, and the vessel could tear when the cervix dilated, or it could get compressed between the baby’s head and the walls of the birth canal. Either way, the baby could die from blood loss when the vessel ruptured—as few as one in twenty babies survived.
‘Margot said she’d bleeped the anaesthetist. If you’re right, we’ll need to do a section and the baby will need a transfusion. We’ll need cross-matched blood and someone from the neonatal team here,’ Kieran said. ‘You’ll do the section with me?’
‘Yes, but I haven’t come across an actual case before.’
‘It’s rare—one in three thousand. OK. Let’s see what’s going on.’
Judith introduced him to Sara and her partner Mick.
‘I’m just going to take a look at you and the baby, if I may, Sara.’ At her nod, he examined her, checked the traces, then looked at Judith. ‘Sara, your baby’s showing signs of severe distress and I think it may be a condition called vasa praevia, where a blood vessel is in the wrong place so delivering the baby will be tricky. We may need to give the baby a blood transfusion straight after birth. But we need to deliver your baby right now, so I need your consent for an emergency Caesarean.’ A quick glance showed him that Sara hadn’t had an epidural, and there wasn’t time to arrange a spinal block. ‘I’m afraid it’ll be under a general anaesthetic, so your partner won’t be able to come into Theatre with you. But he can see the baby as soon as possible afterwards.’
‘Sara doesn’t want a section,’ Mick stated.
‘It’s that, or lose the baby,’ Kieran said quietly. ‘I’m sorry, we don’t have time to argue the point.’
‘I don’t want to lose my baby. Let’s do it,’ Sara said.
‘But we agreed—’ Mick began.
‘Can I have a quick word in private, Mr Cox?’ Judith asked. At his nod, she took him into the corridor. ‘I don’t want to say this in front of Sara because I don’t want her to panic.’ She quickly explained vasa praevia to Mick. ‘Sometimes it can be diagnosed before labour, but we can only really do it with a specialist test known as a transvaginal sonography—vasa praevia’s very rare so we don’t tend to scan for it routinely. But the risks to babies with vasa praevia are very, very high. If we don’t give Sara a Caesarean and deliver the baby now, he’ll literally bleed to death—very quickly. In cases like Sara’s, where we haven’t been able to diagnose vasa praevia before labour and deliver the baby by Caesarean section—which is the safest way—ninety-five per cent of the babies die from blood loss.’
‘But a Caesarean’s a major operation.’
‘I know. But without it, your baby won’t survive.’
‘Might he die even if Sara has the Caesarean?’
‘There’s a possibility, yes,’ Judith said, taking his hand and squeezing it. ‘He’ll need to be resuscitated and have a blood transfusion after the birth. But if anyone can save your baby, Kieran will.’
‘I don’t suppose we’ve got a choice, then,’ Mick said bleakly.
‘There’s always a choice,’ Judith said. ‘If you’re both really against having a section, we won’t force it on you. But you need to know all the options and consequences so you can make an informed decision.’
Mick sighed. ‘OK. I’m sorry. I was being selfish—thinking that Sara won’t be able to do much for weeks after the birth, and I can’t get the time off work.’
‘A section isn’t an easy option,’ Judith agreed. ‘But we’ll give you all the support we can. The health visitor and your community midwife can help after the birth, too.’
Things moved quickly after that. Jan, the consultant from the neonatal team, came into Theatre with Kieran and Judith, Kieran delivered the baby, and Jan took over with the baby while Kieran and Judith stitched Sara up again.
‘He’s still not breathing and it’s been five minutes,’ Jan reported. ‘I can’t get a heartbeat.’
‘I’ve already lost one baby this week. That’s one too many,’ Kieran said softly.
‘Oh, I’m not giving up yet,’ Jan said, grim determination in her voice.
‘What about the blood loss?’ Judith asked.
‘About fifty per cent, I’d say. He’ll be in NICU for a while.’
They all knew what Jan wasn’t saying—if she could get the baby back in the first place.
‘Mick’s probably going frantic out there,’ Judith said quietly. ‘Do you want me to give him an update?’
‘Wait another five minutes,’ Kieran advised. ‘If you give him an update on how things are now, he’ll be worrying even more.’
Then they heard a quiet ‘Yes!’ from the corner of the room.
‘Baby’s back. Transfusing now,’ Jan reported.
Judith saw Kieran’s eyes crinkle—his smile was still hidden by his mask. ‘Good work. Thanks, Jan.’ He nodded at Judith. ‘If you want to go and tell Mick the good news, I’ll finish here.’
When Sara was out of Recovery and back on the ward, Baby Cox had been settled into the neonatal intensive care unit and Mick had promised to go and see the baby and bring a photograph back for Sara to see, Kieran and Judith flopped down in the rest lounge.
‘I really, really don’t want another week like this. One baby I couldn’t save, another heading that way…’ Kieran groaned and closed his eyes. Then he sat up again and looked at Judith. ‘Though I wouldn’t have missed the high points of this week for anything.’
‘Having my first baby named after me,’ Judith said.
A smile flickered at the corner of his mouth. ‘I had something else in mind.’
Oh, yes. She knew what he meant all right. Holding hands in the Lotus Palace. Talking to each other late at night on the phone. The kisses they’d shared by candlelight in her living room. ‘Pirate king,’ she murmured.
‘Mmm, that reminds me.’ He stood up, walked over to his locker and extracted an envelope. He threw it over to Judith, who caught it in her right hand.
‘And this is…?’ she asked.
‘Yours. Open it.’
Inside was a tiny Captain Hook on a keychain. Judith grinned. ‘My own pirate.’
He leaned back against the lockers. ‘As I said, I don’t do coconut shies. But pirates…Yes, I can do pirates.’
She remembered their conversation about the treasure cave, and shivered in anticipation. ‘Monday,’ she said huskily.
‘Mmm. Monday.’ Again, he gave her a half-smile, and Jude felt her knees go weak. ‘I’ve got plans for Monday.’
Her heart rate speeded up. ‘Going to tell me what they are?’
He shook his head. ‘It wouldn’t be a surprise, then.’
She groaned. ‘Monday’s too far away.’
‘Agreed.’ He walked swiftly over to the door, locked it, pulled the blinds, then came to stand in front of Judith. He took her hands and pulled her to her feet. ‘So this is on account,’ he said softly, and bent his head slightly.
When the doorhandle rattled, they broke the kiss. Judith’s hands were still entangled in Kieran’s hair, and his palms were flat against her back under her loose shirt.
‘Just as well I locked the door,’ he murmured wryly. ‘Coming,’ he called to whoever was on the other side of the door.
Judith restored order to his hair while he straightened her clothes, and she sprawled back in her chair as he unlocked the door. ‘We’ll have to get Maintenance to look at that lock,’ Kieran said cheerfully. ‘Must have slipped again.’
‘Yes.’ Louise, the senior midwife, smiled at him. ‘I hear you were a hero this afternoon.’
‘Not me, Lulu. It was a team effort,’ he said. ‘Jan’s back in NICU but Jude and I are…Well.’ He shrugged. ‘We need caffeine but it’s just too much effort to go to the canteen and get some. So we flaked out here, in the hope someone would come along and take pity on us.’
‘Oh, poor babies,’ Louise said with a grin. ‘Was that a hint?’
‘Was that an offer?’ Kieran asked, returning the grin.
She rolled her eyes. ‘Honestly. Doctors.’
‘He’ll be your slave,’ Judith promised. ‘So will I.’
Louise chuckled. ‘All right. What do you want?’
‘Lulu, you’re an angel. Thank you.’ Kieran took a note from his wallet. ‘Coffee and a sandwich for me, please—I don’t care what sort it is, as long as it’s food. Jude?’
‘Same for me, too, please.’
‘And whatever you want,’ Kieran added, smiling at Louise.
‘I don’t think the canteen can do George Clooney with ribbon round his neck and a note saying “Happy birthday, Lulu”,’ the midwife teased.
‘It’s not your birthday until next week,’ Judith reminded her.
‘I don’t mind having an early present,’ Lulu retorted, laughing. ‘So it’s food and coffee for both of you—white, no sugar, isn’t it?’
‘Yes, please,’ Kieran and Judith chorused.
When the midwife left, shutting the door behind her, Kieran dropped into the chair next to Judith and curled his fingers round hers. ‘Safe from gossip.’
‘This time,’ Judith agreed wryly.
‘So I’ll have to wait until Monday. Talk to me, Jude. Take my mind off it.’
‘OK. Lulu’s birthday. She’s forty next Thursday.’
‘Mmm, I signed the card and put money in the envelope yesterday. Daisy said she was getting her some posh earrings, chocolates and a DVD.’
‘Yep. And we’re going to decorate her office. We can’t get George Clooney for her, but we could do second best.’ She eyed him speculatively.
Kieran lifted his free hand in a halt sign. ‘No. Absolutely not. I’m not dressing up as George Clooney.’
‘Just to give her a birthday kiss. In scrubs,’ Judith wheedled.
‘Nope. There’s only one woman I want to kiss.’ He leaned over and kissed the tip of her nose. ‘Uh. I shouldn’t have done that. Talk to me, Jude. Stop me kissing you properly.’
Her gaze was fixed firmly on his mouth. The mouth that had traced a necklace of kisses round her throat last night. ‘I can’t remember what I was saying.’
‘Lulu’s birthday. George Clooney. Have you thought about making her a life-sized cardboard cut-out?’
‘With a ribbon and a tag? Oh, yes!’ Judith grinned. ‘Brilliant. So you’re not just a pretty face.’
‘Pretty?’ Kieran pulled a disgusted face. ‘Hardly.’
‘I never did get to tell you, did I?’
‘What?’
‘Last night. The other bit. Tall, dark and…No, I suppose “pretty” doesn’t quite work,’ she teased.
‘If Lulu wasn’t due back any minute now with our sandwiches, I’d make you say it properly.’
‘Oh, yes?’
He moistened his lower lip. ‘I can be very…persuasive.’
‘Monday.’ Judith brought their joined hands up to her mouth and kissed his fingers before releasing his hand. ‘On Monday, I’m open to persuasion.’
By Monday, Kieran was panicking. Supposing Jude changed her mind? Supposing there was a delay on the Tube so she thought he’d stood her up? Supposing…?
But when he walked out of the station at five minutes to ten, he saw her waiting for him where they’d agreed, next to the railings outside the Houses of Parliament. She was wearing a bright pink top that really should have clashed with her hair, but it worked—more than worked. With her hair loose, and dressed in faded denims and flat loafers, Jude looked a million dollars.
He smiled as he reached her. ‘Hi.’
‘Hi.’
‘Um. I’m a bit out of practice at this. Dating. I was going to bring you a single red rose, but I thought it might be a bit naff.’
She smiled back at him. ‘Hey. We’ve got a whole day together. Let’s not waste it in worrying.’
‘You’re right.’ He slid one arm round her shoulders. ‘Let’s go.’
‘Where are we going, by the way?’ she asked as they headed for the other side of the river.
‘Surprise. Well, not that much of a surprise,’ he admitted. It was hard to miss the biggest observation wheel in Europe—particularly when it was right in front of them.
She followed his gaze. ‘You got tickets for the London Eye?’
‘I thought it was the next best thing to the Eiffel Tower.’
She slid her arm round his waist and hugged him. ‘Wonderful. It’s on my list of things I want to do, but I hadn’t got round to it yet.’
‘On a clear day, like today, you can see for miles,’ Kieran told her.
Kieran had pre-booked their tickets so they didn’t have to queue for long before they got into their capsule. They sat simply holding hands as their capsule began to rise on the wheel very slowly.
Then Judith realised that the woman next to her was holding a hand to her chest.
‘Are you all right?’ she asked.
‘I don’t think so—it hurts. And I feel dizzy,’ the woman said. ‘I can’t breathe.’
‘I’m a doctor,’ Judith told her.
‘I’ve got pins and needles. Oh, my God. I’m having a heart attack!’
‘Not all chest pain means a heart attack,’ Judith said gently. It could be angina, indigestion or even a fractured rib. And the woman’s hand was flat against her chest, rather than clenched in what was known as a positive Levine sign, often given by those who were having a heart attack. ‘What’s the pain like?’
‘It just hurts,’ the woman moaned.
Without Judith having to ask him, Kieran was already crouching in front of the woman and holding her hands. ‘Have you had any pains like it before?’ he asked.
She shook her head.
‘Can you lean forward for me?’ he asked gently.
The woman did so.
‘Does it feel any different now?’ he asked.
She shook her head and straightened up again. ‘I can’t breathe.’
‘Jude, have you got a paper bag?’ he asked.
‘No. I’ll see if I can get one.’
While she asked the other passengers in their capsule, Kieran checked the woman’s pulse. ‘Tell me more about the pain,’ he said. ‘Does it feel like someone’s doing something to you?’
She shook her head. ‘I don’t know. I feel strange. Like I’m not here. My mouth’s dry.’
‘Is the pain moving anywhere?’
‘No. It’s just here.’ She rubbed her chest.
Judith returned with a paper bag.
‘What’s your name?’ Kieran asked the woman.
‘Sylvia.’
‘All right, Sylvia. I’m going to help you breathe. I’d like you to put the end of this paper bag over your nose and mouth, then breathe into it.’
She nodded, and started to breathe into the bag. Within a few minutes, her panicked breaths had slowed to normal, and she took the bag away from her face. ‘The pain’s gone,’ she said in surprise.
‘I don’t think you were having a heart attack,’ Kieran said quietly. ‘It looked more like a panic attack.’
‘Panic? But…’ Sylvia frowned. ‘I’m OK with heights. I mean, I don’t like roller-coasters, but this isn’t like that. It’s safe. And…Oh, I’m so sorry. I’ve made such a fool of myself.’
‘Not at all. Panic attacks sometimes happen when you’re looking forward to something, too—it’s an exaggeration of your body’s normal response to fear, stress and excitement,’ he explained.
‘So what does that mean?’ Sylvia asked.
‘When you’re afraid or stressed or excited, your body goes into fight or flight mode—it produces adrenalin, which makes your muscles tense up. Your body also demands more energy, and your muscles need oxygen to help them make sugar into energy, so your breathing gets faster to help your body get more oxygen to make energy.’
‘And that’s what makes it hurt?’ Sylvia asked.
‘Sort of. When you’re breathing very fast—what we call overbreathing—you breathe out too much carbon dioxide. That changes the acidity of your blood, and that’s what causes the palpitations, cramp and pins and needles. The symptoms are frightening, and a vicious circle starts—your body responds to the fear by producing more adrenalin, you breathe even faster, the palpitations and what have you get worse, and your body reacts by producing more adrenalin,’ Judith added.
Sylvia nodded. ‘So how does breathing into a paper bag help?’
‘When you breathe back in again, you’re taking in more carbon dioxide and less oxygen. That helps to balance the acidity of your blood, and gradually your breathing will go back to normal. If it happens again and you haven’t got a paper bag handy, you can cup your hands over your mouth—it’ll do the same sort of thing,’ Kieran explained.
‘So I’m not going to die?’ Sylvia asked.
‘No. The chest pain’s caused by the panic attack—the messages sent from your brain to various parts of your body go into overdrive and it makes you feel pain. Though it’d be a good idea to have a word with your GP. He might run some tests, just to rule out any problems with diabetes or your thyroid, and he might get your heart checked out,’ Judith suggested.
‘I feel so stupid. It’s…’ Sylvia sighed. ‘My husband left me six months ago. I’ve been a bit low, and my girls decided to surprise me with a ticket for the Eye, because they knew I wanted to go on it and they thought it might cheer me up. I never dreamed I’d end up…well…’ She shook her head. ‘Being silly. Ruining your day.’
‘You haven’t ruined anything,’ Kieran said. ‘And panic attacks aren’t “being silly”—they’re real.’
‘Thank you. For rescuing me.’
‘Not at all.’ Kieran squeezed her hand. ‘But Jude’s right. When we get off, sit down and have a drink—little sips of cold water, but don’t gulp it—then make an appointment at your GP’s surgery and have a chat to him.’
‘I will. Thank you.’
A few minutes later, they disembarked and walked along the river, arms around each other.
‘I’d planned a quietish day,’ Kieran said ruefully.
‘We had to help her,’ Jude pointed out.
‘I know. But I meant the Eye to be a kind of appetiser for Paris. I was going to kiss you when we got to the top.’ He held her closer. ‘I could try to get tickets for later in the day.’
‘It’s OK.’ She paused. ‘You could always kiss me now.’
‘Is that an offer?’
‘Is that an acceptance?’ she fenced.
In answer, Kieran spun her to face him, cupped her face in his hands and brought his lips slowly down to hers. He brushed his mouth against hers, teasing. When she sighed, closed her eyes and opened her mouth, he deepened the kiss. The centre of London faded out, and all Judith was aware of was Kieran’s mouth.
When he broke the kiss, she almost fell over. If he hadn’t been holding her, she’d have slid into a quivering heap.
He sighed and rested his forehead against hers. ‘I had planned to take you on a boat down to Kew Gardens, then go for a wander among the flowers. Lunch by the river. The problem is…all I can think about is you, the other night. Your sofa. Candlelight.’
‘And all I can think about is you as a pirate king.’ She let her hands drift to his taut backside. ‘Wearing faded denims and a black T-shirt.’ Just like the ones he was wearing right then. ‘All you need is the earring and the hat. Or a bandanna.’
He groaned. ‘What was that you were saying about spontaneous combustion?’
‘I think we need a taxi,’ Judith said. ‘Now.’