I wake to find Edward gone. This must be what it’s like to have an affair with a married man, I think. The thought gives me some comfort. In France, for example, where people are more relaxed about these things, our relationship might be considered perfectly normal.
Mia, of course, is convinced it’s going to be another disaster; that he’ll never change, that anyone who’s managed to be so self-contained for so long can never be anything else. When I demur she tuts exasperatedly. “J, you have this schoolgirl fantasy that you’re going to be the one to melt his ice-cold heart. When the truth is, he’s simply going to break yours.”
But my heart has already been broken by Isabel, I reflect, and Edward’s irregular incursions into my life mean it’s easy not to let Mia realize just how serious it’s getting with him.
And it turns out Edward’s right: There is something perfect about two people who come together without expectations or demands. I don’t have to hear the details of his day, or squabble about which one of us is going to take the rubbish out. There are no joint schedules to negotiate, no domestic routines to slip into. We never spend long enough together to get bored.
Yesterday he gave me my first orgasm before he’d even taken off his clothes. That’s something he likes, I’ve noticed. To stay fully dressed while he peels my clothes off, everything but the necklace, and reduce me to a quivering wreck with fingers and tongue. As if it’s not enough for him to retain control: I have to lose it too. Only then does he feel comfortable letting go himself.
That feels like an interesting insight about him and I’m still mulling it over as I come downstairs. There’s a small pile of damp mail on the doorstep. I’ve asked Edward why there’s no letter box here—it seems a strange oversight in what is, generally, such a well-thought-out house—and he told me that when One Folgate Street was built, his partner David Thiel was predicting that email would have replaced physical letters altogether within a decade.
I glance through them. They’re mostly political circulars to do with the upcoming local elections. I doubt I’ll even register to vote. Debates about the local library and the frequency of garbage collections have little relevance to my life at One Folgate Street. A couple of the letters are addressed to Ms. Emma Matthews. They’re clearly junk, but I put them aside anyway to send on to Camilla, the agent.
The last letter is addressed to me. The outside looks so bland that at first I assume it’s just more junk mail. Then I see the logo of the Hospital Trust and my heart skips a beat.
Dear Ms. Cavendish,
Postmortem results: Isabel Margaret Cavendish (deceased).
I agreed to a postmortem because it seemed right to try to get some answers. Dr. Gifford told me when I went for my follow-up appointment that it hadn’t revealed anything, but I’d be sent a note of the findings anyway. That was a month ago. The letter must have been stuck in the system since then.
I sit down, my head swimming, and go through it twice, trying to understand the medical jargon. It starts with a brief history of my pregnancy. There’s a reference to the time, a week before they realized something was wrong, when I’d had back pain and taken myself to the maternity unit for a checkup. They’d done some tests, listened to the baby’s heartbeat, then sent me home to have a hot bath. I’d felt Isabel kicking quite actively after that so I’d been reassured. The letter makes it clear that correct procedures were followed on that occasion, including a symphysis–fundal height assessment in accordance with NICE guidelines. Then there’s a description of my subsequent visit, when they discovered Isabel’s heart had stopped. And finally, the postmortem itself. Lots of figures that mean nothing to me—platelet counts and other blood work, followed by the comment:
Liver: normal.
At the thought of some pathologist patiently removing her tiny little liver, my throat constricts. But there’s more.
Kidneys: normal.
Lungs: normal.
Heart: normal.
I skip down to the summary.
While an exact diagnosis is not possible at this stage, signs of placental thrombosis may point to a partial placenta abruptio, leading to death by asphyxiation.
Placenta abruptio. It sounds like a Harry Potter spell, not something that could kill my baby. Dr. Gifford’s name at the bottom of the page swims glassily as the tears spring to my eyes and I start crying again, great gulping snotty sobs I can’t control. It’s all too much to take in and anyway I don’t understand most of the words. Tessa, the woman I share a desk with at the office, has a background in midwifery. I decide to take the letter to work so she can talk me through it.
Tessa reads the letter carefully, giving me the occasional concerned look. She knows, of course, that I had a stillbirth: Many of the women who volunteer at Still Hope have a similar personal reason for doing so.
“Do you know what it all means?” she says at last. I shake my head.
“Well, placenta abruptio is a ruptured placenta. Effectively, they’re saying the fetus stopped getting nutrients and oxygen before you went in.”
“Nice of them to use English,” I say.
“Yes. Well, there may be a reason for that.”
Something about her voice makes me look at her.
“When you went in with back pain,” she says slowly, “what happened, exactly?”
“Well.” I think back. “They clearly thought I was being over-anxious—first-time mother and all that. But they were very nice about it. I don’t actually remember being given all those tests they talk about—”
“A symphysis–fundal height assessment is just medical-speak for measuring the bump with a tape measure,” she interrupts. “And while it’s true that it’s a NICE guideline to do one at every prenatal visit, it’s certainly not going to reveal a failing placenta. Did they do a cardiotocograph?”
“The heart monitor thing? Yes, the nurse did that.”
“Who did she show the trace to?”
I try to remember. “I think she phoned Dr. Gifford and read the results to him. Or at any rate, told him they were normal.”
“Any other scans? Regular ultrasound? Doppler?” Tessa’s voice has taken on a grim tone.
I shake my head. “They told me to go home, have a hot bath and try not to worry. And I felt Isabel kicking later so I realized they were right.”
“Who’s they?”
“Well—the nurse, I suppose.”
“Did she speak to anyone else? A senior midwife? Resident?”
“Not that I recall. Tessa, what is this?”
“It’s just that this letter reads to me like a carefully worded attempt to give you the impression there was no medical negligence involved in Isabel’s death,” she says bluntly.
I gape at her. “Negligence? How?”
“If you start from the position that the death of a viable baby is a death that should have been avoided, then usually you find one of two things has caused it. First, a mismanaged birth. That obviously wasn’t the case here. But the second most common cause of stillbirth is an overworked midwife or junior doctor failing to read a CTG trace correctly. In your case, the senior doctor on call should have reviewed the results himself and, given the back pain you reported—which can be an indication of problems with the placenta—ordered a Doppler scan.” I know about Doppler scans: One of Still Hope’s campaign goals is for every expectant mother to receive one as a matter of course. It will cost about fifteen pounds per baby, and the fact the NHS currently doesn’t do them unless a senior doctor specifically requests it is one of the reasons why stillbirth rates in the UK are among the worst in Europe. “I’m afraid the kicking you felt after you went home may have been distress, not a sign everything was all right. We’ve got a history with this hospital. They’re consistently understaffed, particularly at senior doctor level. Dr. Gifford’s name comes up again and again. He basically has way too high a workload.”
The words are barely sinking in. But he was so nice, I think.
“Of course, you can argue that’s not his fault,” she adds. “But it’s only by going after the senior doctor and proving they failed the patient that we’ll ever get the hospital to increase their staffing ratios.”
I remember Dr. Gifford telling me, even as he broke the news that Isabel was dead, that in the majority of cases no cause was ever found. Was he trying to cover up for his team’s mistakes, even then? “What should I do?”
She hands the letter back to me. “Write back asking for a copy of all the medical records. We’ll get them reviewed by an expert, but if it looks as if the hospital is covering up incompetence, we should think about litigation.”