‘AND Dr Cassidy wants to be told the moment there’s any change in her numbers or her appearance or—’
‘OK, so any change at all, basically,’ summarised Jane Cameron, the midwife who was about to take over baby Alethea’s care for this shift.
It was already four o’clock, and Emma was late finishing. She still felt reluctant to go, and didn’t understand why, until Pete Croft appeared in the doorway.
I was hoping he’d show up again, and I didn’t want to leave until I’d seen him, she realised.
‘Still here?’ he asked vaguely, and she nodded, feeling foolish.
‘I’m about to head off,’ she said.
‘What about the mum? Where’s she?’
‘She wanted a same-day discharge.’
‘You mean she’s already gone?’
‘Her mother took her home about half an hour ago. There was no medical reason to say no. Unfortunately.’
‘Yes, we would have liked to keep her here for the baby’s sake.’
‘She was feeling good. No temp. Stomach so flat already you’d hardly know she’d given birth.’
‘What’s the mother like?’ he asked. ‘Rebecca’s mother, I mean. Susan. I’ve only had her in and out of my office for such trivial things that I barely remember her.’
‘She seems very sensible. I gave the instruction sheets about post-partum care to her, not to Rebecca.’
‘Or follow their suggestions if she did, I suspect. Um, Jane, I’m going to head off,’ she added to the other midwife.
‘Yes, go. You’re late already.’
‘Let me take a look at her,’ Pete said, speaking to Jane. He picked up the baby’s notes and glanced through them. ‘Dr Cassidy’s been here again,’ he murmured.
‘See you tomorrow,’ Emma said to no one in particular, and Pete only glanced up for a second as he muttered an acknowledgement of her words.
Emma and Pete saw too much of each other over the next two days, but all of their contact revolved around the two small newborns in Emma’s care, and if there were any small windows for a more personal interlude between them, neither he nor she chose to open those windows up.
Emma was happy to work another long shift on Wednesday, her mood closely tied to baby Alethea’s progress, or lack of it. Patsy McNichol was an almost constant presence while her little Lucy remained in the neonatal annexe, but by Thursday morning the baby girl had begun to feed with consistent strength and appetite, and was looking so good that, in the absence of further problems, she would soon be moved to Patsy’s room, ready for discharge on Friday.
Rebecca Childer had only been seen in the unit once, very briefly on Wednesday morning, since her same-day discharge on Tuesday afternoon. During her visit, she had to be coaxed to talk to her baby and to touch her. She seemed frightened that allowing herself to love the baby might prove too painful, and she seemed frightened of the baby, too—so fragile and tiny and different from the fat, healthy, pink ones she’d seen on television commercials for disposable nappies and baby food.
Alethea was still in a precarious condition, with her respiration the biggest problem at this stage, despite the fact that she’d now come off the respirator and was on a mask. Her breathing alarm went off regularly, because she would simply forget to breathe. Emma usually just tickled her feet to get her started again, but it was an indication that she was fragile.
Nell had ordered a precise and detailed monitoring of every aspect of the baby’s system, including the recording of every millilitre of fluid that went in and out, every nuance of temperature change and oxygen saturation reading.
The heart murmur wasn’t clear or conclusive, and Nell was reluctant to perform tests straight away. Not until Alethea was breathing better. Not until her weight had started to claw its way back to what it had been at birth, after the normal initial loss. Not until the drug they’d given her to close that patent ductus had had a chance to work.
The potential need for transport to Sydney or Melbourne remained Nell’s greatest concern at this stage, and she’d muttered a couple more times in Emma’s hearing, ‘Something’s not right…and yet the figures suggest she’s doing well. Am I borrowing trouble here?’
It was heart-rending to see the difference in size between Alethea and the two healthy babies born in the unit since her own delivery on Tuesday morning. Patsy herself talked about it in poignant terms in relation to her own tiny Lucy.
‘To me those other babies look so huge,’ she said to Emma on Thursday, just before lunchtime. ‘Almost unnatural. Like the offspring of giants. Yet I know that it’s my baby who’s the wrong size. And she’s lost a hundred and fifty grams since she was born. When will she put it back on and start to gain?’
‘Soon,’ Emma promised, because she was promising herself the same thing about both babies. ‘That weight loss is normal. She’s feeding, and that’s great. She’s getting fluid, and she’s getting your antibodies for immunity.’
‘Will I really be able to take her home with me?’
‘We hope so. It’s looking that way.’
Patsy was able to hold her baby easily at least. With Alethea, however, the process was far more of an effort, and Emma had to schedule it into her day in order to fit it in. It had to be done with care, given the equipment to which she was still attached. If Rebecca herself had been here, Emma would have had more time.
But apart from that one uncomfortable visit, Rebecca stayed away.
Her mother was the one to come and see Alethea. She seemed to love the baby very much, but was obviously torn.
‘My daughter should be doing this. Is my coming in just encouraging her to pretend this isn’t happening?’ she said to Emma on Thursday afternoon, and Emma didn’t really have an answer. She was pleased that the baby had someone, and wondered if Mrs Childer would have spent even more time here if she hadn’t been so worried about Rebecca’s lack of interest.
Nell came up to the unit several times a day, poring over the detailed figures noted on Lucy’s and Alethea’s charts. Alethea was passing urine, which meant her kidneys and heart were both doing their jobs. Her feeds came via a nasogastric tube, which she occasionally seemed to be fighting. That wasn’t a bad sign either. Some babies were too weak to fight the discomfort of the tube. She also had an IV line for medication and fluids.
Pete dropped in on his way to his practice each morning, on the way home each night, and at any other time he happened to be at the hospital, and Emma knew that she counted on his visits more than she should, just as she’d done on Tuesday, when she’d hung around for that extra hour. By Friday afternoon, there was a sense of something hanging in the air, waiting to happen, but she didn’t understand where it came from, or what it meant.
It worried her.
Pete dropped the girls off at his sister’s at eight-thirty on Saturday morning. He had office appointments, as usual, from nine until one, and then some patients to see at the hospital. Alethea was, of course, at the top of his list. Lucy and her mother were doing fine, and had been discharged as planned the previous morning.
‘Thanks, Jackie,’ he told his sister, as soon as the girls had run off to play with their older cousins. ‘This would be impossible without you.’
‘I can’t go on doing it forever, though, Pete,’ she told him gently, sliding a mug of coffee across the kitchen bench and into his hand. He hadn’t asked for it, but didn’t turn it down. ‘It would be easier if Mum and Dad were able to share the load.’
‘I wouldn’t ask. I know Mum’s fully tied up, dealing with Dad. And I wish…’ He stopped and shrugged.
Jackie knew what the end of the unfinished sentence would have been. Their parents had moved to a retirement unit last year, and their father had a weak heart and type II diabetes. Pete would have liked to have spent more time with them, but how did he fit it in? Jackie did her best in that area, and these emergency sessions of looking after his girls weren’t easy on her.
‘Mum understands,’ Jackie said, answering the statement he hadn’t made. ‘And so do I.’
‘I know,’ he said. ‘You’ve both been great. Not to sound like a condemned man, but how long have I got before the axe falls?’
‘Until you work something out. An arrangement that’s going to last, Pete. Is Claire able to…?’
‘She went to Canberra yesterday. Some project. She needed to see a government minister.’
‘To do with work?’
Claire had a part-time job with a large local winery. It consisted of basic office assistance, and didn’t match her qualifications or her skill level, but she’d been hoping for promotion and increased hours. If the company had sent her to Canberra, perhaps that meant she had been given some additional tasks lately.
‘I assume so,’ Pete answered his sister. ‘I don’t know.’
‘The two of you don’t talk much, do you?’ she drawled.
‘Understatement, Jackie. I’m so angry with her, I can’t see straight where she’s concerned, and she never explains anything properly. Apparently, several times lately she hasn’t turned up to collect the girls from preschool. No phone call, no alternative arrangement made and Claire herself unreachable. The teachers have had to stay on until she showed up, or they’ve sent the girls home with another parent. Once it was nearly six before Claire bothered to track them down.’
‘Goodness!’ Jackie clicked her tongue and frowned. ‘The teachers didn’t try to phone you?’
‘Claire had given them various stories about my being away and unavailable and uninterested. I’ve set them straight now. What they think of it all, I don’t know.’
‘Have you tried talking to her?’
‘Have you tried collecting water in a sieve? We need a consistent, workable arrangement, but Claire won’t see that.’
‘You’ve seen Jim Braithwaite, though, haven’t you?’ Jackie herself had recommended the family law specialist.
‘Yes, and he and I have put the custody petition together, but we have to wait for the hearing. In the meantime, the girls are in limbo, and I’m bending over backwards trying to keep them from feeling as uncertain about their future as I do.’
‘Have you talked to anyone else about this?’
Pete hesitated, hearing the hole in the conversation like a giant resonance in the air, then answered, ‘No.’
What about Emma? He’d talked to her. Sort of. Without planning to. He’d said too much, and not enough, and none of the right things, and she’d listened to him with more focus and care than he’d had any right to expect.
He still had a clear mental picture of her brown-eyed gaze fixed on him with such concern. She hadn’t said much in response to his outpouring. Her halting phrases had suggested she probably thought she’d been inadequate.
She hadn’t. There was just nothing that anyone could say.
This was his life, his problem. His, and the girls’, and Claire’s. He even felt uncomfortable about Jackie’s well-meant suggestions and sympathetic noises, and he deeply regretted having talked to Emma. Dragging her into it. Sending the wrong message.
It didn’t help to have more people knowing about this, more people putting on Jackie’s brisk, supportive expression. He should keep as much of this to himself as possible, from now on. He definitely shouldn’t have talked to Emma. He’d said it was e-mail, but he’d never e-mailed her with that sort of detail about his problems.
‘You have to pin Claire down,’ Jackie said.
‘There’s only one way to do that. Through the family court. I’ve tried everything else.’
Still, he felt in his bones that there was another kind of crisis building—felt it the way you could sometimes feel a late summer storm building in the air, even before you heard the thunder and saw the clouds.
And if he was right about this vague thing that he couldn’t begin to measure or chart, then he needed to stay on top of his emotions, to stay strong, and in control. He needed, too, to steer clear of distractions and involvements. His sudden awareness of Emma Burns as an attractive, desirable woman since her return from Paris was the last thing he wanted, and the last thing that could be of any help to anyone now.
‘I talked to the manager of the child care centre yesterday,’ he told his sister, pulling his focus back with difficulty. ‘They have a couple of part-time staff who’ll take on private babysitting. One’s coming over this afternoon for a talk about what’s involved.’
‘That’s great!’
‘Well, it feels at the moment like I’m adding another piece of scaffolding to a structure that’s already in danger of total collapse, but at least it will take the pressure off you.’
‘I didn’t mean to push, Pete. I’m very willing. It’s just that with Mum and Dad, and also for the girls’ sake…’
‘Believe me, everything at the moment is for the girls’ sake,’ he said, hearing the grating harshness in his voice. He took one more gulp of coffee and listened to the noises coming from the other room. ‘Sounds like they’re happy with Tyler and Sarah, so I won’t make a big deal out of saying goodbye to them. I’ll be back after lunch, probably around two or so.’
Jackie gave him a quick hug and he knew he was rigid in her arms, armoured as if for a battle.
‘Have you put on weight, Alethea? You have!’ Emma said.
It was a tiny amount. Twenty grams. Less than an ounce on the imperial scale. But it was a good sign, all the same.
‘You are a cute girl,’ Emma told her.
Rebecca had visited the baby twice now. The second time, yesterday afternoon, she’d come with her mother, who’d urged her, ‘Sing to her or something, love.’
‘She can’t hear, can she?’
‘Of course she can!’
But Rebecca had remained tentative, and hadn’t yet visited today. Emma felt that she’d better coo to the baby instead, so that Alethea would at least come to know the sound of a caring human voice. It wasn’t a hardship for her to do so.
‘We are going to get you breathing room air, and get you growing and feeding, and you’ll be home in no time,’ she said.
Baby Alethea was receiving her mother’s expressed breast-milk through the nasogastric tube now, and this was the best possible nourishment for her. Emma suspected there’d been some heavy lobbying from Rebecca’s mother to encourage her to breast-feed, and it was Mrs Childer who brought the tiny quantities of expressed breast-milk in to the hospital each day.
Susan Childer had made a couple of oblique references to the fact that Rebecca was having trouble with the pumping process, too, and when Rebecca appeared, at last, just after lunch, looking as hesitant, miserable and fearful as ever, Emma decided to take some action.
‘Things are quiet in the unit at the moment, Rebecca,’ she said. ‘And Alethea’s asleep and peaceful. Would you like one of the other nurses to give you some help with the breast pump? Your mum says you’re tearing out your hair.’
‘It’s awful!’ the young mother agreed. ‘I hate the whole thing! How can anyone help?’
‘Well, I know it seems like a pretty weird thing to be an expert in—’
‘You got that right!’ Rebecca rolled her eyes. ‘I don’t want to be!’
‘But we do have a couple of midwives on staff who are specially trained in helping new mothers with feeding, including using a pump.’
‘I was thinking I’d just ride it out until the milk dries up, and go with bottle-feeding. It’s painful! Mum’s nagging me to death, though.’
‘The nipple soreness doesn’t last, although, of course, it’s your decision. Letting the milk dry up can be painful, too, for a few days. Would you like to talk to someone at least?’
‘OK. I ’spose so.’
Not exactly an enthusiastic response, but enough to allow Emma to dial the desk at the nurses’ station and summon Kit McConnell.
‘Let’s go somewhere quiet, where no one’s going to disturb us,’ the other midwife told Rebecca, and the young mother allowed herself to be led away, still looking miserable. She glanced at the baby on her way out, opened her mouth, then shook her head, as if deciding there was no point in saying anything to her tiny, sleeping child.
‘Let’s hope Kit can help your mum to get better at the pumping stuff, little girl,’ Emma told the baby when Rebecca had gone. ‘Because it’s the best thing for you, and we do so want you to grow for us! Oh, yes, we do, oh, yes we do,’ she crooned, bending over the baby’s special bassinet.
Then she straightened, a little embarrassed, to focus on Pete standing in the doorway. She smiled at him, felt the heat building in her face and said awkwardly, ‘OK, yes, you caught me out, talking baby talk.’ She raised her hands in mock surrender. ‘No point in mounting a defence. I confess everything!’
But the baby talk wasn’t the reason she’d flushed. That was all about Pete himself. He didn’t laugh at her lame attempt at humour.
‘Don’t get too attached,’ he said.
His voice was stiff and cool, and his gaze clashed with hers for one violent moment, before sliding away to look at the figures on Alethea’s monitor. He wasn’t wearing a doctor’s white coat, but was dressed casually, the way most doctors dressed in Glenfallon when their schedule included a mix of office hours, hospital visits and private time.
He wore twill weave pants in a neutral sandy shade, rubber-soled leather loafers and a buttoned, long-sleeved shirt in a low-key abstract pattern. No tie, and there was a pair of sunglasses jutting out of his breast pocket and a stethoscope draped around his neck.
The casual dress and the cool, distant manner didn’t quite fit together, but they were both effective. He looked both attractive and forbidding, and the sensations and emotions that coiled inside Emma were far too complex and unwarranted.
‘It’s always a mistake to get your emotions involved,’ he added.
‘She’s doing really well,’ Emma answered obliquely. She ran her hands down the sides of her blue uniform dress, feeling her palms grow damp.
‘She’s not yours.’
‘I know that, Pete.’
You care about her, too, she wanted to tell him. I know you do. So isn’t this a little hypocritical?
But it didn’t take much diagnostic effort on her part to realise that her feelings about baby Alethea weren’t the real issue, and certainly weren’t the most important one.
Pete regretted everything he’d said the other day. He’d closed off. He was sending out some pretty clear signals that his problems at home were not her business, and that he didn’t want her to trespass into that territory.
Emma understood.
She’d almost been expecting it, which was probably why…partly why…she hadn’t tried to talk to him on a personal level since Tuesday.
That didn’t mean she was happy about it. Something precious had been lost, or perhaps had merely proved an illusion. Face to face, they didn’t have a friendship at all, the way she’d felt they did when she’d been in Paris, and it would be better if she accepted the fact quickly.
It would be better if her heart was more obedient to the dictates of her head!
Feeling his stiffness and his distance, she still felt the same instinctive need to step closer, to touch him, to create a connection, skin to skin, which he was blocking today in the way he was speaking.
‘How is she, anyway?’ he said, staring down at the baby. ‘Can I see her chart?’
He reached out without looking at her, and she handed it to him, making sure their fingers didn’t touch. ‘It’s right here.’
‘When was Dr Cassidy last here?’
‘This morning, pretty early. I’m sure she’ll show up again today.’
‘Thorough is one way of putting it, in her case,’ he said. ‘Takes the pressure off me. She’s been great.’
‘She’s very good.’
‘What about Rebecca?’
‘She’s been having a lot of trouble trying to express her milk. Kit McConnell’s spending some time with her, working on positioning the pump and trying to get her more relaxed.’
‘Motivation’s the real problem. Rebecca is so ambivalent about motherhood to start with. She’s just too young, and there’s no father in sight and no name been mentioned.’ He began to study the figures on the chart. ‘Numbers are good,’ he said. ‘What’s Dr Cassidy thinking? Has she talked to you?’ He looked at her finally, his eyes narrowed and distant.
‘As of this morning, she was still pretty worried,’ Emma said. ‘She can still hear a murmur, even though it seems clear that the heart is pumping oxygenated blood. She’ll send Alethea for tests on Monday, she said, and take it from there.’
Automatically, she looked down at the baby, who lay on her back with her thin little legs bent and apart, still looking like a frog. With her fine skin and absence of fat, Alethea usually looked quite red—darker than the flush on Emma’s cheeks when she’d first seen Pete in the doorway.
Now, however, the baby looked pale and a little mottled, and Emma thought immediately, That’s different. That’s a change, even since Pete got here. Her lips are blue.
She looked at the monitor, and saw a change in the figures there, too.
‘Pete,’ she said, and reached out without thinking, to clutch his arm. It was ropy and hard and warm and tickly with hair, its solid bulk such a temptation to cling to.
For a moment he froze. He looked down at the point of contact between them, and she saw the tight, reluctant look on his face. He didn’t think she was going to mention Claire, did he?
Emma dropped her hand at once, feeling as if her fingers were burning, and told him, ‘Something’s not right.’
She realised at once that she’d echoed the words Nell had been muttering at intervals since the baby’s birth. ‘She seemed fine a few minutes ago, Pete, but look at her now! She’s turning blue.’
He looked, and swore under his breath. ‘What’s happening? What the hell is happening?’ The baby was already looking worse. Drained of colour. Skin mottled with different hues, like a diseased leaf, lips and extremities blue. ‘Is it her heart?’ Pete demanded, clearly not expecting an answer. ‘It has to be. Page Nell, Emma! Is this what she’s been worried about?’
He flicked the earpieces of his stethoscope into place and grabbed the metal disc that dangled on his chest. Emma reached for the wall phone and stabbed with her forefinger at the two digits that would connect her with the A and E department.
‘We need Dr Cassidy in Special Care immediately,’ she said. ‘Is she in the department at the moment?’
‘She’s with a patient,’ said a female voice Emma didn’t take the time to try and identify.
‘This is urgent,’ she said, not knowing if it was but responding purely to the frown, the tight mouth, the deep concern etched on Pete’s face, and the changing colour of the baby.
‘I can pick up that murmur, too,’ he said. ‘It sounds bizarre. Surely this isn’t what Nell’s been in doubt about? It’s clearly not right, and she would have known that at once.’
‘It’s new,’ Emma said. ‘The baby hasn’t looked like this before. The pallor and the mottled skin. And her oxygen saturation and respiration and heart rate are all falling. Her heart must be failing in some way that wasn’t apparent before.’
‘A heart defect that Nell didn’t pick up? A heart defect made worse if that suspected patent ductus arteriosus is closing now?’ He was talking half to himself. ‘Dear God, are we looking something major? Hypoplastic left heart syndrome? Or…? Let me think. It could be that. There was another case I read about, just a year or so ago…’
Hypoplastic left heart syndrome was a very serious congenital defect, Emma knew, and invariably fatal without major surgery.
‘Is that why she was small, even for her dates?’ Pete was saying. ‘Is that why she’s been looking so good until now, because she’s small enough that the PDA was maintaining adequate circulation? We’ve been medicating her to get it to close so the circulation pattern changed, and now that it’s doing exactly that, we’re in real trouble.’
‘Yes. As far as my knowledge goes.’ He closed his eyes and shook his head. ‘I’m not a heart specialist. I’m pulling this out of six different textbooks and a handful of case studies, and—But if that’s what it is, it’s going to be fatal without surgery, and without medication to keep the ductus arteriosus open until we can get her to—Lord, Sydney? Melbourne? Who does this surgery? Not many people, in this country. Nell will know, and I’ve been holding her back.’
‘No, Pete, you haven’t,’ Emma said urgently, the unwanted need to touch him tingling in her hands again. ‘She wanted to hold back, too. She thought the heart was probably fine. Lucy had a murmur, too, and she went home yesterday morning, thriving. Nell is as much aware of the social issues with the mother’s lack of attachment as you are. And she didn’t want to put the baby through unnecessary tests or transport if the heart was already doing its job. It’s—’
‘Nell! Thank goodness you got here so fast!’ His exclamation cut off Emma’s attempt to reassure him, and she had to stand back and listen while he outlined what had happened. His phrases were brisk, clear and decisive, but his fists were held tight. ‘It fits the facts,’ he finished. ‘It fits what we know.’
‘Yes, it does,’ Nell agreed. She took a moment to think, the wheels in her mind turning almost audibly. ‘If you’re right, we need to treat her with prostaglandin E1, to reverse the closure of the PDA.’
‘So we can do that?’ He sounded intensely relieved. ‘Yes,’ he answered himself. ‘If it’ll work.’
‘Obviously that’s the only reason the heart has been functioning, fooling us into thinking everything was all right. Can we get the equipment in here to give her an echocardiogram straight away to confirm this? Then we need to get her to Melbourne. There’s a surgeon at Royal Children’s who does the procedure.’
‘This can’t wait, Nell.’
‘No, it can’t,’ she agreed again. She pressed her hands to her temples, pushing back her dark blonde hair. ‘We’ll start the drug treatment straight away. We’re going to lose her for certain if we don’t. And maybe even if we do. Let me think. Is there a downside that I’m not seeing?’
‘I would probably have picked this up in utero if she’d had proper prenatal care,’ Pete said. ‘It should have shown on a routine scan in the second trimester.’
‘I would have picked it up,’ Nell retorted. ‘I’d have picked something up, if I’d given her the ECG sooner. I knew all along that something wasn’t right, but with her healthy oxygen levels, I was leaving well enough alone…I didn’t fully consider that it could be something this serious.’
‘If we can’t keep that ductus arteriosus open…’
‘I know. We can measure her future in hours, or less.’ Nell blinked. ‘I hate this. She’s come so far in other areas in just a few days!’
‘And so has Rebecca, I think,’ Emma put in.
‘Can we get in touch with the surgeon straight away? They’ll need to get the right team together,’ Pete asked. ‘If anyone’s away…’
‘Geoffrey Caldwell is the surgeon we want,’ Nell answered. ‘With Adrian Fitzgerald for the medical side.’
‘Cardiologist. I’ve heard of him.’
‘They’re both very good, and they’ve dealt with this condition before, as successfully as anyone in the world. We have to get her that far first, get a medivac transport organised. Get her to Royal Children’s alive.’
‘Emma…?’
Both doctors turned to her, and the blaze of urgency in Pete’s eyes drained the strength from Emma’s legs. Was she the one who should have picked this up sooner? Could a handful of minutes make a difference to this baby’s life? She hadn’t realised that a patent ductus arteriosus could close so fast, or that it could have such grave consequences in the environment of a malformed heart.
‘Prostaglandin E1,’ she said. ‘I’ll chase it up. Is that all we can do?’
‘It’s the only thing that really counts,’ Pete said. ‘If we’ve read this right, that is. I’ll get on the phone and start arranging a transport.’
‘I’ll get the ECG machine in here,’ Nell said. ‘She should go to Melbourne today, Pete, if it can be managed. Tomorrow at the latest. I need to think how else we can support her until then.’ She pressed her fingers to her temples and closed her eyes.
Emma heard voices along the corridor, and recognised that they belonged to Kit and Rebecca. She took a deep breath.
‘And one of you needs to talk to Rebecca about this,’ she said. ‘I can hear her coming now.’