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CHAPTER TWO

‘OBSTETRIC Team to Emergency.’

Izzy heard the chimes as she tossed her coffee and sandwich wrapper in the bin and did a little dance at the sliding door that refused to acknowledge her, no matter how many times she swiped her card. An impatient nurse behind her took over, swiping her own card, and Izzy tailgated her in.

They’d start her in Section B.

Of that she was sure.

Writing up tetanus shots and suturing, examining ankles and wrists... Despite her assured words to Jess earlier, Izzy was actually hoping for a gentle start back and was quietly confident that Ben would have arranged for one.

‘Obstetric team to Emergency.’

The chimes sounded again, but Izzy wasn’t fazed. It was a fairly familiar call—frenzied fathers-to-be often lost their way and ended up bringing their wives to Emergency rather than Maternity.

Izzy glanced at her watch.

In ten minutes she’d be starting her first shift...

Walking through another set of sliding doors, which this time opened without the use of her card, Izzy found herself in the inner sanctum of the emergency unit.

She’d timed it well, Izzy thought to herself.

By the time she’d put her bag in her locker, it would be almost time to start, which meant that she could bypass the staffroom, the small talk...

‘Izzy!’ Beth, an RN she’d worked with over the years, was racing past. ‘Cubicle four... Everyone’s tied up... She just presented...’

Except Jess had been right.

There would be no gentle easing in, Izzy fast realised as Les, the porter, relieved her of her bag. Beth brought her up to speed as best she could in short rapid sentences as they sped across the unit.

‘About twenty-three weeks pregnant, though she’s vague on dates,’ the rapid handover went on. ‘She won’t make it to Maternity, I’ve put out a call...’

‘Who’s seen her?’ Izzy asked as she squirted some alcohol rub on her hands.

‘You,’ came Beth’s response

Oh, yes!

She’d forgotten just how unforgiving Emergency could be at times. Just then she saw Ben, wrapping a plastic apron around himself, and Izzy was quite sure he’d take over and usher her off to Section B.

‘Have you got this?’ Ben said instead, calling over his shoulder as he sped off to Resus.

‘Sure!’

‘Her name’s Nicola,’ Beth said as Izzy took one, very quick, deep breath and stepped in.

‘Hi, there Nicola. I’m Izzy Bailey, the emergency registrar.’ Izzy wasn’t sure who looked more petrified, the student nurse who’d been left with the patient while Beth had dashed for a delivery pack or the mother-to-be who brought Izzy up to date with her rapid progress even before Izzy had time to ask more questions—it was Nicola who pulled back the sheet.

‘It’s coming.’

‘Okay.’ Izzy pulled on some gloves as Beth opened the delivery pack, Nicola was in no state to be sped across the floor to Resus. ‘Let Resus know to expect the baby,’ Izzy said. ‘Tell them to get a cot ready.’ She took a steadying breath. ‘Emergency-page the paediatric team.’

‘Vivienne!’ Beth instructed the student nurse to carry out Izzy’s instructions, and Vivienne sped off.

‘There’s going to be a lot of overhead chimes,’ Izzy explained to Nicola, ‘but that’s just so we can get the staff we need down here quickly for your baby.’

The membrane was intact, Izzy could see it bulging, and she used those few seconds to question her patient a little more, but there were no straightforward answers.

‘I only found out last week. I’ve got a seven-month-old, I’m breastfeeding...’

‘Have you had an ultrasound?’ Izzy asked.

‘She’s just come from there,’ Beth said for Nicola, but, as was so often the case in Emergency, a neat list of answers rarely arrived with the patient. They would have to be answered later, because this baby was ready to be born.

He slipped into the world a few seconds

later, just as a breathless midwife arrived

from Maternity and the overhead speaker chimed its request for the paediatric team to come to Emergency. He was still wrapped in the membrane that should have embraced him for many months more and Izzy parted it, using balloon suction to clear his airway. He was pale and stunned, but stirring into life as Izzy cut the cord. Though outwardly calm, her heart was hammering, because difficult decisions lay ahead for this tiny little man.

‘You have a son,’ Izzy said, wrapping him up and holding him up briefly for Nicola to see. Though seconds counted in the race for his life, Izzy made one of the many rapid decisions her job entailed and brought the baby up to the mother’s head, letting her have a brief glimpse of him. Nicola kissed his little cheek, telling him that she loved him, but those few brief seconds were all there was time for.

Beth had already raced over to Resus, and Izzy left Nicola in the safe hands of the midwife and student nurse as she walked quickly over to Resus holding the infant. A man, dressed in black jeans and a T-shirt, joined her. Walking alongside her, he spoke with a heavy accent.

‘What do we know?’

‘Mum’s dates are hazy,’ Izzy said, and though he had no ID on him, there was an air of authority to him that told her this was no nosey relative. ‘About twenty-three weeks.’

‘Mierda!’ Izzy more than understood his curse—she was thinking the same—this tiny baby hovered right on the edge of viability. At this stage of pregnancy every day in utero mattered, but now he was in their hands and they could only give the tiny baby their best care and attention.

‘Diego.’ Beth looked up from the warming cot she was rapidly preparing. ‘That was quick.’ The chimes had only just stopped summoning the staff, but he answered in that rich accent, and Izzy realised he was Spanish.

‘I was just passing on my way for a late shift.’ He had taken the baby from Izzy and was already getting to work, skilfully suctioning the airway as Izzy placed red dots on the baby’s tiny chest. ‘I heard the call and I figured you could use me.’

They certainly could!

His large hands were rubbing the baby, trying to stimulate it, and Izzy was incredibly grateful he was there. His dark hair was wet so he must have stepped straight out of the shower before coming to work. He had gone completely overboard on the cologne, the musky scent of him way too heavy for a hospital setting. Still, she was very glad he was there. As an emergency doctor, Izzy was used to dealing with

crises, but such a premature baby required very specific skills and was terrifying to handle—Diego was clearly used to it and it showed.

‘Diego’s the neonatal...’ Beth paused. ‘What is your title, Diego?’

‘They are still deciding! Sorry...’ Dark brown eyes met Izzy’s and amidst controlled chaos he squeezed in a smile. ‘I should have introduced myself. I’m Nurse Manager on the neonatal unit.’

‘I guessed you weren’t a passing relative,’ Izzy said, but he wasn’t listening, his concentration back on the baby. He was breathing, but his chest was working hard, bubbles at his nose and lips, and his nostrils were flaring as he struggled to drag in oxygen.

‘We need his history,’ Diego said as he proceeded to bag the baby, helping him to breathe. He was skilled and deft and even though the team was just starting to arrive he already had this particular scene under control. ‘You’re late.’ Diego managed dry humour as the anaesthetist rushed in along with the on-call obstetrician and then Izzy’s colleague and friend Megan.

Her fragile looks defied her status. Megan was a paediatric registrar and was the jewel in the paediatric team—fighting for her charges’ lives, completely devoted to her profession. Her gentle demeanour defied her steely determination when a life hung in the balance.

Megan would, Izzy knew, give the baby every benefit of every doubt.

‘Ring NICU.’ This was Diego, giving orders, even though it wasn’t his domain. They urgently needed more equipment. Even the tiniest ET tube was proving too big for this babe and feeling just a touch superfluous as Megan and Diego worked on, it was Izzy who made the call to the neonatal intensive care unit, holding the phone to Diego’s ear as he rapidly delivered his orders.

Though Megan’s long brown hair was tied back, the run from the children’s ward had caused a lock to come loose and she gave a soft curse as she tried to concentrate on getting an umbilical line into the baby.

‘Here,’ Izzy said, and sorted out her friend’s hair.

‘About twenty-three weeks, Megan.’ Diego said it as a warning as the baby’s heart rate dipped ominously low, but his warning was vital.

‘We don’t know anything for sure!’ Megan words were almost chanted as she shot a warning at Diego. ‘I’ll do a proper maturation assessment once he’s more stable. Izzy, can you start compressions while I get this line in?’

Diego was pulling up the minuscule drug dosages; the anaesthetist taking over in helping the tiny baby to breathe. The baby was so small Izzy compressed the chest rapidly with two fingers, hearing the rapid rhythm on the monitor.

‘Nice work.’ Megan was always encouraging. The umbilical line in, she took the drugs from Diego and shot them into the little body as Izzy carried on with compressions for another full minute.

‘Let’s see what we’ve got.’ Megan put a hand up to halt Izzy and the babe’s heart rate was up now close to a hundred. There were more staff arriving and a large incubator had arrived from the neonatal unit along with more specialised equipment, but until the baby was more stable it wouldn’t be moved up to the first-floor NICU. ‘We’re going to be here for a while.’ Megan gave Izzy a grim smile. ‘Sorry to take up all your space.’

‘Go right ahead,’ Izzy said.

‘How are things?’ an unfamiliar face came

in. ‘Ben asked me check in—I’m Josh, A and E consultant.’ She’d heard there was a new consultant, that he was Irish and women everywhere were swooning, but no one was swooning here! Izzy couldn’t really explain it, but suddenly the mood in the room changed. Izzy wondered if perhaps if Josh’s popularity had plummeted, because there was certainly a chill in the air.

‘It’s all under control.’ It was Izzy who broke the strange silence. ‘Though the babe might be here for a while.’

‘How many weeks?’ Josh’s voice was gruff, his navy eyes narrowing as he looked down at the tiny infant.

‘We’re not sure yet,’ Megan responded. ‘Mum was in Ultrasound when she went into labour.’

‘We need to find out.’ Josh’s was the voice of reason. Before there were any more heroics, some vital facts needed to be established. ‘Do you want me to speak with Mum?’

‘I’ll be the one who speaks with the mother.’ Megan’s voice was pure ice. ‘But right now I’m a bit tied up.’

‘There’s a full resuscitation taking place in my department on a baby that may not be viable—we need to find out what the mother wants.’

Megan looked up and Izzy was shocked at the blaze of challenge in them. ‘It’s not like it was eight years ago. We don’t wrap them in a blanket now and say we can’t do anything for them.’

‘I’ll tell you what!’ A thick Spanish accent waded into the tense debate and abruptly resolved it. ‘While you two sort out your own agenda, why don’t you...’ he looked over at Izzy ‘...go and speak with the mother? You have already met her, after all. See if you can clarify the dates a bit better—let her know just how ill the baby is and find out if someone can pull up her ultrasound images.’

‘Sure!’

She was more than grateful for Diego’s presence, and not just for the baby—Izzy hadn’t known what was happening in there. She’d never seen Megan like that! Her response had been a blatant snub to Josh’s offer to speak with the mother, but Izzy didn’t have time to dwell on it—instead she had a most difficult conversation in front of her.

‘I don’t know...’ Nicola sobbed as Izzy gently questioned her. ‘My periods are so irregular and it’s my fourth baby, I was breast feeding...’

‘The doctors will go through your scans and assess your baby and try to get the closest date we can,’ Izzy said gently, ‘but I have to tell you that things aren’t looking very good for your son.’ Izzy suddenly felt guilty talking about this to the mother when she was pregnant herself, and was incredibly grateful when Diego came into the cubicle. He gave her a thin smile and, because he would be more than used to this type of conversation, Izzy allowed him to take over.

‘Another one of my staff is in with your baby,’ he said, having introduced himself to the mother, and did what Megan had insisted Josh didn’t. Izzy felt the sting of tears in her eyes as very skilfully, very gently Diego talked Nicola through all that had happened, all that was now taking place and all that could lie ahead if her baby were to survive.

‘Right now,’ Diego said, ‘we are doing everything we can to save your baby, but he is in a very fragile state. Nicola. Do you understand what I said to you about the risks, about the health problems your baby might face if he does survive?’

‘Do everything you can.’

‘We will,’ Diego said. ‘Megan, the paediatrician, will come in and speak at more length with you, but right now she needs to be in with your son.’ He was very kind, but also very firm. ‘We’re going to be moving him up to the NICU shortly, but why don’t I get you a wheelchair and we can take you in to see him before we head off?’

To Izzy it was too soon, Resus was still a hive of activity, but she also knew that Diego was right, that maybe Nicola needed to see for herself the lengths to which they were going to save the baby and also that, realistically, this might be Nicola’s only chance to see her son alive.

She didn’t get to hold him, but Diego did ask for a camera and took some pictures of Nicola next to her son, and some close-up shots of the baby. And then it was time for him to be moved.

‘Nice work,’ he said to Izzy as his team moved off with its precious cargo, Diego choosing to stay behind. ‘Thank you for everything, and sorry to leave so much mess. I’m going to have a quick run-through of your equipment, if that’s okay. There are a few things you ought to order.’

‘That would be great,’ Izzy said. ‘And thank you. You’ve been marvellous!’

‘Marvellous!’ He repeated the word as if were the first time he’d heard it and grinned, his teeth were so white, so perfect. If the rest of him hadn’t been so divine, she’d have sworn they were capped. ‘You were marvellous too!’ Then his eyes narrowed in closer assessment. ‘You’re new?’ Diego checked, because even though he was rarely in Emergency he was quite sure that he’d have noticed her around the hospital.

‘No. I’ve worked here for ages. I’ve been on...’ She didn’t really know what to say so she settled for a very simple version. ‘Extended leave.’ She gave him a wide smile. ‘You’re the one who’s new.’

‘How do you know that?’ He raised the most perfectly shaped eyebrow, and if eyes could smile, his were. ‘I might have been here for years. Perhaps I did my training here...’ He was teasing her, with a question she was less prepared to deal with than a premature birth. ‘Why do you think