Juliet watched Georgina’s and Leo’s expressions darken. It was a lot to process and, while she had not wanted to put additional pressure on either of them, she felt all the facts had to be stated. Time was unfortunately not on their side and that was the harsh realisation they all needed to accept. To deliver four living babies, something had to be done. She just prayed they chose surgery.
‘Can you give us more details, like what the surgery involves and how long it will take?’ Leo asked as he ceased stroking his wife’s arm and reached down to hold her hand tightly.
Juliet stepped away from the bed to give the couple a little more space. Hearing news and making potential life-and-death decisions, she knew, was overwhelming and they needed to feel safe together in their own space. ‘Of course,’ she began and then noticed that Charlie had brought her a chair. She wasn’t sure if he was being gallant and considerate or if he was trying to make her appear weary. She didn’t waste time deciding which it was, instead choosing to graciously accept the chair and continue.
‘The operation involves endoscopic surgery using a laser beam to cauterise the offending arteries and halt the exchange of blood between your boys. Each baby will remain connected to his primary source of blood and nutrition, the placenta, through the umbilical cord. The use of endoscopic instruments allows for short recovery time and no effect on the other babies and would be done only once during the pregnancy.’
‘Dear God, we pray if we go ahead it’s just one time,’ Leo interrupted as he looked into his wife’s tear-filled eyes. ‘Georgie’s been through so much over the last eighteen months with the three rounds of IVF, and that was unsuccessful, and then finding out we’re having four babies conceived naturally. And now this heartbreaking news about the transfusion while I was away.’
‘Leo, you’re suffering as much as me, and you had to make the trip to New York,’ she told him as she mopped the tears that threatened to escape. Her eyes were reddened from too many nights of crying. ‘We’ve both been through so much and we’re doing our best to stay strong together.’
‘And we will. No matter what, we’ll get through all of this. And we’ll take our babies home to where they belong. Their nonni, all four of them, are waiting to meet their grandchildren.’
Juliet nodded. ‘That’s my plan and I’m so pleased to hear your positive outlook. That’s exactly what your babies need.’
‘Ah, you know Italians, we’re a strong race and our children will be fighters too.’
‘Goodness, Leo,’ Georgina said. ‘You sound like my father!’
‘Well, it’s the truth,’ Charlie added. ‘You and Georgie have been strong and focused since the diagnosis and that’s why you should not completely rule out continuing on the current conservative path.’
Juliet swung around on her chair with a look of indignation. She could not believe what she was hearing. Charlie clearly had not handed over to her as he’d promised. Fuming but unable to tell Charlie how she felt, Juliet regained her composure, turned back to the couple and continued. She would let Charlie know in no uncertain terms how she felt about his interference, after the consultation. But for the moment she intended to calmly give Georgina and Leo all the information so they understood it was their choice, and theirs alone.
‘Minimally invasive fetoscopic surgery is the name of the procedure and it is aptly named because it’s minimally invasive. It involves small incisions and I will be guided by both an endoscope and sonography. Essentially it’s keyhole surgery so far lower risks than open foetal surgery, which is completely opening the uterus to operate on the foetus.’
‘But there’s still a chance it could go wrong?’ Leo asked anxiously, looking from Juliet to Charlie.
‘Yes, but not undertaking the surgery has equal if not greater risk,’ Juliet said honestly and, armed with further facts, she elaborated. ‘I do not want you to be under the misapprehension that the safer choice is doing nothing as that is quite incorrect. In the past the twin survival rate with severe TTTS was very low, around ten per cent before ultrasound made it possible for us to make an early diagnosis and the introduction of laser surgery. I think you should consider taking advantage of this medical advance. In years gone by women had no choice but to wait and pray they did not give birth to a stillborn baby. As I have mentioned excess amniotic fluid caused by the TTTS is causing your uterus to grow to an unsustainable size. It’s a condition called polyhydramnios, and it can cause premature labour.’
‘I have a fifty-four-inch waist now.’
‘Yes, that’s a combination of four babies and the fluid and it will continue to increase,’ Charlie added. ‘We’re monitoring that and can continue to do so, and perform the amniotic reduction procedure.’
Juliet bit her lip again. Charlie was not allowing her much space to move.
‘Georgina, you will be monitored in hospital until all four babies are born, no matter your decision. However, I’m suggesting surgery because there are four very tiny babies still growing inside you and they need optimum time to grow. The final decision rests with you.’
Georgina shifted on the bed and raised her feet again. Her rounded stomach was still covered by the sheet and lightweight blanket, but only just. Her pretty face was almost hidden by the mound that held her precious babies. Juliet knew the young woman’s ribs would be excruciatingly tender from the pressure of four babies.
‘So you can definitely separate the blood supply?’ Georgina finally asked.
‘The tiny telescope in your uterus will allow me to find and destroy all the connecting vessels. This is the only treatment that can disconnect the twins.’
‘How common is it for parents to choose laser surgery?’
‘Laser surgery is now performed all over the world as more and increasing numbers of progressively attuned doctors are convinced that this will lead to the best outcomes.’ Juliet’s words were directed at Charlie but she did not pause over the words or look in his direction. Two could play at the same game. ‘Most physicians worldwide agree that placental laser surgery results in the highest numbers of healthy survivors.’
‘Including those in the UK?’ Leo enquired.
‘Yes, particularly in a hospital like Teddy’s.’
Georgina and Leo gave each other a knowing look. ‘Would I be awake?’
‘Yes, Georgie, you’d be awake. You would be under conscious sedation and local anaesthetic for this procedure. We need you and the babies to be relaxed and pain free during the procedure but there’s no need for a general anaesthetic.’
Leo straightened his back, took a deep resonating breath and looked at Charlie. ‘Charlie, by what we’re hearing, and the urgency of everything, are we right in thinking we have to make the decision tonight? It’s a lot to take in and not a decision we want to make in a hurry.’
Charlie cleared his throat and stepped a little closer. ‘Not quite tonight but, yes, if you choose Dr Turner’s surgical option you would only have a day or two to make that decision. However, my plan would not see you making any changes other than looking at prescribing heart medication as pills given to Georgie, or injected directly into the twin if he is showing signs of heart failure. We can also look at another therapy using medication to decrease the urine output in the recipient and lessen the amount of amniotic fluid that is causing Georgie’s uterus to expand.’
Juliet bit her lip. She could counter but chose not to do so. She had said enough and if they chose the non-surgical option she would remain on staff at Teddy’s to help in any way she could, including the delivery. But she hoped they would choose her way forward and she would be able to use her surgical skills to increase the babies’ chances of survival and happy and healthy lives.
Georgina and Leo looked at each other with what Juliet knew would feel like the weight of the world on their shoulders but their love for each other still shone