He walked into the cubicle. ‘Mrs Patterson?’
The woman on the bed was shaking uncontrollably. He sat down on the edge of her bed and took her hand. ‘I’m Joel Mortimer, the registrar in the department. Can you tell me what happened?’
‘I was in traffic. In a queue, waiting for someone to turn right. And someone rammed straight into the back of me.’ She dragged in a breath. ‘And now—now I can’t feel my baby moving. And my stomach hurts. And I’m wet—between…’ She shuddered. ‘Between my legs,’ she whispered. ‘But it’s too early. My waters can’t have broken yet. They just can’t.’
‘Try not to worry too much until I’ve examined you,’ Joel said gently. ‘Babies are pretty hardy, and they’re fairly well cushioned inside you. Does it hurt anywhere else?’ He was half expecting her to describe whiplash injuries.
‘No, just my stomach.’
Could be panic. But if her stomach had hit the steering-wheel and the wetness was blood…
Joel had a bad feeling about this. At the handover the paramedics had mentioned impact against the steering-wheel: not hard enough to trigger the airbag, but clearly hard enough to have hurt Mrs Patterson. He had a nasty feeling this could be a placental abruption—and a bad tear could be an emergency for the mother as well as the baby.
‘I’m going to examine you, if that’s all right with you, and meanwhile I’ll get a portable scanner brought in so we can take a look at the baby and see what’s going on.’ And, please, please, it would be just panic that was making her unable to feel the foetal movements. He’d do an ultrasound and the baby would be visible on screen, kicking away as if nothing had ever happened.
‘Don’t let me lose my baby,’ Mrs Patterson begged. ‘Please, don’t.’
If it was a major abruption, there might not be much choice. Not at twenty-six weeks. Very pre-term babies could survive in Special Care, but often it took months and months of heartache and worry, and the babies were often left with long-term problems. His heart ached for her. ‘We’ll do our best for you,’ Joel promised. ‘I’m going to order that scanner. I’ll be back in three minutes, tops. Start counting the seconds—I want you to take a big breath in while you say “one second” in your head, and then a big breath out while you say “one second”. Can you do that for me?’ He knew from experience that counting breaths would help to calm her, and concentrating on a simple task would help to distract her from her panic.
She nodded, and began to take deeper, longer breaths.
‘That’s perfect,’ Joel said with an encouraging smile. He was gone for just long enough to ask one of the staff nurses to get him a scanner, page the maternity registrar and order four units of O-negative blood as a matter of urgency, and then went straight back to Mrs Patterson.
‘I’m going to examine you now,’ he said gently. ‘Just tell me if anything’s uncomfortable or if you need me to stop. Don’t worry about being embarrassed or feeling silly—I’m here to look after you, and how you’re feeling is the most important thing right now.’
But he wasn’t happy with what he saw. Mrs Patterson had a small vaginal bleed—the blood was dark red and clotted—but she was starting to look slightly shocky, out of proportion to the amount of blood she’d lost. Her blood pressure was low, too. All the signs were pointing to a placental abruption—the impact from the car accident could have caused part of the placenta to tear away from the wall of the uterus. In cases of minor placental abruptions, the patient could often go home to rest and the tear would repair itself over the next few days. But with a major placental abruption, it could mean an immediate Caesarean section in an attempt to save the mother’s life as well as that of the baby.
Joel had a really bad feeling about this one.
Particularly when he couldn’t hear the baby’s heartbeat either.
Maybe the baby was lying awkwardly and that was why he couldn’t pick up the heartbeat. But he’d feel a hell of a lot better when the portable ultrasound scanner arrived and he could see what was going on. Not to mention having the obstetric specialist on hand.
‘Is my baby all right?’ Mrs Patterson asked, her voice rasping and shuddery with fear.
He didn’t want to panic her. But he didn’t want to lie either. ‘Try not to worry,’ he said softly. ‘I’m going to chase that scanner.’
To his relief, Jack Harrowven, the senior registrar from the maternity unit, was already walking into the department. Joel took him to one side and gave him a quick rundown on the case. ‘I think it’s an abruption. A big one. We’re waiting for the portable scanner, but I can’t hear the baby’s heartbeat.’
‘Oh, hell,’ Jack said. ‘Doesn’t sound good.’
‘It might be the way the baby’s lying,’ Joel said.
Jack shook his head. ‘If the mum can’t feel movement either, that’s not a good sign.’
Joel took a deep breath, showed Jack to Mrs Patterson’s cubicle and introduced him to the patient. The scanner arrived at the same time.
‘Please. Don’t let my baby die,’ Mrs Patterson begged again.
‘We’ll do our best,’ Jack said. ‘Can you pull your top up a little bit for me? I’m going to put some gel on your stomach, and then we’ll see what’s happening.’
‘Mrs Patterson, I’ve been called to see another patient,’ Joel said, ‘but I’m leaving you in the best possible hands. Jack’s the best obstetrician I know.’ He smiled at her. ‘He delivered my daughter.’
Though as he left he glanced at the screen. And what he saw told him that even an obstetrician as good as Jack wouldn’t be able to do much.
Ah, hell. He knew all about how bad it felt to lose a baby at six months’ gestation. Vanessa hadn’t survived the accident. And neither had Beth’s little brother: at twenty-four weeks, he’d been just too tiny.
Life, he thought savagely, really sucked sometimes.
‘You all right?’ Lisa asked when he almost walked straight into her in the corridor.
‘Fine,’ he lied, his voice clipped.
‘You don’t look it. Bad case?’ Without waiting for an answer, she added, ‘Why don’t you take five minutes, have a coffee or something?’
Because he needed to keep busy. If he took five minutes, right now, he’d remember far too much. Feel the pain rolling over him yet again. Get sucked back into the dark days. He couldn’t afford that to happen. Not here, not now, not ever. He gritted his teeth. ‘Thank you, Dr Richardson, but I take orders from my consultant, not my SHO.’
Her eyes widened with hurt. ‘But I wasn’t ordering you. It was just a suggestion because you look a bit…well…’ Her voice trailed off.
‘I’m perfectly fine, thank you. Now, if you’ll excuse me, I have patients to see.’ He brushed her aside and strode off, aware that he was behaving appallingly but unable to stop himself. Right now he was way, way too close to the edge.
Later that afternoon, the news filtered through the department that Mrs Patterson had lost her baby. As soon as Lisa realised that Mrs Patterson had been Joel’s patient, she could guess why Joel had looked so rattled. And why he’d bitten her head off. Cases where babies or children didn’t make it were always hard, but even more so for doctors and nurses who had children of their own—and that was intensified for single parents. Lisa didn’t know the details of Joel’s wife’s accident, but if it had been in a car this had probably reminded him of it.
She hated to think of him sitting in his office, dealing with paperwork and just hurting. Being buffeted by memories. She’d been there often enough. Every time she had to attend a traffic accident with the air ambulance, or dealt with