Midwives On-Call

So now he needed to explain from the ground up. ‘The scans do look blurry,’ he admitted. ‘I have trouble reading them myself. Fine detail like the nerve exposure around vertebrae needs incredibly specialised knowledge to see, but the radiologists here are superb. They’ve double-checked each other’s work, and Dr Zigler agrees. Everyone’s sure. But would you like me to explain what I think is happening? I don’t talk in fine detail, Ruby. I just see the overview. That’s actually what I do, total patient care, looking after you as well as your baby. I’m an obstetrician and a surgeon who specialises in looking after mums and bubs if bub needs an operation before it’s time for her to be born.’

Silence. Ruby cast him a scared look and subsided. He waited, while Ruby pulled herself together a bit more, while Em handed her a wad of tissues, while both women readied themselves to front what was coming.

‘Heinz says he told you the fine detail,’ he said at last, when he thought Ruby was as ready as she was going to be. ‘But here’s the broad outline. The bones of your baby’s spine—the vertebrae—haven’t formed properly to protect your baby’s spinal cord. The spinal cord holds the nerves that control your baby’s movements. Because those nerves run right through the body, if the cord gets damaged then long term, your baby might not be able to walk. She might not have control of her bladder and bowel. If she has a severe problem she can also end up with a build-up of fluid in her brain. Then she’ll need a shunt, all her life, to drain the excess fluid and relieve pressure.’

Ruby was crying again now, but not sobbing. Em’s arm was around her, holding her close, but Ruby’s attention was held. Her distress was taking second place to her need to know, and she seemed to be taking it in.

‘So,’ she whispered. ‘So?’

‘So the good thing is,’ he said, still gently, ‘that many problems of spina bifida aren’t directly caused by the spina bifida itself. Doctors cleverer than me, like Heinz—did you know he’s top in his field in research?—have worked out that the exposure of the spinal cord to the normal fluid in your womb, the amniotic fluid, is what progressively destroys the exposed nerves during pregnancy. If we can operate now, really early, and cover the exposed cord, then we prevent much of the damage. Your baby’s much more likely to be able to live a normal, happy life.’

‘But not with me,’ Ruby whispered.

That was another issue altogether. Adoption. This was a single mum, a teenager, facing a life apart from the baby she was carrying.

‘You haven’t decided definitely on adoption,’ Em murmured, and the girl shook her head.

‘I can’t think …’

‘And you don’t need to think.’ Em’s hold on her tightened. ‘There’s too much happening now for you to think past what you need to face right now. But, Ruby, regardless of what you decide to do when your baby’s born, regardless of whether you decide you can care for her yourself or if you want to give her to parents who need a baby to love, she’ll still be your daughter. You have the choice now to make a huge difference in your daughter’s life.’

‘You’re … sure she has to have this operation?’ Ruby whispered. ‘I mean … really sure?’

‘We’re sure,’ Oliver told her, suddenly immensely grateful for Em’s presence. Without Em he doubted whether he’d have been able to get past the fear. ‘But the operation’s not without risks.’ He had to say that. There was no way he could let this kid agree to surgery without warning her. ‘Ruby, there are risks to you and risks to your baby. I believe those risks are small but they’re still there.’

‘But … I will make a difference.’

‘Heinz tells me that because the spinal cord exposure is relatively high and very obvious on the ultrasound, then if we leave the operation undone, your daughter will probably spend her life in a wheelchair,’ he said bluntly. ‘And with the amount of exposure … there will be fluid build-up in the brain. She’ll need a shunt and there may even be brain damage.’

‘That’s why Dr Evans has arrived here so fast,’ Em went on smoothly. ‘We haven’t had a specialist in-utero surgeon on staff, but when we saw your ultrasound Dr Zigler knew we had to get the best obstetrician here as fast as we could. That’s who Dr Evans is. The best. So now it’s up to you, Ruby, love. Will you let us operate on your baby?’

‘Heinz and I can close the gap over the cord,’ Oliver told her. ‘There’s probably already a little damage done, but it’s so early that damage should be minimal. What we’ll do is put you to sleep, cut the smallest incision in your tummy as possible—you’ll be left with a scar but I’m very neat.’ He grinned at the girl, knowing a bit of pseudo modesty often worked, and he got a shaky smile in return. ‘Then we’ll gently turn your baby over where she’s lying—with luck we won’t have to take her out. Once her back is exposed Heinz will check everything, tweak things to where they should be, then we’ll close the gap over her spinal cord. We’ll settle her back down again and tuck her in, stitch you up and leave you both to get on with your pregnancy. You’ll need to stay in hospital for about a week, maybe a bit longer, until we’re sure we haven’t pressured bub into coming early, but then everything should proceed as normal.’

‘And she won’t have to be in a wheelchair?’

‘Ruby, we can’t make any promises.’ He caught her hand and held it. Em was still hugging her, and Oliver thought, not for the first time, Em was a wonderful midwife. She knew when to intervene and she knew when to shut up. She also exuded a quiet calm that was a tranquilliser all by itself.

He’d met her ten years ago. He’d been a barely qualified doctor, she’d been a student nurse, but already the confidence she’d engendered in the patients he’d worked with had been impressive. He’d seen her with some terrified teenage mums.

There was no nurse he’d rather have by his side and by the time they’d dated twice he’d known there was no woman he’d rather have with him for ever. Their attraction had been instant, their marriage inevitable.

It was only babies … or lack of babies … that had driven them apart.

The night their son had been stillborn had been the worst night of his life. He’d watched Em’s face contort with an anguish so deep it had seemed endless, and there had been nothing he could do to stop it. He’d been unable to help her. He’d been unable to reach her.

But it was hardly the time to be thinking of that now. It was hardly the time to be thinking of it ever. After five years, they’d moved on.

‘I can’t make any promises,’ he repeated, hauling himself back to the here and now, to the needs of the teenage kid in front of him. ‘The procedure Heinz and I are trained to perform usually has an excellent outcome but there are exceptions. I won’t hide that from you, Ruby. There are risks. There’s a chance of infection, for you as well as your baby. We’ll take every care in the world …’

‘But no guarantees.’

‘No guarantees,’ he agreed. ‘So it’s up to you. This is your daughter, Ruby. It’s up to you to make the choice.’

‘I’m too young to have a daughter.’ It was a wail and Em’s arm tightened around her.

‘That’s where I come in,’ she said solidly, a blanket of comfort and reassurance. ‘You want advice, I’m full of advice. You want a hug, that’s what I’m here for, too.’

‘You can’t be here with me all the time.’

‘I can’t,’ Em agreed. ‘I have my own son and daughter to look after. But I’m here every day during the week, and if I’m needed, I can come in at other times. My mum lives with me so I can usually drop everything and come. I don’t do that for all my mums, but I’ll try for you.’

‘Why?’ Ruby demanded, suspicious.

‘Because you’re special,’ she said soundly. ‘Isn’t that right, Dr Evans? You’re one special woman, and you’re about to have one special daughter.’

But Oliver was hardly listening. Somehow he managed to make a grunt of acquiescence but his mind felt like it was exploding.

I have my own son and daughter to look after.

Somehow … a part of his brain had hoped—assumed?—that she’d stayed … as Em. The Em he’d left five years ago.

She hadn’t. She’d moved on. She was a different woman.

I have my own son and daughter to look after …

‘What do you think, Ruby?’ Em was saying gently. ‘Do you want to go ahead with the operation? Do you want time to think about it?’

‘I don’t have a choice,’ Ruby whispered. ‘My baby … It’s the best thing …’

It was. Oliver watched Ruby’s hand drop to cover the faint bulge of her tummy, the instinctive gesture of protection that was as old as time itself.

And the gesture brought back the wedge that had been driven so deep within his marriage that it had finished it. Em had wanted to adopt, and he’d known he couldn’t love like parents were supposed to love. He was right, he thought bleakly. He’d always been right. What was between Ruby and her baby was what her baby needed. Ruby was this baby’s mum. Adoption was great if there was no choice, but how could an adoptive parent ever love a child as much as this?

He knew he couldn’t and that knowledge had torn his marriage apart.

But Em was watching him now, with those eyes he’d once thought he could drown in. He’d loved her so much, and yet he’d walked away.

And she’d walked, as well.

I have my own son and daughter to look after.

It was nothing to do with him. He’d made his choice five years ago, and Em had obviously made choices, too.

He needed to know what those choices had been.

But now wasn’t the time or the place to ask. All he could do was turn his attention back to Ruby, reassure her as much as possible and then set about working out times and details of the forthcoming surgery.

As they finished, a woman who introduced herself as one of the hospital social workers arrived. It seemed Ruby needed help with housing—as well as everything else, she’d been kicked out of her parents’ house. She was staying in a boarding house near the hospital but she wouldn’t be able to stay there when the baby was born.

There’d be more talk of adoption. More talk of options.

Ruby’s surgery was scheduled for the day after tomorrow, but for now he was redundant. He was free to head to the next mum Charles had asked him to see.

He left, but his head was spinning.

Em was still sitting on the bed, still hugging Ruby. I have my own son and daughter to look after.

Whatever she’d done, it had been her choice. He’d walked away so she’d have that choice.

Why did it hurt so much that she’d taken it?

CHAPTER THREE

EM GOT ON with her day, too.

One of the wonderful things about being a midwife was that it took all her care, all her attention. She had little head-space for anything else. What was the saying? Find a job you love and you’ll never have to work again? She’d felt that the first time she’d helped deliver a baby and she’d never looked back.

She sometimes … okay, she often … felt guilty about working when her mum was home with the kids, but the decision to foster had been a shared one. Her mum loved Gretta and Toby as much as she did. They had the big old house, but they needed Em’s salary to keep them going.

Sometimes when Em got home her mother was more tired than she was, but whenever she protested she was cut off at the pass.

‘So which baby are we giving back? Don’t be ridiculous, Em. We can do this.’

They could, and knowing the kids were at home, waiting … it felt great, Em thought as she hauled off her uniform at the end of her shift and tugged on her civvies. Right, supermarket, pharmacy—Gretta’s medications were running low—then home. She’d rung her mum at lunchtime and Adrianna had been reassuring. ‘She’s looking much better.’ But, still, there was no way she was risking running out of Gretta’s drugs.

‘Big day?’ Sophia Toulson, one of the more recent arrivals to the Victoria’s midwifery staff, was hauling her uniform off, too, but instead of pulling on sensible clothes like Em’s—yikes, where had that milk stain come from?—she was putting on clothes that said she was heading out clubbing or to a bar—to a life Em had left behind years ago.

Not that she missed it—much. Though there were times …

‘It has been a big day,’ she agreed, thinking of the night to come. Em had had three sleepless nights in a row. Gretta needed to be checked all the time. What she’d give for a solid eight-hour sleep …

‘But have you met the new obstetrician? You must have—he’s been fast-tracked here to operate on your Ruby. Em, he’s gorgeous. No wedding ring, either. Not that that tells you anything with surgeons—they hardly ever wear them. It’s not fair. Just because rings can hold infection it gives them carte blanche to disguise their marital state. But he’s come from the States and fast, so that hints at single status. Em, you’ll be working with him. How about giving it a shot?’

Yeah, right. Propositioning Oliver? If Sophia only knew … But somehow she managed to grimace as if this conversation were completely normal, an anonymous, gorgeous obstetrician arriving in the midst of midwives whose first love was their job, and whose second love was dissecting the love lives of those around them.

She turned to face the full-length mirror at the end of the change room. What she saw there made her grimace. Faded jeans, with a rip at the knee. Trainers with odd shoelaces. A windcheater with a milk stain running down the shoulder—why hadn’t she noticed that before she’d left the house?

Her hair needed a cut. Oliver had loved her hair. She’d had it longer then and the dull brown had been shiny. It had bounced—she’d spent time with decent shampoo and conditioner, and she’d used a curling wand to give it body.

Now she bought her shampoo and conditioner in bulk at the discount store and her curling wand was rusting under the sink.

Oliver had never seen her like this—until today.

Sophia was suggesting she make a play for him?

‘Can you see Oliver Evans with someone like me?’ she asked incredulously. ‘Sophia, get real.’

‘You could try,’ Sophia said, coming up behind her friend and staring over her shoulder at the reflection. ‘Em, you’re really pretty. With a bit of effort …’

‘All my effort goes into the kids.’

‘You’re burying yourself.’

‘I’m giving them a chance.’ She glanced at her watch and grimaced again. ‘Ouch. I need to go. Have a great time tonight.’

‘I wish I could say the same for you. Home with your mum and two kids …’ She bit her lip and Em knew why. Sophia had the same problem she did—she’d barely worked with her for a month before she’d winkled out of her the reason for the gravity behind what somehow seemed a forced gaity.

Did all women who couldn’t have children feel like this? Maybe they did, but Em’s solution horrified Sophia.

‘I love it,’ she said soundly, even defiantly, because she did. Of course she did. ‘And you have fun at … Where are you going?’

‘The Rooftop Bar. Madeleine just happened to mention to your Dr Evans that we might be there.’ She grinned and started searching her bag for her lipstick. ‘If you’re not interested …’

‘He’s all yours,’ Em said tightly. ‘Best of luck. The supermarket’s waiting for me. Whoo-hoo, a fabulous night for both of us.’

‘Right,’ Sophia said dryly. ‘Em, I wish …’

‘Well, don’t wish,’ Em said, more sharply than she’d intended. ‘Don’t even think about it. This is the life I chose for myself, and I’m happy. Dr Oliver Evans might be at the bar and I guess that’s the life he’s chosen, too. We’re all where we want to be, and we can’t ask for more than that.’

Oliver’s day wasn’t supposed to be frantic. Weren’t new staff supposed to have an orientation day, a shift where they spent the time acquainting themselves with ward and theatre staff, meeting everyone in the canteen, arranging stuff in their office? Not so much. Harry, it seemed, had left in a hurry. His lady had been enticing; he’d left without giving proper notice and the work had backed up.

Apart from that, Harry hadn’t had specialist in-utero surgical training. It seemed that word of Oliver’s arrival had flown around Melbourne before he arrived. He had three consultations lined up for the afternoon and more for the next day.

Ruby’s case was probably the most complex. No, it was the most complex, he thought, mostly because the scans showing the extent of the problem had made him wince.

Plus she was alone. His next mum, Lucy, arrived with a support cast, husband, parents, an entourage of six. Her baby had a congenital heart malfunction. The little boy in utero was a twenty-four-weeker. He needed an aortic valvuloplasty—opening the aortic foetal heart valves to allow blood flow. It was one of the most common reasons for in-utero surgery, the one that Oliver was most comfortable with—as long as he had the backup of decent cardiac surgeons.

Oliver had already met Tristan Hamilton, the Victoria’s neonatal cardiothoracic surgeon—in fact, they’d gone to university together. Tristan had backed up Charles’s calls, pressuring him to come, and he had been one of the inducements. Tristan was incredibly skilled, and if he could work side by side with him, for this mum, things were likely to be fine.

But what seemed wrong was that Lucy and her little boy had huge family backup—and Ruby had no one.

But Ruby had Em.

That had to be compensation. Em would be terrific.

If indeed she was with her. She’d been running late that morning. She’d looked harassed, like she had one too many balls in the air.

She’d come flying into Ruby’s room half an hour after she’d hit his car, burbling about an early delivery. Really? Or had she spent the half hour on the phone to her insurance people?

It was none of his business.

Still, it was a niggle …

Isla Delamere was the Victoria’s head midwife—plus she was the daughter of the CEO. Apparently she’d also just become engaged to the hospital’s neonatal intensive care specialist. Isla was not a person to mess with, he’d decided. He’d been introduced to her by Charles, and as he was about to leave he saw her again.

‘You have how many in-utero procedures lined up for me?’ he said, half joking. ‘You guys believe in throwing me in at the deep end.’

‘You just do the surgery,’ she said, smiling. ‘My midwives will keep everything running smoothly. I have the best team …’

‘My midwife this morning was running late.’ He shouldn’t have said it. He knew it the moment he’d opened his mouth. The last thing he wanted was to get Em into trouble and this woman had power at her fingertips, but Isla didn’t seem bothered.

‘I’m sorry about that. We had three births within fifteen minutes of each other just as Em came on duty. I know her care of Ruby’s a priority, but one of the births was prem, the mum was out of her tree, and there’s no one better at calming a frantic mum than Em. I only used her for the final fifteen minutes but it made a difference. You did cope by yourself until then?’

She raised her beautifully formed eyebrows quizzically … head midwife wondering if surgeon could cope without a little assistance …

Right. He’d got his answer but now Isla thought he was a wimp. Great start.

‘Some of the staff are going to the Rooftop Bar after work,’ Isla told him. ‘Have you been invited? You’re welcome to join us.’

‘Thanks but I have a problem to sort.’

‘Your car?’ She was still smiling and, he thought, that was just the sort of thing that hospital staff the world over enjoyed. Specialist’s car being trashed, especially since most staff here could never afford to run a car like Betsy.

He loved that car and now she was a mess. But …

‘Em’s promised to sort it,’ Isla told him. ‘She’s not the sort of woman to let her insurance lapse.’

‘It’s not the insurance …’

‘And she’s really sorry. She was stricken when she first came in this morning. She’s been so busy all day I suspect she hadn’t had time to apologise but—’

‘Will she be at the bar now?’

‘Em? Heavens, no. She has two kids waiting for her at home.’

‘Two?’

‘Gretta’s four and Toby’s two. They’re special kids but, wow, they’re demanding.’

‘I guess …’ And then he asked because he couldn’t help himself. Had a miracle happened? Gretta’s four … She must have moved like the wind. ‘Her partner …’ He knew there couldn’t have been a marriage because there’d never been a divorce but … there must be someone. ‘Is he a medic? Does she have help?’

But Isla’s eyebrows hit her hairline. Her face closed, midwife protecting her own. ‘I guess that’s for you to ask Em if it’s important for you to know,’ she said shortly, clearing her desk, making signals she was out of there. Off to the Rooftop Bar to join her colleagues? ‘She doesn’t talk about her private life. Is there anything else you need?’

More information, he thought, and he’d bet Isla knew everything he wanted to know. But he couldn’t push without opening a can of worms. Evans was a common name. Em had clearly not told anyone there was a connection.

Better to leave it that way, maybe.

‘Thanks, no.’

‘Goodnight, then. And good luck with the car. You might let Em know when you have it sorted. She’s beating herself up over it. She’s a great midwife and I don’t like my midwives stressed. I’d appreciate it if you could fix it.’

‘I’ll try,’ he said, but it was too late. Isla had gone.

He headed down to the car park. He hadn’t been back to assess the damage during the day—he hadn’t had time.

The park next to his was empty. Em was gone.

Her wagon had still been drivable. Her doors had been bent, but the wheels were still okay, whereas his … One of the wheels was far from okay and he wasn’t driving anywhere. He stooped and examined it and thought of the hassle it had been to find the right parts for his little beauty. Where was he going to find another wheel rim? And the panels were a mess.

Strangely, it didn’t upset him as much as he’d thought it might. He checked the damage elsewhere and knew he’d have to get her towed—actually, carried, as there was no way she could be towed like this. And then he’d go searching for the parts he needed.

He kind of liked searching the internet for car parts. It was something to do at three in the morning when he couldn’t sleep.

Which was often.

He rounded the front of the car and there he saw a note in his windshield. Em?

Oliver, I really am sorry about this. I’ve put my hand up, it was all my fault, and I’ve told my insurance company to pay without arguing. I photocopied my driver’s licence and my insurance company details—they’re attached. One of the girls on the ward knows of a great repair place that specialises in vintage cars—the details are here, too. See you when you next see Ruby.

Em

It was all about the car. There was nothing personal at all.

Well, what did he expect? A mea culpa with extras? This was more than generous, admitting total culpability. Her insurance company would hate her. As well as that, she’d probably have to pay the first few hundred dollars, plus she’d lose her no-claim bonus.

He could afford it. Could she?

He re-read the note. What was he hoping for? Personal details?

Her driver’s licence told him all he was going to get. Emily Louise Evans. She was still using his name, then. So … single mother? How? Had she gone ahead and adopted by herself? He checked again, making sure he was right—she was living at her mother’s address.

He liked Adrianna. Or he had liked her. He hadn’t seen his mother-in-law for years.

He could drop in …

Why?

‘Because she shouldn’t accept full responsibility,’ he said out loud. ‘If she’s supporting kids …’

She’d said she’d already phoned her insurance company and confessed, but maybe he could reverse it. Maybe he could take some of the load.