Midwives On-Call

‘I’m really causing stress for her?’ he asked. When she didn’t say anything his black eyes met hers and he gave a wry smile as he answered his own question. ‘Clearly I am. God, I never meant to, Isla. The thing is, what happened during Niko’s labour was preventable. I just want to …’ His voice trailed off.

‘You want to ensure that nothing goes wrong with this one,’ Isla finished for him, and Alessi nodded. ‘I get that but if something does go wrong, if an emergency does arise, do you really want to be a part of it?’

‘I want to be there to ensure nothing untoward happens in the first place.’

‘Look, I do get that …’ Isla started but Alessi didn’t let her finish.

‘Allegra going for a natural delivery is a crazy idea, given what happened last time.’

‘It’s not a crazy idea to Allegra, and it’s not a crazy idea to her obstetrician—’

‘Darcie’s been here all of five minutes.’

Isla chose to ignore that. She knew it was hard when another doctor took over a patient’s care but it wasn’t for Alessi to air his concerns to his sister so she continued with what she was saying. ‘And it isn’t a crazy idea to me. A lot of women want to experience a natural delivery. She’d have a closely monitored trial of labour and if things didn’t progress well then, perhaps more quickly, given her history, things would move towards a Caesarean. Even if Darcie is new, our recruitment policy is vigorous and she’s joined an amazing team, which means that your sister shall be well looked after here, Alessi, you know that.’

Alessi thought for a long moment. Really, he could only admire Isla for confronting him on this difficult subject but her help didn’t end there.

‘If it makes it any easier for you,’ she continued, ‘I’m happy to oversee Allegra’s care.’

Alessi’s eyes jerked up and met hers.

‘Whatever you think about me personally, Alessi, however you think I landed the role, the truth is I think that we both know that I do a very good job. I will, if you would like, keep an eye on Allegra during her antenatal visits and, as far as possible, I will be there for the birth.’

‘You’d do that?’

‘Of course.’

Alessi was surprised by her offer but, then again, was he? For nearly a year he had chosen to believe she had got the job because of who her father was. He had been wrong about that. Alessi had known it deep down and it was confirmed right now. The patients all raved about her, there was no doubt that she ran a very good midwifery unit and now she was offering to take care of Allegra when both knew how tense things were between them. Even the fact that Allegra had discussed so much with Isla told Alessi something—she didn’t open up easily to anyone, yet she had with Isla. ‘I would like that and I’ll back off, too,’ Alessi said, and then stood. ‘Thank you.’

‘No problem.’

He went to go but then turned around. ‘I was going to come and see you later,’ Alessi said. ‘But now that we’re here, I might as well just say it now—I would like to apologise for the things that I said last night.’ Isla found she was holding her breath as he continued, ‘I had no right to lecture you about your partner and the choices you make. It was out of character for me and I really would like to apologise.’

‘It’s fine.’

‘Also, I broke up with Amber last night, so you don’t have to worry that I’m dating one of your students.’

‘Because of what I said?’

Alessi let out a very mirthless laugh. ‘No.’

‘But …’

‘As I said, I don’t cheat and, given that last night the only person I wanted was you, it seemed appropriate to end things.’

And with that he was gone and only when the door closed behind him did Isla let out the air trapped in her throat—her lungs were still closed tight.

Had he just said what he had?

Yes.

Did that mean …?

It did.

Oh, God.

It was like being tossed three flaming torches and having to learn to juggle with absolutely no clue how.

She walked out of the consulting room into a world that felt very different—Alessi liked her, in that way, and had made it clear that he was single. There was no Rupert to hide behind any more, not that she’d told Alessi that.

She was on the edge of something—scared to step off yet somehow compelled to.

Allegra was holding Niko and speaking with Sophia, but Isla watched her turn and smile widely at her brother as he came over, and as Isla approached she heard their conversation.

‘You should have said.’ Alessi gave her a cuddle.

‘I tried,’ Allegra gently scolded. ‘Several times.’

‘I’ll back off and I’ll make sure Mum and Dad do, too,’ Alessi promised. ‘I just …’

‘I know,’ Allegra said. ‘I know you were just trying to do your best for us.’ She looked at Isla as she joined them. ‘Thank you so much, Isla.’

‘It’s no problem. I’ve spoken with Alessi and, if you’re happy for me to do so, I can oversee things and come down and check all your antenatal visits, rather than your brother, and then, if you’d like, I’d be delighted to be there for your birth of your second child.’

‘I’d really like that, Isla.’

‘Good.’

She nodded goodbye and as Isla walked off Allegra smiled. ‘I feel so much better. You really will speak to Mum and Dad?’

‘Yep.’

‘They’ll give you a hard time,’ Allegra pointed out.

‘So, what’s new?’

‘’Lessi!’ Niko, fed up with all the adults, held out his arms to his uncle and, from a slight distance Isla watched as Alessi took his little nephew in his arms and gave him a kiss and then he must have said something funny because Niko laughed and laughed and Alessi grinned, too.

Then he turned and caught her staring at him and the smile remained as she blushed and returned it then quickly walked away, to return to the ward.

Yes, she was on the edge of something.

Something temporary, though. She knew that much about Alessi and she had almost reconciled herself to that.

Yes, this year was going to be very different. Alessi was going to be her first.

Even if he mustn’t know it.

Somehow she had to hold onto her glamorous, sophisticated reputation while releasing a little of her heart.

CHAPTER FIVE

DARCIE SETTLED INTO the flat and hospital amazingly well.

With one exception.

Her first week at the Victoria passed smoothly but at the start of Darcie’s second week Isla heard an angry exchange coming from the treatment room and then Darcie marched out. Frowning, Isla stepped into the treatment room to find Lucas standing there, the tension still in the air and a wry smile on his face.

‘Issue?’ Isla checked, trying to hide her surprise because Darcie got on with everyone, and no one, no one ever had an issue with Lucas—he was down-to-earth and seriously gorgeous and for him to have had upset Darcie or vice versa was a surprise indeed.

‘You tell me.’ Lucas shrugged.

‘Lucas?’ Isla frowned. He was a part of the glue that tied the MMU together. He got on with everyone, was intuitive, funny and so damn good-looking that his smile could melt anyone. It would seem it simply didn’t melt Darcie.

‘I don’t need the new obstetrician telling me I’m late and to get my act together.’

Isla let out a breath. No, that much Lucas didn’t need.

‘And,’ Lucas drawled, ‘I also don’t need you to have a word for me, Isla. Whatever her issue with me is, I’ll deal with it myself.’

‘Fine,’ Isla said, ‘but whatever the hell your issues are with each other, keep them well away from the patients.’

‘You know that I will.’

‘I do,’ Isla said. ‘Let me know if you need anything …’ She turned to go but Lucas halted her.

‘Isla, I hate to say this, I know I was late in this morning but I really need to go home …’ He blew out a breath and then went to explain but Lucas didn’t need to explain things to Isla. She knew that his home life was complicated at best and if Lucas said that he needed to go home then he was telling the truth.

‘Go, then,’ Isla said. ‘I’ll take over your patients.’

‘I’ve only got one,’ Lucas said. ‘I’m expecting her to arrive any minute, I’m just setting up for her. Donna Reece, she’s pretty complex.’

‘You think I can’t handle complex?’ Isla teased.

‘No, I just feel like I’m landing an awful lot on you.’

‘Return the favour someday.’ Isla smiled. ‘Hand over the patient to me and go home.’

As Isla wheeled through the drip Lucas had set up, there was Darcie, checking drugs for the imminent arrival of Donna Reece. She was forty years old, at twenty-four weeks gestation with twins and a direct admission from the antenatal ward as she had been found to be in premature labour.

‘Where’s Lucas?’ Darcie frowned. ‘He was supposed to—’

‘I’ve got your orders,’ Isla said. ‘I’m taking over this patient.’

‘Oh, so he doesn’t want to work with me?’

‘Lucas has gone home,’ Isla said. She was about to tell Darcie why and to tell her to back off Lucas, but then she remembered that Lucas had asked her not to step in. Anyway, there was no time for that. Donna was about to arrive.

‘Did he page Alessi?’

‘Yes,’ Isla said, and as Donna was wheeled in, just the look on her face had Isla reaching for the phone to page for an anaesthetist to come directly to the delivery ward, too.

‘Hi, Donna, I’m Isla …’

Isla kept her voice calm as she attached Donna to all the equipment. Things didn’t look good at all and it was made worse that Donna’s thirteen-year-old daughter was present and clearly distressed.

As Alessi arrived Isla was taking the young girl down to the waiting room and she gave him a grim smile, in way of small preparation for what he was about to face.

‘Have a seat in here,’ Isla said to Jessica. ‘I know that you’ve had a horrible morning …’

‘I thought that Mum was just coming here for a checkup,’ Jessica said. She was holding a large backpack and Isla could see a towel sticking out of it. It was the summer holidays and clearly they had intended to head out to the beach for the day after the routine appointment that had suddenly taken a different turn. ‘Mum said she didn’t feel well this morning and I said she’d promised we’d go out. I should have listened …’

‘Jessica, I’m going to come and talk to you later. You’ve done nothing wrong and your mum is going to be okay.’

‘But what about the babies?’ Jessica asked.

‘Right now the doctors are in with your mum and we’ll know a lot more soon. Is there anyone I can call for you? Your dad’s overseas?’ Isla checked, because Lucas had told her that he was.

‘He is but Mum’s going to ring him and tell him to come home.’

‘I’ll speak to your mum and we’ll see about getting someone to come and sit with you. Right now, do your best to take it easy and I’ll go and see how Mum is doing.’

She went back into the delivery ward. Alessi was doing an ultrasound and his face was grim and he wasn’t trying to hide it. He was clearly concerned.

‘How’s Jessica?’ Donna asked.

‘She’s just worried about you and the babies,’ Isla said. ‘Is there anybody that you’d like me to call who can come and be with her?’

‘Could you call my sister?’ Donna asked. ‘Tom, my husband, is in Dubai. I’m going to see what Darcie has to say and then call him and ask him to come home.’ Donna closed her eyes. ‘Jessica and I had an argument last night. I told her that I needed more help around the house, especially with the twins coming. Then we had another row this morning because I’d promised to take her to the beach but I told her I was too tired, when really my back was hurting and I was starting to worry that something was going wrong with the twins.’ Donna started to cry. ‘She said in the ambulance that she thinks this is all her fault.’

‘We both know that none of this is her fault,’ Isla said. ‘These things happen all the time, whether there’s an argument involved or not. I’ll speak with your daughter at length about this,’ Isla promised, and Alessi glanced up at the determined note in her voice. ‘Right now, though,’ Isla continued, ‘we need to take care of you and your babies.’

‘Darcie’s said that the medicine might postpone the labour.’

‘That’s right,’ Isla nodded, and then glanced up as Alessi came over.

‘Hi, Donna.’ He gave a pale smile. ‘As I said, I’m going to be overseeing the twins’ care.’

‘Hopefully not for a while,’ Donna said, but Alessi glanced at Isla and her heart sank as Alessi continued to speak.

‘I’m not sure. I have to tell you that I am very concerned about one of the twins on the ultrasound. Do you know what you’re having?’

Donna nodded. ‘Two boys.’

‘That’s right, and you know that they’re not identical?’

Again Donna nodded.

‘The twins are in two separate amniotic sacs and they each have their own placenta,’ Alessi explained. ‘The trouble is that one of the twins is smaller than the other, and the fluid around this twin …’ he placed a hand high on Donna’s stomach ‘… is significantly reduced. Most of the time our aim is to prolong the pregnancy for as long as possible but in some cases it is better that the baby is born.’

‘Even at twenty-four weeks?’ Donna asked, and there was a very long silence before Alessi answered.

‘No,’ he said gently. ‘It is far too soon but this is where it becomes a very delicate balancing game. Darcie has given you steroids that will mean that if the twins come after forty-eight hours then their lungs will be more mature than they would otherwise be. However, I’m not sure that I want the delivery to be held off for much longer. This little one needs to born soon. The placenta isn’t doing its job and that twin stands a better chance out of the womb than inside.’

‘But what about the other one?’

‘That is why it is such a delicate balance,’ Alessi said. There were no easy answers—twin A needed as long as possible inside the womb; twin B, to have a chance of survival, desperately needed to be born. The diagnosis was indeed grim. Twenty-four weeks was, in the best of cases, extremely premature but for an already small undernourished baby it didn’t look good at all. Isla listened as Alessi gently led Donna down the difficult path of realisation that the babies’ chances of survival were poor and that their outlook, if they did live, might not be bright.

It really was a horrible conversation to have, and he did it kindly and with compassion, but he was also clear in that he didn’t offer false hope. By the end of the consultation Donna had said that she wanted everything, everything possible done for both twins when they were born.

‘We shall,’ Alessi assured her. ‘Donna, I can say that you are in the very best place for this to happen. I am going to be there for your boys and I shall do all that I can for them.’ He stood and looked at Isla, asking if he could have a word outside.

‘Any changes, particularly to twin B, I want to be urgently paged. I’ve spoken to the anaesthetist and he’s going to set up an epidural so that we can do an urgent section if required.’

‘How long do you think twin B has got if he isn’t delivered?’

‘I’m hoping to buy a few days,’ Alessi said. ‘Though I doubt we can wait much longer than that, though that would be to the detriment of twin A, who looks very well.’

‘It’s a tough choice.’

‘I don’t think I’ll have to make it.’ Alessi sighed. ‘She has marked funnelling,’ he said, and Isla nodded. The cervix was dilated at the top end and that meant that Donna could deliver at any time.

‘I’m going to go and speak with Jessica now,’ Isla said, ‘and then ring her aunt and ask her to come in.’

‘Do you want me to speak with her?’ Alessi offered, but Isla shook her head.

‘I’m sure you’ll be having a lot of contact with the family in the coming days and weeks. If you could just bear in mind that she’s feeling guilty, when really, whether Donna was in labour or not when she presented in Antenatal, the outcome was always going to be that she was admitted today …’

‘I’ll keep it in mind,’ Alessi said. ‘Oh, and I just had a call from Allegra. She’s very grateful to you. Things are much better.’

‘That’s good.’

‘I spoke with my parents, as well, and they are doing their best now not to interfere.’

‘How did that go?’ Isla asked.

‘Ha.’ Alessi smiled. ‘They do listen to me when it’s about work.’

‘Only then?’ Isla asked, her curiosity permanently piqued when it came to Alessi, but he simply gave a small nod.

‘Pretty much. I’d better get back.’

‘Sure.’

‘Isla?’

‘Yes?’

Alessi changed his mind. ‘It will keep.’

He left her smiling.

When Alessi had gone back to NICU and things were settling down with Donna, Isla had a very long chat with Jessica. Rather than speaking in her office, Isla took the young girl to the canteen and they had a drink as Isla did her best to reassure her that none of the situation was her fault.

‘None of this happened because of your argument with your mum,’ Isla said, when Jessica revealed her guilt. ‘I promise you that. One of the twins is very small and we’d have picked up on that today at her appointment and she would have been admitted.’

‘It’s too soon for them to be born, isn’t it?’ Jessica asked.

‘They’re very premature,’ Isla explained. ‘But as I said, there’s a problem with one of the twins and your mum was always going to have to deliver the twins early. Do you understand that you didn’t cause this?’

‘I think so,’ Jessica said. ‘I’m scared for my brothers.’

‘I know that you are, but we’re going to do all we can for them and for your mum. I’ve spoken with your aunt and she’s on her way in and you’re going to be staying with her tonight. Your mum’s rung your dad and he’s on his way back from Dubai.’

‘It’s serious, then.’

‘It is,’ Isla said. There was no point telling Jessica that everything was going to be fine. It would be a lie and even with the best possible outcome, her mum and brothers were going to be at the Victoria for a very long time. ‘But your mum is in the best place. Darcie, the doctor who is looking after her, is very used to dealing with difficult pregnancies. In fact, she’s just come over from England and we’re thrilled to have her expertise, and Alessi, the doctor who will be in charge of your brothers’ care, is one of the best in his field. He’ll give them every chance.’

She let the news sink in for a moment. It was a hard conversation, but Isla knew that it might be easier on Donna if she prepared Jessica and ultimately easier on Jessica to be carefully told the truth. ‘Why don’t we get Mum a drink and take it up to her now?’

Jessica nodded and they headed back up to the ward. Isla was pleased to see Jessica and Donna have a cuddle and Donna reiterate to Jessica that none of this was her fault.

It was a long day and it didn’t end there because just as Isla was about to head for her home she got an alert on her computer that it was her fortnightly TMTB group tonight.

‘I completely forgot,’ Isla groaned to Emily. ‘I honestly thought it was next week.’

‘Do you want me to take it?’ Emily offered. ‘I can go home for an hour and then come back.’

‘That’s lovely of you but, no, it’s fine.’ Isla smiled. She knew how stretched Emily was and it was incredibly generous of her to offer to stay back.

Isla did some paperwork to fill in the time and then headed over to the room they used for TMTB. She turned on the urn and put out a couple of plates of biscuits and set up. Usually there were five to ten young mums, all at various stages of pregnancy.

As Isla was setting up a young girl put her head around the door. She was clearly nervous and Isla gave her a warm smile.

‘Are you looking for Teenage Mums-To-Be?’ Isla asked, and the girl gave a tentative nod.

‘Then you’re in the right place. I’m Isla.’

‘Ruby.’

‘I’m just setting up but come in and help yourself to a drink. The rest of the group should start arriving any time now.’

Isla watched as the young girl came in. She was incredibly slim and, Isla guessed, around sixteen years old. She was wearing shorts and a large T-shirt and if she hadn’t been here, Isla wouldn’t have guessed that she was pregnant. It was good that she was here so early in her pregnancy, Isla thought, but when she looked over to where Ruby was making a drink her heart sank as she saw the young girl slipping a few biscuits into her pocket and then a few more.

She was hungry, Isla realised.

Pregnant and hungry.

‘I’ll be back in a moment, Ruby,’ Isla said, and headed back to the ward. In her office Isla rang down to Catering and asked for sandwiches and a fruit platter and some jugs of juice to be sent up. There were some perks to being a manager because her request went through unquestioned and Isla only wished that she had thought of this long ago. Still, TMTB was a relatively new project and they were all still feeling their way.

Gradually the other girls started to arrive and at seven the group started and introductions were made. Harriet was nineteen and this was her first pregnancy. She had already been told that her baby was going to have significant issues.

‘He’s going to have to have an operation as soon as he’s born,’ Harriet said. ‘I don’t really understand what is happening, but Mum said that she’ll come to my next appointment with me.’

‘That’s good,’ Isla said. ‘It’s really helpful to have someone with you at these appointments because sometimes you can forget to ask a question or later not remember what was said.’

Then it was Alison’s turn. She was about four weeks away from her delivery date and very excited. ‘I didn’t even want to be pregnant,’ Alison admitted, ‘and now I can’t wait.’

Isla smiled. This was one of the reasons that she loved this group so much. It was very helpful for others to realise that the conflicting emotions they might be feeling weren’t reserved for them. Here the girls got to share in each other’s journeys and Isla had seen that Ruby was listening intently, though she was guarded when it was her turn to speak.

‘I’m Ruby,’ she said. ‘I’m fourteen weeks pregnant.’

‘How old are you, Ruby?’ Isla asked, and suspicious eyes looked back at her before she answered the question.

‘Seventeen.’ She was immediately defensive. ‘My mum wanted me to have an abortion but I’m not getting rid of it.’

‘How are things with you and Mum at the moment?’ Isla gently pushed, and Ruby shrugged.

‘I haven’t really seen much of her. I’m staying with friends at the moment.’ Isla made a mental note to look at Ruby’s file and see if there was anything more that she could do to support her during this difficult time. She would talk to her away from the group, Isla decided, but for now she moved on.

Alison had some questions about delivery and pain control and said that she didn’t want to stay in bed.

‘You don’t have to,’ Isla said. ‘We usually encourage mothers to move around during labour—walking around is wonderful.’

There were always a lot of questions. Isla loved the enthusiasm of the teenage mums and more often than not both the questions and answers were interspersed with a lot of laughter.

It was that sound of laughter that alerted Alessi as he walked out of Maternity, having just checked in again on Donna.

He hadn’t stopped all day and seeing a huge trolley laden with food being delivered to the room, he assumed that there was an administration meeting going on.

He was starving and, completely shameless, he followed the trolley into the room, to be greeted by a sight that he wasn’t expecting!

Isla felt awkward around Alessi and possibly she had every reason to now as he put his head around the door just in time to capture her in a deep squat on the floor as she showed the girls how that position opened up the pelvis nicely!

Here, though, was not the place to be awkward and so, instead of hurriedly standing, as was her instinct, she remained in a rather embarrassing position and gave him a very bright smile as the girls turned round to see who had interrupted the group.