The Honourable Maverick

‘Thirty-six weeks and two days,’ Max said.

Ellie was almost naked now. Totally vulnerable. Exposed to an expanding team of medical personnel. Someone from the obstetric department had arrived, closely followed by a technician pushing a portable ultrasound machine. Jet was holding a mask over Ellie’s face and frowning as he watched the numbers changing on the overhead monitor.

‘Ellie…’ He had his mouth right beside his ear and was speaking loudly. ‘Can you hear me? Open your eyes.’

She wouldn’t want to, Max thought. This would have to be absolutely terrifying.

‘Are there any relatives who could give me her details?’ the clerk persisted. ‘Did her husband come in with her? Or…her partner?’ The woman knew she was failing in her task but she made yet another effort. ‘The father of the baby?’

That flicked a switch in Max’s head and its effect was magnified by how vulnerable Ellie was. How much trouble she was in right now. He had tried to protect her and somehow he had stepped into a new nightmare and was still by her side. Was she aware of what was happening? Still terrified? Did she know he was here?

She had been so determined to stay away from hospitals to protect her child. Maybe the best thing he could do for her at this moment was to respect that determination and carry on with what had already worked once.

‘Yes,’ he said clearly. ‘I’m the father.’

Somebody dropped something metallic on the far side of the room and the sound rang out in the suddenly still moment following his statement. Jet uttered a low profanity but his gaze was still fixed on the monitor and the sound could well have been taken to be concern at a new development in Ellie’s condition. Max was close enough to speak to his friend without being overheard by anyone else.

‘I’ll explain later,’ he murmured. ‘Just back me up.’

The clerk was happy, scribbling on the sheet of paper attached to the clipboard. ‘Surname?’ she chirped briskly.

Oh, Lord. If she got registered under her real name, they have to deal with Marcus Jones turning up and he’d have plenty of time to get here. Even if things went better than any of them could expect in this room, there was no way Ellie would be getting discharged in a hurry.

There was no time to think. In for a penny, in for a pound.

‘McAdam,’ he said wearily. ‘We’re married.’

The nurse, who was sticking on the leads required for a twelve-lead ECG, looked up, open-mouthed, and others exchanged astonished glances but the clerk knew she was on a roll.

‘How old is your wife?’

‘Twenty-eight.’

‘Date of birth?’

As if he’d know. This had gone far enough. Far too far, judging by the look Jet slanted his way.

‘Leave it,’ Max growled. ‘We can sort the paperwork later.’

‘But we need—’

‘Get out,’ Jet snapped. ‘We’re busy.’ He looked up, avoiding Max but catching most others in the room as he issued his orders.

‘I’m going to intubate,’ he warned. ‘Oxygen saturation levels have fallen far enough. We need a central venous line in. And an arterial line.’

‘I’ll do that,’ Max offered.

Jet gave his head a negative jerk. ‘On your wife? I don’t think so.’ He nodded at his registrars, giving them the signal to get started. ‘Get some bloods off as well. We need to know her blood group. Stat.’

‘I’d like a rhesus factor and antibodies, too.’ The obstetric consultant was watching the technician begin the ultrasound examination. ‘Looks like we’ve got a central placenta praevia here and she’s in labour. Fully dilated.’

Less than an hour later, in the middle of the life-and-death battle to save Ellie Peters, she gave birth to a tiny baby girl.

There was a paediatric team amongst the crowd in Trauma One now. And a consultant from the intensive care unit, who was a specialist in dealing with haemorrhagic shock resulting from such massive blood loss. Ellie was being cared for. The baby was being carefully assessed.

Having been forced onto the sidelines due to his own admission of involvement, there seemed to be nothing for Max to do other than watch. He was torn between watching the monitors to evaluate the success of the treatment Ellie was receiving and staring at the scrap of humanity the paediatric consultant was bent over.

‘She’s small but doing OK,’ she pronounced eventually. ‘I’m happy with her breathing but the heart rate’s a bit on the slow side. Did I hear someone say the father is here?’

Ellie was deeply unconscious. The obstetrician was happy that the bleeding had ceased now that delivery was complete but the control of the blood loss might have come too late. The mother of this tiny baby was now on a ventilator to manage what looked like adult respiratory distress from fluid loss. Jet and the ICU consultant were worried about her kidneys. Her production of urine had virtually ceased and her most recent blood test showed deterioration in renal function.

Max had done what he’d thought was the right thing in continuing the pretence that he was the baby’s father and he couldn’t back out now. Jet wouldn’t say anything because he’d asked him to back him up and the brotherhood that they made up, along with Rick, was glued together with a loyalty that would never be broken. There were plenty of other people ready to say something, however. To point him out and draw him into the case that this department would be talking about for a very long time.

‘You’re the father?’ The paediatrician didn’t know him so there was no undertone of astonishment. ‘Good. Come with us. We’re going to take your daughter upstairs and she’ll need you.’

Max took a step towards the group looking after the baby. And then another. And then he stopped.

‘I can’t…’ He looked over his shoulder at Ellie. And then back to the baby, now dried and wrapped in soft, warm towels. What the hell had he got himself into here?

Jet’s voice was calm. ‘Nothing you can do for Ellie at the moment, mate,’ he said. ‘We’re going to transfer her up to ICU very soon. Best you go with the baby. I’ll come and update you as soon as I can.’

And wherever the baby was being taken, whether it was a maternity ward or the paediatric ICU, it would be a more private place, Jet’s tone suggested. They would be able to talk about this. Hopefully, they might even be able to sort out the mess Max had created.

It seemed a reasonable plan. Max wasn’t due on duty here in the emergency department until first thing tomorrow morning. They had a whole night to sort things out. Stepping back from taking any responsibility for Ellie might be a good first step. He took another step towards the baby and nodded.

‘Let’s go,’ he agreed.

‘How would you feel about holding her?’

‘Ah…I’m not sure that’s a great idea right now, is it?’

The paediatrician also took another glance at the monitor where the newborn baby’s heart rate was slowing down yet again.

‘It could help. Have you heard of kangaroo care?’

‘No.’ Max was staring at the baby in the plastic crib. It was lying on its side, a soft white hat covering the dark whorls of hair on its head. One arm was bent, a tiny starfish hand resting on its cheek.

Max hadn’t spent this long in the company of a baby this small…ever. He’d participated in a fair few deliveries, of course, throughout his training and then in a short run on O and G but it was a rare occurrence in Emergency and the babies were always whisked off to places like this paediatric intensive care unit. He’d never had a reason to stay involved. He didn’t now, except as a fraud.

He shouldn’t really be here at all.

‘It’s been around since the late seventies,’ the paediatric consultant broke into his guilt. ‘But it’s gaining quite a following. It’s basically skin-to-skin contact with a parent. As long as the infant is medically stable, there’s no reason not to use it and it’s been shown to improve oxygenation and respiratory rates. It can actually make a significant difference to something like bradycardia.’

‘Skin-to-skin?’ Max couldn’t keep the dismay out of his voice. ‘Are you kidding me?’

‘You don’t sit around naked.’ The doctor smiled. ‘In fact, the baby needs to be under your own clothing to help maintain body temperature stability.’ Her smile became reassuring rather than amused. ‘I know she looks tiny and fragile and that her arrival was a bit unexpected…’

‘You have no idea,’ Max murmured.

‘And I know you’re worried about Ellie,’ she continued, ‘but this is a way to help everybody, including—maybe especially—yourself.’

‘Oh?’ Max was listening now. He needed to help himself. Fast. ‘How, exactly?’

‘You’ll be doing what Ellie can’t do at the moment, which is caring for her baby. You could well make a big difference medically for this little one.’ She was watching him and a tiny frown line appeared. ‘If you’re really not comfortable, then I can get one of the nursing staff to do it, but it’s far better if it’s a parent. It can be a way of bonding that could make all the difference to the stress of the next few days.’

Max had the sensation of being trapped in a kind of glass box. He was being watched. By the paediatrician and her registrar. By the nurse who was hovering near the crib. Even by other nurses in this unit as they went about their own tasks. They all seemed to have paused right now to hold their breath and see what he was going to do.

They all believed that he was this baby’s father and what kind of a father wouldn’t want to do something that might help his kid? If it became obvious that he had no need—or, let’s face it, desire—to bond with this infant, people might start asking questions. Gossiping at the very least, and the less any of this was talked about the better. For Ellie’s sake.

Which was how all this had started, wasn’t it?

He really would have to be more careful next time, he decided with a wry inward smile as he found himself nodding and then being guided to the comfortable armchair rolled into this corner of the PICU.

A nurse took the layers away from the baby. They left her with a nappy and her hat on, an oxygen saturation monitor clipped to a minuscule toe and some unobtrusive sticky dots and soft wires that connected her to a cardiac monitor. She was mostly naked, Max noted with some alarm. Small and pink and awkward-looking, with stick-like arms and legs.

‘Keep her prone and upright,’ the paediatrician advised. ‘The nurses will keep an eye on you both and levels are set for an alarm to go off if the oxygen levels or cardiac rhythm need interventions.’

Max had sacrificed the neck of his T-shirt so that he didn’t need to discard any of his own clothing. The vertical cut allowed him to fold the neckline down so that the baby’s face would be uncovered. He heard the whimper of the baby as she was picked up.

Good grief…he really didn’t want to do this. Was it too late to back out?

An alarm began to sound. A slow bell that pinged ominously. Maybe the baby didn’t like the idea, either. Her heart rhythm was jumping erratically.

‘Does she need to go back in the crib?’ Max tried not to sound too hopeful.

‘Let’s see how we go for a minute or two.’

With an inward sigh, Max held up the bottom of his old, soft T-shirt while a nurse positioned the baby and then covered her. A layer of the leather jacket came next and then she helped him put his arm in the right place for support. He felt awkward. Uncomfortable.

He could feel the baby wriggle against his chest, moving tiny limbs as if in protest. He could feel the miniature chest heaving as she attempted to breathe and cry at the same time but the effort seemed exhausting and the movements diminished.

Max took a cautious glance downwards and found the baby’s eyes were open. So dark they looked black and they were fixed on him. He took a deep, careful breath and let it out very slowly.

‘Look at that.’ The paediatrician sounded delighted. ‘Heart rate’s coming up and it’s steady.’

They waited another minute as Max sat as still as humanly possible.

‘Looking good,’ came the expert verdict. ‘We’ll leave you to it, Max.’

‘Ah…’ He watched as staff began to disperse. To stop watching, even, from all over the unit. Any second now and he would be virtually on his own. ‘How long should I stay here?’

‘The longer the better,’ a nurse said cheerfully. ‘As long as you can, anyway.’

Max tipped his head back and closed his eyes. He breathed. In and out. He could feel the baby breathing. In that first long, quiet minute of being left to himself he could even feel the baby’s heart beating. A soft, rapid ticking against his chest. Almost on top of his own heart.

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