The Country Doctor's Choice (18 page)

As he was about to put a questing finger into the vagina, Denise gave a groan and a push. ‘Well done, it’s coming,’ he muttered, and then, ‘Oh, hell,
no
!’

To their surprise and dismay, the bulge that now appeared was not the head of the second twin, but the placenta of the first. Leigh caught it in a dish hastily grabbed from the delivery trolley. Another brisk loss of blood followed it.

‘Didn’t know it was possible for that thing to come out before the second twin,’ he muttered in the low tone used by delivery staff who had to remember that the patient was conscious.

‘It can do when it’s low-lying,’ whispered Shelagh who was now faced with a life or death decision. ‘Now we have
no time at all
to play with. That placental site will bleed like fury.’

‘Could you do a caesar, Shelagh, if I helped?’ he asked bluntly, wiping the sweat from his forehead with the back of his green sleeve.

‘No time, we must get it out
now
,’ she murmured, adding silently, if it isn’t too late. She liberally coated her gloved right hand with antiseptic cream, and thrust two fingers into the vagina. Her worst fears were confirmed.

‘It’s lying in the transverse diameter,’ she said, and he reflected the shock in her eyes.

They knew that delivery of a live baby in the transverse position was impossible, even with a small, premature baby; either the head or the breech had to descend. This baby’s chances of survival dwindled with every second that it remained inside the uterus, now filling with blood.

‘Get me a gown and a fresh pair of gloves, size six and a half,’ Shelagh rapped out. ‘I’m going to attempt an internal version.’

‘Ever done one before?’ asked Leigh with a sympathetic grimace.

‘No, it’s caesarean these days. And we shall need to put Denise to sleep for this.’

‘I’ll ring for the anaesthetist on call,’ said Elsie.

‘No time. Go into the theatre and fetch the Boyle’s trolley, Elsie. And Marie, you take an ampoule of pentothal out of the cupboard and check it with Dr McDowall. And Leigh, you’re going to have to be gas man.’

Her low, rapid orders were immediately obeyed. Staff Midwife Burns handed the ampoule to Leigh who snapped it open and drew up the colourless liquid into a ten-millilitre syringe which he injected into a vein on the back of Denise’s hand. Her eyelids fluttered, her whole body relaxed, and she passed into unconsciousness. Elsie dragged in the heavy Boyle’s anaesthetic trolley with its cylinders of gas.
Leigh grabbed an airway which he fixed between the girl’s teeth, placed a rubber mask attached to a long, wide flexible tube over her nose and mouth and turned on the nitrous oxide gas mixed with oxygen. It was a simple, basic anaesthetic, and Leigh trusted that it would last until the procedure was completed.

Shelagh whispered a short, silent prayer as she sat on the vacated stool. Her eyes met Leigh’s, and she nodded to him above her face mask.

‘I’m putting my hand up through the cervix now,’ she said quietly. ‘I’ve got hold of a limb – a hand? No, a foot, it’s got a heel. I’m going to pull it down now.’ Speaking helped her to concentrate and make decisions.

‘Now, here it comes – and there it is,’ she said as her hand appeared externally, holding a tiny ankle between her thumb and forefinger. Leigh nodded silently. And Dr Fisher was clearly holding his breath: would he be handed a live child or – luckily Dr Hammond’s hands were small, he thought, as were the babies.

The delivery room was silent apart from the squeaks of North Twin I, now lying in the heated cot. Shelagh continued with her low commentary.

‘I’m pulling on the leg – and there are the buttocks coming down, and it’s a girl. Right, now I think I can hook out the other leg – oh, it’s come down on its own.’

The baby’s body now hung downwards, and Marie
stepped forward to wrap the body in a warm towel. ‘Now to bring down a loop of cord,’ said Shelagh.

‘Is it pulsating?’ Leigh hardly dared to ask, as he supported the mother’s chin with his hand.

‘I think so – yes. Now for the anterior shoulder.’ She hooked a finger in the bend of the child’s elbow, and the arm appeared. The body rotated until the posterior shoulder came uppermost, and the other arm was free. Everybody in the closely knit team hung on her every word and action as she concentrated on the next crucial stage of a breech delivery, the birth of the head. The child was so tiny that she was able to support the body across her forearm, and then gently raised it to allow the face to appear; the episiotomy allowed the head to slide down over the perineum in a controlled, unhurried movement, and the limp, lifeless body of North Twin II was born. Dr Fisher leant over to clear the air passages while Shelagh clamped and cut the umbilical cord, then received the tiny girl into his hands and placed her in the second heated cot. Shelagh was thankful that the paediatric consultant was at hand to perform the necessary procedures to resuscitate her if it were possible, while the second placenta was expelled almost immediately, and McDowall gave an intravenous injection of ergometrine to make the uterus contract. Even so, the blood loss was considerable.

‘Bring her round now, Leigh, and give oxygen,’ Shelagh nodded to McDowall, ‘and she’ll need a drip
up and a couple of pints of blood cross-matched.’

They hardly dared to look at Dr Fisher who had sucked out a quantity of mucus, blood and meconium (black discharge from the baby’s rectum), from her nose and mouth, then had placed a tiny mask over her face to send a stream of pure oxygen into her lungs, at the same time pressing two fingers rhythmically on her chest to stimulate the heartbeat. One minute passed, and another.

‘There’s a heartbeat, just,’ muttered Fisher, and laying the baby along his forearm, he raised the lower part of the body and let the head hang down; with the mucus extractor between his lips, he sucked more fluid from the air passages. There was a faint bubbling from the mouth, followed by a choking sound, and he upended the body again. Suddenly the baby gave a short, convulsive gasp, and the body twitched; another gasp, and the deathly white skin colour began to turn pink. All the onlookers exchanged glances of hope, just as Denise began to stir and moan.

‘You’re all right, Denise,’ said Leigh in a low, reassuring voice close to the girl’s ear. ‘You’ve got two little babies, a boy and a girl. It’s all right, my dear.’

The last sentence was uttered with a glance towards Shelagh. Because it was indeed all right; thanks to smooth and dedicated teamwork, the mother and two small premature babies had survived a difficult and dangerous birth.

Dr Fisher removed the two cots to the ‘warm
nursery’, a small annexe to the main nursery, and Leigh put up an intravenous saline drip on Denise, after cross-matching a blood sample which Elsie took to the laboratory. He sutured the episiotomy, and Marie made out a quarter-hourly pulse and blood-pressure chart for Denise, now ready to be transferred to the postnatal ward to rest and recover.

Suddenly the door opened to admit a white-faced Dr Rowan. ‘My God, what the—’

‘The North twins – Dr Fisher’s taken them down to the warm nursery,’ said McDowall. ‘Boy and girl, about thirty-six weeks, hardly eight pounds between them. First was a breech, second transverse, Shelagh did an internal version and delivered as a breech. At least two pints of blood lost. We were lucky that Dr Fisher was around, that second twin looked like a goner.’

‘God! I’m sorry I wasn’t here – thank heaven you sent for Shelagh,’ muttered Rowan, eyeing her dress and crystal jewellery. ‘And thanks for coming, Shelagh, from wherever you were. It’s been quite a night all round. We skidded on a wet road and ran into a tree on our way back from North Camp. Eve was badly shaken, and started to bleed, so I brought her into Gynae, but she’s losing our baby at about ten weeks.’

He received their condolences with a sigh. ‘But you’re still on compassionate leave, aren’t you, Shelagh – where were you when you were called?’

‘I’d been out to dinner,’ she said.

‘Well, I’ll never be able to thank you two enough. How did you get here, Shelagh?’

She hesitated, and McDowall answered. ‘I prayed, Rowan, for once in my life I prayed, and Providence sent an angel. And never was there a more welcome sight.’

Rowan began to praise Shelagh, but she cut him short, smiled sympathetically and sent him to Gynae to comfort his wife.

By now it was midnight. Shelagh sat in the office writing up the case notes of the twin delivery, her crystal earrings flashing and her elegant dress bloodstained. She did not see Leigh McDowall enter. He stood for several moments regarding the back of her head, the untidy dark hair falling forward over the desk as she wrote, the crystal earrings flashing a rainbow of colours. There were smears of blood on her dress, and she had kicked off the high-heeled shoes. When she finished writing, she sat back in the chair and rubbed her eyes. And saw him.

‘Thank you, Shelagh.’

‘It was lucky that Dr Fisher was around,’ she said. ‘I didn’t have much hope for the girl.’

‘You saved her life,’ he said simply. ‘Suppose you hadn’t come, Shelagh, and she’d had to rely on me as an obstetrician? That second twin would have been dead or brain-damaged, and I’d have had to live with the fact.’

‘We don’t know that, Leigh. It’s futile to speculate on what might have happened. It was the smallness of the babies that made the internal podalic version possible. There are still fatalities with second twins, and probably always will be.’

Elsie the auxiliary came in with a tray of tea, and set it down on the desk. ‘I reckon you’ve both earned a cuppa,’ she said as she left, closing the door behind her.

‘Where were you, Shelagh? And who sent for you, really?’

‘I’d been out to dinner at the Badger’s Nest. And nobody sent for me. I just got this overwhelming urge to get back here and up to the Delivery Unit. I didn’t know that Denise had gone into labour, nor that Rowan and Eve were in trouble. All I knew was that I had to be here.’

‘That’s interesting, because I meant what I said to Rowan in there. No angel could have been more welcome than you in that room tonight. You took over, and got that second twin out – it was nothing short of miraculous.’

He leant towards her as he spoke, and she remembered how intently he had listened to every word of her ‘commentary’ during those suspenseful minutes. Was it possible that the sheer intensity of his need had summoned her to the Delivery Unit in that mysterious way?

She shook her head as she gratefully drank the tea.

‘Who took you out to dinner, Shelagh, if I may ask?’

‘You may. Paul Sykes.’

‘What,
him
? Are you still seeing – after all that nonsense with the actress? Oh, Shelagh, Shelagh, how could you?’

‘He asked me,’ she replied. ‘He said he had something to tell me, and so I went.’

‘And you put on this stunning dress and crystal necklace and earrings just for
him
? He’s got a nerve! So when’s this overdue announcement of an engagement to be made?’

She got up. ‘I must ask switchboard to ring for a taxi. I’m tired.’

‘You must be. But – when is it to be announced, Shelagh?’ he asked urgently.

Suddenly her eyes filled with tears. ‘Soon. Everybody will hear about it, Diane Devlin’s engagement to the young surgeon who saved her life.’

‘
What
? Do you really mean that, Shelagh? Oh, what marvellous news! Congratulations!’ And he drew her into his arms, holding her close and kissing the top of her head. ‘Don’t cry, Shelagh my dear, you’ve had a lucky escape, an incredible stroke of luck! If you’d married that bastard, I think I’d have throttled him.’

‘But we’d been lovers, Leigh – we’ve spent weekends together—’

‘Yes, and that’s what drove me berserk, to see how you let yourself be used. And your dear mum never knew, did she?’

‘No. She and Aunt Maura always thought it ought to be—’ She broke off in confusion, the tears still wet on her cheeks.

He gently released her and rang the switchboard to order a taxi, then escorted her down to the lower corridor and the front entrance. When the taxi arrived, he helped her into the back seat.

‘Good night, Shelagh my angel. I’ll come and see you as soon as I can.’

As the door closed and the taxi moved off, Shelagh tried to organise her thoughts, the words he had used, the feel of his arms around her. So had Paul Sykes been right, then? Or had this amazing evening been a dream? She looked down at a bloodstain on her dress and a ladder in her tights: no, this had been no dream!

Staff Midwife Burns met McDowall on his return to the unit. ‘Sorry, Dr McDowall, no peace for the wicked – there’s an Italian lady on her way in with ruptured membranes at thirty-six weeks, and she can’t speak English. So you’d better not go to your bed yet!’

‘That’s all right, Marie,’ he said cheerfully. ‘Let half a dozen Italian ladies come in, and I’ll teach them English.
O sole mio!
’

Marie Burns stared at him. Had Elsie put anything into that that tea?

He caught her glance and winked. Dr Leigh McDowall was walking on air!

‘Yes, it was a very difficult birth, so Shelagh Hammond said,’ Iris told Jeremy the following day. ‘It was touch and go with the second twin, and Shelagh came in specially to deliver it, though she’s still on compassionate leave after losing her mother. Everybody’s praising her to the skies, except for, er, your wife. She was livid because she hadn’t been informed when Denise went into labour, and came in today to visit them all – the girl twin’s in an incubator.’

‘And I didn’t even know,’ said Jeremy gloomily. ‘Fiona hasn’t sent a word to me.’

‘Ah, I’ve spoken to Dr McDowall who says you can go in to visit your daughter out of visiting hours, and likewise the twins, only make it short, he says, ten minutes at most. We can’t have any – er—’

‘Encounters, bust-ups, arguments, untoward scenes between visitors,’ he finished for her. ‘Not that Denise will want to see her erring father. But thanks to your Dr McDowall, I’ll just pop in and see the tiny tots – a boy and a girl, you said? – poor little bastards, at least they won’t sit up in their cots and order me out!’