The Pregnant Midwife. Fiona McArthur

       CHAPTER THREE

      AT THE destination hospital, if there was time, the first step was always to meet the parents, then quickly move to assess the patient.

      Baby Isaac would become more tired as his in-coordinated heart struggled to achieve what had been so easy inside his mother, and Kirsten knew they’d have to watch out for heart failure.

      Isaac’s parents looked very young as they hovered anxiously on the periphery of the medical drama, and Kirsten went over and shook their hands.

      ‘Hi, I’m Kirsten Wilson and I’m one of the neonatal nurses from Sydney. This must be pretty frightening for you both.’ The young couple nodded and Kirsten smiled. ‘We’re going to keep you updated as we make Isaac as comfortable as we can for the flight. After that we’ll get Isaac and you, Mum, transferred to the major hospital. When you get there, the paediatric cardiologist will talk you through his treatment plan.’

      Lily, Isaac’s mum, clutched her boyfriend’s hand tighter. ‘There seems to be so many people here and Isaac looks so small.’

      ‘I know,’ Kirsten said. ‘But he’s getting the best care so he can have the safest trip we can manage for him. About one baby in a hundred has a heart problem so we’ve done this before.’

      Both parents sagged a little with relief at Kirsten’s confidence. ‘We’ll all be with you until we hand Isaac over to the staff at the city hospital so don’t forget to ask questions as you need to.’

      Lily nodded and Kirsten rejoined her colleagues. She allowed herself a brief stroke of Isaac’s head as she began to record his respiratory rate, heart rate and oxygen saturation as she looked for signs of cardiac failure. Ellen connected the baby to the MIRA monitors as well as the referring hospital’s equipment to ensure constant monitoring during change-over, and she offered Kirsten the stethoscope to listen to Isaac’s chest. The heart murmur was very clear.

      ‘What’s your instinct on this baby?’ Hunter spoke quietly in her ear and Kirsten knew he was testing her.

      ‘He’s breathing faster than he should be so respiration is affected, and he’s sweaty and that’s not a good sign. I’d say he has substantial fluid backing up in his lungs and when I listened to his chest he sounded “wet”.’ She glanced at Hunter. ‘The heart murmur is loud and I’d say it’s a large VSD.’

      Ellen, dressed in a lead apron, held Isaac while X-rays were taken, because it was important to see the quality of Isaac’s lungs and any cardiac enlargement. As soon as they were finished, Kirsten did a quick twelve-lead ECG to give Hunter some idea of the electrical conductivity of the sick baby’s heart.

      Hunter took the chance while the nurses were busy to explain things to the parents and reassure the base hospital staff on the excellent job they’d done in preparation for the retrieval team. She had to admit that when he wanted to use his charm he was a master at putting people at ease, which helped in situations like this.

      She watched him put his arm around Isaac’s mother and clap his father on the back as he congratulated them on their beautiful son. His obvious empathy with frightened parents had a lot to do with the attraction she’d felt for him when they’d first met.

      They couldn’t be friends but they should be professional about their differences at least. She could still admire his skill and empathy as a neonatal intensivist.

      Hunter returned to the baby and the equipment Kirsten had assembled. He inserted an intravenous cannula in Isaac’s hand and when the newborn grasped Hunter’s finger, they shared a smile across the humidicrib at the wonder of tiny babies.

      This was ludicrous, Kirsten thought, and vowed to establish some ‘safe’ camaraderie because moments like this were too special to waste on something that was never meant to be.

      The finality of that thought stayed with Kirsten as she turned away to document the time of insertion and the start of the minuscule measured amounts of intravenous fluids.

      ‘Let’s give him a diuretic to see if we can offload some of this fluid he’s accumulating,’ Hunter said, and Kirsten handed him the preloaded syringe with the ampoule taped to it.

      They checked the dosage together and just as Kirsten started to relax, Hunter had another question for her.

      ‘What else are we looking for?’

      Kirsten glanced down at Isaac and the answer came readily. ‘Probably signs of any other abnormalities or indications for other syndromes that this condition can run with.’ The obvious ones were often identifiable by abnormal facial characteristics. She glanced across at Isaac’s dad, and any facial features that might have hinted at a genetic disease were vetoed by the mirror image of father and son. She smiled, and Hunter, following her thoughts, did too. Then they both looked away quickly and Kirsten busied herself by recording what they’d done.

      All treatment for the stabilisation of baby Isaac would be diligently recorded, as would any improvement or deterioration in his condition. Later in the week, at the team meetings, all cases would be reviewed and discussed to ensure any improvements in care would be noted and used in the next case.

      Within a short while they had achieved the best oxygen saturation and cardiac output they could for Isaac, and all that was left was to fix the cables and tubes, clean up their mess and prepare for transfer.

      For Hunter, working with Kirsten was as hard as he’d feared it would be, yet at the same time incredibly easy. The last few months he’d felt he had become adept at completing retrievals with Ellen and the other neonatal nurses, but with Kirsten the clinical component of patient care seemed so much more streamlined.

      There was no need to ask for anything. She had either already done it or had what was required ready for him to complete the procedure, as it had always been in Dubai.

      And, as it was then, all the time she smiled—at the baby, at the parents, at the referring hospital staff. And at him.

      Hunter had forgotten how much joy she shared with those around her. Even in the midst of tension and fear, she was a reassuring light that parents and staff turned to when things seemed blackest, and suddenly there was hope or at least reason in the chaos.

      He’d blocked out how many times he’d witnessed her like that in the past and he did not want to go there now, but it was hard not to remember. How ironic that she was happy and he was miserable.