The Doctor's Secret Family

‘I wouldn’t worry about it.’ William’s reassuring tone was intended to benefit the baby as much as Hannah. ‘Peter thinks you’re marvellous and as head of department he’ll have significant input into deciding who gets the job.’

‘I hope so.’ The worry wasn’t going to evaporate easily, however. Hannah wanted this position she had waited a long time to apply for. She wanted it badly.

She also wanted to find IV access in this severely dehydrated infant. IV fluid resuscitation was urgent and she wasn’t going to allow any niggling personal fears to interfere with her performance. She should also be using this opportunity to help consolidate William’s skills, not discuss her future employment options.

‘What percentage dehydration would you estimate Jamie to have?’ Hannah was advancing the fine needle in a new direction now. Anatomically, there had to be a vein somewhere close.

‘His skin’s a bit mottled and the capillary return isn’t great,’ William answered promptly. ‘His fontanelle and eyes are markedly sunken but his level of consciousness isn’t too depressed. I’d say about seven per cent.’

Hannah nodded. She drew the needle back towards the surface of the skin and a tiny spot of red appeared in the flashback chamber of the cannula mechanism.

‘Got you,’ she said in satisfaction. ‘Keep him really still for a second, Will.’ Dropping the angle of the needle and advancing it just fractionally, Hannah held her breath as she pushed the plastic cannula off the end of the needle. A smooth entry indicated effective placement and Hannah unsnapped the tourniquet fastening before swiftly removing the introducing needle and attaching a syringe to the end of the cannula.

‘What tests are you going to order on these bloods, Will?’

‘CBC and differential. Urea, creatinine, sodium and potassium levels.’

‘What’s the most likely cause for the gastroenteritis?’

‘Rotavirus.’

‘And how are we going to treat it?’

‘Initial fluid resuscitation with normal saline at 20 mil per kilogram. Then 10 mil per kilogram per hour until we get the serum electrolyte results. We’ll adjust the solution depending on sodium levels after that.’

‘Cool.’ Hannah attached the giving set leading to the bag of IV fluid already set up on the drip stand. She taped the line to Jamie’s arm and then protected the IV cannulation site with a thick layer of crêpe bandaging. When finally satisfied that the fluids were running well, Hannah relaxed and scooped the baby from the table into her arms.

‘There you go, darling,’ she murmured. ‘All done. Let’s get you back to Mummy for a cuddle.’

William grinned. ‘You must be one heck of a substitute. That’s the closest to being happy I’ve seen him look since he arrived. What is it with you and babies?’

Hannah kissed the top of the downy head. ‘I’m just the maternal type, I guess. There’s got to be some reward for the awful things we need to do to the poor wee mites sometimes.’

‘Mind you don’t take a dose of rotavirus home to Olivia.’

‘I’ve been taking things home since she was even younger than Jamie. I reckon we’ve both got fantastic immune systems by now. Livvy never gets sick.’

Hannah’s pager sounded as they walked back to Jamie’s room. ‘I’ll leave you to get those bloods away and chase up the results, Will. Keep a close eye on things. If Jamie’s condition deteriorates any further, we’ll need to transfer him to Intensive Care.’

There was a phone on the wall just outside the room Jamie would share with his mother for the next day or two. William emerged just as Hannah finished taking the call her pager message had requested.

‘You don’t look very happy,’ he commented. ‘What’s up?’

‘I have to get up to Theatre. A woman who’s thirty-five weeks pregnant has just come in with a placental separation following an MVA. They’re rushing her up for an emergency Caesar and it seems I’m the most senior paediatrician available at the moment.’ Hannah was already moving swiftly towards the lifts at the end of the wide corridor. Maybe the cause of that premonition had been some instinct that she might be faced with a particularly challenging case. Thanks to Hannah’s determination to excel in everything she did in the run-up to the decision on appointing the department’s new consultant she had a new pressure and a whole new set of nerves to contend with.

‘You’ll be fine.’ William’s confident words floated through the closing lift doors. ‘Peter will be proud of you, you’ll see.’

* * *

Consultant Peter Smiley was living up to his name when he sat down at the table in the cafeteria Hannah was occupying nearly two hours later. It was far too late to be considered part of any normal lunch-break and the huge room was largely deserted.

‘I’ve been hearing great things about you, Dr Campbell.’

Hannah grinned. If that emergency case had been responsible for the nameless fear stalking her earlier then she had managed to prove her instinct very wrong. Her grin faded as she shook her head.

‘I have to admit I was pretty nervous when I got to Theatre. I had no idea how long the baby might have been hypoxic for. I had the feeling that even if the resuscitation was successful the parents might not thank me for it.’ Hannah bit her lip. ‘What are the precise criteria for deciding not to take an aggressive approach? Have you ever done a resus and left parents to cope with bringing up a badly handicapped child, Pete?’

‘It happens.’ Peter nodded. ‘But there are no hard and fast rules. Even when you get a baby born at the limits of viability, like twenty-two to twenty-four weeks’ gestation, it’s tricky. You have to look at the weight and degree of bruising, along with the baby’s condition at birth, the presence or absence of a heartbeat and any efforts to breathe.’

Hannah nodded. ‘This one had an Apgar score of zero initially. White, flaccid, undetectable heartbeat and no spontaneous breathing.’

‘What gestation?’

‘Thirty-five weeks.’

‘How badly injured was the mother?’

‘She had a fractured tib-fib and seat-belt bruising. It was probably the position of the seat belt that caused the placental separation. She’d begun bleeding heavily by the time she reached the emergency department. They did a quick ultrasound and got her straight up to Theatre. The baby was delivered within thirty minutes of her arrival, which was pretty amazing.’

‘I’ll say. They must have had a theatre ready to go.’

‘They were setting up an elective Caesar. The patient had had her epidural and was on the way. I bet she wasn’t too happy about being sent back to the ward for another couple of hours.’

‘No.’ Peter sat back in his chair, his gaze curious. ‘So, what did you do with this flaccid baby?’

‘Put her under the lights and used gentle suction to clear the upper airway. Inflating her lungs with the bag mask initiated a gasp but no spontaneous breathing so I intubated.’

Peter raised his eyebrows. Intubation of a newborn required considerable skill. Clumsy insertion of the tube could damage the upper airways, and over-vigorous inflation could damage the lungs. ‘Any problems?’

‘No. I ventilated at a rate of thirty per minute with a nice gentle pressure but she still didn’t pink up. Heart rate was less than sixty per minute so then I started cardiac massage.’ Hannah’s smile was a little grim. She had thought she was fighting a losing battle at that point. She had encircled the baby’s chest with both hands, positioning her thumbs to exert pressure on the lower half of the tiny sternum and directing the nurse assisting her to deliver one inflation of the lungs to every three to five compressions.

‘Did you need any adrenaline?’

‘I had it drawn up as I cannulated the umbilical vein but then things started to improve.’ Hannah’s smile was much brighter now. ‘The Apgar score at five minutes was 7. She had facial grimaces, gasping respiration, heart rate greater than a hundred, some flexion and she was finally pink!’

Peter smiled at Hannah’s obvious pleasure. ‘Pretty satisfying, then?’

‘You bet. Apgar was 9 at ten minutes. I still wasn’t happy enough with her muscle tone to give her a ten but I’m pretty confident she’ll be OK. It’s hard to know, though, isn’t it?’ Hannah’s brow furrowed. ‘She could have been without oxygen for long enough to have permanent repercussions.’

‘Some people put all sorts of things down to a mild hypoxic insult—anything from hyperactivity to learning problems. But there’s not much in the way of good evidence. Babies can recover remarkably well from what seems like a dire start to life. We’ll keep an eye on this one for the next few days for any sign of neurological compromise but I doubt we’ll find anything. You sound like you managed a difficult case extremely well, Hannah. Well done.’ The consultant’s face creased into a familiar expression of approval. ‘I’m proud of you.’

‘Thanks.’ Hannah returned the fond smile. ‘If I’m good at what I do a lot of credit needs to go to you, you know.’

‘It’s always been a pleasure to work with you, Hannah. A pleasure that I hope will continue for a long time.’

‘So do I.’ Hannah toyed with her almost empty cup of coffee. ‘I’m going to be biting my nails waiting for this consultancy to be decided.’

‘You really want this job, don’t you?’