St Piran’s: Rescuing Pregnant Cinderella

‘Hi, there Nicola. I’m Izzy Bailey, the emergency registrar.’ Izzy wasn’t sure who looked more petrified, the student nurse who’d been left with the patient while Beth had dashed for a delivery pack or the mother-to-be who brought Izzy up to date with her rapid progress even before Izzy had time to ask more questions—it was Nicola who pulled back the sheet.

‘It’s coming.’

‘Okay.’ Izzy pulled on some gloves as Beth opened the delivery pack, Nicola was in no state to be sped across the floor to Resus. ‘Let Resus know to expect the baby,’ Izzy said. ‘Tell them to get a cot ready.’ She took a steadying breath. ‘Emergency-page the paediatric team.’

‘Vivienne!’ Beth instructed the student nurse to carry out Izzy’s instructions, and Vivienne sped off.

‘There’s going to be a lot of overhead chimes,’ Izzy explained to Nicola, ‘but that’s just so we can get the staff we need down here quickly for your baby.’

The membrane was intact, Izzy could see it bulging, and she used those few seconds to question her patient a little more, but there were no straightforward answers.

‘I only found out last week. I’ve got a seven-month-old, I’m breastfeeding…’

‘Have you had an ultrasound?’ Izzy asked.

‘She’s just come from there,’ Beth said for Nicola, but, as was so often the case in Emergency, a neat list of answers rarely arrived with the patient. They would have to be answered later, because this baby was ready to be born.

He slipped into the world a few seconds later, just as a breathless midwife arrived from Maternity and the overhead speaker chimed its request for the paediatric team to come to Emergency. He was still wrapped in the membrane that should have embraced him for many months more and Izzy parted it, using balloon suction to clear his airway. He was pale and stunned, but stirring into life as Izzy cut the cord. Though outwardly calm, her heart was hammering, because difficult decisions lay ahead for this tiny little man.

‘You have a son,’ Izzy said, wrapping him up and holding him up briefly for Nicola to see. Though seconds counted in the race for his life, Izzy made one of the many rapid decisions her job entailed and brought the baby up to the mother’s head, letting her have a brief glimpse of him. Nicola kissed his little cheek, telling him that she loved him, but those few brief seconds were all there was time for.

Beth had already raced over to Resus, and Izzy left Nicola in the safe hands of the midwife and student nurse as she walked quickly over to Resus holding the infant. A man, dressed in black jeans and a T-shirt, joined her. Walking alongside her, he spoke with a heavy accent.

‘What do we know?’

‘Mum’s dates are hazy,’ Izzy said, and though he had no ID on him, there was an air of authority to him that told her this was no nosey relative. ‘About twenty-three weeks.’

‘Mierda!’ Izzy more than understood his curse—she was thinking the same—this tiny baby hovered right on the edge of viability. At this stage of pregnancy every day in utero mattered, but now he was in their hands and they could only give the tiny baby their best care and attention.

‘Diego.’ Beth looked up from the warming cot she was rapidly preparing. ‘That was quick.’ The chimes had only just stopped summoning the staff, but he answered in that rich accent, and Izzy realised he was Spanish.

‘I was just passing on my way for a late shift.’ He had taken the baby from Izzy and was already getting to work, skilfully suctioning the airway as Izzy placed red dots on the baby’s tiny chest. ‘I heard the call and I figured you could use me.’

They certainly could!

His large hands were rubbing the baby, trying to stimulate it, and Izzy was incredibly grateful he was there. His dark hair was wet so he must have stepped straight out of the shower before coming to work. He had gone completely overboard on the cologne, the musky scent of him way too heavy for a hospital setting. Still, she was very glad he was there. As an emergency doctor, Izzy was used to dealing with crises, but such a premature baby required very specific skills and was terrifying to handle—Diego was clearly used to it and it showed.

‘Diego’s the neonatal…’ Beth paused. ‘What is your title, Diego?’

‘They are still deciding! Sorry…’ Dark brown eyes met Izzy’s and amidst controlled chaos he squeezed in a smile. ‘I should have introduced myself. I’m Nurse Manager on the neonatal unit.’

‘I guessed you weren’t a passing relative,’ Izzy said, but he wasn’t listening, his concentration back on the baby. He was breathing, but his chest was working hard, bubbles at his nose and lips, and his nostrils were flaring as he struggled to drag in oxygen.

‘We need his history,’ Diego said as he proceeded to bag the baby, helping him to breathe. He was skilled and deft and even though the team was just starting to arrive he already had this particular scene under control. ‘You’re late.’ Diego managed dry humour as the anaesthetist rushed in along with the on-call obstetrician and then Izzy’s colleague and friend Megan.

Her fragile looks defied her status. Megan was a paediatric registrar and was the jewel in the paediatric team—fighting for her charges’ lives, completely devoted to her profession. Her gentle demeanour defied her steely determination when a life hung in the balance.

Megan would, Izzy knew, give the baby every benefit of every doubt.

‘Ring NICU.’ This was Diego, giving orders, even though it wasn’t his domain. They urgently needed more equipment. Even the tiniest ET tube was proving too big for this babe and feeling just a touch superfluous as Megan and Diego worked on, it was Izzy who made the call to the neonatal intensive care unit, holding the phone to Diego’s ear as he rapidly delivered his orders.

Though Megan’s long brown hair was tied back, the run from the children’s ward had caused a lock to come loose and she gave a soft curse as she tried to concentrate on getting an umbilical line into the baby.

‘Here,’ Izzy said, and sorted out her friend’s hair.

‘About twenty-three weeks, Megan.’ Diego said it as a warning as the baby’s heart rate dipped ominously low, but his warning was vital.

‘We don’t know anything for sure!’ Megan words were almost chanted as she shot a warning at Diego. ‘I’ll do a proper maturation assessment once he’s more stable. Izzy, can you start compressions while I get this line in?’

Diego was pulling up the minuscule drug dosages; the anaesthetist taking over in helping the tiny baby to breathe. The baby was so small Izzy compressed the chest rapidly with two fingers, hearing the rapid rhythm on the monitor.

‘Nice work.’ Megan was always encouraging. The umbilical line in, she took the drugs from Diego and shot them into the little body as Izzy carried on with compressions for another full minute.

‘Let’s see what we’ve got.’ Megan put a hand up to halt Izzy and the babe’s heart rate was up now close to a hundred. There were more staff arriving and a large incubator had arrived from the neonatal unit along with more specialised equipment, but until the baby was more stable it wouldn’t be moved up to the first-floor NICU. ‘We’re going to be here for a while.’ Megan gave Izzy a grim smile. ‘Sorry to take up all your space.’

‘Go right ahead,’ Izzy said.

‘How are things?’ an unfamiliar face came in. ‘Ben asked me check in—I’m Josh, A and E consultant.’ She’d heard there was a new consultant, that he was Irish and women everywhere were swooning, but no one was swooning here! Izzy couldn’t really explain it, but suddenly the mood in the room changed. Izzy wondered if perhaps if Josh’s popularity had plummeted, because there was certainly a chill in the air.

‘It’s all under control.’ It was Izzy who broke the strange silence. ‘Though the babe might be here for a while.’

‘How many weeks?’ Josh’s voice was gruff, his navy eyes narrowing as he looked down at the tiny infant.

‘We’re not sure yet,’ Megan responded. ‘Mum was in Ultrasound when she went into labour.’

‘We need to find out.’ Josh’s was the voice of reason. Before there were any more heroics, some vital facts needed to be established. ‘Do you want me to speak with Mum?’

‘I’ll be the one who speaks with the mother.’ Megan’s voice was pure ice. ‘But right now I’m a bit tied up.’

‘There’s a full resuscitation taking place in my department on a baby that may not be viable—we need to find out what the mother wants.’

Megan looked up and Izzy was shocked at the blaze of challenge in them. ‘It’s not like it was eight years ago. We don’t wrap them in a blanket now and say we can’t do anything for them.’

‘I’ll tell you what!’ A thick Spanish accent waded into the tense debate and abruptly resolved it. ‘While you two sort out your own agenda, why don’t you…’ he looked over at Izzy ‘…go and speak with the mother? You have already met her, after all. See if you can clarify the dates a bit better—let her know just how ill the baby is and find out if someone can pull up her ultrasound images.’

‘Sure!’

She was more than grateful for Diego’s presence, and not just for the baby—Izzy hadn’t known what was happening in there. She’d never seen Megan like that! Her response had been a blatant snub to Josh’s offer to speak with the mother, but Izzy didn’t have time to dwell on it—instead she had a most difficult conversation in front of her.

‘I don’t know…’ Nicola sobbed as Izzy gently questioned her. ‘My periods are so irregular and it’s my fourth baby, I was breast feeding…’

‘The doctors will go through your scans and assess your baby and try to get the closest date we can,’ Izzy said gently, ‘but I have to tell you that things aren’t looking very good for your son.’ Izzy suddenly felt guilty talking about this to the mother when she was pregnant herself, and was incredibly grateful when Diego came into the cubicle. He gave her a thin smile and, because he would be more than used to this type of conversation, Izzy allowed him to take over.

‘Another one of my staff is in with your baby,’ he said, having introduced himself to the mother, and did what Megan had insisted Josh didn’t. Izzy felt the sting of tears in her eyes as very skilfully, very gently Diego talked Nicola through all that had happened, all that was now taking place and all that could lie ahead if her baby were to survive.

‘Right now,’ Diego said, ‘we are doing everything we can to save your baby, but he is in a very fragile state. Nicola. Do you understand what I said to you about the risks, about the health problems your baby might face if he does survive?’

‘Do everything you can.’