When the police sergeant had told him the only place available was the nursing home he’d felt ill. To treat this woman without facilities seemed impossible.
But here… The room was set up as a small theatre. Scrupulously clean, it was gleaming with stainless-steel fittings and overhead lights. It was perfect for minor surgery, he realised, and his breath came out in a rush of relief. What lay before him started looking just faintly possible.
‘What-?’
But she was ahead of him. ‘Are you really a doctor?’ she asked, and he nodded, still stunned.
‘Yes. I’m a surgeon at Sydney Central.’ But he was focussed solely on the pregnant woman, checking her pupils and frowning. There didn’t seem a reason for her to be so deeply unconscious.
He wanted X-rays.
He needed to check the baby first, he thought. He had two patients-not one.
‘You can scrub through here.’ Amy’s face had mirrored his concern and she’d followed his gaze as he’d watched the last contraction ripple though her swollen abdomen. ‘Or…do you want an X-ray first?’
‘I have to check the baby.’ She was right. He needed to scrub before he did an internal examination.
‘I’ll check the heartbeat. The sink’s through here. Marie will help.’
A bright little lady about four feet high and about a hundred years old appeared at his elbow.
‘This way, Doctor.’
He was led to the sink by his elderly helper-who wasn’t acting elderly at all.
There was no time for questions. Joss was holding his scrubbed hands for Marie to slip on his gloves when Amy called him back.
‘We’re in trouble,’ she said briefly, and her face was puckered in concern. She’d cut away the woman’s smock. ‘Hold the stethoscope here, Marie.’ Then, with Marie holding the stethoscope in position over the swollen belly, she held the earpieces for Joss to listen.
His face set in grim lines as he heard what she’d heard. ‘Hell.’ The baby’s heartbeat was faltering. He did a fast examination. The baby’s head was engaged but she’d hardly dilated at all. A forceps delivery was still impossible. Which meant…
A Caesarean.
A Caesarean here?
‘We don’t have identification,’ Amy was saying. ‘Will you…?’
That was the least of their worries, he thought. Operating without consent was a legal minefield, but in an emergency like this he had no choice.
‘Of course I will. But-’
‘We have drugs and equipment for general anaesthetic,’ she finished, moving right on, efficient and entirely professional in her apology. ‘The Bowra doctor does minor surgery here, but I’m afraid epidural is out of the question. I…I don’t have the skills.’
After that one last revealing falter her eyes met his and held firm. They were cool, calm, and once again he thought that she was one in a million in a crisis.
‘What’s your training?’ he started, hesitating at the thought of how impossible it would be to act as anaesthetist and surgeon at the same time-but she was before him there, too.
‘Don’t get the wrong idea. I’m not a doctor,’ she said flatly. ‘I’m a nurse. But I’m qualified in intensive care and I spent years as a theatre nurse. With only one doctor in the district, I’ve performed an emergency general anaesthetic before. That’s why we have the drugs. For emergencies. So if you guide me, I’m prepared to try.’
He stared at her, dumbfounded by her acceptance of such a demand. She was a nurse, offering to do what was a specialist job. This was a specialist job for a qualified doctor!
But she’d said that she could do it. Should he trust her? Or not?
He hardly had a choice. He’d done a brief visual examination on the way here. The baby was still some way away-the head wasn’t near to crowning-and now the baby’s heartbeat was telling its own grim story. If they waited, the baby risked death.
He couldn’t do a Caesarean without an anaesthetic. The woman was unconscious but the shock of an incision would probably wake her.
He needed a doctor to do the anaesthetic, but for him to perform the Caesarean and give the anaesthetic at the same time was impossible.
Amy wasn’t a doctor. And she was offering to do what needed years of medical training.
But… ‘I can do this,’ she said, and her grey eyes were fearless.
He met her gaze and held it.
‘You’re sure?’
‘Yes.’
‘You realise insurance…’
‘Insurance-or the lack of it-is a nightmare for both of us.’ She nodded, a decisive little movement of her head as though she was convincing herself. ‘But I don’t see that we can let that worry us. If we don’t try, the baby dies.’
It went against everything he’d ever been taught. To let a nurse give an anaesthetic…
But she was right. There was no decision to be made.
‘OK. Let’s move.’
It was the strangest operation he’d ever performed. He had a full theatre staff, but the only two under eighty years old were Amy and himself.
Marie stayed on. The old lady had scrubbed and gowned and was handing him implements as needed. Her background wasn’t explained but it was assumed she knew what she was doing, and she handled the surgical tray with the precision of an expert.
And she had back-up. Another woman was sorting implements, moving things in and out of a steriliser. A man stood beside her, ready with a warmed blanket. Every couple of minutes the door opened a fraction and the blanket was replaced with another, so if-when-the baby arrived there’d be warmth. There was a team outside working in tandem, ferrying blankets, hot water, information that there was no chance of helicopter evacuation…
Joss took everything in. He checked the tray of instruments, the steriliser, the anaesthetic. He measured what was needed, then sized Amy up.
‘Ready?’
‘As ready as I’ll ever be.’ Still that rigid control.
He looked at her more closely and saw she was holding herself in a grip of iron. There was fear…
It would help nothing to delay or probe more deeply into her fear, he decided. She’d made a decision that she could do it and she had no choice. There was no choice!
‘Let’s go, then.’
Amy nodded. Silently she held her prepared syringe up so he could check the dose. He nodded in turn and then watched as she inserted it into the IV line.
He watched and waited-saw her eyes move to the monitor, saw her skilfully intubating and inflating the cuff of the endrotracheal tube, saw her eyes lose their fear and become intent on what they were doing.
He felt the patient’s muscles relax under his hand.
She was good, he thought exultantly. Nurse or not, she knew what she was doing, which left him to get on with what he had to do.
He prepped the woman’s swollen abdomen, lifted the scalpel and proceeded to deliver one baby.
CHAPTER TWO
IT WENT like clockwork.
This team might be unusual but their competence was never in question. As he cut through the abdominal layers the old woman called Marie handed over instruments unasked. When Joss did need to ask, her responses were instantaneous.
And Amy’s anaesthetic was first class.
All this was-had to be-ancillary to what he was doing. He was forced to depend on them: his attention was on the job. The anaesthetic was looking fine. All he knew was that he had what he needed and the woman’s heart rate was great.
If only the baby’s heartbeat held…
This was the moment of truth. He looked up to ask, but once again his needs were anticipated. The second of the older women stepped forward to push down on the uterus, giving him leverage as he slid one gloved hand into the incision.
Please…
‘Here it comes.’ He lifted the baby’s head, turning it to the side to prevent it sucking in fluid. ‘Yes!’
It was a perfect little girl.
Joss had only seconds to see that she was fine-the seconds while he scooped the baby free. As soon as she was free of her mother-before he’d even tied off the cord-hands were reaching for her, the sucker was in her mouth and they were removing mucus and freeing her to breathe. These people knew what they were doing! The old man behind Marie ducked in to scoop the infant into the waiting blanket as the elderly nurse cleared her airway.