now, and sometimes one of the hardest things was having the mum understand that the tiny child inside her was an independent being already. Something totally separate from her. This was a child who could be shifted in her uterus, who even at twenty-two weeks could cope with complex surgery and then be resettled, because, no matter how amazing the technology, the womb was still the safest place for her to be.
‘Ruby, you know your baby has spina bifida,’ he said now, gently. Em still had her arm around the girl. He was talking to them both, as he’d normally talk to a woman and her partner, or a woman and her mum or support person. Em had slid naturally into that role. A good midwife sometimes had to, he thought, and Em had always been brilliant at her job. Efficient, kind, skilled and empathic. He’d worked with her once and he’d loved it.
It was totally disconcerting to be working with her again, but he needed to focus on Ruby.
‘You know we’ve picked up the spina bifida on the ultrasound,’ Oliver said matter-of-factly, trying to take the emotion out of the situation. ‘You’ve seen it?’
‘It just looked blurry. I couldn’t figure it out.’
So she didn’t understand. ‘Heinz Zigler’s a great paediatric neurologist,’ Charles had told him. ‘He’s technically brilliant, but communication’s not his strong suit. He’ll do the spinal surgery but everything else—including explanations to the mum—we’re leaving to you.’
So now he needed to explain from the ground up. ‘The scans do look blurry,’ he admitted. ‘I have trouble reading them myself. Fine detail like the nerve exposure around vertebrae needs incredibly specialised knowledge to see, but the radiologists here are superb. They’ve double-checked each other’s work, and Dr Zigler agrees. Everyone’s sure. But would you like me to explain what I think is happening? I don’t talk in fine detail, Ruby. I just see the overview. That’s actually what I do, total patient care, looking after you as well as your baby. I’m an obstetrician and a surgeon who specialises in looking after mums and bubs if bub needs an operation before it’s time for her to be born.’
Silence. Ruby cast him a scared look and subsided. He waited, while Ruby pulled herself together a bit more, while Em handed her a wad of tissues, while both women readied themselves to front what was coming.
‘Heinz says he told you the fine detail,’ he said at last, when he thought Ruby was as ready as she was going to be. ‘But here’s the broad outline. The bones of your baby’s spine—the vertebrae—haven’t formed properly to protect your baby’s spinal cord. The spinal cord holds the nerves that control your baby’s movements. Because those nerves run right through the body, if the cord gets damaged then long term, your baby might not be able to walk. She might not have control of her bladder and bowel. If she has a severe problem she can also end up with a build-up of fluid in her brain. Then she’ll need a shunt, all her life, to drain the excess fluid and relieve pressure.’
Ruby was crying again now, but not sobbing. Em’s arm was around her, holding her close, but Ruby’s attention was held. Her distress was taking second place to her need to know, and she seemed to be taking it in.
‘So,’ she whispered. ‘So?’
‘So the good thing is,’ he said, still gently, ‘that many problems of spina bifida aren’t directly caused by the spina bifida itself. Doctors cleverer than me, like Heinz—did you know he’s top in his field in research?—have worked out that the exposure of the spinal cord to the normal fluid in your womb, the amniotic fluid, is what progressively destroys the exposed nerves during pregnancy. If we can operate now, really early, and cover the exposed cord, then we prevent much of the damage. Your baby’s much more likely to be able to live a normal, happy life.’
‘But not with me,’ Ruby whispered.
That was another issue altogether. Adoption. This was a single mum, a teenager, facing a life apart from the baby she was carrying.
‘You haven’t decided definitely on adoption,’ Em murmured, and the girl shook her head.
‘I can’t think …’
‘And you don’t need to think.’ Em’s hold on her tightened. ‘There’s too much happening now for you to think past what you need to face right now. But, Ruby, regardless of what you decide to do when your baby’s born, regardless of whether you decide you can care for her yourself or if you want to give her to parents who need a baby to love, she’ll still be your daughter. You have the choice now to make a huge difference in your daughter’s life.’
‘You’re … sure she has to have this operation?’ Ruby whispered. ‘I mean … really sure?’
‘We’re sure,’ Oliver told her, suddenly immensely grateful for Em’s presence. Without Em he doubted whether he’d have been able to get past the fear. ‘But the operation’s not without risks.’ He had to say that. There was no way he could let this kid agree to surgery without warning her. ‘Ruby, there are risks to you and risks to your baby. I believe those risks are small but they’re still there.’
‘But … I will make a difference.’
‘Heinz tells me that because the spinal cord exposure is relatively high and very obvious on the ultrasound, then if we leave the operation undone, your daughter will probably spend her life in a wheelchair,’ he said bluntly. ‘And with the amount of exposure … there will be fluid build-up in the brain. She’ll need a shunt and there may even be brain damage.’
‘That’s why Dr Evans has arrived here so fast,’ Em went on smoothly. ‘We haven’t had a specialist in-utero surgeon on staff, but when we saw your ultrasound Dr Zigler knew we had to get the best obstetrician here as fast as we could. That’s who Dr Evans is. The best. So now it’s up to you, Ruby, love. Will you let us operate on your baby?’
‘Heinz and I can close the gap over the cord,’ Oliver told her. ‘There’s probably already a little damage done, but it’s so early that damage should be minimal. What we’ll do is put you to sleep, cut the smallest incision in your tummy as possible—you’ll be left with a scar but I’m very neat.’ He grinned at the girl, knowing a bit of pseudo modesty often worked, and he got a shaky smile in return. ‘Then we’ll gently turn your baby over where she’s lying—with luck we won’t have to take her out. Once her back is exposed Heinz will check everything, tweak things to where they should be, then we’ll close the gap over her spinal cord. We’ll settle her back down again and tuck her in, stitch you up and leave you both to get on with your pregnancy. You’ll need to stay in hospital for about a week, maybe a bit longer, until we’re sure we haven’t pressured bub into coming early, but then everything should proceed as normal.’
‘And she won’t have to be in a wheelchair?’
‘Ruby, we can’t make any promises.’ He caught her hand and held it. Em was still hugging her, and Oliver thought, not for the first time, Em was a wonderful midwife. She knew when to intervene and she knew when to shut up. She also exuded a quiet calm that was a tranquilliser all by itself.
He’d met her ten years ago. He’d been a barely qualified doctor, she’d been a student nurse, but already the confidence she’d engendered in the patients he’d worked with had been impressive. He’d seen her with some terrified teenage mums.
There was no nurse he’d rather have by his side and by the time they’d dated twice he’d known there was no woman he’d rather have with him for ever. Their attraction had been instant, their marriage inevitable.
It
