twins are in two separate amniotic sacs and they each have their own placenta,’ Alessi explained. ‘The trouble is that one of the twins is smaller than the other, and the fluid around this twin …’ he placed a hand high on Donna’s stomach ‘… is significantly reduced. Most of the time our aim is to prolong the pregnancy for as long as possible but in some cases it is better that the baby is born.’
‘Even at twenty-four weeks?’ Donna asked, and there was a very long silence before Alessi answered.
‘No,’ he said gently. ‘It is far too soon but this is where it becomes a very delicate balancing game. Darcie has given you steroids that will mean that if the twins come after forty-eight hours then their lungs will be more mature than they would otherwise be. However, I’m not sure that I want the delivery to be held off for much longer. This little one needs to born soon. The placenta isn’t doing its job and that twin stands a better chance out of the womb than inside.’
‘But what about the other one?’
‘That is why it is such a delicate balance,’ Alessi said. There were no easy answers—twin A needed as long as possible inside the womb; twin B, to have a chance of survival, desperately needed to be born. The diagnosis was indeed grim. Twenty-four weeks was, in the best of cases, extremely premature but for an already small undernourished baby it didn’t look good at all. Isla listened as Alessi gently led Donna down the difficult path of realisation that the babies’ chances of survival were poor and that their outlook, if they did live, might not be bright.
It really was a horrible conversation to have, and he did it kindly and with compassion, but he was also clear in that he didn’t offer false hope. By the end of the consultation Donna had said that she wanted everything, everything possible done for both twins when they were born.
‘We shall,’ Alessi assured her. ‘Donna, I can say that you are in the very best place for this to happen. I am going to be there for your boys and I shall do all that I can for them.’ He stood and looked at Isla, asking if he could have a word outside.
‘Any changes, particularly to twin B, I want to be urgently paged. I’ve spoken to the anaesthetist and he’s going to set up an epidural so that we can do an urgent section if required.’
‘How long do you think twin B has got if he isn’t delivered?’
‘I’m hoping to buy a few days,’ Alessi said. ‘Though I doubt we can wait much longer than that, though that would be to the detriment of twin A, who looks very well.’
‘It’s a tough choice.’
‘I don’t think I’ll have to make it.’ Alessi sighed. ‘She has marked funnelling,’ he said, and Isla nodded. The cervix was dilated at the top end and that meant that Donna could deliver at any time.
‘I’m going to go and speak with Jessica now,’ Isla said, ‘and then ring her aunt and ask her to come in.’
‘Do you want me to speak with her?’ Alessi offered, but Isla shook her head.
‘I’m sure you’ll be having a lot of contact with the family in the coming days and weeks. If you could just bear in mind that she’s feeling guilty, when really, whether Donna was in labour or not when she presented in Antenatal, the outcome was always going to be that she was admitted today …’
‘I’ll keep it in mind,’ Alessi said. ‘Oh, and I just had a call from Allegra. She’s very grateful to you. Things are much better.’
‘That’s good.’
‘I spoke with my parents, as well, and they are doing their best now not to interfere.’
‘How did that go?’ Isla asked.
‘Ha.’ Alessi smiled. ‘They do listen to me when it’s about work.’
‘Only then?’ Isla asked, her curiosity permanently piqued when it came to Alessi, but he simply gave a small nod.
‘Pretty much. I’d better get back.’
‘Sure.’
‘Isla?’
‘Yes?’
Alessi changed his mind. ‘It will keep.’
He left her smiling.
When Alessi had gone back to NICU and things were settling down with Donna, Isla had a very long chat with Jessica. Rather than speaking in her office, Isla took the young girl to the canteen and they had a drink as Isla did her best to reassure her that none of the situation was her fault.
‘None of this happened because of your argument with your mum,’ Isla said, when Jessica revealed her guilt. ‘I promise you that. One of the twins is very small and we’d have picked up on that today at her appointment and she would have been admitted.’
‘It’s too soon for them to be born, isn’t it?’ Jessica asked.
‘They’re very premature,’ Isla explained. ‘But as I said, there’s a problem with one of the twins and your mum was always going to have to deliver the twins early. Do you understand that you didn’t cause this?’
‘I think so,’ Jessica said. ‘I’m scared for my brothers.’
‘I know that you are, but we’re going to do all we can for them and for your mum. I’ve spoken with your aunt and she’s on her way in and you’re going to be staying with her tonight. Your mum’s rung your dad and he’s on his way back from Dubai.’
‘It’s serious, then.’
‘It is,’ Isla said. There was no point telling Jessica that everything was going to be fine. It would be a lie and even with the best possible outcome, her mum and brothers were going to be at the Victoria for a very long time. ‘But your mum is in the best place. Darcie, the doctor who is looking after her, is very used to dealing with difficult pregnancies. In fact, she’s just come over from England and we’re thrilled to have her expertise, and Alessi, the doctor who will be in charge of your brothers’ care, is one of the best in his field. He’ll give them every chance.’
She let the news sink in for a moment. It was a hard conversation, but Isla knew that it might be easier on Donna if she prepared Jessica and ultimately easier on Jessica to be carefully told the truth. ‘Why don’t we get Mum a drink and take it up to her now?’
Jessica nodded and they headed back up to the ward. Isla was pleased to see Jessica and Donna have a cuddle and Donna reiterate to Jessica that none of this was her fault.
It was a long day and it didn’t end there because just as Isla was about to head for her home she got an alert on her computer that it was her fortnightly TMTB group tonight.
‘I completely forgot,’ Isla groaned to Emily. ‘I honestly thought it was next week.’
‘Do you want me to take it?’ Emily offered. ‘I can go home for an hour and then come back.’
‘That’s lovely of you but, no, it’s fine.’ Isla smiled. She knew how stretched Emily was and it was incredibly generous of her to offer to stay back.
Isla
