one always got to him.
‘Nope,’ she said. ‘Second.’
‘Oh, great!’
‘But so far it’s pretty similar to how we did things at RV. Everything’s the same colour!’
Her calm good cheer soothed his irritation, and his impatience seemed to have affected her like water on a duck’s back, thank goodness. Her disposable cap stuck out all around her head, like a cross between a pancake and a Madonna-blue halo, and her pale forehead was shiny above a pair of brilliant blue eyes. If she had hair, he couldn’t see it.
They were ready for the babies now.
Or as ready as they’d ever be.
‘Everything all right, Mrs Parry?’ asked her obstetrician, Tim Wembley.
‘I can’t feel anything now.’ Her voice sounded shaky, and her husband squeezed her hand and hissed out a tense breath. Both of them were understandably frightened and emotional. They were in their late twenties, which was starting to look young to Laird at thirty-four.
‘That’s the way we want it.’
‘Good to go here,’ the anaesthetist said.
‘Not long now,’ said one of the two theatre nurses, giving Mrs Parry’s shoulder a pat. She was circulating, not scrubbed and sterile like her colleague. Both women had kept up a cheerful stream of reassurance, explanation and general chat as preparations for the Caesarean birth were completed.
‘Dr Burchell, Dr Lutze, how are we over there?’ Dr Wembley asked.
‘We’re good,’ Laird answered, and Sam nodded, too.
Dr Wembley made the initial incision, working cleanly and with no fuss. When the babies were so fragile, they needed speed as well as a gentle touch. Being born could be a jarring process, even for a healthy baby at full term.
Laird watched, standing at the resuscitaire so that he’d be ready to work on the first baby as soon as he was freed from his mother’s womb. The latest scan suggested this would be the smaller and frailer of the two—the so-called donor twin.
The Parrys understood the terminology by now. Laird had seen them in his office last week after it had become clear that the amniotic fluid reduction procedures weren’t doing enough to help the babies.
They seemed like a pretty sensible couple. They knew that roughly fifteen per cent of identical twins developed TTTs, with varying degrees of severity, and that it occurred when the webbing of blood vessels in the babies’ shard placents grew unevenly, creating a circulation system that favoured one twin at the expense of the other.
They’d asked him a whole lot of questions, which he’d done his best to answer. Unfortunately there’d been a couple of factors, including a badly positioned placenta, that had made laser surgery on the placental blood vessels a very risky option. This had meant that any treatment, including the amnio reductions and steroids to develop the twins’lungs, had only been an attempt to head off worsening problems, and had done nothing to deal with the underlying condition.
Scans showed that the donor twin—the one sending too much of his own blood into his brother—was undersized and passing too little urine, while the recipient twin’s heart was enlarged and working way too hard as it attempted to deal with the excess fluid.
The Parrys already knew that their boys were lucky to have survived this far, and that one or both of the babies could still die.
‘OK, here we go,’ Tim said. ‘Yes, this is the donor twin.’
‘Adam,’ said Chris Parry firmly. ‘His name is Adam, for heaven’s sake, not The Donor Twin.’
‘Adam,’ Tim echoed at once.
Parents were sensitive at a time like this. Laird had seen the racking emotions they went through over and over again, and it kept him humble. He wasn’t a father himself. Not yet. Or not ever? Insufficient evidence to reach a conclusion on that one.
From what he regularly saw in the NICU, parenthood seemed to him like the dramatic, uncharted territory of an undiscovered island—alluring and frightening at the same time. He wondered if he’d have the same strength he saw over and over in the parents of ill babies.
‘Nice. Look at that movement!’ Tim said. It was feeble, but it was there. The baby was very pale. ‘Hey, Adam, going to breathe for us?’
He wasn’t.
No surprise.
He was blue and so small, well under a kilogram at a guess.
‘What’s our other one’s name?’ Tim was asking. After the dad’s moment of anger and Tim’s own carelessness, he’d recovered his sensitivity. These parents needed everyone to treat these tiny, fragile creatures as beloved human beings right from the start.
‘Max,’ Fran Parry said.
‘Here comes Max.’
Laird didn’t waste time waiting to see whether Adam’s breathing would happen on its own. The NICU nurse took the tiny baby from the obstetrician’s gloved hands into the dry, pre-warmed towel she had waiting, then laid him in the heated resuscitaire and folded the nest of plastic wrap over him, leaving his head and umbilical cord exposed. Laird decided he didn’t need to suction the tiny nose and mouth. There was no evidence of meconium staining in the waters or blood visible at the baby’s mouth.
In the resuscitaire, baby Adam seemed lost in a wasteland of white mattress. The nurse dried his head and covered it with blue tubular bandage, while Laird began the resuscitation process. He found a pulse at the umbilical artery—roughly sixty beats per minute—and said after a moment, ‘We have a nice heartbeat.’ He heard tearful sounds of relief from Fran Parry. ‘We’re going to get some oxygen into you right now, little guy.’
He found the heart-breakingly small premmie intubation equipment ready for him right at the moment he needed it and took it from the nurse. He had already forgotten her name. Something a bit odd and comical, which belied her wonderful competence.
‘That’s nice. That’s good,’ he said, just to reassure the parents.
OK, here we go, tube going down. Such a tiny distance, seven centimetres, and the tube was only 2.5 millimetres wide. Gently…gently…
The nurse—Plummy, he was going to have to call her for the moment, in his head, even though he knew it wasn’t quite right—clamped and cut the cord, leaving several centimetres intact to allow umbilical line placement.
‘Max is going to need some help here…’ Tim was saying.
One of the theatre nurses took the recipient twin into a second warmed towel, laid him in the resuscitaire and wrapped him, while Sam Lutze checked his responsiveness on the Apgar scale. At a quick glance, Laird expected the one-minute score to come in at two or less. Adam’s had squeaked to three, and he wanted it higher soon. His colour had begun to improve, some pink radiating outwards towards his little limbs.
‘Swap,’ Sam muttered to Laird, about Max. The one-syllable request acknowledged Laird’s extra year of experience and his reputation for superhero
