nodded, finished what she was doing at Adam’s resuscitaire and switched straight to Max, wrapping the plastic, slipping the tubular bandage onto his tiny head with a couple of soft movements.
Laird devoted a critical few moments to repeating Tammy, Tammy, Tammy, over and over in his head, as he moved to the unresponsive baby. Max was a darker red than he should have been, filled with the excess of blood he’d innocently robbed from his much smaller brother. Thick blood, they often called it, because a baby’s tiny liver couldn’t process it and remove the waste. His heart had been struggling, and even without the TTTS the simple fact of prematurity could often present its own cardiac issues.
‘Right, let’s do this,’ Laird muttered. He understood the junior doctor’s reluctance. Max was going to be much harder.
He looked down at the baby, willing it to show some strength and fight, willing the parents’ love to make a difference, to have some power over life and death. Later on it would. Premature babies responded wonderfully to the familiar voice of their mother or father, and to the right kind of touch. Now, though, it was more about medicine than hope.
‘What’s happening? Is he OK?’ Chris Parry had sensed the increase of tension in the medical personnel, and he could probably see for himself that the second baby, although larger, wasn’t looking as good as his twin.
His wife moaned. ‘Max?’ she said. ‘Hang in there. Mummy’s here, and Daddy. We love you so much.’ Her voice cracked and she couldn’t speak any more.
‘Is he going to be OK?’ Chris asked again.
‘We’re going to do everything we can,’ Laird said. Terrible words. Yet false promises were even worse, he considered. ‘Tammy, start cardiac massage while I tube him.’
He hoped she’d sense when he needed her to get out of the way and that she wouldn’t need to be talked through it.
‘Adam’s looking good,’ Sam said, after a moment. ‘I’m getting 85 bpm, his chest’s moving. I’ll get an umbilical line into him now. Then you can go for a ride, little man.’
Laird heard more sounds from the Parrys. Relief and anguish. Then from Tim a suspiciously calm ‘All right, we’re going to have to pack this. Do we have some blood, Helen?’
Mrs Parry had begun to bleed too much, a reasonably common side effect following the procedures she’d had over the past few weeks to reduce her amniotic fluid. ‘What’s happening? What’s going on now?’ Chris demanded, distraught. Like his wife, he had fair, freckled colouring, which made him look very pale under the harsh lights. Fran’s lips were white.
Laird couldn’t spare a thought for them right now. Max needed him too much, needed the tube, needed the massage, needed treatment for that thick blood and some relief for his heart as soon as they had him stable.
At every moment, the Tammy nurse was there. Hands in the right place. Voice pitched low enough to soothe the baby but loud enough for Laird to hear. Fingers nimble and delicate. No unguarded exclamations of doom to scare the stricken parents. Laird spared her a glance and managed a muttered ‘Thanks.’ She nodded, and there was this odd little moment that he didn’t understand. More than mere relief at being paired with a competent colleague. More like…recognition?
He didn’t have time to think about it now.
Chris had tears streaming down his cheeks. Fran was pressing her dry lips numbly together and clamping a death-like grip on her husband’s hand.
‘Come on, darling,’ Tammy cooed to the baby. Her fingers seemed to flutter against his miniature sternum, and her voice was delicious, soft and musical and honey sweet. ‘Come on, sweetheart, let’s see what a big strong boy you are. Let’s try really hard…’
‘OK, he’s tubed,’ Laird finally said. Like Tammy, he’d almost been holding his breath. He saw her nod and look of relief. She cared. ‘Heart rate’s coming up. Not counting chickens…’ he added quietly.
She understood. ‘Want the umbilical line?’
‘Can you? I’ll give a first dose of adrenalin via the ETT, but let’s have that UVC.’
She got the line in with incredible speed and dexterity and he delivered a carefully calculated dose of adrenalin through the endotracheal tube. Next, Tammy nested the baby in a rolled and warmed towel and adjusted the radiant heat setting.
Time had passed, ceased to have meaning. All of this took longer than a non-medical person would expect.
‘Let’s move him now,’ Laird murmured. ‘We need to get him stable and quiet, get him under bili lights to get his blood sorted out, and this is torture for the parents.’
‘I know.’
He raised his voice a little, and told them, ‘We’re ready to move him to the NICU now.’
‘Can Chris go with you?’ Fran asked feebly. Tim was still packing her uterus to stop the haemorrhaging and she looked very pale and weak, alert through sheer force of will and a desperate need to know how her babies were doing.
‘Chris, it’s better if you stay here until Fran’s in Recovery,’ Laird said. ‘Then you should be able to come and see both babies and let her know how they are.’
It would be an enormously stressful time for her, he knew. This first hour. The first day. The first week. No guarantees, yet, as to if or when she’d be taking her babies home—her own process of recovery from the stressful pregnancy, the surgery and blood loss almost an afterthought.
The journey to the NICU was short, and there was an incubator already set up for Max at thirty-six degrees Celsius and eighty-five percent humidity. Little Adam had a nurse working over him, checking his temperature, setting up more lines and monitors, applying a pre-warmed soothing and moisturising ointment to his skin.
They moved Max from the resuscitaire into a second incubator, weighed him in at 830 grams, took his temperature and began to set up and secure his lines. The Tammy nurse with the beautiful voice went looking for a bili light and Laird put in an order for blood for Adam, who weighed just 580 grams. Sam was called to the other end of the room to assess one of his patients whose oxygen saturation levels had fallen.
‘Just need to tell you, Tammy, I’m going home, taking a break,’ announced a mother some minutes later, coming over to her after she’d returned with the phototherapy equipment. The woman spoke too loudly and seemed not to notice tiny Max in his humidicrib or that Tammy was now busy making notes in the baby’s brand-new chart. Again, Laird had lost track of time, except as it related to observing Max.
Tammy looked up from her notes. ‘That’s sensible, Mrs Shergold.’ She took the woman’s arm and led her gently away from Max. She spoke quietly. ‘You were only discharged this morning, weren’t you?’
‘I know. I wanted to stay another couple of days, but no go. It’s just wrong, isn’t it? It’s the insurance companies, and the government. Do they have any idea?’ She still spoke too loudly, hadn’t picked up on the soft cue given by Tammy’s lowered voice.
Laird caught an angry glance in the woman’s direction from an exhausted-looking blonde mother in a nightgown and slippers, who was bending over her own baby’s humidicrib.
One
