wrong, but you’re the specialist. Be honest, was it something we did?’
‘Not at all,’ Juliet answered. ‘It’s something that the medical experts can’t predict. The events in pregnancy that lead to TTTS are quite random events. The condition is not hereditary or genetic, nor is it caused by anything either of you did or didn’t do. TTTS can literally happen to anyone having multiple births at any stage up until about thirty weeks.’
‘So it’s definitely not our fault?’
‘Absolutely not,’ Juliet responded again honestly and without hesitation.
‘Charlie and Mr Darrington told us that but it’s nice to hear it from you.’
Georgina’s expression, on hearing confirmation about the cause of her babies’ condition, was subdued but Juliet was happy that at least unwarranted guilt would not be another struggle for the quads’ mother.
‘We know the boys are in trouble but are there any risks to Georgie from the TTTS?’ her husband asked as he looked at his wife with loving concern.
‘That is something we have to consider, and another reason your wife is in Teddy’s on bed rest,’ Juliet continued. ‘Carrying quads is in itself quite taxing on a woman’s body and that stress has been increased by the TTTS. Her uterus is being stretched past what is normal for pregnancy—’
‘Should you just wait then and take the babies in two weeks as Charlie says and not put Georgie at any risk?’ Leo cut in.
Without giving Charlie time to interrupt, Juliet answered quickly. ‘Actually no. That could’ve been a consideration if, since the diagnosis two days ago, the condition had not progressed, but it has and, for want of a better word, aggressively. I’m not convinced that the recipient baby would survive until thirty-one weeks. If the pregnancy was just twins, we could deliver at twenty-nine weeks. However, with quads the babies are still very small so if we can prolong the pregnancy another few weeks by having the laser surgery, the babies will be bigger when they’re born and that will make their lives easier. At the moment they are all less than three pounds and we no longer have time on our side to observe their growth.’
‘Like you said, Dr Turner,’ Georgina responded, ‘we agree that Charlie has taken such good care of me up until now we’re really struggling to think about ignoring his advice. Perhaps we should have the needle and stay with bed rest.’
Charlie drew in a deep breath, plumped out his chest, and in Juliet’s opinion looked like a pigeon about to mate. His polite interruptions made her believe their professional battle would lean towards a gentleman’s sword fight, but a fight nonetheless, and she was right. But for the good of the mother and her babies, she would not hold back. There would be a level of professional courtesy, but she would not cower to him. Juliet was prepared to argue on the evidence-based merit of surgery and then leave the decision where it should lie. With the well-informed parents.
‘While the needle you spoke of, an amniotic reduction, can work well in stage one patients, you have moved past this option very quickly. Teddy’s brought me here to discuss laser surgery and the benefits and they would not have flown me halfway around the world if there was any doubt that surgery was a viable and preferable choice for you.’ Juliet paused for a moment, then continued with a serious timbre in her voice. ‘But I won’t lie to you, there are risks in the surgical route as there are with any surgery, but the benefit far outweighs the risks. I also must let you know that if you choose to proceed with the laser surgery, then it would need to be this week. On Thursday or Friday at the latest as time is not on our side if we decide to help your sons surgically. If we leave it too long, your body will make the decision for us.’
Juliet watched Georgina’s and Leo’s expressions darken. It was a lot to process and, while she had not wanted to put additional pressure on either of them, she felt all the facts had to be stated. Time was unfortunately not on their side and that was the harsh realisation they all needed to accept. To deliver four living babies, something had to be done. She just prayed they chose surgery.
‘Can you give us more details, like what the surgery involves and how long it will take?’ Leo asked as he ceased stroking his wife’s arm and reached down to hold her hand tightly.
Juliet stepped away from the bed to give the couple a little more space. Hearing news and making potential life-and-death decisions, she knew, was overwhelming and they needed to feel safe together in their own space. ‘Of course,’ she began and then noticed that Charlie had brought her a chair. She wasn’t sure if he was being gallant and considerate or if he was trying to make her appear weary. She didn’t waste time deciding which it was, instead choosing to graciously accept the chair and continue.
‘The operation involves endoscopic surgery using a laser beam to cauterise the offending arteries and halt the exchange of blood between your boys. Each baby will remain connected to his primary source of blood and nutrition, the placenta, through the umbilical cord. The use of endoscopic instruments allows for short recovery time and no effect on the other babies and would be done only once during the pregnancy.’
‘Dear God, we pray if we go ahead it’s just one time,’ Leo interrupted as he looked into his wife’s tear-filled eyes. ‘Georgie’s been through so much over the last eighteen months with the three rounds of IVF, and that was unsuccessful, and then finding out we’re having four babies conceived naturally. And now this heartbreaking news about the transfusion while I was away.’
‘Leo, you’re suffering as much as me, and you had to make the trip to New York,’ she told him as she mopped the tears that threatened to escape. Her eyes were reddened from too many nights of crying. ‘We’ve both been through so much and we’re doing our best to stay strong together.’
‘And we will. No matter what, we’ll get through all of this. And we’ll take our babies home to where they belong. Their nonni, all four of them, are waiting to meet their grandchildren.’
Juliet nodded. ‘That’s my plan and I’m so pleased to hear your positive outlook. That’s exactly what your babies need.’
‘Ah, you know Italians, we’re a strong race and our children will be fighters too.’
‘Goodness, Leo,’ Georgina said. ‘You sound like my father!’
‘Well, it’s the truth,’ Charlie added. ‘You and Georgie have been strong and focused since the diagnosis and that’s why you should not completely rule out continuing on the current conservative path.’
Juliet swung around on her chair with a look of indignation. She could not believe what she was hearing. Charlie clearly had not handed over to her as he’d promised. Fuming but unable to tell Charlie how she felt, Juliet regained her composure, turned back to the couple and continued. She would let Charlie know in no uncertain terms how she felt about his interference, after the consultation. But for the moment she intended to calmly give Georgina and Leo all the information so they understood it was their choice, and theirs alone.
‘Minimally invasive fetoscopic surgery is the name of the procedure and it is aptly named because it’s minimally invasive. It involves small incisions and I will be guided by both an endoscope and sonography. Essentially it’s keyhole surgery so far lower risks than open foetal surgery, which is completely opening the uterus to operate on the foetus.’
‘But there’s still a chance it could go wrong?’ Leo asked anxiously, looking from Juliet to Charlie.
‘Yes, but not undertaking the surgery has equal if not greater risk,’ Juliet
