PROLOGUE
PATRICK strode through the doors of the labour ward, his bleep and his phone buzzing simultaneously. Pushing open the doors of the delivery room, he walked straight into an atmosphere of palpable tension.
His eyes met those of a white-faced midwife. Despite the soothing words she was muttering to the panicking mother, there was no missing the strain in her expression and her relief at seeing him.
‘Cord prolapse, Patrick. The trace has shown persistent variable decelerations and prolonged bradychardia. I’ve put her in the knee-elbow position, they’re preparing Theatre and I’ve emergency-bleeped the anaesthetist. I’m so sorry to drag you out of your meeting. I know the chief exec gets furious when you go running off.’
‘It’s not a problem.’ Patrick shrugged off the jacket of his suit, slung it over the back of the nearest chair and unbuttoned his shirtsleeves. ‘Ed?’ He turned to his registrar and noticed that he looked unusually stressed.
‘She needs a crash section,’ his colleague muttered in an undertone. ‘After I called you, I put a line in and infused 50 mils of saline into her bladder, as you instructed. Did I miss anything?’
‘Did you do an ultrasound?’
‘Yes. There’s good blood flow through the cord.’
‘All right. Good job. So we’ve bought ourselves some time.’ Patrick rolled up the sleeves of his shirt. ‘You say she isn’t suitable for a general anaesthetic?’
‘That’s right.’ The registrar handed him the notes but Patrick gave a brief shake of his head and walked to the head of the bed.
‘Hello, Katherine. I’m Patrick Buchannan, one of the obstetric consultants.’
‘I know what you’re going to say and I don’t want a Caesarean section,’ the mother wailed. ‘I want to have this baby naturally. That’s why I only came into hospital half an hour ago. I knew this would happen. I knew if I came in earlier, you’d muck about with me.’ She was kneeling face down on the trolley, her bottom in the air in an attempt to prevent the cord being compressed between the pelvis and the baby’s head. ‘I feel ridiculous in this position. It’s so undignified.’
‘This position is saving your baby’s life.’ Patrick squatted down next to her so that he could have a proper conversation and build a connection with the labouring woman. ‘Do you understand what is happening, Katherine?’
‘Yes. You’re going to cut me open instead of letting me have the baby the way nature intended!’ The woman was sobbing now, her head on her arms. ‘I hate you. I hate you all. Oh God, why did this have to happen?’
‘You’re very tired, Katherine.’ Patrick spoke gently. ‘From what I’ve been told, you were in labour for a long time at home before you came to us.’
‘I didn’t want to come to you at all! I just want to have the baby naturally.’
Seeing how terrified she was, Patrick felt his heart twist in sympathy. ‘You can’t have this baby naturally, sweetheart. It’s too much of a risk. The cord is prolapsed—that means that it’s dropped down below the baby’s head. That’s why you’re lying in this undignified position. The cord is your baby’s blood supply—if that blood supply is obstructed, the baby could die.’
Katherine gave a low moan and turned her blotched, tear-streaked face to him. ‘Don’t say that! Don’t say that!’
‘It’s the truth. And I won’t lie to you.’
‘You’re putting pressure on me to have the one thing I don’t want!’
‘I’m putting pressure on you, that’s true—but because this is a medical emergency, not for any other reason.’
‘You’re a surgeon. You’d much rather intervene than let women do it by themselves.’
‘I’m the last person in the world to intervene surgically when there is another option.’ Patrick spoke quietly, holding up his hand to silence his registrar, who had drawn breath to speak. ‘Katherine, if I thought you could deliver this baby yourself, I’d let you do it.’
Katherine sniffed, but she kept her eyes on his, desperate for reassurance and guarantees. ‘How do I know you don’t just want to get home in time for Christmas?’
Patrick smiled. ‘Because it isn’t Christmas Eve until tomorrow. I’ve done all my shopping, the turkey is in the fridge and my kids don’t want me hom
e until they’ve ‘secretly’ wrapped my presents. If I turn up now, I’ll be in trouble.’
Katherine’s breath was jerky from crying. ‘I can’t have a general anaesthetic.’
‘So I understand. Don’t worry. I know the whole thing sounds scary and you feel out of control.’ Patrick rubbed his hand over her shoulder to reassure her. ‘I’m going to ask you to trust me to do what’s best for you. Can you do that? I promise you that everything I do will be for you and the baby. Not for me.’
‘If I can’t have an anaesthetic—’
‘We’ll give you a spinal. You won’t feel any pain, I promise.’
‘Is that like an epidural?’
‘Similar.’ Keeping his hand on her shoulder Patrick stood up, his gaze flickering to the senior midwife in the room. ‘Is the anaesthetist on his way?’
‘He’s meeting us in Theatre,’ the registrar said, and then lowered his voice. ‘Can he put in a spinal when she’s in the Trendelenberg position?’
‘Who is the anaesthetist?’
‘Gary Clarke.’
Patrick gave a faint smile. ‘Gary could put in a spinal if she was hanging from the ceiling. I’m going to go and scrub. I’ll see you in there.’
Katherine gave a little moan. ‘It’s going to go wrong. I know it is.’
‘No, it isn’t.’ Maggie, the senior midwife, took over the role of offering moral support. ‘Patrick is the best there is. He’ll have your baby safely delivered in less time than it takes you to make a cup of tea. Come on, now, love. I know it isn’t what you planned, but you have to think of the baby.’
‘Kathy.’ Her husband added his pleas, ‘I know you’re scared but you have to do this.’
Katherine looked at Maggie, panic in her eyes. ‘Would you let him deliver your baby?’
‘Patrick did deliver my baby,’ Maggie said gruffly. ‘I had a condition called placenta praevia, which is when the placenta is lying across the cervix. Patrick did my Caesarean section. And that was seven years ago when he was still a registrar. He was brilliant even then, and he’s had tons of practice since.’
Katherine gave a choked laugh. ‘Perhaps you should start a fan club for him.’
‘I’m too late. If you go on the internet you’ll find loads of threads devoted to chatting about how brilliant he is. We get women coming up from London just to see him because he’s an expert in premature labour. You see? He can even teach those London doctors a thing or two.’
Katherine groaned. ‘It’s just that I hate needles, I hate operations.’ She hiccoughed. ‘I hate—’
Knowing that he couldn’t proceed until the anaesthetist arrived, Patrick turned his attention back to the labouring woman. ‘It’s difficult when things don’t go the way you planned. I understand that. When my daughter was born the whole thing was a nightmare from beginning to end, and I’m an obstetrician. Nothing went the way I wanted it to go.’
He didn’t add that his wife had blamed him.
Ex-wife, he reminded himself wearily. She was his ex-wife.
Katherine’s face was discoloured from crying, her eyes tired after a long labour. ‘I wanted to have this baby at home.’
‘And having a baby at home can be a wonderful experience, but there are certain times when that just isn’t safe,’ Patrick said softly, ‘and this is one of them.’
She gave a strangled laugh. ‘I thought you’d lecture me for staying at home for so long.’