Cinderella and the Surgeon

‘Where do you want me?’ asked Esther.

‘Can you cover cubicles?’ asked the charge nurse as he tried to assign everyone to their spot.

‘No trouble.’ She picked up the charts for the cubicles nearby and scanned them. Stitches. A fractured wrist. A patient waiting for a bed in Respiratory. Another patient needing a catheter inserted due to urinary strictures, and a confused elderly patient that had been found wandering near one of the parks and was bordering on hypothermic. More than enough to keep her busy.

Six hours later she still hadn’t had a break. Esther knew she really needed to grab some more paracetamol and another dose of her new antibiotics but she literally hadn’t had a minute.

‘Where’s the nurse who works in NICU?’ she heard a harassed voice say. ‘And someone call the paed doctor?’

Esther stuck her head from behind the cubicle curtains where she’d just finished stitching up a laceration. ‘I’m here. Need a hand?’

The doctor she didn’t know that well nodded. ‘Please, I’ve got a newborn who doesn’t look great.’

Esther nodded. ‘Absolutely.’ She snapped off the gloves she was wearing and grabbed a new pair, striding quickly alongside the doctor. She could sense his panic. And she understood it. He was new to the department and relatively junior. Dealing with babies could be scary. Paediatrics wasn’t everyone’s bag.

She stepped into the cubicle and saw the baby still clutched in its mother’s arms. She sat down in the chair next to her. ‘Hi there. I’m Esther, a midwife and a nurse. Can you tell me what happened today?’

The mother was trembling. She knew it was important to get a good history from the mother, and to try and keep things calm.

She caught a waft of something and sensed someone had come in at her back. But she kept her concentration on the baby. She really needed to get a look at either he or she.

‘I h-had a home delivery last week. Everything was fine. But...he’s just gone downhill fast. He’s not feeding well, he keeps being sick. His colour is bad, and he gasps when he’s breathing.’

Esther nodded and held out her arms towards the mother. ‘Okay, sounds like I need to take a little look at him. What’s his name?’

‘Jude.’

She smiled and kept her hands outstretched. ‘Do you mind if I take a look at Jude?’

The woman hesitated and then finally handed over the little baby. Esther moved slowly and laid the little boy down on the A&E trolley.

She knew instantly that the person on her shoulder was Harry, and after one look at this baby, for once, she wasn’t too sorry he was there.

* * *

He’d walked into the cubicle just a few steps behind Esther. Paeds had received three panicked calls from A&E. He couldn’t quite understand why Esther was working down here, but he gave her space to talk to what was clearly a very anxious mother. She handled the situation well and he waited until she’d moved the baby to the trolley before moving to the other side. He gave a nod to the mother and opened his mouth to speak but Esther got there first.

‘Was Jude full term when he was born?’

The mum shook her head. ‘Thirty-eight weeks but the midwife said there was nothing to worry about.’

Harry took his stethoscope from his neck and smiled at the mum. ‘I’m Harry, I’m one of the paediatric doctors. I’m just going to check Jude over if that’s okay with you.’

The woman gave an anxious nod and Harry waited patiently as Esther unwound a finger probe from the paed monitor and attached it to Jude’s tiny finger.

Harry had learned not to introduce himself as a paediatric surgeon; it had a tendency to freak people out. Truth was, the paed doctor who was on call was dealing with a meningitis case in one of the wards upstairs. When Harry had heard there was a baby with potential breathing difficulties, he’d offered to cover the call.

And he was glad he had.

This little guy was using all his accessory muscles to breathe. It only took a few seconds to show that he was bradycardic, and his oxygen saturation was lower than he would have hoped for.

Esther didn’t say a word, just reached for the oxygen and handed him the chart. She was efficient, he’d give her that.

She slid the nasal prongs into place and picked up an ear thermometer. Harry listened carefully to Jude’s chest, hearing exactly what he expected to.

There was a definite heart defect. One he’d need to diagnose after a few more investigations. In the meantime he pulled over the sonogram without waiting for a sonographer and had a quick look for himself.

Esther was talking in a low voice to little Jude. He was responding, blinking and kicking his arms and legs. His skin was a little dusky, but not enough to cause huge concerns for Harry. He suspected this was something he could solve with surgery in the next few days. It wasn’t uncommon for heart defects not to be obvious in babies straight away. The most severe were normally picked up at prenatal scans. But the less severe could be missed.

He moved around and sat in the chair next to the mum, then paused, realising he didn’t know her name.

It was like Esther read his mind. She glanced at the chart he’d left sitting on the other side of the trolley and gave a casual smile. ‘Claire, Harry our doctor is going to explain what he thinks is going on with Jude right now.’

Harry gave her a grateful nod. ‘Is there anyone else here with you?’

Claire shook her head, her eyes bright with tears. ‘I just panicked and brought him in. I tried to phone my husband and my mum-in-law but neither of them answered. I left messages.’

Esther nodded. ‘How about I have a quick check in the waiting room to see if either of them have arrived?’

Two minutes later she returned with a breathless man and an older-looking woman with her bag clutched to her chest. Both of them immediately crowded over Jude. Harry waited for them to ease their panic. The guy came and put his arm around his wife. ‘What’s going on?’

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‘He went a funny colour when he was feeding and it just didn’t get better.’

The older woman was stroking Jude’s head and whispering to him. It was clear Claire had supports in place that Jill in the NICU could badly do with. Harry introduced himself and shook hands, then took some time explaining what was wrong with Jude’s heart, drew a diagram for them explaining how surgery would fix things.

It was clear they were horrified, but Esther was smooth, finding tissues for tears, then a chair for gran, whose legs seemed to fold once she found out her precious first grandson needed surgery.

‘But who can do it?’

‘I’ll do it.’

‘You do surgery on babies’ hearts? Doesn’t that need to be a specialist?’

‘I am a specialist. I’m a visiting surgeon at the Queen Victoria. Cardiac surgery in babies is my speciality.’

Esther’s eyes locked with his, and she gave the slightest nod of her head, as if she approved of how he was talking to the mum.

‘How many times have you done this operation?’

Harry counted in his head. ‘This will be number twenty-seven.’

There was an audible sigh of relief. He understood that. Esther made a few notes and stepped outside the cubicle while he kept talking to the family.

When she came back in he had just finished explaining that they’d transfer Jude upstairs and make arrangements for admission.

‘Done,’ said Esther, handing him the paperwork. ‘Porter is just coming. Francesca will review Jude on the ward.’

Harry raised his eyebrows. ‘You don’t waste time.’

She gave him a tight smile. ‘Some people call me efficient.’

He shifted on his feet. Was she mad at him again? He thought they’d sorted things. The porter arrived quickly and Harry decided to head up to the ward with the family.