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of overhead chimes,’ Izzy explained to Nicola, ‘but that’s just so we can get the staff we need down here quickly for your baby.’
The membrane was intact, Izzy could see it bulging, and she used those few seconds to question her patient a little more, but there were no straightforward answers.
‘I only found out last week. I’ve got a seven-month-old, I’m breastfeeding...’
‘Have you had an ultrasound?’ Izzy asked.
‘She’s just come from there,’ Beth said for Nicola, but, as was so often the case in Emergency, a neat list of answers rarely arrived with the patient. They would have to be answered later, because this baby was ready to be born.
He slipped into the world a few seconds
later, just as a breathless midwife arrived
from Maternity and the overhead speaker chimed its request for the paediatric team to come to Emergency. He was still wrapped in the membrane that should have embraced him for many months more and Izzy parted it, using balloon suction to clear his airway. He was pale and stunned, but stirring into life as Izzy cut the cord. Though outwardly calm, her heart was hammering, because difficult decisions lay ahead for this tiny little man.
‘You have a son,’ Izzy said, wrapping him up and holding him up briefly for Nicola to see. Though seconds counted in the race for his life, Izzy made one of the many rapid decisions her job entailed and brought the baby up to the mother’s head, letting her have a brief glimpse of him. Nicola kissed his little cheek, telling him that she loved him, but those few brief seconds were all there was time for.
Beth had already raced over to Resus, and Izzy left Nicola in the safe hands of the midwife and student nurse as she walked quickly over to Resus holding the infant. A man, dressed in black jeans and a T-shirt, joined her. Walking alongside her, he spoke with a heavy accent.
‘What do we know?’
‘Mum’s dates are hazy,’ Izzy said, and though he had no ID on him, there was an air of authority to him that told her this was no nosey relative. ‘About twenty-three weeks.’
‘Mierda!’ Izzy more than understood his curse—she was thinking the same—this tiny baby hovered right on the edge of viability. At this stage of pregnancy every day in utero mattered, but now he was in their hands and they could only give the tiny baby their best care and attention.
‘Diego.’ Beth looked up from the warming cot she was rapidly preparing. ‘That was quick.’ The chimes had only just stopped summoning the staff, but he answered in that rich accent, and Izzy realised he was Spanish.
‘I was just passing on my way for a late shift.’ He had taken the baby from Izzy and was already getting to work, skilfully suctioning the airway as Izzy placed red dots on the baby’s tiny chest. ‘I heard the call and I figured you could use me.’
They certainly could!
His large hands were rubbing the baby, trying to stimulate it, and Izzy was incredibly grateful he was there. His dark hair was wet so he must have stepped straight out of the shower before coming to work. He had gone completely overboard on the cologne, the musky scent of him way too heavy for a hospital setting. Still, she was very glad he was there. As an emergency doctor, Izzy was used to dealing with
crises, but such a premature baby required very specific skills and was terrifying to handle—Diego was clearly used to it and it showed.
‘Diego’s the neonatal...’ Beth paused. ‘What is your title, Diego?’
‘They are still deciding! Sorry...’ Dark brown eyes met Izzy’s and amidst controlled chaos he squeezed in a smile. ‘I should have introduced myself. I’m Nurse Manager on the neonatal unit.’
‘I guessed you weren’t a passing relative,’ Izzy said, but he wasn’t listening, his concentration back on the baby. He was breathing, but his chest was working hard, bubbles at his nose and lips, and his nostrils were flaring as he struggled to drag in oxygen.
‘We need his history,’ Diego said as he proceeded to bag the baby, helping him to breathe. He was skilled and deft and even though the team was just starting to arrive he already had this particular scene under control. ‘You’re late.’ Diego managed dry humour as the anaesthetist rushed in along with the on-call obstetrician and then Izzy’s colleague and friend Megan.
Her fragile looks defied her status. Megan was a paediatric registrar and was the jewel in the paediatric team—fighting for her charges’ lives, completely devoted to her profession. Her gentle demeanour defied her steely determination when a life hung in the balance.
Megan would, Izzy knew, give the baby every benefit of every doubt.
‘Ring NICU.’ This was Diego, giving orders, even though it wasn’t his domain. They urgently needed more equipment. Even the tiniest ET tube was proving too big for this babe and feeling just a touch superfluous as Megan and Diego worked on, it was Izzy who made the call to the neonatal intensive care unit, holding the phone to Diego’s ear as he rapidly delivered his orders.
Though Megan’s long brown hair was tied back, the run from the children’s ward had caused a lock to come loose and she gave a soft curse as she tried to concentrate on getting an umbilical line into the baby.
‘Here,’ Izzy said, and sorted out her friend’s hair.
‘About twenty-three weeks, Megan.’ Diego said it as a warning as the baby’s heart rate dipped ominously low, but his warning was vital.
‘We don’t know anything for sure!’ Megan words were almost chanted as she shot a warning at Diego. ‘I’ll do a proper maturation assessment once he’s more stable. Izzy, can you start compressions while I get this line in?’
Diego was pulling up the minuscule drug dosages; the anaesthetist taking over in helping the tiny baby to breathe. The baby was so small Izzy compressed the chest rapidly with two fingers, hearing the rapid rhythm on the monitor.
‘Nice work.’ Megan was always encouraging. The umbilical line in, she took the drugs from Diego and shot them into the little body as Izzy carried on with compressions for another full minute.
‘Let’s see what we’ve got.’ Megan put a hand up to halt Izzy and the babe’s heart rate was up now close to a hundred. There were more staff arriving and a large incubator had arrived from the neonatal unit along with more specialised equipment, but until the baby was more stable it wouldn’t be moved up to the first-floor NICU. ‘We’re going to be here for a while.’ Megan gave Izzy a grim smile. ‘Sorry to take up all your space.’
‘Go right ahead,’ Izzy said.
‘How are things?’ an unfamiliar face came
in. ‘Ben asked me check in—I’m Josh, A and E consultant.’ She’d heard there was a new consultant, that he was Irish and women everywhere were swooning, but no one was swooning here! Izzy couldn’t really explain it, but suddenly the mood in the room changed. Izzy wondered if perhaps if Josh’s popularity had plummeted, because there was certainly a chill in the air.
‘It’s all under control.’ It was Izzy who broke the strange silence. ‘Though the babe might be here for a while.’
‘How many weeks?’ Josh’s voice was gruff, his navy eyes narrowing as he looked down at the tiny infant.
‘We’re not sure yet,’ Megan responded. ‘Mum was in Ultrasound when she went into labour.’
‘We need to find out.’ Josh’s was the voice of reason. Before there were any more heroics, some vital facts needed to be established. ‘Do you want me to speak with Mum?’
‘I’ll be the one who speaks with the mother.’ Megan’s voice was pure ice. ‘But right now I’m a bit tied up.’
‘There’s a full resuscitation taking place in my department on a baby that may not be viable—we need to find out what the mother wants.’