Wish Upon a Star (27 page)

‘You and I are going to talk,’ he said softly, and she straightened her shoulders.

‘There’s nothing to talk about.’

‘There’s plenty to talk about, but it will keep for now. We need to see to Gail.’

CHAPTER FOUR

W
HY
was it, Miranda wondered as they walked through the labour ward towards Gail’s room, that every time she lowered her guard, it backfired?

When she’d made the impulsive decision to go back to Jake’s house the day before, it hadn’t occurred to her for even a moment that she’d ever see him again, let alone find herself working side by side with him.

And now he’d seen that she was pregnant and had jumped to all the wrong conclusions.

She gave a sigh as she pushed open the door to Gail’s room. Well, she could hardly blame him for that, could she? He didn’t know anything about her circumstances because she hadn’t shared them with him. And she had no intention of sharing them with him.

It had been a mistake to go back to his house with him the day before. A luxury she should never have allowed herself. She’d been naive to think that she could just enjoy the moment and walk away.

She pulled herself back to the present and concentrated on supporting Gail, who was listening to Jake.

‘I’m not happy with what I’m seeing,’ he said gently. ‘The baby’s heart rate is slow and I’m worried about your scar.’

Gail stared at him defensively, a sheen of sweat on her brow and her eyes blank with pain. ‘The scar will be fine. I’ve read enough to know that the chances of a uterine rupture are minimal and I’m not having another Caesarean section. I’d rather take the risk.’

‘It’s true that it isn’t common for the uterus to rupture,’ Jake agreed, ‘but in certain circumstances it can happen. And the risk isn’t just to your life, it’s to the baby’s life.’

Her fear and frustration barely contained, Gail’s eyes filled and she looked away from him. ‘I should have stayed at home,’ she muttered, her voice clogged by the threat of tears. ‘I should never have let them bully me into coming in. Everything would have been fine, then.’

‘No, Gail. It wouldn’t have been fine.’ Determined to add her voice to Jake’s, Miranda stepped forward and slid an arm round the woman’s shoulders. ‘I’m a huge advocate of home birth, but this is one baby that never should have been born at home. And I think, deep down, you know that.’

Gail sniffed. ‘Where are you going to have your baby?’

‘Oh…’ Aware of Jake’s glance in her direction, Miranda’s face flamed. ‘I don’t know. I’ve only just moved into the area and I haven’t had time to give it much thought yet.’

And she couldn’t talk about it in front of Jake. It was too personal.
Too intimate.

Before she could question her further, Gail pulled a face and placed a hand on her abdomen. ‘Ouch! That hurt.’

‘Another contraction?’

‘It didn’t feel like it.’ The woman’s face was pale and she grimaced again. ‘Oh…’

‘It could be the scar.’ Jake stepped forward. ‘I know it’s
the last thing you want, but I want to take you into Theatre, Gail. Just to be on the safe side.’

Miranda caught his gaze and knew instinctively that he was starting to share her bad feeling. ‘She’s only three centimetres dilated,’ she reminded him in a soft voice, and he nodded.

‘I know. I want her in Theatre.’

‘All right.’

Gail stared at him. ‘I really don’t know—’

‘Gail.’ His voice was urgent as he sat down on the edge of the bed. ‘My job is to deliver a healthy baby from a healthy mother. You’re not letting me do that job. I know it’s hard for you but I’m asking you to trust me.’

‘Well, it’s just that I don’t—’ Gail broke off and gasped, one hand on her abdomen. ‘Oh—what
is
that pain?’

‘The trace is showing foetal bradycardia,’ Miranda murmured, and Jake gave a decisive nod and turned as Ruth walked into the room.

‘We need to deliver this baby right now and I want it done under general.’

Jake’s swift glance said it all and Ruth hurried off to bleep the anaesthetist and prepare the theatre.

‘What’s happening?’ Gail’s eyes were wide with fear now and tears glistened. ‘Oh, God, it’s all going wrong, isn’t it?’

Her husband stepped forward, his face pale and his eyes darting nervously to Jake, seeking reassurance.

‘Gail, so far the baby is fine.’ Jake’s tone remained calm. ‘But I think there may be a problem with your uterus. I have a suspicion that’s what the pain is. I’m going to have to take you to Theatre. I’m sorry. I know it wasn’t in our plans and I know it will be disappointing for you, but there’s no other way. I don’t want to risk the baby and I know you don’t either.’

‘I don’t want an operation. Not like last time. I’m terrified of epidurals.’ Hanging onto control by a thread, the tears spilled over from Gail’s eyes and Jake took her hand in both of his, his blue eyes kind.

‘I know you’re worried,’ he said quietly, ‘but you have to let me do what has to be done. I need to deliver this baby and I need to do it fast. And we won’t do it under epidural. It will be under general. You’ll be asleep.’

All animosity forgotten, Gail clutched his hand. ‘I’m
so
scared.’

‘You wouldn’t be human if you weren’t, but let me do the worrying.’ Jake’s voice was firm. ‘I need you to trust me, Gail.’

Miranda swallowed at the kindness and confidence in his voice.

She was hopeless at trusting men and yet at this precise moment she’d trust Jake with her life, she thought to herself, and obviously Gail felt the same way because she gave a wan smile and a nod and reluctantly let go of his hand so that he could leave the room and prepare for the delivery.

Gail’s husband was white with strain and Ruth guided him gently out of the room and showed him where he could wait.

Miranda stayed with Gail in the anaesthetic room, holding her hand until she was unconscious and mercifully oblivious to everything that was going on around her.

Meanwhile, Jake had changed and scrubbed and was waiting in Theatre.

He glanced up as they pushed Gail into the room.

‘Right, folks, let’s work fast.’ He spoke to the anaesthetist. ‘Have we ordered blood?’

‘Six units of whole blood and I’ve requested a full blood
count and coagulation studies. She’s got two peripheral lines in and I’ve bleeped the haematology doctor on call.’

‘Tell me when I can start.’

The anaesthetist checked his machines and nodded. ‘Her blood pressure is dropping. She’s bleeding from somewhere. You were right to bring her to Theatre—you’d better start.’

‘Ruth, I want porters ready to fetch that blood and I want the crash trolley in here.’ Jake’s voice was calm, ‘I’m not taking any chances.’

Miranda watched while he swiftly and skilfully opened the abdomen and then made another incision in the fascia.

‘Forceps.’ Without lifting his gaze from the wound, he held out a hand and the theatre nurse immediately handed him forceps followed by scissors which he used to lengthen the incision and separate the muscles of the abdominal wall. Then he made an opening in the peritoneum and carefully examined the uterus.

‘She’s bleeding badly and I can’t see where from—suction, please.’ He held out his hand again and removed the clots. ‘Uterine rupture of any degree is extremely rare,’ he muttered, ‘so why did it have to be on my shift and with a patient who wouldn’t let me near her? OK—that’s looking better. I can see what I’m doing now. Retractor.’

Miranda watched in fascination. She’d never seen a surgeon as slick and fast as Jake. His concentration was absolute, his fingers moving swiftly as he delivered the baby and the placenta.

She found that she was holding her breath and when the baby suddenly started crying there was a collective sigh of relief, but Jake’s gaze didn’t shift from the operation site. His responsibility towards the baby had ended with delivery. Now he was concentrating on the mother.

‘There’s significant blood loss,’ he murmured, lifting the
uterus out of the pelvis to determine the extent of the injury. ‘Put 20 units of oxytocin in a litre of saline. I want 60 drops a minute until the uterus contracts. Clamp.’

The nurse handed him the instrument he needed and he moved with swift precision, clamping and ligating bleeding vessels and then using figure-of-eight stitches where necessary. Finally he was satisfied that the bleeding had stopped.

Miranda watched in breathless silence as he drained a haematoma that had formed and then examined the area again. ‘Her previous Caesarean section was stitched with a single layer of sutures—a way of shortening the time in the operating room but it does increase the risk of uterine rupture. I’ll do a double-layer closure this time.’ His eyes still on the wound, he held out a gloved hand. ‘I’m ready to stitch.’

The scrub nurse handed him the correct suture and he set about repairing the tear. ‘More light,’ he requested at one point. ‘I need to see the ureter. Don’t want to be stitching that. Right—clots here. Sponge, please.’

The nurse obliged and Jake carefully removed the clots.

Miranda stepped closer, her curiosity overcoming her reluctance to draw attention to herself. ‘Is her bladder OK?’ She knew that bladder injury was a very real risk but Jake gave a nod of his head.

‘It all looks fine. And no signs of infection so I’m ready to close. The uterus has contracted. Reduce that drip to 20 drops a minute. How’s that baby doing?’ Finally, once he knew the mother was out of danger, he turned his attention to the paediatrician. ‘Give me some good news, Howard.’

The paediatrician smiled. ‘Little girl and doing very well indeed.’

‘Apgar scores?’ Jake’s fingers flew as he stitched with equal measures of speed and skill.

‘Eight, nine and ten.’

Miranda smiled with relief. The Apgar score measured neonatal heart rate, respirations, tone, colour, and reflexes immediately after delivery. Gail’s baby had good scores.

Finally Jake finished and stepped back. ‘All right. Well done, everyone. Thank you very much. Ruth, tell the ward to contact me if there are any signs of infection. Day or night, I want them to phone me. Gail has had a rough enough ride. She doesn’t need any more problems. And we need to redeem the reputation of the medical profession.’

Everything about him was calm and steady, Miranda observed as she watched him strip off his gloves and walk towards the swing doors. Just like the time he’d rescued her from the mountain. He assessed the situation and just did what needed to be done. Panic and Jake Blackwell clearly didn’t go together.

He was an amazing doctor.

But it didn’t take a genius to see that he was angry with her.

And who could blame him?

Dreading the inevitable confrontation, she took her time helping Ruth to clear up Theatre and then waited in the recovery room until Gail was well enough to be transferred to the ward.

It was nearing the end of her shift when she finally returned to the labour ward. There was no sign of Jake.

Weak with relief that she was going to be spared a difficult conversation, at least for the time being, Miranda found Ruth. ‘Is there anything else you want me to do?’

‘Are you joking?’ Ruth gave her a smile. ‘You’ve already worked far longer than you should have done, considering it’s Boxing Day. I’m sure you have places you want to be. Go home.’

Miranda gave a wan smile. ‘I’m fine.’ Exhausted would have been a more appropriate word but she’d grown used to tiredness over the last few months. And there was no denying that the money would be very welcome. ‘I’ll see you tomorrow.’

‘Marvellous. Thank you so much for today. You were my present from Father Christmas,’ Ruth joked as she checked on the number of delivery packs. ‘I was expecting to struggle through Christmas with no staff, and suddenly they called me out of the blue and said that they had a midwife available.’

‘I was relieved to get work,’ Miranda confessed, running a hand over her bump and pulling a face. ‘I thought you might not want me.’

And then she would have been in trouble because she needed every penny she could save. Pretty soon she wouldn’t be able to work at all…

‘You’re fit and healthy. That’s all that matters. See you tomorrow.’

Miranda grabbed her jumper and jacket and walked slowly to the set of railings where she’d left her bike. She was so tired, she wanted to cry. Her legs ached, her head throbbed and her eyelids drooped. All she wanted was her bed. At least she’d be too tired to notice the grimness of her surroundings, she thought as she walked across the badly lit car park. She doubted she was even going to find the energy to undress.

She’d just stooped to take the lock off her bike when a smooth male voice came from directly behind her.

‘Running away, Miranda?’

Not having expected to see anyone, she gave a cry of alarm and covered her mouth with her hand. ‘Oh—you frightened me.’

It was Jake and he was leaning against the railings, watching her, his handsome face cold and unsmiling.

‘Why?’ His tone was as chilly as the weather. ‘Expecting someone else, perhaps? Your husband?’

Tall and broad-shouldered, his blue eyes glittered dangerously in the darkness and he looked nothing like a respectable consultant.
Nothing like the kind, reassuring man she’d seen calming Gail and Lucy earlier.

The anger in his eyes was unmistakable and her heart gave an uncomfortable lurch.

She hadn’t anticipated that he’d be angry when he discovered that she was pregnant, but neither had she anticipated the fact that she’d see him again.

They said that your sins always caught up with you and it seemed as though her sin, although small, was currently biting at her heels.

She should never have gone home with him and she
definitely
shouldn’t have kissed him.

She ignored the tension in his jaw and the question in his eyes and tried to turn the conversation to safe ground. ‘You were amazing in Theatre.’ She’d hoped that reminding him that they were colleagues would be sufficient to encourage him to back off, but his gaze didn’t shift from hers.

‘I don’t want to talk about work, Miranda.’ His blue eyes were hard. ‘I want to talk about what the hell you were doing, spending the day with me yesterday—
kissing
me—when you’re pregnant with another man’s baby!’