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‘I need to know what her last BP reading was. I need her last set of blood results and her last urine test. Shout them out when you find them, along with special notes from her obstetrician.’
‘I’ll contact her husband,’ shouted someone else.
Katsuko took less than a minute to draw some bloods and insert a cannula. They’d need access to a vein if she started to fit again.
Now her airway was secure he walked around the bed and pulled off her shoes. Lily was wearing scrubs, the same as everyone else. He pulled up one trouser leg. And blinked.
Oedema. Lots of it. He pressed hard against her skin, trying to reach her ankle bone, and watched as the impression of his finger slowly filled again. Pitting oedema.
He pulled up her scrub top to get a look at her belly. ‘Someone find me a foetal monitor—I need to check the baby.’ He pressed his hands against her stomach. Oedema too.
‘Why did we never notice any oedema?’ he said out loud. He looked back at Lily’s face. Did it look any different from normal? He didn’t think so.
He reached for one of Lily’s hands. She only wore her wedding ring. It was a little tight but not excessively so. Her face and hands weren’t obviously swollen like her abdomen and legs.
‘What’s the BP?’ His eyes glanced at the monitor.
‘One-eighty over one-fifteen.’
There were anxious glances around the room. Avery turned to Katsuko and spoke in a low voice. ‘Find me her obstetrician. I don’t care what time of the night it is.’
He turned to the rest of the staff. ‘We have to treat this as eclampsia. I need a magnesium sulphate infusion to help prevent more seizures and some IV hydralazine for her blood pressure. Let’s get Lily stabilised.’
Hardly anyone spoke. All the staff were too shocked. Everyone kept their heads down and moved on automatic pilot. Avery felt a bit like that himself. He’d only been here six weeks, some of the staff here would have worked with Lily for years. He couldn’t even imagine how they were feeling.
Katsuko walked back in, her expression serious. She handed him the phone. ‘Her obstetrician, Dr Tanaka, is on the other side of Tokyo. He’s more than an hour away. Can you talk to him?’
Avery looked around the room again. This time it was a shout of pure frustration. ‘Did someone find me a foetal monitor?’
Someone scurried from the room. He grabbed the phone from Katsuko’s hand and walked to the doorway, out of earshot of the rest of the staff. Luan, the doctor who’d been studying earlier, appeared wide-eyed in front of him. Avery gestured over his shoulder. ‘I need to speak to Lily’s obstetrician. Keep an eye on her.’
He waited until Luan was inside the room, then pressed the phone to his ear and leaned back against the wall. He kept his voice low. ‘Dr Tanaka? You’ll need to help me out here. I’m an emergency physician. I’ve delivered two babies in the last seven years and both of them virtually fell into my hands.’
He didn’t have time to be coy. He knew basic obstetrics but he was by no means an expert. Some doctors didn’t like to admit that they didn’t know everything. Avery wasn’t that foolish. A staff member’s—and her baby’s—life could be on the line here.
Even Dr Tanaka sounded panicked while he spoke. ‘Tell me what you’ve done.’
‘Lily was seizing when I found her. She’d previously said she was getting tired and her back was sore. She has widespread oedema on her legs and abdomen but not her hands and face. She’s hypertensive, one-eighty over one-fifteen. I’ve started her on magnesium sulphate and given her a bolus of hydralazine.’
He heard Dr Tanaka suck in a sharp breath. ‘Give me a second. I’m pulling up her notes. Okay. There have been no problems with this pregnancy. It’s been straightforward. Lily had two miscarriages before this, but no other history of note. I saw her around ten days ago. BP normal, urine clear. I examined her—there was no oedema.’ He took another breath. ‘Lily’s a nurse. She’s an intelligent woman. This has to have been sudden onset. A little lower leg oedema in late pregnancy wouldn’t be alarming. She’s currently just over thirty-five weeks and was due to see me again in a couple of days. I think, at this stage, we have to consider HELLP syndrome. Tell me about the baby.’
Avery let out the breath he’d been holding. HELLP syndrome. Not what he wanted to hear. Haemolysis, elevated liver enzymes and low platelet count. It could be life threatening for both mother and baby.
There was a hand on his shoulder. Katsuko held up the foetal monitor. ‘Do you want me to do this?’
He could hear the waver in her voice. She was scared. Scared that something bad was about to happen to her colleague. He shook his head. ‘Give me a minute,’ he said into the phone as he handed it to Katsuko. ‘Talk to Dr Tanaka.’
As he strode back into the room he felt like all eyes were on him. The foetal monitor wasn’t the most modern he’d ever seen but then again this wasn’t an obstetrician’s office. All he needed to do right now was find a heartbeat.
He switched on the monitor and put his hands on Lily’s abdomen again, trying to establish the lie of the baby. He turned the sound up on the monitor. The room instantly quietened.
He pressed the monitor to Lily’s swollen stomach and held his breath.
Nothing.
He adjusted the position and pushed back the horrible little surge of panic. Doctors didn’t panic. They just didn’t.
Still nothing. Did this thing even work?
‘Dr Tanaka says he’s found a family history of eclampsia in Lily’s notes. Both her mother and aunt suffered from it.’
Perfect. Just perfect.
He pressed harder.
Finally. A heartbeat. The wave of relief only lasted a few seconds. He checked the reading on the monitor. One-eighteen.
He walked back to the doorway and took the phone from Katsuko. He kept his voice low. ‘Foetal bradycardia. One hundred and eighteen beats per minute.’
‘That’s not unexpected with eclampsia and HELLP syndrome, particularly after a seizure,’ said Dr Tanaka. ‘It could also be due to the magnesium sulphate. You’ll need to keep monitoring closely. Have you taken bloods?’
‘Yes, they’re done.’
‘Good, in that case find an anaesthetist to assess Lily. I’m leaving now. If this is HELLP syndrome we’ll need to deliver the baby as soon as possible. Keep monitoring her blood pressure and the baby.’
Avery listened to a few more instructions before finally hanging up. Katsuko was at his side in an instant. ‘Are you okay?’
‘Are you?’
She closed her eyes for just a second, then opened them again, pushing her shoulders down and meeting his gaze. ‘I have to be. We have to be.’
We.
He knew what she was saying. He knew that she didn’t really mean that. And while he’d always been an attentive and caring boyfriend, as soon as any ex had started referring to them as we it had sent uncomfortable prickles down his spine and he’d looked forward to shipping out.
He’d never made promises of for ever because he just didn’t believe in them. They didn’t exist. Oh, the start of every relationship was good. The honeymoon period when you wanted to see someone as much as possible and just the fact they walked in the room could make you smile.
But it never lasted. At least it hadn’t for his mother, father or sister. Why should he be any different?
But this time he didn’t have uncomfortable prickles. He didn’t have that horrible worry of letting someone down.
Even though the resus room was the busiest room in the ER, no one was looking at them. Everyone was foc
using on Lily—just the way they should.
He reached forward and threaded his fingers through Katsuko’s. Something about touching her felt completely natural. Felt like the thing that he was supposed to do. ‘Let’s get through this,’ he said quietly. ‘We’re not leaving until Lily and her baby are safe.’
Katsuko nodded. ‘Let’s do this.’
* * *
Lily’s husband was distraught. Avery had spoken to him calmly and with an assurance Katsuko knew he didn’t really have. ‘I told her to stop work,’ he said, shaking his head. ‘I told her it was time to rest and forget about work.’
‘Did she complain of anything except being tired and having a sore back?’
Lily’s husband nodded. ‘She’s felt sick the last two days. She was joking about the morning sickness being back. And she was uncomfortable. She had a weird kind of pain around her right side. And she had a bit of a headache last night that wouldn’t shift.’
Katsuko shot a glance at Avery. Everything fitted with the guidelines she’d pulled up for HELLP syndrome. It wasn’t something she’d seen in the ER before. Last time she’d encountered this she’d been doing a student placement in a labour ward. She held out her hand towards Lily’s husband. She’d known them both for a few years. ‘Come on, Luke. Let me take you to see her. The obstetrician will be here any minute and I suspect you’re going to meet your baby soon after that.’
She led him down the corridor to the resus room and put her arm around him when he seemed to crumple. Frank found a chair and said lots of reassuring words. There had been no more seizures and Lily’s blood pressure had started to drop just a little.
* * *
Two hours later Lily and her husband had a baby son. Protocols stated that because a member of staff had become unwell on duty, Blake Anderson had to be called. He took the decision to call in the next shift early and send everyone else home.
‘We’ll debrief tomorrow, folks. It’s always hard when it’s one of our own. Let’s give Lily and her husband some time and space to recover. Then we can all celebrate the new arrival.’
