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She jumped up from her chair. ‘Okay, then. I’ll do it.’ She grabbed the bag and scurried off to the bathroom. ‘But only if you stay to taste my cake. I need it to be perfect for my mummy.’
Logan leaned back in his chair and put his feet up on the other under the table. He might as well get comfortable. Looked like he could be here for quite some time.
Then again, it could give him some thinking time.
Thinking time to figure out how he could sort out this mess he had created.
Because the truth was he had no idea how to start.
CHAPTER NINE
THERE WAS A knock at the door. ‘Come in.’ Gemma was just finishing typing up the last of her notes on the patient who had just left.
Julie stuck her head around the door. ‘Gemma? Edith is looking for a doctor, she’s got some concerns about a patient. Are you free?’
Gemma nodded. ‘Of course. Who is it?’
‘Lynsey Black.’
Gemma typed in the name and quickly pulled up the file to give herself some background on the patient. Lynsey Black, thirty-eight. Twin pregnancy and currently thirty-two weeks. Booked in to see the obstetric consultant on the mainland in a few weeks. Apart from a sore back, there was really nothing significant in her notes. She’d had a few antenatal scans and they’d all looked entirely normal.
Strange. They’d had a chat the other day about any antenatal patients that Edith was concerned about. Lynsey Black hadn’t been one of them.
Gemma stood up and walked through to the other consulting room, pushing the door open and walking over to the sink to wash her hands. ‘Hi, Edith, hi, Lynsey. I’m Gemma Halliday, one of the doctors here.’
She could tell straight away that the normally unflappable Edith was unhappy. A foetal monitor was attached to one side of Lynsey’s abdomen, giving little blips, and Edith was listening with a stethoscope on the other side. She was obviously trying to monitor both babies.
Edith looked up. ‘Lynsey phoned in to say she’d had some PV bleeding and some sharp abdominal pain. She only lives a few minutes away and was already on her way in when she phoned.’
Gemma nodded. ‘How much bleeding?’
Lynsey’s voice was shaky, she was obviously terrified. ‘Quite a bit. I’ve had to change my pad twice.’
‘And what colour is the blood?’
‘Bright red.’ Not a good sign. Gemma walked over immediately and glanced at the pad Edith had wrapped up in tissues. Lynsey was right. It was bright red.
Edith had stopped listening with her stethoscope and started winding a blood-pressure cuff around Lynsey’s arm. ‘Any back pain? Abdominal pain?’ she asked.
Lynsey spoke in guarded breaths. ‘My back’s always sore these days. And my tummy just feels hard.’
Gemma could feel the hackles rise at the back of her neck and she daren’t look at Edith. A hard tummy, along with the PV bleeding could mean placental abruption. That’s what it sounded like. And it was serious. Sometimes deadly.
Gemma started checking off Lynsey’s risk factors in her head.
Multiple pregnancy. Check. Over thirty-five. Check.
She glanced at Edith’s notes on the desk in front of her. Lynsey was a smoker. Check. Maternal smoking was associated with up to a ninety per cent increased risk.
She walked over to the side of the examination couch. ‘Lynsey, if you don’t mind, I’m going to have a little feel of your abdomen.’
Lynsey nodded and Gemma placed her hand on Lynsey’s stomach. It was rigid, masking the signs of further bleeding taking place.
Edith was making a few notes on a chart and Gemma glanced over her shoulder. Both babies were starting to show signs of foetal distress. They had to act quickly.
Lynsey’s colour was pale and she was slightly clammy. All further signs of placental abruption and associated hypovolaemic shock.
Gemma moved quickly, grabbing a tourniquet to wrap around Lynsey’s arm. ‘Lynsey, I’m just going to see if we can get a line in to allow us to get some fluids into you.’
‘What’s happening?’ Her voice was shaking. Inserting the line literally took seconds. Gemma was used to dealing with babies with tiny veins so an adult was much easier.
She sat on the edge of the examination couch. ‘I’m concerned about the bleeding. I think your placenta could be separating from the uterine wall. We’re going to arrange to transfer you to the mainland.’
‘How?’
Gemma didn’t hesitate. ‘By helicopter.’
Tears started to roll down Lynsey’s cheeks. She knew exactly how serious this could be. Anyone who lived on Arran knew that the helicopter was only called for real emergencies.
‘But it’s much too early. I’m only thirty-two weeks. My babies will be far too small. How will they survive?’ Her voice was beginning to break.
Gemma touched her hand. ‘We don’t know everything yet, Lynsey. Give us another few minutes. But I can assure you that babies at thirty-two weeks can live. We can also give you some steroids to try and aid the development of their lungs before delivery. But we’ll cross that bridge when we come to it.’ She took a deep breath.
‘Edith, I’m going to get the ultrasound machine.’ Gemma walked quickly across the hall to the other room and wheeled the portable machine across. It was vital she act quickly, but she also needed to know exactly what she was dealing with.
She plugged the machine in and switched it on, spreading a little gel across Lynsey’s stomach. She swallowed, trying to keep her voice nice and steady. ‘When was the last time you felt the babies move, Lynsey?’
‘I was up most of the night, between them and my backache.’
Backache. Was it really backache, or was it something else? She felt Edith’s hand rest gently on her shoulder, letting her know she was just as concerned.
Gemma swept the transducer over Lynsey’s abdomen. ‘And since then?’
‘They’ve been quieter. They’re probably having a sleep.’ She let out a nervous laugh. ‘But they’re usually quieter at this time of day so I wasn’t worried—not until I saw the bleeding anyway.’
Gemma was keeping her expression as neutral as possible. Her heart gave a little leap as she found the first baby’s heartbeat and pressed a button for a little trace. She sent a little silent prayer of thanks upwards. In cases of placent
al abruption around fifteen per cent of babies died.
She swept the transducer over to the other side of Lynsey’s abdomen. Thankfully she found a heartbeat there too, but this time the reading gave her cause for concern. Edith was instantly at her elbow, watching the printout on the machine. This baby was showing signs of foetal distress. They had to get Lynsey to the maternity hospital as quickly as possible.
Gemma had one final sweep of the abdomen. It was difficult to visualise the placenta with two babies fighting for space in there, but she could see some signs of where it had separated from the uterine wall. Time to act.
As Gemma stood up Lynsey clutched her abdomen. ‘Aaawwww.’
‘What is it, Lynsey?’
Her face was deathly pale. ‘Oh, no, I think that was a contraction.’
Edith was already pulling out some other equipment, designed to monitor women in labour. Gemma didn’t have a single doubt. Class two placental abruption. They had to act quickly.
‘Is there someone we can call for you, Lynsey?’
She nodded. ‘My mum. Callum’s out on the fishing boat. He won’t be back until after two.’
Edith handed Gemma a piece of paper with a number on it. ‘This is Lynsey’s mum. Can you ask Julie to phone her and I’ll wait with Lynsey while you make the other arrangements?’
Gemma nodded. Thank goodness for Edith. Her experience, knowledge and calm attitude were just what was needed in a situation like this.
She walked out the door to make the call for the emergency helicopter, crossing her fingers that it wouldn’t already be on callout somewhere else. Placental abruption could be serious for both mother and babies. In some cases the babies could die.
Lynsey seemed to have a mixed abruption, which meant that some of the bleeding was evident, and some was hidden internally, with the blood trapped between the placenta and uterus. Chances were the babies would need to be delivered—and soon.
She glimpsed the broad span of Logan’s shoulders from the other end of the corridor. It didn’t matter that he could barely talk to her or look her in the eye. All that mattered now was the patient.
