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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 bab
y 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?
