‘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.’