24 #2
Setting the tray down, Maisie didn’t interrupt the distressed women; instead she spoke quietly to Alex.
‘The incident was apparently at the New Year, so she’d be about twenty-five weeks now, but .
. . she glanced meaningfully at the girl’s large abdomen.
Occasionally they saw overweight women, but Maggie-Ann’s arms, shoulders, and face suggested she was not overweight.
If the dates were correct, as they had to be, then why was Maggie-Ann’s stomach so distended? Twins? Maisie’s heart sank. That’s all this poor girl would need.
She could see Alex shared her concerns. ‘We need Russell,’ he said, and Maisie nodded. This level of complexity was way beyond a midwife and a junior doctor.
‘I’m going to see if Mr Russell, the senior doctor, is free,’ Alex said gently. ‘All right?’
The women agreed, and Alex slipped out then, returning a little later with Mr Russell. By that stage some calmness had returned to the clinic room. The women had supped their tea, the crying had eased, and they had spoken together about ending the pregnancy.
‘But what would the priest say?’ Maggie-Ann asked tentatively.
Mrs Boyd snorted. ‘It’s got nahin’ to do with priests. This is women’s business, my girl, and I’m not letting another man add to what thon bastardin’ sailor done to you!’
While inwardly flinching at Mrs Boyd’s colourful language, Maisie was impressed by her strength. If only Teresa Lennon had had somebody like that beside her all those months ago!
Mr Russell’s manner was markedly different to Fenton when he spoke, after hearing the situation in full.
He offered acceptance and sympathy to Maggie-Ann, telling her she had come to the right place.
That no one here would judge her, and they would do all they could to help her.
With gentleness and warmth he spoke first to Maggie-Ann and then her mother, before asking Maggie-Ann if he could feel her tummy.
She agreed, and Maisie helped her on to the examination couch, placing a blanket over her hips and legs and helping her lift her dress. ‘All right?’ she asked, and Maggie-Ann nodded.
Mr Russell washed and dried his hands, rubbing them together to warm them, then carefully palpated Maggie-Ann’s abdomen. His brow creased in concentration, he took his time, then asked Maggie-Ann if Dr Lowe could also examine her.
Maisie was fully alert. Mr Russell had clearly identified a teaching opportunity to share with Alex. But what? Twins weren’t that uncommon. Is something else going on?
As Alex began palpating the girl’s abdomen, Mr Russell was gently questioning her. Any shortness of breath? Yes. Any pain in the abdomen? Yes.
He turned to Alex. ‘What are you noticing, Dr Lowe?’
‘Abdomen feels tight, strained. I’m only getting a singleton, though.’
A singleton. One baby.
‘Precisely.’ He moved to the small sink to wash his hands again, then sat by the desk, writing a note in Maggie-Ann’s file. Maisie helped Maggie-Ann up, then stood by the wall in her usual spot, her mind racing. What is going on?
‘Maggie-Ann,’ Mr Russell began gently, ‘your tummy is larger than it ought to be, and I’m not sure why. We have an X-ray machine in the main Royal, and I wonder if you would agree to having an X-ray done.’
Maggie-Ann’s jaw dropped. ‘X-rays? Like them machines that go round the travelling fairs and you can see the bones in your hand?’
‘That’s it! We have one here for medical use, and very occasionally it’s needed – as in your case. It will allow us to look inside your tummy.’
‘Dr Russell,’ Mrs Boyd spoke firmly. ‘You need to know that we don’t want this pregnancy, and I’d be seriously worried about our Maggie-Ann’s head if something doesn’t get sorted out.’ Abortion. Concerns about suicide.
‘I understand, Mrs Boyd. But as I said,’ he sent her a meaningful look, ‘I’m concerned about the size of Maggie-Ann’s tummy, so . . .’
Mrs Boyd gasped. ‘Something’s wrong, isn’t it?’
‘I can’t say for sure. That’s why I’d like to do the X-ray.’
Mrs Boyd subsided. ‘I see.’ She sent him a concerned glance. ‘When?’
‘Today, if possible.’ He turned to Alex. ‘Can you do the form, Dr Lowe, and send one of the office girls across with it? I’d like Maggie-Ann to have the first available appointment this afternoon.’
‘No problem.’ Alex left, and it struck Maisie that, unlike her, he didn’t seem confused. He knows what Russell’s concern is.
Mr Russell recommended that the two women take tea or lunch in the hospital canteen, and return to the clinic afterwards. ‘Midwife Canavan here will accompany you across for the X-ray, and I will meet you there. Do you have any questions?’
They didn’t – probably overwhelmed with information – and so they left, a canteen note from Sister clutched in Mrs Boyd’s hand.
Once they had gone, Maisie, her mind racing, updated Sister, who nodded grimly.
‘A sad case. Go and have your dinner break now, and then you can be ready to go across to X-ray.’
‘Yes, Sister.’
Leaving the clinic, she ran into Alex. ‘I’m on my dinner break now,’ she told him.
‘Give me five minutes and I’ll join you,’ he said. ‘I have to write up my notes on that last woman we saw.’
‘No problem. I – er – I don’t feel like eating right now.’
He grimaced. ‘Aye. I’ll meet you outside. Usual spot.’
The day was sunny and warm – one of those days that was loved by everyone except women in labour.
Maisie lifted her face to the sun, her mind still frantically trying to work out everything that had happened with poor Maggie-Ann.
Walking slowly past the bike sheds she made for the summer seat near the entrance to the tennis courts.
A few minutes later, Alex joined her, and she noticed how her heart skipped as he approached.
After months and months of being together – albeit only lightly – the thrill of seeing him hadn’t lessened at all.
They walked together, following their usual route through the hospital grounds, and Alex told her what he and Russell suspected: polyhydramnios. There was too much fluid around the baby, and it was concerning because it could cause serious complications.
‘What sort of complications?’
‘Depends on the cause, and what happens as the pregnancy progresses, but pre-PROM, haemorrhage, stillbirth . . . The woman we saw this morning has quite a severe case, so Russell is right to be concerned.’
‘I see.’ She fell silent.
‘Are you all right?’ His expression showed concern. ‘This is a tough one.’
‘Aye. How about you?’
‘I’ll be grand. We need to find a way through for that poor girl.’
‘Given the history, both the woman and her mother suggested . . .’ Maisie’s voice tailed away. She couldn’t say it out loud, especially in a semi-public place. No one was near, but still . . .
He made a face. ‘Poor girl. But we might not have to go there. One of the things we have to think about here is major foetal anomaly.’
‘Ah.’ Major foetal anomaly. A significant pre-birth defect in a baby’s development, often meaning the baby had no chance of surviving. ‘Hence the X-ray.’ And maybe no need for an abortion, if the baby was unlikely to live anyway.
‘Exactly.’
They shared a look, and it occurred to Maisie that in the middle of such a complex, emotional case, it was good to have Alex to lean on.
He was using his brain and his heart and all his attention to support Maggie-Ann and her mother, and still he was looking after her too.
He was quite simply the best man she had ever met.
* * *
Alex peered at the tiny image, trying to work out what he was seeing.
The mother’s anatomy and that of the foetus was all there, in black, white, and grey, making it challenging to decipher.
The X-ray technician had managed to take a number of photographs, and he and Russell were now reviewing them, Maisie having accompanied Maggie-Ann and her mother back to the maternity hospital to await results.
‘There!’ Russell pointed his pen, touching different parts of the foetus’s face, outlined in ghostly white. ‘Mandible, maxilla, supra-orbital ridge, and then—’
‘Nothing!’
‘Correct, Lowe. Anencephaly.’ The baby’s brain hadn’t developed at all, the head flat and misshapen.
Lord! Alex had known of anencephaly from textbooks and lectures, but to actually see it was upsetting. ‘Right.’ He was thinking it through. ‘Which means . . .’
‘The baby has no chance of survival. Yes.’ Russell stood. ‘Right. Let’s go and break the news.’
As they walked out of the main Royal Victoria Hospital towards the smaller maternity hospital, Alex’s mind was racing.
While it was dreadful to see a baby so malformed, in this case it removed the necessity for young Maggie-Ann to have to consider termination.
Nature itself would cruelly resolve the situation, and Maggie-Ann would have a better chance to heal and recover from her ordeal.
Feeling a hundred things at once, Alex listened carefully as Russell spoke in more detail about the risks faced by the young mother.
The excess fluid around the baby was due to the anencephaly, and it was likely that the sac of fluid would give way before long, triggering early labour and potentially a dangerous bleed if the placenta came away abruptly during the process.
Maggie-Ann was still at risk of physical harm, if things went badly.
‘That’s all she would need,’ Alex commented soberly. ‘I presume she’ll be admitted?’
‘She will. We might need to rush her to theatre if it happens, so she’ll be safer here, in the building.’ He sighed. ‘A bad business.’
The sailor. ‘It is indeed.’ They continued in silence for a while. ‘According to the radio, it’s looking likely the Nazis will take Paris today,’ Russell announced in a clear change of topic. ‘They’ll likely surrender within days.’
‘God help them,’ Alex replied. ‘The French, I mean.’
Russell nodded. ‘Indeed. Between war, and complex cases, and evil men attacking innocent girls, the world feels very dark right now.’ He straightened. ‘We do what we must though – it’s all we can do!’