LITMIR.BIZ

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Dr Evans. It’s his first day on the job and I hit him. It’s a wonder he hasn’t tossed me out of the room already.’

      And Ruby’s sobs hiccupped to a halt. She pulled back and looked at Em, then turned and stared at Oliver.

      ‘She hit your car?’

      ‘Yes,’ he said. He wouldn’t normally impart personal information to a patient but he guessed what Em was doing, and he could only agree. What Ruby needed was space to settle. He could help with that—even though he had to get personal to give it to her.

      ‘I have a sixty-four Morgan Plus-4 sports car,’ he said, mournfully, like the end of the world was nigh, which was about how he’d felt when he’d seen the damage—before he’d realised the driver of the other car had been Em. ‘It’s two-tone burgundy with black interior, a gorgeous two-seater. It’s fitted with super sports upgrades, including twin Weber carbs, a Derrington header and a bonnet scoop. It also has chrome wire wheels, a badge bar with twin Lucas fog lamps and a tonneau cover. Oh, and it’s retrofitted with overdrive transmission. Now it’s also fitted with one smashed side—courtesy of your midwife.’

      ‘Yikes,’ Em said, but she didn’t sound in the least subdued. ‘Twin Weber carbs and a Derrington header, hey? Did I damage all that?’

      ‘And if you knew how long it took to get those fog lamps …’

      ‘Whoops. Sorry. But you scratched my car, too.’ But Em was talking at Ruby rather than at him and she still sounded cheerful. Chirpy even.

      ‘Scratched …’ he muttered, and she grinned.

      ‘That’s okay. I forgive you. And they’re cars. They’re just things. That’s what insurance is for. Whereas babies aren’t things at all,’ Em continued, leading seamlessly back to the reason they were all there. ‘Ruby, your little girl is a person, not a thing, and she’s far, far more precious. You made the decision to go ahead with this pregnancy. You made the decision early not to choose abortion and you chose it again when the scan showed spina bifida. But you’ve been telling me you think you might have her adopted when she’s born …’

      ‘I can’t … deal with it.’

      ‘You don’t have to deal with it,’ Em said soundly. ‘There are lots of parents out there who’ll give their eye teeth to have a baby like yours to love. That’s right, isn’t it, Dr Evans?’

      ‘I … Yes.’ But her words were like a punch in the gut. That last night … He’d tried to make her see one last time. ‘Em, I can’t. I know adoption’s the only way, but I can’t do it. I can’t guarantee to love a child who’s not our own.’

       ‘It will be our own.’

       ‘Em, no.’

      It had been their last conversation. He’d turned and walked away from the only woman he’d ever loved and it had nearly killed him. But she’d deserved the family she’d wanted so much. He’d had to give her that chance, and from the evidence he’d seen today, she’d taken it.

      But now wasn’t about him. It was all about Ruby. The kid’s terror had been put aside. He had to take advantage of it.

      Which meant putting thoughts of Em aside. Putting aside the knowledge that his wife, his ex-wife, presumably—did you need to formally sign papers to accept a marriage was over?—was in the same room.

      ‘Ruby, you created this little girl,’ he said, as Em continued to hold her. ‘You can have her adopted at birth, but until then you need to look after her. And the staff here have already explained to you—to look after her means an operation now.’

      ‘But why?’ Ruby demanded, suddenly belligerent. ‘I don’t understand. The kid’s got spina bifida—Dr Zigler showed me on the scans. What difference does it make whether you operate now or operate when it’s born?’

      There was fear behind the question. Oliver recognised it. He’d done many in-utero procedures by now, and sometimes one of the hardest things was having the mum understand that the tiny child inside her was an independent being already. Something totally separate from her. This was a child who could be shifted in her uterus, who even at twenty-two weeks could cope with complex surgery and then be resettled, because, no matter how amazing the technology, the womb was still the safest place for her to be.

      ‘Ruby, you know your baby has spina bifida,’ he said now, gently. Em still had her arm around the girl. He was talking to them both, as he’d normally talk to a woman and her partner, or a woman and her mum or support person. Em had slid naturally into that role. A good midwife sometimes had to, he thought, and Em had always been brilliant at her job. Efficient, kind, skilled and empathic. He’d worked with her once and he’d loved it.

      It was totally disconcerting to be working with her again, but he needed to focus on Ruby.

      ‘You know we’ve picked up the spina bifida on the ultrasound,’ Oliver said matter-of-factly, trying to take the emotion out of the situation. ‘You’ve seen it?’

      ‘It just looked blurry. I couldn’t figure it out.’

      So she didn’t understand. ‘Heinz Zigler’s a great paediatric neurologist,’ Charles had told him. ‘He’s technically brilliant, but communication’s not his strong suit. He’ll do the spinal surgery but everything else—including explanations to the mum—we’re leaving to you.’

      So now he needed to explain from the ground up. ‘The scans do look blurry,’ he admitted. ‘I have trouble reading them myself. Fine detail like the nerve exposure around vertebrae needs incredibly specialised knowledge to see, but the radiologists here are superb. They’ve double-checked each other’s work, and Dr Zigler agrees. Everyone’s sure. But would you like me to explain what I think is happening? I don’t talk in fine detail, Ruby. I just see the overview. That’s actually what I do, total patient care, looking after you as well as your baby. I’m an obstetrician and a surgeon who specialises in looking after mums and bubs if bub needs an operation before it’s time for her to be born.’

      Silence. Ruby cast him a scared look and subsided. He waited, while Ruby pulled herself together a bit more, while Em handed her a wad of tissues, while both women readied themselves to front what was coming.

      ‘Heinz says he told you the fine detail,’ he said at last, when he thought Ruby was as ready as she was going to be. ‘But here’s the broad outline. The bones of your baby’s spine—the vertebrae—haven’t formed properly to protect your baby’s spinal cord. The spinal cord holds the nerves that control your baby’s movements. Because those nerves run right through the body, if the cord gets damaged then long term, your baby might not be able to walk. She might not have control of her bladder and bowel. If she has a severe problem she can also end up with a build-up of fluid in her brain. Then she’ll need a shunt, all her life, to drain the excess fluid and relieve pressure.’

      Ruby was crying again now, but not sobbing. Em’s arm was around her, holding her close, but Ruby’s attention was held. Her distress was taking second place to her need to know, and she seemed to be taking it in.

      ‘So,’ she whispered. ‘So?’

      ‘So the good thing is,’ he said, still gently, ‘that many problems of spina bifida aren’t directly caused by the spina bifida itself. Doctors cleverer than me, like Heinz—did you know he’s top in his field in research?—have worked out that the exposure of the spinal cord to the normal fluid in your womb, the amniotic fluid, is what progressively destroys the exposed nerves during pregnancy. If we can operate now, really early, and cover the exposed cord, then we prevent much of the damage. Your baby’s much more likely to be able to live a normal, happy life.’

      ‘But not with me,’ Ruby whispered.

      That was another issue altogether. Adoption. This was a single mum, a teenager, facing a life apart from the baby she was carrying.

      ‘You haven’t decided definitely on adoption,’

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