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Callie smiled again encouragingly. ‘Kind of,’ she said. It was often hard for laypeople to understand complex medical conditions and part of Callie’s job was helping them to understand. If that meant she had to go over and over the information again, that’s what she did.
‘Your twins share the same placenta—that’s common for identical twins. Usually in this scenario each twin has its own separate connection to the placenta via its umbilical cord, but in TTTS the placenta contains abnormal blood vessels, which connect the umbilical cords and circulations of the twins.’
Callie paused to check that Kathy and Ray were following. She glanced at Cade, indicating for him to jump in. ‘So essentially,’ Cade said, ‘blood from one twin is transfused into the other twin.’
‘That’s the donor twin, right?’ Kathy said. ‘The recipient is the twin who gets the transfusion?’
Callie nodded. ‘That’s right. The recipient twin has a lot of extra stress put on its heart because of the extra fluid. Also the kidneys produce a lot of urine to try and remove some of the excess fluid, which leads to a build-up of amniotic fluid. That’s what I showed you on the scan earlier.’
‘That’s why I’m so big,’ Kathy stated.
‘Yes,’ Cade confirmed. ‘It’s called polyhydramnios. But the donor baby has hardly any amniotic fluid because it’s donating all its blood to its sibling and therefore producing hardly any urine. The donor twin also becomes quite anaemic.’
Cade paused, too, for a moment, glancing at Callie. Ray and Kathy seemed to have grasped the basics. They looked shaken but, from what he’d gleaned already about people from ‘the bush’, as they called it here, also stoic. Something that was confirmed a moment later when Ray cut straight to the chase.
‘Okay. So how do we fix it?’
Callie ran down the rather short list of options from doing nothing, which would almost certainly lead to the death of one if not both twins, to bed rest and nutrition to treating the symptoms with serial reduction amniocentesis and stringent monitoring.
‘There is one more option,’ she said. ‘I’ve asked Dr Coleman here because he offers a one-off treatment that is curative.’
Ray frowned. ‘So let’s do that.’
Cade looked at Callie and she nodded for him to continue. ‘Well, it is a little out there for a lot of people. It’s called fetoscopic placental laser therapy and involves me operating on the placenta while your twins are still in utero.’
Ray looked shocked. Kathy said, ‘You can do that?’
‘Can and have,’ Cade confirmed. ‘You are the first TTTS case I’ve seen since coming to Australia a couple of months ago but I have performed this procedure over a dozen times in the States.’
Cade went on to explain what exactly the operation entailed. He talked about the high operative and twin survival success rates and ran through the benefits as well as the potential complications—from having to repeat the procedure on rare occasions because all the aberrant vessels hadn’t been destroyed to inducing labour and the subsequent complications to do with premature babies.
He was thorough, answering their questions as he went along, and Callie couldn’t help being both pleased and impressed. Invading the safe, sterile world of the uterus was cutting-edge stuff but it should never be taken lightly or dived into willy-nilly.
‘You’ll probably want some time to discuss it,’ Callie said when Cade’s spiel had come to an end and the questions seemed to have been exhausted. ‘Why don’t you guys go down to the coffee shop and figure out which option you want to go with?’
Ray nodded. ‘If we decided to go ahead with the laser thing,’ he said, addressing Cade, ‘how soon can you do it?’
‘Tomorrow,’ Cade said. Prenatal surgery was rare so there wasn’t exactly a waiting list. ‘We’ll admit Kathy straight away, run some more tests and I’ll get a team together. Not sure if it’ll be in the morning or the afternoon yet.’
‘Okay, thanks,’ Ray said. He stood, helping Kathy to her feet, then reached out and offered his hand to Cade. ‘Thanks, Doc.’ He nodded at Callie. ‘You’ll hear from us shortly.’
Callie reached into her trouser pocket and handed them a card. ‘Page me on this number whenever you want.’
Callie watched as Ray opened the door and ushered Kathy through it. ‘You reckon they’ll go for it?’ she asked Cade as the door shut behind the Streets.
‘They seem like really practical people, so I think they will.’ He looked at Callie. Her gorgeous red hair was constrained in a high ponytail today and in the daylight her green eyes dazzled. ‘You wanna assist tomorrow if they do? I’m going to need another set of hands in case I have to deliver twins.’
Callie grinned. Standing next to Cade while he saved two little tiny lives had danger to her peace of mind written all over it, but it wasn’t something she wanted to miss, either.
‘Wild horses couldn’t keep me away.’
Which was why the next morning she was standing in her scrubs and theatre clogs, her hair contained in a blue cap, a mask covering her nose and mouth, eagerly watching the monitor as Cade advanced the fetoscope through the amniotic sac of the recipient twin—Joshua—towards the connecting vessels on the surface of the placenta. It was a strange and beautiful underwater world, like in footage she’d once seen of a sunken galleon, and she held her breath as a little hand was illuminated by the beam of light shining from the end of the scope.
‘Beautiful, isn’t it?’ Cade murmured.
Callie, standing opposite with her arms folded, her body turned to face the monitor, glanced at him and recognised the same sense of awe that was bubbling inside her. ‘Amazing,’ she agreed, her gaze straying immediately back to the screen.
Cade watched her for a moment longer. With the mask firmly in situ, hiding the classic features of her face, he had no idea what colour lipstick she was wearing or if, indeed, she was wearing any. Instead, he’d found something equally captivating: her eyes.
The mask isolated and emphasised the flecks of turquoise amidst the green of her irises. He hadn’t noticed them before and he couldn’t think why. He guessed his determination to concentrate on his career was paying off if he’d missed the fascinating hue of Callie’s eyes.
He was obviously getting good at it.
So, why, suddenly, was that such a depressing thought?
He turned back to concentrate on the job at hand—on Kathy, anesthetised and depending on him, on her babies, on locating the problem vessels.
‘Laser, please.’
The scrub nurse handed him the fibre and he threaded it down through the same sheath the scope was using, without taking his eyes off the visual on the screen. Once the laser was in place he set about coagulating the aberrant blood supply, running the beam along the length of the vessels and obliterating them for good.
It didn’t take long and he was satisfied when he was finished that the procedure had been curative. ‘That ought to do it,’ he announced, as he withdrew the fibre.
Callie glanced at him and her eyes shone with excitement—like they needed any extra enhancement! ‘Well done! You going to take some of that amniotic fluid while you’re in there?’
He nodded. ‘Yep. Looks like I’ve got a good couple of litres I can relieve Joshua and his mother of.’
In the end Cade withdrew one and a half litres before declaring himself satisfied. Kathy would feel an immediate difference in the tightness of her belly and her breathlessness, and Joshua’s heart and kidneys would not have to work as hard. Andrew, his twin, also now had a chance to develop normally.