LITMIR.BIZ

      Twenty minutes later, Juliet was winding up her briefing to the theatre staff, a number of whom were pressed for time as they were due to scrub in for another procedure that afternoon. She had already gone over her theatre equipment requirements, spoken to the anaesthesia team and nursing staff. All of the medical team involved in Georgina’s procedure, bar the one medical student and two interns on maternity rotation, were experienced with TTTS laser surgery, although none on more than two babies. Four was outside everyone’s experience. Including Juliet’s. And she did not hide that fact from the team.

      ‘While I have performed fetoscopic laser surgery on triplets, I will not deny that on quadruplets it will be a slightly more challenging procedure. However, the direct visualisation through the fetoscope will allow us to successfully perform a targeted and focused laser termination of the vascular communications directly responsible for the TTTS and effectively separate the placenta into two components, one for each foetus. With each baby having its own placental mass, and the removal of this communication, there will be an interruption to the transfusion process and we should stabilise the situation so we can advance to a gestational age where the four babies in this situation all have a greater chance of survival. Does anyone have any further questions?’

      ‘If the parents of the quads did not agree to the surgery, what would the risk be to the other three babies if the recipient baby went into stage five heart failure and died?’

      Juliet could see the question came from one of the interns. ‘That’s a very good question. If one foetus was to become non-viable through cardiovascular complication arising from the TTTS, then it would put all three remaining babies at high risk of death, injury or disability. Essentially the fetoscopic laser procedure has taken what was until relatively recently a lethal placental disease and turned it into a manageable condition if detected early.’

      The specialist team were all silent. Each nodded their understanding.

      ‘Just one more question. If the outcome of moving forward with this intervention is pre-term delivery, are you certain that you’re sufficiently prepared for the arrival of four twenty-nine-week gestational babies with a current average weight of less than three pounds?’

      Even without hearing the voice or seeing the man, Juliet knew the question had to come from Charlie, who was standing with folded arms at the back of the room. She took a deep breath. But instead of feeling resentment or interference, she appreciated the question. It was fair and one he had every right to ask in that arena and one that others might have been wondering about.

      ‘Yes, Dr Warren, that’s why we have assembled a multidisciplinary team who can deal with all potential outcomes including pre-term delivery. In addition to Ella, who is Georgina’s midwife, and two anaesthetists, Mr Darrington has already approved the four neonatal intensive care nurses and two neonatologists who are here with us today, and a senior paediatrician, paediatric resident and a paediatric cardiologist, all of whom I assume you will recognise on the day but can’t be at this briefing. In all we will have sixteen in the medical team, three observing and four incubators in Theatre. All of which, God willing, will be under-utilised on the day.’

      Surrounded by Theatre staff, many in scrubs, Juliet suspected the imminent laser surgery for his patient became more real in Charlie’s mind, giving rise to his ongoing concerns.

      ‘Good, I’m not surprised you have it under control, Dr Turner. Let’s hope we don’t need any of it,’ he said, then turned and walked away leaving a tiny grain of doubt in Juliet’s mind.

      Juliet never operated with doubt over anything. She needed to manage it immediately.