LITMIR.BIZ

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      Supposing she were expecting a baby? And Theo, instead of being here as a doctor, was sitting by her side, holding her hand, the anxious father-to-be?

      She shook herself. That was the most ridiculous fantasy she could ever have imagined. Theo didn’t want a permanent relationship, and he’d made it very clear that he didn’t want babies of his own. No way would they ever be sitting in a maternity department together as anything other than colleagues.

      But no matter how hard she tried to push it away, the idea stayed put.

      And what worried her even more was the fact that she actually liked the idea. A nebulous thought about having babies someday had sharpened into focus. A baby, with her own dark wavy hair and Theo’s beautiful eyes…

      Oh, lord. She really had to get a grip. She was supposed to be role-playing a patient with oligohydramnios, not fantasising about something that absolutely wasn’t going to happen. ‘OK, Sanjay. As Iris told you, you can feel the baby’s outline very easily, you already know my blood pressure’s up, my temperature and pulse are both normal, and Iris has already done the dipstick test so there’s no protein or sugar in my urine. So what are you going to ask me?’

      ‘Have you noticed any change in the way the baby moves and how often, Mrs Gregory?’ Sanjay asked.

      Good call. She smiled encouragingly at him. ‘Call me Maddie, please. The baby isn’t moving as much as normal, no. It’s been like this for three or four days—that’s why I called my midwife and she told me to come in.’ Madison was beginning to enjoy herself. This had definitely been one of Theo’s better ideas, and maybe they could do this with some of the junior staff as well as the students, to help prepare them for the less common emergencies.

      Just as long as she could keep the fantasy of actually being pregnant out of her head. Yes, she wanted a child—but Theo didn’t. End of story. It wasn’t going to happen.

      Sanjay and Nita exchanged a glance. ‘We’d get to see her file first?’ Nita asked. ‘Because in this case I’d want to see the ultrasound results and check the size and position of the placenta.’

      ‘And I think we need to do a physical exam to check that there’s no leaking of amniotic fluid,’ Sanjay added.

      ‘Why?’ Theo asked.

      ‘Because if you can feel the baby that easily and it’s small for dates, the amniotic fluid might be on the low side,’ Sanjay said. ‘Which means the baby’s at risk.’

      ‘Good. Why?’ Iris asked.

      ‘Because amniotic fluid protects the baby against infection and helps the lungs and digestive system to mature,’ Nita explained.

      ‘How can you check the fluid levels?’ Theo asked.

      ‘Ultrasound—we’d ask the radiographers to measure the fluid,’ Nita said.

      ‘OK, so you’ve just told me you don’t think I’ve got enough fluid around the baby. I’m worried now. Is my baby going to be all right?’ Madison asked.

      The students turned to her. ‘It’s quite common towards the end of pregnancy,’ Nita said, ‘so try not to worry. But we do want to send you for an ultrasound so we can check the fluid levels and see how the baby’s developing.’

      ‘So there’s something wrong with the baby?’

      ‘There are all sorts of things that could cause you to have low amniotic fluid. If it’s summer and it’s been really hot and you haven’t been drinking enough, that would cause it. You might have a little tear in the membrane, or if you’ve had an amniocentesis you might leak a little—the good news is that the membranes can repair themselves if it’s a small tear, as long as you get plenty of rest,’ Sanjay said.

      ‘And if you’re having identical twins,’ Nita added, ‘there’s a condition called “twin to twin transfusion” where one gets a bigger share of the placenta than the other, so one might have too much fluid and the other might not have enough. It doesn’t necessarily mean the baby has a problem.’

      ‘But if there is a problem, where’s it likely to be?’ Madison asked.

      ‘Are you asking as a doctor or as a mum?’ Sanjay asked.

      ‘Doctor,’ Theo said.

      ‘Kidneys,’ Sanjay said. ‘Absent, enlarged, or not developing properly.’

      ‘Or it could be a blocked urinary tract, or a congenital heart defect,’ Nita added.

      Theo smiled. ‘Excellent. You two really know your stuff.’

      ‘Thanks to Maddie,’ Sanjay said. ‘She’s been brilliant at spending time with us and talking about differential diagnoses.’

      Madison glanced at her watch. ‘Thanks for the compliments, guys, but we’re running short on time. Now, you’ve sent me for an ultrasound. The placenta’s normal but the fluid’s definitely low and the baby’s growth rate is poor. You’ve examined me and the membrane’s fine so you don’t have to keep monitoring me and the baby for signs of infection. What are you worried about now?’

      ‘Delivery, definitely,’ Nita said. ‘Speaking to you as a doctor rather than a mum—without enough fluid, the baby’s likely to end up in the breech position. And I’d be really worried about cord compression.’

      ‘So would I,’ Iris said feelingly.

      ‘So what would you do?’ Theo asked.

      ‘It depends on how little fluid there was,’ Sanjay said. ‘Ideally we’d go for conservative management, keeping a close eye on things and checking the baby’s heart rate to make sure he’s not distressed, and regular ultrasounds to check the baby’s development.’

      ‘But if the fluid’s really low and the scan shows the baby’s growth is affected,’ Nita said, ‘we’d have to deliver early. So we’d give steroids to mature the baby’s lungs and do a section.’

      ‘What would you notice about the baby after delivery?’ Iris asked.

      Sanjay and Nita looked at each other. ‘Um—lots of vernix because it’s early?’ Nita suggested.

      ‘Actually, the baby’s skin is more likely to be dry and leathery because of the lack of fluid,’ Iris explained. ‘And the face might look a bit squashed.’

      ‘And because the baby’s been compressed in the womb, you also need to check for club foot,’ Theo added. ‘Good work, team. Same again on Monday morning?’

      ‘Yes, please,’ Sanjay said, smiling.

      ‘Definitely,’ Nita added. ‘Working with you like this—well, it’s made me realise that this is what I want to do when I qualify, Theo.’

      ‘You don’t have to make up your mind just yet. You’ll have other placements in other departments,’ Theo said gently. ‘It’s lovely to see you both so enthusiastic, but don’t close yourself off to other opportunities just yet.’

      ‘I was wondering,’ Nita said, shifting from foot to foot, ‘if I could ask your advice about my next placement.’

      ‘Sure. We could have lunch today, if you like. Maddie, you’re free as well, aren’t you?’

      ‘Emergencies permitting, yes.’

      Theo smiled. ‘That goes for me, too, so you might end up with just Maddie or neither of us. But we’ll fit something in.’

      ‘Thanks.’

      ‘Now, I have clinic—and you two are with the gynae team today, aren’t you?’ Theo asked.

      Sanjay glanced at his watch. ‘Yes, and we’d better be on time. Thanks for today, Mr Petrakis.’

      Iris and the students disappeared; Madison was about to go to her own clinic, but Theo caught her hand. ‘Promise

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