The Mills & Boon Sparkling Christmas Collection. Kate Hardy

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       CHAPTER FIVE

      THE following morning saw Madison in one of the consulting rooms with Theo, along with Iris, Sanjay and Nita.

      Swiftly, Theo ran through what they were going to do in the role-play exercise. ‘Maddie’s our patient, Iris is concerned so she’s just called you in, and I’m here if you want to ask questions.’ He smiled at the two students. ‘This isn’t a test and it doesn’t matter if you don’t know the answers. It’s a chance for you to practise your skills, show off what you know, and you’ve got two experienced doctors and a senior midwife in the room so you can grill us for information if you need it.’

      Madison liked the way he’d reassured their students. Nita was already confident, whereas she’d had to work hard with Sanjay to convince him that pregnant women were much more robust than he thought and wouldn’t break when he examined their abdomens.

      ‘First question,’ Nita said. ‘Iris would go out of the room to call us, yes?’

      ‘And I’d brief you outside the room, too, rather than in front of the mum,’ Iris said. ‘So I’m calling you in to a mum who’s thirty-five weeks pregnant with her first baby. There haven’t been any complications in the pregnancy so far, but I’ve just examined her and she’s got high blood pressure, the baby’s small for dates, and if you palpate the stomach you can feel the outline of the baby very easily. I’m not happy so I’ve called you in.’ She spread her hands. ‘So what are you going to do now?’

      ‘Introduce ourselves and reassure the patient,’ Nita said firmly. ‘Mrs Gregory, I’m Nita Warren and this is Sanjay Kumar. Iris has asked us to come in and see you this morning as part of our clinic. Would you mind if we examine you?’

      Theo, who was sitting on the edge of his desk, smiled broadly. ‘Well done, Nita. Given that Maddie’s happy to be examined, Sanjay, what are you going to do?’

      ‘Well, if Maddie were a real patient, I’d palpate the baby first and ask a few questions,’ Sanjay said.

      ‘As I’m not pregnant, we can dispense with the palpations,’ Madison said. It felt very strange to be lying here on the couch in the consulting room. Despite the fact she worked with pregnant women every day, she’d never considered pregnancy in relation to herself before.

      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 СКАЧАТЬ