Ali and the Rebel Doc
Autor
Emily Forbes
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12
CHAPTER ONE
‘IF ONE MORE auntie asks me when I’m going to settle down, I’m going to scream,’ Ali said as she walked into her sister-in-law’s kitchen. Dee was bent over a kitchen drawer, her back to Ali as she rummaged through the contents, but Ali kept talking. ‘You’d think they’d have given up by now. How many different ways can I say I don’t want kids?’
Dee straightened up, a triumphant look on her face as she grasped two candles, both shaped as the number one, in her hand. ‘But you’re so good with them,’ she replied with a grin as she pressed the candles into the centres of two separate cakes.
‘Because I can hand them back.’ Honestly, Ali couldn’t imagine anything worse than having to deal with children twenty-four-seven. That was not her idea of fun. She loved her family, which was fortunate because with four siblings, parents, grandmothers and aunts, uncles and cousins, plus nieces and nephews, there was literally no way of escaping them. Life was a constant stream of family gatherings. Which was why she was amazed that the message hadn’t got through. She didn’t want to have kids. She didn’t plan on having kids.
She loved her nieces and nephews, all ten of them—soon to be eleven—and she loved being Awesome Auntie Li-Li but she didn’t want her own children. She never had and she wasn’t about to change her mind at this point in her life. When she and Adam had got married, she knew people thought she’d change her tune but that hadn’t happened. She also knew people found it hard to reconcile her position with her career as an obstetrician, but she was weary of having to constantly explain her decision. After all, it was her body, her life and her prerogative.
‘I hear you,’ Dee said with a laugh, ‘but I’m not letting you hide in here. Go outside and mingle with my friends.’
‘I’ve delivered most of their babies—I know far more about them than I want to,’ Ali said, only half joking. ‘I don’t need to mingle.’
‘Well, in that case, you might as well make yourself useful. Can you take some more plates and forks outside?’ Dee passed Ali a stack of bamboo plates. ‘I’ll bring the cakes out when I find the matches. The sooner we sing “Happy Birthday” the sooner everyone will go home.’
‘I thought you liked hosting parties.’
‘I do,’ Dee said as she let out a big sigh, ‘but I’d forgotten that first birthday parties aren’t really for the kids but for the adults. I’ve been going non-stop for two days getting ready, plus today and tomorrow for what? Kai and Leni aren’t going to remember this. Remind me not to do this again for the next one.’
‘Next one! Are you pregnant?’
‘No, I was speaking hypothetically. Perhaps remind me not to get pregnant again as well. Having three kids under three is exhausting.’
‘And people wonder why I don’t want my own,’ Ali said as she grabbed a handful of forks and headed into the garden.
To her left she spied her twin brother standing with his arms wrapped around his fiancée, looking determined not to let her go again. They looked happy and she was pleased for him, she knew their road to happiness hadn’t been easy. Life wasn’t easy.
Yarran was a single dad, raising his son, Jarrah, on his own since the death of his first wife, and Ali knew that having him finding happiness again at the age of forty had likely reignited the family’s idea that it wasn’t too late for her to find someone after her marriage break-up.
But, post-divorce, if anyone had asked her the other big question, ‘Do you have a man in your life?’, she had responded by saying she didn’t want one. That she wasn’t ready. Adam, her ex-husband, had done a number on her confidence. She had loved the life they’d built together, only to find out it was all a lie, and their break-up had made her wary of relationships. She’d only recently started to, very tentatively, dip her toe in the dating pool again.
She wasn’t lonely—but she didn’t want to be alone. There was a difference.
Testing the water had meant putting some parameters in place for dating. He would need to be fit, intelligent and older than her, with adult kids or, better yet, no kids. She didn’t want to take on anyone else’s children, nor did she want to date someone who might eventually want a family. That wasn’t something she could offer. At the age of forty, even if she’d wanted kids, which she didn’t, as an obstetrician and gynaecologist she knew her chances of conceiving were greatly diminished.
Maybe there was someone out there for her, but if she did happen to meet someone who would make her consider another relationship, she knew it wouldn’t ever lead to motherhood. That was not for her.
So, while she was single, she was trying to focus on the positives in her life. Work was her passion. Her focus. Followed by her family. And her close-knit group of friends. She had her career, her health, her family and friends, her own apartment. She had everything she needed.
Except good sex.
That was one thing she’d had with Adam, until he started cheating on her. Her patients had always told her that it wasn’t marriage that took the gloss off sex but having kids. That had been another good reason to remain childless, Ali had thought, except now she had neither—she didn’t have kids and she wasn’t having sex.
Maybe it was time that she did something about that, she mused as Dee brought out the cakes.
Everyone gathered around the table to sing before the twins tried to blow out their candles, eventually needing help from their older sister.
Ali’s phone buzzed in her pocket as she handed plates of chocolate cake around. She pulled it out and saw the hospital’s number on the screen. As she swiped to answer she was hoping someone needed her. It would give her an excuse to leave and avoid more questions about her personal life.
‘Dr Edwards? This is Sylvia, an RN on the general surgery ward. I’m sorry to interrupt your weekend but there’s a note here saying to contact you if there are any medical issues regarding Emma Wilson.’
Honestly, why couldn’t people just get to the point? she thought. As Head of Obstetrics and Gynaecology, Ali wasn’t familiar with the nursing staff on General but she curbed her impatience. Having her weekend interrupted was par for the course, she was well used to it by now and Sylvia was only doing her job.
‘What’s happening?’ Ali asked. She wouldn’t normally have patients on this ward, but Emma was complicated. She’d initially been admitted with injuries sustained in a fire, but she also happened to be thirty-two weeks pregnant and was, therefore, now under Ali’s care too.
‘Her blood pressure is very high. It’s one-sixty over one hundred and five. I’ve checked it a couple of times just now and it’s not changing. This morning it was one-thirty over ninety. I thought you should know.’
As far as Ali was aware Emma hadn’t had hypertension during her pregnancy but she wasn’t surprised to hear her blood pressure was elevated. Emma had undergone multiple surgeries since being admitted to Sydney Central several weeks ago—undergoing skin grafts and then an emergency appendectomy—but that reading was dangerously high and Ali was concerned.
Gestational hypertension wasn’t uncommon, but Ali knew that prior to her accident Emma hadn’t had any of the usual risk factors and that set alarm bells ringing. Hypertension could be perilous, especially in pregnancy as it could develop into pre-eclampsia, which could threaten not only Emma’s life but the lives of her unborn twins. Ali needed to get to the bottom of this.
‘Does she have any other symptoms? Fever? Oedema? Pain?’
‘She’s afebrile.’ That was good, it reduced the likelihood of an infection. ‘But she was asking for pain relief, that’s when I checked her blood pressure.’
‘Where was her pain? Was it a headache? Abdominal pain?’
‘Abdominal.’
‘Has one of the doctors on duty seen her?’
‘It’s the weekend so we’ve only got a registrar. They asked me to call you but I can call Dr Hurst if you prefer?’
Abdominal pain could be attributed to many things, including Emma’s previous injuries and surgeries, but Ali’s sixth sense was stirring. On numerous occasions she’d sensed things that she couldn’t explain—it was something that seemed to run through the women in her family—and over time Ali had learned to trust her instincts. And her instincts were telling her it was related to Emma’s pregnancy.
‘I’ll come in now,’ she said. ‘If I need to, I can call Dr Hurst once I’ve seen Emma.’ Ivy Hurst was Head of General Surgery and one of Ali’s closest friends, she’d definitely consult her if she needed to, but Ali was now Emma’s primary medical expert and she wanted to examine Emma. ‘Did Emma mention any nausea or visual disturbances?’ she queried.
‘She didn’t mention anything. Would you like me to check?’
‘No, that’s okay, I’m on my way. Can you do a urinalysis for protein and a blood test to check liver function? And alert the radiology department; ask them to bring a portable ultrasound down for me and find out who the sonographer on duty is in case I need them.’
Ali needed to be at the hospital. She could wait for the test results to come in, but test results could only tell her so much, and seeing Emma in person would give her information that the numbers couldn’t. It also gave her a legitimate excuse to say her goodbyes. She loved her family, but she’d had enough questions for one day.
Ali ran through Emma’s history in her head while she drove, knowing she’d familiarise herself with her file when she got to the hospital, but mulling over what she remembered to date.
Emma had been brought to the ED at Sydney Central two months ago. She’d been injured in a house fire, sustaining serious burns to her lower limbs, and Ali’s twin, Yarran, had been one of the firefighters who had been involved in her rescue. Emma had undergone skin grafts and then battled infections before also undergoing an emergency appendectomy. To complicate matters further, Emma had been twenty-four weeks pregnant at the time of the accident. To say she’d had a traumatic few weeks was something of an understatement.
Emma had come through the surgeries but remained in hospital waiting for the birth of her babies. She didn’t need any further complications. But, luckily Emma was a fighter. Ali just hoped she had some reserves left.
Emma was being managed by a team of specialists that had included Ali from day one because of her pregnancy. As the department head, Ali didn’t have a patient caseload as such, but she would give advice or lend her expertise as needed. Emma was a patient who warranted close attention for several reasons, including the fact that she was a high-profile patient as well as high risk.
Emma’s husband, Aaron Wilson, was a local celebrity, hosting a top-rated reality television show, and the media interest in Emma’s case was enormous because of who she was married to. Emma and Aaron were regulars on the red carpet and in the Sydney society pages. Aaron was a quintessential Aussie man who’d done well for himself. He’d started with nothing except a trade as a carpenter before applying for a spot on a home improvement show and eventually, when the network realised how much the viewers loved him, he’d been offered his own show.
Aaron and Emma were a lovely couple but the intense interest from the media had been another reason Ali had wanted to make sure she was the Ob-Gyn looking after Emma. She wanted to make sure she received the best care, but she also wanted to avoid any negative publicity. It was her responsibility to protect the hospital and her department from that. Ali was new in her role as Head of Obstetrics and Gynaecology and she couldn’t afford to have any mistakes. There was enough to deal with in this role as a female and she was determined to prove she’d been appointed to the role on her merits.
It was something she was used to as she was always trying to prove herself. Always making sure no one could question her position. As an Indigenous female she often felt, rightly or wrongly, that she had to work doubly hard—even triply hard—to make sure no one could question her appointment to the top job. Throughout her school and university years she’d strived to be the best, craving recognition of her hard work and intelligence and not wanting to give people an opportunity to cut her down or to say she had been given a hand up the ladder because she was female and Indigenous. She wanted to earn her position and she wanted people to recognise that it had been earned. Not given. Not handed to her to meet a quota.
She knew she was doing a good job so far and she had no intention of letting things slip, she thought as she grabbed her stethoscope from her office and headed for the surgical ward.
‘Hello, Emma,’ Ali greeted her patient. Since Emma’s initial admission Ali had only seen her on a handful of occasions for routine pregnancy checks. She had monitored Emma and the babies to ensure they weren’t being stressed by Emma’s injuries and surgeries. So far, perhaps surprisingly, the babies had been unaffected, but Ali was concerned that might all be about to change.
Today’s visit was not routine so she modulated her tone, not wanting to frighten Emma or her husband Aaron, who was sitting beside her. ‘How are you doing?’
‘I didn’t realise they’d called you in on a Sunday, Dr Edwards,’ Emma apologised. ‘I feel okay, especially compared to what I’ve been through over the past couple of months. I’m sure this is nothing. Just a blip.’
‘How’s your pain?’
‘Easier.’
Sylvia had accompanied Ali into the room. The blood-pressure cuff was still around Emma’s arm and Sylvia inflated it. Ali glanced at the screen, checking the numbers. The reading hadn’t changed. It was still higher than Ali would like.
‘That’s good but now that I’m here there are a few things I want to check, just to be sure.’
She glanced surreptitiously at Emma’s fingers, checking for oedema, pleased to note there was no obvious swelling at this stage. She knew there was no point checking Emma’s feet as her injuries from the fire would complicate things there.
An ultrasound machine had been wheeled in and left in the corner of the room. Ali pulled the curtain around Emma’s bed for additional privacy as she said, ‘I’m just going to check the babies.’ Ali lifted Emma’s pyjama top and squirted gel onto her abdomen ready for the ultrasound. She’d have a quick look and if she saw anything untoward, she’d call a sonographer for a more thorough scan. Blood flow to the babies seemed normal and both babies’ heart rates were within a normal range.
‘Is everything okay?’
‘The babies are fine,’ Ali replied. ‘Tough, like their mum.’
Emma breathed out a sigh of relief and said to Aaron, ‘You can stop squeezing so hard now.’
‘Sorry,’ Aaron replied, letting go of Emma’s hand.
There was a knock on the door and as Sylvia drew back the curtain a second nurse stepped into the room.
‘I have the test results,’ she said as she handed printouts to Ali.
Ali scanned the list of numbers, absorbing the results. Emma’s liver function was within normal limits but there were high levels of protein in Emma’s urine, indicating that her kidneys were not working effectively.
‘What do they say?’ Emma asked.
‘Your liver is fine but there are traces of protein in your urine.’
‘What does that mean?’
‘It means your kidneys are under stress.’ It could also be indicative of kidney damage, but Ali hoped that wasn’t the case.
‘What caused that? What do I do now?’
‘There’s nothing you can do. You’ve developed a condition called pre-eclampsia, but it wasn’t caused by anything you did,’ Ali hurried to reassure her patient. ‘It’s a complication of pregnancy.’
‘Is it related to the fire? To Emma’s other injuries?’ Aaron asked.
‘No.’ Ali shook her head. She wasn’t a hundred per cent sure that it wasn’t related to Emma’s recent medical history, but she’d never had a pregnant patient like Emma before, with critical injuries and multiple interventions, so she couldn’t rule it out completely. But telling them that wouldn’t achieve anything. It didn’t really matter how this condition eventuated. What mattered was what happened next.
‘There are a few risk factors, most of which don’t apply to Emma,’ Ali said.
‘But there are some that do?’ Aaron asked, picking up on what Ali hadn’t said.
Ali nodded. ‘Yes. We see a higher incidence with first pregnancies and twin or triplet pregnancies but plenty of women have the same risk factors without developing this condition,’ she explained, knowing it was crucial to give the right amount of information. Too little would leave them worried. Too much would leave them overwhelmed and anxious. ‘Pregnant women with diabetes or who are overweight or used assisted reproductive technologies or have a family history can also be at risk, but Emma doesn’t tick those boxes.’
‘Does it hurt the babies?’
That was a difficult question to answer. While the babies were in utero they should be fine, but it was almost always impossible to leave them there without risks to both Emma and the babies. ‘Not as such,’ Ali answered vaguely.
‘How do we fix this? What can you give her?’ Aaron asked.
‘Nothing.’ That was the big problem.
‘What do you mean nothing? There has to be something you can do?’
Ali knew that some studies suggested that magnesium supplements could help but those same studies also showed that once the urinalysis showed traces of protein it was too late. ‘The only cure is to deliver the babies,’ Ali told them. Delivering the baby usually dropped the mother’s blood pressure pretty quickly.
Aaron and Emma spoke in unison.
‘But Emma’s only thirty-two weeks.’
‘The babies are too small, they can’t be born now.’
‘I know you’re concerned,’ Ali replied. Emma was right—the babies would be small, and, because she was carrying twins, they were likely to be smaller than a singleton, but she was wrong to think they couldn’t be born now. It wasn’t ideal but if Emma’s condition worsened the alternative was far worse than premature babies. Both Emma and the babies’ lives could be at risk. ‘The babies will be small but ninety-five per cent of babies born at thirty-two weeks survive.’ In Ali’s opinion those odds were good. ‘But there is a risk,’ she continued, ‘a couple actually. The biggest issue for the babies is that their lungs aren’t fully developed yet. I can administer corticosteroid injections, which is an anti-inflammatory medicine that helps the babies’ lungs to mature. Waiting gives me a chance to do that.’
‘You’re going to inject the babies?’ Aaron asked.
‘No, not the babies. I give the injections to Emma but ideally you need two injections, twenty-four hours apart. Which is why I’d prefer to wait if we can.’
‘Is it safe to wait?’
‘At the moment, yes, but if that changes, I will deliver the babies if it becomes necessary. The other risk is to you, Emma. If your condition worsens it can cause seizures and, in the worst-case scenario, it can be fatal.’
‘Emma could die?’ Aaron exclaimed.
‘That outcome is very rare and usually occurs when the condition hasn’t been picked up, but we would be monitoring Emma for any exacerbation of symptoms.’
‘So, it’s a catch-22? The babies or Emma?’
‘No, we’re not having to choose. Let me tell you what I recommend. If you agree, I’ll organise the first injection for Emma now and hopefully we can delay needing to deliver the babies until you’ve had both doses. I’ll postpone delivering the twins for as long as possible but if we can gain another twenty-four hours that gives them a better chance at having reduced breathing difficulties. You’ll be closely monitored and if you develop any additional symptoms, I’ll review your situation.’
‘What other symptoms are we looking for?’ Aaron asked.
‘Swelling in Emma’s hands, feet or face. Headaches. Visual disturbances.’
‘Like what?’ Emma asked.
‘Black spots. Blurred vision. We’ll watch you but you need to report anything unusual, anything you’re not sure about, any changes to how you’re feeling. I know this sounds scary and it’s unexpected and worrying but you’re in the best place. We’ll keep a close eye on you. Now, would you like me to organise the first injection?’
Emma and Aaron agreed as Ali knew they would.
‘You’re sure this is the only way?’ Aaron asked as he followed Ali out of the room.
‘I think this is the best option.’ Ali tried to sound calm and in control. She’d made it difficult for them to make any other decision but she was convinced this was the best choice for this situation although the outcome was out of her hands really—all she could do was monitor Emma and hope she had made the right call.
‘I feel so useless,’ Aaron said. ‘It’s my job to keep my family safe, to fix things. How did we get here?’
‘Aaron, it’s my job to keep Emma and the babies safe.’
Aaron sighed and Ali stopped walking, wanting to let him finish and then get back to his wife. ‘I’m not used to feeling so helpless or inadequate. You know I was a carpenter by trade, back before I got my television gig? Give me some tools and I will fix anything. But I can’t fix this. Do you know how useless that makes me feel?’
‘Your job is just to support Emma. She is in the best place. I’ll take care of her. If I think she’s in any danger, I promise I’ll intervene, but if I can keep the babies in for just one more day and give the steroids time to work their magic that’s one less thing to worry about.’ She put one hand on his arm, trying to reassure him, trying to persuade him to return to his wife’s bedside. ‘I’ll be back with the injection.’
Ali sat at her desk and reached for her phone. She’d administered the cortisone injection and spoken to the paediatrician on call. She’d also spoken to Ivy, her good friend and Head of General Surgery, updating her on Emma’s condition and checking that Ivy didn’t have any other concerns. Ali had wanted a second opinion on the test results and she’d also wanted to ask Ivy how she thought Emma would cope with more abdominal surgery, assuming she’d have to undergo a caesarean section, so soon after her appendectomy. That surgery had been performed through a laparoscope so, in theory, a C-section shouldn’t present any problems as long as there was no infection.
Ivy had been more concerned about the need for another anaesthetic so now, on Ivy’s recommendation, Ali was making a third phone call, this time to Jake Ryan, the anaesthetist who had looked after Emma during her other surgeries. Ali hadn’t met Jake, but Ivy spoke highly of him and so she also wanted to line him up for the procedure if necessary. In her mind there were a lot of benefits to keeping the anaesthetist consistent and she wanted to have all her ducks in a row if Emma needed a third anaesthetic in the space of a few weeks.
It was only when her call went to his voicemail that she remembered it was Sunday. A quick check of the time told her it was after six. Most people, even doctors unless they were on night duty, would have left the hospital.
She left a message asking him to call her mobile when he had a minute before she turned her attention to Emma’s file. She updated the notes and then read through the file again, familiarising herself with all the details, wanting to make sure she didn’t miss anything. She took her time. She had nowhere else to be.
Ali was in a world of her own, focused on Emma’s history, when a knock on her door startled her out of her headspace.
Her door was ajar and she looked up to find a man in green scrubs standing before her.
A stranger.
A tall, handsome stranger.
‘Can I help you?’ she asked.
‘Dr Edwards?’ She saw him double-check the nameplate on her office door. ‘I’m Jake Ryan, the anaesthetist.’
You’re Jake Ryan?
She almost spoke aloud but held her tongue just in time, realising she’d sound rude, but he wasn’t what she’d been expecting, not at all.
She took in his features. He had a symmetrical face, fine boned but with a strong jaw and an aquiline nose. His cheekbones were sharp and well defined, chiselled—she didn’t know if that was a thing but it was the only way to describe them. His eyes were dark, his lips full and his dark brown hair was thick, cut shorter on the sides but with length on top. At a guess he looked to be in his mid-thirties, over six feet tall, slim and rangy.
‘You left me a message,’ he said when she remained mute. She hadn’t expected an anaesthetist who looked like a menswear model, nor had she expected him to turn up at her door and his appearance had taken her by surprise, leaving her speechless. ‘You wanted to talk to me?’ he continued. ‘About Emma Wilson?’
