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By Mark Nethercote, August 24, 2011 10:00 am

Sunday 29th August 2010

One year ago.

We’ve hit our groove.

After watching the DVD, we reassured ourselves that we didn’t do anything wrong.  The pen does require plastic-bending levels of pressure to dial down in an unreassuringly, flimsy manner.  I’ve also improved my grip.  The pen really needs a firm grasp on the barrel, and a thumb on the plunger, while the other hand secures it at the skin.  And, even better, if you let the thing defrost first, it isn’t quite as lumpy on the way in.

Suse already feels bloated, and we’re only about a third of the way through the injections.

“Already I feel twice as heavy as what I do before I ovulate.  This is going to be shit.”

Suse will have an ultrasound to examine her follicles tomorrow.  As we’ve been told, she’ll get Puregon until her follicles are 13-14mm, then three to five days of Orgalutran, then one dose of the Ovidrel.  By then, they’ll be about 18mm each and ready for collection.  That could mean ten follicles all up, five on each side, each nearly two centimetres in size.

According to Shelley, there really aren’t any side effects to the Puregon, other than fullness in the belly.

Try telling Suse that.

She’s cried three times since the injections began, and says she feels like absolute shit.

I’d tell her that it was all placebo effect.  But I want to keep my marriage.

And I know this isn’t a great analogy, but if I had five cysts growing on each of my balls, I think I’d be pretty emotional too.

* * * * *

Work is keeping me going.

I went out on a trip yesterday to retrieve a baby that was born in the back of a taxi.  His parents were on the way into hospital when things got a little out of hand.  They ended up pulling into the carpark of the closest local hospital, where they had their little girl.  She was thirty weeks.  That’s two-and-a-half months early.

I sat there, listening to the call as it came in.

“Oh, hi, this is Jonathan, one of the Emergency Consultants,” he said sounding somewhat flustered.  There was a lot of commotion in the background.  “We’ve just had a baby deliver in the car park.  And we don’t have a paediatric unit here.”

“How’s the baby doing?”

“It looks pink and is breathing on its own.  Pretty well, I think.  You wouldn’t believe the commotion it has caused.”

By the time we arrived, there were about fifteen people in the room.  Nurses, doctors and ward clerks all swarmed around, all keen to help.

“I’ve been here twenty-two years,” said a battle-hardened nurse as I fought my way through, “and I’ve never seen this happen here.”

“Really?” I say, trying to sound interested.  “Do you think we could clear the room just a bit?”

“Yeah, where do you want us to put Mum?” she said, her eyes never leaving the baby.

I pause for a moment.

“I’m fine with Mum being here.  It’s everybody else.”

“Right.  Yes, of course.”

It’s not just us.   Everyone is excited at the prospect of new life.  Even medical staff who’ve seen it all.

There really is nothing quite like the magic of a brand new baby.

* * * * *

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By Mark Nethercote, July 22, 2011 10:00 am

Friday 23rd July 2010

One year ago.

I walk into the Emergency Department, and begin speaking to the person from the Department of Human Services.

She tells me that the two children in the cubicle have been brought in after their mother was found intoxicated on drugs and alcohol.  The children were wearing little clothing, and were found cold.

I walk into the room, and examine the two kids.  The four-month-old smiles and laughs, as yet unscarred.  The two-year-old is quiet and frightened, startling at any sharp movement.

He is adorable, with blonde hair and deep blue eyes.

He has bruises all over his body.

Some people are animals.  Fucking animals.

As I stand there, I can’t help but think:

What would it be like to adopt these kids?

How would their lives be different, if I were their Dad?

* * * * *

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By Mark Nethercote, March 11, 2011 10:00 am

Friday 5th March 2010

Gestation: 23 weeks

One year ago.

For fifteen minutes, we go through motions.  We give adrenaline through the cord.  We give compressions.  We strap the tube in place.

We try.

We really, really try.

To no avail.

* * * * *

“What time did we start?” Matt asks.

“Twenty minutes ago.”

“Heart rate?”

We all stop.

“Twenty six,” Peg says.

“Because of the adrenaline,” I say.  Matt nods.

“And not a single breath.”

The heart still beats, its final beats, pumping oxygen-starved blood.  Despite our breaths, mainlined down a tube in the trachea, the freeway has hit a traffic-jam five centimetres in.  Without lungs, no gas exchange.  Without gas exchange, no oxygen back to the brain.

We are losing.  We’ve lost.

It was a battle from the start.

One with insurmountable odds.

Matt looks off out the window, a mist in his eyes.

“With better planning, she could have held him in her arms for the last twenty minutes.  Instead of him being in here.”  He looks off again.  “Twenty minutes.  Not a breath.  I’m calling it.  Were done.”

Another pause.

“We should get him back around to Mum, as soon as possible.”

* * * * *

We clean him up, and wrap him.  His tummy sags, soft and floppy, motionless.  We take a sponge and clean his arms, and his legs, then the vernix from around his eyes.  His little purple face, scrunching and twisting for air just twenty minutes earlier, is now silent and still.

The Aboriginal Liaison worker appears, ready to accept the baby.  A look in her eyes tells us that she’d love to be able to present the baby back to Mum on her own, but that she can’t.  Her eyes tear up as she holds the baby close.

“Should I go?” Matt asks.

“Absolutely,” Peg and I say in unison.  Matt is the senior, Matt is good with words.  In the frantic lead up, he’d thought to ask the parent’s names.  Peg and I were too caught up to even ask.

“Absolutely,” we repeat.

Jinx.

Matt walks off with the Liaison Officer.  Peg and I stand there, both silent.  The adrenaline runs thinner with each step Matt takes, as I suddenly feel a lethargy, and a deep, hollow sadness, for what has just occurred.  I look at Peg.

“Are you okay?” I ask.

“Yep,” she says, turning slightly.

I look down, thankful that this is the end of my day, not the beginning.

And that the fug – that haze of lethargy that had left me for the last half an hour – is leering up once again, and hoping to return home.

I happily accept, willing the natural numbness to envelope me.

Stopping me from replaying this tragedy too many more times.

* * * * *

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By Mark Nethercote, March 10, 2011 10:00 am

Friday 5th March 2010

Gestation: 23 weeks

One year ago.

Methodically, with the luxury of the three doctors, we make our plan.  I will be on airway, Peg on compressions and lines, and Matt directing.  We will bag and mask the baby around to the Special Care Nursery, where we will then get the tube down and have full resuscitation occur.  Mum and Dad will remain in Birthing Suite until things have settled, in which ever direction.

The contractions crescendo and crescendo, while we talk in muted tones, thinking of things, planning ahead, staking our game plan.

Within moments the baby is out.  It’s a boy.  He squirms, and gasps, no air going in.  As we’d agreed, mum gets to hold him for five seconds, until he is rushed over to us.  Immediately I apply the mask, and we begin giving breaths – or trying to.

Through non-expanding lungs.

We back out the trolley, through Labour Ward, and into the Nursery.  Everyone is at the ready, and the three of us mill, hovering over the now stationary cot.  Through all of this the baby has not had a single breath, his colour going from cherub pink to a purple hue.  His pulse rate has dropped from one hundred to forty, where it now sits.  Without breaths, it will just continue to drop.

“Ready Nethers?”

“Yep.”

Matt hands me the tube and the laryngoscope.  I place the blade down the tongue, looking for the epiglottis.  The tongue sticks up, a strong muscle in the way.  I position the head, then look again.  There are bubbles of spit that gurgle up from below, in time with Peg’s compressions.

“Stop for a second, Peg.”

I look and see nothing, again hoping to see the cords.

Nothing.

“How are you?” Matt asks.

“Give me a second.  Stop again, Peg.”

She stops, and I see the epiglottis.  Behind it sit the cords, but they can’t be seen for the secretions.

“Yep, tube.”

Blindly, I aim for the hole, where they ought to be.  The rush of it has taken me up, and I go for where I think it ought to be, rather than where I can see.

I feel resistance.

“Nup.  Out,” I say.

The mask comes back, and we give more breaths, as ineffective as the earlier ones to this uncompliant set of lungs.

Peg continues compressions.

“Pulse rate?”

We all stop for a moment.

“Forty,” comes the answer.

“Go again, Nethers.”

I take off the mask, again asking for the blade.  I slide the laryngoscope down, looking for the epiglottis.  I see it’s cartilage flap sticking up.  This time, I stop to think.

“Suction.”

I grab the suction tube, and aim it precisely, pulsing up and down in time to compressions.  The field clears, and there I see a sets of cords, not quite a set, not as developed as usual.

I grab the tube.

“Stop for a minute, Peg.”

She stops, and I slide it in beside my blade, coaxing back the tongue.  There I see it, and I introduce it, right where the cords are, right where it ought to go.  Resistance.  I try once more.  Resistance.

“Nup.  I’m out.”

I pull back, and we bag again.  Bag and mask, bag and mask.  Compressions.  No breath attempts, not one breath since birth.

“Do you mind if I have a go?” Matt asks.

“Not at all,” I say. “Your turn.”

Matt moves in where I was, and stands ready.   The process repeats.  Stop Peg.  Blade.  Suction.  Tube.

Stand and wait.  Fifteen seconds hesitation.

“Nup.  Out,” he says.

He looks at me.  I see a bead forming at his hair line.   With that, I notice my own wet head.  Peg, more physical than us both with compressions, is covergirl dry.

“Did you feel resistance?”

“Yep.”

“Maybe the deformity comes up higher.  Maybe the larynx is abnormal too?”

I nod, a thought that hadn’t entered my sleepless brain.  I just know I didn’t get it.  Hadn’t considered explaining it.

We bag some more, before we continue.

“All right.  Again.”  Peg stops.  Blade ready.  “Suction.”  I hand it.  “Tube.”  His hands sticks out, ready to receive.  He takes it, and with finesse, he angles it in.  Five seconds tick an hour.

“Got it,” he says, pulling out the introducer from the centre of the tube, like a sword from its scabbard.  We attach the Neopuff, and start breaths.  I grab my stethoscope, and place it on the chest.  I hear breaths.

“You’re in.”

Breaths sounds present.

Absolutely no chest wall movement.

These lungs are filled with concrete.

* * * * *

to be continued…

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By Mark Nethercote, March 9, 2011 10:00 am

Friday 5th March 2010

Gestation: 23 weeks

One year ago.

Over the next three minutes we establish things.  Plans were in place for the baby to be born in Melbourne at a Tertiary Centre.  Not here, on a Saturday morning, walking in off the street, ready to drop.  There is an ultrasound from a month ago, confirming a very small baby for gestation.  Due to genetic abnormality, drug use, inadequate placental nutrition, or all of the above.  The kidneys looked abnormal, the heart appeared to be structurally okay, but the lungs are underdeveloped to the point of having very little lung tissue at all.

Peg and I look at each other for a moment, reading each other’s thoughts.

This child will not breath normally, if at all.

A sense of dread washes over us simultaneously.

Peg and I do calculations, getting drugs ready.

“Where’s Matt?” she asks.

“I don’t know.”

“We really should have the Consultant here, too, shouldn’t we?”

“Absolutely,” I say.  “Just no one’s had a chance to call him.  I’ll go,” I say, as I head for the door.

Twenty seconds later I have Matt.  I give him the synopsis as quickly as possible.

“And what exactly does it say about the lungs?”

“That there is pulmonary hypoplasia.”

“And what about the kidneys?”

“That they’re abnormal.”

“But what else?”

“Nothing.  Look I don’t have it in front of me this second, Matt.”  With that, Peg is there, passing the report into my hand.

I read it to him, this month-old ultrasound.  The full stop lands after explaining, that there is ‘very little, if any lung tissue seen at all.’

I hear the rush of the road in the background.

I can hear him think.

“And what do they want to do?  Do they want Resus?”

“Honestly, Matt, we haven’t even asked.”

He pauses again.  “I just can’t believe,” he says, deliberating carefully, “that no one in Melbourne has had a discussion with the family about these results.  We need to be having a discussion with them about what their expectations are.  Because it will be a very different situation, dependent on what they want.”

“Couldn’t agree more,” I say.  “We just literally haven’t had a chance to talk about any of that yet.”

We hang up, without even saying goodbye, complicit in the urgency.

* * * * *

Peg and I re-enter the room.

We split, her to Dad’s side, me up to Mum.  Pain and exhaustion line her face, mid-contraction, well into stage two, the birth imminent.  The father sits there, holding her hand, a grave look on him.

“We just have to ask,” I yell, above the contraction, “have you been told about your babies lungs?”

Mum’s eyes remain closed, almost not hearing.  Dad nods a quiet yes.

“And you’ve been told that they are really not formed, and that your baby might not be able to breathe?  And that there is a really high chance that he or she could die?”

Again, mum keeps her eyes closed, groaning through the pain.

“Yes,” Dad says.

A human silence falls after this.  The electrical cacophony continues unabated.

“So we really need to be very clear about this.  About what is going to happen here.”  I pause for a second.  “Do you want us to try and make your baby breathe, or do you want to hold your baby in your arms, without us interfering?”

The moment holds heavy.  Thick.

“We want you to do everything you can,” he says.

“Which we can,” I say.  “But you need to know,” I add deliberately, “that your baby has very underdeveloped lungs, and could well die.”

He nods silently.  Mum’s eyes never once open.

All of the nuances and subtleties of a meaningful birth are out the window.

It doesn’t get any more medical than this.

Another contraction winds up, the babies head starting to show.

I turn and then I see Matt there, as he comes through the door.

“Where are we at?” he asks, panting;  the order of the day.   We give him the latest.  The decision to resuscitate.  His eyebrows furrow with concern.

“I’m going to say hello.  What are their names?”

Peg and I look at each other as we say, in unison, “We don’t even know.”

* * * * *

to be continued…

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By Mark Nethercote, March 8, 2011 10:00 am

Friday 5th March 2010

Gestation: 23 weeks

One year ago.

I rise before dawn, and leave the bedroom on tiptoe.  As I walk the hall, I step where I have learnt that I can;  through summer the boards have begun to creak, the noisiest of all directly under foot, right at the doorstep of the bedroom.

I perform my morning ablutions before I leave, sending an air-kiss to Suse, my overnight bag in tow.  As I walk down the street, the sun beginning to rise, I spot a sweater on the footpath;  arms tied, as if slipped from someone’s waist while running.  It’s not my kind of thing – the jumper or the habit – but for whatever reason, I pick it up and take it with me.

Like a good luck charm for the day.

* * * * *

I sit at Southern Cross Station, waiting to board.  Fifty other disgruntled passengers stand with me, all waiting for the early morning train, now twenty minutes delayed.  V/Line workers stand there as well, walkie talkies at the ready, some on mobile phones.  All waiting for approval to allow us on board.  A train, willing workers and passengers all stand stationary, silently fuming, herded sheep like a John Brack painting, ready to start the day.  No one, not least the employees, quite understands the hold up.

Ninety minutes later, I walk through the doors of the hospital, familiar from previous locums.  I drop my bag in the staff room, and hurry upstairs to meet the ward round, already thirty minutes late.

“Welcome, Nethers,” calls out one of the Consultants.  “Glad you could make it.”

“Are you here this morning?” says Peg, one of the other Registrars.  “We didn’t think you were going to arrive until this arvo.”

My mouth moves into shape, but nothing comes out.

* * * * *

The day whizzes by, a flurry of action.  There are jobs constantly on the go, always something to keep me busy.  I enjoy locuming, working in other hospitals, being the go-to guy to fill the holes in the roster.  I enjoy the challenge of a new place:  new staff, new corridors, new systems, new protocols.  Most people would hate it, but for whatever reason, I kind of enjoy having things shaken up, keeping me on my toes, dealing with totally new scenarios.

I know, I know.  I’m weird.

I knew it was going to be a long day, but by 10pm, there is no end in sight.   Kids continue to roll into Emergency on this Friday night;  a 22-monther with a febrile convulsion, a three-monther with a breath-holding episode, another with a temperature, this time a six-weeker.

Then, I’m called back upstairs to look at another newborn with a temperature, and then to the ward to review a 13-day-old child with a fever that just won’t subside.  Back up to special care nursery to examine a kid dropping her oxygen saturations, and then back down to look again at the 13-day-old.  She’s been awake for eighteen hours, and just won’t settle.  Kind of like me.

My head hits the pillow at 3.30am, for an entire hour, long enough to fall into a deep, deep sleep, only to be woken at 4.30am about blood results for the hypoxic kid, and and then again at 5.30am.

Eventually I rise at 6.30am, my twenty-four hours on call almost up.  Due to be finished in just on ninety minutes.  This has been a nasty on call.  It’s not usual to be quite this busy.  Just a few more things to check before I’ve earnt two days off.

* * * * *

I stand there, at 7.45am, dazed and foggy, counting down the clock until Peg arrives.  Fifteen minutes to go.  Thoughts float slowly, synapses sluggish, not quite stabilised from my two, hour-long catnaps just before.

I check the computer for an X-ray, one of the baby with the low saturations.  I move the cursor round the screen, changing the saturation of the X-ray.  It does so, but with delay;  a second passing between the cursor movement and the effect occurrin.  As if to copy my own slowed thoughts.

“Paed in delivery!  Now!” comes the call from down the hall.  Right from the Delivery Suite.

“What is it?” someone barks back.

“A twenty-eight weeker.  Crowning!”

I grab my phone, looking for Peg’s number.  I ring it quickly, knowing that I need help.  This is not something for my tired brain alone.

I need back up.

There is a flurry of action, as people rush about, getting things together.  I stand there, willing my phone to work.  Just as it picks up, it drops out.  I try again for the number, my phone stalling like a petulant child.  I power it down and reboot it.  All the time, as people rush about me, I feel the pressure in my vessels building.  I wait for it to start up, groaningly slow.  The name comes up, and this time I use a landline.  Just as it picks up, there is another urgent call:

“We need the Paed in here.  Right now!”

I hand the phone to a nurse by my side, someone I’ve not met, who only arrived forty-five minutes ago.

“This is Peg, the Registrar.  Just tell her she needs to get up here.  I need back up.”

I jog over to Labour ward.  Primal groans come out of Room One, initially muffled, then startlingly clear, as the door is opened, and a nurse runs out.

I walk through the open door, and into the scene.  The resuscitation cot sits there in the centre;  still, while all around is action and movement.  It is lit from above, the white wraps already laid out;  an electric manger.  The scene is framed on all sides by bodies, those of the staff.  I approach the cot, grabbing at gloves from the  box on the wall.  As I do, I see a woman, lying on a bed, a man at her side.  They are both dark – in lighting, skin tone, and mood.  He grips her hand as she sucks on the nitrous, riding through another contraction.  Her belly is stretched, but less than you like to see in childbirth.

This is a small child.

I wrestle the gloves, trying to pull them on.

“What do we know?”

“Walked in of the street.  Thirty-one weeks…”

“Thirty-one now?  Well, that’s a start.”

The nurse leans in.  “On the Methadone program, Hepatitis C positive.”

“Yep.  Keep going.”  The time for subtlety has gone.  That boat sailed when we walked in off the street with a head on view.

“Coorie background.  Oligohydramnios.  Pulmonary hypoplasia.”

“What?  How bad?”

“I don’t know.”  It’s like Chinese whispers.

“Well, we’ve got about five minutes.  She what you can find out.”

I check the Resuscitation Cot, getting things in place.  I pull out the enotracheal tubes, and the laryngoscope for placement.  The oxygen is running, the suction tube is ready to go.  We search for the lines, for access to help give adrenaline when we need it.  Because we will need it.  We’ve got more than enough for ourselves; lack of sleep is little more than a memory now.

With that, Peg bursts through.  She is panting, eyes wide, that urgent look when you first arrive at a terrible accident.

“What do we know?”

“Very little.”

“Twenty-eight weeks?”

“Thirty-one, now.”

“Well, that’s better,” she says, sighing a little.

“But pulmonary hypoplasia.”

She stiffens up again, right back to where she was when she first came in.

It’s even worse than she thought.

* * * * *

to be continued…

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By Mark Nethercote, November 29, 2010 10:00 am

Saturday 28^th November 2009

Gestation: 9 weeks, 1 day

One year ago.

To their credit, everything is ready for the trip within thirty minutes.  Two large bore cannulas are in, the bloods are taken, the paper work is written and copied, and the ambulance has arrived.  In this time, I’ve been out to the car twice, past another melee of drunken schoolies, and returned with our folder.

Yep, we now have a folder.

I make it through the hospital security, my silver flecks of hair and lack of pubescent acne permitting me automatic entry.  That, and not sporting a black eye.  I return to the Resuscitation Bay, where a flurry of action continues to occur around my wife, lying there in the middle.  I move up close to Suse.  There she lies, tears forming at the corner of her eyes.  Her lips begin to quiver, as she stoically attempts to hold them back.

“Do you have a box of tissues here?” I ask.  Both nurses turn blithely, taking stock when they see Suse’s face.

“It’s been a rough couple of weeks, love,” one of them says.

“Month,” I say, a bit too harshly.  “It’s been a month.”

They both smile, almost grimacing, in that way you do out of compassion.  They continue to busy themselves with nothing.

* * * * *

Moments later, the ambulance crew arrives.  Oblivious to the previous mood, they bluster in, all cheer and exuberance.  It is a welcome break.

“Thank you,” one of them says, leaning close to Suse.  “I’m Paul.  We’re very happy to be leaving all of this underage machismo behind us.”

“And I’m Helen,” says the other, “and your round trip up north has bought us half a shift away from the Schoolies foolies!”  They laugh happily.  I almost crack a smile.

Suse is carefully loaded into the back of the ambulance, and we begin our ectopic joyride up the road.  I follow in the car behind.  I turn the heat down, and eventually, the air conditioning on.  I wind all four the windows down.  I turn the music up high, skipping between stations, alternating between House and Drum & Bass.  I bob my head in time to the music.  It keeps me alert.

The ambulance ahead speeds up and slows down, never keeping a steady pace.  I adjust the cruise control in response, happy for an extra task to keep my mind active.  I note the speed signs as we go, and the margin by which we break them.  But it’s the least of my current concerns.

The trip takes an hour.  I pull the car into a spot out front, jogging up to the ambulance to meet Suse as she is wheeled out.

“How are you, love?”

“Pretty damn good.  Paul and Helen have been laughing all the way.”

“Really?”

“They’ve been listening in on what their mates are having to deal with.  With the schoolies.  They keep thanking me.”

“Okay.”

“And they gave me a shot-and-a-half of morphine.”

I nod, looking at her sleepy smile.

“Sounds like your trip was more fun that mine.”

Suse is wheeled in, around past the glassed central work station, a virtual metropolis in comparison to Byron Bay.  Paul and Helen are directed to Room Twelve, five metres beyond a screaming toddler.  As we enter through the door, we see flowers painted on the walls, the neutral pastel colours, and the cottony soft Stayfree pads on the shelf by the bed.

This is the Room of Gloom.

Every Emergency Department in Australia has a room where they put their Obstetric disasters.  Often, these rooms have been decorated;  no longer the uniform, stale cream walls, but a slightly more colourful environment.  You don’t ever want to find yourself in this room, because it means that something bad has happened to you and your baby.

Except, we’re okay with this now.  We faced the gloom a month ago.  Right now, this isn’t the Room of Gloom.  This is the Room with a Door.

* * * * *

We unpack.  Within moments, a swish Latino nurse arrives.  He wraps a cuff around Suse’s bicep, inflating and deflating several times.  Numbers jump on the screen, flashing urgently.

“Wow,” he says, eventually.

“It always runs low,” Suse replies, her eyes closing.

“But, lady, it’s low,” he says, his knees dropping as he emphasises the word nervously.  “And you got an ectopic.”

“She’s a hummingbird, mate,” I add.  “Check the photocopy from Byron.”

He flicks through pages until he fixes on numbers, causing his heavy eyebrows to rise.  “Wow,” he says finally.

“It’s always like that,” I say.

He looks across at Suse, thrusting his hip out at an angle.  “Lady, you don’t wanna lose any more blood,” he says finally, leaving through the door with a flounce.

We are left alone for less than a minute before a large, crotchety thing waddles in.

“What’s the deal with the whole Brock and Nethercote mix up?” she warbles.

“Brock is my maiden name,” Suse says, “And Nethercote my married name.”

“Which is on your Medicare card?”

“Brock.”

“So why did you register as Nethercote?”

“Because it’s my name.”

“No it’s not.  It’s Brock.”

“Okay,” Suse says, closing her eyes.  She looks pale.  “It’s Brock.”

“I’m going to have to change it back to your correct name.”

“Knock yourself out.”

“Sorry?” the woman says, pulling her shoulders back so that her immense cleavage puffs out.  She looks like a wrestler.

“She means, do whatever you need to,” I say.  “It’s been a long night.”

She turns, shaking her head as she leaves, mumbling to herself, readying to lay an egg.

A few moments later, a Doctor comes in.

“Hi, I’m Ed,” he says in an English accent, all lethargy and experience.  He wears a wedding band.  Lethargic English husband.  Instantly, I’m a fan.

We talk.  Ed asks appropriate, relevant questions, before apologising for needing to repeat the blood tests because of the whole Nethercote/Brock naming saga.  We comply.  He performs a quick ultrasound, looking for free abdominal fluid.  He finds none.  Suse donates her blood, but keeps our clot in the jar as a souvenir.

Ed returns sometime later.

“Given that you had methotrexate and you’re haemodynamic stable, I’m not that excited.”  I look at Ed’s tired eyes.

“If a bleeding ectopic won’t get you excited, Ed, I don’t know what will.”  He smiles.  So will we see an Obstetrics Registrar tonight?”

“They’ll come by when they’re free.  Probably,” he adds, scratching his head in subtext.

“Are they in the hospital?”

“Ah, no.  I don’t think so.”

“You’ve spoken to them?”

“Yes.”

“Did they say they would be in?’

“They’re waiting for the results.”

“So we’ll see them in the morning.”

He smiles, exiting.

Within minutes, Suse falls into a slumber.  And I sit there, thinking.  About the bleeding.  About my reaction.  About my panic.  I might be able to hold my cool at work, but I’ve learnt just how quickly that all vanishes when it’s someone you love.  There is a quote, by Sir William Osler, the father of modern medicine:

“A physician who treats himself has a fool for a patient.”

And if he treats his own family, he’s brain dead.

* * * * *

I look across at Suse.  I watch her shallow breathing.  Her pale face.  Her dry lips.  I feel moved to tears as I watch her, finally peaceful in sleep.  I softly touch her hand.  It is cold.  I sit there, watching my precious wife.  Just watching her.

After a few minutes, I get up.  I exit the room, and search the department for blankets.  I find a loaded trolley.  I grab four, and bring them back in, placing them on the floor.  I lie flat on the ground, on a bed of three blankets, a fourth for a pillow.

And I think.

It is now 4.44am.

* * * * *

to be continued…

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By Mark Nethercote, November 16, 2010 10:00 am

Thursday 12^th November 2009

Gestation: 6 weeks, 6 days

One year ago.

We hit the ninety-minute mark of staring at the walls in a hospital cubicle.  In that time, Fluid Lady is wheeled away, screaming at the inhumanity of it all.  And Scabby Man has disappeared, never to be seen again.

“I’m going to ask,” I eventually say, twenty minutes after the entertainment has ceased.

I return two minutes later.

“What happened?”

“Apparently the blood tubes are lost somewhere on the second floor.  It seems that nurse wasn’t the only one unaware of its existence.”

“What, so you choose to go privately and you get worse treatment.  Is that how it goes around here?”

“Let’s watch a movie.  It’s a sure fire way of getting the Registrar to come.”

Two minutes later, he does.  He’s all bluster and bravado, telling us about all of the bad things that methotrexate can do.  Just like a good doctor should.

“I advise Anti-D as well, because of your blood group.  As it is a blood product,” he continues, “it can contain all of the diseases as yet undiscovered, like HIV.”

“You were doing well until then,” Suse says.

“Sorry?”

“I’m pretty sure they discovered HIV a few years back,” she says.

He frowns. “You cannot have the methotrexate until the blood tests come back, in case you have liver disease, or leukaemia, or something else.”

“Sounds wonderful,” says Suse.  “So does that mean that someone has finally discovered the Private Pathology Lab?”

He leaves in a huff.

* * * * *

We talk some more, watch some more, eat some more, and wait some more.  I walk out at half-hour intervals, asking after the bloods.

“This is getting ridiculous,” I say finally, “I’m calling Joel.”

I grab my phone and dial.

“Hey Joel.”

“Hey buddy, how are you?”

“Suse has an ectopic.”

“Oh no.”

“And we’re in your Emergency.  And your mates have lost the bloods.”

“Okay, okay,” he says, pausing for a moment.  “Don’t worry, I know who’s on today.  Just give me a little bit of time.”

Within minutes, we are receiving the Royal Treatment.  We are no longer public patients.  We are mates of Joel.  And as such, we’ve been upgraded to first class.  Progress improves exponentially, the bloods are discovered and processed faster than I could effect at my own hospital.  Maybe Joel really is royalty.

“Sorry about the wait,” says a nurse, rushing in, adjusting her hair.  “Joel says ‘Hi’.”  She titters.

Not the Royal Treatment, more the Stud Treatment.

* * * * *

Suse is given the all clear.  As her liver and blood cells are perfectly healthy, it’s safe for us to poison them with abandon.

“You just have to wait for the porter to take you up to Oncology,” says the nurse distractedly.  The final nail.

We wait another fifteen minutes before we are granted passage.  We are escorted up to the fifth floor.  And here we meet Fadiya.

“You will be safe with me,” she says, her adorable Northern African smile putting us both at ease.  Here is someone who grew up in a harsh country, and who now works in Oncology.  The woman exudes calm.

I resist the temptation to hug her ample bosom, even if just to feel safe.  We sit again and wait.  Fadiya and a garrulous old chook check the drug dose.  I do too.  From thirty feet, I strain my eyes to see the dose, trusting Fadiya, but not the battery hen.  They calculate the amount correctly.  All good.

“You know what?” Suse says, breaking me from my spell.

“What?”  I look back around.  There I see my wife, a serene look across her face.

“Being somewhere like this puts things into perspective.”  I stare at her, not quite understanding.  “I may have an ectopic,” she continues, “and this may be a really shit situation we are in.  But, Mark, I do not have cancer.  I will not be returning to Oncology anytime soon.”

She squeezes my hand lovingly.  I look at my beautiful wife a while longer, wholly unsettled by the thought.  A moment later, our African queen returns.

“Now, my dear woman, this one will hurt,” she says.

“That’s okay,” Suse says, “It could be worse.  A lot worse.”

“Which cheek?”

“The left.”

Suse stands, leaning against me.  ‘I love you,’ she mouths, a peaceful smile extending across her lips.

“We’re going to be okay,” I whisper.

Fadiya takes aim, the needle goes in, and the plunger is pressed.  I watch the smile on Suse’s face dissolve, replaced by a look of shock.  The squeeze on my arm tightens, as she struggles to take an in-breath.

“Woah,” she says finally.

“I was right, yah?”

“Yah,” Suse says.

“And the Anti-D?” I ask.

Fadiya looks.  “It’s yet to be written up.”

The marathon is yet to be completed.

We wait some more, this time for the Resident.  A lovely fresh-faced whipper comes in.  He crouches and explains, and then writes the all-important words on a piece of paper.

Fadiya jabs the other buttock, and we are free.

A mere five-and-a-half-hours later.

* * * * *

We walk in the front door.  It’s warm inside.  We are the picture of solidarity.  The afternoon went okay, really;  as well as an afternoon can go where someone injects your wife with poison.  I’m frustrated at the time we spent there, and that paying for blood tests actually wasted an extra two hours.  But I was there to support Suse.  And in the end, that’s all that really matters.

“Why don’t you call in sick tomorrow, love?” she says.  I stand still.  “We’ve got our workshops on the weekend.  And I could really do with you being around tomorrow.  Just think about it.”

“Okay then,” I say, thinking for a moment.  “I’ll do that for you.”  I smile.

She smiles back.  For a sweet moment, we stand there.  Almost happy.

And then she walks to her bag.

“What are you doing?”

“Don’t come outside for a bit,” Suse says.

She is going outside for a cigarette.

This is not the behaviour of a rational human being.  So, my reaction mirrors it.  Building on itself, minute after minute.  All I can see, is that after chemotherapy, she has gone outside to suck down some more toxin.  So, if my wife is so intent on harming herself, I don’t want to have to smell it.

I open the front door.

“Don’t come outside!” she yells.

“Then get off the property!” I yell back.  “I can smell it in here!”

I am white with rage.  I am fuming like her fucking cigarette.  How can this woman, this strong woman – this glorious woman – smoke?  How can she poison herself like this?  How can she do that to me?

I take it all personally.  All of it.  I know I can choose how I react, and right now, I choose to be furious.  Fucking furious.  A whole narrative swirls around my head.  That this is about me.  That this is sand in my face.  That after five-and-a-half hours of standing by her side, of being there for her, of being everything a husband can be, she does this.  She does this to me.  Fuck me.

I storm from room to room.  I turn on lights, walk in tight circles, before blustering out again.  I end up in the study, staring at a blank screen.  Suse slinks back inside, heading straight for the shower.  I hear the water start;  the whirr of the electric toothbrush washing away the stench.  The fucking stench, getting in and killing even more cells.  How thick.  How fucking thick.

After twenty minutes she emerges, to make dinner.  I stay in the study.  She calls me, and I come out.  We eat in silence.  There is nothing else for it.  She asks me, on occasion, whether I want some more.  In a soft voice.  In a voice softer than I have ever heard before.

I say no.  I say nothing.

We sit and watch something;  who knows what.  We watch all the way to the end.  To the very end.  And still, it lasts not nearly long enough.  I am still white with anger.

All I can do is disappear.

I retreat to the study.  And I write.

This is all I can do.

This is my therapy.

* * * * *

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By Mark Nethercote, November 15, 2010 10:00 am

Thursday 12^th November 2009

Gestation: 6 weeks, 6 days

One year ago.

My phone goes again.  I take it out and look at the screen.  I see a picture of Suse’s laughing face, a grin on our wedding day.  I take a deep breath.

“Hey love.”

It’s another one of those calls.  I can sense it already.  Of course, the reception is bad.  But even through the noise, I get it.

“Et…”  Sigh.

“Sorry?”

“I’ve…”  Cry, sob, sigh, crackle.

“One more time, honey?”

“And…”  Another sob, another sigh.

“Look, this line is really bad.  I’ll ring you straight back.”

I hang up the phone and dial.

“Hey, love.”

“I’ve got an ectopic, Mark.”

“What?”  My world spins anticlockwise.

“It’s an ectopic.  They missed it on the earlier scans, or they couldn’t see it.”  She trails off.

“Where are you?”

“East Melbourne.  At the ultrasound clinic.”

“So what now?”

“Kath wants to see us.”

“Are you all right?  I can get a cab over there if…”

“…No, I’ll drive over to you.  I’ll pick you up.”

“Are you sure?”

“Yes.”

“Is that safe?”

“Don’t start, Mark.”  My world keeps rotating.  “Can you meet me?”

“Of course.  I’m gone.  They’ll cope.  I’ll meet you whenever you want.  You say when.”

“I’ll ring when I arrive.”  She hangs up.

I look around the room, like I’ll find an answer.  I head out.

“Are you ready for your next patient, Mark?”

“Ummm, I might be a moment, Raelene.”  I walk out of the front doors of the clinic, and then straight back in.  I lean my head over the desk.  “Raelene, I’ve just found out my wife’s got an ectopic,” I whisper.

Her mouth opens wide, before she closes it again.

“Say no more, everyone is gone.”

“Thank you.”  I walk out the door, leaving everything behind.

* * * * *

“Well, when an ectopic is this size, we can usually get away without surgery.”

“Really?” we both say.

“Yes,” Kath continues, “we can use methotrexate.  As a drug treatment rather than a surgical one.”

Our glamorous obstetrician sits back in her chair.  I think about methotrexate;  a drug for cancer, severe arthritis, refractory inflammatory bowel disease and other such conditions that, simply, will not respond to kinder things.  My mind whirls like a top.  It’s today’s trick.

“Chemo?”

“With a Beta-HCG less than 3500, and a sac smaller than 3cm, methotrexate is our preferred option,” Kath purrs.

I shake my head nervously.  I list my apprehension about side effects, like they’re pending humanitarian disasters.  I’m Woody Allen in a title fight;  laying out each concern with a feeble punch.  She absorbs each blow without even flinching.  Eventually I give up.

“What do you think, hon?” I say, turning to Suse.

“Have I got a choice?”  We both look back at her.  “I mean, really.  This pregnancy has to end, right?  I have no choice in that, do I?”  She sighs, pinching at her eyes.  “And if this might save my tube, then we’ve got to do it.  Don’t we?”

We all sit for another moment.

“So what do we do?” I ask.

“It needs to be done through the public hospital.  You’ll be admitted downstairs through Emergency, and then you’ll go up to Oncology.  It’s just a single shot.”

Fittingly, they don’t deal with dirty drugs like methotrexate privately.  We have to go and wait in Emergency for the public doctors to hand over this grubby injection.

* * * * *

We stand at the Triage Desk, a man in front of us.

“Is this Emergency?” he asks.

“Yes, it is.”

“I’ve got a problem with my abdomen.”  He points, lifting his kaftan and lowering the front of his tracksuit pants as he does.

“This is a women’s hospital.”

“Oh,” he says.  He walks away.  One of his thongs falls off.

“Can I help you?” the Triage Nurse asks.

“Hi,” Suse says.

With that, another man pushes in front of us.

“ ’Scuse me,” he bellows, scratching at the scabs on his arms, “Can I get through, please?”

“You just interrupted this lady,” the Triage Nurse says, cranking her bitch-voice up to nine.

“Oh sorry, love.”  Scabby Man goes to touch Suse on the arm.  I slap his hand down.

“Just ask your question, mate,” I say.

“Thanks, mate,” he says, turning to the counter.

“Do you know any of the patients in the Department?” the Triage Nurse asks.

“Nah, I just want to be in the vicinity of someone pregnant.”  We all raise our eyebrows.  For me, it’s in response to him knowing the word ‘vicinity’.  “But if you could point me in the direction of me partner, that would be great.”  Scabby Man laughs in my direction, rolling his eyes, picking at crusts.  It’s the ‘all-women-are-stupid’ eye roll.  I smile thinly.  He wears a blue singlet, revealing a variety of Asian symbols tattooed on his arms and back, unaware that they announce to all of Vietnam that he’s a cunt.

“If you would just wait, sir, I’ll be with you shortly.”

“No problem, no problem.  You guys feel free to go first.”

Suse smiles, and then begins to tell her story.  She uses the right emphasis on the word ‘ectopic’, she highlights her level of pain, and she appropriately mentions her recent bleeding.  Throughout at all, Suse remembers the rules of engagement.

“You won’t have to wait too long,” the Triage Nurse promises.  As we walk to the seats, Suse winks at me.

We sit.  The waiting room is empty, bar one other person.  That woman is very pale, blending in well with the wall.  Scabby Man is eventually let through.

“How’s your pain right now?” the Triage Nurse asks again.

“Oh, not great,” Suse replies.

We sit for three whole minutes.  Suse reads an old magazine, while I try to make out the breathing wall opposite, finally seeing her yellowed teeth as she smiles.

“Come through, love.”

* * * * *

First stop is the ancient porcelain scales.

“Wow,” I say.

“Aren’t they magnificent?” the nurse proudly replies.  “They’re from the old hospital.”  Suse is weighed in quarts, which are converted into bushels for simplicity.  She moves to the tape on the wall beside, which measures her in centimetres.  The old and the new.

We are ushered to Cubicle Six, to commence our vigil.  For a while it is novel;  it takes Suse fifteen minutes to even lie on the bed.  Eventually another nurse walks in.

“I’m here to take some blood.”

“We already did that upstairs.”

“Oh, right,” the nurse replies.  “Where exactly?”

“At the private lab on the second floor,” Suse says.

“There’s more than one lab?”

So they say.

* * * * *

We sit and wait.  We talk.  We check emails on my laptop.  We talk some more.  And we listen.

Within earshot, in an unseen cubicle, a woman is in pain.  It quickly becomes clear that she is in labour, is carrying too much fluid, and has battered veins following recurrent blood tests.

“I could really do with a fucken’ ciggie and a Jim Beam,” she says with emphasis.

“I just don’t understand why you need all these tests,” says a man.

“This has nothing to do with you!” shouts another unseen female.

“Yeah, all right, all right,” says the man, defending himself.

“Scabby Man found his partner,” I say to Suse.  She nods.

“So just remember, that this has nothing to do with you!” the screaming continues.  “And mind your own fucken’ business!  ’Cause you’ve got shit for brains!”

Everything goes quiet for a minute, before Scabby man appears outside our cubicle.  He stands there pensively, scratching.  He looks across at us, like we might be able to help.  We look away.

“This is my business!” yells the unseen man from the cubicle.  I look at Suse, frowning.  This isn’t Scabby Man in the cubicle;  this is another one.  There are two Scabby Men in the same department.  Cast from the same crusty mould.

“You’ve got shit for brains and you know it!” squeals the second woman.

Everything goes silent.  After a couple of minutes, the conversation starts up again, labouring on about everything else but that.  Fluid Lady starts to talk about her fear of needles, and the excruciating pain of the blood pressure cuff when it blows up around her arm.

“What does she think child birth is going to be like?” Suse asks.

I look back, and shrug.

And all the while, Scabby Man stands there scratching.

TO BE CONTINUED…

* * * * *

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By Mark Nethercote, May 11, 2010 12:04 pm

Good Weekend Magazine, The Age, Saturday 8th May 2010.

The entry was an edited down version of our original email, sent to guru@fairfax.com.au, on 22nd December 2009:

My wife and I were recently travelling cattle class on a plane trip to Brisbane.  The man next to us, an ageing, yet hip gentleman, listened to his treble-heavy music through his iPhone while he dozed.  My wife ordered a cup of tea, and through turbulence, spilt some milk on this gentleman’s striped black trousers.  It was not enough to wake him immediately, but had potential to do so after soaking in.  What is the etiquette in this situation:  does it depend on the depth of the sleep, the amount of milk or the blend of the fabric?

M.N., Richmond, Vic

It seems that they are not made up, after all…