House was in the differential room when his phone rang. Chase watched him as House listened seriously at the voice into the receiver.
"I'm on my way" he said suddenly exiting the room without looking at anyone and heading quickly toward the elevator.
He opened the exam room door without knocking. His worried look immediately looked for his wife. She was lying on the examination table. Her eyes were closed and her left hand was on her forehead while Addison was arranging a double drip on Lisa's right arm.
"I'm going to admit her, Greg" Addison said looking up at him and approaching him.
She handed him a cardiotocography pattern.
"She's having contractions and her cervix is already 1 inches dilated. I'm administering her some magnesium sulfate and a tocolytic agent to try stop her contractions ... I'm trying to slow her pre-term labor to earn time and I'm giving her even steroids to accelerate the development of twins' lungs. She's very upset right now but I can't give her a tranquilizer ... if I can't stop her labor I can't risk the babies have a drug-induced respiratory depression after birth... "
House looked at her and said nothing.
He approached Cuddy taking her hand and kissing her forehead.
"I'm here" he whispered.
Cuddy opened her eyes and looked around. The drip was still attached to her arm and the monitor next to the bed constantly kept monitor her and her babies. The light was dim and it was still dark outside the window. She turned her head toward the armchair beside the bed where House was asleep. He woke up feeling her moving in bed.
"What time is it?" she whispered looking at him.
He glanced at his wristwatch.
"It's five o'clock in the morning" he said "How are you feeling?"
She shook her head and closed her eyes as a tear ran down her cheek.
"I'm...scared ..." she whispered.
House went to the bed and took her hand kissing her gently and caressing her face.
"It's too early..." she whispered as another tear ran down her cheek "They're still so... little..."
"Don't worry ... and try to relax ..." he said softly " at 34 weeks their survival odds are 98% and the risk of neurological complications is low ... they should weigh at least 4,5 lb each... their lungs aren't completely mature yet but perhaps they shouldn't need to be put on life-support system ... sucking reflex ripe at this pregnancy stage and they will probably be able to eat without a feeding tube... "
"I can't lose them..." she whispered closing her eyes.
House didn't answer. He didn't know if he had to be objective or whether he had just to console her by pretending a fake calm. It was easier for him just to analyze the facts. A pre-term labor at 34 weeks was a risk for their babies. Respiratory distress, neurological complications, low weight, feeding difficulties, impaired regulation of body temperature... without forgetting the possible effects on the mental health of the mother in case of a negative epilogue... He tried to dismiss that thought. On the other hand he couldn't deny that any fetuses survive even when born at only 25 or 26 weeks.
"Did you called your mother?" she asked trying to change the subject
House nodded.
"My mother wanted to come here, but I convinced her to wait for news at home"
Lisa nodded her head.
"I called your mother and Julia too" he said "they'll come to visit you in the afternoon"
Cuddy nodded her head again.
"It's not the Thanksgiving I hoped ..." she said as he stroked her hair.
He looked at the monitor and held her hand anticipating a new contraction that he saw appearing on the screen. Cuddy took a deep breath trying to focus on breathing and not on the pain radiating from her belly to her back. It lasted just 30 seconds but it seemed like an eternity to her.
Addison came to examine her at about 8 a.m.
"May I go to the toilette first? I have to pee..." she asked
"Sure" Addison answered.
House accompanied her to the bathroom and supported her in the few steps to go back to bed. He felt her stop suddenly leaning on him.
"Oh God..." she whispered looking at him with scared eyes as a hot liquid ran down her legs "My waters broke..."
"Breathe ... Lisa... breathe" House said as she squeezed his hand during a particularly painful contraction.
Cuddy was being in labor for about three hours and was 3 inches dilated. By now Addison was well aware that birth was imminent.
"Call Dr. Janson, the neonatologist, and alert the Neonatal Intensive Care Unit" she said pointing to the nurse before returning to deal with Cuddy. Typically the Head of Gynecology and Obstetrics didn't deal of labor...that was a task of midwives, but this time the woman in labor was her best friend so Addison didn't want to leave her alone.
"Dr. Janson is on holiday today" the young nurse said after a minute putting down the receiver.
Addison glared at her and snatched the phone from her hand.
"Janson. It's Montgomery." she said in an authoritative tone "I really don't care if you're already gorging on turkey! I have OUR Dean of Medicine on pre-term labor at her thirty-fourth week of pregnancy and twins coming up with possible respiratory distress. BRING YOUR ASS HERE! NOW! Or... don't come in MY ward tomorrow!" She shouted before turning off abruptly the call.
She took a steadying breath and turned to House.
"He's on his way." She said regaining her professional tone.
"Come on Lisa ... push..."
Addison watched as she fell exhausted with her back on the bed trying to breathe. She was pale and sweaty and visibly very tired. House was next to her and held her hand stroking her hair. He wasn't the gruff and domineering diagnostician at that time but just an husband and future-father in anxiety.
"I can't take it anymore..." she moaned as her breathing accelerated for the arrival of another strong contraction.
"I know you can... Lisa. C'mon... again ... push!"
Cuddy lifted her back from the bed and squeezed House's hand as she pushed with all her energy.
"Don't stop Lisa... keep pushing...I can see the head ... "
Cuddy held her breath and screamed as she pushed harder and felt a very strong and painful pressure in her perineum.
"Here's the head..." Addison said smiling "C'mon just another little push, Lisa"
This time a small push was enough and she felt the sensation of that little body slipping out of her.
"Here she is" Addison said with a smile holding Madeline in her hands.
Cuddy held her breath and looked at House. Madeline hesitated only a moment before filling the delivery room with her crying. Cuddy felt tears run down her cheeks as House tenderly kissed her lips.
"House" Addison said handing him a pair of scissors and pliers to cut the umbilical cord "Do you want to cut it?"
He cut the cord and looked at his daughter. She was small but rosy as she kept crying. He held her in his arms and lightly touched her smooth cheek kissing her on the forehead as she relaxed in her daddy's arms. He couldn't look away from her and... as she wrapped her tiny hand around his index finger he realized that from that moment she had wrapped him for life. So that was the feeling of a father toward his child. He didn't want let her go from his embrace but he knew he have to. He whispered a barely audible "I love you" in her ear before giving her to Janson.
"Apgar score 9" Dr. Janson said as he check her respiratory tract "5.0 lb" he looked at House "Her reflexes are ok. Her breathe is ok. Congratulations!" He said.
He put Madeline again in House's arms. She was now wrapped in a pink sheet.
"I'm going to put her in the incubator a few hours just to be safe." Dr. Janson added "But first of all, House, let her meet her mother or tomorrow I'll have to find a new job!" he said laughing and giving House a pat on the back.
House approached Lisa holding Madeline in his arms. She looked at her and gave her a little kiss on the cheek.
"See you later, Mommy" House said handing Madeline to the nurse.
Cuddy felt the abdominal tension of a new contraction. It was not over yet.
"Come on, Lisa. It will be easier this time" Addison said
"Remind me why I didn't want a C-section ..." she whispered looking at House as her breathing returned to be fast and shallow.
"You did very good" he whispered to her "Madeline is healthy and beautiful. And she's waiting to meet her brother"
William was born about an hour later.
"C'mon Lisa ... one last push ... I can see his head"
"I can't ... please... I can't...William please" she whimpered as she felt her forces lacking that last effort
"Lisa, look at me" House said looking into her eyes "just another push and it's over. Just one..."
She felt the contraction coming and pushed again failing to suppress a scream as William slipped out and the pain suddenly vanished. She fell back on the bed while William's crying echoed in the room. House cut the cord again and held his son as he did with Maddy before reluctantly giving him to Janson.
"5.5 lb. Good boy" Janson said before giving him to House. "Congratulations again!" he said as House held his son in his arms and carried him to Lisa.
She smiled and kissed him on his tiny cheek. Again House handed their baby to the nurse.
"Go check on them." Cuddy said with a tired but beautiful smile "I'm fine."
"Ok" he said kissing her gently on the lips "I'll be back soon. Don't go away." he greeted her with a wink.
Addison was now attending to Cuddy during the expulsion of the placenta.
"Add another vial of oxytocin in her drip" she said pointing to the nurse who was at her side.
She began massaging Cuddy's uterus. She was losing more blood than expected and this wasn't a good sign.
"Bring me her medical folder" she said to the nurse.
The nurse approached and stood with Cuddy's folder opened in front of Dr. Montgomery as she looked for the information she needed. Blood type: A Rh +.
"Half an hour after William's birth. Placenta should have been already expelled" Addison thought as she kept to massaging Cuddy's uterus to help it to contract down.
The uterus atony was a complication reliable in twin pregnancies because of the hyper-distension of the uterus. Muscle fibers lose their elasticity and contractility resulting in severe postpartum hemorrhage.
"Damn ..." Addison let out looking at the clock hanging on the wall of the delivery room.
Oxytocin wasn't working.
"A vial of Nalador in 500 ml of saline. In fast intravenous infusion." she said to the nurse
House entered the delivery room door at that precise moment and glanced at Addison.
"I don't feel well ..." Lisa suddenly whispered.
House saw her turn suddenly pale. She was sweaty and her skin was cold. She could hardly keep her eyes open and her breathing was now labored, shallow and fast.
"She's losing too much blood." Addison said "I need four bags of A+ blood! NOW!" She ordered to the nurse that immediately ran out of the room.
House looked at the monitor. Cuddy's blood pressure was falling. She was tachycardic. Her oxygen saturation went down. House felt as if he couldn't move as he saw her on the verge of losing consciousness. He didn't need to ask questions to guess what was going on.
to be continued...