A brief reference to foetal abnormalities in this chapter.

Boy Wonder

by

thedragonaunt

Chapter One

'You will remember the appointment, won't you?' asked Molly, standing in the doorway between the kitchen and the hall, just about to leave for work.

'Yes, I'll remember,' Sherlock replied, not looking up from checking his emails. The last ten hours had garnered a bumper crop of over a hundred, all of which would need to be triaged and either blocked, deleted or starred for further scrutiny.

Molly was not convinced.

'Remember, it's three o'clock in the Radiography Department at Maggie's,' she declared.

'Yes,' he replied, still not looking up.

Molly crossed the room to stand in front of him.

'Put a reminder on your phone,' she insisted.

'I don't need to,' he replied. 'I've got it covered,' still scrolling through his emails, blocking, deleting and starring at breakneck speed.

'Sherlock!' Molly exclaimed.

At last, he looked up, directly into her eyes, slid his thumb across his phone screen then turned it to face her. There, in the Calendar app, on today's page, she read,

3 pm - Twenty-week scan – Maggie's

'I told you I had it covered,' he smirked. Then, by way of an apology for being so deliberately annoying, he reached out and pulled her to him, wrapping his arms around her hips and pressing his cheek to her five-month baby bump. 'Wouldn't miss it for the world,' he cooed.

Molly rolled her eyes but ruffled his hair before dropping a kiss on his head.

'Alright. See you there,' she replied, slipping out of his grasp and heading for the exit, pausing only to stroke Redbeard on the head and tell him,

'You stay, be good boy,' which was the stock phrase they all used to let the puppy know he was not included in the away party.

'Love you!' Sherlock called after her.

'I know!' she called back, before closing the front door behind her.

Sherlock grinned to himself as Redbeard came over and laid his head on his master's knee.

'You're going to the park with Marie, later,' Sherlock assured him, stroking his silky head and scratching him behind the ears - then got back to checking his emails.

It was the second week of the school summer holidays and the Hooper-Holmes household had settled into its school holiday regime.

For Molly, it was business as usual, off to work in the Pathology Department at St Bart's. William was away on a tour with the cathedral choir in Scandinavia but would be home again at the weekend. Freddie had quite a busy schedule of rehearsals, for the dance competition at the end of July, but they were mostly in the evenings and at weekends so his days were fairly free and Violet, who wasn't due to start school in the Foundation department for another two terms, was enjoying Freddie's company and having a companion to play with. And for Sherlock it was also business as usual, as if anything about his business was 'usual'. Every day was different and one never knew when or where the next big case would present itself. It could be in one of these emails…

Freddie and Violet were up on the top floor with Nanny Marie, brushing their teeth and getting dressed. Marie had promised them a trip to the playground in the local park so they were both being super co-operative. Once he had waved them all off at the front door, Sherlock would shower and shave and leave for 'the office', 221B Baker Street.

ooOoo

When Molly entered the waiting room of the Radiology Department at St Margaret's hospital, ten minutes early for her three o'clock appointment, she was pleased to see that Sherlock was already there, lounging in a plastic chair, perusing one of the magazines left on a side table for the convenience of waiting patients.

'Ah, you made it!' he exclaimed, as if there was any doubt. Standing up, he greeted her with a chaste peck on the cheek.

'Yes. I worked through my lunch hour,' she replied as she took a seat beside him.

Like all the staff in Molly's department, she was allowed time off to attend medical appointments that could not be scheduled outside of working hours but also, like all the staff in her department, she was loath to put extra strain on her work colleagues, hence working through her unpaid lunch break.

'Do they know you're here?' Sherlock asked.

'Yes, I registered on the digital touch screen on my way in.'

'I hope you cleaned it first.'

Sherlock was horrified when their local GP surgery introduced digital registration rather than reporting to a receptionist, just imagining the accumulation of bugs on the touch screen. Whenever he took one of the children to the surgery for any reason – usually routine vaccinations - he always insisted on cleaning the screen before he used it and kept a small bottle of alcohol hand sanitizer in his pocket for that express purpose

'No, but I washed my hands after,' Molly replied. 'What are you reading?' He still held the magazine in his hand.

'Oh, nothing of importance,' he huffed, tossing the magazine back onto the side table. 'Just passing the time.'

'You realise that's probably covered in bugs, too,' Molly observed.

'Yes,' he replied, taking the sanitizer from his pocket and cleaning his hands.

'Molly Hooper-Holmes?'

They looked up to see the radiologist – the same person who had carried out their twelve-week scan. June, as her ID lanyard read, smiled and led them down a short corridor into a dimly lit side room that contained an examination couch, the ultrasound equipment and two chairs – one for the radiologist and one for the accompanying person – in this case, Sherlock.

'Lovely to see you again, Dr Hooper,' said June. 'It's been a couple of months since your last scan. Has everything been OK?'

'Yes,' Molly replied, '…well, apart from the sickness but that's pretty normal for me. And that seems to have resolved itself, at last…so now it's just heart burn.'

While they were talking, Molly removed her coat and shoes and climbed onto the couch. She lay on her back, pushed her maternity trousers down to her hips and pulled her blouse up to expose her belly.

Sherlock took the seat next to the couch, with the same frisson of anticipation he always felt just before the modern technological miracle of ultrasound afforded him a sneak peek into the age-old miracle of human reproduction. And, as usual, he was reminded that his contribution to this enterprise had been a mere few minutes of his time and a very pleasurable experience. It was Molly who was making the biggest commitment, taking two individual cells and turning them into a brand new human being. He could never compete with that! Womb envy, he was absolutely certain, was the root cause of misogyny wherever it occurred in human society. But for him, the sense of awe and wonder never dulled.

'I see from your notes you've opted for a hospital delivery this time,' June remarked, as she tucked tissue paper into the top of Molly's trousers and under her blouse, to protect them from the contact gel.

'Yes, well, after what happened with Violet, the community midwife thought it best,' Molly replied.

Neither she nor Sherlock cared to be reminded of how close they had come to losing Violet on that awful night, two years before.

'But I'm pretty sure that her precipitous birth was caused by external factors so I'm not overly concerned…'

Molly taking a tumble during a completely uncharacteristic tantrum by Freddie had almost certainly been the cause of Violet's early and rather hasty arrival.

'…and they said I can still have a water birth at the maternity hub so, although I would have preferred a home birth, I'm OK with a hospital one.'

'Right, let's have a look,' said June, applying the contact gel to the probe and beginning to run it over Molly's baby bump. 'Gosh, this is a lively one!' she exclaimed.

'Yes,' Molly replied. 'We call him Joey…'

'Oh! Do you know the sex?' June exclaimed. 'I have you down in my notes as not wishing to know.'

'No, we don't know and we don't want to know,' Molly replied. ''Joey' is a reference to baby kangaroos, that's all. And 'he' because…well, Joey is sort of a boy's name, I suppose. And it sounds better than 'it'.'

'Well, he/she/it is certainly living up to that name at the moment. Quite the little wriggler.'

'It's probably because I've exposed my belly. He maybe thinks it's Daddy Massage time.'

The radiologist looked slightly nonplussed and Molly realised too late that she might have given slightly the wrong impression so hastened to put that right.

'My husband gives me a bio-oil massage every night, to ward off stretch marks. Joey really enjoys them.' She grinned at Sherlock and he quirked an eyebrow in response. He actually found it quite endearing that his wife had not lost her propensity for accidental innuendo.

'Well, it seems to be working,' June replied. 'However, while we wait for Junior here to settle down a bit, I know I don't really need to go through this with you, Dr Hooper, but it is protocol so I must…' and the radiologist went on to explain the purpose of the twenty-week or 'mid-pregnancy' scan.

'The purpose of the twenty-week scan is to check that the baby is developing normally. So, we're looking to see if there are any anomalies. We look in detail at the baby's bones, heart, brain, spinal cord, face, kidneys and abdomen.

Obviously, there are some conditions that ultrasound can't detect but there are a number of extremely rare ones that it can and those are what we're looking out for, specifically anencephaly, open spina bifida, cleft lip, diaphragmatic hernia, gastroschisis, exomphalos, serious cardiac abnormalities, bilateral renal agenesis, severe skeletal dysplasia, Edwards' Syndrome and Patau's Syndrome.' She wouldn't normally list the actual conditions for fear of alarming lay patients but she made an exception for this particular patient, being a member of the medical profession.

Molly was familiar with all these conditions, mostly through her medical training as they were very rare indeed – as few as one in ten thousand births, in the case of some - but she had come across a few individual examples in her professional career. For the last four conditions on this list, there was no treatment and no cure and the prognosis for the baby was extremely poor. In such cases, the parents would be counselled on whether to continue with the pregnancy or to terminate.

She and Sherlock were grateful they had never been faced with such a decision but they had agreed that they would be guided by what was best for the child. However, that did nothing to alleviate the apprehension they both felt at this point in the process. It was always a huge relief when no obvious problems were exposed.

'OK, our little friend seems to have settled down a bit so let's have a good old look,' June announced and, after applying more contact gel, resumed running the probe over Molly's abdomen, putting a pause on all chit-chat and banter as she focused exclusively on the task in hand.

The screen was angled toward the radiologist so neither Sherlock not Molly could view it. Instead, they looked at one another, both thinking the same thing – hoping that everything would be alright. Sherlock took Molly's hand and gave her an encouraging smile. Whatever the outcome, they would deal with it together.

After what seemed like an age but was probably just a few minutes, June sat up straight and said,

'Well, that all looks totally satisfactory. Would you like to see the little perisher?'

Both expectant parents breathed a sigh of relief and, of course, the answer was a resounding Yes! June adjusted the screen so they could both see it, and ran the probe slowly across Molly's belly.

In the monochrome 2D ultrasound image, fluid appeared black, bone white and soft tissue grey. It was difficult to make out what they were seeing at first but then a white blob on the right side of the screen revealed itself as the baby's forehead. The foetus was lying on its back, curled in the classic foetal position but, as they watched, different body parts appeared out of the gloom of the amniotic fluid – a hand with fingers outstretched, two knees, an arm and another hand, this time with fingers curled into a fist, then the soles of two feet, side by side - and disappeared just as quickly. Then the baby's face presented itself in its entirety.

The lack of subcutaneous fat gave it the appearance of a skull, with two large 'bubbles' in the eye sockets, which were the lenses of its eyes. The nostrils showed as two black dots, being full of fluid, and the grey 'moustache' below the nostrils was the baby's top lip.

As they watched, Joey rolled to the side and gave them a full head profile, with the nose, lips and chin perfectly aligned. The lips were moving as though it was sucking.

'He's having a drink,' June explained. 'I've already checked and there is fluid in the stomach and the bladder, so we know Baby is swallowing and that the kidneys are working properly. He'll be peeing that out in a short while and then drinking it again. Foetuses are excellent recyclers!'

The little wriggler rolled again, presenting its rear view to the probe. The spine was perfectly formed, all the way down to its tail bone. And as it rolled again, they could see the ribs coming off the spine and something moving within the chest cavity.

'There's his heart,' June advised, pointing to the screen. 'It looks black because of the blood inside it. You can see all four chambers. And the valves, opening and closing. And there's the foramen ovale.' This was the hole between the right and left sides of the heart that allowed oxygenated blood to by-pass the baby's lungs, since oxygen was being provided through the umbilical. This hole would close up soon after birth.

The foetus rolled over again and stretched out its legs then drew them up once more, resuming the foetal position - legs crossed at the ankles, arms crossed at the wrists - before disappearing back into the dark gloom of the amniotic fluid. Because the baby was only about six inches long at this stage, it had plenty of room to move around and was certainly taking full advantage.

'Well, that was quite a show Joey put on for you,' June exclaimed, removing the probe from Molly's belly and inviting her to use the tissues to clean up the gel residue left on her skin.

For Molly, feeling the baby move inside her womb while at the same time watching its actual movements, had been a rare treat. From now on, every time she felt those movements, she would be able to picture the baby performing them, in her mind's eye.

For Sherlock, this was the closest thing to a religious experience he could ever have imagined, to be given a glimpse into the baby's secret world. He felt almost like a voyeur. And, more than anything, he wanted to throw himself at Molly's feet and worship her as the goddess she was, as every woman was, who performed the miracle of child-bearing.

'Are you OK?' Molly asked, as she swung her legs over the side of the couch and stood up, before pulling up her trousers and pulling down her blouse.

He just nodded, not really trusting his voice.

'I managed to get a lovely profile shot,' said June, turning towards them, having printed off a screen shot from the scan. 'Who wants it?' she asked.

'You have it,' Molly said to Sherlock, leaning on his arm while she pushed her feet back into her shoes.

'Don't you want it, to show your friends at work?' he asked.

'No,' she replied, with a smile, 'They all know what a foetus looks like and I have the real thing.' She ran her hand over her belly then gave it a little pat.

Sherlock took the image from the radiologist with a nod of thanks. Another one for his collection. He had all the ones from the previous three pregnancies, safe in a box in the bottom drawer of his chest of drawers; even William's, though he hadn't been around for that particular gestation.

'Oh, just one more thing, before you go,' said June. 'I wonder if I could ask you to take part in a little public consultation being carried out by the hospital trust?' She picked up a couple of printed sheets, stapled together, and held them out, hopefully. 'The Obstetrics Department has been charged with devising a protocol for gender inclusive language for use in our maternity services. We're asking all our patients to give us some feedback on what we've come up with so far. Would you mind?'

Molly felt a surge of sympathy for the radiologist. From time to time, St Bart's carried out this sort of thing. Fortunately for Molly, her department's clients weren't really available to give feedback so she was usually let off the hook.

'Yes, why not,' she replied, accepting the document.

'Oh, thank you,' June exclaimed, relieved that at least one of her clients had agreed to help out with this onerous task. 'There's no rush. If you could just hand it in at your next antenatal visit, that will be lovely.'

They said goodbye and departed.

'Are you coming home now?' Sherlock asked, as they exited the hospital through the Main Entrance.

'No,' Molly replied. 'I said I'd go back and finish my shift. What about you? Any new cases today?'

'Nothing I can't solve via Twitter,' he replied, which meant he would head back to East Smithfield.

'Well, I'll see you later, then,' said Molly, turning to him for a parting kiss.

He enveloped her in his arms for a heartfelt hug.

'Thank you so much,' he whispered. There was no need to explain for what.

ooOoo

Many thanks to YouTube and UTSW Med for the video 'Understanding your foetal ultrasound' 14 May 2019, on which I based Joey's scan.

Also, Maggie's is a completely made up hospital. As far as I know, there is no St Margaret's Hospital in London. If there is, any similarity between it and the hospital in this story is entirely unintentional.

ooOoo