Chapter 3: Esme (Part 1)
Two days.
Alice had told him he would be 'stuck' in the hospital for two days after his shift. Given how loudly the winds were now howling, he knew she was right. He, or rather any human, who did not wish to risk a broken neck or freezing in their broken down car, was advised to shelter wherever they were.
Luckily the weather had been dreadful for the past few days and many staff, including most doctors, had already made their escape from the hospital and gone home. It had taken a bit of effort, carefully readying his excuses when Dr. Stewart, the superintendent of the hospital, had told him to go home too.
"Your new kid and wife would be alone at home!"
It had indeed taken effort, but Carlisle had reassured the worried man that his wife and Renesmee were both safe in Seattle, visiting family. And if he went home, he would be all alone in the middle of nowhere.
Truth was, Carlisle knew the hospital was going to be short-staffed. And if someone was gonna be run-ragged working extra hours, extra departments, extra patients…he would it rather be him. He could take being over-worked a lot better than his human colleagues.
And that was how he found himself cornered in the corridor by an impatient Dr. Chloe Huang. "I have a high risk pregnancy I need to deliver right now. Come with me."
"And what exactly would I be doing there?" Carlisle asked her even as he fell in step with her quick strides.
"The baby will be premature. I will need someone to take care of him too." Her reply made it sound like something obvious.
She pushed through the OT complex door and Carlisle followed through. Their dressing room area was just a corridor down to the side of the entrance.
"I don't think I am the right kind of specialty for this job," Carlisle reminded her and Dr. Huang whirled on him.
"And I am an OBG who just intubated a patient and put someone's fractured arm in a cast. Trust me, I am not the correct specialty for those things either. I also know you spent a considerable amount of time a few years ago in the OBG OTs getting an idea of how things are done there. So, I know you know the basics of newborn care. This is a 38 year old woman who has suffered multiple miscarriages, and gone through six rounds of IVF to finally carry this child long enough to have a shot at motherhood. Dr. Cullen, I need you to help me help her. Please."
Carlisle took a nervous swallow at the intensity of her green gaze and slowly nodded. He could hear her accelerated heart and read her pressed lips and see the faint tremors in her hand. This was a woman on a mission and the deadly creature that he might be, he did not stand a chance against her resolve.
With reluctant but helpless steps, he entered the male doctor's dressing room and changed into OT scrubs before walking out the other side into the OT complex proper to wash up and scrub in. Did he need to? He wasn't certain. But it never hurt to be ready just in case.
At the sink, a nervous young girl stood, holding her hands under the running water and looking at the hand wash poster.
"First time scrubbing in?" Carlisle asked her softly and the girl looked up startled.
She gave a small nod before sighing. "I graduated two months ago and have only worked in wards since then. But they don't have enough staff in the OTs so they sent me here."
He gave her an encouraging smile and gently walked her through the proper hand wash for the scrub in. She imitated what he did and at times, Carlisle took a moment to explain why they did what they did. Once done, the girl thanked him before rushing off to her assigned OT.
Carlisle walked into his own OT and knew immediately that half the people inside the room did not belong there.
The patient was prepped well and a nurse was talking to her in a gentle voice, soothing away the pregnant woman's nervousness. He could see two nurses who had worked in the OTs for a few years at least, which was a nice sight to see because other than those two, he knew for a fact that he had never seen anyone else during a surgery before.
Dr. Huang walked in too and both the doctors were helped into their gowns and gloves.
In a voice low enough to not be overheard by the patient, Chloe told him they did not have an anesthetist. "Three emergency OTs are going on right now. And only one anesthetist is in the hospital. We have to make do with a nurse who has done multiple Lumbar Punctures."
Gods, please make sure she and the baby survive this. Chloe's prayers were a lot more muted than her hissed conversations.
Carlisle looked at her face, the nerves visible in her eyes even if the rest of her face was covered with the mask. And then he looked at the mother-to-be. She was heavy, certainly, but not as much as would have been reassuring. Dr. Huang would not have been doing an emergency C-Section unless absolutely necessary. This lady did not seem even 30 weeks pregnant. Despite the blizzard outside and the air-conditioning inside, she was sweating. The nurse beside her dabbed her forehead with a clean cloth and continued murmuring gentle words of encouragement.
"I can do that," Carlisle volunteered and Dr. Huang looked up. "I can administer the spinal anesthesia."
"How-" the other doctor only started to ask before Carlisle cut her off.
"I can scrub out and prove my experience and qualifications with proper documents or…you can take my word for it."
The momentary pause saw Carlisle silently say every prayer he knew. He had no documents to show. At least none that would make him any less old than at least 60 years of age. Perhaps the heavens were in his favor. Or perhaps Dr. Huang was just desperate given the rag-tag assortment of inexperienced staff at her disposal. She gave a swift nod and the two parted ways.
Carlisle was beside the patient instantly and, together with the nurse looking after her, slowly walked her through what she should expect and what she had to do. The woman, Jennifer, was truly a model patient and complied well with every instruction given.
"Please make sure my baby stays okay," she said out loud, to no one in particular and more than one person reassured her that they would do their absolute best to look after her, as well as the baby. Carlisle, on the other hand, focused on giving her the spinal anesthesia. It took a few minutes but Carlisle checked through all the reflexes and vitals on the monitors before giving his go ahead to the rest of the team.
And then, he did what anesthetists do…he went and sat in a corner.
The patient was draped with a record speed and Dr. Huang made the first incision.
Carlisle ignored the smell of burning flesh that quickly became the most prominent smell in the room to him. Blood would follow soon. But for now, Dr. Huang was cauterizing the vessels as the incision was made.
He could have helped with the surgery. He certainly had more experience than the group of people assisting Dr. Huang right now. It would not take him too long to scrub back in, and he would be able to step in should any assistance be required.
But he held his tongue. This is where he was needed, so this is where he would stay.
One careful part of his mind stayed focused on the patient and her vitals. The rest focused on the ongoing surgery. Dr. Huang was as generous with her instructions as she was patient, guiding the new members through everything they needed to do.
He was the first to hear it in the OT. Or rather, the only one. The loud ruckus outside the OT Complex.
That is my child being born! I can't miss the birth of my child! I have a right to see him come into this world!
Carlisle stood up from his chair, far too restless to just sit through the surgery. Instead, he approached Dr. Huang, careful not to break the sterile field. Perhaps it was years of experience, but something in him told him he ought to be a little discreet with what he had heard. So, in a soft and intentionally broken Mandarin, he asked Dr. Huang. "Her husband isn't here?"
Dr. Huang gave him a surprised glance before shaking her head and replying in a much more fluent Mandarin. "No, she asked me to make an excuse so that he isn't there during the birth. He pesters her a lot and stresses her out."
He gave a quick nod and then stepped away. If Dr. Huang had relayed the patient's wishes, the OT guard and the staff would make some excuse or the other and keep him away. He needn't worry about it.
Instead, he turned to the table. They had pushed the bladder down and out of the way. Dr. Huang was about to make the first incision on the uterus. The smell of the blood would soon assault him so he took a deep breath and prepared himself for it. The small amount of blood so far had helped him adjust to the scent. But it was always better to mentally harden himself before more significant bleeds.
Instead, he took another couple of steps back and walked a small circle around the operating table. On the other side of the drape, one of the nurses was still speaking softly to Jennifer, asking her about the baby's name and the nursery decorations. She was still sweating, and grimacing at certain points when Carlisle knew she'd experience a little bit of pressure. But through it all, she had a small smile on her face and her eyes shone as she spoke about her baby.
David. She was going to name her son David.
"It means beloved," she murmured.
"That's a beautiful name," Carlisle told her, as he came to a stop beside her, checking over her vitals once more. When the baby would be delivered, he would have to leave her under the care of the nurse who was originally going to administer the anesthesia and see to the child. He had to make sure everything was all right with Jennifer before he did that.
"Dr. Cullen's wife's name also means beloved," Dr. Huang called out from the other side of the drape and Jennifer's eyes found his face.
"Really? What's her name?"
Carlisle could not help a small smile from creeping across his lips. "Esme," he told her.
"That's a beautiful name," she smiled back at him and Carlisle lightly patted her shoulder.
Carlisle's senses were assaulted by the heady scent of the blood the same moment that Jennifer grimaced. He gestured to the nurse waiting to take over and stepped back. The baby would be out soon. He once again moved towards the other side of the drape. Jennifer would be fine under the care of the two nurses. One of them leaned over and carefully pushed a single, caramel-coloured lock of hair back inside the hairnet that had strayed out.
He changed his gloves with record speed and stood near the cluster of people, waiting on the baby. His eyes darted occasionally to the clock, ready to call out the time of birth the moment he heard the baby's cries. He waited. And he waited. Through the dull buzz of the suction tube and Dr. Huang's patient guidance to those around her while she did what she had to do. A loud squelch. A gush of fluids. And still, no cry.
"01:32AM" one of Dr. Huang's assistants called out the time of birth and Carlisle's eyes snapped away from the clock.
There was no cry.
And yet, he could see a purple lump of a mass being carefully handled by Dr. Huang.
"Clamps" she called out and her assistants started clamping the baby's umbilical cords.
Aren't we supposed to wait for a minute? Why are we clamping right away? He heard the weak but panic-laced whispers of Jennifer and prayed someone would explain things to her. He wanted to. Her accelerated heart rate was as evident to his ears as it was to his eyes on the monitor.
But he had no time to soothe her worries away. Instead, Dr. Huang plopped the practically lifeless child in his hand. At the back of his mind, he heard the rushed explanation given to the mother but he redirected his focus away from that. With a quick glance, he could tell the APGAR of the baby was really low. His body was purple and limp, he wasn't breathing, and his temperature was far, far too low.
The only sign of life Carlisle could find in that child was his heartbeat. Faint, and slow. Imperceptible to anyone but him. His fingers ran over the baby's back and he gave a sharp flick over his feet the moment he placed the baby in the newborn bay set up to the site. No response.
He wiped the baby down and turned up the heat of the warmer all the while still trying to stimulate some reflex out of the child. Nothing.
"Suction tube!" he called out and was instantly handed one. But his order to turn it on was just met with a panicked mumble. His eyes shot up to see a young nurse fumble with the knobs. But the much awaited sound of vacuum did not appear.
A momentary bout of irritation flashed through him. But he pushed it back down and called out for a syringe without the needle. Once again, he was handed that quickly and he tried to suction out the baby's mouth with it. But to no avail. His eyes looked around for the fraction of a second, failing to find anyone or anything that could be of help.
There was chaos behind him too. Something had happened with Jennifer. But he once again schooled his focus on to the baby. Someone would call out to him if he was needed.
Instead, all he had was a baby who was not breathing, a suction machine that somehow wasn't working and a nurse fresh out of nursing school who was still fumbling with the knobs.
It was a mad decision, he knew it. And if he screwed it up, he knew he would have to kill David himself. But it was the only shot he had.
He took a deep swallow, hoping to get every drop of venom out of his mouth. And keeping his sharp teeth carefully away from the skin, brought David's mouth to his own. With a sharp suck, he dislodged the mucus in the baby's mouth. The taste was foul, the texture nauseating and he thanked his own immortal nature that he no longer had a gag reflex for he would otherwise have certainly thrown up. Instead, he turned his face to the side and his helper placed a kidney tray before his mouth for him to spit out.
He repeated the process once more to completely clear up David's mouth and nose of any mucus. All the while, his fingers tried to flick the baby into crying and his mind raced with prayers.
Neither, however, worked.
He once again placed the baby back into the warmer, attached the oximeter, and placed a mask over his nose and mouth. The flow of oxygen started and Carlisle waited a very tense 15 seconds to look for any change. The baby's heartbeat remained slow, undetectable by the oximeter but faintly audible to his ears.
Certainly below 100 beats per minute.
Perhaps even below 60.
Carlisle did not wait to find out.
With two fingers to the baby's chest, Carlisle started chest compression. One to three he counted and in the half a second of pause, the nurse ventilated the child. Over and over again, they did it. Carlisle gave three compressions and the nurse ventilated. And yet, the baby remained unresponsive.
"Doctor, he might be stillborn?" the nurse asked him in an uncertain whisper, carefully keeping her voice low enough to not be overheard by the mother. Given the chaos going on behind him, he doubted Jennifer could hear anything, let alone hushed conversation in the corner of the OT.
"NO!" Carlisle snapped back. The baby was alive. He could hear his heart even if the monitor barely could detect it. Everything about the child told him he was dead. Anyone who looked at the floppy blue mass would say he was dead. But not Carlisle. He could hear the baby's heart. He knew David was alive.
Carlisle stared at the child whose life rested under his relentless fingers. Blue indeed. And far too small. Covered in the white waxy mass. Eyes closed. Chest still, but for his ministrations. Every joint in the body lax.
He should give up. There was no sign of life in that child. None whatsoever. But there was something else. A few scraggly red hair over his head. Damp and waxy. But red all the same.
The same red as Jennifer's.
The same red as Esme's.
The same red as perhaps Esme's son's.
"Epinephrine, now!" he called out at the young girl in front of him.
"You're injuring him, Dr. Cullen."
Carlisle's eyes snapped away from the child when he heard a much older voice speak and his hand stilled. A gray haired, plump, senior nurse had joined them. Her scrubs pocket was embroidered with a neat 'NICU' and in that moment, it was the most beautiful thing Carlisle had ever seen.
"Reduce the pressure of the chest compression," she instructed him, elbowing the younger nurse to the side. Carlisle decreased the pressure and when he paid attention this time, he could hear a very faint crackling sound.
He had broken the child's rib!
But their new companion did not give him time to even be alarmed at what he had done. Instead, she started calling out instructions. With practiced hands, she injected the child with epinephrine through the freshly cut umbilical vein.
"Get me the intubation tray," she ordered the other nurse before turning to him. "Reduce the pressure further, Dr. Cullen. You'd have broken the ribs of a term baby too. This one's a pre-term. Pay attention to how much the chest is retracting. 1/3rd of the antero-posterior diameter. Your patient isn't an adult."
Carlisle followed her instruction to the dot.
Behind him, he could hear Dr. Huang call out instructions and orders. Jennifer's monitors were beeping dangerously. And the smell of fresh blood lay thick on the air. Far too recent, far too fresh and, far too much blood. But yet again, he kept his eyes and hands focused on the child. With each careful compression, he could hear the broken ribs.
Ribs, not rib. For, now that he paid attention, he was certain he had broken more than one bone.
He kept up the rhythm, rate and force to what was approved by his new companion while she worked with a well-practiced ease to intubate the baby.
"Dr. Cullen!"
He heard the panicked call behind him and spared a glance in the direction. The nurse he had left in charge of Jennifer's anesthesia was looking at the monitors with alarmed eyes.
"Just a moment…" the NICU nurse breathed out, fixing the ET tube in place. "You, take over the chest compressions from Dr. Cullen."
The younger nurse was quick to take his place and Carlisle took one hesitant step back.
"Go," the older woman told him. "This baby is my responsibility."
With that assurance, Carlisle spun on his heels. He could not help the tiny, red-headed babe. But he still had a chance to help the dying, red-headed mother.
"What is happening?" he asked aloud to no one in particular.
"Atonic PPH. She is bleeding out." Dr. Huang was the one who answered him.
The two of them stood across from the now-limp Jennifer. Carlisle looked at the blood pooling between Jennifer's legs faster than the suction machine could clean up. There was no point to holding his breath. It was infused way too thoroughly into his senses. He had to work despite that.
"I promised Jennifer I'd help her, Dr. Cullen." Chloe's eyes met his, pleading. Carlisle gave a nod.
He had promised Dr. Huang he'd help her.
Neither of them were one to break a promise. That left just one thing to do…Their best.
A/N:
This chapter is, once again, based on an incident I witnessed during my internship. I was off duty but chilling in the hospital because there had been a really terrible cyclone in my area. The worst in almost 20 years. And the hospital was the only place with electricity.
It was…certainly something…when the very limited number of senior doctors present had all of us clueless people doing things we had never done before. Shout out to the Professor who taught me how to deliver a baby even though I was * this * close to crying out of nerves. And the wonderful nurse who taught my panicked ass proper new born care.
The updates for this story are going to be slow but regular for the next couple of weeks because I want to finish and post Dear Lady. It was originally intended as a Christmas fluff, so, I want to complete it before Christmas.
We'll see more of Jennifer and the baby in the next chapter. Couldn't wrap up the entire thing without this chapter being far longer than all others.
Lastly, I do hope you liked the chapter. Do let me know your thoughts!
ZQ