her groin, and clearly the movement hurt her because she grimaced.
‘Has it been going on for long?’ Madison asked.
‘I’ve had twinges for the last week, but today it’s absolute agony.’ She dragged in a breath. ‘Please—I’m not going to lose the baby, am I?’
‘Aches and pains are pretty common in pregnancy and they don’t necessarily mean that you’re miscarrying or there’s a problem with the baby,’ Madison reassured her, ‘but you’ve done exactly the right thing coming to see us. Do you mind if I examine you?’
With the patient’s permission, she examined Mrs Ellis gently but effectively, then listened to the baby’s heartbeat. ‘That’s nice and strong, so try not to worry too much. The baby’s doing just fine. But what we need to do is stop this pain. Do you get the pain all the time, and does anything make it feel worse or better?’
‘It’s only there some of the time. It’s worse when I’m going upstairs or getting dressed or turning over in bed,’ Mrs Ellis explained.
Given where the pain was and the description, Theo knew exactly what the problem was. But rather than muscling in, he waited for Madison, who smiled at Mrs Ellis and squeezed her hand. ‘The baby’s in absolutely no danger. What you’ve got is something called symphysis pubis dysfunction—SPD for short. It sounds a lot scarier than it is, and an awful lot of women get it. At eighteen weeks, you’re practically halfway through pregnancy, and that’s the most common time to start noticing the pain.’
She sat down next to the bed, drew a notebook and pen from her pocket, and sketched a swift diagram to show their patient. Theo liked the way she was managing this: focusing on the patient’s worries, making it easy for her to understand. That kind of empathy would make her a brilliant consultant, as Iris had said. And on a personal level…
No. No involvements. He’d made his decision years ago: he wasn’t going to settle down, get married and have children. Sure, he dated—he was only human—but he always made sure his dates knew he wasn’t able to offer anything long term. If that meant people thought he was a shallow playboy, then fine—he could live with that. As far as he was concerned, other people didn’t have to know the real reason behind his decision. He wasn’t prepared to put the woman he loved through childbirth, knowing first-hand what could happen when everything went wrong. And no way was he going to go through what his father had gone through.
He forced himself to concentrate on what Madison was saying, just in case she decided to throw a question or two his way.
‘Basically your pelvis is in two parts and it’s held together by a joint called the symphysis pubis, which is strengthened by lots of ligaments. When you’re pregnant, your body produces a hormone called relaxin, which softens your ligaments to make it easier for you at birth—but that also means your pelvis can move during pregnancy, and the movements are what cause the pain.’
‘Can you make it stop?’ Mrs Ellis asked.
‘I’m going to give you a support belt, which will help, and you can take paracetamol to help with the pain—that’s perfectly safe for the baby. I’m also going to refer you to a physiotherapist, who can teach you some exercises for your tummy and pelvic floor that won’t hurt the baby but will help ease the pain. I can’t promise you’ll get an appointment with the physio today,’ Madison warned, ‘but if I can do it, I will.’
‘Thank you.’ Mrs Ellis wiped away the tears that had started to spill over. ‘I was so scared I was going to lose the baby.’
‘It’s always the first thing that goes through your mind,’ Madison sympathised, ‘but you’re going to be absolutely fine. Even better news is that there are a few things you can do to help make the pain go away.’
This was his cue, he thought. ‘Why don’t I tell Mrs Ellis while you talk to the physios?’ Theo suggested.
Her eyes narrowed for a moment, as if she thought he was trying to take over; but then she nodded, clearly realising that this was going to save them some time. ‘Is that all right with you, Mrs Ellis?’
‘That’s fine. I don’t mind talking to student doctors.’
She thought he was a student? Well, it was an easy mistake to make. Madison had been planning to bring her fourth-year students with her, and no doubt the emergency department had cleared it with Mrs Ellis first. Theo just about managed to suppress his grin, though as Madison left the cubicle he could see amusement all over her face. Well, he could live with it. Telling Mrs Ellis that actually he was Madison’s boss wasn’t going to achieve anything other than make her feel awkward and embarrassed—and his patient’s comfort was much more important than his dignity.
He talked her through the things she could do to help herself, and was just discussing the birth plan with her when Madison swished the curtain aside, carrying a support belt. ‘I’m sorry, Mrs Ellis. The physiotherapy department is completely booked up today—but I’ve persuaded them to squeeze you in first thing in the morning, just before their list starts. For now, I’m going to show you how to put this belt on and that’s going to take some of the strain for you.’
‘Thank you so much,’ Mrs Ellis said, looking relieved that she wasn’t going to have to suffer pain for much longer.
‘My pleasure.’ Madison smiled at her. ‘Do you have any questions, or has Mr Petrakis already answered them?’
‘Mr Petrakis said I should put it in my birth plan to make sure I get the most supportive birth position, and it might affect my pain relief. Will I have to have a Caesarean?’
‘I’m not going to rule it in or out at this stage,’ Madison said gently. ‘We’ll see how you go. But I will promise you that we’ll do the best for you and your baby.’
‘Will I get it again if I have more children?’ Mrs Ellis asked.
‘We honestly don’t know,’ Theo replied. ‘You might not get it at all, or it might be not as severe, or it might be worse. It really, really varies. But the best advice we can give you is to leave a good two years between pregnancies—if you do get SPD next time round and your baby’s not walking yet, you’re going to find lifting really hard.’
When Madison had fitted the support belt and checked that Mrs Ellis had transport home, she and Theo walked back up to the ward.
‘So are you happy that I know what I’m doing, or do you want to supervise me with some more cases?’ she asked.
‘I wasn’t checking up on you,’ Theo corrected. ‘I wanted to get a feel for how you worked, and I’m going to be doing the same with all the staff. Mentoring isn’t just for students, you know.’
She looked surprised. ‘What do you mean?’
‘Whatever the stage of your career, you need development or you’re going to feel stuck in a rut and be miserable. The last department I worked in had a policy of job enrichment, and that worked really well. If you don’t already have that here, maybe we can introduce it—and I’ll make sure I liaise with Iris, because I want the midwifery team to be happy with any changes we make and they might have some good suggestions, too.’
She smiled at him. ‘I like the way you think. I’m going to enjoy working with you.’
A feeling, Theo thought, that was very much mutual.
Even though for the rest of the day he was in clinic and she was in Theatre, Theo was aware of Madison all afternoon. To the point that, when their shifts ended and he found himself in the locker room at the same time as her, he said, ‘Come and have a coffee with me.’ Seeing a slightly nervous look on her face, he added, ‘Look, I don’t mean coffee as in a date. I know you’re involved with the guy in the emergency department.’
‘The guy in the…?’ She looked mystified for a second, then smiled. ‘Oh, you mean Ed.’
‘The one who called you down to Mrs Ellis,’ he confirmed.