This is where I want to jump in. I let out a discreet cough and try to speak but Paige jumps in with her question first.
‘It’s safe for me to keep the pregnancy and see you in four weeks then? With regular monitoring, things should be okay? Is that what you’re saying?’
Victoria puts her pen down. ‘Not exactly. We should talk about this now. I know that some of this would have been explained to you when you were in hospital last year, but I’m going to go through it again for you because I think it’s important for you to be as informed as possible about the situation.’ She pauses again. ‘Because you… and Nick… are going to need to make a decision.’
Paige lets go of my hand and Victoria pretends not to notice. ‘Oh. Yes. Sure.’
‘I’d like to explain some of the implications of cardiomyopathy, to give you the chance to ask any questions.’
Paige nods, encouraging Victoria to continue.
‘Do you remember what I told you about PPCM and eventual pregnancy?’
‘Yes, you said that pregnancy was contraindicated until my ejection fraction was at least fifty-five per cent. That it would be too risky otherwise. That’s the number we agreed on.’
‘That’s right. However, we still need to think about the likelihood of a recurrence given your history. We consider the safe zone for pregnancy to be fifty-five per cent because anything less than that is going to mean your heart isn’t as strong as it needs to be to carry a pregnancy to term. During pregnancy, your heart works harder – your blood volume increases by thirty to fifty per cent. And when we’re looking at cardiomyopathy – when we literally look at the size and function of the heart on the monitor – we’re dealing with an already enlarged heart size.’ She shows Paige a diagram she’s been sketching.
‘I understand,’ she says quietly.
‘So when we’re looking at a case like this, where your EF levels aren’t where we’d like them to be, we, as medical professionals, need to look at the risks involved – not only the maternal risk but also that of the foetus. The added strain that pregnancy puts on a woman’s body is something that puts you in a precarious situation.’ She folds her hands. ‘Paige, what I’m trying to say here is that from what I’ve been able to determine, there’s a high rate of relapse and about a fifty per cent chance of maternal fatality, and in cases like yours…’
Paige clenches her jaw, nails digging into her palms as we wait for Victoria to confirm our worst fears.
‘There is a chance your heart, with time, will get back to where we need it to be. That means there is every possibility that in the future, you and Nick will have the chance to become parents.’
‘I’m sorry, I still don’t think I understand what you’re trying to say. You’re saying there’s a fifty per cent chance I could survive pregnancy?’
‘The risk is way too high, that’s what she’s saying,’ I say, interjecting.
‘Hold on a second. She didn’t say that. And that’s not what I asked. It’s not a sure thing. That I’d die, I mean?’ She pins Victoria with her gaze.
‘Maybe you could explain that—’
Victoria raises a hand to stop me from saying anything more.
‘From a professional standpoint, I need to emphasise that attempting to carry a baby to term in these circumstances is extremely high risk, especially when we look at your history and how close we came to losing you with your first pregnancy. We need to consider the way your body reacted and responded to the drugs we gave you. We doctors don’t have crystal balls and we don’t know how things will go this time. Your heart could go into failure sooner this time around. What I wanted to reassure you with today is that there is hope, and you don’t need to rule out the possibility that you may become parents once you’ve recovered fully.’
I rub the stubble on my face. I need Victoria to be as clear as possible here. No skirting around the issue. ‘What’s your advice? Given the circumstances?’ I glance over at Paige briefly. She isn’t going to be impressed with this question.
‘I know this isn’t what you want to hear and it’s not easy for me to say this. I discussed your case with some colleagues, both here and overseas.’ She pauses and I catch the brief expression of sorrow that flickers on her face, like a quick flash of a camera, and then I know. I know what is coming. ‘As a woman, and as your doctor, there really is no easy way to say this to you.’ She uncrosses her legs and then says, ‘I recommend terminating the pregnancy.’
Paige lets out a noise – a sigh, or is it a small moan? I can’t be sure, but then Victoria is sitting next to her and her hand is on her knee, which is more comfort than I can offer her right now. ‘I wouldn’t be recommending interrupting a pregnancy unless I thought it was going to be the safest option for you and your developing baby,’ she tells Paige gently.
‘I’m sorry, but she’s right,’ I say quietly when Paige looks up at me for confirmation.
At first I think she might burst into tears, but she takes a moment for the information to sink in and then she stands up and snatches her handbag from the floor. ‘Thanks for your time, but you can tell your colleagues and specialist team that my baby and I don’t want to be interrupted. We want to be left alone!’
Both Victoria and I jump out of our seats. Victoria moves closest to her, one hand on her hip, an expression of concern on her face, the other hand rubbing Paige’s upper arm.
‘I really am sorry, Paige, but I have to be honest with you.’
‘Paige—’ I say.
‘You’re all for interrupting things. You agree with Victoria.’
‘We’re dealing with the facts as best we can. We’re on the same side here.’
‘Well, it doesn’t feel like it.’
And just like that, right in front of Victoria, Paige and I are arguing again.
Thirty-Four
Paige
The flowers in Imogen’s waiting room are wilting. They aren’t completely shrivelled, but a few rogue rose petals have found their way onto the coffee table.
‘Paige?’ calls a female voice.
Jerking my head up, I notice Imogen standing there, a gentle smile resting on her face. She’s wearing a floral tunic with a pair of ankle boots, and her wavy russet-brown hair is swept into a loose bun.
‘Come on in.’ She motions to the door and I follow the scent of pear into her office. Imogen always has soft music playing in the foyer and a scented candle burning in her room. She sits down on the sofa and crosses her legs, and I sink into my regular place opposite her.
‘The flowers are wilting,’ I say quietly as I reach for one of the cushions and run my finger over the piping.
‘You mean the ones in the waiting room? They get replaced every Monday.’
‘They’re dying.’
‘It’s Friday. They’ll be fine until…’ She uncrosses her legs and observes me for a moment. I’m trying to hold myself together, but Imogen has seen me at my most vulnerable, and it’s impossible to hide my feelings from her now.