Cor Quadraventricularis by Miri

Summary: Rose and 10-II are pregnant with their first child. Story is told from the perspective of their OB/Gyn.
Rating: Teen
Categories: Tenth Doctor
Characters: Rose Tyler, The Doctor (Duplicate 10th)
Genres: Humor
Warnings: None
Challenges: None
Series: None
Published: 2013.04.19
Updated: 2013.04.19

Cor Quadraventricularis by Miri
Chapter 1: Chapter 1
Author's Notes: this story was intended to be humorous, so I hope I’m not the only person who found it funny (terrible to be the only person laughing at your own joke!).
Also, I really wanted to figure out how a Time Lord's cardiovascular system could actually work from an anatomical perspective.

Medical Record #05032005, (Noble, Rose M.)
Notes: Patient is a 27 year old Caucasian female presenting for evaluation of first pregnancy. Patient has no significant previous medical history. Estimated fetal age based on patient’s LMP is 5 weeks.

Dr. Graham was puzzled. Scanning through the patient’s history and medical records, he could discern no obvious reason for her to have made an appointment with a high risk Ob/Gyn. In fact, both parents' histories showed an almost complete lack of any medical issues.

Dr. Graham knocked briskly on the exam room door and then entered with a practiced but warm smile. Both parents smiled back nervously. The mother, a pretty blond who was doing her best to preserve her dignity in the obligatory hospital gown, was reclining on the examination table with a sheet tucked under her arms. Her husband, a tall, handsome man sitting on the chair next to her, gave her hand a reassuring squeeze.

Dr. Graham made small talk to put them at ease while he prepared the ultrasound. “Are you ready?” he said, flourishing the ultrasound gel and probe.

“Yes!” they responded simultaneously with excitement.

Dr. Graham started scanning her abdomen and smiled to himself. He could see a single gestational sac with two heart beats - twins! That explained it; probably had a family history of twins, which was why they’d come to see him.

“Double congratulations, Mr. and Mrs. Noble, you are pregnant with twins!” he said, smiling broadly and pointing out the structures to them.

Their reaction caught Dr. Graham completely off-guard. In his experience, news of twins almost always elicited excited babbling and the father feigning mock dismay over the future cost of two babies. Instead, they turned to each other, ignoring him and whispering intensely. Dr. Graham caught a couple of phrases which just added to his confusion. “…Torchwood… DNA reversion… maybe it really is twins…“

“So what questions can I answer for you?” Dr. Graham asked.

Both heads turned swiftly as if they’d just remembered he was there.

“Should my wife avoid pears during pregnancy? I think they could be dangerous,” Mr. Noble asked inanely.

“Uh… No. There’s no evidence of pears being dangerous during pregnancy.” Dr. Graham managed a straight face. “In fact, she should eat plenty of fresh fruits and vegetables, and get lots and lots of rest while you both still can, and no alcohol of course.”

Dr. Graham smiled at them expectantly, waiting for more questions. Silence. He felt his smile becoming awkward.

“Right then,” he said, clapping his hands together and standing up. “Mrs. Noble, I’m going to send you down the hall for some blood work. Just routine stuff, make sure you aren’t anemic, or your blood sugar is too high, that sort of thing. A nurse will call you in a couple of days with the results.”

Dr. Graham shook hands with them both. “Before you leave, please stop by the reception desk and make an appointment for 6 weeks from now. We’re going to be seeing a lot of each other over the 8 months,” he said, smiling.

. . . .

Medical Record #03052005, (Noble, Rose M.)
Notes: Patient is a 27 year old Caucasian female presenting for follow-up evaluation of pregnancy. Previous ultrasound identified monozygotic twins based upon the presence of two heartbeats in a single gestational sac. Estimated fetal age based on patient’s LMP is 11 weeks.

“How have you been feeling?” Dr. Graham asked. "Much morning sickness?”

“Oh, I’ve been capital! Never better, and eating lots of bananas too!”

“Uh… That’s excellent. I’m very glad to hear that you’re well, Mr. Noble, but I was asking your wife.”

“Oh, right. Sorry.”

Mrs. Noble smiled, rolling her eyes at her husband. “The morning sickness pretty much lasts all day, and I can’t STAND the sight of bananas. But soda crackers and tea aren’t too bad.”

Dr. Graham smiled sympathetically. “Morning sickness is generally considered a good sign. It tells us that everything is working the way it’s supposed to. It should start to subside soon as you are almost past the first trimester.” He sat down at the ultrasound machine. “Ready to get started?” he asked enthusiastically. After all these years, he still loved this part of his job.

Dr. Graham felt a stab of dismay as soon as he started scanning Mrs. Noble’s abdomen. She appeared to have lost one of the twins. Well, it was not uncommon to lose one fetus early on, and it usually meant the remaining one would be stronger. He was considering how best to frame the news for them when he realized the true fetal anomaly. He sighed inwardly, hating this part of his job. He put on his sympathetic but professional face. No point in delaying.

“Mr. and Mrs. Noble, I am very sorry to have to tell you this, but I’m afraid I have some bad news for you.” He could see panic filling their eyes and rushed on. “Your twins are still alive, but I’m afraid they’re conjoined.”

He turned the ultrasound monitor to face them. “This is an extremely rare anomaly. The twins failed to separate and then completely fused at a very early stage. At first, I thought you had lost one of the twins, but as you can see, there are two hearts beating inside the baby’s chest.”

Dr. Graham looked away discreetly as they both started crying, holding each other. He wanted to give them a few minutes to digest the news before discussing their options. He could hear confusing fragments of conversation: “How is this possible?… unbelievable… I wish we could tell him…”

“I am so, so sorry about this,” he said, bringing their attention back around. “But I’m afraid the outlook isn’t very good. Most conjoined twins don’t survive to term, and those that do usually continue to have life-threatening medical problems.” He paused to let them digest this and then said, “We can continue monitoring your pregnancy and see how things progress, or,” and he continued softly, “you may wish to consider your other options in light of the very poor prognosis.”

They both stared at him in utter horror.

“I’m so sorry,” he said again, feeling helpless. “This is every expectant parent’s worst nightmare. Why don’t I step out a moment so you can get dressed, and we’ll talk in a few minutes.

Mrs. Noble sat up. “Dr. Graham, there is nothing to talk about. Of course we will be continuing the pregnancy.”

“Ah, I understand. The decision is entirely yours, and I completely respect your wishes,” Dr. Graham said quickly. “However, we should consider an amniocentesis to assess for fetal chromosomal anomalies.

The two parents looked at each, and something unfathomable passed between them.

“No thank you, Dr. Graham. There isn’t anything that you could find that would change our minds about this,” Mr. Noble said firmly.

“Alright, well then, let’s plan on seeing you for a recheck in another 4 weeks to see how things are progressing. Please call me immediately if you have any cramping, bleeding, or feel anything unusual,” he said to Mrs. Noble.

. . . .

Dr. Graham walked beside the couple to the door of the lobby. He shook Mr. Noble’s hand and gave Mrs. Noble a brief hug. “Please call me anytime if you have any questions.” He stood watching them through the glass doors, feeling heavy hearted about the difficult and painful road that lay ahead for the couple. Then his mouth dropped open in absolute astonishment:

Outside on the sidewalk, Mr. Noble lifted his wife up in a huge hug so that her face was above his. She wrapped her legs around his waist and he spun her around! They were both laughing and grinning insanely, and then she tangled her fingers in his hair and they shared the most outrageous public snog!

. . . .

Journal of Paediatric Cardiology Vol 122; issue 11, pp 23-25.
Abstract: This case report describes the unusual congenital anomaly of a dual cardiovascular system in a live born full-term male infant. Initial fetal ultrasound at 5 weeks revealed a single gestational sac with two heart beats indicative of monozygotic twins. Ultrasound examination at 11 weeks revealed the presence of a single fetus with two intra-thoracic hearts, suggestive of early fusion of conjoined twins. All other fetal measurements (crown-rump length; cephalic length, width, circumference; and volume of amniotic fluid) were within reference limits. Doppler evaluation revealed a heart rate that varied normally from 140 to 160 bpm. No evidence of any septal defects, or valvular abnormalities were noted. Cardiac contractility was within normal limits.

Post-natal MRI (see on-line supplement) revealed the following blood flow pattern: blood from the right side of body predominantly flowed into the dextropositioned right atrium, while blood flow from left side of the body primarily returned to the levopositioned right atrium. Blood flow out the respective pulmonary arteries was distributed to the corresponding ipsilateral lung lobes. However, there was extensive post-capillary crossover of venous drainage such that oxygenated blood from the left lung lobes returned to both the dextro- and levopositioned left atria, and vice versa. Systemic arterial flow occurred via dual aortic arches arising from their respective left ventricles. The two descending aortas merged into a common aortic trunk distal to the respective left subclavian arteries. The remainder of arterial flow appeared normal. In spite of this unusual congenital anomaly, no other abnormalities were found, and the infant appears healthy and clinically normal.

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