by Risk, Mona
“Go, please, go,” Joan told her husband. “Don’t worry about me. I’m in good hands.” Despite her condition and the IV drip in her arm, her voice sounded more authoritative than fearful and strangely familiar.
Holly approached the gurney. “We’re going to do the best we can.” The first thing she’d learned during her training was the need to reassure the patient.
Where have I seen her?
In spite of the white cap covering the expectant mother’s hair and part of her forehead and the oxygen tube in her nose, Holly had that feeling of déjà vu. But where?
The woman was older than Holly and definitely not a social acquaintance. Maybe a previous patient? A nurse?
As Spencer followed his father-in-law, Holly peeked at the chart. She read, Dr. Joan Barnes, and blinked.
Good grief, the patient was an attending neonatologist and her husband an OBGYN. Holly recognized the names. She’d been on Dr. Joan Barnes’s rotation three years ago.
Now she’d better save her mentor’s baby. A tough mentor to say the least, who’d never tolerated procrastination, always insisted on excellent performance from her interns. Holly owed her the deep thoroughness that characterized her resuscitation procedures. Today, she’d better stop daydreaming and repay Dr. Barnes for all that she’d learned from her.
Marc cleared his throat and snapped her back to the task at hand. His eyebrows drew together as their gazes met.
He winked as he always did before a delivery. Holly winked back. She could do it. This close to full term, things should be fine.
“Dr. Barnes,” Holly said, gently touching her patient’s hand. “I’m Holly Collier. I was on your rotation three years ago. I’ll do my best. The way you taught us.”
“Thank you, Dr, Collier. Let’s go.” Joan gave a weak smile and closed her eyes.
The stretcher was hauled up into the helicopter. The pilot urged them to board and closed the door behind them.
Marc measured the patient’s vital signs. “Stable.” He nodded to the pilot. They were ready to go.
The engine roared and they rose into the sky. With their headphones on, they silently watched the patient.
Fifteen minutes into the flight, Joan moaned, gasping for air. Marc secured a blood pressure cuff around her arm and pumped. He frowned and raised a thumb. Her pressure was rising.
“Prepare for landing,” the pilot announced
Marc took another reading. “I don’t like it. Pressure 180 over 100.”
They landed on the helipad of the Washington Children’s Hospital’s terrace. Marc checked the BP one more time. “Damn it, 200 over 110. We need a C-section stat. Call Dr. Halsdale and his team,” he told the nurse as they rushed toward the operating room.
CHAPTER FOURTEEN
In the pre-op room, they scrubbed and donned their sterile gowns and caps. The nurses gloved them, and they hurried into the OR. Dr. Halsdale and the interns moved the patient to the operating table.
Holly wriggled her nose under the mask. How could she be irritated by chemical odors she’d stopped noticing ages ago?
Tonight she was hypersensitive to the pungent smell of antiseptic and anesthetic. Tonight Marc’s kisses had left her dazed, unable to focus. Tonight the patient was her former mentor. Stress twisted Holly’s insides.
Pull yourself together, Collier. Concentrate.
The silence hovering over the OR attested to the urgency of the situation. Marc stuck electrodes on the patient’s collarbones, heart, and stomach. From her station near the radiant warmer, Holly admired his speed. He injected a muscle paralyzing agent into the IV, covered Joan’s face with a mask of oxygen and anesthetic, then immediately introduced a tube into her mouth and throat, and slipped it deep into the trachea. He straightened and adjusted the flow of oxygen and anesthetic from the ventilator to the tube.
“She’s out.” Marc turned toward the EKG screen and monitored her heart. “BP 180 over 90. Better. HR 80.”
“Ready.” Dr. Halsdale didn’t request his tools. The nurse handed him the scalpel before he asked. He made a six-inch incision of the skin and a much bigger one in the uterus. He and a resident shoved down on both sides of Joan’s belly until a foot appeared. Dr. Halsdale reached into the uterus and gently extracted one leg, then the other. Very slowly, the whole body emerged.
Spencer Barnes walked into the OR in scrubs, mask and gloves.
“Good timing. Hold the baby for me,” Halsdale said.
Lines of worry creasing his forehead, Spencer held his baby with steady hands. Dr. Halsdale uncoiled the umbilical cord from around the neck, clamped it on both sides, and then clipped it in the middle.
“Congratulations. You have a beautiful son.” Dr. Halsdale took the baby from Spencer and handed him to Holly. She received him in a blanket, quickly dried him, and measured his vitals herself.
Spencer bent over his sedated wife. “We have a son, darling. Brendon Spencer like you decided.” She couldn’t hear him, but he kissed her cheek, and then wiped his own eyes. “A healthy baby.”
Not that healthy.
The baby hardly breathed, his color a sickly blue. There was no time to waste. “Resuscitation bag,” Holly ordered as she laid the infant onto the warmer.
Dr. Halsdale and Marc continued to work on the mother, but Spencer’s gaze focused on Holly. Dr. Carmichael walked from the pre-op room directly to the radiant warmer.
Holly felt his eyes fixed on her hands. She stiffened. Go away, please. Let me work. She gulped down a calming breath. “Heart rate?”
“80, 90, climbing...” said the nurse. The baby whimpered. Holly released the breath she’d been holding.
Dr. Carmichael gave a heavy sigh. “Good. This child has to live. My daughter has miscarried several times. She can’t get pregnant again.”
Holly’s heart went out to the poor mother. Leaving his wife in the expert care of Dr. Halsdale and Marc, Spencer joined his father-in-law. Now both were breathing down Holly’s neck. As if she needed the additional stress.
She continued to work on the baby, but grew more uncomfortable by the second. Something just didn’t seem right. The baby’s skin was fairly blue.
“Dr. Carmichael, your grandson is cyanotic. We need to intubate. As soon as I’m done with the intubation, I’ll take his vitals again. And you’ll be able to examine him yourself.”
At least her confident tone didn’t betray her inner tremor as she remembered her baby brother and the incompetent doctors who couldn’t save him. “ETT please.” Good. Nice intubation, Holly. Once the endotracheal tube was secured in place, Holly rechecked the breathing sounds. Yes, equal bilaterally.
“Pulse ox, please. Let’s check his oxygen saturation.”
The baby was saturating in the seventies when he should have been in the nineties. Damn it, why? Holly frowned and listened longer.
It was then that she heard it.
The heart rate was back up, but along with it a subtle heart murmur she hadn’t heard the first time.
Dr. Carmichael scowled and waited. “Not normal?”
She shook her head and handed him her stethoscope. He was the expert. He confirmed her diagnosis.
Holly sighed. Her mentor’s baby had major problems. “Let’s get him into an isolette and over to the NICU. I’ll ask cardiology to come see him ASAP.”
She motioned to a nurse to roll the isolette out and ordered, “I need an EKG, a chest X-ray and 4-extremity blood pressures.”
“We’re counting on you, Dr. Collier,” Dr. Carmichael said.
“Yes, doctor.” She removed her gloves and glanced at the operating table.
The obstetrician finished his last stitch. Marc removed the mask from the patient’s face and some of the tubes, but left the IV attached and injected another drug into it. “She’s on magnesium now. BP’s better but still on the high side.”
“We’ll keep her in the ICU,” Dr. Halsdale said. Joan was wheeled out, her husband and father walking beside her gurney.
; Marc joined Holly. “How’s the baby?” he asked as they trashed the OR garb.
“Not well. Looks like congenital heart disease. I had some trouble working with the old doc watching over my shoulders.” They left the OR and walked the corridor side by side.
“You did an excellent job. But take my advice, call the cardiologist right away and let him handle the case.”
“I’m on my way to call. I also have to check on my preemies. They need as much care as the director’s grandson.”
“You’re a good doctor, Holly, a dedicated one. That’s what counts in our profession.”
She smiled, his reassurance like a soothing balm on her nerves. He reached over and squeezed her hand. All soothing thoughts flew away. Heat flared in secret places. How she needed to be held and kissed and loved. If they weren’t in a hospital hallway, she would have wrapped her arms around his neck and asked him to hold her tight.
Stress. She was suffering from an acute case of stress.
“It’s so hot in here.” She rubbed her throat, gulping a deep breath.
“You’re right. Very hot. You want to take a walk in the courtyard?”
“No time. I need to call the hospital cardiologist right away. And you’ll have to pick up Paulito from Stacey’s house. Poor darling, I hope he was able to sleep away from his room.”
“I’m sure he was fine with Stacey. Meanwhile, I need to check my messages.”
Holly keyed in a number on her cell phone and Marc followed her example.
“The cardiologist will meet me in the NICU,” she said a minute later.
“Hmm,” Marc mumbled, his phone still pressed against his ear. “Hmm,” he repeated as he snapped it close, a deep scowl puckering his forehead.
“What’s wrong? You look concerned.”
“I had a message from my sister Gabriella. She called during the surgery.”
“What happened?”
“Abuelita had a heart attack.” His face was a mask of anxiety. “She’s eighty-five. She’s already suffered so much in her life.”
“I’m sorry, Marc. Why don’t you go see her right away?”
He sucked a deep breath and exhaled. “I already took time off for the funerals. I can’t just drop everything again.”
“It’s only a three-hour flight. You can leave today with the first flight and return tomorrow, if she’s better.”
The crinkles at the corner of his eyes gathered into thin lines as his scowl deepened. She admired him for continuously sharing and solving his family’s problems one after the other, but her heart bled for him. Poor Marc, would he have to face another death so soon after his double mourning?
God, I hope she’ll be better.
Marc raked his hand through his hair. “Yes, I may do that. But what about Paulito? You’re on call tonight?”
“Don’t worry. I’ll pick him up from Stacey’s in the morning and take him to the daycare. I’ll bring him here to the hospital. I’m sure one of the nurses will be able to stay with him while I’m on rounds.”
“I hate to put so much pressure on you and Paulito.”
“We’ll be fine.” This baby and his dad had become the focus of her life now. As important as her career. “You won’t be able to live with yourself if you don’t see your grandmother before...while she still can talk to you.”
“Thank you, Holly. I don’t know what I’d do without you.”
He squeezed her hand. Her heart skipped a beat when she saw the flame shining in his eyes. She could swear it wasn’t only gratitude. More like warmth and tenderness.
Could it be love? God, could it be love?
Wrong time to find out. She sighed. Somehow, it was always the wrong time for her and Marc.
“Maybe you should call home and find out exactly what happened?”
“I will. Later. It’s only three a.m. I can’t call now.”
They entered the NICU where a depressing scene brought her back to the reality of her profession.
Holly joined Dr. Carmichael and the hospital cardiologist as they examined the baby. Together they studied the echocardiogram. Transposition of the great arteries, just as she thought.
“He needs an atrial septostomy ASAP, before his ductus starts to close off,” the cardiologist said.
Holly knew the risks involved in perforating a hole in the baby’s heart to allow oxygenation of the blood.
“And then of course he’ll need an arterial switch within the next week or two. Unfortunately, as you are well aware, there’s still a relatively high risk of mortality,” the cardiologist added bluntly. There was no need to soften the painful truth between professionals.
Dr. Carmichael tapped the side of the warmer. “Not if Dr. Morey from the Cleveland Pediatric Cardiology Center performs the surgery. He’s the best. The only one who can save Brendon.”
Marc arched an eyebrow. “The pediatric surgeon who does heart transplants on babies? Would he come all the way out here?”
“He owes me. I’ll call him right away.” Grandpa Director was going to pull some strings. The guy was omnipotent. He stepped out of the NICU with the cardiologist to place his call but paused at the door. “Hold on both of you, please. I may still need you,” he ordered, raising his hand to Holly and Marc.
Why? She’d done her best so far. It was up to the cardiologist to take over. A sense of dread jolted down her spine. She looked at Marc. He had his share of problems at the moment and was probably anxious to get out of the hospital, call his sister, and then jump on the first plane to San Juan.
A few minutes later, Dr. Carmichael returned and pinned them with a stern look. “Dr. Collier, Dr. Suarez, the septostomy will take place at eleven in the morning.”
Wow, that was the Carmichael’s connection at work, all right.
“You’re already familiar with the case. I want you both on Dr. Morey’s team.”
Marc’s eyes narrowed.
Hers opened wide.
What about Marc’s trip to San Juan? His Abuelita might die before he could see her.
“You should both go home and sleep right away. I’ll have the administrator find you subs for the night shift. I want you alert tomorrow morning,” Dr. Carmichael said in a voice that brooked no argument.
“Yes, sir.” She glanced at Marc.
His arms crossed on his chest, he scowled and nodded.
Holly left the NICU, Marc on her heels. “Let’s go home right away. I don’t have a car seat here,” he said, as he strode down the hallway. “I’ll take the Jeep to bring back Paulito. We’ll pick up our clothes later.”
“Marc, I’m sorry you’re not going to San Juan today.” Although he kept a calm front, she knew he was seething.
“I can’t leave.” His lips set in a thin line, he urged her out.
They went directly to his car. Holly settled in the passenger seat. Marc took off at high speed. A lousy habit, but she didn’t dare comment. She buckled her seatbelt. As the Porsche whizzed through the dark streets, she held on for dear life. Eyes closed and jaws clenched so hard they hurt, she shrank into her seat. She’d been concerned about his problem, yet she had a huge one of her own to tackle.
While Marc knew his presence in surgery tomorrow would improve Baby Brendon’s chances to live, she was terrified of spoiling those same chances.
I can’t work on an open heart surgery or even a septostomy. Not ever again.
Attending a delivery, even a C-section with toxemia was part of her routine, but assisting in an open-heart surgery or a brutal procedure on a blue baby was a different ballgame. She’d done it once. The stress had been unbearable. The baby had died, and she’d almost quit Neonatology. Holly vividly remembered the tiny body, pierced by tubes, barely visible in its crib. Her head slumped in dejection.
It was just before Thanksgiving three years ago, she had landed in the program director’s office and presented her resignation. She had stood rooted in front of the large desk, dejected and dismayed, while the director had studied her tired
features. The older doctor had peered straight into her eyes, misty from concealed tears, and found the right words to soothe and encourage.
“Don’t quit, Holly. Give yourself the time to ease into this highly demanding profession.” The director had reached for her hand and squeezed it. “Don’t blame yourself. You are a new fellow, still under training. Two attending doctors were working on the case with you. And I was consulted. There was no way to save this baby.”
Her hands shook on the seatbelt. Tomorrow her whole body would shake even more.
She shouldn’t attend Brendon’s surgery.
Marc had given up going to see his dying grandmother to increase the baby’s chance during surgery. Holly doubled up in her seat. How could she tell the almighty Dr. Carmichael she was afraid to attend the procedure that might help his grandson live?
CHAPTER FIFTEEN
“We’re home.” Marc turned off the ignition key and glanced at Holly. “What’s wrong?” Eyes shut and lips pinched, Holly gripped the seatbelt with rigid fingers and didn’t answer. He touched her arm. “Holly,” he said, raising his voice. “Are you in pain?” Buried in a whirlpool of disturbing thoughts, he hadn’t talked to her during the drive home.
She opened her eyes. A mix of fear and anxiety troubled their limpid blue-green. “Aren’t you worried?” she asked, her lips quivering.
“Of course, I’m worried about Abuelita but—”
“I mean about tomorrow’s surgery. You know, Baby Brendon?” She shivered, crossed her arms over her chest, and hunched her shoulders.
“Don’t be scared, Holly.” He unsnapped his seat belt and hers and stretched his arm behind her back, gathering her against his side. “It’s not difficult. One has to be careful and accurate.”
“Careful and accurate?” She snorted. “I killed a baby in my first month of fellowship.”
He frowned, looking at her. “If it was only your first month, there should have been an attending responsible.”
“There was. But the preemie died at my hands.”
“Don’t blame yourself when a senior staff was in charge. There was probably nothing more he could have done.”
