by Amy Andrews
Shortly she would take her place beside him for who knew how many hours. They both wore blue. It had been decided from the beginning that, given his experience, that Gabe would take the more fragile twin on their separation. And this morning he had insisted she be at his side.
‘I want the best neuro scrub nurse on my team,’ he’d said. ‘Bridie has an uphill battle. More than her sister. I need the best to give her any hope.’
And so now she was wearing blue and hoping, as were they all, she didn’t let him down. Gabe turned and looked directly at her.
‘Are we ready, Beth?’
Beth looked around at the team and took in their silent nods. ‘As ready as we’ll ever be.’
The anaesthetised twins were rolled into the theatre. For a few seconds all movement and all conversation ceased. This was what it was about. Two fragile babies, dwarfed by the complex equipment surrounding them and lost in a sea of blue and green strangers who held their fate in their hands.
‘Let’s get this show on the road,’ Gabe announced, and the team kicked into action.
Once plastic surgeons had made the first incision and exposed the area it was Gabe’s turn. As he and fellow neurosurgeon Eve Mitchell worked, he could feel sweat building on his brow as his heart hammered madly in his chest. So far, so good.
They were about to perform the craniotomy that would open a window into the twins’ brains. No 3-D computer image or plastic moulded replica. This was the moment they’d prepared and practised for. The moment of truth. The enormity was almost overwhelming.
‘Wipe,’ he said.
Beth grabbed one of the folded surgical sponges as Gabe turned towards her, surprised that he required it already. They’d only been at it for a short while.
She glanced into his peridot eyes, piercingly intense above his mask, and thought she saw a fleeting second of uncertainty. Poor Gabe. Bridie’s condition had just magnified the pressure on him. She gave him an encouraging smile, even though she knew he couldn’t see it behind her mask.
Gabe saw it anyway, reflected in her blue gaze as he bent down slightly for her to mop his brow. Their gazes locked for a fleeting moment and the faith he saw there bolstered his confidence.
The procedure took hours as they slowly and cautiously worked their way through the spaghetti-sized blood vessels. Gabe stopped several times to consult the pre-op scans and diagrams held up for him by circulating nurses.
The anaesthetic team kept a close eye on the babies’ vital signs. Gabe asked for regular updates, only too aware that any ongoing blood loss could be catastrophic to patients this size. Transfusions ran to replace the lost volume but it was a delicate balance. Too much could upset the girls’ natural clotting factors.
Gabe checked the clock and was surprised to see six hours had passed. His neck and shoulders ached a little from being hunched over the small operating area and he knew it was time to take a break. He and Eve signalled their intention to hand over and allow two fresh surgeons to take their places.
During one of the many pre-op discussions it had been decided that six hours should be the maximum period any member of the team spent in the theatre at any one time unless there was an emergency or the surgery was at a critical stage. Six hours on, maximum. Two hours off, minimum.
Their replacements arrived and all the scrubbed staff, including nurses, degowned and headed for the staffroom for a well-earned break. The team members waiting in the staff room applauded as Gabe entered the room.
‘Don’t get too carried away,’ Gabe warned.
Yes, things were going according to plan and he was cautiously optimistic, but he knew only too well that things could go pear-shaped very quickly. They had a lot of brain to get through still and Bridie’s frailty worried him.
Beth, feeling slightly nauseated from lack of food, grabbed a bite to eat. Breakfast of tea and toast seemed an eon ago. Someone had brought in cream buns and she bit into one gratefully. There was a mixture of excitement and cautious optimism in the staffroom and she found it difficult not to be infected by it.
The wall-mounted monitors Beth had arranged previously relayed images and sound from the theatre, and as they chatted and relaxed they could keep an eye on the operation. Being able to watch the proceedings and discuss them was invaluable to keeping them all focused and up to date.
Several shift changes came and went from Theatre Ten. The day was long and night fell without anyone being aware of it. Operating theatres were a windowless world, insulated and artificial. History was being made at the General with each tiny slice of the scalpel and that was all anyone was aware of.
As the night wore on, slow progress was being made on teasing the two brains apart. The staffroom was littered with empty coffee-mugs, discarded food wrappings and staff catching some shut-eye in chairs, while others watched the screens with bleary eyes and murmured quietly among themselves.
Gabe and Beth were back in the thick of it, standing side by side. He was frustrated at the snail-pace progress and worried about the increased bleeding.
They placed special gauze soaked in anti-coagulant as they traveled deeper into the dissection to try and minimise the ooze, and anaesthetic nurses hung bag after bag of blood, platelets and fresh frozen plasma to enhance the twins’ clotting factors. But Gabe knew that the longer it took, the worse shape the girls would be in by the end.
Frustratingly, as he meticulously separated the grey matter, the tissues would swell and push into each other again, making the going even more difficult.
Beth could sense Gabe’s growing frustration with the un-cooperative brain tissue. He was tired, they all were. Neither of them had slept—too wired to relax. But at their next break she was going to insist. Despite the slowness, they were much closer to the end and the head of the team had to be alert.
An hour later the brain tissue began to bleed heavily. Gabe’s fingers worked quickly, accepting instruments from Beth to stem the haemorrhage. Just then the monitor alarm went off.
‘What is it?’ Gabe asked, without looking away from his task.
‘Bridie’s pressure’s dropping. She’s bradycardic,’ Don Anderson supplied.
It took thirty minutes to stabilise Bridie again. Luckily Brooke’s vitals remained as steady as a rock.
Several hours later they degowned again. ‘Get some shut-eye,’ Beth ordered. She stopped by the blanket warmer and pulled a deliciously toasty blanket out. ‘Go put your head on my desk.’
Gabe shook his head. ‘I’ll grab forty winks in the staffroom.’
‘No,’ Beth insisted. ‘You won’t. You’ll sit and yack with fifteen different people about the procedure.’ She pushed the blanket into his arms. ‘If everything goes according to plan, the separation is imminent in the next few hours. The girls need you rested.’
‘I’m fine,’ he said abruptly.
‘Dr Fallon!’
His head snapped up and their gazes locked. They’d stopped all that ridiculous formality weeks ago.
‘You are not fine. Bridie needs the best. You are not at your best.’
Gabe saw the fire in her eyes and appreciated her frankness. She was right. But what about her? She was eighteen weeks pregnant after all.
‘What about you, Beth?’ He placed a hand against her stomach. ‘You must be extra-tired. How are you holding up?’
Beth was surprised by his action. He hadn’t mentioned the baby to her once in the last month. His hand there felt so good, so right, so intimate she had to suppress the urge to cover it with her own.
Gabe liked how it felt to touch her there. Operating on the twins made it impossible to ignore he would soon have a baby of his own. Already, despite his conflicting emotions, he felt a weird kind of connection to his child. It enabled him to put himself in Scott and June’s shoes. To realise the operating area beneath his hands belonged to somebody’s babies.
‘I’m OK,’ she said, moving away slightly, conscious that anyone could come out of the staffroom and see them. They�
�d agreed to keep news of the pregnancy quiet until after the separation. ‘I suspect I’ve had more sleep than you the last few nights.’
Gabe dropped his hand, feeling strangely bereft. God, he must be tired. He smiled grudgingly. ‘Sleep has been rather elusive.’ He’d been pulling long nights in the ICU. ‘You’ll wake me if—’
‘I will get you immediately if anything happens.’
Gabe rubbed his jaw, a shadow of stubble evident. He gave her a slow, grateful smile. ‘Thanks, Beth.’
Beth nodded as he brushed past her and she ignored the mad flutter in her chest. His acknowledgement of their baby had stirred something in her that she hadn’t allowed herself to buy into. Gabe as a father figure. And she couldn’t afford to buy into it now either.
Beth stood in the doorway to her office, a steaming mug of coffee and several pieces of honey toast on a plate in one hand. Gabe was slumped over her desk, his face relaxed in slumber, his stubble growth more pronounced. His theatre cap was still firmly in place and he’d bunched some of the blanket beneath his face to act as a pillow.
His full lips were parted slightly and she allowed herself the brief fantasy of waking him by placing her mouth on his. He really did have very tempting lips.
‘Gabe,’ she called quietly.
He didn’t move. Beth walked in, placed the food and drink on the edge of her desk and moved closer to him.
‘Gabe,’ she whispered, and gave his shoulder a gentle shake.
Gabe was awake instantly, his head rising from the desk. ‘I’m awake,’ he announced loudly. His eyes came to focus on Beth’s and he gave her a sleepy smile. ‘What’s happening?’ He sat up fully alert now, pushing the blanket off his shoulders and stretching his neck from side to side.
Beth placed the coffee and toast in front of him. ‘They think they’re only a couple of hours away but the team is tiring.’
Gabe nodded. ‘How long have I been asleep?’
‘Nearly four hours.’
‘Have the twins been stable?’
‘Bridie’s required some support for her blood pressure but she seems to be holding her own. Brooke’s still soldiering on.’
Gabe took a sip of his coffee. ‘OK. I’ll eat this then go back in. Did you sleep?’
Beth nodded. ‘A little.’ He had a mark on his face from the weave of the cellular blanket and she smiled at the crisscross pattern marring his cheek.
‘What? Have I got drool on my chin?’
Beth grinned. ‘No. Blanket face.’
Gabe laughed. ‘Wait till you see my hat hair after thirty hours.’
Beth laughed too. ‘You won’t be alone there.’ It felt good to laugh after the pressure of the last twenty-four hours and a couple of months of stilted formality.
Gabe offered her one of his pieces of toast. Despite having just had a piece, she took one. High-stakes surgery was not her forte and the baby was letting her know it didn’t approve of the extra stress. A vague feeling of nausea had taken up permanent residence in her stomach and, as always, eating helped.
They munched quietly for a few moments. ‘Looks like we did get to have breakfast together after all,’ he said, and smiled at her. ‘Not quite what I’d planned on. Room service at the hotel do the best omelettes and Danish pastries.’
Beth swallowed the toast, which suddenly felt dry and cardboard-like. ‘Gabe.’
Gabe heard the note of warning and felt too weary to tease any further. ‘I know. Sorry. Inappropriate. Forget I mentioned it.’
‘Forgotten.’ She straightened, giving her scrub top a firm yank. ‘I’ll see you at the sinks.’
Gabe sighed as she left, his appetite deserting him. Forgetting their night together, forgetting she was carrying his baby had been a lot easier when they hadn’t been practically glued at the hip for the last twenty-four hours.
‘Separation imminent,’ Gabe announced, looking up into the camera above his head for the benefit of those in the staffroom. ‘I need all hands on deck.’
His pulse picked up. In less than thirty minutes Bridie and Brooke would finally be separate and the surgical team that had been operating as one would become two.
The second table was wheeled in by orderlies and the wheels locked in place. More scrub and scout nurses appeared. They draped the new table in preparation to receive Brooke and continue the delicate process of closure. It had been decided that as Brooke was the more stable twin, she was the best candidate to be moved.
The anaesthetic team prepared for the transfer procedure, as they had practised. Brooke’s surgeons stood scrubbed and ready to receive her. Kelly, Brooke’s scrub nurse, counted instruments and sponges with the circulating nurses. The theatre was now crowded.
And then the moment came. The last bit of tissue and bone was excised and Brooke was gently lifted and slowly transferred across. The manoeuvre was textbook and the collective breaths of nearly thirty people were expelled in one audible exhalation.
But there was no time for self-congratulation as Brooke’s team swarmed around the table and the surgeries continued.
‘She’s bleeding too much again,’ Gabe said, his attention only on Bridie. ‘How’s her vitals?’
‘Pressure dropping,’ Don confirmed. ‘She’s getting more tachy. ECG changes.’
‘Come on, Bridie,’ Gabe pleaded quietly behind his mask. ‘Stay with us.’
Beth and the other scrub nurse frantically passed instruments to Gabe and the two other surgeons who were trying valiantly to get the bleeding under control. The anaesthetic teamed push fluids and administered drugs to bolster Bridie’s failing heart.
‘She’s going brady,’ the anesthetic nurse announced.
‘Come on, Bridie,’ Gabe said, his fingers working desperately to control the bleeding.
Don and his team worked continuously to restore the failing twin’s circulation, to no avail.
‘Surgical staff step back from the table,’ Don ordered, as Bridie’s ECG displayed life-threatening bradycardia.
Beth and Gabe, along with the others, dropped their instruments frantically and stepped back, hands held slightly in front of them to protect their sterility. Bridie’s full anaesthetic team converged on the table, taking turns at external chest compressions.
Fifteen minutes later Gabe moved closer to see what was happening. ‘What’s her rhythm like?’
The anesthetic nurse stopped compressions momentarily. The line on the monitor barely fluttered.
‘It’s no good,’ Don said to Gabe. ‘She’s lost too much blood.’
Gabe shook his head. No. They hadn’t just performed thirty hours of neurosurgery to give up after fifteen minutes.
‘More adrenaline,’ Gabe said, pushing into the circle surrounding tiny Bridie and taking over compressions.
Twenty minutes passed. Thirty. Forty-five. More drugs. More chest compressions. They even achieved a shockable rhythm at one stage and used the defibrillator twice. Beth stood behind Gabe, watching his erect frame, listening to his orders, her heart breaking for him. He’d invested so much in this operation.
Don’s gaze caught hers and she knew what he was thinking. It was no use. Bridie had fought magnificently but it was over. The odds had been stacked against her and it was time to be let go.
But nobody wanted to contradict Gabe. He was the surgeon who had made it all possible, who had so very nearly succeeded, and he was well liked and respected. They all wanted to give Gabe and Bridie every chance. But it was past time.
Beth walked into the circle. ‘Gabe,’ she said in a low voice.
Gabe ignored her as he pumped at the tiny chest with his blood-covered gloves.
‘Gabe,’ she said, louder this time.
‘More adrenaline,’ Gabe said to Don.
The anaesthetist looked at Beth again. ‘Dr Fallon…’ he said.
‘Damn it, Don. I said more adrenaline,’ Gabe snapped. Come on, Bridie, come on.
‘Gabe!’ Beth used the voice she always used when dealing with recalci
trant staff. It wasn’t loud, she didn’t want to draw the attention of the whole theatre, but it had just the right note of don’t-mess-with-me.
Gabe looked down at Beth, seeing her for the first time.
‘It’s time.’ She placed her hands over his.
Gabe shook his head, his hands still moving, their gazes locked. She was just a tiny baby.
She nodded. ‘She’s had nearly an hour of downtime,’ she said, knowing that even if by some miracle Bridie’s heart was to suddenly start, there would no doubt be serious brain damage. ‘You’ve done all you could.’
Gabe knew she was right. Knew she was making sense. But he’d promised June and Scott that he would do everything in his power to give them back two live, separated little girls. How could he break his promise?
‘Let her go, Gabe,’ Beth said gently staring into his conflicted green eyes. ‘Bridie’s telling you she’s had enough. Her little body can’t take any more.’
She was right. Gabe’s hands stilled. Her body had been through a huge ordeal and her recent frailty had stacked the odds against her even further. He sighed and withdrew his hands.
He looked at the clock on the wall. ‘Time of death fifteen twenty-five hours.’
He peeled off his gloves as the whole theatre fell silent. Nobody moved for a moment or two as they took in Bridie’s pale, lifeless body. She looked so small and defenceless among the green drapes.
Beth raised her hand to touch Gabe on the arm as a wave of sadness overwhelmed her. Everyone looked devastated and she knew Gabe would be feeling the worst of all of them. But she remembered herself at the last moment and dropped her hand to her belly instead grateful for the tiny fluttering movements she felt there.
Gabe roused himself like the true professional he was. This day wasn’t over yet. He turned to the table behind him. ‘How’s Brooke?’ he asked.
‘We’ve achieved primary closure,’ the plastic surgeon said.
‘Vitals?’ Gabe queried the anesthetist.
