‘Probably. I’m due for blood tests today.’ Holly eyed the remains of her coffee. Should she use up that much of her daily fluid allowance now or save it for later? She took another small mouthful and then sighed. ‘I’m doing it four nights a week already, Ryan. Soon all I’m going to be doing is coming to work and going home to sleep with a machine.’ She tried to throw in some of the customary humour with which she had always lightened such conversations. ‘I really shouldn’t tick the single box on forms, should I? I’ve had a partner for years.’
Ryan didn’t appear amused. ‘It’s a temporary relationship. You know that a normal life will be entirely possible when you get a kidney transplant.’
‘Yeah.’ Impossible to keep her tone light now.
‘That’s it, isn’t it?’ Ryan looked as though he wanted to slap his forehead for being obtuse. ‘That’s what’s changed. I thought you brushed off that disappointment last month rather too easily.’
Holly couldn’t deny it. ‘It’s caught up with me now. To get that far…’ The disappointment cut more deeply than ever right now. ‘I kept telling myself it was better to have the plug pulled then than to go through the surgery and then have to wait to see if the transplant would work and then battling rejection and dealing with failure and the knowledge that another transplant would be that much more difficult, but I was kidding myself. To actually get prepped for surgery and then sent home was awful.’
‘The donor kidney was found to have kidney disease that hadn’t been diagnosed, hadn’t it?’
‘Yeah. Polycystic. Same as me. Ironic, eh?’
‘No.’ Ryan reached out to cover Holly’s hand with his own. He gave it a brief, gentle squeeze. ‘Incredibly disappointing. You’d waited so long.’
The empathetic touch would have been enough to generate tears in someone other than Holly, but Holly Williams had never cried about her illness. She had simply got on with the most important things in her life and refused to even consider letting it slow her down. Until now, anyway.
She touched the second pager she wore clipped to her pocket. The one that had only sounded once in all that waiting time. ‘It’s been more than two years,’ she said quietly. ‘I went on the waiting list as soon as I had to start regular dialysis.’
‘You haven’t fallen off the list,’ Ryan reminded her. ‘You’ll still be at the top. A compatible organ could come up any time.’
‘With my blood group? I’m O, Ryan—but in my case that’s not really O for ordinary.’
He smiled. ‘I could have told you that.’
Holly’s smile in return was wry. ‘I’m a universal donor but I can only receive from another O. And that’s just the blood group. There’s tissue and cross-matching factors to complicate things as well. Which reminds me, I’m due to send in the monthly sample today. Could you draw some blood for me later?’
‘Sure.’ Ryan had finished his coffee but he made no move to get up. In fact, he had a rather determined look on his face. ‘I’m glad the subject’s come up, actually, Holly.’
‘Oh?’ He was going to agree with her, wasn’t he? Had Ryan just been waiting for an opportunity to ease her out of her senior registrar position?
‘Yes. I’ve been giving your situation quite a lot of thought recently. Ever since that hiccup with the transplant last month.’
Holly waited, her heart sinking. He did want her to give up trying to work full time. He’d supported her so much for so long and the ace up her sleeve had always been that it was worthwhile because when she got her transplant she would make up for any inconveniences she had caused. They would never have such a committed and hard-working registrar on their team. Now Ryan could see, as she did, that holding out for the miracle a transplant could provide might be just a dream. The odds of it happening before she deteriorated further or even died suddenly seemed much smaller.
Almost non-existent.
The door to the staffroom opening at that point to admit one of the ICU nurses was a reprieve that Holly grasped with alacrity.
‘Sue, hi! How’s Callum doing, do you know?’
‘He’s good.’ The nurse sat down and opened a packet of sandwiches. ‘What are you two doing in here? I heard there was a blue baby on its way in.’
Holly’s gaze swerved to Ryan. ‘That baby must have arrived ages ago. Why haven’t we heard anything?’
‘I popped down to see her before while you were…getting the coffee. Sorry, I should have told you.’
Holly could feel the muscles in her jaw tighten. No. She should have been there as well. ‘So what’s the story?’
Ryan stood up, taking Holly’s coffee-mug to the sink along with his own. ‘Full-term baby girl. Nothing abnormal noted on foetal ultrasound. No murmurs but a loud second heart sound and she was still cyanosed on a hundred per cent oxygen.’
‘Transposition of the great arteries?’
‘That’s our pick for the moment. They’ve probably done the echocardiogram by now. Shall we go and see what they’ve found?’
‘Cool.’
Back to business as usual was fine by Holly. She was regretting having let the conversation become so personal. Her warm smile at Sue as they left the staffroom was, in some part, thanks for interrupting before Ryan had been able to ease into the subject of firing her, and Holly made sure their communication was purely professional as they threaded their way through the busy corridors of the large children’s hospital.
‘We don’t get a transposition very often, do we?’
‘Fortunately, no.’
‘Surgery won‘t need to be immediate, will it?’ The physical demands of the rest of Holly’s day were suddenly looking rather more manageable.
‘No, but it’s usually done within the first week or two of life, before the left ventricle becomes unable to handle systemic pressure. If it’s severe enough, they’ll need an interim measure to improve the cyanosis.’
‘A Rashkind procedure?’ Holly had no difficulty in sounding more than interested.
‘Ever seen one?’
‘No.’ Any residual despair at having her own physical weakness demonstrated so recently was chased away by excitement. ‘I’d love to, though.’
‘How much do you know about it?’
‘It’s designed to allow the systemic and pulmonary circulations to mix, isn’t it? They thread a double lumen catheter into the left atrium via the umbilical vein. A balloon gets inflated with contrast medium and then pulled back through the atrial septum to create a tear.’
‘Mmm. Strange business, this, isn’t it? We spend half our morning repairing a septal defect and our cardiologist colleagues might well spend half their afternoon creating one.’ Ryan was smiling at Holly. ‘I take it you’d like to go and watch if it goes ahead?’
‘Oh, could I?’
‘Absolutely. Good learning experience for you. To be honest, I’d quite like to go and watch myself.’
‘What about rounds?’
‘We’ll fit them in. We’ve got a consult to do in the ward as well. Another VSD who’s developing pulmonary hypertension.’
‘How old?’
‘Eighteen months.’
‘Is that Leo?’
‘Don’t tell me you’ve seen him already?’
‘Not as a patient. He’s been in the ward for a few days, though.’ Holly’s smile was a little embarrassed. ‘He was part of that hide-and-seek game you caught me playing yesterday—when I should have been writing up those discharge notes.’
‘You stayed far too late yesterday catching up on them. It’s no wonder you’re tired today.’ Ryan paused as they reached their destination of the neonatal intensive care unit. ‘And we’re giving ourselves a very busy afternoon.’ He held Holly’s gaze. ‘Are you up to it?’
‘I’m not about to fall asleep again, Ryan.’ Damn, this could provide another lead-in to that talk Holly really didn’t want to have. Her chin came up. ‘Of course I’m up to it.’
It was a struggle, anybody could see that, bu
t there was no way Holly was going to admit defeat. She’d push herself until she fell over, Ryan observed with concern. No matter how hard it might be, she simply couldn’t help herself going the extra mile.
Like the way she sat with baby Grace’s shocked parents and drew them a diagram of what had gone wrong with the development of the arteries in their infant’s heart because they hadn’t been able to take it in the first time around with the cardiology team.
‘So the aorta, which takes the blood from the heart to the rest of the body, is attached to this part of the heart on the right side, do you see? And that’s where the pulmonary artery should be. So it means that the blood that’s getting the oxygen from Grace’s lungs isn’t getting to the rest of her body, which is why her lips and fingers look so blue.’
Grace’s father looked desperate to both understand and find a way to help his family. His tone was belligerent.
‘It can be fixed, though,’ he demanded. ‘That’s right, isn’t it?’
Holly’s smile both accepted the anger being directed at her and gave reassurance. ‘When we operate, what we’ll do is attach the arteries to the ventricles they should be attached to.’
‘Why can’t you do that right now, instead of that thing with the balloon they were talking about?’
‘It’s a major operation. We need to make sure Grace is strong enough and there are a few more tests we’ll need to do before surgery.’
The baby’s mother sat hunched in a wheelchair beside the incubator, her face pale. ‘Can I stay with her?’
‘Of course you can. The nurses will show you how you can help care for her. The procedure this afternoon shouldn’t take too long.’
‘Will you be there?’
‘Yes. Don’t worry, we’ll all take very good care of Grace.’
Donning a lead apron so that she could stand close enough to touch the baby during the procedure in the catheter laboratory instead of observing on the screens in the technicians’ area meant that Holly put ten times as much effort into that session than she needed to, but Ryan wouldn’t have dared suggest that she took things easier.
His registrar was already building a bond with both this tiny patient and her parents that would make the upcoming surgery less traumatic for everybody. That kind of bond was automatic when Holly was involved. The huge grin she got from Leo when they slotted that consultation in during their ward round was another example.
The toddler sat on his mother’s knee initially as they examined the child, which wasn’t all that easy because she was heavily pregnant. It was Holly who listened to his heart. She showed Leo the end of her stethoscope before approaching him. She wiggled it. ‘This is Silly Snake,’ she told Leo. ‘He likes tickling people and he wants to wiggle under your T-shirt. Shall we let him do that?’
Leo nodded, wide-eyed.
‘Wiggle, wiggle,’ Holly whispered. Leo giggled as she positioned the disc. She listened intently for a full minute and then nodded. ‘Wiggle, wiggle,’ she said again, and she must have tickled the small boy as she removed the instrument because Leo writhed in mirth. It made both his parents smile and suddenly the consultation was far more relaxed than it might have been.
‘What could you hear, Holly?’
‘There’s a harsh systolic murmur,’ she reported. ‘A pulmonary systolic ejection and a mitral mid-diastolic flow murmur. The pulmonary second sound is loud.’
‘What does that all mean?’ Leo’s father asked.
‘They’re abnormal heart sounds,’ Ryan explained, ‘which we’d expect after the results of the catheter test Leo had yesterday. As you already know, that hole in the ventricular septum hasn’t closed nearly as much as we would have hoped by this stage.’ He glanced up at the X-ray illuminated on the wall of the ward’s small consulting room. ‘Leo’s heart is increasing in size quite dramatically and so are his pulmonary arteries. We don’t want that to continue. He’s getting more symptoms now, too, isn’t he? Despite his medications being increased?’
Leo’s mother nodded. ‘Ever since he started walking. He gets breathless very easily and he’s always so tired.’ She caught her husband’s gaze. ‘We were really hoping to avoid the surgery, though. Especially just now, with the new baby coming.’
‘When are you due?’
‘I’m thirty-six weeks now. And I may need a Caesarean. The baby’s breech. They’re talking about a procedure to try and turn it next week but there’s no guarantee it’ll stay that way. And if I have a Caesar it’ll make everything that much harder, and if Leo’s not well I just don’t know how I’d cope.’ She bit her lip and her hold on Leo must have tightened enough to transmit her tension because the toddler stuck out his bottom lip and wriggled determinedly free.
He went straight to Holly and held up his arms. ‘Wiggle, wiggle!’
Holly grinned and a moment later Leo sat in her lap, happily playing with the end of her stethoscope. His mother watched him for a moment, fighting tears, and then she looked at her husband and they both smiled again.
The message was very clear. Holly had won their son’s trust. Who were they to argue?
Ryan was equally reassuring. ‘If Leo has his surgery now, he’ll be a lot less of a worry by the time the new baby arrives. Kids bounce back from this kind of surgery astonishingly well. He’ll be up and running around within just a few days.’
Details regarding the necessary surgery were discussed and consent forms even signed, with no hint of further tears, and Ryan knew that his registrar was largely responsible for leaving the small family relatively happy to settle back into the ward and ready to face the biggest hurdle in Leo’s life so far.
They finished their afternoon by checking Callum’s progress again in the intensive care unit. While Holly went through the process of reviewing every parameter and noting their satisfactory levels, it was clear she was at the very end of her physical tether.
When they turned to leave, Holly seemed to lose her balance. She swayed on her feet and might well have fallen if Ryan hadn’t taken a firm grip of her elbow. Thank goodness he’d been standing so close.
It was a momentary lapse. Holly pulled free a second later, probably before anyone else had noticed what had happened, and she walked ahead of Ryan as they left the unit. He said nothing until they were alone in the corridor but something did have to be said. This was the opportunity Ryan had been waiting for.
‘My office,’ he commanded. ‘We have to talk, Holly. Now.’
Holly sat amidst the clutter of stacks of journals and case notes in his office, looking as though an axe was about to fall, and Ryan realised that she was expecting some kind of rebuke for her physical failings. It was time she knew just how far from the truth that was.
‘You’re amazing, you know that?’
A flush of colour stained her cheeks. ‘Maybe I’m just stubborn. I don’t like giving up.’
‘I’m not talking about the way you cope physically, Holly, although, God knows, that’s extraordinary enough. I’m talking about you professionally.’
‘You mean this morning? In Theatre?’
‘No.’ Ryan had to smile. ‘But, there again, your talent as a surgeon is pretty outstanding.’
Holly looked nonplussed and Ryan’s smile faded. He cleared his throat. There was a lot he’d like to say right now but this wasn’t the time or place. He knew he had to tread very carefully here.
‘I’m talking about the rapport you have with people,’ he said. ‘The way you can win their trust and calm their fears. You have a natural ability to deal with aspects of patient care that no surgical techniques or drugs could ever hope to touch. I suspect a lot of it has come because of what you’ve had to go through yourself but it’s a gift, Holly. An art. One that needs to go hand in hand with science to achieve the kind of patient outcomes we strive for.’
‘Um…’ Holly seemed lost for words. Then she gave an embarrassed chuckle. ‘Gosh, Ryan—this wasn’t at all what I was expecting you to say.’
‘Wh
at were you expecting?’
‘That you were going to say that a career as a surgeon and living on dialysis were just not compatible. That my physical limitations were becoming way too much of a burden.’
Ryan nodded slowly. ‘You were right. I am going to say that.’
It didn’t seem possible for Holly’s face to become any more pale but it must have done to make those dark eyes seem so huge. Ryan had to grit his teeth against the pain he knew he was causing.
‘But I wanted you to know where I was coming from before I said that,’ he explained gently. ‘For you to know just how highly I value you as part of my team. And that, if I can help it, I have no intention of losing you.’
Her face was utterly still, her head held high on a long, slender neck. Ryan could see the ripple of muscle as she swallowed with apparent difficulty.
‘I have no intention of losing me either.’ What started as a valiant smile went distinctly wobbly around the edges. ‘What do you suggest?’
‘A transplant,’ Ryan said promptly.
Her breath came out in a huff of something very close to despair. ‘Yeah…right. I’m working on it. See?’ She held up a hand, the fingers crossed. Her words had a faint and alien ring of bitterness. ‘Not much more I can do, is there?’
‘Yes,’ Ryan contradicted calmly. ‘There is.’
Holly stared at him as though he was speaking a foreign language. ‘Like what?’
‘Like considering a living donor for a transplanted organ instead of a cadaveric one.’
Holly shook her head wearily. ‘I’ve been down that track as far as it goes.’
‘And?’
‘And nothing. My mother died when I was ten, from the same kidney disease I have. My father’s diabetic. My brother’s not interested. Or, rather, he could be but he has a morbid fear of hospitals and illness and he’s avoided talking about anything to do with my kidney disease ever since I was diagnosed.’
‘What about other relatives? Friends?’
‘I don’t have any other close relatives and it’s certainly not something I’d ask a friend.’
‘What if the friend didn’t need to be asked? If they offered?’
The Surgeon's Perfect Match Page 2
