The Italian Surgeon

by Meredith Webber

  ‘You will have some wine?’

  Rachel shook her head.

  ‘Work day tomorrow, and a big work day. I know Alex has a TAPVR listed first up, and they can be tricky. And if the first op overruns its time, we’ll be late all day, which is when people get frazzled.’

  Luca smiled at her, and just about every cell in her body responded, so she had to remind them it was just a chemical reaction and nothing was going to happen, so to cool it.

  They talked about the operation—far safer, especially as Rachel had assisted in so many total anomalous pulmonary venous return ops with Alex that she knew it inside out. And because talking work helped keep her mind off her physical problems, she asked Luca about his work—about the operations he liked doing—knowing most surgeons had their favourites.

  ‘Transplants.’ His answer was unequivocal. ‘I haven’t done many, but there is something about removing a terribly damaged heart and replacing it with a healthy one that fills me with wonder. I know the operation is only the first part of the battle, but I find that battle—to keep the patient stable, fight infection and rejection—a great challenge. It’s a fight, so far, I’ve been fortunate enough to win, so perhaps that is why the operation is my favourite.’

  The passion in his voice affected Rachel nearly as badly as the attraction. She understood it, because she loved her work in the same way. Every operation was a new challenge, and her total focus, whether she was handing instruments to the surgeon, suctioning, or massaging a tiny heart, was on providing the best possible outcome for the baby or child on the table in front of her.

  She felt the bond between them but at the same time was aware this was a very different kind of attraction and an infinitely more worrying one.

  Talking about work was still the best option so she asked about places he’d trained and surgeons with whom he’d studied.

  It should have been safe, innocuous conversation, but beneath it the attraction still simmered, and when he passed her a bowl of freshly grated Parmesan cheese to sprinkle on her pasta and their fingers brushed together, she felt heat flash through her body.

  Crikey, she was in trouble…

  ‘Phil as a surgeon.’

  And she was missing the conversation.

  She looked at Luca—at the dark eyes, and bronzed skin, and strong-boned face—and tried desperately to guess what he’d been saying.

  ‘He’s terrific,’ she managed to get out, hoping he’d asked her about Phil’s ability.

  He hadn’t! That much was obvious from the delighted grin that spread across his face.

  ‘You were thinking of other things?’ he teased. ‘Too much to hope it might have been of me.’

  ‘Far too much!’ she snapped—perhaps too snappishly! ‘I was thinking about the TAPVR.’

  ‘Ah!’ Luca murmured, dark eyes smiling at her so she knew he didn’t for a moment believe her. ‘Of course!’

  But those smiling dark eyes not only seemed to see right into her soul, they made her feel warm and excited and, damn it all, sexy!

  And that feeling was so unfamiliar she had to mentally question it before deciding, yes, that’s what it was.

  Somehow she got through the rest of the meal, refusing dessert or coffee, anxious to get home now her hormones seemed to be totally out of control.

  Again they took a cab, Luca paying the driver off outside Rachel’s building before offering to walk her up the stairs.

  She thought of the dim lighting on the landings and the temptation the gloom would provide and insisted she could walk up unattended.

  ‘That is not right,’ he protested. ‘I should at least see you to the door.’

  Rachel smiled at him.

  ‘Not right but probably safer. I’m not at all sure about this situation, Luca. I meant it when I said I don’t get involved with men.’

  But her heart was thudding so loudly he could probably hear it, and her body was leaning towards his even before he put his hands on her shoulders and drew her close.

  ‘It is up to you,’ he said softly, the little puffs of air from the words brushing her cheek as he bent his head and kissed her on the lips.

  By this time she was so wired—so jumpy—her brain forgot to tell her lips not to respond. And the heat she’d felt earlier with an accidental touch of fingers was nothing to what she now experienced.

  Hard, hot and horrifyingly exciting—her lips clung to his as her body awoke from a long, long sleep and desire spiralled deeper and deeper into her body.

  An impulse to drag him inside, rip off his clothes and give in to the urges she was feeling came from nowhere and her startled brain was actually considering it when two young lads walked by.

  ‘Get a room!’ one of them yelled.

  Mortified by her thoughts and her behaviour, Rachel pushed away from the man who was causing havoc in her body, muttered her thanks for the meal and hurried into her building.

  Luca watched her disappear—watched the door shut firmly behind her—and wondered just where things now stood between them.

  He could no longer doubt that Rachel felt the attraction between them as strongly as he did.

  So why was she resisting it?

  Because they barely knew each other?

  But giving in to it would help them know each other better…

  He walked slowly along the pavement to his apartment building, thinking about attraction and a woman with red-gold hair and amber eyes who had, so unexpectedly, appeared in his life.

  ‘I’ve called you all together because it’s the first TAPVR operation we’ve done at Jimmie’s and I wanted to run through the whole procedure.’

  Alex stood on the dais at the front of the very small lecture room the unit used for staff meetings. Rachel, whose job today was to explain to the theatre staff exactly what they’d need, sat at a nearby table, uncomfortably aware of Luca in a seat directly behind her.

  Not that she needed his presence to remind her of his…eruption—that was about the only word that fitted—into her life. He’d dominated her thoughts all weekend, both when she’d been with him, fighting the physical attraction, and when she hadn’t been with him, when she’d wondered about it!

  Now here she was, having to sit in front of the man and pretend nothing had happened—which it hadn’t, apart from a mind-blowing, bone-melting, common-sense-numbing kiss.

  Pretend nothing had happened, when her toes were curling every time she looked at him?

  Could it be because of one kiss?

  Was this what lust felt like?

  And, if so, what did one do about it?

  The problem was, she’d been out of circulation for too long for any of this to make sense. Remembered pain had been an effective barrier to involvement for the last four years, but she sensed the barrier was crumbling beneath the onslaught of her attraction to Luca.

  But involvement led to vulnerability and she’d vowed never to be vulnerable again…

  Never again!

  Especially not when all that could possibly occur between herself and Luca was a brief affair.

  She tried to focus on what Alex was saying. No doubt he’d begun by explaining that TAPVR stood for total anomalous pulmonary venous return. Put simply, Rachel knew, the blood vessels bringing oxygen-rich blood back from the lungs to the heart had hooked themselves up to the wrong place. Instead of coming into the left atrium to be pumped into the left ventricle and then out the aorta to be distributed throughout the body, some mistake had occurred during the heart’s development and the blood returned to the right ventricle and was recirculated through the lungs, causing problems there while starving the rest of the body of oxygen.

  ‘When does it happen?’ someone asked, and Rachel realised she’d heard Alex’s explanation so often before she was at the right place in her head.

  ‘Usually during the first eight weeks of pregnancy, which is when the heart is developing from a double tube into a complex muscled organ.’ Phil explained this to the nurse who’d
asked the question and, looking at the young woman in the back row, Rachel realised the questioner was pregnant.

  And worrying.

  Been there, done that, have the T-shirt, Rachel thought, but, though she might act tough, remembered pain had her feeling sympathy for the pregnant woman.

  Luca had also turned towards the speaker, and now he said, ‘You shouldn’t worry. You’ll have had scans by now, and it would have shown up if your baby had a problem.’

  It’s nice he feels for people—even those he doesn’t really know.

  The thought sneaked up on Rachel and she had to remind herself that Luca’s niceness wasn’t her concern.

  The operation was her concern, and explaining what the theatre staff would be doing during it was her immediate concern.

  Right now, apparently, because Alex was waving his hand in her direction and asking her to take over.

  ‘You would make an excellent teacher,’ Luca said an hour later when, the briefing over, he had managed to walk out of the room beside her. ‘Have you thought of doing more academic work?’

  ‘Not often,’ Rachel told him honestly. ‘I really love the theatre work I do, and Alex is good in that he encourages me to be part of the explanations as I was today, so I get to do a bit of teaching that way.’

  Luca nodded.

  ‘Yes, I like the way he includes everyone, theatre and PICU staff, in his briefings. I think I’ll learn more than I even imagined I would from him—in administrative matters as well as surgical skills and techniques.’

  Rachel felt a glow of pride for the man his team called Alexander the Great, then Luca was talking again.

  ‘Have you worked with other surgeons back in the US? Are they all as meticulous in their planning? As thorough in their briefings?’

  ‘I’ve occasionally assisted other surgeons. I suppose assisted sounds strange to you, but back at home I’m what’s known as a PA—a physician’s assistant. Anyway, since Alex joined the staff at the hospital where I trained, I’ve worked exclusively on his team, assisting whoever on the team is operating. Alex usually has a fellow working with him, Phil being the current one, and a registrar or surgeon in training, and then there are other surgeons, like yourself, on short-term visits.’

  ‘So you would assist me if Alex asks me to be the lead surgeon in an operation while I am here?’

  They’d talked as they walked towards the theatre the team used, Rachel fending off the strange sensations being close to Luca caused and answering his questions automatically. It was only after they’d parted, Luca to join Alex, who would have a final talk with the baby’s parents, and she into the theatre to check all was ready, that she wondered if he’d been talking to her because he wanted to know more of the details of her job or to give him an excuse to walk with her.

  Nice thought, that, but did she really want to break her commitment to non-involvement? Or want to have an affair with Luca just because her body was behaving badly?

  The answer to both questions was no, but that was her brain talking at eight thirty-two in the morning, when the man was no longer in the vicinity so his body wasn’t zapping hers with seductive messages.

  Kurt was in the theatre, explaining the finer points of the heart-lung bypass machine to Ned, an Australian theatre sister who’d been seconded to their team and was being trained in the work Rachel did as a PA.

  ‘Fantastic party Friday night,’ Ned said cheerfully.

  ‘Huh!’ Rachel replied, but didn’t elaborate. There was no need for the entire team to know she was in a tizz over Luca. She turned her attention to work, and addressed Ned and the other theatre staff.

  ‘Although the echocardiograms suggest the pulmonary veins are connected to the right atrium instead of the left, the films are never as accurate as we’d like so we have to be prepared for surprises. I always make sure I’ve got extra patches and shunts in case they’re needed, and the runner…’ she nodded to the pregnant nurse ‘…knows where to put her hand on more if we need them.’

  ‘I’ve got a full range ready,’ the woman answered. ‘I’ve put out the ones you usually use on the trolley, and have back-ups.’

  She smiled at Rachel.

  ‘I worked on an op with Phil a couple of weeks ago and he went through five shunts, snipping and shaving them, before he got one exactly the size he wanted. Since then I’ve made sure I’ve got plenty on hand.’

  ‘Great,’ Rachel said, and she meant it. The longer a baby was on bypass, the more chance there was of doing damage to its fragile circulatory system and organs. It was unacceptable to have hold-ups because the theatre personnel weren’t properly prepared.

  ‘The problem with TAPVR is that you can use so many patches and shunts. The surgeons have to detach the veins from wherever they are and patch the holes they left, then rejoin them up to the back of the left atrium and patch the hole between the two atria, which has usually been made bigger by the cardiologist during a catheterisation procedure. Then sometimes the veins are too small, and we either use a stent to hold them open or a patch to make them bigger, so, like the Scouts, we have to be prepared.’

  She checked the trolley, automatically noting that the instruments Alex would need were in the right places, then went to change.

  ‘Teaching again,’ a now familiar voice murmured.

  Luca was standing in the doorway, and had obviously heard her little lecture to the nurses.

  ‘That’s not teaching,’ she protested, while her body suggested her head had been wrong about the two decisions it had made earlier.

  ‘Ah, but it is, and you are very effective.’

  He touched her lightly on the shoulder, then went on his way, while she took her muddled thoughts into the changing room and wondered if physical attraction would get stronger or weaker if one gave in to it and enjoyed an affair purely for the satisfaction and undoubted delight it would bring.

  CHAPTER THREE

  THE operation took longer they any of them had expected, the baby’s left atrium being small and under-developed, so in the end Alex had to splice the four pulmonary veins so he ended up with only two, then use another shunt to join them, attaching it to the tiny heart.

  ‘It’s a damn shame,’ he said much later when he’d seen the baby’s parents and had returned to where most of the team were gathered, holding a general debriefing. ‘It means she’ll need more operations as she grows, because the shunts won’t grow with her.’

  ‘I know you can use tissue from the baby to make patches,’ Maggie said, her hands cupped around a mug of coffee. ‘Could you also use a vessel from the baby instead of a shunt?’

  ‘I’ve used veins taken from another part of the body for a small repair but for a vein as large as the pulmonary vein, I’ve never tried it,’ Luca said, looking enquiringly at Alex.

  ‘I have,’ Alex said, ‘and found it didn’t work as effectively as the shunt. Because it was small, and possibly because it didn’t like the insult of being transplanted from one site to another, it closed off almost immediately. Until we work out some way of successfully growing spare vessels inside the baby—which might not be that far away considering how science is advancing—then I believe we’re better using shunts. At least the subsequent operations to replace them shouldn’t require putting the patient on bypass.’

  It was a fairly normal post-op conversation but there was nothing normal about Rachel’s feelings, sitting as she was next to Luca who’d pulled a chair up close to her desk.

  This distraction had to stop. So far she’d been able to keep one hundred per cent focussed in Theatre, all but forgetting Luca was in the room, but if, as he’d suggested, she was one day called upon to assist him, even a tiny distraction could lead to trouble.

  She was due time off. She’d take it. Get right away. Maybe even, if she could get a cheap flight, go home to the States.

  She was planning this little holiday in her head when she realised Alex was talking again. Something about a trip to Melbourne.

 
; ‘I’m sorry, did you say you’re going away? Does that mean we’re all off duty for a few days?’ She couldn’t go home to the States for a few days but she could go north to somewhere warm—perhaps North Queensland.

  Alex grinned at her.

  ‘No, it doesn’t mean you’re all off duty for a few days. I know you’re due time off, Rachel, but if you can just hang in for this week, I’m sure we can work something out after that.’

  He paused and Rachel sensed something bad was coming—it was unlike Alex not to come right out with things.

  ‘Problem is, Phil, Maggie, Kurt and I are flying to Melbourne tomorrow to do this op. We’re taking an early morning flight, and will overnight there to make sure the baby’s stable before we leave, then be back about ten on Wednesday.’

  ‘Not me?’

  She didn’t particularly want to go to Melbourne, but if the core of the team was going, why not her?

  Alex smiled again.

  ‘It’s not that I wouldn’t like to take you—but you know you trained that theatre sister down there well enough to do your job. Besides, I need you to be here.’

  Another hesitation, so Rachel prompted him.

  ‘You need me to be here?’

  A nod this time—no smile.

  ‘I do indeed. We’ve an op scheduled for midday on the day we get back—a first-stage op for a baby born with HLHS—hypoplastic left heart syndrome. The Flying Marvels, that organisation of private plane owners who volunteer their time and planes, are flying the baby and his parents to Sydney early tomorrow morning. I need someone to do the briefing. Luca can explain the operation to them—what we’ll be doing—but I’d like you, Rach…’ his eyes met hers in silent apology ‘…to explain the post-op situation to them. What to expect when the baby comes out of Theatre—the tubes and drains and special equipment that will be protruding from his body.’