by Barbara Hart
‘Phew!’ said Andrew. ‘No wonder you were awarded the Moreton.’
Helen returned to something he’d said earlier.
‘Did you mention me to Professor Mulberry?’ she asked.
‘Yes, that’s right.’
That’s a bit blatant, thought Helen. A bit blatant but very flattering that someone as eminent as Andrew Henderson should be interested in the medical background of a mere post-doc. student.
‘Your name came up in conversation,’ he replied casually. ‘The professor seemed to believe that we Brits live on such a small island that we’re all bound to know each other. Telling him that I had, in fact, met you only served to reinforce his belief!’
They talked for a little while longer. The minutes seemed to fly, and when they checked their watches simultaneously they each realised it was way past their time to leave.
‘See you tomorrow,’ he said, ‘and come in time to get scrubbed up. I can always use an extra pair of hands to assist.’
That afternoon, Helen found it very difficult to concentrate on her research project for thinking about the ligament operation—and the man who would be performing it. She asked herself what was making her feel so…elated. Was it the career opportunity that was being offered to her? Or was it the prospect of seeing Andrew Henderson again and working at close quarters with him?
If she was being honest with herself…it was definitely the latter.
In the operating theatre at the orthopaedic surgery centre, Helen and Andrew faced each other over the anaesthetised body of the patient, a tall muscular young man called Delroy, an amateur basketball player who had damaged his knee three days previously.
‘He’s lucky to have had his condition diagnosed and dealt with so quickly,’ remarked Helen when she and Andrew were scrubbing up.
‘We’ve found that to be crucial,’ said Andrew. ‘The sooner a torn ligament and damaged cartilage is diagnosed and dealt with, the higher the success rate. If there are no complications we can expect this young sportsman to return to basketball in about six months. The longer the injury is left undiagnosed and untreated, the longer it will take to cure and the greater the chance of permanent disability.’
Before he started the operation he addressed his group of students who were in a special viewing gallery, following close-ups of the proceedings on closed-circuit television.
‘This young man, Delroy, presents with classic cartilage and ligament damage to his right knee as a result of a weight-bearing twist. He’s a basketball player, a high-intensity activity well known for causing this type of sports injury, and his team coach said he heard a pop or snap from the knee which swelled up in a very short time. I examined him and diagnosed a badly torn ligament. Without an operation, Delroy’s basketball days will, most likely, be over.’
Andrew paused for a moment before continuing.
‘With this type of injury it is vital to be seen by an orthopaedic surgeon or sports injury doctor within three days. And if repair or reconstruction is required, this needs to be done within ten days of injury before soft tissue oedema creates technical difficulty. Delroy injured his knee three days ago…and now this is where Dr Blackburn and I come in.’
Helen felt herself heating up behind the surgical mask. Andrew was implying to his group of students that she was a member of his orthopaedic team—not just a hanger-on. It was a very generous act on his part and she prayed that she wasn’t going to let him down.
‘The operation is, as I’m sure you all know, an ACL reconstruction technique using a patellar tendon graft. In this particular procedure we will be obtaining graft tissue from the patient to replace the damaged ligament.’
Andrew glanced at Helen for a moment before looking at the inert body on the operating table.
The anaesthetist confirmed that the patient was completely anaesthetised, the gases being introduced through an endotracheal tube.
‘Before we do the ACL reconstruction,’ he said, speaking to his students once again, ‘we will carefully survey the whole knee joint using the arthroscope.’ He pointed to an instrument attached to a monitor of the type used for keyhole surgery.
‘Thank you,’ he said to the theatre nurse who handed him the arthroscopic probe.
Andrew and Helen scrutinised the images that appeared on the monitor as they evaluated Delroy’s damaged knee. The closeness of their bodies made it seem to Helen, just for a second, that it was just the two of them in the theatre. A pulse beat in her neck.
‘I’m looking to see if the meniscus cartilage is torn,’ said Andrew. ‘In sixty-five per cent of ACL cases we find that the meniscus is also damaged.’
He moved the probe a fraction of an inch at a time inside the knee joint before declaring, ‘I think this young man is in the lucky thirty-five per cent with no damage to the meniscus, which just leaves us with the anterior cruciate ligament tear, which we can see here.’ He moved the instrument in the area where he would soon be operating.
‘Now we’ll proceed with the main operation. Scalpel, please.’ His authority was complete. No one was in any doubt as to who was in charge and all eyes were on him and his surgeon’s hands.
He took the instrument handed to him by the theatre nurse and made an incision into the knee. Helen could sense the body of students moving forward in unison to get a closer look now that the first cut had been made.
‘Dr Blackburn will be retracting,’ Andrew informed the theatre nurse, who immediately handed Helen a retractor and swabs.
‘Now that I have exposed the patellar tendon, which is here just below the skin, I’m going to remove a central strip of about ten millimetres and a small segment of bone from the patella and the tibia.’
Helen watched as Andrew, with great skill and precision, cut out two tiny pieces of bone and a strip of tendon with a special miniature drill. As he sutured the remaining portion of the patellar tendon Andrew explained to his students, and Helen, that when it had healed the patellar tendon would function normally. Then he carefully shaped the graft and prepared it for transplanting back into the knee. The harvested strip looked like a small cotton bud with pieces of bone instead of cotton wool at each end.
The operation proceeded with the damaged ligament tissues being trimmed away and the site prepared to receive the graft.
‘The graft position is extremely critical,’ he told the students. ‘One of the major advances in recent years is the perfection of techniques and instruments that can reliably locate and place the graft tissue literally within a millimetre of where it should go.’
Helen was totally absorbed, watching the way Andrew performed the delicate and intricate procedures with dexterity and confidence. She was also impressed by his modesty. Never once did he boast, as he could have done, that he had played a major role in developing and perfecting these very techniques.
Placing the graft correctly involved more drilling, this time to make small holes in the femur and tibia. As the sound of drilling filled the room, the kind of noise that Helen imagined the general public would probably have expected to emanate from a timber yard or a dentist’s surgery, Andrew said to his students, ‘There’s quite a lot of this in my work. That’s why we orthopaedic surgeons end up being pretty good at DIY. If anyone needs some new bookshelves put up, have a word with me after the operation.’
A ripple of laughter came from the students, and Helen behind her theatre mask let out a giggle. Andrew looked across at her, his eyes crinkling at the sides as he gave her a wink. Helen felt a warm glow spread throughout her body.
Once the holes were made, the graft was passed carefully up into the joint, with the tendon portion lying exactly where the damaged ligament used to be. The bone portions were to be fixed in place using special screws.
‘We used to use metal screws,’ Andrew told the students, ‘but these bio-absorbable ones are much better, for obvious reasons.’
Using a medical screwdriver, Andrew fixed the two screws. He kept the probe focused inside the k
nee so that he and Helen could easily see when the graft had been sufficiently tightened.
Once the graft was in place he asked Helen to irrigate the joint thoroughly to make sure that all the tiny pieces of tissue and bone that might have escaped into the joint during the operation were flushed out. The skin incision was then stitched up using internal sutures to minimise scarring.
‘I’m placing a small drain in the joint,’ said Andrew, ‘just for the first twenty-four hours. And finally,’ he said to the note-taking students, ‘the anaesthetist will give Delroy a measured dose of local anaesthetic into the joint…that should last six or eight hours. This is part of our pain management protocol which adds to the patient’s comfort on awakening in the recovery room. It’s a small detail but it makes a big difference.’
As they left the operating theatre, Helen was touched to see all the students rise and give Andrew a standing ovation.
The operation had taken two and a half hours. As they were removing their theatre garb she suddenly felt totally exhausted. It must be the tension, she told herself, standing there concentrating for all that time without a break. And if she felt like that, how must Andrew feel? She looked across at him as he stripped off his latex gloves and binned them. He seemed as fresh as the moment he’d started.
He looked up. ‘Hope you found it instructive,’ he said.
‘I certainly did, thank you,’ said Helen suppressing a yawn. ‘But I’m now totally whacked! I don’t know how you manage to stay so fresh and alert, concentrating on that kind of microsurgery for hours at a time when you know that one slip could mean permanent disability for the patient.’
‘You get used to it,’ he said warmly. ‘I actually find operating very stimulating. I just love doing it. It makes me very happy that what I do can make the world of difference to someone like Delroy. Basketball is his life and one day he hopes to play professionally.’ Then, almost without pause, he asked, ‘Dinner tonight, Dr Blackburn?’
CHAPTER TWO
HELEN was just out of the shower and wrapping herself in a large fluffy white bath towel when she heard the slam of her apartment door and a voice calling out, ‘It’s only me!’
‘Oh, hi, Jane,’ Helen called back. Jane Howorth and Helen shared the attractive mid-town apartment, an arrangement organised by Professor Mulberry’s secretary.
‘I feel wrecked,’ said Jane as Helen padded out of the bathroom and into the living area. The two girls flopped down on the sofa.
‘Tough day in ER?’
Jane nodded. ‘A major motor vehicle accident—I believe you Brits call them road traffic accidents. Three badly injured drivers, one badly injured pedestrian. And one badly trained doggie that caused the whole messy incident.’
‘Oh, dear,’ said Helen, patting her friend’s hand soothingly. ‘Would you like me to make a cup of tea?’
Jane shook her head.
‘Coffee, then? Or something stronger?’
‘No, thanks, Helen. What I need straight away is what you’ve just had. A really long, hot shower.’ She dragged herself reluctantly from the couch. ‘And then we can send out for a spicy take-away and eat it watching the movie channel.’
‘Ah,’ said Helen, suddenly feeling guilty. ‘I’m going out for dinner. We’ll do the take-away tomorrow, shall we?’
‘No problem,’ said Jane, making her way to the bathroom. ‘Going anywhere nice?’
‘Not sure. He didn’t mention where we’d eat.’
Jane paused in the doorway. ‘So. Who is he? This man who’s taking you heaven knows where?’
Helen turned her head away slightly in an effort to appear casual. ‘Dr Henderson.’
Jane gave a long, low whistle. ‘Nice work, Dr Blackburn. I guess your eyes met over that patellar tendon and, wham, it was a done deal, huh?’
Helen couldn’t help but laugh at the comical way Jane had exaggerated her Midwest accent as she said that last sentence.
‘I suppose you could say that’s what happened!’ Helen chortled. ‘Maybe he liked the way I assisted at the operation. Either that or he wants to talk to someone from home.’
Jane looked impressed. ‘You assisted? That’s great! I knew he’d asked you to come and watch, but it’s a surprise to find you were invited to assist.’
‘It was a surprise to me,’ replied Helen. ‘A very nice surprise. I feel I’ve learned such a lot today.’
‘Lucky you,’ said Jane. ‘And I don’t just mean for assisting at the operation. Lucky you for going out with Dr Gorgeous.’
‘I’d forgotten that you’d met him.’
‘Quite a few times,’ replied Jane. ‘He’s often around the ER, doing his clinical research. We all think he’s great. But as far as I know he’s never asked one of us out on a date!’
Helen plugged in the hairdryer and began to blow-dry her shoulder-length hair. ‘Perhaps he just wants to discuss the operation,’ she said.
‘Maybe.’ Jane winked, adding, ‘Take your notebook,’ before disappearing into the bathroom.
Helen gave careful consideration to what she should wear for the dinner date.
Wanting to look dressy but not over-dressed, she took a great amount of care and attention to detail. It involved the trying on and rejection of several outfits before she finally settled on the right combination. She groomed her dark, lustrous hair into a freshly windswept look, a style that made her mother always say, ‘Why don’t you put a neat parting in your hair and brush it smooth?’ Most other days she wouldn’t have been bothered to spend all that time on getting ready, but tonight was different…tonight was special.
At least she hoped it was going to be. As Andrew arrived to pick her up, she slipped a notebook into her handbag…just in case.
The effort she had put into her appearance had, gratifyingly, not gone unnoticed by Andrew. His eyes swept over her approvingly.
‘You look just perfect for where I have in mind,’ he said.
Flagging down a cab outside the apartment block, he instructed the driver to take them to an address in mid-town Manhattan.
‘I hope you don’t suffer from vertigo,’ said Andrew, ‘because we’re going to a very high restaurant, The Big Window.’
The cab dropped them off at a building which loomed high above the city. They walked through the lobby and rode the non-stop lift to the top floor, a vertical trip which took almost a minute.
‘You don’t get vertigo, do you?’ said Andrew, suddenly becoming concerned. ‘I suppose I should have checked with you before. This place is a quarter of a mile up in the sky with floor-to-ceiling windows and—’
‘I have no problem with heights.’ Helen laughed, seeing the stricken look on his face. ‘My grandfather was a steeplejack so it must be in the genes. I also did a fair bit of mountaineering in my teens.’
‘Terrific,’ said Andrew. ‘In that case, you can hold my hand while I creep up to the edge of the windows. Even though I know the glass is there and that it’s hellish thick, looking down over that sheer drop can be more than a little daunting. When I came here previously I had to stand back a foot and brace my hands against the window-frames!’
Even though Helen had come prepared for a very, very high view, when they entered the bar and she looked out of the enormous glass panels that took the place of two of the outer walls, she couldn’t stop herself from gasping.
Andrew had booked a table next to the window and facing north. ‘This place has one of the best views in New York,’ he told her as they were directed across the restaurant.
The panorama was spectacular, taking in the vertical strips of the Manhattan avenues, the Empire State Building, the Hudson River and the George Washington Bridge. They spent the first few minutes pointing and identifying the city landmarks.
‘There’s the Chrysler Building.’
‘What’s that strange-looking building over there, the one near the white one with spires?’ ‘Is that the Sherratt Institute, over to the left of that building with a roof garden?’
Sipping a glass of chilled white wine and gazing out over the breathtaking view, Helen sighed contentedly. ‘I feel as if I’ve just died and gone to heaven!’
‘It is pretty heavenly, I agree,’ said Andrew as he ran a finger down the bare flesh of her arm.
At that moment the waiter came to take their order and after that the conversation moved away from romantic venues to a more down-to-earth topic.
‘How did you first come to be interested in sports medicine?’ Andrew asked.
‘I suppose it’s because I’ve always been a sporty person,’ she replied. ‘Junior athlete at school, a short burst at gymnastics and later on being a mad tennis fiend. I’d even considered being a professional sports person…an athletics coach or tennis teacher…but I was also keen to be a doctor. My late father was a GP and I grew up believing that’s what I would most probably do. So a job that combined sports and medicine seemed the ideal choice. How about you?’
‘An almost identical scenario,’ he replied. ‘But I also suffered a sports injury in my college years—a pulled hamstring—and it was while I was being treated for it that, like you, I realised I could have a job that involved medicine and sport, both of which I loved. Still do.’
Andrew paused for a moment and lightly stroked his finger across her arm again. ‘Have you brought your tennis racket with you?’
Helen was startled. ‘Tonight?’
Andrew threw back his head and laughed out loud, a rich, warm sound that reminded her of their first meeting in Rolf’s Deli. ‘No, not tonight!’ he said.
‘Oh, I see what you mean,’ replied Helen. ‘Did I bring it with me to New York? Yes, I did. The trouble is, I’m not sure where or when I’ll get to play.’
‘My club,’ he said decisively. ‘I hereby challenge you to a match.’
‘That’d be great,’ enthused Helen. ‘I could certainly do with the exercise. I’m trying to find time to get to a gym as well. Professor Mulberry tells me there’s one near the Institute where we have a special arrangement.’
