‘He’s a great kid,’ Mike said as the paramedic wheeled the trolley through into Paediatrics, and Gina gave him a glance that she hoped was grateful.
She looked back at Cal. There was no gratitude there. His face was set and stern.
Maybe she should have phoned him four years ago.
Or not.
Maybe she shouldn’t be here now.
If she hadn’t been here now, this baby would be dead.
‘We need an echocardiogram,’ Cal said. He hadn’t paused as they moved through the hospital. He was intent only on the baby. Or he acted as if he was intent only on the baby.
‘You said you don’t have a cardiologist? No one with cardiology training?’
‘No.’
‘A paediatrician?’
‘Hamish is on leave. We’re trying to contact him now.’
‘We’re dead short of doctors,’ Mike said, and smiled, but then his smile faded a little. ‘There’s been a couple of…disasters. Just lucky you’re here, huh?’
‘I guess,’ she said dubiously, and cast an uncertain look at Cal. His face said there was no luck about it.
But she couldn’t look at his face. She needed to focus. This baby needed skills that she possessed.
He certainly did.
When the results of the echocardiograph were in front of her she felt her heart sink. Any thoughts she had of flying out of this place tonight were completely gone.
‘It’s pulmonary stenosis.’
With the stethoscope she’d been able to hear the characteristic heart murmur at the left upper chest. That and the fast heart rate had made her fairly sure what was causing the cyanosis. And now… Her fears were confirmed. There was a huge pressure difference between the right ventricle and the pulmonary artery. Blood flowing in one direction and unable to escape fast enough in the other. Recipe for catastrophe.
‘We can’t risk transfer to Brisbane,’ Cal said slowly-reluctantly. ‘We’ll lose him.’
‘What’s happening?’ Mike asked. He’d come in and watched as they worked, but he’d been on the sidelines. Another nurse was there now-a woman in her thirties who’d been introduced as Jill Shaw, the director of nursing. Jill was wheeling the baby back under the nursery lights, with instructions to keep warming, keep monitoring breathing, while the three of them were left staring at the results.
‘We operate,’ Gina said, staring down at her fingers as if there were some sort of easy answer to be read there. There wasn’t. They really needed a paediatric cardiologist, but the nearest available would be in Brisbane and to transfer the baby…
They would have had to if she hadn’t been here. They’d have been forced to. Cal was an excellent general surgeon, she thought, and his additional physician training made him a wonderful all-rounder in this place where multi-skills were vital. She knew that. Cal’s skills were one of the things that had attracted her to him in the first place.
But the operation for pulmonary stenosis on such a tiny child…
The heart valve they’d be working on-the pulmonary valve-was thin, even in adults. Composed of three coverlets, like leaflets, it opened in the direction of the blood flow. With pulmonary stenosis those leaflets were blocked or malformed in some way. In the baby’s case it was a major blockage. His heart was being forced to work far too hard to force blood through.
What she needed to do was to perform a balloon pulmonary valvuloplasty-a tricky manoeuvre even in adults-forcing the valve to open. With babies this size…
She’d normally advise waiting, she thought bleakly. She’d normally advise keeping him on oxygen. She’d try and get him fitter, older. She’d operate at a few weeks.
To operate on such a newborn…
But this was no minor blockage.
‘Do you have the equipment?’ she asked. ‘I’d need to monitor catheters by fluoroscopy.’
‘I’d imagine we have all you need,’ Cal told her. ‘Simon, the cardiologist who’s just left, had the place well set up for heart surgery.’
Gina nodded. She’d worked with this service before, and she’d expected this answer.
Many of the population around Crocodile Creek would be indigenous Australians, and she knew from experience how reluctant they were to leave their people. For a tribal elder to come to Crocodile Creek for an operation would be hugely stressful, but here at least here they could still be surrounded by their own. To be flown to Brisbane, where there was no one of their tribe and no one spoke their language, was often tantamount to killing them. The cultural shock was simply too great for them to handle.
That would be part of the reason Crocodile Creek would be set up so well, she knew. This base would do surgery which would normally only be done in the big teaching hospitals. Death rates would be higher because of it, but the population would accept it. The doctors involved had to accept it.
But this doctor in particular didn’t have to like it.
‘So we have no paediatrician and no cardiologist.’
‘We’re not normally this short-staffed,’ Cal told her. ‘We’ve had a couple of dramas.’
He sounded defensive, she thought. Good. It stopped her thinking about all sorts of things she should be defensive about.
‘Do you have an obstetrician?’
‘Georgie’s mother died last week. She’s flown down to Sydney with her little boy, and we don’t want to pull her back unless we have to. She had back-up-Kirsty was an obs and gynae registrar-but there was a bit of a dust-up and Kirsty and Simon left in a hurry. Emotional stuff.’
‘Emotional stuff?’ she demanded, astonished, and he looked even more discomfited.
‘Um, yeah. We don’t need to go there.’
Of course not. When had he ever?
But she had a baby to take care of. Cal’s emotional entanglement, or lack of it, had to wait.
Mike was waiting for her to make a decision. He was looking interested-as interested in the chemistry between them as he was in the baby-and that made her flush. She remembered how intimate working in this sort of environment could be. She even remembered enjoying it, but she didn’t relish the questions she saw forming in Mike’s eyes now.
‘I’ll wait for an hour and reassess,’ she said, trying to make her voice calm and professional. ‘We need to get him fully warmed and make sure the shock of delivery has worn off. Maybe once he’s settled we might get better circulation.’
‘But probably not,’ Cal said.
‘No,’ she said heavily. ‘Probably not.’
‘So Gina’ll need to stay.’ Mike wasn’t sure what was going on-his eyes were still asking questions-but he was certainly prepared to be friendly while he found out. He gave Cal a rueful smile. ‘Just lucky we have plenty of room in the doctors’ quarters, eh?’
Cal’s face tightened. ‘She can’t stay in the doctors’ quarters.’
‘Why not?’ Mike was confused.
‘I’ll stay in town,’ Gina said hurriedly, but Mike shook his head. He was obviously a skilled paramedic, accustomed to making hard decisions, fast decisions, and he made one now.
‘No way. I’m sorry, Gina, but this baby is sick.’ He cast a dubious glance at Cal-as if he thought Cal might just be losing his mind. ‘We all know this baby’s high risk. It seems to me that we need our cardiologist on hand, right here. Wouldn’t you say, Cal?’
‘Of course.’ The words were tight and blunt. Cal turned away to pack equipment and Mike shook his head at his friend. He was obviously still confused.
‘Cal’s being a bore,’ he told Gina, with another dubious glance at his friend. ‘He’s tired. Too much work. But there’s plenty of us around here who are gentlemen.’ He tried a smile. ‘Especially me.’ He waited to see if he’d teased a reaction from Cal, but a reaction wasn’t anywhere in sight. ‘OK.’ He sighed. ‘Let’s find your son and find you a bedroom.’
‘I’ll stay here and monitor the baby,’ Cal told them, still without turning around.
‘Of course,’ Mike said politel
y. ‘How did I know you were going to say that?’
‘The baby needs monitoring.’
‘Of course he does, Dr Jamieson,’ Mike agreed. He compressed his lips in disapproval and then he turned to Gina. ‘OK. There’s obviously just me being a gentleman, but I’m all yours. Take me or leave me.’
Charles entered the nursery silently, wheeling his chair across the smooth linoleum until he came to rest against the incubator under the overhead lights. Cal was gazing down at the baby and, seeing the look of his face, Charles thought, Uh-oh.
‘Will we lose him?’
Cal turned and stared, almost unseeingly, down at his friend.
‘I don’t know. He has a chance.’ There was a moment’s silence. ‘Gina’s here.’
‘I heard.’ Charles hesitated. He’d met Gina before, just the once. He’d been astounded by the change the relationship had wrought on his reserved friend, and when it had gone pear-shaped he’d felt ill. Now Mike had given him a quick update on what was happening, and he was even more concerned. He’d suspected Cal’s past would catch up with him sooner or later but, damn, he didn’t want him to be presented with it now.
From a selfish point of view they were too many doctors down already. He couldn’t afford to have another of his staff in emotional crisis.
‘Are you coping?’ he asked, and Cal shrugged.
‘I’m coping. You’ve seen the kid?’
‘I’ve seen the little boy, yes.’
‘Dammit, Charles, he looks like me.’
‘Could you be his father?’
It was a direct question and it jolted Cal. He stared at the question from all sides and there was only one answer.
‘Yeah,’ he said heavily. ‘I could.’
‘And that makes you feel-how?’
‘How do you suppose it makes me feel?’ Cal turned and faced his friend square on. ‘If it’s true… She got pregnant and left? Went back to the States to her husband?’ He closed his eyes. ‘Hell, Charles, I don’t want to think about it. I can’t think. I don’t have time. We need to get this baby viable. He needs urgent surgery and we’re stuck with Gina to do it. No one else has the skills.’
He stared down into the crib and his mouth twisted. ‘We’ll do the best for him, poor little scrap. He’s been abandoned, too. People…they play games. They have kids for all sorts of reasons. Who knows what the reason is behind this little one and who knows what the reason is behind the child who’s out in Mrs Grubb’s kitchen, waiting for his mother to take him home? I can’t face any of it. Just… Let’s stick to medicine. It’s all I know. It’s all I want to know.’
There was a moment’s silence. Move on, Cal willed Charles, and finally he seemed to decide that was all there was to do.
‘Emily will do the anaesthetic,’ Charles said mildly, his voice carefully neutral, not giving away any of the anxiety that someone who knew him well could detect behind his eyes. ‘She’s contacting a paediatric colleague in the city who’ll stay on the phone throughout. Do you want to assist, or will I find someone else?’
‘Who?’ He was the only surgeon, and both of them knew it. But he shrugged. ‘It’s OK. I want to assist.’
‘So you can bear to be in the same room as her?’
‘I thought I loved her,’ Cal said heavily. ‘Once. I was a fool-but sure I can stay in the same room as her. I need to be able to. If that’s really my son…’ His voice trailed off.
‘Well, let’s get on with it,’ Charles said, and there was still heavy anxiety behind his eyes. ‘We need to save this life. For now, Cal, that’s all we can think about.’
CHAPTER THREE
SHE was good.
There was no doubting Dr Gina Lopez’s skill. Cal could only watch and wonder.
Not that there was much time for wondering. To operate on a child so young, to insert catheters into such a tiny heart, putting pressure on the faulty valve-that was something that in an adult heart would be tricky but in this pint-sized scrap of humanity seemed impossible.
Emily, the anaesthetist, was at the limits of her capability as well. This procedure should be done by an anaesthetist specialising in paediatrics, but Emily was all they had. She was sweating as she worked, as she monitored the tiny heartbeat, treading the fine line of not enough anaesthetic, or too much and straining this little body past more than it could bear.
Jill, the director of nursing and their most skilled Theatre nurse, was assisting Emily. She was sweating as well.
It was Cal who assisted Gina.
He watched her fingers every step of the way, trying to figure what she was doing, trying to anticipate so there was no delay between her need for a piece of equipment and the time she had it. He was organising, swabbing, waiting for the pauses in her finger movements to reach forward and clear the way for her. Holding things steady. Watching the monitor when she couldn’t, guiding her with his voice, and holding catheters steady when she had to focus on the monitor herself.
Grace, their second nurse, was behind him, and she was anticipating as hard as he was.
There was so much need here. Something about this tiny wrinkled newborn had touched them all.
They needed him to live.
They willed him to live.
All that stood between him and death was Gina.
They were lucky that she was here, Cal thought grimly as he helped her painstakingly introduce her catheters from the groin, monitoring herself every inch of the way. No matter why she’d returned after all these years-she’d been in the right place at the right time and this baby could live because of it.
Maybe.
‘He’s bleeding too much,’ she muttered into the stillness, motioning with her eyes to the catheter entry site. ‘There has to be an underlying problem.’
‘Haemophilia?’ Cal asked, and she shook her head.
‘I don’t think so. It’d be worse. But it’s not right. The cord bled too much and we’re having trouble here. I want tests. A clotting profile, please, including full blood examination, bleeding time and factor eight levels. Fast.’
‘What are we looking for?’
‘I don’t have time to think. You think. Something.’
He went back to sorting tubing, his mind moving into over-drive. Sifting the facts. She was right. The bleeding was far more severe than it should be. They were fighting to maintain blood pressure.
Why?
‘Von Willebrand’s?’ he said cautiously.
Was he right? Von Willebrand’s was a blood disorder that impeded clotting. Like haemophilia, it was genetically linked, passing from parents down to children. It usually wasn’t as life-threatening as haemophilia but it did have to be treated. He watched as Gina frowned even more behind her mask. Her fingers were carefully manoeuvring, she was fully absorbed in what she was doing, but he could see her mind start to sort through the repercussions of his tentative diagnosis.
‘You could be right,’ she said at last. ‘It fits.’
‘I’ll run tests straight away,’ he said. ‘There’s not a lot more we can do about it now, though. And at least it takes away the risks of clotting.’
‘Mmm.’
Silence. The tension was well nigh unbearable. She was measuring the pressures in the right ventricle and the pulmonary artery by placing the catheter tip in each area. It was a tricky procedure in an adult, but in a newborn…
‘My face,’ Gina muttered, and Jill saw her need and stepped forward to wipe sweat beads from above her eyes.
She was good, Cal thought grimly. Good enough?
The work went on. The child’s tiny heart kept beating. Emily was fighting with everything she had. She had a paediatric anaesthetist on the line from the city, and she was working with a headset. Her soft voice asking questions was the only sound as they worked.
Cal had seen this done in adults, but he’d never seen the procedure in one so tiny. As a general surgeon he would never think of doing such a procedure himself. He couldn’t, he acknowledged. Somewhere a
long the line Gina had acquired skills that could only make him wonder.
Gina was working out diameters now, her eyes moving from fingers to monitor, fingers to monitor, and he could almost see her brain doing the complex calculations as she worked out the next step forward.
She was brilliant. An amazing surgeon.
The mother of his son?
‘Now the wire,’ she said into the stillness, and the sound of her voice almost made him start.
Back to silence.
The balloon valvuloplasty catheter was threaded over the wire, painstakingly positioned so its centre was just at the valve. That was the hard part.
Now came the hardest.
Please…
‘Let’s try,’ Gina said into a silence that was close to unbearable. ‘I think…’
The balloon was inflated, showing on the monitor under fluoroscopy, with Gina watching that it remained centred all the time. The balloon had been manoeuvred right to the valve. Now it was stretching the valve, much as a shoe was stretched by a cobbler, hoping that once the stretching was done the valve would self-correct. The pressures would equalise.
If it didn’t happen, then the build-up of pressure could mean instant heart failure-instant death.
This was no time for panic. The procedure called for infinite patience.
The balloon was inflated once. Twice. Three times the valve was stretched.
‘Enough,’ Gina said, and Cal heard exhaustion in her voice.
But she couldn’t stop now. She had to check the pressures again. If the pressures weren’t equalised the whole thing would have to be repeated, using balloons of different lengths and diameters, and this tiny heart was under so much strain anyway…
The catheters were reinserted, once more measuring the pressures in the right ventricle and the pulmonary artery.
Please.
The figures…
‘Hey,’ Jill said in a tiny tremulous voice that didn’t sound the least bit like the efficient director of nursing they all knew-and, if truth be told, they often feared. ‘We have lift-off. Isn’t that right, Houston?’
‘I… Maybe,’ Gina said. She glanced up at her anaesthetist. ‘What do you think?’
His Secret Love-Child Page 4
