St Piran's: The Brooding Heart Surgeon

by Alison Roberts

  He discovered that Anna spent almost as much time in the hospital as he did. Way too many hours to have any kind of life away from a career. How did she find time to work on renovating that small cottage she lived in or to give her pet the attention it needed? Not that it was any of his business.

  Or was it? At one point, he had to wonder if Anna’s willingness to put in so much extra time was purely due to her dedication to her career or whether it had something to do with him still being in some kind of probationary period. Was he just aware of it because he was trying to keep one step ahead of her?

  Or … was he watching for a signal of some kind that she remembered that kiss?

  That she might find herself thinking about it as often as he did? Sometimes he would catch her gaze and he’d feel an odd buzz. A hint that she might remember.

  That she might be wondering if it would be as extraordinary if it happened again.

  Wanting it to happen again.

  On one of the first days of the new year, Anna was with Luke and one of her registrars in his office. They were discussing one of the new research projects due to get under way.

  ‘The main causes of prolonged hospital stay, morbidity and mortality following cardiac surgery are haemorrhage and infection,’ Luke was reminding the young doctor present. ‘And, quite often, infection is one of the sequelae of haemorrhage.’

  Anna was listening quietly. This was an occasion when she was in Luke’s company but his attention was on someone else. Even when he involved her in the discussion, he would forget to glare at her and the simmering undercurrent that she was waiting on for further evidence that Luke was unfit for the position of responsibility he held vanished. She could interact with—and enjoy—the company of an intelligent and stimulating colleague.

  Bask in it even.

  The registrar was nodding. ‘Is that because they’re more susceptible to infection due to a low cardiac output?’

  ‘That’s one of the parameters we need to keep in mind. There’s also the issue of how long the chest has been open, whether they’ve been on bypass or whether hypothermia has been employed. There’s a lot of stuff that’s been written on aspects of this in other studies. What we’re aiming to do is possibly challenge their findings with more current information or testing methods and/or add in any other significant parameters. Here, I’ve printed off some of the articles for you.’

  The registrar’s eyes widened. So did Anna’s.

  How long had Luke been in here already today to search out and print off this stack of material? And this was supposed to be a day off for him. Didn’t he have other places he wanted to be? Or other people he wanted to be with?

  And why was the thought that he’d rather be here, having a meeting with her, a cause for a rather pleasant internal glow? Not that Anna was going to analyse her reaction. She didn’t get a chance to, anyway, because her pager sounded.

  The disruption earned her a sharp look from Luke and Anna sighed inwardly. ‘Can I use your phone?’ ‘Of course.’

  She found Ben Carter on the other end of the line and listened intently.

  ‘I’m on my way,’ she said a short time later. ‘Luke’s here as well. We’ll both come.’

  ‘What’s going on?’ Luke demanded as she put the phone down.

  ‘Helicopter’s due to land any minute bringing in a thirteen-year-old boy. He’s hypothermic and unstable. Ectopic activity increasing so he could arrest at any time. Ben wants us on standby in case rewarming via bypass is necessary. He’s put a theatre on standby as well and called in a technician.’

  ‘You’re the one on call. I’m not even supposed to be here today.’

  Anna was at the door already. She turned to see the registrar looking slack-jawed at the potential case and Luke looking … good grief … wary? Or hopeful? Why?

  She didn’t have time to consider any personal issues. There was a child’s life at stake here and if it came to trying to rewarm him by using cardiopulmonary bypass it was new territory for her. She’d read about it but never even seen it done. A flicker of something like panic had to be crushed.

  She held Luke’s gaze for a heartbeat despite—or perhaps because of—knowing he could probably see that flash of fear.

  ‘But you are here,’ she said quietly. The presence of the registrar in the room ceased to matter. ‘And I need you, Luke.’

  They both followed her but it was Luke’s tall form striding beside her that gave Anna confidence. They moved fast enough for him to be limping by the time they reached the emergency department but they were still side by side.

  A team.

  The main resuscitation area in Emergency was crowded. Helicopter paramedics in their bright overalls and helmets were there with the medical staff, transferring their patient with great care. There was a bustle of activity and a buzz of urgent instructions.

  ‘Gently! Don’t bump him. Cardiac function is fragile.’

  ‘Is the Bair Hugger on?’

  ‘Dextrose, not saline. Get some more in the microwave to get warmed.’

  ‘Make sure that oxygen is warmed and humidified.’

  ‘Get some more dots on. We need a twelve-lead ECG.’

  ‘What’s his temperature now?’

  ‘Nineteen point five degrees Celsius.’ Luke whistled silently.

  ‘The lowest ever temperature that someone’s survived without neurological impairment was around thirteen degrees, wasn’t it?’ Anna kept her voice low. The boy’s mother was on the other side of the room, looking terrified.

  Ben Carter was leading the resus team and he wasn’t happy with the oxygen saturation level of the boy’s blood.

  ‘I’m going to intubate,’ he decided. ‘Anyone who’s not directly involved step back a bit, please. It’s critical we do this with minimal movement.’

  One of the paramedics stepped well back, close to where Anna and Luke were watching. Standing by.

  ‘What happened?’ Anna asked.

  ‘Kid got ice-skates for Christmas,’ the paramedic said quietly. ‘They live on a farm up north a bit and there’s a dam. He and his brother went skating and he hit some thin ice and went through. Took his brother about thirty minutes to find a branch big enough to get him out and another half an hour to run home and raise the alarm. Probably ninety minutes before we arrived on scene and the wind chill was significant. First temperature we got was eighteen degrees.’

  ‘Cardiac rhythm?’ Luke was watching Ben and his team securing the boy’s airway but he was listening to Anna’s conversation with the paramedic.

  ‘Slow atrial fibrillation. Marked J waves.’

  Anything below a core temperature of thirty degrees was enough to put someone at risk of cardiac arrhythmias and arrest. This boy was dangerously cold but there was still hope. Anna remembered a lecturer at medical school talking about hypothermia.

  ‘You’re not dead until you’re warm and dead,’ he’d said.

  The Bair Hugger was a blanket designed to force a current of hot air over the patient’s skin. Intravenous fluids were warmed to try and raise blood temperature but these methods might be too slow to help someone with such severe hypothermia.

  ‘Luke.’ Ben had finally stepped back from the initial flurry of making sure their patient was as stable as possible. ‘Didn’t think you were on today.’

  ‘I’m not.’ Luke flicked a sideways glance at Anna and there was a hint of a smile on his lips. He was here because she wanted him to be but it seemed like he wanted her to know he was happy to be here.

  ‘Well, I’m glad you’re here. Both of you.’

  ‘What’s the plan?’

  Ben looked grim. ‘External exogenous rewarming is only going to achieve a rate of about a two point five degree increase per hour. He’s too cold to wait that long. With full cardiopulmonary bypass we could get a rewarming rate of seven point five degrees an hour.’

  ‘We can’t justify something as invasive as bypass unless he’s arrested. What about pleural lavage?’r />
  The cardiothoracic registrar was looking bemused. Anna leaned closer. ‘That’s using an inter-costal catheter to pour large volumes of warmed water into the chest cavity.’

  ‘Still pretty invasive,’ Ben was saying. ‘And possibly less effective. Right now we’ll keep ventilator support going and monitor his rhythm. We should get results on the bloods we’ve drawn soon. I want to see what his acid-base status is. At least slow A fib isn’t a malignant rhythm.’

  ‘We need an arterial blood gas as well,’ Anna put in. She stepped forward to retrieve the sheet of paper emerging from the twelve-lead ECG machine but she didn’t get time to analyse the trace. An alarm sounded on one of the monitors at the head of the bed.

  ‘He’s in V tach,’ someone warned. ‘I can’t find a pulse.’

  ‘V fib now.’

  ‘Start CPR,’ Ben ordered, moving to the side of the bed. He looked back at Luke, who gave a terse nod.

  ‘One shock. If that doesn’t work, bring him up to Theatre under CPR.’

  ‘Theatre 3’s on standby. Bypass technician was paged when I called Anna.’

  ‘Charging,’ someone announced. ‘Stand clear.’

  Luke gave another nod and touched Anna’s arm. ‘Let’s go. Better if we’re scrubbed and ready by the time they come up if we’re going to be needed.’

  A cold, still heart.

  This lad was technically dead and here they were thinking they could play God and bring him back to life.

  Luke could see the lines of strain around Anna’s eyes. He knew that her lips beneath that mask would be pressed tightly together. And, despite how subtle it was, he saw the way she flinched when her hands touched the chilled flesh in the small chest they had just opened.

  ‘We need to work fast,’ he reminded her quietly. ‘Standard bypass. Arterial cannula in the ascending aorta. Right atrial cannulation with a single, two-stage cannula.’

  Anna nodded. She was already placing a purse-string suture around the major vessel that took blood from the heart to the rest of the body.

  Within minutes, with both surgeons working together in a tense atmosphere, the cannulae had been positioned and the boy’s blood was now being circulated through the heart-lung bypass machine instead of his frail-looking body. Circulated and being carefully warmed.

  There was nothing more they needed to do surgically until it was time to take him off bypass and repair the vessels currently holding the thick tubes. Then they would—hopefully—restart his heart, close his chest and wait to see if he woke up. Wait to see whether his brain function had survived this terrible insult.

  Hours later, Luke found Anna in her office. She had been pacing back and forth between the intensive care unit and the wards. Between the canteen, where she’d eaten nothing at all, and the ICU. Between her office and the ICU.

  ‘It’s taking too long,’ she said when Luke appeared through the door.

  ‘He’s in a good rhythm. Body temperature is within a normal range. The hyperglycaemia has been corrected. Renal function is looking good.’

  ‘I know, I know.’ But Anna was still pacing, her arms wrapped around her body as if for comfort. ‘Blood gases are fine, too, and I’m happy with cardiac pressures. But what about possible complications like thromboembolism? Or disseminated intravascular coagulation?’ She dragged in a breath. ‘Have you met his mum, Janet? Did you know his big brother is six years older and that she had two late miscarriages before Jamie came along? What … what if he doesn’t wake up?’

  ‘Anna …’ Luke stepped in front of her, forcing her to stand still. He gripped her upper arms. She was so wrapped up in this case, so desperate for them to have succeeded, she was losing her perspective. He’d never seen her like this.

  So involved.

  Caring so much.

  ‘The sedation is only being lightened slowly. It’ll take time for him to start breathing on his own and he’s not going to wake up before then.’

  ‘But what if—?’

  ‘Stop,’ Luke commanded.

  He was still holding her. Looking down at Anna’s pale face. Those astonishing green eyes were locked on his. Hanging onto his words of reassurance. Believing what he was telling her. And then his gaze dropped to her mouth and he saw the tiny tremble of her lips and that undid something deep inside him.

  ‘What you need, Dr Bartlett,’ he said very softly, ‘is distraction.’

  She caught the meaning of his words as soon as he’d uttered them. Her gaze dropped to his mouth and he found himself running his tongue across his lower lip. Slowly. Deliberately.

  Time came to a standstill.

  ‘Mmm.’

  The sound Anna made could have been agreement but it sounded more like need. Desire.

  It was all the permission Luke needed. His hands left her arms. He used one to cradle the back of her head and with the other he cupped her chin. Then he bent his head.

  He was initiating this kiss. He was in control and he intended to make sure Anna was aware of nothing but the sensations he was going to provide with his lips. And his tongue.

  This was going to be a kiss that Anna would have no chance of forgetting. Ever.

  Anna kept her arms wrapped around her body even after that first touch of Luke’s lips.

  She’d needed to keep hold of herself in those seconds leading up to that kiss. Feeling the way his fingers splayed and claimed control of her head and her chin. Sensing the intent of this being far more significant than the last time they’d kissed.

  She’d kept her eyes open as she watched his face dipping to meet hers. So slowly. And she’d held herself even more tightly with her own arms then because she’d been sure she was falling.

  Desire had sucked her into some kind of vortex and she was spinning wildly. Totally out of control.

  And then his lips had touched hers and moved over her mouth. Questing. Claiming. Giving. Demanding her involvement and response.

  Sensations rippled through Anna and unlocked the awful tension that had been building from the moment she’d touched Jamie’s small, cold heart. Her skin tingled and seemed to melt and then her muscles gave up conscious control. Her arms let go of her own body and, instead, moved to hold Luke’s. She could feel the strength of his muscles and the steady thump of his heart and all the time his mouth was doing such amazing things to hers. Her bones were melting now. He could just scoop her into his arms and lay her down on the floor of this office and she’d willingly—

  Luke pulled away and for a dazed moment all Anna could think of was holding on more tightly. Pulling him back.

  ‘Phone’s ringing,’ he said gently.

  ‘Oh.’ Anna put her hand to her mouth and took in a shaky breath. ‘I—I’d better answer it, hadn’t I?’

  Luke was smiling at her.

  Really smiling. His eyes were crinkled and the corners of his mouth had disappeared into those deep furrows beneath his cheeks.

  ‘Yes.’ He nodded. ‘I think you had.’

  She actually stumbled moving towards her desk. Heaven only knew what the intensive care consultant on the other end of the line thought of her initial stammered response but the content of the call was more than enough to bring her back to the present and reality. She put the phone down a moment later.

  ‘Jamie’s breathing on his own,’ she told Luke. ‘He squeezed his mum’s hand.’

  To her horror, Anna felt tears gather in her eyes. She never cried. She most certainly never cried in front of a male colleague.

  But Luke didn’t seem to mind. He reached out and pulled her into his arms. Not to kiss her this time but simply to hold her. For long enough to be more than a celebratory hug. Long enough for Anna to know that he understood exactly how she was feeling. Long enough for her to take several deep breaths and get her brain working properly again.

  ‘If we get up there soon, we might see him wake up and then we’ll get an idea of what kind of neurological impairment he might be left with.’

  An hour later they w
ere part of the group around Jamie’s bed in the intensive care unit as the young boy’s eyes flickered open. His father and older brother were there now, too, but it was his mother who was closest. The first person Jamie saw.

  He blinked a few times. Opened his mouth and moved his lips but his brow furrowed as though he couldn’t find a way to make his mouth do what he wanted it to do. He stared blankly at the woman leaning so close to him, with tears running down her face.

  Everybody present was holding their breath.

  Luke and Anna were standing side by side. So closely their shoulders were pressed together. Unseen by anyone else in the cubicle, Luke’s hand moved just enough for his fingers to tangle with Anna’s.

  Jamie tried again.

  ‘Mum?’ The word was croaky but clear. ‘What’s the matter?’

  Anna felt her hand gripped so tightly it was painful but all she moved was her head. Just far enough to meet Luke’s gaze.

  To see the triumph at the back of his eyes.

  He let go of her hand before anyone could notice but that didn’t break the link. It was still there in his gaze. A connection that had taken them way beyond being merely colleagues.

  He would come home with her tonight. Or she would go home with him. It didn’t matter. It wasn’t even a decision that needed to be discussed because it had already been made. Back in her office. Or maybe well before that but neither of them had taken that step forward.

  Now they had taken that step and they both knew there was no going back.

  CHAPTER EIGHT

  CRASH stayed at the farm up the road from Anna’s cottage.

  ‘He often does,’ she assured Luke. ‘That way I don’t disturb the Turners by collecting him if I have to work late. June loves him to bits. She would have kept him except that Doug put his foot down.’

  She was talking quickly, Luke noticed, as the glow of realising she had kept the name he’d suggested for her puppy wore off. Was she nervous? Unsure she was making the right choice here, a passenger in his car as they drove away from St Piran’s hospital that evening?

  He was feeling a bit uptight himself. Sex in an army camp was a lot easier than this. You got attracted or desperate for distraction and a tent or somewhere private was never far enough away to allow for second thoughts. No awkwardness. No pressure. No strings afterwards.