‘The echo shows a problem with the pulmonary artery valve so blood’s building up in the right ventricle instead of heading for the lungs,’ the woman cardiologist told Maggie. ‘I can usually open it with a balloon—it’s a temporary measure but saves operating on a neonate.’
Maggie intubated the baby carefully, mentally apologising to the tiny scrap of humanity for the things she was doing to her. She wondered whether the cardiologist’s words had a hidden meaning, whether the woman had heard of Phil’s refusal to operate, though this was a different problem—or the same problem, but with the valves in a different artery.
Maggie watched the baby, worried about the rising blood gas levels, then glanced at a screen to see the wire inching up the blood vessel towards the heart. Once the wire reached its destination, a hollow tube would be slipped over it and the wire withdrawn, then a tiny balloon on the end of the tube would be inflated with water forced down the tube, and the inflating balloon should force the valves open.
It was delicate, precise work, with risks all along the way.
Maggie knew crossing her fingers wasn’t going to make a scrap of difference, but she did it anyway.
Phil was walking up the street, considering whether there was any feasible way he could move from Alex’s house and so escape life with Maggie, when his pager vibrated in his pocket.
‘Hospital! Well, I’m nearly there,’ he said, only realising he’d spoken aloud when two boys on their way to school walked carefully around him.
He picked up his speed, striding now, wondering what lay ahead of him this morning. At least thinking about escaping life with Maggie had stopped him thinking about yesterday’s disaster.
Jenny Payne, the staff paediatric cardiologist, met him near the ICU.
‘Newborn with a huge heart murmur—the echo shows a faulty valve on the pulmonary artery. I catheterised her to try to open it with a balloon, but it won’t open,’ she explained, handing him the case notes—a thickish file already, although the baby was only hours old.
Déjà vu! Phil thought. Another balloon valvuplasty that didn’t work.
‘Let me check these and talk to Becky. We have a four-year-old booked in for a first-stage repair of a tetralogy of Fallot, but there’s no reason we can’t delay that slightly and do the baby first.’
‘You’ll do the baby?’
Phil closed his eyes for a moment and told himself to remain calm.
‘Jenny, the baby needs a shunt put in to get blood from her heart to her lungs. Of course I’ll do it. We’ve done three or four in the time we’ve been here. Why wouldn’t I do it?’
She looked embarrassed, as well she might, and Phil took pity on her.
‘A shunt is a minor op to keep the baby going until we can do a more complete repair. What Dr Ellis—I assume you’ve heard about the argument I had with him yesterday that you’re looking so jittery?—wanted was a different matter altogether. He wanted me to do major surgery of a kind that has been proved to be more successful when the infant’s older.’
‘I know that,’ Jenny said, ‘and I should have known better than to listen to the stories Ellis has been circulating, but he’s a dangerous enemy to have, Phil, so watch your step.’
Something else to keep his mind off Maggie, Phil told himself as he took the notes to the ICU desk, spread them out and looked at what they knew so far about Baby Creagh.
The team would already be preparing for the tet but if Maggie hadn’t done the pre-med on their patient, a stalwart little boy called Pete, they could do the baby first.
He bundled up the notes and headed for their rooms, finding Becky there and alerting her to the change in schedule. She paged Maggie first, then Rachel, who would tell the others.
‘We won’t need Kurt for this first one,’ Phil told her, as the phone rang on her desk.
Becky nodded and spoke into the phone.
‘Maggie’s on her way,’ she said to Phil as she put down the receiver then lifted it again as the second page was answered.
Phil nodded and, notes in hand, left the rooms. He was at the sink in the theatre suite, scrubbing furiously at his arms, when Maggie came in. The hospital Maggie, all dedication and efficiency! He could handle this.
‘I did the anaesthetic on Baby Creagh when Jenny did the cath. We had to use bicarb to neutralise acidosis even in such a short procedure. I’ll have it on hand but be prepared for fibrillation if she’s still unstable.’
Phil turned towards her, holding his dripping hands high in the air.
‘Thanks, Mags,’ he said. ‘We’ll watch it.’
And though this was the hospital Maggie he was talking to, he couldn’t help but notice anxiety in her soft dark eyes and a tightness in her usually full and luscious lips.
Hospital Maggie with full and luscious lips? He was definitely losing his grip.
But the tightness bothered him more than his reaction.
‘Are you all right? Are you still thinking about yesterday?’
The lips flashed into a smile.
‘Depends what bit of yesterday you mean!’ she said cheekily, then she darted off, leaving him wondering if she could possibly have meant the kiss.
And if so, did that mean she might consider resuming a relationship with him?
‘Gore-tex shunt?’
He turned, arms still dripping water, to find Rachel hovering behind him.
‘I’m sorry, what did you ask?’
‘Nothing complicated,’ she said with a smile. ‘Just wondering if you’ll use a Gore-tex shunt or do you want to try one of the new ones that rep brought in the other day? The information he had on them and recommendations from surgeons back home all sounded good.’
Pleased to be able to focus on work, Phil considered the question. The new shunts had also been demonstrated at a conference he’d attended recently and looked good.
‘Put a range of both out and we’ll see. It would be good if we can find one of either make that is the exact size.’
From the beginning of his time with Alex, he had learned the importance of doing the little things right. He explained this to Scott a little later, when Scott had made an incision, not midline, but a small cut between two ribs on the side of the baby’s chest.
‘We’re already invading this infant’s body and putting in something that doesn’t belong there, so the least we can do is make it the right size, put it in the right place and cause minimum disruption to the proper pattern of her blood vessels.’
With the light angled so he could see into the small hole they’d made, he inserted probes into an artery and a vein to keep an eye on the pressure in each, then carefully clamped the baby’s subclavian artery, cut a small nick, and with swift but careful stitches sewed the shunt into place. Then did the same thing with the pulmonary artery, attaching the little tube with precision. Blood would now bypass the blocked valves and be shunted into the lungs of the baby, picking up oxygen there and bringing it back to the heart to be circulated through the body.
Maggie’s report showed all was well, and Phil felt a huge sense of relief, although this was little more than a minor procedure compared with what he would be doing later.
‘There, that should hold her for a while,’ he said. ‘When she’s a bit older—eighteen months, if she can make it that far—we’ll give her a new valve and remove the shunt. There’s a lot of work being done now on replacing aortic valves with working pulmonary valves and putting a new man-made valve in the pulmonary artery, which takes less pressure so the valve doesn’t need to be as strong. They do it a lot on adults but it’s still experimental with children, although lab tests suggest the transferred valve will grow with the child and save more surgery later on.’
Scott shook his head.
‘I can’t believe the stuff I’m learning from you and Alex.’
‘Make the most of it,’ Phil told him. ‘I’m still learning but Alex is one of the best there is. And learn from Rachel, too—you won’t find a better theatre assis
tant than her anywhere. It’s my belief she could do my job as well as I can, if not better.’
The atmosphere was suddenly light-hearted, Rachel giving a huff of laughter and tension Phil hadn’t known he’d been feeling draining from his body.
‘OK, crew, take a break and be back in…’
He turned to Maggie, knowing she’d need to see young Pete before he came to Theatre.
‘When?’
‘Better give me an hour—I want to keep an eye on this baby for a while, then make sure there’s a nurse available to sit with her. After that, there’s pre-med for Pete. Yes, an hour. We’ll still only be about forty-five minutes later than we’d originally scheduled.’
Maggie hoped she sounded more together than she felt. The tension in Theatre when the operation had begun had suggested everyone had heard the stories Dr Ellis had spread. The worst of these was that Phil had choked—refused to do the operation because he’d been afraid he’d fail. No mention of the age of the baby or the statistics that backed up his decision not to operate.
So all the unit members had been on edge and the theatre had seemed to vibrate with tense expectations.
But Baby Creagh was fine, the operation to insert the shunt successful—although once again Maggie found herself surreptitiously crossing her fingers.
She uncrossed them and patted her stomach, telling the multiplying cells in there it must be their fault she was doing such foolish things. At least, she hoped it was the hormone havoc they were creating within her, not a symptom of something more permanent.
She walked with the baby back to the ICU, although she didn’t expect her to be in there long. She hooked her up to the in-room ventilator and monitor, checked her blood saturation levels then stood and watched the infant until her anxious parents came in.
‘Is she feeling any pain?’ the mother asked, and Maggie shook her head, though since Evan had spoken of his desire to study pain in infants, she’d begun to wonder just how they could tell.
Stress leading to acidosis in the blood, she supposed. Or maybe brain activity if they had the infant’s head wired to a monitor.
But wires might cause their own anxiety in the infant, so how could they tell what they were measuring?
‘Are you worried about her?’
The question made her turn from where she’d stopped outside Baby Creagh’s room, pondering these things, to face the questioner.
Phil!
‘No, she’s good. I was thinking about Evan—’
She stopped because unless she wanted to yell her thoughts at Phil’s departing back, there was no point in saying anything more. He’d swept away as if summoned to a dire emergency.
Because she’d mentioned Evan’s name?
Why should that upset him?
He’d made no attempt to pursue their relationship beyond that one night, so it was obvious it had meant nothing to him—beyond, possibly, a little embarrassment.
So he couldn’t be jealous…
Puzzlement turned to anger. Here she’d been, feeling sympathetic and supportive towards him, and he’d walked away from her in a huff.
‘Well, he can stay huffy,’ she muttered to herself, making her way back to the rooms for a coffee before seeing little Pete to prepare him for the lengthy operation that lay ahead of him.
She walked into the rooms to find Phil there, with a surgeon from the Children’s who’d assisted Alex in an operation some weeks ago, and, of all people, Evan Knowles.
Maggie greeted them politely, made herself coffee, then excused herself, explaining she had work to do. She supposed it was inevitable Evan would follow her out.
‘When Phil asked Dave to assist, he—Dave, that is—asked me if I’d like to come along. I haven’t seen a tet repair and he knew I’d be interested.’
‘It’s a complex procedure,’ Maggie told him, ‘and long, because there’s so much that has to be repaired—the pulmonary valves, shifting the aorta, fixing whatever holes there are between the atria or ventricles. This is just the first stage. Pete will have two more operations after this before his heart can function as normally as possible.’
Evan loped along beside her while she explained this, then she introduced him to the little boy who needed their help to lead a normal life.
‘Pete, this is Dr Evan. He’s going to help me watch over you while you’re asleep.’
Pete extended his hand and gravely shook Evan’s, his short, slightly clubbed fingers lost in Evan’s big palm.
‘How do you do?’ Evan said politely, and Maggie gave him full marks for treating this special patient with respect.
She explained to Pete what she was going to give him—’to make you feel a bit sleepy’—and how he would feel when he woke up.
‘Dr Evan might visit you again after the operation,’ she said, thinking the four-year-old might be able to articulate some of what he was feeling.
‘I’d like to do that if it’s OK with you,’ Evan said, and Pete nodded.
‘But Dr Phil will visit me, too?’ he asked, anxiety screwing up his little face.
‘Of course he will, and so will I. We’ll all visit you,’ she assured him.
She gave him the syrup that would be quickly absorbed into his bloodstream then unhitched the shunt in his hand from the drip line and got him ready to be moved to Theatre.
His mother had left the hospital earlier, having to see to her other four children, but Pete’s father arrived before they took him away.
‘How are you going, soldier?’ he asked, his voice gruff with concern for his boy.
‘Fine, Dad,’ Pete managed to say, then Maggie explained she’d already sedated him.
‘It’s a long procedure, Mr Barron,’ she said. ‘You could go home and someone can phone you when he’s nearly ready to come out.’
The big man shook his head.
‘No, I need to be here, near him,’ he said. ‘I know that sounds stupid because he won’t know if I’m here or not, but I’ve got to stay. My wife, too—she’ll be back, just as soon as she’s fed the baby and her mother comes to mind the other kids. We’re all kinda upset, although we’ve always known he’d have to have these operations.’
His voice broke as he said the words, and Maggie reached out and touched his shoulder.
‘Of course you are,’ she said gently, ‘but Pete’s in the best of hands. No one could do this operation better than the two experts he’ll have in there.’
Mr Barron rubbed his hands across his face.
‘I know that,’ he said, his voice hoarse with emotion. ‘I can only thank God for them.’
A nurse arrived to move Pete to Theatre, and Maggie excused herself to go with them. Evan followed her, although she was hardly aware of his presence, her entire being concentrated on what lay ahead of them.
This operation had to be successful. For Pete’s sake, and for his family’s—they were all counting on it. And once again she thought about the burden of responsibility and the pressure family expectations placed on the shoulders of specialists like Alex and Phil.
How did they do it? Day after day, working to save the lives of children? Knowing full well that one slip and the baby died?
Sometimes they died anyway, and that was another matter. How did they cope with the deaths?
Where in their inner selves were all those dead babies locked away?
‘They’re in my head, every one of them, and sometimes at night I think I can hear them all crying.’
It was six hours later and Maggie had asked Phil the question. They were sitting on the bed in the on-duty doctors’ room of the PICU. Phil would stay the night, getting up at regular intervals to check on Pete, while Maggie was about to leave the hospital but reluctant to go home to an empty house when she was so full of emotion after the operation.
‘But what you did today was textbook perfect. Dave said he’d seen Alex do the same op in the US but yours was even more beautiful.’
‘Beautiful!’ Phil snorted the word. ‘We
mess around in a small heart and leave it stitched and scarred, and someone calls it beautiful!’
Maggie shifted closer to him, sensing something very like despair in the way he spoke, while his words about the crying babies still echoed in her head and ached heavily in her chest.
‘It is beautiful when you can take a mistake of nature and fix it so completely it looks as if that’s how it always was. Yes, there are sutures and there’ll be scar tissue, but when that little boy sits up in bed and smiles at you, and his lips are pink, not blue, won’t that still some of the crying in your head? Won’t his laughter—and we all know Pete can laugh—give you enough pleasure to cancel out at least one unavoidable death?’
Phil turned towards her.
‘You’d think it would, wouldn’t you?’ he said, sounding so harsh and un-Phil-like she put her arms around him and drew his head down onto her shoulder, holding him tightly to her in an effort to banish his ghosts.
Not a good thing to do from her point of view as her body seemed to think this was a romantic embrace, not a comforting one, but she massaged his shoulders—so tense still—and kneaded her fingers into his scalp.
‘Come on,’ she teased, ‘where’s the post-op euphoria we shared after the transplant on Amy? You’re usually on a high after an operation. Alex is the one who suffers letdown.’
‘If I cheer up you’ll stop massaging, and it feels like bliss, Mags,’ he said.
‘I won’t stop,’ she promised.
He lifted his head and she saw his eyes were smiling again—for the first time in what seemed like ages.
‘You could massage lower down,’ he said cheekily, and Maggie felt herself blush for the first time since she’d been fourteen and had walked in on a boy cousin in the shower.
‘I only do shoulders on Mondays,’ she told him, shifting so there was a space between them, though the air seemed so hot she might as well still have been touching him. ‘Turn a bit so I can get at you.’
Phil chuckled and Maggie felt her cheeks heat again, but she ignored the connotation he’d put on her words and dug her fingers into the tight trapezius muscles stretching from his neck and sweeping down across his shoulders.
The Heart Surgeon's Proposal Page 6
