The Heart Surgeon's Proposal

by Meredith Webber

  Inappropriate thoughts about kissing that pale sliver of skin formed in his head, but he held them at bay with practicality.

  ‘Is there something I can get you? A coffee—no, best you don’t have coffee! How early in pregnancy do you have to give up coffee? Do you know? I’ll look it up for you. That’ll probably be the hardest part for a caffeine addict like you. I’ll make a cup of tea.’

  Pleased to have something to do, he crossed to the bench, filled the kettle and turned it on. Seeing beans half-sliced, he finished them while the kettle boiled then made two mugs of tea and carried them across to the table, tea bag strings still dangling over the sides.

  ‘I’ve never made tea for you before so don’t know how you take it,’ he said to the still bent head. ‘Black, two sugars, like you do coffee?’

  He was being so helpful Maggie knew she had to respond. But how? By telling him she hated tea and would sooner drink poison?

  Talk about biting the hand that fed you!

  ‘What you could do is get rid of that test strip,’ she managed to say, her voice croaking out from somewhere near her boots.

  ‘Oh, dear,’ she heard Phil say as he bundled the offending article back into its tissue and dropped it in the kitchen bin. ‘Do I take it you’re not happy about this pregnancy? Are you thinking about a termination?’

  Maggie sighed and lifted her head.

  ‘How could I possibly be happy about it?’ she demanded, knowing her words and her tone were too sharp when concern registered in his eyes. ‘The six months I worked with you and Alex in Melbourne were great, but to be offered the opportunity to do another twelve months with him was better, in my opinion, than winning Lotto! With his name on my CV my dream of getting a fellowship at a hospital in the US might just have come true! Now this!’

  He sat down opposite her and jiggled his tea bag in his tea.

  ‘So, you’re thinking termination?’

  His voice was so full of sympathetic understanding she wanted to slap him, but she didn’t, making do with a good yell instead.

  ‘No, I’m not thinking termination!’ she roared, frightening Minnie out of the room. The sight of the little dog scuttling to safety calmed her down somewhat and she added in a more reasonable voice, ‘I’m sorry. This is bad timing but nothing more than that. I’ve only known a week—that test was the second one—and I need time to get used to the idea myself. And it’s early days yet—think of the statistics, I may not hold onto it—but termination?’

  Her anger died away completely and she shuddered, then hid it with a weak smile.

  ‘It fits with some people’s lives and at another time, under other circumstances, I might have considered it. But I’ve seen too many babies die, Phil—babies I’ve not been able to save, so, no, this baby is mine and if I can carry it safely through to term, I’m keeping it.’

  She realised as she finished the sentence just how fiercely protective she’d sounded, and found that one hand had yet again crept to curl above her stomach.

  Ridiculous when the embryo was still not much more than a heart in a curl of developing cells.

  Even more ridiculous to get attached when she’d twice miscarried…

  She must love the father, to be so definite about it. Maybe he’s married. Bet if he is she doesn’t tell him, she’s so damn independent.

  Phil realised he was still jiggling his tea bag and looked down to see the liquid had turned a tarry black. He didn’t like tea much at the best of times, but this would be impossible to drink.

  Maggie didn’t seem too keen on hers either. She was turning the mug in circles the way his nanny had done with the teapot as she’d waited for the leaves to settle.

  Had the old woman returned to earth to haunt him that he was thinking about her so often these days?

  No, it was Maggie’s fault—with all her poking and probing about his home life.

  He looked up from the tarry tea to see her watching him—Maggie, not his nanny’s ghost.

  Consideringly…

  ‘I’ve never seen you drink tea,’ she said, just when he thought their conversation might become deep and meaningful.

  ‘I hate it,’ he admitted, and she laughed and pushed her mug across the table to him.

  ‘Me, too,’ she said, ‘though maybe I’d better get used to it. Or start drinking decaffeinated coffee!’ She shuddered. ‘Doesn’t bear thinking about, does it? And as for the headaches! Believe me, I’ve tried to give up coffee before and the caffeine-withdrawal headaches are sheer murder. Days and days of them. And I won’t be able to take anything to relieve them, so be prepared for a very cranky colleague.’

  She pushed the chair back as if the conversation was now finished, picked up both mugs of tea and carried them over to the sink, where she emptied them out.

  Then she returned to her cutting and slicing, throwing only the most casual of remarks over her shoulder. ‘You didn’t say if chicken stir-fry is OK with you?’

  So much for sharing with your housemate!

  So much for his offer of support!

  ‘Yes, thanks,’ he said, glaring at Minnie who’d come back in from the garden and was looking for some attention. Then he left the room, going not upstairs but to the downstairs room Alex had set up as a library. He’d look up some medical books and find out just when things like the mother’s caffeine intake became unsafe to a foetus.

  Whether Maggie liked it or not, he was going to be with her every step of the way through this pregnancy.

  In fact, he was quite looking forward to it. A kind of surrogate fatherhood.

  As he pulled down a tome on obstetrics he found himself hoping she wouldn’t give up her job too soon—wouldn’t move back to Melbourne to have the baby.

  Though it was strange to be feeling so proprietorial an interest in it!

  Maggie finished chopping the vegetables, sliced two chicken breasts and turned on the heat under the wok. She was concentrating so fiercely on what she was doing—to prevent thinking about the repercussions of Phil’s discovery—she didn’t notice her pager buzzing on the kitchen table.

  ‘Hospital. A two-week-old being transferred from up the coast—aortic stenosis, picked up late, already treated with a balloon catheterisation that has failed.’

  Maggie turned off the gas, tipped her sliced vegetables onto one plate, the chicken onto another, covered both with clingwrap and washed her hands. Personal problems were forgotten as she translated Phil’s words into a rehearsal of what lay ahead of them.

  For a start, the baby would require the operation Phil had refused to do the previous week, but this time there was no alternative. It was too late for prostaglandin to keep the ductus arteriosis open because the little duct would already have closed and be disintegrating, as it was supposed to do once a baby started breathing air. But a tiny balloon, inserted through a catheter and inflated to force the aortic valves open, had failed to do its job, and Phil would now have to operate to open them or refashion them into working entities.

  ‘Rachel and Kurt on their way?’ she asked, pausing in the hall to get her jacket. Phil already had it, and held it out for her to put on. She thought of the hug he’d given her last time he’d helped her into it, and knew this time he was the one who needed the hug.

  But he was all business, and she knew he wouldn’t appreciate the hug—probably wouldn’t even know what it was for!

  They walked briskly up to the hospital, at first in silence, each thinking of the tasks that lay ahead, then Phil said, ‘Alex is so much better at talking to parents than I am.’

  Maggie turned to look at him and saw a deep frown scoring his forehead.

  ‘I wouldn’t have thought so. The times I’ve heard Alex talk, I’ve wondered why the parents have gone ahead with the op.’

  Phil’s frown cleared as he offered her a brief smile.

  ‘That’s exactly what I mean. He’s able to tell them the downside of things so matter-of-factly they accept it, while I hate having to say, “There�
��s a thirty per cent chance your baby won’t come out of this alive.” I hate having to tell people that, Mags.’

  Unable to think of any comfort she could offer, Maggie took his hand and squeezed it, and they walked the rest of the way hand in hand.

  Within fifteen minutes of the page they were talking to the parents, Maggie anxious to find out about previous procedures the baby had had and what reaction, if any, little Cain had had to anaesthetic.

  Maria Cardella, Cain’s mother, was sitting by the bed where her little son lay, hooked up to a ventilator and monitor, while Al, the father, paced the room.

  ‘All operations, particularly on infants this young, carry an element of risk. In this case, we will be opening up Cain’s chest, cutting through tissue to get to his heart and putting him onto a bypass machine that will put oxygen into his blood and keep blood flowing around his body. The machine has refrigeration that will cool the blood and cool Cain, so eventually we can turn off the machine for a short time to work inside his heart and fix the valve. By cooling him we reduce the demand for blood from other organs in the body.’

  Maggie watched the faces of the two parents. They looked as if they were desperately trying to understand what Phil was telling them, but a glazed look in their eyes suggested it was too much information.

  Yet they had to know.

  ‘The way valves work is they open up as the heart pumps blood into the arteries, then close so it can’t rush back into the ventricles. Because the base of the artery we’re concerned with, the aorta, is inside the heart, we have to go in there to fix the valves. Once in his heart, we’ll see just how bad his valves are. Hopefully, we can open them up by trimming them a bit, and they’ll keep working just fine.’

  Or Cain might need new valves grafted in, which would mean more operations as he grew to replace them when they became too small and started to leak.

  Maggie, reading carefully through Cain’s case notes, thought this but didn’t say it. It was hard enough for parents to comprehend that their beautiful new baby had life-threatening problems, then to have to take in what the surgeons were going to do to him and understand enough to give informed consent to the procedure, without complications way down the track being pointed out.

  Phil was answering Al’s questions now, while Maria sat beside her infant son, fat tears sliding down her cheeks.

  ‘We want you to do whatever you can, and if it doesn’t work for him, that’s how it has to be,’ Al said at last, and Maggie wondered how he would feel when asked to sign the consent form, something a nurse would ask of him as little Cain was being wheeled into Theatre.

  ‘Have you got all you need?’ Phil asked, and Maggie, realising he was talking to her, nodded, but stayed in the room and spoke quietly to Maria.

  ‘We’ll take real good care of him,’ she said, and the woman looked up and nodded, accepting Maggie’s word that everything that could possibly be done for her baby would be done.

  ‘I hate it when it’s their first baby,’ Rachel said, coming into Theatre while Maggie was checking she had all she’d need. ‘I mean, they’re so excited, first baby and all, then, whammo, some person they don’t know is telling them there are terrible things wrong with their new son. Terrible things.’

  Maggie looked at the theatre sister and saw the despair she’d heard in Rachel’s voice mirrored on her face. In the nearly eight months she’d worked with Rachel, Maggie had never heard her upset—or even slightly downbeat.

  ‘Are you OK?’ she asked.

  ‘There is no OK!’ Rachel said, echoing something surgeons often said in Theatre. In top surgeons’ eyes OK was just not good enough. Perfect was their aim and that’s how they wanted things to be.

  ‘There is for ordinary humans like you and me,’ Maggie reminded her. ‘Sometimes OK is as good as you can expect, although there’s always hope we’ll better it.’

  Rachel smiled at her.

  ‘I’m grumpy, that’s all. I’ve been doing this work for eight years and I love it. I’m good at it. I can see things Alex and Phil can’t see because they’re focussed on what they’re doing, and I can react to things when I see them because I’ve seen enough of all the ops they do to know how it should go, and now I hear the fellow who operated last week—when Phil wouldn’t—is telling people things went wrong because of inadequate theatre staff.’

  ‘He what?’ Maggie couldn’t believe it. ‘But he’s at Children’s—how come the stories are circulating here?’

  ‘By kind favour of the great Dr Ellis, of course,’ Rachel snapped.

  ‘And no Annie here to put out the fire,’ Maggie muttered, thinking of the damage this could do the fledgling unit. ‘But don’t take it all personally, Rachel. I’m theatre staff too, I’m sure he’s blaming all of us equally. What about Scott?’

  ‘What about Scott?’ that man said, coming into Theatre, a bright scarf wrapped around his head and his gown on, but not yet gloved.

  ‘Dr Ellis’s rumours,’ Rachel said succinctly.

  ‘Oh, that!’ Scott said, his usual good cheer dissipating immediately. ‘It shouldn’t worry you, you work for Alex. What about me? These last two months have been like a revelation. I mean, I liked hearts and had decided cardiac surgery was definitely for me, but this stuff? Watching Alex and Phil work? It’s so beautiful. I know for certain now that it’s what I want to do, but if I end up carrying the can for that operation, who knows where I’d get another position in paeds cardiac surgery?’

  ‘Damn Ellis!’ Maggie said, but inside she felt a growing concern. Paediatric heart surgery required one hundred per cent concentration from everyone in the team, yet here were two members, three counting her, four counting Phil, who were already uptight before the operation began.

  ‘Forget it all,’ Kurt said, and Maggie realised she hadn’t known he was there. Well, she probably had known, but he said so little from behind his machine they tended to take him as another piece of furniture. ‘We’ve got this baby coming in. That’s all we need to think about now. Later we’ll talk about these rumours and work out a strategy for dealing with them, but the little fellow we’re operating on today needs and deserves all of our attention.’

  It was the most Maggie had ever heard Kurt say, and she was impressed. She told him so, then left Theatre, wanting to supervise the transfer of Cain from his room herself.

  Scott opened Cain’s chest, Rachel sliding the stainless-steel clamps into place and cranking open the rib cage so Scott could go further, cauterising small vessels as he went. He cut open the pericardium, the tough fibrous sac around the heart, and put in a stitch to hold it to the chest wall so Phil would have a clear field around the heart.

  Maggie watched her monitors, tensely alert for any change in the baby’s status.

  She felt rather than heard Phil come into Theatre, then his quiet ‘Good job’ to Scott confirmed his presence. She glanced his way. With mask and loupe and light all strapped around his head, it was hard to see skin let alone read expression, but listening to his voice, seeing the sure way his hands moved, she doubted he’d heard the rumours.

  She prayed he hadn’t, because the slightest lapse in concentration could lead to disaster.

  Not that there wasn’t a little of that. Phil’s soft comment ‘I’ve never seen a malformation like this!’ was the first indication something was wrong.

  ‘That’s the left coronary artery,’ he said to Scott and the other registrar assisting, ‘and instead of curving around the heart to feed the left atrium and ventricle, it’s shunted a large part of itself off into the inferior vena cava. I’ve read about it but never seen it.’

  Without wasting more than a fleeting second wishing Alex was around, Phil began the process of attaching Cain to the bypass machine, first inserting cannulae to take the plastic tube to and from the machine.

  Maggie administered the drugs to keep the baby’s blood from clotting and clogging up the machine, and more drugs that prevented the fragile blood cells being damaged, then C
ain was on bypass and Phil could tackle the problem of the displaced coronary artery first.

  ‘You have to wonder if lack of blood to the left ventricle has been preventing it pumping effectively enough to push blood into the aorta. Is it possible the valves are OK? Why wasn’t this picked up? I wonder if anyone did an oesophageal echo to get a better view. Maggie, did you see one?’

  ‘Not in the notes I read,’ Maggie told him, but they all knew notes that followed a baby from one hospital to another were sometimes not complete.

  ‘I guess they put it down to a left ventricle insufficiency—maybe a hypoblast, which is common with aortic stenosis,’ Phil continued, almost speaking to himself, so Maggie wondered if he was just thinking it through out loud.

  ‘Whatever they put it down to, it’s our problem now, isn’t it?’ Scott said, and Maggie turned in time to see Phil nod.

  She could almost feel his concentration. The problem with moving coronary arteries was that they could kink easily, and once kinked would starve the heart muscles of the blood they needed to keep pumping.

  ‘We can take a vein from his chest if we need to, and use it to repair the artery or replace it,’ Phil said as he worked, and Maggie had to admire the fact that he kept explaining what he was doing to Scott and the other registrar even when things were tough.

  ‘Done! Now for the little fellow’s heart.’

  The bypass machine was turned off to stop it sucking in air when the heart stopped beating, then an injection was given into the coronary arteries to stop the heart. Now Phil worked swiftly, making an incision high up on the left ventricle to reach the opening of the aorta.

  Maggie watched her monitors, checked everything was in place for an emergency and did her own monitoring of the tension levels in the room.

  Not too tight, she decided, and the quiet buzz of orders suggested nothing major was going wrong.

  So far so good!

  ‘Now, make sure you suction all the air out of his heart before we put him back on bypass. We get air into the machine, we put it back into his blood and the poor kid has a stroke.’