‘Her doctor was not really sure what was the matter with the child, and there was no paediatric specialist nearby, so as she was the sister of a…friend…’ he prevaricated, avoiding specifying the real connection between Abir’s family and his own, ‘I was asked to see the child.’
He ran his hand over the child’s head, mourning the fact that all this silky dark hair would be gone in a matter of minutes now, as he was prepared for the life-changing surgery. He refused to let himself remember cradling another little head, little knowing just how short that precious life would be.
Abir had settled under his touch, his big dark eyes gazing up at the two of them with that strange solemnity that he sometimes saw in these little ones.
‘If you would like to clean your hands, you could make an examination of Abir,’ he invited, and stepped aside slightly to gesture towards the child, inviting Dr Emily Livingston to make her own assessment of Abir’s condition.
‘I used antibacterial gel on my hands just before I stepped inside the room,’ she said, then startled him by blushing softly. ‘And apart from trying to shake hands with you, I haven’t touched anything since then.’
‘So…’ He repeated his gesture towards the infant, who seemed almost as captivated by the woman’s blonde hair as he was.
‘Hello, Abir. Haven’t you got beautiful big brown eyes?’ she crooned as she bent down to bring her head almost to the same level as the child’s. She reached out a slender hand to stroke a gentle finger over the back of a chubby little fist and smiled when the little one immediately grabbed it and held on tightly.
‘That’s a clever boy,’ she praised as she began to stroke her other hand over the silky dark hair covering the unusually shaped skull, her voice taking on an almost sing-song quality that clearly mesmerised the child.
The tone of her voice stayed the same as she continued speaking softly to the little one so that it was a couple of seconds before Zayed realised that she was now speaking to him.
‘Without seeing any X-rays, I’m assuming that this is craniosynostosis, with some of the cranial sutures fusing before birth,’ she said with an air of steady confidence in her diagnosis that impressed him no end. Her fingertips were gently tracing the lines where the joins between the plates of the skull were already showing pronounced abnormal ridges. ‘Is there a genetic component here—any history of Crouzon or Apert in the family, for example?’
‘An uncle and a cousin,’ he confirmed. ‘But we only found that out when we started questioning the rest of the family. As neither of the affected members has survived, their disfigurement meant that they are rarely mentioned any more, and especially not in front of a pregnant woman.’
‘For fear her baby will “catch” the problem?’ she asked with a smile in the baby’s direction that had him gracing her with an answering open-mouthed, gummy grin.
‘That sort of superstition still lingers in some of the more remote villages in Cornwall, too,’ she continued, this time smiling directly up at him as though sharing a particularly delicious secret as she added, ‘At one time, it even included redheads being banned from visiting.’
‘And what would be your preferred treatment modality?’ He wouldn’t allow himself to be beguiled by a pair of sparkling green eyes. There was no point.
‘Surgery, of course, to excise the affected bone,’ she answered, so promptly that he wasn’t sure whether it was her own decision or one based on the fact she’d already been told about the impending surgery.
‘Because?’ he probed with unexpected intensity, suddenly needing her to be able to justify her assertion, although he had no idea why.
‘Because otherwise the fact that the bones had already fused before he was born will mean that there’s no room for expansion and his brain will end up terribly damaged. If I remember correctly, a linear craniotomy and excision of the affected sutures is most effective when performed in the first three months of life,’ she added.
She was looking down into those big brown eyes, and he suddenly knew that she had recognised the gleam of intelligence already lighting them, too, and understood just what a tragedy it would be if that spark were crushed out of existence.
‘What are the potential hazards of the operation?’ He forced himself to ignore the sudden feeling of connection with her by concentrating on the specifics of the procedure. This was the sort of detail that he would hope she knew backwards, forwards and inside out, having taken her latest exams so recently.
There was a sudden flash of concern in her eyes, as though she was genuinely concerned that he might not be sufficiently satisfied with her answers to give her the placement on his team. But surely he’d been mistaken. She would only have been informed of Mr Breyley’s departure when she’d arrived at the hospital that morning. It wasn’t as if this position was one that she desperately wanted or that she’d had time to become nervous about a make-or-break interview…or was it?
There was something about the tension in her feminine frame that told him there was a burning need in her to gain his approval for the placement, that there was something inside her that meant she would work every bit as hard in his department as she had in his colleague’s.
So, was there another reason why she wanted the job, a personal reason, completely separate from her career aspirations?
Perhaps she particularly wanted to stay in this part of the country, between the wild desolation of the moors and the rugged majesty of the coast. Perhaps she had family here, or a boyfriend she wanted to be close to.
He was almost grateful for the fact that she began speaking, able to ignore the sudden unexpected clutch of disappointment in his gut at the thought that some undeserving man had the right to wrap that beautiful body in his arms. He had absolutely no right to feel anything for this woman other than the need for her to be the best junior she could be.
‘During surgery, there’s the possibility of hypovolaemic shock, especially in such a young patient,’ she announced with a slight quiver in her voice that belied her apparent confidence. ‘There’s also the chance that there might be dural tears unrecognised during the procedure that can cause cerebrospinal fluid leaks. They could leave a pathway open for infection. There could also be epidural or subdural haematoma due to surgical trauma. Post-operatively,’ she continued swiftly, almost as fluently as though she were reading word for word from the relevant specialist text, ‘there will be facial swelling, of course, especially around the eyes. That usually resolves in the first few weeks, but the improvement in the head shape is almost immediate.’
‘And have you observed such surgery?’ He was careful not to reveal just how impressed he was. Not only had she made a correct diagnosis of a relatively rare condition, but had obviously recalled, verbatim, everything she had read about it.
‘Only in my teaching hospital’s video library,’ she admitted. ‘I’ve always been interested in paediatric orthopaedics.’
‘In that case, we just have enough time to introduce you to Abir’s parents before it’s time to scrub,’ he announced, suddenly eager to see how well this young woman would acquit herself in an operating theatre.
As if they were obeying some invisible signal, that was the precise moment that the Hananis chose to emerge from the interview room.
Zayed led the way towards them, touched by the matched pairs of reddened eyes that were clear evidence that both parents had obviously given in to a bout of tears in his absence.
‘Dr Emily Livingston, these are Abir’s parents, Meera and…’
Further introductions seemed unnecessary as the newest member of his team stepped forward to take the young mother’s hands in hers.
‘You have a beautiful baby,’ Emily said simply, as though she’d guessed that neither of the child’s parents had a detailed command of English. ‘I will do everything I can to help make him well.’
Athar Hanani threw Zayed a puzzled frown, obviously needing some clarification of the situation.
‘Dr Livingsto
n will be in the operating theatre with me, assisting me while I’m operating on Abir,’ he said, and when the young man switched to his own language to question the presence of a doctor who was a female, Zayed was glad that Emily couldn’t understand this clear evidence of his countryman’s chauvinism.
Before he could find the words to set the record straight, it was Meera who did the job for him, rounding on her husband and berating him for failing to see that the young woman doctor obviously cared about their son already.
‘I put my son, Abir Hanani, in your hands,’ she said to the green-eyed woman, reverting to English and wiping away the worried expression Zayed’s new junior had been wearing while the sharp-edged conversation had whirled incomprehensibly around her.
‘I am honoured by your trust,’ Emily said, and her smile almost seemed to light up the corridor.
An hour later, Emily’s concentration on the operative procedure was broken again by her conviction that Zayed Khalil was in pain.
The doctor in her had belatedly tallied the fact that there had been a slight hitch in his stride the first time he strode away from her along the corridor. At the time, she’d been full of a mixture of trepidation and excitement that she would shortly be assisting in a major surgical procedure; she’d also been slightly distracted by her sympathy for the terrified parents. It wasn’t until the first time she noticed that Zayed seemed to be shuffling constantly from one foot to the other that she deliberately started to take notice.
Even as she marvelled at the fact that a live human brain was only millimetres away, under the softly gleaming dura, she found herself speculating that the handsome surgeon probably maintained his impressively fit physique by some form of vigorous exercise. Had he overdone the exercise last time? Or was the marked hitch in his stride the result of an accident in his youth—perhaps the spur that had set him on course towards his career in orthopaedics?
Suddenly, she realised that this was a very similar train of thought to one that she’d had not so very long ago; that this was the second man with impaired gait she’d met since her return to Penhally…although she could hardly say that she’d met the man on the beach, only ogled him from her shadowy hideaway among the rocks. Whereas Zayed Khalil…
Well, she couldn’t really imagine this man standing on a beach as the last of the sunset faded around him while he pushed his body harder and harder to perform such a punishing workout. His preference would probably be some high-tech gym now that he was an important surgeon. And, besides, his position at St Piran’s meant that he would have to live within a relatively short distance of the hospital. The other man definitely had to live somewhere close to Penhally, otherwise he wouldn’t be able to turn up at the beach at roughly the same time each evening.
And if by some impossible fluke of coincidence they happened to be one and the same person…
Well, they aren’t, and that’s that, she told herself crossly as the surgeon shifted position yet again.
Afterwards, Emily told herself it was just her impatience with her silent speculation that took the brake off her tongue but, whatever it was, she couldn’t believe it when she heard herself saying, ‘If your back aches, you might try taking those clogs off for a while.’
There was an instant deathly hush in the operating theatre and she was certain that her mask was nowhere near large enough to hide the fiery blush that swept all the way up her throat and face until it reached her hairline under her disposable hat.
‘I beg your pardon?’ His eyes were almost black, as were the eyebrows that were raised so high that they nearly reached the hat covering his close-cropped hair.
In for a penny, in for a pound, she could hear her grandmother saying, and she tipped her chin up an inch before she repeated her suggestion.
‘I said, if your back aches, you might try taking off your clogs and going barefoot…you could put disposable hats over your feet if you’re worried about contamination.’
This time the silence seemed to stretch for ever, filled only by the rhythmic bleeps and hisses of the monitors and anaesthetic regulators.
When she was beginning to wonder if she was going to be thrown out of the theatre for breaking his concentration, he gave one swift nod.
‘It is worth trying,’ he said, and in an instant there was a nurse on her knees beside him, giving a nervous giggle as she pulled a bright blue plastic hat over each of his elegant long feet before she took his theatre clogs away.
Without another word, the operation continued as seamlessly as though the last couple of minutes had never happened, the second strip of misshapen bone carefully cut out of the skull so that the prematurely fused sutures were removed entirely.
Emily was utterly absorbed in the procedure, even more so now that she was assisting than when she had merely looked at a tape.
The brutal part was over and, hopefully, would never need repeating. Now it only remained to irrigate, check for leaks and close before he’d finished. She was quite looking forward to finding out if his suturing technique was as meticulous as every other one she’d observed when he suddenly stepped back from the table.
‘Taking the clogs off helped for a while,’ he announced in a slightly rough-edged voice as he stripped off first one glove and then the other, somehow managing to tuck one inside the other without getting any fluids on either hand. ‘But now I will watch while you complete the process.’
From the electric atmosphere in the theatre Emily knew that something momentous had just happened, but she couldn’t allow it to break her concentration, not if she was going to do herself and little Abir justice.
‘You might want to rest your best feature on an anaesthetist’s stool while I close,’ she said, as she positioned herself in his place at the table and held her hand out for the gently warmed saline, hoping her tone was matter-of-fact enough not to wound his ego. ‘I’ll probably take rather longer over this than you would.’
She almost chuckled when she heard Zayed murmur ‘rest your best feature’ in obvious amazement, and allowed herself just a couple of seconds to reflect on whether she’d spoken nothing less than the truth. The ubiquitous pale green scrubs he was wearing might be the most shapeless garments in existence, but when they were washed after every use, they soon became thin, and all it had needed was for the man to lean forward over his patient for every lean, tight curve of his muscular buttocks and thighs to be lovingly outlined.
Then it was time to switch her concentration up to full power as she thoroughly irrigated both operating fields to ensure that there were no bony fragments left inside the skull, then a minute inspection of the dura to check for any inadvertent tears. Of course, there weren’t any, and the way was clear for closing the initial incisions.
‘Clips or sutures?’ said the voice with a delicious hint of accent even in those few words.
‘I prefer sutures for areas that will be on constant show, even on a scalp where they will hopefully be covered by hair,’ she explained, pausing before she inserted the first one in case he had any objections to her decision.
Although she’d been conscious that those dark eyes were watching her every move, the fact had been reassuring rather than intimidating. It had been an amazing experience to be allowed to do such a sensitive part of the procedure on her very first morning on his team. Mr Breyley had allowed her to do little more than close for weeks before he’d allowed her to lead on more routine procedures, and even then he’d hovered over her, poised to take over at the first sign that things hadn’t been to his liking.
‘I am sure he will thank you if he eventually goes bald,’ her new mentor said dryly, and she concentrated on drawing the edges of the incisions together with as neat a row of sutures as she could manage.
‘Are you happy to supervise his transfer to Intensive Care?’ he asked as she positioned protective dressings over her handiwork while the anaesthetic was reversed.
‘You’re going to have a word with his parents?’ Her quick glance in his directio
n told her that even sitting down for the last part of the operation hadn’t relieved his pain, if the tension around his eyes was any indication. What on earth had the man done to himself?
‘The waiting is awful, so I’ll just let them know that the operation went well,’ he explained, already on his way to the door, adding over his shoulder, ‘And tell them that they’ll be able to see him in PICU in—what—twenty minutes?’
‘Maybe half an hour, to give us time to get him settled properly?’ Emily glanced up at the experienced nurse who would be accompanying Abir on the short journey from the operating theatre to the nearby unit, and received a confirming nod.
‘That will give us long enough to put some bandages on and clean his little face up a bit,’ the older woman said. ‘Although we’re not going to be able to do anything to disguise his swollen eyes. Poor little mite looks as if he’s not even going to be able to open them when he comes round.’
‘Thank goodness that’s one of the less important side-effects of the procedure…one that will sort itself out,’ Emily murmured, even as she winced at Abir’s appearance. ‘But he does look as if he’s gone several rounds with a prizefighter, and lost.’
After transferring him to Intensive Care she reassured herself that he was receiving the right levels of sedation and pain medication. Then there was the post-operative paperwork to take care of, so it was nearly an hour before she was able to think about the sudden detour her career had taken. And as for finding time to hunt down a cup of coffee and something to put in her rumbling stomach…
‘Forget it,’ she muttered as she hurried towards the outpatients clinic in response to her first bleep.
‘Mr Khalil has been called down to Accident and Emergency, and he is very particular about his clinics starting on time,’ snapped the heavily accented voice of his disapproving secretary. ‘Some of his patients have travelled a very long way to see him.’
Unspoken, but hovering in the air like a bad smell, were the words ‘and they won’t be happy to see someone as insignificant as you when they walk in the room’, but there was nothing Emily could do about that. All she could do was dive in at the deep end and hope that she didn’t drown before he arrived.
Caroline Anderson, Josie Metcalfe, Maggie Kingsley, Margaret McDonagh Page 18
