Alison Roberts - The Surgeon's Perfect Match

Almost non-existent.

The door to the staffroom opening at that point to admit one of the ICU nurses was a reprieve that Holly grasped with alacrity.

‘Sue, hi! How’s Callum doing, do you know?’

‘He’s good.’ The nurse sat down and opened a packet of sandwiches. ‘What are you two doing in here? I heard there was a blue baby on its way in.’

Holly’s gaze swerved to Ryan. ‘That baby must have arrived ages ago. Why haven’t we heard anything?’

‘I popped down to see her before while you were…getting the coffee. Sorry, I should have told you.’

Holly could feel the muscles in her jaw tighten. No. She should have been there as well. ‘So what’s the story?’

Ryan stood up, taking Holly’s coffee-mug to the sink along with his own. ‘Full-term baby girl. Nothing abnormal noted on foetal ultrasound. No murmurs but a loud second heart sound and she was still cyanosed on a hundred per cent oxygen.’

‘Transposition of the great arteries?’

‘That’s our pick for the moment. They’ve probably done the echocardiogram by now. Shall we go and see what they’ve found?’

‘Cool.’

Back to business as usual was fine by Holly. She was regretting having let the conversation become so personal. Her warm smile at Sue as they left the staffroom was, in some part, thanks for interrupting before Ryan had been able to ease into the subject of firing her, and Holly made sure their communication was purely professional as they threaded their way through the busy corridors of the large children’s hospital.

‘We don’t get a transposition very often, do we?’

‘Fortunately, no.’

‘Surgery won‘t need to be immediate, will it?’ The physical demands of the rest of Holly’s day were suddenly looking rather more manageable.

‘No, but it’s usually done within the first week or two of life, before the left ventricle becomes unable to handle systemic pressure. If it’s severe enough, they’ll need an interim measure to improve the cyanosis.’

‘A Rashkind procedure?’ Holly had no difficulty in sounding more than interested.

‘Ever seen one?’

‘No.’ Any residual despair at having her own physical weakness demonstrated so recently was chased away by excitement. ‘I’d love to, though.’

‘How much do you know about it?’

‘It’s designed to allow the systemic and pulmonary circulations to mix, isn’t it? They thread a double lumen catheter into the left atrium via the umbilical vein. A balloon gets inflated with contrast medium and then pulled back through the atrial septum to create a tear.’

‘Mmm. Strange business, this, isn’t it? We spend half our morning repairing a septal defect and our cardiologist colleagues might well spend half their afternoon creating one.’ Ryan was smiling at Holly. ‘I take it you’d like to go and watch if it goes ahead?’

‘Oh, could I?’

‘Absolutely. Good learning experience for you. To be honest, I’d quite like to go and watch myself.’

‘What about rounds?’

‘We’ll fit them in. We’ve got a consult to do in the ward as well. Another VSD who’s developing pulmonary hypertension.’

‘How old?’

‘Eighteen months.’

‘Is that Leo?’

‘Don’t tell me you’ve seen him already?’

‘Not as a patient. He’s been in the ward for a few days, though.’ Holly’s smile was a little embarrassed. ‘He was part of that hide-and-seek game you caught me playing yesterday—when I should have been writing up those discharge notes.’

‘You stayed far too late yesterday catching up on them. It’s no wonder you’re tired today.’ Ryan paused as they reached their destination of the neonatal intensive care unit. ‘And we’re giving ourselves a very busy afternoon.’ He held Holly’s gaze. ‘Are you up to it?’

‘I’m not about to fall asleep again, Ryan.’ Damn, this could provide another lead-in to that talk Holly really didn’t want to have. Her chin came up. ‘Of course I’m up to it.’

It was a struggle, anybody could see that, but there was no way Holly was going to admit defeat. She’d push herself until she fell over, Ryan observed with concern. No matter how hard it might be, she simply couldn’t help herself going the extra mile.

Like the way she sat with baby Grace’s shocked parents and drew them a diagram of what had gone wrong with the development of the arteries in their infant’s heart because they hadn’t been able to take it in the first time around with the cardiology team.

‘So the aorta, which takes the blood from the heart to the rest of the body, is attached to this part of the heart on the right side, do you see? And that’s where the pulmonary artery should be. So it means that the blood that’s getting the oxygen from Grace’s lungs isn’t getting to the rest of her body, which is why her lips and fingers look so blue.’

Grace’s father looked desperate to both understand and find a way to help his family. His tone was belligerent.

‘It can be fixed, though,’ he demanded. ‘That’s right, isn’t it?’

Holly’s smile both accepted the anger being directed at her and gave reassurance. ‘When we operate, what we’ll do is attach the arteries to the ventricles they should be attached to.’

‘Why can’t you do that right now, instead of that thing with the balloon they were talking about?’

‘It’s a major operation. We need to make sure Grace is strong enough and there are a few more tests we’ll need to do before surgery.’

The baby’s mother sat hunched in a wheelchair beside the incubator, her face pale. ‘Can I stay with her?’

‘Of course you can. The nurses will show you how you can help care for her. The procedure this afternoon shouldn’t take too long.’

‘Will you be there?’

‘Yes. Don’t worry, we’ll all take very good care of Grace.’

Donning a lead apron so that she could stand close enough to touch the baby during the procedure in the catheter laboratory instead of observing on the screens in the technicians’ area meant that Holly put ten times as much effort into that session than she needed to, but Ryan wouldn’t have dared suggest that she took things easier.

His registrar was already building a bond with both this tiny patient and her parents that would make the upcoming surgery less traumatic for everybody. That kind of bond was automatic when Holly was involved. The huge grin she got from Leo when they slotted that consultation in during their ward round was another example.

The toddler sat on his mother’s knee initially as they examined the child, which wasn’t all that easy because she was heavily pregnant. It was Holly who listened to his heart. She showed Leo the end of her stethoscope before approaching him. She wiggled it. ‘This is Silly Snake,’ she told Leo. ‘He likes tickling people and he wants to wiggle under your T-shirt. Shall we let him do that?’

Leo nodded, wide-eyed.

‘Wiggle, wiggle,’ Holly whispered. Leo giggled as she positioned the disc. She listened intently for a full minute and then nodded. ‘Wiggle, wiggle,’ she said again, and she must have tickled the small boy as she removed the instrument because Leo writhed in mirth. It made both his parents smile and suddenly the consultation was far more relaxed than it might have been.

‘What could you hear, Holly?’

‘There’s a harsh systolic murmur,’ she reported. ‘A pulmonary systolic ejection and a mitral mid-diastolic flow murmur. The pulmonary second sound is loud.’

‘What does that all mean?’ Leo’s father asked.

‘They’re abnormal heart sounds,’ Ryan explained, ‘which we’d expect after the results of the catheter test Leo had yesterday. As you already know, that hole in the ventricular septum hasn’t closed nearly as much as we would have hoped by this stage.’ He glanced up at the X-ray illuminated on the wall of the ward’s small consulting room. ‘Leo’s heart is increasing in size quite dramatically and so are his pulmonary arteries. We don’t want that to continue. He’s getting more symptoms now, too, isn’t he? Despite his medications being increased?’