St Piran's: The Brooding Heart Surgeon

Yes. That could well explain the death glare he’d caught from over the top of the mask as Anna had finally entered the theatre. She stood outside the cluster of staff around the operating table now, gowned and masked, her gloved hands held carefully away from her body. Taller than average, he noted in that split second of noticing her arrival, and her eyes were green. Very cool right now because she was displeased and that made them seem hard—like uncut emeralds. Unusual enough to make a lasting impression. As did her body language. The way she was standing so absolutely still. It advertised the kind of attention to detail, like not contaminating anything, that came from being not only well trained but highly disciplined.

He’d heard that about her from James as they’d scrubbed in together. That his missing assistant was skilled and meticulous. Uncompromising. Single because she chose to be. Or maybe no man could compete with a job that someone lived and breathed to the exclusion of anything else.

‘She’s good,’ James had added. ‘Very good. You’ll be pleased she’s taken on the job of Assistant Head of Surgery. With the reputation she’s built here, she could have gone anywhere she chose.’

James obviously respected Dr Bartlett but he’d also said he didn’t really know her. Not on a personal level. The way his sentence had trailed off in a puzzled tone had suggested that maybe she didn’t have a personal level.

It was James who acknowledged her presence now, however.

‘Anna! That was quick.’ He gave his colleague a closer glance and frowned. ‘No go, huh?’

‘No.’ The word was crisp. The attempt to save someone in the emergency department had failed. That was that. An unsuccessful case. Time to move on to the next. ‘Want me to take over?’

‘If that’s all right with Luke. I am rather late to start my ward round now and I’ve got my own theatre slot this afternoon.’ James sealed another small blood vessel with the diathermy rod and then looked up at the surgeon across the table. ‘Luke? Have you met Anna already?’

‘No.’ His response was as curt as Anna’s verdict on her emergency case had been.

He carried on with the long, vertical incision he was making in his patient’s chest, not looking up until James moved in to control the bleeding.

She was standing closer to the table now. A mask covered the lower half of her face and a disposable hat hid her hair and ears. All he could see were those green eyes and for a split second the accusation in them hit home.

Yesterday he had been supposed to meet the woman who’d looked after his job for eighteen months, but there’d been that hassle at his house with a burst pipe and there had been no water supply. There’d been a problem getting power reconnected as well, after such a long period of being empty, so he’d had no way of recharging the battery for his mobile phone when it had died. The hassles had underscored the fact that he wasn’t exactly thrilled to be back here anyway and … and she hadn’t waited for him, had she? He’d been less than an hour late but she had gone home and hadn’t left any message other than the theatre list for this morning.

And now she was glaring at him as if accepting her belated assistance for this surgery was only the first challenge he had coming his way. Well, she could take her attitude and deal with it on her own time.

‘If you plan to assist,’ he said curtly, ‘now’s the time to start. I don’t like my surgeries being disrupted and I’d prefer to start the way I mean to go on.’

A tense silence fell around them as James stepped back and Anna smoothly took his place. The familiar ache in Luke’s leg kicked up a notch but that only served to increase his focus. He turned his head to the scrub nurse hovering over the trolley beside him.

‘Sternal saw, thanks.’

The nurse jumped at his tone and handed him the requested item with commendable speed. Then the whine of the saw cut into the silence he could still feel around him. Luke concentrated on splitting the bone beneath his hands. For a short time at least, he had no need—or inclination—to look at the woman now opposite him.

So this was Luke Davenport.

The war hero she’d been hearing so much about in the last few days. Too much. As if it hadn’t been bad enough to have her position as head of department cut short, no one hesitated in rubbing salt in the wound by telling her how marvellous Luke was. What a great surgeon. And soldier. How he’d single-handedly saved everybody he had been with when they had come under attack, dragging them from a burning vehicle despite his own badly broken leg and then providing emergency care that had kept them alive until help arrived.

She could believe it. One glance from a pair of the most piercing blue eyes Anna had ever seen and she knew she was meeting someone just as ambitious and determined as she was herself. Two horizontal frown lines at the top of his nose, between dark eyebrows, added to the intensity of the glance and made her catch her breath. To have him treating her like a junior fresh out of medical school might be unacceptable but it wasn’t totally surprising. This man had seen and dealt with things she couldn’t begin to imagine experiencing.

‘An honourable discharge from the army,’ someone had said. ‘He’s up for a medal.’

St Piran’s was so lucky he had come back. The hospital, the patients, the whole damn community was feeling lucky. Anna had had to hide disappointment strong enough to morph very easily into burning resentment. Had to try and smile and pretend she felt lucky that she was being given the opportunity to be the hero’s assistant from now on.

No wonder the guy was so full of himself he hadn’t even bothered to come and introduce himself yesterday. She’d given him the courtesy of sending an apology for being late for this theatre case and look at his response! He didn’t like his surgeries being disrupted. The voice had been deep and the words clipped. This was a man who was not only used to giving orders, he expected them to be obeyed.

Anna’s spirits—already well dampened by the unsuccessful struggle to save a life in Emergency—slipped a little further. The only way through this, as she’d discovered with any previous difficult episode in life, was to focus on her work to the exclusion of anything else.

It wasn’t hard. ‘Good grief,’ she couldn’t help but comment when the rib spreaders were locked into position and the target of this surgery was exposed. ‘Look at that.’

The sac of membrane enclosing the heart had calcified and become a thick, white casing—a kind of scar from the inflammation a virus had caused and so solid it was preventing the heart from beating effectively. Luke was about to perform a pericardectomy and peel this hard layer away from the heart tissue. A tricky, fiddly procedure that Anna had studied but never performed herself.

She would have been happy enough to do the surgery if a better option hadn’t been available, but she would definitely have preferred to have the patient on bypass and a still heart to work with. Luke was sparing this man the additional risk of being on a heart-lung machine. He was going to do the procedure with the heart moving beneath his scalpel.

‘Your investigations showed the extent of the calcification.’ Luke sounded mildly surprised by her exclamation of astonishment. ‘Right-sided filling was poor and the stroke volume was abysmal. It’s a wonder he’s been able to function at all.’

‘The first sign that it was anything serious only came when he collapsed at work three weeks ago.’

Anna watched as Luke used a scalpel to cut through the hard, white tissue, his hand large enough to make the small instrument almost invisible. She could see how much pressure he was needing to apply but how careful and controlled that pressure was. He needed to open the scarred tissue but not penetrate the heart beneath.

His response of a grunt to her statement could have actually been satisfaction at the gleam of healthy, pink tissue revealed, but Anna caught something that seemed more like a reprimand that it had taken that long to diagnose the condition correctly and arrange livesaving treatment.

The criticism was unfair. This patient, Colin Herbert, had avoided even going to his GP for years, putting his shortness of breath down to being unfit and his tiredness to the broken nights of helping to parent two young children. Even initial investigations hadn’t pointed to a cardiac cause for these symptoms in the thirty-seven-year-old. It had taken a CT scan and then cardiac catheterisation to reveal the rare condition, and that had left Anna having to decide whether to attempt an unfamiliar surgery herself or refer Colin to someone more experienced.

The news of Luke Davenport’s return had made it worthwhile delaying the surgery for just a little longer. If Colin could stay in St Piran’s, close to his family and friends, it would probably speed his recovery. It would certainly make this period far less stressful for his wife and children.

Luke had now begun peeling the pericardium away from the heart muscle. The anaesthetist, amongst others, was peering into the wound with fascination.

‘Looks like plastic,’ one of them commented.

Another grunt came from the surgeon and then silence fell in the theatre again. His requests for instruments or responses to updates on monitoring were curt. He barely acknowledged Anna’s assistance. Surgery with this man was never going to be a relaxed affair, then. Not that he shouldn’t be concentrating fiercely on the task at hand, but that had never stopped Anna from involving her colleagues. Testing their knowledge and sharing her own. Discussing problems and allowing contributions to any trouble-shooting needed. The way mentors had done with her in the past.

Being Mr Davenport’s assistant might be like treading water as far as her career was concerned. Demoted to second best but only allowed to learn anything new by observation. Anna could feel the frustration creeping in already. She might well have to bite the bullet and start fighting for the chance to prove herself elsewhere. Having to apply for sought-after positions where most of the applicants, as well as those making the final choice, were male. Skilled, powerful, alpha men like the one working opposite her right now. Men who needed a lot of convincing that a woman was capable of being their equal.

But even as Anna felt the tightening knot of a tension she’d been aware of for her entire career in medicine, something else was pushing into her awareness. The skill Luke was demonstrating here told her that, merely through observation, she could learn from him. His timing was exquisite as he allowed the heart to beat and squeeze out blood, then advancing his scalpel to free the casing a little further in each fraction of time when the heart was filling again and, therefore, still enough to be safe.

The equipment and the technician needed to put the patient on bypass were standing by. Peeling the pericardium from the back of the heart would be the most difficult part of this procedure and Luke was keeping the option of using cardiac bypass available.

He would prefer not to, however, and so far things were going smoothly. The staff were more than competent and he had no complaints about Dr Bartlett’s assistance. She was good. Somehow she had instantly tuned in with how he worked, and it was like having an extra pair of his own hands in action. Smaller hands, of course. More nimble ones. It was quite possible that Anna would be better suited to continue this when he got to the tight patches around the back.

The thought was embryonic. Barely registered, in fact, because Luke was so focused on what he was doing. Anna had the edge of the hardened pericardium caught in a pair of forceps, holding it up and helping to peel it away as he cut carefully beneath it.

He was using the scalpel with absolute precision. Tiny cuts as close to the hard casing as possible. There was less than a millimetre of space to work in. Luke was vaguely aware that the atmosphere around him was tense and that he could change it by relaxing a little and talking more, but he had no desire to do that.

He was being watched in this, his first surgery on returning to his role as head of department for cardiac surgery. Being watched and judged. They were wondering if his experience in the army had changed him—as a surgeon or as a person.

Of course it had. He had honed skills and one of them was the ability to focus no matter what kind of distractions were around. What anyone else, including Anna—no, especially Anna—might be thinking of him was irrelevant. What mattered here was a good outcome for his patient. His focus was on that scalpel. Right on its tip, which was the only part of the blade he was using.

The blood seemed to come from nowhere. There’d been small bleeders up to now that Anna had dealt with but this was a sudden gush that drowned his scalpel, washed over the fingertips of his gloves and began to form a pool. The beat of the heart made it appear briefly and then the blood washed over it again, totally obscuring his vision.

Red.

So red.

And warm. He could feel it on his fingers. Sticky life blood, ebbing rapidly from where it was supposed to be.

Someone was dying.

He could hear their screams. He could hear the sound of gunfire, too, and smell something burning. He had to do something. But he couldn’t move.