Hearts of Gold: The Children's Heart Surgeon

‘It might only be temporary,’ she said, then remembered why she’d offered.

‘Personally, it might not be ideal,’ she said, standing up so she could look Alex in the eye, ‘but professionally—do you really want a sleep-deprived, twitchy anaesthetist working with you on a child? What else could I do but offer?’

His smile improved, though it was still a wry effort.

‘I wish I’d been here. I could have offered to have her at my place. With Phil there already, it wouldn’t have mattered and we’d still have had some privacy from work colleagues at your place.’

He brightened considerably.

‘We could still do that! I’ll offer to have her at my place. She’ll be with Jamie. I’ll go now.’

He touched Annie on the shoulder and breezed away, obviously delighted with his own brilliance.

But his face was glum again when Annie saw him at the briefing, and he looked far from happy as he explained Jamie’s problem, where a hole in the wall between the heart’s two upper chambers, the atria, hadn’t closed, so blood shunted between the two chambers.

‘It causes increased pressure in the right atrium and ventricle, and too much blood flowing into the lungs. Usually the patient suffers few symptoms—a bit of breathlessness and fatigue from time to time. In Jamie’s case these didn’t become obvious until she started at Little Athletics. Echocardiography has confirmed the hole is there, and her cardiologist has done a cardiac catheterisation as well to determine just where the hole is.’

Alex pointed to his diagram on the whiteboard.

‘New technology is being tried for holes in the centre of the atrial wall, and holes are being successfully closed using transcatheter management—inserting wires through a catheter. But Jamie’s hole is higher up and the new technique doesn’t work, hence the need for an operation.’

‘If she’s been OK up until now, and is only breathless after running or jumping at Little Athletics, is it worth the risk involved in any operation—particularly open heart where she’ll be on a bypass machine for some of it?’

One of the sisters from the special care unit asked the question, and Annie was pleased. For one thing, she’d wondered about it herself, and for another, it meant all the unit staff were becoming increasingly involved in all stages of their patients’ operations.

‘There’s a twenty-five per cent risk of early mortality through pulmonary vascular obstructive disease if it’s not repaired and a less than five per cent—in fact, I feel less than one per cent—risk with the operation itself.’

Alex turned back to the board and sketched a small chest.

‘We make a much smaller incision than we do for a PDA, only…’ He paused, then smiled at them all. ‘I have to convert inches to centimetres…say eighty to a hundred centimetres. Then the defect is fixed with either a patch or stitches, depending on what we find. As you said, the child has to go on the heart-lung machine as soon as we open the pericardium, then once the aorta is clamped, we stop the heart beating with cardioplegia, open it up, fix the hole and Jamie’s back in business again. Within weeks she should be back at Little Athletics.’

‘The results are really good,’ Phil added, turning to smile at the sister who’d asked the question. ‘You probably won’t have her more than a few hours in the PICU, then she’ll be moved to the ward.’

‘Which reminds me,’ Alex said, directing his question to the two nurses present who had been specially selected to work with his patients once they reached the children’s post-surgical ward. ‘How do you think you’ll go, working with our patients exclusively when they’re back in the ward with the others?’

‘I love the idea of it,’ one of them said, while the other nodded agreement. ‘It means you can really get to know the children and their families, and there’s something special about being chosen as part of the team that’s working to make them well again.’

Whatever gloom Alex had shown earlier disappeared, and he beamed at the pair, one male and one female.

‘That’s great to hear, and don’t forget, if you run into administrative trouble at any stage, see Annie and she’ll sort it out.’

Annie’s turn to smile. Alex could so easily have said to see him, but he had enough faith in her to know she’d handle it.

She just hoped his faith would never prove to be misplaced.

The briefing over, the operating crew headed off for the theatre, the nursing staff back to their places and Annie returned to the office. Alex’s prediction that there’d be hospital infighting was already coming true. She had a meeting with the CEO and other surgical co-ordinators at nine-thirty, and guessed pressure would be applied for other surgical services to have equal access to the new theatre.

Not this week they wouldn’t, as Alex was booked to operate twice and sometimes three times a day right through until Friday.

‘Adult cardiac surgery brings in more dollars than CHD,’ the administrator of the adult cardiac programme yelled at her less than an hour later, confirming Annie’s prediction.

‘But it requires more outlays as well,’ Annie shot back, determined to remain calm. ‘And takes more hospital resources as patients are hospitalised for longer. Plus, you have to realise that if we operate on infants and children with CHD, it means these children won’t need cardiac surgery as adults.’

As soon as the words were out of her mouth, she realised she’d made a mistake. The adult cardiac administrator was a money person through and through, and telling him there’d be fewer patients for him in the future was a challenge to his job security.

‘Surely people matter more than dollars!’ she stormed at Alex much later when he was foolish enough to ask her how the meeting had gone. ‘Surely it’s more important to offer children with CHD an opportunity to lead a normal life than to keep up the numbers of adult cardiac patients?’

Alex smiled at her vehemence.

‘Of course it is, but you’ll find very few administrators within a hospital system—or any system, I suppose—who aren’t bent on defending their territory.’

Another smile, and if the first had soothed some of her anger, this second one warmed bits of her left cold from the other man’s attitude.

‘Weren’t you doing just that?’ he asked, and the warmth turned to heat.

‘No, I wasn’t. I was talking people, not numbers or money. I was talking about infants and kids like Jamie who’ll go back and run the legs off the others in her age group at Little Athletics. I won’t talk numbers and money—I’ll keep the figures and use them to prove our worth, but the children and their families will always be my prime concern. And if that’s going to make me a bad unit manager then you’d better sack me right now.’

She glared defiantly at him, though she knew a lot of her rage was leftover frustration from the morning’s meeting.

‘I don’t think I could sack you,’ he said, another smile, gentle this time, playing around his lips. ‘The CEO was most insistent that the job was yours, right from the start. I could ask for just about anything else I wanted, but you were a given. The powers that be in this place have a very high opinion of you.’

‘You make it sound as if you didn’t want me here!’

He sounded so tired she almost let him off the hook, but if the man this morning had made her angry, this man was making her doubly so, with his assumption that she might not be up to the job. Because she was a woman?

‘Were you against me, or against having a woman in the job? Was this a gender issue?’

‘Not at all. Actually, I wanted my old administrator, Karen. Annie, are we arguing?’

‘Yes,’ she told him, then she relented. ‘Not arguing precisely, but I’d like to know more about it. It’s not exactly confidence-building to think you’d have preferred someone else in this job.’

‘Can we talk over dinner?’ he suggested hopefully. ‘Did you say there was an Italian restaurant near the park? Could we go and argue there? I’m famished, and if I caught the drift of all the arrangements you and Maggie made—I did ask her to stay at my place, by the way, but she refused—this might be my last opportunity for a proper first date.’

‘Oh, Alex,’ Annie sighed, then, because the longing was still there—strong and hot and insistent—she nodded. ‘OK. I’ll just phone Dad, because it’s closer to walk straight there, then we can cut across the park to come home. It’s well lit at night.’

‘That’s a shame, though there are sure to be shadows. No rocks and fishermen?’ Alex said, and Annie smiled at him, knowing he was remembering the interrupted kiss.

‘No rocks or fishermen,’ she promised.

Definitely two steps forward and one back in this relationship, and right now he was at the back stage, Alex thought as he had a wash before leaving the hospital.

Hell’s bells, he hadn’t had a date with the woman yet, and he was thinking relationship longevity. And she was as uncertain as a woman could be about any relationship—let alone one with him.

And prickly!

Because she’d been hurt before?

He was as certain of that as he was of his own name. If he wasn’t careful, he’d blow this before it had even begun, and every instinct told him that would be a very bad thing. A disastrous thing! Muddle-headed he might be, but one thing he was quite clear on—both physically and emotionally he wanted Annie Talbot, and he was pretty sure it wasn’t because she was his ghost.