Hearts of Gold: The Children's Heart Surgeon

‘There are people at home you have to let know?’

He asked the question softly, as if he didn’t want it to sound like prying.

‘Of course,’ she said, answering the question yet knowing it wasn’t an entire answer.

Knowing immediately from his silence he was waiting for the rest of it.

‘Dad and Henry. Both at home. Waiting.’

The silence that followed this less than explicit explanation seemed to hover in the room like a third person, then Alex nodded briefly, said, ‘Goodnight, then,’ and walked away.

‘If he’d asked, I’d have told him Henry was a dog,’ Annie told the door which had closed behind him.

‘Plege on!’ Alex said, the order crisp.

Who outside this room could guess it meant a cocktail of chemicals and nutrients, in the main a potassium solution—poison—would flow into the baby’s heart?

The tiny heart stopped beating. It was pale and floppy-looking, clearly visible to Annie where she stood on a stool behind the heart-lung machine that was oxygenating the baby’s blood while the intricate surgery took place.

She held her breath, knowing every second Baby Ross was on the machine increased the risk of long-term damage to his frail body. Alex had explained exactly what would happen at every stage of the operation. He’d called all unit staff, including the sisters from the special care unit, together and drawn diagrams on a whiteboard, but nothing had prepared Annie for how small and totally vulnerable Baby Ross would look on the operating table, or how desperately sad it would be to see the still, lifeless little heart.

She reminded herself his heart would start beating again within minutes. That Alex was the best at what he did. She swallowed the lump of fear for Baby Ross that had lodged in her throat, and concentrated on what was happening now.

The switch, they called it. Baby Ross had been born with TGA, or transposition of the great arteries, which in effect meant that oxygen-rich blood from his lungs, instead of being pumped around his body, was being pumped back into his lungs, while oxygen-depleted blood was recirculated through the rest of his body.

Baby Ross was unlucky to be born with TGA, but his lucky break had been being born in St James’s—Jimmie’s as the staff called it—not just at any time but three days after Alex and his team had begun work there.

Annie studied the man they called ‘the Great’.

Cool. Detached.

Ruthless?

She wasn’t sure about the last, although both the other words would describe her impressions of the man. Having worked with critically ill children for the last five years of her career, Annie knew both the children and their parents needed very special characteristics from their doctors and nurses—characteristics like warmth, compassion, understanding.

Yet the parents she’d seen with Alex in consultations in his rooms didn’t seem bothered by his attitude. In fact, some of them—the fathers in particular—seemed to appreciate the forthright way he described their child’s condition, and the deliberate way he warned them that all surgery had potential dangers for the patient, who could die or be brain damaged for life.

The first time Alex had said this in Annie’s hearing, she was sure she’d reeled from the shock, but in retrospect had decided it was only fair the parents knew the risk, although Alex had quickly followed up his warning with statistics proving how unlikely such an outcome was.

Her thoughts were wandering but her eyes followed every move of the surgeons’ hands. Alex, Phil and a surgical registrar Annie didn’t know were all working on this one small mortal, while Rachel passed instruments and Kurt Reynolds operated the heart-lung machine, making sure the flow of blood was just right for tiny fragile arteries and veins. Maggie Walsh gave blood-gas readings and oxygen perfusion rates in a calm, relaxed voice.

Maggie, a petite brunette, oozed confidence, a great asset in an operating theatre where things could so easily go wrong. Even when Baby Ross had arrested earlier, she’d remained calm, giving Alex the information he’d needed, easing everyone’s tension with her quiet calls of pressure and blood gas.

Was she involved with Alex?

Annie wasn’t sure why the thought entered her head, but once it lodged there she looked from Maggie to Alex, considering the idea. Almost wishing she’d gone to drinks with them on Tuesday evening so she could have seen them together socially.

She gave an impatient shake of her head and turned her attention to the tiny form on the table, although she was sure she felt a frown gathering on her forehead and there was a definite squeamishness in her stomach.

Nonsense!

She concentrated on the operation, watching the glove-sheathed fingers of the surgeon sew with thread so fine she couldn’t see it. The clock on the heart-lung machine ticked off the seconds. Baby Ross had already been dependent on it for over an hour. Below the clock, another set of digital numbers—the baby’s core temperature. Baby Ross’s blood had been slowly cooled as it had gone through the machine so when the machine was stopped for the final stages of repair, he wouldn’t suffer brain or other organ damage.

All this Annie knew in theory—theory she’d brushed up on before the hour the staff had spent in front of the whiteboard—but her own heart thudded with tension as the operation continued. How much could this tiny baby take?

She looked at Alex again, and saw the precision with which he moved, the teamwork between himself, Phil and Rachel. They made it look easy—a symphony of hands moving in concert—and though one small slip could mean the baby died, Annie couldn’t feel any tension emanating from the group.

A little of her own tension eased, as if their confidence was transferring itself to her, but when the heart was stimulated and cannulae to and from the heart-lung machine were removed, the tension built again, until the little heart pumped on its own and the repairs to the big vessels held.

A faint cheer from Phil, while Alex nodded his satisfaction, stepping back from the table and pausing there while the circulating nurse unplugged his light.

Annie glanced at the clock and saw the operation must have proceeded according to plan, for Alex’s estimation of the time of completion of the major work had been spot-on.

He would now leave Phil and the registrar to close.

Annie remained where she was. She hadn’t done much theatre work in recent years, but she knew from her work in paediatric special care units that every stage of an operation was important. OK, if Phil slipped up and didn’t insert his stitches into Baby Ross’s chest just so, it might not make a difference to the final outcome of the operation, but regularly spaced stitches put equal pressure on the fine new skin, so the wound healed more quickly and left less scarring.

She gave a nod of satisfaction as she saw Phil’s work. He might be a light-hearted flirt outside the theatre, but in here he was as meticulous as his boss.

Alex, still trailing the cord from his light, stripped off his gloves and gown and dumped them in a bin. The design of the new theatre meant all the electrical equipment was contained in one central column so there was no tripping over leads and having no room to move because of bulky equipment. Even the echocardiogram machine was fitted into the column, with screens around the walls of the theatre so everyone could see what the machine found.

In this case, as Kurt, who was working it, had run the sensor over Baby Ross’s chest, it had showed blood flowing sweetly through the switched vessels, and now the camera in the column was focussed on Phil’s hands as he closed.

Alex sighed, awed as ever by the insults such small mortals could take to their bodies and yet survive. Behind him, an increase in the chat level signalled the operation was nearly at an end. Normally, he’d be operating again within an hour, but he’d deliberately not scheduled anything for this week, wanting to get the unit organised to his satisfaction first. Baby Ross had been an emergency admission—and in some ways it was good to get that first op out of the way.

Annie had said as much when he’d called the staff together for a pre-op briefing, and he’d wondered if she’d been as nervous as he had been about this first case in the new unit.

Annie, or Rowena?

He shook his head, unable to figure out why he couldn’t let it go. OK, so he’d looked for his ghost on and off for years, trawling through the names at medical conventions, checking lists of hospital employees. Not all the time—not obsessively—not quite obsessively…

She didn’t give much away—the woman everyone knew as Annie Talbot. Very self-contained. Very cool. Utterly charming to everyone she met, yet detached somehow.

He smiled to himself—knowing that was exactly how people described him. But he had his reasons for avoiding emotional involvement. Although he rarely admitted it, his job made huge demands on his emotions. To hold the life of a newborn infant in your hands—to hold the dreams of the infant’s parents—this was where his emotion was spent.

So where did Annie spend hers?

On Henry?

Was he a boyfriend? Lover? Partner?

He turned as he remembered she was here in the theatre. Remembered telling her he wanted her to observe the operation. She was still perched on the stool, and he saw her give a nod as if approving Phil’s handiwork.

‘Can I help you down?’ he said, then clutched at her waist as she wobbled precariously.

‘Sorry, you startled me,’ she said, her soft throaty voice made huskier by the mask she was wearing, although she was beyond the vital ‘clean zone’ of the theatre. ‘Yes, I could do with a hand to get down.’

Eyes he’d thought green earlier today but which now seemed blue looked down into his then slid away as if embarrassed by his closeness, while beneath his hands he could feel her body contracting—drawing away from his touch.