glanced up to catch a pair of hazel eyes regarding her over the edge of a surgical mask. Ryan’s tone was as calm as ever but Holly could see a gleam of pride that was bright enough to more than replace an emotion she couldn’t afford to indulge in just yet.
‘Yes—thanks.’
‘Don’t thank me. I’m getting a holiday here.’
As if. Ryan was aware of every factor involved in this operation. Coaching and monitoring Holly’s work would require far more effort than doing it himself, and Ryan was also keeping tabs on all the parameters being measured on their small patient as the procedure was completed and preparation made to come off bypass.
‘Clamp coming off. Happy that you’ve removed all the air in the aorta, Holly?’
‘Yes.’ Holly moved to insert the needle into the largest chamber of the heart, the left ventricle.
‘Good.’ Ryan nodded. ‘You’ve got it right on the apex.’
The pause as the team watched for the heart to resume pumping stretched on longer than seemed normal and Holly felt a chill race up her spine. It was rare these days for defibrillation to be needed to restart the heart. Had something gone wrong?
Her gaze was riveted on the child’s heart, still lying motionless, but Holly was aware of a very subtle movement beside her. The tall figure that had already been standing close beside her seemed to sway an infinitesimal degree. Not enough for anyone to notice but Holly was aware of Ryan’s shoulder almost touching her own. The solid wave of reassurance the almost-touch provided coincided with the first movement of the tiny heart in her line of vision.
Just an uncoordinated wiggle to start with but it was enough for a collective, if inaudible, sigh of relief as the heart settled into a steady beat with reassuring swiftness. Then the whole chest moved as ventilation of the child’s lungs began again. Step by step, Holly continued the procedure, repairing the connection sites for the heart-lung machine, positioning drains and closing the small chest with fine wire to hold the edges of the breastbone together. She had used virtually all these skills previously but never continuously, and the strain was telling as the final layer of closure was reached.
The tremor was clearly visible now.
Not that Ryan offered to take over. Not even when it took two attempts to knot and tie the final suture. His clipping of the excess length was perfunctory as his attention turned to the anaesthetist.
‘How’re we looking?’
‘All good. Blood pressure’s fine. Oxygen saturation is ninety-eight per cent.’
‘Probably the best it’s ever been for this wee chap. Happy to move, Holly?’
Holly finished covering the sutures with a clear plastic dressing and scanned the chest drains. There was no sign of any untoward blood loss from the field of surgery.
‘I’m happy if you are, Ryan.’
‘Oh, I’m more than happy.’ They could all hear the smile in Ryan’s words. ‘Well done, Holly.’
‘Yes, well done!’ The sentiment echoed amongst theatre staff who were quite aware of what a large step Holly had just taken towards her ultimate goal of being a paediatric cardiac surgeon. The congratulatory sounds stayed with her as they transferred their small patient to the intensive care unit where he would stay on a ventilator for the next twenty-four to forty-eight hours.
She had done well but her clumsiness at the end of the procedure couldn’t have gone unnoticed. How many of the staff were thinking, as Holly was, that it was just as well it hadn’t occurred earlier? Or that maybe Ryan was a little too trusting. Worse—that maybe Holly Williams wasn’t quite up to doing the job she had set her heart on.
Having directed them towards bed position one in the ICU, the charge nurse gave Holly a look that confirmed her fears.
‘You look dreadful, Holly! You’re as white as a sheet. Are you all right?’
‘I’m fine.’
‘Hmm.’ But the nurse’s attention was now on her new admission as they positioned the monitoring equipment and checked all the information made available. ‘Callum’s parents are in the relatives’ room,’ she told Ryan finally. ‘You can send them in to sit with him when you’ve had a talk.’ She raised her eyebrows. ‘I’m assuming everything went well?’
‘You’d better ask the surgeon.’
Holly smiled at the new level of respect she could detect in more than one face turning in her direction.
‘It went very well,’ she said modestly.
‘Textbook perfect, actually,’ Ryan added. ‘Let’s go and give Callum’s parents the good news, shall we, Holly? We might even have time for coffee before we do our rounds after that.’
‘Don’t bank on it,’ the nurse warned. ‘I’ve heard that the neonatal retrieval team have been sent out to collect a blue baby from one of the maternity hospitals.’
‘What’s the ETA?’
‘Thirty minutes or so, I’d guess.’
‘Cardiology up to speed?’
‘They’re standing by.’
Holly listened to the exchange with dismay. An afternoon of patient rounds evaluating their current case load had seemed manageable, but if she was already drained enough to have people commenting on her appearance, how could she hope to find the stamina to assist with what could be a very difficult procedure on a critical newborn baby?
‘In that case…’ Ryan’s tone belied any similar misgivings he might be having. ‘Coffee is imperative. Holly, would you go and put the jug on, please? I’ll talk to Callum’s parents.’
‘But—’
‘No “buts”,’ Ryan said sternly. ‘I need coffee stat!’
He could have been the one to go ahead to the staffroom while Holly spoke to the child’s family but they both knew why that wasn’t happening and it was with a heartfelt sigh, a few minutes later, that Holly sank into an armchair and closed her eyes.
Sometimes, this was just so hard.
His registrar was sound asleep.
Ryan Murphy shut the staffroom door quietly behind him when he arrived nearly an hour later. He’d spoken at length to Callum’s parents and then accompanied them to their son’s bedside, taking the opportunity for another check on his patient. He’d caught up with the cardiology team as their new admission had arrived via ambulance. The neonate was in trouble all right, with a level of cyanosis obvious enough to require urgent management. An X-ray and echocardiogram would be needed to make a definitive diagnosis, however, and that gave Ryan some breathing space.
It was time for coffee.
Maybe it was also time to have that talk with Holly.
She hadn’t stirred as Ryan had entered the small staff-room. Before long, the area would start being used by staff snatching a lunch-break,
