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?’
Leo’s mother nodded. ‘Ever since he started walking. He gets breathless very easily and he’s always so tired.’ She caught her husband’s gaze. ‘We were really hoping to avoid the surgery, though. Especially just now, with the new baby coming.’
‘When are you due?’
‘I’m thirty-six weeks now. And I may need a Caesarean. The baby’s breech. They’re talking about a procedure to try and turn it next week but there’s no guarantee it’ll stay that way. And if I have a Caesar it’ll make everything that much harder, and if Leo’s not well I just don’t know how I’d cope.’ She bit her lip and her hold on Leo must have tightened enough to transmit her tension because the toddler stuck out his bottom lip and wriggled determinedly free.
He went straight to Holly and held up his arms. ‘Wiggle, wiggle!’
Holly grinned and a moment later Leo sat in her lap, happily playing with the end of her stethoscope. His mother watched him for a moment, fighting tears, and then she looked at her husband and they both smiled again.
The message was very clear. Holly had won their son’s trust. Who were they to argue?
Ryan was equally reassuring. ‘If Leo has his surgery now, he’ll be a lot less of a worry by the time the new baby arrives. Kids bounce back from this kind of surgery astonishingly well. He’ll be up and running around within just a few days.’
Details regarding the necessary surgery were discussed and consent forms even signed, with no hint of further tears, and Ryan knew that his registrar was largely responsible for leaving the small family relatively happy to settle back into the ward and ready to face the biggest hurdle in Leo’s life so far.
They finished their afternoon by checking Callum’s progress again in the intensive care unit. While Holly went through the process of reviewing every parameter and noting their satisfactory levels, it was clear she was at the very end of her physical tether.
When they turned to leave, Holly seemed to lose her balance. She swayed on her feet and might well have fallen if Ryan hadn’t taken a firm grip of her elbow. Thank goodness he’d been standing so close.
It was a momentary lapse. Holly pulled free a second later, probably before anyone else had noticed what had happened, and she walked ahead of Ryan as they left the
