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.
Anna saw the moment the small artery got nicked by the tip of the scalpel. It needed more than diathermy. Clamping and tying it off shouldn’t present more than a momentary delay. She picked up a clamp, ready to hand it to Luke, already eyeing up the suture material he would need.
But he didn’t request the clamp. The hand that was holding the scalpel was as still as stone. Frozen.
And then the surgeon looked up, straight at her, and Anna’s own heart missed a beat.
