pressure on the faulty valve—that was something that in an adult heart would be tricky but in this pint-sized scrap of humanity seemed impossible.
Emily, the anaesthetist, was at the limits of her capability as well. This procedure should be done by an anaesthetist specialising in paediatrics, but Emily was all they had. She was sweating as she worked, as she monitored the tiny heartbeat, treading the fine line of not enough anaesthetic, or too much and straining this little body past more than it could bear.
Jill, the director of nursing and their most skilled Theatre nurse, was assisting Emily. She was sweating as well.
It was Cal who assisted Gina.
He watched her fingers every step of the way, trying to figure what she was doing, trying to anticipate so there was no delay between her need for a piece of equipment and the time she had it. He was organising, swabbing, waiting for the pauses in her finger movements to reach forward and clear the way for her. Holding things steady. Watching the monitor when she couldn’t, guiding her with his voice, and holding catheters steady when she had to focus on the monitor herself.
Grace, their second nurse, was behind him, and she was anticipating as hard as he was.
There was so much need here. Something about this tiny wrinkled newborn had touched them all.
They needed him to live.
They willed him to live.
All that stood between him and death was Gina.
They were lucky that she was here, Cal thought grimly as he helped her painstakingly introduce her catheters from the groin, monitoring herself every inch of the way. No matter why she’d returned after all these years—she’d been in the right place at the right time and this baby could live because of it.
Maybe.
‘He’s bleeding too much,’ she muttered into the stillness, motioning with her eyes to the catheter entry site. ‘There has to be an underlying problem.’
‘Haemophilia?’ Cal asked, and she shook her head.
‘I don’t think so. It’d be worse. But it’s not right. The cord bled too much and we’re having trouble here. I want tests. A clotting profile, please, including full blood examination, bleeding time and factor eight levels. Fast.’
‘What are we looking for?’
‘I don’t have time to think. You think. Something.’
He went back to sorting tubing, his mind moving into overdrive. Sifting the facts. She was right. The bleeding was far more severe than it should be. They were fighting to maintain blood pressure.
Why?
‘Von Willebrand’s?’ he said cautiously.
Was he right? Von Willebrand’s was a blood disorder that impeded clotting. Like haemophilia, it was genetically linked, passing from parents down to children. It usually wasn’t as life-threatening as haemophilia but it did have to be treated. He watched as Gina frowned even more behind her mask. Her fingers were carefully manoeuvring, she was fully absorbed in what she was doing, but he could see her mind start to sort through the repercussions of his tentative diagnosis.
‘You could be right,’ she said at last. ‘It fits.’
‘I’ll run tests straight away,’ he said. ‘There’s not a lot more we can do about it now, though. And at least it takes away the risks of clotting.’
‘Mmm.’
Silence. The tension was well nigh unbearable. She was measuring the pressures in the right ventricle and the pulmonary artery by placing the catheter tip in each area. It was a tricky procedure in an adult, but in a newborn…
‘My face,’ Gina muttered, and Jill saw her need and stepped forward to wipe sweat beads from above her eyes.
She was good, Cal thought grimly. Good enough?
The work went on. The child’s tiny heart kept beating. Emily was fighting with everything she had. She had a paediatric anaesthetist on the line from the city, and she was working with a headset. Her soft voice asking questions was the only sound as they worked.
Cal had seen this done in adults, but he’d never seen the procedure in one so tiny. As a general surgeon he would never think of doing such a procedure himself. He couldn’t, he acknowledged. Somewhere along the line Gina had acquired skills that could only make him wonder.
Gina was working out diameters now, her eyes moving from fingers to monitor, fingers to monitor, and he could almost see her brain doing the complex calculations as she worked out the next step forward.
She was brilliant. An amazing surgeon.
The mother of his son?
‘Now the wire,’ she said into the stillness, and the sound of her voice almost made him start.
Back to silence.
The balloon valvuloplasty catheter was threaded over the wire, painstakingly positioned so its centre was just at the valve. That was the hard part.
Now came the hardest.
Please…
‘Let’s try,’ Gina said into a silence that was close to unbearable. ‘I think…’
The balloon was inflated, showing on the monitor under fluoroscopy, with Gina watching that it remained centred all the time. The balloon had been manoeuvred right to the valve. Now it was stretching the valve, much as a shoe was stretched by a cobbler, hoping that once the stretching was done the valve would self-correct. The pressures would equalise.
If it didn’t happen, then the build-up of pressure could mean instant heart failure—instant death.
This was no time for panic. The procedure called for infinite patience.
The balloon was inflated once. Twice. Three times the valve was stretched.
‘Enough,’ Gina said, and Cal heard exhaustion in her voice.
But she couldn’t stop now. She had to check the pressures again. If the pressures weren’t equalised the whole thing would have to be repeated, using balloons of different lengths and diameters, and this tiny heart was under so much strain anyway…
The catheters were reinserted, once more measuring the pressures in the right ventricle and the pulmonary artery.
Please.
The figures…
‘Hey,’ Jill said in a tiny tremulous voice that didn’t sound the least bit like the efficient director of nursing they all knew—and, if truth be told, they often feared. ‘We have liftoff. Isn’t that right, Houston?’
‘I…Maybe,’ Gina said. She glanced up at her anaesthetist. ‘What do you think?’
‘I think maybe you’ve done it,’ Emily said in a voice that was none too steady. ‘Oh, Gina, that was fantastic.’
‘Fantastic?
