St Piran's: The Brooding Heart Surgeon. Alison Roberts
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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. He was looking at her but he was seeing something very different. Something that had absolutely nothing to do with this room or this patient or the surgery he was in the middle of performing.
He was seeing something … terrifying? Her heart missed only a single beat. With the next one she was moving smoothly. Using the clamp in her hand and then a suture. To those around them, it would look as though Luke had silently requested her control of the nuisance bleeding. Given his virtually silent technique up until now, it wouldn’t have surprised anyone. But Anna had been the only one to see the look in his eyes. Had felt the way he had frozen, and it had quite possibly been the most disturbing moment she had ever encountered in Theatre.
It took only moments to deal with the artery and a nurse used suction to clear the operating field again. Anna heard Luke’s indrawn breath and looked up to see the way he blinked with such deliberation it gave the impression of a switch being flicked off. And then normal service was resumed. The surgery carried on as though nothing awkward had happened.
But something had changed. Maybe it was an acknowledgment of the way Anna had rescued the situation. Or maybe it was the beginning of the kind of bond that could weld a tight team together.
‘If I tilt the heart,’ Luke said quietly a short time later, ‘you’re in a much better position to deal with that patch at the back. Are you happy with what you’ve seen of the technique?’
‘Yes.’ The increase in her own heart rate wasn’t trepidation. It was far more like excitement. The challenge of trying something new. The idea that she might be on a new journey to learn skills that nobody else could teach so well. There was something like relief mixed in there as well because her future here at St Piran’s looked a little less bleak. There was even a letting go of a little of that resentment towards the man who had reclaimed his job. The job she had desperately wanted to keep.
Thank goodness her hand was steady as she took hold of the scalpel. Even better was Luke’s quiet praise as he watched what she was doing.
‘That’s excellent. Keep going. The more of this we can remove, the better