Hearts of Gold: The Children's Heart Surgeon

CHAPTER SEVEN

ALEX could sense resistance in his companion as they made their way, with frequent stops, towards her house. Not resistance to his kisses—she was too honest and wholehearted in her response! No, it was to do with the past, and whatever it was it haunted Annie as she had haunted him.

They reached her place and he took her to the back door and waited while she unlocked it, calling to Henry to quieten him.

‘Would you like a coffee now?’ she asked, but lack of sleep and an evening swim had taken their toll and Alex shook his head.

‘I’ll say goodnight,’ he said, and took her in his arms again, kissing her thoroughly, winning sweet, hot kisses in return. But although his body hungered to take things further, his head decreed caution, and he knew it was the right decision at this stage of their relationship.

Especially if Annie was, as he suspected, trying to work out how to tell him it was over before it had begun.

He said goodnight and walked home up the lane, wondering if he was at the two steps forward or one step back part of this relationship. He also found time to wonder why he, with his aversion to emotional dependency, wanted so badly to find out about Annie’s past. Wanted so badly to make things right for her.

Wasn’t he better off just accepting the Annie of the present, enjoying a relationship with her and letting the past remain where it was—in the past?

Yes was the answer to that question, but he knew that wasn’t going to happen. If he had a relationship with Annie then it was already tied to the past.

‘Give it up,’ he told himself, letting himself in through his back door and bending to lift a delighted Minnie and hush her excited yapping. ‘Think about work!’

He dialled the hospital, remembering as the phone rang at the other end that he hadn’t told Annie that Amy’s new catheter had worked and her kidneys were functioning if not perfectly then well.

The report from the PICU was all good, and he went off to bed thinking of work, but with a twist of Annie, because he’d be seeing her there in the morning.

‘So you see my dilemma, Henry,’ Annie said, when she’d filled him in on the Alex situation over a very early breakfast the next morning.

‘Just tell the man about Dennis,’ her father said, coming in on the tail end of the one-way discussion. ‘For Pete’s sake, it doesn’t reflect badly on you.’

Annie looked at her father. He’d been a policeman for over thirty years, yet he still had no real understanding of how victims of the crimes he’d fought—and now wrote about—felt. This wasn’t the first time she’d tried to explain it to him, and it probably wouldn’t be the last, but still she tried.

‘Dad, you and I were closer than most fathers and daughters are—far closer—but it still took me four years to lift that phone and call you.’

Four years and a stranger’s kiss, she amended silently.

‘I’ve known Alex for a week. I can’t talk to him about it, and even if I could, don’t you think he’d run a mile? What sane sensible man would want a woman with so much baggage?’

‘A man who loved you, that’s who,’ her father growled, then he wheeled himself away, not, Annie knew, because he was angry with her but because he, too, still found it hard to cope with what had happened.

Annie said goodbye to her two protectors and walked to work, pleased not to have company because, after a weekend of emotional upheaval, she wanted to get her mind focussed back on the job. Especially as this would be the first week of full-time surgery, the patient first up this morning a young girl Alex had seen last week. Jamie Hutchins was a six-year-old with a previously undiagnosed atrial septal defect, or, in medical shorthand, an ASD, and Alex had scheduled a staff briefing for eight with the operation to start at nine. And because she wanted to be at the briefing, wanted to learn all she could about the work Alex did, here she was heading for work before seven.

And beating Alex, she found when she checked in at the special care unit and learned both patients had enjoyed a peaceful night. But she wasn’t the first on duty. As she pushed open the door that led to the suite of open-plan ‘offices’ she and the doctors used, she saw the light was on, and though her heart skipped an anticipatory beat it was Maggie, not Alex, already at a desk.

‘You want a coffee?’ Maggie used the question as a greeting. She looked and sounded tired, which puzzled Annie, given the status of their patients.

Annie said yes to coffee and watched Maggie as she poured, seeing tiredness in her actions as well.

‘Are you OK?’ she asked, and Maggie gave a weary smile.

‘When Alex offered me the job up here, I thought it would be a good chance to catch up with my sister, who shifted up here when she married, and get to know her family a bit better. So I asked if I could stay with them until I found somewhere to live.’

‘Not a good idea?’ Annie sugared her coffee and stirred it.

‘A terrible idea,’ Maggie told her. ‘She’s got a spaced-out family—I mean in ages, although Pete, the eldest, is definitely spaced out in other ways. Pete’s fifteen and we go down through an eleven-year-old I swear has ADD and twins going through the delightful Terrible Twos.’

‘Not much peace and quiet?’

‘None!’

‘Do you have to stay?’

Maggie shook her head.

‘Not really. I think I’m probably as disruptive for them as they are for me. But finding somewhere else isn’t all that easy. I don’t know the city at all, and have no idea of where to start looking. Somewhere near the hospital, I suppose.’

Annie thought of the house she and her father shared. It had been converted before they’d bought it, so there was a self-contained suite for him downstairs with three bedrooms and two bathrooms upstairs. More than enough room for an extra person.

Yet she felt reluctant to make the offer, and knew the reluctance was tied up with Alex and the relationship they didn’t yet have, and might never have, and really, when she thought about it, should never have.

Then she remembered the size of the hearts Alex operated on, and the skill he required from his anaesthetist.

Would an exhausted anaesthetist exhibit the same skill?

How could she not offer?

‘We’ve plenty of room at our place and it’s just down the road—you can walk to and from work. You don’t have to stay for the whole year, but at least it would be handy while you looked around. You can pop down and check the place out during your break between ops and meet my father, and if you like it, I can drive you to your sister’s after work and bring you and your gear back home.’

Maggie stared at her.

‘You don’t know me,’ she pointed out, and Annie grinned at her.

‘I know you’re an excellent anaesthetist and this unit needs one of those, so anything I can do to make your job easier, it’s yours.’

Maggie got up from where she’d been slumped behind a desk and came across to give Annie a big hug.

‘It needn’t be for the whole year,’ she assured Annie. ‘Just until I get my bearings in Sydney and find somewhere for myself.’

‘Whatever suits you,’ Annie said, though a sinking feeling in the pit of her stomach told her she’d have a boarder for a year. Where else would Maggie find so ideal a situation?

Maggie was chattering on, so obviously delighted by this change in fortune Annie had to feel happy for her.

‘You don’t need to drive me. I’ve got my own car. I’ll check out your place at lunchtime then go back to my sister’s for tonight to say goodbye to them all, pack my stuff into the car and bring it all over tomorrow.’

‘Bring what all over where tomorrow?’

Annie turned at the sound of Alex’s voice. Inside, her stomach turned as well, a happy little flip-type somersault.

She smiled at him—a unit co-ordinator greeting the main man smile—and saw a bit more warmth in the smile he gave her back. Although the warmth faded, and the smile grew forced as Maggie happily explained the situation.

‘Maggie’s coming to live with you?’ Alex asked, when Maggie had left the suite to check her new patient.

He sounded hurt, and puzzled, and Annie understood both reactions.

‘It might only be temporary,’ she said, then remembered why she’d offered.

‘Personally, it might not be ideal,’ she said, standing up so she could look Alex in the eye, ‘but professionally—do you really want a sleep-deprived, twitchy anaesthetist working with you on a child? What else could I do but offer?’

His smile improved, though it was still a wry effort.

‘I wish I’d been here. I could have offered to have her at my place. With Phil there already, it wouldn’t have mattered and we’d still have had some privacy from work colleagues at your place.’

He brightened considerably.

‘We could still do that! I’ll offer to have her at my place. She’ll be with Jamie. I’ll go now.’

He touched Annie on the shoulder and breezed away, obviously delighted with his own brilliance.

But his face was glum again when Annie saw him at the briefing, and he looked far from happy as he explained Jamie’s problem, where a hole in the wall between the heart’s two upper chambers, the atria, hadn’t closed, so blood shunted between the two chambers.

‘It causes increased pressure in the right atrium and ventricle, and too much blood flowing into the lungs. Usually the patient suffers few symptoms—a bit of breathlessness and fatigue from time to time. In Jamie’s case these didn’t become obvious until she started at Little Athletics. Echocardiography has confirmed the hole is there, and her cardiologist has done a cardiac catheterisation as well to determine just where the hole is.’

Alex pointed to his diagram on the whiteboard.

‘New technology is being tried for holes in the centre of the atrial wall, and holes are being successfully closed using transcatheter management—inserting wires through a catheter. But Jamie’s hole is higher up and the new technique doesn’t work, hence the need for an operation.’

‘If she’s been OK up until now, and is only breathless after running or jumping at Little Athletics, is it worth the risk involved in any operation—particularly open heart where she’ll be on a bypass machine for some of it?’

One of the sisters from the special care unit asked the question, and Annie was pleased. For one thing, she’d wondered about it herself, and for another, it meant all the unit staff were becoming increasingly involved in all stages of their patients’ operations.

‘There’s a twenty-five per cent risk of early mortality through pulmonary vascular obstructive disease if it’s not repaired and a less than five per cent—in fact, I feel less than one per cent—risk with the operation itself.’

Alex turned back to the board and sketched a small chest.

‘We make a much smaller incision than we do for a PDA, only…’ He paused, then smiled at them all. ‘I have to convert inches to centimetres…say eighty to a hundred centimetres. Then the defect is fixed with either a patch or stitches, depending on what we find. As you said, the child has to go on the heart-lung machine as soon as we open the pericardium, then once the aorta is clamped, we stop the heart beating with cardioplegia, open it up, fix the hole and Jamie’s back in business again. Within weeks she should be back at Little Athletics.’

‘The results are really good,’ Phil added, turning to smile at the sister who’d asked the question. ‘You probably won’t have her more than a few hours in the PICU, then she’ll be moved to the ward.’

‘Which reminds me,’ Alex said, directing his question to the two nurses present who had been specially selected to work with his patients once they reached the children’s post-surgical ward. ‘How do you think you’ll go, working with our patients exclusively when they’re back in the ward with the others?’

‘I love the idea of it,’ one of them said, while the other nodded agreement. ‘It means you can really get to know the children and their families, and there’s something special about being chosen as part of the team that’s working to make them well again.’

Whatever gloom Alex had shown earlier disappeared, and he beamed at the pair, one male and one female.

‘That’s great to hear, and don’t forget, if you run into administrative trouble at any stage, see Annie and she’ll sort it out.’

Annie’s turn to smile. Alex could so easily have said to see him, but he had enough faith in her to know she’d handle it.

She just hoped his faith would never prove to be misplaced.

The briefing over, the operating crew headed off for the theatre, the nursing staff back to their places and Annie returned to the office. Alex’s prediction that there’d be hospital infighting was already coming true. She had a meeting with the CEO and other surgical co-ordinators at nine-thirty, and guessed pressure would be applied for other surgical services to have equal access to the new theatre.

Not this week they wouldn’t, as Alex was booked to operate twice and sometimes three times a day right through until Friday.

‘Adult cardiac surgery brings in more dollars than CHD,’ the administrator of the adult cardiac programme yelled at her less than an hour later, confirming Annie’s prediction.

‘But it requires more outlays as well,’ Annie shot back, determined to remain calm. ‘And takes more hospital resources as patients are hospitalised for longer. Plus, you have to realise that if we operate on infants and children with CHD, it means these children won’t need cardiac surgery as adults.’

As soon as the words were out of her mouth, she realised she’d made a mistake. The adult cardiac administrator was a money person through and through, and telling him there’d be fewer patients for him in the future was a challenge to his job security.

‘Surely people matter more than dollars!’ she stormed at Alex much later when he was foolish enough to ask her how the meeting had gone. ‘Surely it’s more important to offer children with CHD an opportunity to lead a normal life than to keep up the numbers of adult cardiac patients?’

Alex smiled at her vehemence.

‘Of course it is, but you’ll find very few administrators within a hospital system—or any system, I suppose—who aren’t bent on defending their territory.’

Another smile, and if the first had soothed some of her anger, this second one warmed bits of her left cold from the other man’s attitude.

‘Weren’t you doing just that?’ he asked, and the warmth turned to heat.

‘No, I wasn’t. I was talking people, not numbers or money. I was talking about infants and kids like Jamie who’ll go back and run the legs off the others in her age group at Little Athletics. I won’t talk numbers and money—I’ll keep the figures and use them to prove our worth, but the children and their families will always be my prime concern. And if that’s going to make me a bad unit manager then you’d better sack me right now.’

She glared defiantly at him, though she knew a lot of her rage was leftover frustration from the morning’s meeting.

‘I don’t think I could sack you,’ he said, another smile, gentle this time, playing around his lips. ‘The CEO was most insistent that the job was yours, right from the start. I could ask for just about anything else I wanted, but you were a given. The powers that be in this place have a very high opinion of you.’

‘You make it sound as if you didn’t want me here!’

He sounded so tired she almost let him off the hook, but if the man this morning had made her angry, this man was making her doubly so, with his assumption that she might not be up to the job. Because she was a woman?

‘Were you against me, or against having a woman in the job? Was this a gender issue?’

‘Not at all. Actually, I wanted my old administrator, Karen. Annie, are we arguing?’

‘Yes,’ she told him, then she relented. ‘Not arguing precisely, but I’d like to know more about it. It’s not exactly confidence-building to think you’d have preferred someone else in this job.’

‘Can we talk over dinner?’ he suggested hopefully. ‘Did you say there was an Italian restaurant near the park? Could we go and argue there? I’m famished, and if I caught the drift of all the arrangements you and Maggie made—I did ask her to stay at my place, by the way, but she refused—this might be my last opportunity for a proper first date.’

‘Oh, Alex,’ Annie sighed, then, because the longing was still there—strong and hot and insistent—she nodded. ‘OK. I’ll just phone Dad, because it’s closer to walk straight there, then we can cut across the park to come home. It’s well lit at night.’

‘That’s a shame, though there are sure to be shadows. No rocks and fishermen?’ Alex said, and Annie smiled at him, knowing he was remembering the interrupted kiss.

‘No rocks or fishermen,’ she promised.

Definitely two steps forward and one back in this relationship, and right now he was at the back stage, Alex thought as he had a wash before leaving the hospital.

Hell’s bells, he hadn’t had a date with the woman yet, and he was thinking relationship longevity. And she was as uncertain as a woman could be about any relationship—let alone one with him.

And prickly!

Because she’d been hurt before?

He was as certain of that as he was of his own name. If he wasn’t careful, he’d blow this before it had even begun, and every instinct told him that would be a very bad thing. A disastrous thing! Muddle-headed he might be, but one thing he was quite clear on—both physically and emotionally he wanted Annie Talbot, and he was pretty sure it wasn’t because she was his ghost.

Well, he hoped it wasn’t, because he knew from experience that flesh-and-blood women were a lot more bother than ghosts, but in Annie’s case he was certain…he smiled to himself…she was worth the effort.

‘You don’t have to talk about the administrator issue,’ Annie said as they left the hospital and she guided him along a path that led around the perimeter of the park. ‘It’s really none of my business if you wanted to bring her out here.’

Alex was more than happy to accede to this request, but a tightness in Annie’s voice suggested he’d better get it settled or he’d be eight steps back.

‘Karen Ritchie, my old—no, ex—administrator, is a single mother who has worked sometimes at two or three jobs for the past ten years since her husband left her, to keep her kids and get them through college. They were old enough to be left on their own for a year, with relatives keeping an eye on them, and I thought the year out here, as well as being hard work, would be a treat for Karen.’

‘Oh!’ Annie said, in a very small voice. ‘Yes, she’d have enjoyed it, I’m sure.’

‘But, in case you’re now feeling bad about Karen, I can see it would have been impossible for her to function efficiently in such a different work environment. I discovered that in Melbourne when I needed administrative help to find my way around the workings of the hospital, and without you in the job here we wouldn’t be nearly as far along as we are. So stop worrying about it and let’s just go out and eat together and enjoy it.’

Now they were safely over that issue, Alex wondered what they should talk about.

Annie solved that problem.

‘I phoned Mayarma, the dog-walker I told you about, and she’s more than happy to add Minnie to her mob. She’d like to take her out on her own first to see how she behaves, but I assured her Henry would look after her—Minnie, not Mayarma—if she joins the group.’

‘And what do I have to do? How do I arrange things? And what is this wonderful service going to cost me?’

Annie explained the various ways owners left their dogs to be collected, and then named a sum that seemed ridiculously low to Alex.

‘That’s all she asks?’

Annie nodded.

‘It’s cash. She’s from the Philippines, married to an Australian, and she loves dogs but can’t have one as her husband’s getting on and could be knocked over by a big dog or trip over a small one. I’ll give you her phone number and you can speak to her direct about the arrangements.’

Which sorted out the dogs. Alex wondered if he could turn the subject to more personal matters, but Annie forestalled him with a question.