24/7

The cutting edge of Mills & Boon® Medical Romance™

The emotion is deep

The drama is real

The intensity is fierce

24/7

Feel the heat—every hour…every minute…every heartbeat

Dear Reader,

I’m often blown away by stories of everyday heroism many people display in facing enormous obstacles in life. Coping with a condition like renal failure requiring dialysis is huge and I know there are many people who struggle and succeed, just like the heroine of my story, Holly.

If you are one of them, you have my heartfelt admiration. And I wish, that just like Holly, a heroic person will appear in your life with the courage and the heart to give you the precious gift of health.

In Holly and Ryan’s case the donor-recipient bond provided a rocky testing ground for a much deeper relationship. I got so involved with these characters that giving them the ending they both deserved was particularly satisfying.

Happy reading,

Alison Roberts

The Surgeon’s Perfect Match
Alison Roberts

www.millsandboon.co.uk

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CONTENTS

Cover

Introduction

Dear Reader

Title Page

CHAPTER ONE

CHAPTER TWO

CHAPTER THREE

CHAPTER FOUR

CHAPTER FIVE

CHAPTER SIX

CHAPTER SEVEN

CHAPTER EIGHT

CHAPTER NINE

CHAPTER TEN

Extract

Copyright

CHAPTER ONE

THE tremor was tiny.

So slight it could only be felt, not seen, but it was enough to threaten her confidence.

Could she manage this?

The smallest slip could be catastrophic. A tiny heart lay carefully exposed beneath her fingertips. The defect causing a three-year-old boy’s heart failure was visible and ready to be covered by the small teardrop-shaped patch of Dacron caught between the teeth of the forceps that surgical registrar Holly Williams was holding.

The tremor could be the result of first-time nerves, in which case Holly knew she could conquer it and succeed—as she had done countless times already on the totally focussed journey that had brought her to precisely this point in time.

But it could also be the result of fatigue and, no matter how much practice Holly had had in battling the physical effects of exhaustion, she knew there were times when she simply couldn’t win. And the notion of a three-year-old child sharing the repercussions of losing that battle was absolutely unacceptable.

Pushing herself this far might have been a huge mistake. What if…?

‘You can do this, Holly.’

The quiet, deep voice was so close that Holly could feel the vibration of air as clearly as she’d felt that embryonic tremor. And the confidence that had cloaked the words didn’t stop at her ears. It seeped instantaneously into her brain and then swept further. The ache in Holly’s calves subsided, the knot in her stomach unravelled just enough and her fingers felt rock steady.

She gave a single, decisive nod.

Of course she could do it. She had worked far too hard for far too long to pass up the opportunity of actually touching her dream.

Being more than an assistant, however vital that assistance might be.

So what if this procedure was an almost routine repair of one of the most common types of a ‘hole in the heart’—a ventricular septal defect? Or that all the skilled preparation had already been done by one of the country’s foremost paediatric cardiac surgeons? It was still Holly holding the suture needle and patch. Doing an actual repair herself and not just the final closure for the open heart surgery. There weren’t many consultants in any field that would trust their registrars enough to provide such an opportunity so soon.

She owed it to her mentor to justify that trust. As she had done on more than one occasion when Ryan Murphy’s confidence had deepened, if not actually engendered, an equal trust in herself.

‘Begin on the right side of the inferior rim.’ Ryan’s instruction was calm. ‘And carry it in a counter-clockwise direction to penetrate the septal leaflet.’

Tiny stitches. Through the cardiac tissue and then through the edge of the patch. Again. And again.

‘Perfect.’

The final suture was tied and cut. The rush of oxygen as Holly took a deep breath gave her momentary dizziness. How long had she been holding her breath?

‘Want to carry on?’

Holly glanced up to catch a pair of hazel eyes regarding her over the edge of a surgical mask. Ryan’s tone was as calm as ever but Holly could see a gleam of pride that was bright enough to more than replace an emotion she couldn’t afford to indulge in just yet.

‘Yes—thanks.’

‘Don’t thank me. I’m getting a holiday here.’

As if. Ryan was aware of every factor involved in this operation. Coaching and monitoring Holly’s work would require far more effort than doing it himself, and Ryan was also keeping tabs on all the parameters being measured on their small patient as the procedure was completed and preparation made to come off bypass.

‘Clamp coming off. Happy that you’ve removed all the air in the aorta, Holly?’

‘Yes.’ Holly moved to insert the needle into the largest chamber of the heart, the left ventricle.

‘Good.’ Ryan nodded. ‘You’ve got it right on the apex.’

The pause as the team watched for the heart to resume pumping stretched on longer than seemed normal and Holly felt a chill race up her spine. It was rare these days for defibrillation to be needed to restart the heart. Had something gone wrong?

Her gaze was riveted on the child’s heart, still lying motionless, but Holly was aware of a very subtle movement beside her. The tall figure that had already been standing close beside her seemed to sway an infinitesimal degree. Not enough for anyone to notice but Holly was aware of Ryan’s shoulder almost touching her own. The solid wave of reassurance the almost-touch provided coincided with the first movement of the tiny heart in her line of vision.

Just an uncoordinated wiggle to start with but it was enough for a collective, if inaudible, sigh of relief as the heart settled into a steady beat with reassuring swiftness. Then the whole chest moved as ventilation of the child’s lungs began again. Step by step, Holly continued the procedure, repairing the connection sites for the heart-lung machine, positioning drains and closing the small chest with fine wire to hold the edges of the breastbone together. She had used virtually all these skills previously but never continuously, and the strain was telling as the final layer of closure was reached.

The tremor was clearly visible now.

Not that Ryan offered to take over. Not even when it took two attempts to knot and tie the final suture. His clipping of the excess length was perfunctory as his attention turned to the anaesthetist.

‘How’re we looking?’

‘All good. Blood pressure’s fine. Oxygen saturation is ninety-eight per cent.’

‘Probably the best it’s ever been for this wee chap. Happy to move, Holly?’

Holly finished covering the sutures with a clear plastic dressing and scanned the chest drains. There was no sign of any untoward blood loss from the field of surgery.

‘I’m happy if you are, Ryan.’

‘Oh, I’m more than happy.’ They could all hear the smile in Ryan’s words. ‘Well done, Holly.’

‘Yes, well done!’ The sentiment echoed amongst theatre staff who were quite aware of what a large step Holly had just taken towards her ultimate goal of being a paediatric cardiac surgeon. The congratulatory sounds stayed with her as they transferred their small patient to the intensive care unit where he would stay on a ventilator for the next twenty-four to forty-eight hours.

She had done well but her clumsiness at the end of the procedure couldn’t have gone unnoticed. How many of the staff were thinking, as Holly was, that it was just as well it hadn’t occurred earlier? Or that maybe Ryan was a little too trusting. Worse—that maybe Holly Williams wasn’t quite up to doing the job she had set her heart on.

Having directed them towards bed position one in the ICU, the charge nurse gave Holly a look that confirmed her fears.

‘You look dreadful, Holly! You’re as white as a sheet. Are you all right?’

‘I’m fine.’

‘Hmm.’ But the nurse’s attention was now on her new admission as they positioned the monitoring equipment and checked all the information made available. ‘Callum’s parents are in the relatives’ room,’ she told Ryan finally. ‘You can send them in to sit with him when you’ve had a talk.’ She raised her eyebrows. ‘I’m assuming everything went well?’

‘You’d better ask the surgeon.’

Holly smiled at the new level of respect she could detect in more than one face turning in her direction.

‘It went very well,’ she said modestly.

‘Textbook perfect, actually,’ Ryan added. ‘Let’s go and give Callum’s parents the good news, shall we, Holly? We might even have time for coffee before we do our rounds after that.’

‘Don’t bank on it,’ the nurse warned. ‘I’ve heard that the neonatal retrieval team have been sent out to collect a blue baby from one of the maternity hospitals.’

‘What’s the ETA?’

‘Thirty minutes or so, I’d guess.’

‘Cardiology up to speed?’

‘They’re standing by.’

Holly listened to the exchange with dismay. An afternoon of patient rounds evaluating their current case load had seemed manageable, but if she was already drained enough to have people commenting on her appearance, how could she hope to find the stamina to assist with what could be a very difficult procedure on a critical newborn baby?

‘In that case…’ Ryan’s tone belied any similar misgivings he might be having. ‘Coffee is imperative. Holly, would you go and put the jug on, please? I’ll talk to Callum’s parents.’

‘But—’

‘No “buts”,’ Ryan said sternly. ‘I need coffee stat!’

He could have been the one to go ahead to the staffroom while Holly spoke to the child’s family but they both knew why that wasn’t happening and it was with a heartfelt sigh, a few minutes later, that Holly sank into an armchair and closed her eyes.

Sometimes, this was just so hard.

His registrar was sound asleep.

Ryan Murphy shut the staffroom door quietly behind him when he arrived nearly an hour later. He’d spoken at length to Callum’s parents and then accompanied them to their son’s bedside, taking the opportunity for another check on his patient. He’d caught up with the cardiology team as their new admission had arrived via ambulance. The neonate was in trouble all right, with a level of cyanosis obvious enough to require urgent management. An X-ray and echocardiogram would be needed to make a definitive diagnosis, however, and that gave Ryan some breathing space.

It was time for coffee.

Maybe it was also time to have that talk with Holly.

She hadn’t stirred as Ryan had entered the small staff-room. Before long, the area would start being used by staff snatching a lunch-break, but for the moment it was peaceful and Ryan was reluctant to disturb Holly. Exhaustion was etched onto that pale face in the form of an uncharacteristic frown line between her eyes and bruised-looking skin beneath the fan of dark lashes.

He’d never seen her asleep like this before and for a long moment Ryan felt mesmerised. That aura of strength had deserted her and the sheer vulnerability of the woman in front of him caught and squeezed Ryan’s heart painfully. She was way too thin now. In another life, with Holly’s height and stunningly good looks, she could easily have been a model. But that was not what Holly had set her heart on being, was it?

Ryan sighed inaudibly and moved towards the bench. He shouldn’t have pushed her to go solo on that VSD repair. He’d seen that moment of hesitation—the self-doubt. He’d also felt the gathering of whatever internal resources had been needed to succeed, and he hadn’t realised how tense he’d been himself until Holly had moved to take that first stitch and he’d been able to breathe again.

Not that he’d doubted for a moment that she could do it. If sheer courage and determination were all it took to succeed, there would be no stopping Holly Williams. Sadly, that wasn’t all it took, though, was it? And Holly was getting just a shade too close to the wall now. Maybe others hadn’t noticed yet but Ryan had become so closely attuned to his registrar that he knew as well as she must how much more of a struggle it was all becoming.

Yes. Ryan quietly set two mugs onto the bench and reached for the jar of instant coffee.

It was definitely time for the talk.

‘Holly!’

Her eyes flew open at the sound of her name. Blinking, Holly focussed on the source of the sound. Shaggy, gold-streaked brown hair. A face too craggy to be conventionally good-looking but a pair of the kindest hazel eyes in existence. A wide mouth, more inclined to curve into a slow smile than a grin. The kind of smile she could see right now, in fact.

‘Feeling better?’

Holly nodded, sitting more upright as she noticed the steaming mug of coffee Ryan was holding out for her.

‘Thanks.’ Embarrassed at being found asleep, Holly avoided more than the briefest eye contact. Her gaze slid past Ryan’s face, catching the wall clock visible just behind his shoulder. Her exclamation was horrified.

‘Oh, my God! I’ve been asleep for an hour!’

‘You needed a rest.’

‘I thought you’d only be five minutes. I only sat down to wait for the jug to boil.’ Holly shook her head in disbelief, pushing a long, single braid of dark hair over her shoulder. ‘I’m so sorry, Ryan. This is awful!’

‘It’s no big deal. Don’t beat yourself up over it.’

‘Falling asleep on the job is a pretty big deal in my book.’ Holly tried to stamp on a fear that had been gnawing at her for days. The fear that things were getting worse far too rapidly to control now. That she was reaching a point when she would have to admit defeat. She could only hope that fear wasn’t showing in her eyes as she looked up at Ryan again. ‘Why on earth do you put up with me, Ryan?’

The gentle smile broadened into the closest he ever came to grinning as he sat down beside Holly.

‘What is it they say on the wrinkle-cream ads? “Because you’re worth it”?’

‘Ha!’ But Holly couldn’t help smiling back at Ryan. He’d always made her feel like that. Mind you, he made everybody feel like that. His small patients, their parents—even their siblings. Ryan was just one of those amazing people that made anyone they spoke to feel special. Holly had never known him to complain of any personal cost he suffered and she had to be running up a fair account by now. ‘You have to juggle on-call rosters because half the nights I’m unavailable. I have more time off work than any normal registrar would be allowed and now I’m falling asleep on the job, for heaven’s sake!’

‘You had a big morning.’ Ryan raised his coffee-mug in a salute. ‘Well done again, by the way. When I think back to what my first patch was like on a VSD, I’m impressed all over again. In fact, I think I was only allowed to do half of it before my consultant muttered darkly about having to call in a plumber to fix the leaks and then took over.’

‘I don’t believe that for a minute.’ Holly’s glance at Ryan was very direct. ‘Why did you let me do it?’

‘Because you could.’

‘You didn’t know that. I didn’t know that. I’ve never done it before.’

‘You have more than enough ability. You’ve got to stretch your wings some time.’

‘But something might have gone horribly wrong.’

‘Of course it could. Something could have gone horribly wrong for me as well. That fear is always there.’ Ryan’s expression was quizzical. ‘You’ve had your heart set on a surgical consultancy for as long as I’ve known you, Holly. And that’s, what…two years now?’

She nodded. ‘Off and on.’

‘And as a consultant, you take that risk and responsibility on board and do the best you can. Your best is more than good enough.’

‘I’m not talking about the risk of complications or error.’ Holly stared into the depths of her coffee-mug. ‘I’m talking about the lack of physical ability. What if I’d blacked out or got the shakes badly enough to create a disaster?’

‘You didn’t.’

‘You took a hell of a risk, though, Ryan.’ Holly swallowed hard. ‘And while I’m enormously grateful, I don’t think you should do it again.’

‘That’s my call.’

Holly shook her head sadly. ‘I’m not so sure about that. Not any more.’

‘What do you mean?’

‘Maybe it’s time I faced reality here. The odds are stacked pretty high against me getting where I want to go.’ Holly took a deep breath. This was hard to say. To admit that her fiercely defended independence wasn’t as great as she’d believed. ‘Maybe it’s just not fair that people like you have to keep propping me up.’

Ryan was giving her an oddly wary look. ‘You’ve been battling those odds for as long as I’ve known you and I’ve never heard you come even within spitting distance of admitting defeat. What’s changed?’ He frowned. ‘Did I put too much pressure on you this morning? If I did, I’m sorry, Holly. I never meant to—’

Holly shook her head again, interrupting any apology. ‘It’s not that. You’ve never put too much pressure on, Ryan.’ She smiled. ‘You seem to know how to put on just enough to push people into discovering what they’re capable of without destroying their confidence. You’re a brilliant teacher, you know.’

Ryan shrugged off the compliment. ‘So what is it? Are you just tired?’

‘I’m always tired.’

‘What’s changed, then?’ Ryan persisted. Hazel eyes seemed to darken with concern. ‘Are you needing dialysis more often?’

‘Probably. I’m due for blood tests today.’ Holly eyed the remains of her coffee. Should she use up that much of her daily fluid allowance now or save it for later? She took another small mouthful and then sighed. ‘I’m doing it four nights a week already, Ryan. Soon all I’m going to be doing is coming to work and going home to sleep with a machine.’ She tried to throw in some of the customary humour with which she had always lightened such conversations. ‘I really shouldn’t tick the single box on forms, should I? I’ve had a partner for years.’

Ryan didn’t appear amused. ‘It’s a temporary relationship. You know that a normal life will be entirely possible when you get a kidney transplant.’

‘Yeah.’ Impossible to keep her tone light now.

‘That’s it, isn’t it?’ Ryan looked as though he wanted to slap his forehead for being obtuse. ‘That’s what’s changed. I thought you brushed off that disappointment last month rather too easily.’

Holly couldn’t deny it. ‘It’s caught up with me now. To get that far…’ The disappointment cut more deeply than ever right now. ‘I kept telling myself it was better to have the plug pulled then than to go through the surgery and then have to wait to see if the transplant would work and then battling rejection and dealing with failure and the knowledge that another transplant would be that much more difficult, but I was kidding myself. To actually get prepped for surgery and then sent home was awful.’

‘The donor kidney was found to have kidney disease that hadn’t been diagnosed, hadn’t it?’

‘Yeah. Polycystic. Same as me. Ironic, eh?’

‘No.’ Ryan reached out to cover Holly’s hand with his own. He gave it a brief, gentle squeeze. ‘Incredibly disappointing. You’d waited so long.’

The empathetic touch would have been enough to generate tears in someone other than Holly, but Holly Williams had never cried about her illness. She had simply got on with the most important things in her life and refused to even consider letting it slow her down. Until now, anyway.

She touched the second pager she wore clipped to her pocket. The one that had only sounded once in all that waiting time. ‘It’s been more than two years,’ she said quietly. ‘I went on the waiting list as soon as I had to start regular dialysis.’

‘You haven’t fallen off the list,’ Ryan reminded her. ‘You’ll still be at the top. A compatible organ could come up any time.’

‘With my blood group? I’m O, Ryan—but in my case that’s not really O for ordinary.’

He smiled. ‘I could have told you that.’

Holly’s smile in return was wry. ‘I’m a universal donor but I can only receive from another O. And that’s just the blood group. There’s tissue and cross-matching factors to complicate things as well. Which reminds me, I’m due to send in the monthly sample today. Could you draw some blood for me later?’

‘Sure.’ Ryan had finished his coffee but he made no move to get up. In fact, he had a rather determined look on his face. ‘I’m glad the subject’s come up, actually, Holly.’

‘Oh?’ He was going to agree with her, wasn’t he? Had Ryan just been waiting for an opportunity to ease her out of her senior registrar position?

‘Yes. I’ve been giving your situation quite a lot of thought recently. Ever since that hiccup with the transplant last month.’

Holly waited, her heart sinking. He did want her to give up trying to work full time. He’d supported her so much for so long and the ace up her sleeve had always been that it was worthwhile because when she got her transplant she would make up for any inconveniences she had caused. They would never have such a committed and hard-working registrar on their team. Now Ryan could see, as she did, that holding out for the miracle a transplant could provide might be just a dream. The odds of it happening before she deteriorated further or even died suddenly seemed much smaller.

Almost non-existent.

The door to the staffroom opening at that point to admit one of the ICU nurses was a reprieve that Holly grasped with alacrity.

‘Sue, hi! How’s Callum doing, do you know?’

‘He’s good.’ The nurse sat down and opened a packet of sandwiches. ‘What are you two doing in here? I heard there was a blue baby on its way in.’

Holly’s gaze swerved to Ryan. ‘That baby must have arrived ages ago. Why haven’t we heard anything?’

‘I popped down to see her before while you were…getting the coffee. Sorry, I should have told you.’

Holly could feel the muscles in her jaw tighten. No. She should have been there as well. ‘So what’s the story?’

Ryan stood up, taking Holly’s coffee-mug to the sink along with his own. ‘Full-term baby girl. Nothing abnormal noted on foetal ultrasound. No murmurs but a loud second heart sound and she was still cyanosed on a hundred per cent oxygen.’

‘Transposition of the great arteries?’

‘That’s our pick for the moment. They’ve probably done the echocardiogram by now. Shall we go and see what they’ve found?’

‘Cool.’

Back to business as usual was fine by Holly. She was regretting having let the conversation become so personal. Her warm smile at Sue as they left the staffroom was, in some part, thanks for interrupting before Ryan had been able to ease into the subject of firing her, and Holly made sure their communication was purely professional as they threaded their way through the busy corridors of the large children’s hospital.

‘We don’t get a transposition very often, do we?’

‘Fortunately, no.’

‘Surgery won‘t need to be immediate, will it?’ The physical demands of the rest of Holly’s day were suddenly looking rather more manageable.

‘No, but it’s usually done within the first week or two of life, before the left ventricle becomes unable to handle systemic pressure. If it’s severe enough, they’ll need an interim measure to improve the cyanosis.’

‘A Rashkind procedure?’ Holly had no difficulty in sounding more than interested.

‘Ever seen one?’

‘No.’ Any residual despair at having her own physical weakness demonstrated so recently was chased away by excitement. ‘I’d love to, though.’

‘How much do you know about it?’

‘It’s designed to allow the systemic and pulmonary circulations to mix, isn’t it? They thread a double lumen catheter into the left atrium via the umbilical vein. A balloon gets inflated with contrast medium and then pulled back through the atrial septum to create a tear.’

‘Mmm. Strange business, this, isn’t it? We spend half our morning repairing a septal defect and our cardiologist colleagues might well spend half their afternoon creating one.’ Ryan was smiling at Holly. ‘I take it you’d like to go and watch if it goes ahead?’

‘Oh, could I?’

‘Absolutely. Good learning experience for you. To be honest, I’d quite like to go and watch myself.’

‘What about rounds?’

‘We’ll fit them in. We’ve got a consult to do in the ward as well. Another VSD who’s developing pulmonary hypertension.’

‘How old?’

‘Eighteen months.’

‘Is that Leo?’

‘Don’t tell me you’ve seen him 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 unit. He said nothing until they were alone in the corridor but something did have to be said. This was the opportunity Ryan had been waiting for.

‘My office,’ he commanded. ‘We have to talk, Holly. Now.’

Holly sat amidst the clutter of stacks of journals and case notes in his office, looking as though an axe was about to fall, and Ryan realised that she was expecting some kind of rebuke for her physical failings. It was time she knew just how far from the truth that was.

‘You’re amazing, you know that?’

A flush of colour stained her cheeks. ‘Maybe I’m just stubborn. I don’t like giving up.’

‘I’m not talking about the way you cope physically, Holly, although, God knows, that’s extraordinary enough. I’m talking about you professionally.’

‘You mean this morning? In Theatre?’

‘No.’ Ryan had to smile. ‘But, there again, your talent as a surgeon is pretty outstanding.’

Holly looked nonplussed and Ryan’s smile faded. He cleared his throat. There was a lot he’d like to say right now but this wasn’t the time or place. He knew he had to tread very carefully here.

‘I’m talking about the rapport you have with people,’ he said. ‘The way you can win their trust and calm their fears. You have a natural ability to deal with aspects of patient care that no surgical techniques or drugs could ever hope to touch. I suspect a lot of it has come because of what you’ve had to go through yourself but it’s a gift, Holly. An art. One that needs to go hand in hand with science to achieve the kind of patient outcomes we strive for.’

‘Um…’ Holly seemed lost for words. Then she gave an embarrassed chuckle. ‘Gosh, Ryan—this wasn’t at all what I was expecting you to say.’

‘What were you expecting?’

‘That you were going to say that a career as a surgeon and living on dialysis were just not compatible. That my physical limitations were becoming way too much of a burden.’

Ryan nodded slowly. ‘You were right. I am going to say that.’

It didn’t seem possible for Holly’s face to become any more pale but it must have done to make those dark eyes seem so huge. Ryan had to grit his teeth against the pain he knew he was causing.

‘But I wanted you to know where I was coming from before I said that,’ he explained gently. ‘For you to know just how highly I value you as part of my team. And that, if I can help it, I have no intention of losing you.’

Her face was utterly still, her head held high on a long, slender neck. Ryan could see the ripple of muscle as she swallowed with apparent difficulty.

‘I have no intention of losing me either.’ What started as a valiant smile went distinctly wobbly around the edges. ‘What do you suggest?’

‘A transplant,’ Ryan said promptly.

Her breath came out in a huff of something very close to despair. ‘Yeah…right. I’m working on it. See?’ She held up a hand, the fingers crossed. Her words had a faint and alien ring of bitterness. ‘Not much more I can do, is there?’

‘Yes,’ Ryan contradicted calmly. ‘There is.’

Holly stared at him as though he was speaking a foreign language. ‘Like what?’

‘Like considering a living donor for a transplanted organ instead of a cadaveric one.’

Holly shook her head wearily. ‘I’ve been down that track as far as it goes.’

‘And?’

‘And nothing. My mother died when I was ten, from the same kidney disease I have. My father’s diabetic. My brother’s not interested. Or, rather, he could be but he has a morbid fear of hospitals and illness and he’s avoided talking about anything to do with my kidney disease ever since I was diagnosed.’

‘What about other relatives? Friends?’

‘I don’t have any other close relatives and it’s certainly not something I’d ask a friend.’

‘What if the friend didn’t need to be asked? If they offered?’

‘It’s not exactly minor surgery, Ryan, having a kidney removed. It would be taking a risk with their own life and future health with no guarantee that it’s going to have the desired result. Who would put themselves through that?’

‘Somebody who cares.’

Holly snorted without mirth. ‘The last person that was supposed to care couldn’t wait to get away as soon as I had to start dialysis. Even if I’d had the energy to try another relationship, I doubt that I would have taken the risk.’

‘I know someone,’ Ryan said quietly.

A curious stillness settled onto the small room that was Ryan’s office. The busyness of the hospital on the other side of the closed door could have been worlds away. Sounds that had already been muted seemed to fade away so much that the proverbial pin would have dropped with a clatter. Holly’s whisper sounded weirdly loud.

‘Who?’

Ryan Murphy licked suddenly dry lips. He leaned forward a little, closing the gap between them, and held Holly’s wide-eyed gaze with his own, as carefully as his hands would have cradled a newborn infant.

‘Me.’

CHAPTER TWO

HOW could a single word be that stunning?

The shock was enough for Holly to be aware of nothing but the echoes of that word reverberating in her brain. Her head swam and she closed her eyes.

Breathe, she told herself implacably. Do not faint in front of your boss. Do not make his impression of your physical capabilities worse than it already is.

Nothing had ever been this unexpected. This unsettling. Certainly not the diagnosis of the illness that had brought her to this point in her life. Holly had been monitored carefully from the moment her mother had been found to have had an advanced case of renal failure and her own deterioration to the point of needing dialysis had been far too slow to shock her. Holly had finished medical school and launched herself into a meteoric rise to senior surgical registrar status before that had happened. Even her brother’s horror at the idea of being approached as a donor hadn’t been unexpected, given how badly he’d coped in the final stages of their mother’s illness.

But this…That one word suggesting that Ryan Murphy was prepared to offer one of his own kidneys was so far out of left field, Holly had nothing on which to anchor her reaction. It was, simply, stunning.

Ridiculous but stunning.

She had no idea how much time had passed before she opened her eyes again. Seconds? A minute or more? Nothing had changed. Ryan was still watching her with an expression she couldn’t read. Compassion was there, of course, but it always was to some degree. What she couldn’t pin down was what was mixed in with it. Hope? No, that couldn’t be right. Resignation was more likely. Something had to be done about Holly Williams and this was Ryan just trying to help her out—yet again.

And now Holly had to fight not dizziness but the threat of tears, and as a form of demonstrating weakness they were just as unacceptable as fainting would have been. Holly closed her teeth over the soft tissue on the inside of her bottom lip hard enough to cause pain. She could taste blood but it worked. The prickle of tears was conquered. She even managed a smile.

Ryan raised his eyebrows. He smiled back, a shade tentatively as the silence dragged on, and Holly knew she had to say something.

Nothing sprang to mind.

‘I don’t know what to say,’ she was forced to admit.

‘Say yes,’ Ryan suggested quietly.

Holly looked away. ‘Have you got any idea what you’re offering here?’

‘Of course I do. I’m not stupid, Holly.’

There was an edge to his tone that Holly had never heard before. Ryan was offended.

‘Sorry.’ Holly raised her gaze to find that Ryan appeared not to have moved a single muscle. He sat like a statue, his gaze still fixed on her. ‘It’s an incredibly generous offer and I’m stunned, but it’s totally impossible to even consider.’

‘Why?’

Why, indeed? Because it was simply so huge. It was like, Holly thought wildly, an eccentric millionaire calling in his housekeeper, say, and offering to give her his entire fortune. A gift that would enable her to live the kind of life she’d always dreamed of.

Except that this gift wasn’t money. It was a body part. Something so personal, the thought of even considering acceptance made something within Holly cringe in agonised embarrassment. But how on earth could she tell Ryan that without causing further offence?

‘For one thing,’ she said carefully, ‘it’s highly unlikely we’d be compatible. As I told you, my blood group is O.’

‘So’s mine.’

‘So are forty-five per cent of the population, Ryan. But I’m not rhesus positive. I’m negative. That takes it down to seven per cent. One in sixteen people. Unless the situation is desperate, they’re not going to go for anything less than a perfect match.’

‘I’m O negative.’

Holly couldn’t afford to let that tiny ray of hope in. This was ridiculous. ‘And then there’s tissue and crossmatching. It can look like a perfect match and then they put it together and get some horrible rejection reaction.’

‘We’re compatible, Holly,’ Ryan said calmly. ‘I’ve already checked it out.’

‘What?’ This was another surprise. Another disturbing one.

‘I’ve had the initial tests done already.’ Ryan sounded almost smug—as though he was producing his trump card.

‘Doug said that if I’d come in dead I would have been considered a perfect match for you.’

‘Doug?’ Holly needed to confirm what she was hearing here.

‘Your renal physician,’ Ryan said unnecessarily.

‘You’ve been talking to Doug about this…behind my back?’ Holly’s tone was measured, perfectly calm, but Ryan blinked, clearly disconcerted.

‘Well, I didn’t want to make an empty offer.’

‘So you’ve ticked all the boxes and got it all planned.’ Holly was still trying to assimilate the astounding information. ‘Have you talked to anyone else about this?’

‘I…ah…had a word or two with a transplant surgeon, just to see how much time off work I’d need to organise.’

‘And?’

‘Two or three weeks max. Less if it’s done with keyhole surgery. No heavy lifting for six to eight weeks but that’s not a worry with our jobs. I reckon we could both be back on deck within three weeks.’

‘You didn’t pencil in a date for surgery, by any chance?’

‘Of course not! Why would I do that before I spoke to you?’

‘It seems you’ve done rather a lot already without speaking to me.’ Holly’s words were clipped and Ryan couldn’t fail to get the message that she was upset about this.

Holly was more than upset. She felt like the ground had shifted under her feet—that someone else was taking control of her life. She was being offered something she wanted more than anything, but she couldn’t possibly accept. This was cruel, in fact, and a seed of anger blossomed.

‘I’m speaking to you now, Holly.’ Ryan looked puzzled, which was perfectly understandable. ‘I’ve just been waiting for the right opportunity.’ His mouth twisted in a wry smile as he shook his head. ‘I’m sorry. I should have known not to go behind your back. I know how fiercely independent you are and how you’ve managed your illness so far.’ He spread his hands in a gesture of surrender. ‘There aren’t many people who would choose to cope with home dialysis when they live alone. Even fewer people that could manage to keep up such a demanding career. I admire that independence, Holly. It’s a big part of why I want to help. And…’ the smile tilted up at both corners this time ‘…I wanted to give you a surprise.’

‘You’ve done that all right.’ Ryan’s winning smile was impossible not to respond to, but he’d summed up the problem here, hadn’t he? Holly managed alone. She made her own decisions and weighed up the consequences of those decisions very carefully beforehand. Some required a lot of thought. Others didn’t. Her smile faded.

‘You must have realised how impossible it would be for me to accept.’

‘Why?’

‘You’re offering something I wouldn’t even ask a blood relative for. You’re my boss, Ryan. Way above the level of being equal as a colleague. We’re not even…’ Holly searched for a word that could demonstrate the gulf between them in a personal field. ‘Friends,’ she concluded unhappily.

‘Aren’t we?’

Something in his tone made Holly feel ashamed of what she’d said. As though she was rejecting something of great importance to Ryan. But it was easier from his side of the fence, wasn’t it?

‘You’re my boss, Ryan. You’re older and far more experienced than me. You’re my teacher. A mentor.’ In a position of power that precluded anything as levelling as a personal friendship. ‘Our lives don’t touch outside working hours.’ She sighed, staring down at her tightly linked fingers. ‘And I’m a woman, trying to succeed in what is still a male-dominated career path. I’m also trying to cope with a fairly debilitating illness. I resent the limitations it imposes on my life and having to accept help.’ She glanced up again. ‘That’s not to say I’m not enormously grateful for your help. God knows, I’d never have got as far as I have if it hadn’t been for you, but you’ve done enough, Ryan. I couldn’t…wouldn’t accept any more.’

He looked so disappointed, Holly tried to smile.

‘Imagine if it didn’t work? There I’d be still struggling along and you’d know you’d gone through all that pain, not to mention the risks of having a general anaesthetic, for nothing. I wouldn’t be able to work with you any more because I’d feel like such a failure. I’d feel terribly guilty. As though I’d been given a precious gift and I’d just thrown it out or lost it or something. Nobody would blame you for resenting that. It would be way too much of a burden.’

‘There’s no reason to think it wouldn’t work.’

‘So there I’d be with a debt of gratitude instead of guilt. It would still be enough to prevent me ever stepping up and working alongside you as an equal.’ Holly straightened her back. ‘And that’s exactly where I intend to be, one day.’

A silence fell, laced with unpleasant hints of how unlikely that scenario was going to be unless Holly did get a successful kidney transplant. Holly ignored the vibes. She was really no worse off than she’d been yesterday, was she? And tomorrow was another day. She had learned long ago to take things one day at a time. And maybe…tomorrow, even—that pager on her pocket that linked her to the transplant unit would sound and a well-matched, anonymous kidney would be waiting for her.

Ryan nodded slowly, seeming reluctant but resigned to accepting Holly’s point of view. But then he smiled. A real Ryan smile, full of warmth and understanding.

‘Think about it anyway,’ he said softly. ‘Please.’

As if she could think about anything else!

Ryan Murphy was the most genuine, caring person Holly had ever met. He couldn’t have known how disturbing his offer would be because he would never do anything to deliberately hurt anyone. It hadn’t been fair to suggest that their relationship was less meaningful than a friendship because Ryan meant far more than that to Holly.

Far more.

She had the utmost respect for him as a surgeon and the deepest admiration for him as a person. He was, simply, a wonderful man and Holly had wondered on more than one occasion why there wasn’t an adoring wife in the picture. As far as she knew, Ryan wasn’t in any kind of relationship and that certainly wasn’t due to any lack of opportunity. Holly couldn’t fail to notice the way women looked at Ryan and she knew exactly what they were thinking. If Holly had been looking for a perfect partner herself, she’d be thinking the same things. Ryan Murphy would have more than fitted any bill of that type.

But she wasn’t in a position to be looking, was she? And while Ryan’s concern and support for her had been so much more than she could have wished for, it had never crossed any professional boundaries. They might think highly of each other but they were colleagues on very different rungs of a professional ladder. Not friends, because they knew nothing of each other’s lives outside work.

Holly wouldn’t have a clue what Ryan might be eating for dinner that night. She put the frozen supermarket dinner into her microwave with a grimace. This meal was a cop-out. Only acceptable because the level of protein and probably anything else in the nutrition stakes was low enough for the occasional use not to tip her carefully balanced diet into disarray. Whatever Ryan chose or possibly cooked for himself, it was bound to be more appealing than the plastic-looking pumpkin and spinach lasagne she was heating.

He certainly wouldn’t be counting out pills to have with his food either. Working her way methodically along the row of canisters adorning her window-sill, Holly shook out the phosphate binders, vitamin and mineral supplements, the iron tablets and her doses of diuretics and anti-hypertensive medication.

Maybe Ryan had exotic spice jars on his kitchen win-dowsill. Or herbs growing in pots. Holly wondered what his kitchen looked like. And his house. She had never thought about Ryan in such personal terms before and some of the anger she had felt earlier returned when she couldn’t shake her current train of thought.

Too tired to be hungry, she forced herself to eat and wondered, in some dismay, whether just voicing that extraordinary offer had been enough to seriously undermine her professional relationship with the man who headed her chosen department.

Holly didn’t want to have to leave St Margaret’s Children’s Hospital. She’d have to go offshore to find anything similar and with the support team she had in the renal department of the nearby general hospital, she couldn’t afford to look elsewhere. Neither did she want to leave her home town of Auckland, New Zealand. This was her home. Where she wanted to live. And work.

This apartment would never be her ultimate goal, of course, but it was close to both hospitals. It was tiny and low maintenance, and while it might be without soul it was valued nonetheless for its contribution to Holly’s independence. Did Ryan have a house rather than an apartment? A cat? A garden, maybe, instead of a sad set of pot-plants on a minuscule balcony? The plants weren’t going to receive the attention they urgently needed this evening either. Not when she seemed unable to shake the imaginary comparisons between her life and Ryan’s.

That kind of thinking had the potential to destroy things between them. Holly couldn’t afford to be envious of anybody and particularly her boss. What if she became resentful that he had a life at all outside work when she didn’t? A home and garden to go to? That he had the prospect of that life continuing and including something as wonderful as a family? Something Holly could dream about only if she became healthy again.

Health that could potentially be restored by an offer she couldn’t possibly accept.

Why had Ryan made the offer?

Because he felt sorry for her?

Maybe he’d been influenced by recent media coverage of one of New Zealand’s foremost sportspeople, Steve Mersey, whose career and Olympic hopes were about to be ended due to the sudden onset of debilitating kidney disease. Complete strangers had started putting up their hands, offering to donate an organ. Had that given Ryan the idea? Did he feel obliged to emulate such altruism because of the type of person he was? Or had he realised how much further it was possible to go in helping someone like her and, having done so much already, felt obliged to go that extra mile?

Either explanation was pretty cringe-making. Holly had done the right thing in refusing to consider acceptance. The only thing she could have done. Now all she needed to do was to stop thinking about it, despite Ryan’s exhortation.

What she needed, above all, was rest.

And treatment, of course.

With all her essential chores completed, Holly moved to her bedroom, a small room in which the bed was actually the least significant piece of furniture. Tonight it seemed far more depressing than usual to retire to a room that would not have looked out of place attached to some hospital ward.

Her dialysis machine was the size of an average refrigerator. It would have been enough to make the room look clinical all by itself, but it was far from alone. The large water purifier was flanked by a tall cabinet that held ranks of huge bottles filled with the fluid needed for the machine. A chest of drawers beside that held saline and tubing lines. A trolley with slide-out trays housed alcohol wipes, needles, tapes, dressings and all the other paraphernalia that went along with home dialysis.

The routine of setting up was automatic. Inserting the two needles into the surgically enlarged vein on her forearm was virtually painless. Now all Holly needed to do was wait. In a matter of four to six hours, the entire volume of blood in her body would have passed through the dialysis machine at least six times, having waste products and excess fluid drawn out.

Holly often used most of this time to sit, propped up by pillows, in her bed, studying or catching up on journals. She had brought home a textbook she wanted to read, detailing the latest techniques in arterial-switch procedures such as baby Grace would need to undergo shortly, but she simply couldn’t find the energy or enthusiasm to open it.

On top of a physically challenging day, Ryan’s offer had left her utterly drained and Holly would have to sleep while the machine did its life-prolonging magic tonight. It also seemed the only way she could turn off the endless treadmill of the thoughts that interview with Ryan had sparked. Tomorrow she would feel so much better she’d be able to carry on as normal. And, with a bit of luck, Ryan’s offer wouldn’t change anything other than her appreciation of what a kind person he was.

The call to the intensive care unit came as Holly stepped through the front doors of St Margaret’s at 8 a.m. the following day. Rather than waste time by finding a phone to contact the unit staff, Holly just kept going. It was so good to be able to move along the still quiet corridors and feel as if she was walking normally and not pushing her body through air that felt as thick as treacle. At this rate she would be actually in the unit by the time she would have completed a phone call.

The speed of Holly’s response had far more to do with her renewed level of energy than the early morning absence of obstacles caused by people or equipment, and she took full advantage of the physical strength, bypassing any wait for a lift and heading for the stairs.

It had to be Callum that was causing concern in the unit and the page had been urgent. Hearing footsteps far more rapid than her own behind her on the stairs was frustrating. Dialysis might be magic but it couldn’t work a miracle, like giving her the sudden ability to race up stairs two at a time as someone else was obviously doing.

‘Holly!’ The steps slowed to match hers and Ryan’s smile was delighted. ‘You must be feeling a lot better to be using the stairs. That’s great!’

Holly just nodded, not wanting Ryan to know that climbing stairs half as quickly as him had left her somewhat breathless. He held the door open as they reached the second floor.

‘You’ve been paged by ICU?’

She nodded again.

‘Any idea what’s going on?’

‘We’ll soon find out.’ Holly’s words were clipped but not just by lack of breath. She was fighting a dread that her first VSD repair might be going pear-shaped. Had her stitches not been quite deep enough or sufficiently close together? Was Callum bleeding around his heart and suffering a life-threatening tamponade? Respiratory failure or a hypertensive crisis? Had he spiked a fever or developed renal failure?

Ryan touched her arm as they reached the unit. ‘Don’t worry so much,’ he said. ‘Whatever it is, we’ll sort it out. Together.’

Ryan’s reassurance, even his presence, was kind of like dialysis for her soul, Holly thought wryly. Fears and insecurities got filtered out and confidence renewed. She could focus and perform and not be intimidated when pushed to voice her own opinions.

Such as what she thought about the concern raised by Callum’s heart rate and rhythm. Disturbances were frequent following open heart surgery and fortunately the abnormal pattern being recorded on Callum’s ECG was not immediately life-threatening.

‘It’s supraventricular,’ Holly said in response to Ryan’s raised eyebrows. ‘The drop in blood pressure is most probably rate-related.’

‘How do you want to manage it?’

‘I’ll consult with Cardiology,’ Holly decided. ‘It’s A-fib so adenosine is probably the drug of choice. If it continues, a digoxin infusion should give us sinus rhythm again or drop the ventricular rate, but that‘s much slower. If neither works, we’d need to look at other anti-arrhythmic agents or a DC conversion.’

A telephone call to one of the cardiology consultants led to a rapid instigation of treatment, but by the time Callum was showing a good response and his anxious parents had been soothed, Ryan and Holly were running late for their 9 a.m. theatre start time.

‘Slow down,’ Ryan complained as they made their way to the changing rooms adjacent to the operating theatre suite. ‘I’m not as young as I used to be.’

‘Neither am I.’ Holly threw a quick grin over her shoulder. ‘I turned thirty last week, you know.’

‘No, I didn’t know.’ Ryan quickened his pace to walk alongside her. ‘Hey, happy birthday—belatedly.’

‘Thanks.’

‘Was it a good party?’

‘I didn’t have a party,’ Holly said quickly. She certainly didn’t want to add to any unfortunate impression she might have given yesterday that she didn’t like Ryan enough to consider him a friend and therefore he hadn’t been invited to any party she had held. ‘I didn’t really feel like celebrating my slide into middle age.’

Ryan snorted. ‘I’m thirty-six,’he said indignantly, ‘and I don’t consider myself anywhere near middle-aged, thank you.’ He pushed open the door leading to the male side of the changing-room complex then paused. ‘Don’t you like parties?’ he asked curiously.

‘I like other people’s parties,’ Holly told him lightly. ‘Not mine.’ She grinned again. ‘That way, I don’t have to clean up the mess.’

Inside the changing room, Holly’s face stilled as she sighed. Why had she started that conversation in the first place? Reaching her fourth decade should have been worth celebrating. The trouble was, in her case she wasn’t just marking a significant milestone in the passage of time. It would have been more a celebration that her time hadn’t run out.

Yet.

Why hadn’t Holly wanted a party to celebrate such an important birthday?

She should have had candles and a cake and people around to let her know how special the day was. How special she was. Ryan wished he had known. He could have given her a hug even, without stepping over the boundaries he observed so carefully. He should have known, dammit. He must have seen or signed papers that had to have had the date on them often enough. Perhaps he was closer to being middle-aged than he suspected and was developing a selective memory.

Pulling on white rubber theatre boots, Ryan moved to the dispensing box on the wall of the changing room to pull out the disposable bootees to cover the boots’ soles. Then he plucked a hat and mask from adjoining boxes.

He was feeling older today. Older and wiser.

He’d gone about it all the wrong way and he’d tried so hard to do things just right, too. To keep it all on a kind of professional basis so that Holly would not be influenced by how strongly he felt about it all. Maybe he had tried too hard. He’d done such a good job of not taking advantage of his position of power and acting on any personal interest in Holly that she didn’t even consider him to be a friend.

That had hurt.

A lot.

Ryan’s attention to scrubbing his hands in preparation for surgery was always thorough but it was more vigorous than usual this morning after his registrar joined him at the basins. He welcomed the sting of the bristles on the tender flesh between the base of his fingers.

It was just as well Holly had no idea of the real reason for him making the offer of donating a kidney.

That he was in love with her. That part of his soul was sharing her physical deterioration and would, if she died, be lost for ever.

Boy, would that scare her off in a hurry! She didn’t want to be burdened by gratitude or guilt on a purely professional level. Imagine if she knew how he felt and took it the wrong way—thinking he might be trying to pull her into a closer relationship by offering such a valuable gift?

She would be appalled. Hell, she didn’t even consider him to be a friend.

But how could she not be aware of a bond that went so far past the normal interaction of a registrar and consultant? Had he been so good at hiding the gradual development of his feelings that Holly, and any onlookers, assumed they simply shared a passion for their work that made them inseparable during working hours?

It was entirely possible, Ryan realised as their case for the morning got under way. Their twelve-year-old male patient had had a congenital lesion of aortic stenosis treated by a balloon valvuloplasty in infancy but residual stenosis and incompetence had led to an increasingly severe degree of symptoms which meant it was no longer advisable to wait until growth had completely stopped before replacing the valve. Besides, young Daniel was also very keen to play rugby and strenuous activity had so far been denied him because of the risk of sudden death. If all went well with the new valve he was going to receive today, his life would change considerably for the better.

It was a technically challenging procedure due to the congenital malformation of the valve but Ryan was more than happy to keep up a running commentary and answer Holly’s eager queries.

‘We make the transverse aortotomy about fifteen millimetres above the level of the right coronary artery. We don’t want to be any lower because that can jeopardise the artery and create problems in seating the valve.’

‘What happens if you go higher?’

‘Not much. It’s easy to angle down and any lip can be retracted.’

That was typical of Holly. She had always demonstrated the ability to determine all possible alternatives to any course of action and weigh up the potential consequences. She was sharp enough to do it almost instantly and it was a skill that would stand her in very good stead when she got to be a consultant surgeon herself.

If she got to be a consultant surgeon.

Given a technical problem, Ryan was confident that Holly could make a correct choice of an appropriate course of action. He spared a very fleeting moment of concentration to wonder why she couldn’t apply the same skill to a personal arena.

Maybe she would. Maybe Holly just needed some time to get used to the idea and if he didn’t push her she would be able to view it as an independent choice and find a way to get past what she saw as unacceptable potential consequences.

All he could do was wait. And hope. And help her to do what she wanted to do with her life as far as he was able or allowed to help.

‘You did such a good job on that patch yesterday, Holly,’ he said, when the more technical aspects of preparation had been completed. ‘How about tackling part of this prosthetic valve insertion?’

She was feeling a lot better today. The sparkle Ryan detected in the dark eyes that flashed up to meet his held no hint of any doubt in her own ability. Or any desire not to be given that level of responsibility. Holly was eager to spread her wings again and Ryan only too happy to support her.

As he always would be, given the chance.

Never mind anything too personal. As Ryan guided Holly through what was a new procedure for her, he was very aware of how much less satisfying his job would be without Holly to share his fascination in operating on what was, for them both, at the top of the list of the vital organs humans possessed.

There had to be a way to secure a future for Holly because Ryan didn’t want to even consider the alternative.

And he wouldn’t. Not yet.

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