by Amy Ruttan
“I want you, Ryan.”
“I’ll be gentle, Em. Please tell me if I hurt you. I don’t want that.”
“You won’t hurt me. I just want this moment with you.”
Ryan stroked her cheek and his hand trailed down over her abdomen, lower, touching her intimately. Her body thrummed with desire. She wanted more. So much more.
Their gazes locked as he entered her. He nipped her neck and moved slowly. She wrapped her arms around his neck. She wanted all of him. She wanted him deeper, wanted it hard and fast.
She felt alive.
She was in love with him and she was scared by the way he made her feel, but she didn’t care about that at this moment. She wanted to savor it.
He quickened his pace and she climaxed fast, crying out as pleasure flooded through her veins. It wasn’t long until he joined her.
Ryan kissed the top of her head and held her close. She didn’t want this moment to end. She never wanted him to leave.
It scared her how much she wanted him.
It scared her how comfortable she was in his arms, that soon she forgot about all her worries, all her fears and her own self-doubt. She couldn’t think straight with his strong arms wrapped around her. Her body relaxed, she was warm and safe with him. Safe with a man she wasn’t sure was going to be here the next day, but she didn’t care as sleep overtook her and she fell into a relaxed and blissfully deep slumber.
CHAPTER TWELVE
SOMETHING IS NOT right today. Something is different.
For two weeks everything had been running smoothly. Ryan had left his hotel suite and temporarily moved in with her. During the day they worked with their patients and at night they went home and spent the evenings wrapped up in each other’s arms.
They didn’t talk about the next day.
They just lived in the moment and, for the most part, Emily was happy with this arrangement, but there was a part of her, that niggling self-doubt, that worried that he wouldn’t really stay. That her baby would grow up without a dad. That she was falling for someone who would hurt her in the end.
And every time she thought about that she got emotional and that was the last thing she needed.
The conjoined twins, Sasha and Melanie, were stable and getting stronger. Every day they lived, every day they were stable put them one day closer to a successful separation surgery and that gave her hope.
Every day they practiced the simulation in the sim lab, until they had the procedure down to an art with all the surgeons who would be involved. Ryan would practice in the lab with different scenarios of nerve bundles.
As Emily did her rounds, she had a nagging feeling that today was going to be different. That they had been in this holding pattern for far too long and, much like a volcano, it was only a matter of time before something burst.
“You okay?” Ryan asked when she stopped at the nurses’ station on the general pediatric floor. “You look tense.”
“Something feels off.”
He cocked any eyebrow. “Don’t say the Q word, you know that brings down wrath.”
She chuckled. “I wouldn’t and usually that’s only in the emergency room.”
“Well, it’s best not to say it anyway.”
“How did your simulation go?” she asked.
“Good. I think, based on their last scans, I know how to tackle it. Once you’ve done your part and we flip them, I’ll separate the nerves at the base of their spines. I have a graft for Sasha, because most of the tailbone is on Melanie’s side. Given their young age, the graft should work well.”
Emily nodded but bit her lip, worrying. There was something not right. She heard a crack of thunder and looked up at the skylight in the hall where they were standing. It became dark, really fast. A storm was moving in. There was a flash of lightning.
“Perhaps that’s your sense of foreboding,” Ryan said, pointing at the skylight with his pen.
“I hope you’re right.” And as soon as she said those words her pager went off.
Her heart sank as she saw it was from the NICU.
It was the twins.
She didn’t explain but took off running, dodging people in the hall as she made her way to the NICU. Ryan was right behind her, having received the page too.
“Get Dr. Sharipova to ready the operating room and get your neuro team ready,” she shouted as she got on the elevator.
Ryan nodded. “I’ll see you down there.”
Emily pushed the button. The elevator door closed slowly, or what felt like slowly. She just hoped that she would see him down there. That she was able to stabilize them.
When she got to the NICU Janet was standing outside, tears streaming down her face because they had kicked her out while the babies were in distress.
“Dr. West,” Janet sobbed. “My girls.”
“I’m going to have to do the separation now. I wanted them older and stronger, but if I don’t do the surgery now, they won’t survive. Do you consent?”
Janet nodded. Her husband had his arms on her shoulder and he was trembling.
“We’ll update you as soon as possible.” Emily squirted hand sanitizer on her hands and headed into the NICU. There was a flurry of nurses and neonatologist residents working on the girls.
“What do we have?” Emily shouted over the commotion.
“Tachycardia in twin B and twin A’s organs are beginning to shut down. Their shared kidneys are trying to keep up, but it’s too much. Also the creatinine is high. They’re overworked and they’re in threat of going into multisystem organ failure.”
Emily nodded and went to work, getting the babies ready to transport down to the operating room. “I want all available neonatologist residents in operating room three. I need as many hands as I can. We have practiced this surgery, now it’s time to turn practice into reality.”
“Of course, Dr. West,” one of the NICU nurses said. Emily couldn’t see her face as she worked on the babies. Once she was sure they were stable enough, they hooked up all the leads and monitors to travel and pushed the incubator out of the NICU and straight to the patient transfer elevator.
Emily tried not to look at Janet. She knew that if she looked at Janet crying she would lose control of her carefully guarded emotions because, as she looked down at the two little girls clinging to life, she couldn’t help but think of her own baby.
And how she would feel if she were in Janet’s shoes.
She hoped that she was never in Janet’s shoes.
She hoped that she never had to be in the place most parents were when they had a seriously ill child.
You’ve got this.
Sasha and Melanie were not going to die today.
When they entered the operating-room floor she left the babies to get ready. There was a flurry of doctors and nurses getting ready to scrub in as the babies were taken to the operating room. Emily tied on her favorite scrub cap and headed to the scrub room.
The gallery was filling with interns and the chief of surgery was watching, waiting. It was overwhelming. She hated crowds, but at least they weren’t in the operating room with her. She could drown them out.
Emily took a deep, calming breath.
You’ve got this.
She looked down at her belly when her baby kicked. “Listen, we need to talk before I go in there. This will be a long surgery. I know it will be hard on us, but we have to do this.”
There was no response, so Emily took that as an affirmative her baby would behave and it relaxed her to be just a bit silly, talking to her child.
Ryan was in the operating room already, directing the surgical staff as they came in. The babies were being transferred from the incubator to two operating tables. They were so tiny as they were placed between the two large tables. Once they were separated the two teams would work hard to close the incisions
and repair any damage.
The most stressful part of this surgery would be turning the babies so that Ryan could work on their spines.
You’ve got this.
Emily entered the operating room and a scrub nurse helped her into a surgical gown. Her heart was racing as she looked at those little lives on the operating room table.
Breathe.
The babies were put under and she directed her team to Melanie, while the other pediatric surgeon was working on Sasha. Ryan stood on the sidelines. She glanced up at him and he nodded. His eyes were crinkled and she knew that he was smiling, encouraging her to keep going, that she had this. It was exactly what she needed.
“All right, teams. This is what we practiced for. This is the separation of the conjoined twins Melanie and Sasha Wainwright. I will be working on twin B and Dr. Knox will be working on twin A. After we have separated them down to the spines, we will do a very careful flip and Dr. Gary will take over to separate them at the tailbone, hopefully keeping their nerves intact so that they will have full function. Let’s get started.”
Emily stepped up to the table.
She looked down at those babies. So helpless.
I’ve got you.
“Scalpel.”
* * *
Her body was aching, but the baby hadn’t kicked her and she was glad for that. Separation surgeries were long. After she had done her part and they were able to flip the babies, she could sit down and let Ryan take over.
And after several hours, she was almost ready to do the flip.
Twin A, Melanie, had two kidneys because the one kidney she had was too small and the shared kidney was regular size. Twin B, Sasha, had one kidney now, but it was a strong one. The bowels had been successfully resected and repaired and the liver had been separated. The only thing holding them back now was the tailbone and the nerves at the end of the spines.
“Are you good, Dr. Knox?” Emily asked.
“I am good. You, Dr. West?”
“I’m ready for the flip and for Dr. Gary to take over.”
More than ready.
She needed to sit down and she needed a protein shake so that she could keep going. She could leave, but she wanted to see this through to the end.
“Okay, teams. Carefully.” They had surgeons holding the babies, covering their open incision and making sure all their tubes, their IVs and everything else flipped correctly. Emily held her breath as she held the babies too. More hands, keeping everything steady, would help insure a successful flip. It was like trying not to crush a snowflake in your hand. It was so delicate.
“And the flip is successful!” Emily said in relief.
There was applause from the gallery.
She took a step back as Ryan and his neurosurgical team took over.
Emily sat down on a stool and Dr. Teal handed her a protein shake and then mopped her head.
“Excellent work, Dr. West,” Amanda said.
Emily smiled weakly up at her. “It’s not over yet.”
She watched as Ryan focused on his work. There were sensors monitoring nerve impulses. Emily kept her eyes trained on them. Watching the monitor gave her a sense of calm. Even if one twin couldn’t walk, it was still a victory.
Emily was just hoping for a perfect score.
She worried her lip. Watching the monitor was easier than watching the clock.
“Dr. Teal, give the Wainwrights an update on their daughters. Tell them the flip was successful.”
“Yes, Dr. West.” Amanda left the operating room. It would be some time before Ryan finished his work. Dr. Teal wouldn’t miss the final surgeries. Emily glanced to the side of the operating room where two incubators waited so they could transport the twins up to the NICU.
Come on.
She closed her eyes and sent up a silent prayer.
This had to work.
“Twin A, both legs are working, as are the arms,” Ryan announced after some time. There was applause again and her heart skipped a beat. This was the end of the separation, but she held her breath, watching the second monitor.
Come on, Sasha. Come on.
“Twin B, both legs and arms are working. Well done, team!” Ryan said, and she could hear the relief in his voice. “The twins are successfully separated.”
There was more applause as the tables were separated and Emily moved quickly to work on Twin A, Melanie, who was having a rough start. Dr. Knox knew what he was doing and he took over the other twin. Emily had to put Sasha out of her head to focus on Melanie. She glanced up to see Ryan leaving the operating room. His job here was done.
She nodded and then turned back to her work.
“How are we doing?” Emily asked.
“Her stats are improving,” Dr. Sharipova said.
“Come over here, Dr. Teal, and hold this retractor.” Emily knew Dr. Teal had earned the right and she deserved to see it up close. Dr. Teal had been her right-hand man lately.
“Thank you, Dr. West.” Amanda took the retractor and they worked on closing Melanie’s incisions. The babies were no longer dependent on each other and it would take some time, they weren’t out of the woods yet, but their little bodies were beginning to respond as there wasn’t as much demand on their organs.
Emily finished closing. “Let’s get her transferred to the incubator and up to the NICU. Do you think you can handle that, Dr. Sharipova?”
“Yes, Dr. West.” Dr. Sharipova went to scrub out as Emily and the rest of her team transferred Melanie to her incubator. She was stable and now the next twenty-four hours would tell the real tale.
Emily glanced over at Dr. Knox and his team was placing Sasha into her incubator.
Emily breathed a sigh of relief and took a seat.
“Job well done, everyone.”
There was further applause and she glanced up into the gallery. Interns were starting to leave and the chief of surgery gave her a thumbs-up.
The babies were taken out of the operating room and all that was left was an empty space. Emily took off her mask and discarded her surgical gown. She couldn’t leave the operating room right away. She needed a moment, just a moment to herself in the calm after the storm to cry.
It was done.
Now she needed to regain her composure and let a very worried mother know that her babies had survived their surgery.
Ryan’s hands were still shaking as he headed back up to the neurosurgical pediatric ward. He’d received a page about Jason and he needed to attend to that. He was trying to not let his nerves get the better of him.
He’d done conjoined separations before. He’d worked on aneurysms and delicate spinal cords. He’d worked on some of the most delicate structures, but nothing had compared to that. Nothing compared to separating those tiny babies and knowing that if he messed up somehow Emily might not forgive him.
He scrubbed a hand over his face and he tried to not let his emotions get the better of him. He tried not to think about his baby. The baby he hadn’t got to see.
He’d been almost afraid to touch the twins for fear of hurting them. What kind of person was afraid of touching an infant? What kind of surgeon was he that he was so afraid of working on an infant, because every time he looked down at a baby all he could think about was the one he’d lost.
All he could think about was the irrational part of him that didn’t want to be like his father.
And, truth be told, he’d loved the two weeks he’d been living with Emily, but he was needed for a consult back in New York City and he wanted to go.
That’s because you’re a coward and running. Always running from responsibility on the off chance you might get hurt.
So like his father. Selfish. Never putting down roots.
Ryan hated himself for it.
When he got to Jason’s room he saw a flurry of activ
ity and Jason’s parents were nowhere to be found. Ryan’s stomach dropped to the soles of his feet and he ran into Jason’s room. And all he could think about was the fact that he’d done therapeutic hypothermia on Jason and it had been his first time doing that procedure on a child younger than twelve.
Perhaps Emily was right and he’d done something horrible.
It was something he thought about all the time. Every day when he went to check on Jason and saw no improvement in his paralysis it weighed heavily on him. Perhaps he had made a dreadful mistake.
“What’s going on?”
“He coded. He stopped breathing and we had to intubate him,” the resident said. “We got him back, but his stats are low and there is a bruising and rigidity in his abdomen. We think the spleen might’ve ruptured.”
“Let’s get him to the operating room.” Ryan cursed himself inwardly. It might be a clot somewhere and that’s why he was bleeding out. Something that had been missed because he’d just been focusing on the spine. It could’ve been missed and he was slowly dying inside from a nick.
You’re an arrogant fool.
He should’ve listened to Emily.
As they were wheeling Jason down the hall, Emily was coming up from the operating-room floor. Her eyes widened as she saw them and she rushed over to them.
“What happened?”
“Internal bleeding. Looks like the spleen, but we don’t know. He needs an exploratory laparotomy. He coded and they had to intubate.” Ryan could see the anger in her eyes, but there were too many people around and she didn’t say anything to him. She just took a place beside the gurney and helped them get down to the operating-room floor, but he knew what she was thinking.
She was thinking back to that moment when he’d first arrived in Seattle, when she’d reamed him out for doing the therapeutic hypothermia. He knew that’s what she was thinking. He could see it in her expression.
Jason was taken to an operating room and they headed into the scrub room. Emily still wasn’t saying anything. She was scrubbing, but he could tell she was stressed and tired. She’d just done a separation of conjoined twins and he was worried that she was pushing herself too hard.