by Tina Beckett
“Not exactly. I forgot who I was with for a second.”
She blinked. “I’m sorry?”
“Hell, I’m mucking this up completely. Let’s just say I shouldn’t have done what I did. And it won’t happen again.”
He needn’t have worried, if her expression was anything to go by. He’d probably just earned himself a knee to the groin if he even looked in her direction ever again.
“Then we’re both agreed. We were both worried about Ivy and not acting the way we would normally.”
“Yes, that’s it exactly.”
And if she wanted to believe he had been thinking of Hope that whole time, it would be easier on everyone. Including him.
“I’ll help you get her breakfast situated. I want to peek in on her anyway.”
“No card games this morning?”
“I’ll be back a little later to play, once I’ve checked on my other patients.”
That’s right. It was too easy to forget that Madison wasn’t at this hospital solely for him and Ivy. His mind scrambled around a bit before rephrasing that internal thought. She wasn’t here solely for Ivy. She’d been flown in because the hospital’s own diagnostician had suddenly been offered a six-month medical mission to Africa and had left unexpectedly. Dr. Camargo had been texted about Ivy’s case a couple of months ago, but he was just as stumped as everyone else. He was the one who’d suggested bringing in another set of eyes. Thankfully Madison had agreed to come.
His phone vibrated in his pocket. Reaching for it with the tray still in his hand, he glanced at the screen. “That’s strange.”
Motioning to her to wait a second before going into his daughter’s room, he pressed the talk button and put the phone to his ear. “Hawkwood here.”
“Theo, this is Marco. We’ve got a couple of cases down here we could use your help on, if your surgeon’s hands are still up to the task.”
It was very unusual for them to call him in on anything nowadays, so this had to be urgent. “Alice?”
Marco Ricci and his fiancée Alice Baxter were both pediatric surgeons and handled a lot of the general surgeries in the hospital.
“She’s tied up with an appendicitis case right now, and I need to scrub in on a suspected ovarian torsion.”
Both of those were medical emergencies. “Okay, what do you need help with?”
“We have an eighteen-month-old who is also presenting with right side lower quadrant pain, fever and vomiting.”
“Another appendicitis?”
“We thought so at first because of the location. But the scans actually show a probable intussusception. Ryan is doing a heart cath right now, so we’re running out of available surgeons.”
“Air enema?”
“Already tried it.”
“Okay, I’m on it.” A fairly straightforward surgery, intussusception was where part of the intestines telescoped in on itself, causing blockage and restricted blood flow. Timing was critical, since the sooner they could free the affected bowel the better the prognosis.
He pressed the phone against his hip to mute it. “Are you interested in scrubbing in on a surgical case? Suspected intussusception in a toddler. We’re running out of surgeons.”
“Of course. I’d be happy to help.”
“Thanks.” Putting the phone back to his ear, he said, “On my way. Dr. Archer will assist.”
“Great. Tell her thank you.”
“I already have. What suite?”
“Seven is open. I think it’s been cleaned up after the last case.”
“I’ll check on it. Get back to your patient. We’ve got it from here.”
He rang off and after putting Ivy’s food in front of her Theo left his own on the counter for later. They hurried back to the elevator, arriving at the second floor—where all the surgical suites were located—ten minutes later. Theo went to the desk. “Intestinal intussusception patient? We’re here to scrub in.”
The young woman’s eyes widened. “Right away, Mr. Hawkwood. Let me just check for you.”
He frowned. He hated how his position caused some people to treat him differently than other doctors. Yes, he was the CEO of the hospital, but he was also a doctor...would always be a doctor. His inheritance hadn’t changed any of that.
A minute later, the nurse came back. “They’re getting her prepped for surgery.”
“Great, I’d like to take a look at the contrast scans if I could.”
“Of course. Here’s her chart number.” She wrote it on a sheet of paper, handing it over to him. Was it his imagination or had she just batted her lashes at him?
Your imagination, Theo. You’re seeing things that don’t exist.
“This is Dr. Archer. She’ll be scrubbing in as well.”
Madison reached over to shake the woman’s hand with a murmured greeting, then they both headed toward the small conference area to access the computer. A few seconds later they were looking at Meghan Pitruscki’s scans. Madison found it first with an exclaimed, “There!” as she pointed to the computer monitor.
The area was in the lower right quadrant, just as Marco had said. “We’ll have to get in there to see how compromised the intestines in that area are.”
“Once we get them separated they might be fine.”
“We can hope.” He switched the computer off. “Ready?”
“Yes. It’s been a while since I scrubbed in on a surgery so I don’t know how much help I’ll be.”
“Right now, another set of eyes is exactly what I need.” Those were almost exactly the same words Dr. Camargo had used when suggesting they bring another diagnostician in.
He’d have surgical nurses to assist, but he’d like Madison there to make sure he didn’t miss anything. It had been a while since he’d scrubbed in on a surgery as well.
Once they got the call that the patient was prepped and waiting, they gloved up, Theo using his shoulder to push through the door that led to the surgical suite. The patient lay on a table, her tiny body barely taking up any of its length. The anesthesiologist was already at her head, monitoring the sedation. Theo would meet with her parents after surgery, which was how he preferred it. It was hard to remain objective in the face of anguished pleas and tears. Hell, it was hard to remain objective under the best of circumstances. Somehow operating on a toddler was so much more difficult than treating an adult. There was so much life they hadn’t yet got to experience.
Like Ivy?
Nope, not the time to be thinking of his daughter or her problems right now.
“Hello, everyone. Let’s get started, shall we?”
Making the first incision with Madison standing beside him, he called out his movement, step by step for the overhead recorder.
Then he was inside the abdominal cavity, carefully making his way through myriad folds of intestines, laying them aside as he continued to search for the affected area. “I see it.”
“I do as well,” Madison said. “It’s red and inflamed, but I don’t see evidence of necrotic tissue at this point. We’ll know more once you’re able to free the trapped portion.”
Carefully checking for tears or perforations that could contaminate the abdominal cavity and cause peritonitis, he used his gloved fingers to try to ease the telescoped part out of the confined area. It didn’t budge.
The surgical nurse on the other side moved closer, handing over forceps when he asked for them. He tried again.
“It’s not coming loose.” The intestines were small and slick and, since he was having to be delicate in handling them, he was stumped. “I may have to resection the affected portion.” It was a small enough piece that it shouldn’t affect little Meghan’s digestion, but cutting and removing bowel always carried an added risk. He tried again, using a tiny bit more pressure, but it was still wedged tight.
Madison’s low voi
ce whispered past his ear. “Can you try getting some saline in the space between the two and moistening it? Maybe it’s adhered.”
It was a good idea.
Without needing to be asked, the nurse loaded a syringe with the solution and placed it in his hand. Theo then nudged the plastic tip into the space and slowly pushed the plunger. He made his way around the area, centimeter by centimeter, until he reached his starting point. He handed the syringe back to the nurse, then repeated the separation attempt. This time the trapped portion of the intestine popped free. Theo heard audible sighs of relief come from various parts of the room.
The affected tissue was blue from lack of oxygen, but hopefully they’d caught it before it went necrotic. He’d give it a few minutes before closing up to make sure. In the meantime, he felt along the length to make sure there wasn’t another section that they’d missed.
“It’s pinking up.” Madison’s voice broke through. He finished his inspection, though, before going back to look. It was indeed returning to the pale pink of the rest of the intestines.
“It looks good. Thanks, people, great work today,” he called out to everyone in the room.
Returning everything to the abdominal cavity, he glanced up. “Let’s get her closed up and back home for Christmas, where she belongs.”
Over the next twenty minutes he sutured muscle and skin and then placed a layer of sterile gauze over the area, taping it in place. Meghan would have a little war wound on her lower belly, but that was much better than the alternative.
“Done.” He nodded to the anesthesiologist. “Let’s wake our little patient up.”
“Gladly.”
When he glanced at Madison, the corners of her eyes had crinkle lines and she nodded at him. “Thanks for asking me to come.”
He should be the one thanking her. She was the one who’d suggested he try saline to lubricate the tissues. It had worked beautifully.
“Thank you, you were a big help.”
“Just glad to work on something that is a little more straightforward.”
“Something other than Ivy?”
“No, of course not. It’s just different from what I normally do.”
He shut his eyes for a moment. Why the hell was he putting words into her mouth?
Moving up to the girl’s head, he watched as the other doctor adjusted the dials that would send oxygen to her body, replacing the gases that had been used to keep her under sedation.
Twenty minutes later the trach tube had been removed and the toddler’s eyes flickered, pure blue irises struggling to focus on his face. He put his hand on her forehead. “Hi, sweetheart. Welcome back.”
And just like that it was over and people were moving to do their jobs, and Meghan was wheeled away to the recovery area to finish waking up.
“I need to speak to her parents. Can you wait for me?”
“Of course. How about if I meet you in my office?”
Her tone didn’t sound as sure as it had a few minutes ago. Afraid of being alone with him? Well, she should be. Although he’d kept his mind on surgery as it had been happening, now that it was over he found himself wanting to study her, from those cute little smile lines all the way to how her hair drifted in different directions when freed of its normal clip.
Except her hair was covered by a surgical cap at the moment, so there was no hair to see. Just those beautiful clear green eyes and the straight length of her nose. High cheekbones. Smooth forehead. All things he had no business noticing.
“Thanks, I’ll try not to be long.”
Turning, he forced himself to stride away, ruing the fact that he’d asked her to wait for him. To talk about Ivy’s case. That was all. Otherwise he would while away the hours worrying about every little detail of her condition. Better to just talk about it and be done with it. Maybe in the same way that two pairs of eyes had been better than one, two minds might be able to figure out a solution when his was stuck in limbo. A fearful limbo that was stealing his soul just like the disease that was stealing his daughter’s ability to move. He had no idea which side would succumb first. His soul. Or his daughter.
* * *
“The symptoms look like appendicitis. But it’s not. It’s something completely different.”
Theo’s words as they’d walked down to the surgical suite a couple of hours ago stuck in her head and wouldn’t leave.
It looks like appendicitis. But it’s not.
A tickling at the back of her brain was slowly gaining strength. Slowly consuming her other thoughts.
Reaching into her desk, she grabbed her little notebook, flipping a couple of pages past Ivy’s wish list, and wrote down her thoughts.
“Add to whiteboard at home: It looks like appendicitis. But it’s not.”
She didn’t know what they meant. Not yet. But she knew from experience that her brain would be fiddling with those words in the background, much like a computer program might work behind the scenes until you opened it again and saw what had happened.
She just hoped it wasn’t another rabbit hole.
A quick knock, and then Theo poked his head in. “Thanks.”
“I was tempted to go on up to check on Ivy, but I did this instead.” She nodded at some food on the desk. “Hope that was okay.”
She’d stopped by the cafeteria and bought some fruit for herself and another omelet for Theo, since the one he’d left upstairs had to be stone-cold by now. “I wasn’t sure what you had in it, so I just had them add some cheese and seasonings.”
His brows went up. “You didn’t have to do that.”
She smiled. “I know I didn’t, but since I was getting something for myself anyway, it only made sense. I called upstairs, and Ivy ate most of her oatmeal and all her fruit. How were Meghan’s parents?”
“Relieved. Thanks to you and your saline idea.”
“There was no guarantee it would work. It was pure luck.”
“It was thinking outside the box.” He lowered himself into one of the metal chairs with a groan. “I need to find you some better furniture.”
“It’s fine. I won’t be here forever.”
The reminder was more for herself than anything. She was feeling a little too comfortable in her tiny little space, metal chairs and all. Only she didn’t want to feel comfortable here. This had never been intended to be permanent.
“I’m aware of that.”
There was a hint of something in his tone that made her take a second look. Was he thinking about Ivy and how she might not be here long enough for them to come up with a diagnosis?
She wanted to find a solution as much as he did. Madison did not like leaving things undone. She liked everything tied up with a neat bow, unlike her childhood where things had never been neat and had rarely ever been followed through to completion. Those insecure years had turned her into a fanatic about finishing tasks and making sure she had closure. One way or another.
And closure with Ivy and her dad? What would that look like? She had no idea.
She pushed the plate containing his omelet across to him, placing a fork on top of it. “I’m not leaving until we figure this thing out, Theo, if that’s what you’re worried about.”
His eyes closed for a second. “Sorry. I haven’t been getting much sleep lately.”
“I can imagine. But you can’t help her if you’re completely run down yourself.”
His hands went behind his neck, and she braced herself for the popping of that shoulder joint. It didn’t come as he seemed to catch himself just in time. “I forgot that you don’t like that.”
How did he even know that? Was she that obvious?
Lord, she hoped not, because that might mean he saw a whole lot more than she wanted him to.
“It’s not that I dislike it. It just surprised me that first time. Go ahead if it helps.”
“I can do it later. When you’re not around.” Then he smiled before his eyes tracked to the desk and his head tilted before he opened his box and cut into his omelet. “What are you writing?”
For a split second she thought she’d left the book open to Ivy’s wish list, but then remembered what she’d been doing. “I was writing down something that struck me during Meghan’s surgery. I’m just not sure why yet.”
“You’re not sure why it struck you, or why you wrote it down?”
“Both.”
She turned the book to face him so he could read it.
“I don’t understand.”
“Neither do I. Yet. It might mean nothing. Or it could trigger a thought.”
He took a bite, his strong throat contracting as he swallowed. “About Ivy’s case?”
“Yes, I think so.” She felt the need to warn him. “I do this a lot with cases. Many times, it ends up being a dead end. But there are enough times that it’s not to keep me doing it.”
“You think Ivy’s symptoms could be something related to appendicitis?”
“No. I’m not sure why it seemed important. I have a board at the apartment with all Ivy’s symptoms on it. It helps me visualize what’s happening inside a patient. And if it’s staring me in the face at every turn, it can help a diagnosis leap out of nowhere. I’m going to add this to that board.”
“You have one made up for Ivy?”
“I do.”
They ate in silence for a minute or two, and Madison wished she’d gone ahead and eaten before he’d arrived. Because this companionable silence was disconcerting. It didn’t feel as awkward as it should have. In fact, it felt kind of good to be able to sit and talk through a problem with someone. Which was also weird. She usually preferred to work alone, not sharing details with anyone, which was another reason she was loath to go to the meetings upstairs. She preferred to keep her cluttered thoughts to herself. Adding someone else’s to the mix was just too confusing. Oh, she could sit and listen to others’ ideas, but she rarely wrote them down or added them to her lists. Theo’s comment had been the exception to that rule, evidently.
“I’d like to see your board.”