The last pantaloon-shaped piece of pericardial tissue was sutured into place to cover the defects the surgical technique had created, and the slow business of discontinuing bypass began. Finally, all suture lines were covered with a fibrin glue. Holly was pleased when the surgeons decided that primary closure of the sternum could be tolerated. Having the chest wall left open even temporarily would have made it far more traumatic for Grace’s parents in the immediate post-operative period.
As it was, their baby would be kept heavily sedated and on a ventilator for twenty-four to forty-eight hours, with a barrage of medication to support her through the recovery period. The outlook was good, however, with a high survival rate, and Ryan and Colin would soon be able to break the family’s tense wait with the news that the surgery had gone extremely well.
The news of Holly’s own upcoming surgery was the talk of the whole of St Margaret’s within a few hours of baby Grace being transferred to the surgical ICU. Holly’s friend on the nursing staff in the unit, Sue, found her in the ward late that afternoon when Ryan was meeting with Colin to dictate their surgical notes on the morning’s case.
Her expression was enough to make Holly’s heart skip a beat.
‘What is it, Sue? Is Grace in trouble?’
‘No, she’s a wee fighter, that one. She’s doing fantastically well so far.’
‘Is it Leo, then?’
‘No, no. He woke up for a minute not long ago and smiled at his mum. She’s rapt.’ Sue’s eyes were suspiciously bright as she gave Holly an impulsive hug. ‘I’ve just heard about you and Ryan and I’m so happy for you. Congratulations! When’s the big day going to be?’
Holly almost winced. ‘You make it sound like we’ve just got engaged.’
Sue laughed. ‘I did, didn’t I?’ Her glance, as she stepped back, held an edge of curiosity that Holly knew she would encounter again as the news spread. Sue knew perfectly well that there was no man in Holly’s life but how many people would assume that there had to be something more than a working relationship between her and Ryan?
Should she set out to make things clear? Ryan had said he was happy to be open about the transplant but that might not include having his motivation discussed. Holly hadn’t known he was a widower. That he’d tried, and failed, to make a physical contribution to save his wife’s life. People might accept that as motivation enough, as Holly had done, thinking that by helping someone else like this might be helping Ryan to exorcise a painful ghost from his own life. But if Ryan wanted that to be common knowledge, that was his business. He had to be fielding as much interest as she was.
What was he telling everybody?
Holly found out, a short time later, when Ryan arrived to check her notes on Daniel.
‘He’s so keen to get home. And back to school. Sounds like he’s a real hero now that he’s been on TV. He’s been up and down the stairs with the physio today with no problems.’
‘We can look at discharge in the next day or two.’
‘Apparently Sox gave him some tickets to the next Blues game in a couple of weeks. I said he’d have to talk to you about whether he’ll be able to go.’
Ryan smiled. ‘I’d better go and give him the good news, then. Nothing like having something to look forward to, to help speed up recovery. Speaking of which…’ Ryan raised an eyebrow ‘…are you being bombarded with questions about what we’ve both got to look forward to?’
Holly nodded. ‘The grapevine is humming, that’s for sure.’
‘Getting to you?’
‘A bit. I’m not sure what I should say when people want to ask me about why you’re doing this.’
‘Just tell them what I’m telling them.’
‘Which is?’
‘That, by some happy coincidence, we’ve turned out to be a perfect match.’ Ryan’s gaze was oddly serious. ‘That’s all they need to know, Holly. Anything else is between you and me.’
So he didn’t want people to know his personal history. The phrase was nicely ambiguous, though, wasn’t it? Holly could just imagine it fuelling gossip that there was more than a blood or tissue type match being referred to. She wasn’t about to point that out to Ryan, however. How embarrassed would he be to know that she was even thinking along such lines?
‘Have you heard from Doug?’ Ryan queried as he reached for Daniel’s notes. About the meeting with the transplant team?’
‘They’ve pencilled in a slot for 3 p.m. tomorrow. It looks clear in our schedules but I said I’d check with you.’ Holly caught her breath. ‘Things seem to be moving a bit fast. We don’t have to rush this if you’d rather wait, Ryan.’
‘The sooner the better, as far as I’m concerned.’
Holly’s gazed rested on his profile for a moment as he scanned her notes on the physical examination she had made on Daniel. Of course he would want to get it out of the way. Maybe he was aware of the potential gossip and found it intrusive. The sooner life was back to normal, the better.
It was more like an interdepartmental meeting than a patient-doctor interview.
Doug Smiley, two transplant surgeons, Holly and Ryan sat drinking coffee as they discussed her case.
‘You’ll both be well aware of the mechanics of the surgery. Your op will take two to four hours, Holly. You’ll get an incision of around twenty centimetres, lower abdomen.’ The surgeon winked. ‘I’ll make sure I keep it low enough for the scar not to show on the beach when you’re wearing your bikini.’
‘Not a problem, Ken. I might dream of a day or two lazing on a beach but I haven’t managed it in about six years so I don’t think it’s a major consideration.’
‘I’ll keep it pretty anyway. You’ll get the renal artery and vein of the new kidney connected to a main artery and vein in your pelvis, and the ureter will be connected to your bladder. We went over all this not so long ago, didn’t we?’
Holly nodded. ‘I’ll have a Foley catheter in for a few days and I shouldn’t expect to be producing urine immediately. It’s no biggie if I need dialysis to start with.’
‘We’ll expect to be discharging you in seven to ten days.’
The other surgeon looked at Ryan. ‘You probably won’t need to be in that long. With laparoscopic surgery and being as fit as you are, you might find you can get home by day five.’
‘Great. I’m arranging a two- to three-week cover period in any case.’
‘Doug said you weren’t keen to talk to the counsellor we’ve got on our team.’
‘No. I’m well acquainted with any risk statistics.’
‘And the possibility that the transplant might not succeed?’
Ryan just smiled. ‘As far as I’m concerned, the potential benefits outweigh any risks by a country mile. I’m quite happy with my decision and I don’t need to take up any counsellor’s time.’
‘Neither do I,’ Holly added.
Both surgeons nodded. ‘We’ll need you both in the day before surgery for a final physical check and the fluid loading. Holly, you’ll need longer because we’ll be giving you a dialysis session and getting you started on your immunosuppressive medication about twelve hours prior to surgery.’
‘What will you use?’ Ryan asked with interest.
‘Cyclosporin A to start with. We’ll kick off with a high dose of about 10 to 15 milligrams per kilogram a day and then reduce it to a maintenance dose hopefully low enough to avoid side effects. We might have to juggle with other immunosuppressants or corticosteroids for a while until we get things just right. Doug will be taking care of that side of things.’
Doug smiled at Holly. ‘I intend to make it my mission to ensure you don’t grow a beard, become obese or get a bad tremor.’
‘Thanks.’ Unless she had to, Holly didn’t want to cross the bridge of unwanted side effects to drugs she would have to be taking for the rest of her life. ‘I’ll hold you to that, Doug.’
‘Anything else either of you want to know?’
‘Yes,’ Ryan said. ‘How about giving us
a date?’
‘Would next week be too soon?’ Ken queried. ‘We’ve both got a morning free in Theatre.’
‘No,’ Ryan said.
‘Yes,’ Holly said with a note of panic she couldn’t suppress. Then she looked at Ryan, caught his gaze for several seconds and received a wave of reassurance. It was that dialysis effect again, which sent fears and doubts out the window and instilled confidence…and hope.
It was hard to break the eye contact, even knowing that its length could transmit the wrong message to the other people present. Holly took a deep breath and forced herself to look away from Ryan.
‘I meant no,’ she said as firmly as she could. ‘Next week would be just fine.’
Ryan had been watching her all through her evaluation of baby Grace’s condition.
‘No significant change from this morning. She’s quite stable,’ Holly reported with satisfaction. ‘All her vital signs are within normal limits. Oxygen saturation is a hundred per cent and she’s in sinus rhythm with a good rate. Blood pressure’s fine, urine output’s good and the wound’s clean. We could think about weaning her off the ventilator now, couldn’t we?’
‘Absolutely.’
‘And Leo’s ready to go to the ward.’
‘He’s looking good, isn’t he? I’ll have a chat to Mum and make sure she’s ready for the move.’
Looking up from charting the new plan of treatment for Grace, Holly wasn’t surprised to see Leo’s mother, Bianca, looking anxious. The one-on-one nursing and all the high-tech equipment available in the intensive care unit were very reassuring for many parents. They could easily keep Leo here for another day if necessary.
She saw Ryan reach out to touch Bianca’s arm but the gesture didn’t seem to be one of reassurance. The surgeon looked as though he was clutching Bianca’s arm, and Leo’s mother was looking progressively more anxious. Sue was standing beside the bed and her expression as she stared at her patient’s mother was one of sheer disbelief.
Holly scribbled her signature on Grace’s chart and moved swiftly to the door in the glass walls of Leo’s cubicle. What on earth was being said in there?
Ryan glanced up as she entered but he was busy helping Bianca to sit down. On the floor, of all places! Was she feeling faint?
‘Grab some towels, would you, please, Sue?’ Ryan stretched over Bianca’s head to pull some gloves from the box over the handbasin.
Holly could see why the towels were needed. Something had been spilled on the floor. The puddle was large…and growing.
‘Oh!’ Being the end of a busy day wasn’t really enough of an excuse that she’d taken so long to click, but this was hardly an expected occurrence in the paediatric surgical ICU. ‘Your waters have broken, Bianca. Should I find a stretcher, Ryan?’
‘I doubt we have time for a transfer.’ Ryan had lifted the hem of Bianca’s maternity dress and, over his shoulder, Holly could see the shape of part of a baby through the thin fabric of a pair of very wet knickers. ‘When did you last deliver a baby, Holly?’
‘I can’t have it now,’ Bianca gasped. ‘Not here!’
‘You had a scan done yesterday, didn’t you?’ Holly found a pair of scissors on the tray of the nearby dressings trolley and handed them to Ryan.
‘Yes. And the baby had turned around. I thought that might be why things felt a bit funny today. I was going to call my midwife once Leo’s dad came back to sit with him.’ Bianca took another gasping, inward breath. ‘Ooh, I’m getting another contraction.’
If the baby had turned itself around yesterday, the position hadn’t been held. What Holly and Ryan could see clearly, as the fabric was cut free, was a pair of tiny buttocks.
The obstetrics Holly had done seemed a very long time ago and she’d only ever assisted once at a breech birth. The potential for disaster was much higher than with a normal presentation. Horror stories of entrapment of the head, brain damage and even death crowded Holly’s thoughts. Leo’s parents had quite enough to cope with right now, without adding major complications from a difficult delivery of his sibling.
This was a paediatric hospital. They might have any number of paediatricians used to dealing with newborn babies but there were no obstetric specialists on the staff. Holly had to fight back a major dose of nerves.
Ryan, however, appeared perfectly calm. ‘You’re doing just fine, Bianca. She’s a few weeks early so I suspect she’ll be small enough to make this easy.’
Sue appeared back with an armload of clean, fluffy towels. ‘We’ve got a team and an incubator on their way up from Neonates.’
‘Excellent.’ Ryan was cradling the presenting part of the baby and first one leg and then the other appeared.
Leo stirred and whimpered at that point. He was still under sedation for pain control but Sue moved to check on the toddler. Bianca groaned and Holly crouched to hold her hand. She gave it a squeeze.
‘It’s all good,’ she said reassuringly. ‘Sue’s looking after Leo and Ryan knows what he’s doing.’
He certainly seemed to, anyway. Tiny legs were held between the gloved fingers of one hand while the other supported the rest of the baby. She saw him move his hands, carefully holding the body as it turned one way and then the other to allow delivery of the shoulders and arms.
There was a small lull as Ryan waited for another contraction to help the delivery of the baby’s head. Holly could see the intense concentration on his face—absolute determination to do this exactly right—and because she was watching him just as intently, she saw the moment anxiety gave way to relief as he lifted the baby clear.
Ryan was watching the baby, keeping it tilted down to help keep the airway clear. The suction tubing Sue had detached from the wall unit and was clutching on the other side of the bed wasn’t needed. The baby’s arms moved and then its face, scrunching into lines of dismay before a tiny mouth opened to take its first breath and emit a warbling cry.
But Holly didn‘t see the baby‘s face. She was still watching the man who had just completed the unexpected delivery of this infant and she saw the joy that now softened his features. Ryan looked up then, lifting the baby to place her on her mother’s stomach but his glance stopped as it caught Holly’s.
And then the whole world seemed to stop.
There were tears in Ryan’s eyes. Hardly surprising, given the emotion of the moment. Holly was feeling choked up herself and Bianca was laughing and sobbing at the same time as she reached to touch her baby. The touch of Ryan’s gaze with Holly’s lasted only a split second but its aftermath made everything happening from then on seem hazy.
The team from the neonatal unit arrived seconds later and Leo’s room was a scene of happy chaos as they took over the care of a small but apparently healthy baby girl. Holly helped set up the incubator as a paediatrician examined the baby, whose cries were amazingly not enough to wake her older brother. Ryan dealt with the delivery of the placenta and Sue went to summon an ambulance crew to transfer Bianca to the maternity unit at Auckland General Hospital for the check she would need. Leo’s father arrived at the same time as the ambulance crew and Holly stood back as the chaos finally receded.
Remarkably, it had all occurred in the space of less than thirty minutes. That moment of eye contact with Ryan had lasted less than a second but Holly still couldn’t shake the feeling of connection it had given her. The warmth that had been generated was still with her. So was that odd sensation of tightness in her chest and stomach. Holly had not experienced that sensation for a very long time, but it was all too easily recognisable.
You could only get that feeling with someone who was as close as it was possible to get with another person.
With someone you were in love with.
Was this a result of sharing a rather extraordinary experience with Ryan in the last half-hour? Being blown away by his presence of mind and skill and his emotional involvement with the situation?
Or was it because she’d been seeing him in such a different and more personal lig
ht over the last few days?
Or was it simply a form of gratitude for what he was preparing to do for her with such generosity of spirit?
Or had all of these circumstances combined to open a door to a space that had actually been there all along? A closed door that Holly had simply walked past in her mind on countless occasions, never for one moment considering that she had the opportunity to open it.
Leo’s cubicle was clear now, except for Sue who was busy taking a set of routine vital sign measurements on the peacefully sleeping toddler. And Ryan was still there, of course.
He was looking at Holly. And smiling.
‘That was a bit different,’ he said dryly. ‘Life’s full of surprises, isn’t it?’
Holly could do nothing but return the smile and nod.
And thank her lucky stars that Ryan Murphy was not privy to the extra surprise life had just handed her.
CHAPTER FIVE
IT WOULDN’T last.
A night of reflection had convinced Holly that the new feelings she had discovered for Ryan were a perfectly understandable reaction to the physical and emotional journey he was responsible for her having embarked on.
Negative emotions like fear and frustration and despair were being nudged out of long-term occupancy in her life to make way for genuine hope. For the first time in years Holly could think about a future beyond getting through her day or her next dialysis session and past being simply a slot on a waiting list for a transplant organ.
She was very careful to keep her interaction with Ryan as professional as possible over the next couple of days. A new fear had been spawned, in fact. What if Ryan thought he could be stuck with a love-sick registrar because he’d offered to save her life? It could well be enough to make him reconsider.
To back out.
Hard to believe it was only a matter of days since Holly had dismissed Ryan’s offer as being stunning but ridiculous. Now, with surgery only days away, the thought of the offer being withdrawn was terrifying. Holly was on the biggest emotional roller-coaster of her life right now. Feelings for Ryan had to go into one of those carriages. A passenger on the ride that was probably not even strapped in.
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