The Italian Surgeon

by Meredith Webber

  He walked away, leaving her to follow, uncertainty dogging her footsteps, though this time it was to do with Luca, not with what lay immediately ahead.

  Do not tell him what to feel in his heart?

  He barely knew her, yet he was saying things that confused her heart.

  Forget it!

  Non-involvement, that’s your go!

  Think work!

  She caught up with him so they walked into Bobbie’s room together. Luca answered all the questions the parents had, then talked again about the procedure, before explaining that Rachel would tell them about the immediate post-operative period.

  Rachel looked at the couple, wondering how much they could absorb, then looked again at the baby on the bed.

  So beautiful her heart ached for him, knowing what lay ahead.

  ‘He’s already on the ventilator, so you probably understand that what it does is breathe for him—not all the time, but when and as he needs extra help. It saves him the energy he would use if he was breathing entirely on his own.’

  ‘So he’ll be on that again when he comes out?’ the woman asked, and Rachel nodded.

  ‘I was reading in the papers someone gave us where it’s sometimes hard to wean a baby off a ventilator,’ the father put in. ‘Is that likely to happen?’

  ‘It can happen,’ Rachel said cautiously, then she smiled. ‘But we rarely send our kids off to their first day of school with a bottle of oxygen so you’d better believe we can get them off!’

  Both parents smiled back at her and Rachel knew the tense atmosphere in the room had relaxed slightly.

  Time to take advantage of it.

  ‘He’ll have a nasogastric tube—up his nose and down into his stomach—to keep his stomach clear of acid and gas that might have built up during the op. He can also be fed nutrients using this tube. Will you be expressing breast milk for him?’

  The woman nodded.

  ‘Good, because not having to change from formula to breast milk will be better for him later when he’s able to feed for himself. If necessary, the hospital dietician might advise staff to give him supplemental calories, which will be added to the milk. These will help him grow while allowing him to take in less fluid. Speaking of which, he’ll have a urinary catheter, and he will be given diuretics to make sure his body isn’t retaining excess water. What happens is the surgery upsets all the body—especially in a body this small—so during the immediate post-op period other organs might not do their jobs as well as they should.’

  She paused, knowing all the information must be mind-boggling to the parents, and wanting to give them time to assimilate at least a little of it. Then, thinking carefully so every word would count, she continued.

  ‘Sometimes we leave a tube in the abdomen to help the liver flush out toxins and he’ll definitely be on a heart monitor and maybe have a tiny pacemaker to keep his heartbeats regular while he recovers from the insult of the operation. It will look like a thin wire protruding from his body, and will be attached to a battery-operated device that will stimulate the heart if it falters.’

  ‘So he’ll come out with tubes and drains and wires poking out of him, and his chest all sewn up, and we have to stay calm?’

  The baby’s father had stood up and was by the bed as he spoke, smoothing his long forefinger across his son’s head, looking, Rachel guessed, at the perfection of a body that would soon be marred.

  ‘No, you don’t have to stay calm,’ Rachel told him. ‘You can be as upset as you like. You should be. The little fellow is going to go through major surgery that would take an adult months to recover from, but your little boy will probably be out of here—the cardiac paediatric intensive care unit—in two or three days, a week at the most. Infants are amazingly resilient. Once he leaves here he’ll have another couple of weeks in the babies’ ward, then you can take him home.’

  ‘You will be given plenty of instructions and information and support when you take him home,’ Luca said, sitting in the husband’s chair beside the woman and taking her hand. He must have noticed how distressed she was getting, Rachel realised, while she herself had been yammering on and probably making things worse, not better.

  ‘I’m sorry,’ she said, coming to kneel beside the distressed mother. ‘It’s hard to take in but it’s best that you know what’s going to happen.’

  ‘It’s not that, it’s the decision,’ the woman cried. ‘Why do we have to decide? Why can’t the doctors decide?’

  ‘You have to decide because he is your baby,’ Luca said gently.

  ‘Then tell me what to do for him—tell me what is best,’ the woman demanded. ‘What would you do if it was your baby?’

  The air in the warm room grew very cold—or at least the bit of it surrounding Rachel’s body developed an icy chill. She looked at the baby on the bed—twice the size her Reece had been—outwardly perfect, apart from a blue tinge to his lips. Jake had known he would be leaving her—that decision had been made—so had he listened to the doctors explaining what they had to do, then decided Rachel wouldn’t be able to cope with a very sick baby on her own?

  Was that why he’d decided to say no to an operation?

  ‘Is your marriage strong?’ she asked, and realised she must have spoken harshly because all three adults in the room spun to look at her. ‘That’s probably a rude question, but it’s important, because you’ll need each other’s strength to get you through this. There’ll be bad times, and worse times, and you’ll need each other more than you ever realised. So it has to be a united decision. You must both agree to it, and not hold grudges or lay blame later on. But, that said, then, yes. I’m not a doctor, but if Bobbie were my baby, I’d opt for the operation. I’d give him a chance, and if it doesn’t work—if the worst happens—at least you’ll know you tried.’

  Realising she’d become too emotionally involved with the entire situation, she tried a casual shrug and smiled at the bemused parents.

  ‘But, then, as I said, I’m not a doctor,’ she said. ‘It’s Luca you should be asking.’

  She hurried out of the room, sure if she stayed another moment she’d burst into tears.

  Crikey! What was this about? She hadn’t cried in years! It couldn’t have been seeing the baby, could it?

  Or was it because she’d broken her vow not to get involved?

  She blinked and sniffed back tears, fumbling in her pocket for a handkerchief, glad she’d made for the less-used service foyer and no one was around to see or hear her unprofessional behaviour.

  ‘Are you all right? Dio, it was wrong of Alex to ask you to do that.’

  Luca was there, his arm around her, drawing her close. And for a moment she gave in to the need to be held and comforted, then she pushed away, knowing he was comforting her for all the wrong reasons.

  ‘No, it wasn’t wrong,’ she said, smiling weakly at the man who looked so concerned for her. ‘Alex probably knew me better than I knew myself. I had to get past what happened—I should have got past it long ago—and as long as I was avoiding situations like that, I wasn’t going to.’

  She turned away, and leant against the wall—not as comforting as Luca’s body but infinitely safer.

  ‘I didn’t get upset over losing Reece—not when I was talking to the parents. I got upset because for the first time I looked at Jake’s—my husband’s—decision from his point of view. He’d been unfaithful, sure, but we hadn’t been that committed to each other when we married. We’d been going out together, having fun, and vaguely thinking our relationship might lead somewhere. When I realised I was pregnant, he thought I should have an abortion but, as a nurse, the idea of doing such a thing horrified me, so we made the absolutely wrong decision right there and then, and got married. Don’t get me wrong, I loved Jake but I knew he didn’t love me in the same way. By the time Reece arrived, although I dearly wanted that baby—already loved him, if you know what I mean—we both knew the marriage wasn’t working.’

  An aide walked past and
looked curiously at them.

  ‘This is not a conversation I should be having here,’ Rachel said, straightening off the wall. ‘Or with you,’ she added, as embarrassment at how frank she’d been began to surface.

  ‘It is often easier to talk to strangers, though I hope I am more than that to you,’ Luca said. ‘And here and now is as good a place and time as any. Will you finish telling me?’

  Rachel thought about it, then decided she might feel a whole lot better if she did finish, if she explained to someone—anyone—the revelation she’d had in that room.

  ‘I’ve always blamed Jake. I thought the decision not to operate stemmed from selfishness, from him not wanting to be saddled with a sick child for the foreseeable future, but in there, talking to those parents, I realised he’d already made his big decision. He was moving on, child or no child, and he was thinking of me, and how I’d cope. I’d have had to give up work, and he knew how much I loved my job and how much it meant to me.’

  She looked bleakly at Luca.

  ‘I’ve blamed him all these years for that decision yet I realise now he made it for my sake.’

  Luca thought he knew a fair bit about women. After all, he’d grown up with four sisters. But this woman’s pain was new to him—new because he couldn’t grasp where it was coming from.

  But his lack of understanding didn’t make her condition any less real. He took her in his arms and though she stiffened momentarily she then relaxed enough to return the embrace, holding him close against her for a moment, then lifting her head to look into his eyes.

  ‘Thank you for listening,’ she said softly. ‘For being there.’

  Amber eyes repeated the message, and her lips parted softly, so it seemed only natural to kiss her.

  Very gently! Feeling her emotional fragility, and not wanting to take advantage of it.

  Not wanting to take advantage?

  Weird thought, that, when the idea foremost in his mind most of the time was getting her into his bed!

  Equally gently, he disengaged.

  ‘Come,’ he said. ‘The parents are talking again with other family members, and a man I think is a priest has also come to talk to them. We didn’t have time to drink our coffee last time. Let’s go to the rooms and try again. The parents know to page us if they need us.’

  He wanted to put his arm around her shoulders again, but knew from the way she held herself that it would be wrong. She was gathering her strength, renewing her reserves of courage—he could see it in the proud tilt of her head, and the stiffening of her spine—and he guessed she would not welcome sympathy right now.

  ‘Shoot, but I’d hate to be Alex—or you, for that matter—doing this stuff before every single operation.’

  She was striding towards their suite, and threw the remark over her shoulder at him, confirming his reading of her change in attitude.

  ‘Not all of our conversations with parents concern life-or-death decisions,’ he reminded her.

  ‘No, I guess not,’ she said soberly, then she turned and smiled at him. ‘You were right—talking to a stranger definitely helped. Kurt’s been telling me for years I should see an analyst. Maybe that’s how psychologists and psychiatrists achieve their success—simply by being strangers mixed-up people can talk to.’

  Luca would have liked to protest the stranger tag, but he sensed there was a brittle quality to Rachel’s change of mood so he said nothing, merely offering to fix the coffee. When Becky, who was at her desk, said she’d do it, Luca took himself across to the desk he used and made notes about the talk they’d had with the little patient’s parents.

  He would then have to check on the baby they’d operated on yesterday, while no doubt Rachel would be busy preparing the theatre for the operation.

  ‘Coffee for the sexy Italian!’ Becky said, depositing a mug of strong black coffee on his desk, then put a small tray with two chocolate-coated biscuits beside it. ‘And sweets for the sweet,’ she added cheekily, pointing at the biscuits.

  Luca had to smile. She flirted as naturally as she breathed, the pretty blonde Becky. What puzzled him was his lack of inclination to flirt back. Certainly his pursuit of Rachel wasn’t getting far, and now that he understood her reluctance to get involved he doubted it would progress at all.

  Yet something apart from her glorious hair attracted him, and beyond that he was coming more and more to think what an asset she’d be at his clinic. If he stole her heart, could he steal her away from Alex?

  Not an honourable thought at all, but beneath their emotional exteriors most Italians were innately practical.

  He nodded to himself, pleased to have this sorted out in his mind, though he doubted Americans could think as practically when love came into it. In his experience, love to them came with roses and chocolates and heart-shaped balloons—practicality was nowhere to be found.

  He wrote his notes and drank his coffee, then began to worry why he hadn’t been paged. Alex would be back soon and would want to know if the operation was to go ahead. In fact, Alex fully expected it would go ahead, having already spoken to the parents via a phone conference hook-up at the hospital where the baby had been born.

  So if he, Luca, with Rachel, had ruined this plan with their explanations, how would Alex react?

  ‘I think we should see if they’ve reached a decision before Alex gets back.’

  As if summoned by his thoughts, Rachel stood at his desk. Luca nodded his agreement, and pushed his chair back, straightening up while Rachel waited.

  ‘You don’t have to come,’ he told her, not wanting to subject her to more distress.

  ‘They might have questions about post-op care,’ she replied, in a voice that told him not to argue. So, together, yet in separate worlds, they walked towards the baby’s room, where the man in the clerical collar was the only person waiting for them.

  ‘The Archers have asked me to speak to you on their behalf,’ he said. ‘They have decided not to go ahead with the operation on baby Bobbie.’

  Luca heard Rachel’s gasp and moved closer to her. They might be inhabiting different worlds, but her world right now needed support.

  ‘But he’s so healthy,’ she protested, and Luca took her hand, squeezing it to show his sympathy but also to warn her to think before she spoke.

  ‘It is the parents’ decision,’ he reminded her, then he turned to the priest. ‘Can you tell them we understand, but that Dr Attwood, who is head of the team, will need to hear it from them when he gets in from his trip to Melbourne.’

  The man nodded. ‘I’ll tell them. It’ll be hard for them, but I’ll be with them.’

  He looked from Luca to Rachel, then back to Luca before he spoke again.

  ‘They didn’t reach this decision easily, and they are deeply upset about having to make it. But they have other children—four—and in giving so much to this one, with regular trips to the city for his check-ups with specialists after the three operations, they would be denying the others. That is part of it. The other part is the uncertainty of the outcome. Even with the operations there are no guarantees that Bobbie will be healthy. Today it is hard for them to say they will let him go, but to lose him when they have loved and nurtured him for maybe four or five years—how much harder would that be? These are their thoughts.’

  Luca felt the cold tenseness of Rachel’s fingers and squeezed them, silently begging her not to argue—not to fight for this baby’s one chance at life. They had given the parents all the facts they needed to make a decision—to not respect that decision now would be deplorable.

  The priest offered his hand to Luca, hesitated in front of Rachel, then made do with a farewell nod and left the room. Rachel sank into a chair, and though Luca guessed her legs would no longer hold her up he still urged her to her feet.

  ‘Come. The parents will want to sit with Bobbie, and there are alternative arrangements that must be made,’ he said. ‘We’ll find somewhere else.’

  He guided her out of the room and, be
cause it was closest, chose the little bedroom just off the PICU used by on-duty doctors at night.

  ‘Here, sit!’ he said, gently easing her onto the bed. Then he squatted in front of her and took her cold hands in his.

  ‘Alex will talk to them. Maybe that will change their minds,’ he said, hoping to wipe the dazed, blank look from her eyes.

  She shook her head so violently her hair flew out in a wide arc the colour of molten gold.

  ‘No, you were right. We told them what they needed to know, and they put that information with the other circumstances of their lives and decided. I have no doubt it is the right decision for them, but that baby, Luca?’

  Desperate gold-amber eyes met his.

  ‘He is so beautiful. To just let him die! It seems so unfair. So many people have healthy babies they don’t really want or need, yet that one…’

  She began to cry, not noisily but with deep, gulping sobs, then shook her head as if to shake the misery away and straightened once again. He wondered if she practised yoga, for she breathed deeply now, and he could see the inner strength he had seen before shoring up her defences. She even found a smile of sorts, though it was so pathetic it made Luca’s chest hurt.

  ‘Alex will be pleased! Not! He spoke as if the op was definitely on. The team members were coming back from Melbourne expressly to do it.’ She glanced at her watch. ‘Is there time to let them know it’s off? They might prefer to stay on down there.’

  She looked at Luca, who’d shifted to a chair, and continued, ‘My brain’s not working properly. Of course there’s no time. It’s a short flight—they must be almost back in Sydney by now.’ A pause, then she added, ‘I’m so sorry I fell apart all over you. This isn’t the normal me, you know. I’m Rachel-who-can-cope-with-anything!’

  Her courage was like a hand gripping and squeezing at Luca’s heart, but he found a smile to give back to her.

  ‘I think it is normal to feel emotional about a situation such as this. If we, as medical people, divorced ourselves from all our emotional reactions, we would become automatons instead of human beings. Medicine is about humanity, and we should all remember it—and be grateful, not negative, when we are reminded of it.’