‘We will need either a very small donated human artery with an intact valve for a homograft or a very small dacron artery with a manufactured valve.’ She emphasised the ‘we’ just enough to let him know he was going to be taking equal responsibility for this operation. ‘A donated human artery is best if you can get one small enough because it has the ability to develop normally so might reduce the need for further operations as he grows.’
‘Kam and I, working with our own staff, have been cryo-preserving donated tissues for more than a year now. I’m sure we’d have what you need. And what about the patch for the hole between the left and right ventricles?’
‘I should be able to use a piece of the pericardial sac, which will save any rejection problems, otherwise we can fix it with…’
She paused, and studied Arun’s face, although he doubted she was seeing it, simply using it as a focus as she thought ahead.
‘Sometimes we leave it open for a while in case the new artery causes high ventricular pressure but, no, I think we should close it if we can.’
‘And for now?’
‘Ah!’
Melissa looked down at the tiny baby in the crib. He would need to be as strong as possible before the operation, so optimal oxygen intake, some medication to help the heart work more efficiently and not over-strain, and adequate nutrition through high-calorie formula or breast-milk, possibly with supplemental feedings.
‘Would Tia nurse him?’ Mel quietly asked Arun, remembering how the young woman had reacted to being asked to hold the baby.
Arun looked from Mel to Tia then back to Mel.
‘I doubt it, but I could ask.’
Mel shook her head.
‘Let’s not upset her any more, but maybe if we can arrange to care for the baby here in her room, she might grow interested enough to want to hold him.’
Arun nodded, then he shook his head.
‘You are one amazing woman,’ he said, startling Mel because he sounded as if he really meant it and that made her feel all warm and fuzzy inside.
Dangerous stuff, warm and fuzzy!
‘I’m not doing any more than anyone would,’ she told him, hoping she sounded practical enough to hide her reaction. ‘We can put in a nasogastric tube to feed him, which will save him using what little energy he has sucking either a breast or a bottle, and I need an IV line and an oximeter to keep an eye on the oxygenation of his blood and…’
She paused, wondering what else the fragile infant would need.
‘And?’ Arun prompted.
Mel shook her head.
‘I want to keep things as minimally invasive as possible to give him every chance to get stronger. From a purely cardiac point of view, what do you think?’
‘Let’s get someone in to watch him so we can sit down somewhere quiet and work out a plan, looking at what we hope to achieve before the operation and what negatives might make it impossible to leave it for two weeks.’
He didn’t wait for her answer but disappeared out the door, leaving Mel with the baby, and his mother, who lay with her face turned to the wall.
Having assured herself the baby was managing as well as could be expected, Mel crossed to sit beside the new mother.
‘This is so hard for you—I can understand that—but I’m nearly sure we can fix what’s wrong with him. Had you chosen a name?’
Dark eyes opened and were soon awash with tears.
‘I cannot give him the name,’ Tia whispered. ‘It is the name my husband chose, and if the baby dies he will want it for the next baby.’
‘Oh, love,’ Mel said, putting her arm around the young woman’s shoulders, overwhelmed by the sadness in Tia’s voice. ‘This isn’t your fault, you know. Babies are often born not quite right. No one is to blame.’
Seeing this comfort wasn’t working, Mel tried another tack.
‘Where is your husband? Are husbands not allowed to be present at the baby’s birth in your culture? Is that why he’s not here?’
The dark hair moved from side to side then Tia raised her head again.
‘He’s in America. He’s studying. His father said he had to stay there—that he couldn’t come home just to be with me for the baby’s birth. I should have gone with him and been there and had the baby in an American hospital, but when I went to America before, I was so homesick I said I wouldn’t go.’
Mel gave her a comforting pat.
‘Where you had the baby wouldn’t have made any difference,’ she explained. ‘This is something that happens when you are very newly pregnant, maybe eight weeks or so—the little heart just doesn’t develop properly. But I have operated on babies as small as yours to fix their hearts, and they have been perfectly all right later.’
This time Tia turned right around and even hitched herself up on her pillows.
‘You have? You can operate on tiny babies and fix their hearts?’
Hope crept cautiously into the words and flickered in the dark, tear-washed eyes.
‘I have, and I can,’ Mel told her, stroking Tia’s long hair back from her face and smiling gently at the young woman.
‘And you can fix my baby?’
Arun, returning to the room with one of his most trusted nurses, saw the improvement in his sister then heard the question and read Melissa’s dilemma in her hesitation.
Would she lie?
He rather doubted it but for a moment he wished she would, just to keep Tia from diving back into the depths of misery.
‘I cannot promise that, but more than ninety per cent of babies we operate on for this condition do survive. In fact, they not only survive, they thrive. It will take a little time, he’ll need to be specially cared for before and after the operation, just for a few days, then another week in hospital. Later on, there are infections he might be susceptible to, and as he grows he might need another operation, but there’s no reason he won’t do well.’
Arun remained where he was, his arm held out to prevent Zaffra from entering the room. Melissa seemed to have worked some kind of miracle in getting Tia interested in the baby, and he didn’t want to interrupt until he was sure the conversation was finished.
‘I heard Arun say you must talk about what you have to do. Can I hold him—the baby—while you talk?’
Arun felt a grin as wide as the desert split his face and saw similar delight in the way Melissa hugged Tia.
‘Of course you can. I’ll put him in your arms then fix the oxygen so it blows across his face. That way most of what he breathes is pure oxygen, which will ease the workload on his heart.’
She crossed the room and gently wrapped the swaddling cloth around the infant then lifted him from his warmed mattress, carrying him across to his mother, who would warm him with her body.
‘You take your time to look at him,’ she told Tia. ‘Later we’ll put a feeding tube into his nose and he’ll have to wear a nappy so we can work out how much fluid he’s losing, but for now just hold him and marvel at the miracle a new baby is.’
Arun brought Zaffra forward and introduced her to both women then, while Melissa placed the oxygen tube from the wall unit so it would blow across the baby’s face, Arun watched Tia’s bemusement as she examined her little son.
‘But he looks perfect,’ she said, after checking all the limbs and digits were in place. ‘Except his little feet are blue and his fingernails and lips.’
And Arun was pleased to see she was right. The baby had finally achieved some pinkness in the rest of his body so the oxygen was working.
‘Later,’ he told his sister, ‘when Melissa and I have talked, I will sit down and explain what is wrong and how we fix it. I will draw you a picture so you understand and can show Sharif when he comes home.’
Tia nodded and, satisfied his sister was now as comforted as it was possible to be with a very sick baby on her hands, Arun touched Melissa on the shoulder and indicated they should leave.
‘We won’t be long,’ she promised, turning back as she reached the doo
r to reassure Tia once again.
Tia smiled as if confident Melissa meant exactly what she’d said.
‘Working miracles with mothers now, are you?’ he asked Melissa as he led the way down the corridor to his suite of rooms.
‘It’s hard for them,’ was all the reply he got, and he turned back to see that, far from looking happy at what she’d achieved, Melissa looked…depressed?
Sad, anyway. Sad enough for him to want to put his arms around her, draw her close and hold her until the sadness went away.
Hold her?
Madness lay that way!
But sadness?
‘Is it worse than you’ve been saying, the baby’s heart?’ It was a guess, and he knew it was the wrong one when she shook her head.
‘No, it’s the grief,’ she said, studying his face as if hoping to see understanding there.
But how could she when he didn’t understand what she meant?
‘Grief?’
‘Think about it, Arun,’ she continued. ‘A woman goes into labour, goes through childbirth, and though it’s messy and painful at least there’s joy at the end—a healthy baby to hold and cherish. For Tia, and mothers like her, where the outcome’s not as good, she has to suffer the loss of that healthy baby she was expecting—she has to grieve for it. And while grieving, it is hard to accept the other baby—the one she did have—the one that’s fragile and in need of care she has to rely on strangers to provide.’
He stared at her, then shook his head.
‘I can’t believe I’ve never thought of it that way,’ he murmured, awed by the depth of her understanding and feeling something for this woman that went beyond renewed attraction.
This pregnant woman, he reminded himself as she let him off the hook with a smile.
‘Your heart patients are usually a whole lot older and often victims of their own over-indulgence, so you see heart problems from a different perspective.’
He nodded acceptance of her excuse, but now his brain had thrown up the fact of her pregnancy once again and the knowledge that it was his baby she carried hit him like a shock from a faulty electrical connection.
His baby— she was carrying his baby!
OK, he could just about accept that, but how he felt about it—that was the problem. Would his thoughts become clearer as his mind reached full acceptance?
Would it have been easier to think about it if Tia’s baby hadn’t arrived so inopportunely?
What he did know was that this was hardly the time to be working out what he felt, let alone what he intended doing about it…
‘So, a plan,’ Melissa said, as Arun resumed their walk towards his office, finally opening a door and waving her into a large room, furnished with a wide desk littered with papers, and a leather-clad lounge suite set around a coffee-table.
A coffee-pot, cups and trays with a selection of cakes and fruit had been set out on the table.
‘I thought you might need a snack,’ he said, leading her towards one of the comfortable-looking chairs. ‘It is terrible that we have whisked you from the stables to the hospital with no time for you to relax, to bathe and change, or even to eat something. So sit, eat, and then we’ll talk. I had coffee sent up but if you’d prefer tea or a cold drink of some kind…’
Mel shook her head, although now she was away from the baby and had relaxed slightly, she realised she was starving.
‘Coffee’s fine, but with a lot of milk, if you have it,’ she said, sliding into the big armchair and leaning forward to examine the enticing-looking pastries on display. ‘And these are?’
‘Various sweet treats, mostly flavoured with rose or orange syrup and honey, but also with nuts sprinkled between the layers of pastry. You will find similar pastries right across the Middle East, all the way through to Greece in Europe and Morocco in North Africa.’
Mel chose a pastry and bit into it, feeling the sweetness fill her mouth then honey dribble from her lips.
Arun came closer, a serviette in his hand, but rather than hand it to her he caught the tiny drop of honey on it, his fingers brushing the soft paper of the napkin across her lips at the same time. His body bent over her, his face close enough for her to see the stubble of beard and the shadow of tiredness beneath his eyes—lines of strain that had not been there when they’d met four months ago.
The time had not been kind to him and she felt a surge of sympathy. If health care in his country was as neglected as Jenny said, he must have enormous worries on his shoulders.
But he was also close enough for her to see, as he bent towards her, desire leaping in his eyes, a desire that was echoed in her body.
Her nipples peaked and her breasts swelled as anticipation tingled through her body.
Would he kiss her again?
Would she respond?
Wouldn’t kissing Arun just make things more complicated?
Then, with his lips close enough to kiss if she straightened just a little, he moved away, leaving her feeling a sudden sense of loss.
Stupid! Irrational! How could she even think of kisses at a time like this?
‘Arun?’
His name escaped in a sigh so soft Arun was sure she hadn’t meant to say it but he responded anyway, bending over her again to brush the honey-tasting lips with his. To brush her name, ‘Melissa’, on them.
The chemistry that had worked between them from their first meeting flared back to life. Arun’s hand slid around the back of her head, his fingers weaving into her hair, holding her captive.
Or was it her clasp on his head that held them together?
The kiss deepened, Arun feeling the power of it as desire shuddered through his body, tightening his muscles and heating his blood.
This was madness.
The baby…
They should stop…
She broke away from the kiss but not before he’d felt enough of her response to know the chemistry still worked for her as well. Now, leaning back in her chair, defiance shaded the desire he knew he’d read in her eyes.
‘We have to talk about the baby,’ she said. ‘About Tia’s baby.’
‘And your baby? The one you say is mine? When will we talk of it?’
‘The one I say is yours?’
Her disbelief was like another person in the room yet, now the words were out, he realised he did have doubts. With reason, for how could he be sure?
‘How do I know you didn’t take another lover immediately after me? Or have one before me, close enough that you can pass off the child you carry as mine?’
He spoke coldly, the words damning her, but surely he was right to be suspicious. Her reaction was immediate—the fire of anger in her eyes and fury in every line of her body as she rose to her feet and glared across the table at him.
‘My love life is not, and never has been—apart from ten short days—any of your business, but I can assure you the baby is yours.’ She spat the words at him, as angry as a maltreated cat—her hands clenched, perhaps to stop her clawing him as well as mauling him with words. ‘Now it’s up to you. I will pretend you didn’t say what you just said to me and we sit down and discuss the baby’s problems—Tia’s baby’s problems—and together work out a treatment plan, or you call your pilot and get the plane ready to fly him out.’
She was right—Tia’s baby was the issue. How could he have been so easily diverted?
Because he’d kissed her?
Tasted honey on her lips?
Felt the frantic beat of need in both their bodies?
Or because he was beginning to accept that what she’d said was true—that she carried his child? Added to which was the fact that, while in theory marrying and having a child was all very well, in reality the thought of fatherhood was very unsettling. What did he know about raising a child? Could he, who’d barely known his father, be a good father to a child?
He nodded stiffly, waited until she seated herself again, then sat opposite her, outwardly calm—he hoped—but inwardly churning with su
ch a tumult of emotions he couldn’t put names to them.
Mel watched him settle back in his chair. She took a deep breath, trying to calm her thudding heart, to settle the fear and hurt she felt inside.
But she hadn’t got to where she was, a top paediatric heart surgeon, without being able to hide her emotions successfully. She hid them now and matched his earlier coldness with her own.
‘So, shall we discuss this case?’
He hesitated long enough for her to realise few people gave him orders, but in the end he nodded.
And scowled at her.
Ignoring the scowl, she leant forward, opened the file and spread the prints on the table.
‘You can see here the artery leaves the ventricles as one big trunk, and here, the hole in the ventricular wall. The problem is that too much blood is flowing through the pulmonary arteries where they branch here…’ she pointed with a pen that had been beside the file on the table ‘…into the lungs, causing congestive heart failure. From the look of this there’s a narrowing of the aortic arch as well, so the heart is having to work extra hard to get blood flowing around the rest of the body.’
‘And the operation?’
She glanced up at the interruption, pleased he had switched his attention from personal matters, feeling her own inner agitation ease as they spoke professionally.
‘I need to detach the pulmonary artery from the main artery and use a small piece of artery with valves intact to connect it the right ventricle, stitch it in place there, fix the hole between the ventricles and patch up the aorta where I’ve detached the pulmonary artery.’
‘That’s a huge operation for so young a child,’ he said, frowning over the scans, following the lines she’d drawn with the pen. ‘Saying it like that, you make it sound simple, but for an infant…’
He lifted his head to look at her, and Mel read the doubt in his eyes—doubt and pain.
‘There’s a ninety per cent success rate,’ she said, to quell the doubt. The pain was something else. ‘She means a lot to you, Tia?’
This time he looked surprised, then he offered Mel a twisted kind of smile, so sad it nearly broke her heart.
‘Tia’s mother, Miriam, was my father’s favourite wife. She was also more a mother to Kam and me than our own mother was. Tia was an afterthought, the last child of my father, and Kam and I, when we came home from school in England, regarded her as our special pet—a living doll, I suppose, although boys are not meant to play with dolls.’
The Sheikh Surgeon's Baby Page 6