St Piran's: The Brooding Heart Surgeon

by Alison Roberts

He would prefer not to, however, and so far things were going smoothly. The staff were more than competent and he had no complaints about Dr Bartlett’s assistance. She was good. Somehow she had instantly tuned in with how he worked, and it was like having an extra pair of his own hands in action. Smaller hands, of course. More nimble ones. It was quite possible that Anna would be better suited to continue this when he got to the tight patches around the back.

  The thought was embryonic. Barely registered, in fact, because Luke was so focused on what he was doing. Anna had the edge of the hardened pericardium caught in a pair of forceps, holding it up and helping to peel it away as he cut carefully beneath it.

  He was using the scalpel with absolute precision. Tiny cuts as close to the hard casing as possible. There was less than a millimetre of space to work in. Luke was vaguely aware that the atmosphere around him was tense and that he could change it by relaxing a little and talking more, but he had no desire to do that.

  He was being watched in this, his first surgery on returning to his role as head of department for cardiac surgery. Being watched and judged. They were wondering if his experience in the army had changed him—as a surgeon or as a person.

  Of course it had. He had honed skills and one of them was the ability to focus no matter what kind of distractions were around. What anyone else, including Anna—no, especially Anna—might be thinking of him was irrelevant. What mattered here was a good outcome for his patient. His focus was on that scalpel. Right on its tip, which was the only part of the blade he was using.

  The blood seemed to come from nowhere. There’d been small bleeders up to now that Anna had dealt with but this was a sudden gush that drowned his scalpel, washed over the fingertips of his gloves and began to form a pool. The beat of the heart made it appear briefly and then the blood washed over it again, totally obscuring his vision.

  Red.

  So red.

  And warm. He could feel it on his fingers. Sticky life blood, ebbing rapidly from where it was supposed to be.

  Someone was dying.

  He could hear their screams. He could hear the sound of gunfire, too, and smell something burning. He had to do something. But he couldn’t move.

  Anna saw the moment the small artery got nicked by the tip of the scalpel. It needed more than diathermy. Clamping and tying it off shouldn’t present more than a momentary delay. She picked up a clamp, ready to hand it to Luke, already eyeing up the suture material he would need.

  But he didn’t request the clamp. The hand that was holding the scalpel was as still as stone. Frozen.

  And then the surgeon looked up, straight at her, and Anna’s own heart missed a beat. He was looking at her but he was seeing something very different. Something that had absolutely nothing to do with this room or this patient or the surgery he was in the middle of performing.

  He was seeing something … terrifying? Her heart missed only a single beat. With the next one she was moving smoothly. Using the clamp in her hand and then a suture. To those around them, it would look as though Luke had silently requested her control of the nuisance bleeding. Given his virtually silent technique up until now, it wouldn’t have surprised anyone. But Anna had been the only one to see the look in his eyes. Had felt the way he had frozen, and it had quite possibly been the most disturbing moment she had ever encountered in Theatre.

  It took only moments to deal with the artery and a nurse used suction to clear the operating field again. Anna heard Luke’s indrawn breath and looked up to see the way he blinked with such deliberation it gave the impression of a switch being flicked off. And then normal service was resumed. The surgery carried on as though nothing awkward had happened.

  But something had changed. Maybe it was an acknowledgment of the way Anna had rescued the situation. Or maybe it was the beginning of the kind of bond that could weld a tight team together.

  ‘If I tilt the heart,’ Luke said quietly a short time later, ‘you’re in a much better position to deal with that patch at the back. Are you happy with what you’ve seen of the technique?’

  ‘Yes.’ The increase in her own heart rate wasn’t trepidation. It was far more like excitement. The challenge of trying something new. The idea that she might be on a new journey to learn skills that nobody else could teach so well. There was something like relief mixed in there as well because her future here at St Piran’s looked a little less bleak. There was even a letting go of a little of that resentment towards the man who had reclaimed his job. The job she had desperately wanted to keep.

  Thank goodness her hand was steady as she took hold of the scalpel. Even better was Luke’s quiet praise as he watched what she was doing.

  ‘That’s excellent. Keep going. The more of this we can remove, the better the outlook for this patient will be.’

  By the time the surgery was complete, the outlook was good and Luke finally stood back from the table and stripped off his gloves, thanking everyone for their contribution to the successful procedure. As he turned to leave, he tugged at his mask, breaking the strings that held it in place, and for the first time Anna saw more than those intensely blue eyes.

  She saw a rugged, unsmiling face, with deep furrows from his nose to the corners of a mouth wide enough to balance the size of his nose. He wasn’t what you’d call classically good-looking but it was hard to look away. The raw, unpolished masculinity was compelling. Those frown lines were still there at the top of his nose so maybe they were a permanent feature. When Luke started tugging off his bloodstained gown as he neared the swing doors of the theatre, Anna saw the lean muscles of deeply tanned arms. She could have sworn that those doors opened of their own accord, which was impossible but there was something about the commanding height and the way this man moved that made the notion perfectly feasible.

  Luke Davenport was a soldier as much as—or possibly more than—he was a surgeon.

  Every female in the room was watching as he made his exit, no doubt equally impressed, but Anna knew she would be the only one who found the image conflicting. Downright confusing, really.

  Yes, Luke had lived up to his reputation as a gifted surgeon and he was apparently prepared to let her close enough to absorb valuable new skills but … what the heck had happened back when that bleeding had occurred?

  Was Luke even aware of the way he had zoned out like that? He certainly hadn’t acknowledged her contribution to the situation. He’d been injured during his time on the front line. An injury that was serious enough to prevent his return to his army position. Maybe he’d received wounds to more than his leg? A head injury perhaps that had left him with a form of epilepsy? Absence seizures where the sufferer was unaware of their surroundings and could freeze for up to a minute or so would explain it, but if that was the case, there was no way he should be still holding a scalpel.

  That explanation didn’t seem plausible, however. A seizure would have someone looking blank and Luke hadn’t looked blank at all. He’d looked … Haunted was the word that sprang to mind. As though he’d been sucked into a flashback that he hadn’t been able to escape from. This seemed far more likely but no less excusable.

  What if he’d been close to the pulmonary artery? Or, worse, the aorta? Even a few seconds of delayed response in trying to control the kind of bleeding those vessels were capable of producing could have been disastrous. What really bothered Anna was knowing that she was probably the only person who had noticed the incident, which meant that saying anything might be seen as a form of professional sour grapes. Revenge, even, for the reprimand she’d received because of her late arrival for the case. Everyone knew that she’d missed out on the job as departmental head when she’d first applied. Now they’d be watching to see how she was handling her new role. To make an accusation that could have major repercussions on Luke’s career within the first few hours of them working together was unthinkable.

  There was only one person who might accept and understand her concerns. The same person who could provide an explan
ation that could possibly negate the need to take it any further. If nothing else, Luke deserved the courtesy of direct communication but it was also a conversation that needed to happen in private.

  Right now her focus had to remain with their patient as he went into Recovery and was then settled into the intensive care unit for monitoring and post-surgical care. She had surgery she was due to perform with a registrar to remove sternal wires from a patient who’d had heart surgery a long time ago but was continuing to suffer pain that was probably a reaction to the foreign material in her body. The procedure wouldn’t take too long and she’d planned to use her lunch break after that to talk to Luke and suggest a detailed ward round to bring him up to speed with all the cardiac inpatients.

  Maybe she’d better use that time for something rather more personal. To make a judgment call on the integrity of the man she had to be able to trust if she was going to work with him at all. For some reason, the prospect of getting that close to Luke Davenport was more intimidating than anything Anna could remember facing.

  She needed to think of it as nothing more than a new professional challenge. Backing away or trying to make it easier was not an acceptable option. She’d take it face on. Anna gave a decisive nod as she followed Colin’s bed out of Theatre. She actually found herself almost smiling, having made the decision to confront Luke. If the situation had been reversed she had no doubts at all that Luke would be addressing the issue. He would probably have done so on the spot, with no thought of sparing her the humiliation of an audience.

  Maybe this was a subtle opportunity to demonstrate not only her ability to do the job he had reclaimed but that her way of doing it might be better.

  The prospect of the private interview with Mr Davenport was no longer simply intimidating.

  It was … exhilarating.

  CHAPTER TWO

  THE need to escape was overwhelming. And impossible.

  Having ripped off the theatre scrubs, Luke had gone straight to the showers in the changing room but he couldn’t wash away the aftermath of those few seconds in the middle of Colin Herbert’s surgery. Turning the water to lukewarm hadn’t brought its recent comfort of familiarity. Even the icy cold blast he finished with couldn’t shock it out of his head the way it could chase nightmares away.

  His clothes felt wrong, too. His trousers and an open-necked shirt felt too smooth against skin used to the thick fabric of camouflage overalls. At least he didn’t have to knot a tie around his neck, like tying a bow on a pretty parcel. How ridiculous would that seem when he would far rather be fastening the Velcro straps of a Kevlar bulletproof vest over his shoulders. Feeling the weight of the armour plating and the bulkiness of pockets stuffed with whatever he might need at a moment’s notice.

  He felt too light as he strode out of the theatre suite without a backward glance. Almost as though he was floating.

  Lost.

  The corridors were full of people going about their business, but it was all so slow. There was no sense of urgency as beds and wheelchairs were propelled to new destinations or staff moved from one task to another. They had time to stop and chat to each other. He saw people smiling and even heard laughter at one point. Someone said hello to him and Luke managed to smile back, but the facial contortion felt grim.

  He didn’t belong here any more. This was a joke that wasn’t the least bit funny. Like the whole of civilian life. It was a game. A pretence. Meaningless.

  Going outside was better. A brisk walk around the sprawling, modern structure that was busy St Piran’s hospital. A helicopter was coming in to land, no doubt bringing a trauma patient to the emergency department. Luke’s eyes narrowed as he watched it intently and soaked in the sound of its rotors. If anything was likely to give him a flashback, surely that was?

  It wasn’t going to happen. He knew that because he was aware of the potential and he was focused. In control. The way he should have been for every second of that surgery. He kept watching anyway. Testing himself, until the helicopter took off again and disappeared into the distance.

  A tempting distance. He could start walking again and just keep going. Stride down the cobbled streets of this picturesque market town until he got to the harbour. Or, better yet, a stretch of beach where he could push himself with the added difficulty of walking in sand. Or hurl himself into the surf with its magic, albeit temporary, ability to numb his body and brain and wash everything away. An effect a thousand times better than a cold shower.

  But this was early December. It was freezing and his wetsuit was hanging to dry on his back porch after his early swim that morning. His leg hurt, too, thanks to standing so still for so long in Theatre. And he was here because he had a job to do. A job he had been lucky to be able to come back to. An anchor. Something to build on and the only thing he had, really. Given time, this might start making sense again, giving him the bonus of feeling like he was doing something worthwhile even, though after this morning that goal seemed further away than ever.

  At least the patient who had been unfortunate enough to be his first case back here was doing well.

  It was nearly an hour later that Luke arrived in the intensive care unit and Colin was awake, though very drowsy. A nurse was by his side and she smiled warmly at the surgeon.

  ‘I’ve been hearing all about the surgery,’ she said to him. ‘I wish I could have seen it. I hear you did an amazing job.’

  Luke made a noncommittal sound without looking away from the monitor screen giving detailed recordings of what was happening inside Colin’s heart thanks to the catheter that had been positioned at the very end of the surgery.

  Surgery that could have been a total disaster.

  An amazing job? He didn’t think so.

  The nurse was still hovering. He heard the intake of her breath. She was about to say something else. Possibly another admiring comment. Luke shifted his gaze to give her what he hoped would be a quelling glance. Sure enough, her mouth snapped shut, a flush of colour stained her cheeks and she turned to fiddle with an IV port on her patient’s arm.

  Colin’s eyes flickered open. He saw the surgeon standing beside his bed and smiled weakly.

  ‘I’m still here,’ he said, his voice slightly raspy. ‘Thanks, Doc.’

  Luke returned the smile. ‘You’re doing fine. We’ll keep an eye on you in here for a bit and there’s a few tests we need to run later today, but we’ll get you onto the ward as soon as possible. Do you have anything you want to ask me about?’

  Colin’s head moved in a slow shake. ‘I think my wife’s asked everything already. Dr Bartlett seems to know what she’s talking about. I’m still a bit groggy to take it in but I’m alive and that’s what matters.’ He smiled again, his relief obvious.

  ‘I’ll be back later. I can talk to you and your wife then.’

  ‘Dr Bartlett said how well things had gone. What a great job you did.’

  ‘Oh?’ That surprised him. Or did Anna not worry about embellishing the truth when it came to reassuring her post-operative patients?

  ‘The wife’s just gone to find my mum downstairs and look after the kids so Mum can come in for a visit. Hey, did I say thanks?’

  ‘You did.’

  Luke knew he sounded brusque. He didn’t need the nurse to give a look vaguely reminiscent of the glare he’d seen more than once in Theatre from Anna. Did she know? Had word spread that his new colleague had had to leap in and prevent the error he’d made during surgery becoming a potential catastrophe?

  ‘Where is Dr Bartlett?’ he asked the nurse as he signed off a new addition to the drug chart and prepared to leave the intensive care unit. ‘I need to have a word with her.’

  ‘Back in Theatre, I expect.’

  Of course she was. He’d seen the case listed on the whiteboard in the theatre suite. A sternal wire removal. In the same theatre Colin had been in. With the same theatre staff, presumably. Would Anna be checking whether anyone else had noticed the incident and could back up her report on the
concerns she now had about the abilities of the returning head of department?

  She hadn’t said anything at the time. Hadn’t even sent a significant glance in his direction, but that said something in itself, didn’t it? She hadn’t bothered to hide what she thought of him returning to take her job in those early glares. It suggested that she was weighing the implications. Making sure she used the ammunition he had handed her to best effect by choosing the best time and place.

  Dammit! How the hell had it happened? He was well used to the nightmares, but to have a flashback like that happen during the day? In the middle of surgery? It was appalling. He wasn’t quite sure of how long he had lost his focus but he had no doubts about what could have happened if there hadn’t been someone as quick as Anna on the other side of that table.

  It wouldn’t happen again. He’d lost focus because that had been his first slot back in a civilian theatre. His concentration had been too much on a procedure that couldn’t have been more different to the kind of work in an Iraqi field hospital or, more particularly, as a member of the medical emergency response team on a mission on the front line. It had been slow and fiddly compared to the aggressive, lifesaving measures of treating major trauma under circumstances as tough as they got. It had been a mental ambush, triggered by the unexpected amount of blood he’d seen, or the way it had pooled, maybe.

  Whatever. It wouldn’t happen again because he’d be ready for it and wasn’t going to allow a loss of control. Luke was perfectly confident of his ability to do just that.

  But would Anna believe it?

  A pair of green eyes came to mind. Framed by dark lashes that were unadorned by any mascara. Angry eyes. Accusing and assessing at the same time. What would they be like, softened by trust?

  Even more compelling, no doubt, but Luke had to wonder if he would ever witness such a change.

  Winning Anna’s trust was not even the priority it probably should be because this underlying tension … this waiting for something potentially unpleasant to happen, was oddly welcome. It made him feel a little more alive than he had ever felt since he’d been shipped home.