St Piran's: The Brooding Heart Surgeon

by Alison Roberts

  He was there, in the hospital canteen. Sitting alone near a window.

  Brooding was the word that sprang to Anna’s mind. Hunched over a plate of food he appeared to be toying with rather than eating. The big room was well populated and noisy. Was that why the table with its single occupant seemed to stand out like a beacon? Or was her glance drawn there like a magnet because so many other people were eyeing the newcomer and probably talking about him?

  She could understand not wanting to be in there and either listening to or being the object of the kind of speculation and gossip rife in any group of people as large as the St Piran’s staff was, but why on earth hadn’t he done what she almost always did—buy a sandwich and some fruit to take back to the privacy of an office?

  Was he hoping for company? There must be so many people there who knew him but there was a hierarchy involved and maybe there weren’t any of his peers around. Anna found herself hoping that by the time she got to the end of this long queue someone would have joined Luke. That way, she wouldn’t need to feel guilty about not doing so.

  Not that she didn’t want the chance to talk to him, but this was hardly the place to have the kind of conversation she had in mind, and the idea of making small talk with this man was not appealing. It would be dishonest, in a way, when they both knew what needed to be discussed—the kind of game-playing Anna had never had the slightest inclination to indulge in. Besides, Luke was making himself look so very unapproachable. Self-contained and cool. If he knew and agreed with all the praise going on behind his back, his self-image would have to be more than a little inflated. Maybe his own company was enough?

  Like Anna, Luke had changed out of his scrubs and was dressed neatly. Professionally. Anna slid her tray along the metal bars in front of the food cabinets and found herself running her hand down the side of her close-fitting skirt to make sure it wasn’t creased. And then touching her hair to ensure that no tendrils had escaped the sleek knot at the back of her neck. She could do professional, too. Better than anybody, which was no surprise given the amount of practice she’d had.

  ‘Anna. Hi!’

  A new burst of hungry staff members was milling behind her, settling into the queue. The greeting had come from Charlotte Alexander, one of St Piran’s cardiology staff members, who was behind a couple of nurses who’d stopped to stare into a chilled cabinet containing rolls of sushi.

  If Anna made personal friendships among her colleagues, which she didn’t, Charlotte would have been at the top of her list. While their relationship was friendly, it was still as professional as Anna could keep it. Even now, when the loose top Charlotte was wearing reminded her that she’d noticed the obvious increase in weight a week or two ago and it had occurred to her that Charlotte could well be pregnant, she wasn’t about to ask such a personal question.

  Girl stuff, like heart-to-hearts or sharing secrets and especially wedding or baby talk, was never going to happen. They were in the same category as frilly clothes or loose hair or make-up. Badges of femininity. Barriers to acceptance as an equal in a male-dominated profession. How did women like Charlotte manage it? Looking and dressing in a way that accentuated their best features but still having the respect of both colleagues and patients?

  It made Anna feel like she had some kind of split personality, but it was so engrained now it was getting hard to know whether it was the Anna at home or the Dr Anna Bartlett at work that was the real her. The only thing she could be sure of was that never the twain could meet.

  But sometimes … like right now … it struck Anna that her work persona was simply armour. Concealing anything feminine and vulnerable. Giving her focus and strength. Her gaze strayed of its own accord back to the solitary figure of Luke Davenport. What was it about him that made her even more aware that she didn’t look as feminine or, God help her, attractive as she could? Just as well her work persona was so firmly engrained. If armour was what it was, she might need its protection more than ever.

  Charlotte had been held up too long. She moved around the nurses who couldn’t decide between the teriyaki chicken or smoked salmon.

  ‘Hi.’ She smiled at Anna. ‘How’s it going?’

  ‘Very good. Theatre’s over for today and both patients are doing well. I just took the sternal wires out of your Violet Perry. I’m sure the irritation will be gone and she’ll be pain-free in no time.’

  ‘That’s great.’ Charlotte was peering into the sandwich cabinet. ‘Hmm. Chicken and Camembert sounds nice. Or turkey and cranberry. No … we’ll be sick of that soon. Have you seen how many Christmas decorations are up already?’

  ‘Mmm. Way too soon, in my opinion.’ Anna found the seasonal celebrations at work disquieting. Too much of a bridge to personal lives.

  ‘Ham salad,’ Charlotte decided, reaching for one of the triangular plastic boxes. ‘Oh … weren’t you in Theatre with Davenport this morning? Doing Colin Herbert’s pericardectomy?’

  ‘Yes.’ Again, Anna’s gaze strayed towards Luke.

  ‘How did it go?’

  For a split second Anna considered confiding in Charlotte. Telling her all about how Luke had frozen and she’d had to take over the surgery. If she did, she’d be taking a step she could never undo. Charlotte would tell her husband, James, and the snowball effect might sweep them all into places they would rather not go. This man was going to be her professional partner from now on. They would be working closely together. Closer than she was with Charlotte or James or any of the other cardiology or cardiac surgery staff. She and Luke would share duties in Theatre, on ward rounds, during outpatient clinics.

  As though he sensed her stare, Luke raised his head to look up. Straight at Anna. Just for a heartbeat she held his gaze and tried to analyse what she could feel in that connection.

  Maybe he wasn’t bad tempered and brooding, she decided as she looked swiftly away. Strangely, for that moment in time, it had looked more like something deeper. Possibly even unhappiness? What reason could he have?

  He had been forced to leave the army early due to his injury, hadn’t he? Perhaps Luke didn’t want to be here just as much as Anna didn’t want him to be.

  She looked away but not before she felt an odd squeeze beneath her ribs. She knew what it was like to feel unhappy.

  Lonely.

  Did she really have to kick someone who might already be down? Maybe she was overreacting. She had stepped in so fast, after all. If he’d been about to move at the same time it wouldn’t have been such a big deal at all. Not that she’d had the impression he would have moved that fast, but it wouldn’t hurt to think about things a little longer.

  ‘It was amazing,’ she heard herself telling Charlotte, absently picking up a pack of chicken sandwiches. ‘I’ve never seen a technique quite that precise. I got to do a patch behind the left ventricle and it wasn’t easy.’

  ‘Wish I could have seen it,’ Charlotte sighed. ‘Did you know he’d ordered the observation deck closed?’

  Her disappointment was clear. It was an opportunity to express caution about the man’s personality or even say something negative. Curiously, Anna felt the need to defend Luke.

  ‘I guess you wouldn’t want too many people watching when you’re doing your first case after a long time away.’

  ‘I guess. How’s Colin doing now?’

  ‘Really good. We might be able to move him to the ward later today. Tomorrow, anyway, if he stays this stable. We should be well past the danger period for complications from acute dilation of cardiac chambers but his heart’s still got to get used to dealing with much more of a blood flow.’

  ‘I’ll get up to see him this afternoon. Here’s hoping the surgery report won’t be far away. I’ll be very interested to read it.’

  So would Anna, but her agreement was silent. If she’d voiced it, her tone might have suggested that there would be more to read about than Charlotte might expect. They were getting near the cashiers’ part of the counter now and she turned her attention to the bask
ets of fruit. An apple, she decided. The nice-looking green one on the top of the second basket.

  The crash that came from somewhere in the kitchens behind the food counters was astonishingly loud. Metallic. Jarring enough for every head in the cafeteria to swivel sharply in that direction and for conversation to cease abruptly.

  And in that second or two of startled silence a scream rang out. And then a cry for help.

  Jaws dropped as staff members looked at each other as though trying to confirm the reality of what was happening. Anna heard Charlotte’s gasp behind her but she was watching something else. Weirdly, her instinct had been to look away from the source of the sound so she had seen the first movement in the crowd. A reaction time so fast it was hard to process.

  Luke Davenport was on his feet. His chair tipped backwards and he pushed at the table in front of him rather than stepping around it. The table also tipped, the tray sliding off to send china and cutlery crashing to the floor but Luke didn’t even spare it a glance. He was heading straight for the kitchen.

  Access was blocked by the tall, glass-fronted cabinets apart from the space where Anna was, beside the tills and the fruit baskets. There was a flap in the counter beside the last till where kitchen staff could go in and out with the trolleys of used dishes but Luke didn’t bother to stop and lift it. Or maybe he didn’t see it. He swept the baskets clear to send apples and oranges bouncing around the feet of those still standing motionless and then he vaulted the space, making the action seem effortless.

  Kitchen staff were backing away hurriedly, but not quickly enough for Luke.

  ‘Move!’ he barked. ‘Clear the way. What’s happened?’

  ‘Over here,’ someone shouted. ‘Oh, my God … I think he’s dead.’

  Luke took several steps forward. Between the tills, Anna could see the blue uniforms of kitchen staff moving. Clearing a space near the stoves in front of which a large man in a white jacket lay very still.

  Luke took in the scene. He turned his head with a single, rapid motion.

  ‘Anna!’ he shouted. ‘Get in here. I need you.’

  Someone had raised the flap now but, if they hadn’t, it occurred to Anna that she might have tried to leap over it, too. Luke needed her?

  The man was obviously one of the chefs. His white hat had come off when he’d collapsed and was lying amongst the pots and pans of an overturned rack.

  Luke kicked one of them aside as Anna raced into the kitchen. ‘Get rid of those,’ he ordered. ‘Someone help me turn him. Did anyone see what happened?’

  ‘He just fell,’ a frightened woman offered. ‘One minute he was cleaning down the cooker and then he toppled sideways.’

  ‘What’s his name?’

  ‘Roger.’

  The man had been rolled onto his back now. Luke gripped his shoulder and shook it firmly, hunched down so that he could lean close and shout.

  ‘Roger? Can you hear me? Open your eyes!’

  He barely waited for the response that didn’t come. His hands on Roger’s chin and forehead, he tilted the head back to open his airway.

  ‘Does anyone know him?’ he demanded. ‘Medical history?’

  ‘He takes pills,’ someone said. ‘For his blood pressure, I think.’

  ‘No, it’s his heart,’ another voice added.

  The few seconds that Luke had kept his fingertips on the side of Roger’s neck and his cheek close to his face had been enough to let him know that there was no pulse or respiration to be felt or seen. Anna crouched on the other side of the collapsed man as Luke raised his fist and brought it down squarely in the centre of the man’s chest. A precordial thump that was unlikely to be successful but was worth a try.

  Ready to start CPR, Anna was thinking fast, compiling a mental list of what they would need. Luke was way ahead of her.

  ‘Get a crash trolley in here. Find a cardiac arrest button. Send for someone in ED or wherever’s closest. Anna, start compressions.’ He looked up at the silent, horrified onlookers. ‘Move!’

  They backed away. Anna heard someone yelling into the canteen for the cardiac arrest button to be pushed. If there wasn’t one in there, it wouldn’t be too far away. She positioned her hands, locked her elbows and started pushing on Roger’s chest. He was a big man and it was hard work to compress the sternum enough to be effective.

  Ten … twenty … thirty compressions. At least someone would arrive with a bag-mask unit very soon so she didn’t have to worry about the implications of unprotected mouth-to-mouth respirations on a stranger.

  The faint possibility of contracting something like hepatitis didn’t seem to occur to Luke. Or it didn’t bother him.

  ‘Hold it,’ he ordered Anna, pinching Roger’s nose and tilting his head back as he spoke. Then he sealed the man’s mouth with his own. One slow breath … and then another.

  Anna started compressions again, the image of Luke’s lips pressed to someone’s face emblazoned in her mind. The kiss of life … She’d seen it before, though it was a rarity in a medical setting. Was that why it was so disturbing this time? Shocking, in fact. She had to concentrate on her silent counting until it was time to warn Luke.

  ‘Twenty-seven, twenty-eight, twenty-nine, thirty …’

  By the time they had completed another set of compressions and breaths, there were new voices nearby and the rattle of a trolley.

  ‘Crash team,’ someone announced. ‘We’ll take over now.’

  ‘I’ve got it, thanks,’ Luke growled. ‘But it’s what we—’

  ‘We just need the gear,’ the surgeon interrupted. ‘And some assistance.’

  Anna could feel the resentment at not being allowed to do what they thought they had been summoned for, but a life pack was lifted from the trolley and put on the floor along with an IV roll, a bag mask and a portable oxygen tank.

  She carried on with the chest compressions, pausing only to let Luke rip the chef’s jacket and the singlet underneath open to expose the chest and stick the pads in place. On direction, one of the doctors in the crash team secured his airway and attached oxygen to the bag mask, holding it in place until Anna paused again.

  Could she ask to hand over compressions to someone else? This was enough of a physical effort to make her aware of perspiration dampening her shirt. No, she wouldn’t ask. She was with Luke on this.

  He had been the one to respond and identify the crisis, which made this man his patient until he chose to hand him over. And he’d asked for Anna’s help. Roger was their patient and they could do this as well, probably better, than the junior doctors assigned to crash-team duties for the day.

  ‘Stop compressions.’ Luke was watching the screen of the life pack, waiting for a readable trace to appear. ‘V fib,’ he announced moments later. ‘Charging to three hundred joules. Everyone stand clear.’

  The junior doctors inched back, exchanging glances.

  ‘Who is this guy?’ Anna heard one of them ask another.

  ‘Luke Davenport,’ came the response. ‘You know, the surgeon who’s just got back from Iraq?’

  ‘Oh …’

  In the short space of time it had taken for three stacked shocks to be delivered, the atmosphere in this inner circle around the victim changed. The crash team, who had been busy resenting not being allowed to showcase their skills in managing an arrest, suddenly couldn’t do enough to help their leader.

  ‘Do you want an intubation kit, Mr Davenport?’

  ‘Shall I draw up some adrenaline? Atropine?’

  ‘Here’s a sixteen-gauge cannula. And a flush.’

  ‘Dr Bartlett? Do you need a break?’

  Anna sat back on her heels, nodding. There was plenty of scientific evidence that compressions became less effective after two minutes unless someone else took a turn. She didn’t move far away, however. She watched, totally amazed by the speed at which Luke worked. And she noticed things she hadn’t noticed before.

  Like the streaks of grey in his short brown hair. They had to be prem
ature because she knew he was only a few years older than her and couldn’t have hit forty quite yet. He had such neat fingernails too and his hands looked so different without gloves. Far more masculine, which made their speed and cleverness more impressive as he gained intravenous access and secured the line.

  His brain was working just as fast. He seemed to be able to think of everything at once and keep tabs on what everybody was doing, but most of all, Anna was caught by the way he’d taken a trolley of equipment and a group of young medics who hadn’t been thrilled not to be allowed to take over and forged them into a team that was now working under difficult conditions as well as they could have in a resuscitation bay in Emergency.

  It was a team that had achieved success even before Luke had made a move to secure Roger’s airway with an endotracheal tube. When the static cleared from the next, single shock delivered, the flat line suddenly gave a blip. And then another.

  ‘Sinus rhythm,’ one of the crash team said triumphantly. ‘Yes.’

  ‘Have we got a stretcher?’ Luke still hadn’t relaxed. ‘Let’s get this man into the ED. Or CCU.’

  Charlotte had edged her way to the back of the kitchen. ‘Great job, Mr Davenport. Would you like to hand over now?’

  ‘Call me Luke,’ he said, still watching the monitor. The rhythm was picking up steadily and Roger was taking his own breaths now. The chef’s eyes flickered and he groaned loudly.

  And, finally, Anna saw the grim lines of Luke’s face soften a little. He leaned down and gripped Roger’s shoulder again with his hand—the way he had when he’d first begun this resuscitation effort. He didn’t shake it this time. This was a reassuring touch.

  ‘Just relax,’ he told Roger. ‘We’re looking after you. Everything’s all right.’

  He looked up at Charlotte and gave a nod to indicate transfer of responsibility. Charlotte moved closer to talk to him, but as she moved, Luke shifted his gaze to Anna.

  And something inside her tightened and then melted.