by Amy Andrews
Callie smiled again encouragingly. ‘Kind of,’ she said. It was often hard for laypeople to understand complex medical conditions and part of Callie’s job was helping them to understand. If that meant she had to go over and over the information again, that’s what she did.
‘Your twins share the same placenta—that’s common for identical twins. Usually in this scenario each twin has its own separate connection to the placenta via its umbilical cord, but in TTTS the placenta contains abnormal blood vessels, which connect the umbilical cords and circulations of the twins.’
Callie paused to check that Kathy and Ray were following. She glanced at Cade, indicating for him to jump in. ‘So essentially,’ Cade said, ‘blood from one twin is transfused into the other twin.’
‘That’s the donor twin, right?’ Kathy said. ‘The recipient is the twin who gets the transfusion?’
Callie nodded. ‘That’s right. The recipient twin has a lot of extra stress put on its heart because of the extra fluid. Also the kidneys produce a lot of urine to try and remove some of the excess fluid, which leads to a build-up of amniotic fluid. That’s what I showed you on the scan earlier.’
‘That’s why I’m so big,’ Kathy stated.
‘Yes,’ Cade confirmed. ‘It’s called polyhydramnios. But the donor baby has hardly any amniotic fluid because it’s donating all its blood to its sibling and therefore producing hardly any urine. The donor twin also becomes quite anaemic.’
Cade paused, too, for a moment, glancing at Callie. Ray and Kathy seemed to have grasped the basics. They looked shaken but, from what he’d gleaned already about people from ‘the bush’, as they called it here, also stoic. Something that was confirmed a moment later when Ray cut straight to the chase.
‘Okay. So how do we fix it?’
Callie ran down the rather short list of options from doing nothing, which would almost certainly lead to the death of one if not both twins, to bed rest and nutrition to treating the symptoms with serial reduction amniocentesis and stringent monitoring.
‘There is one more option,’ she said. ‘I’ve asked Dr Coleman here because he offers a one-off treatment that is curative.’
Ray frowned. ‘So let’s do that.’
Cade looked at Callie and she nodded for him to continue. ‘Well, it is a little out there for a lot of people. It’s called fetoscopic placental laser therapy and involves me operating on the placenta while your twins are still in utero.’
Ray looked shocked. Kathy said, ‘You can do that?’
‘Can and have,’ Cade confirmed. ‘You are the first TTTS case I’ve seen since coming to Australia a couple of months ago but I have performed this procedure over a dozen times in the States.’
Cade went on to explain what exactly the operation entailed. He talked about the high operative and twin survival success rates and ran through the benefits as well as the potential complications—from having to repeat the procedure on rare occasions because all the aberrant vessels hadn’t been destroyed to inducing labour and the subsequent complications to do with premature babies.
He was thorough, answering their questions as he went along, and Callie couldn’t help being both pleased and impressed. Invading the safe, sterile world of the uterus was cutting-edge stuff but it should never be taken lightly or dived into willy-nilly.
‘You’ll probably want some time to discuss it,’ Callie said when Cade’s spiel had come to an end and the questions seemed to have been exhausted. ‘Why don’t you guys go down to the coffee shop and figure out which option you want to go with?’
Ray nodded. ‘If we decided to go ahead with the laser thing,’ he said, addressing Cade, ‘how soon can you do it?’
‘Tomorrow,’ Cade said. Prenatal surgery was rare so there wasn’t exactly a waiting list. ‘We’ll admit Kathy straight away, run some more tests and I’ll get a team together. Not sure if it’ll be in the morning or the afternoon yet.’
‘Okay, thanks,’ Ray said. He stood, helping Kathy to her feet, then reached out and offered his hand to Cade. ‘Thanks, Doc.’ He nodded at Callie. ‘You’ll hear from us shortly.’
Callie reached into her trouser pocket and handed them a card. ‘Page me on this number whenever you want.’
Callie watched as Ray opened the door and ushered Kathy through it. ‘You reckon they’ll go for it?’ she asked Cade as the door shut behind the Streets.
‘They seem like really practical people, so I think they will.’ He looked at Callie. Her gorgeous red hair was constrained in a high ponytail today and in the daylight her green eyes dazzled. ‘You wanna assist tomorrow if they do? I’m going to need another set of hands in case I have to deliver twins.’
Callie grinned. Standing next to Cade while he saved two little tiny lives had danger to her peace of mind written all over it, but it wasn’t something she wanted to miss, either.
‘Wild horses couldn’t keep me away.’
Which was why the next morning she was standing in her scrubs and theatre clogs, her hair contained in a blue cap, a mask covering her nose and mouth, eagerly watching the monitor as Cade advanced the fetoscope through the amniotic sac of the recipient twin—Joshua—towards the connecting vessels on the surface of the placenta. It was a strange and beautiful underwater world, like in footage she’d once seen of a sunken galleon, and she held her breath as a little hand was illuminated by the beam of light shining from the end of the scope.
‘Beautiful, isn’t it?’ Cade murmured.
Callie, standing opposite with her arms folded, her body turned to face the monitor, glanced at him and recognised the same sense of awe that was bubbling inside her. ‘Amazing,’ she agreed, her gaze straying immediately back to the screen.
Cade watched her for a moment longer. With the mask firmly in situ, hiding the classic features of her face, he had no idea what colour lipstick she was wearing or if, indeed, she was wearing any. Instead, he’d found something equally captivating: her eyes.
The mask isolated and emphasised the flecks of turquoise amidst the green of her irises. He hadn’t noticed them before and he couldn’t think why. He guessed his determination to concentrate on his career was paying off if he’d missed the fascinating hue of Callie’s eyes.
He was obviously getting good at it.
So, why, suddenly, was that such a depressing thought?
He turned back to concentrate on the job at hand—on Kathy, anesthetised and depending on him, on her babies, on locating the problem vessels.
‘Laser, please.’
The scrub nurse handed him the fibre and he threaded it down through the same sheath the scope was using, without taking his eyes off the visual on the screen. Once the laser was in place he set about coagulating the aberrant blood supply, running the beam along the length of the vessels and obliterating them for good.
It didn’t take long and he was satisfied when he was finished that the procedure had been curative. ‘That ought to do it,’ he announced, as he withdrew the fibre.
Callie glanced at him and her eyes shone with excitement—like they needed any extra enhancement! ‘Well done! You going to take some of that amniotic fluid while you’re in there?’
He nodded. ‘Yep. Looks like I’ve got a good couple of litres I can relieve Joshua and his mother of.’
In the end Cade withdrew one and a half litres before declaring himself satisfied. Kathy would feel an immediate difference in the tightness of her belly and her breathlessness, and Joshua’s heart and kidneys would not have to work as hard. Andrew, his twin, also now had a chance to develop normally.
And as the cherry on top, Callie was looking at him like he hung the moon.
And all-round great result.
Kathy and Ray thought so, too, when four days down the track she was ready for discharge. The twins were doing well, no complications had developed and they were thrilled to be heading home with weekly follow-up from their local medical centre.
‘Thank you so much,’ Kathy said to Callie as
Ray zipped up her bag. ‘You saved our boys’ lives.’
Callie laughed. ‘I think Dr Coleman deserves those accolades.’ She’d only seen Cade on and off briefly over the intervening days, which was just as well because she was fast developing a crush on his medical prowess.
As if his body wasn’t bad enough!
‘We both do,’ a deep voice rocking a sexy accent said from behind her.
Kathy laughed as Callie turned. ‘See, Cade agrees with me.’
Callie’s stomach went into free fall at the sight of Cade lounging in the doorway. His business shirt was rolled up at the elbows, his tie knot loosened, somehow making him look more wicked frat boy than a skilled prenatal surgeon. ‘Cade,’ Callie said, turning back to face Kathy for the sake of her sanity, ‘is being too kind.’
‘Nonsense,’ he said, and Callie didn’t need to look around to know he was closing in—she could sense it. ‘You put the twins’ interests first and sought the most cutting-edge treatment option available. That’s gutsy. Trust me, a lot of doctors out there rank voodoo higher than what I do.’
His sleeve brushed hers as he drew level and Callie’s stomach looped the loop.
Ray stuck out his hand and Cade shook it as he said, ‘Voodoo or not, we owe both of you.’
‘Just remember,’ Callie said. ‘Weekly ultrasounds are vital. Vital. A good diet and rest, too. You’re at a higher risk of premature birth so you really do need to take it a little easy.’
‘I will,’ Kathy promised.
‘Ray?’ Callie said, addressing him. ‘You and I both know that Kathy wouldn’t know how to take it easy if it came up and bit her on the backside so I’m relying on you to police it, okay? It’s very important.’
‘Hey,’ Kathy objected good-naturedly.
Ray nodded, ignoring his wife. ‘No worries, Doc.’
‘Is she always like this?’ Kathy grumbled to Cade.
Cade looked at Callie speculatively. Who knew? He knew she was a consummate professional. He knew she was an excellent neonatal specialist. He knew she wasn’t afraid to take a risk.
But he hadn’t stuck around long enough in any of his dealings with her in the past to know what her bedside manner was like. To know that she fussed over her patients—and not just the babies.
Who’d have thought that beneath her busy, professional exterior she was a bit of a softie?
‘Only with those who don’t obey my rules,’ Callie jumped in, not wanting to hear whatever answer Cade was cooking up in his brain. Talking about her like she wasn’t here was just too intimate somehow and she’d already been forced into enough intimacy with him this week, thanks to this case.
Sure, they’d worked on cases before—the occasional consult—but this one felt more personal. Was it timing, landing so soon in her lap after the fundraiser and her five-thousand-dollar bid? Or the excitement and professional milestones involved? Or was it the rapport they’d both built with Kathy and Ray as they’d worked together in the fight for their twins’ lives?
‘You must be ready to knock off,’ Kathy said, changing the subject. ‘Please tell me you guys swan off to glamorous city nightclubs on the weekend, dancing and drinking fancy cocktails until the sun comes up.’
‘Don’t answer her.’ Ray smiled. ‘She’s just trying to live vicariously.’
Kathy stuck her tongue out at her husband. ‘Spoilsport. Do you know how long it’s been since I had a cocktail or danced till dawn?’
Callie laughed at the note of longing in Kathy’s voice but couldn’t help but notice the protective way she cradled her belly. ‘I hate to break it to you but a glass of red wine and an early night is about as exciting as it gets.’
‘Yep,’ Cade confirmed, ‘hitting the beach is about it for me.’
Although he did have a sudden hankering for Shiraz.
When Callie’s foot hit the still-warm sand a couple of hours later she told herself it was about getting some fresh air. Just because she didn’t often come to the beach it didn’t mean she couldn’t. She had felt restless after work and when the ocean was a stone’s throw away it had seemed stupid not to take advantage of it.
Not that she wanted to swim. But a walk was a healthy outlet for her restlessness and if she should happen to bump into Cade in his boardies—all wet and clingy—well, that wouldn’t exactly be a tragedy.
With a good hour before the sun would even begin to fade from the sky, Callie slogged through the thick, softer sand, heading straight for the shoreline where it was easier to navigate. The patrolled area of the beachfront was relatively busy and she dodged groups of teenagers whooping it up in thank-god-it’s-friday jubilation and holidaying families taking advantage of the damaging Australian sun finally losing its sting.
The tide was on its way back in as Callie set out, walking away from the impressive Surfers Paradise skyline behind her. A brisk wind picked up her hair and she was pleased she’d pulled it into a loose, low ponytail. The way strands had already tugged free and whipped across her face didn’t bode well for the state it would be in when she got back to her apartment.
She kept her eyes fixed on the choppy ocean as the crowds thinned out. An occasional jogger passed her but other than that it was just her footprints in the sand before the ocean quickly erased them. Water occasionally licked at her ankles and splashed up her legs and she pulled the skirt of her strapless black sundress up a little, anchoring it into the elastic sides of her underwear to try and keep the hem dry.
The number of people swimming lessened as she moved farther away from the flagged area and Callie couldn’t help but feel concern for those who were swimming outside the boundaries of what the professionals considered safe. The Gold Coast was known for its fabulous beaches and magnificent surf, which was one of the advantages of working at the GCCH—killer views from every floor. But it was also notorious for its dangerous rips and all-too-frequent drownings.
The last thing she wanted to do on her relaxing walk was to have to pull someone out of the ocean half-dead.
Realising she was thinking like a doctor rather than enjoying the ambience, Callie, reined in her thoughts.
Beach. Zen. Bliss.
Relaxing.
No NICU. No sick twins. No work for two whole days. No on-call, either.
Breathe in. Breathe out.
Breathe in. Breathe out.
That worked well for a few seconds until the form of the jogger heading in her direction became clearer and she realised it was a shirtless Cade. That’s when she forgot the breathing-in bit for a moment or two until the words ‘Oh, hell’ fell from her lips of their own volition and things returned to their normal function.
Sort of.
What a fool she’d been to think he looked better in his scrubs than a tux. Clearly, his birthday suit was going to win hands down when it came to things Cade looked good in. Certainly if the top half was anything to go by!
He recognised her at about the same time she recognised him and he gave a surprised smile and a half wave as he continued to pound towards her. She slowed her pace as his tanned, nicely muscled chest swayed closer into her line of sight with every movement of his body.
Her gaze dropped lower, following the fascinating trail of hair that arrowed down, bisecting the ridges of his abdomen before disappearing beneath the band of shorts that rode very low on his hips.
She stopped as Cade pulled up in front of her and said, ‘Hey.’
Sweat beaded on his forehead but he didn’t even have the decency to be too out of breath or smell sweaty. In fact, her nostrils flared as salt and sand and sea mixed with Cade’s earthy male fragrance. A wave swamped her ankles and she didn’t even notice until he grabbed her elbow and pulled her higher up the beach.
‘You jog,’ she said, dragging her gaze to his face, where a slight shadow darkened his jaw. ‘I thought Americans preferred the gym.’
Cade laughed at the stereotyping. ‘I used a gym in New York because it’s a bit far to the beach. But in L.A. I used
to jog on the beach all the time.’ He stuck out a leg and bent at the waist, performing a stretch now that he’d stopped running so abruptly.
‘I have to say, though, I’m a little disappointed. I thought Australians were supposed to have kangaroos on their beaches. I haven’t seen one yet.’
Callie frowned for a moment before realising he was calling her on her gym quip. ‘Funny,’ she said.
He stood and grinned. ‘So, are you swimming?’ he asked.
‘Oh, no.’ Callie shook her head. ‘I don’t swim in the ocean.’
Cade raised an eyebrow. ‘Why not?’
‘I like to be able to see what’s swimming around with me.’
‘Ah, you’re scared of being taken by a shark.’
Given that sharks were just one of the hazards in Australian oceans, her fears were more varied than that, but it would do for the purposes of this explanation.
‘Pretty much.’
‘You know that’s really rare, right? Sharks are much more frightened of us. Statistically very few people worldwide die from shark attacks.’
Callie gave him a bald look. ‘I come from a small country town. It’s a four-hour drive to the nearest beach. Statistically no one’s ever died from a shark attack where I’m from. I’d like to keep it that way.’
Cade laughed. ‘Okay. But you don’t know what you’re missing.’
‘Thanks, but I think I’ll stick to the sand, if you don’t mind.’
Callie’s mobile rang and she fished it out from where she’d stashed it in the cleavage of her strapless bra. Cade lifted an eyebrow at the action. ‘Didn’t want to bring a bag with me,’ she said, as she looked at the display. ‘Hell. It’s my mother. Hold on for a moment—it won’t take me long.’
Cade watched her as she walked away slightly and talked. The wind blew her skirt against her legs, outlining their athletic length, the elastic waist emphasising the curve where his hand had rested the other night as they’d danced, and the strapless top showed off the beautiful curves of her shoulders and collarbones and outlined the thrust of her breasts. Hair had escaped from her ponytail and was blowing across her face, which was free of make-up.