Leo nodded, wide-eyed.
‘Wiggle, wiggle,’ Holly whispered. Leo giggled as she positioned the disc. She listened intently for a full minute and then nodded. ‘Wiggle, wiggle,’ she said again, and she must have tickled the small boy as she removed the instrument because Leo writhed in mirth. It made both his parents smile and suddenly the consultation was far more relaxed than it might have been.
‘What could you hear, Holly?’
‘There’s a harsh systolic murmur,’ she reported. ‘A pulmonary systolic ejection and a mitral mid-diastolic flow murmur. The pulmonary second sound is loud.’
‘What does that all mean?’ Leo’s father asked.
‘They’re abnormal heart sounds,’ Ryan explained, ‘which we’d expect after the results of the catheter test Leo had yesterday. As you already know, that hole in the ventricular septum hasn’t closed nearly as much as we would have hoped by this stage.’ He glanced up at the X-ray illuminated on the wall of the ward’s small consulting room. ‘Leo’s heart is increasing in size quite dramatically and so are his pulmonary arteries. We don’t want that to continue. He’s getting more symptoms now, too, isn’t he? Despite his medications being increased?’
Leo’s mother nodded. ‘Ever since he started walking. He gets breathless very easily and he’s always so tired.’ She caught her husband’s gaze. ‘We were really hoping to avoid the surgery, though. Especially just now, with the new baby coming.’
‘When are you due?’
‘I’m thirty-six weeks now. And I may need a Caesarean. The baby’s breech. They’re talking about a procedure to try and turn it next week but there’s no guarantee it’ll stay that way. And if I have a Caesar it’ll make everything that much harder, and if Leo’s not well I just don’t know how I’d cope.’ She bit her lip and her hold on Leo must have tightened enough to transmit her tension because the toddler stuck out his bottom lip and wriggled determinedly free.
He went straight to Holly and held up his arms. ‘Wiggle, wiggle!’
Holly grinned and a moment later Leo sat in her lap, happily playing with the end of her stethoscope. His mother watched him for a moment, fighting tears, and then she looked at her husband and they both smiled again.
The message was very clear. Holly had won their son’s trust. Who were they to argue?
Ryan was equally reassuring. ‘If Leo has his surgery now, he’ll be a lot less of a worry by the time the new baby arrives. Kids bounce back from this kind of surgery astonishingly well. He’ll be up and running around within just a few days.’
Details regarding the necessary surgery were discussed and consent forms even signed, with no hint of further tears, and Ryan knew that his registrar was largely responsible for leaving the small family relatively happy to settle back into the ward and ready to face the biggest hurdle in Leo’s life so far.
They finished their afternoon by checking Callum’s progress again in the intensive care unit. While Holly went through the process of reviewing every parameter and noting their satisfactory levels, it was clear she was at the very end of her physical tether.
When they turned to leave, Holly seemed to lose her balance. She swayed on her feet and might well have fallen if Ryan hadn’t taken a firm grip of her elbow. Thank goodness he’d been standing so close.
It was a momentary lapse. Holly pulled free a second later, probably before anyone else had noticed what had happened, and she walked ahead of Ryan as they left the unit. He said nothing until they were alone in the corridor but something did have to be said. This was the opportunity Ryan had been waiting for.
‘My office,’ he commanded. ‘We have to talk, Holly. Now.’
Holly sat amidst the clutter of stacks of journals and case notes in his office, looking as though an axe was about to fall, and Ryan realised that she was expecting some kind of rebuke for her physical failings. It was time she knew just how far from the truth that was.
‘You’re amazing, you know that?’
A flush of colour stained her cheeks. ‘Maybe I’m just stubborn. I don’t like giving up.’
‘I’m not talking about the way you cope physically, Holly, although, God knows, that’s extraordinary enough. I’m talking about you professionally.’
‘You mean this morning? In Theatre?’
‘No.’ Ryan had to smile. ‘But, there again, your talent as a surgeon is pretty outstanding.’
Holly looked nonplussed and Ryan’s smile faded. He cleared his throat. There was a lot he’d like to say right now but this wasn’t the time or place. He knew he had to tread very carefully here.
‘I’m talking about the rapport you have with people,’ he said. ‘The way you can win their trust and calm their fears. You have a natural ability to deal with aspects of patient care that no surgical techniques or drugs could ever hope to touch. I suspect a lot of it has come because of what you’ve had to go through yourself but it’s a gift, Holly. An art. One that needs to go hand in hand with science to achieve the kind of patient outcomes we strive for.’
‘Um…’ Holly seemed lost for words. Then she gave an embarrassed chuckle. ‘Gosh, Ryan—this wasn’t at all what I was expecting you to say.’
‘What were you expecting?’
‘That you were going to say that a career as a surgeon and living on dialysis were just not compatible. That my physical limitations were becoming way too much of a burden.’
Ryan nodded slowly. ‘You were right. I am going to say that.’
It didn’t seem possible for Holly’s face to become any more pale but it must have done to make those dark eyes seem so huge. Ryan had to grit his teeth against the pain he knew he was causing.
‘But I wanted you to know where I was coming from before I said that,’ he explained gently. ‘For you to know just how highly I value you as part of my team. And that, if I can help it, I have no intention of losing you.’
Her face was utterly still, her head held high on a long, slender neck. Ryan could see the ripple of muscle as she swallowed with apparent difficulty.
‘I have no intention of losing me either.’ What started as a valiant smile went distinctly wobbly around the edges. ‘What do you suggest?’
‘A transplant,’ Ryan said promptly.
Her breath came out in a huff of something very close to despair. ‘Yeah…right. I’m working on it. See?’ She held up a hand, the fingers crossed. Her words had a faint and alien ring of bitterness. ‘Not much more I can do, is there?’
‘Yes,’ Ryan contradicted calmly. ‘There is.’
Holly stared at him as though he was speaking a foreign language. ‘Like what?’
‘Like considering a living donor for a transplanted organ instead of a cadaveric one.’
Holly shook her head wearily. ‘I’ve been down that track as far as it goes.’
‘And?’
‘And nothing. My mother died when I was ten, from the same kidney disease I have. My father’s diabetic. My brother’s not interested. Or, rather, he could be but he has a morbid fear of hospitals and illness and he’s avoided talking about anything to do with my kidney disease ever since I was diagnosed.’
‘What about other relatives? Friends?’
‘I don’t have any other close relatives and it’s certainly not something I’d ask a friend.’
‘What if the friend didn’t need to be asked? If they