‘I’ll be scheduling that surgery within the next two days but we need earlier intervention to ensure immediate survival so shortly I’ll undertake a nonsurgical procedure to create an arterial septal defect, using a balloon catheter. Essentially we will open a small hole in the heart to allow the blue and red blood to mix and provide sufficient oxygen to the newborn.’
‘How did you diagnose the condition so quickly?’ Jon asked with interest.
‘The mother has been under the care of Dr Nate Hopkins in Sydney. He’d planned the C-section for next week but they travelled here yesterday for some family function and labour ensued. The condition was detected at the twenty-week scan. Thank God she didn’t go into labour somewhere along the Hume Highway or we might not have had the same prognosis for mother or child.’
Just then the swing doors opened and the tiny child was wheeled in on open bed. Tristan looked up to see Flick standing in scrubs beside the infant. He caught her glance and held it. He couldn’t ignore the look of pain and disappointment in her beautiful blue eyes. But there was no anger. That seemed worse to him. He fought the strongest urge to throw his gloves, gown and surgical cap to the floor and pull her into his arms. But he reminded himself sternly that it was not himself that he was protecting. It was her.
‘The vernix has been wiped clear from his abdomen and suction of mouth and nasal cavity done,’ Flick said, as she handed over the care of the baby, wrapped loosely in green sterile sheeting, to the Theatre nurse, then left without looking back.
Tristan hated that it was over between them and that one night would be all they ever shared, but there was no other way, he reminded himself as he refocused on the tiny child who now needed him. An infant who would be facing a childhood much like his own if this surgery was not successful.
The radiographer continued the Theatre tutorial for the student. ‘I’m providing the two-dimensional transthoracic echocardiography. Essentially this is live imaging of the child’s heart to allow Dr Hamilton to monitor the catheter’s positioning during the procedure.’
‘The procedure can also be of potential benefit in patients with other severe congenital heart defects. I can explain them later if you’d like,’ Tristan added, as he watched the Theatre nurse unwrap the sterile covers and wash the baby’s abdomen with antiseptic solution.
‘Today I’ll be using the umbilical vein as an access. This simplifies this procedure dramatically. It can be performed at the bedside in the neonatal intensive care unit but as the infant was down here I chose to do this immediately before the transfer to NICU. I also prefer sedation to general anaesthesia if possible.’
Jon stepped a little closer. ‘If the condition hadn’t been identified at twenty weeks, due to poor antenatal monitoring, how would you diagnose the condition after birth before it was too late to reverse the condition for the newborn?’
‘The symptoms would be detected by the neonatologist or the nursing team. The child would present as unusually quiet, he or she wouldn’t wake, and they would have a low pulse ox test. All the indicators of a congenital heart condition, so I would be called to consult immediately.’
‘Ready to go,’ the radiographer announced.
‘I’m set too,’ said the paediatric anaesthetist.
Tristan nodded and began the intricate procedure, talking the medical student through each step. ‘We’re now in the right atrium, as you can see on the echocardiography. I will now thread the catheter into the foreman ovale, the naturally existing hole between the atria that normally closes shortly after birth.’ Tristan watched the screen to ensure the catheter was positioned correctly.
‘Now I will inflate the balloon with three to four mils of dilute radiopaque solution to enlarge the foramen ovale enough that it will no longer become sealed. This allows more oxygenated blood to enter the right side of the heart where it can be pumped to the rest of the body. To ensure that there is flow, I am now locking the balloon. I will now carefully but sharply withdraw into the right atrium to create a permanent flow.’
Tristan continued his explanation of the procedure and repeated the manoeuvre three times before he then deflated the catheter and removed it completely.
‘We can monitor the effectiveness directly via the echocardiography,’ he said, pointing to the monitors. ‘But it’s clear there’s been a sharp rise in systemic arterial saturation so we’ve been successful. This little chap will be good to go until we can schedule his major operation in the next two days.’
Tristan and the medical student stepped away as the nursing team prepared the baby to be transferred to Neonatal Intensive Care. He was pleased that the stunned-deer expression had slowly disappeared from the young man’s face and he appeared more at ease. After agreeing that Jon could scrub in on the arterial switch repair surgery, he invited the student to accompany him to visit with the parents once the mother had been released from Recovery and returned to the maternity unit ward. It was equally important to Tristan that the bedside manner of medical students was developed at the same time as their technical skills.
Tristan then headed to Neonatal ICU to brief the nursing team before he went back to his office to finalise some paperwork and grab some lunch. He had an afternoon of hospital rounds and consults, so he needed to eat something substantial.
Flick paced the corridor outside Tristan’s office nervously. She had taken a break after she’d visited a new mother in MMU with Sophia. Flick loved shadowing Sophia and was learning so much about the spectrum of roles within midwifery but that day she felt removed from what was happening. She hadn’t liked the feeling of not being in the moment during the birth. It was what she loved more than anything but that day her mind and her heart were weighed down by what she needed to say to Tristan.
This was her career and she would not allow Tristan to take that away from her. She would get through her personal issues because she loved what she did. She loved it all—the antenatal care, the birth and the postnatal assistance. She wanted to be a community midwife and spend more time in the field in the future.
But first she had to speak with Tristan. She had made her decision after two weeks of deliberation. She couldn’t delay it any longer.
Finally, after taking a deep breath, she knocked on his door.
‘Come in,’ Tristan called, trying to swallow a mouthful of his sandwich as he checked his incoming emails, some of them spam from pharmaceutical and medical supply companies.
Flick’s legs were shaking like leaves in the breeze as she entered his office. She looked across the room at the man who had made love to her on that fateful night and she knew immediately that there was no regret in her heart. No anger. And definitely no blame, as she had willingly invited him into her bed.
‘Flick.’ He was stunned and his voice didn’t mask his surprise at seeing her in his office. She looked even more beautiful. She had a glow, he thought as she stood before him in her shapeless hospital scrubs. He knew underneath she had the most gorgeous body but her beauty went so much deeper than that. She had a wonderful, warm spirit and the fact they couldn’t be together ate him up inside.
It took less than a minute, with Flick standing so close, to realise that his feelings for her were real and that made it so much harder to keep his distance. It tore at him that he couldn’t act on his feelings, to cross the room and kiss away the last three months. As much as he wanted to, he couldn’t let it happen. He needed to stay in control. She deserved so much better than the problems he could bring into her life.
Resolutely he knew he must deal professionally with whatever hospital matter she had come to discuss and then pretend she had never been within his arms’ reach.
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