Top-Notch Surgeon, Pregnant Nurse

CHAPTER TWO

TWO weeks later, Gabe was staring down at the eight-month-old Fisher twins, lying back to back in their pram, fused occipitally. He was still amazed at the rare phenomenon. One in two hundred thousand live births. And craniopagus? Only two per cent of Siamese twins were joined at the head.

Most doctors could go a whole lifetime and never see this condition but in his relatively young career he’d now seen three sets of craniopagus-conjoined twins and had successfully separated two of them. Consequently, he was one of the world’s foremost experts.

As the late, great Harlan Fallon’s son, the world had expected big things of him, and fate, it seemed, had intervened to ensure that Gabe’s career was just as stellar as his father’s had been. A tremor of excitement ran through him. In approximately four months he could give these precious babies separate lives.

He hoped. Gabe was aware, more than anyone, of the pressures that were being put on him to ensure a third successful operation. With two positive outcomes under his belt and the Fallon reputation at stake, failure wasn’t an option—despite the enormous odds against him. But he’d faced long odds twice already and won. Looking down at the girls now, he hoped his luck wasn’t about to run out.

Bridie babbled away while her sister slept. She smiled a dribbly smile at him and he offered her his finger, which she grasped willingly.

‘She likes you,’ June Fisher commented.

‘Well, I do have a way with women,’ he joked as he allowed Bridie to suck his finger.

‘Oh, yeah, you’re real big with the babes.’ Scott Fisher grinned.

Gabe laughed and they chatted some more about the op. ‘As I explained earlier, the most important thing we can have on our side is time. We’d like to wait until Bridie and Brooke are at least ten kilos before we operate. It’s a big operation and we want them to be as strong as possible. Brooke is almost there but her sister…’ He stopped and smiled down at Bridie ‘…is still lagging behind. We’ll get the dietician involved and hopefully she should be bang on target for her first birthday.’

‘That’d be a great birthday present for them,’ a teary June said. ‘To be able to see each other for the first time.’

Gabe repeated his warning that while they would do everything they could, it was a long, risky operation and there were no guarantees. They could lose one or both of the girls. Or even if they both survived the rigours of the operation, one or both of them could have brain damage. He was particularly worried about Bridie. Her sluggish weight gain indicated she wasn’t as strong as her twin.

‘The team’s going to be spending these next four months practising every step of the operation. I have all the scans, the MRIs and the angiography, and we have 3D images as well as several plastic models of the girls’ heads we’re working with so when we come to operate, every step will have been rehearsed.’

Gabe had been consulted in the Fisher case since their birth and, thanks to the wonders of the internet, had been involved with the planning right from the start.

‘I want you to come along to the weekly case conferences we’ll be having. It’s important to me that the whole team meets both you and the girls so we can all get to know each other. It’ll be a good forum for any questions you may have too.’

Scott nodded. ‘Of course. We’d love to get to know the people who are going to be involved in the girls’ separation. Thank you for involving us. You’ve been great, disrupting your life and career in the UK. We can’t thank you enough, Gabe.’ He gave his wife’s hand a squeeze.

Gabe smiled. ‘Don’t thank me yet. The other thing we need to think about is that, despite everything, we may have to go for an emergency separation if something unforeseen happens.’

‘Yes, we’ve been told that’s a possibility,’ Scott said.

Gabe nodded. ‘It’s obviously something we want to avoid. We want to be able to control as much of the situation as possible so the girls get the best outcome possible. If we have to go for an emergency separation it’ll be because one or both of the girls’ health is failing, and that’s not an optimal condition to be operating under. So keep doing what you’re doing. Feed them up and keep them healthy.’

Gabe chatted with the Fishers for a little while longer and then held open his office door as June manoeuvred the pram out. He waved at them as they walked away, shutting the door as they disappeared round a corner. Two lovely people, parents who would go to the ends of the earth for their children—he hoped he didn’t let them down.

He stood looking at the scans illuminated on the viewing box. The enormity of the task ahead was staring back at him. Two separate but fused brains, tethered together by networks of wispy fibres.

It would take hours, at least twenty if everything went successfully—many more if it didn’t. And involve a team of about thirty people. Several other neurosurgeons, plastic surgeons, vascular surgeons, anaesthetists, radiographers and nurses.

And that didn’t take into account the hours of treatments and scans they’d already endured. A month ago plastic surgeons had implanted tissue expanders under the scalps around the operative site. Every week the twins had came back to have saline injections into the expanders so the skin would be nice and stretched and able to be closed over the gaping surgical wound that would remain after the separation.

Gabe switched off the light and removed the scans. He checked his watch. Three o’clock. His outpatient clinic was over for the day. He had time to go down to Theatres and get some more practice in on the Fisher twin model.

He entered the male staff change room and climbed into a set of theatre greens. He donned a blue hat and tied it securely in place at the base of his skull and covered his shoes with the slip-on bootees made out of the same thin, gauzy material as his hat.

He passed Beth’s office but noticed she was talking to a group of people and didn’t stop. Their relationship had been cordial, strictly business, their night together a taboo subject. Which was just as well. Neither his career nor the Fisher twins could afford the kind of distraction that could flare out of control should they ever cross that line again.

Except as he snapped the scans in place on Theatre Ten’s viewing boards, he realised he did think about her and their night together an awful lot. Too much. Even now, while he was trying to concentrate on the intricate meshing of Bridie and Brooke’s cerebral vasculature, his mind was wandering to the room down the corridor.

Damn it! He turned away from the scans in disgust. In a few short months, maybe less if they were unlucky, he had to separate the intertwined circulation—he needed to focus!

Gabe was good at focus. Focus had got him to where he was today. One of the world’s foremost neurosurgeons. And at work his mind was always on the job. Always. He was driven. Career orientated. Focused. Nothing distracted him. Certainly no woman. And he couldn’t let that happen now.

His father had reached the pinnacle of transplant medicine by never letting anything divert his attention. Not a wife or son or colleagues or a reputation as an arrogant, pompous bastard. Thousands of transplant patients had benefited from the advances Harlon Fallon had pioneered and that was the most important thing. If ever Gabe had felt neglected or had yearned for a little attention, he’d remembered the Nobel Prize his father had won.

His father had made a difference to the course of modern medicine. And that’s what he wanted to do. He wanted to be to neurosurgery what his father had been to organ transplantation. And before his death his father had been proud of him. But he couldn’t rest on his laurels. He’d gained an impressive global reputation, now it was his job to build on it.

Beth stared at the four student nurses standing in front of her. They looked terrified. She remembered how scary and overwhelming it had been when she’d first been sent to the operating theatres as a student and softened her words with an encouraging smile.

She was giving them her usual spiel about her high standards and what she expected of them. The operating theatres were a dynamic environment where one mistake could have serious ramifications—one careless miscount, one accidental contamination of a sterile field. She needed them to be vigilant.

They all looked impossibly young. They were second years. The three young women didn’t look twenty. The young man looked slightly older, maybe twenty-two or three. The same age as her son. Her heart ached just looking at David Ledbetter. He was tall and blond with a dimple in his chin, and she found herself wondering for the millionth time what her own son would look like before she ruthlessly quashed it.

‘OK, then. Time for a tour. Go round to the change rooms.’ Beth pointed to the door through which they’d entered. ‘Put on a set of greens, a pair of bootees and a cap and then knock on my door.’ She pointed to the door on the other side of her office that led into the theatres.

The four of them stood there, looking nervous. ‘Now,’ she prompted.

The students darted from her office and Beth relaxed. For a moment she wished she could be one of those NUMs that she heard the students talk about with affection. The ones who smiled a lot and befriended their students. But she was a little too reserved for that. Her background had taught her to be wary. Detached. So a reticence to get too close or involved was almost second nature to her.

Although Gabe hadn’t had any problems getting past her reserve.

And it was difficult to be chummy when she had to ride them over their sterile technique and lecture them on the necessity of the endless cleaning required to keep the ultra-clean environment of the operating theatres as pristine as possible.

Her job required that she be a perfectionist—patients’ lives depended on it. It was up to her to set standards and see they were maintained. And in the operating theatres, the standards had to be highest of all. Sterility and safety were paramount and the buck stopped with her. There was no place in her theatres for sloppy standards. And everyone who worked in the OT knew it.

Beth had struggled for years over how to bridge the gap between the person she had to be and the less reserved, more outgoing one she’d like to be. And in the end she’d given up. The people who mattered, who had known her for a long time, knew the real Beth beneath the guarded exterior. And she was fine with that.

There was a knock at the door and Beth opened it, stepping onto the sticky antiseptic mat which removed any dirt that had dared to venture into her office and stick to the bottom of her clogs. She gave a brisk nod of acknowledgement.

‘This is the main theatre corridor,’ Beth said, looking up and down, launching straight into it.

‘Down this side are a couple of offices, the staffroom, change rooms and storeroom. On the other side…’ she pointed to the swing doors of Theatre Five opposite ‘…are the ten theatres.’

She strode down the corridor. ‘The theatres are not to be entered from these doors we see here but rather through the anaesthetic antechamber.’

Beth walked through an open doorway into Theatre Eight’s antechamber. ‘The patient is put under anaesthetic and intubated in here.’ Beth indicated the monitoring equipment and stocked trolleys. To the left a double swing door separated the operating suite from the anaesthetic area.

She walked through the antechamber and under another open doorway. ‘This is the room where the surgeons and scrub nurses scrub up.’ The room housed a line of four sinks and it too had a closed swing door to the left which led into the theatre.

‘This door,’ Beth said, walking past the sinks to the far side of the scrub room, ‘leads to the equipment corridor.’ She pushed the single swing door open and indicated for the students to precede her. ‘Basic supplies are kept here. It’s also where the trays of instruments are sterilised prior to each procedure.’ Beth stopped at a large steriliser fixed to the wall, its door open.

‘At the end of the procedure, after all the instruments have been accounted for, the instrument trays come back out here and are passed through this window,’ Beth pointed to the small double-hung opening behind the students.

‘You lift the window, place the tray on the bench and shut it again. This puts the instruments in the hands of the nurses who run the dirty corridor beyond the window. This is the area where the instruments are cleaned, the trays reset and then sent to the central sterilising department.’

Beth drew breath and looked at the students, who all looked like their heads were about to explode with information overload. She saw the lost look on David’s face and her heart went out to him.

‘It’s OK,’ she said, taking pity on them. ‘It’s a lot to take in now but you’ll soon get the hang of it.’

It didn’t seem to help. None of them looked convinced so she kept them moving back out to the main corridor.

‘There are ten operating suites. Two are usually kept free for emergency operations. Today that’s Theatres Eight and Ten. This afternoon in the other suites we have three general surgery lists, two orthopeadic lists, an ENT list, one Caesar list and one gynae. Tomorrow you can go in and observe cases.’

Beth noticed the lights ablaze in the tenth suite as she approached. ‘This is not acceptable,’ she muttered as she strode towards it. ‘I try to run these theatres as efficiently as possible. These big theatre lights are hellishly expensive to run,’ she lectured. ‘Lights must always be out if the suite is not in use.’

Beth entered the anaesthetic area, making a mental note to talk to Tom, the head theatre orderly, about it. It was the orderly’s job to do end-of-day cleaning and that involved turning the lights off.

She veered to the left and shoved the double swing doors open with a shoulder, the students following close behind.

Gabe looked up at the interruption to his concentration. He’d been engrossed in a particularly tricky vessel dissection and was annoyed at the intrusion. Especially as it was thoughts of the woman in front of him that had made it difficult for him to get into it in the first place.