The Surgeon's Perfect Match

‘We don’t get a transposition very often, do we?’

‘Fortunately, no.’

‘Surgery won‘t need to be immediate, will it?’ The physical demands of the rest of Holly’s day were suddenly looking rather more manageable.

‘No, but it’s usually done within the first week or two of life, before the left ventricle becomes unable to handle systemic pressure. If it’s severe enough, they’ll need an interim measure to improve the cyanosis.’

‘A Rashkind procedure?’ Holly had no difficulty in sounding more than interested.

‘Ever seen one?’

‘No.’ Any residual despair at having her own physical weakness demonstrated so recently was chased away by excitement. ‘I’d love to, though.’

‘How much do you know about it?’

‘It’s designed to allow the systemic and pulmonary circulations to mix, isn’t it? They thread a double lumen catheter into the left atrium via the umbilical vein. A balloon gets inflated with contrast medium and then pulled back through the atrial septum to create a tear.’

‘Mmm. Strange business, this, isn’t it? We spend half our morning repairing a septal defect and our cardiologist colleagues might well spend half their afternoon creating one.’ Ryan was smiling at Holly. ‘I take it you’d like to go and watch if it goes ahead?’

‘Oh, could I?’

‘Absolutely. Good learning experience for you. To be honest, I’d quite like to go and watch myself.’

‘What about rounds?’

‘We’ll fit them in. We’ve got a consult to do in the ward as well. Another VSD who’s developing pulmonary hypertension.’

‘How old?’

‘Eighteen months.’

‘Is that Leo?’

‘Don’t tell me you’ve seen him already?’

‘Not as a patient. He’s been in the ward for a few days, though.’ Holly’s smile was a little embarrassed. ‘He was part of that hide-and-seek game you caught me playing yesterday—when I should have been writing up those discharge notes.’

‘You stayed far too late yesterday catching up on them. It’s no wonder you’re tired today.’ Ryan paused as they reached their destination of the neonatal intensive care unit. ‘And we’re giving ourselves a very busy afternoon.’ He held Holly’s gaze. ‘Are you up to it?’

‘I’m not about to fall asleep again, Ryan.’ Damn, this could provide another lead-in to that talk Holly really didn’t want to have. Her chin came up. ‘Of course I’m up to it.’

It was a struggle, anybody could see that, but there was no way Holly was going to admit defeat. She’d push herself until she fell over, Ryan observed with concern. No matter how hard it might be, she simply couldn’t help herself going the extra mile.

Like the way she sat with baby Grace’s shocked parents and drew them a diagram of what had gone wrong with the development of the arteries in their infant’s heart because they hadn’t been able to take it in the first time around with the cardiology team.

‘So the aorta, which takes the blood from the heart to the rest of the body, is attached to this part of the heart on the right side, do you see? And that’s where the pulmonary artery should be. So it means that the blood that’s getting the oxygen from Grace’s lungs isn’t getting to the rest of her body, which is why her lips and fingers look so blue.’

Grace’s father looked desperate to both understand and find a way to help his family. His tone was belligerent.

‘It can be fixed, though,’ he demanded. ‘That’s right, isn’t it?’

Holly’s smile both accepted the anger being directed at her and gave reassurance. ‘When we operate, what we’ll do is attach the arteries to the ventricles they should be attached to.’

‘Why can’t you do that right now, instead of that thing with the balloon they were talking about?’

‘It’s a major operation. We need to make sure Grace is strong enough and there are a few more tests we’ll need to do before surgery.’

The baby’s mother sat hunched in a wheelchair beside the incubator, her face pale. ‘Can I stay with her?’

‘Of course you can. The nurses will show you how you can help care for her. The procedure this afternoon shouldn’t take too long.’

‘Will you be there?’

‘Yes. Don’t worry, we’ll all take very good care of Grace.’

Donning a lead apron so that she could stand close enough to touch the baby during the procedure in the catheter laboratory instead of observing on the screens in the technicians’ area meant that Holly put ten times as much effort into that session than she needed to, but Ryan wouldn’t have dared suggest that she took things easier.

His registrar was already building a bond with both this tiny patient and her parents that would make the upcoming surgery less traumatic for everybody. That kind of bond was automatic when Holly was involved. The huge grin she got from Leo when they slotted that consultation in during their ward round was another example.

The toddler sat on his mother’s knee initially as they examined the child, which wasn’t all that easy because she was heavily pregnant. It was Holly who listened to his heart. She showed Leo the end of her stethoscope before approaching him. She wiggled it. ‘This is Silly Snake,’ she told Leo. ‘He likes tickling people and he wants to wiggle under your T-shirt. Shall we let him do that?’

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 offered?’

‘It’s not exactly minor surgery, Ryan, having a kidney removed. It would be taking a risk with their own life and future health with no guarantee that it’s going to have the desired result. Who would put themselves through that?’

‘Somebody who cares.’

Holly snorted without mirth. ‘The last person that was supposed to care couldn’t wait to get away as soon as I had to start dialysis. Even if I’d had the energy to try another relationship, I doubt that I would have taken the risk.’

‘I know someone,’ Ryan said quietly.

A curious stillness settled onto the small room that was Ryan’s office. The busyness of the hospital on the other side of the closed door could have been worlds away. Sounds that had already been muted seemed to fade away so much that the proverbial pin would have dropped with a clatter. Holly’s whisper sounded weirdly loud.

‘Who?’

Ryan Murphy licked suddenly dry lips. He leaned forward a little, closing the gap between them, and held Holly’s wide-eyed gaze with his own, as carefully as his hands would have cradled a newborn infant.

‘Me.’

CHAPTER TWO

HOW could a single word be that stunning?

The shock was enough for Holly to be aware of nothing but the echoes of that word reverberating in her brain. Her head swam and she closed her eyes.

Breathe, she told herself implacably. Do not faint in front of your boss. Do not make his impression of your physical capabilities worse than it already is.

Nothing had ever been this unexpected. This unsettling. Certainly not the diagnosis of the illness that had brought her to this point in her life. Holly had been monitored carefully from the moment her mother had been found to have had an advanced case of renal failure and her own deterioration to the point of needing dialysis had been far too slow to shock her. Holly had finished medical school and launched herself into a meteoric rise to senior surgical registrar status before that had happened. Even her brother’s horror at the idea of being approached as a donor hadn’t been unexpected, given how badly he’d coped in the final stages of their mother’s illness.

But this…That one word suggesting that Ryan Murphy was prepared to offer one of his own kidneys was so far out of left field, Holly had nothing on which to anchor her reaction. It was, simply, stunning.

Ridiculous but stunning.

She had no idea how much time had passed before she opened her eyes again. Seconds? A minute or more? Nothing had changed. Ryan was still watching her with an expression she couldn’t read. Compassion was there, of course, but it always was to some degree. What she couldn’t pin down was what was mixed in with it. Hope? No, that couldn’t be right. Resignation was more likely. Something had to be done about Holly Williams and this was Ryan just trying to help her out—yet again.

And now Holly had to fight not dizziness but the threat of tears, and as a form of demonstrating weakness they were just as unacceptable as fainting would have been. Holly closed her teeth over the soft tissue on the inside of her bottom lip hard enough to cause pain. She could taste blood but it worked. The prickle of tears was conquered. She even managed a smile.

Ryan raised his eyebrows. He smiled back, a shade tentatively as the silence dragged on, and Holly knew she had to say something.

Nothing sprang to mind.

‘I don’t know what to say,’ she was forced to admit.

‘Say yes,’ Ryan suggested quietly.

Holly looked away. ‘Have you got any idea what you’re offering here?’

‘Of course I do. I’m not stupid, Holly.’

There was an edge to his tone that Holly had never heard before. Ryan was offended.

‘Sorry.’ Holly raised her gaze to find that Ryan appeared not to have moved a single muscle. He sat like a statue, his gaze still fixed on her. ‘It’s an incredibly generous offer and I’m stunned, but it’s totally impossible to even consider.’

‘Why?’

Why, indeed? Because it was simply so huge. It was like, Holly thought wildly, an eccentric millionaire calling in his housekeeper, say, and offering to give her his entire fortune. A gift that would enable her to live the kind of life she’d always dreamed of.

Except that this gift wasn’t money. It was a body part. Something so personal, the thought of even considering acceptance made something within Holly cringe in agonised embarrassment. But how on earth could she tell Ryan that without causing further offence?

‘For one thing,’ she said carefully, ‘it’s highly unlikely we’d be compatible. As I told you, my blood group is O.’

‘So’s mine.’

‘So are forty-five per cent of the population, Ryan. But I’m not rhesus positive. I’m negative. That takes it down to seven per cent. One in sixteen people. Unless the situation is desperate, they’re not going to go for anything less than a perfect match.’

‘I’m O negative.’

Holly couldn’t afford to let that tiny ray of hope in. This was ridiculous. ‘And then there’s tissue and crossmatching. It can look like a perfect match and then they put it together and get some horrible rejection reaction.’

‘We’re compatible, Holly,’ Ryan said calmly. ‘I’ve already checked it out.’

‘What?’ This was another surprise. Another disturbing one.

‘I’ve had the initial tests done already.’ Ryan sounded almost smug—as though he was producing his trump card.

‘Doug said that if I’d come in dead I would have been considered a perfect match for you.’

‘Doug?’ Holly needed to confirm what she was hearing here.

‘Your renal physician,’ Ryan said unnecessarily.

‘You’ve been talking to Doug about this…behind my back?’ Holly’s tone was measured, perfectly calm, but Ryan blinked, clearly disconcerted.

‘Well, I didn’t want to make an empty offer.’

‘So you’ve ticked all the boxes and got it all planned.’ Holly was still trying to assimilate the astounding information. ‘Have you talked to anyone else about this?’

‘I…ah…had a word or two with a transplant surgeon, just to see how much time off work I’d need to organise.’

‘And?’

‘Two or three weeks max. Less if it’s done with keyhole surgery. No heavy lifting for six to eight weeks but that’s not a worry with our jobs. I reckon we could both be back on deck within three weeks.’

‘You didn’t pencil in a date for surgery, by any chance?’

‘Of course not! Why would I do that before I spoke to you?’

‘It seems you’ve done rather a lot already without speaking to me.’ Holly’s words were clipped and Ryan couldn’t fail to get the message that she was upset about this.

Holly was more than upset. She felt like the ground had shifted under her feet—that someone else was taking control of her life. She was being offered something she wanted more than anything, but she couldn’t possibly accept. This was cruel, in fact, and a seed of anger blossomed.

‘I’m speaking to you now, Holly.’ Ryan looked puzzled, which was perfectly understandable. ‘I’ve just been waiting for the right opportunity.’ His mouth twisted in a wry smile as he shook his head. ‘I’m sorry. I should have known not to go behind your back. I know how fiercely independent you are and how you’ve managed your illness so far.’ He spread his hands in a gesture of surrender. ‘There aren’t many people who would choose to cope with home dialysis when they live alone. Even fewer people that could manage to keep up such a demanding career. I admire that independence, Holly. It’s a big part of why I want to help. And…’ the smile tilted up at both corners this time ‘…I wanted to give you a surprise.’

‘You’ve done that all right.’ Ryan’s winning smile was impossible not to respond to, but he’d summed up the problem here, hadn’t he? Holly managed alone. She made her own decisions and weighed up the consequences of those decisions very carefully beforehand. Some required a lot of thought. Others didn’t. Her smile faded.

‘You must have realised how impossible it would be for me to accept.’

‘Why?’

‘You’re offering something I wouldn’t even ask a blood relative for. You’re my boss, Ryan. Way above the level of being equal as a colleague. We’re not even…’ Holly searched for a word that could demonstrate the gulf between them in a personal field. ‘Friends,’ she concluded unhappily.

‘Aren’t we?’

Something in his tone made Holly feel ashamed of what she’d said. As though she was rejecting something of great importance to Ryan. But it was easier from his side of the fence, wasn’t it?

‘You’re my boss, Ryan. You’re older and far more experienced than me. You’re my teacher. A mentor.’ In a position of power that precluded anything as levelling as a personal friendship. ‘Our lives don’t touch outside working hours.’ She sighed, staring down at her tightly linked fingers. ‘And I’m a woman, trying to succeed in what is still a male-dominated career path. I’m also trying to cope with a fairly debilitating illness. I resent the limitations it imposes on my life and having to accept help.’ She glanced up again. ‘That’s not to say I’m not enormously grateful for your help. God knows, I’d never have got as far as I have if it hadn’t been for you, but you’ve done enough, Ryan. I couldn’t…wouldn’t accept any more.’

He looked so disappointed, Holly tried to smile.

‘Imagine if it didn’t work? There I’d be still struggling along and you’d know you’d gone through all that pain, not to mention the risks of having a general anaesthetic, for nothing. I wouldn’t be able to work with you any more because I’d feel like such a failure. I’d feel terribly guilty. As though I’d been given a precious gift and I’d just thrown it out or lost it or something. Nobody would blame you for resenting that. It would be way too much of a burden.’

‘There’s no reason to think it wouldn’t work.’

‘So there I’d be with a debt of gratitude instead of guilt. It would still be enough to prevent me ever stepping up and working alongside you as an equal.’ Holly straightened her back. ‘And that’s exactly where I intend to be, one day.’

A silence fell, laced with unpleasant hints of how unlikely that scenario was going to be unless Holly did get a successful kidney transplant. Holly ignored the vibes. She was really no worse off than she’d been yesterday, was she? And tomorrow was another day. She had learned long ago to take things one day at a time. And maybe…tomorrow, even—that pager on her pocket that linked her to the transplant unit would sound and a well-matched, anonymous kidney would be waiting for her.

Ryan nodded slowly, seeming reluctant but resigned to accepting Holly’s point of view. But then he smiled. A real Ryan smile, full of warmth and understanding.

‘Think about it anyway,’ he said softly. ‘Please.’

As if she could think about anything else!

Ryan Murphy was the most genuine, caring person Holly had ever met. He couldn’t have known how disturbing his offer would be because he would never do anything to deliberately hurt anyone. It hadn’t been fair to suggest that their relationship was less meaningful than a friendship because Ryan meant far more than that to Holly.

Far more.

She had the utmost respect for him as a surgeon and the deepest admiration for him as a person. He was, simply, a wonderful man and Holly had wondered on more than one occasion why there wasn’t an adoring wife in the picture. As far as she knew, Ryan wasn’t in any kind of relationship and that certainly wasn’t due to any lack of opportunity. Holly couldn’t fail to notice the way women looked at Ryan and she knew exactly what they were thinking. If Holly had been looking for a perfect partner herself, she’d be thinking the same things. Ryan Murphy would have more than fitted any bill of that type.