CONSULTANT NEONATAL SURGEON Emilia Gonzales strode along the indistinguishable hospital corridor, her head held high as if she knew exactly where she was going. No one would guess it was her first day—new job, new hospital, new country.
Battling nerves and a raft of other unsettling emotions, she followed the signs for Theatre, scanned her security pass and entered the operating suite. Faced with another corridor, she tried to orientate herself to her surroundings.
She’d been given a tour when she’d come to the Hospital General de Buenos Aires for her interview earlier in the year. She was used to working in leading tertiary referral hospitals in her native Uruguay, but the General was four times the size of its counterpart in Montevideo. And she couldn’t help but be distracted by the painful dull throb of her heart.
Her late husband, Ricardo, had been born in this very hospital. Despite five years of widowhood, Ricardo was always in her thoughts. How was she supposed to work here, be back here in Argentina, and not be constantly reminded of the loss of the love of her life?
Emilia breathed through the now familiar grief, pulling herself together. This new job represented a fresh start for her and her daughter, Eva. Eva had wanted to attend the same university as her father, and Emilia was happy to facilitate and support all of Eva’s dreams. She just wished this particular change could be less triggering.
‘Are you lost?’ A man spoke from behind Emilia, making her jump.
She turned, and found herself eye to chest with his tall, athletic frame and looked up. With dark hair sprinkled with grey and deep brown eyes, her rescuer’s friendly smile immediately set Emilia at ease.
‘Is it that obvious?’ she asked with a smile of her own. ‘I was hoping to hide it better. It’s my first day.’ And she had a surgery to get to.
The tall and helpful stranger glanced at her brand-new name tag, his expression shifting from mild curiosity to pleasant surprise.
‘Ah, you’re Dr Gonzales,’ he said, his smile widening. ‘Our new neonatal surgeon. I’ve been expecting you.’
‘Sorry if I’m late,’ Emilia said with a wince. That was no way to make a good first impression.
‘Not late at all.’ He offered his hand. ‘I’m Felipe Castillo. Welcome to the General.’
Emilia shook his hand, momentarily thrown by his welcoming manner and the confidence of his relaxed smile. They’d never met before, but she knew Felipe Castillo was a senior neonatal surgeon there. Not only was he jointly responsible for the patient Emilia was in Theatre to meet, he was also Emilia’s clinical supervisor, until her full registration with the Argentine Medical Council was granted.
‘Please, call me Emilia,’ she said, sliding her hand from Felipe’s warm and sure grip, her nerves intensifying.
They were a similar age, both in their fifties, but Felipe would be overseeing all her surgeries for a probationary period of three weeks. As a mother, Emilia had taken a little longer to train, what with maternity leave, years of part-time work while Eva had been small and then time off on compassionate leave during the two years Ricardo had been ill.
Only she hadn’t expected her clinical supervisor to be so...attractive—setting her heart aflutter and raising her body temperature. After losing Ricardo, she’d assumed herself immune to physical desire, but no, her body seemed to be fully back in business. Her stare furtively dipped to his left hand, confirming the absence of a wedding ring, but his marital status was irrelevant.
As she’d told Eva again and again, she wasn’t interested in dating. It seemed too hard and pointless as well. She’d had the great love of her life, and she had no intention of looking for love again.
‘I’m looking for Theatre Six, the Lopez case,’ she said. ‘I assume that’s where you’re heading, too, seeing as we’re going to be working together for a few weeks.’
‘I am.’ Felipe nodded and gestured with an outstretched arm. ‘Allow me to show you the way.’
Emilia gratefully fell into step at his side, ignoring the sexy surgeon’s swagger and how good he looked in the hospital’s shapeless, green scrubs. She rarely noticed a member of the opposite sex, but when she did it still somehow felt as if she were cheating on Ricardo.
But then, they had been married for over twenty years. Sometimes, when she remembered that he was gone, she had to catch herself. It was as if half her heart was missing.
‘So you’re from Uruguay?’ Felipe asked, glancing her way with obvious interest. ‘What brings you to Buenos Aires?’
Emilia sucked in a breath. She’d known this line of questioning was inevitable. Consultants her age, the wrong side of fifty, rarely shifted hospitals, unless it was for personal reasons. And there was nothing more personal to Emilia than her beloved daughter, Eva.
‘My late husband was Argentine. He was born in this hospital in fact,’ she said, her voice tight. It often was when she talked about Ricardo. ‘Our daughter wanted to go to university here, so I thought I’d make the move, too, as it’s just the two of us. My parents died a few years ago, so there’s no family keeping me in Uruguay.’
She trailed off, aware that she might be viewed as an over-protective mother. She had no intention of smothering Eva, but her eighteen-year-old daughter was all the family Emilia had left. It made sense to at least reside in the same country in case of emergencies, and to emotionally support Eva.
But she was thrilled that Eva would be able to spend more time with her father’s side of the family. Losing her father at the age of thirteen, Eva had been through a lot. There’d been times during the past five years where Emilia had worried for her daughter’s mental health—she’d seemed so sad and withdrawn.
‘And why not?’ Felipe’s easy smile widened. ‘Why should the youngsters have all the fun?’
‘Quite.’ Emilia heard herself laugh, the sound high pitched and a little strained. Since Ricardo’s death, there’d been little time and even less inclination for fun. What with raising a teenager solo and maintaining her busy and demanding career, Emilia often reached the end of another week exhausted and faced with the realisation that, yet again, she’d inadvertently put herself last.
‘Buenos Aires is a great city,’ Felipe continued, with enthusiasm. ‘You’ll both love it here, I’m sure, once you’ve settled in.’
Emilia stayed silent. Settling into a new life, a new home and new job would be no mean feat. But as long as Eva was happy, she’d be happy.
Just as they rounded the corner to Theatre Six, their pagers sounded in unison with an urgent call.
‘Looks like we made it in the nick of time,’ Felipe said, silencing the alarm.
They hurried into Theatre Six’s scrub room and passed their pagers to a theatre technician. Felipe reached for a theatre hat and mask and Emilia did the same.
‘Nothing like a little excitement to start your first day,’ he added, switching on the water over the sinks and vigorously washing his hands.
Emilia laughed. ‘If you say so.’
Tamping down her adrenaline with some deep breaths, she glanced into the theatre as she joined him at the sinks. Through the glass, they had a bird’s eye view of the brightly lit obstetrics’ theatre. Isabella Lopez was already gowned up and surrounded by the delivery team, and a man Emilia assumed was Sebastian Lopez, her husband.
‘So, a few weeks ago, the smallest of the Lopez triplets was prenatally diagnosed with a congenital diaphragmatic hernia, using foetal MRI scanning,’ Felipe said, bringing her up to speed on the case as they scrubbed up, side by side.
Emilia nodded, working a scrubbing brush under her nails. ‘I came in early to read the case file. I understand you performed a fetoscopic endoluminal tracheal occlusion at twenty-seven weeks. That’s impressive in a multiple pregnancy.’
He raised his eyebrows over his mask. ‘You’ll see I’m not a shy surgeon. But the parents, Isabella and Sebastian, are both emergency doctors here at the General, so they were happy to consider the procedure. They want the best possible outcome for all three babies, so together we weighed the pros and cons of the FETO. Hopefully the gamble paid off.’
‘I met Isabella Lopez when I came for my interview in January,’ Emilia said, briskly scrubbing her hands and arms.
She’d immediately clicked with the other woman, who, along with her husband, ran the emergency department at the General. And after their difficult fertility journey, she knew how much the couple wanted these three miracle babies that were about to be born. At nearly thirty-one weeks gestation, all three Lopez triplets would need to spend some time on the neonatal intensive care unit, or NICU, and the smallest baby also faced surgery to correct the defect in the diaphragm.
‘Right, let’s go meet the Lopez triplets,’ Felipe said, turning off the taps and using his back to push through the door into the operating room.
Three resuscitation tables for newborns were set up to one side of the room, each warmed and awaiting a baby. A cluster of neonatal registrars and nurses waited nearby, expressions tense.
Emilia glanced over at Isabella, trying to send her calming positive vibes from behind her mask. The birth of a child was always emotional, but when the babies were premature and one needed surgery, it might be overwhelming for the couple.
After being assisted by scrub nurses into surgical gowns and sterile gloves, Felipe and Emilia nodded to the Lopezes and joined the obstetrician performing the elective caesarean section.
The first two babies were delivered, one after another. Their umbilical cords were clamped, and they were quickly whisked away by the neonatal team. Each baby was placed on the resuscitation table’s heated mattress. The neonatal nurses gently dried the newborns with a towel and cleared their noses of mucus with a small suction tube.
‘Apgar is nine,’ the registrar caring for the first triplet said.
Emilia breathed a sigh of relief and glanced at Felipe, who nodded. The oldest Lopez baby had a low birth weight but was breathing spontaneously, had a good skin colour and normal reflexes, his condition stable enough for transfer to the NICU. The baby was wrapped up and carried over to Mamá and Papá for a quick cuddle.
At the next resuscitation table, triplet number two was being assessed by a second registrar. While slightly smaller than his brother, baby two was mewling loudly, his tiny pink face scrunched up in outrage.
‘Apgar is ten,’ the neonatal nurse said, wrapping him in a sheet and scooping him up for a few seconds of skin-to-skin contact with his parents.
Emilia smiled under her mask at Isabella and Sebastian’s joy. But there was still one more baby to deliver. As the obstetrician delivered the head of the third and smallest baby, the atmosphere in the room changed.
‘Syringe,’ Felipe asked, holding out his hand.
The tube blocking the baby’s airway, which had kept the lung expanded as the baby developed in utero, needed to be removed before the umbilical cord was cut, as it was essentially breathing for the baby via the placenta.
Emilia had only seen the FETO procedure a handful of times, so she was glad for Felipe’s greater experience in this instance. Felipe quickly deflated the balloon and removed the endotracheal tube from the baby’s mouth. The delivery of the third Lopez baby was completed and the cord clamped as usual. Except unlike his brothers, baby three was limp and silent, his skin grey with cyanosis—a lack of oxygen.
Moving quickly, Emilia and Felipe carried the baby to the third resuscitation table, which had been set up in a screened off area with dimmed lighting.
While a nurse suctioned mucous from the mouth and nose, Emilia gently dried the baby with a towel to stimulate spontaneous respiration. Urgency shunted her pulse through the roof. She reached for the neonatal resuscitator, just in case the third triplet failed to start breathing on his own.
Those couple of seconds, during which the baby made no respiratory effort, felt endless. Emilia willed him to make it, her stare flicking to Felipe’s.
‘There’s a heartbeat,’ Felipe said, removing his stethoscope, ‘but little respiratory effort. We already know from the scans that the left lung is hypoplastic.’
Emilia nodded, quickly but gently inflating the baby’s underdeveloped lungs with the resuscitator. The third Lopez baby was struggling to breathe unaided. Because of the hole in the diaphragm, abdominal organs had herniated into the chest and prevented the left lung from growing. Felipe had mitigated some of the pressure on the developing lungs with the FETO procedure, but the underdeveloped lung was still smaller than normal.
Emilia placed electrodes on the newborn’s chest, her relief mounting when the heart monitor picked up a normal trace.
Their eyes met over the tops of their masks. ‘We still have sinus rhythm,’ Emilia told him.
Felipe nodded, his thoughts likely matching hers. For the time being, the smallest Lopez baby would need to be ventilated until they could close the diaphragmatic defect and give his lungs the space to grow.
‘I’m going to intubate,’ Felipe said, reaching for a laryngoscope and endotracheal tube. ‘Then we’ll transfer him to the NICU.’
With the intubation complete, Emilia passed a nasogastric tube into the baby’s stomach to empty it of any contents and take the pressure off the baby’s tiny lungs, which were already compromised by the herniation of small bowel loops into the chest.
As the baby’s oxygen saturations climbed into the normal range, Felipe inserted an umbilical vein catheter into the cord so they could administer fluids, drugs and easily take blood samples. They worked together as if they’d been doing it for years, each of them anticipating the other’s moves and assisting where required.
Once they had the third triplet stabilised, Emilia glanced at Felipe. ‘A quick hello to Mamá and Papá and then up to NICU?’
Felipe nodded, peeling off his gloves and mask. ‘Let’s reassess him this afternoon, but he’s booked for surgery in two or three days, as long as he remains stable. The sooner we can close that hole in his diaphragm the better.’
As Isabella was still on the table being sewn up from her C-section, Felipe and Emilia carefully wheeled the mobile resuscitation table over to the parents.
‘We knew from the scans that the left lung was small,’ Felipe explained to Isabella and Sebastian, who were understandably tearful and overwhelmed, ‘so I’ve placed baby three on a ventilator, to help him breathe.’
‘We’ve decided to name him Luis,’ Sebastian said, gently taking his wife’s hand so together they could reach out and touch their son’s tiny curled fist.
‘We’re taking Luis to the NICU,’ Emilia said, trying to sound reassuring, although they all knew the situation was serious. ‘As soon as you’re ready, you can see him and his brothers there. Try not to worry.’ She met Isabella’s stare. ‘We’ll take the best of care of them.’
Isabella nodded, tears seeping from the corner of her eye as she reached out and squeezed Emilia’s hand. From one mother to another, Emilia heard what was being left unsaid: Take care of my babies while I can’t.
‘Congratulations on the birth of your sons,’ Felipe added, resting his hand on Sebastian’s shoulder, as if he too was aware of the turmoil and concern of the new parents. ‘What a blessing.’
While the registrar and neonatal nurses whisked Luis upstairs to the NICU, Felipe and Emilia de-gowned, tossing the garments into a dirty laundry bin outside Theatre Six.
Emilia sagged a little, releasing an audible sigh as most of the adrenaline left her system. ‘Well, that was an eventful first morning.’
Felipe nodded, one side of his mouth curling up in a charming smile. ‘Now that the excitement is over, let me show you the most important room in the department, in case you get lost again.’
Emilia ignored the return of the silly flutter in her chest at how attractive and charming he was. It made no difference. That Felipe was so friendly and welcoming was nice, given they’d be working so closely together, but it also left her strangely unsettled. She wasn’t used to male attention, not that he was overtly flirting. Would she even know what flirting looked like, having been off the market for so long?
‘I hope it’s the coffee room.’ She laughed, smoothing her hat-flattened hair back from her face. ‘I may not know my way around the rest of the hospital yet, but when I came for my interview, I made sure to ask for directions to the nearest coffee machine.’
‘A woman with priorities,’ he said with that confident smile that put her at ease, but also sped up her pulse. ‘Although there’s only instant in the break room. For the real thing, espresso, the best place to go is Café Rivas, upstairs in the foyer.’
‘Oh, I definitely need the real thing to get through my first day.’ Instant coffee just wasn’t going to cut it.
‘In that case,’ he said, ‘why don’t I show you the way?’
‘Great, thanks.’ She followed him from the suite of theatres and up the stairs. She’d have to find her way around the hospital without his help soon enough. But, for now, there was no harm in accepting a guided tour from a supportive and approachable colleague.
‘Café Rivas has an app so you can pre-order drinks without waiting in line,’ he said, pushing through double doors at the top of the stairs.
‘Uh-oh,’ she said, waggling her eyebrows, ‘that sounds dangerous.’
‘Very,’ Felipe agreed, holding the door open for her to pass through. ‘Although I won’t tell if you don’t. It will be our little secret.’
Emilia couldn’t help but smile, even as she felt her barriers rising. Charming, a fearless surgeon and hot. Never mind the easily accessible coffee being dangerous—she’d have to be very careful around Felipe Castillo.