IT WAS ONE of those days.
The ones where there wasn’t a minute to spare and it felt like you had to focus that much harder to ensure that no time got wasted and, more importantly, that no attempt to get as close to perfection as possible got sacrificed by taking short cuts.
The kind of day that Hugh Ashcroft liked the most. When his life was exactly the way he had worked so hard to make it. The fresh appreciation for it after the interruption of taking annual leave only made a pressured routine more enjoyable. Not that he’d been lazing around on holiday. Hugh had only flown back to arrive in New Zealand yesterday afternoon, after delivering a whirlwind lecture tour in several major cities in the United States—a world away from this children’s hospital in the South Island’s largest city.
It was also pleasing to find he had a new, senior registrar assigned to his team. Someone who was already following his own career pathway to becoming a paediatric orthopaedic surgeon. Even better, Matthew was someone who was particularly interested in his own subspecialty of oncology.
‘So I only met this seven-year-old girl yesterday.’ Hugh broke the strings of the mask dangling around his neck and pushed open the doors to the operating theatre they were leaving after the successful pinning of the complicated fracture a teenager had given himself when his skateboarding trick hadn’t quite worked. ‘She fell over in the playground at school and came in late in the day because her leg was still painful. She had an X-ray, which ruled out any fracture, but I got an urgent call to ED.’
Hugh didn’t mention that he had still been in his office at ten o’clock last night, catching up on the paperwork that had accumulated in his absence. It wasn’t anyone else’s business that his work filled the vast majority of his life, was it?
He pulled a clean gown on backwards to act as a coat over his scrubs and looped his stethoscope around his neck. ‘I couldn’t get a slot for CT and a PET scan until tomorrow morning and an MRI is booked for the afternoon but I managed to get a slot in Radiology to do an urgent bone biopsy under ultrasound and they’ll be waiting for us now.’
‘So you think it’s an osteosarcoma?’
‘Certainly looks like it. Huge lesion, just above her knee. Size of an orange. I can’t believe she hasn’t had problems before this.’
‘The family must be terrified. What’s her name?’
‘Sophie Jacobs. And yes, the family is, of course, extremely concerned.’ Hugh headed for the stairs rather than waiting for a lift, shoving open a heavy fire-stop door to the stairwell. ‘Which is why we need to be able to give them answers as quickly as possible.’
He wasn’t quite quick enough to shut down the echo of Sophie’s mother’s voice in the back of his head.
‘But...but she’s just passed her first ballet exam. She lives for her dancing...’
Yeah...‘terrified’ definitely summed up the parents’ reaction he had witnessed last night but Hugh would never use such emotive language. He knew all too well just how devastating a diagnosis of cancer could be for a child and their family.
He knew that, if he let himself, he could be sucked back to a time when another young girl had received such a diagnosis. He would remember realising why the fight for life was called a ‘battle’ and the crippling toll it could take on everybody involved for months. Years, even. And, if he was careless enough, he might also get an unwelcome glimpse of that darkest of spaces when the battle was lost.
But that wasn’t going to happen. Because Hugh also knew that his ability to avoid tapping into the emotions of personal memories was what made him so good at his job that getting asked to be a guest speaker all over the world was now a regular occurrence.
There were plenty of people available to provide the empathy and psychological support that was, admittedly, badly needed, but what seven-year-old Sophie Jacobs and her family needed even more were the specialists like him and his esteemed colleagues in the paediatric oncology team, who could provide the science and skill to follow through on tough decisions and provide the best quality of life for the child in a worst-case scenario and a complete cure in the best.
He was still moving fast as he reached the procedure room in the radiology department, which was another very familiar clinical space for Hugh. A glance at his watch told him he would most likely find his patient on the table with either her mother or father beside her and she might already be sedated and under the care of a team of medics and technicians. He pushed open yet another door and stepped into the room with Matthew hot on his heels.
And then he stopped, so abruptly that his new registrar very nearly collided with him.
Because he was staring at something he’d never seen in any procedure room.
Ever.
‘Can somebody please tell me...’ Hugh Ashcroft kept his voice quiet and he spoke slowly and very clearly so that nobody could miss the significance of what he was asking ‘...why there is a dog in here?’
Uh-oh...
Molly Holmes caught the gaze of the black and white dog sitting by her feet but if her border collie, Oreo, had picked up on the dangerous tone of this man’s voice, she wasn’t bothered. Why would she be, when she was so well trained to cope with anything that could happen in a clinical environment like this? Alarms going off, people moving swiftly, children screaming—none of it would distract Oreo from her mission in comforting and supporting a child. She didn’t even move her chin from where it was resting on a towel on the edge of the bed, in just the perfect place for a small hand to be playing with her ear.
Molly, however, was bothered. Because this was the first time this was happening here and the last thing she wanted was for it to be a disaster. Thank goodness the clinical director of the entire hospital, Vivien Pryce, had chosen to observe what was going on this afternoon and she was smiling as she took a step closer to the person who’d just spoken. Molly would have thought twice about getting that close to someone who looked like a human iceberg but Vivien actually touched his arm.
‘Oreo’s here to help Sophie with her biopsy,’ she said softly. ‘Just give us another moment, would you please, Hugh? I can fill you in then.’
So...this was Hugh Ashcroft—the orthopaedic surgeon that everybody said was the best in the country when it came to dealing with any skeletal tumours? One of the best in the world, even? Of course it was. Molly had also heard that he insisted on doing any biopsies of his patients himself, rather than leaving it to the very capable radiology department’s doctors and technicians.
Mr Ashcroft had been away on leave when Molly had started working here, having moved back to her hometown of Christchurch a few weeks ago after working in Australia for several years. Had no one informed him that the new programme of using therapy dogs in the children’s hospital had been approved after apparently waiting in the wings for too long? Perhaps it had been Molly’s arrival—with Oreo—that had finally tipped the balance in favour of getting the project under way?
The radiologist was on the point of inserting the cannula in Sophie’s hand that would allow them to administer the sedation needed for this invasive procedure. The little girl was lying on the bed on her side. She hadn’t even noticed the doctor peeling off a sticky patch on the back of her right hand, revealing skin that would now be numb from the anaesthetic cream that would make the insertion of a needle painless, because she was stroking Oreo’s silky ear with her left hand.
‘She’s so pretty...’ Sophie whispered.
‘She thinks you’re pretty too,’ Molly whispered back. ‘Look at the way she’s smiling at you.’
‘How do you know she’s smiling?’
‘It’s her ears. See the way she pulls them down?’ Talking was another distraction for Sophie from what was going on. ‘You can see her teeth, too, and the way her tongue is hanging over them a bit. That’s how a dog tells you they’re happy and that they like you. They’re smiling...’
Sophie was smiling too. So was the doctor, as she slipped the cannula into a tiny vein and taped it into position. A nurse handed her a syringe.
‘You’re going to start feeling a bit sleepy,’ the doctor told Sophie. ‘You’ll be awake again very soon, okay?’
‘Will Oreo still be here when I wake up?’ Sophie’s gaze was a desperate plea as she looked up at Molly. ‘Like you said she would be?’
Molly wasn’t completely sure about that now but she chose to ignore the waves of hostility she could feel coming from Hugh Ashcroft’s back as he scrubbed his hands at a basin. A nurse was waiting with the gown and gloves he would need to wear to perform a sterile procedure.
‘Yes,’ she said, firmly. She even raised her voice a little. ‘We promised, didn’t we? We’re not going anywhere.’ She could see Sophie’s eyes drifting shut as the medication was injected. ‘Sweet dreams, darling.’
Oreo didn’t move as Sophie’s hand slid away from her ear. She would be quite happy to sit here beside the bed, as still as a rock, to guard Sophie while she had her biopsy taken, but when Molly moved back the dog followed instantly. Molly headed for the far corner of the room to tuck herself into a corner amongst the big metal blocks of X-ray machinery. Surely that would be acceptable so that she wouldn’t have to break her promise to be here the moment Sophie began waking up again?
Vivien’s nod suggested approval.
Hugh’s glare did not. But he was glaring at Oreo, so Molly didn’t get the full effect.
‘We can discuss this later.’ Hugh’s tone was dismissive but his tone as he turned to Sophie’s mother was noticeably warmer. ‘Hi, Joanne. I’m sorry I couldn’t get here any sooner.’
‘It’s okay.’ Joanne stroked her daughter’s wispy blonde curls. ‘I can’t believe how easy it’s been with having Oreo able to be with her. Sophie just adores dogs... Dancing and dogs are her two favourite things in the world.’
‘Mmm.’
The sound from Hugh was strangled enough for Molly to start feeling nervous about the upcoming discussion that she would, no doubt, be part of. She caught Vivien’s glance as Hugh, now gowned and gloved, stepped towards the table and the older woman’s expression was reassuring. Moments later, however, the beeping of a pager saw the clinical director reaching for the message and then mouthing an apology to Molly as she slipped out of the room.
Sorry...have to go...
Molly would have loved to have followed her but she’d made a promise to Sophie and wasn’t about to break it. She knew she had Vivien’s support. It had been Vivien who’d signed off on Molly using her highly trained dog for an extension of duties that went quite a long way above any simple animal therapy programme that allowed dogs to visit public areas of a hospital or even within the wards. Using medical assistance dogs, or ‘dogtors’ as they were affectionally known, was happening more and more overseas but Oreo was one of the first dogs in this country to be approved to enter clinical areas like this procedure room, recovery areas and even the intensive care unit to assist children. Molly had made the dog version of a gown Oreo was wearing to cover her back and the elastic topped booties for her paws, which were a smaller size of the disposable ones available for staff to put over their footwear.
Sophie was lying on her back now with an area of her upper leg being prepped. An ultrasound technician was manoeuvring her equipment into place and a nurse was uncovering the top of a sterile trolley that had all the instruments and other supplies that would be needed, including the jars to hold the fragments of bone tissue about to be collected.
‘You don’t have to watch this bit, Joanne, if you’d rather not.’ Hugh looked away from the screen as the technician located the bone lesion. They were ready to begin the procedure. The biopsy needle would show up on the screen to let him position it so that they could be confident the samples would be coming from exactly the right spot.
‘I won’t watch,’ Joanne said quietly. ‘But I’d like to stay close. Just in case Sophie might know if I’m not here.’ She turned to face the head of the bed so she couldn’t see what was happening and she bent down so that she was curled protectively over her daughter, her lips touching Sophie’s hair. ‘Mummy’s here, sweetheart. It’s okay... I’m here...’
Molly blinked back a tear but she could feel herself nodding at the idea that Sophie might be aware of her mother’s touch. During the later stages of Oreo’s training in Australia, she’d seen children respond to the dog’s presence even when they were deeply unconscious and on a ventilator in ICU. She’d seen their heart rate and blood pressure drop after just a few minutes of their fingers being in contact with the soft warmth of Oreo’s body.
She couldn’t see the screen of the machine monitoring Sophie’s heart rate and blood pressure so Molly watched Hugh instead. He certainly seemed to know what he was doing and she knew he was so focussed he’d totally forgotten her—and Oreo’s—presence in the room. He was calm and confident, making a small incision on Sophie’s leg and inserting the device that placed a cannula down to bone level.
‘Drill, thanks.’ Hugh smoothly removed the stylet and went on to the next stage of the procedure to make an opening in the bone, his gaze on the screen to get right inside the tumour. ‘This won’t take much longer,’ he told Joanne. ‘I’m about to start collecting the samples. I’ll have an eleven-gauge biopsy needle, please,’ he said to his scrub nurse.
Molly could see the care he took to remove several samples of tissue and ease them into the collection jars. She knew some would be used for tissue-based diagnosis and others for molecular analysis. If this tumour was malignant, they would soon know just how dangerous it might be. Again, her heart squeezed painfully enough to bring tears to her eyes. Molly might not be a mother herself, yet, but she was an aunty to nieces and nephews whom she adored and she had chosen to become a paediatric nurse because of her love for children. The joy of sharing their journey back to health was the best feeling ever but being part of the challenge of caring for them when they faced—and sometimes lost—a battle for life was as much of a privilege as it was heartbreaking.
She could feel a tear tickling as it ran down the side of her nose. Without thinking, she reached up to wipe it away with her fingers. She knew she hadn’t made a sound, like a sniff or something, so it had to be purely coincidence that Hugh Ashcroft looked in her direction at that particular moment as he stepped back from finishing the procedure.
Molly could only see his eyes between the top of the mask and the cap that was covering his hair, but that was enough to know that he was even less impressed than he had been when he’d seen Oreo in here.
The sedation for Sophie was already wearing off as a nurse put a dressing over the wound on her leg. The little girl was turning her head.
‘Where’s Oreo...?’
‘Right here, darling...’ Molly moved back towards the bed with Oreo glued to her leg. ‘We’re going to go back to the ward with you.’
Oreo put her chin on the edge of the mattress again. Her plume of a tail waved gently as she felt the touch of Sophie’s hand on her head.
‘Can she sleep with me tonight?’
A sound that was reminiscent of a growl came from Hugh’s direction but maybe he was having trouble stripping off his gloves and gown. Or perhaps he was simply clearing his throat before speaking quietly to Sophie’s mother about how long it would take for the pathology results to come through.
Molly had to shake her head. ‘Sorry,’ she said to Sophie. ‘We can come back to the ward with you for a bit but there are special rules for dogs that visit in the hospital and Oreo’s got to come home with me to sleep.’
Behind her, she could hear Joanne being told that an MRI and PET scan were booked for tomorrow and her heart sank. The surgeon had to be already very confident of his diagnosis if he wanted the kind of diagnostic tests that would let them stage the cancer by checking for its spread to other parts of the body like the liver or lungs.
Molly made her tone bright. ‘Hey...did I hear your mum say that you love dancing, Sophie?’
Sophie’s nod was drowsy.
‘So does Oreo.’
Sophie dragged her eyes open again. ‘Dogs can’t dance...’
‘Oreo can. We’ll show you when she comes to visit one day.’
‘Promise...?’
Molly didn’t shift her gaze but she could hear that the conversation with Sophie’s mum had ended and she could feel the stare coming in her direction from the orthopaedic surgeon, who was now listening to what she was saying.
It was already clear that Hugh Ashcroft didn’t like dogs. Or women crying. But it wouldn’t be the first time that she’d encountered a surgeon who found it difficult to show a bit of compassion. Maybe it was because their patients were unconscious for most of the time they spent with them so it was easier to be aloof? To see them as simply patients needing surgical treatment without the complications of their own lives and families or their dreams and fears that could make a situation unbearable. And maybe it was just as well there were people like her around to balance the equation.
‘I promise,’ she whispered to Sophie.
She looked up as she heard another pager beeping, just in time to see Hugh Ashcroft leaving the procedure room.
Copyright © 2024 by Alison Roberts