ANNIE woke very early on Sunday morning to a sense of great misgiving. She’d stayed on at the nightclub for another hour, then, because the offers from men she didn’t know had been getting more drunken and insistent, she’d tried to persuade Maggie to leave.
But Maggie had been having a wonderful time and had been happy for Annie to go on home, though she had insisted on phoning a cab from the club to make sure Annie was safe.
Where Phil had disappeared to, neither of them knew, though Annie sensed he was still somewhere around—no doubt with the blonde and her friends.
Where things now stood, with Phil and Maggie or with herself and Alex, she had no idea, but she’d been worrying more about the Carters during the night and regretted not asking Alex about the latest news on their decision.
One way to find out. She’d pull on some clothes and go up to the hospital.
Mrs Carter was in Amy’s room, and Annie marvelled at the woman’s patience and dedication as she sat beside her failing daughter, talking softly to her and rubbing one finger across the little girl’s skin. Up and down her arm, around drip tubes and monitor wires, down her cheek, across her head.
If loving touch could heal, Amy would be better.
Annie sidled into the room and was greeted with a smile.
‘Did Dr Attwood talk to you yesterday?’ she asked quietly.
Amy’s mother nodded.
‘He’s a wonderful man—stayed with us all morning and some of the afternoon as well.’
No wonder Alex hadn’t wanted to stay at the club! Annie thought, then Mrs Carter was talking again.
‘He talked us through all the pros and cons and let us ask questions, and just sat because he said the more we thought about things, the more questions we’d come up with. And we did.’
Realising the woman was so much more relaxed than when Annie had last seen her, Annie guessed the family had reached some kind of decision and were happy with it.
Should she ask?
Was it her place?
She’d need to know, but Alex would eventually fill her in.
She was still mentally debating her position when Amy’s mother continued.
‘We decided while she’s still stable—and Dr Attwood says she is. He showed us how the monitors tell him things, and said her condition wasn’t deteriorating. He said sometimes babies get so sick with other things they can’t do a transplant, but Amy’s not like that so that’s why we decided.’
Mrs Carter gave a little laugh.
‘I still didn’t tell you, did I? We’re going to wait. He said to take each day as it comes and not to hope too hard, but to believe that if Amy’s well enough for them to do a transplant when one becomes available, we’ll go ahead. If she starts to slip or gets an infection or we feel she’s suffering, we’ll think again and maybe turn off the machines supporting her.’
Annie reached for the woman’s free hand and gave it a squeeze. She was too choked up to speak, knowing just how hard this decision had been. Yet Mrs Carter was far more settled now than she’d been the previous morning after Annie had spent the night with her.
All because of Alex who, no doubt in his precise way, had made it all sound so rational and easy, divorcing the huge emotional content of the decision from the medical one and letting Amy’s parents see a way through their dilemma.
‘Have you slept at all?’ Annie asked when she’d swallowed her own emotional reaction. ‘I could sit with Amy if you like.’
Mrs Carter turned to her with a smile.
‘I slept all night. Bill sat with Amy and he’s gone off to sleep now. We’re so thankful for the accommodation provided by organisations so we can stay close to our darling all the time.’
Annie chuckled, genuinely delighted to see the woman so positive. Annie had known from the first operation she’d seen him perform that Alex could work miracles inside the chests of tiny babies, but apparently he was just as good with miracles outside the theatre, too.
She was still smiling as she made her way to the office, thinking she’d catch up on some paperwork while she was there, but she was barely through the door when her pager chirped and her heart accelerated.
As unit manager, she was the one who would receive first news of an available heart, and though, on another day, a page might mean Becky contacting her from the office, on a Sunday the sound brought hope.
She knew by heart the plan Alex had given her. She had to find out the details, organise a retrieval flight, have planes and ambulances for the retrieval team standing by at each end of the journey. Or just an ambulance on alert, if the heart was in the city. A member of the surgical team, Phil preferably, would go with either Kurt or a nurse on the retrieval flight.
Annie ticked off this information as she dialled the number. It was the donor programme co-ordinator. A heart that might be suitable for Amy had become available in Brisbane. Did they want it?
‘Yes,’ Annie said, and got contact details of the hospital and attending paediatrician so Alex could talk direct to him. She paged Alex, then phoned the number she had for the Flying Marvels, a group of men and women who owned their own planes and volunteered to fly sick children to the city for treatment. They’d been used before for organ retrieval flights, and Annie was delighted when the man she spoke to said he could organise a flight to Brisbane and back and could have a plane and pilot waiting at the airport within forty minutes. Annie told him she’d phone him back to confirm it as soon as possible.
Alex phoned and once again Annie explained, giving him the Brisbane number and telling him she had a plane standing by.
‘Who do you want to go?’ she asked him, and he didn’t hesitate.
‘Phil—I’ll wake him—and Kurt if you can get hold of him. He knows how to bring it back. But if you can’t get hold of him, get Rachel—she’s done retrievals before.’
‘They both have pagers. I’ll get one of them,’ Annie assured him.
Alex hung up before she could ask if she should speak to the Carters or wait for him. Theirs would be the final decision—whether to put Amy through another operation, knowing that transplants could fail.
Annie looked at her hands and saw they were shaking, but there was so much still to do—people to call, arrangements to be confirmed.
Alex came into the office half an hour later, and Annie was able to tell him everyone was standing by.
‘I’ll talk to the Carters,’ he said, and left the room, returning five minutes later.
‘We’re on,’ he said. ‘Can you give me a time frame for retrieval?’
‘One hour and twenty minutes to Brisbane in the light plane, same for return trip, though one way is usually shorter than the other because of wind factors. Ambulance from here to the airfield, Sunday morning and not much traffic, twenty-five minutes, in Brisbane fifteen minutes. How long does Phil need?’
Alex looked at the ceiling for a moment.
‘Thirty—maybe forty minutes.’
Annie was on the phone as they had this conversation, first confirming with the donor organisation that, yes, they’d take the heart, then speaking to the Flying Marvels man, getting details of where the team should meet the pilot and explaining where they were going.
‘We have a cooler?’
Annie, dialling Kurt’s number, looked up.
‘A cooler?’
Alex made a gesture with his hands, outlining the shape of a small box.
‘For drinks!’
And it dawned on Annie that in this day and age of such sophisticated medical technology, they carried hearts for transplant around in a drinks cooler.
‘Pathology has heaps of them,’ she said, then told Kurt that Phil would collect him in twenty minutes. Alex disappeared and she phoned the ambulance, asking them to pick up Phil from the hospital and to be standing by for a return trip from the airport in a little over three hours.
Alex returned with a cooler and Phil. Annie joined them and the three walked together to the ambulance bay. Not running, but certainly striding out as suddenly every minute counted.
‘That’s why we go by ambulance,’ Alex said to her as the vehicle sped away, siren wailing. ‘Whatever minutes we save are minutes we can add to Amy’s life.’
He slid an arm around Annie’s shoulders and led her back inside, and for a moment she thought he was going to talk about the previous evening.
Silly thought. The arm was nothing more than a teamly gesture—his mind was totally involved with what lay ahead.
‘I’ll need Rachel, and if you can get that male nurse—’
‘Ned?’ Annie suggested, and Alex nodded.
‘That’s the one, and Maggie. No hurry, but I’ll open Amy up as soon as we know the plane has landed back here in Sydney. It’s all a matter of timing now.’
Annie made her way back to the office, ready to field phone calls if anything went wrong. All the team had pagers, the flight people had her number, the hospital in Brisbane had her number. What could go wrong? The weather was perfect, flying conditions would be great.
Alex came in and dropped a piece of paper on her desk.
‘That’s the number of the sister on duty at the PICU in Brisbane. Could you phone her and get some more details on the baby?’
Annie looked up at him, knowing she was frowning.
‘Didn’t you do that when you spoke to the paediatrician?’
‘I asked medical questions, Annie,’ Alex said gently. ‘We don’t need to know names and addresses—in fact, confidentiality is key in these cases—but Amy’s family will ask questions about the donor, and if we can answer them, everyone will feel more at ease.’
Annie knew what he was saying must be true because Alex had been involved in these situations before, but in this position would she want to know more about a baby that had died to give her child life?
She wasn’t sure and her uncertainty must have showed for Alex leaned across the desk and touched her lightly on the shoulder.
‘Believe me,’ he said, ‘the questions will come. Maybe not right away, but soon, and it’s best for us to be prepared.’
He sat down in the chair across the desk from her, and she could see the understanding in his eyes. Understanding that she was still coming to grips with the situation. Oh, she’d coped with the physical side of it, organising and arranging, but emotionally? Yes, she was at a loss.
‘Knowing a little about the donor makes it more personal—which you’d think might be a bad thing, but it isn’t. It makes it less like a shopping trip—I’ll take those shoes, and if you have a very small heart, I’d like one of them as well.’
Alex smiled, but Annie felt more like crying, grieving for the owner of that very small heart, and for the owner’s parents and siblings, and all the relations.
She blinked away a tear, and said, ‘OK, I’ll take your word for it and find out more, but I think I’d prefer the shopping trip. That way I could pretend it was just a heart, not something that had once been part of a living, breathing baby.’
‘No, you couldn’t,’ Alex argued. ‘You might be able to pretend to others, but inside yourself you’d know the truth. You’re too courageous for pretence to be part of your life.’
Annie looked at him and shook her head, knowing they were no longer talking about the baby but about her own life. Had Alex guessed it was all pretence, that he was saying this? Was he pushing her to be honest with him?
Heaven knew, she wanted to, but the thought that in doing so she might put him within reach of even the remotest possibility of danger had made her hold her tongue.
She shook her head, and said sadly, ‘No, Alex, that’s wrong. My entire adult life seems to have been about pretence. You’re so open and honest—with parents, staff, everyone—that you can’t imagine that other people aren’t.’
Alex heard the words, even took them in, but looking at Annie—knowing what he did of her—he couldn’t accept what she was saying. Annie and deceit? The equation didn’t gel.
‘We’ll talk later,’ he said, more determined than ever to find out what lay behind some of the things Annie had said.
He needed to find out what lay behind last night’s outing, too. That it was something to do with Maggie, he knew—but what? And why had Annie not come home with him?
That was the question that had tormented him during his cab ride home, but once there he’d put the entire evening into the ‘too hard basket’ and had gone straight to bed. He’d had two hours’ sleep in the past thirty-six and had needed to catch up. Fortunately for him—and Amy—he did sleep well.
Maggie was in Amy’s room when he returned there, taking blood for testing and making notes to herself about the medications Amy had been on since the operation.
She followed Alex out and they discussed what would happen in Theatre and the drugs they’d need for different stages of the operation. Amy’s blood would be cooled to minimise organ damage during the changeover, and she’d need drugs to thin her blood while she was on the bypass machine. Once the new heart was in place, a lot of the actions of the drugs would have to be reversed. It was important to get blood into the coronary arteries as soon as possible so they could feed the muscle of the new heart.
So many details—so much to anticipate. If this went wrong, what would they need? If that happened, did they have the equipment on hand to make it right?
‘Flight’s landed in Brisbane and the boys are on their way to the hospital,’ Annie reported, poking her head around the door of the theatre anteroom where Maggie and Alex were talking.
‘Keep us posted,’ Alex told her, then Rachel and Ned arrived, and Alex included them in the discussion they were having, explaining the operation step by step, though he knew Rachel had been through this with him before.
‘What theatre staff do we have?’ Rachel asked, and Alex shook his head.
‘Don’t know, but for sure Annie’s dug up the best she can find.’
‘Blood?’
‘Already on hand,’ Maggie told Ned.
‘So, you guys set up, I’m going to phone a friend. I stood in as a spare pair of hands for him on Friday night, now I’ll wreck his weekend by asking him to do the same for me.’
He phoned from the anteroom, and when his colleague agreed to come, Alex felt excitement begin to build within him. A lot of the operations he did on children were more complex and risky than a heart transplant, but this was life-giving.
‘Aren’t all of them life-giving?’ Annie asked, coming in a little later to tell him the plane was in the air on the return flight.
‘Yes,’ he agreed, ‘insofar as the child could die if he or she isn’t operated on, but they’re different somehow.’
Annie wasn’t sure she understood, but she nodded anyway, then was surprised when Alex put his arms around her and drew her close.
‘You’ve found out more about the other baby,’ he said gently—a statement, not a question.
She nodded against his shoulder.
‘We didn’t make that baby die, or even will its death, Annie,’ Alex continued, ‘but through the sadness of his death, we can offer hope for Amy. Can you not find some solace in that?’
‘I suppose so,’ she said, her voice muffled by his shirt. ‘In fact, I know so, but just not yet.’
He kissed her lightly on the top of her head, and she knew it was a signal for her to leave the comfort of his arms. It was work time and every second counted.
Annie went back to her office. She ran through the procedure schedule Alex had given her when the unit had first opened. Every item had been ticked off. Pathologists were on standby, drugs available, extra staff on hand in case the operation took longer than expected and the special care unit staff primed for what to expect when Amy returned to them.
Which left the Carters, but Annie, knowing phone calls could be coming in, couldn’t leave the office to talk to them. Once Amy was in Theatre, she could sit with them, and though part of her really wanted to see this operation, another part of her felt she would be more useful waiting with the parents.
Alex phoned as she made this decision. ‘We’re taking Amy into Theatre now,’ he said, ‘so when you hear anything, let us know in there.’
Annie was about to hang up when Alex added, ‘Aren’t you going to wish us luck?’
‘You don’t need luck—you’re the best there is,’ she told him, though she did add a soft ‘Good luck!’ before she put the phone down.
Now all she could do was sit and will the plane to land and the ambulance to make good time to the hospital. Once there, Phil and Kurt would have to scrub before taking their places in Theatre—Kurt already had a stand-in, a perfusionist from Children’s, in Theatre, ready to operate the machine as soon as Amy was anaesthetised.
Looking back later, it seemed to Annie that everything had happened at once. The phone had rung to say the plane had come in and the ambulance was already on its way back to the hospital. The surgeon from Children’s had arrived and Annie had taken him through to Theatre, then Phil and Kurt had arrived back, Phil holding the cooler with the heart as casually as he might have taken some cans of beer to a football game. Annie had watched him slide it through the theatre door, calling to Alex, ‘It’s just the best little heart. Behaved beautifully as we took it out. Be with you all shortly.’
Then he went to change and Annie sought out the Carters, sitting tensely in the family room off the special care unit.
‘It’s here?’ they asked in unison, and Annie nodded, then Mrs Carter reached out for her hand.
‘Tell me this is the right thing to do,’ she pleaded, and Annie led her back to the settee and sat her down, sitting beside her and putting her arm around her shoulders.
‘It seems to me,’ she said carefully, ‘that this is how things were meant to be. I mean, you’d decided to wait and see what happened—whether a heart became available while Amy was still relatively stable. The chances were so small really. I know Alex told you that. Yet it happened, and so quickly, and everything else fell into place, so don’t you have to think it was meant to be?’
Mrs Carter considered this for a moment, then she nodded, while her husband, holding tightly to her hand now she was sitting down again, said, ‘Makes you believe there’s someone or something on our side. We wondered, when Amy was born with so much wrong and was so sick, whether it was our fault this had happened. But it’s fate, isn’t it? It’s all about fate!’
He put his arm around his wife and Annie moved away, shifting to the armchair so the pair could share some physical comfort on the settee.
It seemed an interminable time but finally the door opened and Alex came in. He looked exhausted and Annie feared the worst, but he summoned up a smile for the Carters and said, ‘All well so far. Her new heart is beating beautifully.’
They rose as one, Mr Carter gripping Alex’s hand, Mrs Carter throwing herself against him and hugging him tightly.
Alex waited a moment, then said, ‘She’s not out of the woods yet, remember. Her body could reject it, or she could react badly to the drugs we have to give her to guard against rejection. Then there are other organs that might have been affected by the length of time she was on bypass.’
Annie listened, amazed as ever that Alex could list so many negatives yet still keep hope alive in his listeners. It wasn’t that he told anything but the plain, unvarnished truth, yet people heard it with hope in their hearts and trusted him enough to believe those bad things wouldn’t happen.
She studied him, wondering how the faith others had in him must affect him, physically and emotionally, when the bad things he spoke of did happen. For a moment superstition replaced faith and fate, and she crossed her fingers. Not for Amy, she prayed silently. Don’t let the bad things happen for her.
Alex left the room but Annie lingered in case the Carters wanted to ask questions, but they were so excited and delighted she might as well not have been there so she walked back to the office where Alex was slumped at his desk.
‘What’s wrong?’ she demanded, frightened by this sight of a dejected Alex. ‘Did things not go as well as you made out?’
He lifted his head and gave her a tired smile.
‘Afterburn!’ he said. ‘At least, that’s what I call it. It’s a kind of exhaustion that comes with the let-down of tension when an op like that is done. I always feel totally wrung out. Phil’s different, he gets a high, and I understand that because I feel like that after a good switch, or something regular, but for some reason I can’t feel that euphoria after a transplant. For all my brave words to you and to the Carters, I still feel as if I’m meddling with fate, and on some atavistic level it scares the hell out of me.’
‘Oh, Alex,’ Annie said gently, walking towards him so she could perch on the desk and lean forward to massage his shoulders and neck, ‘you give so much confidence, and talk such common sense to other people, can’t you spare some for yourself?’
He smiled again and took her hand, resting it against her cheek.
‘Later, I’ll be able to,’ he promised, ‘especially if Amy pulls through the next few days. If that happens, I’ll take it as a sign that fate didn’t mind me meddling. Maybe even approved of it.’
He pressed a kiss into her palm, then gave her back her hand, and she knew he needed to be alone to work through his let-down in the way that best suited him.
Other members of the team drifted in, most of them, as Alex had foretold, on a high.
‘Come on, late lunch in the canteen. The tab’s on me,’ Phil said, and even Alex stood up and joined the others trooping out. He turned back and waved to Annie, but she shook her head. Phil had put his arm around Maggie as he’d made the suggestion, and there was no way she was going to rain on whatever small parade Maggie might be enjoying.
‘I’ve some phone calls to make. I told the Flying Marvels I’d let them know how things went, and I need to call a few other people who’ve been involved.’
Alex didn’t argue but followed the others out, and though Annie told herself he had to go because the lunch would serve as a debrief after the operation, she was still disappointed.
‘Stupidly disappointed!’ she muttered to herself. ‘Get over it!’
She didn’t get over it, but she did get through the day, and then the week, and even into the next week. Amy had thrown up every complication Alex had predicted and then some, and he’d been all but living at the hospital, returning home at weird times to grab clean clothes but otherwise making the on-duty room off the special care unit his home.
Annie told herself this was good because, although she still saw him any number of times a day, and still had regular conferences with him over his consulting appointments and operating programme, work was always on both their minds, if not to the exclusion of all else, at least blotting out most of the manifestations of their attraction. The team might be operating normally, but every member of it was emotionally caught up in Amy’s roller-coaster ride.
‘Her condition’s turned,’ Alex finally announced the following Thursday. He’d called the team together, and Annie had found herself hoping it wasn’t to say he was going to put Amy back on the list for a transplant.
His words elicited a rough cheer from the group and Alex smiled, his tired, drawn face lightening so imperceptibly that Annie felt her heart tug with pity for him.
‘Days off all round! We’ve no ops scheduled for tomorrow so, the medical team, you’re off for three days—four if Annie can juggle Monday’s list and fit the ops in later in the week. Nursing staff, again, see Annie. We’ve enough experienced people who’ve been working with our patients on the ward to maybe bump some of them to the PICU and give you lot from there a few days off as well.’
He turned expectantly to Annie.
‘Annie?’
She wasn’t sure she had that many nurses at her disposal, but it was so good to see Alex starting to relax that she smiled at him and said, ‘Can do, boss!’
She’d do it, even if it meant taking a nursing shift herself. The PICU was still a very familiar environment to her.
Alex went on to detail why he felt Amy was showing more stable improvement and why he didn’t expect her condition to deteriorate again, then ran through what they’d be doing the following week and sent everyone home.
Everyone but Annie, who had to check the nursing rosters and see how she could juggle staff, and also to see the intensivist on duty at the PICU—how much easier to call it that as Alex and Phil did, than the special care unit—and make sure he knew the surgeons wouldn’t be quite as available to him in emergencies as they had been twenty-four hours a day since Amy’s operation.
She was pencilling her name into the altered nursing roster—she could work Saturday and Sunday nights—when Alex walked into the office, a bunch of flowers in his hand and a much better smile on his face.
‘These are for the best unit manager in the country, and I’ve more ordered for my best girl. They’ll be waiting for you at a little cabin in the mountains where I’m taking you first thing tomorrow.’