DR. RYDER ANDREWS didn’t think McKenzie had anything to worry about when it came to spinster hashtags.
She was an intelligent, beautiful woman any man would be lucky to spend time with and call his own.
No doubt, when she was ready, she’d soon replace her ex.
But next weekend, she’d be spending with him.
With him playing the role of her pretend boyfriend.
He stared down into the wide green eyes looking up at him, full of hope that he was saying yes. Eyes he’d been avoiding looking into for months because he’d instantly liked McKenzie, been attracted to her, and quickly learned she was taken.
With McKenzie, he’d been tempted to walk down that slippery slope and risk the fallout.
He’d been down that road before, and it hadn’t ended well.
That he was tempted to become involved with someone involved with someone else had made him that much more determined to stay away from her as much as possible.
He’d found her eyes enchanting, found looking into them left him unsettled, so he’d stayed away.
Yeah, McKenzie had no worries on growing old alone unless remaining single was what she chose. Not with those killer eyes that flashed with intelligence, lush auburn hair that he’d once thought about running his fingers through more often than he could count when his eyes closed and dreams took over, and a curvy bod that no lab coat or scrubs could conceal. He might have suppressed his fascination with her, but that didn’t mean he didn’t recognize that McKenzie was a beautiful woman.
If Ryder had to say what he liked best about her, though, his answer would be her intelligence and how she could see outside the box. How, during those first few weeks they’d known each other, their gazes could meet, and he’d know what she was thinking. She’d know what he was thinking. And they’d share a smile. When he’d realized she was off limits, he’d tried to avoid consults on her patients, but when it had been unavoidable, he’d always been impressed.
He’d never met anyone like her, had been disappointed she was already taken, had often had to remind himself to back away and remain aloof so as not to overstep.
He’d asked her once, early on, if she was happy in her relationship. She’d enthusiastically told him she was, that she and Paul were in love and planned to spend the rest of their lives together.
That’s when he’d decided to squash his attraction to her.
“I’ve never been to Nashville,” he admitted, knowing she was waiting for him to clarify that he was going. “Maybe we’ll get a chance to do a little sightseeing.”
“Seriously?” Her forehead scrunched. “You’re going with me and will be my pretend boyfriend?”
Rather than see her hire an escort service? Absolutely.
“I’ll go with you to your cousin’s wedding in Tennessee as your pretend boyfriend.”
McKenzie asking Ryder to be her pretend boyfriend had morphed him into the friendly man she’d met initially.
Okay, not quite that friendly, but he at least didn’t run in the opposite direction anymore when he spotted her.
Whether at the clinic or at the hospital, he’d smile when their paths crossed, had even stopped to chat when he’d come into the break room and found McKenzie and her nurse there, having coffee while discussing phone calls from patients’ parents.
He’d stuck around only long enough to refill his reusable water bottle, but his smile had stuck with her for the remainder of the day.
As long as he was smiling, that meant he hadn’t changed his mind, right?
Regardless, his avoidance of her seemed to be a thing of the past.
Such as now with Sawyer Little’s case.
McKenzie had been doing her one day a week on call at the hospital when she’d been consulted for the newborn who’d been okay for the first few hours of life but had started having a grayish-blue tinge to her skin—thankfully her mother had noticed and called for the nurse.
The nurse noted a decreased oxygen level and mild dyspnea and contacted the pediatrician. The pediatrician had checked the baby, ordered an oxygen tent and consulted McKenzie as he suspected a cardiac issue in the newborn.
McKenzie was just getting ready to do a crib-side echocardiogram when Ryder had walked into the neonatal cardiac intensive care unit.
Meeting her gaze, his eyes darkened, but then, the corners of his mouth lifted.
Heaven help her, the man had an amazing smile.
That had to be why her breath hitched up a few notches.
An alarm dinged from the next bay over and it took McKenzie a moment to realize it hadn’t been a warning bell sounding in her own head.
She really needed to keep Ryder in proper perspective. She was just getting out of her relationship with Paul. The last thing she needed was to confuse Ryder’s kindness with the possibility of something more happening between them.
She didn’t want anything more to happen between them.
The nurse who was assisting McKenzie with Sawyer glanced up. “That’s my other patient. I need to change an intravenous medication bag.”
“Go,” McKenzie told the woman. Each NICU nurse was assigned two patients, typically. “I’m good and will call out if I need you for anything.”
The nurse took off for the next bay. Their unit was designed with an open hallway with each baby in their own semiprivate three-sided bay. The nurse’s station was on the opposite side of the hallway and faced the open bays.
Ryder had stopped at the nurses’ station and was pulling up a chart on the computer system. He wore dark navy scrubs and she doubted anyone would be surprised if a camera crew walked in and started filming his every move for some medical drama. He looked as if he should be gracing the big screen and tugging on hearts by resolving one medical drama after another.
McKenzie pulled her attention back to the sweet little girl, took warmed gel, tested the temperature on the back of her hand, then applied some to Sawyer’s chest.
She ran the conducer over the baby’s left ribs, checking the heart chambers, walls, valves and vessels.
She grimaced at what she found.
Sawyer’s left ventricle and aorta were too small. There was very little blood flow through the underdeveloped left side of the heart, which explained the faint bluish tinge to the baby’s skin despite the oxygen her pediatrician had started.
“You have a minute?” she called over to where Ryder stood fifteen or so feet away.
“Sure.” First making a couple of clicks to close out whatever he’d been looking at on the screen, he came into the bay and stood by Sawyer’s hospital bed. “Everything okay?”
“Not for this little one. She was born during the night. Mom attempted her first breastfeeding and thought her color looked off. Her pediatrician consulted me. Unfortunately, I’m going to be consulting a pediatric cardiothoracic surgeon and you just happened to be standing nearby.”
Ryder glanced down at the almost seven-pound baby with various tubes and monitors attached. McKenzie moved the conducer back over the baby’s chest to show Ryder the undersized ventricle and vessel and the lack of blood flow on the left side of Sawyer’s heart.
“Hypoplastic left heart syndrome,” Ryder said, giving voice to McKenzie’s thoughts.
She nodded. “It wasn’t picked up on during Mom’s ultrasound. She only had one, between four and five months, but the anomaly mustn’t have been as prominent as Mom says nothing unusual was mentioned.”
McKenzie moved the conducer over to where she could see the ductus arteriosus. The small vessel that connected the aorta to a pulmonary artery was still patent, allowing oxygenated blood to travel from the right ventricle to the aorta. Thank goodness.
If the opening closed, as it normally did within a couple of days, blood wouldn’t be able to be pumped to the body.
If blood wasn’t being pumped to her body, Sawyer would die.
“Is she on Prostaglandin E1?”
“Not yet,” McKenzie answered, knowing they needed to start the substance that the body naturally made to keep the vessel open while in utero, but that the body stopped making at birth. “She’d just started showing symptoms right before I was consulted and you’re seeing this as I am.”
“Gotcha. I’ll get an order for stat Prostaglandin E1 so we can keep that vessel open,” Ryder offered, walking over and logging into the bay’s computer to type in the order.
The nurse came back into Sawyer’s bay and Ryder told her what he’d ordered.
The nurse nodded, then went to carry out the order to start the medication that would, hopefully, prevent Sawyer’s ductus arteriosus from closing.
“It’s on its way,” he assured her, watching as McKenzie still checked the baby with the ultrasound machine.
“Look at the foramen ovale.” She pointed out the hole between Sawyer’s heart ventricles. “It’s patent, but what do you think?”
She let him take the ultrasound conducer so he could run it over the baby’s chest to get the views he wanted. He did so, studying what he saw.
“The opening is too small,” he yet again verbalized what she’d been thinking.
“She’ll need to go to surgery as soon as I can get her on schedule.”
“Yes,” Ryder agreed. “Her oxygen level is running low enough even with her oxygen mask that you’re going to need to put her on a ventilator as well to keep her from getting into trouble.”
McKenzie nodded. “Poor little sweetheart has a long road ahead of her.”
“Yes, she does, but a road that’s smoother than it used to be.”
Something in his voice had McKenzie lifting her gaze from the baby to stare at him.
He had an expression she’d never seen on him in the past, one that hinted his mind had gone somewhere far beyond the pediatric cardiac care unit where they were.
Was he thinking about the research he was involved with?
Ryder belonged to a research team involved in 3D printing of human cardiac tissue research that hoped to eventually be able to use the printed tissue for surgical rebuilding of too-small aortas and to repair other congenital heart anomalies, among other heart repairs.
Not long after they’d met he’d told her the research opportunities had been what led his move to Seattle, that the development of 3D-printed cardiac tissue opened the doorway to great advances and better outcomes of the care they provided their patients, and he’d wanted to be a part of that research.
Was he wishing they were further along so Sawyer could benefit from the research being done at Trevane Technologies?
Or had something else caused the odd look on his face?
“Do you want me to consult one of the other surgeons?”
Seeming to snap out of whatever had momentarily taken hold, he shook his head. “Why would you do that when I’m already familiar with her case?”
“I just thought...” She paused, not sure whether to remind him that prior to a few days before he’d gone out of his way not to share patients with her, that her patients were always assigned to one of his colleagues, but never him. “If you’re willing to take on her case, that would be wonderful.”
“I’m willing,” he assured her as he pulled out his phone and punched in a number. “Oddly enough, I’ve a Glenn shunt scheduled later this morning on a five-month-old.”
McKenzie’s brow lifted. Fortunately, they didn’t see many hypoplastic left heart syndrome cases, so to diagnose a new one, especially one not picked up on during ultrasound, and Ryder to be doing surgery on another on the same day was indeed a coincidence.
The Glenn shunt was the second phase of the series of surgeries Sawyer would need on her heart. Usually that procedure occurred four to five months after the Norwood, the procedure that would connect the superior vena cava, which brought blood back to the heart from the upper half of the body to the pulmonary arteries to the head and then the lungs to be reoxygenated.
Later, a third surgery called a Fontan procedure would be needed when Sawyer was a toddler. The Fontan would connect her inferior vena cava, which was a big vein that brought the blood from her lower body to her heart, to her pulmonary arteries. Hopefully, at that point, Sawyer would do well and have normal oxygenation of her blood.
Ryder spoke to his nurse practitioner, telling her what he needed so she could handle getting the procedure scheduled. When he finished, he turned back to where McKenzie had told the nurse to gather what she’d need to ventilate the baby.
“I’ll make sure Sawyer’s Norwood procedure is done prior to our leaving for Nashville. I’ll plan to do the surgery but will consult with Dr. Rhea—” another pediatric cardiothoracic surgeon at the hospital “—as he’ll be covering my patients while I’m out of town.”
“Thank you.” She wasn’t sure if she meant his taking on Sawyer’s case and making sure the baby’s surgery happened as soon as possible or if she was thanking him for being willing to shuffle his schedule to go with her to Nashville.
She appreciated both.
“It’s my job,” he reminded her, seeming almost embarrassed at her gratitude.
It was more than a job. For both of them.
That was one thing they had in common and she could always use as a go-to if they ran out of things to talk about on their trip. They both loved their job, doing what they could to repair tiny hearts, and save lives.
She hoped silence didn’t abound because she didn’t want to bore Ryder out of his mind.
“Do you want me to go with you to talk to this little one’s parents?”
McKenzie’s heart squeezed at the thought of what she’d soon be doing. Talking to new parents, explaining what was going on with their precious baby had always been McKenzie’s least favorite part of her job.
“Thanks, but I’ll tell them what’s going on.” She wouldn’t pass that off on Ryder. She was Sawyer’s pediatric cardiologist and needed to meet her mom and dad as they’d be seeing each other many times in the years to come. No doubt Ryder would meet with them soon enough to discuss specifics of the surgery. “Mom was who first picked up on something not being right, so she knows something’s up. I’ll spend some time explaining the diagnosis and what to expect. You can meet with them later when they’ve had a bit of time for the reality of what Sawyer faces to sink in.”
Because the diagnosis, the stark reality of just how serious the diagnosis was, would put the child’s parents into shock—they’d need a little time before they’d be able to process what was happening. It wasn’t easy to go from thinking you had a healthy newborn to discovering that without major intervention she’d be dead within a few days.
His gaze met hers. “Do you want to assist?”
Be a part of his team to rebuild Sawyer’s aorta? Was that a trick question?
“Absolutely.”
“Awesome.” His eyes sparkled, conveying he was glad she’d said yes to going into surgery with him.
McKenzie’s insides tingled at the way he was looking at her, at the fact he’d just asked her to be a part of his team.
Over the past year, she’d been a part of a few teams he led. Each time, she’d been impressed with his focus and skills as he intricately worked to repair whatever anomaly ailed their tiny patient.
He was such a talented surgeon and always seemed to go above and beyond in the care he provided.
She’d been so excited when he’d first come to work for Seattle Cardiac Clinic for Kids, had hoped to frequently go into surgery with him because of his involvement with several innovative techniques, including his research position. She’d thought about applying for a position on his research team, even.
Those first few weeks, she had been lucky enough to assist with a handful. And what seemed to be only another handful since that time.
Because he’d become almost inaccessible to her, and Dr. Rhea tended to see the majority of her patients.
Maybe she had done something to upset Ryder, she thought for the thousandth time. Whatever, he must have moved past it when she’d asked him to go with her to Nashville. She still couldn’t imagine what she’d done, but obviously she had done something as he’d actively avoided her.
Whatever, he wasn’t avoiding her anymore and had asked her to assist on Sawyer’s Norwood procedure. Plus, he was smiling at her as he hit a button on his phone, making another call to set the wheels into motion to get Sawyer to surgery and to have McKenzie in the operating room with him, along with all the others who would be a part of Sawyer’s heart surgery.
Going to surgery with him shouldn’t make her so excited, but she’d be lying if she didn’t admit that it did. She never wanted any child to be born with defects, but she loved every opportunity to help those who had been.
McKenzie brushed her fingertip gently over the baby’s chest and said a quick prayer that everything would go smoothly during this first surgery, and the many more Sawyer would face during her lifetime. Two within her first six months.
It was highly possible that down the road, in addition to all her initial surgeries, that if a heart could be found, Sawyer would need a heart transplant.
If Sawyer survived her first year of life, her odds were good. Unfortunately, the number of babies who didn’t survive was still too high.
Ryder’s hand covered hers. “You sure you don’t want me to go with you?”
Surprised at his touch, at the electricity that shot up her arm, McKenzie met his gaze, marveling at the compassion she saw there, as if he understood all too well the devastation she was about to unleash upon the Littles.
“I... Thank you. That would be wonderful.”
Why had Ryder offered to go with her to tell Sawyer’s parents their precious baby had hypoplastic left heart syndrome and their lives would never be as they’d thought when they’d arrived at the hospital expecting to bring home a healthy baby?
Typically, by the point he interacted with a baby’s parents they already had a good idea of what was going on. The Littles didn’t.
But he’d seen the heaviness on McKenzie’s heart at the prospect of going to talk to the baby’s parents. What was it about her that had him yet again offering to jump to the rescue?
Ryder watched as McKenzie told the baby’s upset family why they’d noticed the blue tinge to Sawyer’s skin. Seeing how she patiently explained the problems with Sawyer’s heart, answering their questions, and even drawing a simple visual of a normal heart and a likeness of Sawyer’s, impressed Ryder with her compassion and thoroughness.
It also brought back memories.
Memories that he’d been too young to really understand at the time.
Memories that had changed his life.
Memories he relived every time he went into surgery, knowing his actions and a whole lot of divine intervention determined whether another family would go through what his once had.
“This is Dr. Ryder Andrews. He’s a pediatric cardiothoracic surgeon and I consulted with him on your daughter’s case. He examined her with me, saw what I saw on the ultrasound of Sawyer’s heart. I know this is a lot to take in, but time is of the essence and decisions have to be made.
“I’m going to let him explain his recommendations, and then we’ll discuss how you want to proceed.”
As McKenzie had, Ryder explained what was needed for Sawyer to survive, he laid out the staggering obstacles that stood in her way, and the different options on tackling those obstacles.
He also gave the less-than-stellar statistics Sawyer faced, even with surgery.
“She’ll die if you don’t operate? You’re sure?”
“Positive. Without a way to get oxygenated blood to her body, she has zero chance of survival. Even with surgery, she might not make it.” He referred to the statistics he’d given them with each phase of treatment. “It’s up to you on how we proceed. You can choose not to operate if that’s what you both want.”
“But she’d die!” Sawyer’s mother sobbed, triggering her husband to wrap his arms around her.
“With surgery Sawyer faces a lifetime of health challenges, but she does have a good chance of surviving and eventually having a somewhat normal life,” McKenzie informed them, reaching over to place her hand on the woman’s arm. “The decision is yours. If you need some time alone to discuss it, we can step out for a few minutes.”
Sawyer’s parents both shook their heads.
“We don’t need more time,” her father said, hugging his wife tighter.
“Operate,” they said simultaneously.
Ryder explained what would happen over the next few days.
Not surprising to him, McKenzie hugged them, assuring she would keep them informed each step along the way.
Ryder shook their hands. As he was getting ready to move away, Sawyer’s mother grasped his hand.
Tears ran down her face as her gaze met his. “Please save our baby girl.”
Sharp pains stabbed into Ryder’s chest. “I’ll do my best.”
The woman nodded. “Thank you.”
“I—I know it’s not much, but I do somewhat understand what you’re feeling.” He took a deep breath. “Over twenty years ago, my sister was born with the same condition Sawyer has.” Ryder swallowed back the emotions that hit him when he recalled the turmoil his parents had gone through following Chrissy’s birth. The same hell Sawyer’s parents faced.
Only Ryder would do everything within his power to make sure Sawyer had a very different outcome from his sister.
“Did she survive?”
Ryder could feel McKenzie’s gaze boring into him but didn’t look her way. Couldn’t look her way.
Wishing he’d kept his past to himself, Ryder kept his focus on the Littles and shook his head. “Technology was very different a quarter of a century ago. Babies with hypoplastic left heart syndrome rarely survived. That isn’t the case now. Although there’s still a chance Sawyer won’t survive, odds are in her favor that she will.”
Ryder talked with them for a few more minutes, then he and McKenzie left the obstetrics room Sawyer’s mother was still in.
They walked in silence down the hallway to the elevator. Once inside, McKenzie’s gaze lifted to his and was full of such emotions it threatened to overflow the elevator car.
“Oh, Ryder,” she said with a sigh. “I’m so sorry about your sister.”
“Me, too.”
“Sometimes our job is so heart wrenching and I wonder why we do this,” she mused.
“Not me. I’ve always known I’d specialize in pediatric cardiology.”
Her look was full of empathy. “Because of your sister?”
“Yes,” he answered, wishing they weren’t having this conversation in an elevator.
Wishing they weren’t having this conversation at all.
“Life works in mysterious ways,” she murmured. “Your sister’s death led you to prevent many more.”
She glanced up at him, looked pensive. “Don’t take this the wrong way, because I truly am sorry about your sister, but I’m glad you’re a pediatric heart surgeon. Very glad.”
Ryder nodded. “It’s all I’ve ever wanted to be.”
“It’s what you were meant to be.”
Maybe. He’d never considered any other profession, not even as a small child when friends would say firefighter, police officer, or professional athlete. Ryder had surprised people by saying he was going to be a pediatric cardiothoracic surgeon.
And that’s what he’d done.
For Chrissy.
For his parents.
For himself.
A warm hand wrapped around his and gave a gentle squeeze.
Ryder’s gaze jerked to McKenzie’s green one and what he saw there had him feeling as if the elevator cable had snapped and they were spiraling downward.
Fortunately, he was saved by the elevator coming to a stop and the door sliding open.
He immediately pulled his hand from McKenzie’s, resisted the urge to shake away the electricity still zinging up and down his arm.
He needed to be careful.
It would be way too easy to forget she was on the rebound of a broken heart.