MEL blocked it all from her mind.
‘The tests—we need to start at once,’ she reminded him. ‘Where do we go?’
He nodded agreement and led her from the room, but the quick glance he’d shot her told her he knew she’d ignored his statement.
And that the conversation wasn’t finished.
The radiology department was as up to date as Jenny had said it would be, and technicians, no doubt alerted by Arun, were on standby. Mel explained the views she’d need, and left the baby with the radiologist while she and Arun studied the pictures on the screen.
‘His heart’s enlarged,’ Arun said, using his pen to outline it. ‘But it’s hard to see clearly. We need an echo?’
‘Just a minute,’ Mel said, watching the image change. ‘See there.’
She took Arun’s pen and pointed. ‘It’s blurry but it seems to me there’s only one blood vessel coming out of the heart.’
‘Truncus arteriosus?’ Arun’s voice was grave. ‘We should fly him out.’
‘To where? How far does he have to go to a specialist centre with a heart bypass machine? Because he’ll need open-heart surgery, Arun, and need it soon—and I have concerns about flying so fragile a baby anywhere.’
‘Can you be sure that’s what it is?’
He wasn’t doubting her, Mel knew, just reminding her there were more tests available.
‘No, but we’ll do an echo, that should tell us, and just to make sure, an MRI scan. They’re all non-invasive and can be done quickly. I could do a cardiac catheterization, which would show the extent of the malformation, but I’d rather not put him through that if we don’t have to.’
Arun spoke to the technician who wheeled an echocardiogram machine close to the crib and rubbed gel on the baby’s chest. Once again Mel and Arun watched the monitor, although they would get all the results printed out and would be able to study and compare them later.
‘See,’ Mel said, again using the pen. ‘One thick artery coming out of the heart and, here, a hole between the two ventricles.’
‘We have a heart bypass machine.’
His voice was strained, as if the words had been forced out of him against his will.
And Mel understood why. He was a proud man, brought up in the ruling family of his country. To ask a favour of someone would be very, very hard.
And, she guessed, asking a favour of a woman would be even harder.
She turned her attention from the screen to his face, wiped clean of any emotion, although his eyes told of his stress.
‘You want me to do it?’
‘You’re very good, I’ve heard enough of you to know that, seen DVDs of your work. And your ambition has always been to have your own paediatric surgical unit, to be the head of one with all the best equipment money can buy so babies from your regional hospital don’t have to be sent to other places. If you are willing to do this for us, whether the baby lives or dies, I will guarantee you the equipment you need to achieve that ambition.’
Mel stared at him in disbelief.
‘You’re bribing me? You’re bribing me to do an operation to save a baby’s life?’
She wasn’t sure if the radiologist and technician understood English, but she was so angry she didn’t care.
‘How could you think so little of me that you’d offer me money? It’s a baby’s life we’re talking about here, not some pathetic tummy tuck!’
Arun held up his hands in surrender.
‘It is asking too much of you—you’re a visitor in our country, a guest. It is not your problem.’
He was losing ground with every word, but his pride and his upbringing made the situation impossible. He was a giver of favours, not one who asked for them, and this woman had already thrown him off balance once today.
Badly off balance…
He fought back the memory of her revelation and concentrated on what she was saying.
‘Forget asking too much of me, and start thinking of how to get what we’ll need. Two weeks after birth is the optimal time for a truncus arteriosus repair because if we leave it longer than that the increased pressure on the pulmonary arteries and other pulmonary vessels can cause irreversible damage. What we need to do is get him as strong and stable as we can in that time…’
‘You can stay that long?’
He realised as soon as he’d asked the question that it had been stupid. Surely, given the circumstances of her pregnancy, she must have arranged to stay at least that long so they could discuss the future of their child. Or had she intended telling him then departing as soon as possible?
‘I can stay.’
Her eyes defied him to question that statement but once again his mind seemed to have divided, one part concentrated on Tia’s baby and the operation he would require, the other on the unbelievability of what was happening here. First the woman he’d thought never to see again reappearing in his life.
Carrying his child!
No, he couldn’t afford to think about that right now.
But add the fact that she was the one person this baby needed to save his life, and here she was, right on hand to do the operation.
It had to be fate.
He followed the practical part of his mind, locking down the fate-flustered one in a distant corner.
‘So what will you need?’
‘We will need either a very small donated human artery with an intact valve for a homograft or a very small dacron artery with a manufactured valve.’ She emphasised the ‘we’ just enough to let him know he was going to be taking equal responsibility for this operation. ‘A donated human artery is best if you can get one small enough because it has the ability to develop normally so might reduce the need for further operations as he grows.’
‘Kam and I, working with our own staff, have been cryo-preserving donated tissues for more than a year now. I’m sure we’d have what you need. And what about the patch for the hole between the left and right ventricles?’
‘I should be able to use a piece of the pericardial sac, which will save any rejection problems, otherwise we can fix it with…’
She paused, and studied Arun’s face, although he doubted she was seeing it, simply using it as a focus as she thought ahead.
‘Sometimes we leave it open for a while in case the new artery causes high ventricular pressure but, no, I think we should close it if we can.’
‘And for now?’
‘Ah!’
Melissa looked down at the tiny baby in the crib. He would need to be as strong as possible before the operation, so optimal oxygen intake, some medication to help the heart work more efficiently and not over-strain, and adequate nutrition through high-calorie formula or breast-milk, possibly with supplemental feedings.
‘Would Tia nurse him?’ Mel quietly asked Arun, remembering how the young woman had reacted to being asked to hold the baby.
Arun looked from Mel to Tia then back to Mel.
‘I doubt it, but I could ask.’
Mel shook her head.
‘Let’s not upset her any more, but maybe if we can arrange to care for the baby here in her room, she might grow interested enough to want to hold him.’
Arun nodded, then he shook his head.
‘You are one amazing woman,’ he said, startling Mel because he sounded as if he really meant it and that made her feel all warm and fuzzy inside.
Dangerous stuff, warm and fuzzy!
‘I’m not doing any more than anyone would,’ she told him, hoping she sounded practical enough to hide her reaction. ‘We can put in a nasogastric tube to feed him, which will save him using what little energy he has sucking either a breast or a bottle, and I need an IV line and an oximeter to keep an eye on the oxygenation of his blood and…’
She paused, wondering what else the fragile infant would need.
‘And?’ Arun prompted.
Mel shook her head.
‘I want to keep things as minimally invasive as possible to give him every chance to get stronger. From a purely cardiac point of view, what do you think?’
‘Let’s get someone in to watch him so we can sit down somewhere quiet and work out a plan, looking at what we hope to achieve before the operation and what negatives might make it impossible to leave it for two weeks.’
He didn’t wait for her answer but disappeared out the door, leaving Mel with the baby, and his mother, who lay with her face turned to the wall.
Having assured herself the baby was managing as well as could be expected, Mel crossed to sit beside the new mother.
‘This is so hard for you—I can understand that—but I’m nearly sure we can fix what’s wrong with him. Had you chosen a name?’
Dark eyes opened and were soon awash with tears.
‘I cannot give him the name,’ Tia whispered. ‘It is the name my husband chose, and if the baby dies he will want it for the next baby.’
‘Oh, love,’ Mel said, putting her arm around the young woman’s shoulders, overwhelmed by the sadness in Tia’s voice. ‘This isn’t your fault, you know. Babies are often born not quite right. No one is to blame.’
Seeing this comfort wasn’t working, Mel tried another tack.
‘Where is your husband? Are husbands not allowed to be present at the baby’s birth in your culture? Is that why he’s not here?’
The dark hair moved from side to side then Tia raised her head again.
‘He’s in America. He’s studying. His father said he had to stay there—that he couldn’t come home just to be with me for the baby’s birth. I should have gone with him and been there and had the baby in an American hospital, but when I went to America before, I was so homesick I said I wouldn’t go.’
Mel gave her a comforting pat.
‘Where you had the baby wouldn’t have made any difference,’ she explained. ‘This is something that happens when you are very newly pregnant, maybe eight weeks or so—the little heart just doesn’t develop properly. But I have operated on babies as small as yours to fix their hearts, and they have been perfectly all right later.’
This time Tia turned right around and even hitched herself up on her pillows.
‘You have? You can operate on tiny babies and fix their hearts?’
Hope crept cautiously into the words and flickered in the dark, tear-washed eyes.
‘I have, and I can,’ Mel told her, stroking Tia’s long hair back from her face and smiling gently at the young woman.
‘And you can fix my baby?’
Arun, returning to the room with one of his most trusted nurses, saw the improvement in his sister then heard the question and read Melissa’s dilemma in her hesitation.
Would she lie?
He rather doubted it but for a moment he wished she would, just to keep Tia from diving back into the depths of misery.
‘I cannot promise that, but more than ninety per cent of babies we operate on for this condition do survive. In fact, they not only survive, they thrive. It will take a little time, he’ll need to be specially cared for before and after the operation, just for a few days, then another week in hospital. Later on, there are infections he might be susceptible to, and as he grows he might need another operation, but there’s no reason he won’t do well.’
Arun remained where he was, his arm held out to prevent Zaffra from entering the room. Melissa seemed to have worked some kind of miracle in getting Tia interested in the baby, and he didn’t want to interrupt until he was sure the conversation was finished.
‘I heard Arun say you must talk about what you have to do. Can I hold him—the baby—while you talk?’
Arun felt a grin as wide as the desert split his face and saw similar delight in the way Melissa hugged Tia.
‘Of course you can. I’ll put him in your arms then fix the oxygen so it blows across his face. That way most of what he breathes is pure oxygen, which will ease the workload on his heart.’
She crossed the room and gently wrapped the swaddling cloth around the infant then lifted him from his warmed mattress, carrying him across to his mother, who would warm him with her body.
‘You take your time to look at him,’ she told Tia. ‘Later we’ll put a feeding tube into his nose and he’ll have to wear a nappy so we can work out how much fluid he’s losing, but for now just hold him and marvel at the miracle a new baby is.’
Arun brought Zaffra forward and introduced her to both women then, while Melissa placed the oxygen tube from the wall unit so it would blow across the baby’s face, Arun watched Tia’s bemusement as she examined her little son.
‘But he looks perfect,’ she said, after checking all the limbs and digits were in place. ‘Except his little feet are blue and his fingernails and lips.’
And Arun was pleased to see she was right. The baby had finally achieved some pinkness in the rest of his body so the oxygen was working.
‘Later,’ he told his sister, ‘when Melissa and I have talked, I will sit down and explain what is wrong and how we fix it. I will draw you a picture so you understand and can show Sharif when he comes home.’
Tia nodded and, satisfied his sister was now as comforted as it was possible to be with a very sick baby on her hands, Arun touched Melissa on the shoulder and indicated they should leave.
‘We won’t be long,’ she promised, turning back as she reached the door to reassure Tia once again.
Tia smiled as if confident Melissa meant exactly what she’d said.
‘Working miracles with mothers now, are you?’ he asked Melissa as he led the way down the corridor to his suite of rooms.
‘It’s hard for them,’ was all the reply he got, and he turned back to see that, far from looking happy at what she’d achieved, Melissa looked…depressed?
Sad, anyway. Sad enough for him to want to put his arms around her, draw her close and hold her until the sadness went away.
Hold her?
Madness lay that way!
But sadness?
‘Is it worse than you’ve been saying, the baby’s heart?’ It was a guess, and he knew it was the wrong one when she shook her head.
‘No, it’s the grief,’ she said, studying his face as if hoping to see understanding there.
But how could she when he didn’t understand what she meant?
‘Grief?’
‘Think about it, Arun,’ she continued. ‘A woman goes into labour, goes through childbirth, and though it’s messy and painful at least there’s joy at the end—a healthy baby to hold and cherish. For Tia, and mothers like her, where the outcome’s not as good, she has to suffer the loss of that healthy baby she was expecting—she has to grieve for it. And while grieving, it is hard to accept the other baby—the one she did have—the one that’s fragile and in need of care she has to rely on strangers to provide.’
He stared at her, then shook his head.
‘I can’t believe I’ve never thought of it that way,’ he murmured, awed by the depth of her understanding and feeling something for this woman that went beyond renewed attraction.
This pregnant woman, he reminded himself as she let him off the hook with a smile.
‘Your heart patients are usually a whole lot older and often victims of their own over-indulgence, so you see heart problems from a different perspective.’
He nodded acceptance of her excuse, but now his brain had thrown up the fact of her pregnancy once again and the knowledge that it was his baby she carried hit him like a shock from a faulty electrical connection.
His baby— she was carrying his baby!
OK, he could just about accept that, but how he felt about it—that was the problem. Would his thoughts become clearer as his mind reached full acceptance?
Would it have been easier to think about it if Tia’s baby hadn’t arrived so inopportunely?
What he did know was that this was hardly the time to be working out what he felt, let alone what he intended doing about it…
‘So, a plan,’ Melissa said, as Arun resumed their walk towards his office, finally opening a door and waving her into a large room, furnished with a wide desk littered with papers, and a leather-clad lounge suite set around a coffee-table.
A coffee-pot, cups and trays with a selection of cakes and fruit had been set out on the table.
‘I thought you might need a snack,’ he said, leading her towards one of the comfortable-looking chairs. ‘It is terrible that we have whisked you from the stables to the hospital with no time for you to relax, to bathe and change, or even to eat something. So sit, eat, and then we’ll talk. I had coffee sent up but if you’d prefer tea or a cold drink of some kind…’
Mel shook her head, although now she was away from the baby and had relaxed slightly, she realised she was starving.
‘Coffee’s fine, but with a lot of milk, if you have it,’ she said, sliding into the big armchair and leaning forward to examine the enticing-looking pastries on display. ‘And these are?’
‘Various sweet treats, mostly flavoured with rose or orange syrup and honey, but also with nuts sprinkled between the layers of pastry. You will find similar pastries right across the Middle East, all the way through to Greece in Europe and Morocco in North Africa.’
Mel chose a pastry and bit into it, feeling the sweetness fill her mouth then honey dribble from her lips.
Arun came closer, a serviette in his hand, but rather than hand it to her he caught the tiny drop of honey on it, his fingers brushing the soft paper of the napkin across her lips at the same time. His body bent over her, his face close enough for her to see the stubble of beard and the shadow of tiredness beneath his eyes—lines of strain that had not been there when they’d met four months ago.
The time had not been kind to him and she felt a surge of sympathy. If health care in his country was as neglected as Jenny said, he must have enormous worries on his shoulders.
But he was also close enough for her to see, as he bent towards her, desire leaping in his eyes, a desire that was echoed in her body.
Her nipples peaked and her breasts swelled as anticipation tingled through her body.
Would he kiss her again?
Would she respond?
Wouldn’t kissing Arun just make things more complicated?
Then, with his lips close enough to kiss if she straightened just a little, he moved away, leaving her feeling a sudden sense of loss.
Stupid! Irrational! How could she even think of kisses at a time like this?
‘Arun?’
His name escaped in a sigh so soft Arun was sure she hadn’t meant to say it but he responded anyway, bending over her again to brush the honey-tasting lips with his. To brush her name, ‘Melissa’, on them.
The chemistry that had worked between them from their first meeting flared back to life. Arun’s hand slid around the back of her head, his fingers weaving into her hair, holding her captive.
Or was it her clasp on his head that held them together?
The kiss deepened, Arun feeling the power of it as desire shuddered through his body, tightening his muscles and heating his blood.
This was madness.
The baby…
They should stop…
She broke away from the kiss but not before he’d felt enough of her response to know the chemistry still worked for her as well. Now, leaning back in her chair, defiance shaded the desire he knew he’d read in her eyes.
‘We have to talk about the baby,’ she said. ‘About Tia’s baby.’
‘And your baby? The one you say is mine? When will we talk of it?’
‘The one I say is yours?’
Her disbelief was like another person in the room yet, now the words were out, he realised he did have doubts. With reason, for how could he be sure?
‘How do I know you didn’t take another lover immediately after me? Or have one before me, close enough that you can pass off the child you carry as mine?’
He spoke coldly, the words damning her, but surely he was right to be suspicious. Her reaction was immediate—the fire of anger in her eyes and fury in every line of her body as she rose to her feet and glared across the table at him.
‘My love life is not, and never has been—apart from ten short days—any of your business, but I can assure you the baby is yours.’ She spat the words at him, as angry as a maltreated cat—her hands clenched, perhaps to stop her clawing him as well as mauling him with words. ‘Now it’s up to you. I will pretend you didn’t say what you just said to me and we sit down and discuss the baby’s problems—Tia’s baby’s problems—and together work out a treatment plan, or you call your pilot and get the plane ready to fly him out.’
She was right—Tia’s baby was the issue. How could he have been so easily diverted?
Because he’d kissed her?
Tasted honey on her lips?
Felt the frantic beat of need in both their bodies?
Or because he was beginning to accept that what she’d said was true—that she carried his child? Added to which was the fact that, while in theory marrying and having a child was all very well, in reality the thought of fatherhood was very unsettling. What did he know about raising a child? Could he, who’d barely known his father, be a good father to a child?
He nodded stiffly, waited until she seated herself again, then sat opposite her, outwardly calm—he hoped—but inwardly churning with such a tumult of emotions he couldn’t put names to them.
Mel watched him settle back in his chair. She took a deep breath, trying to calm her thudding heart, to settle the fear and hurt she felt inside.
But she hadn’t got to where she was, a top paediatric heart surgeon, without being able to hide her emotions successfully. She hid them now and matched his earlier coldness with her own.
‘So, shall we discuss this case?’
He hesitated long enough for her to realise few people gave him orders, but in the end he nodded.
And scowled at her.
Ignoring the scowl, she leant forward, opened the file and spread the prints on the table.
‘You can see here the artery leaves the ventricles as one big trunk, and here, the hole in the ventricular wall. The problem is that too much blood is flowing through the pulmonary arteries where they branch here…’ she pointed with a pen that had been beside the file on the table ‘…into the lungs, causing congestive heart failure. From the look of this there’s a narrowing of the aortic arch as well, so the heart is having to work extra hard to get blood flowing around the rest of the body.’
‘And the operation?’
She glanced up at the interruption, pleased he had switched his attention from personal matters, feeling her own inner agitation ease as they spoke professionally.
‘I need to detach the pulmonary artery from the main artery and use a small piece of artery with valves intact to connect it the right ventricle, stitch it in place there, fix the hole between the ventricles and patch up the aorta where I’ve detached the pulmonary artery.’
‘That’s a huge operation for so young a child,’ he said, frowning over the scans, following the lines she’d drawn with the pen. ‘Saying it like that, you make it sound simple, but for an infant…’
He lifted his head to look at her, and Mel read the doubt in his eyes—doubt and pain.
‘There’s a ninety per cent success rate,’ she said, to quell the doubt. The pain was something else. ‘She means a lot to you, Tia?’
This time he looked surprised, then he offered Mel a twisted kind of smile, so sad it nearly broke her heart.
‘Tia’s mother, Miriam, was my father’s favourite wife. She was also more a mother to Kam and me than our own mother was. Tia was an afterthought, the last child of my father, and Kam and I, when we came home from school in England, regarded her as our special pet—a living doll, I suppose, although boys are not meant to play with dolls.’
‘Boys can play with anything they like,’ Mel replied gently, hearing the pain and loneliness of the child he’d been behind the simple explanation. ‘And this boy will, too, because we’re going to fix his heart,’ she added, to get them back on track. Feeling sorry for this man was a sure way to disaster. She was already doomed to feel attraction—but sympathy? Empathy?
Way too dangerous!
‘For now we need to keep an eye on his oxygen saturation. Because of the hole in the ventricular wall, the oxygen-rich blood from his lungs is mixing with the oxygen-depleted blood from his body, which means the blood going into the aorta isn’t as oxygen-rich as it should be.’
She glanced across at him and smiled.
‘Teaching my grandmother to suck eggs, aren’t I?’ she said.
‘Your grandmother to what?’
‘It’s an old expression—telling you things you already know.’
He returned her smile—with interest apparently because it made her forget all the reasons she didn’t want to be attracted to Arun again.
Although, now he knew about the pregnancy…
Was she mad?
Of course they couldn’t continue their affair. It would complicate matters far too much.
And, no doubt, start the dreams again—dreams where he held her in his arms, and brought such sensual joy to her body…
‘I thought we were sensibly discussing the baby’s case,’ he said quietly, and she looked across at him and saw a smirk that suggested he’d read her momentary distraction with ease.
‘We are!’ she protested, but it was a feeble effort. Somehow she had to shut away all memory of the past and concentrate on the present—now. ‘I was saying how I needn’t explain it all to you.’
‘Ah, but you do, because although I know what is wrong and what must happen, hearing you explain will help me tell Tia.’
Mel understood and continued to run through the regimen the baby would need, with tube feedings for maximum nutrition, ACE inhibitors to dilate the blood vessels and make it easier for the heart to pump blood through the body, digoxin to strengthen the heart muscle, diuretics to help the kidneys remove excess fluid.
‘So, we organise all of this now, and have nurses rostered on to keep an eye on him at all times,’ Arun said. ‘What about a doctor? Do you want a registrar to keep an eye on him? We could fly in a paediatric registrar.’
‘You could? From where? Do you pluck them out of the air?’
She was teasing him, Arun knew, and for a moment he wondered if they could get back to where they’d been, not necessarily lovers again but two adults enjoying each other’s company, talking and laughing easily, discussing every subject under the sun.
Except the future, which had been off limits, for they’d agreed that what they’d both wanted had been a brief affair. And if, in retrospect, it had seemed much more than that…
He forced his mind back to practicalities, at the same time registering that very soon the future would have to be discussed.
The baby’s future—his baby’s future…
‘As I said, Kam and I have been working on changes at the hospital. The maternity ward came first, but paediatrics was to come next. We have been interviewing applicants for the positions available—a paediatrician and three paediatric registrars—and I am sure at least one of those we’ve short-listed could come immediately.’
‘That would be great.’ She sounded genuinely pleased so he wouldn’t mention that money might have to change hands to achieve this as quickly as possible. Mention of money—or of what money could provide for her—had upset her earlier, despite his experience of women suggesting they were far more practical about gifts or payments for services than men were.
But this woman was unlike any woman he’d ever known—the dreams that had cursed his nights for the past four months had been enough to tell him that. And though, whenever he’d considered following up on their brief affair—maybe flying to Australia to see her—he’d ruthlessly dismissed the thought as a passing fancy, he’d known the attraction went deep.
Now she was here.
Carrying his child…
And about as friendly as a hungry barracuda!
‘I will get moving on the medications first. You will fit the feeding tube? Should he be sedated for that?’
‘A mild sedative.’ She picked up a pen and turned over one of the printouts to write a list of what she’d need on the back of it, but as she pushed it across the table to him, their fingers touched. She drew her hand back as though she’d been burned and Arun knew she’d felt the searing awareness that had shot through his own blood at the touch.
‘No,’ she said, answering a question he hadn’t asked. ‘Later, when we have this baby stable, that’s when we’ll talk.’
He took the list and guided her back to Tia’s room, leaving her there with the two women and the baby while he went to organise first the equipment and drugs and then another doctor so Melissa wouldn’t have to spend all her time at the hospital.
Although he suspected she was conscientious enough to want to be here a lot of the time.
Which meant that, apart from the promised talk, he’d see precious little of her, as all her spare time would, naturally, be spent with Jenny, preparing for the wedding, doing girl things…
By the time he returned to Tia’s room, it was filled with relatives. At least the hospital had been built with local customs in mind so the rooms were big enough for a mass of family to squeeze in, but to intubate a fragile baby with such chaos all around?
‘I know I said it would be good for the baby to stay with Tia,’ Melissa said, when he’d battled through the crowds to the side of the crib where she was fending off women who wanted to hold the newborn, ‘but this is impossible, and he really needs to be monitored. An ICU room perhaps, but one somewhere not too far away so Tia can visit and sit with him, just her and maybe Miriam, not the whole family.’
‘It will be hard to explain that to them,’ Arun said, ‘but, yes, you’re right. We need to move him. Come.’
He handed the equipment he’d brought with him to Zaffra and pushed the crib from the room, calling back to Tia that he would come back and see her very soon.