THOMAS WOLFE WASN’T the only person in the gallery to watch this particular surgery.
Rosie Hobbes was sitting beside him, alternatively watching the screen that gave a close-up view of what was largely obscured by the gowned and masked figures below and leaning forward to watch the whole team at work.
‘I’ve never seen the insertion of a VAD before.’
‘No. It’s not common. Especially in children.’
‘Do you think it’ll work?’
‘It will certainly buy us some time. The only thing that could guarantee more time is a transplant. This is a bridge which should give her a much better quality of life while we’re waiting.’
Rosie was looking down into the theatre again. At the small chest now open and so vulnerable.
‘Life’s so unfair sometimes, isn’t it?’ she murmured.
‘Mmm.’ Thomas couldn’t argue with that. He had firsthand experience of exactly how unfair life could be. So did the surgeon he was watching so intently.
The last time he had watched Rebecca operate had, ironically, been on this same patient, when Penny had been only about six months old.
Life wasn’t only unfair, it had patterns to it. Circles. Or were they spirals? A kind of pathway, anyway, that could take you back to places you’d been before. Places where memories could be looked at through a lens that changed with increased distance or wisdom.
Did you choose to follow those pathways with the familiar signposts, Thomas wondered. Or were they somehow set in place by fate and always there, waiting for you to step back onto them? Spirals could go either way, couldn’t they? They could go downwards into tight loops that sucked you into a place you didn’t want to be. Or they could lift you higher into loops so wide that the possibilities were no more than promises.
He was, very unexpectedly, back on one of his life pathways. Ever since that walk with Rebecca the other day when they’d reached some kind of truce and sealed it with that hug.
Or maybe he’d stepped back onto that path the moment he’d agreed to come back to Paddington’s.
It still felt weird.
The way the memories had begun to rush at him from every direction but without the pain he would have expected.
He could think of Gwen and find himself ready to smile.
He could remember Rebecca falling out of that boat and how unbelievably sexy she’d looked in that wet dress...
He had even found himself reliving that hug on the top of Primrose Hill and how it had reminded him—again—of their very first date.
‘We’re ready to go on bypass.’ Rebecca’s voice was calm and clear through the speaker system. ‘And the pocket for the pump is all set. How’s the pump preparation looking?’
The surgeon working on the back table to prepare the device looked up and nodded. ‘Ready when you are.’
‘Stand by.’ Rebecca and her registrar started the task of getting Penny onto bypass. Despite her obvious focus, she kept her audience involved. ‘Because we know that this surgery is a bridge to transplant, I’m being careful to leave space for re-cannulation at the aortic cannulation site.’
It took long minutes to get Penny onto bypass and to the point where the heart was stopped. Her life now depended on the oxygen being circulated by the cardiopulmonary bypass machine. It was a procedure that was common and relatively safe these days but it still gave Thomas a sense of wonder at what medicine was able to achieve, along with a dollop of pride that he was able to be a part of this astonishing world.
He was proud of Rebecca, too. He had been perfectly sincere when he’d told her that she was the best surgeon he had available and that her skills were amazing, but he hadn’t realised how much better she had become in the last few years. So confident but, at the same time, so exquisitely careful of every tiny detail. His gaze was fixed on the screen again as she inserted a suture.
‘This marks the site of the core,’ she said, for the benefit of the observers. ‘I’ve used the left anterior descending artery to identify the intraventricular groove. We’re going to core anteriorly due to the small size of the left ventricle.’
We. It was Rebecca who was doing the actual task but she’d never shown any sign of developing the ego that some surgeons were famous for. She’d always seen herself as part of a team.
And now Thomas felt like he was part of that team, too. As difficult as it had been to step onto personal ground during that walk, they had found a space just within the perimeter that was apparently going to make it possible to work together without the awful tension of the last months.
Maybe it would even allow them to become friends one day.
It had also given him rather a lot to think about. The quiet conversations between the surgeons, nursing staff and technicians below were only catching the surface layer of his attention as his thoughts drifted back to what was becoming a familiar route.
He’d known that her heartfelt words would haunt him.
I felt more and more alone...
He’d felt alone, too. They might have been walking the same path back then, in those dark days, but they had been nowhere near each other and the distance had only increased.
Looking back, he could see that it had been Rebecca who’d made the effort to reach out time and time again.
‘I’ve kept some dinner for you. It’s in the oven.’
‘I’m not hungry.’
The bed, where they would lie side by side, should have made them feel less alone but those sleepless hours had been the worst. The slightest contact with her skin would make him flinch and move away.
‘It’s been a long day. I’m tired.’
But he’d been there. He hadn’t been running away. He’d been desperately sad. He’d needed more time to try and put the shattered pieces of his life back together and it was something that Rebecca couldn’t help with. Not just because she was fighting her own battle but because she was so much a piece of what had been shattered.
His family.
The family that he had failed to protect.
She’d been right to accuse him of being distant ever since he’d returned to Paddington’s. Was she also right that he’d coped with his grief by initiating that distance all those years ago? Had he been the one to push them so far apart that there had been no hope of connecting enough to help each other?
How could he have let that happen to the person who’d been his whole world until Gwen had arrived? The only woman he would ever love like that...
‘Look at that,’ Rosie whispered beside him. ‘That’s the inflow cannula going in and getting secured to the sewing ring. Dr Scott’s incredibly neat, isn’t she?’
Rebecca’s size had often led people to make incorrect assumptions about her abilities but having such small hands with those long, delicate fingers was a bonus for a surgeon who often had to work on tiny patients. Being so much shorter than he was had always seemed another bonus because it made it easier for children to be drawn to her. At six foot one, Thomas towered over his small patients. And when was the last time he had crouched down to talk to one of them? Had he forgotten the difference that could make in his years of working only with adults?
Maybe he’d forgotten how tall he was, along with ignoring so many other personal things that only intruded on his focus on his work.
Hugging Rebecca on Primrose Hill had made him acutely aware of his height because of the way her head only reached his shoulder. Not that that had ever been a bad thing. As if it was a step from a well-remembered dance, she had turned her head so that it fitted perfectly into the natural hollow beneath his collarbone. It probably wasn’t such a good thing that holding her that close had also reminded him of how soft her curves were...
With an effort, Thomas refocused on what he’d come here to watch. Brooding about how much he had failed Rebecca to leave her feeling so unbearably alone that she’d had to escape her marriage was not only inappropriate, it wasn’t going to help anyone. The past was simply that—the past. They could only move forward and now they seemed to have found a way to do that.
At least he’d been the one to reach out this time.
To offer that hug that was a physical connection on top of an emotional one.
And it had felt good.
More than good.
As if there was a promise in the air he was breathing now.
The promise of finding peace?
* * *
She knew he was watching her.
Not that she’d looked directly up at the gallery at any point but she’d caught movement from the corner of her eye as she’d entered the theatre—her arms crossed in front of her, keeping her scrubbed and gloved hands safe from contact with anything—and she’d known it was Thomas, simply from the impression of height and that measured kind of movement he had these days.
Rebecca wasn’t about to let anything disturb her focus. She did allow herself a heartbeat of pleasure that he was there but the only other irrelevant thought that escaped that part of her brain before she closed it down was that the last time Thomas had been observing her work had been during the second cardiac surgery that Penelope Craig had had, when she was still so tiny—only a few months old.
Or maybe the thought wasn’t completely irrelevant. The surgery had been a success that time. She was going to do her utmost to make sure it was this time, too.
Finally, it was time to find out. The ventricular assist device had been meticulously stitched into position and Penny had been weaned off the cardiopulmonary bypass.
‘We’ll start the device at the lowest setting and keep the aortic clamp on to get rid of the last of the air.’ Rebecca turned to one of the Theatre technicians. ‘I’ll need the transoesophageal echo soon, so I can check the final position in the chest without the retractors.’
She took plenty of time to gradually increase the flow of the device while the heart’s function and pressures were closely monitored.
‘We may not decide on final settings for a few days,’ she said, for the benefit of everyone watching. ‘Some people leave the chest open for a day to allow for stabilisation but I would only do that if I was concerned about something like ongoing bleeding. This is looking great, so I’ll be happy to close. Let’s get these cannulas removed and some chest drains in.’
There was movement again in the gallery and Rebecca glanced up to see that some people were leaving now that the procedure was all but over and it had clearly been successful. Thomas was still there, however. He acknowledged her glance with a nod and the hint of a smile.
A smile...
Things had certainly changed in the last few days.
That hug on Primrose Hill had been a turning point. A starting point, perhaps, of a new relationship. One of colleagues who could work together without causing discomfort to themselves and those around them.
Maybe it could even be the start of a friendship?
Rebecca turned back to coach her registrar through the placement of the chest drains. She had to admit that the idea of being friends with Thomas might be pushing things and getting closer than colleagues might not be a good idea, anyway. It had messed with her head more than a little, that hug. Especially coming in the wake of so many memories that had been undisturbed for so long. Not that she’d ever forgotten how it had felt to be held in his arms with her head nestled in that hollow beneath his shoulder but she’d never expected to actually feel it again.
But, like the memories that they’d shared, that hug had stirred up feelings that might be far better left alone.
Like how much she had missed Thomas in her life.
How much she still missed him...
No. She missed having a partner but Thomas would never be that man, again. You couldn’t rewrite history and too much damage had been done.
Minutes ticked past to add another hour to the long stint in Theatre but Rebecca wasn’t about to leave her small patient under the complete care of others. Even when the surgery was completely finished and she had stripped off her gloves and mask and hat to dispose of them in the rubbish, she stayed in the room, keeping a close watch on all the monitors as the team tidied up around Penny and prepared her for the transfer to Recovery. And then she went with them, still watching for any change in pressures or heart rhythm.
It was no surprise that Thomas arrived by her side almost immediately.
‘She’s stable,’ Rebecca told him. ‘It’s looking good.’
He was scanning the bank of monitors himself. ‘You did a fantastic job,’ he said quietly. ‘Julia and Peter are waiting in the relatives’ room. Do you want to come with me to tell them the good news?’
‘Of course.’ She stayed a moment longer, however, moving to the head of the bed. She put her forefinger against her lips and then reached down to touch Penny’s cheek gently. ‘Be back soon, pet. Sleep tight.’
Sleep tight, don’t let the bedbugs bite...
Had Thomas remembered the final goodnight she had always given Gwen? That soft touch that transferred a kiss and the whisper of an old rhyme that was irrelevant except that it was remembered from her own childhood.
When had it become something she had started to do with her youngest patients?
She couldn’t remember. Somewhere in the last few years, it had just become one of those automatic, preferably private things. Like a good luck charm? No. She was too much of a scientist for something like that. It was because she worked with children and you couldn’t help connecting with them at a level that was never appropriate or possible with adults.
And maybe it was because she knew, better than most, how precious these little lives were.
If Thomas remembered, he didn’t show any sign of it. He was still looking at the monitors, in fact, rather than the small person attached to them. Rebecca’s heart sank a little as she followed him from the Recovery area. They might have made a breakthrough in their own relationship but was Thomas ever going to step any closer to his patients? Allow himself enough of an emotional connection to share the joy that came with success?
He certainly had a smile for Penny’s parents.
‘I’ll let Rebecca tell you how well the surgery went but it was all I could have hoped for. You’ll be able to go in and see her very soon.’
Julia burst into tears. Peter put his arms around her and ignored the tears rolling down his own cheeks.
‘She’ll have to go to intensive care after this, won’t she?’
‘Yes. But probably not for long. It’s amazing how quickly children can bounce back from even open heart surgery.’
‘And she’s going to be better?’ Julia lifted her head from her husband’s chest. ‘She won’t need the wheelchair or to be on oxygen all the time?’
‘That’s what I expect.’ Thomas nodded. He smiled again but the glance at his watch told Rebecca that he was already preparing to move on to his next patient. Stepping back from this emotional encounter with his patient’s parents?
Perhaps he wasn’t ready for the kind of connection that would allow him to share their intense relief with its glimmers of joy that would become hope. And she could understand that. If you were distant enough not to buy in to the joy, it meant that you were protected from the pain when things didn’t go well. With many of the cases doctors like she and Thomas had in their care, the long term outlook wasn’t good, so that pain was inevitable. Rebecca had learned to deal with it. To remind herself that it was worth it because of the heavier balance of the joy.
Thomas had chosen to step back.
To run away...
But he had come back. Surely being willing to work with children again was a sign that something big had changed. And there’d been moments during that walk when she could believe that the man she’d married really did still exist somewhere behind those barriers.
Baby steps...
Like the fact that he could smile at her again.
It wasn’t as if the distance he kept made the care he provided any less thorough. He went above and beyond what most doctors did which was why it was, again, no surprise to find him in the intensive care unit late that evening, when Rebecca went back for a final check on Penny.
‘I met Julia by the elevator. She’s finally gone to get something to eat in the cafeteria and then she’s coming back to stay the night with Penny.’
Thomas nodded. ‘Are you still happy to lighten the sedation level as early as tomorrow morning?’
‘Yes. She’s been stable ever since the surgery. The VAD is working perfectly. We’ll keep the pain control up, of course, but I wouldn’t be surprised if she wakes up and wants to get out of bed and put her tutu on. Like Sapphire, there.’
Thomas glanced at the end of the bed where the sparkly blue, soft toy bear that Julia had bought as Penny’s post-surgery gift was waiting for her to see as soon as she woke up. But he wasn’t smiling. Did he know how desperately Penny wanted to be a ballerina? Did it matter?
‘It’s very late,’ she added. ‘What are you still doing at work?’
Had his career become his whole life, the way hers had?
Did he not have someone to go home to?
The thought had occurred to her before, but she’d never heard any hint of what Thomas’s life outside the hospital contained these days. It had been five years. It shouldn’t be surprising if he did have someone else in his life by now but Rebecca knew how much of a shock it would be.
She wasn’t ready to find out.
‘It is late,’ he agreed. ‘I was catching up on some work. Trying to decide whether or not to go to that thing at the pub over the road.’
‘Oh, the Frog and Peach. I’d completely forgotten about the celebration drinks.’ Rebecca looked at her watch. ‘It’s only ten p.m. The party should be only just getting going.’
How good would it be if she and Thomas could go to a work function together? To have a drink with their colleagues and make it obvious that they’d found a way to work together again?
‘Saving Paddington’s is definitely something to celebrate,’ she said, looking up to catch his gaze. ‘Shall we pop in? Just for a quick drink?’
He hesitated and she could almost see him following the same train of thought she’d just had.
‘Sure,’ he said. ‘Why not? Give me a few minutes to sort what I’ve left on my desk and I’ll meet you in Reception.’