Dani ducked into OR room four and looked over the shoulder of her fourth year resident, Winn Templeton. Carlos, the third year who was doing the hernia repair under Winn’s supervision, was just putting in the final sutures on the abdominal closure.
“How’d it go?” Dani said.
“Great,” Carlos said instantly, his eyes above the surgical mask practically glowing.
“Winn?” Dani asked again.
“Not bad.”
Translated, everything went fine. Plus, Winn thought the third year was solid. If he’d said We’ll be done in a few minutes or some other nonspecific comment, she’d know Winn wasn’t happy with Carlos’s performance, and she’d need to wait around to talk to Winn in private. Happily, she didn’t have to.
“All right, try to finish up in here before your next birthday, would you,” Dani said, “and text me when he’s extubated.”
Leaving them to finish up, she continued on in her search for Zoey. She wanted to know what was going on with Ren. Ren hadn’t come back up after her mysterious, urgent call to the ER, and every other moment Dani wondered where Ren was, what she was doing. What she was thinking. And her preoccupation with all things Ren didn’t all have to do with surgery. In fact, most of it didn’t. She really tried to go with what Zoey had said, that Ren was just figuring out what to do about the night they’d spent together. That a little time and patience—ha!—might be a good idea. Zoey made sense, sure, but the trouble was, in Dani’s mind, there wasn’t anything to figure out.
The time she and Ren had spent together had been great. Just about everything she might want had happened. They could talk to each other, about most anything or not much at all, and the words came easily. The feelings came out too, and for her that was a big thing. Scary, yeah, but…good. Time passed without her noticing it, too quickly. And forget about the sex.
That was for sure a problem, wasn’t it? She couldn’t really forget about the sex, considering that it was not just effortlessly amazing, but they seemed to understand each other physically as well as they did when they talked. They communicated, even when they weren’t talking. And Ren was…well, Ren was spectacular.
Why would she want to forget that? Why would she even want to stop thinking about it? Other than the fact that the little flashbacks and instant flickerings of excitement destroyed her concentration and made her a little crazy and—oh, yeah, by the way—borderline horny all the time. Dani blew out a breath. This was not good. She’d never met a woman who’d had this sort of effect on her, and she’d been sleeping with women since she was fifteen. Not that there were an innumerable number, but all the same, enough for her to know what was amazing.
Ren was amazing.
Dani caught sight of Zoey ducking into the OR lounge and followed her in. “Hey, Zoey—I’ve been looking for you.”
Zoey looked over her shoulder and slowed. “Hi, what’s up?”
“I was about to ask you that. What’s going on with Ren?”
Zoey frowned. “I dunno, what do you mean?”
Dani gritted her teeth. Was she speaking another language? “She went downstairs to the ER in a big hurry and hasn’t been back. So what’s going on?”
Zoey gave her an odd look. “Oh. You mean the case.”
“Well of course I mean the case, what else would I mean?”
Zoey’s brows rose. “I don’t know, Dani. Are you asking about Ren Dunbar, senior surgery resident—my chief, by the way—or Ren the extremely hot younger woman who has your ovaries melting? Or possibly your brain. Or both.”
Dani ran a hand through her hair. She loved Zoey, she did. But sometimes she could really do without the poking and prodding at her sore spots. “Never mind all that. Just, what’s going on in the ER?”
“The kid with the appendectomy, from the transplant service a few days ago? He’s being readmitted. In fact, Ochoa wants him up as soon as the room is clear.” Zoey took a few more steps toward the locker room. “As soon as I change, I’m supposed to make sure the room is ready. So I gotta go.”
“Oh man, that’s Leo.” Dani followed Zoey into the locker room and leaned against the wall of lockers while Zoey opened hers.
“I guess that’s him. Why?” Zoey pulled off her scrub pants and grimaced at the blood-soaked cuffs as she tossed them in the hamper. “Just once I’d like to get through a vascular case without standing in a puddle.”
Dani’s mind was on Ren and how she’d take Leo being readmitted. “I’m pretty sure Ren did the case with Ochoa. She took care of him while he was here. You know how it is with kids.”
“Oh, I get it,” Zoey said absently, stepping into clean pants. “That’s why they called Ren with the consult.”
“Damn,” Dani muttered.
Zoey frowned. “What’s going on, Dani? It’s what happens sometimes. You know that. So what’s the deal?”
“I know it happens,” Dani said, “but this is gonna really be a tough one for Ren. She really likes that kid.”
“We all like our patients. Give her a little credit. She can handle it.”
Dani stared at Zoey. “You know something, you’re right. I don’t know what’s wrong with me. Of course she can handle it.”
“Listen,” Zoey said, a gentle note to her voice edging out her usual hard-edged, tough-love sarcasm. “I know you care about her. And that’s…well, I hope it’s going to turn into something good, whatever it looks like. And we all need someone to understand us when we’re having a hard time, so that’s good too. But right now, Ren needs something else.”
Dani nodded. “I know. She needs to know she can do what needs to be done. She needs to know how freaking smart she is, and how good she is.”
Zoey smiled. “Very good. Just remember that.”
“I got it, I got it.”
“And if I were you, not that you’re asking,” Zoey said as she started to turn away, “I’d try to get her into bed again soon. That’ll help too.”
Dani laughed as Zoey disappeared from the locker room. It wasn’t as if she didn’t want to get Ren into bed again. She’d been thinking about it since she’d opened her eyes in the morning. She was ready, whenever Ren wanted. She just hoped there would be another time.
* * *
Ren pushed the gurney with a very sleepy Leo down the hall toward operating room ten.
Peter, the PA student from the ER, who had stayed with the case the entire time, asked in a quiet voice, “Will it be okay if I stay and watch?”
“It should be,” Ren said, “as long as Dr. Ochoa doesn’t mind. You should ask her when she gets here, though.”
“Right, I will.”
“Have you ever been in the OR before?”
“Um, no.” He looked down, obviously expecting her to say he couldn’t observe.
“Okay. Once we get Leo inside, I’ll show you where to stand. Do not move, and whatever you do, don’t touch anything. If you feel light-headed, sit down.”
He grinned. “Right, I got it!”
Ren tried not to roll her eyes. “Great. Put your mask up.”
Peter hastily complied, and Ren shouldered open the door to the OR and guided Leo in. The circulating tech met them at the door, Ren motioned Peter to a spot near the anesthesiologist, and in a minute, they had transferred Leo onto the operating table. He looked very small lying in the center of the table, surrounded by the anesthesia machines, the long stainless-steel tables filled with surgical instruments, and the line of equipment carts arrayed along one wall.
Ren adjusted Leo’s surgical cap and lightly brushed her fingers down his cheek. “You’ll be going to sleep pretty quick, Leo. When you wake up, you’ll be in recovery with your dads.”
He was barely awake, but as sick as he was, he smiled that brilliant smile. “Okay, Dr. Ren.”
His trust was so simple, and so pure, she might have been undone by the enormousness of the responsibility if she hadn’t quickly reminded herself that his trust was a gift, and doing her job was the best way to honor it. She glanced at anesthesia and nodded.
“Okay, Leo buddy,” the anesthesiologist said as he injected medication into the IV line, “time for you to have some good dreams.”
Ren waited until the intubation was over and Leo was stable before she left the room to scrub. She was halfway done when Dr. Ochoa arrived. A woman a bit taller than Ren and built like a rugby player with a thickset, muscular physique, she blew into the scrub area like a hurricane, all rapid motion and swirling energy.
“Everything set to go?” she said briskly, tearing open the covering on a disposable scrub brush and kneeing on the water with the paddle built into the front of the scrub sink.
“Yes. Infectious Disease didn’t want us to give him any broad-spectrum antibiotics until we were able to culture him. He’s still febrile, but stable.”
“How do you suggest we proceed?” Dr. Ochoa scrubbed the antiseptic-impregnated plastic brush over her hands and forearms with rapid strokes.
“From the ultrasound, it looks like there’s a large collection around the lower right colon, but it may still be localized,” Ren said. “We could try to access it laparoscopically and drain it percutaneously. That would make his recovery a lot easier.”
“What’s the downside?” Ochoa peered into the operating room through the window above the sink. “Good. Markovic is scrubbed. He’s good with the scope.”
“Things are likely to be sticky in there,” Ren said, “after the previous procedure, and now with an acute inflammatory process, we may not be able to distinguish the tissue planes easily. We could miss a second collection.”
“I don’t like the idea of trying to do this without direct visualization,” Ochoa said, and Ren grimaced behind her mask.
Surgical judgment was every bit as important, even more important in many instances, as the ability to perform a procedure flawlessly. The body was forgiving of small errors, which making the wrong choice of procedure never was.
“But,” Dr. Ochoa went on, tossing her scrub brush into the trash, “I agree we should try the least invasive approach first. But I’m not going to spend a lot of time on it. If we can get into the collection, get it drained, and get a reasonable image in here to be sure we haven’t missed something else, I’ll be very happy.” She glanced at Ren. “You get one shot at it.”
“I’ll get him prepped,” Ren said, relieved that her initial plan hadn’t been in error. Inside, Ren quickly prepped and draped the field, a small square of pale flesh that encompassed almost Leo’s entire abdomen. When she’d finished, Markovic, the scrub tech, held out her sterile gown, and she pushed her arms through the sleeves and then her hands into the gloves he had opened.
Dr. Ochoa, already gowned and gloved, said, “Take the right side of the table, Dr. Dunbar.”
The surgeon’s side, at least when the surgeon was right-handed.
Ren stepped up to the table. “I think we should try to go through the previous entry incisions. He’s not that far out from the last procedure, so the tracts should be easy to open. That might help us avoid opening up new tissue planes to infection.”
“Good idea, but go slow. Blunt dissection only. We don’t want to get into the kidney.”
Ren incised the locations where they had inserted the laparoscopic instruments previously and then carefully spread down through the underlying layers of muscle, opening up the same paths they’d used before. When she’d penetrated the abdominal cavity, she asked for the laparoscope and passed it in.
“Can we turn the camera on, please,” she said.
Everyone in the room angled to looked at the monitor mounted at the head of the table. The door opened and closed behind Ren, but she paid no attention to it. People were always coming and going in the operating room.
Quinn Maguire spoke from somewhere right behind her. “What did you find?”
Ochoa said, “Nothing yet. Everything looks pretty hot down here, though.”
Quinn grunted. “Lot of inflammation in there. Did you get much of a look at the transplant?”
“No,” Ochoa said, “and I don’t plan to. We’re staying away from it.”
Another voice said, “Good idea.”
Dr. Doolin, the chief of transplant.
“Go ahead, Ren,” Dr. Ochoa said. “Carefully work your way down to the colon, and let’s see if we can find the appendiceal stump.”
Watching the monitor while manipulating the instruments intra-abdominally, Ren alternately separated tissue, irrigated, and suctioned the blood from the area. Bodies pressed close around the table, several close enough to her to touch her back. Her back wasn’t sterile and neither were they, so as long as they were behind her, they couldn’t contaminate the field. The impersonal intimacy of the operating room had never bothered her, even when someone put a hand on her shoulder to lean in for a better look. Quinn Maguire. Watching her work. In a second the pressure eased, and Quinn moved away.
“There,” Ren said. “There’s one of the clips on the appendiceal stump, only…” Her stomach clenched. The clip didn’t appear to be attached to anything except a tiny strip of tissue. “It’s avulsed.”
Had she done that after she’d clipped it, while removing the instruments? Had she inadvertently torn the tissue she’d meant to close off, leaving an opening that allowed contaminated bodily fluids to leak into Leo’s abdomen? Had her error caused an infection that had now become an abscess?
“Let’s see if we can get another view,” Ochoa said.
Carefully, delicately, Ren eased the laparoscopic camera ninety degrees, and her fears were confirmed. The stump of the appendix was completely open into the colon.
“Well, that’s our culprit,” Ochoa said in a calm voice.
“I could have pulled the clip off when I was coming out,” Ren said.
“I don’t think so,” Ochoa said instantly. “If you had, there would’ve been a lot more bleeding than what we’re seeing here. And we would have seen it before we closed. No, I think this is a question of his poor tissue healing.”
“Probably chronically infected,” Quinn said, “and then, once the clip was on and the appendix was out, the surrounding tissues just fell apart.”
“Not surprising with all the immunosuppressants and steroids he’s been on,” Dr. Doolin said.
Quinn said, “Do you think you can get that adequately drained without opening him up?”
“Let’s get it irrigated out first,” Ochoa said, “and then we’ll see about getting some drains in there.”
They worked for another half an hour until Dr. Ochoa was satisfied that the abscess had been drained. They were even able to oversew the opening with some healthier looking surrounding tissue to hopefully prevent further contamination.
“Start him on broad-spectrum antibiotics,” Ochoa said as she removed her gown and gloves, “and we’ll wait on what the cultures show before we adjust. Don’t feed him for at least twenty-four hours until we see how he’s doing.”
“Of course,” Ren said, applying Steri-Strips and dressings to the incisions that they’d reopened.
“I’ll talk to the family.” Ochoa paused at the door. “Good job, everybody.”
Once Ren got Leo settled in the pediatric intensive care unit, she went to see Leo’s parents herself. “The PICU staff will let you know when you can see him. It shouldn’t be too long. Don’t worry, he won’t wake up before you get there.”
“Do you think this is going to take care of the problem?” Martin Marcoux asked.
“Dr. Ochoa is confident that we were able to drain all of the infection. The best treatment for now is the antibiotics, which have already begun.”
Both men studied her, and Father Lopez finally smiled. “You’re very good at reassurance. Thank you. What are the chances the infection will recur?”
Yes, definitely intelligent parents. “It’s hard to say, but not zero. A lot will depend on his tissue healing and—”
“And he’s compromised,” Martin said grimly.
“Yes. But,” she said firmly, “on the other hand, he’s generally been healthy right up until this time, and we got a good look at the area, and his kidney is functioning normally.” She caught a flicker of movement out of her peripheral vision. Dani stood in the doorway of the family room. She turned back to Leo’s parents and finished, “All of those things are on his side.”
“Thanks again,” Martin said.
“Of course. I’ll check in later, and either I or Dr. Ochoa will let you know if there’s any change.”
When she stepped out into the hall, Dani was waiting.
“Is there a problem?” Ren asked quickly, expecting some problem with a patient.
“What? No. I wanted to see you.”
“Oh.” Ren tried to ignore the swift surge of pleasure. Dani was being Dani—kind and thoughtful. Being friends, that’s what she’d said. “Thank you. I’m glad you’re here.”
“So. How’d it go?” Dani said.
“Good, I think,” Ren said. “There were a lot of people checking on that case. Quinn was there and Dr. Doolin.”
“Not surprising,” Dani said as they walked back toward the OR lounge. “Tough cases like that are interesting. Everybody wants to see what’s going on with them.”
“I think Quinn was there to check up on me.”
“Probably not,” Dani said.
“I don’t know. I’m still not sure it wasn’t my fault.” Ren glanced at Dani. “The stump’s blown.”
“Could have been a lot of reasons.”
“Yeah, maybe,” Ren said uncertainly.
“Listen,” Dani said. “I’ve been there, too. If Ochoa thought you’d made a technical error, she would have told you by now. Probably as soon as you finished the case.” After a quick look around, she grasped Ren’s hand and squeezed. “Okay?”
Ren smiled and held on for a heartbeat before letting go. “Okay.”
“Good,” Dani said. “Are you doing anything right now?”
“Um…” Ren glanced at the clock. “Most of our cases should be started already. I should check the board, though.”
“Yeah, okay,” Dani said, keeping pace with her.
Since Dani wasn’t about to leave, apparently, Ren slipped into the hall outside the OR office and checked the board. All the A service cases were underway and covered.
“I should get back and check on Leo,” she said.
“The nurses are probably still getting him settled,” Dani said. “Come on, let’s go grab something to eat.”
“I’m not really hungry,” Ren said.
Dani said, “You probably are, and even if you aren’t, it’s never a bad idea to refuel.”
She ought to say no. She already knew all the reasons why. But they were in the hospital. Dani couldn’t possibly kiss her in the hospital. As if Dani even wanted to kiss her again. And why was she thinking about that when she’d already decided there would be no more kissing. Not with Dani or anyone else. She had plenty of time for that later.
“Come on, Ren,” Dani said softly. “Just friends, okay?”
“I’m really fine, Dani,” Ren said, although she wasn’t so sure. The case had been doubly hard, worrying about what she might have done to cause the problem. She couldn’t shake the feeling she’d been judged in there, and maybe found lacking. “I think I might like to get out of here for a few minutes, though,” Ren said softly. “Just to get some air.”
“I know just the place.” Dani took her hand again, but before Ren could squeeze back or pull away, she dropped it. “Come with me?”
“Yes,” Ren said. That would be safe enough.