KALEB AND NICOLA jumped up from their bench, drinks and conversation forgotten as they rushed to the teen’s aid. The bicyclist had already driven by, oblivious to what both of their distractions had caused.
Nicola dialed 911, while Kaleb kneeled down beside the downed kid. The operator answered, and she quickly relayed what they knew, telling her there were two doctors on the scene of a suspected head injury, and that they needed an ambulance.
“I’m going to put you on speaker, while I help.” Nicola set down the phone and took vitals of the unconscious kid. He was breathing, at least. She glanced at his pupils. One was blown. Not good. “Kaleb, look.”
He glanced over and swore softly.
The emergency services operator said, “Central Park’s medical unit is en route. They’re about five minutes out.”
“Okay, thanks.” She gave the dispatcher the boy’s vitals so she could pass them on. “His right pupil is blown. And there’s a small amount of blood coming from the ear on that side.”
Possible skull fracture. Her argument with Kaleb seemed so ridiculous now. Of course, he could come to her appointments. Could be a part of his child’s life. Unlike her brother, who would never be anything more than a few stories told around the dinner table. The ache in her heart almost floored her, almost made her miss the dispatcher’s next words.
“Can you secure his head and neck?”
“He’s unconscious, so we can keep him still for as long as possible, but neither of us has any medical gear with us.”
Nicola got up to direct another cyclist to the other side of the road. “Can you go down a ways and warn people that we’ve got a medical situation here and ask them to use a different route?”
“Sure. Is he going to be okay?” The woman’s eyes were large. “He looks so young.”
That had been Nicola’s thought, as well. “We hope so. Thanks for your help.”
She might not have been able to help her brother, but she could do something to help this boy. That’s why she’d gone into medicine. To save lives.
The woman pedaled about fifty yards down the path and stopped, parking her bike sideways to make it more difficult for anyone just to zoom by her.
In the distance, Nicola thought she heard the sound of sirens, but she couldn’t be sure. Just then, the boy moaned, his eyes fluttering. Kaleb put his hands on the boy’s face. “You need to lie very still, okay?”
“My...head...” The words were slurred, trailing off at the end.
“I know it hurts. You’ve had an accident. Help is on its way, but for now we need you to lie here and rest, can you do that?”
“Think so.”
The ambulance arrived on the scene, the vehicle emblazoned with the words Central Park Medical Unit. Two emergency services workers got out, one pulling a gurney from the back of the vehicle. It didn’t take long for them to do their own assessment and get a neck brace and backboard in place.
“Thanks, you guys. We’ll take it from here.”
“Where are you taking him?”
“NYC Memorial,” said one of the EMTs. Five minutes later, the patient was loaded up and headed back to Kaleb and Nicola’s own hospital.
Nicola called ahead to let them know a trauma case was one the way. She waved at the bicyclist down the path, thanking her and letting her know she was free to go.
Kaleb took her arm. “You okay?”
“Yes, why wouldn’t I be?” She paused, wondering if he was saying what she thought he was. “I’m going to work, Kaleb. For as long as I can. I love my job and don’t plan to give it up, even after the baby’s born.”
“I know. I wouldn’t expect anything different. But that doesn’t mean I won’t worry about the stress of what we do and how it might affect you and the baby.”
She should be really irritated with him, but instead, she found his words touched her. Even if the concern wasn’t for her so much as it was for the baby—at least it showed her that he would be a caring father.
So maybe they wouldn’t end up hating each other after all. Maybe she’d find he had some really good character traits. Character traits that might make her start to...
A quick thought flitted through her head, and she dismissed it immediately. They’d both been working under the influence of adrenaline for the last bit of time. Coming down from it meant her thoughts were suspect right now. So were his. So she needed to extinguish any ideas that weren’t based on reason.
Sitting back on the bench and taking a long drink of her sweet tea, she let the sugar course through her, hoping for a jolt of energy. “Well, I think I’ve had my excitement for the day.”
“Yes. Me, too.”
Ha! Well, Kaleb had had even more to deal with today than she had. She’d had a couple of days to get used to the idea of being pregnant. He hadn’t. He’d had a matter of hours. Hours that he’d spent working cases like Trey’s.
“So as to the question of my appointments, if you really want to come to them, I won’t stop you. But please don’t feel like I expect it.” She paused. “I really don’t expect anything out of you, Kaleb. My only reason for telling you was that I felt I owed it to you. Plus the fact that you were probably going to figure it out, once I started showing, anyway.”
Something like a snort came from beside her. “Well, I appreciate you not making me find out that way.”
“It wouldn’t have been right. No matter how tempting that might have looked yesterday.”
“So you thought about keeping me in the dark. It was the fear of getting caught that made you do the right thing?” There was a tightness to his voice that she didn’t like.
“I hope not. But I have to be honest and say it went through my head before I finally decided to tell you.” She licked her lips. “Saying that, I’d really rather not tell anyone at the hospital. Not for a while. Maybe not at all. If my appointments are at Grace Central that might make it a little easier to contain.”
“Any particular reason you want it kept a secret?”
Her eyebrows shot up. “You want people to know?”
He stared off into the distance. “I hadn’t given it a lot of thought. But I do have a friend who is bound to figure it out. I’d like to tell him at some point. Just to make it easier on me. Not that that will be a fun conversation.”
“I understand. And I’ll tell my parents, of course. They’ll probably want to meet you.” She couldn’t imagine a more awkward scenario than sitting there while her dad grilled Kaleb on whatever questions came to mind. But if Kaleb truly wanted to be a part of this baby’s life, he was going to meet them at some point. Better to do that sooner rather than later.
“That’s fine. So when is your first appointment?”
“In about a week. I’m thirty-five, so they’re going to want to monitor me a bit more closely than their younger patients.”
He smiled. “You say that like you’re ancient, Nicola. I’m thirty-eight.”
“Wow, you really are an old man, aren’t you?”
When his lips curved, bringing that deadly craggy line in his cheek into play, she gulped and quickly added, “Speaking of ages. Anything on your side of the family I should know about? Genetic conditions?”
His smile turned sober. “No. Not that I’m aware of.”
“Okay, nothing on mine, either, except a general absence of luck, I guess. When you said something about a double layer of protection that day in your office, it almost made me laugh. I’d thought if only we’d pulled out two packets instead of just one, this might not have happened.”
“Remind me to never use you as a good-luck charm then, while gambling.”
For some reason, that stung and she wasn’t quite sure why. As if realizing it, he put a hand on hers. “I was joking. It was a simple defect in the condom or packaging. It had nothing to do with luck, bad or otherwise.”
“Sorry. I know I’m on edge right now. I’m hoping my hormones don’t suddenly decide they’re not going to play nicely anymore. I’ll do my best not to boo-hoo on your best shirt or anything.”
Except she’d already done that. When she’d talked to him about her brother’s death. But that hadn’t been because of hormones. That had been because there’d been an actual tragedy in her family. A tragedy that was still taking its toll on her and her parents.
She sucked down a deep breath “Okay, so anything else we need to go over?”
“I can’t think of anything. Let me know how things go with your parents when you decide to tell them. I’ll have to tell my mom and dad, as well. And, like I said, I’ll need to tell Snow.”
Snow. The man she’d met at the restaurant. The one who’d given her a funny look. “Sounds good. I want to wait a couple of weeks until after my first exam before saying anything to them. Just in case something goes wrong.”
Just saying those words made her heart cramp. What if they found something that shouldn’t be there. What if her pregnancy hormones really were due to something awful, like a molar pregnancy.
No. She was pregnant. Something inside of her had whispered in her ear even before she’d taken the home pregnancy test. She’d known.
And now, so did Kaleb. The hard part was over. At least she hoped it was. Because if it wasn’t, then with the exception of her brother’s death, these might be the hardest nine months she’d ever have to endure. As she watched Kaleb pick up their trash and take it to the nearest waste receptacle, she sucked down a deep breath. She needed to be on her guard. Because those pregnancy hormones might not simply cause weepy moments here and there. What if they deceived her and made her think she had feelings for Kaleb? Like she’d had when she’d thought of his character traits?
Any feelings like that would be traitorous, and likely to disappear as soon as the baby was born.
Oh, Lord, had that already happened? What if that incident in his office had been dictated by the baby chemicals that were coursing through her veins? If that was the case, she’d have to be more careful from now on. Any mushy feelings she might develop for Kaleb she was going to attribute to hormones, plain and simple. She’d just have to wait it out and ignore them as much as she could. Then once the baby was born, she could sort out what was and what wasn’t real. She held on to that thought as they walked out of the park and each got in their separate cars, and continued to hold it as she took the exit that led to home. And it remained on her mind as she drifted off to sleep later that night.
Saturday found Kaleb in surgical room three waiting for Nicola to get gloved up and in the room. Her last case had run over by fifteen minutes and she said she was on her way. He had a schedule to keep, but he didn’t want to start this without her, and he wasn’t sure why.
He hadn’t seen her all day on Friday, but that was probably just as well. He wasn’t quite sure why he’d insisted on being there other than it seemed strange to just ignore the baby until after it was born and then suddenly start making appearances in the child’s life. What if Nicola decided during that time that she wanted to do this on her own?
Not happening. So it was better to be there than to sit on the bench and pretend he didn’t want to be in the game.
The door to the room opened and Nicola entered with her hands held out for her gloves. She wasn’t taking an active part in the surgery and now that she was here, his nerves were acting up.
“Okay, we’re ready to start.” He glanced at the anesthesiologist, who nodded and adjusted his instruments to deepen sedation.
“Go ahead.”
His eyes found Nicola’s, before his glance dropped to her stomach. How would he feel if this was his child and Nicola was watching him work?
Ridiculous. There is no way he could work on his child or any other relative.
Choosing his first tool, he studied the baby’s lip. He would make the repair using the rotation-and-advancement method, where the side of the defect nearest the nostril would be rotated down to join the lips together and the other side would be “advanced” to fill the hole created by the rotation.
Clearing his throat, he began to talk his way through the procedure to document each step. Out of the corner of his eye, he saw Nicola take a step closer so she could see.
“Could someone turn the screen on?”
Someone flipped a button and the screen on the wall across from him flickered to life. It wasn’t just for the diagnostician’s benefit. It was also to help the entire team see exactly what Kaleb was seeing through the little camera mounted on the side of his lighted loupes.
“Making the rotation incision. Scalpel, please.”
He held his hand out and the surgical nurse placed the tool on his palm.
The first cut is always deep.
The words to a familiar song whispered through his head. It wasn’t just the deepest. It also had to be the most accurate for Trey to have a natural appearance.
He gauged the space he needed to cover with the flap. Normally, Kaleb was only minimally aware of the rest of his team in the room. He got into a zone where no one existed except for him and his patient. Only this time, there was a third person in his little circle. Nicola.
He could feel her gaze on him, feel the tension crackling off of her in waves as she followed his progress. If it had been him watching, his hand would be curling around an imaginary scalpel, planning how he would make the incisions. Where he would place each suture. But those were things he couldn’t think about right now.
“Rotating the flap and moving it into place. Could someone adjust my loupes a bit to my right, please?”
Hands moved in to do his bidding, then backed away to get a fresh pair of surgical gloves. They had to make sure the surgical field was as free from contamination as possible. This child would not get another chance at this if infection ate away the repair.
With the loupes adjusted, he could see without having to compensate and he moved the flap down to where he’d prepared one side of the lips. It was just a bit tight. So he modified the incision he’d made to help ease the tension.
He secured the innermost part of the repair with dissolving sutures, continuing to describe what he was doing, both for the surgical record and for Nicola’s benefit. She’d said she had never seen a cleft repaired before. But that wasn’t the only reason she wanted to be here. They’d both talked about how moved they’d been by this child and how it was probably due to the fact that their own child was growing in Nicola’s womb at this very second.
Right now, he was glad his expressions were hidden by both the mask and the loupes, because he wouldn’t want Nicola to see his eyes. His tension was probably tighter right now than that flap’s had been. Only unlike what he’d done with his scalpel, there was no easing this particular tension.
When he got to the outermost part of the repair, he made his stitches as tiny as he could without compromising the strength of the sutures. He adjusted the fit so that the Cupid’s bow on the repair side matched that of the other side.
That was about as good as it was going to get. “Rotation completed. Starting the advancement procedure.”
He eyed his incision site, using the measurements he’d taken during the baby’s exam. His notes were displayed on the screen along with his camera’s view. He moved his scalpel a little more to the right.
This should be like second nature to him by now. He’d done a number of these repairs, including volunteering with a medical unit overseas to help impoverished areas. Those children were all equally important, but somehow his performance right now wasn’t by rote. He was considering each and every move he made.
Maybe he needed to be doing that with Nicola. Not just coasting along and hoping for the best, but considering every move and its ramifications.
A sound caught his ear. A little blip that stood out from the rest of the background noise. The steady rhythm that always accompanied his surgeries. When they were going well. He ignored it. His scalpel hovered over the incision site just as it came again. A syncopated sound that made him look up and lock eyes with his anesthesiologist. “What’s going on, John?”
“Not sure. He’s just thrown a couple of PVCs. I’ll let you know if they become concerning.”
PVCs weren’t uncommon during surgery, and normally he just took them in stride unless they became frequent. But right now, his ears were super tuned to the sound. He waited a beat or two and then forced his muscles to relax, wondering if Nicola were as tense as he was at this moment.
“Making the incision.”
His scalpel sliced true, freeing the skin to move forward. As if fitting a piece to a jigsaw puzzle, the flap filled the hole perfectly, just as another off-rhythm blip hit his ears. Every muscle in his gut tightened. “Do I need to stop?”
“No. We’re still okay.”
Forcing himself to ignore the monitor, he sutured the flap in place, his hand surprisingly steady as he molded the baby’s new lip.
When the last suture was in place, he looked at the repair with critical eyes, searching for any puckers in the baby’s skin that would cause problems later. But the little zigzag-looking line was smooth and even, and the bows on the baby’s lips looked symmetrical.
Another blip. A double this time.
Hell. He needed to call it before this turned into something worse. “Okay, the last suture is in place.”
He dropped the instrument into the stainless steel bowl on the table and glanced at his anesthesiologist. The man looked totally unconcerned. As well he should. Kaleb was the one who was having a fit over it.
“Easing back on the sedation.”
The cramped muscles in his stomach were starting to ease as he took in the cardiac monitor that was now beeping with nice steady points of sound. Nothing bad had happened, except in his mind.
What if their child had an emergency? Had to have surgery? Was he going to turn into a basket case while in the waiting room, imagining every possible thing that could go wrong?
Judging from his emotions right now? Probably.
He glanced over at Nicola and saw her eyes were glassy as if she, too, had been riding the same emotional roller coaster as he had.
But now it was over and he could get off the ride. He looked around. “Good work, people. We just helped a little boy lead a more normal life.”
The atmosphere in the room turned gleeful as people clapped and congratulated him. He didn’t want it, any of it. He had just wanted to do his best for this boy.
He went over to John Laroby and nodded. “Thanks. Sorry for pointing out the PVCs.”
In reality, John was one of the best anesthesiologists the hospital had. If anyone was aware of the tiniest nuances of sedation it was him.
“I understand. It’s a baby. I always get keyed up when we work on them.”
“Yeah. Me, too.” Except he didn’t. Not usually. And he wasn’t sure he liked being this involved in one’s care. It had to be due to finding out he was going to be a father.
Nicola made to leave the room and gave him a quick wave. He moved to join her, waiting as she discarded her mask and gloves, and then joined her once he’d gotten rid of his.
“How’d it look?”
She nodded with a tilt to her head. “I was impressed.”
“Hey, I wasn’t looking for accolades, just wanted to know if the repair looked okay.”
“You know it does.” She smiled. “I have to tell you, I was a nervous wreck, though. I don’t know how you do it.”
“I was a little nervous on this one, as well.”
“Because of the baby?” she said, probably not realizing she’d hit the nail on the head.
“Yes. It was hard not to imagine how I’d feel if Trey were mine. I really wanted to do right by him.”
“And you did. But I have to tell you, I’m glad it’s over. Especially when you heard his cardiac sounds change. It was hard for me to just stand there.”
“John’s a great anesthesiologist. I’m sure he was on top of it.”
“I’m sure. It doesn’t change how I felt, though, when I heard them.”
He leaned a shoulder against the wall, noting how tightly her hands were clasped. “Hey, he’s fine. It worked out just the way it should have.”
Sudden moisture appeared in her eyes. “I know. And I’m just being silly. It’s hormones, I’m sure.”
“It’s the reaction of a human being that is hoping for a good outcome.”
She touched his hand, her smile doing something to his insides. “And there was a good outcome, wasn’t there? I’m so glad for Trey and his family.”
“Me, too.” He sucked down a deep breath and decided to tackle a question that had been at the back of his mind all day. “Do you have your appointment date yet?”
“Are you sure you want to come?”
“Absolutely.” He was more sure now than he’d been when he’d started the surgery. He wasn’t sure why, other than the fact that he needed to be there. No matter how hard it would be when she took the baby home and left him behind.
“It’s on Friday.”
“Okay. Do you want me to pick you up?”
She hesitated, moistening her lips. “Do you want to?”
“It might not be a bad idea, just in case we need to talk about something.”
“Okay. That sounds like a plan.” Her smile had faded and something he couldn’t read replaced it. “Good job again. Thanks for letting me watch.”
“You’re welcome. I’ll see you next week, then, if not sooner.”