SURGERY HAPPENED TWO DAYS LATER.
Snow had gotten a call that a heart had become available for his heart patient three hours ago. It had just arrived, in fact, from a different part of New York. The team was getting everything ready in the surgical suite and he’d already met with the family. He checked in with Kirsten.
“I’m looking at around thirty minutes as a start time. Can you make it?”
“Yes, just tell me which suite and I’ll be there.”
He double-checked the number for the operating room. “Looks like it’s number four. I’m heading down in a minute to scrub in.”
“Okay, see you there.”
He quickly reviewed the patient’s chart, reminding himself of the game plan as he took the elevator to the surgical area. Then, scrubbing his arms with a little more vigor than necessary, he tried to figure out why he’d agreed to let Kirsten observe. But it would have appeared strange if he’d said no to her, when really, any of the staff with enough interest were usually allowed to watch as long as the surgeon agreed. There were only one or two who preferred to keep a “closed” surgery, one in which no one outside of surgical staff was allowed to watch. For those few, they usually stated that they wanted no distractions, and usually no music in the room.
Snow was also a no-music guy, although he wasn’t as much of a hard ass about observers. The only time he’d closed a surgery that he could remember had been at the wishes of a patient who hadn’t wanted anyone except for necessary staff to see her unclothed. He’d respected her wishes.
His arms still wet, he pushed through the doors to the surgical suite with his shoulder, then dried his hands with the provided sterile towels, finishing his routine. There was always an air of anticipation and nerves as he got ready to operate. There would be no second chances, if he made a mistake.
Unlike lungs or other organs, the heart was especially difficult, because if it refused to start, there was no going back, no fix, and the patient would die on his operating table. So far, every donor heart had cooperated with him. But he knew that with each surgery, the odds were growing that there would be a first time.
His gaze headed to the observation area, despite his admonitions to avoid glancing over. And just like Kirsten had said, she was there. She gave a little wave, which he acknowledged with a nod in her direction.
He again wondered about her being there. But why? Why her in particular? Was it because they’d slept together? Because she knew why he locked himself in his bedroom?
Actually, maybe that’s why she should be here. So she could see that he was as normal as any other surgeon. He wasn’t sure why that was so important, but it was.
He turned back to his team, which was already in place. “Is everything ready?”
The heart was there in its special container and the patient was already sedated and ready. They were just waiting on him.
He nodded for the recorder to be turned on and gave his initial remarks, including the patient’s name, age and diagnosis. “Ready to begin.”
The instruments were already placed in order of use on sterile trays and the surgical nurse was there, waiting on his first request.
They washed the patient’s chest with surgical scrub and put the drape in place.
The first part of the surgery went like clockwork—he opened the chest and spread the ribs, exposing a heart that was enlarged and weakened by cardiomyopathy. There’d been no way to fix this heart, no medication that could reverse the disease process, just short-term patches geared toward getting the patient to this point in the transplant process. He took note of the implanted defibrillator and planned the timing of removing it. Everything had to be done in a methodical order. One mistake...
Damn. He needed to stop this before it became a self-fulfilling prophecy. He could feel Kirsten’s eyes on him, even though she wasn’t in the room. But none of that mattered. The only thing that counted was the patient, who was depending on him for life. For a fresh start. Someday that patient might be ten-year-old Gretchen, her family sitting in some waiting room hoping and praying that their daughter made it out of surgery alive.
He pulled his attention fully back on his patient. Preparing her for bypass was one of the most critical stages of the surgery, and he was well aware that he was about to take a beating heart and shut it off forever. Essentially, he was playing God. There was a scary solemnity to the act, and he paused for a second or two as he always did and weighed the risks and benefits. But this first actual look at the diseased heart proved what the MRI, EKGs and biopsy had told him. It was dying and carrying his patient down the river with it. It had reminded him of his dying marriage and the need to sever the link before it sucked both he and Theresa down with it. It had been the right decision.
And Kirsten? Was this the right decision? Yes, because he was simply letting her observe, not marrying her.
“Getting ready for bypass.” He glanced at the perfusionist, who was sitting at a board, adjusting knobs and sliding relays. The man nodded at him. Okay, it was now or never.
With the tubing attached to the aorta and the vena cava, he shifted the job of oxygenating blood over to the machine.
“We’re good,” the perfusionist said.
Danny’s job was as nerve-racking as his. Set up behind a table of controls, he looked almost like someone sitting at a mixing board at a recording studio. And maybe it was similar. And although it had nothing to do with sound, he had to get the levels perfect to give the patient the best chance at surviving. Maybe relationships were like that. If one element was out of whack, it could mean death. Or if one body part started to fail, it could mean the same thing.
Time to disconnect the heart.
Snow worked on detaching the organ from the patient, putting it in the stainless-steel specimen tray. A nurse whisked it away. Halfway there. He glanced at the clock. Two hours—right on time.
He sucked down a cleansing breath and clenched his fists twice, a habit he’d gotten into as he prepared for the second stage of his surgery—placing the donor heart into the patient. He’d already examined the heart once, but he gave it another pass as he got ready to put it in the chest cavity. He carefully reconnected it, and allowed the blood supply to flow through the tissues. Sometimes that was all that was needed to start the heart beating again.
Not this time.
It was okay. Sometimes the technique worked and sometimes it needed a little extra push.
“Paddles.” The nurse handed the small unit to him and charged them to the correct specifications. Saying a quick prayer over the donor heart, he laid the paddles on either side of the heart.
“Clear!”
Snow sent the electrical charge through the organ and it spasmed, then was still.
Hell! Not what he wanted to see. A jolt of fear went through him and he tamped it down, then he placed the paddles a second time on the heart and shocked it. Stared at it. Willed it to come back to life in its new home.
It did. With big steady pumps that replaced the shallow strained movements of his patient’s old heart. He closed his eyes for a second, sheer thankfulness spearing through him. Another life, saved. The energy in the room turned electric as the team began excitedly talking among themselves for a few seconds before settling back in to focus on the final stage of surgery.
He double-checked all of his sutures, looking for any and all leaks that might compromise the patient once they left this room. Finding none, he prepared to close the chest cavity. Sternal wires were used to put the sternum back together, and while some heart surgeons still used sutures or staples to close the surgical incision, Snow actually preferred glue, finding it made for a better scar.
And after that... Well, Kirsten was still up there, so he’d have to go speak to her once he was done, as well as the patient’s family. But right now, his mood was one of elation, something he felt each time he had a successful surgery. It had been a little over four hours, and he was tired. But it was the good kind of tired. While his team sometimes went out for celebratory drinks, Snow rarely joined them. He preferred to sit in the dark of his office and unwind. It was one of the times he played music, a kind of “recovery” playlist that he’d made up specifically for surgeries, since he liked to spend the night in his office, in case there were complications.
He’d joined the skin edges together with the glue and left openings for the drainage tubes, so everything held together, just as it should have. He glanced at the monitors. The heart was still going strong. There could be some PVCs and arrhythmias as a result of postsurgical inflammation, but they’d keep a close eye on the patient for several days.
A long gauze bandage was applied over the incision to keep things as clean as possible and to protect the site.
“Okay, that about wraps it up. Good work, everyone. Let’s hope for an excellent outcome.”
Snow waited until the patient was wheeled out of the operating room and headed to recovery before he removed his gloves and surgical gown. Only then did he look up at Kirsten and motion for her to meet him outside the room.
He wasn’t sure why, but he was suddenly glad he’d allowed her to watch. He had a few friends, but they were all in different fields. But from watching the way she dealt with Tanya, his earlier patient, and with Gretchen, she’d probably been holding her breath, too, when he’d tried to get that donor heart started.
Kirsten was waiting for him when he pushed through the door. She smiled. “That was...amazing. Truly amazing. But I can honestly say, I do not envy you your job. I don’t think I could handle the tension of trying to start a heart and honestly not knowing if it will beat.”
“It can be nerve-racking, no doubt. But every field has its own pressures. You just learn to deal with it.” He nodded toward the hallway. “Want to walk with me so I can let the family know how things went?”
“Isn’t that something you’d rather do alone?”
“If you need to leave, I’ll understand. I just thought we could grab some coffee or something.”
“I’d like that.” They walked down the corridor while Kirsten’s animated voice recounted all the things about the surgery that she’d found interesting. Now that the initial euphoria had worn off, Snow was feeling a bone-dragging tiredness that came from hours of double-checking each step before he actually performed it. From the adrenaline that had been pumping through his system nonstop to the sudden cessation of the hormone, he swung back toward the low end of the spectrum. Kirsten’s voice was actually helping slow the fall in some weird way, becoming a buoy that kept him from being sucked too far down.
He went into the waiting room and a small group of people rose from their spots, the fear on their faces clear. He smiled at them before he ever reached them.
“Oh, God, she’s okay, then?” The woman’s husband, Mr. Fisher, was the first to speak.
“She did very well. Everything went as expected.” No need to say the heart hadn’t started right away. That happened from time to time, since the organ had had a shock of its own.
Chaos erupted as family members hugged each other, some laughing, some crying as they all coped in different ways. He understood their reactions all too well. He’d had his own ways of coping. He still did, although the biting fear of abuse was long gone. He glanced at Kirsten to make sure she was still there.
She was. He wasn’t sure why he’d suggested coffee. But he really wanted some. Wanted to drink it in his office to decompress. With her. Normally he preferred doing that alone with just his playlist going softly in the background. He’d sip at his coffee and kick up his feet, thinking of just...nothing. The after-surgery ritual was so strongly ingrained, he could feel it before it even happened.
“I’m going to go back and check on her in a moment. Once she’s awake enough—” he nodded at her husband “—you can go back to see her for just a few minutes. Right now, what she needs the most is rest. But her new heart is working very well. It’s strong, and her oxygen levels are great for a change. She should start feeling a whole lot better once the surgical wounds heal. She even mentioned wanting to do a five-K sometime in the future.”
Mr. Fisher’s eyes watered. “She loved to run. Did it every year until her heart started acting up.”
“She’ll have to be careful for a while, but there’s no reason she can’t take up running again.” He patted the man’s shoulder. “They’ll come and get you as soon as she’s ready for a visitor.”
“Thank you. For everything. She would be dead without you.”
“She has a strong will to live. That’s what kept her going long enough to get the transplant.”
He said his goodbyes and went back through the same door. He turned to Kirsten, who had been quiet through the exchange. “Ready for that coffee?”
“Yes. But if you don’t want me to stay, I’ll understand. I know some surgeons like to go off by themselves for a while.”
“I’m normally one of them, but I could really use some company right now.”
“Are you sure?”
“I am. If you’re okay going back to my office, that is. A whole cafeteria full of chaotic conversations isn’t exactly what I had in mind.”
She hesitated.
Hell, maybe she thought he wanted something besides company. Or the lock incident had her nervous about spending time with him. “We can go somewhere else, if you’d prefer. I promise, all I want is someone to sit with.”
“No, it’s not that... Your office is fine. Or mine. Either one.”
“Let’s do mine, then.” He wasn’t sure why, but he needed to be on familiar turf right now. Just a place that he knew and understood.
“How about if I grab our coffees while you check on your patient. I’ll meet you back at the office.”
“I would really appreciate that.” More than she knew. “I just take mine black.”
She smiled. “Yeah. I remember from our trip to the Statue of Liberty.”
That seemed like ages ago, but it wasn’t. It had been less than a week ago.
He made a quick trip to Recovery, where his patient was awake, but groggy from pain meds and the aftereffects of anesthesia. And was still intubated at the moment.
“You did really well, Marilyn. I just talked to your husband about the possibility of you running a five-K. I told him that’s a very real possibility now.” The woman squeezed his hand to show she understood. “I’ll come back by in the morning, okay? Your husband will be here in a little bit to see you. But we need to make sure you get some rest.”
Then he was headed back to his office. Kirsten was already standing outside the door, holding two disposable cups with heat sleeves wrapped around each. “I hope you haven’t been waiting long.”
“Nope. Just got here.” She handed him a cup. “Nothing but straight coffee in there.”
“Thanks.” Snow unlocked the lock on the knob, then, conscious of her eyes on him, he turned the key in the dead bolt. Then the door swung open, and he waited for her to go inside.
“Do you mind if I play some music?” Of course, that could be taken the wrong way, too. “It’s on a loop that I run through, every time I do surgery.”
“It’s fine. How about I take one of the chairs, and you can stretch out on your sofa. You look exhausted.”
“It’s been a long day,” he admitted. “I’ll try not to fall asleep on you.”
She frowned and stood just inside the door. “Are you sure you wouldn’t rather be alone and take a nap?”
“Like I said, it would be nice to have company. As long as you don’t mind staying.”
“Of course not. I’ll be happy to.” She came fully into the room. “And if you do happen to fall asleep, I’ll just let myself out.”
He nodded, then went over to his computer and cued up his playlist. Soft jazz filled the space, the sound of a saxophone pouring over him. Sighing, he sat on the sofa, took a sip of his coffee and then held it on his thigh. When she sat down on a nearby chair, she was concentrating on something, her head tilted.
“What?” he asked.
“Your music. I like jazz,” She said. “The Ohio Jazz Festival was one of the last places I went with my mom. It was very different, and we thought we’d just go to see what the music was like. We both ended up loving it. It was very different from anything we’d ever heard before. I went on a listening binge when we got home.”
That surprised him. People either liked jazz or they didn’t. There wasn’t much in between. “I find it relaxing.”
They sat for a few minutes in silence. He could feel his muscles beginning to unwind, the cramps working their way out of his fingers. One of the reasons he sat in his office rather than going home was because Theresa used to talk incessantly the second he arrived, even when he was so tired he could barely focus. And she expected him to carry his share of the conversation.
Yet, Kirsten seemed to instinctively know he needed quiet. He wasn’t even sure why he’d invited her back here, but he was now glad he had.
And when she kicked off her shoes and curled into a corner of her chair, head leaning on the back cushion, he couldn’t quite take his eyes off of her. She made his heart do all kinds of things. But right now she made him feel restful.
She looked like she was totally into the music. Was barely moving, except to put one arm under her head. “Would you rather have the sofa?”
She didn’t answer, so he looked closer and noted the slow rise and fall of her chest, the way she seemed totally at peace. It was then he realized he needn’t be worried about falling asleep in front of her. Because she’d just fallen to sleep in front of him.
Sleep had never been further from his mind at the moment. All he wanted to do was sit and watch her, a strange longing singing through his veins that seemed to match the plaintive tones of the saxophone.
When he’d finished telling her about his father earlier, he’d felt a relief greater than any he could remember, and wasn’t sure he’d ever feel again. And afterward, she hadn’t avoided him or talked a mile a minute as if needing to fill every gap of silence, for fear he might bring up his past again.
No, he’d caught a few glances that he thought might be pity, but he hadn’t been convinced of that. And she definitely hadn’t balked at coming back to his office. Or falling asleep in front of him.
So with a sigh, he set down his coffee on the table and stretched out on the sofa, turning on his side so that he could continue to watch her.
And as he did, something stole over him that he hadn’t felt in a very long time: a sense of peace and rightness. Rightness in her being here. Rightness in confiding in her, even though he still wasn’t sure why he had.
He wasn’t sure what he was going to do about it, but that was a decision that didn’t need to be made today. Or even tomorrow.
So for right now, he was content to simply lie on this couch and simply...be.