ADELINE’S PULSE WAS thundering in her ears.
She hated it when TTP presented. Thankfully, there was only one other time it had when she’d been on rotation in the ER.
It had been that diagnosis which caught the attention of Dr. Wilder, but it had been that diagnosis which terrified her to her very core and reminded her of all the things she could have.
She wanted to help save those afflicted by it, but it scared her too. It took every ounce of strength to gain a hold of her emotions.
Maybe it’s not TTP?
Only she shook that optimistic little voice away.
She was never wrong about TTP. She’d seen it so much growing up.
Your mom is okay, kids.
Her dad had looked tired. There’d been dark circles under his eyes.
This won’t happen again. Not like this.
Adeline had been scared as she and her brother were ushered into their mother’s hospital room. Her mother had lain there, pale, weak and broken.
The kids are here, Bev.
Okay...
Her mother had just whispered, not looking at them and not sounding like herself. Just a fragment, a ghost.
Adeline shook that thought away as they approached the patient’s room. Mrs. Bryant had a jaundiced tinge to her skin. Adeline could see it even from the door, and her stomach knotted knowing it was TTP from that first glance. She resolved right then and there she would save her patient.
“Mrs. Bryant, I’m Dr. Garcia. We met when you were admitted, remember?”
“Yes, Dr. Garcia. I remember,” Mrs. Bryant said quietly, smiling.
“This is Dr. Turner. She’s an obstetrics fellow working with Dr. Wilder on her service.”
Mrs. Bryant smiled at Adeline, and Adeline could see the exhaustion, the worry in the patient’s eyes.
“How are you feeling, Mrs. Bryant?” Adeline asked gently as she pulled out her stethoscope to listen to the baby’s heartbeat.
“A headache, some indigestion...again.”
“A headache? When did that start?” Adeline asked the nurse.
“About an hour ago,” the nurse said. “Her BP was normal, though.”
Adeline nodded and listened to the heartbeat of the baby, which was strong. She stopped listening and palpated Mrs. Bryant’s abdomen, and everything felt normal.
“We’re going to do another blood draw. We need to rule out some things and I’d like to do an ultrasound and check on the baby if that’s okay, Mrs. Bryant?” Adeline asked.
Mrs. Bryant nodded. “Of course.”
“I can do the ultrasound now,” Elias said.
Adeline then checked the patient’s skin. She was looking for the purpura, the small bruises under the skin that would confirm the thrombi in the small blood vessels.
She saw them on the underside of Mrs. Bryant’s arm and then on the belly where she had palpated.
Elias did the ultrasound, so Mrs. Bryant was distracted, watching her baby. Adeline leaned over to watch.
“Baby looks good,” Elias said. “Strong heartbeat. Good amount of amniotic fluid. The baby is stable.”
Adeline nodded and turned back to the nurse.
“I need an ADAMTS13 draw. Put a rush on it. I need you to also start a dose of betamethasone.”
“Yes, Dr. Turner,” the nurse said.
Adeline turned to the patient. “Mrs. Bryant, your baby is strong, but on the off chance your blood pressure goes up or the baby goes into distress, we’ll start a medication to help with lung maturity. That’s the betamethasone I just ordered.”
“Okay,” Mrs. Bryant said, her voice shaking.
Adeline smiled at Mrs. Bryant and squeezed her shoulder gently. “It’ll be okay. This is standard. You’re in good hands.”
“I will continue to monitor your baby,” Elias reassured the patient. “The baby is fine.”
“Thank you, Doctors.” Mrs. Bryant closed her eyes. “It’s a lot to process.”
“It is, but you’re stable and we’re going to watch you.” Adeline and Elias left the patient’s room and walked down the hall to the nurses’ station.
“What’re you thinking?” Elias asked. “You’re awfully quiet.”
“And how do you know that? You only met me yesterday.”
“You were a lot more vocal and engaged yesterday. Very opinionated, especially with regard to my moving in,” he teased.
Adeline sighed, but couldn’t help but relax just a bit.
“Fine. I’m troubled. Mrs. Bryant has purpura.”
Elias frowned. “And with the headache and indigestion?”
“It’s TTP. Whether it’s genetic or acquired, I won’t know until genetic testing is done, but we have to keep her admitted and monitor both her and the baby.”
“We can’t go to Dr. Wilder with a hunch,” Elias stated.
“I’m usually not wrong. The ADAMTS13 test will determine it. The nurse is giving the patient betamethasone now. If it is TTP, we need to consult with hematology and start TPE to thin her blood and to help with clots.”
Elias nodded. “We’ll see what the blood work says. We’ll keep a close eye on the baby.”
Adeline’s phone vibrated in her pocket. She pulled it out. “Dr. Wilder needs me in OR three. An emergency surgery.”
“I got the same page.” Elias flashed his phone. “The baby must be in distress.”
“Let’s go, then.”
“You lead the way. I’m still learning this place.”
Adeline smiled. “Come on.”
Adeline had to get her mind off the TTP. She had to compartmentalize it away, like she always did because she was a professional.
Right now, there was another life to save.
Adeline focused on her patients, working in tandem with Dr. Wilder as they performed an open fetal surgery on the baby. By half delivering it, but not cutting the cord, they could perform surgery on the spina bifida.
Dr. Wilder had been planning to do a fetoscopic surgery, using small incisions and passing instruments through to operate on the baby in utero, but there was a complication and they had to open up the mother instead.
The baby was thirty weeks along, but the mother had blood pressure problems and Dr. Wilder had called in the neonatology team on the off chance the baby would have to be delivered fully.
“How is the mother doing?” Dr. Wilder asked.
“Her blood pressure is rising,” the anesthesiologist said.
Dr. Wilder’s brown furrowed. “Preeclampsia.”
“So we may have to deliver?” Adeline asked as she gently worked on the tiny life still attached to her mother.
Dr. Wilder nodded. “If the BP continues to rise we’ll have no choice. Dr. Garcia, can you come here?”
Elias stepped forward, gowned and ready. “Yes, Dr. Wilder?”
“You’ve performed a spina bifida repair on an infant, yes?” Dr. Wilder asked.
“Yes. I have.”
“Then take my place. I may have to deliver and close the mother.”
“Of course, Dr. Wilder.”
Adeline watched as Elias took the spot at the table across from her. His large hands moved delicately as he assisted her without guidance.
He knew what to do. Just like she did.
Don’t be so shocked. He was an attending too, after all.
“Hmm. Just what I thought,” Dr. Wilder remarked, watching them.
“Dr. Wilder?” Adeline asked.
“You two. You work well together. In tandem. I thought so.” Dr. Wilder moved to attend to the mother.
Adeline shook her head and went back to work.
“You disagree?” Elias asked quietly.
“This is our first surgery together. Hardly enough to base a whole opinion on,” Adeline muttered.
“Oh, I think it’s enough,” Elias said. “Some surgeons instinctively fit together. They know what to do and can intuitively predict the next step of the other surgeon. I think we move and work well together.”
Heat crept up her neck, and she was glad of the surgical mask and gear hiding her blush because of what he was insinuating. How they intuitively knew how to move together, again with that promise of something more.
You can’t go there.
She had to remind herself of that. Elias was getting too close for her liking. He was getting in her head.
Especially after he had suggested she should get the genetic testing because she wanted a family.
His presumption had been too personal, and it had made her uncomfortable.
She was frustrated that she still hadn’t done it, but she was too afraid about what it would say.
You’re afraid it’ll be positive, and you’ll never have a child.
An alarm went off.
“She’s crashing!” someone shouted.
“Turner, I need you here!” Dr. Wilder shouted. “Garcia, we’re delivering the baby. Ready the team to take the baby to the NICU.”
Adeline dropped her instruments and made her way to the mother.
The NICU team came and helped Dr. Garcia finish up.
“Cutting the cord,” Dr. Wilder announced as Adeline clamped it.
They delivered the baby, and Adeline watched from the corner of her eye as Elias gently scooped up the tiny infant, stepping in to save the baby’s life while she saved the mother’s. He might seem like an arrogant brute to her, but watching him handle that tiny baby, so small in his strong hands, made her melt just a bit.
“When the baby is stable, Garcia, I need you here,” Dr. Wilder shouted. “She’s bleeding out and I need all hands. Hang some more blood.”
Adeline turned back to the work. The patient’s blood pressure was dangerously high, and Adeline drowned everything out to focus on the task at hand. She didn’t even notice Elias had returned until she heard him speaking beside her.
“The baby is stable and in the NICU,” he said.
After that, time stood still as she and Elias worked side by side with Dr. Wilder to save a life.
Dr. Wilder was right. Elias was right. They worked well together. Seamlessly.
He might be her competition, but they were a dream surgical team.
Even though she hated admitting it.
It was easy to work with Dr. Elias Garcia.
Elias now really knew what that old saying of “out of the frying pan and into the fire” meant. He was exhausted as they had spent hours repairing vessels and the uterus of the mother. Not to mention having done the spina bifida repair on the baby before that.
He was used to long surgeries, but not two surgeries in a row. In Houston his focus had always been on the baby, not the mother.
So he was drained, but that was why he was here.
To learn.
Still, he was beat.
All he could do was sit on the bench outside the operating room, trying to stretch out the knot in his back.
Adeline came out of the scrub room and sat down next to him.
Yesterday she would have shouted something ridiculous like This is my bench. Get lost! But it seemed she’d finally accepted him.
For now.
“That was grueling! I thought some pediatric surgeries were hard,” Elias admitted. “But two lives on the line?”
“Right?” Adeline sighed. “You did well. I guess my gut was right to be worried about you.”
There was a twinkle in her eyes as she said it, and he couldn’t help but smile back at her. There was so much he liked about her. She was smart, determined, talented and beautiful.
Stop finding reasons to like her.
She wouldn’t care two figs about him if she got the position.
She’d swoop in and take what was his. Just like Aidan had done.
Elias had to remind himself she was the enemy. He would work with her, but he was at San Diego Mesa Hospital to win.
“Dr. Wilder wants a meeting first thing tomorrow about Mrs. Bryant. She has other residents on call tonight. She told us to go home and rest.”
Elias nodded. “I won’t argue. Shall we walk home together, or do you own the sidewalk too?” he teased.
She slugged his arm playfully. “I suppose we could walk home together. Meet you out front in twenty minutes?”
Elias nodded as she stood. “Sounds good.”
Adeline started to walk away, but then turned back, her arms crossed. Elias braced himself for the worst, but instead she smiled at him.
Softly.
“Good job today, Dr. Garcia.” A pink blush tinged her cheeks, and she turned quickly and left.
His pulse quickened at the compliment.
“Same,” he whispered.
He got up and made his way to the NICU before he went to change.
The NICU always calmed him. He had started out here, and his fifteen-year-old nephew Manny had spent his first days here too.
He saw the little girl they had saved, and she was thriving. Her father, in a gown, stood by the incubator.
Elias smiled. There was a time in his life when he would have given almost anything to be a father, when he’d thought he’d marry Shea after he got through with all his training, but then that had fallen through.
So fatherhood was not in the cards for him.
He couldn’t even remember the last time he’d been home to Napa and the family vineyard. It had been two years. He couldn’t recall the actual visit. Only that it had been brief.
He felt his family’s disappointment in him that he hadn’t taken over the vineyard. His brother was married to the woman he had loved, and they were now running the land.
They rubbed it in his face every time he came home. They let him know he was the inadequate son, an inadequate choice for a husband.
A disappointment. He saw the disappointment in his father’s face.
It’s why he hadn’t been home for so long. He was tired of feeling inadequate.
Elias’s heart sank and he walked away. There was no use brooding over broken, buried dreams or giving a second thought to the family he’d lost.