“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.

  Chapter Sixteen

  For just a heartbeat, Dani thought Ren was actually going to hold her hand. But that was crazy, wasn’t it? First of all, that just wasn’t Ren—she wasn’t going to get personal, not here in the hall, even if they were alone. Not anywhere in the hospital, and from every indication she’d given upstairs in the OR lounge earlier, not anywhere. If Dani’d had half a working brain cell, she wouldn’t have touched her, not even a casual glancing brush of a hand on Ren’s arm, but she couldn’t seem to help herself. Whenever Ren was near, every fiber in her body seemed drawn to her, like a stem bending toward the sun. That wasn’t her either.

  “Sorry,” Dani muttered. If she’d had pockets, she would’ve shoved her hands into them, but all she had on was the stupid yellow cover gown over her scrubs.

  Ren looked at her oddly. “For what?”

  “I shouldn’t have, you know…” She held up her hand helplessly. “Reached out.”

  Ren frowned at her for an instant, then her eyes widened. “Oh. That’s okay. I mean, I didn’t mind. I mean…” She gave a helpless shrug, looking a little frustrated and a little unsure.

  Just great. Way to make Ren even more uncomfortable. Dani contemplated headbanging, but that probably wasn’t going to make Ren feel any better.

  “I didn’t mean to make you think something like that would bother me,” Ren said.

  “You didn’t. It’s me. I’m not right.”

  Ren cocked her head. “You aren’t? Are you…upset about last night?”

  “What? No! Of course not!” Dani checked the hall. Still alone. She moved closer, ruthlessly stamped out the urge to touch her. “I’m so totally not upset about last night. It was—you were—just great, okay? Don’t even think anything else.”

  “I don’t really want to think about it at all,” Ren said. “But I am, and I really don’t have any space in my head to do that.”

  “Look, I know. I do. We ought to talk, and I get now’s not a good time.”

  Ren relieved. “I know. Thank you. I should go. I have—”

  “Nope, we’re going to get some air.” Dani smiled. “I promise, nothing heavy. And you’ll be five minutes from anyplace in the hospital. Just a few minutes, Ren.”

  Ren gave her a slightly wary look, but she smiled, and that smile—well, Dani would probably do anything for that. “All right. Just five minutes.”

  “Stairs or elevator?” Dani said, leading the way down the hall.

  “Um, stairs?” Ren said, making it sound like a question.

  “Stairs it is.” Dani realized she probably wasn’t making a lot of sense or even speaking in complete sentences, but that was the best she could do. She just wanted to keep Ren from changing her mind and disappearing.

  They climbed up three flights before Ren said, “Dani?”

  “Yeah?”

  “Where are we going?”

  “Two more flights.”

  Ren followed silently for another thirty seconds before blurting, “But that’s the—”

  “Yep.” Dani pushed open the door at the top of the stairwell and held it open so Ren could walk out past her. “The roof.”

  Across the flat expanse of gray concrete, several wide, white swaths of paint denoted several circles within a square. Red flags on slender metal poles at the corners designated the landing area for the medevac helicopters. None of the helos from Starvac and Airmed were housed at PMC. Their home bases and flight crews flew out of two of the other trauma centers across the river in Center City, but all the level-one trauma centers in the city received patients as needed from both air transport systems. Presently the rooftop was empty of everything except the breeze rippling the LZ flags and the midday sun.

  “Over here.” Dani held out her hand automatically, and before she could take it back, Ren grasped it. When she didn’t let go, Dani lightly tugged her across the roof to the chest-high wall facing the four-thousand-plus acres of Fairmont Park, the Schuylkill River bordered by the river drives, and beyond that, Center City, Philadelphia. Cars silently whizzed by on the expressway, just visible beyond the tops of the trees along Lincoln Drive. Up on the roof of the hospital, in the heart of the Mt. Airy residential section, they were far enough from the city that none of the sounds or the scents of an urban metropolis reached them. Instead, the breeze coming across the river through the trees almost tasted like mountain air, fresh and clean in the bright sunlight.

  “Oh,” Ren said, letting out a surprised breath. “This is beautiful.”

  “Yeah, I’ve always thought so. I discovered it a couple days after I started here. Well, I knew about it because I came up for a trauma, but I was looking for someplace to get away for a few seconds, you know? And I thought of here.”

  “I’ve been up here when a trauma has come in,” Ren said, leaning her forearms on the top of the wall, “but I never looked out. Not really.” She turned her head to study Dani. “I think I have a very narrow field of vision.”

  The way she said it sounded as if she’d just discovered something about herself she didn’t like.

  “Maybe,” Dani said, “that’s just because you can focus so well on what you’re doing.”

  Ren pressed her lips together in an almost-smile. “There you go, finding the good side of things. Even if they aren’t really there.”

  “They’re there, where you’re concerned.” Dani chuckled and shook her head. “Believe me, I don’t always. That’s what got me up here in the first place—those first few weeks after coming over from Franklin, I wasn’t finding much to be happy about.”

  “Was it tough, starting in a new place like that, when you were almost finished with your training?” Before Dani could answer, Ren grimaced, as if catching an unwanted thought in midsentence. “Well, that was a dumb question. Of course it was. I imagine it was a nightmare.”

  “Not quite that bad—Quinn made the transition as smooth as anyone could. Still, none of us expected it, so we were pretty much in shock. And yeah, it was scary, but…” She shrugged. “Not much scarier than anything else we’ve had to do—all of us. Right? First night on call, first emergency room consult, first of a million first procedures. You do what you have to do.” She grinned. “Besides, you can do anything for a month.”

  Ren smiled at the universal mantra of medical and surgical residents worldwide. Rotations usually lasted a month, or two or three months, but somehow it all got distilled down to a month for the purposes of survival. No matter how bad it got, how grueling the assignment, they could all do anything one month at a time.

  “I’m sorry that Franklin’s program got defunded—that was terrible for all of you,” Ren said, catching Dani’s gaze. “But I’m glad you’re here.”

  “Me too.”

  “I would—” Ren caught her breath. “I would be very sorry if we’d never met.”

  “Ren,” Dani said softly, wondering if it was possible for a feeling to grow so large, so intense, she really would drown in it.

  When Ren leaned closer, Dani held her breath and stood very, very still. If this moment, fragile as crystal, was to shatter, it would not be her doing. Ren’s lips brushed over hers, incredibly soft and somehow even warmer than the sunlight on her face. She kept her eyes open, watching Ren’s pupils widen as her lids fluttered, as delicate as a hummingbird’s wings above a petal. She ached to reach out, to glide her fingertips down Ren’s cheek to rest on the pulse leaping beneath the creamy expanse of her throat. She held back, lest Ren pull away and break the spell.

 

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24