The Surgeon's Secret Baby Wish

“Mike Winthrop.”

Make that a third family. She filed that bit of information away for when the family members started coming in. “Start fluid resuscitation until Ortho gets here.” Naomi glanced at the second patient. With all the blood covering the child’s face, it was difficult to determine the gender. “What’s the story with this one?”

“Crushing chest injury, and another long extrication at the scene. The car that hit them was on top of their car, crushing the victims in the back seat.”

“Age and name?”

“Emily Brown. We almost had to sedate her brother who wasn’t doing very well himself yet was still trying to crawl back into the car to get her.”

Having just spoken to Tristan, she wasn’t surprised. Her gaze landed on Emily and she swallowed her fear, knowing the massive injuries stretched her limitations as a trauma surgeon. “Call the cardiothoracic surgeons, I need someone here to evaluate her asap.”

One of the nurses scurried off. Naomi did a quick examination of Emily, but she could see the poor girl’s ribs flailing from the foot of the gurney. Dear God most if not all of her ribs were broken. She hated to think of the damage that had already been done to her small heart. Most of the trauma surgeons could do a little open-chest surgery, but she’d only done it a couple of times and never alone. Given a choice, she’d rather have the experts with her.

“The CT surgeon is on his way in from home, but the weather may cause him to be delayed,” the nurse informed her a few minutes later. “He said he’d get here as soon as possible.”

She blew out a breath. No choice. Emily was her patient. “Okay, we can’t waste any more time. Get those labs sent off and we’ll take her straight up to surgery.”

“What about Mike Winthrop?” Missy, the charge nurse, asked, a harried expression on her face.

“Get the ortho trauma team to write the admitting orders on both Tristan Brown with his multiple fractures and Mike Winthrop with his crushed pelvis. Get them ICU beds and either Rick or I will be up to see them as soon as we’re finished in the O.R.”

“Okay.” Missy bustled off. Naomi didn’t waste any more time, but headed up to the O.R. with little Emily.

The O.R. team had Emily prepped, draped and ready to go. Anesthesia was there, putting the seven-year-old to sleep and monitoring her labile vital signs. Naomi scrubbed at the sinks outside the room and then donned her sterile garb. Her stomach clenched and she was glad she hadn’t eaten much for dinner because she felt sick at the thought of doing this alone. Taking a deep breath, she entered the O.R. suite.

“Ready?” she asked, taking her place at the patient’s chest. She wasn’t tall, and she generally used a step stool to perform surgery, which everyone had pretty much gotten used to by now.

“We’ve been giving blood as fast as possible, but she’s not gaining any ground,” the anesthesiologist warned. His name was Matt Granger and she’d done many cases with him before.

“Keep doing what you’re doing, and let’s see what we have.” Naomi reached for a scalpel and made the incision straight down the center of Emily’s small chest.

Her ribs were a mess and she didn’t need to cut the sternum as it was already broken. “Suction,” she barked when blood gushed, obliterating her view of the heart. Sweat trickled down the center of her back. “I need to find the source of her bleeding.”

“Need a hand?” a deep voice asked from behind her. She turned to see Rick standing there.

She wanted nothing more than to have Rick’s help, but the other five trauma patients needed him, too. And it was possible that Emily’s heart was beyond repair. No sense in putting the other patients at risk by tying up both of them. “I’m fine for now. The CT surgeon is on his way in from home. You’d better go and check out the ICU admissions. All of the trauma patients have been admitted to the ICU, the ortho trauma team should be evaluating the two with major fractures.”

“Sounds like everything is under control.” He gestured to the open chest. “Are you comfortable with this?”

“I’ve only done open-chest procedures a few times,” she admitted, “but hopefully I’ll find the bleeder.” She turned back to her patient and examined the chest cavity as well as she could, thinking it was possible Emily had a tear in her inferior vena cava, one of the major veins carrying blood to the heart.

“I’ll check on the ICU patients and then come back,” Rick said, his voice fading as he moved away. She didn’t bother to respond. If Emily’s vena cava was torn, things were going to get worse before they got better.

More suction, and she still couldn’t quite pinpoint the source of the hemorrhage.

“We’re losing her. I have maximum doses of three different vasopressors running with no response in blood pressure,” Matt informed her.

“Give more blood.” Sweat pooled at the base of her spine as she fought to slow the bleeding. The vena cava wasn’t an artery but its proximity to the heart made things tricky. “Does anyone know when the CT surgeon will arrive?” she asked, hoping the tremor in her voice didn’t betray her.

“I’ll check.” The circulating nurse left.

There was way too much blood. If she didn’t do something to get the bleeding under control soon, this poor little girl would die. “I want her placed on the heart-lung bypass machine.”

Matt’s gaze met hers over the supine body of their patient. “Are you sure?”

“I don’t have a choice. I can’t fix the tear in her vena cava without additional support for her heart.”

The second circulating nurse in the room wheeled in the heart-lung bypass machine. Naomi was out of her depth with the extent of this surgery and she knew it. “Call Dr Weber back, tell him I need help.”

“I spoke with Dr Yulton, the CT surgeon on call. He’ll be here in ten minutes.”

She wasn’t sure Emily had ten minutes to spare, but she nodded to indicate she’d heard. The techs set up the bypass machine while she began to cross-clamp the major arteries in preparation for the switch-over.

“I’m here.” Rick’s voice had never sounded so good.

“I’m losing her,” she said, her voice steady. “The CT surgeon will be here soon, but I need help now.”

Rick didn’t say a word but helped her perform the switch to bypass. They managed to get Emily safely transferred to the heart-lung machine just as the pediatric cardio thoracic surgeon walked in.

Naomi didn’t leave, but was more than happy to let the CT surgeon take the lead. Rick stayed too, and once Craig Yulton got Emily’s bleeding under control, she breathed a little easier.

“I’ll take her from here,” Craig said, glancing up at Naomi from the opposite side of the patient. “I heard about the multi-car crash after the ballgame, so I’m sure you have other patients to see.”

They did, so Naomi nodded gratefully and stepped down off her stool away from the table. Rick followed her out of the O.R. suite.

They stripped off their face masks simultaneously. The post-adrenaline rush hit hard and she struggled to breathe.

“Are you all right?” he asked, his voice full of concern.

She tried to nod, but her knees trembled and she suddenly felt weak. Taking a few steps, she sank into the nearest chair and buried her face in her hands.

“Naomi?” Rick’s hand on her shoulder was warm, when she was cold inside and out.

“I almost lost her.” Regret for every minute she’d wasted burned in the back of her throat. She took a deep breath and tried to pull herself together, but kept remembering how she’d sent Rick back to the ICU when she really should have handed Emily’s care over to him. “I let my ego get in the way and I almost lost her.”

“What are you talking about?” Rick asked in an incredulous tone. “You did everything exactly right. It was your decision to put her on bypass.”

“Too late. I should have made the decision sooner.” She lifted her head, forcing herself to meet Rick’s puzzled gaze. “I should have asked you to stay. I’ve never done an open-chest case on my own.” The truth weighed on her shoulders like a truckload of bricks and she glanced down, noticing how badly her hands were shaking yet powerless to make them stop. “It’s my fault if Emily dies.”

Rick stared at Naomi, realizing she was completely serious. Her hands were shaking and she was truly upset. Pediatrics wasn’t an easy specialty, not when their small patients had so much life yet to live. But even so he couldn’t remember the last time he’d seen a surgeon take a patient’s outcome so personally. “No, it’s not. Five pediatric trauma cases is a major disaster. There were several adults we sent over to Trinity, too. You did everything possible to save each and every patient. If this young girl dies, it’s because a car landed on her, not because of anything you did or didn’t do.”

She shook her head, refusing to believe him.

His heart ached for her, and if they were handing out blame, he knew he deserved a large portion for himself. If he hadn’t convinced Naomi to switch shifts with him, he would have been the one in charge and would have stayed in the trauma room to triage patients. The seven-year-old with the crushing chest wound would have ended up as his patient. But he didn’t honestly think he could have handled the surgery very differently than Naomi had. Heck, it was always easy to second-guess yourself after the fact, dissecting every little thing you could have done differently.

“We’d better get over to the ICU,” Naomi said in a low voice, clearly struggling to pull herself together. “There’s still a lot of work to do.”

She was right. They did have a lot of work yet to do, but he couldn’t stand to see her beating herself up like this. Especially when she didn’t deserve it. He took her hands and drew her to her feet. Naomi was a tiny thing, her figure hidden by the baggy O.R. scrubs, but he could see silky wisps of her ebony hair escaping the edges of her cap. There was something about her that drew him to her, something he couldn’t ignore. He gave her hands a gentle squeeze. “Naomi, you’re an excellent surgeon.”

“Thanks.” She didn’t meet his eyes and he knew she was simply being polite. She didn’t believe he meant what he said.

He had the crazy urge to fold her into his arms for a reassuring hug, but held himself in check. After all, he was her boss and he barely knew her, only having met her for the first time at their meeting that morning. He willed her to see he was telling the truth. “I’m not handing you a line, Naomi. I haven’t been here long, but this situation tonight would have put immense pressure on any member of the team. I’m impressed.”

“You wouldn’t be so impressed if one of the more experienced members of the team was here,” she pointed out. “I just happen to be the youngest and least experienced surgeon on staff.”

“No, actually, I’m most impressed because of how much you care.” Rick released her hands and took a step back, knowing he was treading on dangerous ground. For too long he’d been so lost in his own misery he hadn’t allowed anyone close. Hadn’t allowed himself to care about anyone except his sister Jess and his niece Lizzy. Yet suddenly, here with Naomi, he was feeling dangerously vulnerable. “You’re a trauma surgeon who truly cares. I think some of us tend to keep ourselves distant from our patients.”

She tilted her head, regarding him warily. “I guess I can understand. I mean, you’ve been treating pediatric trauma patients for years and after a while I’m sure it’s difficult to handle the loss.”

He swallowed hard, wishing he could tell her the truth. Was surprised he even wanted to. But he couldn’t force the words out of his throat. His wife and daughter were buried too deep in his soul to let them free. “Losing children is never easy.” He was impressed his voice was so steady when Sarah’s face was etched so clearly in his mind. “Now, come on, we have patients to see.”

She didn’t smile, but nodded and fell into step beside him as they headed out of the operating room and down the hall toward the pediatric ICU. She didn’t say much until they entered the unit, and then she began asking questions about the newest patients.

Together they made rounds, making sure all aspects of care were covered. They saw Tristan last, and he watched as Naomi approached his bedside. “Tristan, Emily is here at the hospital, in surgery.”

Tristan couldn’t respond verbally—they’d been forced to intubate him during the CT scan. The kid had a pretty severe grade-four liver laceration and multiple fractures. But Rick noticed the teenager clung to Naomi’s hand.

“Emily’s heart had a small tear next to it, and many of her ribs were broken, but she’s doing okay. You need to rest, Tristan, so you can be strong for Emily.”

The boy nodded and after a few minutes, Naomi reassuringly patted his hand and stepped back. After they’d reviewed Tristan’s orders, they headed down to the nurses’ station.

“Emily Brown is coming out of the O.R. in fifteen minutes,” the unit clerk informed them.

“I’ll stay until she’s settled in,” Naomi said.

Rick glanced at his watch, not surprised to see it was well after midnight. “Naomi, you can’t. You really need to go home and get some sleep. You’re on call tomorrow night, aren’t you?”

She nodded, fatigue evident on her face. “Yeah, I’m covering for Dirk. Another half-hour isn’t going to matter one way or the other. I want to see her before I go home.”

Suspecting more arguments would be useless, he gave up. He would have offered to take her call shift, but had a bad feeling he was going to be up most of the night as it was.

He helped himself to a cup of coffee and then headed down to bed fourteen, where Emily was due to be placed. The CT team had brought her out quicker than the promised fifteen minutes and he stood beside Naomi, watching as they settled Emily.

The young girl was stable, her heart was doing as well as could be expected. All they could do now was to wait and see.

“Go home, Naomi,” Rick said in a low tone. “I’ll be here with her all night.”

“I know.” She flashed a small smile and he was struck by how beautiful she truly was. His chest squeezed tight. “Promise you’ll call if you need anything.”

“I will.” He shoved his hands deep into the pockets of his lab coat as she turned and walked away, her shoulders slumped beneath the weight of her guilt.

He stood watching her leave, wishing she didn’t have to go. He liked working with her. Scary, considering he’d revealed more of himself to Naomi than he had to anyone else over the past two years, since he’d lost his wife and two-year-old daughter.

He shook his head. Since Gabrielle and Sarah had died, he’d kept his emotions in deep freeze. He’d stayed in peds because starting over in another specialty hadn’t appealed to him, but he kept himself emotionally isolated from everyone. It had been the only way he’d been able to survive.

Emily’s sweet face reminded him painfully of his daughter’s. Innocent Sarah, far too young to die. He blocked the image the best he could as he went to work.

But somehow he couldn’t find his usual, comfortable emotional distance. His feelings were already involved.

With Emily.

And especially with Naomi.

CHAPTER THREE

NAOMI tried to sleep in the following morning, especially since she was off work until five o’clock when it would be time for her to take over her call shift.

But she woke up every hour, starting at seven in the morning, and finally gave up at ten. She dragged herself out of bed, knowing there was no way she’d manage to get any rest until she went back to the hospital to follow up on her trauma admissions from the night before.

Especially Emily. And Tristan. Had their parents survived the crash? She hoped there was someone close to them who could come and support them during this time of crisis.

After taking a quick shower, she dried her hair, appreciating the ease of her simple, chin-length bob. She didn’t use much make-up, especially when she was only going to be on call later anyway. She pulled on a pair of trim black trousers and an electric-blue blouse topped with her white lab coat. Outside, the sun was shining brightly, no sign of the heavy fog from the night before that had caused such devastation after the baseball game.

Her house wasn’t far from Children’s Memorial Hospital. For practical reasons she preferred to live close to the hospital. After Andrew had left, she’d kept the house as she’d paid most of the mortgage anyway. He hadn’t argued, happy to take the cash buyout, which hadn’t been a surprise considering how hard he’d tried to convince her they’d needed to move to a bigger and better place outside the city limits.

Reminders of her ex-husband made her frown. She’d been devastated at losing their baby, and when Andrew had moved out during one of her extended call shifts, she’d been shocked. How could he have been so cold? So callous?

When she’d tried to talk to him, he’d told her he’d been thinking of leaving her anyway, because of her erratic schedule and long hours. The discovery of her infertility had convinced him there was no hope for them. He hadn’t wanted to go through the stress and agony all over again.

As much as she’d tried to tell herself she was obviously better off without him, she had never felt so lonely.

Naomi pulled into the designated private parking garage reserved for physicians and shook off thoughts of Andrew as she strode into the hospital. She didn’t bother with the elevator but took the stairs to the third-floor pediatric intensive care unit.

Rick was standing at the main desk when she walked in and he glanced at the clock with a puzzled frown. “You’re a little early, aren’t you?”

“Couldn’t sleep.” She lifted a shoulder in a half-shrug, feeling self-conscious after the way she’d gotten so emotional on him last night. “How are things going?”

“So far, good.” Rick’s gaze slid from hers and her gut clenched, knowing he was holding something back. With unspoken agreement, they walked down the hall towards the physician conference room.

“Emily? How’s Emily doing?”

Rick didn’t say anything but steered her toward the conference room, which for once was empty of residents. He turned to face her, his expression grim. “She had a rough night, Naomi. They’ve decided to place her on the heart transplant list.”

“What?” Shocked, she could only stare at him. “She needs a new heart? How? Why?”

He nodded. “They took her back to surgery this morning, because she’d continued to bleed. During the surgery they decided they didn’t have any choice but to put her on a Heartmate.”

A Heartmate was an external device that took over the work of the heart. It was often used as a bridge to a transplant. But pediatric organs were rarely available. It was possible that Emily would be forced to live much of her life on the device. If she could manage to avoid a life-threatening infection, that was.

“Poor Emily.” She had to blink back tears. “Does her family know? Tristan?”

“Her parents are patients at Trinity Medical Center, but the nurses in the ICU over there brought Emily’s mother over during the night. Emily’s father was too sick to be moved.”

The poor family. How awful to be hospitalized in different places. Especially when Emily’s life hung in the balance. “If she dies, it’s my fault.”

Rick sighed and scrubbed a hand over the back of his neck. “Naomi, don’t do this to yourself. Emily was crushed by a car. If she dies, it’s not your fault.”

Yes, it would be her fault, but there was no point in arguing. The trauma department had a monthly morbidity and mortality review, and this case would certainly be discussed, along with her performance during surgery. The best thing a surgeon could do was to own up to their mistakes and learn from them. The fact that Emily would have died without the Heartmate was serious enough.

“Naomi?” She started, realizing Rick had been talking to her, his blue eyes bright with concern. “Are you sure you’re all right?”

“I’m fine.”

“You saved the lives of five pediatric trauma patients last night. Don’t the others count at all?” his exasperated tone grated on her nerves. “Give yourself a break, would you? Or were you responsible for the DOA on the scene, too?”

She grit her teeth, knowing he was right, even if she didn’t appreciate his sarcasm. “Yes, the other patients do count.” She pulled herself together, knowing Emily was still alive. Maybe a miracle would happen and the youngster would get a new heart, sooner rather than later. “How are the families dealing with everything?”

“As well as can be expected. As you know, both Brown parents are patients in the adult ICU at Trinity, and so is the father of the Dupont family. The Winthrop parents are here—their son was injured only because he’d gone along with the Dupont family for the ride.”

“Some ride.” She sighed. “Okay. Thanks for filling me in.”

Rick tucked his hands in the pockets of his lab coat. “Are you heading back home or do you have an hour to spare?”

“I have time,” she said, wondering what he wanted to talk about. Maybe he wanted to give her some friendly advice on how to handle multiple trauma victims in a mini-disaster. Heaven knew, she could use the education.

“Great. I thought maybe we could talk about the goals for the community education committee.” He glanced up at the clock on the wall. “We could grab a quick lunch in the cafeteria.”

She wasn’t very hungry. Emily’s condition weighed heavily on her shoulders, but at the same time she didn’t want to keep Rick from eating, especially as he was post-call. He looked pretty good for a guy who’d no doubt been up most of the night. “Are you sure you want to do this now? You probably didn’t get much sleep last night. We can always talk about the community education plan later.”

“Believe it or not, I got about four hours of sleep between four and eight this morning.” He led the way out of the conference room, through the PICU and to the elevators. “At this point, I need to stay up or I won’t sleep tonight, when I’m supposed to.”

She knew what he meant. Being post-call wreaked havoc on a body’s sleep cycle. Stepping into the elevator beside him, she caught a whiff of his aftershave and the musky scent filled her head, teasing her pheromones. Her pulse kicked up and she took a subtle step back, hoping the distance would help. He wore a shirt, tie and smart trousers this morning, reminding

her of how great he’d looked the night before in a suit, when he’d come in to help her with the MVA victims.

She frowned, a kernel of resentment unfurling in her belly. Wait a minute. She’d given up her chance to become pregnant to help him out. How dared he use the time to go out on a date?

The elevator doors opened and she led the way into the cafeteria, telling herself to drop it. In truth, she was glad to have been there when so many trauma patients had needed her. Even if she had almost caused little Emily more harm than good. Besides, what Rick Weber did in his personal time was none of her business.

Except when he dragged her into it, by asking her to cover his call shift. Maybe she was wrong. Maybe he hadn’t been on a date but at something more serious, like a funeral. She helped herself to a salad while Rick went for the barbequed spare ribs. She added a cup of soup to complement her salad, and then stood in line to pay.

“I’ll take care of it.” Rick spoke up from behind her.

She swallowed another flash of irritation. Would he offer to pay for Chuck’s lunch? Or Frank’s? Or Dirk’s? She highly doubted it.

He must have sensed her mood because he quickly handed a twenty-dollar note to the cashier. “Please. To help pay you back for covering me yesterday.”

She arched a brow as they walked to the nearest table. “Don’t think you’re going to get off that easily. I plan to make you cover one of my call nights in return. Maybe even on a holiday,” she threatened.

Rick’s laugh was a low, rusty sound and she couldn’t help but smile as she sat down opposite him.