“It will never work.”
“Of course it will.”
“As much as I’d like to think you’re right, I don’t know.”
“Well, I do. Sit back and see for yourself.”
Chapter One
For the second time in twenty-four hours, baby Kyle had coded. His heart simply couldn’t take the stress of pumping blood into his little body any longer.
On the heels of two early morning surgeries, and bolstered only by a tall cup of coffee and a twenty minute power nap, Dr. Heather Preston finished her meticulous scrub routine. Her mind thinking through every carefully planned step of the longshot surgery.
Born with a rare congenital valve malformation, the baby was scheduled for surgery next week when the chief of cardio-thoracic surgery returned from his trip to Geneva. But this last failure had forced Heather’s hand; they couldn’t wait for Dr. Michaelson. She would have to step in as lead surgeon. Pulling this off would take a miracle, and even with the best surgical team any doctor could ask for—she was still banking on a whopper.
It was time. Through the OR doors, baby Kyle fought for his life as heparin dripped to stop his blood from clotting in the heart-lung machine. Hip checking the door, Heather entered the room, hands in the air, and the circulating nurse did her gown and gloves then tied the mask.
“Time to get this show on the road.” Through the mask her voice held a note of extra sunshine. Only positive thoughts.
The perfusion team was ready and waiting, having already set up the complex array of equipment to keep Kyle’s body alive when his heart was stopped.
When his heart was stopped. The magnitude of those five simple words kept Heather forever thankful for the daily miracles that came to pass when a repaired heart beat again. They would do this.
“Jim has a surprise for you.” Betty, her best scrub nurse smiled.
Jim Taylor, never using his full first name James in order to avoid jokes about the famous singer, was a phenomenal anesthesiologist. She was eternally grateful he would be sitting at the helm for this.
“Thought I’d change things up a bit today.” Jim said. “Mozart may be good for the brain, but I woke up humming ‘Don’t Stop Believing’.”
“Journey?” That was a surprise indeed.
“My wife gave me a CD.”
For as long as she’d worked at this man’s side he’d chosen the tranquil, calming—and occasionally snoozeable—sounds of classical music. Journey would be…different.
The familiar sounds of a well choreographed team echoed from the first cut to the peeling back of the pericardial membrane. Betty, who’d worked so well with Heather they might as well have been one body, sucked in an audible breath and muttered aloud what every person watching thought—damn it. A heart they’d expected to be the size of the patient’s fist was so enlarged it would have been more suitable pumping life into an elementary-aged child, and yet, it was too scarred to pump for tiny Kyle. An already complex procedure just got a whole helluva lot harder.
The signal to go on bypass given, technology took over and an empty little heart waited for reconstruction. For every cut of the malformation, the following stitch had to be precise, accurate, and better than watertight.
Within hours of stopping the heart, they were ready for blood to flow again. Removing the clamp that had stemmed the flow, the pale pink heart quickly turned dark. Crap.
What had they missed? She’d checked for bleeding.
“He’s in V-tach,” Jim called out. The EKG monitor showed the erratic activity.
Breathing deeply to still her own rapid heartbeat, the order had to be given. “Ten joules.” The sound of an electric shock directly through the muscle to restore normal rhythm snapped in the air. Her heart hurting, knowing odds were not in Kyle’s favor, Heather and the entire team stared, breath held. Nothing. Damn it. “Shock it again!” Come on, Kyle.
Still no reaction. Too much scar tissue for the tiny heart to handle. And now, a mitral valve leak was visible. Hell on a broomstick. Where had that come from? They couldn’t keep him on bypass forever and with no response the odds of any recovery were tanking fast. There wasn’t a choice. She’d have to cut some more. It was a risk, but a high risk was better than no chance at all.
Cutting away as much additional scar tissue as she dared, and having stitched the central point in a best effort to stem the mitral leak, Heather lifted her hands and drew from that last drop of emotional strength she stored up for days like today. Time to defibrillate and pray for a normal rhythm. “We’re done. Twenty joules.”
“Clear.” All eyes on the tiny heart. A second felt like an hour, and then she saw it—a flicker on the overhead screen. A long held breath, and like flipping a switch, Kyle’s heart muscle contracted in response. “Yes!”
Fatigue slipped away and adrenaline took its place. Almost four hours on bypass and not a moment to spare, she gave the order. “Come off slowly.” Stripping her gloves and walking away, Heather’s own heart did a joyful dance. She’d have stood on her aching feet with nothing but bad coffee and a prayer from now till the next millennium if it would have helped.
Now, God willing, and as her Grams would add "if the Creek don't rise," one more child would make it home and grow up with his family. Life didn’t get any better than this.
***
Some days didn't want to cut a man a break. The brick building that housed the family hardware store was indestructible—not so much the ancient plumbing. Jake Harper had spent the better part of the morning curled into the cabinet under the bathroom sink. How he'd never noticed that in all the generations before him no one had ever installed a shut off valve was beyond him.
Now, he stood balancing the new window air conditioning unit in his office in an effort to secure it before he and everything in the hundred and twenty square foot room melted under today’s unseasonal spike in temperature.
"Whoa.” Jake's right-hand man stepped into the blistering office. "This place is hotter than the sandbox in July.”
"Tell me something I don't know.”
"Got the floor in the bathroom mopped up and the shipment of blades and cutters you've been waiting for finally arrived.”
"About time.” Jake turned the knob to full blast and took a step back, basking in the quiet rumble and cool air blowing from the small contraption. "Much better.”
"Shh," Tom chuckled. "Don't say anything or something else might break.”
Earlier today, Jake had barely sat down to work on incoming inventory when the a/c unit in his office gave a sizzle and spark performance worthy of ringing in the New Year. Leaping to his feet, he'd barely unplugged the thing before it caught fire when Tom burst into the room announcing the cascading pipes. The only thing working in his favor was having the bathroom tucked far enough into a warehouse corner that the small flood didn't have time to do any collateral damage to stored inventory.
The ding of the front door opening sounded and Jake spun about. "You take a well-deserved break; I'll take care of the customer.”
Lawford was a small community on one of New England’s best hidden lakes. There were plenty of new faces when the tourists swept in during the summer season to vacation but otherwise, Jake knew just about every local resident. Some since he was a kid working the register at his dad's side. Sadie Norton was no exception. Though until his passing about a year or so ago, it was Mr. Norton who always popped into the hardware store.
"How can I help you, Mrs. Norton?"
The petite woman glanced up from the wall of hammers and offered him a shaky smile meant to show confidence. "I'm going to fix my sink.”
Jake did his best to smother an amused smile. There wouldn't be much she could do to her sink with a hammer. "What seems to be the problem?"
“I'm tired of emptying the bucket under the U-tube.”
It actually took Jake a second to realize she meant the P-trap. "I see.”
Her gaze scanned the varying types of hammers and skimmed over to nearby saws. "I'm thinking I need one of those plumber thingies.”
Okay, he might have figured out P-trap, but it was more his own knowledge of plumbing than her explanation that had him guessing. "You want a pipe wrench.”
Eyes wide with confusion suddenly twinkled with satisfaction, and she bobbed her head. "Yes. That's what I need.”
“Have you tried calling Mike’s Plumbing? I'm sure one of his guys could pop by in a minute and fix it for you.”
The light in her eyes dimmed. "He's too busy for something so simple. My Bill would fix those things in a heartbeat. I'm sure I'll figure it out.”
Or break something, including an arm. "You know, I'm leaving here in a few minutes, going to stop by the grocery and pick up a frozen dinner. I could go by your place on the way and fix that up in a jiffy.”
"Frozen dinner. Nonsense.” Her face lit up with something akin to delight. "You come straight over, and while you fix the sink, I'll whip you up a good hot meal.”
"If it's not too much trouble, that would be a nice change.”
Straightening her shoulders, her grip tightened on her purse and her smile spread across her face. "Yes. I'm sure it will. I'd better hurry.”
Jake was still watching the older woman scurry away when he almost heard Tom shaking his head.
"You do remember we have a freezer full of home cooked meals in the back.”
Jake turned and smiled at his friend since kindergarten. How could he forget? There wasn’t enough room in his own freezer at home for all the homemade foods he’d collected as payment over the last few months from the growing list of seniors struggling with home repairs. "What's one more sink to fix today? You don't mind closing up for me, do you?"
“Nope.” Tom shook his head. Like anyone else who'd been deployed overseas by the Marine Corps, Tom understood the concept of a little sacrifice to help others in need. "Go fix her sink. You may want to look around for a few other things in disrepair while you're there. Her husband always seemed to be in here holding that old house of theirs together with spit, a little ingenuity, and a prayer. It may be falling down around her by now.”
“That’s exactly what I had in mind.” He'd have to add Ms. Norton to his list. Like he told Tom, what was a little more time tucked under a sink? After a day like today there was one thing he was sure of—sleep tonight would come nice and easy.
***
Right about now Heather needed a good hard slap in the face—or a cold shower—or maybe both. The probability of getting enough sleep to wake up actually feeling human again made the odds slim to none sound favorable.
During her internship she’d come to terms with absurdly long hours. Then, as a resident, functioning on sheer adrenaline and coffee had become a way of life. She'd come to accept long hours on her feet and cat naps on sofas as her forever normal—even more so since working with Doctor Michaelson.
Satisfied baby Kyle was stable, for now, she adjusted the pager on her hip and strolled into the break room. Waving to one of the cardiac fellows, she tipped her head in the direction of the pot. “Fresh?”
The woman offered a friendly smile. “No, but it’s strong.”
“Works for me.” She poured herself a cup.
“Done for the day?”
Breathing in the familiar aroma of bad coffee, Heather nodded. After Kyle they’d had to wheel the 8:30am surgery back in for a second time. She was overdone.
“Then why aren't you on your way to the parking lot?”
“I could ask you the same thing.” Lifting a shoulder in a half-hearted shrug, Heather was too tired to make the effort at hefting both shoulders and blew out a sigh. “You know how it is. I’m going to put my feet up and rest my eyelids in the on-call room, just in case we need to go back in on Kyle.” Yeah, she was still just a tad worried. She’d feel much better when the sweet baby was at least forty-eight hours post op. “You, however, should go home and get some sleep. Tomorrow is an early start.”
The other woman threw back the last drop of coffee and staring down at the empty cup, shook her head. “Some days the coffee just isn’t strong enough to keep up.”
Amused by the departing words but too tired to laugh, Heather collapsed onto the well-worn sofa. She wouldn’t be the first or last doctor to forego a good night’s sleep in her own bed in case a patient needed her—fast. Fishing in her pocket, she pulled out her phone and debated if there was any point to going home to her own bed only to have to turn around and come back for the morning's surgery schedule.
Sliding her thumb over the glass screen, she hissed out a sigh. Not one, not two, but ten missed calls. Almost all from her family.
The first two were from the lake house. That would be her Grandmother. The woman had a cell phone but rarely remembered to charge or carry it. A few from her sister, Violet and one from her sister Rose. A smattering from her cousins Iris and Lily. But the final missed call from the General himself, her grandfather, was the one that had her stomach pitch left then right before springing into a full-blown somersault.
"Blast.” If her phone was correct, and of course there was no reason to believe it wasn’t, time had gotten away from her—again. Lately the General had been calling often to remind her about Sunday dinner at the lake house, and every time she’d promise to do her best to make it. Growing up, having the family all home when the General was in house was the biggest deal. Attendance was not requested, it was expected. Her aunt Marissa would pack up Iris and Zinnia, swing by Boston to pick up Heather’s mom with Rose, Violet and of course Heather in tow. The two sisters would grumble all the way to the lake and then spend the weekend with their sister Virginia and her four daughters, laughing and promising to stay longer next time. By the time the General retired, Sunday suppers were pretty much compulsory, but as his granddaughters had all grown up, the frequent dinners had become merely open door policy. Come if you can. The exception: the last Sunday of the month. Six days from now.
Blowing out a long slow sigh, she closed her eyes, summoning the stamina to return the call. No nap. Her only reprieve, stalling long enough to call the land line first knowing her grandmother would be the one to answer. Since the General worshipped the ground his wife of decades walked on, reaching out to Grams before calling his cell would be the only acceptable delay that wouldn't bring censure down with a boom.
The phone rang twice before the line clicked to life.
“Hello?”
“Hi Grams, how are you?”
“Hello, dear.” Two simple words and the warmth of the familiar voice soothed her tired soul. “We’re hoping to see you this weekend.”
“I know, but there’s a fellow shadowing our group this month from France and Dr. Michaelson is stacking back to back surgeries for all of us like sardines in a can. “
“You do sound tired. Are you getting enough sleep? Eating right?”
The barrage of concern made Heather smile. She glanced over at the coffee pot and estimated the warm sludge she’d inhaled most likely did not constitute eating right. “I could use a nap.”
“Lily’s been testing new recipes for chocolate cake.”
Ooh, hitting below the belt. Her cousin Lily had managed to produce the most delectable confections since her first Easy Bake Oven. Though her cousin’s kolackys were hard to resist, chocolate cake was Heather’s weak spot and Grams knew it. She couldn’t blame her grandmother for going straight for the chocolate jugular. If she had a normal nine to five job, she’d be on her way to the lake right now, but life, her life, especially, was beyond busy. There simply weren’t enough hours in the day. Certainly not in days like this one. Escaping to the lake wasn’t an option. Not even for Lily’s latest chocolate cake creations.
In the distance a husky, male voice boomed, “Fiona?”
“I’m on the phone, dear."
"With who?”
"It's Heather, dear.”
Before anyone could say another word, the General had picked up an extension and muttered her name through a momentary coughing fit.
The unexpected sound took Heather by surprise. “Are you feeling okay, General?”
“Never better," he rumbled. "We’ve missed you at dinner. It’s been a while.”
“I’m sorry. You know how things go.”
“I don’t.” The older man tried to muffle another cough. "But I might if we ever saw you.” Her grandfather’s brusque tone might have concerned her more if she wasn’t so fixated on why the man who never seemed to have caught even the common cold in his entire life was now trying not to hack up a lung.
“Grams, do you mind if I talk to the General for a bit?”
“Not at all. I love you, sweetie.” The extension disconnected and her grandfather coughed harder, and this time louder.
“I don’t like the sound of that.” Anyone else and she wouldn’t have given a cough a second thought.
“It’s nothing. Frog in my throat. I want to make sure you’ll be here for dinner on Sunday.”
She knew better than to let her grandfather deflect the conversation. “Have you been to see Dr. Wilkins?”
“That old coot? He doesn’t know what ends up.”
"So you've seen him?"
"I didn't say that.”
“But you have. What did he say that you didn’t like?” She asked more firmly this time.
“Are you coming to dinner or aren’t you?”
"You forgot your pills, dear," her grandmother's voice sounded in the distance.
Pills? She really didn’t like the sound of this. The man didn't even believe in vitamins. Holding her breath, she quickly considered her options. Grilling the former military man on the phone would get her nowhere fast. With a little—okay a lot—of careful tap dancing, she could rearrange things at the hospital well enough to get away a few days and see what was going on for herself. Even if it was just a cold, with a man as stubborn as General Harold Hart USMC RET, pneumonia could easily become a concern if he didn't take care of himself.
"Well, young lady?" he groused.
Only her grandfather could make one of the city’s most revered surgeons feel like a twelve year old caught stealing her first kiss on the family back porch. "I'll be home Saturday.” Sooner if she could make it happen.
Warmth seeped into her grandfather's tone. "That's my girl.”
Instantly, the cool deep voice of praise settled her nerves. Already feeling better about rearranging her schedule, and looking forward to a lot of chocolate cake, she smiled. Maybe soon she'd finally get a decent night's sleep.
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