Chapter 64: Excising Three Tumors

June 21

Amelia pulled her car into her parking spot at 8:30 am. She had hoped to be at the hospital an hour earlier, but Simba's bleeding adventure had unexpectedly adjusted her schedule. On her drive in, Amelia had called Lynne and begged her to stay with Owen and the kids into the evening. She also dictated a text message to Stephanie instructing her to push the surgery by 30 minutes and to use the additional 30 minutes to obtain a repeat head CT. With a 9:30 am start time, Amelia would have one more opportunity to review Jason's scans and to greet the couple before cutting.

Lynne was more than willing to accommodate Amelia's unexpected schedule shift. Her gentle and flexible nature was such a gift, but Amelia worried that Lynne would eventually tire of working for two doctors with such unpredictable lives. When Amelia shared that concern during their phone conversation, Lynne assured her that she couldn't imagine being with any other family. The three adults coordinated well with each other and the children were a true joy.

"However," Lynne added, "I have been meaning to find a time to sit down with you and Dr. Hunt." Even though Lynne had just assured her that she had no intention of leaving, Amelia's heart sank.

"Absolutely," Amelia confirmed. "Anything we can chat about now?"

"I hope I don't sound presumptuous, Dr. Shepherd-Hunt, but it seems like additional help could really ease the shared overload we are all experiencing," Lynne observed.

Amelia was a bit shocked. She had no problem with Lynne's suggestion, she'd just never considered hiring another person. "Owen and I would be more than happy to brainstorm about that. Do you have a particular position or set of responsibilities in mind?"

"I have a few different ideas. Perhaps a college student could help with errands and shuffling the children to their practices and events. Another option would be to hire someone to clean and cook. Between the three of us, I'm sure we could consider a bevy of options," Lynne expressed.

"I'm just pulling in at the hospital. Let me chat with Owen and we'll definitely arrange a time soon when the three of us can talk," Amelia concluded.

As she hopped out of her car and walked to the hospital entrance, she received an adorable text from Owen showing Ryder all robed and masked. Ryder Hunt, DVM, assisting with Simba's stitches. Laughing at the sight, Amelia forwarded the picture to her email, so she'd remember to have a print made for her desk.

"Amelia," Derek called when he saw his sister enter the lobby.

"Hiya, Derek. What's your scoop this fine morning?" she asked as she continued walking toward the OR.

Derek paused and looked at Amelia thoughtfully, before remarking, "I understand you have a Grade 2 or 3 astrocytoma on your hands this morning. I… I wasn't notified about that and found out when I reviewed the board just now."

"And that's a problem, because….?" Amelia asked, not accustomed to clearing her schedule with Derek.

Smirking, Derek hesitated and then revealed, "I'm usually made aware of any neurosurgery that will exceed 4-5 hours. Maybe that practice began while you were gone. It doesn't mean I necessarily approve or deny…just that I'm made aware and consult on the case."

"Are you concerned about my surgical abilities or my aptitude?" Amelia queried.

"Not at all," Derek assured, just slightly anxious about confronting Amelia so soon after their recent conversation.

Amelia looked him in the eye, "Did you want to assist?"

Attempting to hold back his slightly offended response, Derek sputtered, "No."

"Alrighty then. Well, looks like I'll be clogging up an OR today for 6-10 hours and won't be available for other departmental needs, Chief," Amelia shared as she smirked and patted his back. Then she turned to enter the room where she planned to review Jason's latest scans.

Derek, dumbfounded, stood still in the hallway alone attempting to figure out what had just occurred. He thought to himself, Well, that didn't go as I'd planned. I guess Hurricane Amelia is on her way back.

Amelia entered the room and Stephanie already had the scans displayed and ready for review. "Which tumor will we address first, Dr. Shepherd-Hunt?" the resident asked.

"Good question, Edwards. Where would you begin and why?" Amelia inquired.

"Given the risk of extended anesthesia, I would begin with the astrocytoma," Edwards offered.

Amelia nodded and asked, "And what if you had to close unexpectedly before examining the smaller tumors?"

"Um… I suppose a follow up surgery could be considered once the patient was stable," Edwards guessed.

"And if one of the smaller tumors was actually causing more symptoms? Would you still begin with the larger one?" Amelia challenged.

Edwards, hunching that Amelia was seeing something that Stephanie was not, sought clarification, "Is that the case in this instance?"

"Take a look at the scans from 3 days ago and compare them to today's scans. What do you notice?" Amelia directed.

Stephanie studied the scans and tried to figure out what she could possibly be missing. Amelia encouraged her to hone in on Tumor Two and enlarge the shot. "Tumor Two seems to have grown and sprouted tentacles," Stephanie discovered.

"What about Tumor 3?" Amelia hinted.

"Tumor 3 is unchanged, but the astrocytoma has grown. Not as much as Tumor Two, but its appearance has become more complex," Stephanie declared.

"We've got some expanding monsters ready to take us on," Amelia observed. "Now how would you order your surgery?"

"My choice would be to begin with Tumor Two, which appears to be the most aggressive. I would move on to Tumor One and conclude with Three," Stephanie surmised.

"Great plan. Jot down the slide numbers and put them in surgical order. I want two displays available during the entire surgery – one with the static views and one with the fluid motions. Of course, those are in addition to the live view of my scopes and instruments. Do you have enough time to arrange all that before we begin?" Amelia questioned.

"Sure, Dr. Shepherd-Hunt," Edwards assured her mentor. "And Dr. Shepherd-Hunt?"

"Yes?" Amelia responded.

"It's wonderful to be working with you again," Edwards smiled.

Amelia grinned and suggested, "See if you're still saying that after I've watched you excise Tumor Three." Turning around and stepping out of the room before seeing Edwards reaction, Amelia smiled as she imagined Edwards simultaneously celebrating and fainting.

After checking in on Jason and speaking one-on-one with Jason's wife, Amelia felt grounded and ready to cut. She had walked the couple through the basics of the surgery and explained the changes she observed in the latest scans. Reassuring them that leaving Option 3 behind had been a wise choice, Amelia excused herself to prep and scrub. She spoke to Richard on her way to the OR and encouraged him to join her if he so chose. He declined but mentioned he would be popping in and out of the gallery during the day to observe.

At 9:30 exactly, Amelia entered the OR with her hands in the air and approached the nurse who stood ready to place surgical gloves on her hands. She walked over to Jason and reassured him just before the anesthesiologist sedated him. Once Jason was out, Amelia announced, "Let's do this, people," as she asked for a scalpel and began cutting. Her entire being was focused solely on this patient, his tumors, and the present moment. Nothing outside the OR was even remotely on her radar.

Throughout the process, Amelia entrusted Stephanie with increased responsibility. Edwards was ready to become more hands on with complex procedures. As Amelia operated, she thoroughly explained each step as she removed the 1st and 2nd tentacles. Handing the instruments to Edwards, Amelia encouraged her resident to remove the 3rd, 4th, and 5th tentacles of Tumor Two. When Stephanie began addressing the 6th and final tentacle, she paused and asked, "Dr. Shepherd-Hunt, this one appears to be discolored and bent."

Amelia intervened and praised Edwards' observation, explaining that it had just begun to infiltrate the healthy surrounding tissue. "Time for a change of plans," Amelia announced. "Let's get an intra-operative MRI. I need more clarity about where the healthy tissue begins and ends."

"Edwards, while we are waiting for that, you have one specific, critical, and important task: keep an eye on that surgical area and tend it fully. I'm moving over to address Tumor Three so we aren't wasting time," Amelia explained.

Stephanie was honored but also tentative, responding with a slight shake in her voice, "Yes, Dr. Shepherd-Hunt."

"Are you comfortable with the task, Dr. Edwards, or do I need to call in another doctor?" Amelia pushed.

"I can handle it," Stephanie declared.

Amelia reassured her, "I'll be here the whole time. Better to ask questions you should know the answer to than neglect to ask a question and cause irreversible brain damage." Turning to the area around Tumor Three, Amelia made an initial cut and asked for the images to be placed upon the screens.

"Dr. Shepherd-Hunt?" Owen's voice came over the loudspeaker.

"Dr. Hunt, as I live and breathe," Amelia flirted with a fake Southern accent as she easily began to remove Tumor Three.

Owen smirked and attempted not to laugh as he pressed the speaker button again, "Good morning."

"How's Simba?" Amelia asked with concern as she kept her eyes focused upon Jason's brain.

"Home, healing, and surrounded by an overly-attentive nursing staff of 3," quipped Owen. Amelia glanced up at him with a smile that he could see in her eyes.

Clipboard and pen in hand, Owen cleared his throat and requested, "Can you give me a summary of current status please? Am I seeing two open surgical areas with only one attending present?"

"You are indeed, Chief," Amelia confirmed. "Initial scans showed that Tumor Two was well contained and bordered. This morning, a repeat scan showed significant growth. When we explored, we discovered a growth from Tumor Two has infiltrated healthy tissue. We need an iMRI stat to complete work on that area. In the meantime, I'm going to be in and out on Tumor Three within 20 minutes. Time is of the essence and I didn't want to waste it waiting for the iMRI."

"Are you in need of an additional neurosurgeon?" Owen challenged.

"I have Edwards here. She is exceptional and will be learning far more today than we bargained for. Oh – and by the way – the nanny is willing to stay with you and the kids until I return home this evening," Amelia quipped as she briefly looked up to the gallery and winked at her husband in an attempt to charm away the mild anger she sensed he held.

Owen couldn't contain a return smile and responded, "Good work, Dr. Shepherd-Hunt. On the tumors and the childcare. Thanks for the update." He shook his head in mild disbelief and stepped into the hallway as he proceeded to his next obligation before he headed home.

The iMRI was performed and showed the level of detail Amelia required. As long as the scans were being done, she was able to view detail on both of the complex tumors. Once she verbally reviewed the findings on Tumor Two with Edwards, Amelia relinquished her instruments and placed them in Stephanie's hands. Amelia moved over and announced, "Edwards, you're up. Begin to excise the growth. Take your time and think through your process. Walk me through each step," Amelia commanded.

Stephanie, terrified and eager, spoke haltingly sharing her first three steps and seeking reassurance before beginning. Encouraged by Amelia's initial confirmation, Stephanie moved on to the next steps and requested, "Samii knife, please." A moment later, like a practiced surgeon, Edwards ordered, "Vessel clamp," then later, "microforceps."

In the gallery, Wilson was ready to burst out of her skin. She grabbed Alex's arm as she smiled and watched her friend succeed in the OR. Alex leaned over and mumbled, "No screaming. There's no Medical Cheerleader position, ok? Now calm down." Then he grinned at her, admiring her joy. Webber leaned his elbows on his knees and witnessed Edwards' skilled and precise technique.

After 90 minutes of delicate and intense effort, Edwards had successfully removed all of the tumor tissue without even a tiny nick in the surrounding healthy brain matter. "Edwards, I think I can die and go to heaven," Amelia jested, "You've proven yourself to be a neurosurgeon today."

"Thank you, Dr. Shepherd-Hunt," Stephanie uttered as she glanced quickly up at Jo.

Wilson leaned toward Alex and asked, "Awww…why don't you ever say anything that nice?" He glanced at her with a playful face and simply shrugged to bide some time while he came up with a response. Then he offered, "Well, I'm not really qualified to assess neurosurgeons, so…" Jo rolled her eyes and playfully nudged his elbow off the armrest between them.

Once the area was completely addressed, Amelia ordered, "Let's all step away for a moment. Stretch, do what you need to do to re-center. The astrocytoma awaits us, and we need to attack it with fresh eyes and renewed energy. Breathe, people. Hannah – could I have some water please?"

Hannah, a nursing assistant, untied Amelia's mask and held up a water bottle with a straw. Amelia blinked repeatedly and stretched before asking, "Edwards, you still with me? Here for the long haul?"

"Without question, Dr. Shepherd-Hunt. Ready and willing," Stephanie confirmed.

"Please note the time. Beginning Tumor One, Astrocytoma, at 16:42. Anybody who needs to be tagged out, now is an ideal time to speak up. We have at least two hours to go," Amelia instructed. "No judgment – do what you need to do." One nurse stepped away and another stepped up. Amelia looked up toward the gallery, "Dr. Webber? Dr. Wilson? Care to join us and observe?" Richard shook his head, while Alex nudged Jo to stand up and go scrub in.

At 18:30, a call from Owen was put through to the OR. "Dr. Shepherd-Hunt, Dr. Hunt calling for you," Hannah announced.

"Thank you. Can you hold the phone to my ear, please?" Amelia asked.

"Yes?" Amelia answered.

Owen sought to clarify, "Am I on speaker?"

"No," Amelia promised.

"You run one hell of an OR. You are an amazing surgeon, and you are a phenomenal teacher. Great work today, Mia," Owen declared. "I just called to tell you I love you."

"Thank you, Chief," Amelia responded professionally as she beamed under her mask.

"Am I still just being heard by you?" Owen queried.

Amelia answered, "Yes."

"You're still in the OR and I know you'll want to stay until the patient regains consciousness. Since I've arranged for evening childcare, can I come buy you dinner and help you relieve your post-op stress while you wait?" Owen invited with a sultry tone.

"I'll be sure to have Hannah call you when we begin closing," Amelia promised, hiding the flirtatious conversation that was taking place. "I look forward to hearing more about all of that."