A/N: Thank you so much, Joel Shell, BJMccoy, Kymby, Elena, and Lillepus, for your continued interest! This chapter was ready lickety-split as a result of my happiness to see I haven't lost you throughout this journey!
Charles worked throughout the weekend, not on any of the numerous reports and forms he had to inspect and sign, but on the long-term scheduling of surgeries.
By the time he'd left his office on Sunday afternoon, Charles had successfully mapped out the next month of procedures, ensuring that his plan to arrest Dr. O'Rourke's budding romance would be fully established.
No longer could he actively attempt to dissuade Margaret from speaking of Clyde. He had to maintain an air of complete disinterest in the subject so that when it came to pointing fingers at who'd purposely kept her from Clyde, he might not be immediately suspected as the cause.
Yes, he had accomplished much this weekend and felt energized to be pulling strings from afar without suspicion. Ironically, he was able to use this very position that Margaret had helped him acquire, to eradicate what was surely an impetuous and ill-advised relationship.
"Tell us about your day, Charles," his father asked, as he took his place at the Winchester dinner table on Sunday night.
"I'd be glad to," Charles replied smugly, swallowing the soup that was currently at the back of his throat. "This weekend I successfully scheduled an entire month of cases for the department of thoracic surgery."
"H-have you been working with M-Margaret?" Honoria asked him then, startling him. Before the arrival of Margaret, no one had ever interrupted the rehashing of the daily highlights but now it was becoming more commonplace.
"I have," he said, nodding enthusiastically, "and my scheduling has ensured that it will continue."
"V-very good," Honoria replied, glad to see her brother so joyful. "I'm very h-happy for you."
It was then that Charles thought of the three surgeries he and Margaret had participated in together this week, and the lack of compliments and small talk from her that had been present that very first day. Instead, she stood quietly next to him like some kind of shadow or ghost, dutifully passing him the appropriate instrument at the precise moment it was needed. As she'd mentioned last Friday, Margaret had apparently become just what he wanted of her, so why did he suddenly feel strangely empty?
"Suction," Charles murmured, watching the clear fluid seep from the pericardium he'd inadvertently nicked with his scalpel. It was early on Monday morning after a long weekend of formulating the schedule, and it seemed Charles's strongly worded request for Margaret to be always assigned to him was still in effect.
The tube was instantly placed in the exact spot of leakage, removing the pericardial fluid from the field and allowing a clear view of the aneurysm once more. The patient had been prepped on ice, his skin almost gray now, his heart rate and breathing rate dangerously low.
Charles focused on the movement of his and Margaret's hands in the patient's steaming chest cavity, the deft movements of her hands as she placed and removed sponges and reset clamps so that the field was maximally accessible. His own hands remained near the patient's pulmonary artery, preparing to create a temporary bypass so he could graft some tissue to replace its dilated wall. The condition that he'd scheduled for himself today, a pulmonary artery aneurysm, was an exceedingly rare condition, one that he'd only observed once or twice in his ten-year career. Even so, with Margaret by his side, he knew he had the greatest chance of success.
"Margaret, you are permitted to speak, you know," he finally uttered, after another ten minutes of complete silence.
"Did you not say you needed me for my hands? That's exactly what I've been doing."
"Your recall is impeccable," he replied, "but what you have forgotten is the tension and stress that accompanied my statement. In fact, I would in fact be happy to converse with you."
"Really? On a case like this, no less?" she said, her eyes nervous. "I think I've only heard of this kind of aneurysm maybe one time before in my entire nursing career. I don't even know what exactly your plan is. Too bad we're not in Philly right now, with their heart-lung bypass machine."
"Boston will have its own soon enough, one that far surpasses Gibbon's disastrous prototype; you'll see."
"Well, how do you plan to cut out that bulge without draining half the blood from the patient?"
"I've read about the relative success of hypothermia in cardiac surgery from the University of Minnesota," Charles commented. "And so, as you can see, I am cooling this patient down to a chilly eighty-two degrees to greatly decrease the body's oxygen demand and buy additional time to operate. It should slow the flow of blood as well."
"Well, if anyone can handle this type of case, it would be you," she responded. "I'm just surprised you wouldn't want another surgeon from the department here just in case. Most of them probably haven't seen something like this before."
"Margaret, if I wanted to perform before a crowd of lackeys, I could have applied to teach at Harvard Medical School, standing in the operating theatre, the incessant baying of oos and aahs ringing in my ears at all times."
"I can't imagine Clyde's seen anything like this. He probably would have liked to see this."
"…but you forget that he is currently involved in another procedure at this very moment," Charles said, smirking behind his mask. "Thus, he will have to wait his turn to witness such a rarity."
"Whole blood here, right now!" Charles exclaimed, the circulating nurse immediately racing for the refrigerator to fetch a bag. The clamp he'd applied upstream of the aneurysm had been in a tricky position and had spontaneously shifted, leading to a spurt of blood exiting the hole he'd just created in the wall of the blood vessel, drenching the front of his surgical gown. "And fix that damn clamp!"
Margaret reached into the fast-filling chest cavity now, her view of the current clamp obscured by the rising sea of blood as she felt around for the shifted clamp. Her other hand moved into the surgical field, feeling around to apply a clamp to the distal part of the artery, preventing blood backflow from the lungs.
"Did you find it, Margaret?"
"No, I didn—"
"His blood pressure is falling, Doctor," the circulating nurse interrupted, hanging the bag of whole blood on an IV stand and quickly prepping the needle as she watched the pressure gauge with wide eyes. "Forty over twenty now."
"Shit!" Charles yelled, jamming his own hands into the warm red liquid while causing Margaret's hands to retreat, a wad of sterile sponges positioned in his fingers. Running his free hand along the anterior aspect of the heart, he felt for the hole he'd made and, finding it, teased each sponge individually into the opening until he encountered the resistance of the pulmonary valve. After several sponges had been placed in the lumen of the artery, the hemorrhaging had been effectively stopped in its tracks.
Now Margaret was applying suction and slowly draining the blood away from the surgical field. As the aneurysm came into view, Charles quickly finished the aneurysmectomy and began to position the graft in place, his sutures entering the tissue just as the final drops of blood were being suctioned from the cavity by Margaret.
"I should have clamped both venae cavae before making the incision," Charles muttered, shaking his head. "I'd only bothered with the superior. I should have known a clamp by the damn valve wouldn't hold."
"You probably weren't even trained in this, Charles," Margaret replied, her voice trembling with anxiety. "Probably no one else in this department has worked on anything like this."
"That is no excuse," he muttered, frowning. "Harvard Medical School, Massachusetts General, the 4077th, all down the drain. With such education and experience afforded me, I should at least be capable of effective improvisation."
"But isn't the whole idea of improvisation is that you don't know if it will be effective?" Margaret commented. "You stopped the bleeding, didn't you?"
"…which should never had occurred, had I clamped both venae cavae first."
"You can't even see the damn inferior vena cava right now."
"Exactly," he shot back.
"Is it even standard procedure to clamp it? Most of the time, it's too deep to even be seen."
"It would have taken several minutes longer to find it, but I didn't think it necessary. And now I cannot be certain of this patient's recovery."
Now that a flap of tissue had been sutured to the artery, much like a door, he turned to Margaret.
"We haven't much time to repair this, before I am forced to remove those sponges from the artery. At that point you will reapply the clamp. Will you be ready?"
"Yes, Doctor," Margaret commented, her eyes grave as she watched the beauty of his fingers as they swiftly threaded the silk through the artery wall, joining the graft to the remainder of the artery.
Several minutes passed in utter silence, the only sound to be heard the subtle squishing of the tissues being manipulated.
"Forceps, Margaret," he said, gritting his teeth. "The moment has arrived. Now, the most important thing will be your applying pressure to the tissue just there as you apply the clamp," he said, indicating the area through which the inferior vena cava ostensibly passed. "If you apply steady pressure there with your hand, we should be able to stop blood flow through the inferior vena cava without the need to clamp it. I haven't the time to properly tease out it out, but I am certain it is just below this tissue here."
"Right."
"Ready?"
A determined nod met him, the tendons in her hands and arms visible as she waited for the signal.
"Go!"
Instantly, Margaret pressed down her gloved hand on the area of tissue Charles had indicated, effectively collapsing the large vein that ran through the area. At the same time, Charles snaked a pair of forceps into the small hole he'd left in the aneurysm graft, pulling out the four sponges he had placed, one by one, until they were all on the tray next to him. When he was certain he'd removed the four sponges he'd placed, he stifled the rather lethargic leak of crimson blood from his incision with a finger, deftly threading the remaining sutures through the hole he'd left.
"My God, that was insane," Margaret exclaimed with a loud release of breath, as she and Charles stepped into the hallway, the patient having since been brought to recovery with normal vitals. "Whew—what a ride. I think I need a drink after that."
"I agree," Charles said, blotting his sweaty forehead with a tissue. Surely his blood pressure had to be sky-high at the moment. Quickly he checked the time. "It's now long past lunch. Would you like to get something to eat elsewhere? I'm famished."
"Sure. Let me just go to the bathroom to freshen up."
"Of course. Myself as well," he replied. "I can still feel that man's blood on my forearms."
Charles and Margaret sat across from each other in the dim tavern, Charles looking more relaxed than he had since she'd begun working at Boston Mercy. He sat back in his booth, an arm over the back, languidly sipping a snifter of cognac.
"I just can't get over that today," Margaret said, shaking her head. "You did beautifully in there."
"I would call my technique today chaotic at best. On the other hand, if there had been any other nurse with me today, I am certain the patient would have expired mid-surgery."
"Awww, you flatter me," she said, blushing both from his compliment and the wine she'd been drinking. "You really think so?" Their procedure had taken so much time that her assigned afternoon surgery with Dr. Baker had to be reassigned to another nurse. It was a rare moment of freedom for both Charles and Margaret.
"I know so," he commented, his grin growing. "I am simply grateful that you are here now, by my side."
"Well, right now I'm across from you, but I know what you mean," she said, laughing. "When do you think we'll be working together again?"
"Tomorrow morning," he replied, a bit too quickly. "A complicated lobectomy. It will involve the removal of several disseminated tumors from the mediastinum and lungs."
"That does sound complicated," she admitted, shrugging. "They usually tell us about our next day's assignment at our afternoon nurse's meeting. Guess I'll be finding out soon enough if you're right, huh?"
"I guess so."
"I'm just glad I got out of working with Dr. Baker today. He takes himself way too seriously. Not sure he's ever gotten over me pointing out that leaky suture."
"That's a shame, Margaret," Charles replied, feigning a look of deep concern. "Would you like me to talk with him for you?"
"That's exactly the same look he keeps on his face the whole surgery!" she said, pointing and guffawing at Charles's contrived frown. "His face is a permanent scowl!"
"You would frown all the time as well, if you required a ladder to reach the sink!" Charles joked, a big appreciative grin on his face, one that even put his upper teeth on display, a true rarity. "Not only that, but I presume his piss-poor attitude is partly due to his having to piss all over the bathroom floor on account of not being able to reach the urinals!"
Margaret could scarcely believe her eyes; in the seventeen days since her arrival in Boston, Charles had gone from vulnerable and raw, to unbearably arrogant, and had now seemed to settle into some kind of happy medium. Relief and humor flooded her, culminating in tears streaming down her face as she now doubled over with laughter, her head practically touching the tabletop in front of her.
"How am I gonna look at him now without cracking up, thinking of him pissing all over the floors?!" she almost shrieked, her sides aching from the laughter. "It's going to make things so awkward."
"Let's face it, Margaret; you and Dr. Baker will never see eye to eye," he commented, a mist of cognac emerging from his lips as he snickered appreciatively.
"You can say that again!" she said, slapping her leg.
"Let's face it, Margaret," he replied with a big grin, "you and Dr. Baker will never see eye to eye."
"Can you be any funnier!" she cried, her makeup totally ruined from the tears of laughter. "Oh my God!"
Now they were both laughing so loudly that the scanty number of patrons in the tavern were looking over at them.
"This was great," Margaret said, finishing the last of her wine. "We should do this more often."
"I concur," Charles replied with a nod of the head, as he stood up and peered at his wristwatch. "Perhaps after tomorrow's surgery."
"I can let you know what the nursing supervisor says about my schedule tomorrow, if you want," she remarked.
Now he flashed her an enigmatic smile, holding out his hand to help her stand up.
"No need."
Margaret could only wrinkle her brow at Charles's unusual combination of self-confidence, easy humor, and humility. It was probably the healthiest combination of those traits he'd ever expressed, and she was here to witness it. And yet, Charles's complete confidence in knowing when Margaret would be assigned to his cases was a bit unnerving, being that Clyde had told her just last week that he'd requested her to be assigned to his procedures.