Despite the expected tension, the build up to Christmas this year seemed slow. Everyone was on pins waiting for some big event to drop on them whether it be personal or work related.
To keep things interesting, Dr Glassman had reintroduced the patient survey incentive and they were all currently competing to get a chance for the pick of the next week's surgeries.
The first patient Kevin and Jo saw was a man in his forties who had caught the fingers of his left hand on a moving wood saw in work. The wound had been tightly wrapped on site but they were going to have to remove the dressing for as proper assessment. Inside they found the fingers dangling by a few shreds of muscle and skin and not a lot else. Dr Edwards, the plastic surgery attending was called urgently and decided that he could try and save just two of the fingers with what was left. However they had to get his wedding ring off his finger first.
The patient was out cold already at this time but his wife informed them that his ring was made from titanium and could not be simply cut off. Dr Edwards tasked Kevin to use a Q-tip to push bloody fragments of his finger back through the ring to remove it. The wife sat and held her husbands undamaged hand through the whole thing before they whisked him off to surgery.
Taking about it afterwards over coffee, they were all amazed by the woman's nerves of steel. "That's a real relationship goal" Kevin said wincing at the thought. "To have someone love you enough they could hold your hand through that."
Neil and Audreys case was a little more simple, but bloody nonetheless. A guy came in on his 19th birthday absolutely blind drink after deciding to sit on the edge of a large fish tank during a party at his parents home. Unfortunately for him, the tank did not take the weight, the glass broke and almost sliced off his entire butt cheek.
It was urgent but because of the amount of alcohol in his system, they would not be able to operate for a few hours during which they had to regularly change the dressing and entire that the flap of buttock was still receiving enough blood so it didn't die.
They eventually operated later that day and had to explain to some very irate parents about the delay and how their very expensive collection of tropical fish would have to be replaced.
The patient survey for Neil and Audreys patient came out on top and Dr Glassman congratulated them whilst commenting Kevin and Jo on an extremely close result.
X
Studying the surgery schedule for the following week, Neil and Audrey found themselves debating which case they should take.
Neil wanted to jump in on what could be a long term cardiac case for a man called Michael Kim. He had been a patient at the hospital for many years already and this time was scheduled for Coronary Artery Bypass Grafting. Michael had received his first transplant aged 12 as a result of severe endocarditis but now there were further complications. In an effort to delay another transplant, they were going to operate to improve blood flow to the heart.
Attempts to manage his condition with lifestyle changes and medication had not been successful so he was given the choice of angioplasty or bypass surgery. While neither of these procedures would provide him with a solutions that would last forever, he decided with his family to go big and then go home. It was going to be a possibility with the angioplasty that he would be back sooner than he would have liked for another procedure. It was considered less permanent than bypass as it would not correct the underlying cause of the blockages which pretty much made the decision for them.
Audrey listened intently as Neil made his case and couldn't find a single reason not to agree. It was becoming more obvious that cardiac surgery was his passion while she remained focused on trauma. The fact that all of the procedures to choose from were scheduled, meant that none of them particularly held her interest so she would relent and follow his lead. Just not before making him work for it.
Arguing her case for what she considered a mundane and simple tumour resection they left each other at an impasse, with Audrey having the benefit of knowing exactly which way the decision would go the whole time.
The next two days, Neil continued to build his case almost every time he saw Audrey until Kevin and Jo banned him from talking about it during lunch, making him roll his eyes.
"Maybe we'll have to ask Glassman if we can do separate procedures this time?" he said. "I know we're meant to agree on it, but it's never going to happen."
"He won't like that" Jo replied, trying to stoke the fire. Audrey had told her exactly what her plans were and they were finding it amusing watching Neil squirm.
Just as he put the last bit of his lunch in his mouth, his bleep sounded and he excused himself to head back to the ward.
"You know you could get him to agree" Jo winked once she was sure he was out of ear shot. "He is an arrogant, stubborn S.O.B, but he'd do anything for you if you just asked."
"I'm not playing that card" Audrey laughed. "I'll let him have his surgery, it is actually the best choice but I want him to work for it first" she shrugged innocently.
The following day, he made a last ditch effort to persuade Audrey to agree the procedure on Michael Kim and restrained himself from hugging her when she finally agreed. He'd already done a phenomenal amount of research into the procedure and was very relieved to hear her decision.
X
The following Tuesday saw Mr Kim being prepped for surgery. The final tests had been completed and he was currently laid out on the table waiting to start.
The cardiac attending had decided on off-pump procedure also called beating heart bypass grafting because the heart isn't stopped and a heart-lung machine isn't used. Instead, the part of the heart where grafting is being done is steadied with a mechanical device for the duration. There would be less chance of infection, stroke or kidney complications for Michael who had already been through so much st his relatively young age.
The procedure went like clockwork and Michael spent just two days in the ICU. They continually monitored his circulation and blood pressure and he was moved to his room for the rest next five days.
Before they knew it, they were running through his post-op care ready for him to be discharged. He knew the drill, but it was a required formality. They went through how to care for his incision and how to recognise if there was any infection setting in. They scheduled his follow up appointments where they would do regular stress testing and echocardiograms.
"See you guys soon" he called over his shoulder as the porter wheeled him away.
"Thank you so much" Mr Kim's mother said as she shook both Audrey and Neil's hand vigorously. "We'll see you soon."
"Not a problem" Neil replied. "We'll see you again, but not too soon okay?"
X
"We should go celebrate. I think we can call that one a success" Audrey said as they walked together towards the locker rooms at the end of the shift. "Was really good to see him go home so well."
"I can't tonight sorry Aud. I'm picking up Louise in an hour" he said checking his watch. "We're..."
"Some other time maybe?" she interrupted not wanting to hear the detail.
"Sure" he smiled turning and heading inside to get changed.
She stood a moment, feeling unsure of how she felt. She honestly couldn't think of a single time in the last few years that he had said no to spending time with her. She was so lost in her thoughts that she didn't hear Jo coming up beside her.
"I'd offer a penny for your thoughts" she said, startling Audrey, much to her amusement. "Although, looking at your face I'd say they're worth a lot more."
"It's nothing" Audrey said smiling, giving a smile that didn't quite reach her eyes.
"Hardly" Jo pushed. "You usually save that most pensive look for your patients and junior residents. What's up?"
"Our cardiac patient from last week just went home and I thought Neil might want to celebrate, that's all."
"But..."
"But he's got plans with Louise."
"Ah" Jo replied, quickly figuring out the reason behind her mood.
"I haven't really spoken to him about it because... well, you know. Is it serious?" she asked Jo, knowing her friend would tell the truth and not just what she wanted to hear.
"As much as it can be, I suppose. They aren't living in each other's pockets but that's probably mostly because of this place" she said gesturing around at the hospital itself. "Maybe if they had more time together they might be. But let's be truthful, if you worked it out, you probably spend more tine with him than she does."
"Hhmmph" came the unimpressed response. "Maybe I should start dating?" she said quietly, as if she said out loud by accident.
"Still married?" Jo reminded her. "Remember?"
"How could I forget. But no harm in testing the waters" she said, standing up a little straighter.
They both startled this time as the door behind them burst open and Neil appeared.
"Have you been stood here the whole time?" he asked Audrey, frowning a little. "You okay?"
"Sure, just getting caught up with Jo" she replied.
"That's okay then. I have to run sorry" he said smiling. "I'll see you tomorrow."
After saying their goodbyes, Audrey turned back to Jo with a serious look.
"He's happy isn't he?" she asked Jo.
"I think he is" Jo replied, nodding.
With a wry smile, Audrey turned and headed to the female locker room to change. There was not much more to say.