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‘Not at all,’ Callie murmured, her palm still smoothing along the line of his shoulder. ‘I think you and I speak the same language.’
‘We do?’
‘Sure. We live to work. And everything else is superfluous. That’s a good thing.’
He gave her a puzzled look. ‘Women don’t usually see it that way.’
Callie smiled. ‘I am not your usual woman.’
Cade was about to mutter ‘Damn right’ when the music faded to a close. Couples were parting and clapping and they followed suit.
She leaned in close and put her mouth to his ear as they left the dance floor. ‘But I’m still going to call in my debt one day.’
The brush of her lips and her warm breath arrowed straight to his groin and the stirring bloomed to full-blown arousal.
CHAPTER TWO (#u592084ef-6f73-5b50-b031-87fa0e167af1)
CADE WAS STILL THINKING about her parting shot on Monday morning in his office when he received a page from the woman herself. He’d thought of little else over the course of the weekend and even now as he reached for his phone he found himself smiling.
He couldn’t remember anticipating anything this much in a long time. Certainly not a date!
He dialled the extension appearing on his pager screen, a zing in his veins. ‘I knew it wouldn’t take you long to crack,’ he said when she answered on the second ring. ‘I knew the accent would get you sooner rather than later.’
He could hear the smile in her voice as she said, ‘Sorry, still on team Hugh.’
Cade grunted. ‘I could grow a floppy fringe?’
‘I thought you didn’t date, either?’
‘I don’t. But we have an outstanding transaction. It’s a pride thing.’
‘Ah…so it’s your ego talking. Poor Cade,’ she cooed. Cade laughed. ‘I’m sure my ego will survive.’
‘I’m sure it will, too,’ she quipped.
‘Was there a reason you paged me or is it your sole purpose in life to be disagreeable?’
Callie laughed in his ear and his body remembered vividly the havoc her laugh had wreaked on Saturday night. ‘I need a consult,’ she said. ‘I’m looking at a twin-to-twin transfusion syndrome and I want to give the parents all their options, including that new-fangled fetoscopy thing you do.’
Cade grinned at the faux reverence in her voice. ‘On my way.’
Five minutes later there was a knock on her door and Callie took a moment to mentally prepare herself before she said, ‘Come in.’
She was glad she did. Cade in a tux was a sight to behold. But Cade in a business shirt, stethoscope casually slung around his neck and his tie askew—utterly befitting the image of the dashing, maverick, prenatal surgeon—was tempting on a whole other level. He appealed to the doctor in her and, for Callie, that was way more dangerous than looking sexy in a suit.
‘Hey,’ he said.
His smile was open and friendly and his gaze was full of familiarity, and the sense of emotional danger she felt when he was around increased. ‘Thanks for coming,’ she said. ‘Have a seat.’
And then she launched straight into her spiel because she suddenly realised that with Cade, everything she’d practised over the years was in peril. That smile could make her do something crazy, like throw every ounce of caution and control she’d ever exercised to the wind.
It could make her put her heart on the line for him. A man who was as reluctant to get involved and as burned by life as she was. Hadn’t her heart already suffered enough at the hands of a man who wasn’t capable of love?
No. She’d dodged a bullet when Cade had rejected her advances. Putting herself in front of the gun again was just plain stupid.
‘Kathy Street is a twenty-six-year-old multipara. She has three children under five and is now twenty-two weeks with her fourth pregnancy, identical twin boys.’
‘With a monochorionic placenta?’
‘Yes.’ Callie nodded. ‘She had a scan at twelve weeks, which diagnosed the twin pregnancy, and was supposed to have her standard nineteen-week ultrasound but missed it due to personal circumstances.’
Cade frowned. ‘Which were?’
‘The recent floods prevented her from making the nineteen-week scan. They live three hours west in a small farming community that was flooded in for two weeks and the last week they’ve been cleaning up and trying to get back on their feet. Yesterday was the first chance she had to get to the medical centre for the ultrasound, which is, by the way, an hour’s drive.
‘The GP was concerned she was large for dates, which Kathy had put down to carrying twins and the breathlessness and exhaustion she was feeling down to the stress and hard work of mopping up. But the ultrasound…’
Callie handed over the images that Kathy had brought with her.
‘It shows a larger twin with evidence of polyhydramnios and enlarged bladder and the smaller twin with next to no amniotic fluid or discernible bladder.’
Cade looked at the dramatic images. The larger twin, or the recipient twin as it was medically known, was sitting pretty in its over-filled sac while his brother, the donor twin, was practically shrink-wrapped inside his.
‘They were referred here immediately and travelled up last night.’ Callie turned to her computer and retrieved the data she was looking for. She swivelled the monitor round for Cade to see. ‘These are the images I took just now,’ she said.
Cade shifted forward but the angle and the light in the room made it difficult to see properly so he perched on the edge of her desk, letting his leg swing a little as he leaned in towards the screen.
As he watched he was thankful he worked in, and had had exposure to, the more advanced technology of a large modern hospital. Still images were fine but to be able to see the babies in action, so to speak, was much more helpful. Callie had been thorough with all her measurements and the colour Doppler flow study was particularly helpful.
Callie looked up at him. ‘I think she’s a good candidate for FPLT.’
‘Well, they’re obviously too young to deliver. Certainly fetoscopic placental laser therapy is an option but reduction amniocentesis would be a more conservative approach.’
Callie smiled. Cade Coleman was not known for his conservative approach to medicine or else he wouldn’t be blazing a trail in prenatal surgery, but it was good to know he wasn’t a cowboy, either.
‘Yes. But I think Kathy and Ray’s personal circumstances lend themselves much better to a one-off therapy like FPLT. You and I both know that removing the excess amniotic fluid from the recipient twin is a procedure that often needs to be done multiple times with associated risk of premature birth each time. Not to mention the need for stringent follow-up.
‘They don’t live close to a treatment centre, which would cause a lot of undue stress both physically and, I suspect, financially for them. And she’d need to be on bed rest for the remaining pregnancy. Kathy is not a bed rest kind of woman—she has three little kids and a farm that she helps run. We’d have to admit her for the rest of her pregnancy to ensure that.’
‘She’ll still need to rest after laser therapy.’
‘I know,’ Callie agreed, tapping her pen absently against the wooden desktop. ‘But if she’s non-compliant or poorly compliant, at least the basic cause has been dealt with.’
Callie had grown up around women like Kathy—they worked hard from sun-up to sundown. Rest was something people in the city did.
‘I think she’d be much happier having weekly follow-up ultrasounds locally than stuck in a city hospital, worrying about how her hubby is coping with the kids and the farm.’
She put down her pen and stared at him for a moment. She didn’t think she’d have to work this hard to convince Cade Coleman, of all people!
‘It has the best outcomes for both twins over any other treatment,’ she said. ‘Prior to your arrival, Kathy and Ray would have to have travelled to Sydney for this.’
He grinned. ‘You know you’re preaching to the converted, right?’
Callie shot him an exasperated glare. ‘Well, what are we waiting for?’ she said, standing up. ‘Let’s go and talk to them.’
He followed her through an interconnecting door to the next room, where a couple sat quietly holding hands. After the introductions were over, Callie gave them a reassuring smile.
‘You’ve both had a lot to take in this morning,’ she said. ‘Before I get on to treatment options, have you got any questions about the actual condition?’
Kathy’s husband, Ray, nodded. ‘Yes. I’m sorry, it’s all a little overwhelming. Did you say that the twins are sharing the same blood supply through the placenta?’
Callie smiled again encouragingly. ‘Kind of,’ she said. It was often hard for laypeople to understand complex medical conditions and part of Callie’s job was helping them to understand. If that meant she had to go over and over the information again, that’s what she did.
‘Your twins share the same placenta—that’s common for identical twins. Usually in this scenario each twin has its own separate connection to the placenta via its umbilical cord, but in TTTS the placenta contains abnormal blood vessels, which connect the umbilical cords and circulations of the twins.’
Callie paused to check that Kathy and Ray were following. She glanced at Cade, indicating for him to jump in. ‘So essentially,’ Cade said, ‘blood from one twin is transfused into the other twin.’
‘That’s the donor twin, right?’ Kathy said. ‘The recipient is the twin who gets the transfusion?’
Callie nodded. ‘That’s right. The recipient twin has a lot of extra stress put on its heart because of the extra fluid. Also the kidneys produce a lot of urine to try and remove some of the excess fluid, which leads to a build-up of amniotic fluid. That’s what I showed you on the scan earlier.’
‘That’s why I’m so big,’ Kathy stated.
‘Yes,’ Cade confirmed. ‘It’s called polyhydramnios. But the donor baby has hardly any amniotic fluid because it’s donating all its blood to its sibling and therefore producing hardly any urine. The donor twin also becomes quite anaemic.’
Cade paused, too, for a moment, glancing at Callie. Ray and Kathy seemed to have grasped the basics. They looked shaken but, from what he’d gleaned already about people from ‘the bush’, as they called it here, also stoic. Something that was confirmed a moment later when Ray cut straight to the chase.
‘Okay. So how do we fix it?’
Callie ran down the rather short list of options from doing nothing, which would almost certainly lead to the death of one if not both twins, to bed rest and nutrition to treating the symptoms with serial reduction amniocentesis and stringent monitoring.
‘There is one more option,’ she said. ‘I’ve asked Dr Coleman here because he offers a one-off treatment that is curative.’
Ray frowned. ‘So let’s do that.’
Cade looked at Callie and she nodded for him to continue. ‘Well, it is a little out there for a lot of people. It’s called fetoscopic placental laser therapy and involves me operating on the placenta while your twins are still in utero.’
Ray looked shocked. Kathy said, ‘You can do that?’
‘Can and have,’ Cade confirmed. ‘You are the first TTTS case I’ve seen since coming to Australia a couple of months ago but I have performed this procedure over a dozen times in the States.’
Cade went on to explain what exactly the operation entailed. He talked about the high operative and twin survival success rates and ran through the benefits as well as the potential complications—from having to repeat the procedure on rare occasions because all the aberrant vessels hadn’t been destroyed to inducing labour and the subsequent complications to do with premature babies.
He was thorough, answering their questions as he went along, and Callie couldn’t help being both pleased and impressed. Invading the safe, sterile world of the uterus was cutting-edge stuff but it should never be taken lightly or dived into willy-nilly.
‘You’ll probably want some time to discuss it,’ Callie said when Cade’s spiel had come to an end and the questions seemed to have been exhausted. ‘Why don’t you guys go down to the coffee shop and figure out which option you want to go with?’
Ray nodded. ‘If we decided to go ahead with the laser thing,’ he said, addressing Cade, ‘how soon can you do it?’
‘Tomorrow,’ Cade said. Prenatal surgery was rare so there wasn’t exactly a waiting list. ‘We’ll admit Kathy straight away, run some more tests and I’ll get a team together. Not sure if it’ll be in the morning or the afternoon yet.’
‘Okay, thanks,’ Ray said. He stood, helping Kathy to her feet, then reached out and offered his hand to Cade. ‘Thanks, Doc.’ He nodded at Callie. ‘You’ll hear from us shortly.’
Callie reached into her trouser pocket and handed them a card. ‘Page me on this number whenever you want.’
Callie watched as Ray opened the door and ushered Kathy through it. ‘You reckon they’ll go for it?’ she asked Cade as the door shut behind the Streets.
‘They seem like really practical people, so I think they will.’ He looked at Callie. Her gorgeous red hair was constrained in a high ponytail today and in the daylight her green eyes dazzled. ‘You wanna assist tomorrow if they do? I’m going to need another set of hands in case I have to deliver twins.’
Callie grinned. Standing next to Cade while he saved two little tiny lives had danger to her peace of mind written all over it, but it wasn’t something she wanted to miss, either.
‘Wild horses couldn’t keep me away.’
Which was why the next morning she was standing in her scrubs and theatre clogs, her hair contained in a blue cap, a mask covering her nose and mouth, eagerly watching the monitor as Cade advanced the fetoscope through the amniotic sac of the recipient twin—Joshua—towards the connecting vessels on the surface of the placenta. It was a strange and beautiful underwater world, like in footage she’d once seen of a sunken galleon, and she held her breath as a little hand was illuminated by the beam of light shining from the end of the scope.
‘Beautiful, isn’t it?’ Cade murmured.
Callie, standing opposite with her arms folded, her body turned to face the monitor, glanced at him and recognised the same sense of awe that was bubbling inside her. ‘Amazing,’ she agreed, her gaze straying immediately back to the screen.
Cade watched her for a moment longer. With the mask firmly in situ, hiding the classic features of her face, he had no idea what colour lipstick she was wearing or if, indeed, she was wearing any. Instead, he’d found something equally captivating: her eyes.
The mask isolated and emphasised the flecks of turquoise amidst the green of her irises. He hadn’t noticed them before and he couldn’t think why. He guessed his determination to concentrate on his career was paying off if he’d missed the fascinating hue of Callie’s eyes.
He was obviously getting good at it.
So, why, suddenly, was that such a depressing thought?
He turned back to concentrate on the job at hand—on Kathy, anesthetised and depending on him, on her babies, on locating the problem vessels.
‘Laser, please.’
The scrub nurse handed him the fibre and he threaded it down through the same sheath the scope was using, without taking his eyes off the visual on the screen. Once the laser was in place he set about coagulating the aberrant blood supply, running the beam along the length of the vessels and obliterating them for good.
It didn’t take long and he was satisfied when he was finished that the procedure had been curative. ‘That ought to do it,’ he announced, as he withdrew the fibre.
Callie glanced at him and her eyes shone with excitement—like they needed any extra enhancement! ‘Well done! You going to take some of that amniotic fluid while you’re in there?’
He nodded. ‘Yep. Looks like I’ve got a good couple of litres I can relieve Joshua and his mother of.’
In the end Cade withdrew one and a half litres before declaring himself satisfied. Kathy would feel an immediate difference in the tightness of her belly and her breathlessness, and Joshua’s heart and kidneys would not have to work as hard. Andrew, his twin, also now had a chance to develop normally.
And as the cherry on top, Callie was looking at him like he hung the moon.
And all-round great result.
Kathy and Ray thought so, too, when four days down the track she was ready for discharge. The twins were doing well, no complications had developed and they were thrilled to be heading home with weekly follow-up from their local medical centre.
‘Thank you so much,’ Kathy said to Callie as Ray zipped up her bag. ‘You saved our boys’ lives.’
