Chapter 30
Rhys
Hospitals are quieter at night, but the hum never stops.
The thrum of monitors, the low buzz of fluorescent lights, the soft shuffle of nurses doing rounds. Most patients say they never really sleep here. They’re right.
I badge in, exchange nods with the charge nurse, and head straight to the consult room.
They didn’t call me because the patient was crashing. They called because they wanted another set of experienced eyes. I’m not on call tonight—Paul is out of the country, and Dr. Patel is out with the flu—so they reached out. And they had already given me the update two hours earlier.
The patient was stable. Not decompensated.
“But something doesn’t feel right,” the resident said when I talked to him on the phone. “We’d love your opinion—tonight, if possible.”
I asked the only question that mattered. “Is this emergent?”
“No, sir. She’s holding. Just…concerning.”
That’s the only reason I allowed myself to go to Mikaela’s floor routine first.
I would never—ever—choose anything over a crashing patient. I’ve missed birthdays, holidays, and even my own anniversary for surgery.
Tonight wasn’t that.
Tonight was a judgment call—an easy one.
The patient was monitored, stable, but trending in a direction I didn’t like.
The resident, Dr. Lewis, already has the imaging up in the consult room.
“Dr. Prescott, thanks for coming,” the resident says, relief visible in every line of his face. “We were worried it was tamponade, but the echo’s borderline. She’s not crashing. We just didn’t want to miss something.”
“You did the right thing calling,” I assure him. “Let’s take a closer look.”
Even after all these months, it’s, as they say, like riding a bicycle. Calm settles over me. An old, familiar coat.
Together, we review the echo.
Small-to-moderate effusion.
Early right atrial collapse.
Not diagnostic tamponade, but not nothing either.
“She’s not in full tamponade.” I trace the faint compression on the screen with my finger. “But she’s heading in that direction. This is tamponade in evolution.”
The resident nods, relieved to have a name for what his gut was warning him about.
I step back and pull the chart onto the resident’s tablet.
“Her vitals show subtle signs of trouble.” Tachycardia. Narrowing pulse pressure. Soft systolics.
“Her preload’s starting to disappear,” I explain. “But she’s not decompensated.”
“So…I didn’t do anything wrong by telling you not to rush here?”
“No.” I smile. “Like I said, she’s not decompensated. That’s why it was safe to wait until now.”
The resident exhales, clearly reassured.
“We can’t drain this at the bedside—the clot burden’s too organized. She needs the OR, controlled setting, a good look at the repair.”
The resident nods, listening carefully like I’m imparting the code to open the doors of Atlantis.
“Call anesthesia,” I say. “Let’s get the room ready.”
I straighten and pat the pocket of my jacket. Jayne made sure my lucky bandana is with me.
The resident exhales, tension breaking from his shoulders. “Yes, sir.”
And just like that, it all comes back to me.
Effortlessly, the team falls into rhythm around me, the familiar choreography slipping back into place.
I scrub in.
The ritual centers me.
Warm water, antiseptic scrub, elbows held high.
The muscle memory is sharper than ever, but the frantic edge I used to ride is gone. I don’t miss it.
In the OR, anesthesia has already been induced.
Sinus tachycardia—muted, but still there.
Narrow pulse pressure.
MAPs drifting lower than they should.
These numbers used to spike my adrenaline. Tonight, they don’t.
We go through the previous incision—standard for post–cardiac surgery bleeding. A rush of dark, pressurized blood spills into the suction tubing.
“Confirmed,” I announce quietly. “Tamponade physiology.”
We irrigate, suction, and clear the field. The heart relaxes visibly under the sudden release of pressure.
I lean in, scanning along the previous operative site. There, a shimmer of red exactly where it shouldn’t be.
“Hold suction,” I command.
Everyone stills—anesthesia watching the monitors, the scrub nurse freezing her instruments midair, the resident gripping retractors.
I learned a long time ago to take my time.
I pause. It’s a deliberate, practiced moment to see what speed would miss.
I tilt the retractor a single inch, adjusting the angle so the surgical lights catch the tissue directly.
“There,” I say triumphantly.
A slow, rhythmic ooze along the suture line. Small, but insidious.
“4-0 Prolene.”
The resident passes the suture.
We reinforce the repair with interrupted stitches, test the line with irrigation, wait, take another pause, then watch for any sign of fresh bleeding.
Nothing.
“Good,” I murmur. “Place the Blake drain.”
Once it’s seated, we close in layers. The monitors stabilize almost instantly.
Normal sinus.
Stronger pressures.
A heart working as it should, relieved of its strangling cage.
We step out into the scrub alcove, the quiet space just outside the OR, and peel off our gloves. The resident shakes his head in disbelief. “Nice call, Dr. Prescott. That pause you asked for…if we’d rushed, we might’ve missed it.”
I toss my mask in the bin.
“Pausing’s underrated,” I tell him.
He nods like I’ve handed him the secret to the universe. Maybe I did. Took me twenty years to learn it.
After the ICU handoff, I find the patient’s husband in the waiting room. The moment he sees me, he shoots to his feet.
His eyes are swollen, and his hands twist in front of him. “Is she—?”
“She’s stable,” I tell him. “It was a bleed, but we controlled it. She’s responding well.”
His knees buckle with relief. He sinks into the chair, hands covering his face. When he looks up, tears streak his cheeks.
“Thank you, Doctor. Thank you. I didn’t—” His voice breaks. “I didn’t know if I’d see her again.”
I rest a hand on his shoulder. “She’ll be waking up soon. You can see her in about an hour.”
His gratitude is palpable. Nourishing.
I always assumed it was hero worship, or as Jayne would say, I’d let it feed my God complex, but today, I can see it for what it is.
Humanity meeting humanity.
These past months have not merely been about prioritizing my family and my wife over my work; they have changed me in visceral ways. I have learned to connect with myself—for real—and that has taken away my need for validation, as well as my hunger to be recognized as a world-class surgeon.
It’s just one more epiphany in a long line of them since I started my sabbatical. I thought I was going to reconnect with my family, but the surprise of it is that I reconnected with myself.
And strangely, I’m a better surgeon for it.