Prologue
Seamus - Eight Months Prior
Thepre-oproomisquiet.
Humming with the weight of too many emotions in too small a space.
I’m nearing the end of my third year in my neurosurgery residency at University of Washington Medical School so I’ve been here before.
It never gets easier.
Especially when a patient is so young and vibrant.
Miranda Black sits on the exam table, her scrawny legs swinging like a metronome of nervous energy, oblivious to the gravity of what’s about to happen. She’s twelve—too young to shoulder the dread etched into her parents’ faces.
Instead, she looks at me with big, brown eyes, radiating a kind of trust which makes my gut twist. This little girl should have a long future ahead of her. Filled with childhood memories. Sleepovers and scraped knees, awkward kisses and graduation caps—everything she deserves but might never get.
I’d burn down the goddamn world to give her a shot at all of it.
“You ready for your big day, superstar?” I crouch slightly so we’re at eye level.
She grins. “Ready as I’ll ever be. Will I be able to feel it?”
“Nope.” I shake my head. “You’ll be asleep the whole time. When you wake up, all those nasty tumors will be gone, gone, gone.”
Miranda giggles and Myra, her mom, makes a choked sound behind her. I glance up, meeting Mrs. Black’s eyes. They’re rimmed red. Her fingers are clenched so tightly her knuckles have gone white. Beside her, Miranda’s father, Daniel, stands rigid. His face is carefully blank and his arms are crossed like they’re the only thing holding him together.
How I conduct myself now is, in my opinion, the most important part of a critical case like Miranda’s. Her family deserves hope. Trust. Honesty. We want to give them their daughter back. It’s important to coach them through what to expect.
I gesture to Layla, the nurse practitioner. “Can you take Miranda into the children’s waiting room and give her one of the iPads? We need to chat with her parents.”
“Sure.” Layla winks at me and leads Miranda from the room, looking over her shoulder with a distinct nod toward the exit sign.
Yeah. I’ve been there. Not going back for seconds.
My longtime mentor, Bryce Caldwell, clears his throat from the other side of the room, reminding me he’s in charge.
“Mr. and Mrs. Black. We’ll be using MRI-guided laser interstitial thermal therapy.” He doesn’t see the benefit of being soft—a point of contention between us on occasion. “Lasers make this surgery minimally invasive, and our goal is to remove as many of the tumors as possible while preserving healthy brain function.”
Myra sucks her bottom lip over her teeth. “What are the risks, again?”
“Either way, they’re severe.” Bryce doesn’t sugarcoat. “The tumors are deep. Near the brainstem and the motor cortex. There’s a significant risk of bleeding, swelling, and neurological damage. Surgery is our best option.”
“Which means there are bad options.” Mr. Black chokes back a sob.
Bryce barely inclines his head. “Leaving the tumors in will make life agonizing. Along the way, Miranda will endure debilitating headaches. Seizures. All sorts of complications. There are always risks in neurosurgery. In my opinion, this operation is theonlyoption.”
Jesus. He’s like a robot. I step in before the conversation turns completely mechanical. “We’ve gone over Miranda’s case extensively. Dr. Caldwell is the best. I’ll be assisting every step of the way.” I meet their eyes, my voice steady. “We’ll take care of her like she’s our own.”
Mrs. Black bursts into tears. “Do you promise?”
Something clenches in my chest. “I promise we’ll do everything we can.”
It’s not the answer she wants.
It’s the truth.
The OR is cold, sterile, and humming with focused energy. I feel at home here, in a room where nerves don’t exist.