Sebastian and his mentors had several things in common. They were all persistent perfectionists, determined to execute their role flawlessly. They were also confident. Thick-skinned. Tough-minded. Ambitious.

Sebastian was unlike the rest of them in one key way, however. He’d been a foster kid, and because of that, his street smarts were wickedly sharp. In elementary school, if he took a toy from another kid and that kid cried, he hadn’t cared. Why should he care? He’d ended up with the toy. In middle school, he’d learned to defend himself with his fists. In high school and college, he’d used people to get ahead, he’d put his own interests first, and he’d bent every rule that didn’t suit him.

Plenty of people had called him ruthless, but no one had ever called him humble.

Then he’d graduated and begun his internship, followed by his residency, followed by his fellowships. Working on children’s hearts had a way of maturing a person. The job had taught him that no human or technological advance of the last century had the ability to improve on God’s ingenious design of the human heart.

Sebastian was not the architect of the heart. He was simply a very well-trained plumber. His goal today, and every day, was to restore defective hearts as close as possible to God’s blueprint. The more effectively he could do that, the better and faster his patient would recover.

The phone rang. Dave, the anesthesiologist, answered, then murmured to the caller.

Sebastian continued without pause, his attention fixed on closing the hole between the left and right ventricles. The heart-lung bypass machine hummed, doing the work of both the heart and the lungs during surgery by pumping the infant’s blood through his body. The less time Mateo was on bypass, the better, so Sebastian had to make the right decisions, and he had to make them fast.

He also had to think two, six, eight steps ahead. The best surgeons possessed more than knowledge and skillful hands. They possessed feel. In this line of work, disaster was usually the result of several minor mistakes instead of a major one. He was learning to recognize subtle patterns and anticipate every way in which things could go wrong.

“A baby with transposition of the great arteries has been delivered in Macon,” Dave said to him, holding the phone against his chest. “His name’s Josiah Douglas. Fourteen hours old, eight pounds. They’re transporting him here by ambulance.”

Sebastian paused his stitching and looked up over his surgeon’s loupes. “Have they started him on prostaglandins?”

“Yes.”

“When will he arrive?”

“About an hour.”

He bent his head back to his task. His current repair was progressing like poetry.

Josiah would need a septostomy procedure today. Then, after giving him a week or so to recover and grow, an arterial switch operation.