She tried to smile at the group but failed. She did, however, manage to introduce herself and apologise for the delay in starting.
‘I’m sure you’ve all heard by now of the reason why I was delayed and you, more than most, will understand that emergencies happen.’
Oh, help. Charlotte could hear the sound of her own voice, magnified by the loudspeaker system. Where was the calm, professional tone she always used in public?
What would her grandmother think of this? The niggling worry that there was something wrong that her grandmother wasn’t telling her couldn’t be allowed to surface until this was all over but it was impossible not to have a flash of shame that the pride her only living relative had taken in her achievements was going to be dented.
‘Ah…’ Charlotte stared at the group, totally at a loss for what she could say next. Please, God, let the ground open and swallow me up, she thought.
The ground didn’t open but the door of the conference room did, to admit a latecomer. Everybody’s head turned at the interruption but Charlotte’s gaze had got there first and now it was stuck.
The worst moment of her life had just taken a dive to a new low.
How on earth could Nicholas Moretti have the nerve to show up here, knowing he’d ruined her preparation for this talk? He’d already revealed his disbelief that she was who she said she was. Did he now want to see if she was going to make a fool of herself and confirm that disbelief?
He was about to get what he came for, then, wasn’t he?
Nico gave a very European hand gesture, apologising for his interruption as he took the empty space at the table. His body language conveyed complete confidence that he had the right to be here, though. That he was, in fact, eager to take part in the proceedings. And then his gaze locked with Charlotte’s and that weird spinning sensation in her gut seemed to catch fire.
Anger?
Quite possibly.
Charlotte Highton wasn’t about to let the actions of a man even threaten to destroy her.
Not again.
She took a deep breath, jerking her gaze away from Nico and vowing not to let it return to that section of the table until she was finished. In a way, he’d done her a favour. His entrance had covered her stumble and now she was fired up. Whether it was from anger or desperation was immaterial.
‘Some of you might be asking whether I should have let myself become involved in that emergency situation, especially when the result has deprived you of the audiovisual accompaniment you were supposed to have this morning.’
A ripple of sympathy went through the gathering.
‘It’s a fair question,’ Charlotte continued. ‘How far should any of us go in getting involved? How far should we go as emergency medicine specialists? Out in the field or in our own departments?’
Her words were clear and her tone as professional as ever now. Everybody was listening. Looking at her. She could feel one gaze in particular so strongly that she knew exactly who it was coming from. Good. Let him watch and listen. Let him see who Charlotte Highton was now.
‘We can do so many things that can be done in an operating theatre in our emergency departments or out in the field. Burr-holes, tracheotomies, amputations, thoracotamies, Caesareans.’ Charlotte paused for effect. ‘Extreme measures in desperate circumstances. How many are justified? Does the weight of evidence suggest we’re performing miracles? Or guilty of performing mutilations?’
Another pause. This was the moment that would make or break this talk.
‘I had a presentation that was full of statistics about these kinds of extreme procedures and graphics to show you the controversial relationship between patient outcomes and cost-effectiveness. Obviously it’s not possible to do those facts and figures justice from memory, so instead…’ The solution to this problem came to her in a flash of inspiration. ‘I’m going to present a case history.’
Nico sat back in his chair.
He could feel the surprise of the people around him. What was this? They were all intelligent people who were hungry for new knowledge. They wanted to be presented with the results of cutting-edge research that they could use to improve what they did for a career. But they were going to be told a story?
‘The man I’ll call Bernie was forty-three years old,’ Charlotte was saying. ‘He went to the corner shop very late one night, because his pregnant wife had a craving for chocolate ripple ice cream. The timing was unfortunate. The shop was held up and Bernie got stabbed. A small knife with a short blade was buried to its hilt in his chest, deflected by the sixth rib, maybe five or six inches to the left from the midline.’
Nico could sense the interest picking up around him. The injury had been dangerously close to the man’s heart.
‘The ambulance crew knew not to remove an impaled object. Bernie’s still conscious when they arrive but his blood pressure’s dropping. Fortunately, this corner shop is only about two minutes’ drive from St Margaret’s hospital. They put a doughnut dressing around the knife to stabilise it, give Bernie some oxygen and load and go. They establish IV access en route.’
The way Charlotte had changed to the present tense drew them all into the urgency of this case. Clever. Or were they all drawn in, as he was, by the sound of her voice? Soft, but as clear as a bell. As under control as her hair was again, all scraped back into that complicated knot thing.
Nico had preferred it the way he’d seen it after that resuscitation scene, with enough loose wisps to suggest that the whole knot could be released if you buried your fingers in it, wiggled them and then dragged them gently through the length of the hair. How long was it when it was loose? he wondered. And then he sharply dismissed the errant speculation and concentrated again on what she was saying.
‘By the time Bernie comes through our doors, he’s lost consciousness. His BP’s unrecordable. His cardiac rhythm goes from SVT to VF to asystole within thirty seconds of my team getting him hooked up to the monitors.’
Nico was really listening now. So this was a case that Charlotte herself had managed? He could imagine her there, in the emergency department of St Margaret’s. Wearing scrubs, probably, with a white coat over them. No…she’d been expecting a major trauma. She’d have a plastic apron on. And gloves. And a head covering that probably had a plastic face shield to protect her from blood spatter. She would have been in charge. In control. Her voice might have been louder than it was right now but just as clear.
‘We know our protocols inside out but how do we start CPR? This man’s got a knife in his chest that’s probably punctured his left ventricle. He’s bleeding out. We can pull the knife out and push fluids but there’s a hole in his heart so that would be futile.’
Nico was holding his breath without realising it. Everybody here knew that the only option was to do one of the most invasive procedures that could ever be done out of an operating theatre. Cracking open this man’s chest and getting to the heart of the problem, so to speak.
‘He’s dead already unless we do something major and do it fast.’ Charlotte’s tone told them she agreed with the conclusion they’d all reached. ‘A thoracotomy is the only option but I know as well as everybody else in the team what the odds are for a successful result. Virtually nil. But, hey…we have to try, don’t we? This man is about to become a father. Right now, his pregnant wife is probably wondering why it’s taking him so long to get back with her ice cream.’
Charlotte seemed to straighten her back. ‘I’m the one who has to make the call and, as far as I’m concerned, it’s a no-brainer. We take out the knife and I do a clam-shell thoracotomy. There’s a gaping hole in the left ventricle and I suture it shut while we deal with more blood in a thorax than I’ve ever seen before.’
Nico closed his eyes for a heartbeat. He could picture it. A nightmare scene. The tissue of the myocardium would have been slippery. The visual field would have been impossible to keep clear with all that blood so you’d have to work almost blind.
‘We start p
ushing fluids and begin CPR. I’m riding that stretcher to Theatre with my hand inside Bernie’s chest, doing internal compressions and praying that my rough suturing is going to hold.’
Oh, Nico could imagine that scene too. Charlotte would have had to have been astride the man’s legs, with one hand on the side rail to steady herself. Amongst the bank of monitoring and ventilation equipment that would have been in place. Speeding along with her team running to get them to Theatre as fast as possible.
It felt like he was standing in one of the wide corridors of St Margaret’s right now, watching the dramatic spectacle rush past him. Opening his eyes again, he knew that he was looking at Charlotte with growing admiration. This was some woman.
‘The cardiac surgical team is waiting for us. They do a much better job than me in repairing the damage. They replace the blood volume and get Bernie’s heart started again. By this time his wife is at the hospital. Bernie’s taken to the intensive care unit. He’s still alive but what none of us know is whether we’ve done the right thing in saving him. Will he wake up? And, if he does, how much brain damage has been caused by the lack of oxygen? His wife is distraught and, just to add to the tension, she goes into labour three weeks before her due date.’
A soft groan came from her audience. This might be nothing like what they’d expected as an opening talk but they were all invested in the story now. They had to know the outcome.
‘I’ve told you this story because it does, unlike so many, many others, have a happy ending. Bernie did have a degree of neurological compromise. His cognition and speech were affected and he had a unilateral weakness on his right side.’
It was the first time Nico had seen Charlotte smile. He felt his own lips curve in an unconscious response.
‘But his weak arm didn’t stop him being able to cradle his newborn daughter a couple of days later. His difficulty in finding words didn’t dim the way he could communicate his joy to his wife.’
Dammit. Was that a lump Nico could feel in his throat? He swallowed it away. His own career was full of success stories like this, wasn’t it?
‘The bottom line,’ Charlotte continued quietly, ‘is that our job is about the people who come under our care. Bernie was a miracle. But if he hadn’t made it, that resus scene in my ED could have been denounced as unnecessary mutilation. We couldn’t know how it would go before we started but is it just a coin toss?’
Charlotte was looking around the room. Nico was waiting for her gaze to cross his. He was oddly disappointed when it didn’t.
‘No.’ She answered her own question. ‘That’s what our chosen specialty is all about. Working towards being the best we can be in our field of expertise. Knowing when there’s a choice that pulling out the big guns is going to make the difference between life and death.’
Nico saw Charlotte take a deep breath. She was wrapping up now and the unusual introduction had clearly been a huge success. Everybody was leaning forward, totally engrossed and eager to participate in the programme that was about to start.
He felt the same way so how on earth could he be distracted by the way that deep breath pushed Charlotte’s breasts against the material of the plain blouse she wore under that tailored jacket? The way a hint of cleavage struggled to appear over the top button. Good grief. She was so buttoned up with that hairstyle and the fitted clothes she wore, it was almost as if she was trying not to look remotely feminine.
Maybe she was batting for the other team. Nico tucked the thought away with satisfaction. That would explain a lot. Maybe she had been trying to deny her true preference when he’d seen her out with that man in The Cosmopolitan Club all those years ago. And even if she was now comfortable with who she was, in her position Charlotte probably wouldn’t want to come out of the closet and travel in the company of her girlfriend. Or wife, perhaps. It was none of his business and it didn’t bother him.
So why did that curious feeling of disappointment in not making eye contact with her a second ago suddenly deepen several notches?
‘The papers you are going to be privileged to hear today are from invited speakers who are leading their particular fields. I’m looking forward to hearing the discussions that will follow the presentations. Again, I must apologise for my unorthodox keynote speech but, on behalf of Dr Richard Campbell, our chairman for today, and the others involved in organising this satellite session, let me welcome you to our symposium on critical interventions.’
Nico joined the round of applause. His neighbour leaned sideways to say something about how moving the story had been and how good it was to be reminded of the human aspects of their science. But Nico merely murmured agreement. He couldn’t take his eyes off Charlotte. As if she felt his intense gaze, she looked up from her position at the front of the room.
So there, her gaze seemed to say. I did it—even if you did do your best to stop me.
After the awkward start to the day things were running smoothly. Richard was delighted. He smiled at Charlotte as they were preparing to follow the others out of the conference room for the lunch break.
‘Do you know, I think your introduction has allowed for some very interesting questions to be raised that people might not have considered appropriate otherwise. You’ve given this whole forum an informality that has brought people closer together. It was a stroke of brilliance.’
‘Thanks.’ Charlotte rubbed the back of her neck, trying to ease the tension that still hadn’t gone away completely. ‘It could have taken things in the opposite direction. I was lucky.’
‘I think everyone was impressed.’
Had Nicholas Moretti been impressed? And why did it matter so much that he had been?
‘I’m sure they’ll want to tell you that themselves, over lunch.’
Charlotte wasn’t at all sure she wanted that to happen. She might be used to talking to colleagues while balancing a plate of food and eating but the idea of doing that in Nico’s company seemed disturbingly…intimate?
Whatever. She had the perfect excuse.
‘I’m going to skip lunch, if you don’t mind, Richard. I’ll grab a sandwich or something but I really need to check on my grandmother and make sure she’s being taken care of. And that she has something to do for the afternoon. Goodness knows what kind of mischief she could get up to otherwise.’
Richard was grinning now. ‘She’s quite something, your grandmother. How old is she?’
‘Eighty-two. Going on about sixteen, I think. I often feel as if I’m in the company of a wayward teenager.’ Charlotte’s smile was fond. ‘And then, at other times, she comes out with the kind of wisdom and advice that only someone who’s experienced life to the full could have. She’s amazing.’
Richard patted her arm. ‘Go and catch up. I’ll give your excuses to anyone who asks.’
‘Thanks.’ Charlotte hurried out to the reception area, away from the dining room, and asked whether her grandmother had left a message for her.
‘No. But she’s had lunch delivered to your room. Would you like your key now?’
The room was massive and decorated in Venetian style with sumptuous drapes, bed coverings and deep armchairs all in tones of silver and soft bronze. There was a Persian rug on the floor beneath the chandelier hanging from an astonishingly high ceiling. A small table with spindly legs supported a silver tray that had plates of delicate-looking sandwiches and cakes, a pot of tea and cups.
The first thing that struck Charlotte was that the tray hadn’t been touched.
Almost at the same time she noted how tidy the room was. Where were the clothes strewn about that always happened when Geraldine was choosing her next outfit? the open guidebooks as she chose her next adventure?
And why on earth was her grandmother lying on a bed in the middle of the day? Lady Geraldine Highton might be eighty-two but she didn’t do naps. ‘Life’s too short,’ she always said. ‘And it’s getting shorter for me by the day. Why waste it by sleeping? I can sleep when I’m dead.’
‘Gran…’ Charlotte moved towards the bed. ‘What’s wrong?’
‘Oh…’ Geraldine clearly hadn’t been expecting a visitor. She sat up swiftly, looking…embarrassed. No, make that guilty. ‘Charlie…I didn’t think I’d see you until this evening.’ The odd expression vanished, to be replaced by a beaming smile. ‘That was a wonderful talk you gave, darling. I can’t tell you how proud I was. And I understood every word. Well, almost every word. The next speaker was terribly dull in comparison. I went for a walk and watched the gondolas for a while. I might go for a ride in one after lunch. It’s been years…’
Charlotte sank down onto the edge of the second bed, facing her grandmother. Something here was off-key. Terribly off-key.
‘Gran…’ She reached out and took hold of a soft hand decorated with several diamond rings. ‘What’s going on?’
‘Whatever do you mean? Nothing’s going on, Charlotte. Come and have lunch with me.’ Lady Geraldine got to her feet but then her face changed. She couldn’t hide a grimace of pain and her hand went to her stomach.
‘You’re not well,’ Charlotte gasped. ‘That’s why you haven’t touched your lunch. Why didn’t you tell me?’
‘I’m fine. There’s nothing wrong with me.’
‘Lie down,’ Charlotte ordered. ‘I want to have a look at you.’
For a long, long moment Geraldine looked undecided. But then she quietly lay down and answered the barrage of questions. Yes, she had abdominal pain. No, it wasn’t the first time. Yes, she’d been to see a doctor about it. She’d had a scan. She was booked to have a biopsy between Christmas and New Year.
A biopsy?
With absolute dread giving her a chill that almost made her shiver visibly, Charlotte quietly asked if she could feel her grandmother’s tummy and when she did, the hard edges of the mass she could feel confirmed her worst fear.
‘Did…did your doctor tell you what he thought it was after the scan?’
From Venice With Love Page 3
