by Kate Hardy
‘Answer that as well, if you need to,’ he said.
‘It can wait.’ Kelly grimaced. ‘I love my sister dearly, but I swear since she’s been pregnant...’
‘Older sister bossing you about?’ he guessed.
‘Trying to.’ She sighed. ‘Actually, you might as well hear it from me, than from someone else in the department who means well. My husband died two years ago, at the age of thirty. He was cycling to work when he had a cardiac arrest. The paramedics couldn’t save him, and the coroner’s report said he had HCM. It was a complete shock because he’d had no symptoms whatsoever.’
‘But, as a cardiologist, you think you must’ve missed something?’ Luc guessed.
Kelly swallowed hard. ‘I’ve been over and over it in my head, trying to see what I missed, and he really didn’t have any symptoms. His dad died young from a heart attack, but his dad had a high-stress job, plus he smoked and drank too much; everyone assumed his heart attack was because of all that and they didn’t bother doing a post-mortem. I guess because of what happened to his dad, Simon was more aware of heart health than the average person, even before he met me. He didn’t smoke, he drank in moderation, he ate sensibly, he cycled to work and exercised regularly. He did everything right.’
Yet still he’d died. And how she missed him. Why, why, why hadn’t she joined the dots together and made him go for that all-important check-up that would’ve spotted his unusual heart rhythm? Why hadn’t she made the connection about his father? Why hadn’t she thought there might be more to his father’s heart attack than his lifestyle?
‘My sister, my mum and my friends have all decided that I’ve been on my own for long enough and they’re forever trying to fix me up with a suitable potential partner,’ she continued. ‘That’s why Susie’s asking me to go over to dinner tonight. She says it’s so she can show me the scan pictures, but I know she’ll also have invited someone that she thinks is perfect for me.’
‘And you’re not ready?’
‘I’m not ready,’ she confirmed. ‘I know they all mean well, but it drives me crazy and I can’t seem to get them to back off. I loved Simon and I know he wouldn’t have wanted me to be alone, but...’ She sighed. ‘Sorry. I didn’t mean to dump all that on you. What I was really going to ask was if the rumours are true about you running a trial for HCM patients, and if so whether you were looking for people to join the trial?’
‘Because you have a patient who might be suitable?’
She wrinkled her nose. ‘Not my patient, but I do know two people. Simon’s younger brother Jake, and his daughter Summer—she’s four. After Simon’s PM, I nagged Jake to get tested just in case there was a faulty gene involved, and unfortunately I was right. Which also makes me think they inherited the condition from their dad—except obviously there aren’t any medical records to back that up.’
‘And Summer has inherited the gene too?’ Luc guessed.
‘Yes. With a family history that spans at least two generations—and I’m pretty sure if you went back there would be more—they’ll be good candidates. And you’ll get a spread of age and gender.’
* * *
Even though Kelly was clearly devastated by her husband’s loss, she was still thinking about his family and trying to help them, putting their needs before her own, Luc thought. He could certainly talk to their current medical practitioner and see if they would be suitable candidates for his trial.
But something else Kelly had said struck a chord with him. Maybe, just maybe, they could help each other out. He’d had a crazy scheme percolating in the back of his head for a while now, but he hadn’t found the right person to help him. Maybe Kelly was the one; she was in a similar kind of position, so she might just understand his problem.
He was normally a good judge of character and he liked what he’d seen of Kelly Phillips so far; her colleagues had spoken highly of her, too. So maybe it was time to take a risk—after he’d had the chance to check out her background and got to know her a little more, because he wasn’t reckless or stupid enough to ask her right at this very second. ‘If you can ask their family doctor to contact me, we’ll go through all the prelims and see if they fit the criteria,’ he said.
‘Thank you. I really appreciate that,’ she said.
‘It’s not a promise that it will definitely happen, but it’s a promise that I’ll do my best to help,’ he said.
‘That’s fair.’ She smiled at him. ‘So did you train at the Royal Hampstead Free?’
‘Yes, and I loved working with the team there. But then this opportunity came up, so I applied for the role,’ he said. ‘How about you?’
‘I trained here,’ she said, ‘and cardiology was my favourite rotation. I love the area, too, so I stayed. What made you become a cardiac surgeon?’ she asked, sounding curious. Then she grimaced. ‘Sorry. Ignore me; that was a bit rude and pushy. You really don’t have to answer.’
‘It goes with the territory. Given who my family is, most people expect me to be part of the family business rather than being a medic.’ He shrugged. ‘That’s what probably would have happened—but my best friend, Giacomo, died when we were fifteen.’ He winced slightly as he looked at her.
‘From a heart condition?’ she guessed.
He nodded. ‘I’m sorry if this opens any scars, but yes—the same one as your husband.’
‘HCM.’ Three little letters that had blown her world apart.
‘It wasn’t genetic, in Giacomo’s case. His family doctor thought the chest pains were just teenage anxiety because Giacomo was worrying about his exams.’
She blinked. ‘Chest pains in a teenager and the doctor didn’t send him for tests?’
‘No. Knowing what I do now, I wish he had. His condition would’ve shown up on the ECG, and then medication or an ICD might’ve saved him. But hindsight is a wonderful thing.’ He shrugged. ‘Giacomo was playing football at school with me at lunchtime when he collapsed and died. The teachers tried to give him CPR but they couldn’t get his heart started again.’
She reached across the table and squeezed his hand for a moment, conveying her sympathy. ‘I’m sorry. That must’ve been hard for you.’
‘It was. He was the brother I never had.’ And it had shocked him profoundly to come face to face with his own mortality at the age of fifteen. Giacomo had been the first person he’d ever known to die, and the fact it had happened in front of him had affected him deeply. Not wanting to feel that way again, he’d put up a slight emotional wall between himself and everyone he loved. ‘I’m reasonably close to both my sisters,’ he added, ‘but we don’t talk in quite the same way, with Eleonora being two years older than I am and Giulia being five years younger.’
‘So you wanted to save other families going through what your best friend’s family went through?’
Just what he suspected she was trying to do, too. He nodded. ‘Becoming a doctor pretty much helped me to come to terms with losing him. And I like my job—bringing people back from the brink and giving them a second chance to make the most of life.’
‘Me, too,’ she said.
When they’d finished lunch, they headed back to the cardiac ward together.
‘Thank you for lunch,’ Luc said.
‘Pleasure. I might see you later today—if not, see you tomorrow and have a good afternoon,’ Kelly said.
‘You, too,’ he replied with a smile.
And how bad was it that he was really looking forward to seeing her?
CHAPTER TWO
ON TUESDAY MORNING, Kelly was due in to the cath lab. Her first patient, Peter Jefferson, looked incredibly nervous, and his knuckles were white where he was gripping his wife’s hand.
She introduced herself to them both. ‘Come and sit down. I promise this looks much scarier than it is. I’m going to check your pulse and your blood pressure, Mr Jefferson, and then I’ll put a
little plastic tube called a cannula into your arm. Then all you have to do is lie on the couch for me, hold your breath and keep still for a few seconds, and the scanner will take 3D pictures of your heart so I can take a look at what’s going on. Then we can talk about it and decide the best way to treat you to stop the chest pain. Is that OK?’
He nodded.
‘I’m going to inject some special dye into your veins to help the scanner take the pictures. It’ll make you feel a bit warm and you might notice a funny taste in your mouth, but that’s completely normal and it’ll only last for about thirty seconds,’ she reassured him.
‘And it’s not going to hurt?’ He was still gripping his wife’s hand.
‘It’s not going to hurt,’ she said. ‘If you’re worried about how you’re feeling at any stage, just tell me. I might need to give you some medicine called a beta-blocker to slow your heart down very slightly, or some GTN spray under your tongue to make the arteries in your heart get a little bit wider—that will help me get better pictures of your heart. But it won’t hurt,’ she promised.
‘It’s just the chest pain has been so bad lately,’ Mrs Jefferson said, ‘and the medicine our family doctor gave him doesn’t help.’
Angina that couldn’t be helped by medication often meant that the arteries were seriously narrowed, and the treatment for that could mean anything from a simple stent through to bypass surgery under general anaesthetic. Hopefully a stent would be enough, but she wasn’t going to worry him until she could review the scan pictures.
She gave them both a reassuring smile. ‘Once we’ve gone through the tests, I should have a better idea how to help you. Can I just check that you’ve stayed off coffee, tea, fizzy drinks and chocolate yesterday and today, Mr Jefferson?’
He nodded.
‘And he’s been eating better lately and stopped smoking,’ Mrs Jefferson added.
‘Two of the best things you can do,’ Kelly said. ‘OK, Mr Jefferson. When you’re ready, I’ll check your blood pressure.’
As she’d expected, the first reading was really high; a lot of patients were so nervous about the tests that it sent their blood pressure sky-high. By the third reading, he was beginning to relax and Kelly was a little happier with the numbers.
Once she’d put the cannula in, she asked Mr Jefferson to lie on the scanner couch with his arms above his head. ‘I’m going to put some wires on your chest now,’ she explained, ‘so I can monitor your heart rate during the scan, but again it’s not going to hurt.’
But she really wasn’t happy with what the scan showed her. His right coronary artery was severely narrowed, as were the two on the left. An angioplasty with a stent wasn’t going to be enough to make any difference.
‘I’m sure your family doctor has already explained why you’re getting chest pain, Mr Jefferson, but I’d like to go through it with you again. Basically your heart pumps blood round your body, but sometimes deposits of fat and cholesterol—what you might hear called plaques—stick to the wall of your arteries and make them narrower. It’s kind of like when you see the inside of a kettle in a hard water area and the pipes are furred up, except in this case the furred-up bits are inside the pipes rather than outside. This means not enough oxygen-rich blood gets through to your heart, and that’s why it hurts.’
‘But you can make my arteries wide again?’ he asked.
‘I was hoping I could do an angioplasty and put a stent in—that’s basically a wire mesh that I can put inside your arteries to keep them open,’ Kelly said. ‘But in your case there’s a lot of narrowing in three of your arteries, and I think your best option is surgery. I need to talk to one of my colleagues—the cardiothoracic surgeon—very quickly, so if you’ll excuse me I’ll be about five minutes. If you’d like to nip out to the waiting area to get a cup of water while I’m gone, please feel free.’
To Kelly’s relief, Luc was in his office, dealing with paperwork.
‘Can I have a quick word about one of my patients?’ she asked.
‘Sure.’
She drew up Peter Jefferson’s scan results on the computer. ‘My patient has angina, and the meds his family doctor prescribed aren’t helping. I hoped that I might be able to do an angioplasty, but I’m really not happy with the scan results. I think he needs a CABG.’
‘I agree. That narrowing is severe. I’d recommend a triple bypass,’ Luc said as he reviewed the screen. ‘Is he still with you?’
‘Yes. He’s in the cath lab with his wife. He knows I’m having a quick word with you.’
‘Let me check my schedule.’ He flicked into the diary system. ‘Operating days for me are Wednesday and Friday.’ He blinked. ‘I’ve got a cancellation tomorrow, by the looks of it, so we can grab that slot now before someone else does. Do you want me to come and have a word?’
‘Meeting you is going to reassure him more than anything I can say to him,’ Kelly admitted. ‘Would you mind?’
‘No problem.’ He smiled at her.
And her heart would have to feel as if it had done an anatomically impossible backflip because of that smile.
Kelly had got herself completely back under control by the time they went into the cath lab.
‘Mr and Mrs Jefferson, this is Luciano Bianchi, one of our surgeons,’ she said. ‘We’ve had a quick discussion, and we both feel that the best way forward is surgery—a coronary artery bypass graft.’
‘It means I’ll take another blood vessel from your leg and attach it to your coronary artery on either side of the bit where it’s blocked—that’s the graft—so the blood supply is diverted down the grafted vessel.’ Luc drew a swift diagram.
‘I guess it’s a bit like roadworks, when you get diverted down a slightly different road round the bit that’s blocked. Your blood will flow through properly to your heart again and you won’t get any pain,’ Kelly said.
‘Exactly,’ Luc said with a smile.
‘But what about the bit in his leg? Doesn’t he need that vein?’ Mrs Jefferson asked, clearly looking worried.
‘It’s one of the extra veins we all have close to the surface of the skin,’ Luc said. ‘The ones that return the blood back to the heart are deep inside your leg. The rest of the veins in your leg will manage perfectly well if I borrow a little bit for a graft, Mr Jefferson. I’ll stitch it up and you’ll have a little scar, but it’s nothing to be worried about.’
‘Heart surgery. Does that mean you have to cut through my chest?’ Mr Jefferson asked.
‘In your case, yes—unfortunately I can’t do keyhole surgery for you because you need three grafts,’ Luc said. ‘It means you’ll have a scar down your chest, but that’ll fade with time. And once I’m happy with the grafts, I can re-join your breastbone with stainless steel wires and stitch up the opening.’ He smiled. ‘And I happen to have a slot free tomorrow morning, so I can fit you in then.’
‘Tomorrow?’ Mr Jefferson looked utterly shocked.
‘Tomorrow,’ Luc confirmed. ‘Which gives you less time to worry about the operation.’
‘Surgery.’ Mr Jefferson blew out a breath. ‘I wasn’t expecting that.’
‘I’ve done quite a few bypasses in my time,’ Luc reassured him. ‘You won’t feel a thing, because you’ll be under a general anaesthetic.’
‘Isn’t that the operation where you’ll stop his heart beating?’ Mrs Jefferson asked. ‘I read up about that on the Internet.’
‘It’s one way of doing a bypass operation, using a heart-lung machine to breathe and pump the blood round your body for you, but actually I prefer to do my surgery off-pump—where the heart’s still beating while I operate,’ Luc said.
Kelly hadn’t expected that, and it intrigued her.
Mr Jefferson’s eyes widened. ‘But isn’t that dangerous?’
‘It’s quicker, so you’ll be under anaesthetic for less time, there’s less chance o
f you bleeding during surgery, and you’re also less likely to develop complications after the operation,’ Luc said. ‘So in my view it reduces the risks.’
‘And after the surgery you’ll be with us in the ward,’ Kelly said. ‘You’ll be in Intensive Care at first, where we’ll keep an eye on you to make sure everything’s working as it should be. You’ll still be asleep for the first couple of hours, but then we’ll wake you up and your family will be able to see you.’
‘You’ll be well enough to get out of bed and sit in a chair, the next day,’ Luc said. ‘A couple of days later you’ll be back on your feet, and a couple of days after that you’ll be ready to tackle stairs again.’
‘A whole week in hospital.’ Mr Jefferson looked as if he couldn’t take it in. ‘My doctor said I’d be in here for half an hour, maybe a bit longer if you had to do a procedure like a stent. He didn’t say I’d have to stay in for a week.’
‘But if you need the operation, love,’ Mrs Jefferson said, ‘then you’ll have to stay in.’
‘I’m afraid you do need the operation, Mr Jefferson,’ Luc said gently. ‘Right now I know it feels very scary and a bit daunting. But it’s the best way of preventing you having a heart attack.’
‘But our daughter’s having a baby next month,’ Mr Jefferson said.
‘Which is another reason to have the operation now. You’ll be able to cuddle the baby without worrying that you’ll start getting chest pains,’ Kelly said. ‘By the time the baby’s crawling, you’ll have made a full recovery and can really enjoy being a grandad.’
‘And you won’t be left to deal with everything on your own afterwards,’ Luc added. ‘Heart surgery is a big operation, and we’ll help you recover on the ward.’
‘You’ll come back to us a few weeks after the operation to start a rehabilitation programme,’ Kelly said, ‘and that will help you get completely back on your feet. There are support groups, too, so we can put you in touch with other people who’ve already been through the same thing—they’ll understand how you’re feeling and can help you.’
