From Venice with Love

A time that it hadn’t even occurred to her that she might be reminded of today.

Not only reminded of but stripped of any protection she would normally have to ward it off. How long had it been since she’d felt this vulnerable?

To Charlotte’s absolute horror, she could actually feel the prickle of tears at the back of her eyes. Tears that could unleash weakness that might undo her completely. She blinked. Hard. She dragged her gaze away from yet another expression she could read in this man’s eyes. He had such an open face. He was probably a very nice person but she didn’t need anyone to be concerned about her.

She could look after herself. And succeed. She’d learned that long ago.

A police officer had come to stand beside them. This man who had an Italian name that matched his looks but who, curiously, spoke perfect English with an Irish accent, translated his query.

‘He wants to know if you need assistance of any kind.’

A snort of something akin to laughter escaped Charlotte. She alone was the only person who could provide the kind of assistance she needed right now. Unless by some miracle a police diving team could be available within seconds and an even more impressive miracle would reveal a laptop that could survive total submersion.

But a rapid conversation in Italian led to the police officer nodding and indicating, with a wave of his arm, that Charlotte should follow him.

Nick was also following. ‘He’s going to take us to the symposium venue,’ he said briskly. ‘In the police launch. It will only take a few minutes.’

Charlotte looked down at her ruined clothes. She couldn’t appear anywhere looking like this.

‘We will explain what’s happened.’ His hand was on her arm, guiding her through the crowd that was only now dispersing properly. ‘Please let me help if I can. I feel responsible for this unfortunate turn of events and I will do anything I can to put things right. Perhaps they can rearrange the order of the presentations. And do you have a back-up of your material?’

Having a man step in and try and solve this problem was the last thing Charlotte needed.

‘Of course I do. It’s on a flash drive.’

‘Which is where?’

Charlotte focused as the police officer offered her a hand to step into the speed boat. She ignored the hand, climbed aboard unaided and then turned back.

She had to speak through gritted teeth. ‘It’s in the side pocket of the laptop case that you threw into the canal.’

It was a totally unjustified accusation in the wake of an obvious accident. It was also an undeserved slap in the face given that he was trying so hard to help.

But Charlotte didn’t care. She couldn’t afford to.

‘Please don’t concern yourself any further.’ She turned away and nodded to the pilot of the boat, who revved the engine. Waved at him imperiously enough to indicate that speed was of the essence and it was time to leave. ‘This is my problem and I will deal with it.’

Nico watched the police launch speed away down the canal.

He could walk to the venue in only a few minutes longer than the boat trip would take. He hadn’t actually told her that he was booked to attend the symposium himself so he couldn’t really take offence that he hadn’t been invited to share the ride.

Besides…he needed a few minutes to try and get his head around this extraordinary development.

She might not remember him but he remembered Charlotte Highton very well indeed. He’d been looking forward to seeing what that dynamic young doctor was like further down the track of her brilliant career.

Not that she’d been his type when he’d met her all those years ago but he’d been able to appreciate her attributes. The soft femininity that had been such a delightful contrast to the skill and intelligence she’d radiated as a young clinician. The sparkle of a woman who’d had the world and most of its men at her feet.

Now she was a female clinician who exuded power and control. There wasn’t even the slightest hint of softness.

Or emotion, other than anger.

Except…just for a moment there, when he’d told her that he’d met her before, Nico could swear he had seen real fear in her eyes. A vulnerability that had been so out of place with the external appearance of this woman that he’d thought he’d been imagining things.

What he certainly wasn’t imagining was the stark contrast between the woman he remembered admiring in the past and the one he’d just encountered.

What the hell had happened to Charlotte Highton?

And what was she trying to hide?

CHAPTER TWO

‘CHARLOTTE…THERE YOU ARE! Thank goodness…I’ve been seriously worried about what might have happened to you.’ The tall, grey-haired man was hurrying towards her. As he got closer, however, his step faltered and his eyes widened. ‘Oh, my goodness. What has happened to you?’

The hotel Bonvecchiata had a water landing for gondolas and motorboats so Charlotte had entered the foyer moments after leaping out of the police launch. She knew she looked a fright but there’d been no chance to duck into a restroom and at least tidy her hair and sponge some of the mud from her clothing. Richard Campbell, the co-ordinator of this select symposium and the man who’d invited her to open it, must have been pacing the foyer as he’d waited anxiously for her to arrive.

‘Long story, Richard. I’m very sorry, but I got caught up in an emergency. A man went into cardiac arrest and fell off some scaffolding right in front of me. I had to keep up the CPR until the ambulance got there.’

Charlotte was speaking quickly but her mind was working even faster. There were about fifty people who’d been invited to attend this symposium. Where were they? Sitting in the conference room already, drumming their fingers on the tabletops and muttering about the substandard organisation of this gathering?

Richard was an old friend. Charlotte felt terrible about letting him down like this by being late and he didn’t even know the worst of it yet. How was she going to tell him that she’d lost her presentation material?

He’d noticed her gaze sweep the foyer.

‘They’re serving coffee and cake in the restaurant for everybody. As soon as I knew you were running late I put back the start time for half an hour. There’s a couple of attendees that aren’t here yet as well.’

‘Oh…’ Charlotte nodded. She had been given a small breathing space. Now she had to decide if there was any way in the world she could rescue the situation. ‘Richard…about my opening address…’

The older man smiled. ‘Catchy title. “Miracles or Mutilation?” It’s caught everybody’s attention already, I have to say. But, Charlotte…’ Richard was frowning now, looking down at her shredded tights and grazed knees. ‘Are you going to be able to deliver it?’

Richard Campbell’s reputation was on the line here. There were people from all over the world who’d chosen to come to this satellite symposium—a breakaway group from the much larger conference that had finished in Rome yesterday—plus others who had chosen to come to this forum without attending the main conference. They were all leaders in the field of emergency medicine. Exceptionally busy people who would not be happy to have their precious time wasted.

Charlotte’s presentation had been researched meticulously. the medical illustrations department of her university hospital had spent hours preparing the graphics that represented the facts and figures, the trends and the controversies about cost-effectiveness. It didn’t matter how phenomenal her memory was, there was no way she could do justice to her presentation.

If she could get hold of someone at St Margaret’s they could find the presentation on her desk computer and email it to her, but that would take too much time. They only had a matter of hours to fit in the other presentations and discussions before the symposium dinner this evening. And someone needed to open the day’s programme.

How would it look it she backed out? Even with the best excuse in the world it would still dent her reputation as a young leader in this field, and Charlotte needed that reputation. It was who she was. The professional Charlotte Highton was strong enough to hide the real Charlotte. The inadequate, shameful one who wasn’t a real woman at all.

She was caught between a rock and a hard place here. If she explained that there was no way she could do this, she would tarnish her reputation with the taint of failure and that chink in her armour might never be mended. It might grow, in fact, and eventually split open and the whole world would know what she was hiding.

They might look at her the way Nico Moretti had. As if they knew she was a fraud.

Charlotte could feel her heart thumping rapidly and there was a sinking sensation in her stomach that threatened to spiral into nausea.

‘I’ve got a small problem,’ she confessed to Richard. ‘I’ve lost my presentation. My laptop ended up in the canal.’

‘Oh…Lord…’ Richard shaded his eyes with his hand. ‘Can you manage without it?’

Charlotte opened her mouth to tell him how unlikely that was, but before she could force the words out she was distracted by the sound of her name being called from somewhere near the reception desk.

‘Charlotte Jane Highton…’

The voice was as familiar to her as her own but Charlotte didn’t want to believe that there was yet another problem she had to deal with. She kept her gaze on Richard, who gave her a rueful smile.

‘Sorry. I hadn’t got around to telling you. Your grandmother’s here.’

Charlotte shook her head sharply. ‘No. She’s not supposed to arrive until tonight. After the symposium. We’re travelling back to London together tomorrow.’

But the voice was much closer now. It couldn’t be ignored.

‘Charlotte Jane…What on earth have you done to yourself, child? You look like you’ve been run over by a gondola.’

Charlotte closed her eyes. She might be thirty-one years old but her grandmother could make her feel like a child again in a heartbeat. Flame-haired and larger than life, Lady Geraldine Highton was never one to stand on ceremony.

‘Gran…what are you doing here?’

‘I’m supposed to be here. I booked a room for us tonight.’

‘Yes, but you were flying in this evening.’

‘I changed my flight and arrived first thing this morning. I decided I wanted to hear you speak and this lovely man has told me I can sit in with all the translators and hear you on some headphones.’

Richard was nodding now and his smile was intended to reassure Charlotte that this problem, at least, had been dealt with. Clearly, he had been charmed by Lady Geraldine. Or intimidated. Either way, she had made arrangements that she now deemed satisfactory.

‘But, Gran, you hate hearing anything about medical procedures. You’ve never wanted to hear me talk about my work.’

‘Today’s different.’

Something was different. With the kind of skill Charlotte found invaluable in her dealings with people in traumatic situations, she could sense that there was something important her grandmother was keeping to herself.

‘I might not like hearing it,’ Lady Geraldine continued, ‘and I might not understand it, but it won’t stop me wanting the chance to be proud of my granddaughter. Who knows? It might be the only chance I ever get.’

Yes. There was a shadow there in her grandmother’s eyes. Eyes that usually sparkled with the determination to squeeze the best that life had to offer out of every opportunity. What was going on?

Charlotte knew she was staring. She also knew that her grandmother could read her like a book.

‘We’ll talk later,’ Lady Geraldine said crisply. ‘What we have to do now is get you tidied up. Thankfully, I have spare hosiery in my bag. And a hairbrush. Come on, Charlotte. Where’s the nearest bathroom? There’s no time to waste. You don’t want to keep all these important people waiting, do you?’

‘But…’

There was a plea on Richard’s face now. ‘You don’t have to give the presentation you prepared,’ he said quietly. ‘I have every confidence that you can think of something to say that would be an appropriate way to open this symposium. Could you do that, Charlotte? Please?’

The space between that rock and hard place suddenly got so small that it squeezed the breath out of Charlotte’s lungs. She couldn’t think. Maybe because she had no choice.

‘I’ll do my best.’

So it was that Charlotte found herself looking almost presentable again fifteen minutes later, standing in front of a room full of people who sat at a huge, U-shaped table. Some wore headphones to receive the translation service. Most had laptops or tablets on the table in front of them, along with pads of paper, pens, pitchers of iced water and even bowls of mints.

Charlotte had nothing other than a microphone clipped to the lapel of her jacket. From the way her heart was pounding and how exposed She felt, she could have been standing here stark naked.

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 pushing 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.’