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Jack nodded. ‘They’re clear. No signs of polycythaemia, thyrotoxicosis or hyperlipidaemia.’ So Imogen Parker’s blood didn’t have an abnormally large amount of red blood cells, she didn’t have an inflamed thyroid gland and there weren’t abnormally high levels of fat in her blood. ‘Not diabetes or anaemia either,’ he added.
‘What about her angiography?’ Miranda asked. It was standard procedure in these cases to take an X-ray of the blood vessels around the patient’s heart.
‘It showed a slight narrowing of a couple of the blood vessels.’
‘Is she on GTN?’ GTN, or glyceryl trinitrate, increased the flow of blood through the heart muscle and controlled the symptoms of angina.
‘It gave her headaches, so she’s on beta-blockers,’ Jack said. ‘Her GP’s worried as the drugs weren’t working that well and she’s still getting pain on rest, so we’re keeping an eye on her.’
‘So you’re thinking about surgical intervention?’
‘Possibly.’
They went into the room. ‘Good morning, Miss Parker,’ Jack said with a smile. ‘I’d like to introduce our new consultant, Miss Turner.’
‘Miranda,’ she corrected. ‘May I?’ She indicated the edge of the bed.
‘Of course, Doctor,’ the old lady said.
‘May I call you Imogen?’
Imogen nodded.
Miranda sat down and held the elderly woman’s hand. Imogen Parker was even around the same age that May would have been—in her late seventies. This was way too close for comfort. ‘Jack tells me we’re keeping an eye on the pain you’ve been having lately. How are you feeling today, Imogen?’
‘Not so bad,’ Imogen said quietly.
The slight greyness in her face told Jack and Miranda otherwise. Jack flicked quickly through her chart. ‘You had another two attacks last night?’
‘It was nothing, really.’ Imogen made a dismissive gesture. ‘I don’t like to bother the nurses. They’re busy.’
‘They’d be a lot more bothered if they thought you weren’t feeling well and hadn’t told them,’ Miranda said. That was precisely what May had done. And then it had been too late. ‘Imogen, trust me—you’re not making a nuisance of yourself if you call them. They’re here to help you.’
‘So when can I go home?’ Imogen asked.
‘I can’t tell you right now,’ Miranda said. ‘Dr Sawyer and I need to talk about how your drugs are working and what we can do to stop the pain coming back so frequently. Do you have anyone to look after you at home?’
‘My Floss—she’s my little Westie. She hates being in kennels.’
Jack and Miranda exchanged a glance. ‘If you tell me where she’s staying, I’ll ring the kennels for you and find out how she’s doing,’ Miranda said.
‘She’s at Berrybank, on the other side of Calderford.’
‘I’ll ring them at lunchtime for an update, and I’ll get a phone brought in so you can hear it for yourself.’
‘Would you?’ Imogen’s eyes glittered with tears. ‘Thank you, love.’
‘No problem.’ Miranda squeezed her hand. ‘We’ll be back to see you a bit later on. And if you feel even the slightest twinge, promise me you’ll press your buzzer.’
‘I will.’
‘Thank you. Is there anything you’d like to add, Jack?’
He shook his head. ‘We’ll see you later, Miss Parker.’
‘Does she have any relatives nearby?’ Miranda asked as they left the room.
‘There’s a great-niece who’s either phoned or popped in every day.’
Oh, yes. Miranda knew all about great-nieces being the only ones in the family who cared enough to check on their elderly great-aunt.
‘But apparently she has three under-fives.’
‘So Imogen can’t stay with her—the niece already has enough on her plate, and you can’t expect small children to give an elderly woman the peace and quiet she needs while she recovers.’
‘You’re really going to ring the kennels?’ Jack asked.
‘If she’s worrying, it’s likely to bring on another angina attack,’ Miranda said. Jack didn’t need to know the other reason: that she wanted to do for Imogen what she’d failed to do for May. ‘I’ll go and see the dog myself, if it’ll help her—maybe bring her a photograph so she doesn’t feel quite so alone.’
This definitely wasn’t the attitude he’d been expecting. Jack had a nasty feeling that he’d underestimated Miranda Turner. ‘Maybe,’ he said, wishing he’d thought of it in the first place. One little phone call would make a big difference to their patient’s mental state—and that would make an even bigger difference to her ability to deal with the physical problem. He really should have thought of that himself.
‘Next, we have Sidney Patterson. He has a thoracic aortic aneurysm,’ Jack continued as they stood outside Room Two. ‘He hadn’t had any specific symptoms but he’d gone for a routine check-up and the GP suspected something was up and sent him for a CT scan.’ An aortic aneurysm—a bulge in the wall of the main artery carrying blood from the heart—didn’t always cause symptoms, depending on which part of the artery it affected. Sometimes the patient had difficulty swallowing or was hoarse because it pressed on a nerve controlling a vocal cord; if it was further down in the abdomen, it sometimes caused backache. ‘It’s around seven centimetres in diameter, so he’s booked in for surgery on Friday afternoon.’
Miranda nodded. Aneurysms of that size were more prone to rupture, and there was a high mortality rate. She glanced at his notes. ‘He’s a prime candidate, isn’t he? Mid-fifties, male, high blood pressure, atherosclerosis.’ She paused. ‘We ran some trials in my last hospital to repair aneurysms without major open surgery. One was on keyhole surgery, and the other was putting a catheter into the artery at the groin which carried an endovascular stent to the aneurysm.’
‘Then you leave the stent in place to support the aneurysm,’ Jack said thoughtfully. ‘I’d like to see some studies on that. But here we take the open-surgery approach, using Dacron tubing.’ The tubing supported the aneurysm and stopped it growing any bigger.
‘Fair enough,’ Miranda said. ‘Keyhole surgery and endovascular stents are still fairly experimental and need controlled trials. But maybe we can consider them as options in the future.’
So much for her speech about new brooms. She really was trying to prove herself the hotshot, wasn’t she? ‘If the clinical director agrees to a research proposal,’ he reminded her.
She gave a rueful smile. ‘He’s going to need a lot of persuasion.’
Jack couldn’t help himself. ‘Then you’re the right person to do it, aren’t you?’ And then he wished he hadn’t said it when he saw her flinch. Just momentarily. Nothing in her manner changed—but he knew he’d hurt her. He might just as well have said to her straight that she’d only got her job because of who she was.
She made no comment, simply went into Room Two. And Sid was as charmed by Miranda as Mrs Parker had been. ‘So are you going to be the one with me under the knife, Dr Turner?’
Jack noticed that she didn’t correct him that she was ‘Miss’. ‘Fraid not,’ she said with a smile. ‘You’re in Dr Sawyer’s very capable hands—actually, I’m assisting him.’
She was going to assist him? Since when? Or was she trying to prove that she wasn’t going to take over completely?
‘So tell me, Mr Patterson, how are you getting on with keeping your blood pressure down?’
He shrugged. ‘I’m taking the tablets, love.’
She grinned. ‘How many times do you forget them?’
‘Ooh, let me see—I forget,’ he teased back.
‘And you’re cutting your cholesterol levels?’
‘The wife’s in charge of that. Though I miss my bacon sandwiches at lunchtime.’
‘The odd one won’t hurt you. Dieting’s tough,’ Miranda said, ‘and if you feel deprived, you’re more likely to crack and have a binge.’
‘Especially when you smell bacon cooking.’
She chuckled. ‘Tell me about it. But make sure it’s grilled, it’s lean and any visible fat’s removed, and the bread’s wholemeal.’ She glanced at his fingers. ‘And I don’t have to nag you about the cigarettes, do I?’
‘My daughter threw away all my duty-frees,’ he said ruefully. ‘No one else in the house smokes, so they can smell if I’ve slipped up. And I know I won’t hear the end of it if I do.’
‘Sounds as if you’re in good hands,’ she said with a grin.
Then they saw the rest of the patients on the unit, starting with a woman who’d contracted bacterial endocarditis following a routine tooth extraction—she was near the end of a six-week course of antibiotics and the unit was checking to see whether her heart valve would need surgery. The other patients had recently had heart attacks—one was still very recent so he was under observation in Room Four and the man in Room Five was ready to move down to the general ward.
‘Right. Coffee and a quick confab?’ Miranda asked when Jack had signed the discharge notes.
‘Sure.’
‘How do you take your coffee?’ she asked as they headed for the kitchen.
‘Black, no sugar.’
‘Same as me. Good. That’ll make life easy.’ She poured them both a coffee, topped up the water in the filter machine and handed him a mug. ‘My office?’
‘Sure.’ Was she pushy or just efficient? Jack wanted to think it was the former, but he had a niggling feeling that it was the latter. And then he had an even more niggling feeling: he admired her for it. Oh, hell. Why couldn’t Miranda Turner be just an ordinary person? Why did she have to be the clinical director’s daughter? Why had she had to come onto his ward and throw his brain into chaos?
‘Right, then. Sid’s having surgery on Friday; Jane’s awaiting tests with a query valve replacement; Joe’s under obs and Martyn’s going home.’ She ticked the cases off on her fingers.
Definitely efficient, Jack thought. She didn’t waste words.
‘That leaves Imogen. Her angina’s unstable and the drugs aren’t working.’ She flipped through the file and looked at the angiography results. ‘We’ve got two options—a bypass graft or an angioplasty.’ An angioplasty was where a small balloon was inserted in the narrowed artery and inflated so it flattened out the fatty plaques lining the blood vessel.
‘Angioplasties often have to be repeated and a bypass gives better symptom control,’ Jack said.
‘But if she has a bypass it’ll take her longer to recover and she’ll have to stay here longer—which will worry her more, because of her dog. And worry leads to higher blood pressure—’
‘Which increases her risk of a heart attack,’ Jack finished.
‘Given her age, and the fact that only a couple of the vessels show narrowing—here and here—I’d prefer an angioplasty. It’s not quite so invasive so it’ll be less of a shock to her system, and the newer heparinised stents lower the risk of a heart attack.’
‘And if it doesn’t work?’
‘Then we’ll have to do a bypass.’ She looked levelly at him. ‘Do you think a bypass is the better option?’
He shook his head. ‘We’ll play it your way.’
‘No. We’re a team. We do what we agree is best for the patient. Ego doesn’t come into it,’ she said crisply.
Jack sucked his teeth. ‘And that’s telling me.’
Her eyes narrowed. ‘I don’t like playing games, Dr Sawyer. If you have a problem with me, let’s get it out in the open now.’
‘Is it that obvious?’
‘That you resent me? Yes. Though I don’t know what I’ve done to upset you—apart from the car-park incident, and I’ve already apologised for that. Besides, it was a win-win situation.’
He lifted his chin. ‘How do you work that out?’
‘We both got what we wanted. You were all too happy to park the Roadster, and I got the car parked without a scratch on it so Seb didn’t murder me.’
Her boyfriend? Even though it was none of his business—and he shouldn’t even want to know anyway—he couldn’t help asking. ‘Seb?’
‘My next-door neighbour in Glasgow.’
No reason for his heart to give that little lurch of relief. No reason at all.
‘My car decided not to start the day of the interview. Seb took pity on me and lent me the Roadster—on condition there wasn’t so much as a speck of dust on it when I got back.’
Was that a glint of mischief in her eyes? He couldn’t tell. ‘You believe in straight talking, don’t you?’
‘It makes life simpler.’
He nodded. ‘OK. Then you may as well know that I went for this job, too.’
‘And you think I got it because I’m Ralph Turner’s daughter.’
‘I didn’t say that.’
‘But it’s what you’re thinking.’ She shrugged. ‘I got the job because of what I can do, not for who I am.’
‘On the round, you sounded as if you knew what you were talking about.’
‘Well, thanks for the vote of confidence,’ she said dryly.
‘And that came out badly. I didn’t mean it like that.’ He sighed. ‘We’ve got off to a bad start.’
‘Look, I’m sorry you didn’t get the job, but I hope it’s not going to cause us problems working together. From my point of view, I get a special reg who knows exactly what he’s doing. From your point of view, I’m not going to change the way you work—and you can get on with being a doctor and leave the hospital politics to someone else. So, let’s start again. Perhaps, this time, we can do it on first-name terms.’ She held out her hand. ‘I’m Miranda Turner. Pleased to meet you, Jack.’
‘Pleased to meet you, Miranda.’ Jack took her proffered hand. ‘I’ve seen your re´sume´. If that didn’t convince me, the ward round proved you know your stuff.’
She didn’t push for a grovelling apology, he noticed. She just gave him a quick smile. ‘Thanks.’
Jack refused to acknowledge the beat his heart had just missed. Nothing was going to happen between them. They were colleagues and that was it. And even if Miranda hadn’t been the professor’s daughter, he’d already learned his lesson with Jessica. The hard way. ‘I’ll ring Jordan Francis—he’s our theatre manager, if you haven’t met him yet—and see if he can fit us in tomorrow.’
‘If Imogen agrees,’ Miranda added. ‘We need to talk to her great-niece as well. I don’t want to send her home without any support.’ Not after what had happened to May. ‘Perhaps there’s someone else in the family who can help. Or maybe Imogen could stay in a convalescent home short term, then we can arrange to get someone to look in on her at set times when she comes home and take her dog for a walk.’ She glanced at her watch. ‘Speaking of which, I need to phone the kennels.’
By the time they’d finished writing up their notes, Jack had booked theatre time and Miranda had reassured Imogen that Floss was fine, it was nearly lunchtime.
