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‘So I suggest you check your facts first next time before you write stroppy letters.’
She took a deep breath. But before she could apologise there was a rap on the door and Jack came in.
‘Sorry—I’ll come back later,’ he said.
‘Not at all. We’ve finished. Come in, my boy,’ Ralph said.
Miranda’s stomach lurched at the words. My boy. She wasn’t his boy—and never could be. The tone, too, was different: when he called her ‘my girl’, it meant he was putting her in her place, not being genial and proud.
‘I wanted to see you anyway,’ Ralph continued, smiling at Jack.
Why didn’t the professor ever smile at her like that?
‘We’ve got a little one coming into Paeds tomorrow. Possible tetralogy of Fallot. I’d like you to take a look at her.’
Well, excuse me. I’m supposed to be the consultant here, Miranda thought. But her father had made it obvious that he respected Jack’s abilities above her own.
‘Is that OK with you?’ Jack asked, looking at her. ‘Or do you need me here?’
What could she say? If she said, no, he couldn’t do it, they’d both think she was being petty—jealous even. The worst of it was, they’d be right. She was jealous of Jack, and the fact that the Professor clearly respected him. A respect he certainly didn’t feel for his daughter. ‘Fine,’ she said tightly. ‘Was there anything else you needed me for, Professor?’
‘No.’ His voice cooled noticeably as he looked at her. ‘Just think about what I said.’
She nodded, her throat tight with misery. Same old, same old. She’d thought by working with her father she’d finally persuade him to value her abilities. All she’d done had been to make things even worse between them.
When Ralph left, Miranda virtually snapped at Jack. ‘So what can I do for you?’
He lifted his hands in surrender. ‘Hey, what did I do?’
‘Nothing.’
‘Then what’s the problem?’ When she said nothing, he folded his arms. ‘So much for straight talking.’
‘If you must know, the Prof was tearing me off a strip. Apparently he’d booked the demonstration ages ago. Ours wasn’t the only slot he’d moved.’
Jack shrugged. ‘Might be better to check before you act next time.’
Her eyes narrowed. ‘So you think I’ve been unreasonable?’
‘Yes and no. You were right to challenge our slot being moved—but you should have made sure of your facts.’ Maybe he should have warned her about Jordan’s slapdash tendencies—though he’d tried to be fair and let her make up her own mind about their theatre manager instead of prejudicing her against him.
‘Great. So you think I’m incompetent, too.’
Jack frowned. ‘No, of course not.’ And her father couldn’t think it either, otherwise he wouldn’t have let the others on the selection panel offer her the job. ‘Just…you’re playing a dangerous game.’
‘So what am I supposed to do? Curry favour with the Prof?’
Was that what she thought he was doing, just because he’d agreed to go down to Paeds? It wasn’t that at all. He was interested in paediatric cardiology—besides, he owed it to his family to get on as well as he could at the hospital. He wasn’t going to turn down opportunities just because Miranda was having a private war with the Prof. Just in time, he stopped himself telling her that. It was none of her business. ‘If you’re going to argue with your father, that’s up to you—but leave the ward out of it.’
Her eyes darkened. ‘I’m not playing games.’
Yeah, right. And neither had Jessica, he thought bitterly. Except on a day with a Y in it. ‘You asked my opinion. I gave it to you.’
‘OK. I’m sorry. What did you want to see me about?’
He couldn’t remember now. Not now she’d made him think of Jessica. ‘Doesn’t matter,’ he said. ‘Some other time.’ He left, closing her office door and resisting the temptation to bang it. He was not going to let her get under his skin. In any way.
Thursday was less fraught, until Miranda promised to help their new student with setting up an ECG and reading the results.
‘Dr Sawyer, can I borrow you for a second?’ Miranda asked.
‘Sure,’ Jack said, with a smile that turned her knees temporarily to jelly. ‘What’s up?’
‘I need a model. I’m walking Hannah through a 12-lead ECG, and she doesn’t want to do it on a patient.’
‘So you’re just after my body?’
She wished he hadn’t said that. The images his words brought to mind were way too disturbing—particularly after the way he’d smiled at her. But she wasn’t going to let him know that he’d rattled her. ‘That’s right. Any old body’d do, but I thought Hannah might find a supposedly young and fit male easier for her first ECG,’ she said, adopting the same light, teasing tone he’d used. ‘Come into my office and strip to the waist.’
Definitely disturbing, she thought as Jack took off the white coat, shirt and tie to reveal a perfectly toned torso and a light sprinkling of dark hair on his chest. Just pretend he’s middle-aged with a paunch, she told herself. He may be gorgeous, but he’s off limits. ‘OK, Hannah. The V1 lead goes on the edge of the sternum, on the patient’s right-hand side. Count down between the ribs until you get to the fourth intercostal space.’
‘Here?’ Hannah asked.
‘Perfect. The V2 lead goes in the same place on the left-hand side.’
Hannah did as she was asked.
‘Now we’ll do the V4 lead. Why do you think I want to do that one next?’
‘No idea,’ Hannah admitted.
‘V3 goes halfway between V2 and V4, so it’s easier if you put V4 in place first,’ Jack explained.
Miranda was forced to meet his eyes. She stopped herself blushing—just. She only hoped he wasn’t a mindreader—she definitely didn’t want him knowing what she was thinking, right then. ‘Exactly. V4 picks up the patient’s apex beat. That’s the point furthest from the manubrium—that’s the hexagonal part at the top of the breastbone—where we can still feel the heart beating. It’s in the fifth intercostal space, in a line roughly halfway across the collar-bone.’ She found the spot and her fingertips brushed lightly against Jack’s skin. Just as well he was the one having the ECG, she thought. Her own heartbeat had just become extremely erratic, simply from touching him. This was crazy. He was her colleague. Her junior. She couldn’t think like this about him. Particularly when she’d agreed to go on a date with someone else. This really, really wasn’t good.
‘Can you show me where you’d put V3?’ she asked Hannah, avoiding looking at Jack.
Hannah nodded. ‘Here.’
‘Well done.’ Miranda smiled at her. ‘The rest of the leads go in a horizontal line with V4. V5 is here, in the anterior axillary line, and V7 is on the posterior axillary line. So V6 goes…?’
‘Halfway between them?’ Hannah guessed.
‘Spot on,’ Miranda said, then talked the junior doctor through placing the rest of the leads. ‘Great. You’re done.’ She switched the monitor on. ‘The trace shows the electrical activity of the heart so we can see what’s going on. We can tell if someone has had a heart attack, and roughly when it was—in the last few hours, days, weeks or months.’ She let the machine run until she had a strip of a dozen heartbeats, and turned it off. ‘This is a good example of normal sinus rhythm. There’s a small rise here at P just before the upper heart chambers contract.’ She marked it with a cross and labelled it ‘P’. ‘Then there’s the QRS spike…’ again, she labelled the points on the trace ‘…which happens just before the lower heart chambers contract. And finally there’s the rise at point T at the end of the beat.’
‘To find the number of heartbeats per minute,’ Jack added, ‘you measure how many big squares there are between the R points—what we call the “R-R interval”. The ECG machine usually runs at twenty-five millimetres per second so you just divide three hundred by the number of big squares.’
‘Some machines run at fifty millimetres per second, so always check if you’re not sure,’ Miranda added.
Hannah looked at the trace and did a quick calculation. ‘Three hundred divided by four—that’s seventy-five.’
‘Well within the normal resting range,’ Miranda pronounced.
She couldn’t help looking at Jack. And there was a distinct question in his eyes which she dared not answer. She forced herself to think of work. ‘Do we have a book of sample traces, Jack?’
‘For teaching? Yes—I’ll go and get it.’ He removed the leads. ‘You’ll be surprised how quickly you learn to spot the differences in the waves and what they mean,’ he told Hannah. ‘When you first start, you think you’ll never remember them all, but you’ll soon get the hang of it. And you can always ask one of us if you’re not sure. We won’t mind or think you’re stupid. We’ve all been in the same position.’
Miranda fiddled with the machine until she heard Jack put his white coat on again. Her face felt hot and she hoped it wasn’t too obvious. She could claim that her office was too warm—it was unusually hot for March—but she had a nasty feeling Jack would guess why she was flushed.
She needed to get her professional objectivity back. Fast.
And then she heard the call, ‘Crash team!’
‘We’ll carry on with the traces later,’ she told Hannah. ‘Come on, we’re needed.’
She walked quickly out into the ward and saw the light flashing above the door of Room One. Her heart sank. No. Please, not Imogen, she thought.
Jack was already there, giving CPR at the rate of five chest compressions to one breath, while Leila was getting the defibrillator ready.
‘She’s in VF,’ Leila said. VF, or ventricular fibrillation, was an abnormal heart rhythm—it meant Imogen’s heart was contracting quickly but not effectively.
Miranda went straight into action and attached the defibrillator paddles to Imogen’s chest so Leila could check the monitor. ‘Charging to 360. And clear,’ she said. Jack stopped the CPR so Miranda could shock Imogen.
‘Still in VF,’ Leila said, watching the monitor closely.
‘Have you given her adrenaline?’ Miranda asked.
‘Not yet,’ Leila said.
‘Hannah, get me some adrenaline now. Charging to 360. And clear,’ Miranda repeated. Imogen had to respond. She had to. They weren’t going to lose her.
‘Still in VF,’ Leila reported.
‘Charging. And clear,’ Miranda said.
‘She’s back in sinus,’ Leila said. ‘Well done.’
Tears pricked the backs of Miranda’s eyes. Thank God. ‘Jack, we can’t wait until tomorrow morning for the angioplasty. Not now she’s had an MI.’
‘Bypass?’ he asked.
‘Yup. I’ll call Jordan and sort out a slot in Theatre now. Can you prep her?’
‘Will do,’ he said.
‘Leila, can you get in touch with Emma and tell her that we’re taking her great-aunt down to Theatre now, please?’ she asked.
‘Will do,’ Leila said.
‘Hannah, check if Leila needs you for anything—if not, you’re welcome to come and observe,’ Miranda continued.
‘Thanks,’ Hannah said, flushing faintly.
Miranda rang Jordan and organised an emergency theatre slot. On the way down to Theatre, Imogen arrested again but Jack managed to bring her back. Before Miranda could make the first incision, Imogen arrested again.
‘Come on, come on,’ Jack said. ‘We’re not letting you go, Imogen. Stay with us. Charging. And clear.’
But this time they couldn’t bring her back.
‘It’s been twenty minutes,’ Jack said softly as Miranda continued CPR. ‘Do you want me to call it?’
‘No. We can’t give up now.’ She continued giving CPR. ‘Come on, Imogen. You have to stay with us.’
But it was no use. Gently, Jack put his hands over hers. ‘I’m calling it,’ he said. ‘She’s been down too long.’
‘No.’ Miranda shook her head in frustration. ‘No. We can’t have lost her.’
‘She’s gone,’ he said, his voice compassionate yet firm.
Miranda nodded dully, then glanced at the nurse’s watch on her white coat. ‘Time of death, three twenty-four.’ She stroked the old lady’s forehead. ‘I’m sorry, Imogen. I’m so, so sorry,’ she said softly, then turned away. ‘I’d better go and ring Emma.’ She swallowed hard and walked back to her office to ring Imogen’s great-niece.
‘But—but she was going to have her operation! I thought she was going to be all right,’ Emma said. ‘You said you were going to put a balloon in her arteries to clear them, and it would stop her getting the pain any more.’
‘I’m so sorry, Emma. We did everything we could. But her heart had just had enough.’
‘Poor Imogen. She was…It’s my fault,’ Emma said. ‘We should have had her to live with us.’
‘It wouldn’t have made any difference,’ Miranda reassured her. ‘And it wasn’t your fault at all. She was ill.’
‘I should have done more.’
‘You did your best. You came in to see her when you could, and rang when you couldn’t—and it isn’t easy to care for an elderly relative when you have three small children to look after as well.’ Easier if you didn’t have children. She could have done more for May. But she hadn’t, had she?
‘I can’t believe she’s gone.’ Emma’s voice was unsteady. ‘And Floss…I don’t know what we’re going to do about Floss. We can’t have a dog—we’re renting and the landlord won’t let us have pets, not even a hamster. We can’t keep her in kennels but I can’t have her put down. She’s not that old and she’s not even ill.’
‘I’ll see what I can do,’ Miranda promised. ‘Someone here might be able to give her a new home.’
‘Can I…can I come and see my great-aunt?’
‘Of course you can. And I’ll be here if you want to talk to me.’
‘Thank you.’ Emma was clearly crying as she rang off.
Miranda returned the receiver to its cradle, put her arms on her desk and rested her head on her arms. If only she’d done the angioplasty the day before. If only…
She heard a click and looked up. Jack had closed her office door. He walked towards her and laid a hand on her shoulder. ‘Hey, it’s not your fault. It was a risk with anyone who had her condition. You know that.’
‘I lost her, Jack.’
