Loe raamatut: «The Heart Consultant's Lover»

CHAPTER ONE

‘I REALLY don’t know why we all have to sit here, waiting for her,’ Jack said, his mouth compressed into a tight line. ‘I’ve got a ward round to do. And I want to check on Imogen Parker.’

‘It’s Miss Turner’s first day and she’s called a meeting of all the coronary care unit staff,’ Leila Ward, the senior sister, reminded him. ‘Obviously she wants to introduce herself and meet the team.’

‘Yeah. If she turns up on time.’

Leila patted his hand. ‘Don’t be such a grouch. I know you’re disappointed you didn’t get the job, but give her a chance.’

‘Right.’ Jack rolled his eyes. ‘But remember who we’re talking about. Her dad’s the clinical director of Calderford General.’

‘She might be nice. She might be extremely competent. She might be better than you,’ Leila pointed out. ‘Which might be why she got the consultant’s job.’

‘“Might” being the operative word.’ Jack sighed at the look on his colleague’s face. ‘OK, OK, I’ll give her a chance. But if she’s late or incompetent, or it turns out to be a case of a job for the boss’s daughter, don’t expect me to keep my mouth shut.’

‘It might help if you start with it closed,’ Leila whispered as the new consultant walked in and Jack’s jaw dropped.

It was her. The girl with the sports car. The girl who couldn’t park.

Ms Fluffy.

Except…she didn’t look in the slightest bit fluffy this time. She was wearing a business suit, albeit with a short skirt; that glorious dark hair was pulled back severely at the nape of her neck; and she was wearing oval glasses with narrow metal frames. If she was wearing any makeup at all, it was so understated that it was barely there. She looked serious and studious—and competent.

Or maybe she was Ms Fluffy’s sister. No way could someone change their image just like that! When she glanced quickly round the room, she didn’t give the slightest indication that she recognised anyone—and surely she would have remembered him as the person who’d got her out of a fix in the car park the other week?

His mouth compressed further. Or maybe she was just so used to people doing what she wanted that she hadn’t given him a second’s further thought. Not that it should bother him. He wasn’t interested in Miranda Turner anyway.

Of all the people, in all the hospital, Miranda thought, her knight in shining armour would have to work on her ward! Which meant that she was going to have to play this very, very carefully.

No. She was just going to be honest. She’d leave the games to her father.

She took a deep breath, psyching herself up for the speech she knew she had to make. ‘Good morning, everyone. Thanks for making it—and I promise not to keep you long. I just wanted to introduce myself properly. I’m Miranda Turner, and I’m delighted to be joining you here at Calderford General.’ She smiled. This was the nasty bit. ‘You’ve probably guessed by now that Ralph Turner is my father. Believe me, being interviewed by someone who knows all the most embarrassing things about you is a nightmare! Luckily, he couldn’t vote on my appointment because of the family connection.’ Hopefully that would squash any rumours that she’d only got the job because of who she was, not what she could do.

She smiled again. ‘I’ve already met one of you, though I didn’t know it at the time.’ She gestured to her champion. ‘He rescued me in the car park when I realised I’d left my shoehorn at home and couldn’t get the car into the smallest space in the world.’

To her relief, one or two of them actually laughed.

‘I can assure you, I’m a much better doctor than I am a driver. I’m really looking forward to working with you—and I’d like to invite everyone on the ward for a drink on Friday night in the Calderford Arms at seven, so I can start getting to know you better. In the meantime, I’ve restocked the biscuit and coffee supplies in the kitchen.’ She glanced round again. No overt hostility—except from her rescuer. His face was expressionless but his eyes definitely weren’t friendly.

‘Some of you might be worried that I’m going to do the new-broom thing, and make changes just so it looks as if I’m actually doing something. That’s not the way I work,’ she said. ‘I’ve spent the last seven years in Cardiology at Glasgow, so I might be able to bring some new ideas in—but you might be able to teach me new things, too. I believe in teamwork, and I hope you’ll see me as just another team member.’

She couldn’t help looking at her rescuer again. And ‘no chance’ was written all over his face. She sighed inwardly. Time. She just had to give it time. ‘Thanks, everyone. I’ll catch up with you all individually during the day.’

She was good. He had to give her that. She’d told the car park story against herself before anyone else could—attack being the best form of defence. And she was clearly going out of her way to be friendly, asking the whole ward to a welcome drink at the pub near the hospital. But he still couldn’t quite forgive her for lying to him, saying that she was visiting someone. Why couldn’t she just have said that she was going for an interview?

An interview for the same job he’d gone for. The job he hadn’t got. And how long would it be before he had another chance to show his family that all those sacrifices had been worth it? Maybe a few months, until she got bored and moved on. Or maybe longer if she decided she liked it, or her father wanted her to stay…He sighed inwardly. He knew he had to be flexible if he wanted his career to take the fast track—he had to be prepared to move to where the opportunities were—but how could he possibly leave Calderford?

‘Hello.’

She sounded a little unsure of herself. Jack hardened his heart and gave her a professional nod. ‘Ms Turner.’

‘It’s Miranda,’ she said, holding out her hand. ‘And I wanted to apologise. About the car thing.’ She made a face. ‘Interview nerves.’

‘Yeah.’ Unwillingly, he took her hand to shake it. Then wished he hadn’t when a spark of awareness jolted his whole body.

Oh, no. Oh, no, no, no. Nothing could possibly happen between them. He wasn’t even going to start thinking about his boss in those sorts of terms. And even if she hadn’t been his boss, nothing could happen between them. They lived in completely different worlds, and he really wasn’t into the lifestyle of the rich and pampered. He’d been there, done that and learned the hard way that it wasn’t for him. No way was he ever going to get involved with a posh girl again. Jessica’s words had burned into his soul, the giggled conversation he’d overheard with her friends. Jack? Yeah, he’s drop-dead gorgeous. But Mummy’s right. He’s from the wrong side of town—fun for now, but he’s not the kind of man you’d marry.

Then he realised he was still holding Miranda’s hand. He dropped it as if he’d been scalded. Hell. He didn’t want her to think he’d lost his concentration because of—well, because he fancied her. She might be beautiful but she wasn’t his type. Besides, he wasn’t looking for a relationship. Not until he’d reached consultant level. He wouldn’t be the kind of man a woman wanted to marry until then. ‘Sorry, I didn’t catch what you said.’

‘Just that I really did appreciate you rescuing me.’

She sounded sincere. And her body language matched her words. Now he felt horrible. Perhaps Miranda Turner wasn’t the hard, manipulative woman he’d assumed she was. Or maybe his judgement was just out of kilter. She might seem nice now—but, then again, so had Jessica.

‘And I’d like to join you on the ward round, if that’s OK with you, Dr Sawyer.’

She’d clearly read his name from his badge, and he could tell she was waiting for him to say, ‘Call me Jack.’ Well, she’d have to wait a bit longer, until he could see what she was really made of. Whether she’d really got the job on merit.

‘And I’m perfectly happy for you to lead—you know the patients and the staff better than I do.’

She didn’t say it but he knew what she meant. At the moment. ‘Right.’

‘Shall we?’

‘In Room One, we have Imogen Parker. She has unstable angina,’ Jack said.

Unstable angina. No. Oh, no. Of all the things she had to face, why did that have to be her first case on her new ward? Miranda shook herself, knowing that she had to put the memories behind her. Now wasn’t the time or place to think about what had happened to May. Her patient had to come first.

With angina pectoris, the heart muscle didn’t get enough blood and oxygen to meet its needs, so the patient felt tightness or a burning sensation in the chest when climbing stairs or walking. In more severe cases, known as unstable angina, the patient felt pain on resting, too. ‘She had an ECG when she came in, and a cardiac stress test a while back,’ Jack told Miranda. An ECG or electrocardiogram measured the electrical activity in the heart; the stress test was a second ECG while the patient walked fast enough on a treadmill to cause chest pain. Both could show up current heart problems or previous heart attacks. ‘They were both normal.’

‘What about blood tests?’ Miranda asked. They might show an underlying cause for the angina.

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.