The tension in the room behind him felt like an additional solid presence as he faced the screen and clicked the pointer to bring up his first slide.
‘As you know, we’re here to discuss a case we’re all involved with—that of Penelope Craig, who’s currently an inpatient in our cardiology ward. For those of you who haven’t been so directly involved in the last few years, though, here’s a quick case history.’
The slide was a list of bullet points. A summary of a clinical case reduced to succinct groups of words that made one crisis after another no more than markers on a timeline.
‘The diagnosis of hypoplastic left heart syndrome was made prenatally so Penelope was delivered by C-section and admitted directly to the cardiac intensive care unit. She underwent her first surgery—a Norwood procedure—at thirteen days old.’
He had been in the gallery to watch that surgery. Rebecca had been a cardiothoracic surgical registrar at the time and it had been the most challenging case she’d assisted with. She’d sat up half the previous night as she’d gone over and over the steps of the surgery and Thomas had stayed up with her, trying to make up for any lack of confidence she was feeling. Even as he paused only long enough to take a breath, the flash of another memory came up like a crystal-clear video clip.
He had been in the front row of the gallery, leaning forward as he looked down at the tiny figure on the operating table and the group of gowned and masked people towering over it. Over the loudspeaker, he had heard the consultant surgeon hand over the responsibility of closing the tiny chest to Rebecca. As they changed positions, she had glanced up for a split second and caught Thomas’s gaze through the glass window—as if to reassure herself that he was still there. That he was still with her with every step she took. And he had smiled and nodded, giving her the silent message that he believed in her. That she could do this and do it well.
That he was proud of her...
His voice sounded oddly tight as he continued. ‘A hemi-Fontan procedure was done at six months to create a direct connection between the pulmonary artery and the superior vena cava.’
Rebecca had been allowed to do most of that procedure and she’d been so quietly proud of herself. They’d found a babysitter for Gwen and they’d gone out to celebrate the achievement with dinner and champagne and a long, delicious twirl around the dance floor of their favourite restaurant.
Those ‘date’ nights had always had a particular kind of magic. It didn’t matter how frantic the hours and days before them had been or how tired they were when they set out. Somehow they could always tap back into the connection that had been there from their very first date—that feeling that their love for each other was invincible. That there could never be anyone else that they would want to be with.
The idea that the night after that surgery would be the last ‘date’ night they would ever have would have been unthinkable at the time. As impossible as losing their precious child.
Thomas didn’t actually know if it had been Rebecca who had done the final major surgery to try and improve the function of Penelope’s heart. He’d walked out by then, taking a new job in adult cardiology at a major hospital up north in the wake of that personal tragedy that had torn their lives apart.
He’d run away...like he always did...
Thomas cleared his throat as he rapidly ran through the list of the more recent admissions.
‘April of this year saw a marked deterioration in Penelope’s condition following a series of viral infections. She’s been an inpatient for the last ten weeks and was placed on the waiting list for a heart transplant about two months ago. This last week has seen a further deterioration in her condition and there’s an urgent need for intervention.’
The next slide was a set of statistics about the availability of transplant organs and how many young patients were unlikely to make it as far as receiving a new heart.
The slide after that sombre reminder was a picture of a device that looked like a tiny rubber plunger with a single tube attached to the top and two coming out from the base.
‘For those of you not familiar with these, this is a ventricular assist device—an implantable form of mechanical circulatory support. Parental consent has been given and it’s our plan for Penelope to receive a VAD as soon as theatre time can be arranged.’ Thomas sucked in a longer breath. ‘Dr Scott? Perhaps you’d like to speak about what the surgery involves?’
Using her formal title caused another round of those raised eyebrows and significant glances. Was it his imagination or did this meeting feel really awkward for everybody here?
‘Of course.’ Rebecca’s gaze quickly scanned everybody at the table. It just didn’t shift to include himself. ‘To put it simply, it’s a straightforward bit of plumbing, really. The device is a pump that uses the apex of the left ventricle as the inflow and provides an outflow to the aorta, bypassing the ventricle that’s not functioning well enough.’
Thomas could feel himself frowning. It was fine to describe something in layman’s terms for the members of the team with no medical background, like the dietician and the psychologist, but to his own ears it was simple enough to be almost dismissive. Like describing a donor organ as a spare part?
His anger had settled into his stomach like a heavy stone. No wonder he hadn’t been that interested in eating in the last few days. Was it going to get even worse when he had to work so closely with Rebecca on Penelope’s case? Perhaps the unwanted memories that had ambushed him during his brief presentation had been a warning that it was going to become increasingly difficult to work with his ex-wife. The prospect was more than daunting, especially given that everybody else here seemed to be aware of the tension between them.
David, the cardiac intensive care consultant, was giving him a speculative glance as if he was also having concerns about how this particular combination of the lead carers in this team was going to work. With an effort, Thomas erased the unimpressed lines from his face.
‘Of course it’s not quite that simple in reality,’ Rebecca continued. ‘It’s a big and potentially difficult surgery and there are complications that we have to hope we’ll avoid.’
‘Like what?’ The query came from one of the physiotherapists.
‘Bleeding. Stroke. Infections. Arrhythmias.’ Rebecca was counting off the possible disasters on her fingers. ‘Some might not become apparent immediately, like renal failure and liver dysfunction. And some intraoperative ones, like an air embolism, are things we will certainly do our best to control. I guess what I’m trying to say is that there are risks but everybody agrees that the potential benefits outweigh these risks in Penny’s case.’
Rebecca’s smile was poignant. ‘As most of you know, Penny Craig is one of those patients you just can’t help falling in love with and we’ve known her all her life.
‘I’m sure we’re all going to give this case everything we’ve got.’ Her smile wobbled a fraction. ‘I know I am...’
The murmur of agreement around the table held a note of involvement that was very unusual for a clinical team meeting like this. Heads were nodding solemnly. Rosie was blinking as if she was trying to fight back tears.
For heaven’s sake... Did nobody else understand how destructive it could be to get too involved? Was the staff psychologist taking this atmosphere on board and making a mental note that a lot of people might need some counselling in the not-too-distant future if things didn’t work out the way they all had their hearts set on?
Thomas raised his voice. ‘It’s certainly all about teamwork and it’s to be hoped that we will see a dramatic improvement in this patient’s condition within a very short period of time.’ He glanced down at the laser pointer in his hand, looking for the ‘off’ button. ‘Thank you all for coming. I look forward to working with everybody.’
A buzz of conversation broke out and more than one pager sounded.