‘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