you have any pain?’
‘Not really.’
‘Where was it?’ Vicky asked.
‘You’re as bad as my daughter. She never gives up either,’ Mrs Carter grumbled. ‘Just a little bit in my chest. It’s gone now. And, before you ask, I gave up smoking years ago and I eat proper meals. None of that microwave ready-meal junk.’
Vicky grinned. She could see herself being like Violet Carter in forty years’ time. Dressed in purple and outrageously independent. ‘Mrs Carter, I respect the fact you can look after yourself perfectly well. But I need to be sure you’re not just being brave. If you do have any problems, I can give you medication for it and you’ll be fine—but if you’re not telling me something, you could end up being very ill.’ When the old lady looked recalcitrant, she added her trump card. ‘Which means I’d have to talk to your daughter, and she’d probably want you to live with her so she can keep an eye on you.’
‘God forbid!’ Mrs Carter exclaimed. ‘I’d be up in front of the bench within a week.’
‘The bench?’
‘On a murder charge. I can’t bear all that fussing. Not to mention putting up with teenagers slamming doors and listening to that rubbish they call music nowadays.’
‘Me neither,’ Vicky said feelingly. ‘So is there anything you’re not telling me?’
‘I was a bit breathless. But I told you, I just stood up too quickly.’
‘Would you let me examine you and run some tests, then?’
Violet rolled her eyes. ‘If it means you won’t tell my daughter, yes.’
Vicky smiled. From their discussion, she’d already been able to assess Violet Carter’s attentiveness, ability to interact, language and memory skills—and they were all fine. But she checked the blood pressure in each of Violet’s arms, then her respiratory rate and her temperature.
‘I’m going to look into your eyes, if you don’t mind.’ She checked for retinal plaques and the pupils’ reaction to light. Everything was fine.
Nerve testing was equally inconclusive. She started with the cranial nerves: there were no problems with Mrs Carter’s eye movements and her eyelids closed normally; there were no problems with swallowing or the movement of her tongue; and the wrinkles on her forehead were symmetrical—no sign of drooping. Somatic motor testing told her a little more—there was no sign of tremor or any problems with the major joints or shoulder girdle, though there was a slight weakness on the left-hand side. When Vicky asked Mrs Carter to walk a few steps, her movements looked fine. She was able to put her finger on her nose and her heel to her knee.
‘So are you satisfied I’m all right now?’ Mrs Carter asked.
‘Nearly. I’m going to send you for a CT scan—that’s just so I can get a better look at what’s happening inside your head.’
Mrs Carter snorted. ‘If you could read my mind right now, young lady, I think you’d be shocked.’
Vicky laughed. ‘No. I wish more people were as independent and determined as you are.’ Mara certainly wasn’t. Never had been, never would be, and Vicky was guiltily aware that too often she left Charlie to deal with their mother. Though so did Seb.
‘As well as the CT scan, I’m sending you for an ECG—that’s to check how your heart’s working.’
‘There’s nothing wrong with my heart.’
‘Good. But I’m still sending you for the tests. I want to know what caused you to have your “funny turn” —and I don’t think it was anything to do with standing up too quickly. I’d like to make sure there isn’t a clot hanging around that might give you a full-blown stroke or a heart attack.’ At Mrs Carter’s mutinous look, she added, ‘Or I could just phone your daughter.’
Mrs Carter grimaced. ‘You win. And I’d never play poker against you.’
‘Chess is my game.’
‘Never played it.’
‘If your tests make me keep you in for observations, I’ll teach you,’ Vicky promised. ‘And then you can extort promises from your grandchildren. If you beat them at chess, they have to turn the volume down and not slam doors.’
Mrs Carter gave her a narrow look, then grinned. ‘You’re on.’
‘OK, Mrs Carter. I’ll come and see you when your test results are in.’
‘My name’s Violet,’ Mrs Carter said.
‘Vicky.’ Vicky held her hand out.
‘I think you and I will rub along just fine,’ Mrs Carter said, shaking her hand. ‘You’ll tell me the truth.’
‘I will if you will.’
‘And you’ll keep my daughter out of it.’
‘I’m not promising anything until I’ve seen your results,’ Vicky warned. ‘But if I can avoid worrying her, I will.’
‘That’s good enough for me.’
JAKE was in the middle of reviewing patient files ready for clinic when there was a knock on his door.
‘Come in,’ he called, and blinked in surprise when he saw Vicky. ‘What can I do for you?’
‘I’d like to discuss a patient with you.’ She carried some films and a file with her. ‘My ED case.’
So it had been a genuine case—not just a phone call from a friend she’d phoned earlier and asked to give her an excuse to get out of having breakfast with him. He’d wondered. And he was shocked at the rush of pleasure he felt now he knew it hadn’t been an excuse. ‘Sure.’
She quickly explained Violet Carter’s case to him. ‘From the symptoms, I thought it was a TIA. Carotid rather than vertebrobasilar. Anyways, the ECG shows I was right. There’s carotid bruit.’ Carotid bruit was a murmur over the carotid artery in the neck, showing that blood was having difficulty passing through the blood vessel.
‘And?’
‘I want to send her down to Radiology for magnetic resonance angiography to check the site of narrowing. If the stenosis is big enough, I’d recommend an endarterectomy.’
An endarterectomy was surgery to remove the lining of the arteries: a very delicate operation. Jake remembered what she’d said that morning about wanting more surgical experience. ‘Have you done any before?’
‘A couple by open surgery.’
‘How about endoscopically?’
‘No.’
‘Right. Let me have a look at the MRA results. If
