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. David came around to his end of the table. ‘I’m being paged to get back upstairs but come and see me when you have a moment? I’d like to go over the postoperative care for Penny in some more detail so I can brief my staff.’
‘Sure. I’ll be heading up there shortly. There’s a four-year-old who was admitted to ICU with severe asthma last night but now they’re querying cardiomyopathy. We might need to transfer her to your patch.’
‘I heard about that. Page me if you need me in on that consult.’
‘Will do.’
The rest of the room was emptying during the brief conversation with David. Everybody had urgent tasks waiting for them elsewhere, including himself. Thomas shut down the programme on his laptop and picked it up, his thoughts already on the case he was about to go and assess. Severe breathlessness and wheezing in children could often be misdiagnosed as asthma or pneumonia until more specific tests such as echocardiography were used to reveal underlying heart disease.
It was a complete surprise to turn and find he was not alone in the room.
Rebecca was standing at the other end of the table.
‘We need to talk,’ she said.
Thomas said nothing. Given how disturbing their last private conversation had been, he wasn’t at all sure he wanted an opportunity that could, in fact, make things worse.
‘I’m sure you agree that we can’t work together with this kind of tension between us. Especially not on a case like this. Everybody’s aware of it and it’s destructive to the whole team.’
He couldn’t argue with that. And, to his shame, he knew he had to take part of the blame. He had no reason to feel angry with Rebecca for anything to do with her involvement in Penelope’s case. He was letting personal baggage affect his relationship with a colleague to such an extent, it was actually difficult to make eye contact with her right now.
He looked down at the laptop in his hands.
‘So what do you suggest? That we call in a different cardiologist? In case you hadn’t noticed, they’ve been short-staffed around here ever since the threat of the merger got real. That’s why I agreed to take on a permanent position again.’
A brief upwards glance showed that Rebecca’s gaze was on him. Steady and unrelenting. He held her gaze for a heartbeat. And then another as those dark eyes across the length of the table merged with that flash of memory he’d had during his presentation—when they’d been looking up at him for reassurance that she had his support when she’d been facing one of her biggest challenges.
A
