THREE
CORDELIA SIGHED AND leaned against the wall as she checked the chart again. One of her patients was failing. Truth was, most of the patients in the heart failure study were failing—that was why they were here.
But Jonas Delphine was one of her favourites. He was an old sea captain, eighty-six, and had smoked for forty years. His chest complaints, along with his cardiovascular disease and heart failure, made him a difficult candidate to manage.
Some trials only wanted ‘perfect’ candidates. Ones who had no other health complaints but who had unhealthy lifestyle issues that could be changed and monitored then assessed to within an inch of their lives. But the Reuben Institute didn’t work with unrealistic patients. What was the point of that? More complicated patients meant more bias for the trials. Some people didn’t like that. Some drug companies definitely didn’t like it. But Professor Helier had always been clear. The institute was here to help real patients. Not perfect ones who didn’t really exist.
Now, after listening to Jonas’s heart and lungs, she’d just ordered another chest X-ray and echo cardiogram.
‘Something wrong?’ Gene’s voice made her jump.
She couldn’t help but grin at the sight of him. He’d been a man of his word and had come to the institute this morning full cowboy.
The patients loved it. The staff loved it. The Stetson, cowboy boots and jeans had certainly made their mark. Even the normally frosty Marie had seemed to like his unusual appearance.
Gene was still wearing his Stetson and tipped it towards her. ‘Cordelia?’
She held up the electronic tablet. ‘Nothing that a new heart won’t cure.’ She straightened up. ‘Actually, now that you’re here, you can give me a second opinion on someone.’
He held up his electronic tablet. ‘Great minds think alike. I was just coming to get you to do the same.’
A tiny surge of pride welled in her stomach. She was pleased. Pleased that he’d came to her for a second opinion on one of his patients. Hopefully, that meant he thought she might be a good clinician.
They swapped tablets. ‘You tell me yours, and I’ll tell you mine.’
‘Aryssa Maia, forty-seven, hypertrophic cardiomyopathy. She’s had unsuccessful ablations for atrial fibrillation and she can’t tolerate the usual drugs. She also has a permanent pacemaker in place. I’ve checked her previous scans and just listened to her chest. I think her ventricle is getting to the stage it is barely functioning. She’s symptomatic, breathless and tired, with swollen extremities.’
She nodded. ‘I have a similar case. Jonas Delphine is eighty-six, with existing COPD and chronic heart failure. I think I’m going to have to take him off the study and put him on IV steroids and diuretics. In the space of one day he’s gone downhill fast.’
Gene nodded slowly. She knew he understood. The patient’s welfare was always their prime concern. But the regulations for any research study were strict. They didn’t want any findings skewed. If they used certain other drugs on patients then they were taken off the study programme. It was important that any improvement in a patient’s current condition was only attributed to the drug being studied—not to any other intervention made.
Cordelia sighed as she looked at Aryssa’s chart. ‘She was doing so well,’ she said sadly. ‘I really thought that this might be the one drug that could make a difference for her.’
Gene ran his fingers through his hair. ‘I get that. But my gut is telling me that something else is going on. I almost feel as if her pacing wire has moved. Her heart just isn’t functioning the way it should be.’
He glanced at Jonas’s chart and smiled. ‘Why do I feel as if this guy could teach me everything I need to know about life?’
‘He probably could. I’m not ashamed to say I love him and have a completely unnatural bias towards him.’ She lifted her hand. ‘That’s why I’m checking for a second opinion. I need someone who can just look at the clinical signs.’ She gave a slow nod and handed back Aryssa’s notes. ‘And as for your patient, I agree, she needs an ECG and a cardiac echo. I suspect her pacing wire has moved too. That’s what fits the symptoms, rather than anything happening within the trial.’
He gave a nod. ‘I ordered the tests. Just wanted to double check.’ He kept a hold of Jonas’s tablet. ‘Now, let’s go meet your patient, while mine has her investigations.’
* * *
Things moved so swiftly here. He was secretly pleased that Cordelia had come to him for a second opinion. By the time he’d sounded Jonas’s chest and looked at his hands and ankles, the nurse from his part of the clinic had brought along Aryssa’s ECG. It couldn’t be clearer. The pacing wire definitely wasn’t capturing, meaning Aryssa’s heart rate was erratic and low. Both he and Cordelia nodded.
‘I’ll come back and speak to her. But can you attach her to a portable cardiac monitor in the meantime and ask them to put a rush on that cardiac echo?’
The nurse gave a nod. ‘I’ll take her for the echo now.’
He gave Cordelia a nod and walked through to the treatment room. ‘It looks like we’re both about to lose patients from our trials. Jonas needs some IV steroids and diuretics.’
Her eyes were downcast for a moment. It probably wasn’t what she wanted to hear. But he knew she would always put the patients first. That’s the way it should be. Research work always brought these challenges and any medic who worked on the trials knew that.
She looked back up, nodding and opening the drug cupboard. ‘I’ll draw them up. Can you prescribe them on the tablet? Thanks.’
He gave her a nod and checked the bottles with her as she drew up the medicines. He couldn’t pretend not to notice the slight shake of her hands. ‘How about I do this for you? You can distract Jonas and persuade him this is a good idea.’
She sucked in a deep breath and let her hands rest back down on the counter top. ‘Do you know what? I’d like that. Thank you.’ She gave him a small smile and his insides clenched. He got the distinct impression that Cordelia Greenway didn’t normally let anyone help her. But from the way her jaw had been clenched and the shake in her hands he knew she was emotional about this. He knew she felt connected to this old guy. She’d worked here for four years. She might even have known him that long.
It was hard not to get attached to patients you saw on a regular basis, let alone nearly every day. It was harder still if those patients condition got worse—which inevitably frequently happened to doctors.
He understood. He’d been there and felt it himself. For the last few years he’d moved from place to place. All of his emotional investment had been in Rory. That’s the way it had to be. He’d had to learn to be mom and dad to the little guy. He’d always done a good job by his patients, but he hadn’t been around long enough to form lasting relationships.
And he missed that. He couldn’t pretend that he didn’t.
He moved his hand to lift the tray with the syringe and Venflon but Cordelia’s was still there. His first instinct was to pull away, but instead he put his hand over hers and left it there as she gave a little sad sigh.
She
