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 we can do it endoscopically, I’ll lead and you assist; if it’s open surgery, you lead and I’ll assist. If both sides are affected, maybe you can do one and I’ll do the other.’
Vicky nodded. ‘She’s a nice woman, Jake. I like her. Feisty, independent—she’s really going to hate the idea of being an inpatient.’
Yeah. Jake knew someone else like that. Except—
No. Now wasn’t the time to think of Lily. Or wish he’d known back then what he knew now. If only he’d insisted…But he hadn’t. He’d deferred to her wishes.
He couldn’t change the past. Only the future—for someone else.
‘Let me know when you’ve got the results. I’m in clinic for the rest of the morning.’
‘OK.’ She gave him an odd look. But he wasn’t in the mood to find out why. He just wanted to see his patients and get his head back to where it ought to be before he met Violet Carter.
When Vicky reviewed the results, she sighed inwardly. Eighty per cent stenosis—the arteries were severely narrowed, which meant nowhere near enough blood was getting through them. This was definitely a case for operating.
She went to see Violet Carter. ‘How are you doing?’ she asked.
‘Fine. Can I go home now?’ Violet asked.
‘No. I’ve found out what caused your funny turn this morning. Your carotid arteries are narrowed.’ Gently, she ran her finger along one side of Violet’s neck. ‘They run both sides of your neck and they supply the blood to your brain. If they become narrow, not enough blood or oxygen reaches your brain.’
‘So what does that mean?’
‘They’re narrowed because some fatty material in your blood sticks to the lining of your arteries—it’s called atherosclerosis. You have a choice. We can do an operation called an endarterectomy—what that does is remove the lining of the arteries and the stuff that’s starting to block them, and the lining will grow back within a couple of weeks of surgery.’
As she’d expected, Violet caught on quickly. ‘And if I don’t have the operation?’
‘They could block completely. Which means you’ll have a full-blown stroke. If you want the figures, about half of people who have a TIA have a stroke within a year, and twenty per cent of those have a stroke within a month.’
‘And if I have a stroke, I’ll have to go into a home instead of being in my own place.’
Vicky nodded. ‘You won’t be able to look after yourself. You’ll need care.’
‘If I have the operation, I’ll be all right.’
‘There are no guarantees—but the odds are loaded in your favour.’
Violet seemed to be thinking about it. ‘Would I be awake during the operation?’
‘No, you’d have a general anaesthetic.’
Violet sighed. ‘So I’m going to have to stay in.’
‘For a few days,’ Vicky explained.
‘Which means I have to tell my daughter.’
‘If you were my mum, I’d want to know,’ Vicky said.
‘Your mum’s lucky,’ Violet grumbled. ‘She’s got a sensible one who doesn’t panic and run around like a headless chicken.’
Vicky’s common sense was nothing to do with Mara. Besides, there wasn’t room for two headless chickens in a family.
She pushed the thought away.
‘I hope she appreciates you,’ Violet said.
Vicky made a noncommittal sound. Mara didn’t understand her and always said Vicky should have been born a boy. Especially after Vicky, as a five-year-old, had taken scissors to her tutu and ballet shoes and threatened to chop off her hair if anyone made her go back to ballet lessons. Mara also hadn’t appreciated Vicky getting herself expelled from finishing school in the first week. Or finding out that she could get herself made a ward of court so she could do her A-levels if Mara tried to make her go to another finishing school.
‘I’ll ring your daughter and explain the situation,’ Vicky said. ‘I can get you on this afternoon’s list, if you’d like to sign the consent form.’
‘And you’ll be doing the operation?’
‘With our consultant, Jake Lewis. I’ll introduce you to him before the operation,’ Vicky said. ‘Oh, and in the meantime…’ She pulled a magazine out of her pocket. ‘Just to stop you getting bored.’
Violet took the puzzle book and flicked through it. ‘Oh, yes! It’s got those logic problems in it. I like them.’ She smiled at Violet. ‘Thank you, love. That’s really kind of you.’
‘Pleasure. I had a feeling you’d enjoy it.’ Because Vicky could see herself like Violet, in forty years’ time. Except she wouldn’t have a daughter fussing over her, or teenage grandchildren. She just hoped a stranger would show her that same kindness.
Vicky introduced Jake to Violet, and noted approvingly that Jake treated the elderly woman with respect, rather than talking down to her. He explained exactly what they were going to do and how long she’d need to be in afterwards, and that they were going to do the operation by keyhole surgery.
Though when they were scrubbing up, she noticed the brooding expression in his eyes.
‘Are you all right?’ she asked.
‘Fine,’ he said curtly.
Hmm. Maybe it was surgeon’s nerves. Every surgeon she knew was keyed up before an operation—which was a good thing, as it meant they weren’t taking their skills for granted and there was less chance of them being sloppy. Some people talked too much when they were nervous. Jake clearly went the other way and barely spoke at all.
Jake had chosen to operate to Corelli, surprising her. She’d expected him to work to pop music rather than classical. Then she was cross with herself for reacting in the same snobbish way Mara would have done. Sure, Jake had an East-End accent rather than a posh one, but since when did the way you spoke dictate your tastes in music?
He talked her through the two-hour operation, clearing one artery himself and then giving her
