Heart Surgeon, Prince...Husband!

CHAPTER TWO

ON TUESDAY MORNING, Kelly was due in to the cath lab. Her first patient, Peter Jefferson, looked incredibly nervous, and his knuckles were white where he was gripping his wife’s hand.

She introduced herself to them both. ‘Come and sit down. I promise this looks much scarier than it is. I’m going to check your pulse and your blood pressure, Mr Jefferson, and then I’ll put a little plastic tube called a cannula into your arm. Then all you have to do is lie on the couch for me, hold your breath and keep still for a few seconds, and the scanner will take 3D pictures of your heart so I can take a look at what’s going on. Then we can talk about it and decide the best way to treat you to stop the chest pain. Is that OK?’

He nodded.

‘I’m going to inject some special dye into your veins to help the scanner take the pictures. It’ll make you feel a bit warm and you might notice a funny taste in your mouth, but that’s completely normal and it’ll only last for about thirty seconds,’ she reassured him.

‘And it’s not going to hurt?’ He was still gripping his wife’s hand.

‘It’s not going to hurt,’ she said. ‘If you’re worried about how you’re feeling at any stage, just tell me. I might need to give you some medicine called a beta-blocker to slow your heart down very slightly, or some GTN spray under your tongue to make the arteries in your heart get a little bit wider—that will help me get better pictures of your heart. But it won’t hurt,’ she promised.

‘It’s just the chest pain has been so bad lately,’ Mrs Jefferson said, ‘and the medicine our family doctor gave him doesn’t help.’

Angina that couldn’t be helped by medication often meant that the arteries were seriously narrowed, and the treatment for that could mean anything from a simple stent through to bypass surgery under general anaesthetic. Hopefully a stent would be enough, but she wasn’t going to worry him until she could review the scan pictures.

She gave them both a reassuring smile. ‘Once we’ve gone through the tests, I should have a better idea how to help you. Can I just check that you’ve stayed off coffee, tea, fizzy drinks and chocolate yesterday and today, Mr Jefferson?’

He nodded.

‘And he’s been eating better lately and stopped smoking,’ Mrs Jefferson added.

‘Two of the best things you can do,’ Kelly said. ‘OK, Mr Jefferson. When you’re ready, I’ll check your blood pressure.’

As she’d expected, the first reading was really high; a lot of patients were so nervous about the tests that it sent their blood pressure sky-high. By the third reading, he was beginning to relax and Kelly was a little happier with the numbers.

Once she’d put the cannula in, she asked Mr Jefferson to lie on the scanner couch with his arms above his head. ‘I’m going to put some wires on your chest now,’ she explained, ‘so I can monitor your heart rate during the scan, but again it’s not going to hurt.’

But she really wasn’t happy with what the scan showed her. His right coronary artery was severely narrowed, as were the two on the left. An angioplasty with a stent wasn’t going to be enough to make any difference.

‘I’m sure your family doctor has already explained why you’re getting chest pain, Mr Jefferson, but I’d like to go through it with you again. Basically your heart pumps blood round your body, but sometimes deposits of fat and cholesterol—what you might hear called plaques—stick to the wall of your arteries and make them narrower. It’s kind of like when you see the inside of a kettle in a hard water area and the pipes are furred up, except in this case the furred-up bits are inside the pipes rather than outside. This means not enough oxygen-rich blood gets through to your heart, and that’s why it hurts.’

‘But you can make my arteries wide again?’ he asked.

‘I was hoping I could do an angioplasty and put a stent in—that’s basically a wire mesh that I can put inside your arteries to keep them open,’ Kelly said. ‘But in your case there’s a lot of narrowing in three of your arteries, and I think your best option is surgery. I need to talk to one of my colleagues—the cardiothoracic surgeon—very quickly, so if you’ll excuse me I’ll be about five minutes. If you’d like to nip out to the waiting area to get a cup of water while I’m gone, please feel free.’

To Kelly’s relief, Luc was in his office, dealing with paperwork.

‘Can I have a quick word about one of my patients?’ she asked.

‘Sure.’

She drew up Peter Jefferson’s scan results on the computer. ‘My patient has angina, and the meds his family doctor prescribed aren’t helping. I hoped that I might be able to do an angioplasty, but I’m really not happy with the scan results. I think he needs a CABG.’

‘I agree. That narrowing is severe. I’d recommend a triple bypass,’ Luc said as he reviewed the screen. ‘Is he still with you?’

‘Yes. He’s in the cath lab with his wife. He knows I’m having a quick word with you.’

‘Let me check my schedule.’ He flicked into the diary system. ‘Operating days for me are Wednesday and Friday.’ He blinked. ‘I’ve got a cancellation tomorrow, by the looks of it, so we can grab that slot now before someone else does. Do you want me to come and have a word?’

‘Meeting you is going to reassure him more than anything I can say to him,’ Kelly admitted. ‘Would you mind?’

‘No problem.’ He smiled at her.

And her heart would have to feel as if it had done an anatomically impossible backflip because of that smile.

Kelly had got herself completely back under control by the time they went into the cath lab.

‘Mr and Mrs Jefferson, this is Luciano Bianchi, one of our surgeons,’ she said. ‘We’ve had a quick discussion, and we both feel that the best way forward is surgery—a coronary artery bypass graft.’

‘It means I’ll take another blood vessel from your leg and attach it to your coronary artery on either side of the bit where it’s blocked—that’s the graft—so the blood supply is diverted down the grafted vessel.’ Luc drew a swift diagram.

‘I guess it’s a bit like roadworks, when you get diverted down a slightly different road round the bit that’s blocked. Your blood will flow through properly to your heart again and you won’t get any pain,’ Kelly said.

‘Exactly,’ Luc said with a smile.

‘But what about the bit in his leg? Doesn’t he need that vein?’ Mrs Jefferson asked, clearly looking worried.

‘It’s one of the extra veins we all have close to the surface of the skin,’ Luc said. ‘The ones that return the blood back to the heart are deep inside your leg. The rest of the veins in your leg will manage perfectly well if I borrow a little bit for a graft, Mr Jefferson. I’ll stitch it up and you’ll have a little scar, but it’s nothing to be worried about.’

‘Heart surgery. Does that mean you have to cut through my chest?’ Mr Jefferson asked.

‘In your case, yes—unfortunately I can’t do keyhole surgery for you because you need three grafts,’ Luc said. ‘It means you’ll have a scar down your chest, but that’ll fade with time. And once I’m happy with the grafts, I can re-join your breastbone with stainless steel wires and stitch up the opening.’ He smiled. ‘And I happen to have a slot free tomorrow morning, so I can fit you in then.’

‘Tomorrow?’ Mr Jefferson looked utterly shocked.

‘Tomorrow,’ Luc confirmed. ‘Which gives you less time to worry about the operation.’

‘Surgery.’ Mr Jefferson blew out a breath. ‘I wasn’t expecting that.’

‘I’ve done quite a few bypasses in my time,’ Luc reassured him. ‘You won’t feel a thing, because you’ll be under a general anaesthetic.’

‘Isn’t that the operation where you’ll stop his heart beating?’ Mrs Jefferson asked. ‘I read up about that on the Internet.’

‘It’s one way of doing a bypass operation, using a heart-lung machine to breathe and pump the blood round your body for you, but actually I prefer to do my surgery off-pump—where the heart’s still beating while I operate,’ Luc said.

Kelly hadn’t expected that, and it intrigued her.

Mr Jefferson’s eyes widened. ‘But isn’t that dangerous?’

‘It’s quicker, so you’ll be under anaesthetic for less time, there’s less chance of you bleeding during surgery, and you’re also less likely to develop complications after the operation,’ Luc said. ‘So in my view it reduces the risks.’

‘And after the surgery you’ll be with us in the ward,’ Kelly said. ‘You’ll be in Intensive Care at first, where we’ll keep an eye on you to make sure everything’s working as it should be. You’ll still be asleep for the first couple of hours, but then we’ll wake you up and your family will be able to see you.’

‘You’ll be well enough to get out of bed and sit in a chair, the next day,’ Luc said. ‘A couple of days later you’ll be back on your feet, and a couple of days after that you’ll be ready to tackle stairs again.’

‘A whole week in hospital.’ Mr Jefferson looked as if he couldn’t take it in. ‘My doctor said I’d be in here for half an hour, maybe a bit longer if you had to do a procedure like a stent. He didn’t say I’d have to stay in for a week.’

‘But if you need the operation, love,’ Mrs Jefferson said, ‘then you’ll have to stay in.’

‘I’m afraid you do need the operation, Mr Jefferson,’ Luc said gently. ‘Right now I know it feels very scary and a bit daunting. But it’s the best way of preventing you having a heart attack.’

‘But our daughter’s having a baby next month,’ Mr Jefferson said.

‘Which is another reason to have the operation now. You’ll be able to cuddle the baby without worrying that you’ll start getting chest pains,’ Kelly said. ‘By the time the baby’s crawling, you’ll have made a full recovery and can really enjoy being a grandad.’

‘And you won’t be left to deal with everything on your own afterwards,’ Luc added. ‘Heart surgery is a big operation, and we’ll help you recover on the ward.’

‘You’ll come back to us a few weeks after the operation to start a rehabilitation programme,’ Kelly said, ‘and that will help you get completely back on your feet. There are support groups, too, so we can put you in touch with other people who’ve already been through the same thing—they’ll understand how you’re feeling and can help you.’

‘And it’s really bad enough that I should have the operation tomorrow?’ Mr Jefferson asked.

‘Your arteries are severely narrowed,’ Luc said. ‘Right now that’s causing the pains in your chest, and the medication isn’t enough to stop the pain. But on top of that there’s a risk that one of the plaques will split and cause a blood clot that will completely block the blood supply to your heart and give you a heart attack. That could do a lot of damage to your heart muscle.’

‘And kill him?’ Mrs Jefferson asked.

‘We always try our best to save our patients but, yes, I have to tell you that’s a possibility,’ Luc said. ‘I know it’s a lot to take in, but we’d really like to keep you in overnight here and do the bypass tomorrow, Mr Jefferson.’

‘So will the operation cure him completely?’ Mrs Jefferson asked.

‘It will stop the pain and lower the risk of having a heart attack,’ Luc said.

‘But because you have coronary heart disease you’ll still need to look after your heart,’ Kelly added. ‘Your family doctor’s probably already told you what you need to do. Stopping smoking and eating better are brilliant, so definitely keep that up, and maybe add in a bit more gentle exercise.’

Mr Jefferson still looked terrified. ‘I hate needles. I can’t even make myself give blood, even though I know I ought to. Coming here today for this was bad enough.’

Kelly held his hand. ‘I know it’s scary now, but in the long run you’ll feel so much better. And your wife and daughter won’t have to worry about you as much as they do now. Luc’s really good at what he does, and so is the rest of our team. It’s natural to feel worried, and you’ll probably feel a bit wobbly at times after the operation—that’s absolutely normal. But the operation is really going to help you. You’re going to feel a lot better, and you’re not going to worry that your chest pain or breathlessness is going to stop you playing with your grandchildren.’

‘Are there risks?’ Mrs Jefferson asked.

Luc and Kelly exchanged a glance.

‘There are risks with all anaesthetic and surgical cases,’ Luc said. ‘But they’re small, and we’re experienced enough to know what to look out for and how to fix things. I know it all sounds really daunting, but there’s a greater risk if we don’t do the surgery.’

Mr Jefferson swallowed hard. ‘All right. I’ll do it.’

‘Good man.’ Luc rested his hand briefly on the older man’s shoulder. ‘We’ll get you settled in to the ward, and I’ll be doing rounds later if you have any questions. Dr Phillips will also be on hand if you need anything.’

‘Or talk to any of the nurses,’ Kelly added. ‘That goes for both of you.’

‘Thank you,’ Mrs Jefferson said.

* * *

Once Mr Jefferson was settled on the ward and had been put on a nitrate drip, Kelly went back to the cath lab. The rest of her clinic was more straightforward, to her relief, and she managed to catch up with Luc afterwards.

‘Thank you for talking to Mr Jefferson with me.’ She’d liked Luc’s warm, easy manner and the way he’d described things without being dramatic and terrifying their patient even more. He’d acknowledged Mr Jefferson’s fears and reassured him.

‘No problem,’ he said.

‘You actually do the surgery off-pump?’

He nodded. ‘I’m assuming that’s unusual for here, then?’

‘Yes, it is. I haven’t actually seen off-pump surgery done before.’ And it was the first time in a long time that Kelly had been interested in seeing something different—that her old passion for her job had resurfaced instead of being buried by the fear that she might have missed something and let a patient down, the way she’d let Simon down.

‘If you can spare the time, you’re welcome to scrub in and observe as much of the operation as you like,’ he offered.

‘I’d love to. I won’t be able to stay for the whole thing, but maybe I could come before or after my clinic tomorrow, if that’s OK?’

‘Whenever fits your schedule best,’ he said.

‘Thanks. I’m definitely taking you up on that.’

‘Actually, you can spread the word that I’m always happy to have observers,’ Luc said. ‘The actual operation is only a part of caring for our patient. I’m a great believer in all areas of the team knowing exactly what happens in the other parts of a care plan, and the more we all understand what each other does, the more we can work together and help our patients.’

‘That’s very much Sanjay’s approach as the head of the department,’ Kelly said. ‘Cross-fertilisation of ideas. And you’re welcome in my cath lab any time, as are any of your students.’

‘Thanks. I’ll take you up on that.’ He smiled. ‘So is Mr Jefferson settled in?’

She nodded. ‘His wife’s just gone home to pick up his things. She had a bit of a chat with me beforehand. She’s worrying about losing him.’

‘Understandable, in the circumstances,’ Luc said. ‘But that must’ve brought back some tough memories for you.’

She shrugged. ‘If anything, what happened to Simon has probably helped me empathise a bit more with my patients and their partners.’ There had to be some good coming out of such a senseless death.

‘You’re still brave,’ Luc said, patting her shoulder.

Again, his touch made her feel all flustered. Which was crazy. She hardly knew him and this wasn’t supposed to happen. ‘You have to get on with things,’ she said.

As if realising that she desperately wanted him to change the subject, Luc said, ‘So Mr Jefferson’s on his own and he’s got time to worry, then. I’ll go and sit with him for a bit. Catch you later.’

Surgeons had a reputation for arrogance, Kelly thought, the next morning, but Luc Bianchi definitely wasn’t one of them. Yesterday he’d deliberately taken time to sit with a nervous patient and reassure him. Today, he was courteous to the rest of the team in the operating theatre, asking them to do things rather than barking instructions at them, and even checking that they were OK with his choice of music to work to; and he’d made it clear that he was happy to explain anything he was doing and why.

She was fascinated by the glimpses she had of the off-pump bypass surgery where just the small area he was working on was kept still and the rest of the heart was visibly pumping. As a student, she’d been fascinated by cutting-edge treatments. Since Simon’s death, she’d focused on keeping things safe and steady. Work hadn’t been a chore, exactly, but she’d become hyper-focused. She managed to be there for the end of the op too, when Luc was closing up; his movements were deft and very sure.

‘Thanks for letting me sit in,’ she said before he went to scrub out. ‘Can I buy you lunch and ask you a ton of questions about the op?’

‘I’d be delighted to have lunch with you and answer anything I can,’ he said, ‘but I’m paying. I might have to rush back here if the team beeps me too.’

In other words, if Peter Jefferson developed any complications before he came round in the intensive care unit. ‘Of course,’ she said. ‘Thank you. I’ll see you when you’ve scrubbed out.’

* * *

The more time Luc spent with Kelly Phillips, the more he liked her. The kind, calm way she treated her patients; her inquisitive mind; the way she treated all her colleagues with respect.

‘Was that really the first OPCABG you’ve seen?’ he asked when he’d scrubbed out and joined her.

‘Your predecessor preferred working on pump,’ she said. ‘So, yes, it was my first off-pump bypass graft. And it was fascinating.’

‘And you have questions?’

‘Absolutely. Let’s get lunch, and I’ll pick your brain,’ she said with a smile.

She asked a lot of questions. All bright, thoughtful questions. Luc answered to the best of his ability, and finally she nodded.

‘Thank you. I understand a lot more, now. But the most important thing is that you’ve made a real difference to Peter Jefferson’s life.’

‘We’re not quite out of the woods yet,’ he said. ‘But I hope so.’

* * *

Over the next couple of days, Peter Jefferson moved from the intensive care area to the ward. But, when Kelly came to see him on Friday morning during her ward round, he started crying. ‘This is so pathetic. I can’t understand why I feel like this. I was a finance director, used to making decisions and dealing with huge sums of money, and now I’m crying all over the place and it’s just not me. And I can barely even get out of bed without help.’ He looked despairing. ‘Now I’m just a shuffling old man.’

She sat on the bed next to him and held his hand. ‘You’ve been through major surgery, Mr Jefferson. Lots and lots of people feel like this afterwards. You’ll have good days and you’ll have wobbly days. But the rehab programme will really help you, because you’ll meet other people who are going through it too or are a couple of weeks further down the line than you are, and that will help you realise that what’s happening to you and how you’re feeling is all perfectly normal. It’s going to take time to get you back on your feet and doing the same things you did before you had surgery, but you will get there. Just be kind to yourself.’

Luc walked onto the ward at that moment. ‘Good morning,’ he said with a smile. ‘I just popped in to say hello to you before I go into the operating theatre today.’

Mr Jefferson wiped his eyes. ‘I’m sorry. I’m being so stupid.’

‘You’ve had major surgery with a general anaesthetic. Of course you feel wobbly,’ Luc said. ‘Tell me, do you play chess?’

‘I do.’

‘Good. I’ll get a board sorted out and I’m challenging you during my lunch break. I might be a bit late,’ he said, ‘depending on how the operation goes this morning, but I’ll definitely be in to have a cup of tea and a chess match with you, OK?’

‘But—you’ll have been so busy this morning.’

‘And a game of chess is the perfect way to relax,’ Luc said. ‘As long as you don’t mind me eating a sandwich at the same time. I’m horrendously grumpy if I don’t eat regularly.’

‘Thank you, Dr Bianchi. That’s—that’s so kind of you.’ Peter Jefferson wiped his eyes again.

‘I’ll see you soon,’ Luc said, patting his hand.

‘I need to see my next patient,’ Kelly said, ‘but I’ll pop back later, too.’ She walked out with Luc. ‘That’s really nice of you.’

‘I just want my patients to be comfortable.’ He shrugged. ‘I don’t suppose there’s a chess board on the ward?’

‘Probably not, but I might be able to borrow one from Paediatrics. I’ll get that organised—and a sandwich for you. What would you like?’

‘I eat anything, so the first thing you grab off the shelf will be fine,’ Luc said. ‘Thanks, and I’ll settle up with you later.’ He paused. ‘Are you at the team thing tonight?’

‘The ten-pin bowling? No, I’m working. Are you?’

‘Yes. I thought it’d be a good way to get to know the team.’

‘It is.’ She smiled. ‘Have a good time.’

‘Thank you.’

To her relief, he didn’t push to see if she was going to any of the other team events. She liked her colleagues very much—but going out was a strain. Too many people trying to push her into being sociable when she was really much happier here at work, making a difference to her patients’ lives.

* * *

Luc spent the morning in Theatre fixing an aortic aneurysm on an elderly woman, his lunchtime with Peter Jefferson, and his afternoon in Theatre sorting out a narrowed aortic valve in a teenage boy suffering from severe breathlessness.