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‘No idea,’ Hannah admitted.
‘V3 goes halfway between V2 and V4, so it’s easier if you put V4 in place first,’ Jack explained.
Miranda was forced to meet his eyes. She stopped herself blushing—just. She only hoped he wasn’t a mindreader—she definitely didn’t want him knowing what she was thinking, right then. ‘Exactly. V4 picks up the patient’s apex beat. That’s the point furthest from the manubrium—that’s the hexagonal part at the top of the breastbone—where we can still feel the heart beating. It’s in the fifth intercostal space, in a line roughly halfway across the collar-bone.’ She found the spot and her fingertips brushed lightly against Jack’s skin. Just as well he was the one having the ECG, she thought. Her own heartbeat had just become extremely erratic, simply from touching him. This was crazy. He was her colleague. Her junior. She couldn’t think like this about him. Particularly when she’d agreed to go on a date with someone else. This really, really wasn’t good.
‘Can you show me where you’d put V3?’ she asked Hannah, avoiding looking at Jack.
Hannah nodded. ‘Here.’
‘Well done.’ Miranda smiled at her. ‘The rest of the leads go in a horizontal line with V4. V5 is here, in the anterior axillary line, and V7 is on the posterior axillary line. So V6 goes…?’
‘Halfway between them?’ Hannah guessed.
‘Spot on,’ Miranda said, then talked the junior doctor through placing the rest of the leads. ‘Great. You’re done.’ She switched the monitor on. ‘The trace shows the electrical activity of the heart so we can see what’s going on. We can tell if someone has had a heart attack, and roughly when it was—in the last few hours, days, weeks or months.’ She let the machine run until she had a strip of a dozen heartbeats, and turned it off. ‘This is a good example of normal sinus rhythm. There’s a small rise here at P just before the upper heart chambers contract.’ She marked it with a cross and labelled it ‘P’. ‘Then there’s the QRS spike…’ again, she labelled the points on the trace ‘…which happens just before the lower heart chambers contract. And finally there’s the rise at point T at the end of the beat.’
‘To find the number of heartbeats per minute,’ Jack added, ‘you measure how many big squares there are between the R points—what we call the “R-R interval”. The ECG machine usually runs at twenty-five millimetres per second so you just divide three hundred by the number of big squares.’
‘Some machines run at fifty millimetres per second, so always check if you’re not sure,’ Miranda added.
Hannah looked at the trace and did a quick calculation. ‘Three hundred divided by four—that’s seventy-five.’
‘Well within the normal resting range,’ Miranda pronounced.
She couldn’t help looking at Jack. And there was a distinct question in his eyes which she dared not answer. She forced herself to think of work. ‘Do we have a book of sample traces, Jack?’
‘For teaching? Yes—I’ll go and get it.’ He removed the leads. ‘You’ll be surprised how quickly you learn to spot the differences in the waves and what they mean,’ he told Hannah. ‘When you first start, you think you’ll never remember them all, but you’ll soon get the hang of it. And you can always ask one of us if you’re not sure. We won’t mind or think you’re stupid. We’ve all been in the same position.’
Miranda fiddled with the machine until she heard Jack put his white coat on again. Her face felt hot and she hoped it wasn’t too obvious. She could claim that her office was too warm—it was unusually hot for March—but she had a nasty feeling Jack would guess why she was flushed.
She needed to get her professional objectivity back. Fast.
And then she heard the call, ‘Crash team!’
‘We’ll carry on with the traces later,’ she told Hannah. ‘Come on, we’re needed.’
She walked quickly out into the ward and saw the light flashing above the door of Room One. Her heart sank. No. Please, not Imogen, she thought.
Jack was already there, giving CPR at the rate of five chest compressions to one breath, while Leila was getting the defibrillator ready.
‘She’s in VF,’ Leila said. VF, or ventricular fibrillation, was an abnormal heart rhythm—it meant Imogen’s heart was contracting quickly but not effectively.
Miranda went straight into action and attached the defibrillator paddles to Imogen’s chest so Leila could check the monitor. ‘Charging to 360. And clear,’ she said. Jack stopped the CPR so Miranda could shock Imogen.
‘Still in VF,’ Leila said, watching the monitor closely.
‘Have you given her adrenaline?’ Miranda asked.
‘Not yet,’ Leila said.
‘Hannah, get me some adrenaline now. Charging to 360. And clear,’ Miranda repeated. Imogen had to respond. She had to. They weren’t going to lose her.
‘Still in VF,’ Leila reported.
‘Charging. And clear,’ Miranda said.
‘She’s back in sinus,’ Leila said. ‘Well done.’
Tears pricked the backs of Miranda’s eyes. Thank God. ‘Jack, we can’t wait until tomorrow morning for the angioplasty. Not now she’s had an MI.’
‘Bypass?’ he asked.
‘Yup. I’ll call Jordan and sort out a slot in Theatre now. Can you prep her?’
‘Will do,’ he said.
‘Leila, can you get in touch with Emma and tell her that we’re taking her great-aunt down to Theatre now, please?’ she asked.
‘Will do,’ Leila said.
‘Hannah, check if Leila needs you for anything—if not, you’re welcome to come and observe,’ Miranda continued.
‘Thanks,’ Hannah said, flushing faintly.
Miranda rang Jordan and organised an emergency theatre slot. On the way down to Theatre, Imogen arrested again but Jack managed to bring her back. Before Miranda could make the first incision, Imogen arrested again.
‘Come on, come on,’ Jack said. ‘We’re not letting you go, Imogen. Stay with us. Charging. And clear.’
But this time they couldn’t bring her back.
‘It’s been twenty minutes,’ Jack said softly as Miranda continued CPR. ‘Do you want me to call it?’
‘No. We can’t give up now.’ She continued giving CPR. ‘Come on, Imogen. You have to stay with us.’
But it was no use. Gently, Jack put his hands over hers. ‘I’m calling it,’ he said. ‘She’s been down too long.’
‘No.’ Miranda shook her head in frustration. ‘No. We can’t have lost her.’
‘She’s gone,’ he said, his voice compassionate yet firm.
Miranda nodded dully, then glanced at the nurse’s watch on her white coat. ‘Time of death, three twenty-four.’ She stroked the old lady’s forehead. ‘I’m sorry, Imogen. I’m so, so sorry,’ she said softly, then turned away. ‘I’d better go and ring Emma.’ She swallowed hard and walked back to her office to ring Imogen’s great-niece.
‘But—but she was going to have her operation! I thought she was going to be all right,’ Emma said. ‘You said you were going to put a balloon in her arteries to clear them, and it would stop her getting the pain any more.’
‘I’m so sorry, Emma. We did everything we could. But her heart had just had enough.’
‘Poor Imogen. She was…It’s my fault,’ Emma said. ‘We should have had her to live with us.’
‘It wouldn’t have made any difference,’ Miranda reassured her. ‘And it wasn’t your fault at all. She was ill.’
‘I should have done more.’
‘You did your best. You came in to see her when you could, and rang when you couldn’t—and it isn’t easy to care for an elderly relative when you have three small children to look after as well.’ Easier if you didn’t have children. She could have done more for May. But she hadn’t, had she?
‘I can’t believe she’s gone.’ Emma’s voice was unsteady. ‘And Floss…I don’t know what we’re going to do about Floss. We can’t have a dog—we’re renting and the landlord won’t let us have pets, not even a hamster. We can’t keep her in kennels but I can’t have her put down. She’s not that old and she’s not even ill.’
‘I’ll see what I can do,’ Miranda promised. ‘Someone here might be able to give her a new home.’
‘Can I…can I come and see my great-aunt?’
‘Of course you can. And I’ll be here if you want to talk to me.’
‘Thank you.’ Emma was clearly crying as she rang off.
Miranda returned the receiver to its cradle, put her arms on her desk and rested her head on her arms. If only she’d done the angioplasty the day before. If only…
She heard a click and looked up. Jack had closed her office door. He walked towards her and laid a hand on her shoulder. ‘Hey, it’s not your fault. It was a risk with anyone who had her condition. You know that.’
‘I lost her, Jack.’
‘We can’t save them all,’ he said softly. ‘I know how you feel. She was a sweetheart. But she’s not in pain any more, and you did your best for her.’
‘No, I didn’t. I should have told the Prof to stuff his demo and insist on taking my slot back.’
‘And she might have arrested on the way down to Theatre yesterday afternoon. Besides, you know the risks with angioplasties. When the balloon inflates and blocks the artery temporarily, that sometimes triggers an MI. The chances were, it would have happened in Imogen’s case.’ He pulled up a chair next to hers and put his arm round her shoulders. ‘Don’t blame yourself, Miranda.’
She knew she shouldn’t lean towards him. Shouldn’t let him hold her. But right then she needed the comfort.
‘So what’s the real story?’ he asked softly. ‘We’re all upset when we lose a patient—but this really seems to have knocked you for six. You spent time with Imogen when you were supposed to be off duty, and you went and took a photograph of her dog for her. That’s going beyond the call of duty.’
Miranda shrugged. ‘I liked her.’
‘And?’
‘I suppose she reminds me of May, my great-aunt.’ She hadn’t intended to tell Jack any more than that, but somehow the words spilled out. ‘May was a cardiac nurse, years ago, and I used to love listening to her stories about the ward. It’s one of the reasons I wanted to work in the same area. My father didn’t want me to be a cardiologist—he didn’t even want me to be a doctor—but May told me to follow my heart and do what I really wanted to do. She said if he cut off my allowance, as he’d threatened, she’d support me through my training.’
Jack whistled. ‘I bet that went down well.’
Miranda nodded. ‘She was the one who advised me to do my training in Glasgow, away from him—not here. And she was right.’
‘And you feel that because we lost Imogen you’ve let your great-aunt down?’
‘Something like that,’ she admitted.
‘Hey.’ He rubbed the pad of his thumb against her cheek. ‘She was a medic, too. She knows you try your hardest but you can’t save everyone. I bet if you talk to her about it, she’ll tell you you’re being ridiculous.’
‘I wish she could.’ Miranda swallowed hard. ‘She died two years ago. She—she had unstable angina. She didn’t tell any of us, so we had no idea. One day I had a funny feeling. I couldn’t get hold of her on the phone, so I dropped in on my way home from work. I had a key and that’s when I found her. She’d had a massive MI. And…’ she closed her eyes ‘…it was too late to do anything.’
He groaned. ‘Oh, hell. I’m sorry. No wonder you’re so upset. I had no idea. I didn’t mean to make things worse.’ He leaned forward and kissed away the single tear from her cheek. ‘Miranda…’
She wasn’t sure which of them moved first. But the next thing she knew, he was kissing her. Really kissing her, his mouth warm and soft and demanding all at the same time. And she was kissing him back, sliding her fingers into his hair and urging him on.
His hands slipped to her waist and he pulled her onto his lap, still kissing her. It was only when she realised that he’d loosened her hair that she pulled back.
‘No. We can’t do this.’
His pupils had expanded so much his eyes were almost black with desire. His lips were full and slightly swollen, his cheeks were flushed and his hair was a mess. Miranda had a nasty feeling that she looked just as bad. And an even nastier feeling that if she didn’t move off his lap right now, she’d end up initiating another kiss. And another. She wanted him to touch her, stroke her skin all over, soothe away her pain with those clever fingers and that beautiful mouth—
No. She had to stop this, right now. With an effort she stood up.
‘Miranda, I—’ he began.
‘I know.’ She put her hands behind her back and clenched them together, to stop herself placing a finger on his lips. Stop herself touching him. ‘It was unprofessional. But understandable. We were both upset about losing our patient, both wanted comfort—and we were both here.’
‘Mmm-hmm.’ His mouth was saying he understood. His eyes were saying something entirely different—that he wanted her, and he knew she wanted him, too. It hadn’t been just comfort.
‘We’re colleagues. It wouldn’t work out.’
‘Mmm-hmm.’ Again, his eyes held a different message. How do we know until we try?
‘And I…’ No. She couldn’t pull rank on him—even though she was his boss, she wasn’t going to rub it in that she’d got the job he’d gone for. ‘I’m not looking for a relationship.’ She might be going out to dinner with Jordan Francis next week, but she’d make very clear to him that it was as friends only. ‘My career’s the most important thing in my life.’
‘Me, too.’
‘Good. Then we’re agreed—this was a one-off and it didn’t mean anything.’
‘Yep.’
She dropped her gaze. ‘I—um, I’d better sort out the paperwork. And I promised Emma I’d see what I could do about Floss. It’s the least I could do for Imogen.’ She gave him a quizzical look. ‘Do you have a dog?’
‘No, and it wouldn’t be fair to keep one. Not when I live on my own and work doctors’ hours.’
‘How about your family?’
‘How about yours?’ he fenced.
Her mother might, possibly—but her father would definitely refuse. She sighed. ‘All right. I’ll put a notice on the board in the staffroom and see if anyone wants to take her on.’
‘Right. I’d better get cracking on a ward round.’
She couldn’t let him walk out of her office looking like that—not unless she wanted the hospital rumour mill to work overtime! ‘You…um, you’d better do something with your hair first,’ she said, rummaging in her desk drawer and pulling out a comb.
‘Leave yours,’ he said softly. ‘It’s a crime to hide hair that beautiful.’
She flushed, and his body stirred. Hell. They’d just agreed that nothing was going to happen between them. But just looking at her made him want her. Made him remember how her warm, soft mouth had responded to him. How she’d kissed him back.
He was really going to have to keep a tight rein on himself.
‘I’ll see you at the end of the ward round,’ she said. ‘Take Hannah with you.’
‘Yes, boss.’
She was already pulling her hair back in that severe style. Putting her Ms Brisk-and-Efficient front on. The trouble was, now Jack knew what lay beneath it. And he wanted to know a lot, lot more.
CHAPTER THREE
‘SO HOW are you feeling, Sid?’ Miranda asked.
‘Nervous,’ he admitted. ‘The wife’s been looking things up on the internet. Surgery on what I’ve got is really risky, isn’t it?’
They’d already discussed it before Sid had signed the consent form for the operation, but Miranda had been prepared for last-minute nerves. ‘It’s risky, yes—but nowhere near as risky as leaving it. If it ruptures—which it’s very likely to do, in the next five years—you’ll lose a massive amount of blood and you’ll only have a fifty per cent chance of making it to hospital. If you do make it, you’ll have a fifty per cent chance of coming through the op. That’s a one in four chance of surviving.’ Miranda squeezed his hand. ‘Whereas with surgery you’ve got an eighty-five to ninety per cent chance of surviving. Better than that, in fact, because that’s the average, and Dr Sawyer has plenty of experience. So have I.’
‘Bronny says there’s something you can do that doesn’t mean cutting me open.’
‘Keyhole surgery? Yes, but it’s still being trialled. There’s also something called an endovascular stent, which is a special wire that supports your artery, but again it’s experimental. I need to get funding for a trial here before I can do either of them,’ Miranda said.
‘Can’t I wait until you’ve got the funding?’
She smiled. ‘Oh, Sid. I don’t know how long it’ll take—and I’m not taking any risks with you. If you really, really don’t want to have surgery, I’ll respect your wishes—but I do think it’s in your best interests to have the op.’
‘OK, Doc.’ Sid looked glum.
‘Hey, cheer up. You’ll be on your feet again tomorrow and you’ll be eating normally in four or five days. And I’ll cook you a bacon sandwich myself, to celebrate.’
His smile was watery. ‘I’ll hold you to that, Doc.’
‘It’s a deal,’ she said. ‘No butter—but you can have lots of tomato ketchup.’
‘I wish you hadn’t said that,’ he said. ‘I’m starving!’
‘I know. But you’ve got something to look forward to now.’
‘And seeing my first grandchild. My Lauren told me yesterday she’s expecting.’
‘Hey, that’s great news. Even better, you’re going to be able to play with your grandchild without everyone worrying that you’ll keel over.’ Miranda squeezed his hand again. ‘I know it’s hard, but try not to worry, Sid. Claire Barker’s going to give you your pre-med, and you’ll be out of Theatre before you know it.’
She went to join Jack. ‘Ready to scrub?’
‘Yep.’
‘Miranda?’ Claire came over to them, looking worried. ‘Sid Patterson’s complaining of a pain in his back, between the shoulder blades.’
Jack and Miranda looked at each other. ‘Dissection?’ Jack asked.
‘I don’t know what’d be worse, that or a rupture. Claire, is he talking about pain in his chest, arms or stomach?’
‘No. He just says he feels a bit funny and his back aches.’
‘Let’s get him down there now,’ Miranda said.
The aneurysm was in the descending part of the aorta, just beneath the heart. ‘Fusiform,’ Jack commented, seeing the distension all the way round the aorta’s circumference, tapering at both ends. ‘An absolutely textbook example. The good news is, it hasn’t ruptured. I can’t see any sign of a tear either—so let’s just hope his back pain was due to nerves. Everyone ready?’
‘Ready,’ the team confirmed.
‘OK. On bypass, please.’
Jack worked quickly, clamping the aorta and checking the blood pressure with the anaesthetist and perfusionist. He cut out the damaged part of the blood vessel, then grafted the synthetic material into the artery. Miranda worked flawlessly with him, as if reading his mind—before the words were half out of his mouth she was giving him exactly what he needed.
He was good, she acknowledged. Very good. He’d make an excellent consultant. And, the way things were going between herself and the Prof, that might happen sooner rather than later.
‘Ready for clamp removal?’ she asked.
He nodded. ‘Let’s increase the flow rates, see what happens.’ He kept a close eye on the suturing. ‘Looks as if it’s holding up.’
‘Release the clamps gradually, please,’ Miranda instructed.
They watched the graft area closely as the clamps were released. And then Jack gave a sigh of relief. ‘We’re there.’
‘Want me to close?’ Miranda asked.
He nodded. ‘Let’s leave the double lumen tube in until tomorrow.’
‘OK. You go and shower—I’ll finish up.’
‘Cheers.’ He flexed his shoulders. ‘Any chance of a back massage as well?’
At least he didn’t bear grudges—after he’d stomped out of her office the other day he’d been fine with her. He’d even started bantering with her, the kind of casual, teasing remarks that made her feel as if she’d worked with him for a lifetime instead of just a few days. He was easy to be around. And that, in itself, was dangerous. She couldn’t afford to get involved. Even if she hadn’t worked with him…No. She’d sworn off relationships for good. Dates were fine—but no commitment. Her judgement in men was lousy, so it was safer to stay on her own. Much safer.
‘On your bike, Sawyer,’ she informed him with a grin. ‘I’ll see you back on the ward.’
She stayed with Sid in the post-operative recovery area, then accompanied him back up to the ward.
‘It went really well,’ she told Bronny Patterson. ‘Dr Sawyer did an excellent job. Sid’s going to have a tube in his throat for another twenty-four hours to help him breathe and get over the operation, but we’ll get him a pen and pad so he can still communicate with you.’
‘I don’t think anything would stop him communicating,’ Bronny said with a smile.
‘Bless him.’ Miranda echoed her smile. ‘He’s going to be hooked up to a heart monitor and a blood-pressure monitor, too, and there’s a drain in his wound so it doesn’t get infected,’ she explained. ‘I know we went over all this before the op, but sometimes it’s hard to take in until you see him, and I don’t want you to be frightened by all the tubes and wires. It all went really smoothly, and there’s nothing out of the ordinary in his post-operative care.’
‘Thanks.’
‘Sid told me you’d been doing some research.’ Miranda smiled. ‘There’s some scary stuff out there.’
Bronny nodded. ‘I wished I hadn’t started when I saw some of the statistics.’
‘We’ll be keeping a close eye on him. Anyway, I owe him a bacon sandwich. I don’t think he’ll risk missing that,’ Miranda said lightly. ‘Or his first grandchild—congratulations, by the way.’
Bronny smiled. ‘Thanks.’
‘I’ll take you through to him now. Is there anything I can get you?’
‘No, pet. I’ll be fine. But thanks. We both appreciate what you’ve done.’
‘Not me. Dr Sawyer did the hard work.’
‘Taking my name in vain?’ Jack teased as he met them by the door. But he was oddly pleased all the same. Miranda hadn’t known he was there, but she’d still made sure he’d got the credit he was due. It almost made up for the row they’d had after she’d seen the Prof in her office. And even that he could understand now—she’d overreacted because Imogen had reminded her of losing someone she’d loved dearly.
‘Thank you, Dr Sawyer,’ Bronny said, taking his hand and squeezing it.
‘No problem,’ he said with a smile. He waited until Bronny was settled in with Sid, then caught Miranda on her way out of the room. ‘I’ll stay here tonight,’ he said. ‘Just in case.’
‘You will not,’ she informed him. ‘You’re off duty and I have the bleeper.’
‘But—’
‘Plus I’m expecting you in the Calderford Arms,’ she added. ‘When I said I’d buy everyone on the ward a drink, I meant everyone.’
‘What about the night staff?’ he fenced.
‘That’s covered, too. I’ve left them a stack of nibbles and some decent soft drinks.’ She eased her shoulders. ‘We’ve had a rough week. I think we all need to let our hair down. I’m taking my bleeper and my mobile, so I can get back here quickly if I’m needed.’ She smiled at him. ‘Go and get your glad rags on.’
‘Yes, boss.’ He could just see it now. The rest of the staff would be dressed up to the nines, but she’d still be wearing her formal business suit, with her hair scraped back.
‘See you there. Seven o’clock sharp.’
‘I’ll be there,’ he promised. ‘Though I hope you’re not going to start doing paperwork now.’
She gave him another of those smiles that clearly said, Don’t ask questions. ‘See you in the Calderford Arms.’
When she strolled into the bar at precisely seven o’clock, Leila dug Jack in the ribs. ‘Close your mouth,’ she said.
‘Uh,’ was all Jack could say. Because Ms Fluffy was back—and how! Her hair was loose and fell over her shoulders in glossy waves. She wasn’t wearing much make-up—no more than a light slick of lip-gloss and a coat of mascara—but it was her clothing that really floored Jack. A crop top which revealed a smooth, flat torso, a pair of black trousers that were slung low round her hips, high-heeled strappy shoes and what he had a nasty feeling was a real diamond in her navel.