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Calling each other ‘Thomas’ and ‘Rebecca’ with never a single slip into the ‘Tom’ and ‘Becca’ they had always been to each other. Discussing test results and medications and surgery as if nobody involved had a personal life or people that loved them enough to be terrified.
It was bad enough that he’d destroyed their marriage by withdrawing into this cold, hard shell but she could deal with that. She’d had years of practice, after all. To see the effect it was having on others made it far less acceptable. This was Penny’s mother he’d been talking to, for heaven’s sake. They’d both known Julia since she’d been pregnant with her first—and only—child. They’d both been there for her a thousand per cent over the first weeks and months of her daughter’s life. He’d been the old Thomas, then.
And then he’d walked out. He hadn’t been there for the next lot of surgery Penny had had. He hadn’t shared the joy of appointments over the next few years that had demonstrated how well the little girl had been and how happy and hopeful her family was. He hadn’t been there to witness the fear returning as her condition had deteriorated again but now he was back on centre stage and he was acting as if Penelope Craig was just another patient. As if he had no personal connection at all...
How could he be walking away from Julia like that, when she was so upset she had buried her face in a handful of tissues, ducking back into the relatives’ room for some privacy?
Rebecca’s forward movement came to a halt as Thomas came closer. She knew she was glaring at him but, for once, she wasn’t going to hide anything personal behind a calm, professional mask.
‘What’s going on?’ she asked, her tone rather more crisp than she had expected. ‘Why is Julia so upset?’
Thomas shifted his gaze, obviously checking that nobody was within earshot. A group of both staff and visitors were waiting for an elevator. Kitchen staff went past, pushing a huge stainless steel trolley. An orderly pushing a bed came towards them, heading for the service lift, presumably taking the small patient for an X-ray or scan. The bed had balloons tied to the end, one of them a bright yellow smiley face. A nurse walked beside the bed, chatting to the patient’s mother. She saw Rebecca and smiled. Then her gaze shifted to Thomas and the smile faded a little.
He didn’t seem to notice. He tilted his head towards the group of comfortable chairs near the windows that were, remarkably, free of anyone needing a break or waiting to meet someone. Far enough away from the elevator doors to allow for a private conversation.
Fair enough. It would be unprofessional to discuss details of a case where it could be overheard. Rebecca followed his lead but didn’t sit down on one of the chairs. Neither did Thomas.
‘I was going to send you a memo,’ he said. ‘I’m meeting both Julia and Peter in the next day or two to discuss the option of Penelope receiving a ventricular assist device. It’s only a matter of time before her heart failure becomes unmanageable.’
‘Okay...’ Rebecca caught her bottom lip between her teeth. No wonder Julia had been upset. A VAD was a major intervention. But she trusted Thomas’s judgement and it would definitely buy them some time.
His gaze touched hers for just a heartbeat as he finished speaking but Rebecca found herself staring at his face, waiting for him to look at her again. Surely he could understand the effect of what he’d told Julia? How could he have walked away from her like that and left her alone?
But Thomas seemed to be scanning the view of central London that these big, multi-paned old windows provided. He could probably see the busy main roads with their red, double-decker buses and crowds of people waiting at intersections or trying to hail a black cab. Or maybe his eye had been drawn to the glimpse of greenery in the near distance from the treetops of Regent’s Park.
‘You’ve had experience with VADs? Are you happy to do the surgery?’
‘Yes, of course. It’s not a procedure that happens very often but I’ve been involved with a couple. Do you want me to come to the meeting with Penny’s family and discuss it with them?’
‘Let’s wait until it’s absolutely necessary. I can tell them what’s involved and why it’s a good option.’
Rebecca let her gaze shift to the windows, as well. She stepped closer, in fact, and looked down. The protesters were still in place, with their placards, outside the gates. They’d been there for months now, ever since the threat of closure had been made public. It hadn’t just been the staff who had been so horrified that the land value of this prime central London spot was so high that the board of governors was actually considering selling up and merging Paddington Children’s Hospital with another hospital, Riverside, that was outside the city limits.
Thanks to the incredible donation a month or so ago from Sheikh Idris Al Khalil, who’d brought his daughter to Paddington’s for treatment, the threat of closure was rapidly retreating. The astonishing amount of money in appreciation of such a successful result for one child had sparked off an influx of new donations and the press were onside with every member of staff, every patient and every family who were so determined that they would stay here. Even so, the protesters were not going to let the momentum of their campaign slow down until success was confirmed. The slogans on their placards were as familiar as the street names around here now.
Save Our Hospital
Kids’ Health Not Wealth
The knowledge that that announcement couldn’t be far off gave Rebecca a jolt of pleasure. Things were looking up. For Paddington’s and maybe for Penny, too.
‘It is a good option.’ She nodded. ‘I’d love to see her out of that wheelchair for a while.’
‘It would put her at the top of the waiting list for a new heart, too. Hopefully a donor heart will become available well before we run into any complications.’
The wave of feeling positive ebbed, leaving Rebecca feeling a kind of chill run down her spine. Her muscles tensed in response. Her head told her that she should murmur agreement and then excuse herself to go and see her patient, maybe adding a polite request to be kept informed of any developments.
Her heart was sending a very different message. An almost desperate cry asking where the hell had the man gone that Thomas used to be? Was there even a fragment of him left inside that shell?
‘Yes,’ she heard herself saying, her voice weirdly low and fierce. ‘Let’s keep our fingers crossed that some kid somewhere, who’s about the same age as Penny, has a terrible accident and their parents actually agree to have him—or her—used for spare parts.’
She could feel the shock wave coming from Thomas. She was shocked herself.
It was a pretty unprofessional thing for a transplant surgeon to say but this had come from a very personal place. A place that only a parent who had had to make that heartbreaking decision themselves could understand.
She was also breaking the unspoken rule that nothing personal existed between herself and Thomas any more. And she wasn’t doing it by a casually friendly comment like ‘How are you?’ or ‘Did you have a good weekend?’ No. She was lobbing a verbal grenade into the bunker that contained their most private and painful history.
In public. During working hours.
What was she thinking? Being angry at the distance Thomas was keeping himself from his patients and their parents was no excuse. Especially when she knew perfectly well why he had become like that. Or was that the real issue here? That she had known and tried so hard to help and had failed so completely?
‘Sorry,’ she muttered. ‘But, for me, it’s never an anonymous donor organ that becomes available. I have to go and collect them so I get involved in both sides of the story.’
Thomas’s voice was like ice. He really didn’t want to be talking about this.
‘You choose to do it,’ he said.
He didn’t even look at her as he fired the accusation. He was staring out of the damned window again. Rebecca found that her anger hadn’t been erased by feeling ashamed of her outburst.
‘And you choose to shut your eyes.’ The words came out in a whisper that was almost a hiss. ‘To run away. Like you always did.’
There was no point in saying anything else. Maybe there was nothing more to say, anyway.
So Rebecca turned and walked away.
CHAPTER TWO
‘THE LINE HAS been crossed.’
‘Oh?’ Thomas had opened the file he needed on his laptop. He clicked on options to bring his PowerPoint presentation up and sync it to the wall screen he had lowered over the whiteboard in this small meeting room. ‘What line is that, Rosie?’
He certainly knew what line had been crossed as far as he was concerned. It had been a week since Rebecca’s astonishing outburst and he still hadn’t recovered from the shock of how incredibly unprofessional she had been.
What if someone had overheard? Members of the press were still all over any story coming out of Paddington’s. Imagine a headline that revealed that the leading transplant surgeon of Paddington Children’s Hospital described her donor organs as ‘spare parts’?
Anyone else could well have taken the matter elsewhere. Filed a formal complaint, even. And was Rosie now referring to it? Had it somehow made its way onto the hospital grapevine?
No. Her expression was far too happy to suggest a staff scandal. He tuned back in to what she was saying.
‘...and now that the bottom line’s been crossed, thanks to the flood of donations, the government’s stepping in to make up any shortfall. It only needs the signature of the Minister of Health and Paddington’s will be officially safe. There won’t be any merger.’
‘That’s good news.’ Thomas reached for the laser pointer in its holder on the frame of the whiteboard. ‘Very good news,’ he added, catching sight of Rosie’s disappointment in his lack of enthusiasm.
‘Mmm.’ Rosie looked unconvinced. ‘Apparently there’s going to be a huge party organised in the near future as soon as everything’s finally signed and sealed but some of the staff are planning to get together at the Frog and Peach over the road on Friday to celebrate early. Guess we’ll see you there?’
She was smiling but didn’t wait for a response. Other people were arriving for the meeting now and there were bound to be far more acceptable reactions from anyone who hadn’t heard the big news of the day. One of the physiotherapists, perhaps. Or Louise, who was the head dietician for Paddington’s. One of the staff psychologists had just come in, too, and Thomas nodded a greeting to the head of the cardiac intensive care unit, who came through the door immediately after her.
Everybody in the team who had—or would be—directly involved in Penelope Craig’s case had been invited to this meeting, including Rosie as one of the nurses that had provided so much of her care over the many admissions the little girl had had. One of the only people missing as the clock clicked onto the start time of eleven a.m. was her surgeon.
Rebecca Scott.
He hadn’t seen her all week, come to think of it. Not that he’d wanted their paths to cross. The shock of their last interaction hadn’t been only due to her lack of professionalism. Or that she had so unexpectedly crossed the boundaries of what their new relationship allowed.
No. Thomas had not been able to shake the echo of that vehement parting shot. That he chose to shut his eyes. To run away. And that he had always made that choice.
Did she really think he was such a coward?
He wasn’t a coward. Had Rebecca had no understanding of how much strength it had taken to deal with what they had gone through? How hard it had been to keep putting one foot in front of the other and keep going?
Obviously not.
No wonder their marriage had fallen apart so easily.
No wonder he had been left feeling such a failure. As a husband and as a father.
But to drag it out again and hurl it in his face like that...
It had been uncalled for. Unhelpful. Insulting, even.
And so, yes, he was angry.
‘Sorry we’re late...’ The door opened as Rebecca rushed in to take a seat at the oval table, followed by her senior registrar.
Thomas could feel himself glaring at the late arrivals.
Rebecca was glaring right back at him. ‘We got held up in Recovery after our last case. I couldn’t leave until I was sure my patient was stable.’
‘Of course you couldn’t,’ someone said. ‘We wouldn’t expect you to.’
Thomas looked away first. Just in time to notice the raised eyebrows and shared glances that went round the table like a Mexican wave.
‘No problem,’ he said evenly. ‘But let’s get started, shall we? We’re all busy people.’
The tension in the room behind him felt like an additional solid presence as he faced the screen and clicked the pointer to bring up his first slide.
‘As you know, we’re here to discuss a case we’re all involved with—that of Penelope Craig, who’s currently an inpatient in our cardiology ward. For those of you who haven’t been so directly involved in the last few years, though, here’s a quick case history.’
The slide was a list of bullet points. A summary of a clinical case reduced to succinct groups of words that made one crisis after another no more than markers on a timeline.
‘The diagnosis of hypoplastic left heart syndrome was made prenatally so Penelope was delivered by C-section and admitted directly to the cardiac intensive care unit. She underwent her first surgery—a Norwood procedure—at thirteen days old.’
He had been in the gallery to watch that surgery. Rebecca had been a cardiothoracic surgical registrar at the time and it had been the most challenging case she’d assisted with. She’d sat up half the previous night as she’d gone over and over the steps of the surgery and Thomas had stayed up with her, trying to make up for any lack of confidence she was feeling. Even as he paused only long enough to take a breath, the flash of another memory came up like a crystal-clear video clip.
He had been in the front row of the gallery, leaning forward as he looked down at the tiny figure on the operating table and the group of gowned and masked people towering over it. Over the loudspeaker, he had heard the consultant surgeon hand over the responsibility of closing the tiny chest to Rebecca. As they changed positions, she had glanced up for a split second and caught Thomas’s gaze through the glass window—as if to reassure herself that he was still there. That he was still with her with every step she took. And he had smiled and nodded, giving her the silent message that he believed in her. That she could do this and do it well.
That he was proud of her...
His voice sounded oddly tight as he continued. ‘A hemi-Fontan procedure was done at six months to create a direct connection between the pulmonary artery and the superior vena cava.’
Rebecca had been allowed to do most of that procedure and she’d been so quietly proud of herself. They’d found a babysitter for Gwen and they’d gone out to celebrate the achievement with dinner and champagne and a long, delicious twirl around the dance floor of their favourite restaurant.
Those ‘date’ nights had always had a particular kind of magic. It didn’t matter how frantic the hours and days before them had been or how tired they were when they set out. Somehow they could always tap back into the connection that had been there from their very first date—that feeling that their love for each other was invincible. That there could never be anyone else that they would want to be with.
The idea that the night after that surgery would be the last ‘date’ night they would ever have would have been unthinkable at the time. As impossible as losing their precious child.
Thomas didn’t actually know if it had been Rebecca who had done the final major surgery to try and improve the function of Penelope’s heart. He’d walked out by then, taking a new job in adult cardiology at a major hospital up north in the wake of that personal tragedy that had torn 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 different lifetime.
One in which giving and receiving that kind of reassurance and support had been as automatic as breathing. When success for either of them had created a shared pride so huge it could make it hard to catch a breath and when failure was turned into a learning experience that could only make you a better person. A lifetime that had been iced with so much laughter.
So much love...
It had been a long time since that loss had kicked him quite this hard. A wave of sadness blurred the edges of any anger he still had.
‘That’s not what I’m suggesting,’ Rebecca said quietly. ‘Penny deserves the best care available and, on either side of the actual surgery, you are the person who can provide that.’