A Change Of Heart

‘Just as well you weren’t given this office,’ she commented lightly. ‘It wouldn’t do to provide a surgeon with such blatant distractions.’

Something about her inflection made David’s gaze transfer swiftly. ‘You’ve got something against surgeons?’

‘Nothing personal.’ Lisa’s smile looked mechanical. ‘I’m sure you get a lot of job satisfaction.’ She toyed with the rose she was still holding.

David leaned his back against the windowframe. So this was what the attitude was all about. He smiled encouragingly. ‘What’s so wrong with being a surgeon?’

‘Oh, there’s nothing wrong. Quite the opposite.’ Lisa’s eyebrows moved up expressively. ‘A surgeon is the best thing to be. Ask any patient. Wait for that awed gaze when they know they’re going to be referred. They’re going to see the real thing.’ Her chuckle was genuine enough. ‘God holding a knife. A chance of a real cure.’

David held onto his smile with increasing difficulty. ‘OK, so it’s a bit more glamourous. That’s not my fault.’

‘More glamourous, more important, more skilled and more highly paid. A hell of a lot more highly paid.’

‘Ah! Now we get down to it.’ David’s smile was forgotten. ‘You’re jealous!’ David felt a flash of annoyance at her belligerent attitude and his control slipped significantly. ‘So what stopped you becoming a surgeon, then? Course too tough?’

‘Typical!’ It was a wonder the rose didn’t wilt under the heat suddenly generated around it. ‘You’re not good enough to be a cardiac surgeon so you take the easy route and become a cardiologist. Exactly the attitude from most surgeons and more than most of the general public. What you—and they—fail to appreciate is that you couldn’t function without us.’

‘Really?’ David’s anger had been overidden by a very different emotion. He had never been tempted to try the line that a woman looked beautiful when she was angry but, then, he wasn’t in the habit of making women angry. Passionately angry, judging by the play of expression before him now. The rose was tossed aside.

’Really.’ It was a snap like a steel trap. ‘Who diagnoses these patients? Keeps them alive and makes the decision about whether surgery is even necessary?’

David couldn’t take his eyes off her. Her guard had really slipped now. He had never seen a face quite so alive. ‘I think we might have a little input into that one,’ he suggested evenly. Lisa ignored him.

‘Who continues the care after the surgery? They’re our patients from go to whoa. Sure, we might need the technical assistance with a bit of replumbing in the interim but that’s as far as it goes. We create your workload and we pick up the pieces afterwards. And we carry the can for any less than successful interventions. Envious! Listen, I know who the real doctors are.’

The end of the tirade coincided with the abrupt termination of the neighbouring exercise test. The silence was startling. David was still staring at Lisa. He had been watching her mouth with fascination, the soft, mobile lips now set into an uncompromising line. He met her eyes, disappointed to find that the fire had been extinguished. David raised an eyebrow eloquently but said nothing. The blush he saw appearing was unexpected.

‘Sorry.’ She looked away and her voice dropped to a mutter. ‘I shouldn’t take it out on you.’

‘Take what out?’ David’s curiosity was aroused. Perhaps there was more going on than an irrational professional intolerance.

‘It doesn’t matter.’

‘It seems to matter quite a lot.’ David tilted his head thoughtfully. ‘If I’m stepping into some political minefield, I’d prefer to get some idea of whose toes I should avoid treading on. Apart from those I’ve irreparably damaged already.’

‘Oh ? Like whose?’

‘Yours. You weren’t exactly happy at being evicted from your office—at least not by a surgeon.’

‘I don’t give a damn about the office. I knew it was only a temporary luxury. It wasn’t that I was…’ She shook her head and then pushed a stray curl back from her face. ‘Never mind. Don’t concern yourself about my toes, David. They’re indestructible.’ The smile was apologetic, embarrassed even, and David was happy to return it despite the attack to which his specialty had been subjected.

‘Like your heart, yes?’

‘You got it.’ Lisa nodded, reaching for the phone as her beeper sounded. The silence was brief. ‘What’s the blood pressure now? OK, stop the TPA infusion. I’m on my way.’

She was gone. David moved slowly as he followed her example. Without her physical presence he found himself thinking more about exactly what she’d said. So, he was a glorified plumber, was he? Nothing personal, though. Strangely enough, the attack hadn’t felt personal at the time, but David found a new wariness nibble at the edge of his confidence. If that was the general attitude of the whole cardiology department then the obstacle to gaining respect might be a much bigger hurdle than simply exorcising any rumours about his past.

Thank goodness for a friendly face. It was late that afternoon that David encountered a welcome he’d been waiting for. It came at the end of what now seemed like a very long day.

‘Mike! Where the hell have you been hiding?’

‘Cath lab all morning. Then we had an emergency angioplasty this afternoon. Some of us have to earn a living, mate.’

David shook his head, confident that Lisa Kennedy’s opinion of surgeons was not being reinforced from this quarter. ‘It’s good to see you, mate. You’ve been the world’s worst correspondent.’

Michael Foster grasped the outstretched hand and then slapped David on the shoulder. ‘Look who’s talking! We must have about five years to catch up on. God, it’s good to see you, Dave.’

‘Likewise. Got time for a coffee?’

‘I’ll make time. What’s the point in being a consultant if you can’t manage that?’

‘I thought you’d be head of the cardiology department by now.’

‘Give me time. I’ve had a rough couple of years.’

‘Oh?’ David’s face was concerned as he followed his friend into the small staffroom. ‘What’s happened, Mike?’

‘Anne and I split up six months ago. Things were pretty difficult for a long time before that.’ Mike spooned coffee into the mugs but glanced up to catch David’s expression. He laughed ruefully. ‘You were right all along, mate. Marriage is the quickest way to ruin a good relationship.’ He handed David a steaming mug. ‘I should have listened to that lecture you gave me. I just wish you hadn’t waited until my stag night.’

David smiled but was disturbed by the shadows in Mike’s eyes. He tried to lighten the atmosphere. ‘You should have listened,’ he said sternly. ‘Like I always said, ‘‘Why buy a book when you’ve got a whole library to choose from?’’’

The incredulous snort from behind David made his head turn sharply. In his concern for Mike he had managed to walk right past the figure curled into the armchair beside the door. Mike followed his glance.

‘Have you met my registrar, Dave? This is Lisa Kennedy.’

‘We’ve met.’ David winked at Lisa. ‘In fact, I’ve already broken her heart.’

Mike laughed. ‘That was quick even for you, mate. But I don’t believe a word of it. Lisa’s the one that leaves the trail of broken hearts around here. The job description for that vacancy is a bit hard to measure up to, isn’t it, Lisa?’

‘Oh, please!’ Lisa uncurled her long legs from the depths of the armchair and reached for her shoes. ‘I’m sure David James isn’t remotely interested in my love life, Mike.’

‘Oh, I wouldn’t say that,’ David murmured. He watched appreciatively as Lisa eased on her narrow, heeled black shoes. Very elegant footwear, he concluded. And a perfect match for the rest of her outfit.

‘Well, I’m not remotely interested in sharing it.’ Lisa stood up gracefully. With her heeled shoes she was only an inch or two shorter than David’s height of six feet.

Mike laughed. ‘That’s the problem, isn’t it? You’d better watch out, though. You’ll probably be well up on David’s required reading list.’

Lisa deposited her mug into the sink, turned and met David’s eyes with a direct stare.

‘My collection doesn’t include paperbacks, sorry. Or over-popular fiction. I prefer something with a bit more quality…and durability.’

Mike’s exaggerated indrawn breath feigned fear at Lisa’s attack beautifully. Much to David’s relief, it was enough to break the hold that Lisa’s eye contact was having. Her short chuckle was dismissive. ‘See you later, Mike. Some of us have work to do.’

David wasn’t included in the farewell. Something flicked off at the dismissal and David was acutely aware of an emotional U-turn. OK, he’d been attracted but now he’d come to his senses. He’d been wrong in his assumption that the woman was attached and now he could see why. With blinding clarity. She was rude, snooty and totally unapproachable. And as for her attitude towards surgeons! Well, David James knew where he wasn’t welcome and he certainly wasn’t going to waste any more time trying. Lisa Kennedy wasn’t going to be on any list as far as he was concerned.

Mike hadn’t failed to notice the line of David’s intense stare.

‘Gorgeous, isn’t she?’

‘Mmm.’ David’s tone was carefully noncommittal. ‘Shame about the personality.’

CHAPTER TWO

PERHAPS it wasn’t so great to be back after all.

Feeling out of sorts was such an infrequent experience that David was seriously disturbed. Lack of sleep hadn’t helped. Had it been a medical emergency that had kept him awake most of the night he wouldn’t have thought twice about it. In fact, the adrenaline would still be running and he’d be in top form for at least another twelve hours. It was his accommodation that was problematic. The temporary arrangement for the room in the staff quarters had seemed perfect, but the walls were thin and the young medic next door had clearly scored in a big way with a woman who seemed to find the whole business excruciatingly funny. A pneumatic drill would have been much less disruptive than her giggles. Even when he’d finally managed to fall asleep the experience had been less than restful.

‘It was a nightmare,’ he related solemnly to Mike Foster. ‘Crushing chest pain, electrodes plastered all over me and Lisa Kennedy standing at the end of the bed…Smiling.’ He punctuated his tale with a woeful groan.

Mike grinned. ‘Lisa’s OK. Don’t judge her on the basis of one bad day.’ He pointed to a fire-stop door coming up on their right. ‘Let’s take a short cut.’ Mike led the way up the stairs. ‘If anybody’s kept me sane over the last year it’s been Lisa.’ He shot his companion a quizzical glance. ‘In fact, she’s a lot like you.’

‘What a ghastly thought!’

‘She works bloody hard, plays just as hard, great sense of humour…’ Mike was sounding breathless. ‘And a body to die for.’

‘I plan to keep living,’ David muttered.

‘You’d be perfect for each other.’

‘I doubt it. She thinks I’m a glorified plumber. A knife-wielding technician with a God complex. Surgeons suck.’

‘Ah! Well, there’s a bit of a history there.’

‘Oh, yeah?’ Despite himself David felt curious. By tacit agreement the two men paused at the top of the stairs, screened from the corridor by another set of fire-stop doors. ‘Perhaps you’d better fill me in.’

‘Have you met Lewis Tanner yet?’

David shook his head. The hospital’s third cardiothoracic surgeon had not put in an appearance during his tour of introduction yesterday.

‘Lewis arrived about eighteen months ago—about the same time Lisa started here. ‘‘Sex on wheels’’, as one nurse was heard to report. Wealthy, confident, charming and…single.’

‘And Dr Kennedy fell for him.’ David nodded, feeling somehow disappointed.

‘Not exactly. He fell for Lisa—in a big way. She did go out with him a few times.’

‘And?’

Mike glanced around them and lowered his voice. ‘Lewis presented her with an engagement ring. A rock that could have given her carpal tunnel syndrome if she’d worn it for any length of time.’

‘A generous man.’

‘Mmm.’ Mike bit back a smile. ‘Unfortunately he was overheard by a secretary telling your predecessor that he had no intention of marrying Lisa. The engagement seemed to be the price he’d have to pay to get her into the sack, so he was happy to fork out and with a bit of luck he might even get the ring back later.’ Mike cleared his throat expressively. ‘Word got around, you know?’

‘I know.’ David smiled wryly. He looked at Mike curiously. ‘So Lisa knew what was going on, then? I take it she didn’t accept?’

‘Oh, she accepted it. She returned it a day or two later. Lewis was not impressed.’

David said nothing. He had a feeling there was more to the story. Sure enough, Mike laughed quietly but gleefully as he gave another quick glance over his shoulder.

‘Lisa had the ring valued. She put it in a clear plastic envelope with the formal valuation. She also put in an address of a local house of pleasure with a suggested list of services—all couched in the most tasteful euphemisms—that added up to the exact worth of the ring. Then she posted it in the internal mail system.’

David whistled silently. Half the hospital had probably seen it before it arrived at its destination. And the other half would have heard about it.

‘Photocopies of the list still surface occasionally,’ Mike added wonderingly. ‘It was a major form of entertainment for months, trying to guess what some of those services might actually be. Even Lewis came to see the funny side—or pretended he did. I suspect it bumped up his estimation of Lisa Kennedy no end but he had no show after that.’

‘I’ll bet.’ David shook his head. ‘No wonder she’s not too keen on surgeons.’

‘Don’t take it personally.’

‘Funny, that’s what she said.’

‘She goes out with Alan Bennett now.’

‘What?’ David was appalled. ‘He’s old enough to be her father.’

‘It’s a convenient arrangement. They accompany each other to medical functions. Lisa’s great company.’

‘So it would seem.’ David’s tone was ironic. ‘Is there anyone she doesn’t go out with?’

Mike laughed again. ‘Yeah—Lewis Tanner.’

‘Can’t wait to meet the guy.’

‘You don’t have to wait,’ Mike promised. He pushed the door open. ‘Let’s go and see if he’s putting in an appearance at this meeting for once.’

Lewis Tanner would be in his early forties, David guessed. He was charming, sure enough. His welcome for David and apologies for missing his visit the day before were quite sincere. David eyed dispassionately the tall, impeccably dressed figure, the smooth, glossy black hair, the blue eyes and the automatic smile. David had more than a passing interest in keeping up his own appearance but Lewis Tanner made him feel distinctly scruffy. Perhaps it was the silk handkerchief or the miniature carnation in his buttonhole. Or maybe it was the unnaturally high sheen on his black shoes. Instinctively, he disliked the man and he spent the first ten minutes of the meeting trying to fathom out why.

The meeting was a regular weekly occurrence. Cardiology staff presented their referrals for surgery and decisions were made on priorities and theatre lists. The cardiothoracic team had a similar meeting later in the week with the respiratory department. David was only half listening to Lisa as she went through the scoring system on the sixty-two-year old woman being referred.

‘Severe triple vessel coronary artery disease,’ Lisa stated. ‘Left main stem was normal but there is a seventy to eighty per cent stenosis on the left anterior descending. Dominant right coronary artery with an eighty per cent lesion in its mid-conduit portion and further fifty per cent lesion prior to the origin of the posterior descending artery.’

David watched Lewis Tanner who was watching Lisa. There was no hint of any personal animosity or long-held grudges. It was interesting to note that Lisa could hold a professional relationship with someone who had failed so stunningly to make it on a personal basis. There was hope for David yet. Lewis was nodding occasionally in agreement and his expression suggested that he was impressed at Lisa’s presentation. From the angle David was sitting at he could follow the line of Lewis’s gaze quite accurately, however.

Lisa had crossed her legs and David had to admit that the glimpse of thigh offered by the split skirt was arresting. When Lisa paused momentarily in her summary he glanced up and was startled to find her eyes fixed on him in a baleful glare. She looked away as soon as David caught her eye and continued her presentation, but he could have sworn her lip curled fractionally. It was only then that he realised what had caused her disgust. His tie felt suddenly over-tight. He adjusted the knot with a casual movement but his lips were pressed firmly together. Damn the woman! Now she assumed he had been sitting there thinking of nothing but her legs!

‘Class one angina with ongoing pain at rest,’ Lisa finished up. ‘The echo shows a well-preserved left ventricular function with an ejection fraction of eighty per cent. We recommend urgent revascularisation.’

‘Of course,’ Lewis murmured. ‘Let’s get her on the list for this week.’

That was it. David forgot about Lisa—her legs, her attitude problem and even her scary ability to publicly humiliate surgeons. He found himself nodding but his agreement had nothing to do with the patient. He realised why he didn’t like Lewis Tanner. The man was assuming a controlling influence in the group even though the heads of both departments were sitting nearby. He oozed confidence in his own opinion and reeked of assumed power.

David’s glance shifted to Alan Bennett. The older surgeon’s face was impassive as he nodded agreement but David could sense the undercurrent. He swore silently. What kind of interpersonal warfare had he stepped into? He resolved to keep silent until he got a better feel for what was going on.

He didn’t have long to wait. Mike Foster launched into a polite but clearly personal criticism of Lewis Tanner.

‘We don’t seem to have resolved the communication difficulties between departments, Lewis. The Monday morning elective angioplasty slot is required to have surgical back-up for any emergency. You were covering this slot yesterday.’

Lewis raised his hands, palms upward, the diamond on his signet ring catching the light. ‘I know, I must apologise again. It was—’

Mike interrupted him. ‘It was a potential disaster. We had our patient on the table, sedated and finally psyched up for what she viewed as a major procedure. We were unable to contact you to confirm your availability.’

‘That’s because I wasn’t available.’

‘Precisely. Owing to the lack of communication, the only indication we received was the message that your cellphone was switched off.’

‘I had an emergency at Greenpark. As you know.’ Lewis Tanner’s tone suggested that the explanation should not have needed repeating. David’s brow creased thoughtfully. Greenpark was a private hospital. He had declined his own offer of operating privileges there.

‘Our patient was highly stressed by the delay and eventual cancellation of her procedure. She went on to have an acute myocardial infarction and required emergency angioplasty yesterday afternoon. For which, fortunately, surgical back-up is not mandatory.’

Lewis’s shrug was barely noticeable. ‘She got her procedure done, then, didn’t she?’ He shot back a cuff to expose a discreet gleam of gold. ‘I’m running out of time here. Is that it for today? Looks like we’ve got a full case load for the week.’

‘No, that’s not it for today,’ Lisa snapped.

David rather enjoyed the look of irritation on Lewis Tanner’s face but it was gone as quickly as it had come.

‘I would like further discussion regarding the case of Desmond Knight. He was readmitted yesterday with intractable angina. In the last four weeks he has spent eighteen days in the coronary care unit. His need for surgery has become progressively more urgent.’

This time the shrug was pronounced. ‘I reviewed the man last week. He’s not a good risk. He’s hypertensive, hyperlipidaemic and overweight. Above all, he’s still smoking. As I told him, he has to be prepared to take some responsibility for the outcome of his surgery. I’m not prepared to operate until I have concrete evidence that he’s given up smoking and is making an attempt to lose weight.’

‘His level of angina precludes any form of exercise.’ Lisa was clearly angry. ‘He had cut down to one cigarette a day. The stress of receiving your letter suggesting that surgery would not be available was enough to push him back into it. He’s forty-three years old with four children to support. He hasn’t been able to work for six months. I’m quite confident that a chance to live a normal life will be more than enough incentive for him to make the appropriate lifestyle changes post-surgery.’

‘It hasn’t been enough of an incentive so far.’

David’s resolve to stay silent evaporated. ‘Is this a departmental policy?’ he enquired.

‘No, it’s not.’ Alan Bennett broke the tense silence. ‘Lewis’s principles are well known but not necessarily shared to the same degree. Desmond Knight was referred initially to Lewis but I think a change of consultant at this point might be advisable.’

‘I’ve got a theatre slot tomorrow morning,’ David announced. ‘Has that been filled?’

‘No.’ Alan Bennett smiled. ‘We planned to ease you in gradually.’

‘I’m more than happy to start operating immediately,’ David offered. He smiled at Lewis Tanner. ‘As long as you don’t object to me poaching one of your patients?’

‘Not at all, old chap.’ Lewis smiled back. ‘Are you sure you want to? Operating on no-hopers like Mr Knight will play merry hell with your statistics.’

‘I’ll take the risk.’ David felt as if his smile was glued on. The eye contact with his colleague was challenging. He definitely did not like this man. No wonder Lisa Kennedy was prepared to loathe cardiac surgeons on sight—particularly when they made it obvious they found her attractive. The thought made him shift his glance. The expression on both Lisa’s and Mike’s faces was enough reward for any risk he might be taking, politically or otherwise. If there was a line drawn in the sand here it seemed that David had unintentionally chosen which side to stand on. He was surprised at how good it felt.

‘Did you hear the one about the cardiac surgeon who told his patient that he had some good news and some bad news?’

‘Probably.’ David grinned. ‘I reckon I’ve heard them all by now.’ Desmond Knight was a bit of a character and they had established a quick rapport during the introductory interview David had just concluded. ‘Is the good news that you have twenty-four hours to live and the bad news that I should have told you yesterday?’

‘No.’ Desmond Knight chuckled. ‘The bad news is that he’s only got a week to live.’

‘And the good news?’

‘Well, the surgeon points to a nurse who’s really…’

‘Stunningly gorgeous?’

Desmond nodded enthusiastically. ‘And he said, ‘‘You see that great-looking nurse over there?’’ The patient looks and then he nods eagerly and looks back at the surgeon kind of hopefully and the surgeon says, ‘‘Well, the good news it that I’m taking her out on Saturday night.’’’

David laughed with genuine amusement. He even looked in the direction Desmond had been pointing, but there was no nurse, stunningly gorgeous or otherwise. There was, however, an impressive expanse of pink candlewick—a back view of Mrs Judd, her walking frame parked in the doorway as she stopped to catch her breath. David caught Desmond Knight’s eye.

‘Rather you than me,’ Desmond murmured.

The pink tidal wave receded, replaced almost instantly by the slim figure of Lisa. The contrast was astonishing and Desmond’s face brightened considerably.

‘Hi, Doc.’

‘Hi, Des. I see you’ve met our new surgeon.’

‘He tells me I’ll never play the violin again.’

‘You couldn’t play it before.’ Lisa’s smile was only for her patient but David could sense its warmth and felt oddly excluded.