His Honourable Surgeon

‘Because medicine was interesting.’ And because it was a challenge.

‘Anyone else in your family a doctor?’

Why did he want to know? It had no relevance to the way she did her job. ‘My brothers,’ she said shortly.

‘Which specialty?’

That definitely wasn’t relevant. And why did he want to know about her brothers? Charlie, with his rose-tinted glasses, would’ve said Jake was trying to be friendly. Seb—well, pre-fatherhood Seb—would’ve said Jake was a social climber, hoping that by making friends with her he’d get an introduction to the baron and invites to swish parties. Vicky was somewhere in the middle—and she wanted her brothers left out of this. ‘Not neurology.’

She’d been short with him—rude, even—but he didn’t have that you’ve-just-slapped-me-down look.

But before he could say anything else, her pager bleeped.

Perfect timing.

She glanced at the display. ‘Thanks for breakfast. I’m needed in ED.’

‘You’re not on duty yet.’ He frowned. ‘Do you always have your pager switched on?’

‘No.’ Not always. Just ninety-odd per cent of the time.

His dark eyes held a hint of amusement, almost as if he didn’t believe she’d been paged. As if he thought she’d called one of her friends from the changing room at the gym and asked them to bleep her in fifteen minutes’ time—to get her out of a potentially difficult situation.

She’d thought about it, admittedly, but she also knew it would have fuelled gossip: why did Vicky Radley want to wriggle out of having breakfast with Jake Lewis? People would speculate. Rumours would start running round the hospital. So having breakfast with him had been the lesser of two evils. And it had been work-related, anyways. ‘See you on the ward,’ she said, and headed for the emergency department.

‘Hello again,’ Hugh Francis said with a smile when she reached ED. ‘I was hoping it’d be you.’

‘What’s the problem?’

‘Mrs Carter, seventy years old, suspected TIA—but I’m not sure if it’s a very early stroke.’

‘OK. I’ll have a look. If I’m worried, I’ll admit her to our ward.’

‘Thanks.’ Hugh took Vicky through to the cubicle where Violet Carter was sitting on the bed, and introduced her.

‘I’m perfectly all right, you know. You don’t need to fuss over me—you go and see someone who’s really ill,’ Mrs Carter said.

Vicky smiled at her. ‘That’s very public-spirited of you, but I’d like to check you over.’

‘It was just a funny turn.’

‘Tell me about it,’ Vicky invited.

‘It was like a curtain coming down over one eye. But it’s gone now.’

Mrs Carter was describing a textbook case of amaurosis fugax, a typical symptom of a TIA or transient ischaemic attack, Vicky thought. ‘Anything else?’

‘I banged my knee when I answered the door, but that’s just clumsiness. Old age.’

Or another symptom of a TIA. ‘How about talking?’

‘Perfectly normal. I think our postman’s deaf, you know—he kept asking me to repeat things.’ Mrs Carter sighed. ‘I don’t know why he insisted on bringing me here.’

Vicky glanced down at the notes. ‘He was just worried about you. I think you might have had something called a transient ischaemic attack—called a TIA for short. It’s where the supply of oxygen is cut off to part of your brain, usually by a blood clot. Your body can restore blood flow and break down any little clots, so that’s why you feel perfectly all right now.’

‘So I can go home?’

‘Soon,’ Vicky said. ‘The thing is, if you’ve had a TIA it means you’re likely to be at risk of having a stroke in the future, so I want to check you over thoroughly before I let you escape. May I ask you a few questions?’

Mrs Carter nodded.

‘Have you had a stroke before, or any recent surgery?’

‘No.’

‘Has anyone in your family ever had a seizure or a fit?’

‘Not that I know of.’

‘Have you had a virus or infection lately?’

‘No.’

‘Are you taking any medication?’

‘I take water pills—the doctor says my blood pressure’s too high—but I never forget to take them, because I’ve got one of those little boxes you put your week’s supply in. My daughter got it for me.’

‘And she lives near?’

Mrs Carter sighed. ‘Yes. And she’s a worrier, so don’t you go telling her about this. I just stood up a bit too quickly when the postman rang, that was all.’

‘Did you have any pain?’

‘Not really.’

‘Where was it?’ Vicky asked.

‘You’re as bad as my daughter. She never gives up either,’ Mrs Carter grumbled. ‘Just a little bit in my chest. It’s gone now. And, before you ask, I gave up smoking years ago and I eat proper meals. None of that microwave ready-meal junk.’

Vicky grinned. She could see herself being like Violet Carter in forty years’ time. Dressed in purple and outrageously independent. ‘Mrs Carter, I respect the fact you can look after yourself perfectly well. But I need to be sure you’re not just being brave. If you do have any problems, I can give you medication for it and you’ll be fine—but if you’re not telling me something, you could end up being very ill.’ When the old lady looked recalcitrant, she added her trump card. ‘Which means I’d have to talk to your daughter, and she’d probably want you to live with her so she can keep an eye on you.’

‘God forbid!’ Mrs Carter exclaimed. ‘I’d be up in front of the bench within a week.’

‘The bench?’

‘On a murder charge. I can’t bear all that fussing. Not to mention putting up with teenagers slamming doors and listening to that rubbish they call music nowadays.’

‘Me neither,’ Vicky said feelingly. ‘So is there anything you’re not telling me?’

‘I was a bit breathless. But I told you, I just stood up too quickly.’

‘Would you let me examine you and run some tests, then?’

Violet rolled her eyes. ‘If it means you won’t tell my daughter, yes.’

Vicky smiled. From their discussion, she’d already been able to assess Violet Carter’s attentiveness, ability to interact, language and memory skills—and they were all fine. But she checked the blood pressure in each of Violet’s arms, then her respiratory rate and her temperature.

‘I’m going to look into your eyes, if you don’t mind.’ She checked for retinal plaques and the pupils’ reaction to light. Everything was fine.

Nerve testing was equally inconclusive. She started with the cranial nerves: there were no problems with Mrs Carter’s eye movements and her eyelids closed normally; there were no problems with swallowing or the movement of her tongue; and the wrinkles on her forehead were symmetrical—no sign of drooping. Somatic motor testing told her a little more—there was no sign of tremor or any problems with the major joints or shoulder girdle, though there was a slight weakness on the left-hand side. When Vicky asked Mrs Carter to walk a few steps, her movements looked fine. She was able to put her finger on her nose and her heel to her knee.

‘So are you satisfied I’m all right now?’ Mrs Carter asked.

‘Nearly. I’m going to send you for a CT scan—that’s just so I can get a better look at what’s happening inside your head.’

Mrs Carter snorted. ‘If you could read my mind right now, young lady, I think you’d be shocked.’

Vicky laughed. ‘No. I wish more people were as independent and determined as you are.’ Mara certainly wasn’t. Never had been, never would be, and Vicky was guiltily aware that too often she left Charlie to deal with their mother. Though so did Seb.

‘As well as the CT scan, I’m sending you for an ECG—that’s to check how your heart’s working.’

‘There’s nothing wrong with my heart.’

‘Good. But I’m still sending you for the tests. I want to know what caused you to have your “funny turn” —and I don’t think it was anything to do with standing up too quickly. I’d like to make sure there isn’t a clot hanging around that might give you a full-blown stroke or a heart attack.’ At Mrs Carter’s mutinous look, she added, ‘Or I could just phone your daughter.’

Mrs Carter grimaced. ‘You win. And I’d never play poker against you.’

‘Chess is my game.’

‘Never played it.’

‘If your tests make me keep you in for observations, I’ll teach you,’ Vicky promised. ‘And then you can extort promises from your grandchildren. If you beat them at chess, they have to turn the volume down and not slam doors.’

Mrs Carter gave her a narrow look, then grinned. ‘You’re on.’

‘OK, Mrs Carter. I’ll come and see you when your test results are in.’

‘My name’s Violet,’ Mrs Carter said.

‘Vicky.’ Vicky held her hand out.

‘I think you and I will rub along just fine,’ Mrs Carter said, shaking her hand. ‘You’ll tell me the truth.’

‘I will if you will.’

‘And you’ll keep my daughter out of it.’

‘I’m not promising anything until I’ve seen your results,’ Vicky warned. ‘But if I can avoid worrying her, I will.’

‘That’s good enough for me.’

CHAPTER FOUR

JAKE was in the middle of reviewing patient files ready for clinic when there was a knock on his door.

‘Come in,’ he called, and blinked in surprise when he saw Vicky. ‘What can I do for you?’

‘I’d like to discuss a patient with you.’ She carried some films and a file with her. ‘My ED case.’

So it had been a genuine case—not just a phone call from a friend she’d phoned earlier and asked to give her an excuse to get out of having breakfast with him. He’d wondered. And he was shocked at the rush of pleasure he felt now he knew it hadn’t been an excuse. ‘Sure.’

She quickly explained Violet Carter’s case to him. ‘From the symptoms, I thought it was a TIA. Carotid rather than vertebrobasilar. Anyways, the ECG shows I was right. There’s carotid bruit.’ Carotid bruit was a murmur over the carotid artery in the neck, showing that blood was having difficulty passing through the blood vessel.

‘And?’

‘I want to send her down to Radiology for magnetic resonance angiography to check the site of narrowing. If the stenosis is big enough, I’d recommend an endarterectomy.’

An endarterectomy was surgery to remove the lining of the arteries: a very delicate operation. Jake remembered what she’d said that morning about wanting more surgical experience. ‘Have you done any before?’

‘A couple by open surgery.’

‘How about endoscopically?’

‘No.’

‘Right. Let me have a look at the MRA results. If we can do it endoscopically, I’ll lead and you assist; if it’s open surgery, you lead and I’ll assist. If both sides are affected, maybe you can do one and I’ll do the other.’

Vicky nodded. ‘She’s a nice woman, Jake. I like her. Feisty, independent—she’s really going to hate the idea of being an inpatient.’

Yeah. Jake knew someone else like that. Except—

No. Now wasn’t the time to think of Lily. Or wish he’d known back then what he knew now. If only he’d insisted…But he hadn’t. He’d deferred to her wishes.

He couldn’t change the past. Only the future—for someone else.

‘Let me know when you’ve got the results. I’m in clinic for the rest of the morning.’

‘OK.’ She gave him an odd look. But he wasn’t in the mood to find out why. He just wanted to see his patients and get his head back to where it ought to be before he met Violet Carter.

When Vicky reviewed the results, she sighed inwardly. Eighty per cent stenosis—the arteries were severely narrowed, which meant nowhere near enough blood was getting through them. This was definitely a case for operating.

She went to see Violet Carter. ‘How are you doing?’ she asked.

‘Fine. Can I go home now?’ Violet asked.

‘No. I’ve found out what caused your funny turn this morning. Your carotid arteries are narrowed.’ Gently, she ran her finger along one side of Violet’s neck. ‘They run both sides of your neck and they supply the blood to your brain. If they become narrow, not enough blood or oxygen reaches your brain.’

‘So what does that mean?’

‘They’re narrowed because some fatty material in your blood sticks to the lining of your arteries—it’s called atherosclerosis. You have a choice. We can do an operation called an endarterectomy—what that does is remove the lining of the arteries and the stuff that’s starting to block them, and the lining will grow back within a couple of weeks of surgery.’

As she’d expected, Violet caught on quickly. ‘And if I don’t have the operation?’

‘They could block completely. Which means you’ll have a full-blown stroke. If you want the figures, about half of people who have a TIA have a stroke within a year, and twenty per cent of those have a stroke within a month.’

‘And if I have a stroke, I’ll have to go into a home instead of being in my own place.’

Vicky nodded. ‘You won’t be able to look after yourself. You’ll need care.’

‘If I have the operation, I’ll be all right.’

‘There are no guarantees—but the odds are loaded in your favour.’

Violet seemed to be thinking about it. ‘Would I be awake during the operation?’

‘No, you’d have a general anaesthetic.’

Violet sighed. ‘So I’m going to have to stay in.’

‘For a few days,’ Vicky explained.

‘Which means I have to tell my daughter.’

‘If you were my mum, I’d want to know,’ Vicky said.

‘Your mum’s lucky,’ Violet grumbled. ‘She’s got a sensible one who doesn’t panic and run around like a headless chicken.’

Vicky’s common sense was nothing to do with Mara. Besides, there wasn’t room for two headless chickens in a family.

She pushed the thought away.

‘I hope she appreciates you,’ Violet said.

Vicky made a noncommittal sound. Mara didn’t understand her and always said Vicky should have been born a boy. Especially after Vicky, as a five-year-old, had taken scissors to her tutu and ballet shoes and threatened to chop off her hair if anyone made her go back to ballet lessons. Mara also hadn’t appreciated Vicky getting herself expelled from finishing school in the first week. Or finding out that she could get herself made a ward of court so she could do her A-levels if Mara tried to make her go to another finishing school.

‘I’ll ring your daughter and explain the situation,’ Vicky said. ‘I can get you on this afternoon’s list, if you’d like to sign the consent form.’

‘And you’ll be doing the operation?’

‘With our consultant, Jake Lewis. I’ll introduce you to him before the operation,’ Vicky said. ‘Oh, and in the meantime…’ She pulled a magazine out of her pocket. ‘Just to stop you getting bored.’

Violet took the puzzle book and flicked through it. ‘Oh, yes! It’s got those logic problems in it. I like them.’ She smiled at Violet. ‘Thank you, love. That’s really kind of you.’

‘Pleasure. I had a feeling you’d enjoy it.’ Because Vicky could see herself like Violet, in forty years’ time. Except she wouldn’t have a daughter fussing over her, or teenage grandchildren. She just hoped a stranger would show her that same kindness.

Vicky introduced Jake to Violet, and noted approvingly that Jake treated the elderly woman with respect, rather than talking down to her. He explained exactly what they were going to do and how long she’d need to be in afterwards, and that they were going to do the operation by keyhole surgery.

Though when they were scrubbing up, she noticed the brooding expression in his eyes.

‘Are you all right?’ she asked.

‘Fine,’ he said curtly.

Hmm. Maybe it was surgeon’s nerves. Every surgeon she knew was keyed up before an operation—which was a good thing, as it meant they weren’t taking their skills for granted and there was less chance of them being sloppy. Some people talked too much when they were nervous. Jake clearly went the other way and barely spoke at all.

Jake had chosen to operate to Corelli, surprising her. She’d expected him to work to pop music rather than classical. Then she was cross with herself for reacting in the same snobbish way Mara would have done. Sure, Jake had an East-End accent rather than a posh one, but since when did the way you spoke dictate your tastes in music?

He talked her through the two-hour operation, clearing one artery himself and then giving her a chance to work on the other carotid artery. She liked the way he worked: deft, neat, precise. But as soon as the operation was over he seemed to switch back to the brooding, uncommunicative man he’d been while scrubbing up.

Something was wrong. Not the operation—it had been a complete success. She didn’t think it had been anything she’d done either. So had this op brought back bad memories? A patient he hadn’t been able to save?

When Violet was out of the recovery room and had settled back on the ward—with her daughter fussing round her bedside—Vicky quietly slipped out to the canteen on her break. She bought a slice of carrot cake and two coffees—he took his black and sweet, she remembered—then headed for Jake’s office and rapped on the door.

‘Come in.’

He was doing paperwork at his desk, and there was strain in the lines of his face.

‘What’s this?’ he asked when she closed the door behind her and put the coffee and cake on his desk.

‘Carrot cake.’

Cake. The Hon. Victoria Radley had brought him cake. ‘Why?’

She shrugged. ‘The men in my life are cake addicts.’

Jake tried to squash the pinpricks of jealousy. He had no right to be jealous. She was a colleague—a distant colleague at that, barely even an acquaintance. The men in my life… He didn’t think she meant that she had a string of men, but clearly she’d been good at keeping her relationships secret from the hospital grapevine. ‘Oh.’

‘Our cook made the best cake in the world,’ she said, almost as if explaining. ‘Which is why both my brothers are putty in the hands of any woman who gives them cake.’

Jake frowned. Was this her way of saying she wanted him to be putty in her hands? Or was she just explaining about the men in her life—her brothers?

As if in answer to his unspoken question, she said quietly, ‘You looked upset earlier. I wanted to make you feel a bit better. It’s also an apology for running out on you over breakfast this morning.’

He shrugged. ‘No problem. You were paged.’

‘Want to talk about it?’ she asked.

Then he realised what was going on. Vicky had made a fuss over little Declan, who’d been bullied. She’d fussed over Violet, too, but on the old lady’s terms—practical things, like bringing her a puzzle magazine. And now she was quietly adding him to her collection of lame ducks, bringing him cake and offering him a sympathetic ear.

‘I’m fine,’ he said stiffly.

‘No, you’re not. It’s something to do with Violet.’

How did she know?

She must have been able to read his mind, because she said quietly, ‘She got to me, too. I never really knew my grandparents because they died when I was very young. Violet’s the kind I would’ve liked as a gran.’ Her smile was suddenly bleak.

Jake knew exactly where she was coming from. The same place as him. Loss and loneliness. ‘She reminds me of my nan,’ he admitted.

‘You were close to her?’

He nodded. ‘She brought me up. My mum was a singer and Dad was her manager. They were always on the road, and Nan refused to let them drag me along with a home tutor or put me in boarding school. She said kids need a steady place to grow up.’ He looked away. ‘They were in America, flying interstate on my mum’s first US tour, when their plane crashed.’

He was half expecting Vicky to trot out the usual platitudes or try to work out who his mum was, but she surprised him. ‘Hard for you. How old were you?’

‘Twelve.’

‘That’s a really tough age to lose your parents.’

Something in her voice made him look at her. The expression on her face…she knew exactly how it had felt. It had happened to one of her schoolfriends, probably. Another of her lame ducks.

‘Yeah. But at least I had Nan.’ Then, to his horror, the words he’d tried to bury whispered out of him. ‘I just wish she’d seen me qualify.’

‘Missed it by much?’

‘Two terms.’

‘Ouch. But, if it helps, she’d have known from your prelims that you’d qualify.’

At least Vicky hadn’t gushed that his gran would have been proud of him. He appreciated that, because how did you ever know exactly how someone else felt—especially if you’d never met that person? That kind of reaction always drove him crazy.

Vicky Radley, on the other hand, was calm, practical and sensible.

He took a sip of his coffee to buy himself some time, and discovered that Vicky had sweetened it exactly to his taste. Which meant she was observant. He already knew she was clever, so she’d probably guess whatever he didn’t tell her. So he may as well spill the rest of it. ‘Nan died of a stroke. She had a TIA first, except she wouldn’t admit there was anything wrong. It was only when our neighbour found her that she admitted she’d had a “funny turn”. I rang home that night and got Bridget, who told me. I tried to get Nan to see her GP for a check-up at the very least. But she insisted it was nothing and I was making a fuss. Nan was one of the old school.’

‘Stiff upper lip?’

‘Sort of.’ Though not posh, like Vicky’s family. Lily Lewis had had backbone. ‘She grew up in London during the Blitz. She hated being evacuated, so she ran away and made her way back to the East End. The way she saw it, if she managed to get through the war without being hit by a flying V, she wasn’t going to let anything else throw her.’ Including losing her only child. Lily had been the rock Jake had leaned on after the plane crash, and, even though her heart must have been breaking, she’d held it together for his sake. ‘She’d just take the “funny turns” in her stride and pretend they hadn’t happened.’

‘TIAs.’

‘Yeah. She wouldn’t listen to me. And she ended up having a stroke.’

‘So that’s why you specialised in neurology?’ she guessed.

He didn’t want to answer that, though he guessed that the muscle he felt tightening in his jaw would give him away. ‘If you hadn’t persuaded Violet to let us do the endarterectomy, I’d have told her about my nan.’

‘Bullied her into having it done?’

‘Guilt-tripped her into it,’ Jake corrected. Then he saw a flicker of a grin on Vicky’s face. ‘What?’

‘Beat you to it. I told her the stats and let her work it out for herself: she could have it done and go back to her own home, or risk a stroke and being stuck in a care home. Or—worse, in her view—being fussed over in her daughter’s home.’

‘You understand your patients well.’ With a flash of intuition, Jake guessed, ‘You’re the same, aren’t you? You hate being fussed over.’

She nodded. ‘Worst nightmare. Comes of being the youngest of three—and the only girl.’

‘I remember you told me your brothers are both doctors. What are their fields?’

‘Plastics and ED. And they insist on referring to me as “our baby sister, the brain surgeon”.’

Teasing, but he’d guess that they were proud of her. And that they knew exactly what she was like: if they made a fuss over her and told her how they felt, she’d shut them out. So they teased her instead, saying the words in the way they knew she’d accept them.

Her family. People who loved her. Jake forced the surge of envy down. He’d made his decision years ago. Losing one family—his parents—had hurt enough. Losing his second, his nan, had been even harder. And he wasn’t going to risk it a third time. He’d go out with the crowd, sure. But he wasn’t letting anyone close. Wasn’t going to have another family that he could lose.

And that included Vicky Radley. Despite the fact that his whole body yearned to touch her, hold her, he wasn’t going to take the risk.

Asking her to breakfast this morning had been a mistake. He’d been listening to his libido instead of his common sense. Well, he wasn’t going to make that mistake again. ‘Thanks for the coffee and cake,’ he said, though he hadn’t touched a crumb. ‘See you later.’