A Change Of Heart

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.

‘I’ve just been explaining the surgery to Desmond here. We’re scheduled for 8 a.m. tomorrow.’

Lisa nodded. ‘I wondered if you had the time now to review everything. I’ve got all the notes and I’ve set up the cardiac catheter film in the viewing room if you want to see it.’

‘Of course. I was about to call you.’ David turned back to Desmond. ‘Try and have a good rest and I’ll see you in the morning.’ He leaned forward conspiratorially. ‘I’d better check out the home movie you had done in the cath lab. I wouldn’t want to miss a bit of plumbing that needs attention.’

‘Make sure you do the bolts up nice and tight. That’s what bothers me.’

David could see the fear beneath the levity. He reached out and gripped Desmond’s hand briefly. ‘No worries, mate. I’ll get you running on full bore and leakproof.’