His Honourable Surgeon

‘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 (#u1bf1a218-724b-5e67-a93b-fe4c4dc27921)

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.’