The Heart Consultant's Lover. Kate Hardy
Miranda said, then talked the junior doctor through placing the rest of the leads. ‘Great. You’re done.’ She switched the monitor on. ‘The trace shows the electrical activity of the heart so we can see what’s going on. We can tell if someone has had a heart attack, and roughly when it was—in the last few hours, days, weeks or months.’ She let the machine run until she had a strip of a dozen heartbeats, and turned it off. ‘This is a good example of normal sinus rhythm. There’s a small rise here at P just before the upper heart chambers contract.’ She marked it with a cross and labelled it ‘P’. ‘Then there’s the QRS spike…’ again, she labelled the points on the trace ‘…which happens just before the lower heart chambers contract. And finally there’s the rise at point T at the end of the beat.’
‘To find the number of heartbeats per minute,’ Jack added, ‘you measure how many big squares there are between the R points—what we call the “R-R interval”. The ECG machine usually runs at twenty-five millimetres per second so you just divide three hundred by the number of big squares.’
‘Some machines run at fifty millimetres per second, so always check if you’re not sure,’ Miranda added.
Hannah looked at the trace and did a quick calculation. ‘Three hundred divided by four—that’s seventy-five.’
‘Well within the normal resting range,’ Miranda pronounced.
She couldn’t help looking at Jack. And there was a distinct question in his eyes which she dared not answer. She forced herself to think of work. ‘Do we have a book of sample traces, Jack?’
‘For teaching? Yes—I’ll go and get it.’ He removed the leads. ‘You’ll be surprised how quickly you learn to spot the differences in the waves and what they mean,’ he told Hannah. ‘When you first start, you think you’ll never remember them all, but you’ll soon get the hang of it. And you can always ask one of us if you’re not sure. We won’t mind or think you’re stupid. We’ve all been in the same position.’
Miranda fiddled with the machine until she heard Jack put his white coat on again. Her face felt hot and she hoped it wasn’t too obvious. She could claim that her office was too warm—it was unusually hot for March—but she had a nasty feeling Jack would guess why she was flushed.
She needed to get her professional objectivity back. Fast.
And then she heard the call, ‘Crash team!’
‘We’ll carry on with the traces later,’ she told Hannah. ‘Come on, we’re needed.’
She walked quickly out into the ward and saw the light flashing above the door of Room One. Her heart sank. No. Please, not Imogen, she thought.
Jack was already there, giving CPR at the rate of five chest compressions to one breath, while Leila was getting the defibrillator ready.
‘She’s in VF,’ Leila said. VF, or ventricular fibrillation, was an abnormal heart rhythm—it meant Imogen’s heart was contracting quickly but not effectively.
Miranda went straight into action and attached the defibrillator paddles to Imogen’s chest so Leila could check the monitor. ‘Charging to 360. And clear,’ she said. Jack stopped the CPR so Miranda could shock Imogen.
‘Still in VF,’ Leila said, watching the monitor closely.
‘Have you given her adrenaline?’ Miranda asked.
‘Not yet,’ Leila said.
‘Hannah, get me some adrenaline now. Charging to 360. And clear,’ Miranda repeated. Imogen had to respond. She had to. They weren’t going to lose her.
‘Still in VF,’ Leila reported.
‘Charging. And clear,’ Miranda said.
‘She’s back in sinus,’ Leila said. ‘Well done.’
Tears pricked the backs of Miranda’s eyes. Thank God. ‘Jack, we can’t wait until tomorrow morning for the angioplasty. Not now she’s had an MI.’
‘Bypass?’ he asked.
‘Yup. I’ll call Jordan and sort out a slot in Theatre now. Can you prep her?’
‘Will do,’ he said.
‘Leila, can you get in touch with Emma and tell her that we’re taking her great-aunt down to Theatre now, please?’ she asked.
‘Will do,’ Leila said.
‘Hannah, check if Leila needs you for anything—if not, you’re welcome to come and observe,’ Miranda continued.
‘Thanks,’ Hannah said, flushing faintly.
Miranda rang Jordan and organised an emergency theatre slot. On the way down to Theatre, Imogen arrested again but Jack managed to bring her back. Before Miranda could make the first incision, Imogen arrested again.
‘Come on, come on,’ Jack said. ‘We’re not letting you go, Imogen. Stay with us. Charging. And clear.’
But this time they couldn’t bring her back.
‘It’s been twenty minutes,’ Jack said softly as Miranda continued CPR. ‘Do you want me to call it?’
‘No. We can’t give up now.’ She continued giving CPR. ‘Come on, Imogen. You have to stay with us.’
But it was no use. Gently, Jack put his hands over hers. ‘I’m calling it,’ he said. ‘She’s been down too long.’
‘No.’ Miranda shook her head in frustration. ‘No. We can’t have lost her.’
‘She’s gone,’ he said, his voice compassionate yet firm.
Miranda nodded dully, then glanced at the nurse’s watch on her white coat. ‘Time of death, three twenty-four.’ She stroked the old lady’s forehead. ‘I’m sorry, Imogen. I’m so, so sorry,’ she said softly, then turned away. ‘I’d better go and ring Emma.’ She swallowed hard and walked back to her office to ring Imogen’s great-niece.
‘But—but she was going to have her operation! I thought she was going to be all right,’ Emma said. ‘You said you were going to put a balloon in her arteries to clear them, and it would stop her getting the pain any more.’
‘I’m so sorry, Emma. We did everything we could. But her heart had just had enough.’
‘Poor Imogen. She was…It’s my fault,’ Emma said. ‘We should have had her to live with us.’
‘It wouldn’t have made any difference,’ Miranda reassured her. ‘And it wasn’t your fault at all. She was ill.’
‘I should have done more.’
‘You did your best. You came in to see her when you could, and rang when you couldn’t—and it isn’t easy to care for an elderly relative when you have three small children to look after as well.’ Easier if you didn’t have children. She could have done more for May. But she hadn’t, had she?
‘I can’t believe she’s gone.’ Emma’s voice was unsteady. ‘And Floss…I don’t know what we’re going to do about Floss. We can’t have a dog—we’re renting and the landlord won’t let us have pets, not even a hamster. We can’t keep her in kennels but I can’t have her put down. She’s not that old and she’s not even ill.’
‘I’ll see what I can do,’ Miranda promised. ‘Someone here might be able to give her a new home.’
‘Can I…can I come and see my great-aunt?’
‘Of course you can. And I’ll be here if you want to talk to me.’
‘Thank you.’ Emma was clearly crying as she rang off.
Miranda returned the receiver to its cradle, put her arms on her desk and rested her head on her arms. If only she’d done the angioplasty the day before. If only…
She