‘Does it hurt anywhere else?’ Sophie asked.
‘My shoulder. The left one.’
Kehr’s sign, meaning that there was definitely a problem with Sophie’s spleen, In addition to that, Katrina’s abdomen was distended and Sophie already knew there was an internal bleed, thanks to Paul’s lavage.
‘Mr and Mrs Jackson, I think your daughter has a ruptured spleen,’ Sophie explained to Katrina’s parents. ‘She’s going to need an operation.’
‘She can’t have a transfusion,’ Mrs Jackson said immediately. ‘We’re Jehovah’s Witnesses. It’s against our religion.’
‘I’ll do my best to respect your wishes,’ Sophie said. ‘I need to take a closer look—I’ll do a procedure called a laparotomy. It’s a small incision in her stomach, and it will show me how bad the damage is. I may be able to glue it back together if the damage isn’t too bad, but I might need to remove her spleen.’
‘She can’t have a transfusion,’ Mrs Jackson repeated.
‘As I said, I’ll respect your wishes as far as I can,’ Sophie replied.
‘If there are complications during surgery and she needs blood, she could die without a transfusion,’ Charlie warned quietly.
Mrs Jackson’s face was set. ‘I know my rights. You can’t give her a transfusion without my permission, and I won’t give it.’
‘I know. But I have responsibilities to my patient, too. In an emergency, my priority will be to save your daughter’s life,’ Sophie explained.
‘If it’s willed …’ Mrs Jackson shook her head. ‘No.’
‘All right, Mrs Jackson. If you’ll excuse me, I just need a word with my consultant.’ Sophie looked at Charlie and slid her eyes sideways, indicating that she wanted a word away from the Jacksons.
‘What?’ he asked softly.
‘I’ve got a hunch that Katrina’s dad doesn’t feel the same way as his wife. Can you do me a favour and keep Mrs Jackson talking while I have a quick word with Mr Jackson?’
‘Sophie, you’re opening a can of worms here,’ Charlie warned.
‘What’s the choice? A row between the parents or the unnecessary death of a child. I know where my vote goes. We haven’t got time to fight. Please. Just keep her talking.’
He nodded. ‘I’ll explain autologous transfusion and see what her views are on that. But if you get the slightest indication from Katrina’s father that you’re going the wrong way, stop. We’ll get a co-ordinator in to do the talking for us.’
‘But—’
‘No arguments, Sophie.’
His accent was suddenly cut-glass, and it raised her hackles—particularly as she knew he was right. ‘OK. I’ll tread carefully,’ she promised.
While Charlie talked to Mrs Jackson, Sophie drew Katrina’s father to one side. ‘Mr Jackson, you know that the treatment we give people is confidential, don’t you? The only people who will know anything about Sophie’s treatment are you and your wife.’
He nodded. ‘My wife’s a Jehovah’s Witness.’
Meaning that he wasn’t? ‘Do you share your wife’s beliefs?’ Sophie asked carefully.
He closed his eyes. ‘No. She was converted by some friends. She was depressed after Katrina was born, but going to meetings made her happy again, so I went along with it.’ He opened his eyes again and looked at Sophie. ‘Could Katrina die if she doesn’t have a transfusion?’
She had to be honest with him. ‘I won’t know until she’s in Theatre. But it’s a possibility, yes. If she needs a transfusion and I can’t give it to her …’ She spread her hands. ‘That’s the worst-case scenario. Hopefully it won’t come to that.’
He shuddered. ‘I don’t want her to die.’
‘This isn’t about a battle of wills or judging your wife. But I want to give Katrina the best treatment available. We only need one parent to agree,’ Sophie said softly. ‘I know it could make things difficult between you and your wife.’
‘Katrina comes first. I’ll sign the consent form,’ he said.
‘Thank you,’ she said quietly. ‘I won’t say anything to your wife. It might not even come to this. But if it does—it’s good to know there’s a safety net there.’
But Mrs Jackson had clearly anticipated Sophie’s move. ‘If you sign that form, Derek, I’ll make sure you never see Katrina again.’
Mr Jackson paled. ‘Alice, be reasonable. Katrina’s life could be at stake.’
‘If it’s a bad rupture, she could bleed to death,’ Sophie said quietly. ‘And I need to take her to Theatre now.’
Charlie stepped in. ‘Maybe we can do the autologous transfusion we talked about.’
Alice Jackson’s face set. ‘Maybe.’
‘Mrs Jackson, I will do my best to abide by your wishes,’ Sophie said, ‘but as a surgeon I cannot allow your daughter to die due to the lack of a transfusion.’
‘BP’s dropping,’ Charlie said quietly. ‘Mrs Jackson, we have to go to Theatre now.’
‘You’re doing the operation? I’ve seen you in the papers. Out with all those women.’ She shook her head. ‘No. I don’t want you touching my daughter.’
‘Katrina is my patient. I’ll be doing the operation,’ Sophie said. ‘But if Charlie did it, she’d be in excellent hands. He’s the director of surgery. He got the post because he’s an excellent surgeon. And the papers whip up all that stuff about him to sell copies, so don’t believe what you read. I’ll come and see you immediately after the operation,’ she said, and started moving the trolley out of the emergency department.
‘Thank you for the vote of confidence,’ Charlie said as they went into Theatre.
‘It’s the official line, isn’t it?’
So she hadn’t meant it. Not personally. ‘Yeah,’ he said, trying to ignore the sinking disappointment in the pit of his stomach. Why should it matter what she thought of him?
Though it did.
‘It stopped the discussion. That’s the main thing. Where’s Sammy?’ she asked the scrub nurse, wanting to know where her senior house officer was.
‘Held up.’
‘I’ll assist,’ Charlie said as Sophie started to scrub up. ‘I was planning to observe all the surgeons anyway, so I may as well kill two birds with one stone.’
‘Observe?’ Sophie asked coolly.
‘I need to know my team’s capabilities. Where your strengths are, how you do things, where we can learn from each other.’
‘So, despite what you said to me, you are planning new-broom stuff.’
‘No.’ He kept his temper under wraps. Just. Hadn’t they agreed on a truce last week? And he’d thought they’d been getting on all right, before they’d seen the Jacksons. Obviously he’d been wrong. ‘But I believe in keeping my team motivated. To do that, I need to know where you are now and where you want to be. And it’s my job to get you the extra experience you need to move your career onwards.’
As soon as Sophie had opened Katrina’s abdomen and suctioned out the blood, she groaned. ‘Her spleen’s split completely in two. Gluing isn’t an option.’ She nodded at the screen where Katrina’s spleen was visible.
‘Agreed. It’s going to have to come out,’ Charlie said.
‘Her BP’s dropping,’ the anaesthetist said.
‘OK. I want four units of O-negative on standby, please. In the meantime, we need to filter and reuse her blood,’ Sophie said. ‘I’m doing an open operation, not laparoscopic,’ she added to Charlie. ‘Do I need to explain my decisions to you?’
‘Later. Just do it,’ Charlie said.
Sophie increased the size of her incision so she could perform the operation. To her relief, there were no further complications and the rest of the operation was textbook—grasping the splenic pedicle between the fingers of one hand, ligating the splenic artery, splenic vein and short gastric arteries, then removing the spleen, while trying not to damage the tail of the pancreas or the splenic flexure of the colon.
‘Would you like to close?’ she asked Charlie.
; ‘As I’m assisting?’
‘As your suturing is neater than mine,’ she corrected.
Was that the ghost of a smile in her eyes? Or her idea of an olive branch? Whatever. He nodded and stitched the wound.
‘How is she?’ Derek asked, as soon as Sophie came out of Theatre.
‘Her spleen had completely split in two,’ Sophie said. ‘I’m afraid I had to remove it. The good news is that Katrina should come round from the anaesthetic in a few minutes, and you’ll be able to see her then. She’ll be a bit wobbly at first, but she’ll be fine. She’ll be transferred to the paediatric ward, and she’ll be in for a week or so. She’ll have a drip to get fluids into her system and help with pain relief, and the stitches will dissolve by themselves so she won’t have to have them removed.’
‘What does the spleen do?’ Alice asked.
‘It filters the blood and helps fight infection,’ Charlie explained. ‘Katrina will be fine without a spleen, but it does mean that she’s more likely to get an infection.’ There was one thing that worried him: some Jehovah’s Witnesses had issues with injections. If Katrina’s family shared those beliefs, too, that could be a problem. ‘Has she had the Hib immunisation?’
‘Yes,’ Alice said.
‘Good.’ And better than he’d expected. ‘The Hib bacteria—haemophilus influenza type B—is the most common problem, but as she’s been immunised she should be fine,’ Sophie said. ‘You need to watch that she doesn’t get bitten by an animal—she’s more likely to develop an infection afterwards. We’ll also give you a card she needs to carry around with her which will tell any other medics that she has no spleen, or you could get her to wear a medical alert bracelet. And she’ll need antibiotics before she has any dental work done to avoid the risk of her getting sepsis. The staff on the paediatric ward will be able to reassure you about her care, or you’re welcome to contact me if you have any questions.’
‘Did you—?’ Alice began.
Derek placed his hand warningly on his wife’s shoulder. ‘Don’t ask. Then you can honestly say that to your knowledge the answer is no.’
‘But—’
‘Actually, no. I won’t lie to you—I did have blood on standby. If the worst had happened, I would have had to act very, very quickly to save Katrina’s life. But we managed with autologous transfusion and I’m going to give Katrina some plasma expander. She’s going to be fine,’ Sophie said gently. ‘If you’d like to wait here in the relatives’ room, I’ll make sure the nursing staff come and get you as soon as she wakes up.’
‘Thank you,’ Derek said.
‘While we’re waiting for Katrina to come round, how about a bacon sandwich?’ Charlie asked when they’d left the relatives’ room.
‘No, thanks. I have paperwork to do.’
‘Scared?’ he asked.
She lifted her chin. ‘Why would I be?’
‘Because,’ he said mildly, ‘I’ve noticed that you avoid me as much as possible. Even though we agreed on a truce.’
‘I am not scared of you.’
‘It’s only a sandwich. And a coffee,’ he said. ‘Platonic. And to say thanks for the vote of confidence.’
She frowned. ‘What do you mean?’
‘As you said, it’s the official party line. I was hired for my skill, not my title. I don’t think you meant it, but you still didn’t have to say it. Besides, I want to talk to you.’
‘About what?’
‘Your career plans. You’re a good surgeon. You’re precise, you tell the theatre staff what you need without being dictatorial or arrogant, and you’ll make an excellent consultant. When you learn to take the emotion out of it.’
Her eyes widened. ‘What emotion?’
‘Your initial reactions to Alice Jackson. You played a very risky game with your divide-and-rule strategy.’
‘You went along with it.’
‘Against my own judgement. And it didn’t work anyway,’ he reminded her. ‘Alice guessed what you were doing.’
‘So what are you saying?’
‘You have a cool head. You need a cool heart as well.’ ‘Sorry. I have red blood.’
‘And a head full of prejudice. You’re right. Forget the sandwich,’ he said, and walked away. Before his own red blood fired into life and he did something stupid—like kissing her to break down the barriers between them.
CHAPTER FIVE
‘WHAT’S her name?’ Seb asked.
‘What are you talking about?’ Charlie asked, feigning ignorance.
‘You’re distracted. That means a woman’s involved. Not that I’ve seen any pictures in the gossip rags for a while, so you’ve managed to keep this one quiet.’ Seb swirled the wine round in his glass and inhaled. ‘Mmm. I love Margaux. And this is a good one, Charlie. I hope you took it from the cellars at Weston.’
‘I took a case last time I was there,’ Charlie admitted.
Seb grinned. ‘Good. I don’t see why Barry should get all the benefits from Dad’s cellar. Especially as, strictly speaking, it’s your cellar.’ He gave his brother a sidelong look. ‘Don’t tell me. She’s tall, blonde and pretty.’
Charlie sighed. ‘Medium height, blonde and pretty, actually. And nothing’s going to happen because, unlike some people around here, I don’t play around at home.’
Seb pounced. ‘Aha. So you work with her. Nurse?’
‘No, but it’s irrelevant.’
‘Charlie, Charlie, Charlie.’ Seb shook his head sadly. ‘You can’t go looking for another Julia for ever.’
‘I am not looking for another Julia,’ Charlie said, stung.
‘Then why do you always go for blondes?’
‘I don’t.’
Seb snorted. ‘Yes, you do. And Vic agrees with me.’
When would his younger siblings stop trying to run his life? Charlie gritted his teeth. ‘Leave it, Seb. I told you, nothing’s going to happen.’
‘Not a nurse. Fellow surgeon, then? Hmm.’ Seb cut himself a slice of Stilton. ‘Well, at least you picked one with brains this time. And, since she’s a doctor, she has strong moral values—yes?’
Remembering the Jacksons, Charlie nodded. Sophie had strong moral values, unlike his ex-fiancée. On the other hand, she’d bent the rules about ethics. Even though her motives had been pure—to keep her patient safe—she hadn’t played entirely by the rules. Which was another reason why he ought to stay away from her. ‘Seb, if you want to interfere in someone’s love life, why don’t you pick on Vicky?’
Seb gave Charlie his most charming smile. ‘Because she’d skin me?’
‘I could skin you. I have scalpels.’ Charlie rubbed his face thoughtfully. ‘Actually, out of the two of us, I do the most work with skin. By a long, long way.’
‘Ah, but you’re a soft touch. Push comes to shove, you wouldn’t use them on me,’ Seb said with a grin. ‘Why don’t you go for it? You need a good woman. It stops things getting … pent up.’
Charlie scowled at his younger brother. ‘Don’t be crude.’
‘I can be cruder than that.’ Seb raised an eyebrow. ‘Dish the dirt, brother mine. Unless you want me to leave it for Vic to ferret out?’
And their sister definitely wouldn’t take no for an answer. Charlie sighed. ‘Have I told you how much I hate you?’
‘Frequently.’ Seb topped up their glasses. ‘Kid brothers are meant to be annoying. You can tell me, or you can tell Vic. Your choice.’
Charlie leaned back in his chair. ‘OK. She’s serious, clever—and she doesn’t like me very much.’
‘What’s not to like about you?’ Seb’s eyes glittered.
‘Drop the she-wolf act, Seb. You’re the wrong sex.’
Seb lifted his chin, looking every inch the aristocrat. ‘ Nobody disses my brother,’ he said, his accent pure cut-glass.
‘She hasn’t dissed me.’ Well, not straight out. Charlie sighed. ‘She just … avoids me most of the time. I think it’s because of my title.’
Seb snorted. ‘That’
s tactics, bro. Reverse psychology. She’s just playing hard to get in the hope that you’ll go running after her. Come on, you know women go weak at the knees at the thought of dating Baron Radley. Even more so when they find out he’s not old or short with bad teeth and nasal hair. You’re a prime catch—the reason half those celeb mags are still going.’
‘They’d get much more gossip if they followed you. A different woman every night.’
‘You go out with a different one every time,’ Seb pointed out.
‘I escort different people to different events, yes—but I don’t sleep with them all.’
‘That’s your problem.’ Seb grinned. ‘Love’s sweetest part, variety. And don’t change the subject. What’s she like?’
‘She cares about her patients. And she’s very close to her family—they took on second jobs to put her through med school.’ And Charlie still envied her that. What would it be like to have parents who loved you enough to make your dreams come true? A mother who fussed over you and went pink with pride, instead of one who moaned that you should settle down and produce an heir—and then, when she realised that meant you’d need the family home back, started complaining about the limitations of the Dower House?
Though it seemed his brother had a different take on it. ‘She’s poor? Then, as I said before, reverse psychology,’ Seb announced, digging into the cheeseboard again. ‘Classic tactics. You pretend to despise money, when you really want it more than anything else.’
Charlie rolled his eyes. ‘I don’t have any money.’
‘You would have if you made Barry-the-wannabe-baron pull his weight.’
‘The estate isn’t his problem. It’s mine.’
‘And it doesn’t help that you let him and Mum live there rent-free. You even pay all their bills, for heaven’s sake.’ Seb shook his head in despair. ‘I keep telling you, you’re a soft touch, Charlie.’
‘I’m not. How could I charge my own mother rent?’
Seb spread his hands. ‘Business. I would. So would Vic.’
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