Unlocking the Italian Doc's Heart

by Kate Hardy

  ‘I think there might be a problem with her heart, but I want to do some more tests to be sure,’ Jenna said. ‘You can go with her to the X-ray department and be with her, and if you’ve got any questions at any point then please ask, because that’s what we’re all here for.’

  When the chest X-ray results came in, they really worried Jenna; Florence’s heart looked big. Before seeing the Reynoldses again, she wanted a second opinion. But, when she went to find one of the senior doctors, of course the only one available would have to be Lorenzo.

  Well, her patient came first. Even though she’d rather work with someone else, she’d just have to put her feelings aside and talk to him. Be professional and cool, the way he was with her. And she did at least respect him as a doctor. He was quick and knowledgeable; and he was kind to the patients and their parents, putting them at their ease so they could ask questions instead of looking things up on the Internet and worrying themselves even more.

  She took a deep breath and rapped on his open door. ‘Sorry to interrupt, but there isn’t anyone else around. I need a second opinion on one of my patients, Florence.’

  The colour drained from his face. ‘Florence?’

  Of course—she should have thought he’d react like that to the child’s name. ‘Don’t worry, this isn’t your Florence,’ Jenna said. ‘This is Florence Reynolds. She’s nineteen months old, and I think she has cardiomyopathy.’ Lorenzo seemed to shake himself mentally, and she ran through the symptoms. ‘Can I show you the X-ray?’

  He nodded, and she called up the file.

  ‘I agree—it looks and sounds like a cardiac issue. OK. I’ll come and see her,’ he said.

  She walked back to the cubicles with him—for once not talking on the way—called the Reynoldses in, and introduced Lorenzo to them.

  ‘I agree with Dr Harris that we need to check the way Florence’s heart is working,’ Lorenzo said. ‘I’d like to give Florence an ECG—it checks the electrical activity of the heart, and won’t hurt her,’ he explained.

  The results backed up Jenna’s suspicions.

  ‘Dilated cardiomyopathy?’ she asked Lorenzo.

  He nodded. ‘It’s going to be a lot for Florence’s mother to take in. I’ll stay and back you up.’

  ‘Thank you.’ They might have personal issues, but Jenna respected his clinical judgement.

  She called Mrs Reynolds in again.

  ‘So did the ECG show what was wrong?’ Mrs Reynolds asked.

  ‘Yes. Florence has a condition called dilated cardiomyopathy,’ Jenna said. ‘It means her heart muscle has become enlarged and weakened, so it can’t pump blood efficiently to her lungs and her body. That’s why she’s breathless and tired, and fluid has built up in her body.’

  ‘But—how can that happen?’ Mrs Reynolds asked. ‘She’s only nineteen months.’

  ‘It can happen at any age,’ Lorenzo said. ‘Sometimes it’s an inherited condition, or sometimes it develops after a virus.’

  ‘She had a bug, a few weeks back—that’s what our family doctor thought it was, but she just never seemed to get better.’ Mrs Reynolds bit her lip. ‘Can it be cured?’

  ‘We can give her some medication to help with the tiredness and help her heart pump blood round her body a bit better, but because her heart beat is too slow she’ll need a pacemaker as well,’ Jenna said.

  ‘What’s a pacemaker?’ Mrs Reynolds asked.

  ‘It’s a small metal box containing batteries and electronic circuits. It has wires which carry electrical impulses to Florence’s heart to regulate her heartbeat,’ Lorenzo explained.

  ‘A metal box?’ Mrs Reynolds looked horrified.

  ‘It’s not that big—it’s about the size of a matchbox, and it weighs less than fifty grams,’ Jenna reassured her. ‘Because Florence is so small, you might see a raised bump on her skin where the pacemaker sits, but when she’s older you won’t know it’s there.’

  ‘It’s programmed to a certain number of beats per minute, so if the gap between two of Florence’s heartbeats is longer than it should be, the pacemaker will send an impulse through the wire into Florence’s heart to make it contract and produce a beat,’ Lorenzo added.

  ‘And when the wire sends something into her heart, it doesn’t hurt?’ Mrs Reynolds asked.

  ‘It doesn’t hurt,’ Jenna confirmed.

  ‘But Florence will need an operation to insert the box into her chest,’ Lorenzo said.

  ‘An operation.’ Mrs Reynolds looked petrified. ‘But she’s only nineteen months old.’

  ‘If she doesn’t have the pacemaker,’ Jenna said gently, ‘she won’t get better and she might end up needing a heart transplant, which is a much bigger operation.’

  Mrs Reynolds bit her lip. ‘This is a lot to get my head round.’

  ‘Of course it is, and of course you’re worried.’ Lorenzo squeezed her hand. ‘But a pacemaker is the best way to help Florence get better.’

  ‘Can you do the operation here?’ Mrs Reynolds asked.

  ‘Yes. We have a special operating room called a catheter lab, and one of the cardiac surgeons will do the operation,’ Jenna told her. ‘I’ll book an appointment so you get to meet the cardiac team before the operation, and then after the operation we’ll look after Florence here on the ward.’

  ‘How long does the operation take?’ Mrs Reynolds asked.

  ‘About an hour. She’ll need to come in the day before, so we can do tests to prepare her for the operation. She won’t be able to have anything to eat or drink for about six hours before the operation, because she’ll have a general anaesthetic—she’ll be asleep during the operation,’ Lorenzo explained. ‘But you can stay with her right until she’s had the anaesthetic and she’s asleep.’

  ‘Can’t I go in with her?’ Mrs Reynolds asked.

  Jenna shook her head. ‘We only allow doctors, nurses and technicians into the catheter lab, to help us stop any infections. But as soon as Florence is awake in the recovery room after the operation, you can be with her again.’

  ‘But a metal box.’ Mrs Reynolds looked anguished. ‘You’re going to cut her chest wide open?’

  Lorenzo shook his head. ‘The surgeon will make a small cut—not even as long as your thumb—under her collar bone on her left-hand side, so he can make a pocket for the pacemaker box and thread an electrode lead into a vein. He’ll use an X-ray to help him put the lead in the right place in Florence’s heart, then connect it to the box and fit it in the pocket.’

  ‘They use dissolvable stitches when they close the cut,’ Jenna said, ‘so she won’t have to have any stitches removed. And, when you see the surgeon, he’ll show you what the pacemaker looks like and I think that’ll reassure you.’

  ‘Once she’s awake again, she’ll go back onto our ward, and the team here will check her wound dressing and give her antibiotics to make sure she doesn’t get an infection,’ Lorenzo said.

  ‘Florence will have another X-ray, the next day, to make sure the pacemaker lead is in the right place,’ Jenna said. ‘We recommend she doesn’t do any really active things like the toddler gym club for about three weeks after the operation, and during that time it’s a good idea not to let her make big movements with her arm on the side where the pacemaker’s fitted, to make sure the leads don’t move.’

  ‘Will it hurt, after the operation?’ Mrs Reynolds asked.

  ‘It might be a little bit sore,’ Lorenzo said. ‘We can give her some infant paracetamol to help with that, but it’s important she doesn’t pick at the wound or scratch it, or it might get infected.’

  ‘And then after that she’ll be better?’ Mrs Reynolds asked.

  ‘She should be better,’ Jenna said, ‘and she can live a normal life—though we would advise that you don’t let her take up contact sports like karate.’

  ‘The pacemaker will set off any alar
m detector at the airport,’ Lorenzo said, ‘but we’ll give you a card you can show to security staff. She won’t be able to have an MRI scan with a pacemaker, and if you’ve got an induction hob in your kitchen she needs to stay away from it, because the magnets will interfere with the settings of her pacemaker.’

  ‘And if she does look at things on your mobile phone, make sure the phone’s in the opposite hand to where the pacemaker’s fitted,’ Jenna said.

  ‘Will she have a pacemaker for the rest of her life, and will she need a different pacemaker when she’s bigger?’ Mrs Reynolds asked.

  ‘To the first, we don’t know—it depends how she responds to treatment. The pacemaker will last for about four or five years,’ Jenna said, ‘and then she’ll need it to be replaced.’

  ‘It’s a lot to take in,’ Lorenzo said. ‘We can give you some leaflets about Florence’s heart condition and about the pacemaker, and you’ll probably have more questions over the next few days. Come and see us or give us a call, and we’ll do our best to answer.’

  ‘Thank you,’ Mrs Reynolds said. ‘I’m still trying to get my head round the fact she’s so ill.’

  ‘We can put you in touch with a support group, too,’ Jenna said. ‘It’ll help to talk to other mums who’ve already been through this. But I would advise not reading too much on the Internet. You tend to get the really scary stuff there.’

  ‘I guess it’s like when you’re pregnant,’ Mrs Reynolds said, ‘and you hear about all the really awful labours people have been through and not the ones that just went normally.’

  ‘Pretty much,’ Lorenzo said with a smile. ‘Pacemakers have been around now for around fifty years, and about five hundred people in Britain get a pacemaker fitted every week.’

  Mrs Reynolds looked surprised. ‘As many as that?’

  Jenna nodded. ‘So our cardiac team is really used to doing the procedure. Florence will be in excellent hands.’

  Mrs Reynolds blew out a breath. ‘Thank you for that. I feel a bit better about it.’

  Jenna smiled at her. ‘We’ll have Florence feeling better soon. And then you’ll be less worried.’

  ‘Jenna will sort everything out for you—I’m afraid I’m due in clinic shortly and there are some things I need to do before I see my patients,’ Lorenzo said.

  ‘Thank you, Doctor,’ Mrs Reynolds said.

  ‘Yes—thank you, Dr Conti,’ Jenna added.

  ‘It’s what I’m here for,’ Lorenzo said, but his smile was solely directed towards Mrs Reynolds and her daughter. He didn’t even look Jenna in the eye.

  At least he too had put their patients first, she thought. And things would get easier between them on the ward. Eventually. It would just take a bit of time.

  And as for how long it would take her to get over him...

  She’d just have to focus on her job.

  * * *

  Lorenzo was checking through some files at his desk before clinic when his phone beeped. He took it out of his pocket and glanced at the screen; when he saw the notification, he nearly dropped the phone in shock.

  Why would Georgia be emailing him?

  And it looked as if there was an attachment to her email. Maybe it was a mistake, then, and someone had hacked into her account and sent a message to everyone who’d ever been in her contact list.

  He went into his email account to delete the message unread, but accidentally clicked on the message.

  When he saw the photograph attached to the file he caught his breath. It was a photograph of Florence, wearing a blue dress and holding a pink balloon bearing the slogan ‘3 Today’ in glittery silver writing.

  His little girl, on the birthday he’d missed.

  He had to blink away the tears.

  Why had Georgia sent this now?

  The words of the email blurred before his eyes, and he had to read it three times before the message sank in. Georgia was moving back to London with Scott, who had a new job. They were happy; they’d got married and they’d had a little boy, a brother for Florence, the previous month. She realised she’d been unfair to him, so if he’d like to see Florence once they’d settled in he’d be very welcome to come round.

  If he’d like to see Florence?

  His heart felt as if it had just cracked.

  She added the caveat, We probably need to talk first and agree what we tell her about you. Maybe you could be her Uncle Renzo.

  Not Dada. Not the man who’d held her when she was only a few seconds old, who’d brought her up as his little girl. That stung. But the important thing was that he’d still be part of her life: the thing he’d wanted so desperately and missed so much.

  He looked at the photo again. Florence had changed so much in the last eighteen months; then again, he knew from his niece and nephew that toddlers changed very swiftly. He wondered if she’d become a total chatterbox, if she still loved having stories read to her, if she liked singing or dancing or messy play. Right now he didn’t have a clue.

  But what hadn’t changed was the brightness of her smile. She looked happy.

  And that was what he’d wanted to know more than anything: that his little girl was happy.

  * * *

  Once Jenna had booked the appointment for Mrs Reynolds and Florence with the cardiac team, reassured Mrs Reynolds further and given her all the information leaflets and information about support groups, she went in search of Lorenzo. Hopefully she’d catch him before his clinic and she could talk to him, thank him for his help and maybe try to bridge the gap between them. If nothing else, it would make things easier at work.

  When she rapped on his door, he looked up. The expression on his face was slightly dazed. Was he OK?

  He beckoned her in, and she closed the door behind her. Close up, she could see that he had wet eyes.

  Something was definitely wrong.

  ‘Right—start talking,’ she said.

  ‘I...’ His voice tailed off and he shook his head.

  For him to have tears in his eyes, something serious must have happened. Was someone in his family seriously ill—or, worse, had there been an accident? She couldn’t just switch off her feelings or ignore it. He was clearly hurting and her first instinct was to make it better. ‘Renzo, I know we’re not exactly getting on right now, and you’re the King of Clamming Up, but I do care about you and I’m here. Something’s obviously happened, or your eyes wouldn’t be wet.’

  ‘Florence,’ he said helplessly.

  Oh, no. Worse than she’d thought. ‘Something’s happened to her?’ she asked carefully.

  ‘I... Oh, it’ll be easier for you to see it yourself.’ He handed her his phone with the email open.

  She could see that the message was from Georgia, and there was a picture attached of a little girl that she assumed was Florence. On her third birthday, by the look of it. The day she and Lorenzo had been in Verona.

  ‘Renzo, this is personal,’ she said warily.

  ‘Read it,’ he said.

  She scanned it swiftly, and she felt her eyes widen in surprise. ‘She’s actually going to let you see Florence?’

  He nodded. ‘I can’t believe it, either. But it’s there in black and white. She’s even given me her new phone number so I can call her and arrange to meet.’

  ‘What made her change her mind?’

  ‘I have no idea. Maybe it’s because they’re coming back to London, and maybe her parents talked to her.’ He shrugged. ‘Maybe now they’ve had another baby, it’s made Scott realise what they took from me and he’s talked to her about it. But the main thing is she’s actually going to let me see Florence.’

  ‘That’s good. I’m glad for you.’

  He rubbed his eyes. ‘Jenna, I have to go to clinic—it’s not fair to my patients to be late—but maybe... Can we perhaps talk afterwards?’

  ‘Afte
r our shift,’ she said. ‘Sure. I’ll meet you at the main entrance.’

  ‘Thank you.’ He looked at her. ‘Was there something you needed?’

  Yes, but she wasn’t going to ask and risk being rejected again. ‘I just came to let you know that Florence Reynolds is booked in with the cardio team, and to say thanks for your help.’

  ‘It’s my job,’ he said.

  And their job was all they had together now. She got it. ‘OK.’

  ‘I’ll see you later,’ he said. ‘We’ll talk.’

  Just as long as he didn’t make it a Dear Jane talk. Then she’d have to stop him and walk away.

  * * *

  After his shift, Lorenzo waited by the main entrance to the hospital. And waited. And waited.

  He glanced at his watch. He knew Jenna wasn’t the sort to be deliberately late and he didn’t think she’d just not turn up, so she was probably still with a patient. She was meticulous at work, kind and caring.

  She was kind and caring outside work, too.

  Even though they weren’t getting on right now, she’d still noticed that something was wrong and still offered to let him talk to her, unload whatever was upsetting him.

  Right now he had a lot to say. Starting with a massive apology. He just hoped that she’d listen to him and not shut him out—even though he knew he was being a massive hypocrite because he’d shut her out.

  Eventually she came rushing up to him. ‘Sorry, sorry. I was—’

  ‘Patients come first,’ he cut in gently. ‘It’s not like a job where you can close a file for the evening and come back to it tomorrow.’

  ‘No. I just hoped you didn’t think I’d...’ She grimaced.

  Just abandoned him? That wasn’t Jenna. ‘Of course I didn’t. Thank you for meeting me.’ He took a deep breath. ‘Shall we go somewhere a bit quieter?’

  ‘Good idea.’

  They headed out to Alexandra Park, and found a quiet bench in a corner.

  ‘First of all,’ he said, ‘I owe you a massive apology for what happened in Verona. I know I hurt you, and I’m sorry for that. That really wasn’t my intention.’

  She winced. ‘It was my own fault. I expected too much. I shouldn’t have said anything.’