Standing by the projector screen, dressed in a sleek black pantsuit that Jen thought was probably designer, her hair tidied back into its usual sleek French twist, was Dr. Ashley Proctor. One bold dark eyebrow lifted into a perfectly plucked arch, and her damn prissy mouth pinched for a brief moment before she addressed Jen’s entrance. “So very, verykindof you to join us for the meeting, Doctor Colton.”
Jen slumped into a chair, wishing she’d dared to waste more precious minutes in the pursuit of a cup of tea. “I’m sorry, Doctor Proctor.”
“I’m sure.” Lifting her hand, Ashley clicked on the remote she held. A presentation filled the screen. “I’ll try to cover the entirety of my plan in the time we have left.”
Jen winced and slumped further into her chair.
Only to sit up straight as an arrow, her spine galvanized steel as her mouth dropped open. Ashley was proceeding through her minimalist PowerPoint slides briskly, with a plan she clearly thought was the most sensible approach to managing Maria’s heart condition.
They’d all read the same records, Jen was sure. They’d all seen the state of Maria’s heart from the scans, that the management she had insisted on thus far had helped some but had gone on too long. She should have been on a transplant list long, long ago, in Jen’s opinion. And Jen had spent the last two days gently talking to Maria about it in between Maria’s efforts to squeeze more sexy gossip out of her.
Maria, predictably, had been resistant, but Jen knew it was just because she didn’t have the info she needed. Jen did, and she’d shared it. Told Maria that most surgeons would have had a pacemaker or implantable defibrillator in her years ago but for her resistance. Now, Jen felt, they were well past the time when those would be effective for long. It was time for the radical approach, she’d explained. Maria’s big heart had to go. Yes, itmeant waiting for a while, and then medication for the rest of her life, but there’dbea rest of her life. A fresh new heart beating in her chest and giving her a new lease on living. She’d regain strength, her blood flow would improve, and she could get back to work.
A device would help for a while, but, Jen had pointed out, if Maria was going to have surgery anyway, why not get the big one and hopefully be done, rather than prolong things?
It had taken some doing, but Jen had eventually gotten Maria to understand. And now Maria was ready to hear that she was going on the transplant list.
But Ashley was breezily presenting a procedure to install an implantable cardioverter defibrillator. “The recovery time is four to six weeks, but the patient will be able to go home and resume her life, slowly and under frequent observation, the day after we complete the implantation.”
“And in a year or less, she’ll be back on your operating table under your scalpel,” Jen blurted out before she could stop herself.
Once again, all eyes were on her, with varying degrees of astonishment in them. Except for Ashley’s. Ashley’s brown eyes went dark with anger at the interruption, and Jen saw her grip on the presentation remote get white-knuckled. “Excuse me, Doctor Colton?”
In for a penny…“Well, I think you heard me. We’ve seen the records.” Jen gestured to the fat pink folder on the table in front of Ashley. “At this point, any kind of device is merely a Band-Aid. Ms. Rivera’s heart has deteriorated rapidly over the last months. She’s had minor heart attacks already, the next one could be fatal. She should havebeenon the transplant list a long time ago, we need to put her on therenow.”
“As you well know in your position of transplant director, Doctor Colton,” Ashley began through gritted teeth, “donor hearts are rare. So hard to obtain.”
“Yes, which is why time is of the essence.” Jen was amazed that she was having to fight for what, to her, seemed like the only sensible solution. “Get an LVAD on Ms. Rivera, get her on the list, and let’s get that bad heart out of her as soon as we can. I don’t see why this is even in question.”
“Why should we put her life on hold more than it already has been?” Ashley shook her head. “The ICD will let her get back to work in a couple of months. A transplant will put her in a holding pattern while we hope to get a heart, and who knows how long that will take? Then the recovery time, assuming she’s lucky enough not to reject the donor organ, is significant.”
The other doctors, nurses, and surgeons in the room glanced between the two surgeons as the clash went on. Nobody volunteered an opinion. Jen could not believe what she was hearing. Or not hearing, rather. She turned her astonished gaze back to Ashley. “I don’t understand why you’d rather prolong her suffering with a quick-patch procedure that will just land her back here sooner rather than later.”
“Perhaps,” Ashley began, her voice silky, “you’re too close to the patient to see the rationality of my decision to help her get her life back as soon as possible.”
Jen was left speechless. Ashley was so intent on being right and in charge that she had actually decided to call Jen emotionally overinvolved in front of their colleagues. Was the presentation a decoy, another tactic to get Jen either thrown off the team or given no choice but to recuse herself?
No. No, Jen couldn’t believe the cardio surgeon was quite so conniving. She genuinely believed this conservatism was the best solution for Maria and that Jen was being too radical inwanting to go for a transplant. She just wasn’t going to pass up an opportunity to undermine Jen.
Fortunately, Steve Sundstrom finally spoke up. Clearing his throat, he got to his feet. “Let’s table thebest courseconversation for now. Doctor Proctor has the floor. Please, Doctor, complete your presentation.”
Ashley smiled tightly and turned back to the projector screen, clicking to advance to the next slide. “Now, here’s the team I want with me in the OR, plus Doctor Colton…”
The little jab didn’t get past Jen, but she did ignore it in favor of trying to control her temper for the rest of the meeting. When it finally ended, she didn’t wait for Steve to waylay her. She was first out the door and making a beeline for a distant supply room at the far end of the surgical wing.
Closing the door behind her, Jen crossed over to a plastic-sheathed stack of thermal surgical blankets and face planted into it. The pile neatly muffled the primal scream of rage she howled into it, a scream she found so entirely satisfying that she let out another one. And then another.
The door squealed open behind her and she stood up, whirling to see who was disturbing her.Ugh. You.
“I thought I’d give you a moment to collect your thoughts,” Ashley said, inspecting her fingernails with a studied casualness. “And to ask you again if you could please remove yourself from my surgical team. You’re welcome to visit the patient as much as you like, of course, but you’re too close to actually be involved.”
“She has aname!” The words exploded out of Jen with a force that made Ashley step back in surprise. Jen strode forward and poked her finger right into Ashley’s puffed-up chest. “Her name is Maria! She’s a human being, not a surgical practice dummy. That’s flesh and blood you want to cut into. Stop calling her ‘the patient,’ damn it!”
Ashley brushed Jen’s hand away, eyes narrowing. “I’m aware that Ms. Rivera is a human being. The problem is that you aretooaware, and I am trying to remind you that she may be your friend, but she isalsoa cardiac patient, and her care comes before your emotions.”
“My emotions are because you’re proposing a course of action that’s going to see her under the knife again and again when it’s unnecessary at this late stage.” Jen spun around and paced the room. “Yes, Maria is my friend. But I would advocate this hard for transplantation for any patient at her stage of heart failure. I see no need to waste the hospital’s resources or her precious time by subjecting her to surgery after surgery.”
“And I am not wasting her time,” Ashley snapped impatiently. “I’m allowing her to get back to doing what she loves sooner. That is giving her timenow. I implant the ICD, and she’s sitting at home reading scripts by next week. She’ll be ready to go back to work, with some limitations, in two or three months.”