Page 31 of Broken Heart Syndrome
‘Just a friend of Tabitha’s, okay?’ he said softly, and I was shocked that he remembered her belief that I was her errant niece. ‘If you won’t let us call the nurses, will you let me lift you? I promise not to carry you off and take advantage of you.’ He winked at her and she gave him a watery smile.
‘I suppose you may assist me,’ she said imperiously, as if bestowing a great honour on him. He smiled at her and reached down, easily lifting her into his arms as if she were as light as a feather. I could personally attest after wrestling with her clothes that she was not. Health and safety would have had a field day.
‘Where to, my lady?’ he asked once they were out of the bathroom.
‘I think I will lie down now, young man,’ she informed him, and he carried her to her bed and settled her gently under the covers.
‘Tea?’ he asked.
‘Yes dear,’ she replied. ‘Two sugars, and I’ll have one of Tabitha’s cakes if you don’t mind.’ I had noticed that when it came to some things (cake in particular) Mrs Jones’s memory could be surprisingly good.
‘Frankie?’ Tom called, and I realized that I was staring at him tucking Mrs Jones in. I also realized in that moment, after watching him reassure and carry a grumpy old lady to her bed (likely knackering his back), that I had done something very stupid. Just like eleven years ago when I first saw him, I had fallen in love with Thomas G. Longley again.
Bloody hell.
Our last patient was also in a side room and I decided that I needed to talk to Tom before we went in there. As we approached I laid a hand on his arm and he stopped abruptly, turning towards me. He lifted his eyebrows expectantly.
‘I, um … I need to talk to you about Bill,’ I told his shirt collar. I paused, unsure quite how to approach it. I didn’t want to criticize his management and I wasn’t sure how he would take my advice, but I knew that I had more experience in this than him.
‘Yes?’ he prompted, his voice edged with impatience.
‘Well, I just wondered whether you’d considered maybe a different approach. I’ve been talking to Bill and I –’
‘Frankie, Bill’s been a patient of mine for a very long time. I treated him before I even became a consultant. I’m sorry but I think I know which approach is best,’ he said firmly, before moving into the room, leaving me staring open-mouthed after him.
‘Bill –’ Tom was smiling as we filed in ‘– how are you holding up?’
Bill gave us a weak smile. ‘Bit … short of … puff … but otherwise … alright.’
‘I’ve brought the consent form for the pacemaker insertion. If I could just go over a few points with you –’
‘Tired … so tired,’ Bill forced out, interrupting Tom’s spiel.
‘Yes, well, I’m hoping that this procedure might help a bit with that,’ Tom said confidently. ‘I’ve spoken at length to your daughter and she’s very keen to go ahead.’
Bill gave me a pleading look before closing his eyes and turning away. Tom started to shift on the plastic hospital seat, looking uncertain for once.
I gathered up the charts and Bill’s notes, and gestured to Tom and Ash to leave the room with me.
‘We’ll be back in a minute, Bill, okay?’ I said, then led them out into the corridor.
‘What’s going on?’ Tom asked me once he’d shut the door behind him.
Forcing myself to hold his eyes, I told him softly, ‘He’s dying, Tom. He’s tired. He needs us to make him comfortable. He needs us to talk to his family for him and explain, because he doesn’t have the strength to stand up to them. He’s at end stage heart failure now. It isn’t fair to keep pushing him if it’s not what he wants.’
‘He’s never given me any indication that he’s giving up, Frankie. I don’t –’
‘I’ve talked to him,’ I interrupted. ‘Many times. He doesn’t want the pacemaker. He doesn’t want any more aggressive medication that makes him feel rubbish. It’s not giving up, Tom, it’s just his time. Deep down you know this.
‘Look,’ I urged, ‘I’ve written a plan up in his notes. I would suggest we stop the ACE inhibitor as his postural hypotension is limiting his activity at the moment. We need to also consider reducing the beta-blocker. Now, whilst cardiac resynchronization with a biventricular pacemaker might improve his symptoms, he doesn’t want to go through the procedure. We need to start some sort of opiate for the dyspnoea; my recommendation would be a buprenorphine patch at this stage, but –’
‘Where on earth is all this coming from?’ Tom was looking at me like I’d grown another head. ‘What do you know about palliative care?’ His brows drew together. ‘Wait, are these Rosie’s suggestions? Why not just tell us that rather than trying to pass them off as your own?’
‘What?’ I said in confusion.
‘Oh come on, Frankie,’ he continued. ‘I know you don’t have any experience in palliative care. Why you’ve chosen this moment to try and impress me with someone else’s work is beyond me, when you haven’t given a “flying foo-foo” what I thought for the last two months.’ I took a step back and looked between Ash and Tom. Ash looked about as confused as me.
‘Frankie, I’m not stupid and we do know what experience our trainees have before they start with us,’ Tom continued. ‘I’ve read your CV. You don’t know anything about palliative care.’
