chocolate yesterday and today, Mr Jefferson?’
He nodded.
‘And he’s been eating better lately and stopped smoking,’ Mrs Jefferson added.
‘Two of the best things you can do,’ Kelly said. ‘OK, Mr Jefferson. When you’re ready, I’ll check your blood pressure.’
As she’d expected, the first reading was really high; a lot of patients were so nervous about the tests that it sent their blood pressure sky-high. By the third reading, he was beginning to relax and Kelly was a little happier with the numbers.
Once she’d put the cannula in, she asked Mr Jefferson to lie on the scanner couch with his arms above his head. ‘I’m going to put some wires on your chest now,’ she explained, ‘so I can monitor your heart rate during the scan, but again it’s not going to hurt.’
But she really wasn’t happy with what the scan showed her. His right coronary artery was severely narrowed, as were the two on the left. An angioplasty with a stent wasn’t going to be enough to make any difference.
‘I’m sure your family doctor has already explained why you’re getting chest pain, Mr Jefferson, but I’d like to go through it with you again. Basically your heart pumps blood round your body, but sometimes deposits of fat and cholesterol—what you might hear called plaques—stick to the wall of your arteries and make them narrower. It’s kind of like when you see the inside of a kettle in a hard water area and the pipes are furred up, except in this case the furred-up bits are inside the pipes rather than outside. This means not enough oxygen-rich blood gets through to your heart, and that’s why it hurts.’
‘But you can make my arteries wide again?’ he asked.
‘I was hoping I could do an angioplasty and put a stent in—that’s basically a wire mesh that I can put inside your arteries to keep them open,’ Kelly said. ‘But in your case there’s a lot of narrowing in three of your arteries, and I think your best option is surgery. I need to talk to one of my colleagues—the cardiothoracic surgeon—very quickly, so if you’ll excuse me I’ll be about five minutes. If you’d like to nip out to the waiting area to get a cup of water while I’m gone, please feel free.’
To Kelly’s relief, Luc was in his office, dealing with paperwork.
‘Can I have a quick word about one of my patients?’ she asked.
‘Sure.’
She drew up Peter Jefferson’s scan results on the computer. ‘My patient has angina, and the meds his family doctor prescribed aren’t helping. I hoped that I might be able to do an angioplasty, but I’m really not happy with the scan results. I think he needs a CABG.’
‘I agree. That narrowing is severe. I’d recommend a triple bypass,’ Luc said as he reviewed the screen. ‘Is he still with you?’
‘Yes. He’s in the cath lab with his wife. He knows I’m having a quick word with you.’
‘Let me check my schedule.’ He flicked into the diary system. ‘Operating days for me are Wednesday and Friday.’ He blinked. ‘I’ve got a cancellation tomorrow, by the looks of it, so we can grab that slot now before someone else does. Do you want me to come and have a word?’
‘Meeting you is going to reassure him more than anything I can say to him,’ Kelly admitted. ‘Would you mind?’
‘No problem.’ He smiled at her.
And her heart would have to feel as if it had done an anatomically impossible backflip because of that smile.
Kelly had got herself completely back under control by the time they went into the cath lab.
‘Mr and Mrs Jefferson, this is Luciano Bianchi, one of our surgeons,’ she said. ‘We’ve had a quick discussion, and we both feel that the best way forward is surgery—a coronary artery bypass graft.’
‘It means I’ll take another blood vessel from your leg and attach it to your coronary artery on either side of the bit where it’s blocked—that’s the graft—so the blood supply is diverted down the grafted vessel.’ Luc drew a swift diagram.
‘I guess it’s a bit like roadworks, when you get diverted down a slightly different road round the bit that’s blocked. Your blood will flow through properly to your heart again and you won’t get any pain,’ Kelly said.
‘Exactly,’ Luc said with a smile.
‘But what about the bit in his leg? Doesn’t he need that vein?’ Mrs Jefferson asked, clearly looking worried.
‘It’s one of the extra veins we all have close to the surface of the skin,’ Luc said. ‘The ones that return the blood back to the heart are deep inside your leg. The rest of the veins in your leg will manage perfectly well if I borrow a little bit for a graft, Mr Jefferson. I’ll stitch it up and you’ll have a little scar, but it’s nothing to be worried about.’
‘Heart surgery. Does that mean you have to cut through my chest?’ Mr Jefferson asked.
‘In your case, yes—unfortunately I can’t do keyhole surgery for you because you need three grafts,’ Luc said. ‘It means you’ll have a scar down your chest, but that’ll fade with time. And once I’m happy with the grafts, I can re-join your breastbone with stainless steel wires and stitch up the opening.’ He smiled. ‘And I happen to have a slot free tomorrow morning, so I can fit you in then.’
‘Tomorrow?’ Mr Jefferson looked utterly shocked.
‘Tomorrow,’ Luc confirmed. ‘Which gives you less time to worry about the operation.’
‘Surgery.’ Mr Jefferson blew out a breath. ‘I wasn’t expecting that.’
‘I’ve done quite a few bypasses in my time,’ Luc reassured him. ‘You won’t feel a thing, because you’ll be under a general anaesthetic.’
‘Isn’t that the operation where you’ll stop his heart beating?’ Mrs Jefferson asked. ‘I read up about that on the Internet.’
‘It’s one way of doing a bypass operation, using a heart-lung machine to breathe and pump the blood round your body for you, but actually I prefer to do my surgery off-pump—where the heart’s still beating while I operate,’ Luc said.
Kelly hadn’t expected that, and it intrigued her.
Mr Jefferson’s eyes widened. ‘But isn’t that dangerous?’
‘It’s quicker, so you’ll be under anaesthetic for less time, there’s less chance of you bleeding during surgery, and you’re also less likely to develop complications after the operation,’ Luc said. ‘So in my view it reduces the risks.’
‘And after the surgery you’ll be with us in the ward,’ Kelly said. ‘You’ll be in Intensive Care at first, where we’ll keep an eye on you to make sure everything’s working as it should be. You’ll still be asleep for the first couple of hours, but then we’ll wake you up and your family will be able to see you.’
‘You’ll be well enough to get out of bed and sit in a chair, the next day,’ Luc said. ‘A couple of days later you’ll be back on your feet, and a couple of days after that you’ll be ready to tackle stairs again.’
‘A whole week in hospital.’ Mr Jefferson looked as if he couldn’t take it in. ‘My doctor said I’d be in here for half an hour, maybe a bit longer if you had to do a procedure like a stent. He didn’t say I’d have to stay in for a week.’
‘But if you need the operation, love,’ Mrs Jefferson said, ‘then you’ll have to stay in.’
‘I’m afraid you do need the operation, Mr Jefferson,’ Luc said gently. ‘Right now I know it feels very scary and a bit daunting. But it’s the best way of preventing you having a heart attack.’
‘But our daughter’s having a baby next month,’