down to the dorsal digital artery, to stop himself thinking of anything else.
But on Sunday afternoon his eldest sister called him.
‘Is everything OK, Elle?’ he asked. He and Eleonora usually managed to grab a few words during the week, but there was something slightly antsy about her tone.
‘Ye—es.’
‘But?’
‘Babbo wants to start taking things easier. He told me yesterday that he’s planning to step down at some point in the next year,’ Eleonora said.
Meaning that King Umberto was expecting his wayward son to give up his job as a surgeon, come home and take his rightful place on the throne? So the clock he’d pretty much managed to ignore, thanks to its silence, had just started to tick. ‘Is that Elle-speak for “come home right now”?’ he asked wryly.
‘No, I’m just putting you in the picture so you know what our father’s thinking. He’ll probably summon you home to talk about it at some time in the next month, though,’ Eleonora warned.
Summon him home. Normal people of his age were happy to visit their parents; whereas Luc knew a visit home wouldn’t be time to catch up with each other and enjoy each other’s company. It would be another chance for his father to nag him about his future in the monarchy, and he’d end up having another argument with his father. He sighed. ‘Elle, you and I both know you’d make a better ruler than I would. So does our father. And you’re the oldest. It’s ridiculous. This is the twenty-first century. It makes absolutely no sense that, even though I’m second-born, I should be the heir just because I have a Y chromosome.’
‘It’s how things are.’
He could hear the resignation in her voice. ‘Well, things need to change. It’s time our father modernised the monarchy.’
She sighed. ‘I hate it when you fight.’
‘Elle, I’m a cardiac surgeon. I’ve spent half my life either studying to become a doctor or practising medicine—and I’m good at what I do. I can make a real difference to my patients and their families, give people a second chance at life. That’s such an amazing thing to be able to do. And I want to stay here for a couple more years, get experience in all the cutting-edge surgical developments. Then I can bring it home to Bordimiglia and set up a world-class cardiac centre.’ And he’d name it after his best friend. So Giacomo would never be forgotten.
‘Giacomo would be proud of you,’ Eleonora said softly. ‘His parents think you’re wonderful.’
Whereas his own parents thought he was being stubborn and unreasonable. They’d given him the freedom to do what drove him, so far, but now it seemed the pressure was going to start in earnest: they’d want him to go back to being a prince instead of a surgeon. But that wasn’t who he was. He could serve his country much better as a surgeon. Make a real difference to people’s lives.
‘I really hate all the fussiness of protocols and politics, Elle. If I become king, I’ll make a dozen horrible gaffes in my first week, and we all know it. Whereas you’re a born diplomat.’ Though even Eleonora hadn’t been able to talk their father into changing a certain tradition.
‘Sometimes you have to pick your battles wisely. This isn’t one we’re going to win, Luc.’
Unless he did a little shaking up himself.
He’d talk to Kelly. Hopefully she’d agree with him that they could do each other a favour and his plan would work. ‘Leave it with me,’ he said.
‘No fighting with Babbo,’ Eleonora warned.
‘I know. Mamma hates it when we fight, too, and so does Giu. And it’s not that much fun for me, either. I’m not arguing for the sake of it. Don’t worry, Elle.’ He switched the conversation to how his niece and nephew were doing, and his sister sounded a lot less strained by the end of the call than she had at the beginning.
When he’d hung up, he went through the dossier on Kelly that the palace PR team had quietly compiled for him. There was nothing the press could use to pillory her, so she’d be protected. There might be a bit of press intrusion, to start with, but it would soon die down because he knew that he was too quiet and serious and frankly boring to make good headlines.
He’d talk to her on Monday.
* * *
Luc spent Monday morning in clinic. His first patient, Maia Isley, had Marfan Syndrome—a genetic connective tissue disorder which caused abnormal production of the protein fibrillin, so parts of the body stretched more than they should when placed under stress. It was a condition which needed help from a variety of specialists, as the patient could develop scoliosis, have loose and painful joints, and suffer from eye problems. From a cardiac point of view, Marfan Syndrome could also cause problems with the aorta being enlarged, so patients needed regular check-ups and a yearly echocardiogram where the team could look at the structure of the heart and measure the size of the aorta.
Luc had already compared the new scan that Kelly had just performed to last year’s, and he wasn’t happy with the differences.
‘How are you feeling, Mrs Isley?’ he asked.
‘Fine,’ the young woman replied. ‘But, from the look on your face, you’re expecting me to feel worse than usual, right?’
Luc nodded. ‘Obviously you’ve learned a lot about your condition, so you know there’s a risk of your aorta—the biggest artery in your body, the one that starts at the top of the pumping chamber in your heart—getting wider, and that can make blood leak back into your heart so your heartbeat starts pounding and you get breathless.’
Maia shrugged. ‘My heartbeat feels like it normally does.’
‘And also there’s a risk of the aorta tearing.’
‘If it tears, I die, right?’ Maia asked.
‘There’s a high chance, yes. Your aorta’s grown wider since last year. We’re at the point where we need to do surgery to make sure it doesn’t tear,’ Luc said. ‘And we’ve got three options, depending on what you’d like to do. May I ask, were you thinking of having children?’
‘I’d like to,’ Maia said, ‘but my partner’s worried. Not so much the risks of the baby having Marfan’s, because we can have IVF and with preimplantation genetic diagnosis so we can be sure the baby doesn’t have the gene, but he read up that women with Marfan’s were more at risk of aortic rupture, especially during pregnancy.’
‘And he doesn’t want to lose you,’ Luc said softly. ‘I understand that. Surgery now will take that risk away.’ He drew three quick pictures. ‘The first option is where we replace part of the aorta and its root, including the valve. The treatment’s very safe and has a long track record, but you’ll be at risk of developing a blood clot so you’ll need blood-thinning medication for the rest of your life.’
‘Which means I can’t get pregnant, right?’
‘Which means if you do want to try for a baby, your doctor will switch your blood-thinning meds to one that’s injected under the skin and doesn’t cross the placenta,’ Luc said. ‘Or we can do a different sort of surgery where we replace part of the aorta but keep your valve—it’s called a valve sparing root replacement or VSRR for short. Because we’re keeping your valve, you won’t need the blood-thinning medication, but there’s a one in four chance we’ll have to redo the operation within the next twenty years.’
Maia looked thoughtful. ‘What’s the third?’
‘It’s a very new treatment where we make a special sleeve to go round your aorta, called a personalised external aortic root support or PEARS.’
‘So it wraps round and acts like a support, say like when my knee’s playing up and I have to strap it up?’ Maia asked.
‘Yes. The idea is that it’ll keep