Chapter 6 The Consult Room

My St. Ansel badge photo made me look like a woman who'd been arrested for something petty and was planning to appeal.

I clipped it to my scrub top anyway and stood at the window of my new office on the sixth floor. Below me the harbor spread out gray and choppy, and on the far side of it the Calloway Meridian cranes stood in a row along the container quay, red against the March sky. I'd forgotten they were visible from here. I hadn't forgotten anything else.

His face from the magazine rack was still behind my eyes. Two days, and it hadn't moved.

I turned my back on the window and unpacked my loupes. They lived in a foam-lined case Lorenz had given me when I qualified, and I set them out on the desk as I did on every first day: lenses up, headlamp beside them, battery pack charging. I was humming. I didn't notice until I heard it.

---

Dr. Trent Kemp gave me the tour at ten. He was the cardiothoracic chief, forty-eight, tall and tanned in the way of men who sail on weekends and mention it on Mondays. He had expensive teeth and showed me most of them.

"We're all very excited," he said, walking me past the ICU, "about your little Swiss stitch."

"It's a valve repair."

"Of course. Of course it is." He pushed open the doors to the OR suite. "Very elegant. I read the paper. Small numbers, though, aren't they? Forty patients? Here we tend to stick with what works. Replacement. Tried and tested." He glanced at me sideways. "Fairley. I remember a Fairley. You were here before, weren't you? An intern. The Calloway thing."

"I was an intern here, yes."

"Terrible business." He shook his head with great sympathy. "Well. Water under the bridge. Bramport has a short memory."

Bramport had the longest memory of any town I'd ever lived in. I didn't say so. Instead I asked him where the department kept its annuloplasty rings and who signed them out, and I wrote his answer in my notebook while he watched me write as if I'd lifted his wallet.

We were standing outside OR 4 when a short, broad man in a white coat came around the corner at speed. Winston Okafor, chief of surgery, the man who'd called me in Zurich and talked for an hour about valve outcomes without asking about my personal life. He had a tablet under his arm and the look of someone who'd been waiting all morning to use it.

"Dr. Fairley. Good. A consult." He didn't look at Kemp. "Eighty-five-year-old with aortic stenosis. Dr. Kemp has written 'inoperable.' I would like a second pair of eyes."

Kemp's smile stayed exactly where it was. "Winston, that patient's been seen."

"And now he will be seen again." Okafor held the tablet out to me. "Consult room two. Ten minutes."

I looked down at the screen.

CALLOWAY, EDMUND. DOB 03/13/1941.

---

Consult room two was small and too warm, with a desk, two chairs, an exam couch, and a framed print of the harbor in fog. I was standing by the window with my stethoscope around my neck when the door opened.

A nurse came in first, pushing a wheelchair. She was in her fifties, solid and neat, in a navy cardigan with a name badge: U. BLYTHE, RN. She had a small notebook in her breast pocket and a pen clipped to it.

In the wheelchair was Edmund.

He was so much smaller. That was what hit me first. He'd been a tall man, broad through the shoulders, a man who filled doorways. Now he sat folded into the chair under a plaid blanket, his right hand curled uselessly in his lap. His white hair was thin and combed flat. His face had sagged on the right side.

Behind him came Rhys.

He'd been reading something on his phone. He looked up and he stopped in the doorway, and for a second nobody in the room moved at all.

He was thirty-five. He'd been thirty when I left, and the five years were all there in his face, cut deeper, every line of him harder and more finished. Dark suit. No tie. His left hand was on the door frame.

There was no ring on it.

"The booking said Fairley," he said. "Zurich."

"It does that."

"I thought it was a coincidence." His voice was perfectly level. "The Margot Fairley I knew quit her internship."

"She did."

Edmund made a sound.

Not a word. A long, low, broken sound that came up from the bottom of his chest, and his good hand lifted from the blanket and reached for me across the air, trembling. His eyes had filled. As I watched, the tears ran down both sides of his face, silently, into the collar of his shirt.

I crossed the room and took his hand.

"Hello, Edmund," I said. "It's been a while. You still owe me a game."

His fingers closed on mine. His grip was weak but it didn't let go.

Ursula Blythe watched this. Then she took the notebook out of her pocket and wrote something in it.

---

I examined him properly, because that was what I'd been asked to do, and because if I didn't do it properly I was going to do something else entirely.

I listened to his heart first. Rhys stood against the wall with his arms folded and watched me as if I were a contractor he suspected of overbilling. I ignored him. I moved the stethoscope from point to point across Edmund's chest and closed my eyes.

The murmur was there. Harsh, mid-systolic, loudest at the right upper sternal border, radiating to the neck. Aortic stenosis. But it peaked early, and the second heart sound was still there, soft but present. A truly critical valve tends to swallow that second sound. This one hadn't.

That wasn't the sound of an inoperable valve. That was the sound of an old valve doing a moderate job.

I opened my eyes. Edmund was looking at me. His eyelids were heavy, half-lowered, and his eyes were glassy in a way I didn't like.

I took the penlight from my pocket. "Can you follow the light for me, Edmund? Just with your eyes."

He tried. When I moved the light to the side, his eyes went after it slowly, and then, at the end of the movement, they jerked back. A slow, coarse flicker. Nystagmus. I moved it the other way. Same. His pupils were on the small side, but they reacted. His lids drooped again as soon as I stopped.

I knew that face. I'd seen it on the geriatric wards in Zurich a hundred times, on old patients somebody had been giving too much of something to keep quiet.

"What's he taking?" I asked Ursula.

"It's all in the chart, Doctor." She smiled pleasantly. "Dr. Stroud manages his medications."

"I'd like to hear it from you."

"His heart pills. His blood thinner. Something to help him rest." She closed her notebook. "He gets terribly agitated without it."

I looked at Edmund. He was looking at Ursula. His left hand had tightened on mine.

"I'll need the full list," I said. Then I crouched by the wheelchair so that my face was level with his, and I put his good hand flat in my palm.

"Edmund. I'm going to ask you some questions. You don't have to talk. Squeeze once for yes. Twice for no. All right?"

One squeeze.

"Are you in pain?"

Two.

"Are you short of breath when you're lying down?"

He thought about it. Two.

"Do you feel sleepy? Most of the time?"

His hand closed on mine, once, hard, and stayed closed. His eyes held mine. They were wet again, and under the heaviness of the lids something fierce and frightened was looking out at me through the fog of whatever they'd been giving him.

"Do you know who I am?"

One squeeze. Then another, smaller. That was all the alphabet he had.

"He understands so little now, Doctor," Ursula said. "I'm afraid he just squeezes."

"He understands everything," I said, without looking up. "That's what makes it cruel."

Edmund's grip tightened.

"Do you want me to look after your heart?"

One squeeze, before I'd even finished the sentence.

---

Rhys came off the wall.

"You'll recuse yourself," he said.

He said it the way he used to say Noted: the matter decided in another room, and me informed out of politeness.

"From what?"

"From my grandfather's care. You know why."

"I know you think you know why." I let go of Edmund's hand and stood up. I had to tilt my head back to look at Rhys, which had always annoyed me. "Dr. Okafor asked me for a consult. I'm doing one. I'll finish my exam. Then you can file a complaint." I picked up the tablet. "Third floor. Ask for the form with the most pages."

His face did nothing. But something moved at the corner of his mouth, and I couldn't tell if it was anger or if, somewhere far down, a part of him had almost been amused.

"You don't get to be in a room with him," he said, low.

"I've been in a room with him before. I kept his heart going for nine minutes on a ballroom floor."

"And before that you made his tea."

The room went cold. Ursula's pen stopped. Edmund made the sound again, the low broken one, and his hand reached out and found nothing.

I let my voice drop until Rhys had to bend toward me to catch it.

"Interesting," I said. "Five years, and you still haven't asked me a single question."

He opened his mouth.

The door burst open.

---

"Mama!"

Pippa came in at a run. Wild dark curls, pink cheeks, her coat buttoned wrong, Admiral clamped under one arm by his tail. She skidded on the linoleum and caught herself on the end of the exam couch.

Behind her in the corridor I heard Dora Mahoney, breathless. Dora was a widow from three doors down Netmaker Lane who'd known Helen for thirty years, and she'd offered to mind the twins until they started school. "Pippa! Pippa Fairley, you come back here, I said wait by the elevator!"

"Mama," Pippa announced, ignoring this completely, "Felix counted ninety-one stairs. We didn't take the elevator because Felix wanted to count. No, wait, it was ninety-two, but one was broken."

Felix was in the doorway.

He stood straight, small for his age, his dark hair falling in his eyes, his blue stethoscope hung around his neck. He'd climbed six floors to find me and he was breathing hard. His gray eyes went from me to Edmund in the wheelchair to Ursula with her notebook. Then they went to Rhys and stayed there.

He leaned toward his sister and whispered.

Pippa listened. Then she turned around, slowly, and looked up at the tall man in the dark suit standing beside her mother.

She had his eyes. There was no mistaking it in that small hot room. The exact same green. The same narrowing when she was deciding something. She'd had them since the day she was born, and every morning for four and a half years I'd looked at them across the breakfast table and not let myself think about where they'd come from.

Dora appeared behind Felix with one hand pressed flat to her chest. "I'm sorry, Doctor. She's quicker than an eel off a dock." Nobody answered her.

Rhys looked down at Pippa.

He didn't move. I watched the color leave his face, from the forehead down, the way blood leaves a limb when you put a tourniquet on it. His thumb moved to his ring finger, where there was nothing left to turn.

Pippa tilted her head.

Rhys's eyes went from her to Felix in the doorway and back again, and then they came to me.

"How old are they?" he said.