CHAPTER 10 — THE SECOND WARNING POV: Amelia Carter

The message arrives at 6:17 a.m. on a Thursday.

Mr. Blackwood had another episode overnight.

I read it twice.

The nurse has written the basics down. Palpitations, brief light-headedness, no loss of consciousness reported. Instead of waiting for his next appointment, Damian phoned the department himself.

And that part counts.

So does the episode.

I put my phone down and stare at the ceiling for a moment. Then I get out of bed.

By the time I get to the hospital, the corridors are already filling up. Morning staff walk between departments with coffee in paper cups, tablets tucked against their sides. Usually, the familiar rhythm of the place settles me.

It doesn't today.

Damian’s evaluation is not finished. His previous monitoring had yielded sufficient information to continue specialist input but not enough to make a major treatment decision. Given his history of hypertrophic cardiomyopathy, any new symptom is something that must be taken seriously.

Not every symptom is a sign of decline.

But neither can I afford to dismiss a pattern because the patient would rather have certainty.

I find Dr. Harris by the cardiology workroom.

“Damian Blackwood had another episode last night,” I say.

He looks up at once.

“How long?”

“Several minutes, according to the message. Palpitations and dizziness. No syncope.”

“Any chest pain?”

“Not mentioned.”

He extends his hand.

I pass him the message.

“We have to look at him again.”

“Agreed.”

“And check the monitoring again.”

“I’ve already asked for it.”

Dr. Harris nods.

“Bring him in.”

I reach for my phone.

He stops me.

“Amelia.”

I face him.

“Don’t let him talk his way into taking this down a notch.”

“I won’t.”

He gives me a knowing glance.

“I’m not worried about you.”

I get what he’s saying.

Damian has a knack for making every conversation feel like a negotiation. He questions every instruction, questions every assumption, and seems determined to prove that his life can go on exactly as it always has.

But behind the arrogance, I've seen something else.

Terror.

Not the kind that makes people panic.

The silent type.

The kind that makes them say they’ve got everything under control because admitting they haven't is worse.

I ring him.

He picks up on the fourth ring.

“Dr. Carter.”

“You reported something during the night.”

“Yes.”

“What was it?”

Silence.

“I was up. It started with the palpitations.”

“When?”

“Shortly after midnight.”

“What were you doing?”

“Reading.”

“You were lying down?”

“Yes.”

“How long did it go on?”

“Long enough to see that—”

“That’s not a measurement.”

“I didn’t time it.”

I close my eyes for a moment.

“Did you get light-headed?”

“Yes.”

“Any chest pain?”

“No.”

“Breathlessness?”

“Not too much.”

“You fainted?”

“Nah.”

“Did the symptoms just go away on their own?”

“Yes.”

“Any symptoms since then?”

“Nope.”

“I’m going to need you to come down.”

“I have a ten o’clock meeting.”

“Call it off.”

Silence.

“Sounds unnecessarily melodramatic.”

“No. Sounds like a doctor’s orders.”

“I feel good now.”

“I didn't ask how you feel now.”

His breathing changes a little.

“You’re worried.”

“Yeah.”

It is pointless to pretend otherwise.

“How long?”

“Less than an hour.”

“I’ll be there.”

The call goes dead.

I put the phone down.

At least he was agreeable.

The hard part will be preventing him from thinking that agreement means surrender.

He arrives forty minutes later.

The first thing I notice is how calm he looks.

The second is that he looks tired.

He takes off his coat and hands it to Adrian, who came with him. Damian’s movements are calculated, but his fingers brush his cuff for a moment before dropping to his side.

“Good morning,” I say.

“Is it?”

“Not yet.”

His lips press into a tight line.

“Good to know.”

“I didn't say it to appease you.”

“I hear you.”

Adrian gives us a quick look.

“I’ll be outside.”

Damian nods.

The door closes, and I gesture toward the chair.

“Sit down.”

He does.

I take his blood pressure, check his pulse, and ask the questions again, only this time face-to-face.

The episode lasted for minutes.

It started when he was resting.

His heart pounded, and he felt light-headed.

He stayed conscious.

No chest pain.

No significant shortness of breath.

It stopped on its own.

“And you've had similar episodes since your last visit?” I ask.

He pauses.

“It depends on what you mean by similar.”

“Palpitations.”

“Yep.”

“How many?”

“Two.”

“When?”

“Yesterday and Tuesday.”

I put my pen down.

“Two episodes before last night?”

“They were small.”

“That wasn't my question.”

His jaw hardens.

“Tuesday morning. Yesterday afternoon. Last night.”

“And you only reported the third?”

“I reported the one that bothered me.”

“They all worry me.”

“I didn't know that.”

“Now you do.”

He’s looking at me.

Neither of us says a thing for a few seconds.

“Why did you not report the rest?” I ask.

“I thought you wanted pertinent symptoms.”

“I do.”

“I thought the short episodes didn’t matter.”

“You can't say that until you give us the information.”

“I was working on something.”

“So?”

He looks away.

I wait.

Finally, he says, “I didn't want any more appointments.”

The honesty is so unexpected it almost makes me go soft.

Not quite.

“Damian, this isn’t about how many appointments you want.”

“I know.”

“You do?”

“Okay.”

He’s softer now in his answer.

I look at the monitor.

“We need to repeat your assessment today and review the prior rhythm information alongside these new symptoms. Depending on what we find, we may need further monitoring or additional testing.”

“How many more tests?”

“I don’t know yet.”

He laughs, but not with humour.

“That’s your favourite answer now.”

“It’s the honest one.”

“Can you tell me if this is getting worse?”

“Not from the symptoms alone.”

“So what can you tell me, then?”

“Something’s changed, so it’s time for another assessment.”

He stares at me.

I meet his gaze.

“I can tell you I will not say everything is fine just because you are asking me to.”

His face sets.

“I never told you to lie.”

“You asked me, ‘Is it getting worse?’ We don’t have the evidence to say that.”

“And you think I'm seeking reassurance.”

“I think what you’re looking for is certainty.”

The room goes very still.

He studies his hands.

Perhaps I have crossed the line.

Then he says, “What’s the fuckin’ difference?”

“Reassurance can be given without proof. Certainty cannot.”

He looks back at me.

I continue before he can interrupt.

“What we know, I can tell you. I can tell you what we don’t know. I can tell you what we’re doing next. But I will not give you an answer just because it is the answer you want.”

His eyes narrow.

“That makes it sound easy.”

“It is not.”

“Then why do you say it so softly?”

“Because panicking won’t improve the assessment.”

Something changes in his face.

Not agreement.

Recognition.

He has heard me.

I arrange the next steps.

An ECG. A review of the prior rhythm monitoring. Further imaging as appropriate. Further rhythm monitoring or specialist testing, depending on those findings.

I walk him through each step and why it matters.

He listens without interruption.

That's new.

We wait for the first reading after the ECG is done.

Damian is sitting by the window, one ankle crossed over the other knee. His phone sits face down next to him.

I say, “You’re not replying to your messages.”

“I told my office I was not available.”

“You missed your appointment.”

“Yes.”

“Why?”

He looks at me.

“Because you said so.”

I lift an eyebrow.

“It’s as if you think I invented you.”

“I’ve thought about it.”

I smile, against my will.

He sees it.

“Did you smile?”

“No.”

“It was.”

“You’re seeing things.”

“I’m glad to hear that.”

I shake my head.

The tension eases for a moment.

The door swings open.

Dr. Harris comes in with the initial ECG reading.

“Nothing here gives us a definitive explanation,” he says. “But given his symptoms and history, we should keep investigating rather than dismissing the episodes.”

Damian’s face goes blank again.

“So we’re still investigating it.”

“Yep.”

“How long?”

“Until we have sufficient information to make the appropriate decision.”

He looks toward me.

I can see what he’s thinking.

Another vague answer.

Another wait.

But this time, he does not decline.

Dr. Harris leaves to schedule the next assessment.

Damian doesn’t say a word.

I sit down across from him.

“You did the right thing calling last night.”

“I almost didn't.”

“I know.”

He gazes at me keenly.

“How the fuck?”

“Because you waited until the symptoms went away before calling us.”

He doesn't reply.

I go on.

“But you phoned us. That’s what counts now.”

He looks out the window.

“I don’t like the dark.”

“I know.”

“I hate being told to wait.”

“I know.”

“And I don’t like being told I have no say in something.”

I study him.

“Guess that last one’s the hardest.”

His eyes come back to me.

I say nothing further.

No pity needed for him.

No more lectures.

He needs to know the truth.

“I’ll keep looking into it,” I say. “I’m going to be involved, and the staff will assess everything as it comes in. You report it if you get another episode. You don’t say, ‘It’s too short, too inconvenient, or too unimportant.’”

He breathes out slowly.

“And if I don't want you to supervise me?”

“A second opinion is available.”

He seems surprised.

“But?”

“But if you're under my care, I want honesty.”

He is quiet for a long time.

Then he nods.

“Okay.”

I wait.

“Fine what?”

“I’ll continue with you.”

The words sound reluctant, but the choice is straightforward.

“Fine.”

He stands up.

He pauses in the doorway.

“You know what I hate about you?”

“I bet you’re going to tell me.”

“You do not allow me to make things easier than they are.”

“That’s not what you hate.”

His eyes narrow.

“You are pretty cocky.”

“No. I see things.”

For the first time that morning, he almost grins.

Then the expression is gone.

“See you at the next appointment, Doctor.”

“See you then.”

He walks off.

I watch him leave the room.

This episode counts.

The new pattern is more significant.

But so is the fact that he reported it.

That little decision may be the most important one he's made.

I go back to the desk and look at his folder.

We still do not know enough.

And there’s something else I’ve started to understand about Damian Blackwood.

He does not merely hate uncertainty.

He experiences it as a loss of control.

This makes him a valuable participant in his own care.

It also makes the situation delicate.

When he returns, I will have to keep remindi

ng him that medicine is not a negotiation and he cannot win by demanding better terms.

Things are not going according to plan.

I know this because I learned it long before I became a heart doctor.

But knowing something is one thing, and accepting it is another ball game.

I shut his file and wonder which of us will have more difficulty making that distinction.

Because Damian has agreed to continue under my care.

That will do for now.

But as I look over the new symptoms on his chart, I know one thing with uncomfortable certainty.

The next warning might not afford us the luxury of time.