CHAPTER 13 — THE COST OF IGNORING ME POV: Amelia Carter

Damian Blackwood has already given my receptionist three different excuses for being late for his appointment at eight-thirty.

The first is a meeting that ran long. The second is a summons he cannot avoid. The third, far less confidently put by his assistant, is that he would prefer to reschedule.

I stand beside my desk and read the message for the second time.

I'd rather change the time.

Those words make me want to call him myself.

“When will he be free?” I ask.

The receptionist shakes her head. “His assistant said he’d call us back.”

“Of course he did.”

I return to the patient file on my screen. Damian’s assessment is not finished yet, and his symptom record is current, including yesterday’s episode. He reported it himself. That's an improvement. But reporting a symptom does not eliminate the need for follow-up.

I check the appointment schedule. It's not an easy slot to fill, the one he's been given. There are other patients waiting for reviews, and I can't shuffle them around because one man thinks his calendar is more important than anyone else's.

I pick up the phone.

“Get me Mr. Blackwood's office, please.”

His assistant picks up after two rings.

“Good morning. Damian Blackwood's office.”

“This is Dr. Carter's office. I need to speak with Damian.”

“Mr. Blackwood is in a meeting at present.”

“Then tell him I'll be waiting.”

A brief pause.

“What is this about, please?”

“His health.”

“I know, Doctor, but he's—”

“I didn't ask you to interrupt his meeting. I told you to tell him I'm waiting for him.”

There is another pause, and then the assistant agrees to relay the message.

I hang up.

Maya appears at my door with a takeaway coffee and that look she gets when she knows something's going to annoy me.

“Let me guess. Your favourite patient?”

“He's not anything of my favourite sort.”

“You're standing as if you're about to prosecute someone.”

“I'm considering it.”

She puts the coffee on my desk.

“Have this first, anyway.”

I look at her, and she chuckles softly.

“Really, Amelia. You can't spend all morning trying to pound one man into the shape of a patient.”

“I am not trying to control his behaviour. I'm trying to make him realise what happens when you don't follow medical advice.”

“They're a little too familiar when you're angry.”

“I am not angry.”

Maya raises an eyebrow.

I look back at the monitor.

She knows it's no use arguing with me when I've set my mind on winning a point, so she leaves the coffee and returns to her own office.

Five minutes later, my phone rings.

“Dr. Carter,” Damian says.

His voice is controlled, as though he's walked out of a room full of people and expects the world to stay exactly where he left it.

“Mr. Blackwood.”

“I know you're trying to get to me.”

“Your appointment was this morning.”

“I know.”

“Your assistant said you wanted to reschedule.”

“I have a prior commitment.”

“Is that more important than your follow-up?”

A brief silence.

“That's an unreasonable question.”

“It's a reasonable question when you're trying to delay an evaluation we haven't completed.”

“I reported the incident yesterday. I did as you said. I haven't had another one since.”

“That doesn't tell me everything I need to know.”

“It shows that I have no symptoms at present.”

“It means you're not currently experiencing symptoms. Those are two different things.”

I can hear muffled voices in the background. He's busy somewhere, surrounded by people waiting for him to make decisions.

“Can we talk about this later?” he asks.

“We can talk about it now, or you can attend your appointment and we can talk about it in person.”

“You're making this more complicated than it has to be.”

“No, Damian. I will not pretend your schedule changes the medical facts.”

The silence is sharper than before.

“You like giving orders, it seems.”

“I like to see that my patients understand that medical advice is not a personal attack.”

“I'm not going to argue with you.”

“Then don't treat every recommendation as if you have to negotiate it.”

I hear him breathe out.

“Change the appointment to tomorrow.”

“I'll give you the next available time that works, but I won't promise you a time until I check the schedule.”

“Fine.”

“And Damian?”

“What?”

“Before we discuss rescheduling, you need to tell me if you've experienced any other symptoms.”

“I have not.”

He answers too quickly.

I grip the phone a little tighter.

“Are you sure?”

“Yes, Dr. Carter.”

“Then I'll have the receptionist check for the first available appointment.”

He hangs up without saying goodbye.

I stare at the phone for several seconds.

He hasn't shouted or threatened to complain. He's simply decided the conversation is over because he no longer wants to take part in it.

I know that trick.

It works in boardrooms, where people need his approval, his money, or his willingness to continue negotiating.

It won't work here.

I call the receptionist and tell her to hold the next available appointment while I look through the schedule.

Then I return to my patients.

---

At eleven forty, Damian enters my office.

His assistant is not with him, and he has taken off his jacket. The sleeves of his shirt are buttoned neatly at the wrists, but his shoulders are tense in a way I hadn't noticed before.

I check the clock.

“You weren't scheduled until this afternoon.”

“I was in the neighbourhood.”

“Great coincidence.”

His eyes narrow slightly.

“I came because you made it clear you wouldn't discuss it over the phone.”

“I told you that a review was needed.”

“Then we'd better get on with it.”

I point to the chair across from my desk.

He sits and places his phone beside him. The screen lights up almost immediately. He flips it face down.

“Have you had any more palpitations since yesterday?” I ask.

“No.”

“Light-headedness?”

“No.”

“Chest discomfort or unusual breathlessness?”

“No.”

I enter his answers into the record and then look up.

“Anything else I should be aware of?”

His jaw tightens.

“Why do you keep asking me that?”

“Because I need to know exactly what you're experiencing, not just what you think will get you out of here sooner.”

His eyes harden.

“You think I'm hiding facts.”

“You've had to admit to symptoms you didn't report initially. Now you're trying to delay a review before we've completed your assessment. I have my reasons for asking.”

“I told you about yesterday's episode.”

“Yes, and I acknowledged that. But one honest answer doesn't mean I should stop asking questions.”

He leans back and looks out the window.

For a moment, I wonder if he's going to walk out.

Instead, he picks up his phone, checks the screen, and puts it back.

“The episode yesterday happened during a meeting,” he says.

I wait.

“I was sitting at the table.”

“How long did it last?”

“Just a few seconds.”

“Did it feel like the other episodes?”

“Yes.”

“Did you feel light-headed?”

“No.”

“Did it stop on its own?”

“Yes.”

“And you recorded it?”

“Later.”

“How much later?”

He looks at me.

“Does the exact minute matter?”

“It matters if we're trying to establish an accurate account of what happened and whether you followed the instructions we discussed.”

“I wrote it down after the meeting.”

“How long after that?”

“An hour or so.”

I make a note.

“Why didn't you excuse yourself from the meeting and record it as soon as you could?”

“I was in the middle of negotiating a major acquisition. Walking out would have raised questions.”

“What kind of questions?”

He gives me a look that suggests the answer should be obvious.

“About why the CEO of Blackwood Industries suddenly needs to leave a meeting.”

“You're concerned about what people will think.”

“I was concerned about the control of something that involved hundreds of millions of dollars.”

“And you decided that a medical symptom could wait.”

“It did wait. Nothing happened.”

“Something happened, Damian. Your heart rhythm was different enough for you to notice. The fact that the sensation passed doesn't prove it was harmless or explain why it occurred.”

His fingers tap once against the arm of the chair.

“You keep talking as if I deliberately took risks.”

“I'm saying we might miss a pattern because the symptoms interfere with your work and you push them aside. We're still evaluating your condition. I can't give you certainty we don't have, and you can't manufacture certainty by ignoring what you don't want to deal with.”

His expression changes.

Only slightly, but I see it.

The anger remains. Something else surfaces beneath it, then he pushes it aside.

“You make it sound easy,” he says.

“What part?”

“Walking away from a meeting. Telling people I need time. Admitting that something might be wrong when I have no solution to give them.”

I put my pen down.

“Those things might be hard. That doesn't make them medically irrelevant.”

“You have no idea what it does to people when they think you can't handle your own responsibilities.”

“Tell me, then.”

He looks at me as if he's unable to decide whether the question is sincere.

I give him time.

Finally, he says, “People start making decisions for you. They stop asking what you want and start deciding what they think you can handle. They become suspicious of you. They watch you. Every conversation changes.”

His voice remains even, but his hand grips the edge of the chair.

I think about how he challenged me during our first consultation, insisting on answers I couldn't truthfully give him. His insistence on seeing every result himself. The way he treats information as though it must remain under his control.

“You think that if you tell people you're scared, they'll take control away from you.”

His eyes flick towards me.

“I didn't say I was scared.”

“No, you didn't.”

“Don't put words in my mouth.”

“Fair enough.”

I set down my pen.

“But I'm not going to pretend fear has nothing to do with how you're handling this.”

He stands abruptly.

For a moment, I think the consultation is over.

He turns towards the window, his back still to me.

“You have a gift for assuming things about people you've known for five minutes.”

“I know you want answers, but you keep trying to avoid the process that might give us some.”

“Because the process takes time.”

“Yes.”

“And you can't tell me what the results are going to show.”

“Not yet.”

He turns around.

“Do you have any idea how maddening that is?”

“Yes.”

The answer seems to catch him off guard.

I continue before he can mistake my understanding for a promise.

“You want me to tell you everything will be all right. I can't do that. I can't tell you something terrible is going to happen, either. We haven't established either conclusion. What I can do is study your symptoms, review the results, and make decisions based on evidence rather than fear.”

He studies me.

“And if the evidence is bad?”

“We talk about what it means and what we can do about it.”

“And if there's nothing you can do?”

I meet his eyes.

“Then I'll tell you what we know, what we don't know, and what options we have. I won't abandon your care because the answer is difficult.”

Something in his expression stills.

For a moment, the room seems quieter than it should be.

Then he turns away.

“My father hated being treated like a patient,” he says.

The confession is so unexpected that I fight the urge to move closer to it.

“He would ignore symptoms until they were impossible to ignore. If he kept working, he figured he could have some kind of normal life.”

“Did he tell you much about his condition?”

“Not much.”

“Was that his decision?”

“I don't know. The adults around me seemed to think that not telling me was the same as protecting me.”

His mouth tightens.

“I learned more from overhearing conversations than anyone ever took the time to tell me.”

I think of the child he must have been, trying to understand why the adults around him had suddenly started lowering their voices.

“Now you want to make sure nobody can do that to you again,” I say.

He looks back at me.

“I'm trying to understand what's happening with my own body.”

“Fair enough.”

“Then don't treat me like I can't make decisions.”

“I'm not. I'm asking you to make them with accurate information, and that requires you to tell me what you're experiencing.”

He returns to his chair but doesn't sit down immediately.

“What if I tell you everything and it makes no difference?”

“Then we won't have missed something because you were afraid to mention it.”

His eyes drift towards the phone beside him.

I wait.

“I don't like not knowing what's going on,” he finally admits.

Then he sits.

It's a smaller admission than the one I suspect lies beneath it, but it's honest.

“Most people don't.”

“This isn't most people.”

“No. It's you.”

He looks at me sharply, but the anger has lost some of its force.

I explain the immediate plan. We'll proceed with the assessment already planned, review the findings we have, and decide what further investigation is appropriate. He must report changes in his symptoms rather than decide for himself that they aren't significant. If he experiences severe or persistent symptoms, faints, develops chest pain, or has significant difficulty breathing, he needs urgent medical attention rather than waiting for a scheduled appointment.

He listens without interrupting.

When I finish, he asks for a copy of the plan.

“Of course.”

“And I want to know when the results are available.”

“We'll let you know when they're ready to discuss.”

“Not through my assistant.”

“Through you,” I agree. “Your medical information is yours.”

He gives a single nod.

I begin writing the consultation notes. He remains seated, unusually still, while his phone buzzes several times beside him.

He doesn't reach for it.

The silence stretches.

“Dr. Carter?”

I look up.

“Yes?”

He seems to reconsider what he was about to say. He looks at the window, then back at me.

“The symptoms scare me more than I'd like anyone to know.”

The words are soft, almost hesitant.

I'm in no hurry to reassure him. I don't tell him fear is a weakness or that everything will be fine. Neither would be honest.

“Thank you for telling me,” I say.

He swallows, his expression guarded again.

“Don't take that as permission to run my life.”

“I won't. But I'll keep telling you to take your health seriously.”

“I'd expect nothing less.”

He gets up and picks up his phone. At the door, he stops without turning around.

“If I have another episode, I'll inform you.”

“I hope you will.”

He turns.

I look at the consultation notes on my computer screen. His admission doesn't change the medical facts, but it changes something about the way I understand his resistance.

He's not simply protecting his calendar or his authority. He's trying to hide his uncertainty.

And I suspect he's been doing that for a lot longer than I've known him.

I save the notes and turn to the next patient.

My phone rings before I can open the file.

The cardiology department's number flashes on the screen.

When I answer, the nurse speaks immediately.

“Dr. Carter, there's a new development regarding Mr. Blackwood's pending evaluation. Dr. Harris wants you to look it over as soon as possible.”

I sit

up in my chair.

“Something new?”

“There's new information in his file. He hasn't been informed yet.”

I look at the door that has just closed behind Damian.

“What information?”

“I think Dr. Harris should explain it himself. He's asking you to come to his office.”

The call ends.

I sit motionless for a few seconds, my hand resting beside the keyboard.

Damian has finally admitted his fear.

Now I have to find out whether the information we've been waiting for will give us answers or leave us with more difficult questions.