CHAPTER 7 — THE ASSIGNMENT

The cardiology conference room is occupied when I arrive.

Dr. Harris sits at the head of the table, looking at a report on the screen. Two members of the cardiology team are sitting next to him, their copies of Damian Blackwood’s results covered in scrawled notes. I grab the last chair and place my notebook in front of me.

"Have we all gone through the findings?" Dr. Harris asks.

Everyone nods in agreement.

I've read the report twice since I got it this morning. I'd hoped the extra monitoring would help us get a better handle on Damian's situation. It has given us useful information, but useful information is not always a complete answer.

We all know about his hypertrophic cardiomyopathy. He needs ongoing specialist assessment due to his reported palpitations, medical history, and preliminary imaging findings. But we still need to review the outstanding results and investigations before we make any major decisions about treatment.

Dr. Harris turns his head to me. “Amelia, you want to get us started?”

I unfold my notebook.

"The monitoring results should be interpreted according to his symptoms and previous investigations. They give us more information on his cardiac rhythm, but we should not consider the report a comprehensive assessment of his present status. We need to review the outstanding findings before determining whether any change in management is required."

One of the specialists nods in agreement. “Okay. We have enough reason to keep looking, but not enough to make a definitive treatment decision.”

“All right.”

Dr. Harris examines the report. "And your recommendation?"

"Continued specialist input and completion of the assessment plan. I wouldn’t recommend making a major treatment decision based on what we know now."

The other questions are discussed. We reflect on the significance of Damian’s symptoms, the need to correlate them with the recorded observations, and the importance of reviewing the entire clinical picture. No one is suggesting we ignore the information we have, but no one is prepared to say it tells us more than it does.

Before the meeting closes, the recommendation is clear.

Damian needs ongoing specialist care. No major decision should be made without further assessment.

Dr. Harris collects the papers.

"He won’t like to hear we don’t have a final answer."

"He doesn't have to like it," I say. "He has to know what we know and what we don't know."

"Double it," one of the men says.

"Yeah, I will."

I take the report and walk out of the conference room, tucking it under my notebook.

Outside, the hospital is busy with its morning routine. Files and equipment clatter along the hallways, patients wait outside consultation rooms, and a nurse calls for help from the department beyond the lifts.

I don't see much of it.

I’m thinking about the conversation to come.

Damian has already questioned my judgement, challenged the monitoring plan, and made it clear he hates being told what to do. He will probably question the recommendation that I stay involved in his care.

I don’t blame him for wanting the best specialist available. He has a condition that calls for proper attention, and he has a right to ask questions about the person responsible for his care.

What I will not do is let his money, position, or impatience dictate the medical recommendation.

I arrive at my office to find out from the receptionist that Damian is early.

Of course he is.

I see him standing by the window outside my door, looking at his phone. His dark suit is spotless, his expression composed. He shows no sign of having been unsettled by the monitoring period.

He looks up as I come near.

"Dr. Carter."

"Mr. Blackwood. I didn't expect you so early."

“I don’t waste time.”

"Then we agree on one thing."

His eyes narrow a little, but he follows me into the office.

I sit down behind the desk and point at the chair opposite me. Damian sits and places his phone next to his knee. His eyes instantly fall to the report in my hand.

“Have the results come in?”

"Yes. I’ve gone through them with the cardiology team."

"And?"

"We'll work through them together."

"I hear you."

I put the report on the desk between us.

"The monitoring has given us more information about your heart rhythm. It has to be interpreted in conjunction with your symptoms, your established diagnosis, and the other findings from your assessment. The team has agreed that you should remain under specialist care while we complete the investigation."

He looks at my face, not at the report.

“Has something gone south?”

“Based on what we know right now, I can’t come to that conclusion. That’s where further assessment comes in.”

"So the monitoring hasn't given you an answer."

“It’s given us information. It hasn’t provided all the answers.”

His mouth pinches.

I continue before he can make another argument. “I don’t want you to confuse uncertainty with inaction. We have a plan. The next step is to complete the assessment and then decide whether your management needs to change.”

"And what if the assessment gives you a different answer?"

“Then we take that new information, process it, and adjust the plan accordingly.”

He looks at the report.

“You make everything look so easy.”

"The process is easy. I can’t guarantee the outcome."

He is quiet for a moment. Then he raises his eyes.

“Why are you still like this?”

There you go.

My face remains blank. “Because I have been involved in your assessment from the beginning, and the team believes that continued specialist involvement is appropriate.”

"That's not what I said."

"No. You asked why I'm the specialist."

"Okay."

I put my hands on the desk. “I have looked at your medical history, reviewed your symptoms, and arranged the investigations we’ve been talking about. I know what we have and what’s still outstanding. It is reasonable to recommend that this work remain under specialist supervision.”

“Reasonable,” he says again. “Not necessary.”

"I never said I was the only doctor who could treat you."

"Then why should I carry on with you?"

“The team supports the recommendation, and continuity of care is important while we are still working through an assessment. But that doesn’t mean you have to agree with me just because I say so.”

His expression alters a little.

I hand him the report and turn it so he can see it.

"You have the right to get a second opinion. If you want to do that, we can help with the proper transfer of your records and make sure the next specialist knows what has been investigated and what remains outstanding. I won’t stop you from making that choice.”

He studies me closely.

"You'd be quite happy to pass my case on to someone else?"

“I am responsible for your care, not for keeping you as my patient at any cost.”

“And if the other specialist disagrees with you?”

"Then we look at the reasoning and the evidence. A second opinion is meant to give you another qualified opinion, not to guarantee that you’re going to get what you want."

He has a pale, mirthless smile on his face.

“You have an answer for everything.”

"No. I just said I don't."

This earns me a short silence.

I use the opportunity to walk him through the report. I talk about what the monitoring can tell us, why the findings need to be interpreted in light of his wider medical history, and why the team is not in a position to make a major treatment decision at this point. I explain what has been established and what still needs to be clarified.

He listens without interruption, though his fingers tap once against the arm of the chair.

He looks down at the pages as I finish.

"So I have to wait."

"You have to complete the next stage of the assessment. That isn't the same as doing nothing."

“And how long will it take?”

“The timing depends on the ongoing investigations and the appointments that have to be made. I’ll give you the clearest schedule I can once I have those details confirmed.”

“I’m already booked.”

“I know you have professional obligations.”

"Do you?"

"I understand that your time is valuable to you. But we can’t schedule your care around your calendar either."

His eyes become keener.

"I run a company with thousands of staff. I can't just go away when a hospital decides it needs me."

"I didn't tell you to go away. I have called you in for the appointments you need to complete your assessment. We’ll look at reasonable scheduling options, but we will not sacrifice your care for calendar convenience."

The pause this time is longer.

I can see the frustration on his face. He is accustomed to solving problems through decision-making, delegation, and time frames. In his world, a problem is usually solved by finding the right person or applying enough pressure.

But that’s not what a medical condition is.

Nor is uncertainty.

"I want copies of the results," he says finally.

“The records are available through the usual channels.”

“And I want to know if there is anything different.”

"If the assessment changes our understanding of your condition or the plan we are recommending, we will discuss it with you."

He nods, but it’s more a gesture of unwilling acceptance than agreement.

I record our conversation and document the recommendation, including the pending assessment and follow-up plan.

“Once we have confirmed the necessary steps, we’ll set up your next appointment,” I say.

“I will come.”

"Good."

He rises and brushes his jacket down. For a moment, I think the conversation is over. Then he stops beside the desk.

"Don't take this the wrong way, Dr. Carter. Just because I agreed to the next appointment doesn’t mean I’ve decided you’re right about everything."

“I wouldn’t expect you to.”

"And I’m not promising to make this easy."

I close his file.

“I’m not asking you to make it easy, Mr. Blackwood. I am asking you to cooperate with the assessment and give us accurate information. Feel free to question my suggestions. You can disagree with them. But if you want us to make good decisions about your care, you have to tell us the truth."

He looks into my eyes.

"And what if I decide I don't like your decisions?"

"Then we’ll talk about your concerns. You are free to look for another specialist if you wish."

He looks at me for another second, as if searching for the menace, the hidden clause he’s learned to expect from those who won’t bow to him.

There is none.

At last, he gives a brief nod.

“See you at the next appointment, Doc.”

“See you there.”

He leaves, closing the door behind him.

I sit for a moment, looking at the closed door, then turn back to my notes.

The meeting with the cardiology team has given us a clear direction, though not all the answers Damian wants. What matters now is what happens next: his willingness to participate honestly in his care.

He accepted the appointment. That is progress, no matter how small.

But cooperation is not trust, and I am not going to confuse the two.

I complete the documentation of the

consultation, save the record, and reach for the next file on my desk.

Working with Damian Blackwood is going to require patience, precision, and more than a little determination.

He has been given a clear warning, and it looks like he’ll test all three.