Broken Hearts

Prologue
My name is Miranda Jackson. I am 28 years old and I am a heart surgeon. Last week I had an interview for the position of consultant on the cardio-thoracic’s ward of Redgrove Hospital, the same ward I’ve worked on as a registrar for three years, and I even did a term here when I was a student. Most doctors will have you believe that they became doctors because they want to help people, to save lives, to change the world. But I don’t kid myself, nor do I kid my patients, that this job was ever about making the world a better place. Not really. You see, my father is in prison. He killed 17 people. And I have to make that right. So here I am, working every day to save people, to try and make it right, to save people that might have died otherwise. I know I’m being ridiculous, and no matter how many people I save it won’t make my father’s crimes right again. Nothing will ever put right what he did to those people. But at the same time, my reasons aren’t important anyway. As long as I’m working to save people, they don’t really question why. So maybe I am doing this for all the wrong reasons, but the fact I'm doing at all outweighs the bad reasons that led me here. It doesn’t matter what my motivation is, I have still chosen a profession that makes people better.
 
It was 4am and I was asleep in the on-call room of my hospital ward. Well, I wasn’t asleep actually, because my pager was beeping; very loudly. I dragged myself out of bed and reached for my scrubs, pulling them on over the vest and leggings that I’d been asleep in. Then I  rubbed my eyes and left the room. In the corridor the fluorescent lights jolted me awake further as I moved to the main office of the ward. Inside was the consultant, Jac Burns. She was waiting for me when I came inside.

‘Morning Miranda.’ She smiled. I returned it tiredly.
‘What’s the emergency?’ I asked.
‘We’ve got a maj-ax coming in. 7 car pile up on the motorway. Acute Admissions are handling the A and E overflow, but we’ve got two coming straight to us. We need to keep all our theatres clear for emergencies so I need you to cancel all the elective surgeries.’ Jac explained. I nodded once. ‘Can you also ask Michael to call as many nurse, F2’s and registrars that he can get hold of?’
‘Will do.’ I answered, turning to the door.
‘Oh Miranda, I never got a chance to say, congratulations. I look forward to sharing my office with you.’
‘Thanks Jac.’

While I was clearing the surgery list a young man approached me, with a notepad in one hand and a pen in the other.
‘Are you Miranda Jackson?’ He asked.
‘That’s me.’ I replied, barely glancing up from my clipboard. ‘Can I help you?’
‘I’m from the Star. I’m here to interview you?’
‘Interview?’ I asked, confused.
‘Redgrove’s youngest heart surgeon to make consultant. I was told that you knew.’ The man said to me.
‘I remember, yeah.’ I told him. ‘Look...um...’
‘David.’ He told me.
‘Look David, we’re right in the middle of a major incident so it’s not really a good time.’ I told him. As if on cue the double doors banged open and our first patient arrived, ‘Look, there’s a relative’s room over there.’ I said pointing to the door. ‘Wait in there and if I get five minutes I’ll come to you.’ I said.

Having got rid of David, however temporarily, I jogged over to the trolley, unlooping my stethoscope from my neck as I moved.
‘Bed four please.’ I said to the porter. I followed them as they moved the young woman to the bed. After the porter had left I began to examine her. There was a large triangle of glass in the middle of her chest cavity, and from the wound I could see that it had narrowly missed her heart. She was very lucky. ‘What’s your name?’ I asked, moving the oxygen mask away from her mouth.
‘Jessie.’ She croaked.
‘How old are you Jessie?’
‘Twenty-three.’
‘Can I call anyone for you? Family? Partner?’ I offered.
‘My sister.’ She croaked. ‘My phone’s in my bag. Her name’s Shelley.’ I nodded, replacing the oxygen mask.
‘Try to relax Jessie. I’ll be back in a few minutes.’ I said, jotting down her sisters number and walking away.

I’d been at the nurses’ station desk for about thirty seconds when David reappeared.
‘Got those five minutes?’ He asked.
‘Not likely.’ I answered, as our second patient crashed into the ward. ‘Sorry David, this is gonna have to wait.’ I told him. ‘Michael!’ I called towards the young nurse. ‘Get Jac please!’
‘Jac Burns works here?’ David asked, following me as I approached the new arrival.
‘Please go and wait in the relatives’ room.’ I said. ‘You’re not allowed on the ward.’ I added.

David was still standing beside the trolley when Jac arrived behind him. She looked him up and down once, shaking her head.
‘You. Off my ward now.’ David opened his mouth but didn’t get a chance to speak. ‘David, if you want your interview with Miranda you’ll do as I say.’ Jac turned to me with a smile as David fled.
‘Thanks Jac.’ I smiled. ‘I really need to get Jessie into theatre. Can you take this one?’ I asked.
‘Of course. Who’s assisting?’Jac asked me, as she began to examine the man that had just arrived.
‘John’s scrubbing up now and Lily is prepping the patient.’ I answered. ‘I gotta run. Thanks.’ I repeated, walking away quickly.

After I’d finished with Jessie I completed my rounds on the ward, then went to the locker room to change. I was so grateful to be able to strip off my scrubs and put on my own clothes. After a day, and night, in the same scrubs I was exhausted and I felt grimy. I had been on shift since noon the previous day and I was tired nad my skin was sticky with sweat and firt. I walked into the washroom off teh locker room and splashed some cool water from the tap onto my face and arms. Feeling much more refreshed I pulled on my jeans and bluse, slipped my feet into my high heels and took my hair out of the elastic band. I instantl felt ten times better than I had at half past seven when I walked into the locker room.

As I emerged David was waiting for me.
‘Time for that interview?’ He asked.
‘I’m off the clock.’ I replied. ‘I’ve been up since noon yesterday. It's now eight in the morning. I’ve spent two hours of today elbow deep in my patient’s chest cavity. Do you think I want to talk to you?’ I answered.
‘I’ll be really quick.’ David said, his eyes pleading. ‘If I don’t get this interview my boss is gonna fire me.’ He added.
‘I’m very sorry about that...I really am. But I really don’t have the time for this.’ I told him. His face fell noticeably. ‘Five questions.’ I said firmly. ‘I’d choose them very carefully if I were you.’

I finished answering David’s questions and then went home. I ran a long hot bath and slid into the water. Just then my pager bleeped. Swearing under my breath I reached for the small black box. As I did my mobile rang.
‘Hi Jac.’ I answered it. ‘I’m at home, just. Is it an emergency?’ Even as she answered I was dragging myself out of the bath. ‘I’ll be back as soon as I can Jac.’ I told her with a strained smile.

Some days I do wonder why I became a doctor. All I seem to have to show for it is a lack of sleep and no social life. But then I got to work and a patient thanks me and tells me I’ve changed their life, then I remember why I studied medicine. When I arrived at the hospital it was the ward was in the throes of chaos. Jac was sitting at the nurses’ station, surrounded by all the cardio-thoracic's staff that she could get hold of. I joined the crowd.

‘First of all I’d like to say well done on the good work many of you did earlier today with our pile-up victims. Unfortunately the job is never done. St Luke’s hospital had a fire this morning and they have had to evacuate all of their patients. As you would expect they discharged all the elective surgical procedures. However, they had 7 urgent cardiac patients that must e treated as soon as possible. Our electives were all cleared this morning anyway, so we’re taking those 7 patients.’ Jac told us.
‘Seven cases?’ John, our longest serving registrar, piped up.
‘As many of you know St Luke’s had a lot more man-power than we did. But the cases are coming regardless so it’s time to see what we’re made of.’ Jac told him. ‘So, nurses and F2’s will be assigned to a registrar, or consultant, see Sister Adams for your assignment. Registrars can you go to mine and Miranda’s office for your patient briefs.’

I followed the group into the office, waiting for Jac to speak again.
‘I will be dividing the cases between myself and Miranda. I will also be assigning each of you to work with one of us. It will then be up to Miranda and I how we assign you cases. Questions?’ Jac finished. When no-one spoke she passed me three folders.
‘John, I’d like you and Simon to work with Miranda.’ She smiled. I secretly suspected that she’d given me our two most experienced registrars because it was my first day as consultant. But at that moment, I wasn’t going to complain. I needed all the help I could get.

Outside I found that Lily, the newest nurse, had been assigned to me, along with the two F2’s that had been assigned to John and Simon.
‘We’ve got...heart transplant, aortic transection and a valve replacement.’ I told the group that had gathered around me. ‘The heart’s due to arrive in two hours so we’re first up for our theatre slot. John scrub in with me, Simon I want you to do the valve replacement as soon as theatre two is available. The transaction will have to wait til tomorrow.’ I said. Simon and John walked away then, taking the files that I offered. Then I turned to the F2s. ‘You two, shadow the registrars you’ve been assigned to. They say jump and you say how high. Got it?’ they nodded and rushed away. Then I turned to Lily. ‘I need you to be my scrub nurse ok? So can you prep the heart transplant patient?’
‘Got it.’ Lily smiled. ‘Miranda...you’re a good doctor. You’ll be fine.’ She told me, walking away.

Being a doctor is like any other profession. There are good days and there are bad days. There are days that make you want to scream until you cannot breathe anymore. As I scrubbed into theatre beside John I really did feel like screaming. I was tired and frustrated and it was one of those days where I wished I had a different job.

‘You ok?’ John asked as I tucked my long black hair into my cap.
‘I’m tired John. I’m twenty-four. I’m a consultant and...I’m scared.’
‘You’ve done transplants before.’ John said gently.
‘Not of the op! Of the job! Do you think I should’ve turned it down?’ I asked.
‘No, I don’t.’ John said simply. ‘Miranda...I have confidence in you, even if you don’t have it in yourself. Love you.’ Josh smiled.
‘Love you too.’ I smiled.

After the operation I found Jac on the ward.
‘I'm going home. My last op is scheduled for tomorrow.’ I told her.
‘Are you sure?’
‘I’m in no fit state to work Jac. I’ve been up now for more than twenty four hours, apart from the two hours I managed to grab in the on-call room before our pile-up’s came in. I need a shower and a decent night’s sleep.’ I told her. ‘Will you be ok?’
‘We’ll manage. Bye Miranda.’
‘Bye Jac.’ I smiled. 

I stepped out of the shower and wrapped myself in a fluffy black towel. I walked into the kitchen and John was leaning on the counter.
‘Hey babe.’ He smiled and passed me a plate. ‘Raspberry jam.’ He told me.
‘I love you.’ I giggled, taking a massive bite out of the piece of toast he’d given me.
‘You’re welcome. Feeling better?’
‘Much. I just needed some time to relax.’ I told him. ‘I’ll be even better tomorrow, after a good night’s sleep.’ I added. ‘Than you John.’
‘Any time Miranda...I know you’ve been struggling at work lately...but you’re a good surgeon.’ John told me.
‘Thanks.’ I smiled as I finished my toast. ‘Bedtime?’ I suggested.
‘It’s only four o’clock.’John began, but then took one look at me and changed his mind. ‘Let’s go.’ He smiled and slid his hand into mine.

I woke up to the sound of beeping, but for once it wasn’t my pager, it was my alarm clock.
‘Morning babe.’ I heard John’s voice in my ear. 
‘That’s my alarm clock.’ I murmured, switching it off.
‘Yeah. I believe the two of you have met before.’ John chuckled. I smiled, laughing.
‘It’s been a while.’ I admitted. ‘We should get up.’
‘Yeah.’ John agreed, leaning over to kiss me. I returned his kiss, looping my arms around his neck. ‘How are you feeling?’ He asked when we broke apart.
‘Ready to go to work.’ I replied.

John and I arrived on the ward and it was unusually peaceful. I walked into my new office, but even Jac wasn’t there yet. Mine and John’s aortic transaction was first on the surgery list for the day so I went to talk to the patient again.

John’s eyes were on me as I performed the surgery. I could feel his piercing gaze.
‘Stop watching me.’ I said simply.
‘Sorry.’ He looked down at the patient’s chest cavity.

I was getting ready to close up when I heard my pager bleep.
‘Not now. Please.’ I moaned as John took it off my belt for me.
‘It’s Jordan.’ He told me. I sighed. As the CEO of the hospital he could page anybody, whenever he wanted, but he did have lousy timing.
‘I better go. Can you close?’ I asked.
‘Course I can.’ John smiled at me. ‘Love you.’
‘Love you too.’ I called as I rushed away.

I knocked on My Jordan’s door and he called me in.
‘Good morning Ms Jackson. I understand you’re performing a complex procedure today?’ He asked me. ‘I’d rather like to watch that if I may?’ He added. 
‘If you mean the aortic transection I just finished it.’ I told him.
‘And the patient?’ He asked.
‘Hasn’t woken up yet, but all seems well.’ I replied.
‘Congratulations Ms Jackson. Promotion and life and death surgery all in the same week. I’m impressed.’ Mr. Jordan leant back in his chair, a look on his face that looked like anything but impressed.
‘Well, I’ve never lost a patient yet, and I don’t plan to start now.’ I told him. ‘Can I go?’
‘Of course. Just remember...my door is always open.’ He reminded me. Even as I left I rolled my eyes at the clichéd statement.

‘What did Jordan want?’ John asked as I returned to the ward. I motioned for him to follow me as I began my rounds.
‘He wanted to watch the transection. And congratulate me on the promotion. And tell me his door is always open. It was weird.’ I explained.
‘He is weird.’ John smiled.
‘How did the rest of the op go?’ I asked as we approached the patient. He was still out cold from teh anaestetic but his temperature and heart rater were normal and he seemed fine.
‘It was fine.’ He assured me. ‘You’re a good surgeon Miranda. You’ve never lost a patient. I don’t know anyone else that can say that.’ He reminded me gently. ‘You need more confidence in yourself.’ He added.
‘I know. I’m working on it.’ I told him, walking away.

I was sitting at my new desk when my pager bleeped. It was John and he needed me on the ward. I rushed over to the bed he was standing by. Our aortic transection patient was crashing.
‘What happened?’ I asked, starting the chest compressions.
‘He just crashed.’ John told me.
‘What if the surgery went wrong? I’ve only done it once before today!’ I asked. John shook his head then turned to Lily.
‘Adrenalin. Now!’ Lily ran off and he turned back to me. ‘Calm down. The surgery went perfectly.’ He assured me.

After two shots of adrenalin and nearly 15 minutes of CPR John looked at me and shook his head softly.
‘We need to call it Miranda.’ He told me.
‘No. I will not lose this patient.’ I insisted, pressing my hands harder into his chest. ‘Lily, get me a scalpel!’ She handed me one and I cut the stitches open, massaging is heart in my hand.
‘Miranda...it’s been too long. He’s gone.’ John rest a hand on my forearm comfortingly. ‘We need to call it.’ I nodded and took a step back. ‘Time of death 13:21.’ John murmured. Then I walked away, as quickly as I could. I knew john wanted to follow, but a doctor had to sign the notes so he couldn’t.

John found me sitting in the stairwell, twisting the strap of my ID card around my wrist, then untwisting it again.
‘Miranda.’ He smiled, sitting beside me. ‘You ok?’ I shook my head.
‘He’s dead John. I did that.’ I whispered.
‘No you didn’t.’ John told me. ‘It was life or death surgery Miranda. Sometimes patients die.’
‘I performed it. I should’ve saved him.’ I murmured.
‘We both know it doesn’t work like that. There was nothing you could do Miranda.’ He said gently. ‘Now, come on, we need you on the ward.’ He stood up, offering me his hand.
‘I’ll be there in a minute.’ I said, not taking his hand. I heard his footsteps as he walked away.

I ran my fingers over the photo on my ID card. It was old, taken a few years earlier when I was just an F1 – a first year foundation doctor. I looked younger. It was only five years old, but I looked ten years younger. I also looked happy and confident. I was so certain that I had all the answers. I was so convinced I would be a good surgeon. A single tear slid down my cheek and I brushed it away fiercely.
‘Don’t be so stupid Miranda.’ I told myself. ‘It wasn’t your fault.’

When I returned to the ward the wife of the patient that had just died approached me.
‘You operated on my husband didn’t you?’ She asked. I nodded. ‘Where is he? No-one will let me see him.’
‘Mrs Gold...I’m very sorry but your husband died earlier today.’ I whispered. ‘I’m very sorry.’ I repeated.
‘Can I see him?’ The woman asked. I took a deep breath and closed my eyes for a moment before I answered her.
‘His body was moved to an intensive care unit and put on a heart-lung machine. I’ll take you up there in a minute.’ I answered. ‘But first...I know this is hard...but I have to ask...your husband carried a donor card...?’ I began.
‘What?’ The woman sounded angry then, and I didn’t blame her. ‘His body isn’t even cold and you want to cut him up again?’ She gasped.
‘I’m sorry. I know how hard this is. But the organs are only viable for a few hours.’ I said slowly. Mrs Gold shook her head to herself, and then I felt her hand across my face.

John was at my side in an instant, with two security guards.
‘No. It’s ok.’ I told them. ‘She’s just lost her husband, she’s very upset.’ I looked at Mrs Gold who had now fallen to her knees and was sobbing. I knelt down in front of her. ‘I’m really very sorry.’
‘Stop saying that! I don’t need your sympathy!’ Mrs Gold wept.
‘I understand.’ I told her.
‘How? How would you have any idea...’ She trailed off. I looked at her, the tears pouring down her face and decided it was time to open up, to show her who I was, or what made me who I am.
‘When I was just a student I lost my boyfriend. He died. I couldn’t do anything. I wasn’t allowed to treat him because we were personally involved, that’s the way it works. I knew how to save him but I wasn’t allowed to do it. I tried to tell his doctor but she wouldn’t listen, she thought she knew how to help him.’ I told Mrs Gold. ‘I had to watch him die. So I understand how you’re feeling right now.’
‘I’m sorry. About your face.’ I rose my hand to my cheek, wiping away the blood from the cut that her nails had made.
‘It’s ok. I’ve had worse.’ I smiled, helping her to her feet.

John asked Lily to take Mrs Gold up to intensive care, then he took me to my office and began to clean the cut on my cheek.
‘I never knew...about your boyfriend.’ He murmured.
‘It’s not exactly public knowledge.’ I told him. ‘I don’t like to talk about it.’ I added.
‘OK.’ John smiled. ‘You didn’t get the paper this morning.’ He told me, passing it to me. ‘Luckily enough I did. Middle pages.’ He told me. I flicked it open and found myself looking at my own face. Then I read the caption underneath the photograph; “miracle heart surgeon has never lost a patient”, and my heart sunk. ‘It’s ok.’ John told me. ‘You’re still the best surgeon we’ve ever had.’

Epilogue
One year ago today I lost my first patient. I’m still a surgeon, still a consultant. The world didn’t stop spinning when Peter Gold died. My life didn’t really change at all. I learnt that the thing I was most scared of in this job, was the thing I had limited control over; death. It wasn’t my fault. I did my best. I know now that I can’t save everyone. There are still good days and bad days. But now and then, once in a while, a patient will look at me and say “thank you”, and when they do my life s good. Those days will always be the best days, because they are the days when my life has a purpose. I’ve also learnt, that even on the very worst days, the world keeps turning, and eventually the day will end and life is good again. Very good, in fact.