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CHAPTER TWO

‘CHARLOTTE…THERE YOU ARE! Thank goodness…I’ve been seriously worried about what might have happened to you.’ The tall, grey-haired man was hurrying towards her. As he got closer, however, his step faltered and his eyes widened. ‘Oh, my goodness. What has happened to you?’

The hotel Bonvecchiata had a water landing for gondolas and motorboats so Charlotte had entered the foyer moments after leaping out of the police launch. She knew she looked a fright but there’d been no chance to duck into a restroom and at least tidy her hair and sponge some of the mud from her clothing. Richard Campbell, the co-ordinator of this select symposium and the man who’d invited her to open it, must have been pacing the foyer as he’d waited anxiously for her to arrive.

‘Long story, Richard. I’m very sorry, but I got caught up in an emergency. A man went into cardiac arrest and fell off some scaffolding right in front of me. I had to keep up the CPR until the ambulance got there.’

Charlotte was speaking quickly but her mind was working even faster. There were about fifty people who’d been invited to attend this symposium. Where were they? Sitting in the conference room already, drumming their fingers on the tabletops and muttering about the substandard organisation of this gathering?

Richard was an old friend. Charlotte felt terrible about letting him down like this by being late and he didn’t even know the worst of it yet. How was she going to tell him that she’d lost her presentation material?

He’d noticed her gaze sweep the foyer.

‘They’re serving coffee and cake in the restaurant for everybody. As soon as I knew you were running late I put back the start time for half an hour. There’s a couple of attendees that aren’t here yet as well.’

‘Oh…’ Charlotte nodded. She had been given a small breathing space. Now she had to decide if there was any way in the world she could rescue the situation. ‘Richard…about my opening address…’

The older man smiled. ‘Catchy title. “Miracles or Mutilation?” It’s caught everybody’s attention already, I have to say. But, Charlotte…’ Richard was frowning now, looking down at her shredded tights and grazed knees. ‘Are you going to be able to deliver it?’

Richard Campbell’s reputation was on the line here. There were people from all over the world who’d chosen to come to this satellite symposium—a breakaway group from the much larger conference that had finished in Rome yesterday—plus others who had chosen to come to this forum without attending the main conference. They were all leaders in the field of emergency medicine. Exceptionally busy people who would not be happy to have their precious time wasted.

Charlotte’s presentation had been researched meticulously. the medical illustrations department of her university hospital had spent hours preparing the graphics that represented the facts and figures, the trends and the controversies about cost-effectiveness. It didn’t matter how phenomenal her memory was, there was no way she could do justice to her presentation.

If she could get hold of someone at St Margaret’s they could find the presentation on her desk computer and email it to her, but that would take too much time. They only had a matter of hours to fit in the other presentations and discussions before the symposium dinner this evening. And someone needed to open the day’s programme.

How would it look it she backed out? Even with the best excuse in the world it would still dent her reputation as a young leader in this field, and Charlotte needed that reputation. It was who she was. The professional Charlotte Highton was strong enough to hide the real Charlotte. The inadequate, shameful one who wasn’t a real woman at all.

She was caught between a rock and a hard place here. If she explained that there was no way she could do this, she would tarnish her reputation with the taint of failure and that chink in her armour might never be mended. It might grow, in fact, and eventually split open and the whole world would know what she was hiding.

They might look at her the way Nico Moretti had. As if they knew she was a fraud.

Charlotte could feel her heart thumping rapidly and there was a sinking sensation in her stomach that threatened to spiral into nausea.

‘I’ve got a small problem,’ she confessed to Richard. ‘I’ve lost my presentation. My laptop ended up in the canal.’

‘Oh…Lord…’ Richard shaded his eyes with his hand. ‘Can you manage without it?’

Charlotte opened her mouth to tell him how unlikely that was, but before she could force the words out she was distracted by the sound of her name being called from somewhere near the reception desk.

‘Charlotte Jane Highton…’

The voice was as familiar to her as her own but Charlotte didn’t want to believe that there was yet another problem she had to deal with. She kept her gaze on Richard, who gave her a rueful smile.

‘Sorry. I hadn’t got around to telling you. Your grandmother’s here.’

Charlotte shook her head sharply. ‘No. She’s not supposed to arrive until tonight. After the symposium. We’re travelling back to London together tomorrow.’

But the voice was much closer now. It couldn’t be ignored.

‘Charlotte Jane…What on earth have you done to yourself, child? You look like you’ve been run over by a gondola.’

Charlotte closed her eyes. She might be thirty-one years old but her grandmother could make her feel like a child again in a heartbeat. Flame-haired and larger than life, Lady Geraldine Highton was never one to stand on ceremony.

‘Gran…what are you doing here?’

‘I’m supposed to be here. I booked a room for us tonight.’

‘Yes, but you were flying in this evening.’

‘I changed my flight and arrived first thing this morning. I decided I wanted to hear you speak and this lovely man has told me I can sit in with all the translators and hear you on some headphones.’

Richard was nodding now and his smile was intended to reassure Charlotte that this problem, at least, had been dealt with. Clearly, he had been charmed by Lady Geraldine. Or intimidated. Either way, she had made arrangements that she now deemed satisfactory.

‘But, Gran, you hate hearing anything about medical procedures. You’ve never wanted to hear me talk about my work.’

‘Today’s different.’

Something was different. With the kind of skill Charlotte found invaluable in her dealings with people in traumatic situations, she could sense that there was something important her grandmother was keeping to herself.

‘I might not like hearing it,’ Lady Geraldine continued, ‘and I might not understand it, but it won’t stop me wanting the chance to be proud of my granddaughter. Who knows? It might be the only chance I ever get.’

Yes. There was a shadow there in her grandmother’s eyes. Eyes that usually sparkled with the determination to squeeze the best that life had to offer out of every opportunity. What was going on?

Charlotte knew she was staring. She also knew that her grandmother could read her like a book.

‘We’ll talk later,’ Lady Geraldine said crisply. ‘What we have to do now is get you tidied up. Thankfully, I have spare hosiery in my bag. And a hairbrush. Come on, Charlotte. Where’s the nearest bathroom? There’s no time to waste. You don’t want to keep all these important people waiting, do you?’

‘But…’

There was a plea on Richard’s face now. ‘You don’t have to give the presentation you prepared,’ he said quietly. ‘I have every confidence that you can think of something to say that would be an appropriate way to open this symposium. Could you do that, Charlotte? Please?’

The space between that rock and hard place suddenly got so small that it squeezed the breath out of Charlotte’s lungs. She couldn’t think. Maybe because she had no choice.

‘I’ll do my best.’

So it was that Charlotte found herself looking almost presentable again fifteen minutes later, standing in front of a room full of people who sat at a huge, U-shaped table. Some wore headphones to receive the translation service. Most had laptops or tablets on the table in front of them, along with pads of paper, pens, pitchers of iced water and even bowls of mints.

Charlotte had nothing other than a microphone clipped to the lapel of her jacket. From the way her heart was pounding and how exposed She felt, she could have been standing here stark naked.

She tried to smile at the group but failed. She did, however, manage to introduce herself and apologise for the delay in starting.

‘I’m sure you’ve all heard by now of the reason why I was delayed and you, more than most, will understand that emergencies happen.’

Oh, help. Charlotte could hear the sound of her own voice, magnified by the loudspeaker system. Where was the calm, professional tone she always used in public?

What would her grandmother think of this? The niggling worry that there was something wrong that her grandmother wasn’t telling her couldn’t be allowed to surface until this was all over but it was impossible not to have a flash of shame that the pride her only living relative had taken in her achievements was going to be dented.

‘Ah…’ Charlotte stared at the group, totally at a loss for what she could say next. Please, God, let the ground open and swallow me up, she thought.

The ground didn’t open but the door of the conference room did, to admit a latecomer. Everybody’s head turned at the interruption but Charlotte’s gaze had got there first and now it was stuck.

The worst moment of her life had just taken a dive to a new low.

How on earth could Nicholas Moretti have the nerve to show up here, knowing he’d ruined her preparation for this talk? He’d already revealed his disbelief that she was who she said she was. Did he now want to see if she was going to make a fool of herself and confirm that disbelief?

He was about to get what he came for, then, wasn’t he?

Nico gave a very European hand gesture, apologising for his interruption as he took the empty space at the table. His body language conveyed complete confidence that he had the right to be here, though. That he was, in fact, eager to take part in the proceedings. And then his gaze locked with Charlotte’s and that weird spinning sensation in her gut seemed to catch fire.

Anger?

Quite possibly.

Charlotte Highton wasn’t about to let the actions of a man even threaten to destroy her.

Not again.

She took a deep breath, jerking her gaze away from Nico and vowing not to let it return to that section of the table until she was finished. In a way, he’d done her a favour. His entrance had covered her stumble and now she was fired up. Whether it was from anger or desperation was immaterial.

‘Some of you might be asking whether I should have let myself become involved in that emergency situation, especially when the result has deprived you of the audiovisual accompaniment you were supposed to have this morning.’

A ripple of sympathy went through the gathering.

‘It’s a fair question,’ Charlotte continued. ‘How far should any of us go in getting involved? How far should we go as emergency medicine specialists? Out in the field or in our own departments?’

Her words were clear and her tone as professional as ever now. Everybody was listening. Looking at her. She could feel one gaze in particular so strongly that she knew exactly who it was coming from. Good. Let him watch and listen. Let him see who Charlotte Highton was now.

‘We can do so many things that can be done in an operating theatre in our emergency departments or out in the field. Burr-holes, tracheotomies, amputations, thoracotamies, Caesareans.’ Charlotte paused for effect. ‘Extreme measures in desperate circumstances. How many are justified? Does the weight of evidence suggest we’re performing miracles? Or guilty of performing mutilations?’

Another pause. This was the moment that would make or break this talk.

‘I had a presentation that was full of statistics about these kinds of extreme procedures and graphics to show you the controversial relationship between patient outcomes and cost-effectiveness. Obviously it’s not possible to do those facts and figures justice from memory, so instead…’ The solution to this problem came to her in a flash of inspiration. ‘I’m going to present a case history.’

Nico sat back in his chair.

He could feel the surprise of the people around him. What was this? They were all intelligent people who were hungry for new knowledge. They wanted to be presented with the results of cutting-edge research that they could use to improve what they did for a career. But they were going to be told a story?

‘The man I’ll call Bernie was forty-three years old,’ Charlotte was saying. ‘He went to the corner shop very late one night, because his pregnant wife had a craving for chocolate ripple ice cream. The timing was unfortunate. The shop was held up and Bernie got stabbed. A small knife with a short blade was buried to its hilt in his chest, deflected by the sixth rib, maybe five or six inches to the left from the midline.’

Nico could sense the interest picking up around him. The injury had been dangerously close to the man’s heart.

‘The ambulance crew knew not to remove an impaled object. Bernie’s still conscious when they arrive but his blood pressure’s dropping. Fortunately, this corner shop is only about two minutes’ drive from St Margaret’s hospital. They put a doughnut dressing around the knife to stabilise it, give Bernie some oxygen and load and go. They establish IV access en route.’

The way Charlotte had changed to the present tense drew them all into the urgency of this case. Clever. Or were they all drawn in, as he was, by the sound of her voice? Soft, but as clear as a bell. As under control as her hair was again, all scraped back into that complicated knot thing.

Nico had preferred it the way he’d seen it after that resuscitation scene, with enough loose wisps to suggest that the whole knot could be released if you buried your fingers in it, wiggled them and then dragged them gently through the length of the hair. How long was it when it was loose? he wondered. And then he sharply dismissed the errant speculation and concentrated again on what she was saying.

‘By the time Bernie comes through our doors, he’s lost consciousness. His BP’s unrecordable. His cardiac rhythm goes from SVT to VF to asystole within thirty seconds of my team getting him hooked up to the monitors.’

Nico was really listening now. So this was a case that Charlotte herself had managed? He could imagine her there, in the emergency department of St Margaret’s. Wearing scrubs, probably, with a white coat over them. No…she’d been expecting a major trauma. She’d have a plastic apron on. And gloves. And a head covering that probably had a plastic face shield to protect her from blood spatter. She would have been in charge. In control. Her voice might have been louder than it was right now but just as clear.

‘We know our protocols inside out but how do we start CPR? This man’s got a knife in his chest that’s probably punctured his left ventricle. He’s bleeding out. We can pull the knife out and push fluids but there’s a hole in his heart so that would be futile.’

Nico was holding his breath without realising it. Everybody here knew that the only option was to do one of the most invasive procedures that could ever be done out of an operating theatre. Cracking open this man’s chest and getting to the heart of the problem, so to speak.

‘He’s dead already unless we do something major and do it fast.’ Charlotte’s tone told them she agreed with the conclusion they’d all reached. ‘A thoracotomy is the only option but I know as well as everybody else in the team what the odds are for a successful result. Virtually nil. But, hey…we have to try, don’t we? This man is about to become a father. Right now, his pregnant wife is probably wondering why it’s taking him so long to get back with her ice cream.’

Charlotte seemed to straighten her back. ‘I’m the one who has to make the call and, as far as I’m concerned, it’s a no-brainer. We take out the knife and I do a clam-shell thoracotomy. There’s a gaping hole in the left ventricle and I suture it shut while we deal with more blood in a thorax than I’ve ever seen before.’

Nico closed his eyes for a heartbeat. He could picture it. A nightmare scene. The tissue of the myocardium would have been slippery. The visual field would have been impossible to keep clear with all that blood so you’d have to work almost blind.

‘We start pushing fluids and begin CPR. I’m riding that stretcher to Theatre with my hand inside Bernie’s chest, doing internal compressions and praying that my rough suturing is going to hold.’

Oh, Nico could imagine that scene too. Charlotte would have had to have been astride the man’s legs, with one hand on the side rail to steady herself. Amongst the bank of monitoring and ventilation equipment that would have been in place. Speeding along with her team running to get them to Theatre as fast as possible.

It felt like he was standing in one of the wide corridors of St Margaret’s right now, watching the dramatic spectacle rush past him. Opening his eyes again, he knew that he was looking at Charlotte with growing admiration. This was some woman.

‘The cardiac surgical team is waiting for us. They do a much better job than me in repairing the damage. They replace the blood volume and get Bernie’s heart started again. By this time his wife is at the hospital. Bernie’s taken to the intensive care unit. He’s still alive but what none of us know is whether we’ve done the right thing in saving him. Will he wake up? And, if he does, how much brain damage has been caused by the lack of oxygen? His wife is distraught and, just to add to the tension, she goes into labour three weeks before her due date.’

A soft groan came from her audience. This might be nothing like what they’d expected as an opening talk but they were all invested in the story now. They had to know the outcome.

‘I’ve told you this story because it does, unlike so many, many others, have a happy ending. Bernie did have a degree of neurological compromise. His cognition and speech were affected and he had a unilateral weakness on his right side.’

It was the first time Nico had seen Charlotte smile. He felt his own lips curve in an unconscious response.

‘But his weak arm didn’t stop him being able to cradle his newborn daughter a couple of days later. His difficulty in finding words didn’t dim the way he could communicate his joy to his wife.’

Dammit. Was that a lump Nico could feel in his throat? He swallowed it away. His own career was full of success stories like this, wasn’t it?

‘The bottom line,’ Charlotte continued quietly, ‘is that our job is about the people who come under our care. Bernie was a miracle. But if he hadn’t made it, that resus scene in my ED could have been denounced as unnecessary mutilation. We couldn’t know how it would go before we started but is it just a coin toss?’

Charlotte was looking around the room. Nico was waiting for her gaze to cross his. He was oddly disappointed when it didn’t.

‘No.’ She answered her own question. ‘That’s what our chosen specialty is all about. Working towards being the best we can be in our field of expertise. Knowing when there’s a choice that pulling out the big guns is going to make the difference between life and death.’

Nico saw Charlotte take a deep breath. She was wrapping up now and the unusual introduction had clearly been a huge success. Everybody was leaning forward, totally engrossed and eager to participate in the programme that was about to start.

He felt the same way so how on earth could he be distracted by the way that deep breath pushed Charlotte’s breasts against the material of the plain blouse she wore under that tailored jacket? The way a hint of cleavage struggled to appear over the top button. Good grief. She was so buttoned up with that hairstyle and the fitted clothes she wore, it was almost as if she was trying not to look remotely feminine.

Maybe she was batting for the other team. Nico tucked the thought away with satisfaction. That would explain a lot. Maybe she had been trying to deny her true preference when he’d seen her out with that man in The Cosmopolitan Club all those years ago. And even if she was now comfortable with who she was, in her position Charlotte probably wouldn’t want to come out of the closet and travel in the company of her girlfriend. Or wife, perhaps. It was none of his business and it didn’t bother him.

So why did that curious feeling of disappointment in not making eye contact with her a second ago suddenly deepen several notches?

‘The papers you are going to be privileged to hear today are from invited speakers who are leading their particular fields. I’m looking forward to hearing the discussions that will follow the presentations. Again, I must apologise for my unorthodox keynote speech but, on behalf of Dr Richard Campbell, our chairman for today, and the others involved in organising this satellite session, let me welcome you to our symposium on critical interventions.’

Nico joined the round of applause. His neighbour leaned sideways to say something about how moving the story had been and how good it was to be reminded of the human aspects of their science. But Nico merely murmured agreement. He couldn’t take his eyes off Charlotte. As if she felt his intense gaze, she looked up from her position at the front of the room.

So there, her gaze seemed to say. I did it—even if you did do your best to stop me.

After the awkward start to the day things were running smoothly. Richard was delighted. He smiled at Charlotte as they were preparing to follow the others out of the conference room for the lunch break.

‘Do you know, I think your introduction has allowed for some very interesting questions to be raised that people might not have considered appropriate otherwise. You’ve given this whole forum an informality that has brought people closer together. It was a stroke of brilliance.’

‘Thanks.’ Charlotte rubbed the back of her neck, trying to ease the tension that still hadn’t gone away completely. ‘It could have taken things in the opposite direction. I was lucky.’

‘I think everyone was impressed.’

Had Nicholas Moretti been impressed? And why did it matter so much that he had been?

‘I’m sure they’ll want to tell you that themselves, over lunch.’

Charlotte wasn’t at all sure she wanted that to happen. She might be used to talking to colleagues while balancing a plate of food and eating but the idea of doing that in Nico’s company seemed disturbingly…intimate?

Whatever. She had the perfect excuse.

‘I’m going to skip lunch, if you don’t mind, Richard. I’ll grab a sandwich or something but I really need to check on my grandmother and make sure she’s being taken care of. And that she has something to do for the afternoon. Goodness knows what kind of mischief she could get up to otherwise.’

Richard was grinning now. ‘She’s quite something, your grandmother. How old is she?’

‘Eighty-two. Going on about sixteen, I think. I often feel as if I’m in the company of a wayward teenager.’ Charlotte’s smile was fond. ‘And then, at other times, she comes out with the kind of wisdom and advice that only someone who’s experienced life to the full could have. She’s amazing.’

Richard patted her arm. ‘Go and catch up. I’ll give your excuses to anyone who asks.’

‘Thanks.’ Charlotte hurried out to the reception area, away from the dining room, and asked whether her grandmother had left a message for her.

‘No. But she’s had lunch delivered to your room. Would you like your key now?’

The room was massive and decorated in Venetian style with sumptuous drapes, bed coverings and deep armchairs all in tones of silver and soft bronze. There was a Persian rug on the floor beneath the chandelier hanging from an astonishingly high ceiling. A small table with spindly legs supported a silver tray that had plates of delicate-looking sandwiches and cakes, a pot of tea and cups.

The first thing that struck Charlotte was that the tray hadn’t been touched.

Almost at the same time she noted how tidy the room was. Where were the clothes strewn about that always happened when Geraldine was choosing her next outfit? the open guidebooks as she chose her next adventure?

And why on earth was her grandmother lying on a bed in the middle of the day? Lady Geraldine Highton might be eighty-two but she didn’t do naps. ‘Life’s too short,’ she always said. ‘And it’s getting shorter for me by the day. Why waste it by sleeping? I can sleep when I’m dead.’

‘Gran…’ Charlotte moved towards the bed. ‘What’s wrong?’

‘Oh…’ Geraldine clearly hadn’t been expecting a visitor. She sat up swiftly, looking…embarrassed. No, make that guilty. ‘Charlie…I didn’t think I’d see you until this evening.’ The odd expression vanished, to be replaced by a beaming smile. ‘That was a wonderful talk you gave, darling. I can’t tell you how proud I was. And I understood every word. Well, almost every word. The next speaker was terribly dull in comparison. I went for a walk and watched the gondolas for a while. I might go for a ride in one after lunch. It’s been years…’

Charlotte sank down onto the edge of the second bed, facing her grandmother. Something here was off-key. Terribly off-key.

‘Gran…’ She reached out and took hold of a soft hand decorated with several diamond rings. ‘What’s going on?’

‘Whatever do you mean? Nothing’s going on, Charlotte. Come and have lunch with me.’ Lady Geraldine got to her feet but then her face changed. She couldn’t hide a grimace of pain and her hand went to her stomach.

‘You’re not well,’ Charlotte gasped. ‘That’s why you haven’t touched your lunch. Why didn’t you tell me?’

‘I’m fine. There’s nothing wrong with me.’

‘Lie down,’ Charlotte ordered. ‘I want to have a look at you.’

For a long, long moment Geraldine looked undecided. But then she quietly lay down and answered the barrage of questions. Yes, she had abdominal pain. No, it wasn’t the first time. Yes, she’d been to see a doctor about it. She’d had a scan. She was booked to have a biopsy between Christmas and New Year.

A biopsy?

With absolute dread giving her a chill that almost made her shiver visibly, Charlotte quietly asked if she could feel her grandmother’s tummy and when she did, the hard edges of the mass she could feel confirmed her worst fear.

‘Did…did your doctor tell you what he thought it was after the scan?’

‘Oh, yes…’ Lady Geraldine took hold of Charlotte’s hand with both of hers. ‘He’s sure it’s some form of bowel cancer.’ Her voice wobbled. ‘I didn’t want you to find out, darling. Not yet.’

Charlotte’s voice was thick with tears. ‘Why not? You should have told me. I should have been there with you when you had your appointments.’

‘We’ve been planning this trip for so long. Going on the Orient Express has been on my bucket list for far too long.’ Unbelievably, Geraldine was smiling mischievously. ‘And what better time to fulfil a bucket list item than when you’ve been told the end probably isn’t that far off?’

‘Gran…We can’t spend thirty hours on a train. We have to fly back to London tonight. I’ll talk to people. We’ll find a way to bring that procedure forward so we can start treatment earlier.’

‘No way, Jose.’ The way Lady Geraldine’s eyes narrowed was a warning that she was not about to be contradicted. ‘I’ve taken some painkillers. I’ll be as right as rain after a little rest. You’re not going to spoil this for me, Charlotte. Are you?’

It wasn’t really a question. And the look coming from those faded blue eyes wasn’t disapproving. It was full of absolute love. The kind of love Charlotte had received from this remarkable woman ever since she’d been orphaned as a small, terrified child.

This was why her grandmother had wanted to hear her speak today. Why she’d wanted to tell her how proud she was of her. Well, that cut both ways, didn’t it?

‘Let’s enjoy this time together,’ Lady Geraldine added softly. ‘Before we know anything for sure. Let’s pretend you didn’t find me like this. The way I wanted it to be. Go back to your conference, darling. I need a little rest and then I’m going to choose my outfit for the dinner tonight.’

Those words stayed with Charlotte during the afternoon’s symposium proceedings and it was the hardest thing she’d ever done, to keep up her professional image. The papers being presented were fascinating and the discussions lively, and Charlotte had learned long ago to firmly shut the door between her professional and personal lives, but today it was impossible.

Today had started badly. She thought she’d made the best of a bad situation and survived but now it felt as if the world had tilted far too sharply on its axis. What did her brilliant career matter if she was about to lose the person she loved most? The only person she truly loved, come to that.

The conference attendees were invited to a cocktail session before a break to get ready for the dinner but Charlotte quietly slipped away from the group. She had to pull herself together. Had to find the strength to deal with what was undoubtedly coming. Did she really want to deprive her grandmother of the long-awaited pleasure of the train trip tomorrow and whisk her back to London and into hospital? Did she have that right?

The balcony leading off the now deserted dining room offered a private space with the bonus of an idyllic canal view where more than one ornate gondola could be seen floating past.