Heart Surgeon, Prince...Husband!

CHAPTER THREE

OVER THE NEXT couple of weeks, Luc found himself working with Kelly on their patients’ care between the cath lab and the operating theatre, where she needed to do the investigations and liaise with him about potential surgery. The more he got to know her, the more he liked her. The way she put everyone at ease, the way she told terrible jokes, the way she made the day feel brighter just because she was in it.

In other circumstances, he would’ve been so tempted to ask her out on a date. But she’d told him she wasn’t ready to move on after losing her husband, and he had a political tightrope to walk in Bordimiglia. So he’d enjoy her friendship and he’d just have to start mentally naming every blood vessel in the body, from the internal carotid artery down to the dorsal digital artery, to stop himself thinking of anything else.

But on Sunday afternoon his eldest sister called him.

‘Is everything OK, Elle?’ he asked. He and Eleonora usually managed to grab a few words during the week, but there was something slightly antsy about her tone.

‘Ye—es.’

‘But?’

‘Babbo wants to start taking things easier. He told me yesterday that he’s planning to step down at some point in the next year,’ Eleonora said.

Meaning that King Umberto was expecting his wayward son to give up his job as a surgeon, come home and take his rightful place on the throne? So the clock he’d pretty much managed to ignore, thanks to its silence, had just started to tick. ‘Is that Elle-speak for “come home right now”?’ he asked wryly.

‘No, I’m just putting you in the picture so you know what our father’s thinking. He’ll probably summon you home to talk about it at some time in the next month, though,’ Eleonora warned.

Summon him home. Normal people of his age were happy to visit their parents; whereas Luc knew a visit home wouldn’t be time to catch up with each other and enjoy each other’s company. It would be another chance for his father to nag him about his future in the monarchy, and he’d end up having another argument with his father. He sighed. ‘Elle, you and I both know you’d make a better ruler than I would. So does our father. And you’re the oldest. It’s ridiculous. This is the twenty-first century. It makes absolutely no sense that, even though I’m second-born, I should be the heir just because I have a Y chromosome.’

‘It’s how things are.’

He could hear the resignation in her voice. ‘Well, things need to change. It’s time our father modernised the monarchy.’

She sighed. ‘I hate it when you fight.’

‘Elle, I’m a cardiac surgeon. I’ve spent half my life either studying to become a doctor or practising medicine—and I’m good at what I do. I can make a real difference to my patients and their families, give people a second chance at life. That’s such an amazing thing to be able to do. And I want to stay here for a couple more years, get experience in all the cutting-edge surgical developments. Then I can bring it home to Bordimiglia and set up a world-class cardiac centre.’ And he’d name it after his best friend. So Giacomo would never be forgotten.

‘Giacomo would be proud of you,’ Eleonora said softly. ‘His parents think you’re wonderful.’

Whereas his own parents thought he was being stubborn and unreasonable. They’d given him the freedom to do what drove him, so far, but now it seemed the pressure was going to start in earnest: they’d want him to go back to being a prince instead of a surgeon. But that wasn’t who he was. He could serve his country much better as a surgeon. Make a real difference to people’s lives.

‘I really hate all the fussiness of protocols and politics, Elle. If I become king, I’ll make a dozen horrible gaffes in my first week, and we all know it. Whereas you’re a born diplomat.’ Though even Eleonora hadn’t been able to talk their father into changing a certain tradition.

‘Sometimes you have to pick your battles wisely. This isn’t one we’re going to win, Luc.’

Unless he did a little shaking up himself.

He’d talk to Kelly. Hopefully she’d agree with him that they could do each other a favour and his plan would work. ‘Leave it with me,’ he said.

‘No fighting with Babbo,’ Eleonora warned.

‘I know. Mamma hates it when we fight, too, and so does Giu. And it’s not that much fun for me, either. I’m not arguing for the sake of it. Don’t worry, Elle.’ He switched the conversation to how his niece and nephew were doing, and his sister sounded a lot less strained by the end of the call than she had at the beginning.

When he’d hung up, he went through the dossier on Kelly that the palace PR team had quietly compiled for him. There was nothing the press could use to pillory her, so she’d be protected. There might be a bit of press intrusion, to start with, but it would soon die down because he knew that he was too quiet and serious and frankly boring to make good headlines.

He’d talk to her on Monday.

* * *

Luc spent Monday morning in clinic. His first patient, Maia Isley, had Marfan Syndrome—a genetic connective tissue disorder which caused abnormal production of the protein fibrillin, so parts of the body stretched more than they should when placed under stress. It was a condition which needed help from a variety of specialists, as the patient could develop scoliosis, have loose and painful joints, and suffer from eye problems. From a cardiac point of view, Marfan Syndrome could also cause problems with the aorta being enlarged, so patients needed regular check-ups and a yearly echocardiogram where the team could look at the structure of the heart and measure the size of the aorta.

Luc had already compared the new scan that Kelly had just performed to last year’s, and he wasn’t happy with the differences.

‘How are you feeling, Mrs Isley?’ he asked.

‘Fine,’ the young woman replied. ‘But, from the look on your face, you’re expecting me to feel worse than usual, right?’

Luc nodded. ‘Obviously you’ve learned a lot about your condition, so you know there’s a risk of your aorta—the biggest artery in your body, the one that starts at the top of the pumping chamber in your heart—getting wider, and that can make blood leak back into your heart so your heartbeat starts pounding and you get breathless.’

Maia shrugged. ‘My heartbeat feels like it normally does.’

‘And also there’s a risk of the aorta tearing.’

‘If it tears, I die, right?’ Maia asked.

‘There’s a high chance, yes. Your aorta’s grown wider since last year. We’re at the point where we need to do surgery to make sure it doesn’t tear,’ Luc said. ‘And we’ve got three options, depending on what you’d like to do. May I ask, were you thinking of having children?’

‘I’d like to,’ Maia said, ‘but my partner’s worried. Not so much the risks of the baby having Marfan’s, because we can have IVF and with preimplantation genetic diagnosis so we can be sure the baby doesn’t have the gene, but he read up that women with Marfan’s were more at risk of aortic rupture, especially during pregnancy.’

‘And he doesn’t want to lose you,’ Luc said softly. ‘I understand that. Surgery now will take that risk away.’ He drew three quick pictures. ‘The first option is where we replace part of the aorta and its root, including the valve. The treatment’s very safe and has a long track record, but you’ll be at risk of developing a blood clot so you’ll need blood-thinning medication for the rest of your life.’

‘Which means I can’t get pregnant, right?’

‘Which means if you do want to try for a baby, your doctor will switch your blood-thinning meds to one that’s injected under the skin and doesn’t cross the placenta,’ Luc said. ‘Or we can do a different sort of surgery where we replace part of the aorta but keep your valve—it’s called a valve sparing root replacement or VSRR for short. Because we’re keeping your valve, you won’t need the blood-thinning medication, but there’s a one in four chance we’ll have to redo the operation within the next twenty years.’

Maia looked thoughtful. ‘What’s the third?’

‘It’s a very new treatment where we make a special sleeve to go round your aorta, called a personalised external aortic root support or PEARS.’

‘So it wraps round and acts like a support, say like when my knee’s playing up and I have to strap it up?’ Maia asked.

‘Yes. The idea is that it’ll keep your aorta at the size it is now, so it won’t get any wider in the future—and that reduces the risk of a tear or the valve leaking. The procedure’s not as invasive as replacing the root or the valve-sparing surgery, though I’ll still need to open your chest under a general anaesthetic. And it means it’ll be more appropriate if you do want to have a baby, because it’ll keep your aorta at this size and reduce the risks during pregnancy. But it’s still a very new procedure,’ Luc warned, ‘so not that many have been done.’

‘So how do you do it? Wrap it round?’

‘We give you a CT scan and we make a 3D computer model of your aorta from the scan, print it, and we use that to make a fabric mesh support tailored exactly to your aorta,’ Luc explained.

‘3D printing? That sounds cool,’ Maia said. ‘I know you said it’s new, but have you done many?’

‘You’ll be my second patient—and the first at this hospital,’ Luc said. ‘Though, if you decide to go for that option, I’ll ask one of my former colleagues to come over and assist, because he’s got more experience than I have. Or it might be that we end up doing the operation at my old hospital.’

‘Can I talk the options over with my husband?’ Maia asked.

‘Of course,’ Luc said. ‘I’ll want to see you again anyway, and maybe he can come with you if he has any questions. Though I’ll give you some leaflets to take away with you—it’s a lot to remember and it’s always good to have things written down so you can refer back.’

‘Thank you,’ Maia said. ‘I know there are risks, but I’m leaning towards that 3D support thing. I like the sound of that much more.’

‘Let’s book you in my clinic for next week,’ Luc said, ‘and you can talk it over with your husband in the meantime and bring all your questions with you to clinic.’

After clinic, he managed to catch Kelly. ‘Are you free for lunch? I could do with your opinion on something.’

‘Sure.’ She smiled at him.

‘Maybe we could grab a sandwich and head over to the park,’ he suggested. Where it would be quieter and more private than the hospital canteen and he could sound her out.

‘That sounds good,’ she said.

‘Thanks for doing that echo on Maia Isley for me,’ he said when they’d found a quiet bench in the park.

‘Her aorta’s quite a bit bigger than last time. Are you planning surgery?’ she asked.

‘She’s talking it over with her husband, but there’s a fairly big chance she’ll opt for PEARS.’

‘Aortal support?’ Her eyes gleamed. ‘If she does, I’d love to sit in on the op. I’ve heard about it but not seen it done.’

‘Given that you’re her cardiologist,’ he said, ‘if she takes that option then you’ll be involved in the CT scans and you can definitely sit in on the op. We might need to print the 3D model of her heart elsewhere, but I’m sure Sanjay will be happy for you to be involved, and maybe do a presentation to the rest of the team. I need to talk to one of my old colleagues as well as Sanjay, so we might end up doing the actual op at the Royal Hampstead Free instead of here, or it might be that my colleague comes here to help out.’

‘I am so up for that,’ she said. ‘I’ve never done anything like that before.’

He smiled. ‘That’s important to you, isn’t it? Being able to make a difference.’

‘Yes. And I’m pretty sure it’s the same for you.’

‘It is.’ Should he ask her now? He’d been thinking about it ever since Elle had called him. He took a deep breath and said carefully, ‘I think you and I could make a difference for each other.’

‘Job enrichment? Absolutely,’ she agreed. ‘We’ve got a new F1 doctor starting next week. I’m responsible for her training, and it’d be great if she could do some observation or even some work in the operating theatre as well as in the cath lab. And your trainee surgeon might enjoy doing some stent work with us.’

‘That’s fine, but actually I was thinking on a more personal level.’ He paused. ‘What you were saying the other week about inventing a boyfriend.’

She frowned. ‘What about it?’

‘I need to get married. So if you married me, it would solve a problem for both of us.’

Her green eyes widened in apparent shock. ‘What? That’s crazy!’

He winced. He’d been thinking about this for a while; for her, this was completely out of the blue. ‘Sorry. I could have put that better. I’m not hitting on you, Kelly. I mean a marriage in name only.’

‘You’re the heir to the kingdom of Bordimiglia,’ she said. ‘Surely you’ve got to marry someone of royal blood? And why do you need to get married? And why me?’

It was a fair list of questions. ‘This is in confidence, yes?’

‘It’s a little late to be asking that now,’ she said. ‘I might be the heart of the hospital gossip machine.’

‘I’m pretty sure you’re not,’ he said, ‘though you have a point.’

‘OK. In confidence.’

‘Trust you, you’re a doctor?’ he asked wryly.

‘You started this,’ she reminded him. ‘And you haven’t given me any answers yet.’

‘From the top—my parents expect me to get married to someone who’d be suitable as a queen. So, yes, you’re probably right about the royal bloodline. The problem is, someone who wants to be queen doesn’t want to be married to a cardiac surgeon.’ He knew that from bitter experience. ‘A cardiac surgeon is who I am and who I want to be.’

She frowned. ‘But you’re a prince. Don’t you have to take over from your dad?’

‘Technically, yes. But he’s the king and he can change the rules of succession if he wants to,’ Luc explained. ‘I told you I have two sisters, Eleonora and Giulia. Elle’s the oldest and she’d make an absolutely brilliant queen. Apart from the fact that she’s good with people and everyone loves her, she’s astute—she’s got a real business mind, and she’d do a lot for our country.’

‘Would she actually want the job, though?’ Kelly asked.

‘We’ve talked about it, and she agrees that she’d make a better ruler than I would. She already does a lot of royal duties and she advises our father on ecology issues. I don’t believe I should get the job just because I’m the son. And I’m a much better doctor than I am a politician. I know I’ve had a really privileged life and I appreciate that. I’m not shirking my duty—I want to serve my country in a different way, to make it a leading research centre for cardiac health. In a couple of years’ time, I want to go back to Bordimiglia with everything I’ve learned here and set up a new cardiac centre. All our father has to do is change the rules of succession, so then his oldest child instead of his son will take over when he decides to step down. Elle deserves her chance to change our bit of the world. All I’m suggesting is pushing a little bit harder to give her that chance.’

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