Parsons blew out a long breath. "So, what's the verdict?"
He was seated across from me in a visiting physician's office in Truro Hospital, a functional if unattractive, decades-old metal desk between us. It helped reinforce my role as Parsons' GP and not merely colleague and friend.
Parsons, in a dress shirt, trousers and jacket, but absent a tie, seemed outwardly relaxed and still showed no lingering effects of his attack several days ago. Nonetheless, I'd detected apprehension in the way he'd carried himself when he'd entered the room and, now again, as he picked at the upholstery on the chair awaiting my diagnosis.
He'd had the scans I'd ordered earlier in the day. I knew he was anxious to learn the results, and that he needed to hear them directly from me. Since we were both present in hospital, there was no need to subject both of us to the long drive back to my surgery to discuss the issue. Thus, we were meeting in this barely functional room where, quite frankly, neither of us was particularly comfortable.
"The scans confirm you have carotid stenosis," I said formally, clasping my hands together atop the desk. It was one of the few times I took little satisfaction in being correct with my diagnosis, one I'd given probably a thousand times in my career as a vascular surgeon, much less frequently in my days as a GP. Carotid stenosis was a serious condition, but also a curable one. I watched to see how Parsons would take the news.
His eyes held mine and reflected resignation more than fear. "Well, it's what you suspected all along." His fingers drummed along his leg. "I assume you're recommending surgery."
"Yes. The scans showed a significant narrowing of the left carotid – more than 80 percent. Surgery is your best option."
"You don't mince words, do you?"
I never did. "The diagnosis is straightforward, as is the recommended treatment." I forced myself to remain professional and not allow myself to think of Parsons as anything more than another patient.
He sighed again and leaned back in the chair. "Damn."
"It is routine surgery," I reminded him. "You're young for this type of surgery and in overall good health. The risks are minimal."
"Easy for you to say."
"Yes, it is. And it also happens to be true."
"So, assuming I decide to have the surgery, what comes next?"
"I call Leahy or Meadows and get you on the list as soon as possible."
"You really think it needs to be done right away?"
"I do. Every day you wait increases the odds of having a CVA," I added, somewhat unnecessarily. He knew the risks.
Parsons sat there for a moment, twisting his hands. Finally, he looked up and I suspected that I wasn't going to like the next words that came out of his mouth.
"I know I shouldn't ask this Mart, but any chance you could do the surgery?"
"Me?" I couldn't control the expression of surprise that must have crossed my face. I certainly hadn't expected that question.
"If I'm to have this bloody operation, there's no one I trust more than you to do it."
Bloody operation, indeed. "I'm, um, flattered, but—"
"And, all things being equal," Parsons prattled on, "I'd rather be operated on by you here in Truro than by some so-called expert in London."
"Chris, I'm . . . I haven't exactly started up again as a surgeon, you know."
He waved off my comeback. "Come on, Martin, you did this surgery for years. You could probably do it in your sleep – though I hope you'll be awake for my procedure," he added with a wink. "Besides, if fate hadn't intervened, you'd be in London right now. What better way to restart your surgical career than a routine procedure on someone you know? And, someone whom you yourself said is at least a decent surgical candidate."
Factually, he was correct. Parsons' case was relatively simple from a surgical perspective. The procedure could be done right here in Truro. And I was unquestionably the best vascular surgeon between here and London. This was the perfect situation for me – a way to get my hands back in surgery, so to speak, while I was waiting to take up my position at Imperial.
So why was I hesitating? "I don't even have surgical privileges here," I protested.
"That's easily arranged. You have privileges at Imperial. A few calls and faxing of documents is all it takes."
He had a fair point and we both knew it.
"And besides," he continued, apparently taking my silence for acquiescence, "I know it will make Emily much more comfortable about the whole thing. She's scared half to death, and you're the one person she'd actually trust to cut me open."
Parsons, damn him, had the whole thing sorted. Everything he said made perfect sense. A quick, uncomplicated vascular procedure away from the limelight of London on an otherwise healthy patient who wasn't likely to complain about my bedside manner, surgical skill, or anything else.
I grabbed a ballpoint from the desk, suddenly longing for the fountain pen I loved to fiddle with when I was contemplating. I pulled the cap off and pushed it back on, off and on, off and on.
"Mart?"
I looked up, suddenly realizing I'd been playing with that blasted pen for God knew how long.
"Something wrong?" Parsons asked solicitously, brows furrowing.
"No," I replied quickly, too quickly. Thankfully, Parsons didn't seem to notice.
"Then you'll do it? My surgery?"
Of course I could do it, I assured myself. This is what I'd spent the last six months preparing for. If I couldn't handle a simple carotid endarterectomy on an otherwise healthy patient, how would I ever deal with the complex vascular cases for which I'd been renown and which I would again be expected to perform on a daily basis?
"Yes." The word came out almost before I realized I'd said it. A clench in my gut told me that, for better or worse, I was in.
I looked down at the desk calendar and spoke quickly, lest I give myself a chance to change my mind. "Let's see. Today is Monday. I'd like to schedule surgery for a week from today. That will give me time to get my privileges organized and for you to have the necessary pre-op work."
It all sounded so routine. It was routine, I reminded myself. Perfectly routine. Just as I'd imagined it would be. Exactly what I needed.
We both looked up at the sound of a soft knock on the door. When Parsons opened it, Emily was standing outside.
"Oh, sorry," she said. "Chris, your office said I'd find you here. I can come back . . ."
"No, it's alright," Parsons said. "Mart has convinced me to have the surgery we talked about, and I've convinced him to do it."
Emily clutched her husband's sleeve and swallowed deeply several times. I could see that she was struck by the news but also trying to regain her composure before speaking.
"The scans showed . . ." she started, turning her gaze to me.
"Carotid stenosis," I finished. "A narrowing of the carotid artery. It supplies blood to the brain."
"Right." Emily took a deep breath. "So you think surgery is the best option, Martin?" she asked.
I nodded. "I do."
"Well, thank goodness you're doing it. I know Chris will feel much better knowing he's in your hands and I can't begin to tell you how much better it makes me feel as well." Her hand snaked down and grasped her husband's firmly.
I wasn't sure who was giving and who was receiving support, only that the two of them seemed to cling to each other. It reminded me of . . . no, I wouldn't let my mind drift back to that day. I shifted from one foot to the other, unsure what to say or do. They were both counting on me, counting on the surgeon I'd once been and one that I hoped I could be – no, needed to be – again.