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'I'm a widow, Dr Stuart. My husband was killed in a car accident by a drunk driver two years ago so there's only me to do all the organising. I can't be sick. There's no time for me to be sick. Please, tell me there's nothing to worry about.'

'Tell me more about your breathlessness,' Annabel instructed. 'You say it's mostly when you lean forward?'

'Or bending over, sometimes if I'm sitting,' the older woman agreed. 'It goes away if I lie flat.'

Annabel wondered about that. In most types of heart disease breathlessness was caused by the accumulation of fluid in the lungs and was made worse by lying down. She finished taking a history and then examined her patient carefully. 'What are these?' she asked, frowning at the small red lesions on her patient's fingers and palms as she inspected the trembling hands. 'How long have you had these?'

'A few weeks.' Mrs Di Bella shrugged but her eyes were worried. 'Perhaps months. They're little sores, I thought. They're a little painful, but they go away on their own in a few days or a week or so. They're nothing, are they, Doctor?'

Annabel checked her feet, noting similar lesions there, too. 'Do you ever have dizzy spells?' she asked, examining the rest of Mrs Di Bella's skin and inside her mouth and her eyes. 'Funny turns, fainting, pins and needles attacks, anything like that?'

'Just the heart thumping.'

'No hot flushes? Sweating in the night?'

'I do get hot sometimes. Occasionally I have to get up to change the sheets. I put that down to going through the change, Doctor.'

'Are you still having periods?'

'Just every few months,' Mrs Di Bella revealed. 'Not regular, the way I used to be. Is that what it is, Dr Stuart? Do you think it's the change of life?'

Annabel wished she could reassure her on that but she couldn't. 'Have you lost weight at all, Mrs Di Bella?'

'Quite a bit.' Her patient's pallor deepened. 'About fifteen pounds. But with all the preparations for the wedding...' She trailed off, wringing her hands together. 'My doctor says my blood pressure is very good.'

'It is,' Annabel agreed, checking the note of it one of the clinic nurses had made earlier. 'It's perfect.' She took out her stethoscope and sat Mrs Di Bella forward to listen to her chest properly. 'Breathe out normally,' she said quietly when her patient held her breath. 'At the moment I'm just listening to your heart.'

'He said my blood tests were good, too,' Mrs Di Bella told her anxiously when she'd finished that part of her examination.

'All the results I've looked at appear completely normal,' Annabel confirmed. The GP had had copies forwarded to her and she'd checked them when she'd read his letter.

Finally, she used an ophthalmoscope, a small portable, torch-like device with lenses for examining the inside of the eye, to look for lesions of a similar nature to the ones on Mrs Di Bella's hands and feet, but thankfully her eyes were clear.

When she was finished, she lowered the back of the bed again so Mrs Di Bella could lean back. 'This jelly will just feel a little cold on your chest,' she warned, explaining what she was doing as she squeezed clear lubricating jelly from a tube across the front of her patient's chest, then picked up the probe of her ECHO machine. 'This machine's called an echocardiography she explained. 'It shows me pictures of your heart. I promise it won't hurt.'

Annabel moved the probe across Mrs Di Bella's chest slowly, first getting a general picture on her screen of the way her patient's heart was functioning and then narrowing in on the area she was concerned about.

When she'd finished she wiped away the jelly with tissues, helped her patient back into her gown and sat on the edge of the bed. 'Is there anyone waiting for you in the Waiting room, Mrs Di Bella? Is your daughter with you today, or have you brought a friend?'

The older woman shook her head vigorously. 'I came alone, Dr Stuart. Is it serious? If you've something to say, please, just tell me. I have to know. Please. I have so much to organise. What do you think?'

Ideally Annabel liked to have someone with patients when she had bad news but obviously in this case circumstances weren't ideal and she was sure that delaying what she wanted to say would merely increase Mrs Di Bella's already considerable anxiety. 'The ECG the technician took when you arrived here this morning shows that your heart rhythm is abnormal,' Annabel said gently. 'It's in a rhythm we call atrial fibrillation. What that means is that there's some disruption to the electrical system in your heart.'

Her patient crossed herself. 'This is serious?' she whispered.

'Atrial fibrillation in itself can be caused by dozens of things,' Annabel explained. 'Sometimes we never discover what's causing it and some people can have this sort of rhythm for years without us knowing about it. But in your case I know the reason because on the scan I just did I can see a lump on one of your heart walls between the top parts of your heart.' She drew a picture on the back of her notes, outlining the anatomy of the heart. 'Here, you see,' she said quietly, drawing the large mass she'd seen. 'There's a type of tumour growing here and it's upsetting your heart rhythm. It's causing your breathing problems and I suspect the bumps on your skin are because blood clots forming on the lump here are being thrown off occasionally and then they're getting stuck in the tiny blood vessels in your hands and feet.'

'Oh, Doctor.' Mrs Di Bella clutched at Annabel's hands. 'How long do I have?'

'It's not fatal.' Annabel squeezed the older woman's trembling hands reassuringly. 'Or, at least, only very rarely. This is a rare sort of tumour which usually behaves completely benignly. The treatment involves admitting you today to give you some blood-thinning medication to stop any more blood clots forming, then surgery as soon as possible to remove the tumour and repair the hole where it's been. You're going to need an operation, Mrs Di Bella. Soon. If all goes well there's no reason to think you'll lead anything but a normal life. Now, with your permission I'd like to speak with one of our surgeons today.'

'Is it a big operation?'

'All heart surgery is big,' Annabel admitted.

'But the wedding...?'

'You'll be there. After your operation. But I don't want you worrying about weddings in the meantime. Your daughter and her fiancé and his family are going to have to take over the organising for you. You're going to have to delegate.'

'I'll write lists.' Her patient slumped back against the bed, her eyes wide. 'Long, long lists. But, God willing, I will be at the wedding?'

'God willing,' Annabel confirmed.

'I did know it was serious,' the other woman whispered. 'I don't know how but I just knew it was serious.'

'That's often the way,' Annabel said gently. 'Pop your clothes on, Mrs Di Bella. I'll go and telephone the surgeon and see where he would like me to send you. I'll be back in a few minutes.'

Happily Simon Rawlings was holding a clinic in Outpatients as well and once Annabel had explained Mrs Di Bella's case he agreed to see her immediately. 'Send her straight across, Annabel,' he told her heartily. 'I'll squeeze her in now.'

Annabel offered to try and get better ECHO pictures by sedating Mrs Di Bella and passing a lead down into her oesophagus, but he told her not to worry about that.

'We'll organise to get good pictures tomorrow with an MRI scan,' he told her confidently, referring to another type of scan particularly useful for outlining the anatomy of the heart. 'We've space on our surgical list for Thursday if we can get her worked up in time. Is she otherwise well?'

'She gets a rash with sulphur antibiotics but no other problems,' Annabel confirmed. 'Thanks, Simon.'

'No problem. Young Tamsin Winston's doing well. Have you seen her yet today?'

'I was running late this morning,' Annabel admitted. 'I'm planning on visiting this afternoon.'

'She had breakfast today and she'll be leaving the unit after lunch,' the surgeon told her. 'You did a good job, assessing her so quickly and getting her to us.'

'Thank Luke for that,' Annabel told him. 'I was just the onlooker.'

'He seems a capable sort of chap,' Simon said stoutly. 'I was impressed with him yesterday. I hear he's stirred up the trust about the delay in approving the medical budget next year. There's been a rumour he got it all rubber-stamped over the weekend.'

'That's the first I've heard of it.' Annabel's teeth gritted at this, the second source of confirmation that Luke was indeed making waves, but then she realised that on the particular issue of funding he had her support. In his position she might have been more diplomatic in her approach to the trust, but it wasn't in Luke's nature to twiddle his thumbs patiently while the board prevaricated. And clearly his intervention had been good for the department. Harry had been tiptoeing around nervously about the department's funding for months and getting nowhere.

Wendy put her head around the door as Annabel was finishing her call. 'Annabel, we're getting way behind.'

'Sorry.' Annabel hurriedly wrote in Mrs Di Bella's notes. 'I couldn't rush this one. Mrs Di Bella has to go straight across to Simon Rawlings's clinic. He's going to admit her under his care. Can you spare a nurse to go with her, Wendy? She's had a bit of a shock.'

'Bad news?'

'Looks like an atrial myxoma,' Annabel confirmed. 'Simon's going to try and fit her in for surgery on Thursday.'

'I'll take her myself.' Wendy took the notes and passed Annabel a new set. 'Mr Hill's in three. He'll only take a few minutes. I've put your next one in two and Professor Geddes is next door in five, seeing some of your new general referrals.'

Annabel looked up sharply.
'What?'

'He happened to be going by and he was a bit concerned about how many people were waiting. When I explained about Hannah being sick today and you being on your own he decided to help,' Wendy said calmly. 'He's ever so nice, isn't he? I expect he needs to build up his own list as well. You don't mind, do you, Annabel?'

'Mind? Why would I mind?' Just because the man who was effectively now her boss had decided she was too slow to be able to manage her clinic in the efficient way he clearly demanded, what reason in the world would she have for minding? Annabel picked up a set of notes at random. 'Mr Hill's in four, you said.'

Wendy sent her a strange look. 'Three,' she said slowly. 'Mr Hill's in room three. The Professor's in four.'

Although he shared her clinic, Luke clearly didn't feel any need to consult with her about any of the cases he saw because she didn't see anything of him until the next afternoon when he turned up late to chair the medical department's monthly meeting in one of the seminar rooms on the top floor of the hospital.

'Harry won't be with us today,' he announced with an easy air of command and a confident nod to Annabel, along with all the other gathered physicians who'd just spent almost twenty minutes of precious time waiting for him to show up.

If she'd been braver, Annabel speculated from the safety of her carefully chosen chair as far away from Luke as it was possible to sit, she might have voiced some protest about his tardiness. But the plain fact was that where Luke was concerned she'd decided that avoidance was the only way she was going to be able to cope with him. Besides, as she already knew, her courage was non-existent. The last vestiges of it had flown out the window, along with her self-respect and peace of mind, that morning in the X-ray changing room.

And if she didn't protest about Luke being late, no one else would. She looked around her colleagues with a resigned expression. Out of the twenty or so gathered doctors in the room she was the only one not sitting at full attention, eager to hear the great man speak.

'He's taken an extra couple of days on the weekend for his fishing trip,' Luke added evenly. 'Sorry I've kept you waiting.' But he offered no excuse, merely swung himself around into the leather chair at the head of the table, checked his watch as if he was in a hurry, then directed one of his particularly charming brand of smiles towards Harry's secretary. 'Mary, minutes from the last meeting, please.'

'I've got them right here, Professor Geddes.'

Annabel, noting the secretary's flush and tremulous smile as she scrambled to collect her notes, felt ill. Mary might be fifty-five and proud grandmother of seven, but she was a woman and it seemed that meant she was as susceptible to Luke's appeal as the rest of them were.

After dispensing with the minutes, Luke went on to deal rapidly with each item on the formal printed agenda they'd all unexpectedly found in their pigeon-holes the previous afternoon. Although his brisk efficiency and the consequent lack of discussion, let alone dissent, seemed to be adding to his already astronomical approval rating among her colleagues, Annabel felt a sad wave of nostalgia for the passing of Harry's more rambling, democratic, if bureaucratic style of leadership.

'That has to be a world record,' murmured Geoffrey beside her as the meeting drew rapidly to a close. He shook his watch, as if doubting its accuracy. 'Twenty minutes. We used to be here two hours with Harry.'

Annabel pointed out he was forgetting the extra twenty minutes Luke had kept them waiting, but Geoffrey merely shrugged. 'We still come out way ahead,' he said cheerfully. The group was dispersing and they joined the throng moving towards the door. 'It's a long time since we've got away this early,' Geoffrey remarked. 'Feel like catching a film tonight?'

Annabel blinked. 'On a Tuesday?'

'Why not?'

She stopped, hesitating, allowing the other doctors to move around them out of the room. She had spent the occasional pleasant Saturday evening—once every three or four months or so—seeing a movie or play with Geoffrey, but she supposed there wasn't any reason why they couldn't go to a film during the week. She had paperwork to catch up on but suddenly the idea of being able to lose herself in a movie for a couple of hours appealed to her. 'What's on?'

'There's a new comedy at Whitley's. It's tipped for awards and it's had good reviews. It starts at eight-forty.'

'OK.' Annabel nodded abruptly. 'Why not? I'll meet you there ten minutes before. If you get there before me, go ahead and buy the tickets and I'll settle up with you when I arrive.'