She was going to pull through. Her ruptured spleen lay safely under the table in its gleaming metal basin. Symmetrical chest drains, restrained inside Chinese Finger Trap sutures, rested flat against her ribs, and a long row of neat white knots covered the devastation within: the huge tears in the diaphragm, the bruised liver. Against all the odds the surgery had been successful.
“Are you okay to talk to the parents Emma?” the head theatre nurse looked at me, her glance searching.
I turned and raised an eyebrow at the anaesthetist. “She’s breathing on her own now. And her parameters are great considering… ” he tailed off.
I nodded once. “Thanks.”
Under the brilliant lights I peeled off the mask and cap, the gown and the sweat filled gloves and threw them into the clinical waste. Stripping off the foot protectors, I let the theatre doors swing shut behind me and wandered towards the softly lit room set aside for relatives awaiting news.
I paused outside the door, gathering my thoughts. The long adrenaline buzz that fuelled successful surgery was wearing thin. I pushed the door open, and the girl’s parents looked up, their eyes exhausted from anguish and hope.
“Hello.” I said nodding, dragging a chair over and sitting down beside them.The mother looked down, fiddling with the ring on her finger. The father stared at me, the dim light accentuating the tired lines around his eyes and mouth.
“The operation went well.”
“Oh…!” the mother’s hands flew to her mouth as if to stifle the involuntary sound, the father closed his eyes, slowly re-opening them, relief slow to displace the agony of the past hours.
I had to warn them.
“She’s not out of the woods yet. There can still be complications after this kind of trauma. We can’t really be sure of anything over the next couple of weeks.”
The see-saw of hope and despair had to continue.
Sometimes I was unsure whether anyone heeded these warnings. Coming so soon after liberation, I was rarely certain they understood or cared. Over time, through repetition, my words had become automatic: a strange combination of sympathy and the prosaic knowledge that if I failed to say the right words I might be sued. Sometimes I felt that half the words I spent in that place were an investment against legal action. Institutionalised cynicism awaited the unwary.
“She’s just coming round at the moment – they’ll be taking her to the intensive care unit in a few minutes and you’ll be able to see her.”
Blue eyes, brown eyes. Drained of feeling.
“She’ll still be very sleepy. We’ll be keeping her on strong painkillers for a few days to keep her as comfortable as possible but she might seem a bit out of it…….” I ground to a halt. “Um….is there anything you want to ask?”
The faces were blank. The father shook his head. “Thank you,” he said eventually. “Thanks for everything.” I tried to smile. Touched him gently on the shoulder. Left the room.
Undoubtedly there would be questions. The nurses could answer, I thought, dragging my weariness back up the stairs, back to the magnolia broom cupboard with the dirty grey blinds which served as an occasional resting place when I was working. Bypassing the bed, I walked to the window and tugged the blind cord. The spring was broken again. Lifting a corner, I peered out at the sluggish dawn. Time stretched ahead as leaden and grey as the sky. The shift was ending but the empty bed at home seemed as enticing as a swim in the Clyde. Noise from the inner-city motorway penetrated the glass. Speed, colour, action. Everything I craved. I turned away from the window, letting the blind fall.
The shower, at least, was powerful. The sweat and the smell of disinfectant ran down the drain and I emerged, hair slicked back, pulling on jeans and shirt, feeling cleaner if not wholly refreshed.
“Bye Emma,” the night porter sketched a wave as I reached the door.
“Bye Ivan.” Shrugging into my coat I walked out of the door, not looking back. The blessedly cold air embraced me and I inhaled deeply, scenting ice on the north wind. My car stood in the parking lot but with only a glance, I walked on, making for the city centre, drawn by the noise and the morning hustle. Walking fast, I strode up North Hanover Street to George Square, hub of the city.
Cars and buses traversed the roads, enclosing the square in a continuous flow, and a never-ending stream of people criss-crossed the tarmac, unencumbered, as yet, by Christmas frivolity. No ice rink. No decorations. No children’s rides. The city shivered as dust blew in spiral gusts across the red-grey expanse. I felt almost alive here. Almost alive amongst the living. My blood was stirred; my face and hands were warm from the brisk walk. A warm blast; the scent of coffee assailed me from a doorway and I entered, breathing in the aroma. I chose a skinny latte as always. The server smiled as she handed over the steaming container and with an effort, the corners of my own mouth lifted a millimetre before I nodded and turned to go.
There were benches in the square, all empty. I crossed to the nearest and sat down, wrapping my hands around the cup, lifting it to my face to feel the steam. My thoughts wandered back down Cowcaddens Road to the young patient I had recently left. She should be in the ICU by now. She would survive, I thought. The operation had gone well. Surprisingly so. The patchwork of the diaphragm had come together satisfactorily, closely knit and airtight. The spleen had come out without glitches and the remaining bruising was manageable; there was always the risk of clots, of unexpected haemorrhage, but on balance I was optimistic. I closed my eyes and pulled my coat around me more tightly, breathing deeply, resting the coffee on my thigh. Despite the chill of the wind I could feel myself sliding towards sleep. I drifted, enveloped in the warm satisfaction of a job well done and lulled by the vibrancy of the city. Against the odds I slept.
A hand closed around mine, righting the perilous tilting of my coffee cup. I jerked back into consciousness, taking in a man’s face close beside me. Even in my current semi-delusional state I could see that he was beautiful.
“You were going to spill that,” he observed seriously. His voice was American, rich and brown. He looked down at me.
“Dead tired…… or dead drunk?” he asked, a crooked smile lifting the sparkling eyes, his warm hand steadying my cold one.
“Drunk? At this time of day?” My voice creaked.
“Best time for it I reckon!” He shrugged.
“Just tired then.” My eyes fell… then rose again, drawn irresistibly to his.
“Are you sure you’re okay,” his voice was gentle. “Can I get you anything?”
“I’m fine. Really. I’m fine……I’m fine……..” I shut off the words. Closed my mouth stopping the idiotic words dribbling out. I felt uncommonly foolish sitting there with sleep in my eyes, my damp hair blowing in the near-frosty wind, trying not to shiver.
“I’d better go – I’m late.” He released my hand and stood for a second watching me, concern half-etched on his forehead. Turning he scanned the square, as if looking for someone. His eyes, when they returned to mine, were distracted. “Bye,” he said, and strode away before I could reply. I watched him cross the square and disappear from view, the weariness creeping back into my soul. Sighing, I stood up, threw my cold coffee into a bin and walked back to the car.
It was a Stormy Blue Mazda RX-8, and I loved it. Falling into its embrace, I left the car park and took the exit to the motorway, heading homewards, foot to the floor. Despite the rawness of the day I wound down the window, turning the heater at my feet up to full. Wind rushed through my hair chilling my neck until shivers ran down my spine. I turned the radio up, alive through the howling blast and the throbbing rhythm of the music, waves of a strange euphoria propelling me forwards, on and on.
It ended as always, the speed and the sound. I turned slowly into the dusty road of the farmhouse where I lived. The familiarity and contentment of coming home was inextricably overlaid now with raw loneliness. There were letters on the doorstep for Iain: junk mail. I lifted them from the mat and threw them in the bin, unable as ever to face the effort required to effect a more permanent solution. The house was silent, the grate was empty. No leaping fire, no warmth awaited my return. I ascended the narrow stairs to my bedroom and lay alone on the king-sized bed, my entire being screaming out for what I had lost.
The department was quiet. Even the triage nurses were twiddling their thumbs and gossiping beside the water cooler. I sat in the brightly lit staff room, bleeper on the table beside me, a copy of Celeb! open on my knee. An astonishing array of similar magazines was available, materialising there in a drawer each week. Vividly coloured and glossy they shared the same ‘news’ about current ‘stars’: their flaws revealed; their dalliances, on or off from one week to the next; their style, (or lack thereof); and their addictions. Other than the worthy text books lining the shelves outside the staffroom door, they seemed to be the only reading material in the department, and upon my return to night work I had become fascinated with the whole ‘other’ world I found within them. No matter that I had never heard of ‘film star’ Lesley Lindermann (what was she in again….?) I knew every alleged detail of her love life, which institution she had checked into this week and whether she had been wearing knickers on her drunken night out in the Viper Club last Tuesday (she hadn’t). I derived an odd satisfaction from this knowledge, devouring the information whenever I got the chance, a recent addict to that empty plastic world belonging to those empty plastic people I would never meet.
Before the shift had begun, I had checked on yesterday’s patient. She was comfortable. I had checked her charts and watched her breathing. Her chest rose and fell with reassuring steadiness. She was sleeping, all signs of pain absent. I sought out the nurse who was charged with her care and she had reassured me that everything was going well.
“You’re doing a great job,” I had told her. “Eileen yes?”
“Yes,” she said. “Thank you!” She had looked pleased and, I thought, surprised, and I had found myself wondering, with an irritation which seemed to be triggered all too easily nowadays, when she had last heard those words from anyone. Consciously I had halted the cynical thought. Who was I to second guess? When I bumped into her boss in the corridor, I complimented Eileen, hoping he would pass it on.
Closing my magazine and turning my back on Ms Lindermann, I stood up, switched on the kettle and made another coffee. Night duty was always unpredictable. Sometimes the patients piled up in the corridors, their examinations complete, their diagnoses in place, treatment initiated, shuffling on their trolleys and waiting as the cogs creaked around in the slow and complicated process of finding a bed. Sometimes they arrived faster than they could be seen, the essential triage process determining whether they were red (may die imminently) through to blue (could be seen next week at their GP if they only had a bit of common sense). On these occasions they cluttered up the waiting room instead, grousing at the flashing signs telling them three hours average waiting time… four hours… five…
The selection procedure was crucial; the worst case scenario involved patients dying in the waiting room having been asked to take a seat, something I always dreaded. The receptionists were generally good at ensuring that urgent cases were checked immediately, but like all systems it wasn’t infallible. Tonight was slow, and everyone was being seen within minutes of their arrival. Although technically in charge, I rarely played much part in the triage process. My preferred work was with complicated or difficult cases, my speciality, emergency surgery and, in particular, trauma patients. My coffee finished, I slid my bleeper into my pocket and went for a stroll round the department.
A nurse was suturing a girl’s hand, sliced open on a tin can lid. A mother sat with a blond-haired child, his leg bandaged and raised. The inevitable drunk was sobering up in a side room. Periodically an eternally patient nurse popped in to tell him to stop smoking. As I watched, a car drew up at the main door, discharging a man. His path to the doorway was erratic. His face was white; cheeks, lips, everything.
Approaching the receptionist, his breath came fast.
“Is there somewhere I can lie down?” Annie eyed him and stood up without panic but also without delay, leaving her post to join him in the waiting room.
. “Sit down.” She pointed to a seat, pausing only to make sure he made it, before hurrying round the corner, returning immediately with Valerie, my most senior nurse. With a last quick glance, Annie peeled off to return to her glass box and Valerie approached the patient.
“Are you okay to walk round to a bed?” she asked. The man nodded, his face still ghastly white, and dothered to his feet. She guided him to bay number one, designated for urgent cases, next door to the crash room. Discreetly, I followed them and saw him installed on the paper-lined trolley.
The team moved in, well trained, precise, each to their allotted task. Valerie placed a catheter and sent off baseline bloods. Martin the junior houseman delved into the history, digging deep. Physical examination, blood pressure, x-rays of chest and abdomen. The technician came and placed her electrodes. Drugs were injected to alleviate nausea. His colour improved.
I watched them quietly, mesmerised by their skill, their efficiency and their teamwork. Once the initial examinations were complete, the patient’s wife was brought round to be with him. She perched on the edge of a chair, watching with wary eyes as the monitoring continued.
The blood test results came back; acute hepatitis – inflammation of the liver. Seeing me, Martin came over.
“Would you mind talking to him please?” he asked. “He says he’s a vet.”
“I don’t mind at all if that’s what you’d prefer.” His eyes were on mine, his gaze steady, at ease in his self-awareness, suffused with the essential knowledge that his experience was not sufficient for the circumstances. The ability to ask for help or seek additional insight was a life-saving aptitude.
“It’s just… well there are so many things that could be causing it. Diseases he could have caught when he was working. I want to be sure there’s nothing I’ve missed.”
I nodded and walked over to the bed, introducing myself. I asked all the questions I needed to know. Which animals did he work with, what diseases had he encountered lately? He answered readily and we narrowed down the list of possibilities. I recommended an ultrasound scan and a drip. He smiled at me and I found myself smiling back with ease.
Communication was paramount. All sorts walked in through the door. There were patients who were grateful; there were patients who were petrified. There were patients who screamed and yelled and wanted details NOW; what is it, how did I get it, what are you going to do about it? With Rob the vet it was simple. We discussed the possibilities, and I prescribed Penicillin. Valerie brought round the drug, running it into the vein through the already-connected giving set.
I asked Rob’s wife to go through to the waiting area for a few minutes. With a look of confusion, she pulled herself upright and retreated, looking back over her shoulder as she walked way. “It’s nothing,” I called after her. “I just have to ask some questions in private.” I didn’t enjoy making the request. It seemed so rude; I could see that to her it seemed inexplicable … and yet it was necessary.
“Why did she have to go away?” asked Rob when she had departed. “There’s nothing you can’t ask in front of her.” I nodded and shrugged. He was probably right, but however nice the patient’s friends or relatives appeared, there were protocols I had to follow. I asked him the questions: Had he indulged in different sexual partners, taken drugs, used needles?
When he realised this was why we had sent his wife away, he laughed at me.
“Not me! I’m a boring as hell,” he said.
“Best way to live till you’re ninety,” I responded smiling, and I called his wife back and he explained it to her, still chuckling.
He was admitted: a couple of days in hospital, I explained to him. Rest and fluids and a break from work. Take it easy. He smiled and waved as they wheeled him off on his trolley, the drip attached high above his head. Looking at my watch, I walked slowly round and checked the empty waiting room and then walked back, speaking to Valerie, to Martin, to the technicians and the radiographer.
“That was good work all of you,” I said, “and thank you.” They nodded appreciatively and thanked me in return.
It was 2 a.m. After a brief consultation with Martin, I made my way upstairs and cleaned my teeth. Lying in the narrow bed, I read a magazine by the dim bedside light. The little room was hot, as it so often was, and after a while I crawled out from under the sheet, looped up the still broken blind and slid the window upwards. The Glasgow rain was falling. I turned off the bedside lamp and lay awake in the gentle orange glow of the street lamps, listening to the soporific swish of cars on the motorway as they floated past. By infinite degrees, I drifted away.
The alarm woke me at seven. I felt refreshed. Not bad for a night on duty. The rain had stopped and the sun was shining. I donned my rumpled scrubs and walked back down to A&E. It was quiet. A couple of people were waiting, nothing looked urgent. Annie was long gone and a new receptionist had appeared in her place.
“Everything’s under control,” she assured me. I made my way back upstairs, showered, dressed and walked to the door.
Martin was there, talking to the porter, but on seeing me he turned and followed. As usual the first breath of air was bliss. The natural light was welcoming after the infernal fluorescence. I walked past the car once more, feeling wide awake. After a brief pause, Martin fell in beside me.
“Going for coffee?” he asked.
“Mind if I join you?” His stride was long, his pace effortless. I smiled at him easily.
“No not at all. This is your last shift, isn’t it?”
“Yeah!” he grinned. “A whole week off.”
“Fantastic!” I replied. “That’s one of the reasons I do this job. None of that nine to five nonsense for us!”
He laughed and I studied his face, so much younger than my own, but filled with maturity and good sense.
“How old are you Martin?” I asked suddenly.
“Twenty four. Why?”
I shrugged. “No reason.”
Twenty four. He was fifteen years younger than me. Almost young enough to be my son. I could barely remember being that age. Like Martin I had already been qualified and working, youth and frivolity past. Iain had been a year younger and we had married that year. If we had had a child back then…
“Hi.” Martin waved a hand in front of my face. “Where have you gone?”
I dragged myself back to the present. “How did you get on last night?” I asked him. “Were you busy after I went up?”
“Not really,” he replied. “A couple of things I guess… but nothing worth disturbing you for.”
I was pleased. “What about Rob… the vet. Do you think you could cope with that next time on your own?”
“Yeah, I think so,” he answered thoughtfully. ”I listened to what you said. And I read up about it when we’d sent him to the ward. All those diseases! How can you remember it all? You always seem to know everything.”
I chuckled to myself. My memory had been horrendous lately. Apparently I was covering it well.
“I spend a lot of time upstairs reading round cases too. Never stop doing that,” I said. I glanced at him, screwing up my forehead in thought. “Actually one of the most frustrating things is that when you look young, you have to hide the fact that you read. People seem to think if they see you peering into a textbook it means you’re ignorant.” I shook my head and rolled my eyes. “They should be worried if you’re not looking stuff up.” I sighed, climbing down off my hobby horse. He knew it all anyway.
“But last night?” he said. “You didn’t look anything up then. I asked you and you came right across. You didn’t have time.”
“ Ummmm……” I grinned and shrugged, giving up my secrets. “Six months ago I had to give a lecture on emergencies relating to diseases that could pass from animals to people. The audience was a group of eminent physicians!” I stressed the word eminent, making it a joke, but it had always seemed to me that the higher up the tree the doctors had climbed, the more demanding they could be. “I gave that lecture three times to three different sets of people. It’s hard to forget after that.”
“Aha!” he gave a sudden guffaw. “And there was me thinking it was just because you were a genius.”
I rolled my eyes and smiled ruefully at the thought.
The warmth and subtle aromas of the coffee shop engulfed us as we opened the door. Chocolate brownies and sticky pastry twists lay behind protective glass in mouth-watering piles. Our drinks came and we walked outside and over to a bench; the same one I had fallen asleep on. Was it only yesterday? With my coffee in my hand the man who had rescued me suddenly filled my thoughts. Who was he? What he was doing now? I had watched him walk away, had made no effort to call him back and suddenly regret filled me. He had been unusually attractive, but it was the expression I had caught in his eyes which seemed significant. He had seemed alone somehow, despite the crowds. His expression had intrigued me, reminding me of the emptiness inside myself. I found myself wondering what his sufferings had been… and then shook my head, thrusting away the ridiculous rambling thoughts. I had seen a stranger, and in my exhaustion had hallucinated some kind of connection. Martin spoke to me and, distracted as I was, I didn’t catch his words.
“Sorry Martin, I was miles away.” I tried to turn my attention to him, but my eyes were still on the square.
“I just asked what you liked best about this job?” he repeated.
Luckily the answer came easily. “Surgery.” I said, dragging my eyes towards him. “Trauma patients. I just like getting in there and sorting everything out… and then afterwards, knowing that what I did made a difference.” Despite me, my eyes wandered as I thought some more. “I don’t mind explaining things to patients, trying to make sure they understand everything. And I think I’m quite good with frantic relatives as well!”
“You like talking to relatives?” Peripherally, I could see Martin looking at me, his mouth half way to a smirk, his eyebrows raised crazily.
“I didn’t say I liked it,” I corrected. ”I said I thought I was quite good at it. But yes, there’s satisfaction in giving comfort to people.”
He lifted the lid off his cup, blowing onto his coffee and I found myself calculating the timings as I scanned the square. I was earlier than last time. I had been delayed then by the operation. I suddenly realised my eyes were searching with a strange, almost feverish intensity, looking for him.
And there he was. My eyes were drawn to him as he rounded the corner and strode unswervingly across the concrete. I hadn’t recalled the taut cleanliness of his tanned skin, the hard slant of his cheekbones making shadows in the hollows beneath. And his eyes, those dark, sad eyes, sepia toned like chocolate, intense, frowning and somehow untouchable. They lit on me, sitting there on the bench with Martin and amusement spread over his face, the eyes sparkling from the inside.
“Sober today?” He grinned suddenly as if he sensed my discomfiture, and he laughed as I rolled my eyes. And then he was past and walking on, waltzing out of my world once more, leaving behind a whirlwind.
“Who was that?” Martin turned back to me, a frown creasing his brow.
“I don’t really know, he just…..” I could feel my face reddening, my mind was throbbing, change the subject, change the subject, though there was no good reason… no reason at all.
Martin looked at me thoughtfully. “Didn’t he look familiar?” he asked.
“Don’t think so,” I shrugged. “I’ve seen him out here once before but I don’t know him. “Maybe he’s been in before. You know… a patient.”
“I don’t think so,” said Martin, then visibly thrusting the thought away he stood up. “Time to go home for some sleep,” he said.
I stood up and we strolled back to the hospital. I drove home, my mind distracted by a pair of twinkling eyes. The dark feelings and despair which I carried in my chest like a physical presence lifted an inch. When I arrived home Iain laughed at me from his photographic home and feeling comforted, I smiled back knowing I would love him forever.
The Christmas tree was already up in the Princes Square arcade. Descending slowly on the escalator, I admired my new haircut, reflected in the glass. I had just seated myself in front of a mince pie and a cup of coffee when the phone in my pocket buzzed into life. It was the hospital. With a reluctant hand, I pressed the button to accept the call.
“Emma, it’s Tenby,” the usually calm voice was high and breathless. Alarming.
“Is everything okay?”
“Oh yes… well yes and no.” Her voice came out in a rush, “it’s mad crazy here and I’ve just had a phone call from a doctor in Tobermory. He’s got a patient there with suspected meningitis. She’s unconscious. I’ve given him some first aid advice and the air ambulance is there but they don’t think she’s stable enough to move. They’re asking if someone can go out there.” My mind raced through the possibilities as she went on, “the search and rescue people say they can help, but we just can’t spare anyone just now.”
The mince pie sat in front of me, warm and fragrant, scattered with icing sugar. The new me stared back from a mirror on the wall with not a hair out of place and I heard my voice say. “I can do it, if you need me.”
She fell upon the offer, gushing like a river in flood. “Oh thank you so much, I just didn’t…”
I cut through the rattle of gratitude. “Can you get someone to put a kit together?”
A deep breath. “I’ll do that!”
I looked sadly at the coffee cup and took a sip but it was too hot to drink. Lifting the mince pie, wrapping it in a napkin, I stood up and made my way to the door.
The blades of the Sea King roared into life and there was only a momentary pause before we rose into the sky with a swooping sensation that caused a lurch of pleasure in my stomach. Adrenaline flooded my brain as Scotland unfolded outside the window. I contemplated the task ahead, clicking through the procedures one after the other, and in a few short minutes the rainbow houses of Tobermory hove into view. We landed in a field. Grabbing my bag, I jumped down. A woman stood by the gate, waving furiously. “This way” she gasped as we ran towards her and we dashed from the buffeting updraught and into the rain, throwing ourselves with relief through a doorway into an old-fashioned doctor’s surgery.
She lay on the trolley, the woman: my patient. Neat clothes, pale face. Her breathing was shallow. Her eyes were open and her heart was beating but the life force was wandering. A brief examination was sufficient. I wasn’t sure whether she could hear me but I murmured a few reassuring words before I drew the paramedic outside the door.
“We need to get to Glasgow as soon as we can but you’re right that she isn’t stable enough. She’ll need to go on the ventilator,” I said quietly. He disappeared to fetch the apparatus and I got to work drawing up the sedative and setting out my tools. The catheters slid easily into place, one in the patient’s wrist, the longer one penetrating further, measuring blood pressure in her heart. By the time the man returned everything was ready to go and I popped the needle of the drug-filled syringe through the rubber port on the catheter. The woman’s heart never missed a beat as her eyes rolled upwards into her head. I adjusted the dosage to suit the requirements. As the drugs took her more deeply into unconsciousness, I was able to slide a tube into her trachea. Moments later, the steady beat of the ventilator was echoing the rise and fall of the patient’s chest. The roar of the rotor blades, the surge of the engines could not disturb her now, and we moved her through the rain-swept landscape enveloped in blankets and a carefully controlled mist. The machine rhythm remained steady as we flew, ticking away the moments. We landed on the hospital rooftop in the pouring rain and lifted the trolley out onto the tarmac, delivering our package into the waiting hands of the neurologists. As they retreated from the downpour, I stood looking after them with water running down my face, side by side with the paramedic who had helped me. The pilot of the helicopter climbed out, coming to a halt beside us.
“Slick operation!” he said.
“Thanks!” The rain was slowing a little now, but together we moved into the shelter of the doorway.
“Your first time?” He wiped a hand down his face, shaking away the wetness from his fingers with a disdainful flick.
“Pretty good going!”
“It feels good!”
It did. Despite the damp, the air had been fresh, the viewpoint so different from that inside.
“You should do it more often.”
I laughed and shook his hand, wishing that I could. “Can you arrange for better weather the next time?” I asked.
“Almost certainly,” he said,and I laughed.
“Thanks again. I guess I’d better go in.” I turned to pass through the doorway as the two men marched off across the roof and settled themselves back in the helicopter. Still on a high, I sauntered down to see how Tenby was faring.
Even in the aftermath of flight, I could see that the department was in chaos, worse than I had ever seen it. Patients were piled in the corridors. It was standing room only in the waiting area, the queue overflowing the doors. I sought out Tenby.
“What’s going on? It’s crazy in here.”
She stared at me, the bright light glancing off her glistening forehead.
“Martin had to go home. Some drunk ba…” she glanced at the patient beside her and bit her tongue. “Some drunken idiot stabbed him.”
There was a rushing sensation. I felt for a second as if I would fall but the moment passed and I was still on my feet. “Was he badly hurt?”
“I stitched him back up. It was only a skin wound. But enough, you know.”
“So…” I looked through the doorway. I could see the covered legs of a patient on a trolley, his sick body lying exposed in the corridor. “Do you want me to stay?”
The melee assimilated me instantaneously, and before I could turn round, I was suturing a youth’s face, cut by flying glass. The wound came together neatly and I waved the patient off. A mother came in. Her three year old had drunk paracetomol. I bit my tongue. Maybe she wasn’t incompetent. I prescribed fluids, an antidote and continued monitoring, and moved on. Abdominal pains, a broken ankle, breathlessness, head trauma. Patch them up, move them on. I was stitching again, a tricky cut digit with damage to the ligament, when Valerie entered the bay.
“Glad you’re here,” she nodded a brief greeting. “But I’m afraid you’re needed in theatre.”
“Right,” I replied, “I’ll just finish up…..”
“You’re needed now.” I looked up at her sharply. Her voice was calm but her eyes were telling me to hurry.
“Can you finish up here then? The ligament is fixed, just the skin. Get John to give you a hand if you need…” She nodded. My mind was running on ahead as I walked towards the theatre. Walked, not ran: Running engendered panic: wasted energy. The door swung open before me.
“What’ve you got?” I asked the theatre nurse.
“Female, eight months pregnant. Been in a road traffic accident. She was wearing a lap belt, and she was complaining of abdominal pain at the scene. Blood pressure’s dropped through the floor on the way in. We can’t even get a vein.”
I entered the theatre, washed my hands and donned sterile gloves. The patient’s arms were as white and featureless as her mucous membranes. The veins had dwindled to nothing: they were flat and invisible under the skin. I took a scalpel blade and cut down through the white flesh of the arm. The vein was there, thin and dark. I threaded in the catheter. Secured it in place.
“Here,” the nurse replied, indicating the dark red bag of life-giving cells.
“Get a sample and cross type,” I said. “O Neg at the moment. Fast as you can.”
She was taking the blood bags and setting up the giving set before I finished speaking, running the blood through, connecting the bags to the catheter as I moved to the other side of the patient to repeat the process. Blood poured into both arms and the skin colour changed from white to pale grey suffused with blue.
“Central line is … in.” stated the anaesthetist.
“Thanks Geoff.” He nodded without raising his head.
The patient was unresponsive but I spoke to her anyway. Told her where she was, what we were doing. Told her she’d be okay, that we knew she was carrying a baby. Calm and reassuring.
With stabilisation underway and activity all around, I looked to see whether the ambulance driver had waited. He was there in the doorway. I approached him, intent on gathering as much information as I could.
“Was there any sign of head trauma?” I asked.
“No,” he replied. And there were no breathing difficulties initially – she was a bit breathless – consistent with pain I thought… she said there was pain in her abdomen. There was bruising. We gave her oxygen but she crashed on the way in.” He was mature: experienced. His voice was measured. The clinical signs he described, the bruising on the abdomen, the place where the seat belt had bitten in. It was obvious; their position was far too high up. The belt should have been down over her pelvis, its pressure absorbed by bone not internal organs.
“Ready to go with X-rays,” the radiologist barked and took views of the abdomen and chest.
“Get her scrubbed,” I instructed. “We can’t wait for the results.” I cleaned and gowned rapidly while the anaesthetist and nurses prepared the patient. Elsewhere the X-rays were being processed, the blood tests going ahead.
“Both suction units ready?” I asked, receiving a nod in reply.
The hugely distended abdomen protruded upwards from the green drapes. I incised through the skin decisively, dissecting fast to the linea alba. Carefully raising the tough tissue with rat-tooth forceps, I reversed the scalpel and nicked through, extended the opening with scissors. The abdomen was swimming with blood, overflowing as I cut. Clots and liquid obscured my vision.
“Suction,” I said. The flood lowered.
The baby floated free in the mess. A boy. I lifted him out, handed him over gently. The paediatrician moved in, assessing and testing. I carried on searching, searching for the source of so much blood.
The tide was rising again. More suction. Searching. The mangled uterus came into view. I tied it off. I couldn’t save it; the damage was too great.
Blood ran into her arms through tubes, was sucked out of her abdomen. Massive clots. Too much blood. More suction. The aorta, I thought. It had to be.
I fought to remain calm. Struggled to locate the vessels in the storm of haemorrhage. Sweated to find the source. Damage. Too much damage. Too… bloody… much.
“Blood pressure’s dropping.” The anaesthetist’s statement sounded calm and impersonal. I gritted my teeth. Dug deeper. I found it at last. The aorta was torn, pouring forth a hot torrent of blood.
“Clamp.” I snapped. The nurse handed it to me and I applied it above the tear. The rush of blood slowed. The suction tubes began to win. “We have to put her on bypass.” Another rush of activity followed in efficient silence. And then the machinery was in place and humming as the blood began to recirculate.
“Blood pressure stabilised!” A nod from the anaesthetist.
I sutured endlessly, concentrating fiercely, eyes to the scope, carefully obliterating the tear. Tiny painstaking stitches. My arms ached. I stitched on and on.
And finally the graft was in place; attached, complete. I checked the site and rechecked, took a deep breath and removed the clamps carefully. Blood flooded through the gap, thrumming and pulsing. The repair was strong and I watched for a long moment. The seal was good. I breathed again and stood flexing and extending my fingers, getting them moving, ready to continue. I rechecked and swabbed the abdomen. The blood was minimal. I checked the other organs and the entire length of intestine. All were miraculously intact. The stumps of the uterus and the ovaries were dry.
“What about the baby?” I asked, turning away for a moment, now that the urgency had passed. The paediatric nurse shook her head sadly. I took a deep breath and opened my mouth to reply and then snapped it shut. The beep, beep of the heart monitor had changed. My whole body twisted to look.
“Ectopics,” the anaesthetist stated, checking the screen. He injected drugs into the i/v line, smoothly and efficiently and the insistent bleat steadied for a moment, then slowed, becoming erratic once more. He cracked open another vial, drew up the contents and injected. The rhythm stopped, restarted, stopped again and then the whine became continuous, the line on the heart monitor chaotic.
“Vent fib,” the anaesthetist stated, his face grim. He injected again. The technician prepared the defibrillator; uncovered the chest, applied the paddles.
We obeyed. The machine whirred and clicked. The body bucked on the table, the monitor whining continuously. Chest compressions began. The technician increased the charge.
The body convulsed again. Nothing. More compressions. Once more. Charging. Stand clear. Convulse.
The monitors were flat.
“We’ve lost her.” The anaesthetist’s voice was steady and regretful, the theatre silent but for the long drawn out tone of the monitor. He reached out and switched it off.
I shut my eyes tightly. Opened them again breathing heavily. I felt glazed and unfocussed. Stepping back in defeat, I watched in silence as the monitors were detached, as the nurse stepped into my place and began slowly to suture the gaping hole, making the body decent. The anaesthetist looked at me, shrugged and sighed.
“Sorry,” he said.
It wasn’t his fault. I shook my head and tried to raise a smile, another failure. I removed the bloodstained gloves, stripped off the hat and gown, dropped them in the clinical waste and washed my hands automatically.
“Shit, shit, shit, shit…” The word was pounding in my brain, pointless but unrelenting.
“Her husband’s in the relatives’ room; he came in with her.” The theatre nurse stated quietly. “Are you okay to talk to him?”
I blinked slowly, drew a breath and held it. Exhaled.
“Yes.” I looked at the clock. He had been waiting five hours.
My head hurt. The trudge to the relatives’ room was long and my feet and head were heavy. Standing outside the door, gathering my thoughts, I steeled myself and then pushed open the door. The young man rose to his feet and looked at me, and I knew he could tell from my face what was coming.
“No.” he beseeched, his head moving from side to side, a desperate negative movement. “Oh no, please…..”
“I’m sorry.” I said. There was never a way to soften it. There were no right words. He staggered and sank into his chair, his eyes huge, not wanting to believe but understanding too well.
“The baby?” his voice was a whisper. I shook my head.
“I’m sorry,” I repeated. “He had no heartbeat. There was nothing….nothing…” my voice tailed off.
“Can I see her? I want to see her.” He stood up.
“Not yet. She’s not ready yet.” I looked at him, could only see the white face and hollow eyes. “Would you like to see your baby?”
“Yes,” he whispered.
The paediatric nurse came. She handed over the tiny body, tightly wrapped in a white blanket. He held it in his arms, so fragile and perfect, studying the little fingers, stroking the soft downy hair. He lifted his gaze to mine speaking quietly.
“A boy,” his voice cracked. “My son.” A kind of desperate pride was in his voice. “My son…..”
“Would you like some time alone?”
He looked up and shook his head again. “No,” his voice was strange and empty, politeness overlaid with desperation. “No … thank you.”
I waited quietly and we stood there, together and alone in this impossible grief. The moment lengthened, became unbearably long. How long is long enough? I breathed quietly, patiently standing still until he turned towards me. Tenderly he handed back the small bundle and watched in silence as I handed the tiny body to the nurse and she bore it away. He stood there, white faced and stricken. I moved towards him wanting to comfort. He reached out to me and I held him, offering what I could. It was too much. All too much. We stood there an eternity, entwined like lovers and as far apart as the stars. Eventually he pulled away and looked at me, dry eyed and empty.
“I’d better go.” he said. “I need to phone…….”his voice trailed off. He set off for the door. Stopped and looked back.
“Thank you,” he said.
The door closed on his retreating back and I stood alone. How could he thank me? I didn’t want his gratitude. The clock ticked on the wall and my shift was ending; game over. I retreated up the interminable staircase to the duty room. Its cream walls seemed dingier than ever, the air foetid. I showered automatically, washing away the blood and rank sweat, smells of human frailty. Drying myself, I shrugged into outdoor clothes, the desire to escape a heartbeat in my mind. I trudged back down the stairs towards the outside world under the artificial buzzing brightness. The door swung open. The chill air was sharp. I shivered in its grasp and stepped outside.
The daylight was flat under the dreary sky. I paused beside my car, unlocking the door and then relocking it, leaning on the roof and wondering where to go. Once (it seemed so long ago) I would have run for the warmth of home. To a listening ear, a shoulder to cry on and strong arms to hold me. They were dead and gone. There was nothing left but the second hand hustle of the streets, fast-moving, noisy and impersonal. Abandoning the car, I reached out for their lonely embrace.
I had forgotten my gloves, and burrowing my hands into my pockets I felt a tangle of wires and something hard: my i-Pod. I pulled it out. It offered solitude of a kind, insulating me, protected inside a wall of music. I had downloaded Snow Patrol, Eyes Open, into its memory. Stopping for a moment, I made my selection and walked on, the unfamiliar music passing me by like so much traffic. A haunting chord sequence began. Its hypnotic two-tone backing was familiar, sampled for a hundred television programs and films. I found myself drawn in as voices were added, layer upon layer of instrumentation, until the chords were a crashing wave of sound rushing onwards. The words. They were unfamiliar to me, and yet exquisitely painful, raising thoughts of togetherness and of mutual reliance, and there was nothing I wanted more in the world. An image of Iain surged into my head, he was there, and yet he wasn’t. I needed him fiercely and I listened to the words and despaired. Iain and I. We would never do everything, would never lie together; I would never again look into his perfect eyes, and I wondered, as I had wondered so often in the past few months, why I had to live now that he was gone.
The song finished and I pulled the speakers from my ears. Would I ever want to lie with another man? I didn’t know, couldn’t even imagine the feeling. The bright garden that had once been my life was frozen; the flowers were dead and my mind was as bleak and barren as the concrete underfoot. George Square seemed grim, litter blowing on the tarmac with the dust. I sank onto the bench, empty and alone, as the world washed by a million miles away.
He came. My friend. He must have seen the sadness in my face and he greeted me warmly, wreathed smiles. “What’s up with you? Lost your toyboy?” His voice cracked across me like a whip. He was joking; he must have been referring to Martin but the world stood still all the same. I had lost my patient, lost my husband, lost my life. It was all too much. I couldn’t move to answer and only stared up at him biting my lip at first, then clamping my jaw, gritting my teeth tightly together. The wave that had threatened to engulf me crashed down and I was powerless, drowning. I closed my eyes against the flood and pressed my palm to my mouth, gripping until my fingernails bit. Eventually I took a deep breath and opened my eyes.
He looked stricken standing there. I think he swore under his breath; his lips were moving but no sound emerged. Somewhere inside me, I felt almost sorry for him. A wave of laughter at his ludicrous expression came as far as my throat before being strangled. Once released I wasn’t sure I would be able to stop. The tension inside me rose and then he reached out his hand and took my shaking one in his warm steady grasp.
“Come with me,” he urged gently, his voice low, his eyes sympathetic.
I followed him without resistance, not caring what happened, and he led me across the square and along the street. He stopped in an unprepossessing doorway and looked both ways before wielding two sets of keys; a Yale and a robust mortise. Internal bolts shot back. He pushed the door open and stood aside, no longer urging, merely waiting; offering a haven if I wanted to take it. I searched his face, finishing at those steady eyes, and then stepped inside.