by Peter James
Noon checked the time. It would take a good five minutes before everyone was assembled, and it would be fifteen to twenty minutes at the very earliest before the first ambulances arrived. He hurried into the changing room, undressed and donned his pink scrubs. He had a feeling it was going to be a very long day.
41
Monday 14 January
Marcus Valentine was going through his list of operations scheduled for the afternoon, with his student, Robert Resmes – his registrar, Barnaby Cardigan, was away at a funeral – when his pager beeped. He glanced down. The message read:
MAJOR INCIDENT DECLARED. ALL MEDICAL STAFF GO TO THE EDUCATION CENTRE IMMEDIATELY. ALL NON-EMERGENCY SURGERY CANCELLED.
Holding up the message for Resmes to read, he hit the fast-dial button for the hospital manager, asking him what had happened.
‘Marcus, we have a report of a major incident at the airport, with multiple casualties. The information is sketchy, but it sounds like there’s been a collision between two small aircraft. At present we have four confirmed dead and up to ten seriously injured. Every ambulance we have is at the scene. Can you step in and join the emergency team?’
‘Oh Jesus, yes, of course,’ he said. ‘I can cancel my whole list for today – there’s nothing too time critical.’
In addition to his roles as consultant obstetrician and gynae-oncology surgeon, like all the surgeons here, he was also able to perform most general surgery procedures. With this being a relatively small hospital, all the hospital staff were regularly rehearsed in dealing with an emergency such as this, when all hands were needed at the pump.
‘Thanks. The first ambulances will be here in ten minutes. If you can go to the Education Centre right away for a briefing, please.’
‘I’m on my way.’
Aside from the slight unease about what he was going to be facing, he was excited at the prospect of doing something different to his routine obstetrics surgery. Doing what he had originally signed up for when he had made the decision to go into medicine. Saving lives.
He turned to his student. ‘Looks like the big one! You’re going to be thrown in the deep end, Robert. Now, some things you may see today could be quite distressing. But this is a learning curve, an opportunity to develop your skills. Don’t forget I’ll be alongside you, just keep talking.’
Then the two of them ran through the list of scheduled operations, agreeing there was nothing that couldn’t wait until later today, at the earliest. Resmes was already dressed in blue scrubs, as he was all the time they were at work. Marcus changed rapidly, then they hurried down to the large room of the Education Centre, which was packed. Adrian Noon, in his pink scrubs, stood on the podium, in command.
‘How many surgeons do we have present?’ Noon asked. ‘Please raise your hands.’
There were seven in the room, including three orthopaedics. Two general surgeons were off on leave, one was down with flu, and another two were currently in their private consulting rooms in the Bon Sante medical centre some distance away in the Hotel de France building.
Noon formed the assembled company into three teams, each headed by an anaesthetist, orthopaedic and general surgeon. Identification bibs were distributed for each team member to wear, labelling them Team Red, Team Green and Team Blue – one for each of the bays in the Emergency department. Marcus and Resmes formed part of Team Green.
Two minutes later, Adrian Noon stood outside the emergency receiving bay in light drizzle, as the first ambulance arrived, siren wailing. It contained a badly burnt woman. He did a quick triage, deciding in moments that she was in a critical condition, categorized her as grade 1 and assigned her to the Blue Team in Bay 1, headed by the surgeon Matt Stephenson, assisted by Kath Clow.
The second ambulance reversed in and the stretcher was unloaded. On it was the lean figure of a man in his late forties or early fifties, with short salt-and-pepper hair. He was conscious but confused, with several facial lacerations. All his clothes apart from his boxer shorts had been removed. There was a wide area of bruising across his abdomen.
The man’s initial triage report from the airport, delivered verbally by the paramedic, was a ruptured spleen and suspected fractured skull. Noon carried out a capillary test, squeezing his index fingernail hard and then releasing it. In a normal, healthy person the blood would have returned under the nail instantly. He timed this man’s – it was taking dangerously longer. Next, he felt for the radial pulse. A normal systolic pulse should be above 90, but this was way below, he could tell within seconds.
Noon escorted the porter wheeling the trolley along to Bay 2, where the Green Team were waiting, and shouted out an urgent request for an ultrasound machine. It was brought in rapidly. As he applied gel to the man’s abdomen, then placed the ultrasound nozzle just below the left side of his ribcage, Noon announced to the team, ‘The ultrasound is showing a lot of free fluid in his upper abdomen.’ He moved the nozzle across the bruised area. ‘He has a capillary refill of four seconds and an absent radial pulse. This is almost certainly indicative of a ruptured spleen. He also has a possible fractured skull and broken left tibia and fibula. But more concerning at this stage is his blood loss. I need a general surgeon to take this patient to theatre right away.’
Marcus Valentine was staring down at the barely conscious man. Although his face was camouflaged with streaks of drying blood, he recognized him instantly and went cold.
He stepped forward. ‘Jeez, this poor chap, I know him, Adrian, I’ve flown with him a few times. And I did that surgery as part of my general medical training. I can take him.’
Noon thought for a moment. Under normal circumstances an obstetrician would not operate on a male. But these were not normal circumstances. He could already hear the wail of another approaching siren. He had ten possible critical casualties and maybe more. There were three emergency bays down in this department and just five operating theatres upstairs. Some of the patients might be in theatre for hours. Removal of a spleen was a relatively simple procedure. Better to keep some of the more experienced general surgeons fresh for potentially complicated operations.
‘OK,’ he nodded. ‘Thank you, Marcus. He’s yours.’
42
Monday 14 January
Georgie hurried into the caretaker’s office and switched on the radio to BBC Jersey, just in time to catch the start of the 1 p.m. news and the solemn voice of the anchor. Half a mile away, from Victoria Avenue, came a constant din of sirens.
‘A major emergency has been declared at Jersey Airport following a collision between two aircraft. First reports indicate a number of casualties, with several dead. We will bring you further updates throughout the day. The airport authorities say that all outgoing and incoming flights are cancelled, and the airport is likely to remain closed for some time.’
Georgie felt every fibre of her body tightening. Her next appointment sauntered in through the door, an elderly, retired English dentist, Steve Cowling, who had recently moved to Jersey with his wife and was determined to keep fighting fit after a liver transplant a few years back. He gave her a cheery wave and hurried through to the changing room.
She had the number of the flying club programmed into her phone, found it in her contacts list and dialled it.
Engaged.
She dialled again.
Still engaged.
She dialled the main airport switchboard and that was engaged, too. Finally, she tried Gama Aviation, the private commercial aviation hub, and also got the busy signal.
Oh God, please be OK.
Roger was probably helping out with the situation, she thought.
Hoped.
Fervently hoped.
Please God.
Sirens continued wailing.
Her first instinct was to apologize to Cowling, jump in her car and head over to the airport. To make sure Roger was OK.
But he would be all right. He was highly experienced. He couldn’t possibly have let his plane collide with another.
It was almost certainly a couple of the amateur, recreational pilots, and Roger would be there, doing whatever he could. He didn’t need the distraction of her turning up. She ran through all the sensible, calming thoughts in her head, trying not to revert to the panic she’d felt so often since her sister’s childhood accident, making her fear the worst, but gradually learning to control the irrational anxieties.
She left messages with Lucy and Kath to contact her if they had heard anything, then, hoping that Roger would call her back or text her as soon as he was able, she decided to carry on. She pulled up Cowling’s training programme on her phone. She’d get this session over as quickly as she could.
His first activity was to be five minutes’ warm-up on the cross-trainer, at Level 2. She swivelled the five-minute egg timer and released it. As soon as he had started, she hurried back into the office and listened to the radio again.
‘What we understand so far is that an incoming Piper plane veered off the runway and collided with a taxiing Beechcraft.’
Roger gave his lessons in a Piper. Goosebumps ran down her back and along her arms.
She returned to her client and watched the last grains of sand in the egg timer. Then she installed him in the leg press and set the one-minute timer, her mind elsewhere.
Glancing at her phone again.
No more updates.
She got Cowling to lie back on an exercise mat and gave him a weighted ball to lift repeatedly in the air.
While he was doing that, she checked her phone.
Still no message from Roger.
Feeling sick with dread, she dialled the airport again. Still busy.
She rang Roger again.
Voicemail again.
‘Right,’ she said to Cowling, as enthusiastically as she could muster. ‘Assault bike next!’
‘Welcome to the Georgina Maclean torture chamber,’ he said with a smile, as she helped him to his feet, for once not smiling back. This time, she was the one enduring torture, and she felt an immense flood of relief when the session was over and she could usher him out.
By then, Georgie was shaking. Unable to stand not knowing any longer, she jumped in her car and drove, faster than she should, towards the flying club. As she came off the roundabout, turning towards the airport, a short distance ahead of her the traffic was backed up. Some cars were turning round.
As she crawled in the slow-moving queue of traffic past St Peter’s Garden Centre on her right and the display of cars outside the swanky car showrooms of Jacksons to her left, she saw blue lights in the distance. All the vehicles ahead were now making U-turns and heading past her in the opposite direction. Drawing nearer, she saw a police car parked across the road, with two officers, a male and female, standing beside it, blue-and-white tape stretched across the road behind them. A sign read:
POLICE – ACCIDENT – ROAD CLOSED
In the distance she heard the wail of yet another siren.
She pulled over, jumped out of her car and hurried towards them, her heart in her mouth. ‘My fiancé’s an instructor at the flying club – is there any way you could let me through?’
‘I’m sorry, madam,’ the female officer said. ‘Emergency vehicles only, the airport’s closed.’
‘Can you tell me what’s happened?’
‘I’m afraid not,’ she said, friendly and apologetic. ‘There’s an incident at the airport but we have no more information at this stage.’
‘If you tune in to Radio Jersey, I’m sure there will be bulletins,’ the male officer suggested.
Georgie went back to her car and turned up the volume on the radio. A Tom Odell song was playing and normally she liked him, but all she wanted now was for it to end and to hear some news. She turned the car round, and when she reached the garden centre pulled in and drove into a parking bay. The song was still playing. She googled Jersey General Hospital on her phone, then dialled the number, turning down the radio.
When the switchboard operator answered, Georgie said, ‘Hi, could you tell me if a Mr Roger Richardson has been admitted?’
‘One moment please.’ Then he asked, ‘Are you a relative?’
‘I’m his fiancée.’
‘And your name is?’
‘Georgina Maclean.’
‘Can you hold please, madam?’
After an age, he came back on the line. ‘Yes, Mr Roger Richardson has just been admitted.’
‘Is he all right? Is he OK?’
‘I’m afraid I cannot give you any information.’
‘Oh God. Oh God.’
Tears welling in her eyes, she started the engine, reversed out and drove, as fast as the heavy traffic allowed, towards St Helier and the hospital.
43
Monday 14 January
In the scrub area of Theatre 3, Marcus Valentine washed his hands twice, dried them and held them out. A nurse helped him into his gloves. Behind him, Roger Richardson lay on the operating table, swathed in sterile green cloth. Heart-rate patches were stuck to his chest, trailing with wires to monitors with digital readouts; a grey pulse oximeter was clipped to his index finger. Veins were cannulated with drip lines into the back of his hand and there was a plastic ID tag around his wrist. Next to Richardson was an anaesthetic machine and trolley, with the anaesthetist standing beside him, studying the readouts in deep concentration.
Out of respect, there was no music today, and Marcus had donned a plain blue cap.
All the theatre team were fully gowned up. The anaesthetist informed the surgeon that his patient was ready. Marcus, followed by Robert Resmes, went across to the table. He stared down at the unconscious man. Thinking about how he had held court at the table in his house last month, captivating all the ladies.
What a difference a few weeks make.
He was handed a scalpel from a tray of sterile instruments by a scrub nurse and hovered it over the flying instructor’s abdomen.
He stood in silence, holding the scalpel, aware of all the eyes on him.
Waiting and thinking. Then he started.
Knife to skin.
He began making a steady, long incision midline from the xiphisternum straight down to the pubic bone. As he cut, a ribbon of yellow, fatty flesh followed the path of the blade, filled seconds later by bright-red blood.
Assisted by his student, and a theatre nurse who was suctioning away the blood, he clamped back the folded tissue and began to prod around, pushing down the top of the bowel to expose the spleen.
‘I can see the immediate cause of the internal bleeding,’ Marcus announced. He liked to keep his team well informed during all emergency surgery procedures. At this moment, here in this microcosm of the universe, this crucible, he was the master.
‘A badly ruptured spleen. There is no possibility of repairing it, so our safest chance to stop the haemorrhaging is to remove it.’
For the benefit of Resmes and any of the juniors attending, he continued. ‘The spleen’s not that important an organ. It will leave him more open to infections, so he will need pneumococcal vaccinations and antibiotics for the rest of his life, but hey, that’s better than the alternative.’
‘Bleeding out until death?’ Resmes queried.
‘Exactly,’ he said.
Marcus Valentine was feeling extremely happy he’d made the incision so long, because it had exposed something very interesting. Something no one in the theatre team could have spotted without peering in as closely as he did. And even then, they almost certainly would not have noticed what he could see.
The tiny perforation in Roger’s bowel.
Just a faint nick.
He remembered from his medical training that such holes in the bowel could be caused by a number of reasons. Appendicitis; bowel disease; cancer; or, in this case, trauma.
Richardson had been through a pretty big accident. Perfectly credible that among his injuries would be a perforated bowel.
And perfectly credible that his surgeon might not spot it. Especially such a tiny hole a
s this.
It would be a simple procedure to repair it. Two, maybe three sutures. Self-dissolving ones. In three or four days, assuming no brain damage from his fractured skull, Roger would likely be well on the road to recovery.
But we don’t want that, do we? You’ll recover when I decide you recover. If, of course, I decide that at all.
He could easily ignore it. Simply remove the man’s catastrophically damaged spleen, and under normal circumstances that operation would save his life.
But, of course, these were not normal circumstances.
They’re not, are they, Roger? he nearly whispered, excitedly.
He held the power of life or death over this man. Literally. In his two hands. All the team around him assumed he was doing his very best to save Roger Richardson. And what possible reason could he have not to? It was the perfect opportunity!
All he had to do now was what everyone was expecting him to do. Remove the spleen.
And nothing else.
Over the next few days, bile from the leaking bowel would start to enter his system. Blood poisoning would set in. Sepsis would attack all his internal organs, causing gradual failure. When Roger Richardson began to regain consciousness, his speech would be slurred – which the hospital team would put down to concussion from his skull injury. He might shiver, stop passing urine, perhaps become breathless. His skin would eventually start to become mottled, at which point an alert medic would diagnose possible sepsis.