Becky had the first patient—Mr Bamford, for an incisional hernia repair—on the table and asleep before Jack had even emerged from the change room.
‘What happened to you?’ Gwen gaped as Jack pushed through the theatre doors, arms upturned after his first scrub.
‘I ran into something in the dark last night,’ Jack mumbled from behind his mask. ‘Just a little cut but the bruising has given me a black eye.’
‘Gosh, it looks gross.’
Jack sent Becky a speaking glance before turning to Gwen. ‘Thanks, but it looks much worse than it feels, I can assure you. Prep, please.’
He prepped the abdomen, applied the steridrape and set up the diathermy and sucker while Robert gowned.
‘We’re using mesh, Dr Baxter. Can you give a gram of cephalosporin?’
‘Yes. I’ve got it mixed, it’ll go through in a sec,’ Becky answered, without looking at him.
Jack made a vertical incision and freed up and reduced the hernia.
‘Let’s have the 12 by 12 centimetre polypropylene mesh, Gwen, please, and lots of one-nylon sutures.’
‘Do you want me to clip those, or cut as we go?’ Robert asked.
‘Cut, thanks, Robert, about a centimetre long. We need big bites and no tension.’
For the next twenty minutes Jack sutured in the mesh patch, trimming it to match the size of the hernia neck as he went.
‘One-sixty milligrams gentamicin for the wound please, Gwen.’
‘Will you use a drain, Mr Colcannon?’ asked Robert.
‘No, I don’t use drains in this situation. Seroma formation is common, but there is no evidence that drains prevent it.’ Jack suggested a couple of reviews for Robert to consult as he closed the wound with staples.
Jack was just finishing up the next routine case, a laparoscopic gall bladder, when Robert’s page went off. ‘Unscrub, Robert. I’ll put in the skin sutures. You’d better get that page,’ he said as he removed the last of the laparoscopic ports.
‘Thanks, Mr Colcannon, I think that’s a code blue for an emergency in A and E.’
Robert moved to the back of the theatre to use the theatre phone, but within a couple of minutes he was back at the operating table, looking a little pale.
‘What’s the problem?’ Jack asked as Becky accompanied the patient out to recovery.
‘There’s a ruptured triple-A downstairs, confirmed on CT. He needs Theatre now. They want to break into our list—all the other theatres are in the middle of cases,’ Robert informed him.
‘Shoot!’ Jack gritted his teeth in frustration. ‘That’s going to take three hours at least. We may as well forget about the rest of our list.’
‘I’m afraid that’s not the worst news, Mr Colcannon.’
‘I can’t imagine what’s worse than having my elective list screwed up with a ruptured triple-A. Some of these patients have been waiting months for surgery, now I have to hand over my valuable theatre time to the vascular guys.’
‘Well, actually…’ Robert said with a grimace. ‘All three vascular surgeons are away at a conference, and general surgery is covering vascular cases.’
‘Oh, great,’ Jack said darkly. ‘I didn’t get a memo from Admin about that. I wonder who the poor guy on call is who’s going to have to deal with that?’
‘Yes, well, that’s the rest of the message,’ Robert said.
Jack gave him a narrow-eyed look. ‘You’re kidding me, right?’
The registrar shook his head. ‘You’re on call for general surgery today.’
‘I can’t be on call again. Triple-A? I haven’t done an elective triple-A since my registrar training, let alone a ruptured triple-A.’
Robert’s pager beeped a text message and he read it out loud, ‘“Patient’s in the lift, on his way up, with eight units of blood.”’
‘This is totally ridiculous!’ Jack raised his voice. ‘I’m being shafted into doing an operation I’m not properly trained for because the idiotic administration let all three vascular surgeons go on leave at the same time, and then tell me at the last minute that I’m covering.’
Becky could hear the shouting from the recovery room, where she had just taken the last patient. She had just been told of the situation by the recovery staff, and as she was the only free anaesthetist right now, she knew she was going to have to anaesthetise the triple-A. Theatre staff had already moved into action and were quickly setting up for a vascular case.
The lift doors burst open and two nurses and the A and E senior resident wheeled the desperately ill patient straight down the corridor toward Theatre.
Becky took over bagging and masking the patient and proceeded into Theatre, the orderlies transferring him across to the operating table. She administered high-flow oxygen while the anaesthetic nurse continued to pump in blood through the drip. Becky injected and intubated the patient, and connected him to the anaesthetic machine. She helped pump in blood through two drips as the monitor warned her of hypotension.
Jack burst through the theatre door, having scrubbed and rapidly gowned while Gwen had set up the vascular instrument pack.
‘You’ve got to clamp that aorta, Jack,’ Becky said urgently. ‘I’ve got no blood pressure up this end.’
‘Rapid prep and drape, Gwen,’ Jack said tightly.
Robert assisted with the set-up, and Jack made a long midline incision in the abdomen. The distended abdomen suddenly exploded with a gush of several litres of bright red blood.
‘Aortic clamp!’ Jack shouted, as he positioned Robert’s hands with packs. He rapidly positioned the clamp across the aorta and squeezed hard on the handles, but the massive blood loss continued unabated.
‘What the hell? The aorta won’t clamp. It’s rigid with calcification!’
Becky’s anaesthetic machine gave a long monotonous beep.
‘He’s arrested, Jack. I’ve got no blood pressure and he’s in asystole.’
In desperation Jack opened the aneurysm sac, scooped out plaque and clot from the calcified aneurysm sac, and shoved his left index finger into the lumen of the aorta. But the brittle vessel simply split further, releasing a final few surges of bright red blood before even that stopped, Becky’s machine screaming the message that the patient had bled out and had no more blood to pump around.
In spite of twenty minutes of external cardiac massage, intracardiac adrenalin and massive volume replacement, with Jack finally managing to clamp the aorta, but above the renals, Becky gave the bad news.
‘I’m stopping resus, Jack. He’s gone, and nothing’s going to restart this heart.’
Becky watched as Jack stood perfectly still for a moment or two, his gloved hands and gown covered in the patient’s blood, his eyes behind his protective shield staring down at the lifeless body on the table.
‘It was calcified,’ she said. ‘No one could have clamped it.’
Jack stripped off his gloves and gown and tossed them aside, his head gear soon following, his expression grim.
‘You did the best you could do,’ she added to fill the awkward silence. ‘No one can ask more than that.’
Jack’s hard green gaze hit hers with the full force of his bitter disappointment. ‘Somehow I don’t think that’s going to comfort this man’s wife and family, is it, Dr Baxter? That I tried my best?’
Becky opened her mouth to respond but closed it when she saw the rigid set of his jaw. He was upset, and rightly so.
No one wanted to fail in an emergency, especially an emergency that had been thrust upon him with no time for him to prepare. And now he had the unenviable task of going out and meeting the patient’s relatives to deliver the bad news, a task no doctor ever felt up to no matter how many years of experience he or she had gathered over their career.
Becky had seen it so many times it made her feel ill to think of what he had to face—the sea of expectant faces, small bright fragments of hope shining among the shadows of their eyes as they rose from the edges of the waiting-room chairs, the smell
of half-drunk tea and coffee lingering in the air, along with the scent of gut-wrenching fear.
CHAPTER TEN
THE rest of the list resumed after the theatre was cleaned, but the usual conversation among the theatre staff gradually ceased as they witnessed Jack’s brooding silence as he worked his way through the routine cases.
Becky felt sorry for Robert, who had a tendency to try too hard at the best of times. Now, with Jack’s added tension, it seemed the registrar couldn’t do a thing right.
‘Robert, I’m off the screen. I can’t do laparoscopic surgery unless you hold the camera on what I’m doing,’ Jack clipped out tersely.
‘Sorry, the other instruments seem to be clashing with the camera.’
‘Look, just hold it still. If I knock the camera, just keep watching the screen and keep me in the middle of it,’ Jack snapped back.
Robert kept trying to point the camera where he thought Jack wanted to look, but in the end Jack pushed and pulled the camera into position himself, telling the registrar in a hard tone to just hold the thing still.
Becky gave Jack a reproving look as a cowed-looking Robert left the tearoom after the list was finished.
‘You didn’t have to be so hard on him. I think he’s doing a good job, considering the piecemeal cases he gets from the other surgeons,’ she said.
Jack thrust his coffee-cup down with a sharp crack on the table.
‘He needs to toughen up or he’ll never survive the training scheme. He simpers about, showing no confidence at all. No patient is going to take to him unless he demonstrates his ability to think and speak clearly, take some initiative and show some confidence.’
‘You’re hardly helping the process if you have him on tenterhooks all the time,’ she pointed out. ‘Everyone understands this afternoon’s death was difficult, but I don’t think it’s fair to take it out on him.’
Jack’s eyes glittered with sparks of anger as they pinned hers. ‘What would you know? You weren’t the one who had to face his wife, two daughters and three young grandchildren.’
‘That must have been awful.’
He sucked in a ragged breath and turned away from her empathetic gaze.
‘They had such hope in their eyes.’ He moved across to the window and stared out over the hospital car park, his back turned towards her. ‘I hate that—the way they look at you as if you are coming to tell them everything’s gone well and he’ll be up and about in a couple of hours for a cup of tea and a plate of sandwiches. Everyone expects miracles.’ He swung around to look at her, his bruised eye looking all the more obvious with the shadows of disappointment in his gaze. ‘It really gets to me. I always feel like the bloody Grim Reaper.’
‘Jack—’
He held up his hand. ‘No, don’t insult me by saying it again. I don’t need to hear I did my best, because you and I both know my best wasn’t nearly good enough.’
‘I wasn’t going to say that.’
He gave her a long, hard look. ‘What were you going to say?’
She stepped towards him and took one of his hands in hers, her small fingers stroking the long tanned length of his as she looked up into his face.
‘I was going to say you are one hell of a surgeon and that if I ever had a surgical emergency you’d be the only one I’d want to help me.’
He held her look for a long time before speaking, his eyes, slightly misted, holding hers.
‘Let’s hope you won’t be ever needing me that way,’ he finally said, his tone a little rusty.
‘I’m not planning on it, but I guess you never know, do you?’ she said.
He didn’t answer. Instead, he lifted his hand and traced one long finger down the curve of her cheek in a caress so soft Becky thought she must have imagined it.
‘What was that for?’ she asked, her voice a soft thread of sound.
He held her gaze for a long moment.
‘Jack?’
He stepped back from her, his expression closing over, effectively shutting her out. ‘I’ll be ready to drive you home in about ten minutes. I just want to speak to someone first. I’ll meet you at the front desk.’ He turned and left the room, the door swinging shut behind him.
Becky turned and stared at his discarded cup on the table, and before she could stop herself she reached for it, running her fingertip around the rim where his lips had been, her mouth tingling in remembrance of how it had felt to have those lips pressed hard against hers.
Jack found Robert in the change room, gathering his things from his locker.
‘I’ll do a ward round now, Mr Colcannon, and ring you at home if any more emergencies come in.’
‘No, you won’t. Robert, you’ve got the potential to make a good surgeon. You did well this afternoon to cope with my mood after I lost that patient. I hope you’re never in that situation but the odds are at some time you will be. It goes with the territory, I’m afraid, especially in the public system. But you look tired, and you should go home. I’ll see the post-ops myself. Let A and E know they can reach you at home, and go get a break. I won’t be far behind you. I’m more than a little bushed myself.’
‘Thanks, sir.’ Robert gave him a grateful glance. ‘I was beginning to doubt myself this afternoon.’
‘Don’t be crazy, Robert. You’re fine, just lacking in experience, which can easily be remedied. Now, get out of here. The place won’t fall down without you.’
Jack allowed himself one small inaudible sigh as the registrar left the change room a short time later.
In some ways Robert reminded him of himself when he’d first started out—eager to please, wanting to learn as much as possible and be the sort of surgeon everyone had full confidence in. It only took a few losses to erode that growing confidence and he knew some trainees never quite recovered from it.
Losing patients was part of the cycle of a surgeon’s life; even routine operations could go wrong. The human body, for all that science had discovered about it, still held some surprises. All one could hope for was that the cause of death was brought on by natural causes as the result of a disease going too far before treatment had occurred to try to stall the process. That was often true in the very elderly who had left things a little too long before having checks carried out. By the time they came to see him he had the loathsome task of offering them an operation that would very likely kill them or suggesting doing nothing, which would achieve exactly the same end. There had been some talk of rationing care in the public system—that expectations were too high, and that it couldn’t provide maximal care to everyone.
Trauma, of course, was different. That was when good technical skill and a perfectly clear head in the ‘golden hour’ were vitally important. You still had your losses, inevitably, and often the recovery of those who did actually make it was long and arduous, some never making it back to full health.
It was times like these that he truly envied his father. Emery Colcannon hadn’t lost a patient in the thirty years or so he’d been operating as a cosmetic surgeon, and never missed an opportunity to remind Jack of it. Jack had to make himself refrain from chipping back with some pithy comment about the dangers of getting it wrong with a Botox injection or eyelid lift hardly comparing with category-one trauma surgery.
Jack often wondered how his mother had survived living with his father as long as she had. He could stand about five minutes; she had survived eleven years, although she had barely spoken a word to her ex-husband since their divorce when Jack had been ten.
Jack knew his relationships with women were directly influenced by the bitter interactions between his parents. He hated feeling vulnerable in a relationship and had never allowed himself to feel anything other than physical desire with any of his previous partners.
But Becky was something else.
For years he had seen her as the kid sister of his best mate, almost wilfully blocking out the attraction he felt for her, in case he was tempted to act on it.
Damn it, but he was temp
ted.
Had been since that day he’d hauled her young supple body up against his and kissed her. And it hadn’t been just a simple exploratory kiss, but the full works. The whole tongue routine, the pelvis against pelvis thing, and his hand on the soft budding breast, which he could still feel against his palm even after all these years.
He closed his hand into a fist a couple of times but the sensation was still there, as if the essence of Becky had eased itself beneath the surface of his skin, never to come out.
Even his house felt different now. He could sense her presence in every room and not just from her natural untidiness, which drove him crazy. It wasn’t just the squashed cushions on the sofa where she’d been curled up or the damp towels hung up crookedly in the bathroom, or the scattered cosmetics containers with some of the lids still off. It wasn’t even her perfume, which lingered in the air long after she’d left a room.
It felt to him as if by simply entering his house her lively personality had invaded the austere formal décor and somehow rearranged it permanently.
She was waiting for him at the front desk, chatting with the woman on duty as if they were old friends. Jack deliberately slowed his steps so he could watch her undetected. Her laughing brown eyes were sparkling with amusement, her soft mouth smiling, but her smile instantly faded when she turned her head and saw him. Jack couldn’t help feeling annoyed, and to disguise his hurt he adopted a gruff demeanour as he led the way out to where his car was parked.
‘What were you talking to the switchboard operator about?’ he asked.
‘Nothing.’
He gave her a disbelieving look as he unlocked his car. ‘I would prefer it if you wouldn’t discuss me with the hospital staff.’
‘I wasn’t discussing you,’ Becky said. ‘I was telling June about my date tonight.’
Jack’s stomach gave a painful lurch. With all the stress of the day he’d forgotten all about her date with the cop. He drummed his fingers on the steering-wheel, wondering if he could come up with a good enough reason to get her to change her plans.
A Surgeon Worth Waiting For Page 11