A Surgeon Worth Waiting For

by MELANIE MILBURNE

  ‘Good, thanks, Jack. Sux is in, Dr Baxter.’

  The patient gave several brief twitches as the sux took effect, paralysing him so that Becky could intubate. Grasping the laryngoscope, Becky inserted an endotracheal tube and connected it to the insufflation bag, ventilating until the sats stabilised.

  ‘I’m using 20 mls one per cent Xylocaine with adrenalin LA,’ Jack said, so that John could keep tally of all the drugs used, even though the entire resuscitation was being recorded on video from the ceiling-mounted camera, as was routine in A and E.

  ‘This might be the time to ask the audience to leave,’ Jack said over his shoulder, referring to the milling police.

  ‘They won’t budge,’ John informed him. ‘This is one of their officers. Plainclothes. They’re not saying much but they insist he be under police guard at all times.’

  Jack grunted. He prepped the left chest, and made an incision over the lateral chest wall. He tracked over the top of the sixth rib and punctured the pleura with a popping sensation, then inserted a clamped intercostal drain towards the apex of the left lung, connected it to the underwater seal bottle and released the clamp. Immediately fresh blood poured out into the underwater bottle, the flow slowing over the next few minutes. Jack sewed in the drain with heavy black silk and taped the connectors to the tube and bottle. The drain continued to swing and bubble, but there was no further major bleeding.

  ‘That’s a total of less than 500 mls blood from the left chest, hardly enough to drop his BP to 80. Chest sounds clear. What’s his pulse and BP now?’ John asked.

  ‘Pulse still 130, BP is now 70 systolic.’

  ‘I don’t get it,’ said John. ‘How come the BP is so low with only 500 mls loss?’

  ‘I don’t think there was a tension on the left with mediastinal shift,’ Jack said. ‘That would markedly drop his BP from mediastinal compression, but his trachea was midline wasn’t it, Becky?’

  ‘Yes, midline, but his jugular venous pressure is still up,’ Becky said.

  ‘Get the ECG dots on, Rachel,’ John Hickson ordered the A and E nurse. ‘And I want to listen to his chest again.’

  John placed his stethoscope over the patient’s praecordium while Becky secured the endotracheal tube with tape and Jack examined the abdomen and gave instructions to the radiologist, who had just arrived.

  ‘Heart sounds are muffled, Jack, and look at the ECG—very low voltage,’ John observed.

  ‘You’re thinking cardiac tamponade?’

  ‘Got all the signs, and he’s now had three litres of colloid and no response whatsoever.’

  ‘That’ll mean a cardiac injury if this is just a gunshot. His BP is desperate, John. It justifies the risk of a pericardial tap.’

  ‘I agree. If we don’t do something now he’s going to expire. Jack, you’re the trauma surgeon, I’d prefer you do it.’

  ‘Yes of course. Get me a 12-gauge cardiac needle, Nurse, and skin prep. John, get straight onto Cardiac Theatre. A pericardial tap is only likely to give short-term improvement. See which cardiac surgeon is in the hospital and tell them to see if one of the cardiac anaesthetists can get a bypass machine on line quickly.’

  Jack prepped the epigastric region with Betadine, and made a small nick in the skin. Keeping one eye on the ECG monitor, he inserted the cardiac needle at a 45-degree angle, aiming towards the tip of the left scapula. On the end of the cardiac needle was a three-way tap and syringe. Centimetre by centimetre Jack advanced the needle, each time aspirating on the syringe and checking the monitor for VEBs. When the needle reached about 15 centimetres, aspiration produced fresh blood.

  ‘I’ve got fresh pericardial bleeding,’ reported Jack. ‘Sixty mls out and still coming. Any improvement in BP?’

  ‘BP 80,’ Rachel replied. ‘No real change.’

  ‘There’s blood still coming out fast and fresh, John. This guy’s got a cardiac injury that has got to be closed quickly. What’s the cardiac theatre situation?’

  ‘There’s no hope there, Jack. They’re in the middle of a triple bypass, which will tie up the cardiac theatre, their anaesthetist and the bypass machine for at least another hour and a half.’

  ‘This guy’s not going to last twenty minutes unless we crack his chest and repair that cardiac defect. Are there any other cardiac or thoracic surgeons around?’ Jack asked.

  ‘Not in the hospital, no, I already asked,’ John said. ‘You’re it, I’m afraid. He’s dying in front of us. If you can’t crack the chest we may as well start calling his relatives with the bad news.’

  ‘Get him up to my general theatre now,’ Jack ordered. ‘Becky, hand over ventilation to Rachel, get on the phone and tell Jenny to set up for an immediate thoracotomy plus the vascular extras. Get Robert and the Surg. B or C registrar in to help and I’ll stay with him on the way up to control this pericardial tap and get O-negative blood started. Get patient transport now, John.’

  Less than four minutes later, Jack, Rachel and John were in the patient lift, struggling to maintain some blood pressure, while two porters held the bed steady. The police were forced to use the normal lifts, but they weren’t happy about it.

  The lift seemed to take for ever to travel the four floors up to the operating theatre.

  ‘Looks bad, Mr Colcannon,’ David, the new orderly, commented as the lift hydraulics hissed beneath them.

  ‘He’s definitely not well,’ Jack agreed.

  ‘He’s a cop, right?’ David asked.

  ‘Yeah,’ Jack answered vaguely, mentally preparing himself for what was ahead.

  ‘Should have been wearing a bulletproof vest,’ David said. ‘I guess that means the place will be crawling with cops.’

  Jack didn’t answer.

  The lift doors wheezed open, and the trolley and its entourage headed up the corridor towards Jack’s theatre, theatre overshoes and paper headgear ignored in the emergency.

  Jack ordered the patient straight onto the operating table in the left lateral position, while he, Robert and the Surg. B registrar scrubbed.

  Jenny already had the theatre set up, and Becky immediately connected the patient to the anaesthetic machine, administered propofol and more muscle relaxant, and gave orders to two anaesthetic registrars who had come in to assist her to maintain rapid IV infusion and get the cross-matched blood, which had just arrived, in the blood fridge.

  Jack rapidly prepped and draped the left chest, including the existing chest drain, and made an incision, entering the pleura with a slight hiss.

  ‘I’m in the chest, Becky. There’s a peripheral lung injury from one gunshot but it’s not bleeding. The pericardium is tense.’

  ‘Jack, I’ve got virtually no BP. Do something now or he’ll arrest,’ Becky urged.

  Jack incised the pericardium laterally, releasing a gush of arterial blood, which kept on coming at a furious rate.

  ‘That’s improved things. His BP’s jumped to 100,’ Becky reported.

  ‘There’s a cardiac defect from the second gunshot. His heart movement is making it difficult to control.’

  ‘Blood loss is catching up with us, Jack. His BP is falling again,’ Becky informed him.

  ‘Jenny, give me a 2/0 prolene on a large needle and 2 centimetre square felt pledgets,’ Jack ordered.

  ‘Right here,’ Jenny said, loading the needle at Jack’s preferred angle in the needle holder.

  Jack passed the needle through one felt pledget, took a big bite of myocardium through the slit-like defect caused by the passage of the bullet, passed the needle through another pledget, then reversed the process, making a U-shaped suture through the defect with a pledget on each side. He tied the suture, compressing the cardiac defect between the pledgets. Immediately the blood flow slowed to a trickle. Jack repeated the procedure with another pledget, stemming the bleeding completely.

  ‘That was fantastic, Mr Colcannon. I’ve never seen anything like that, ever,’ Robert said.

  ‘I’ve never done it before,’ Jack said. ‘I l
earnt it at the last DSTC course. Damage control was the emphasis.’

  ‘Amazing,’ Robert said, shaking his head in awe.

  Jack closed the chest, leaving the pericardium open and the existing chest drain in place, and left Robert and his companion registrar to resecure the drains and close the skin while he stripped off his gear. The police were waiting outside the operating theatre, peering in through the porthole-like windows.

  He exchanged a short glance with Becky as she prepared to accompany the patient out to ICU. ‘You OK?’ he asked, frowning at her unusually pale face.

  ‘I’m fine,’ she said. ‘Robert’s right. You did a great job.’

  ‘So did you.’ He gave her a small smile. ‘I’ll have a word with the police. Don’t leave without me, we need to talk some more. I’ll wait for you in my office.’

  Becky had only just stepped into the lift on her way to Jack’s office half an hour later when David, the orderly, called out to her.

  ‘Hold that lift, Dr Baxter.’ He raced up to block the doors with one arm and gave her a quick grin as they sprang back open. ‘Phew! Thought you were going to leave without me. I hate taking the stairs unless I have to.’

  ‘Me, too,’ she said, reaching out to press the button for Jack’s floor.

  David stepped in front of the number pad, his eyes suddenly losing all trace of his previously easygoing friendliness. ‘Let’s not go to that floor. I have other plans for you.’

  Becky’s gaze flicked to the emergency button just out of her reach, her mouth suddenly drying out with fear.

  ‘W-what are you talking about?’ she asked, forcing her tone to remain calm.

  He gave her a smile that sent a chill down her spine.

  ‘We have an apartment to look at, remember?’

  She frowned in confusion. ‘I don’t know what you’re talking about. I have an appointment with one of the recovery staff…’ She hunted her brain for the name. ‘Lyndal Hanlon. We’ve arranged to meet later this evening at the property at Bronte.’

  ‘Lyndal is my girlfriend,’ he said. ‘She does whatever I tell her to do.’

  Becky stared at him, trying to make sense of what he was saying. ‘You mean it’s your apartment?’

  He smiled that same chilling smile. ‘What’s wrong, Dr Baxter? Don’t you fancy the idea of a threesome?’

  ‘I think you’ve got the wrong person,’ she said coldly. ‘Now step aside and let me out of this lift.’

  He took her arm in a vice-like grip while his other hand prodded her in the belly with a hard cold object. ‘Don’t make me pull the trigger,’ he said. ‘Haven’t you seen enough blood for one day?’

  Becky swallowed the solid lump of fear in her throat.

  A gun.

  He turned her so she was facing the front of the lift, the gun now prodding her in the back as he pressed the button for the first floor.

  She forced herself to think clearly and calmly even though her heart was racing behind her chest wall, the deep throbs of the lift’s acceleration making her feel sick and light-headed.

  The first floor was the medical ward. There would be staff and patients and visitors within calling distance. She could alert them to the danger even if it meant taking the first shot herself.

  The gun stabbed at her again as the lift came to a halt. ‘Don’t get any ideas,’ David said. ‘Just keep walking. We’re going to the fire escape on the right. If you give off any signals or say a word to anyone, I’ll shoot you first and them second.’

  Becky did what he said, in some ways almost relieved when no one appeared. He escorted her roughly down the stairs to the locked door of the basement.

  ‘Why are you doing this?’ she asked.

  He kept the gun trained on her as he took a key out of his top pocket and unlocked the door leading out to the hospital car park.

  ‘Shut up and keep moving.’ He shoved her through the door, walking by her side with one arm around her, the other pressing the gun to her side.

  A hundred horrible scenarios raced through Becky’s brain. She could almost imagine the pathway of the bullet as it tore through her flesh, the spurt of blood, the loss of consciousness as her blood pressure dropped and her life drained away.

  ‘We’ll take your car,’ he announced, steering her towards where she’d parked it that morning.

  ‘I haven’t got my keys on me,’ she said. ‘My bag is in my locker.’ She didn’t tell him her keys were at front reception where she’d arranged for the mechanic to leave them. She couldn’t risk him brandishing his gun among so many innocent people.

  ‘Don’t worry,’ he said with a sly smile. ‘I have my own set.’ He took out a set of keys and aimed them at the car.

  Becky swallowed convulsively as the central locking responded, her startled gaze swinging to the coldness of his.

  ‘You’re the one who broke into my flat! I didn’t even think about my spare car keys—’

  ‘Get in and drive.’

  She got in the car with every limb shaking with reaction, her hand fumbling with the key in the ignition.

  ‘Start the car.’ His voice was devoid of all emotion. ‘I’ll give you ten seconds. One, two, three—’

  In her panic she forgot to put her foot on the clutch. The car started with a jerk and bumped into Jack’s car, parked in front of hers.

  David swore viciously and gave her another prod with the gun. ‘You think I don’t mean it, don’t you? Drive, bitch, or you’ll regret it and so will your brother.’

  Becky almost stalled the car as she stared at him. ‘You know my brother?’

  ‘Keep your eyes on the road,’ he commanded. ‘Yes, I know your brother.’ He gave a throaty laugh that sickened Becky to her stomach. ‘You could say we’ve had some dealings recently.’

  Becky’s brain tumbled over the possibilities. She knew Ben had been doing some time in the drug squad. Was David somehow involved in dealing with drugs? But how did he know Ben? Ben was a cop, not a dealer…but, then, if Ben was working under cover maybe he had to pretend…

  ‘What sort of dealings?’ she asked. ‘Drugs?’

  ‘Take the next left,’ he said, looking back over his shoulder. ‘Yeah, drugs.’

  ‘What sort?’ She checked her mirrors, hoping for a miracle, but none showed up. Where were the police when you needed them? ‘Cocaine, heroin?’

  ‘You ever heard of crystal meth?’

  A wave of fear washed over her. She’d not only heard of crystal meth, she’d seen the effects of it during one of her terms at St Vincent’s. They had a drug unit there with a padded room for people who had overdosed on crystal meth. It was a frightening drug. Perfectly normal people turned into vicious uncontrollable animals on it, became delusional and paranoid and incredibly dangerous, most never even remembering the things they’d said or done once the drug wore off. Some, she’d heard, never fully recovered from the personality changes or psychotic conditions the drug triggered.

  ‘Yes, I’ve heard of it.’

  He gave another one of his stomach-churning laughs. ‘Your big brother thinks he’s so smart. He thought he could infiltrate the company. But he seriously underestimated me.’

  ‘Where are we going?’ she asked as he indicated for her to take the next street.

  ‘A meeting place,’ he said. ‘Ever gone fishing?’

  ‘Yes…’

  ‘Well, this time you’re the bait,’ he said. ‘Your brother has something I want and now I have something he wants.’

  Becky could feel the smugness of his smile even though she didn’t look his way.

  Never in her wildest dreams had she ever imagined Ben’s work as a cop would throw her into the path of dangerous criminals. She didn’t know how to deal with someone as maniacal as David Barker. He’d seemed such a normal sort of guy before today, working as an orderly as if he’d been doing it for years.

  ‘Is that why you came to work at St Patrick’s?’ she asked. ‘So you could kidnap me when you had the chance?’
/>
  ‘You’re smart, you know that?’ he grinned at her. ‘I bet you’re smarter than your brother. Of course I got the job to get to you.’

  Becky frowned in confusion. ‘But if you wanted to kidnap me, why didn’t you do it that first night?’

  ‘What first night?’

  ‘The night you broke into my flat and shone that torch in my face.’

  ‘Wasn’t me,’ he said and indicated for her to take the next road. ‘Turn here and park behind that silver Mercedes.’

  Becky parked the car somewhat crookedly as her brain tried to grapple with what he’d just said.

  ‘What do you mean, it wasn’t you?’ She turned to look at him.

  ‘Get out of the car and no fancy moves,’ he said, ignoring her question.

  She got out and walked stiffly to where he pointed towards a neat cottage, the perfectly manicured lawn and the heady scent of gardenias in the tidy garden beds totally at odds with what she’d been expecting.

  The door opened as they approached and a well-dressed man greeted her. ‘Welcome, Dr Baxter. How nice that you could take time out of your busy schedule to visit us.’

  She gave him a filthy look. ‘Who are you and what do you want?’

  ‘You can call me Carl. Come in and make yourself comfortable.’

  David shoved her through to the lounge where a woman was sitting, smoking. Becky assumed from the way the woman got up to greet David that she was Lyndal, his girlfriend.

  ‘Have we heard from our friend?’ David asked Carl.

  ‘The message has been circulated that we have his sister,’ Carl said, glancing at his watch. ‘Let’s see how long it takes him to get here.’

  ‘I need to use the bathroom,’ Becky said, wishing it was indeed a lie.

  The men exchanged glances and Carl turned to Lyndal, handing her a small pistol. ‘Take her. Don’t let her out of your sight.’

  The woman scowled as she dragged herself to her feet. ‘Come on. It’s out the back.’

  On her way to the bathroom Becky did her best to get an idea of the layout of the cottage in case she got a chance to escape, but all of the doors along the hall were closed except for the bathroom at the end.

  Lyndal shoved her into the bathroom and stood in the open doorway. ‘Hurry up.’