The Surgeon's Secret Son

by Rebecca Lang

  As she sat down in the front row of chairs in the lecture theatre, nursing her cup of coffee while she waited for rounds to begin, Nell recalled again the popular clichés of 'going with the flow', 'playing it by ear', that were bandied about. They provided the framework of how she was planning to proceed, as far as one could plan.

  She let out an involuntary sigh. Now she was very glad that few of her colleagues knew she had a son, as they might discern the link between him and Joel. One who did know about him was the head of department, John Lane, whom she had told in confidence once when she had needed a few days off because Alec had been ill. She could imagine the surprise of her other colleagues if she told them about Alec and that Joel was his father. She had no intention of telling them. Only a few close friends knew about Alec, were part of his life.

  The room filled up quickly, then there was a stir as Joel came in with two of the burns unit junior residents who were to present cases. With them was Trixie. To her chagrin, Nell felt a twinge of jealousy at the familiar and friendly way that Trixie was talking to Joel, and the attentive way that he bent his head down to hear what she had to say as they came and sat in the front row, not far from her. He was smiling, looking very attractive.

  Nell took a swallow of coffee and looked away. Already she felt exhausted and the day had hardly started. Part of that was because she had worked over the weekend. Part was due to nervous tension.

  'Hello, Nell. How are you?' Nell looked up to find Joel standing in front of her.

  'Oh...' She struggled for words. 'Hello, Joel. Nice to see you. I had a hectic weekend.' She pushed her untidy hair behind her ears, aware that she wasn't looking her best. Usually she didn't think too much about her appearance once she was at work. Now she was uncharacteristically self-conscious, especially as his eyes were going over her face. 'It didn't help to have a teaching session at eight o'clock this morning with some first-year medical students.'

  'I expect they hung on your every word,' he said, grinning, something that made his familiar grey eyes light up, and she felt a lifting of her mood. Annoyed at her involuntary response to his charm, she looked down at the cup of coffee in her hand.

  'I think they did,' she said, unable to resist smiling back. 'They were pretty attentive, anyway. Everything's great, really. I'm just being a grouch. How are you, Joel?'

  Joel settled himself in the chair beside her. He always had an intense aura, it seemed to her, of masculinity about him that attracted her to him like a flower to the sun, and she felt it now that he was only inches away from her. Never macho, he seemed to have an unconscious, easy acceptance of his manliness, which had the effect on her of making her feel intensely womanly.

  'I'm well,' he said. Again, there seemed to be a certain nuance in his tone that puzzled her and she told herself that she was imagining it.

  'It's surprisingly good to be back in this hospital, challenging but good,' he went on. 'I wasn't sure how it was going to be. So far, I have no regrets about making the move from Montreal.'

  'I'm glad,' she said stiltedly. 'It was quite a coup for John Lane to get you to come here. You're a good doctor.'

  'You have quite a reputation here as a good doctor too, a good surgeon, so I'm finding out,' Joel said, looking at her so intently that she felt almost shy under his scrutiny. 'Quite a change from the girl who had to run to get the urinals in the emergency department.'

  'Maybe,' she said, her face warm, unable to repress a smile at the memory, in spite of a mild embarrassment about her youthful confidence that she sometimes thought of now as over-confidence. 'Don't remind me of that. What carefree days they were. As for the career, it's been a long haul,' she said. 'I've a lot to learn yet, being pretty junior still, but I'm enjoying it. We have a really great team here.'

  'So I'm finding out,' he said.

  'Sometimes, when things get tough, I wish I was back giving out urinals,' she volunteered honestly, with a sigh. 'We see such horrible things sometimes.'

  'Yes,' he murmured gently. 'All part of the job.' Then he put a hand over hers briefly and squeezed it.

  Damn him! She wished he wouldn't look at her so astutely, or touch her, especially when they were surrounded by other people, although she doubted that anyone had noticed the brief intimate gesture that was, after all, quite common among commiserating colleagues. At least, she wished he would not touch her until she had had a better chance to make up her mind about him. Seeing him outside work had sensitized her to his presence at work.

  At the moment she was happy that her son should have a relationship with him, but where that left her she wasn't at all sure, after he had stated that there probably wasn't going to be any 'us'. What she did know was that the sight of him smiling attentively at Trixie left her feeling decidedly crabby.

  'Any regrets about your choice of specialty?' he asked. 'You could have done psychiatry or maybe bacteriology, more or less nine-to-five jobs.'

  'No regrets,' she said. And I don't have any regrets about meeting you, she confirmed again to herself. The clarity of it surprised her. Well, at least that's out of the way, she told herself.

  Joel sighed, much as she had done a few moments before, as though he had a load on his mind, as she did. 'Well, here we are, Dr Montague,' he said quietly, so that no one else could hear, 'With you, I feel like an actor who finds himself back in an old play, having forgotten his lines, and the script as well.' Leaning back in his chair, he put his hands casually into the pockets of the white lab coat that he wore over a green scrub suit, and stretched out his legs, looking the epitome of relaxed sophistication.

  Looking at him, she had an intimation that he was just as churned up inside as she was, and the knowledge warmed her towards him, bringing with it a sense of being less alone. At last, perhaps, he would share some of the responsibilities with her of being a parent to Alec. Sometimes, when she allowed herself to think about it, she dreaded the future of having to deal with a teenage boy as a single mother.

  'Yes,' she agreed, not looking at him. 'That's a good way of putting it.'

  'Why did you decide not to tell many people here about Alec?'

  'It's none of their business, for one thing,' she said shortly, deciding not to tell him at that moment about John Lane. 'And for another, I was concerned that they might think I wasn't capable of doing certain things, putting in the required hours. That would probably have been the case if my parents hadn't been so wonderful about it all. They saved me, and him, so to speak. And I have a part-time housekeeper. I believe that babies and young children need to be with people who love them, and my parents dote on him.'

  Another doctor, Rex Talbot, a general surgeon on the burns team, took the vacant chair on the other side of Joel. 'Morning.' He nodded at both of them.

  'Hi, Rex.' She smiled back at him. He was a member of the team whom she liked very much, and who had recently been away on holiday. He was very married, with a slew of young children. 'You've met Joel Matheson?'

  'Yep, we've met,' he said.

  'Are you still on for the excision and debridement this afternoon?' Joel asked her, referring to a case of his that she had agreed to help with in the burns operating suite, a case of third-degree burns that required extensive excision of necrotic tissue. She had agreed the day before, having asked a colleague to take over an outpatient clinic of hers so that she could free herself to help. This was often the case in the burns unit, they helped each other as emergency cases came in. Rex would also be there in the operating room.

  'Yes, I've managed to free up some time,' she said.

  'Great. I appreciate it,' he said.

  She thought he would get up and move back to sit next to Trixie before the talk started, but he stayed where he was. This was all going to be very, very strange, she decided. Over the past two weeks she had not seen a great deal of him at work, as he had been meeting many other colleagues, getting into the routine of working in a new place. Joel had spent a lot of time with John.

  Without any more ad
o, for all had a busy day ahead, two of the burns unit residents began to present two cases, with slides and graphs, talking about the history of the. patients, their treatment, infection rates, progress.

  Soon Nell was absorbed in the cases, although still acutely aware of Joel next to her. You have no claim on him whatsoever, she reminded herself silently. Did she want one? The unwelcome twinges of jealousy seemed to answer her question. She had thought she had known herself pretty well, then something had happened and she had found out that she hadn't. She had thought herself above jealousy. She shied away from all the unspoken questions. Concentrate on the job, she told herself sternly.

  When the presentation was over, she excused herself and went to the back of the room to meet up with her group of students, who were scheduled to be with her for the remainder of the day.

  'In the burns operating room,' she said to them, 'you'll be in the observation room and we can talk to each other through the intercom. We don't want you in the actual operating room because of the risk of infection that you might bring in. So only essential staff will be inside.'

  The students exchanged glances a little nervously.

  'We're looking forward to it,' one said. 'We haven't been in the burns OR before.'

  'I'll take you there now,' she said, 'to show you where you can change. You'll need to put on scrub suits, overshoes and hats,' she said. 'When I've done that, we can go to the floor again in the intensive care unit and you can read the case history of the patient we're going to operate on. He's a thirty-six-year-old man who has extensive third-degree burns from being in a house fire. Who can tell me what third-degree burns are?'

  One of the students, a petite, earnest young woman who reminded Nell of herself at that age, spoke up. 'It's when the epidermis, the papillary and reticular dermis and different depths of subcutaneous tissue have been damaged,' she said.

  'Right,' Nell said, nodding. 'Can injuries like this heal spontaneously, as we know some burns can?'

  'No,' the young woman said, 'they won't heal spontaneously.'

  'So how do we deal with that situation?'

  'Treatment involves excision of all injured tissue,' the student said.'

  'Right. Good,' Nell said. 'So what we're going to do during the operation is remove that dead tissue, which is a source of infection, and we'll cover the underlying tissues with autografts, and with dermal substitutes as well, since he hasn't a lot of his own skin left.'

  She went on to explain that autografts were skin grafts taken from the patient's own body, while homografts were donated skin from someone else. Then there were various types of commercially produced artificial skin which were all used to cover raw tissue when the burnt tissue had been excised. Pigskin was also sometimes used, she explained.

  Although the medical students had no doubt done some reading on the subject, Nell always made it a policy to give a brief explanation of everything she was doing, so that they could then ask further questions if the information was new to them.

  Joel came up to them and introduced himself to the students. 'It's my case,' he said, 'so you can also ask me any questions. It's a rather bloody operation while we're removing all that dead tissue, because when we've cut off the dead tissue, the healthy tissue underneath bleeds rather profusely. We stop that bleeding with dressings impregnated with an adrenaline solution, until we can get the grafts in position.'

  They all nodded wisely, and then all moved off in a body to go to the operating unit which was part of the large burns unit, next to Intensive Care.

  *

  'I'm using the Watson dermatome,' Joel explained to the medical students, describing the specialized plastic surgery knife that he was using.

  The students were safely ensconced behind the glass wall of the observation room that was located at one side of the operating room, where they could communicate through an intercom. 'And Dr Montague is using a Goulian knife, which you can see is smaller, and is very useful for the hands and face,' Joel continued. 'This dead tissue that we're removing is called the eschar and the operation is an escharotomy.'

  Nell cast a quick glance at the medical students. They were all wide-eyed, with a somewhat stupefied expression of surprise, while a few of them looked decidedly greyer in the face. Carefully she returned her attention to what she was doing.

  As the case neared completion several hours later, Nell allowed herself to relax a little. Concentration had been complete for a long time, so that they had scarcely been aware of time passing. For a moment she closed her eyes and flexed her tired shoulder muscles. Everything had gone well. They had grafted what they could with autografts, and had used various synthetic materials and dermal substitutes elsewhere. There was a great satisfaction in a job well done. Although the patient looked a mess now, in a few weeks he would look totally different.

  'Thank you all for your expert help,' Joel said to her, Bill Currie—the senior burns resident—Rex Talbot, the scrub nurse and circulating nurse.

  He looked at each of them in turn, and Nell felt a warmth and something like pride in him, as though she had a right to it. There were a lot of surgeons who did not thank anybody for a job well done, or for anything else. She could tell that Joel was going to be well respected and popular. The thought came to her then that her judgement as a sixteen-year-old girl had been instinctively right about Joel Matheson. She had gravitated to him then like a homing pigeon.

  The door to their operating room opened and John Lane entered, tying on a fresh face mask over his nose and mouth.

  'Hi, everyone,' he said. 'How's it going?' He smiled at them. He always liked to support his staff, to keep in touch, to find out what exactly was going on, and how.

  'Pretty good,' Joel replied for all of them. 'We'll be finished here very shortly.'

  'Hello, Nell,' John said, coming to stand near her. 'How are things with you?' There was a warmth and intimacy in his voice, to which Nell always responded, as she did now, being reminded of how much she liked and respected him. He always remained professional in the workplace, and she respected him for that, yet he was relaxed and friendly, without being familiar. There was much bantering in the operating rooms, which helped to counter the stress engendered by some of the horrendous injuries they had to deal with, the sights they had to witness.

  'Oh, fine, just helping out,' she said airily, an answering warmth in her voice. 'It also gave me a chance to show the students something.'

  'I think we scared the hell out of them,' Bill Currie broke in. 'They left some time ago. Maybe we'll have a few more recruits for psychiatry, dermatology and maybe bacteriology.'

  John chuckled.

  'They'll be back. After all, look at you.'

  'Oh, well,' Bill said, 'I do it mainly to be close to Nell. And I like the way she handles a knife. It keeps me mesmerized.'

  'That makes two of us,' John said, laughing. 'The closeness, I mean. Although I don't get to do it often enough these days now that she's more competent than I am.'

  Nell laughed. 'Don't say that. I won't be able to live up to it.' She turned to smile at John, who, although close, was not close enough to contaminate her sterile gown.

  As she turned her head back to face the operating table, her eyes met Joel's for a few seconds and she was surprised by the sharp look in his, a speculation, a questioning, and something else...cynicism. Annoyingly, she felt a wave of heat envelop her, flooding up to her face which, thankfully, was well covered by a mask, goggles and a paper mob cap pulled well down over her ears and part of her cheeks.

  With that sense of annoyance was an odd feeling of shame, which took her by surprise, thinking that she, perhaps, was at least partially responsible for his cynicism. Once, it had seemed to her, he had been idealistic, believing the best of people. Don't assume it's you, she told herself. Ten years have gone by, with plenty happening to him to make him cynical. Yet she could not shake the feeling. At that moment she was aware only of Joel, so intensely aware that she thought everyone else in the r
oom must know of it. And she sensed that he felt the same about her.

  Determined not to make eye contact with him again until after the operation, she turned with slow deliberation to take a wad of dressings that the scrub nurse was handing to her. They needed to pad the grafts well so that those thin layers of precious skin were properly protected.

  Concentrating on placing those dressings, prior to bringing the operation to an end, she kept her head bent, forcing the movements of her hands to be deliberate, practised and efficient. What's it to you? she wanted to say to Joel angrily. What right have you to look at me in that judgmental way? It's nothing to do with you, she wanted to add, yet at the same time feeling that it was a lie. She and Joel had a son. Any man that she was involved with from now on would be of interest to Joel and to Alec. Up to now, Grandpa had also been Daddy to Alec. Now all of a sudden he had his real daddy in his life and everything had changed.

  Concentrate on the job, for heaven's sake, she told herself. Pushing all thoughts of her personal life out of her head, she meticulously helped Joel and Bill to place the thick pads of dressing material over their patient's body.

  When the operation was over, with the patient safely wheeled back into the burns intensive care unit to recover, Nell went into the area of the scrub sinks outside the operating room and took off her face mask and paper hat and threw them into a waste bin. Then she took off her protective goggles and put them into the pocket of her green scrub suit. Every muscle in her body, it seemed, was aching, as well as her feet. It would be good to get home.

  With a sigh, she allowed herself to relax, running her fingers through her hair which had become plastered to her scalp with sweat. The case was Joel's, so she did not have to do any of the follow-up work. Bending over a sink, she splashed a little cold water onto her face and ran her hands under the water.

  'You coming for a cup of tea or coffee, Nell?' John was there beside her, washing his hands. 'I might take a few minutes off myself.'

  'Yes, I'm dying for a cup of tea,' she said, wiping her hands on a paper towel. 'Are you finished operating for the day?'