The Surgeon's Secret Son

by Rebecca Lang

  John appeared in the department. 'Hi,' he greeted them. 'I'm going to finish off a few cases in Outpatients, then I'll go straight to the OR to get ready. I'll leave you guys to make the assessments. Who's working with whom in the operating rooms? Have you decided that yet?'

  'I'm with Bill,' Nell said.

  'Right. Trixie, you work with Rex,' John said. 'Joel, you'll get one of the general guys who have been contacted to help us out. Sy, you'll be with me.'

  'All right, sir,' Sy replied.

  'Sy, you stay here just long enough to see how the assessments are done, then you come on up to the operating room. The emergency doctors will do some of the preliminary work down here—IVs and maybe the intubations if necessary—then we'll carry on where they left off.'

  'Right,' the intern said.

  'Where do you want us?' Joel asked one of the emergency room doctors.

  'We'll be putting the burns cases in trauma rooms one through four,' he said, pointing. 'If we get more than four patients initially, we'll have to double up.'

  'OK,' Rex said, 'let's get ourselves organized here. Bill, since you're working with Nell in the OR, maybe you can stay with her here. Joel, how about if Sy is with you for now? You'll learn a thing or two, Sy.'

  'Sure,' Joel said. 'We'll be here for a few minutes only, I assume, then dash up to the OR.'

  'Yes. Trixie, you and I will take a room each, if that's all right with you,' Rex went on, assuming a leadership role, as Joel had not yet experienced a disaster plan in Gresham General.

  'Ready and waiting,' Trixie said.

  Three ambulances pulled up one behind the other at the main loading bay, at which time the burns team dispersed to the trauma rooms.

  Nell and Bill stood back as a patient was unloaded quickly by two paramedics onto the bed of the room they were in. An emergency doctor, an anaesthetist and two nurses stood waiting.

  'Burns to seventy per cent of the body,' one of the paramedics said. 'She's had morphine, oxygen. There was some smoke inhalation and possible inhalation of toxic gases—she's got the IV Ringer's lactate going. We had trouble getting an IV line in, on account of all the burns, so went into the subclavian.'

  'Good,' the anaesthetist said, helping them to move the patient, taking note of the IV line that had been inserted just below the woman's neck, at the side.

  The two paramedics, burly guys in their thirties, were breathing heavily from the exertion and speed with which they had had to respond to and deal with this crisis. 'We just put in an airway,' one of them explained, 'but haven't intubated because we're not sure about damage to the trachea. She's breathing OK but respiration's a little fast.'

  'OK,' the anaesthetist said. 'You did a great job, by the look of it. Thank you.'

  Nell gave Bill a meaningful look. 'Now we know what we're up against,' she said. 'Let's move in for a closer look.' This was going to be a challenging one, and she felt herself gearing up a few notches.

  With the others, they helped to cut off the woman's clothing, what was removable. Synthetic fabrics often just melted and adhered to the tissues of the body. Mercifully, her face and neck had been spared, but the rubber soles of her shoes had melted and adhered to the bottoms of her feet.

  Nell and Bill wielded a pair of scissors each and made their assessment. They would get out of the way of the emergency team soon and prepare in the OR. Everyone worked quickly, not speaking unless necessary. Each person knew what he or she had to do.

  The anaesthetist intubated the patient carefully, using a thin bronchoscope through a nostril to see his way down the airway to assess the damage inflicted by inhaled smoke and gases before inserting the endotracheal tube.

  'I'll remove most of this burnt-on clothing in the OR,' Nell said to the emergency doctor. 'We'll go up now to prepare for her arrival.' All that would have to be removed with the general debridement.

  'OK,' he said. 'Thanks for your help. We'll do what we can here.'

  After talking to the anaesthetist, Nell motioned to Bill and they left the room to hurry towards the elevators that would take them up to the operating suite.

  'What a mess,' Bill said, shaking his head. 'Does anyone know how it happened?'

  'A dust cloud of explosive material, I think.' She said. 'I don't know what triggered it. I guess the factory didn't have sufficient safety measures in place.'

  'I hope they get prosecuted to the hilt,' he said.

  As Nell and Bill started the scrub procedure in the scrub room off the operating rooms, Trixie came in to join them, followed after a few moments by Rex and Joel. For once, Trixie was silent.

  They discussed the cases briefly, then went to their separate operating rooms. 'Good luck, Nell,' Joel said to her quietly before they separated. 'We may have to combine forces to finish up the last few cases. Otherwise, maybe I'll see you in the middle of the night, which is about the time we'll get finished.'

  'I'll treat you to a drink in an all-night bar,' Nell said, half joking.

  'I'll keep you to that,' he said. Over the last days they had been polite and friendly to each other, professional. Nell did not discern any change of attitude in him towards her personally, although she often caught him looking at her when they were in a room together, would look up and find his eyes on her.

  Later on that evening it was as Joel had predicted, four of them—Joel, Rex, Bill and herself were working on one of the last two patients, while John, Trixie and Sy were working on the other.

  They were more than halfway through, with Joel and Rex doing the skin grafts, while she and Bill did final excisions of burnt tissue.

  Utterly exhausted, running on adrenaline and nervous energy, Nell dropped a knife that had become slippery with blood. As the knife slithered to the floor, she looked at it and said, 'Bugger! As my old English grandmother would say.'

  'I always find "Damn and blast" more effective,' Joel said lightly, his perceptive grey eyes regarding her over the top of his mask.

  Everyone laughed, and there was a relaxing of tension while they took a few moments to flex and stretch tired neck and shoulder muscles. They had taken turns to scrub out to get quick cups of coffee, yet the effect was wearing off again.

  'Have you got another dermatome?' she asked the nurse. 'Please.'

  'Sure, several of them. We allow for at least one of everything to be dropped.'

  'I find "Damn, blast and set light to it" better,' Rex offered.

  Again they all laughed, a very necessary letting go of the tension of concentration.

  'I could up that,' Bill said.

  'No, don't.' Rex said. 'I might die laughing, and where would you be without me?'

  'Up the creek,' Nell said, flexing her arm muscles, preparing to use the new knife. She had forgotten the name of the patient; each case seemed to be blurring into the one that had gone before.

  'Without a paddle,' Bill said.

  At last it was all over. The evening shift nurses had gone home, to be replaced by those on the night shift. The operating rooms had taken on that hushed, spectral quality of the night hours.

  Nell found herself staggering a little as she went out to the scrub sinks, having thrown her soiled gown, mask, hat and latex gloves into the appropriate bins.

  Ah, it was good to splash icy cold water on her face repeatedly. She felt faint from hunger, hypoglycaemic, and knew that her face was pale and drawn with fatigue.

  John came into the room and put a hand on her shoulder. 'Are you OK, Nell?' he asked with concern.

  'Essentially, yes. I'll be better when I've had something to eat and drink.'

  At that moment Joel and Rex came in and Nell was surprised by the sharp look that Joel gave her, with John's hand still on her shoulder. Surely he wasn't jealous? She was too tired to speculate further.

  'Must go to check up on my patients in the recovery room,' she muttered, 'before making the final exit.'

  In the recovery room she checked on the patients they had operated on earlier. One or two had been mov
ed to the burns intensive care unit.

  'How are they all doing?' she asked the nurse. Extra nursing staff had been brought in to deal with the emergency. 'How's Ida Rowley?' She named the woman she had operated on first.

  'She's holding her own,' the nurse said. 'Blood pressure's a bit low. We're dealing with that.'

  After doing a quick round of her patients, checking the monitors and the vital signs that they were recording, she said to the nurse, 'I'm going home to sleep now before I collapse. I'll be back in the morning, not too early, I hope. I've got my pager if you need me.'

  'OK. Goodnight, Dr Montague.'

  'Goodnight, and thanks.'

  As she left, Joel came in. 'Wait for me in the main lobby,' he said, at which she nodded casually.

  In a daze of tiredness she left the operating suite and made her way to the female doctors change room near the outpatient department, where she had a shower and shampooed her hair before changing into her casual clothes, feeling a little more refreshed.

  Joel was already in the lobby when she went out there, sitting in a patient area with his feet up on a chair. A security guard manned a small booth by the large rotating doors. This area was quiet at night, the main activity being at the back of the hospital where the entrance to the emergency department was situated.

  When she approached, Joel stood up slowly to greet her, taking in her appearance, her damp hair and scrubbed clean face, devoid of make-up. At the sight of him her heart gave a flip of recognition and something like happiness, she supposed.

  She still hadn't got over the fact that here he was, in this city and this hospital again, actually working with her. Their love-making seemed like something she had fantasized about. Sometimes it seemed that one day she would wake up and find that it had all been a figment of her imagination and desires.

  His hair was also damp, and he was casually dressed.

  'You look about sixteen again,' he said.

  'I wish,' she said. 'I'm not susceptible to flattery, especially when I feel about ninety years old.'

  'If you were sixteen again, would you do anything differently?'

  'I don't suppose I would,' she said.

  'What awful cases those were,' he said. 'We won't forget those in a hurry.'

  'No. The smell of burnt flesh always seems to cling to the inside of your nose,' she said. 'When I was first on the burns service I used to put a bit of Vick's VapoRub in each nostril, so that I was breathing in the scent of that instead.'

  Joel smiled, taking her arm. 'Do you still do it?'

  'Eventually my supply ran out and I didn't get around to buying a new jar,' she said, her spirits lifting as they made for the door.

  Before leaving they checked out with the security guard, showing him their identity badges.

  'Ah...fresh air. What ecstasy,' Nell said, taking a deep breath, once outside in the pleasant night air. 'I'd like to get something to eat before I collapse.'

  'I know a place that's open most of the night,' Joel said. 'It's behind the art gallery.' They began to walk briskly towards the parking lot. 'I thought we could take my car.'

  'Then I'll have to come all the way back here to get mine,' she said, stopping to look at him.

  'Not if you spend the night with me,' he said quietly. 'I'm hoping you will. Then I can drive you to work in the morning, or home, if you wish. I plan to sleep in for a while.'

  When he reached forward and pulled her into his arms in the deserted parking lot, she felt bemused. It was so good to be in his arms. The tiredness seemed to fall from her and she felt cherished. At times like this her mood would often be marred by the sudden sharp realization that Joel had not committed himself to her in any way, and that he did not seem to be in any hurry to do so. The poignancy of her love for him was almost unbearable at times:

  Instinctively her arms went round him, holding him tightly against her. 'Oh, Joel,' she said, as he bent to kiss her. 'I'd like that, but I'd rather go to my place in case Alec wonders where I am. He's at my parents' place for the night.'

  The kiss rendered her weak at the knees and she leaned on him as they made their way to his car. More than anything she wanted to lie in her comfortable bed again with his arms around her, in spite of knowing that he wanted a sexual relationship with her and nothing else...apart from having Alec in his life. At that moment she didn't care, would take what he was offering. Maybe then she could put all the awful sights she had seen that day out of her mind.

  The cafe was small and cosy, a French bistro. They sat close together at a very small table and drank the delicious soup of the day from enormous bowls, with crusty bread on the side. There were four other people in the cafe, apart from one waiter and the chef-owner who beamed benignly on everyone who came and went.

  'I love this place,' Nell said to Joel. 'How come I've never seen it before?'

  'It's very small, easily missed when you're walking by, behind the trees and shrubs,' he said.

  'As well as the wrought-iron fence,' she commented, looking around her at the framed antique French posters on the crimson-painted walls. 'Do you come here much?'

  'A lot,' he said. 'If you like, you can come here a lot with me, too.'

  'I like,' she said, 'especially now I know that it's open half the night.'

  He put a hand over hers as it lay on the table. 'It's nice to talk about ordinary things,' he said. 'Not about burns, accidents, explosions...disease, and all that stuff. We can pretend we're artist, or poets, starving in a garret, only able to afford soup...living for our art.'

  'Yes...' She smiled. 'Instead of living to save other people's lives and sometimes screwing up our own in the process. Maybe the angst of the artist is no less than ours.'

  'It would be arrogant to assume otherwise, I guess,' Joel said.

  'I'm going to be out of character for a starving artist and order a small brandy,' she said.

  Joel laughed. 'My fatigue is already making me punch-drunk, but I may just join you in that,' he said, as though mulling it over carefully. 'Before we become artists for a while, I've been wanting to say for a long time that, having worked with you, I've come to respect and admire you as a surgeon and doctor. I hope I don't embarrass you by saying that?'

  'No. Thank you.'

  'I'm getting to know you. Although we did work together when you were a volunteer all those years ago, it was rather different,' he said.

  Nell traced an invisible pattern on the tablecloth with the handle of a spoon. 'Does that mean you're beginning to trust me?' she asked.

  'I don't know,' he said.

  'You haven't changed, Joel,' she said quietly, 'I'm glad to say. You always were a good doctor.'

  He inclined his head in acknowledgement. 'Thank you. Do you think I'm using you, wanting to sleep with you?' he asked softly.

  'Sometimes I think that,' she said honestly, 'but that doesn't matter, because I'll be using you as well. There's nothing that would stop me spending the night with you right now.'

  Joel grinned, just as the waiter came to ask them if they wanted anything else. 'We have very nice fruit flan,' he said, in heavily accented English. 'Made by our chef.'

  'Lovely,' Nell said. 'I'll have some peach flan and a small brandy, please.'

  'The same, please,' Joel said.

  'Do you think that accent's genuine?' Nell whispered to Joel when the waiter had departed.

  'Definitely fake,' he said. 'Having worked in Montreal, I know a fake accent when I hear one.'

  'Oh, really?' she said.

  Joel leaned over and kissed her. As he did so, the awful images that they had seen that day receded further from her mind. They would come back, she knew, maybe later on in the night, when she might wake suddenly for no apparent reason and there they would be. This time Joel would be there, in her arms...

  The dessert and brandy were brought and served with great aplomb.

  'This is definitely out of character for starving artists,' Nell said, as she polished off the flan in short order, w
ith sips of brandy in between.

  Joel stretched his arms above his head. 'Ah, bed!' he said. 'I can't wait.'

  'You'll have to,' she said. 'I'd like to pay for this meal, since you're giving me the pleasure of your company for the remainder of the night.' She grinned at him and he grinned back wolfishly. 'Not exactly buying your services, of course, since you've already offered them.'

  'All right,' he agreed, gesturing to the waiter for the bill. 'I'm not averse to being bought, by the right person. Give the guy a good tip. He's a sort of muse, you might say.'

  'Mmm.'

  'Going to bed with you will be right in character,' he said.

  Later in the night, Nell did wake. But the images in her head were not as she had anticipated: they were of the crimson walls of the bistro instead of the red of blood; they were of antique posters of Biarritz, Paris, Brittany, Provence, of truffle pigs and truffle dogs...

  And she had Joel's arms warmly around her. When she turned her head softly to one side, his face was there next to hers, with the quiet, even sound of his breathing. It all seemed like a dream and, contented, she drifted back to sleep...

  CHAPTER NINE

  Life was hectic over the next two weeks. Among the burns patients who had been in the explosion, three were very seriously ill, mainly because of the extent of their burns, from inhaled substances and from some infection developing in their wounds and grafts. Nell found herself spending long days and parts of nights at the hospital, functioning in a constant state of exhaustion. Every spare moment she spent with Alec.

  One morning, early, she met Joel in the nursing station at the burns unit, where she was reviewing the charts on cases «and the latest lab reports on the computers there.

  'Good morning, Nell,' he said. 'I guess you're here bright and early for the same reason that I am.'

  'Yes. I'm worried about Ida Rowley. She had some damage to her airway.'

  'That's the one with the shoes baked on to her feet?' Joel asked, as he searched out his own charts.

  "That's right. I'm worried about the feet, too. There wasn't much left of the soft tissue, and the muscles were damaged.' She didn't have to tell Joel that she was worried about gangrene, that they might have to amputate the feet.