The Next Wife: An absolutely gripping psychological thriller with a killer twist

by Liz Lawler

  After Daniel said all those things to her, she’d expected a cooling-off period between them, a period of penance for what she had done. What she hadn’t expected was for him to be kind to her. Which made her feel worse as it hadn’t felt deserved, and it hadn’t taken away a certain look in his eyes. When he asked if everything was all right she wanted to ask the same back, but wasn’t brave enough in case he answered he’d lost trust. Her worries had dug in firmly.

  He had taken to standing at their bedroom window, looking out of it as if looking for answers, while smoothing those stale curtains. She felt she had ruined something between them and didn’t know how to make it better.

  Yesterday morning he made love to her but it was more of a coupling. He hadn’t been rough or hurt her, or forced her like he did that one time. He’d asked first. Do you mind? And that politeness felt like she was lying in bed with a stranger.

  She’d spent the last two weeks with a great deal of agonising over how she could put things right and the only conclusion she could come to was to quit her job. She’d woken this morning with the idea fixed in her head. At the end of her shift today she was going to hand in her notice to Stella. It was the only sensible action to take if she wanted to save her marriage.

  In the early hours, a few nights ago, she’d tried calling Sara for advice, but her number was currently unavailable, and the option to leave a message failed. The number was as good as useless to Tess if Sara had her phone switched off. Tess could honestly say she was missing her friend and could have done with her right now. Sara was noisy, brash and dressed too loudly, but underneath was a sensitive soul who recognised when someone was troubled, and was able to counsel, having been hurt herself. Sara would have been able to fix the problem.

  Tess checked her appearance in her compact mirror before she got off the bus. She tried to put on a brighter expression. It was going to be a long day today. She was scrub nurse for Daniel all day.

  At the morning brief, held in the anaesthetic room, Tess was conscious of Daniel gazing at her. She chanced a look at him and her breathing stopped at the smile he gave her. There was a warmth in his eyes not seen in a while and she quickly had to lower her own gaze. One smile was all it had taken to loosen the stranglehold on her emotions. Any minute there’d be a puddle of tears on the floor if she wasn’t careful. She sniffed and cleared her throat as if she had a bit of a cold.

  The assembled team introduced themselves to one another as was protocol before any operating list began. It gave Tess a moment to compose herself and to now focus on the people around her. The registrar assisting was Dr Suzanne Lewis, with her calm clear voice – something Tess wanted when listening out for instructions spoken through masks. She was pleased the runner was Julia. She’d worked with the nurse several times now and found her very competent. She was also pleased they’d been given Lucy, the healthcare assistant supporter. She was always in a good mood, sharing some happy news regarding her two small children.

  As the operating surgeon, Daniel gave a rundown of the operations listed on the sheet of paper in his hand. There was only one listed for the morning, but three for the afternoon. ‘There are no changes to the order of the list as far I’m concerned unless the anaesthetist says differently. We’re starting with seventy-eight-year-old John Backwell. Procedure to carry out: a femoral popliteal bypass to right leg. The vein graft will be taken from the left leg, it has already been mapped out and marked by the vascular studies team yesterday. I will need a sterile doppler and Prolene 4-0 and 5-0 sutures as usual. Can we let the radiographers know we will need the C-arm for completion angiograms, please?’

  As he finished speaking, the anaesthetist, Dr Reid, but known as Dr Bob, began his part. ‘I’m happy with the patient after seeing him this morning. There are a few concerns to consider: diabetic, peripheral vascular disease, but non-smoker, and BMI twenty-six. I’ve ordered some blood, should we need it, as his haemoglobin is low. This is going to be an intubation anaesthetic as he has a regurgitation reflux. And we’ll put in an arterial line. That’s it from me.’

  Daniel gave a short nod. ‘OK, everyone, thanks for your attendance. Let’s get started, so send for the patient as soon as, please.’

  The next forty-five minutes went by in a rush. After leaving the briefing, Tess put on a surgical facemask before heading to the scrubbing area, a three-person stainless-steel trough. In readiness she tore open a sterile, singular-use, nailbrush-sponge. She washed her hands and lower arms with liquid soap before beginning in earnest the five-minute hand-wash scrub, nudging the taps with her elbow. Using a nailbrush across her fingernails, she next worked on palms, backs and sides of hands, making her way methodically up her arms to her elbows, before raising her hands for the final rinse. With a sterile towel ready Tess dried her hands and then opened her sterile gown. She pushed her arms through the long sleeves, keeping hands tucked in, while Julia tied her at the back. Then lastly, and very carefully, she worked her fingers into sterile gloves, without touching the outside of them, ensuring they covered not just her hands but sleeve cuffs as well.

  Ready, she clasped her hands together in front of her chest, the safest thing to do to keep them sterile, and followed Julia to the layout area, the designated place in the corner of an operating room for the scrub nurse to set up the trolley of surgical instruments.

  Julia opened the outer paper cover of a vascular surgical tray, allowing Tess to open the sterilised inner cover. Together they checked the instruments listed were all there. They did swab counts and sharp counts and Julia recorded the count numbers on the theatre whiteboard. At the end of surgery she would confirm the count number used matched. No one wanted a swab or an instrument left inside the patient. They then prepared a second trolley for a complex major general surgery tray.

  Tess was now ready and watching the anaesthetist. Dr Bob was telling the patient he was going to be asleep soon, and to have nice dreams. Tess heard the patient chuckle. ‘You mean stop jabbering? The wife will be glad if I do that.’ And then he was silent. A few minutes later Tess could see that the anaesthetist and his assistant, the operating department practitioner, were nearly done with their checks on their monitors and infusion pumps. All that was waiting was for the surgeons to appear.

  A moment later, the doors to the operating room swung open. Tess was surprised to see Cameron walk in. For some reason she hadn’t expected to see him working in Daniel’s theatre again, which was nonsense, he was an ST1 and needed to learn. Mindful of Daniel’s warning, she’d kept conversations between them short since then. In the staff room he’d glanced at her questioningly, but what could she say to him? That her husband thought she was a bad influence on him and didn’t want them to be friends? It was best if she said nothing at all, given that Daniel was his boss, and let him lose interest naturally. After today it would no longer matter anyway. She wasn’t going to be there much longer. She was sticking to her decision even though he’d smiled. Their relationship needed more than that to repair it.

  Suzanne was next to arrive. Getting the nod from the anaesthetist that the patient was under, she commenced prepping skin with bright pink chlorohexidine solution. Indelible ink marked the operation sites: a black arrow pointing down from the top of the right thigh, black ink following the course of a vein below the left knee. She was placing green drapes across both legs when Daniel made his entrance.

  The ODP, whose name Tess forgot, picked up the WHO laminated card to do ‘Time Out’. Part of the World Health Organisation surgical safety checklist was a list of questions that had to be read aloud, literally a time out period where everyone stopped what they were doing to check their readiness for the operation.

  ‘Are we ready? Can we do “Time Out” now, please?’

  Everybody stopped what they were doing to give their attention.

  Tess glanced briefly at Daniel and saw he was looking at her. She gave a small smile and hoped it showed in her eyes, because of course he couldn’t see it through her mask.r />
  The first two questions asked the patient’s name and the procedure, and checked the name on the patient’s wristband matched the name called out.

  Daniel answered, ‘John Backwell. Femoral popliteal bypass to the right leg. Vein harvest from left leg.’

  The anaesthetist confirmed that yes, this was the name on the consent form, and yes, this was the procedure signed for. The ODP then confirmed this was the procedure written on the theatre whiteboard. He directed his next question to Tess.

  ‘Are instruments and equipment ready?’

  Tess replied, ‘Yes, thank you.’

  ‘Estimation of blood loss?’

  ‘Minimal,’ Daniel replied.

  The next questions the ODP himself answered. ‘Patient’s temperature is thirty-seven. Antibiotic prophylaxis has been given.’ He then looked to the anaesthetist. ‘ASA classification? Any concerns?’

  ‘ASA 3. His diabetes is well controlled. Satisfactory vital signs and observation checks. As stated, low haemoglobin. Bloods on standby if needed. I’ve booked a HDU bed just in case, given his age.’

  The final question was for Daniel. ‘Are you happy to start?’

  Daniel, seeing everyone was ready, nodded. ‘Yes. Ready to start knife to skin.’

  Daniel and Suzanne took their positions at the table. Tess would be passing instruments to both of them, as while Daniel located the blocked femoral artery, Suzanne would work on the lower part of the left limb to harvest a good vein that could be used as an anastomosis so blood in the artery had a new channel to flow through, bypassing the blockage. Vascular surgery was not unlike plumbing, Tess thought – replacing and re-joining blockages in pipework. The main difference being, a plumber could cut off the water supply and walk away. A surgeon didn’t have that option. The pipework in the human body didn’t bleed or block water but blood. Blocked blood.

  ‘When you’re ready, nurse?’

  Tess looked up across the table and saw Daniel waiting with his hand out. Her face warmed as for a moment she’d thought to take hold of it. And how would that have looked if she had? Nurse holds surgeon’s hand across the operating table. She almost giggled and had to control herself. She needed to be sensible. This was only her second time as his scrub nurse.

  ‘I’m ready, Mr Myers. What would you like?’

  He held her gaze for a few seconds as if to steady her. Then he spoke. ‘Knife, please.’

  The operation had been ongoing for over three hours and Tess’s shoulders were beginning to ache from taking one action after another after another. Knife, swabs, suction. Knife, swabs, retractor. Suction, sutures, swabs. More light, please. Less noise, please. More suction. Tess wished for less noise too. Her hearing was getting muffled from the slurping sound of wetness being suctioned through narrow tubes. The annoying buzz the diathermy made cauterising bleeding capillaries. Daniel wasn’t talking about those noises, though, when he asked for quiet. It was the talking at the head end of the table between anaesthetist and ODP, the ringing of a mobile phone in someone’s pocket, and the singing, or rather the humming, poor Lucy was doing, which stopped immediately.

  The long incision made down the inside of the lower left leg had been closed neatly by Suzanne, and a clear-window dressing covered it. They were reaching the last stages of securing the anastomosis graft. The femoral artery had been clamped either side of the blockage. The new vein had been attached to the healthy artery below the blockage and Daniel was now readying to secure the other end above it.

  ‘Prolene 5-0 suture, please.’

  Tess picked up a needle holder and clamped the threaded curved needle securely before handing it to him. She was startled when Cameron interrupted them. She’d forgotten he was even there.

  ‘Sorry for interrupting, Mr Myers. I’ve got surgical assessment unit on the phone and they wonder if they could have a very quick word with Dr Lewis, please?’

  Daniel sighed behind his mask, then spoke to Suzanne. ‘I’ll start attaching so be quick.’

  Tess watched the doctor hurry over to a corner of the room to let Cameron carefully hold the phone to her ear, so that she didn’t desterilise her hands. When she brought her gaze back to the table she thought she saw Daniel eyeing her a little coolly. Damn. He probably thought she was looking at Cameron. He returned his attention to the job and put in his final suture, securing it with a surgeon’s knot.

  Suzanne’s voice was rising a little and she was talking rapidly. Tess stared into the operation field. Daniel was waiting for his assistant. She picked up the suture scissors to have ready. There was only one suture waiting to be cut. The operation would then be over. The clamps on the artery could be removed. The blood could start flowing through the new vessel. She looked at Daniel. He looked at her. Then he nodded. She could see the suture clearly. The tails of the tiny threads were being held by atraumatic forceps. She needed to get the scissors in below the forceps but above the tiny surgeon’s knot. Daniel angled the instrument to give her a clear view. She captured the threads in the opened scissors and slid them down the suture. When satisfied with the length left, she cut.

  Daniel released the clamps, one at a time, slowly in case of a spurt of blood from where the new vessel was attached. There was a small amount of blood oozing from the suture line, which was to be expected. They paused with a swab over the area for a few minutes. Whilst everyone had visibly relaxed and started talking, he winked at her and said, ‘All bleeding stops… eventually.’ He then switched back into business mode and asked for pedal pulse check, for a blood pressure check, ensuring the redirected blood flow was passing through the vein graft. He took his time making sure all other checks by both him and the anaesthetist were satisfactory. He could now close up.

  Tess felt the tension leave her. It had been a long operation, but Daniel had been easy to work with. Giving clear, precise instructions every time from beginning to end.

  When Suzanne came off the phone, Daniel released her to go visit the ward as clearly it was a problem that could not be sorted out over the phone. Sign Out – the protocol checks to be completed at the end of an operation – was directed by Lucy. Again, everyone’s attention was required to answer the questions: Are instruments, swabs, sharps a correct count? Has blood loss been calculated, swabs weighed, suction bottle fluids measured and total added up? Was the patient ready to go to the recovery room?

  Yes, everything had gone well, the patient could be taken to recovery.

  Chapter Eighteen

  Tess was ready to eat by the time she got to the atrium café. At the counter she ordered a jacket potato with a tuna top, a large coffee and a can of regular Coke in hopes of reviving her energy. Her seesawing emotions after that smile this morning followed by that long operation had all but drained her. She needed another few hours of concentration before she finished her shift. Before she finished her job?

  How she wished she didn’t have to – wished she had told Stella at the very beginning who she was, then this decision to leave wouldn’t have arisen. Tess was good at her job, she loved it, but come five o’clock it would end, because she loved her husband more.

  Loving someone can hurt, Sara said to her after she and Tess moved in together, after her doctor boyfriend broke up with her and married someone else. She was right. Even though she was only twenty-one at the time Sara still carried that hurt eight years later, better hidden but still there. Tess would like to reverse that, because love could also heal. She wanted to heal this rift between them, heal the cause. That smile this morning might not be seen for another while. It could go back to how it was last night, when she caught him staring out the window. A smile that barely raised his lips. In retrospect, regardless of her deception, leaving her job was the right move.

  The two o’clock brief, in the same anaesthetic room, hadn’t begun yet as they were waiting on the surgeon and the anaesthetist to join them. Suzanne had a copy of the afternoon list and was discussing the three cases while they waited. All were quick procedures that
shouldn’t tax them. The ODP, whose name Tess now knew to be Oli, was itching to get started. The tall lanky man was setting out infusion trays on the counter, saying he had to get off on time as it was his turn to mind the kids.

  Right then the door to the anaesthetic room opened. Daniel quickly stepped into the room and spoke only to Suzanne. ‘Sorry, can’t stay. Cameron can assist unless you’re not happy.’

  Suzanne nodded to show she was okay either way.

  ‘Dr Bob will be back any minute. He’s just handing over to the anaesthetist in the emergency theatre.’

  Suzanne stared at him surprised.

  Daniel’s expression showed he was too. ‘Our patient this morning; he’s not doing well.’

  Tess looked at the clock on the wall at every passing hour, hoping to hear an update of the Cat1 patient in the emergency theatre, and hoping Daniel was okay and able to sort out the problem that brought the patient back into the operating room. The only thing she’d gleaned was the man never left the recovery room, so while she was having her lunch, Daniel and the anaesthetist must have spent their time there.

  Suzanne was finishing up with the last patient on the table, a woman with debilitating veins stripped from her right leg, and was bandaging the limb now with Cameron’s help. He had assisted with each case and Suzanne had been full of praise. His eyes smiled at Tess several times, and she was pleased for him. He’d needed that after having his confidence knocked.

  At quarter past four the patient was wheeled to the recovery room. The anaesthetist and ODP returned to theatre fairly quickly, the handover of care to the recovery nurse taking little time as it was uncomplicated. The team for the afternoon then set about putting the theatre back straight, snapping off gloves, freeing faces of masks, and finally relaxing. It was the end of another day.