But as things turned out, my contribution was to be bigger than I thought. As I helped the other senior theatre nurses to arrange the trolleys and put the gloves and gowns ready, I heard a sudden loud hiss of steam, and a sharp cry from the sterilizing room, that ran off the main theatre. I hurried out there, to find Sister bent almost double, her face white with pain.
“Sister!” I said anxiously. “Are you ill?”
She managed a grin. “Not really. Just damned stupid.”
“What’s the matter?”
She indicated the biggest of the instrument sterilizers with a movement of her head.
“I’m always telling you girls to be careful of those big sterilizers, and to turn the steam off before you open them. And I forgot.”
She moved her arm gingerly, and I saw the angry crimson stain of a severe scald, running up her bare arm almost to the elbow. Her fingers were red and swollen, the normal slender contours lost in the shiny puffiness of the skin.
I grabbed the big canister of bicarbonate of soda we keep for just such emergencies, and, as quickly as I could, I made a thick paste of it with some cooled sterile water. I applied this as tenderly as I could to the scald, covering it with a sterile dressing towel handed to me by one of the other nurses. They had all come crowding in to the sterilizing room to see what had happened.
All the time, Sister stood rock still, biting her lip and making no sound at all, though the pain must have been excruciating. When I had finished, she managed to essay a little smile, and I said, “Can you walk to Casualty, Sister, or do you feel shaky? Shall I send for a porter with a chair?”
“Neither,” she said, with some of her usual asperity. “We have a big morning on, and I can’t possibly leave the theatres. Too many nurses are off for the weekend as it is, and there are only five of us to cover two theatres. I’ll have to stay.”
“But your arm, Sister.” The other senior nurse, a rather quiet girl called Mullins, looked worried. “You must get a doctor to see it -”
“Mr Bartlett is in the surgeon’s changing room now, I think. He’ll look after it for me. I can see someone else later if he thinks it necessary.”
Mullins looked fussily at her watch. “Mr James will be here to start the brother’s op. in a minute. Shall I start to scrub, Sister?”
Sister moved her scalded arm experimentally.
“Mmm. You’d better. Take Nurse Rimmell to run for you instead of Nurse Davies, will you? Davies -” She turned to the little red-headed junior. “You must run in the main theatre for Sir Jeffrey’s case. No need to look so scared, girl. He won’t eat you. And I’ll be there to help you. Now, Rimmell -”
She turned to the other junior, a shy German girl who had only been working in the theatres for a fortnight.
“ - can you cope with Mr James’ case with Nurse Mullins? He is a very easy surgeon to run for, so you needn’t be afraid of him. If you get into any trouble, come through to the main theatre and ask me for help. I’ll come into the second theatre as often as I can. All right? And remember - if you don’t understand what someone says to you, ask to have it repeated. Don’t guess. More time is wasted by bad guesses, and time is valuable. Your English is excellent. I’m sure you’ll cope.”
She smiled at the girl, who responded with a blushing, “Thank you Sister. This I will try to do my best, I assure you.”
Sister looked at me. “Now - Nurse Gardner. You have had three months’ theatre experience before - what did you scrub for then?”
“Only little things, Sister. Varicose vein ties, things like that.” I was alarmed. It had been a long time ago, and I still had a great deal to learn about theatre technique. Surely she wasn’t going to -
But she was. “Then at least you know how to scrub, and how to handle instruments and needles and gut and so on. You will have to scrub for Sir Jeffrey.”
I almost yelped with fright. “Sister! I can’t! I never even ran for him before - and everyone says he’s so short tempered!”
Sister raised her arm. “I can’t scrub, can I? But I can run. So you must scrub. I’ll be your runner, together with Nurse Davies - you won’t be alone. And I’ll look after the anaesthetic room - is it laid up and ready?” I nodded miserably. “Then that’s all right. I’ll also be able to keep an eye on Mullins and Rimmell with Mr James. The porter can look after the phone and run the errands outside the theatre. We’ll manage somehow.”
She swept us all out of the sterilizing room like a busy sheepdog harrying a cluster of lambs. Lambs to the slaughter, I thought wildly, and wanted to giggle.
Mullins and Rimmell scuttled into the second theatre, and I saw Mullins start to scrub at the sink, her whole body tense with anxiety. Rimmell started to check the gloves, her face a mask of concentration.
Sister sent Davies to get her some aspirin - a sure sign she was in pain, for she had never been known to take any pills, scorning aches and pains as a sign of physical weakness reprehensible in a nurse. Dickon came out of the surgeon’s room, and she asked him to look at her arm, explaining rapidly what had happened. As Dickon followed her into the second anaesthetic room to look at the scald, she called to the porter over her shoulder to get the patient for Mr James.
The next fifteen minutes were a hectic rush. Dickon started to undo the dressing I had put on Sister’s arm, and while he did so, Sister started to tell me what to do for the case I was to scrub for. But before she could get the first words out, Sir Jeffrey appeared, his face set and grim as it always was. My heart sank as I looked at him. He had a reputation for being the most difficult of all the Royal’s surgeons. Indeed, he always insisted on having the most senior of all the theatre nurses to scrub for his cases.
He disappeared into the surgeons’ room, and I turned back to Sister, my heart in my mouth. Dickon was reapplying my original dressing, and covering it with a loose bandage.
“It’s the best we can do for now,” he said tersely, “if you are absolutely sure you’ve got to stay on duty. But I’d better give you a shot of penicillin as a prophylactic, at least. It can’t do any harm, and it may prevent a secondary infection. But make sure you’re seen by the Casualty people as soon as possible, Sister. This is a nasty scald.”
Sister nodded impatiently, and turned to me again, while Dickon prepared her penicillin.
“He’ll be using the abdominal approach, Nurse Gardner. He doesn’t like it - prefers going in at the loin, but he can’t today because of the difficulty of fitting in with the kidney machine. So you’ll have to be on your toes. He uses merchurochrome as a skin prep, diathermy for bleeding points - don’t worry about the pad on the patient, I’ll see to that - but make sure you connect the leads at your end. And see you have plenty of haemostats, fast - diathermy is much quicker than using catgut ties. Now, he’ll need a lot of artery sutures, so break the tubes before you start. When he needs them, he needs them fast. He uses plain catgut as well as chromicized - break out 00 and 0 as well as size 1, of both kinds. He likes roundbodied needles all the time - only uses cutting edged ones when he must, so whatever you do, don’t give him a cutting needle unless he asks for it. He likes a new knife for every cut he makes, so discard the used scalpel blades into the trolley tray as soon as he’s finished with them. Curved Mayo’s scissors, and Gillie’s plastic scissors - there are two pairs of each ready -”
Her clipped voice went on and on, and my head swam as I tried desperately to remember what she was saying. The instruments, the needles, the sizes of catgut, the nylon sutures for the skin, the drainage tubes, the catheters - my terror mounted.
When Dickon had finished giving the penicillin - and even in the midst of my fear of what was to come, I couldn’t help being amused by the way she presented her good arm, firmly, for the jab. She obviously didn’t intend to have it in her seat, as she should have done - he said, “There you are Sister. That should tide you over. Don’t worry about Nurse Gardner with Sir Jeffrey. I’ll help as much as I can, I promise. And you’ll be there to keep an eye o
n her.” He smiled across at me, and I smiled back gratefully. Whatever discords there may be in our social relationship, there were obviously none in our professional one.
Sister looked at me for a second. Then she, too, smiled.
“I’m sure she’ll cope,” she said. “Don’t worry too much, Gardner. We’re all on your side.” She straightened her shoulders. “You go and scrub. I’ll speak to Sir Jeffrey.”
As I scrubbed my hands and arms under the big taps in the theatre, I feverishly repeated under my breath the things Sister had told me. Behind me, the lights filled the theatre with a shadowless radiance as Davies scurried from switch to switch. The anaesthetist had arrived, an outside man Sir Jeffrey always brought in for these special cases. He sat at the head of the table, speaking softly to the boy, who had woken from his shallow doze, while he checked the kidney machine before starting the anaesthetic. Then, as I dipped my hands in a bowl of spirit and waited for them to dry before taking my sterile gown from Nurse Davies’ cheatle forceps, I heard Sir Jeffrey’s voice outside the door.
“Good God, Sister! Isn’t there another experienced theatre nurse in the blasted hospital who could come? Do I have to be saddled with a damned amateur?”
Sister’s reply was too quiet to be heard above the hiss of the anaesthetic machine, and the bubbling of the big sterilizers through the open door of the sterilizing room. But I heard Sir Jeffrey again.
“Oh, all right, then. If I must, I must. But God help her if-”
Davies turned on the sucker to check it at this point, so I missed the rest, but I’d heard enough. This wasn’t going to be easy, Heaven knew. With an irate surgeon it would be much worse.
My fingers shook as I put my gloves on, carefully avoiding any contact with their outer surface. Already, my forehead was wet, and perspiration was beginning to run down my back, under my uniform. Nurse Davies saw my beaded forehead, and came over with a pack to mop it for me, looking at me with a mixture of sympathy and awe that made me feel even worse. I prayed wordlessly for the morning to be over.
I walked over to the trolley standing ready by the table. Dickon had started to scrub by now, and even though he didn’t speak, I was glad he was there. His steady presence calmed me. Having him on the other side of the operating table would be a great comfort.
I took off the sterile towel that was covering the trolley and dropped it on the floor to be salvaged by Davies. I looked at the neat array of bowls and the trays of sharp instruments and needles, the rack of tubes of catgut and sutures, and thanked my lucky stars that Sister had laid it. I knew that everything I could possibly need would be on it. As I looked at the trolley, taking a deep breath to settle my fluttering tummy, the memory of the right technique came flooding back, and almost of their own volition, my hands started to prepare the things I would need first.
I took the scalpels and scissors from their tray of pure carbolic acid, using a pair of dissectors, and rinsed them in surgical spirit before lying them ready on a sterile towel. I counted the first bundle of packs, and the first dozen swabs, and murmured the totals to Davies, who wrote them up on the big wall blackboard, so that we could check the number at the end of the operation. I must make absolutely sure that no swabs were left behind in the boy afterwards - that would be real catastrophe.
I snapped the first glass tube of catgut, and for a sickening moment, it tangled in my forceps. I swore softly, but then the hank of gut came smooth, and I dunked it in saline before laying it on another towel.
Davies appeared at my side, carrying the big tray of instruments in the holders that looked too big for her small hands, and I unloaded it, arranging haemostats, sponge forceps, retractors, needle holders and the rest, in neat rows on the trolley.
Dickon came over to the other side of the table, smoothing his gloves. He cocked an enquiring eyebrow at the anaesthetist, who looked at the kidney machine and the indicators bobbing in the long glass tubes on the anaesthetic machine, and nodded. Out of the corner of my eye, I saw Sir Jeffrey start to scrub, his lean back bent over the basin, a little fringe of grey hair showing under the back edge of his cap.
Together, Dickon and I arranged the sterile green towels over the top of the table, clipping them into position, and tucking the clips away out of sight. Then I handed Dickon a pair of sponge holders, a swab in their teeth, and with a ghost of a wink, he took it, dipped the swab into the galleypot of merchurochrome I held ready, and systematically painted the boy’s body a rich orange red. He dropped the sponge holders into the bowls Davies held ready, and we completed the towelling up, until all that could be seen of the living body on the table beneath our hands was a square of coloured skin in a green towelled mound.
Sir Jeffrey stumped over to my side, and glared at me coldly over the top of his mask. I looked back at him as steadily as I could, using all my willpower to stop my eyes falling under the chilly grey gaze.
“If you don’t know what to do next, girl, be sure and ask me in good time. Don’t trust to luck,” he growled.
“I won’t, Sir,” I said, and held out a scalpel, its blade shrouded in a swab.
The first stage of the operation started. Above us, the huge shadowless light threw an even radiance on to the green-shrouded figure on the table, on the swift, brown-gloved hands of Sir Jeffrey and Dickon, as they moved surely and steadily. As I turned back to my trolley, I suddenly caught sight of us reflected in the big window, a tableau of mysterious hooded people. It was as though I wasn’t really involved at all - just an onlooker. But the moment passed almost as soon as I was aware of it, and I lost myself in concentrating on the job in hand.
The first incision soon sprouted a fringe of gleaming haemostats, as Dickon followed Sir Jeffrey’s knife with a pack, mopping away the blood, and clipping the bleeding points sharply as they started to well crimson again.
The diathermy machine buzzed, and the faint smell of charring that accompanied it filled the air sickeningly. I dropped the discarded artery forceps in the bucket at my feet. I was vaguely aware of Sister in the background, telling Davies what to bring, what to take away, counting swabs as I threw them on to the sheet of mackintosh laid ready on the floor, replenishing the hot saline on the trolley.
It was almost as though my hands knew what to do. I laid instruments ready on the little Mayo’s table over the foot of the operating table, removed used ones for rinsing or reboiling, handed swabs to Dickon. The sucker and the oxygen on the anaesthetic machine bubbled and hissed gently. The anaesthetist put up a blood drip, via the kidney machine, Davies helping him silently. And no one spoke a word, except Sister, whispering to Davies.
Then, the site for the graft of the new kidney was clearly visible, deep in the boy’s abdomen, and Sir Jeffrey straightened his long back with the ghost of a sigh, and looked at his work.
“Hope we’re not wasting our time,” he grunted at Dickon. “Should have got hold of this boy long ago - damned physicians - however - “
The door that led to the second theatre swung open, and Rimmell appeared at the foot of the table, holding a towel-covered dish stiffly before her, her eyes glued to her burden as though she carried solid gold.
I took the towel off with my forceps, and Rimmell held the dish out to Sir Jeffrey. Gently, he picked up the swab-covered kidney that lay in it, and nodded at Dickon.
“Nice timing,” he said. “Good man, that James. Now - pull that retractor a shade to your left - that’s right - “
With meticulous and delicate movements, he laid the new kidney into position. “All right your end?” he asked the anaesthetist.
“Still with it, Sir,” the man at the top of the table said. “Blood pressure’s a bit dicy though - “
“Won’t be any longer than I can help.” Sir Jeffrey bent again to his work, and the theatre settled back to a silence broken only by the hiss of the anaesthetic machine and the faint clatter of instruments.
It was nearly an hour later before he straightened again.
“You’re d
oing pretty well, girl,” he said, addressing me directly for the first time. “I’m ready to come out now.”
Sister rustled over to my side, and together we counted the swabs remaining on the trolley, now a wreck of its original ordered self, and checked them against the numbers on the blackboard and the used ones lying soiled on their mackintosh sheet.
“Swabs correct, Sir,” I murmured.
He nodded, and took a loaded needle holder from the Mayo’s table. Rapidly, he sewed up, a layer at a time, looking for all the world like a lady of leisure making a tapestry. When he reached the skin level, he put his needle holder down, and stretched his neck wearily.
“You finish, will you, Bartlett?” he said. “I want to see the other boy.”
Dickon took the next needle I had ready, and started to sew the skin, while I took the scissors from him, ready to cut each stitch as he tied the knot. Sir Jeffrey pulled off his red-stained gloves and dropped them on the floor, before going out through the door Davies held open for him.
Almost perceptibly, the tension slackened, and all of us, Sister included, relaxed. The anaesthetist said something to her that made her laugh, and Davies almost skipped across the theatre to get the many-tailed bandage that would be needed soon. And I breathed a deep sigh of relief and smiled happily at Dickon, who winked back at me.
Perhaps that was why it happened.
As I turned to the trolley to get the dressing for the wound, now neatly stitched, with the red drainage tube lying carefully arranged over a swab, my hand slipped. The big shallow tray of carbolic acid that had held the sharp instruments - now empty of everything but the thick crimson fluid tottered sickeningly on the edge of the trolley and then crashed to the ground, making a noise like a clash of cymbals.
The powerful acid swamped my shoes, splashing my legs. I hardly felt it for a moment, and the coldness of the liquid disappeared in a flood of hot pain. I looked down stupidly at the vivid red pool on the floor, at my own feet standing in it, at the huge holes that appeared in my white theatre stockings, and laughed shakily. And then I leaned forward on to the trolley, holding on to it with brown-gloved hands, and laughed.
Final Year Page 10