by Amy Andrews
She just wanted to get off her feet, take some more painkillers and curl up in bed for a while. Although she might ask Joan if she could run the hand-held ultrasound over her abdo first just to confirm it was a cyst. Harriet was beginning to become a little concerned by the ferocity of the pain. What if it wasn’t an ovarian cyst? What if she was brewing an acute case of appendicitis?
That’d be a pretty horrid way to end a very eventful last day. She hadn’t been looking forward to the end of her rotation here—too many permanent goodbyes to be said, too much history coming to an end—but now it couldn’t come fast enough.
Gill started to saw through the femur and Harriet shuddered as she suppressed another rush of nausea. The sawing noise wasn’t much different from sawing through wood but just knowing it was human bone lent a certain gruesome quality to the procedure. In fact, watching a mangled piece of leg being sawn off a body did have a certain Frankenstein ghoulishness about it.
After some furtive position changes, Harriet worked out a stance that minimised the pain. She half leaned on the operating table for support, enabling her right foot to be raised off the ground slightly so there was no weight being applied down through her right side at all. The pain was still there but the intensity was less and until the operation was over that was going to have to do.
Gill approached the bone-shortening stage of the operation with great caution. If he got the length wrong, it could set the patient’s recovery back. And if he didn’t smooth the end of the bone properly, uneven prominences could be damaging to surrounding tissue, cause pressure and irritation and even make it too painful to wear a prosthesis.
His goal was to be quick, but everything he did now was going to count when the next lot of surgeons came to complete the patient’s surgery. He had to get the basics right now so it didn’t complicate any further surgical procedures.
He sawed it level with the incision line, knowing that the bone had yet to be smoothed, which would shorten it a little further. The femur needed to be shorter than the muscle and skin flaps that the next surgeon would construct to cover the raw end of the bone. The muscle flaps would be sutured over the bone and then the remaining flaps of skin would be sutured together to make the stump.
Gill fussed around with this part of the operation for about half an hour and Harriet shifted off her right leg again and tried not to scream. Not even the soothing tones of Ella helped. Yes, Gill was just doing the best job for his patient, checking and double-checking that the muscle and skin would adequately cover the bone. And then not being totally satisfied that the raw end of the bone was as smooth as it could be and asking for the rasp once more so he could smooth it further.
She blinked as a bead of sweat ran into her eye and she gripped the table as a surge of dizziness made her sway a little. She could feel the threatening nausea and didn’t know how much longer she could stand there for. Something was very wrong. The pain in the last ten minutes had kicked up another notch. It felt like someone had stuck a hot, sharp knife into her side and was twisting it back and forth.
This was now much worse than the time she’d had her cyst aspirated. Was it much bigger this time or had it ruptured? Or was it something else? She’d never had appendicitis and if it was that, had it ruptured? The knife twisted again and Harriet suppressed the moan that sprang to her lips.
‘Harry? Harry? Did you hear me?’ Gill turned to look at her.
Harriet blinked, shaking the fog out of her brain, and the two Gills she could see merged into one.
‘Dressing. We’re done here.’
Harriet almost cheered as, with shaking hands, she passed him a non-adhesive dressing to place on the open wound. Lifting the stump so he could wrap a bandage around it took a supreme effort. Her arms felt like they couldn’t support a leaf, let alone half a leg, but she gritted her teeth, biting down on the sob that almost escaped as stretching across the table caused the knife to twist again.
‘Higher,’ said Gill, trying to wrap the last of the bandage down the thigh to anchor it a little.
Harriet heard his voice from far away as a ringing in her ears grew so loud it was like being in the middle of a million crickets. Her arms shook uncontrollably and her vision blackened from the edges in until all she could see were two pinpoints of light and then not even that. She felt rather than heard the cry of pain escape her lips before she lapsed into unconsciousness.
Gill realised what was happening just in time, dropping the almost bandaged leg with a thump and twisting to catch Harriet before she banged her head on the floor. Luckily he didn’t need to be sterile any more because he ended up on the floor beside her.
‘Harry! Harry!’ he said, shaking her, ripping her hat and mask off, alarmed at her rag-doll limpness. He heard her moan and saw her eyes flutter open briefly, and felt such a surge of relief she was alive he almost kissed her.
‘What’s wrong?’ demanded Katya. Everyone had gathered around and were squatting next to Gill, their patient temporarily forgotten. The look of alarm and concern on their faces spoke volumes about their feelings.
‘She fainted,’ said Gill, laying her head gently against the floor and calling her name.
Harriet came round slowly and then was ripped suddenly out of the warm haze by the stabbing pain in her abdomen. No, she panicked, she wanted to go back into the dark hazy place. It hadn’t hurt there. For a few blissful moments the pain had ceased to exist and it had been pure heaven.
She moaned and sobbed and brought her legs up so she was lying in a foetal position, her arms folded across her aching stomach. She slowly became aware of her dearest friends and colleagues all peering anxiously at her.
‘Joan, can you reverse the anaesthetic on our one-legged friend and get him out to Megan so we can put Harry up on the table?’
The team sprang into action. Joan injected the reversal agent and the patient came round quickly. The four of them helped to shift the groggy amputee onto a trolley and Helmut and Joan wheeled him in to Megan as Siobhan and Katya cleared all the operating debris and wiped the table down quickly.
Helmut returned quickly and he and Gill lifted Harriet off the floor and placed her on the table.
‘What happened?’ he asked Harriet, alarmed by her pallor as he wrapped her arm in the blood-pressure cuff attached to the anaesthetic monitor and pushed the button. Her skin felt cool and clammy and he tried to stay calm. Joan clipped a tourniquet on her other arm and flicked the prominent vein in the crook of her elbow, ready to insert an IV.
‘The pain’s been getting worse and worse, Gill,’ she said, tears running down her cheeks.
‘Why didn’t you say something?’ he chided gently.
‘I just kept thinking, It’s only a cyst, it’s not going to kill you. But I don’t know, Gill. This is different. I think maybe it’s ruptured or I have appendicitis.’
‘Where does it hurt?’ he asked.
‘Same place, but it’s never been this bad. Not even that time in London.’ Harriet unfurled herself with great difficulty so Gill could examine her abdomen. He lifted her top to expose her abdomen and pushed down gently with his fingertips in the right lower quadrant, using the prominent jut of her hipbone as leverage.
Harriet cried out and clutched his sleeve.
‘I’ll get the hand-held,’ said Katya.
The blood-pressure reading pinged onto the screen. Eighty-five systolic and her heart rate was one hundred and twenty.
Katya arrived back and handed the portable ultrasound machine to Gill. He flicked it on, applied some gel and ran the transducer over the suspect area. Harriet groaned and tried to push the transducer away, guarding the tender area. It was hard to get a decent view because Harriet was combative and not letting him push hard enough, but he could see an alarming amount of free fluid and flicked a quick, worried glance at Joan.
He located the ovary and it looked normal. It wasn’t her appendix either. He thought he could see an irregularity in her Fallopian tube and felt his heart
sink. A problem tube, extreme pain, hypotension, tachycardia and a lot of free fluid added up to only one thing.
He took a deep breath to calm his racing heart, which was thudding so loudly he almost thought there was another helicopter landing outside. ‘Harry, are you pregnant?’ He switched off the machine and passed it back to Katya.
Harriet looked at him, trying to compute what he’d said. ‘W-what?’ She shook her head. ‘What do you mean?’
‘I mean I think you have an ectopic pregnancy that’s ruptured your Fallopian tube.’
She stared at him, her foggy brain making it difficult to process what he was saying. Pregnant? She was pregnant? But what…? How? It didn’t make any sense. She was on the Pill…
‘Harry, I need to operate. You need a laparotomy.’
‘No,’ she said, placing her hand protectively over her abdomen. ‘No.’ And burst into tears.
CHAPTER TWENTY
0200 HOURS
GILL shut himself down. Hardened himself to Harriet’s tears. If he didn’t do something pronto, she was going to die.
‘Let’s go, people. There’s a lot of blood. Joan, let’s get another line and rapidly infuse some O into her. Are you right to do the anaesthetic?’
‘Of course. What about you? You shouldn’t be operating on Harry. I can get Ben.’
‘No. He’s in the middle of his amputation.’
‘You can swap,’ she said gently.
He shook his head vehemently. ‘We don’t have time. I’m it. I’m doing it.’
Joan looked at the determined jut of his jaw and nodded silently.
Harriet sobbed harder as they talked around her, the true implications dawning. She’d been pregnant and now she wasn’t. And there was no time to ponder the details or grieve over a baby she had never known about. Ectopic pregnancy was the highest cause of maternal death in the first trimester of pregnancy. If it had ruptured, she was bleeding—seriously. She could die.
If it had ruptured and she survived, then she’d probably never be able to conceive again. It just wasn’t fair.
She clutched Gill’s arm. ‘Promise me you’ll try and save the tube, Gill. Promise me. Don’t take away any chance I have of having a baby.’
Gill shut down all the feelings and all the questions he had crashing around in his brain. Right now he had to be a surgeon first and a husband second. ‘Harry, I love you. I will try but you know…’ He shook his head.
‘Just try,’ she begged, her face screwing up as she choked on a sob. ‘Please, Gill. Please.’
He looked at the woman he loved and all he could feel was the frantic reality of her situation. He had to stop the bleeding or she would die. Her request shouldn’t even rate, but her desperation clutched at his heart. He could be the one responsible for taking away her already reduced fertility and deny her the one thing she wanted more than anything. More than him. More than their marriage.
‘I’ll try,’ he said, and walked away to scrub.
The next few minutes passed in a blur as Helmut placed a mask on her face and connected her up to the monitor. She couldn’t stop crying. Even among the hustle and bustle all around her and amidst some of her dearest friends, she felt totally alone.
‘I’m going to put you to sleep now, Harry,’ said Joan gently.
Harriet blinked as Joan’s blurry face appeared above her. ‘No, wait, Joan,’ said Harriet, pulling her mask off, desperate to garner more support. ‘Swear to me you’ll remind Gill of his promise.’
‘Harry…’ said Joan, torn between Gill’s surgical duty and her friend’s grief.
‘I will keep him to it,’ said Katya, her head appearing in view now as well, as Joan replaced the mask. She was scrubbed so she was standing well back from the edges of the table, her gloved hands clasped together and in close to her body.
‘Thank you, Katya,’ whispered Harriet, more hot tears pouring from her eyes. She wanted to link hands to touch her friend and convey her gratitude, but even in this warm and fuzzy state she knew Katya was sterile and therefore untouchable.
‘It’s time,’ said Joan gently.
Harriet nodded and swallowed another lump of emotion rising in her chest that threatened to overwhelm her. She pulled the mask off again. She knew that things were touch and go with her and that she might not pull through. She didn’t want to leave without them knowing.
‘I love you guys,’ she said in a voice she had to force to be loud, a single tear squeezing out from the corner of an eye. She didn’t have the energy for grand speeches but at least she’d said what she’d needed to.
Everyone paused for a moment at Harriet’s words. Gill’s step faltered as he entered the theatre. Joan stopped in mid-check of the laryngoscope. Helmut looked up from preparing drugs and Siobhan and Katya stopped their count. Every one of them knew what was on the line. They knew that Harriet’s life was hanging in the balance.
Gill recovered first. ‘Let’s go, people,’ he barked tersely.
The team resumed their duties. Joan injected the milky anaesthetic agent into Harriet’s IV and Gill watched, relieved, as her eyes drifted shut and the muscle relaxant smoothed the lines of anguish on her face. Joan then inserted the long metal blade of the laryngoscope into Harriet’s mouth and Gill looked elsewhere. He couldn’t stand to watch her being intubated. A procedure he’d seen a thousand times, a necessary requirement for surgery, but he just couldn’t bear to see it. It suddenly seemed brutal instead of necessary, and the thought of the woman he loved undergoing such a procedure was more than he could bear.
Siobhan cut Harriet’s scrubs away, preserving as much of her modesty as possible, and Gill prepped her abdo with Betadine and then quickly draped her body. He couldn’t stand to see her lying there so exposed. Harriet was comfortable with her nudity, sure, but this wasn’t a beach. It was a cold operating theatre in a strange country and these weren’t random strangers, they were her friends and colleagues.
When he looked back at Joan she had completed the intubation and Gill swallowed hard as she taped Harriet’s not quite closed eyes shut. The large plastic tube protruding from Harriet’s mouth and tied to her beautiful face looked so gruesome, so mechanical.
She didn’t look like Harriet, his wife, his lover any more. Harriet, who he had made love to only that morning. Harriet, who had thrust the divorce papers at him. She looked pale and thin and small and…ill. He felt an edge of desperation rise in him and a moment of panic at all the possible adverse outcomes.
He thought back to all the complicated operations he had performed over the last ten years. This was so simple in comparison, a lot simpler than the amputation he’d just performed, but the stakes had never been higher.
Trying to mentally prepare himself for what he was about to do, he understood why surgeons weren’t allowed to operate on relatives. The crush of emotions crowding his head and filling his chest made concentration impossible. And what if he failed? What if he couldn’t stop the bleeding and she bled out? What if he couldn’t do what she’d asked him to do? What if he couldn’t save her tube?
Suddenly he wished Benedetto was doing the operation instead. That Harriet’s life and fertility weren’t his sole responsibility. He wished he could just pace up and down the corridor outside and be free to worry and think the worst. He couldn’t think the worst now. He had to do his best, his very best, and that was all he could think about. He was it. It was his responsibility.
Ella started to sing ‘I’ve Got You Under My Skin’ and he rejected it immediately. ‘Turn if off, Siobhan,’ he snapped. He didn’t mean to be so terse but it was their song. His and Harriet’s. He had proposed to her with it playing in the background and they had danced to it at their wedding. He couldn’t bear to hear it now, not when her life hung in the balance.
‘Go, Gill,’ said Joan.
He didn’t need to be told twice. ‘Scalpel,’ he said, and Katya passed it to him.
He took a deep steadying breath and made a midline vertical incision fro
m below her umbilicus straight down to her pubic bone. He thought how she would now for ever have a scar and wondered if that would prevent her from nude sun-baking.
His hand shook slightly as he made a smaller vertical incision in the fascia and then lengthened the fascial incision, using scissors. He could see the rectus muscle and used the scissors to separate it.
Below was the shiny peritoneal lining and he used his gloved fingers to make a small opening in it near the umbilicus and then used the scissors to lengthen the incision. The object was to be able to view the entire uterus but there was blood everywhere and nothing but Harriet’s viscous red life force could be seen.
Gill almost swore out loud, shocked at how much there was even though he knew ruptured tubes bled profusely. This wasn’t a surgical emergency for no reason. Oh, dear God! Don’t die, Harry. Please, don’t die.
‘Suction,’ he said, knowing that his urgent voice sounded panicky but he couldn’t see a goddam thing and he needed to clear it so he could clamp the arteries. He tried to control his panic as the continuous welling of blood slurped down the suction tubing and spat into the bottle, filling one and half filling the next. And he tried not to think the worst as he manually removed the clots and tissue too large to go down the sucker.
He tried to divorce himself from the grisly facts and failed. The fact that her blood loss was frightening and the tissue he was touching was the remains of a tiny, tiny embryo. His embryo. His baby. And he could do nothing. Nothing.
Suddenly he had flashes back to Nimuk’s mother. Her abject misery as she had handed Nimuk over, knowing he was dying and knowing there was nothing she could do about it. He remembered identifying with how awful it must have felt for her to be totally powerless, and as he delved inside Harriet he truly understood her despair.
‘What’s her pressure?’ he demanded.