by Sam Archer
She became so absorbed in the activity that for a moment she wasn’t aware of somebody at her shoulder. Looking up and round from where she was listening to the patient’s chest with her stethoscope, she saw Fin, his broad chest inches from her face.
‘What have we got?’ he asked.
She gave him the summary. The CT scan revealed no intracranial abnormality, and there was no immediately obvious neurological deficit. The man’s right leg was a mess, fractured in several places. Of more immediate concern was the crush injury to his thorax, which had broken most of the ribs on the right hand side and had collapsed the underlying lung. He needed to go to theatre as soon as possible.
‘Okay, good,’ said Fin when she’d finished. ‘Care to assist me?’
‘Of course.’ Melissa hadn’t spoken to him since the day before, when there’d been the awkwardness about his seeing Mrs Reynolds. She’d spent the night in turmoil, her feelings swinging from a creeping shame that she’d overreacted to a minor issue, to hot anger at Fin for his arrogance. Yes, he was the boss… but that didn’t mean he was always right. Was he toying with her in some cruel way?
Now, though, she jumped at the chance both to re-establish the goodwill between them and to assist him in a complicated case. He said, ‘See you in theatre,’ and headed out.
Melissa cast a final glance at the patient’s vital signs – blood pressure, pulse and oxygen saturation all acceptable – and scribbled some notes in her quick, unusually neat hand. She gave instructions to the nurse to prepare Mr Khan for theatre and to alert the anaesthetist on duty, and stepped outside the cubicle.
Mr Khan’s friend, his fellow construction worker, was seated on one of the orange plastic chairs outside. He looked up anxiously.
‘How is he?’
‘He’s going to need surgery,’ said Melissa. She gave the man a quick layman’s account of his friend’s injuries. While she did so she saw him rise to his feet and grimace.
Melissa frowned. ‘Are you all right?’
‘Yeah.’ He winced. ‘Bit of pain in the shoulder, that’s all.’
His face was putty-coloured. Melissa took him by the arm and guided him into one of the adjoining cubicles.
‘You said you had a slight tap from one of the scaffolding poles?’
‘Yeah.’
‘Where?’
He allowed her to lay him on his back, though Melissa could see from the contortion of his face that it hurt him to do so. ‘Just here.’ He waved his hand over his abdomen. ‘Fell across one of the bars.’
‘From a height?’
‘Only ten feet or so. Not like Sunil.’
Melissa felt her pulse quicken. She called, ‘Deborah.’
Deborah Lennox, the trauma ward sister, was passing. Accident & Emergency wasn’t one of her usual haunts but she sometimes came down here to ‘majors’ to see who would be ending up under her care after surgery. She came over.
‘Could you get a BP on Mr – what was your name, sir?’
‘Barry Davis,’ he hissed between his teeth. ‘Call me Barry.’
‘Sure thing,’ said Deborah, and busied herself with the cuff. Melissa propped the man’s feet up to raise them above the level of his head, and felt his carotid pulses. His heart was going at over 120 beats per minute. She helped him out of his overalls and exposed his abdomen, then began to probe with flat hands. She pressed down gently and released, but Barry didn’t react. No rebound tenderness, then.
‘Where’s the pain?’ Melissa asked. ‘Still in your shoulder?’
‘Yeah,’ he groaned. ‘The left one. Getting worse.’
‘BP’s ninety-seven over fifty-two, Ms Havers,’ said Deborah.
That was low, and coupled with the rapid pulse the finding was ominous. Melissa said, ‘Barry, does the shoulder pain get worse when you breathe in?’
He inhaled, then gasped. ‘Oh yeah.’
Kehr’s sign. Pain in the left shoulder, aggravated by inhaling. It indicated blood in the abdominal cavity, most likely from a damaged spleen. A life-threatening injury.
‘Deborah’, said Melissa, ‘could you please bring the CT scanner over here?’
While she was waiting for the CT films to process, Melissa kept close watch over the injured man. He’d started to report pain in his abdomen, and this time when she palpated it there was a sharp moan of pain. She set up an intravenous drip but when his blood pressure failed to rise satisfactorily she asked Deborah for a central venous line kit. With practised skill Melissa inserted a large-bore cannula into the internal jugular vein in the side of Barry’s neck. It allowed a high volume of fluid to be infused rapidly into his system to counteract the blood loss that was occurring somewhere within his abdominal cavity.
Deborah handed her the CT films. Melissa clipped them into the backlit screen mounted on the wall. There it was: an extensive fluid collection in the right upper quadrant. The spleen was hard to see accurately, but looked far from intact.
At her shoulder Deborah said, ‘I’ll call Mr Finmore-Gage out of theatre.’
‘There’s no time,’ said Melissa. ‘That’s a stage five injury. A shattered spleen. He needs it out, and urgently.’
Deborah gazed into her eyes, as if gauging whether Melissa understood the implication of what she’d said. Melissa nodded silently: yes. I know.
Over her shoulder, already on the move, Deborah called: ‘I’ll alert theatre.’
Heart hammering in her throat at the realisation of what she was going to have to do, Melissa spoke rapidly to the injured man, explaining the procedure, trying to keep a tone of calmness in her voice. He took the proffered pen and consent form from her and signed, and she assured him that his wife would be notified immediately.
On the way to theatre, as a nurse and a porter steered the trolley deftly through the corridors with Melissa at its head, Deborah appeared beside her. ‘Theatre’s ready,’ she murmured. ‘There are complications with Mr Finmore-Gage’s case and he’s tied up there, so he says you’ll have to do this one. I’ve arranged an assistant for you and an anaesthetist.’
In the scrub room, her hands sheathed in sterile latex gloves and a nurse tying her surgical gown behind her back, Melissa stared at her reflection in the mirror over the basin. Her eyes were calm, her mouth set. To all appearances she was relaxed, confident, the very model of a cool and collected surgeon. Inside, she was terrified. She was about to perform a laparotomy and splenectomy on her own for the first time ever. The patient’s life depended on her.
The nurse put on Melissa’s face mask for her, leaving only her eyes exposed. Melissa used her back to push open the door and stepped into the theatre, where amongst the beep of the monitoring equipment and the clatter of the instrument trolley as it was moved into place, her patient lay supine on the operating table, draped in green apart from his exposed abdomen, yellow in the harsh light from above.
The next hour would linger in Melissa’s memory as one of the most intense of her life, in which her senses – sight, smell, hearing – were heightened to an almost animal level. She made the incision in the upper abdomen at the midline and opened the abdominal wall. As she’d predicted, and as the scan had confirmed, the cavity was filled with blood. In short order, while the junior doctor assisting her held the retractors to keep the cavity exposed, Melissa used suction to visualise the internal organs, detached the anchoring ligaments of the spleen, clamped off and cauterised the vessels connecting the organ to the vascular system, and lifted the spleen free. It was a wreck, fragmented beyond salvage. After that the process was straightforward: examine the rest of the organs including the pancreas for damage, clear out all remaining fluid from the cavity, check for bleeding vessels, and, at last, suture the abdominal wall closed.
Melissa emerged into the scrub room and fired her gloves at the waste container with a loud snap. She felt delirious, light-headed, and fifteen feet tall. For the first time she’d taken charge completely, suspecting a problem and following her instincts to make the corre
ct diagnosis, then operating to solve the problem, without any outside advice or supervision. There was still a lot that could go wrong, of course, and the patient would have to adjust to life without a spleen which would render him more susceptible to infection. But he was alive now, all because of Melissa; his wife still had a husband and his children a father. Nothing Melissa had ever experienced before came close to the bursting joy she felt now.
One by one people filtered into the scrub room to slap her on the back and offer their congratulations: her junior assistant, the theatre nurse, even the anaesthetist, who’d perched through most of the operation on a stool reading a newspaper, as nonchalant as members of his specialty usually were. Melissa basked in the praise, all the while knowing there was someone else whose admiration would matter so much more.
Fin emerged nearly two hours later from the adjacent theatre, his gown painted with blood, the sweat matting his hair to his forehead. Melissa helped with the post-operative write-up of his case – the severely injured construction worker, Mr Khan, would live, though it would be a long time before he’d walk again – and found Fin as he was coming off the phone.
‘How did the laparotomy go?’ he said, as if he’d only just remembered it.
‘Not badly,’ she said as neutrally as she could. Quickly she described her approach. He listened, nodding slightly.
When she’d finished he nodded and asked, ‘Mind if I take a look?’
She led him into the post-op room where Barry, her patient, was still unconscious and being tended by a nurse. Fin uncovered him and gently peeled away the dressing, inspecting the incision she’d made in his belly.
Melissa watched Fin’s face, her body taut with tension. At last Fin smoothed the dressing back in place.
‘It’s okay,’ he said. ‘Spacing of the sutures could be a little more even.’
With that, he turned and left.
Melissa slumped into a chair, closing her eyes. She felt like a tyre which had suddenly had all the air let out of it. The adrenaline, the exuberance she’d been coasting on for the last few hours had dissipated like smoke in a storm.
What was his problem? Why was nothing she did ever good enough for this unreadable, infuriating man?
Chapter Three
The blow-up with Deborah Lennox happened on a Wednesday evening, and it was the first really serious point of conflict Melissa had had with anyone at the hospital since she’d started working there.
Melissa found Deborah in the nurses’ mess, shrugging on her overcoat. It was October, Melissa had been at St Matthew’s for six weeks, and the autumn chill was beginning to bite outside.
‘Deborah, I know you’re about to go home, but do you have a minute?’
The nurse looked at her in mild surprise. ‘Of course. Here, or my office?’
Melissa glanced about. There was nobody else in the cluttered, comfortable lounge, but someone might walk in at any moment and she really did want this to be a private conversation. ‘Your office, if that’s all right.’
In the office Deborah indicated a chair and took one herself, then crossed her legs and gazed at Melissa enquiringly. Melissa hadn’t seen the other woman out of uniform and with her hair down before, and she was surprised at how much younger she looked, and how much more attractive. Her auburn Scottish hair was naturally wavy and her figure was trim. Melissa thought she was probably in her middle thirties, five or six years older than Melissa herself.
‘What’s on your mind?’
‘It’s… a bit awkward.’ Melissa found it difficult to look directly at Deborah for any length of time. She could imagine how bewildered the other woman felt, seeing this normally so confident and decisive doctor at a loss for words. ‘It’s just… I need your advice.’
‘Go ahead.’ Deborah splayed her palms in encouragement.
Melissa took a breath. ‘I need to know what Fin thinks of me.’
It sounded desperately needy the moment it came out, and inwardly Melissa cringed. Deborah raised her eyebrows. Melissa hurried on: ‘You’ve worked with him for years. You know him better than most. I can’t tell if he’s pleased with the work I’m doing or not. I think I’m doing a good job, and I’m getting good feedback from everyone else. Plus he’s never actually criticised me. I just get the feeling sometimes… it’s as if I’m falling short of his expectations in some way. You must have seen lots of other registrars come and go before me. Is he like this with everyone?’
It had all come out in a rush and Melissa closed her mouth to shut off the flow. She stared at Deborah, unable to read the expression on her face. Then the nurse gave a faint smile.
‘Perhaps you should ask Fin yourself.’
‘I’ve thought of that… but it’s difficult to know what he really thinks. He says my work’s fine, so I can’t really very well keep pestering him and asking him if there’s something he’s not revealing, can I? It’ll irritate him and make me look flaky.’ She shook her head. ‘There’s this wall of reserve about him that I just can’t get through. It’s maddening, and so unexpected. His looks, his charm, they make him seem so open.’
Melissa had decided to approach Deborah because as she’d mentioned, the nurse had known Fin longer than most in the hospital and might be best placed to judge his thoughts and feelings about his staff. But Melissa had also come to her because, frankly, she didn’t know who else to turn to. Emma, her counterpart in Professor Penney’s team, had become a close friend over the last few weeks, but she didn’t work directly with Fin and was unlikely to have any insights into his psyche.
She noticed Deborah watching her in silence. The small smile had slipped a little. Just as the atmosphere began to feel uncomfortable Deborah said, ‘You said you wanted my advice, Ms Havers. I’ll give it to you, though it won’t be the advice you were expecting, still less hoping for.’
Melissa frowned, confused.
‘My advice,’ Deborah went on, ‘is that you be very careful what you’re getting into here. It’s not going to work, and it’ll end in trouble for everyone. You, mostly, but also for Mr Finmore-Gage and the rest of us.’
Melissa wondered if she was hearing right. Had she dozed off, or slipped into some sort of fugue state? She opened her mouth to speak but Deborah leaned forward in her chair and held up a finger.
‘Hear me out. You’re a bright, hard-working doctor. One of the best ones I’ve worked with, that’s for sure. And you know how good you are. You’re not boastful or arrogant in the least, but still, somebody with your ability always knows she’s competent. You don’t need external validation to feel good about yourself. That’s for insecure people.’ She sat back, drew breath. ‘Which makes it all the more odd that you’re so concerned what your boss thinks about you. Which makes me wonder if you haven’t got some other agenda.’
Melissa found her voice, with difficulty. ‘What – what do you mean?’
‘Come on. We both know.’ Deborah’s eyes were a dark blue, and they flashed. ‘You’re a beautiful young woman. Fin’s a good-looking man. You’ve got feelings for him, and you want him to reciprocate.’
‘I don’t know –’
‘So you’re fishing around to find out if he’s said anything to me suggesting that he likes you, that he wants to get together with you. And you’re doing it under the guise of seeking confirmation that he’s happy with your work performance. Well, you can just drop it.’
Melissa was on her feet, the blood pounding hotly in her face. ‘How dare you?’
Deborah rose too. ‘Admit it. To yourself, if not to me.’
Not normally given to public displays of anger, Melissa couldn’t help herself. She jabbed her forefinger at Deborah. ‘You have no idea what you’re talking about. You know nothing about me, or my wishes, or my motivations. Nothing at all. You’re probably –’
Melissa broke off, partly because her voice was rising and in a moment somebody was going to come and investigate, and partly because she’d been struck by a sudden thought, an insight abou
t Deborah that almost floored her. She took a step back, lowered her hand, began to bring her breathing under control. Across from her, the other woman’s emotions were being held in check, though her eyes still burned.
‘I shouldn’t have come to you,’ Melissa muttered. ‘I won’t do it again.’
She managed not to slam the door on the way out. On shaking legs she stalked the corridors, unable to sit or stand still. She didn’t quite snap at the porter who called hello to her, but she was brusque, leaving his eyes boring into her back.
Even if the woman was right about Melissa’s feelings for Fin – and she wasn’t, she was just speculating – what right did that give her to interfere? How dare she judge how two people ought to behave towards one another if one of them wasn’t her? She’d said they would all suffer if Melissa carried on with her supposed pursuit of Fin, but that was absurd. Office romances were controversial, they raised all kinds of ethical questions – but they didn’t damage a service as finely honed and smooth-running as the Trauma Department.
The only reason Deborah Lennox might have to get so worked up about an imaginary relationship between Melissa and Fin – and it was the insight that had arrived out of the blue while Melissa had been responding to Deborah’s accusations – was that Deborah was herself after Fin. Basic, primal jealousy had driven her to say what she’d said. She’d worked with Fin for years, was close to him professionally, and it was natural that she’d develop feelings for him. She might content herself that these feelings would be reciprocated one day, given enough time. But now this interloper, this younger potential rival in the form of Melissa, had arrived, and Deborah felt threatened.