by Manda Scott
There was silence in all of the furious movement. Jason bit his pen and then wrote something new on the chart. He hasn’t got Steff’s presence of mind. Steff was halfway out of the box to collect the clippers from outside. She turned in the doorway, her hand on the foal.
‘His globulins are fine,’ she said and she knew she wasn’t answering the question I had asked, ‘but we’ll have to keep him on the pen-strep for now. Switching from natural feeding to the bottle does crap things to their immune system. It’s not worth bringing him off the antibiotics now.’
I let it go. Time enough later. I held Rain while Steff and Jason took a pair of clippers each and shaved hair from both sides of her neck. They slid catheters into the jugulars. Two catheters; one left, one right. So now she has three. One from the surgery—which is the one that I used in the morning—and two from now. Branding Iron had four. They wore gloves while they put them in and when they were finished they turned them inside out and knotted them before they dropped them into the yellow clinical waste bag. The air smelled suddenly of blood.
The foal began to grizzle for his mother. He tugged against the foal slip. Flashed white around the eyes and flicked a hind foot at Sandy. We let the mare go, let the foal into the box and shut the door. Just in that moment, you could look over the door and believe it would all be all right. The smell of the straw and the mare and the foal were more than the smell of the disinfectant and the hibitane they had poured on her neck. Just in that moment.
Steff gave Sandy directions to the feed room and sent him off to mix milk for the foal and a hot mash for the mare. Jason got a list half a page long and ran off to get the fluids and antibiotics and intravenous feeding solutions. And a flask of coffee for an overnight watch.
I stayed with Steff. We let ourselves back into the box. To be with Rain and her foal. The foal tried to suck. The mare flicked her tail and lifted a leg in threat and then she gave up the protest and stared, dull-eyed at the straw while her foal butted hopelessly at her belly. I could have wept.
I sat down in the straw. Steff pushed her hands deep in her pockets, leant back on the door, kept her eyes on the far end of the barn for signs of someone, anyone, returning.
‘So where is she?’ I asked.
She didn’t ask who I meant.
‘I don’t know.’ She chewed skin from her lip. ‘I haven’t seen her since just after Sandy rang.’
‘What happened?’
‘We were operating. One of Matt’s cases. A retriever for a triple pelvic osteotomy. To correct a—’ She stopped, shook her head, the way the foal shook off hands. ‘I’m sorry. It doesn’t matter what it does. It’s a big, long, complicated orthopaedic op. And it took us about an hour longer than it should have done. I sent her out about ten minutes after Sandy rang.’
‘You did what?’ You can’t do that. Residents don’t order their surgeons out of theatre. Never.
Steff stared straight at the mare. The muscles ran tight along the line of her jaw. Inside the pockets of her overalls, her hands curled tight into fists. She shrugged. ‘I requested that she leave,’ she said.
‘Why, Steff?’
‘Because I had to. She wasn’t part of the game. She wasn’t exactly up to scratch before the phone call. She was a complete mess afterwards. We weren’t going to get it done with her in there.’
‘And she went? Because you told her to?’
‘Hardly.’ The foal gave up on the mare. Tried Steff as the next most likely mother substitute, mouthing across her hands for milk. She cupped her hands for his searching lips. ‘We … had words. I said it was her or me. That if she wanted to stay and cut, I would scrub out and go do something more useful.’ She looked at me, then. There was fire eating out round her eyes. ‘She knew that if I went, she couldn’t finish it on her own. She wasn’t that far gone.’
‘So where is she now?’
‘I don’t know. She said she’d be waiting in the ward for when Sandy arrived. I came straight over from theatre. I thought she’d be here.’
‘Have you tried her office?’
‘Twice. When you got here and just before Jason arrived. And I told the switchboard to page her at five-minute intervals and then to page me if she showed up.’ She held her pager up to the light. Dead to the world. ‘I don’t know where she’s gone, Kellen. But wherever she is, I can’t find her.’
Time goes very fluid in a crisis. The air turns to treacle so that nothing can move. Inertia sucks. I stood up. It took an age to make it to vertical. The door to the box took hours to open. ‘So why are we here, Steff?’ My voice came from too far away to make sense. ‘Why are we not out finding her?’
‘Because the last thing she said as she walked out of theatre was that she was relying on me to sort out your mare.’
‘Oh Christ.’ I was running down the barn by then. Like you run in dreams. Not going anywhere. Just running. Running too slowly. Running down the barn. Away from the stocks and the feed room and the hay-barn. Down towards the theatres and the offices and the changing rooms. And the pharmacy.
Steff was at my shoulder. Long, loping strides. Like a tiger. The door at the end stopped us. Time hung in the vacuum while Steff fumbled for the keys, unlocked it, heaved it open. I was panting. Hyperventilating. Worse than Jason. Panic does that to you, if you let it push you that far. I breathed in, deep and slow. Caught the last edge of sanity before it all unravelled completely. Breathed deeper and slower. Brought the nightmare into focus. ‘Was she hallucinating?’ I asked. ‘Was Nina seeing things before she walked out of theatre?’
‘Kellen, she couldn’t tell the difference between the needle holders and the scissors by the time she left.’
We ran, both of us, for the far building.
13
I have a new nightmare. It is this:
It is dark. Dark like the inside of her bedroom. I have no torch. I can’t find the light switch. All I can see is the dark. But I know she is here. In the pharmacy. Because I have radar for skin and it says she is here. And because this is where she always knew she would be. In the nightmares. When the gravity got too much.
She is here. All I have to do is find her.
I hunt. I feel. Reach out. Call her name. The darkness speaks silence. Her silence. She has lived with this dark for so long she can call it a friend. She knows I will come. Sometime, I will come. She doesn’t want to be found. Not yet. And so she has made a bargain with the darkness, her ally, to keep me away. I need to find the light. I feel my way back to the door. Bump into shelves. Trip over packing boxes. Knock bottles off shelves to smash on the floor. Liquid mixes with glass to make glue. A trap for unwary feet. Strange, noxious gasses mix and rise in the air. I can’t breathe.
The light switch is here. Where it should be. By the door. And so now, in the nightmare, there is light. Nasty, flickering, off-yellow fluorescent light. And the ceiling is blue. Blue like the sky over Skye.
She is there. In the corner. Where she said she would be. Half sitting against the fridge. The tangled mass of her hair shows henna-red against the white of the door. Her skin is yellow. Pentobarbitone yellow. A trick of the light. A bright yellow drip bag floats upwards from the vein in her arm like a fat, bloated balloon. There’s enough pentobarbitone in there to kill a horse. Several horses. I can tell by the colour, even from here. Even from halfway across the room. But I can’t see if she’s breathing. From here I can’t see if she’s breathing.
‘STEFF … Stephanie. In the pharmacy. She’s in here.’ In the nightmare, I can scream if I want to. Wake the dead if I need to. And I can run. Now, I can run.
The drips run in a steady stream. Lethal, yellow, poison. Between one drip and the next, I grab the drip set. Shut it off. Remember, just in time, not to pull the catheter from her arm. She got it in. It might still save her life. Last time, after she blew the vein, it took the ambulance team three tries to find another one. Three tries take time. We don’t have any time.
We may have no time at all.
/> I find her wrist. Find no pulse. Try her throat. Give up. Try her heart.
Please. Have a heart beat. Please.
She has a heartbeat. If I put my ear to her sternum and hold my own breath I can hear it. Regular, rhythmic, drumming. Slow, slow drumming. Pentobarbitone slow. But there could be other things with it. Who knows what she might choose to mix in her cocktail this time? It was morphine and ketamine before. Neither of them quite enough to be fatal. She’s learnt more pharmacology since then.
But now she isn’t breathing. Dear God, I don’t think she is breathing.
ABC. The first lines of the crash. Airway. Breathing. Circulation. I was trained to do this once. Except we always did it on dummies, plastic models who didn’t matter. And once on Lee. For the practice. Thirteen years ago.
Tilt the head back. Hold the nose. Make a seal, mouth to mouth. Deep breath in and then exhale everything you’ve got. Watch her chest rise and fall. And again. And again. And again. Watch lips that were blue turn to lilac. Feel for the heart. The slow, even canter of the drumbeat. Still drumming. Keep drumming. Please, whoever is listening, don’t let her heart stop now.
And Steff is here. Steff who runs like a tiger. Steff who is weeping, fast tears of frustration and anger and other things, less easily read. ‘She can’t do this … Fuck it … Kellen, she can’t do this.’
‘She’s done it. Call an ambulance. Get me some oxygen. And some adrenaline. Get the crash cart. Anything. Just get me something to keep her alive.’
There’s a phone on the wall. They say the ambulance is on its way. In Greater Glasgow, that could be anything up to three hours from now. Make them understand it’s urgent. They say that they do. If they get here too late, I will kill them. All of them. One at a time. Slowly.
Breathe. Just keep breathing. Head back. Fingers on the nose. Mouth-to-mouth seal and keep breathing.
Steff is back. Throwing the crash cart ahead of her like a demon shopper. No grace in her movements now. But she has brought me the crash kit from the ward. With oxygen and face masks and adrenaline. We don’t need the adrenaline. Not yet. We just need oxygen to keep her lungs full. To keep her heart moving and to keep her brain alive.
Just breathe. Just keep breathing.
The mask’s the wrong shape. Built for a cat. Or a dog. Something with a nose that sticks out like a cornet. The seal doesn’t fit round her mouth or her nose. Oxygen blows out round the edges.
Just breathe.
‘I need an ET tube. And a laryngoscope. And get a drip going into that vein.’
They are there. In the crash cart. All the things that I want. Laryngoscope. Tube. Oxygen line.
But I haven’t done this. Ever.
‘Steff, I can’t do it. I don’t know how.’
‘You’re the doctor, woman. If you can’t do it, nobody else can.’
I have never done this. Never. But I have been to the lectures.
Tip the head back further, shine the light from the ’scope on the vocal chords. Remember, too late, what they said about not levering the scope against the teeth. ‘Shit.’ She will smile now with a chip in her left upper incisor. If she ever smiles again.
Shine the light in, spray the local, slide the tube in. Fail. Breathe. Try again. Slide the tube in. Watch it go somewhere.
‘Is it in?’
‘It better be. Give me the oxygen. And the bag.’
My hands know how to do this. Two nights ago, I did it for a dying foal. Last night it was a cat that may have lived. I didn’t know I was practising for the real thing. Squeeze. Pause. Squeeze. Watch the chest rise and fall. Watch the lips change from lilac to pink. Watch colour come back to skin that was not yellow by a trick of the light.
Keep squeezing. Don’t stop squeezing.
Look up and see an ECG trace run; slow; rhythmic, but slow, across the monitor that’s built into the crash cart. Because Steff, who is not weeping now, has a clean drip running into the line and has had the presence of mind to set up an ECG. And to count the heart rate. And to start drawing adrenaline into a syringe, ready for injection. In case the drumming stops.
And then I think we have done all that we can do. Except to pray for the ambulance. And a clear bed in a ward. And a consultant who knows what they’re doing.
They listen, sometimes, the gods of the ben. We got an ambulance faster than I’ve ever known one to come. We got a sane team who accepted the drip line and the ET tube and the oxygen and didn’t ask stupid questions about who was qualified to put what where. We got a clear ride to the Western with the sirens blaring and the lights flashing and not one single Glaswegian driver found it amusing to get in the way. And we got Eric Dalziel. Big Eric. Eric the Climber with his red hair like the colt and his dark eyes like the mare and his sense of humour that would strip the paint from a whore and leave her standing, naked in the street. Except when it matters. When it matters, Big Eric has an understanding of the technology of medicine that would rival Matt Hendon’s and a body of knowledge locked away in his mind that would fill textbooks if he ever had the time. And he has compassion. When it matters Eric Dalziel will work through the night and out the other side to keep someone alive and there aren’t many who will do that when they’ve signed up beyond senior registrar. He was in the year below me when I sat my finals. He climbs with Lee whenever they’re both not on call. He was a friend of Malcolm’s and he spoke for Bridget when we finally got ourselves together to hold a service. And he was waiting for Nina when they carried her upstairs to the wards.
They gave her a room of her own, which is more than she got the last time. A pale room, one shade pinker than white, with scattered rosebuds across the curtains and a salmon-rose blanket on the bed. The air was conditioned and dry. It smelled of violets, aerosol violets, cloying and sweet. I would have handled phenol better. They laid her on the bed; a pale plastic, slack-lipped doll with threads of saliva drooling round the tube in her mouth. Without that she could have been dead. The dead don’t dribble. Not for long.
Then they started on the high technology. They didn’t shave her head. Not yet. But the rest was the same as the last time. Multiple drip lines adding scars to her arms and to her neck. Monitors muttering electronic threats whenever they got numbers they didn’t like. The ventilator. The dead-whale gasp of the ventilator. Gaspin. Whistle-out. Repeat, once every twelve seconds. More than anything else in the wards, I hate the noise of the ventilator. I stood at the end of the bed wearing Steff’s white coat and with Steff’s stethoscope round my shoulders and I watched them set up more monitors than I knew you could fit on a human being. I thought Branding Iron was overwired. On Nina Crawford, I stopped counting when the lines reached double figures.
They let me stay and watch them. The nurses. The house officer. The registrar. The myriad other white-coated people who ran at the double doing efficient things to keep her alive. They let me stay because I shared the uniform and a clinical coat still carries you a long way in a hospital. But more, they let me stay because they had seen Eric greet me when I followed her in. They saw him come over and put one huge bear-muscled arm around my shoulder and they saw him show me where to stand, out of the way but not out of sight. He didn’t say anything and he didn’t ask questions. But it told them I could stay.
But they still watched me, sideways. In the gaps between the arterial pressure lines and the blood samples and the urinary catheter, they asked silent questions and gave each other silent answers. And when they undid her gown to place the leads for the ECG and they found the bite marks on both her shoulders and another on her breast, their eyes danced faster and their brows rose higher and they nodded to themselves in the corners.
Only Eric didn’t join in. Because Eric is a friend and he knew most of the answers anyway and he knew that he’d get all the rest when he asked.
He came over and stood beside me, at the foot of the bed, the case notes hanging loose from his fingers.
‘She was your friend, yes?’ And with Eric, because he is Eric,
these things are not ambiguous.
‘She is my friend. Yes.’ Then, because I have to tell somebody sometime, and Eric, of all people, is safe: ‘She was a client.’
‘Oh. I see. Bad luck.’ And from Eric, there is no judgement.
But I want to be judged.
‘Until Friday, she was a client.’ He needs to understand. Whatever made her do this, I was part of it. ‘I didn’t get her a referral.’
‘Kellen …’ He put his arm round my waist. Slid me back into a chair. Out of range of the whispering ears. ‘… Sit down. It’s history now.’ He crouched in front of me. Not all doctors stand at bedsides. In his hand, hidden beneath the case notes, was the drip bag. The lethal, yellow drip bag. Flaccid now because half of it was in her body and half of the rest had gone off in bottles to be analysed.
‘They said there was pentobarbitone.’ He watched my eyes. ‘Do you know if there’s anything else?’
‘I don’t know. I think there could be. She was hellish bradycardic when I found her. She put morphine and ketamine in it the last time. They blew her mind …’ You can come round from the pentobarb. Chew it up with the liver. Pee it away. Clean out your system. Learn to breathe. Repair the mess on your arm. Grow the hair on your head. But a 2 g dose of ketamine opens the doorways to hell and I don’t know if we could ever have closed them completely.
‘Kellen … keep a grip … don’t go out on me now.’ Eric. Shaking my shoulders. Eric, who is still not judging. ‘What do you mean, “the last time”?’
‘She was in here before. Seven years ago.’
‘The same thing?’
‘More or less. Things die. She doesn’t cope.’ Although I thought she had reasons, now, to cope. ‘You’ll have the records somewhere.’
He made a note on the file. A house officer came to his beckoning; an Asian lass, slight, with shining, dark hair and dull, dark eyes. Eyes that said she’d been on her feet for at least the weekend if not most of the previous week and wasn’t expecting to see sleep for another month or so. She took the note, read it and vanished.