He asked, ‘Would you think me a heel if I said yes?’
‘I’d rather you were a heel than a liar. Maybe you were right.’
‘Useful to know the strength of the opposition?’
‘Opposition?’ I shook my head. ‘No.’
‘I don’t follow you, Maggie. I thought you loved the man.’
‘I do. That doesn’t mean I’m prepared to do battle. I’d fight with him. Not for him against another woman. He’s not my property. He wouldn’t be that, even if we were married, but I might be prepared to put up a fight then to save a home, or for our kids. Not for a man alone. If he wants her he can have her. I may go on loving him, but I still don’t want a man that doesn’t want me.’
‘So there’s no truth in that “Hell hath no fury” routine?’
I thought of Sandra. ‘I wouldn’t rule it right out. Like most generalizations it’s based on truth, but doesn’t always apply.’ I turned to him. ‘But you’d fight for a woman?’
‘With no holds barred, sweetie.’ He patted my hand. ‘And no nonsense about keeping the fight clean. Haven’t we long agreed I’m that heel?’
‘You have. I’m not so sure. No ‒’ I pushed him away ‒ ‘you don’t have to prove things. I want to ask you something.’ And I went on to talk about Joe’s rheumatism. ‘Would it be some form of arthritis?’
He shrugged. ‘More likely simple fibrositis. Who doesn’t get the odd twinge?’
‘That’s roughly what he said. Would you know if he’s having anything for it?’ I could not mention those injections without giving Bachelor away. ‘It’s some time since I was in a medical ward. What’s the latest in drug therapy?’
‘You should have asked Frances that,’ he replied casually. ‘That’s her line of research. They keep bringing out new things. I doubt there is yet anything to touch the good old aspirin tablet. But talking of medicine, have you heard who’s giving the gas for that hole job mane? Old “Hearts” himself. And the boy’ ‒ he tapped his chest ‒ ‘will be assisting. Going to be a toughie, that job.’
We were always given ample warning before an operation to repair a hole in the heart because of the vast amount of organization necessary beforehand. Once the time was fixed and the theatre reserved, there was no question of the operation being pushed to a later hour to make room for a sudden emergency either blowing up in one of the wards or coming in from outside, as so frequently happened with our normal lists. As surgical emergencies continued to occur whether or not the G.S.U. was free to deal with them, while we were occupied with our scheduled case the Orthopaedic Theatre, after adjusting its lists accordingly, dealt with all the general surgery for us. That inevitably meant warning the Orthopaedic Theatre about the situation at the same time as the G.S.U.
Very early next morning our corridor was blocked by the slow train of expensive electronic machines being wheeled into their appointed positions in the theatre proper by the small army of physicians and technicians who would preside over them during the operation. Dr Mailing, the senior member of the automatic-heart team, came into the duty-room. ‘Would you object to a couple of post-grads whom we’re training being on the floor with us, Sister? They would be most grateful.’
‘Of course, Dr Mailing.’ I found Bachelor, whose job that morning was to look after the team. ‘Ten, not eight, sets of gowns, caps, masks, boots, Nurse.’
Alcott stopped me in the corridor. ‘Please, Sister, I know I’m off at nine-thirty, but may I stay on and watch?’
‘By all means, but from the gallery. I’m afraid there’ll be no spare room on the floor.’ We stepped aside to let another machine go by. ‘There’s still more equipment to come.’
‘More?’ Her eyes were round. ‘Sister! I know in that class you gave us yesterday you said the automatic heart was big, but surely it isn’t all this?’
‘A bit more than all this. The human heart is a highly complicated organ, Nurse. Any machine that has to do its work isn’t something you can just pick up and clip on.’ I looked at the time. We were well ahead, so I took her round. ‘We’ll start here. This is the heart-lung. These rubber pipes carry the blood to and fro once it’s in action.’
‘Why all these dials, Sister?’
‘Pressure gauges. This one’ ‒ I pointed without touching anything ‒ ‘is the thoracic aorta; this, superior vena cava; inferior vena cava, and so on. The physician working this machine will call out the various pressures in the arteries and veins constantly. It’s something the surgeons have to know, as I explained yesterday, but can’t see for themselves.’
Bachelor was at my elbow. Behind her Nurses Cotton and Jones hovered hopefully. Bachelor asked if they could join in. ‘We have finished our routine, Sister.’
She had seen two other previous hearts repaired, but it was the first time for the other three. I had another glance at the clock. ‘Right. Let’s have another look at the heart-lung.’
A minute or so later we moved on. ‘This machine you all know. Well, Nurse Alcott? What is it?’
‘Electroencephalograph, Sister.’ She sounded doubtful. ‘But why? This isn’t a brain operation.’
‘No. But the oxygen supply to the brain has to be under constant check. It mustn’t fail. This’ll tell us what’s going on.’
Nurse Cotton asked, ‘If it does fall, Sister, or if the blood pressure drops or something, who makes the decisions? Dr Mailing? Sir Robert?’
‘No. Not in this operation in this hospital. The anaesthetist is in charge of everything apart from the actual surgery. Next to Sir Robert he is the most important man in the theatre. That’s why Dr Homer is giving it himself to-day. Either Dr Homer or the Senior Medical Officer preside in these operations here. Of course, every member of the team looks after his or her own machine, but Dr Homer has to keep an eye on the lot. That’s why we use this particular anaesthetic machine with all these recording instruments.’
The girls considered the rows and rows of dials. Cotton said, ‘Place looks like the cockpit of a jet aircraft!’
Nurse Alcott liked to get her facts clear even if she seldom remembered them, and asked Cotton how she knew what the cockpit of a jet aircraft looked like.
‘Saw it on television.’
We moved on again and stopped by a transfusion trolley and stand. ‘Why blood, Sister? Will she lose a lot?’
‘We hope not. We have to be prepared. And it is sometimes necessary to transfuse while the machines are working. The right volume of circulating blood must be maintained, it mustn’t clot, and may need an extra pint ‒ or less, or more.’
Nurse Jones said she had been wondering about clotting. ‘How about the coronary artery, Sister? Isn’t there a hideous risk of a coronary, if it’s clamped?’
‘A clot’s one of the dangers, as I explained yesterday. These suckers here deal with the coronary. One’s high pressure, the other low. Sir Robert’s assistants will use them to stop the coronary blood getting in his way.’
‘While he’s stopping the heart?’
‘Not only then. Throughout.’
Alcott said slowly, ‘Sister, if the heart is stopped, isn’t someone technically dead?’ Her eyes were worried. ‘I mean ‒ supposing it doesn’t want to start up again?’ She hesitated. ‘Does it? Always?’
The few men already there had been listening casually. Suddenly they all looked at the floor, like a well-drilled chorus.
I said, ‘Not always, Nurse Alcott.’
Her eyes stopped being worried and were fearful. ‘So this child Sir Robert’s doing could be going to die?’
‘She will die very shortly if she doesn’t have this operation, or if it isn’t successful. Physicians don’t advise, and surgeons don’t undertake this repair lightly. It’s only done when there is considered to be no alternative.’ I was briefly silent. ‘You seen a blue baby, Nurse?’ She nodded. ‘How old?’
‘Only babies, Sister. In Charity.’ (Charity was our infants’ ward.)
‘You remember how they gasped for breath
? Well, this little girl is nine. Apart from her heart, Dr Homer says she’s a very nice, very normal child. But she can’t go up stairs without collapsing. She can’t run, jump, play games, dance, go to a normal school, play with normal children. If she lived long enough to grow up, which is very doubtful indeed, she couldn’t risk marrying, having children, running a home of her own. Would you say the poor child was living? Or just existing? This is a dangerous operation, and it doesn’t always succeed. When Sir Robert opens up the heart he may find the lesion is too extensive for repair. But if it can be repaired and he can stitch in that gusset I showed you yesterday, which will later be absorbed by the body, then although she’ll have to go carefully for six months or even a year, after that she can be a normal little girl doing the things all normal children do. Her parents know the risk ‒ everything has been explained to them. They have decided it’s worth taking. I think they are right. I also think they are showing the most tremendous courage and unselfish love. She is their only child.’
The girls nodded dumbly. Then the irrepressible Alcott asked impulsively, ‘Does she understand, Sister? Of course, she’s only nine.’
Bachelor turned on her fiercely. ‘My little sister’s nine! Of course she understands! Kids of nine always understand what’s going on!’
Alcott looked as much shaken by the good-natured Dolly Bachelor’s explosion as she had been by what I had previously said. I pretended not to notice and dismissed the class.
Sandra came over from the sterilizers. ‘The S.S.O. rang while you were teaching the nurses, Sister. I didn’t interrupt as he only wanted to let us know Mr Ellis is to be registrar on call for any G.S.U. emergencies this morning and won’t be coming to us. He has let the Orthopaedic Theatre know.’
‘Thanks.’ It was just a routine call. Despite everything, I found I still wished so much that I had been free to take it, just to hear his voice and perhaps manage to ask if this really was his last day, that it was just as well my job had prevented me. ‘Now all we have left to do is get scrubbed up, and wait for the job to start.’
‘It should be a fascinating case.’ Her eyes were shining over her mask. ‘I wish we did more hearts.’
‘They are very interesting.’ I did not tell her I could not share her elation at the prospect ahead. Cases were simply ‘cases’ to her. Academic exercises requiring the utmost technical skill, and nothing more. If she had heard Bachelor snap just now, she would have thought her unnecessarily dramatic, and myself unnecessarily indulgent, for not slapping the girl down with some reminder about our being there to think and do, and not feel. If I admitted sharing Bachelor’s dread of seeing a child’s heart stopped, it would only add to her conviction that I was unfitted for my job. Nothing would persuade her that I could love and yet be hurt by the theatre. Pain did not cease to be pain because it was inflicted with good intent, any more than a wound ceased to be a wound because it was inflicted with a surgeon’s knife.
Our patient’s name was Pauline Dawson. She had very fair hair and was smaller than the average nine-year-old. Unconscious she looked like a waxen doll, and when Sir Robert laid bare her heart it looked too large to be fitted back in her narrow chest.
I stood behind my usual trolley, close to Sir Robert’s right hand. Joe, Bill Swan, another registrar, and two housemen were assisting. One of the housemen was a spare. He waited, gowned and gloved, in case an extra pair of hands was needed. Qualified hands. Our dressers were all banished to the gallery.
In the mirror above the table the waiting heart-team were able to watch everything that was going on in the wound. The heart-beat began to slacken, then flutter like a trapped butterfly. Then it stopped.
‘Right,’ grunted Sir Robert. ‘Right. Total by-pass, gentlemen.’
Almost immediately, as the machines hissed, sucked, heaved into motion, Dr Mailing’s slightly monotonous voice began chanting the various arterial and veinal pressures. Occasionally Sir Robert broke in to explain briefly what he was doing to the packed gallery above. Every now and then he paused to look at the clock. The machines could keep that child alive for so long, and not one minute longer. The exact time for that particular operation had been previously worked out by Dr Homer, and Dr Mailing and his team. Sir Robert had agreed to do what must be done within the time set. He did not query the cardiologists. He was on their ground now.
The tension in the theatre increased as the time limit grew closer, then reached its maximum as the final stitches were put in several minutes the right side of the danger line.
‘Right,’ muttered Sir Robert ‘Right. Now, let’s see …’
The exposed heart gave a little shudder, then the ventricles stirred almost sleepily. The beat was irregular, but it was beating. Then very slowly, its rhythm adjusted itself and settled into a reasonably strong, but above all steady, motion.
No one spoke. The surgeons’ concentration was still too intense for spoken relief. Dr Homer looked up at Mark, who had been towering over him throughout, and nodded. Mark mopped his forehead with the sleeve of his clean but unsterile gown.
When the chest wall was stitched up Joe replaced his scissors on my trolley. Momentarily our eyes met, and we smiled at each other. The past and the future were unimportant. The present was sheer, exquisite joy.
It was not our private joy. The automatic-heart men were flexing their shoulders, beaming at each other, and Dr Mailing patted his specific machine affectionately. Dr Homer supervised the moving from the table to the bed with the portable oxygen tent that was brought right into the theatre by the porters and the senior staff nurse from Christian Ward. ‘You take her up, Mark, I’ll be up to see her parents directly.’ He walked over, slapped Sir Robert on the shoulders. ‘Thanks, Bob. Nice child, young Pauline. Her parents are going to want to thank you.’
Sir Robert nodded heavily, looked round. I guessed what for, and pushed forward a high stool.
‘Thank ye, Sister. Thank ye.’ He sat down, removed his cap and mask, dried his face with his cap. ‘Thank yourself, Hearts. And you, gentlemen. And your good self and nurses, Sister. Must be getting old. These things take it out of me more than they used to. But it all went very well. Capital,’ he said wearily, ‘capital.’ He noticed his assistants. ‘Go and get yourselves some tea, you boys. I’ll be along in a moment.’
Slowly the theatre began to clear. Joe remained, talking to Sir Robert. He had removed his mask, gloves, and gown, but forgotten his cap and long white thin-rubber operating-apron. It flapped round his overboots as he came over to me. He looked nearly as tired as Sir Robert.
He stopped in front of the trolley I was clearing, glanced round. We were for the moment alone in that particular corner of the theatre.
‘A good case, Maggie. Your predecessor couldn’t have run it better.’
‘I don’t know about that. But it was good. Oh, very, very good.’
‘Yes. I’m glad about that. A nice swan-song.’ He pushed at his hair, felt his cap, took it off, dropped it on my trolley-top. ‘I won’t be here this afternoon. I’m off.’
I held on to my trolley. ‘For good?’
‘Yes.’ He touched my gloved hand as it held the trolley very lightly. ‘Good-bye.’ He walked out of the theatre before I could say another word.
Sir Robert got off his stool. ‘Much obliged, Sister.’ He went out after Joe.
I was Sister Theatre. The case was over. I could walk where I wished in my own department. I followed the men out. Sir Robert would have no objections to my having a private word with a retiring S.S.O.
But Dr Homer was in the corridor by the open door of the surgeons’ room. ‘There you are, Joe! What’s this I hear about your leaving us this afternoon? I thought Sir Robert told me you weren’t going in to Martha’s yet?’
‘What did I tell ye?’ demanded Sir Robert before Joe could answer. ‘What’s that, Hearts?’
The three men vanished into the surgeons’ room before I heard any more. I was very tempted to knock on that closed door and demand a
word with Mr de Winter. It would cause no comment, as I might well want to know the answer to some professional query. Dr Homer’s remark made me decide against it. I was badly shaken about Joe’s going, and I now had to have time to think. Joe had not mentioned working at Martha’s; no one had mentioned it. He was officially off to the States. All Barny’s knew that. All Barny’s also knew that when you work in any hospital you go ‘on’ the staff. You go ‘in’ as a patient.
I went back to the theatre and my clearing to think things out. A few minutes later Bachelor told me the surgeons’ room had been emptied in a body. ‘Mr Swan asked me to tell you he’ll be in early for this afternoon’s list as he’d like a word with you, Sister. He said there are no changes on the list.’
Bill, as I had expected, came to tell me he had taken over officially. He was one of Joe’s greatest friends. We had always got on well, on and off duty. After we discussed the various changes in the G.S. Unit resident staff resulting from his moving up the ladder, I repeated the remark I had overheard. ‘Why did Homer say that, Bill?’
‘Don’t ask me, Maggie.’ He looked through some notes he was carrying. ‘Why should Joe want to work at Martha’s? Barny’s is a much better hospital.’
‘I didn’t say work, Bill. I didn’t get the impression that was what Homer meant, either. I heard him clearly. He said “going in”. He must have meant as a patient.’ I watched his expression. ‘Mustn’t he?’
He studied me thoughtfully. He was a quiet man, not given to much talking, with light brown hair and a long, pale, English face. ‘Why would he want to do that?’
‘I’m asking you. For his rheumatism?’
‘You suggesting he’s got acute rheumatism?’
‘Of course not! He’d have been warded with that. But’ ‒ I shrugged ‒ ‘I just don’t know, Bill. That’s why I’m asking all this.’
‘Sorry, Maggie.’ He shuffled the notes together like a giant set of playing cards. ‘I can’t answer any of this. Would if I could.’ He looked at his watch. ‘If you’ll excuse me and I move I can get down to Cas to see how things are shaping there before I have to start here.’
The New Sister Theatre Page 8