She inserted a cannula to give the anaesthetic and prepared the drugs in syringes. She set up the basic monitoring equipment: a blood pressure cuff on his arm, a pulse oximeter clipped onto his finger to measure oxygen saturations, and an ECG monitor. Adam’s heart rate – still too high – was registered in a series of regular beeps.
The important thing now was to get him to sleep as fast as possible. She put a mask over his face and gave him a hundred per cent oxygen. Next were the drugs that would induce unconsciousness and then paralysis.
As soon as they took effect Adam would stop breathing. She would have to intubate the patient in order to get him breathing on the ventilator.
“You can do this,” she told herself. “You’ve prepared for this.”
She was glad to see that her hands were completely steady as she carried out the procedure with the laryngoscope. Moments later the tube was in the right place and the monitors were registering Adam’s condition in a series of regular bleeps. She let out her breath in a sigh of satisfaction.
She turned on the anaesthetic gas that would keep Adam asleep.
“OK,” she said, “over to you, Craig.”
He nodded.
She went to scrub up and put on her hat, gown, mask, and surgical gloves. She swabbed Adam’s abdomen with antiseptic and covered him in drapes, leaving only the area around his appendix visible.
She nodded to Ernesto to indicate that she was about to start. She put in her earpiece. Craig had fixed up the communications earlier and she knew that Rose, the surgeon at Addenbrooke’s, was waiting on the other end of the line.
“I’m here,” Katie said.
“OK,” Rose said. “You’re going to be fine. No hurry. Just take a moment. Relax. Focus. Let me know when you’re ready.”
She let her breathing settle. She said a little prayer. She saw everything with an extraordinary clarity: Adam, the regular bleeping of the monitors, Ernesto with his eyes fixed on her face.
“I’m ready,” she told Rose.
“OK. Take the marker and draw a line between the umbilicus and anterior iliac crest. McBurney’s Point is about two-thirds down that line and, as I said earlier, that’s where you make the incision. Done that? OK? The incision needs to be about seven centimetres. You know all this, but I’ll talk you through it.”
Katie nodded to Ernesto and he handed her the scalpel.
Now that the moment had come, all her anxiety had dropped away. Her own feelings were unimportant. She was just a tool. Her whole being was narrowed down to this place, this moment. A great sense of calm descended.
Rose’s voice continued in her ear. “OK?”
“OK. I’ve made the incision.”
“Now you dissect through the subcutaneous fat…”
“There’s a bit of bleeding.”
“No problem. Just cauterize that and continue.”
The calm voice in her ear was a lifeline. The ritual of the operation continued.
She was almost at the point of taking the appendix out when Rose’s voice disappeared in a burst of static.
“Craig! She’s gone!”
He was at her side in a moment. A quick adjustment and Rose’s voice was back, loud and strong.
She sighed with relief. This was the trickiest part and she didn’t want to be doing it alone.
She was just about to lift the appendix out when something happened. She paused with the scalpel in mid-air, alerted to a problem without knowing what it was. Then she did know.
The bleeping of the monitor had dropped a tone. And now it dropped another tone. She turned her head to look at the digital display. The oxygen saturations had dropped from ninety-eight per cent to ninety-four. What the hell was happening?
She forced herself to stay calm. OK, suspend the op, cover the wound with a swab, find out what had gone wrong.
Craig was looking at her with horror in his eyes. She motioned him back. Adam’s oxygen level was continuing to drop. OK. Turn the oxygen right up to a hundred per cent. Check the ventilator. Was Adam’s chest moving? No! He was not breathing! Stay calm, stay calm. Is the tube still in? No, somehow it had got dislodged.
All the time the warning bleeps were growing more and more insistent. Oxygen saturations were down to eighty-six per cent. Time was running out and if she didn’t reintubate Adam, he would be dead or brain-damaged in a matter of minutes.
She reached for the laryngoscope. Stay calm, she told herself, stay calm. Stay calm. Stay calm. You can do it. You’ve done this before. Don’t rush, gently, gently. It seemed to take forever and for a terrible moment she thought she hadn’t got the tube in correctly – but she had. His chest began to move. She looked at the monitor and saw that his oxygen level was going back up. She was limp with relief.
Everything was back to normal.
Somehow her earpiece had stayed in. She told Rose what had happened and gave herself half a minute to let her heart rate settle.
Then she went on. She lifted the diseased organ out and put it in a kidney dish that Ernesto held ready. She would incinerate that later. She was on the home straight now. All that remained was to sew up the wound and that was the easy part.
“That’s it, all done,” she told Rose.
“Way to go, girl!” Rose said, and Katie could hear the smile in her voice.
Katie said, “First thing I’m going to do when I get home is come up to Cambridge and buy you a meal in the best restaurant in town.”
“Looking forward to it. OK now, Katie? This is me signing out then.”
Katie gave Adam morphine for the post-operative pain. She turned the anaesthetic off and waited until he began waking up. She removed the tube. She knew what must have happened earlier. When Craig left his post to fix the line to Rose, he must have dislodged it without realizing. It had been concealed under the drapes. But no harm had been done. Adam was breathing nicely on his own now. She’d have to keep a close eye on him for the first few hours, but it was over, she had done it, and she had saved Adam’s life.
She thought of what Shackleton had said. “We all have our own White South.” Yes, there are some things that test you to the limit and change you forever. This was one of them.
CHAPTER 27
ELY
Daniel was so absorbed in what he was doing that he didn’t hear Rachel come in with a cup of tea. He only realized that she was there when she said, “Dan?” It was Saturday afternoon and she’d been baking with Chloe. A warm and fragrant smell wafted in with her. He reached for the mouse but it was too late, she’d seen what was on the screen.
“What’s that?” she said, looking at the pictures of smiling babies and happy parents. She leaned over his shoulder and read what was on the screen. “Surrogacy? You’re looking at websites about surrogacy?”
There was nothing for it. He’d have to tell her what was on his mind – and it was time he did that anyway.
He swung his chair round to face her and said, “I’ve been thinking… about another child… one that might be a match for Chloe.”
She pulled up a chair and sat down. “I’ve been thinking about that, too. About what’s best for her – and what’s best for us as a family and I’ve decided –” She hesitated.
He waited with bated breath. Was it really going to be this easy? Had they all along been thinking along the same lines? He hardly dared to hope.
At last she came out with it. “I’m ready to try for another baby, Dan.”
He let out a sigh and leaned back in his chair. He might have known it was too good to be true. Assuming a patience that he didn’t feel, he said, “We’ve been over this, Rachel. After what happened last time, it’s out of the question. We agreed –”
“That was when it was all fresh in our minds. Maybe it’s time to think again. OK, I’m not very likely to get pregnant, but the doctors have never said that I shouldn’t try…”
“But Rachel, surrogacy is so much more common now. I know there’s a lot that’s dodgy – women in India or
the Ukraine who are exploited because they are so poor – I wouldn’t want to do that either. But there are women right here in the UK, who undertake surrogacy for altruistic reasons. And with surrogacy we could arrange things –”
She broke in. “It seems all wrong to expect a woman to take a risk that I’m not prepared to take myself.”
His exasperation was mounting. “But there isn’t a risk – not really – for a woman who’s given birth without any problems in the past.”
“There’s always some risk.”
“But not like with you!”
“OK,” she admitted. “Yes, there is a bigger risk, but they know that, so it can be managed.”
“And that’s not all.” He hesitated, knowing that he was on shaky ground.
A cloud crossed Rachel’s face. He saw that she knew what was coming.
“We could select an embryo that would be a match for Chloe. It’s her best hope. Rachel, can’t you see that this is the answer?” he pleaded.
“We’ve been through this before,” she said. “And we agreed it was a road that we wouldn’t go down.”
“That was your decision. I was never really on board, you know that, Rachel. But while we were agreed that you weren’t going to have another baby, it wasn’t worth arguing the toss.”
Rachel’s mouth was set in a stubborn line. “Embryo selection means that one is chosen and others are rejected – that embryos have to be destroyed. Even if I could accept that, what about those children who are born to be saviour siblings – does anyone know the long-term effect? How they’ll feel knowing that they owe their life to being a match, that they were born to provide stem cells for another child. And what about informed consent? How can a baby consent to anything?”
“It’s not just for that,” he protested. “We want another child anyway.”
“But will he or she know that? And can we even really know that it’s the truth? We didn’t talk of having another child before we had Chloe.”
He felt his temper rising. “OK, it’s not perfect. Life’s not perfect. We just have to do the best we can in the circumstances.”
“And that is really the best we can do?” she demanded.
“Those embryos, they’re not children, they’re not even foetuses. They’re just a…” – he sought for the words – “they’re just a bundle of cells. Rachel, you’re not being rational.”
“I’m not being rational!” Rachel got to her feet, her eyes wide. “You’re the one who won’t accept the medical evidence – won’t believe that it’s safe for me to have another baby.”
Now he too was on his feet. He was so angry that he scarcely trusted himself to speak. “You know what, Rachel. I can’t talk about this now.”
He left the room, slamming the door behind him. Chloe must have heard their raised voices. She was standing open-mouthed at the top of the stairs. He snatched his car keys from the table by the door and grabbed his coat from the peg.
Then he was outside, taking in long breaths of the fresh, cool air and feeling a speckling of rain on his face.
* * *
Without thinking about where he was going he took the road west out of Ely. He drove aimlessly, not caring where he went; he just needed to drive until his anger and frustration subsided. Why couldn’t Rachel understand that he meant everything for the best? Why was she so obstinate?
He found himself heading towards Ramsey along a road that ran parallel with one of the dykes, straight as a ruler, that cut across the Fens. Curtains of rain were advancing across the vast, open fields and then the heavy rain arrived, beating against the windscreen. It occurred to him that he was driving too fast, but as his foot touched the brake, the car hit a patch of mud made slick by the rain. He felt the car float free from his control and his stomach lurched. He tried to steer into the skid. The car swung first one way and then the other. Then the tyres gripped again and he slid to a halt on the verge at the side of the road.
He sat with his hands pressed to his face and took in deep breaths. It had all happened so quickly and it was frightening to think how differently it might have ended if something had been coming the other way.
The rain was easing off, only flecks now on the windscreen. He got out of the car, leaving the door ajar. The gentle rain was welcome on his face. He stood looking out across the Fens at houses made tiny – like Monopoly houses – by the distance and the lines of bare trees were flattened by the misty drizzle.
Something moved on the periphery of his vision. He hadn’t noticed that the verge sloped gently towards the dyke. The car was inching forward. Very, very slowly, so slowly that it was hardly moving – yet seeming possessed of malign purpose, it was lumbering away from him.
The driver’s door swung open. Without thinking he launched himself head first into the car, intent on wrenching the steering wheel around. But he was too late. The car was picking up speed and was already moving too fast. He found himself on his knees, with his body half in and half out of the car. He tried to pull himself clear. He almost succeeded, but as the car plunged down the bank, the momentum swung the driver’s door shut again and it closed on his left hand. Pain shot up his arm and he tried to pull loose, but his hand was trapped. His feet scrabbled for purchase on the slippery grass, but he was dragged along faster and faster down the slope into the dyke. The car hit the water with a fearsome splash. It came to a jarring halt and the brackish water rushed up over his head and filled his mouth and nose.
Still tethered to the car by his trapped hand, he swung around in the water. His free hand closed on the wing mirror. He pulled himself as high up the side of the car as he could and got his chin above the surface of the water. He coughed and spluttered, and water streamed out of his nose.
The water was swinging back and forth in the dyke like a solid block. Slowly it settled. There was no sound except for the patter of rain on the roof of the car. He was aware now of the pain in his hand, was aware of almost nothing else. His own ragged breathing was loud in his ears.
The car shifted. It was settling deeper into the dyke and taking Daniel with it. With his free hand he fumbled with the door, but the handle seemed somehow to have got jammed and he couldn’t get it open. Was he going to drown? He thought of Rachel and Chloe. There were voices. Someone was shouting and, twisting his head around, he saw a figure against the sky. Then someone – a man – was scrambling down the bank. He plunged into the water and seized Daniel’s arm. Daniel wanted to explain that his hand was trapped and he couldn’t open the door, but the words wouldn’t come. There was someone else there now, a young woman, two anxious faces trying to make out what he was saying. Then the man disappeared and the woman was stroking his face and saying, “It’s alright, it’s alright. Mike will get the door open.” The car creaked and sank a little more. Then the car door opened from the inside and his hand came free.
Then they were both there with a shoulder under each arm and they were half supporting him, half dragging him out of the water and up the bank. They lowered him onto the verge.
“Thank you, thank you,” he gasped.
There was someone else standing there, an older woman.
“The ambulance is on its way,” she said.
He wanted to protest. “I don’t need – I think it’s just my hand…” He cradled it, held it close to his chest.
The younger woman said, “You’re in shock. And they’ll need to X-ray that hand.”
“Thank you, thank you,” he said again. “You’ve been… you’ve been…” His voice trailed off. He couldn’t think what he wanted to say. He was shivering.
Mike said, “Nah, you’re alright, mate. Good job we saw the car go off the road.”
The older woman had gone back to her car. She brought back a blanket and put it around Dan’s shoulders.
There was the sound of sirens. The ambulance arrived and the police, too.
Dan was helped into the ambulance. The younger woman said, “Let us know how you get on” and he had the prese
nce of mind to ask for their names and email addresses, those of the older woman, too. The younger woman wrote them down and put the piece of paper in his jacket pocket. As the ambulance was about to move away, the older woman came hurrying over. “You’ll probably be ages in A & E. Have these.” She handed him a small bottle of mineral water, an apple, and a Penguin biscuit.
The ambulance drove off. When he arrived at Addenbrooke’s hospital, he found he was still clutching the apple in his good hand as if it were a talisman.
* * *
“You’ve fractured your fibula.”
Mr Wright, the orthopaedic surgeon, gestured to the X-rays pinned up on the screen. He looked as if he had stepped out of some US hospital soap opera. He was tall, broad-shouldered, and blonde chest hair curled at the V-neck of his green hospital scrubs.
“But it was my hand that was trapped – it’s just a cut on my leg.”
“’Fraid not. The hand looks worse than it is, nothing’s actually broken. As for the fibula – look, you can see it here.” He ran a finger along a chalky line on the X-ray. “Luckily it’s quite straightforward – it isn’t out of alignment – and it doesn’t require surgery. It should be enough if we put it in plaster, but you’ll have to rest it.”
“How long am I going to be out of action?”
“Well, you’ll have to be in plaster for a couple of weeks. You should be pretty mobile after that. The fracture will heal just fine. The soft tissue damage will take longer. It could be months before the wound on your leg heals.”
“Months! But how did it happen without my realizing?”
Mr Wright examined Daniel’s leg with gentle hands. “Well, judging by the pattern of bruising, my guess is that the back wheel of the car went over your leg. There’s quite a bit of soft tissue damage there.”
The painkillers had kicked in now and Daniel was having trouble focusing – or maybe he was still in shock. He couldn’t make sense of this. “It went over my leg?” he asked. “But why didn’t it hurt?”
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