‘A bit longer, I’m afraid, Mr. Quayle,’ the nurse said, expertly lifting him up in bed to arrange the gown neatly round his buttocks. ‘There’s an emergency to do before you. Sister says you’ll probably go to theatre about nine or so. She’ll give you an injection soon. Just you relax now——’
And she went away, leaving Mr. Quayle feeling anything but relaxed.
Eight fifteen a.m. The Staff Nurse in theatre pulled her mask down to dangle comfortably round her chin as she closed the main theatre door behind her. Trolleys, set. Mayo table, ready. Gloves, out. Gown drums, ready. Mentally she ran briskly through the arrangements for the morning’s list, and then made for the anaesthetic room to check that everything there was ready for Dr. Elliot before going to see whether Sir James had arrived so that she could send for the first patient. Emergencies. An awful nuisance today, seeing it was her half day and she wanted to get off on time, but it couldn’t be helped——
Barney Elliot came through the big swing doors, nodding cheerfully to Gellard, the theatre porter, who was checking the oxygen cylinders on the spare anaesthetic machine.
‘See the soda lime is fit, will you, Gellard? I’ll need it later today for the first big case on this afternoon’s list—Good morning Staff Nurse Cooper! I trust I see you in bouncing health? Ready for work? Nothing like one of Sir James’s pernicketty gastrectomies to start the day——’
‘Morning, Dr. Elliot. And we aren’t starting with the gastrectomy. There’s an emergency hernia on first.’
Barney stopped. ‘What? Why doesn’t anyone tell me these things? I haven’t seen any hernia, or written up a premed——’
‘Mr. Foster saw him in Cas this morning early, and phoned Sir James, apparently. Sir James told him to alter the list and to write up the pre-med. Didn’t he tell you?’
‘He wasn’t at breakfast, lazy devil. Though if he was up in the small hours—oh, well, send for the man, will you? I’ll have a good look at him in the anaesthetic room. I prefer to write up my own pre-meds, but it’s a bit late now——’
And he went across to the anaesthetic room, shrugging off his white coat as he moved. ‘Is there a gown ready for me?’ he called over his shoulder.
‘Mmm. I set up in there last night,’ Nurse Cooper said. ‘But I haven’t unlocked yet. I’ll get the key——’
But Barney had already opened the door. ‘You’re dreaming, sweetheart!’ he called cheerfully. ‘This door’s not locked——’
She followed him into the small anaesthetic room, her forehead creased in surprise.
‘That’s odd. I remember perfectly well that I locked up last night——’
‘You must be in love again,’ Barney said, and laughed. ‘Never mind. I won’t breathe a word to Sister. Get me my sterile tray, there’s a good girl, and forget you forgot.’
‘I did nothing of the sort!’ Cooper said indignantly. ‘I did lock up. I have to, when I’ve put out the drugs and all—but look, I would be grateful if you didn’t mention it to Sister. I mean, she doesn’t like us setting up the anaesthetic room overnight, but it does save time in the mornings——’
‘Promise. And now can I have my patient? Because the old boy’ll be a great deal nastier than Sister if he has to waste his time because I’m not ready for him.’
‘I’ll send Gellard for the patient,’ she said, and turned to go. ‘Mind you, I still think it’s odd. I know I locked up properly last night——’
‘Oh, go on——’ Barney said, and went to wash his hands. And Gellard went to collect the Polish sailor, by now feeling a good deal too ill to care whether he had an operation or not, and Sir James arrived in a pomp of grey striped trousers and black jacket, and the junior theatre nurse turned off the steriliser ready to dish up Sister’s first lot of instruments.
The day had started.
CHAPTER TWO
AS HE mixed the pentothal, snapping the slender glass neck of an ampoule of sterile water and squirting the contents into the yellowish powder before drawing the resulting straw coloured fluid into his favourite big syringe, Barney was happy. It was odd how much pleasure there was to be found in anaesthetics. He’d never thought back in his student days that he’d turn into a gas-fight-and-choke man, the label given to anaesthetists by irreverent third year men, but there it was. The speciality fascinated him, and he was good at it.
Another six months here at the Royal and he’d be ready to apply for a junior consultancy in anaesthetics. And that would mean a better income, and all the agreeable possibilities that more money meant. Like a home of his own, for example, instead of living a celibate life in hospital.
And then he remembered the patient he was to deal with on Female Medical later that morning, and felt even more contented. Sister Beaumont provided excellent coffee in her neat ward office, and fifteen minutes spent drinking it in her company was something well worth looking forward to.
Behind him the man on the trolley muttered in the depths of his drug-induced sleep, and the little Junior Ward Nurse who had accompanied him to the theatre leaned over nervously and patted his shoulder.
‘Poor man doesn’t speak English,’ she told Barney, feeling obscurely that she ought to explain why she hadn’t spoken to her patient in the approved manner. ‘He just mutters at us when we try to explain things to him.’
‘Poor feller,’ Barney agreed sympathetically. ‘Bad enough to have a belly ache like his without it happening where no one speaks your language. Ah, well, the sooner I put him out, the sooner we can deal with his belly ache, hmm? Roll up his sleeve for me, will you? That’s it—good girl——’
And the little nurse blushed and obeyed, wishing she were senior enough to work in the theatres all the time, near this nice ugly man who was always so kind to juniors.
As he gently pushed home the plunger of the syringe and dripped the pentothal into the vein in the crook of the elbow, watching his patient’s face all the time, Barney felt the draught of warm antiseptic air that meant someone had come through the big swing door behind him. But he didn’t look up until all the pentothal had been given, and the airway tube was snugly in place in the patient’s lax mouth. Then, as he fixed the anaesthetic mask into place over the face, he raised his eyes.
‘Hello, Colin. Ready for me? Won’t be long now——’
The older man shook his head without looking up from the folder of notes he had picked up from the foot of the trolley. ‘Not yet—Sir James hasn’t changed, so I can’t scrub up yet. Where’s this patient’s notes?’
Barney twisted the knobs on the machine, sending the little chrome markers dancing in their tubes as he balanced the supply of oxygen and nitrous oxide. The rubber balloon of the respiration bag on the machine filled, emptied, filled again and then settled to the rhythmic pattern of the patient’s breathing.
‘You’ve got them there,’ he said, and looked up in surprise as Jackson moved swiftly to the other side of the trolley to stand staring down at the patient. ‘Why? What’s the matter?’
‘What the hell is going on? This isn’t Quayle! What do you think you’re doing?’
‘Giving an anaesthetic,’ Barney said, crisply. ‘It’s a habit of mine——’
‘Don’t be so bloody funny!’ Jackson snapped, and his face was blotched red with anger above his mask. ‘The first patient on today’s list is Quayle, a gastrectomy——’
‘I thought you’d have known though I only just found out,’ Barney said. ‘They switched the list for this feller—a strangulated hernia that came in in the small hours. What’s the panic?’
‘Who switched the list without telling me?’ Jackson said, his voice high with anger. ‘I don’t spend my valuable time planning lists so that people can come along and alter them without so much as a by-your-leave! Sir James will——’
‘Sir James already knows,’ Barney said soothingly. ‘Foster diagnosed the case and called Sir James, and apparently the old boy decided to do the job himself. So there’s nothing to worry about——’
‘Foster. Interfering idiot!’
Barney frowned, and glanced at the nurse beside him, round-eyed with interest at this disagreement between members of the medical staff. This would be something to tell the girls at coffee break.
‘I imagine Foster preferred not to wake you unnecessarily in the small hours. I’d call that consideration, not interfering.’
‘I should have been told,’ Jackson said stubbornly, still staring down at the unconscious patient on the trolley. ‘He should have told me at breakfast.’
‘Which he missed. Probably because he had a broken night. Oh, look, Colin, do stop fussing. I know Derek’s sometimes a bit slaphappy about the details of administration, but he’s a good chap, and meant no harm. If I know Derek, he’s spitting bullets because he wasn’t allowed to do the case himself. He’s working for his Fellowship, remember, and——’
‘What did you give him?’
‘Hmm? This chap? Pentothal, and nitrous oxide. He was pretty shocked on admission, so I want to keep it light. You’ll need a good deal of relaxant, I daresay, come to think of it. Those abdominal muscles will be pretty rigid. Nurse—go and tell Nurse Cooper I want her, will you?’
The little nurse went, and Jackson turned to follow her.
‘Well, since you’ve started there’s nothing I can do about it, I suppose. But I’ll have a good deal to say to Foster when I see him, and so you can warn him if you see him first. I won’t have these damned junior housemen taking the law into their own hands——’
Barney shrugged, and grinned at Nurse Cooper as she came in with the junior nurse scuttling behind her.
‘We’re going to have a lovely morning, sweetheart. Jackson’s in a temper, and Sir James will probably catch the infection, so Gawd ’elp us all. Look, I want to give this man some curare, so get me some sterile water, will you? I want to use a dilute dose.’
‘There’s some in the rack,’ Cooper said, moving over to the drug tray and the little rack of ampoules.
‘If there were, I wouldn’t be asking you for some now,’ Barney said patiently. ‘There was only one and I used it for the pentothal. Now do put a move on. All those surgeons need now is to have to wait for me and there’ll be all hell let loose. This isn’t one of your efficient days, is it?’
‘There was some there,’ Cooper said sulkily. ‘But I’ll get some more. And Sir James has started scrubbing, so you’d better put a move on——’
But Sir James wasn’t in a temper. Jackson still had a heavy, angry look on what could be seen of his face as he stood facing Sir James across the table and holding retractors and swabs, but the old man himself was in fine form. He flirted heavily with Sister Osgood, who responded with her usual overdone kittenish giggling, which made Barney wink at Cooper, who moved about the theatre fetching and carrying instruments and counting swabs.
‘Very pretty little case, this, Sister. I like a tricky one to start the day, while I’m fresh. Puts me on my mettle, hmm? Let me have a couple of Allis forceps, my dear. Thank you—yes. Very pretty little case indeed. See, Jackson? That’s a very cedematous loop indeed, isn’t it? Yes. No wonder poor chap is in such a state. Everything all right at your end, Elliot? He’s a bit blue down here.’
‘Pretty good, sir,’ Barney said. ‘Hope he’s relaxed enough?’
‘A shade on the boardlike side, m’boy. Can you remedy that for me? Maybe I’m not as strong as I was, but it’s certainly harder work to move these muscles than it was when I was a younger man. Eh, Sister?’
‘Oh, sir, you’re not old,’ Sister Osgood said, and snickered, and Sir James peered at her over the top of his mask, and snorted cheerfully.
‘Well, I don’t know—don’t know. I’m nearly at the third stage of a surgeon’s career, you know! Just pull that retractor a little to the left, Jackson—yes, fine. Fine. A piece of catgut, Sister, and then I’ll be ready for the diathermy. Yes, the third stage. Do you know the three stages of a surgeon’s career, Sister?’
He took the piece of catgut from her hand and tied a suture with a deft twist of his wrists in their smooth golden brown gloves.
‘No, sir,’ Sister said, looking up at him with an appearance of breathless interest. ‘What are they?’
Barney almost laughed aloud. The old bag! She’d heard this hoary old joke as often as the rest of them—Sir James told it at almost every operating session.
Sir James worked in silence for a moment, and then stretched his shoulders a little and turned his head so that Nurse Cooper could swab the beads of sweat from it.
‘I’ll tell you. The first stage is to get on.’
He paused, and taking a needleholder from Sister, began to put a running suture into the sheet of muscle under his fingers.
‘The second stage is to get honour.’ And he held out his hand for a pair of scissors which she slapped into it smartly.
‘And the third stage is to get honest!’ he finished triumphantly, looking round at all of them, and they laughed obediently. Sir James’s jokes were so familiar now that Barney could have repeated them with him, word for word, pause for pause.
‘Hey!’ Sir James said suddenly. ‘Who’s that in the anaesthetic room? I won’t have outside people hangin’ around these theatres while I’m working, do you hear me, Sister? Told you that before—send him away!’
Barney turned his head to look through the glass panels of the theatre door, following Sir James’s irritated glare. He could see the anaesthetic room quite clearly, and grinned a little. John Hickson.
He was leaning against the wall of the anaesthetic room where the drug tray was set, an expression of almost imbecilic hopefulness on his face as Nurse Cooper, in response to a jerk of the head from Sister Osgood, hurried through the swing doors to speak to him.
Poor Hickson, mesmerised by the pale blonde good looks of Nurse Cooper, produced a series of highly transparent excuses to spend time in the Private Wing theatres. Irritating little devil though he was, Barney couldn’t help feeling sorry for him.
Nurse Cooper came back after a moment, her face pink and her eyes demurely cast down.
‘Dr. Hickson, sir,’ she reported. ‘He says please could he come and watch since he has a free period until the ward rounds at eleven and he’d very much like to learn from you.’
‘No!’ Sir James roared. ‘He can do nothing of the sort! If the bad mannered young puppy hasn’t the courtesy to come at the beginning of a list the way I did when I was a houseman he can go and whistle. Tell him to go away!’
And Nurse Cooper scuttled away, but didn’t return for at least five minutes. After all, she had to see Dr. Hickson out of theatre, didn’t she? Only courtesy——
Sharply, Barney’s amusement at this little byplay evaporated. The bag on the anaesthetic machine began to expand and collapse less vigorously, and with an uneven rhythm, and he put down the syringe with which he had just given an injection of muscle relaxant, and slipped one hand under the sheet covering the patient’s face to check the pulse at the temple. It was thin, and uneven, and Barney frowned.
At the site of the operation, Sir James was touching forceps with the diathermy point, and instruments clattered into the bowl Sister held out for him as each bleeding point was sealed with a faint hiss and a familiar acrid odour.
‘Sir James!’ Barney said sharply after a moment, and the surgeon turned his head.
‘What’s the matter, m’boy? He’s nicely relaxed now, so not to fret——’
Barney shook his head worriedly. ‘I don’t understand this. His pulse is failing——’
‘What? Sister, a hot swab——’ Swiftly, Sister Osgood twisted a big abdominal swab in hot saline and gave it to Sir James, who covered the incision with it before turning his full attention to Barney.
‘Now, what’s his blood pressure?’
Barney was already checking it, and turned to Sir James with a puzzled look on his face. ‘It’s falling rapidly—I don’t understand this—look, can you hold on while I give him some
intravenous coramine?’
‘Of course——’ And Sir James folded his hands against the front of his gown and moved up the table to stand beside Barney and watch him closely.
Cooper had come back into theatre now, and at a signal from Barney, wheeled a small trolley to his side and began to draw up a syringe of heart stimulant while he pulled back the covering sheet and exposed the man’s arm. Then, he checked the pulse again, and felt himself whiten.
‘Damn and blast—damn, damn, damn—the pulse has stopped—put a cardiac needle on—I’ll inject straight into the heart——’
The silence in the theatre was so thick that it was like a tangible thing, only the faint hiss of the anaesthetic machine cutting into it. Barney moved with a swiftness he wouldn’t have thought possible, ripping the gown back from the broad chest, now ominously still, and running his fingers over the ribs, seeking the rib space directly above the heart.
‘Colin—take the respiration bag and keep pumping—keep his lungs ventilated——’ and Jackson obediently took the bag in his gloved hand and began a rhythmic squeezing and relaxing that filled the lungs with air. The chest began to move again under the artificial respiration and Barney, taking a deep breath, slid the wickedly long needle on the syringe into the intercostal space above the heart.
As he withdrew the needle, and put one hand back on the pulse his face cleared for a moment as he felt the lurch that meant the heart had started to pump again. But the movements fluttered wildly, and then stopped again, and Barney looked up at Sir James almost piteously, and shook his head.
‘I’ll try direct massage,’ the older man said crisply, and held out his hand to Sister Osgood.
She thrust a scalpel into it, and they watched breathlessly as the skin moved under Sir James confident fingers. Barney, his fingers glued to the pulse at the temple, found himself praying, almost willing the heart to beat again, willing the pulse that was so ominously still to start its heavy throbbing.
Death on the Table Page 2