Kiss the Hare's Foot

by Janet Wakley

  “If this is just another time-wasting exercise, you’ll regret it. My patience is fast running out.”

  “We’re doing everything you’ve asked. All we want is someone to help us. It’s up to you. How much do you want Charlie to survive this operation?”

  The big man turned and shambled out of the room. Fifteen minutes passed before an anxious looking Danny presented himself to the team, accompanied by Maddie. Looking uncomfortable in the unfamiliar attire, he fidgeted awkwardly as he looked from one to the other before fixing his gaze upon the empty operating table, as though he were in the presence of empty gallows awaiting a condemned man. They were waiting for his father. His commitment to the care of his father and the long hours spent anxiously at his bedside had drained him and now the expectation that he should participate at his father’s operation put fear on the face of the young man. How much could he trust these strangers who had been subjected to such violence and imprisonment? They wouldn’t care if he lived or died. He looked as if he were about to be sick.

  Observing his distress, Mel was the first to step forward, smiling. “Thank you for coming to help.” She knew he had been given no choice in the matter, but felt his co-operation had to be encouraged. “When we start,” she continued, “none of us will be able to leave what we are doing. I am going to scrub with the surgeon. That means neither of us will be able to touch anything that is not sterile until the end of the operation. Clive here will be looking after Charlie throughout the operation, keeping him anaesthetised and managing his breathing. That means that you will have to open some of our packs and help me count all the swabs and needles to make sure we finish with everything we started with.”

  Danny looked even paler and apprehensive. A fleeting thought struck Mel that he might just faint when the opening incision was made into his father’s abdomen, but brushed it quickly aside, preferring not to consider yet more possible complications. He was part of a tough gang, she assured herself, and so such a sign of weakness would hardly be tolerated by the other members of the gang.

  Clive and Silas waited patiently while Mel spent several minutes demonstrating to the young man the correct way to strip open a package and tip it forwards onto her trolley without touching the contents with his fingers. They used a couple of dressing packs from the storeroom for practise and when satisfied that he was competent to assist, Mel nodded to Silas that they were ready.

  Silas approached Hood, this time ignoring Maddie’s presence completely. “Right, then,” he commanded, almost appearing to enjoy his temporary superiority, “you’d better send for our patient.”

  18

  Instructed to stand back against the farthest wall, the three hostages watched as Charlie was carried carefully and slowly into the theatre suite by Mat and the man in the green corduroy trousers. Transported on a stretcher that was too short, his feet hung down unsupported. He was awake and still showed signs of respiratory distress, his chest heaving with the effort of each breath. He was very weak. Dark sunken eyes, now bordered by a red rim, scanned the room anxiously, fear imprinted on his sallow complexion.

  Clumsily the stretcher was lifted and rested awkwardly onto the make-shift operating table.

  “For goodness’ sake, be careful, Dennis.” Maddie instinctively reacted to the uncoordinated action of the guard in the corduroy trousers, whose grip on one of the stretcher poles slipped, causing it to twist precariously and very nearly losing control of the weight. Silas boldly stepped forward to take control and direct the accurate supine positioning of the casualty, spending what Mel perceived to be an excessive amount of time making small and unnecessary adjustments to Charlie’s eventual position. Nobody objected to his interference and gaining in confidence, Silas began giving instructions to Mat to fetch some bandages from the storeroom with which to secure Charlie onto the table. Next, under his direction, the position of the light was then aimed onto Charlie’s torso and the primitive suction machine placed to one side of the table and plugged into a socket in the wall. These tasks completed, Silas eventually nodded his approval at the end result, and the bearers were at last allowed to withdraw. With a dismissive nod from Maddie, Hood also left the room.

  Only Maddie and Dennis remained as guards. The two stood side by side against the closed outer door. Dennis looked relaxed, his arms folded, with the look of someone about to be entertained, but the bulky line of his jacket was sufficient evidence to show that he was still armed.

  Clive, grinding his fists together, was showing the inevitable signs of stress. With a quiet, almost husky voice, he questioned Charlie about loose or crowned teeth and his last oral refreshment. Charlie offered no response and after a short pause, the information was provided by Danny, who appeared equally ill-at-ease. Examining the cannula, which had earlier been positioned into the back of Charlie’s hand by Silas, Clive decided to introduce another into the side of his wrist. Mel stepped forward to squeeze Charlie’s arm, acting as a human tourniquet, while Clive gently tapped the back of his hand with the tips of his fingers until the veins, filled with blood, stood proud. Deftly he inserted the new tube and secured the cannula with tape, ensuring good venous access for the drugs and fluids that were soon to be administered.

  Silas began to wash his hands with a vigour that splashed the golden iodine liquid, onto the wall behind the sink. Both he and Mel now sported blue theatre hats and masks and began their preparation for the operation, leaving Clive to attach a new litre bag of intravenous fluid to one of the cannula and take initial observations of blood pressure and pulse.

  Two sterile gowns, folded into cubes stood side by side on the opened paper wrapping, each accompanied by a pack of sterile gloves. Mel watched attentively as Silas, after drying each hand with a separate sterile paper towel from the pack, took a firm grip of the cube where the inside of the armholes were folded onto the uppermost surface. The procedure looked easy as he turned away from the trolley and allowed the bulk of the gown to drop away, while still holding the armholes and into which he pushed his hands. Thrusting his arms into the sleeves as far as the cuffs, Mel moved closer to take hold of the tapes hanging from the back opening of the gown and tied them securely. Next he manipulated the gloves, with his hands still hidden from view within the long sleeves, and one by one expertly pushed his hands through the cuff into the body of each glove. His slick adroitness at this deceptively tricky task added further anxiety to Mel, who, despite the limited number of glove packs at their disposal, now laid open an extra pair beside her own gown. Better safe than sorry, she thought, before turning away to position the instrument trolley and remove the outer paper packaging of the instrument tray.

  Next she returned to Clive to assist him with the induction of Charlie’s anaesthesia. For several minutes, Clive supplied Charlie with a high volume of oxygen, via a plastic facemask, improving his oxygenation before connecting a syringe to the cannula on his wrist. Charlie quietly succumbed to the anaesthetic drug without resistance as slowly the milky-white liquid, passed from the syringe and into the vein. Mel watched as Charlie’s eyes closed and hypothesized what thoughts had been in his mind as he drifted into unconsciousness. Did he really believe that he would survive the trauma that was about to begin, or had he submitted to the likelihood of death with passive acceptance? Longevity perhaps didn’t rate very highly in their occupation, she surmised grimly. And yet they were going to a great deal of trouble to save this particular member of their gang. How had it come to this? Attempting to operate on a very sick man in a veterinary surgery was entering into the realms of fantasy. The operation stood about as much chance of success as a golfer hitting a hole in one. Mind you, that has been done...

  She continued to watch as drugs contained in two further syringes chased the first into his veins. Clive calmly stepped behind Charlie’s head and, lifting his chin to extend his head back, expertly inserted the long plastic endotracheal tube into his airway, guiding it down past
the smooth metal blade of a laryngoscope. Satisfactorily positioned, he then squeezed the empty syringe to inflate the bulbous cuff of the tube, deep in the trachea. Charlie at least now had a safe and protected airway during the period of the operation. If Clive was suffering stress, it was no longer apparent. Mel witnessed his professional competence replace the nervous anxiety that had looked likely to overwhelm him earlier and hoped to be similarly blessed.

  Silas, scrubbed and gowned ready for the surgery, had little option but to wait patiently for the anaesthetic to be given. He stood away from the side of the table watching the preparation of his patient with his gloved hands clasped together at waist height.

  Finally, when Clive acknowledged his readiness to start, Mel stepped away and attempted to emulate the surgeon as she scrubbed her hands and managed to successfully negotiate her way into her own sterile gown in an acceptable, if awkward manner. Frown lines creased her forehead as she gingerly manipulated the first of her gloves.

  “Move away from the trolley!” Silas yelled abruptly from the far side of the theatre, from where he was observing Mel’s clumsy attempt to prepare for the surgery. He stood, feet apart, still with both gloved hands clasped together, in the familiar stance of theatre personnel to avoid accidental contamination.

  The sudden shout startled Mel, whose recoil lost the grip on the glove and she saw too late as it fell from her grasp to the floor. Silas glared. His angry dark eyes bore into Mel with pure contempt. Mel flinched, but obediently stepped smartly back from the trolley and, turning her back towards Silas, took advantage of the second pair of gloves with greater success. Biting her lip, she resolved not to be intimidated by him. Danny, under instruction, tied the tapes at the back of Mel’s gown.

  “He’ll be okay, won’t he?” The whisper in her ear was almost a croak.

  “We’ll do our best.” Mel hardly felt confident.

  Mel crossed to the larger of the metal trolleys and after gently covering the surface with a green sterile linen towel from the pile packed onto the top of the instrument tray, began sorting through the instruments and laying them out in neat rows. There were so many; nearly sixty items. She was pleased to realise how many she recognised from her earlier experience as a student, but so many she had forgotten, both their name and their purpose. She began by setting out onto her trolley the metal dishes and placed neatly together the six varied pairs of scissors. The scalpel handles she placed into a kidney dish and then spread into a line all the forceps and retractors as she had seen scrub nurses do and hoped it would make it easier to identify those that Silas asked for during the operation. Taking hold of two gauze swabs, she wrapped each around the farthest end of long handled sponge holders, securing them by closing the ratchet handles. These she placed beside a small plastic galipot into which Danny was instructed to pour some pink alcoholic chlorhexidine skin wash.

  Aware that he must not touch the trolley, he held out the bottle at arm’s length. She noticed with amusement how Danny’s tongue protruded from his opened mouth in concentration as he aimed, as best he could, the liquid as it fell from the container towards the small receptacle. The resulting splash splattered the surrounding green towelling and without looking up, Mel sensed rather than heard the long intake of breath by the agitated surgeon as he watched their incompetence and struggled to maintain his composure. Despite repeated instructions from Mel, Danny wrestled with the connection of the diathermy lead to the machine before correctly setting the dial for cauterisation. Fingers that fumbled with the unfamiliar equipment were already delaying the start of the procedure, which they all hoped would take little more than half an hour. No one looked towards Clive, who had already spent many minutes manually depressing the oxygen reservoir bag in order to artificially breathe for their patient.

  Mel stood, with her trolley beside her, on the opposite side of the operating table to Silas. Repeatedly she ran her eyes over the shiny rows of instruments and tried frantically to familiarise herself with the layout of the set.

  “What are these again?” she studied a small collection of forceps with distinctive shaped teeth.

  “Babcocks, Lanes and Allis forceps. Don’t worry about remembering all the names, I’ll tell you what I want and when I need it.” Silas’s frustration was evident as he strove to control his volatile temper, surrounded as he was by bungling amateurs.

  “Are we all ready to start then?” Clive anxiously looked towards Silas.

  “Yes, let’s get on with it,” replied Silas curtly and then added more civilly, “good luck everybody.”

  Seven circular down-lights focussed upon an area of dappled burgundy flesh, its taut distension reflecting the brightness. Silas took hold of the sponge holders and one at a time painted the alcoholic skin solution in methodical strokes across the abdomen, covering the area thoroughly and well beyond the area to be incised. Mel relieved him of the spent sponge holders and next held out to him each of the green linen towels, which he systematically draped over the patient, attaching them with large metal towel clips until just a square area of painted skin remained uncovered. After a sweeping glance to assess the readiness of all the participants in the room and receiving a nod of acknowledgement from Clive, Silas held out his hand to receive the scalpel with which to make the first incision.

  “Ready?” he looked directly at Mel.

  With a nod, she handed the dish containing the knife.

  19

  One slow deliberate stroke, as though drawing a straight line with a pencil, Silas drew the scalpel from just below the sternum down the centre of the abdomen as far as the pubis, an incision of more than six inches. Once through the skin, he proceeded to cut further into the flesh, stopping frequently to take the diathermy probe from Mel as each bleeding point required to be cauterised. Each time it emitted a short sizzling sound and the slight smell of hot flesh as the probe gripped and burnt the tiny tissue ends. Through the rectus sheath, he continued cutting until he reached the layer of the peritoneum.

  “Two clips please,” ordered Silas without looking up.

  Mel placed the handles of the forceps, one at a time, firmly into his opened hand. She watched as he attached each instrument to the layer of peritoneum in order to lift it.

  “Knife.”

  She returned the scalpel to his hand.

  “Now I’m going to make a small incision here to start with to allow the air to get in. This will allow the abdominal organs to drop down. Then I’ll extend it. You need to be ready with the sucker.” He explained the procedure, as if speaking into the wound, eyes firmly fixed upon the increasingly cavernous opening.

  As the sharp curved blade sliced through the visceral sheath of the peritoneum, just like the puncture of a water bed, it released the internal pressure. A copious clot, like a spongy glutinous mass, shining under the fierce bright lights, rose up on its bed of free fluid as though it were boiling. The release of its confinement allowed the eruption of its hidden contents to rush from its depths. Liver-like clots obscured the scene, evidence of the long slow seepage that was sapping Charlie’s strength and life.

  “Suction! Quickly!” yelled Silas, his hand already extended to receive the apparatus. Thrusting the hissing tube into the cavity, it gurgled and spluttered as it vacuumed away what seemed to Mel copious amounts of the liquid blood.

  “Receiver!”

  Pulling clots the size of golf balls out of the opened wound, he flung them into the metal dish, continuing to use the sucker, which now dragged the dark thick blood down the length of its tubing into a plastic receiving canister. As the canister filled, Mel called to Danny to bring over a replacement.

  Danny, who had fidgeted and carefully moved unobtrusively around the confined theatre space, to gain the best possible view of the proceedings, now stood like a statue. The unexpected drama unfolding before his eyes, drained the colour from his face, his eyes wide and staring
, mouth opened as fear transfixed him to the spot.

  “Danny! Somebody! Get me another bottle! I need it now!” Mel’s shout left Danny unmoved.

  Maddie left the door she was guarding like a greyhound from a trap. Grabbing a replacement canister from a box in the corner of the room, she delivered the item almost at a run. Mel talked the novice through the procedure of stopping, disconnection and re-connecting the new bottle and, after a few minutes delay, once again the sucker tube gurgled and rattled as it withdrew yet more blood from the patient.

  Silas perspired heavily. Droplets of water ran down his forehead unchecked. Unable to wipe away the moisture whilst enveloped in sterile gown and glasses, he could only blink repeatedly, trying to relieve the smarting in his eyes and maintain reasonable visibility. Lack of air-conditioning in the veterinary theatre and with no facility for rapid air exchange, the temperature within the confines of his attire rose. The discomfort was exacerbated by the tension.

  Mel was quick to recognise his difficulty. “Maddie,” she called, deciding to waste no more time on her official helper Danny, who remained in a catatonic state. Instead she turned to the woman who at least appeared to have temporarily abandoned her role as prison guard. “Use one of those paper towels over there to mop his brow, please. Whatever you do, don’t touch his gown or the green drapes,” she added the warning.

  Obediently Maddie carried out her instructions, reaching on tip-toe beside Silas to remove the persistent perspiration. Silas, who turned slightly towards her to accommodate the wiping of his forehead, turned back immediately to the matter in hand, without acknowledgement.

  As the bloody scene was at last cleared of almost a litre of blood, Silas began to pull aside the small bowel and omentum, at last exposing a view of the top of the spleen. A fibroelastic capsule encased the purple organ, resembling a soft aubergine, which now oozed a new persistent leakage of blood.