Kiss the Hare's Foot

by Janet Wakley

  The sudden massive loss of blood caused frantic activity at the top end of the table. A flustered Clive attempted to both continue rhythmically squeezing the reservoir bag supplying oxygen to Charlie, at the same time exchanging the now empty bag of intravenous fluid with a full one. This he managed to single-handedly achieve by tucking the oxygen bag beneath his right armpit, maintaining the pumping action with his arm, and using his teeth to tear open the outer plastic covering of the new fluid bag.

  Clive’s expression portrayed a desperation bordering on panic. Crushing the new fluid bag with his hands, he forced the liquid into Charlie’s vein in an attempt to maintain the sudden drop in his blood pressure.

  “You okay there, Clive?” Mel asked in alarm.

  Silas paused to peer at his colleague, piercing dark eyes perturbed by the distraction.

  “Blood pressure” hissed Clive. “Seventy-five over thirty. Suddenly dropped. Can’t sustain him like this. You’ll have to close up and get out, Silas. Stop the operation!”

  “I can’t; not yet at least,” defied Silas. “I’ve identified the spleen now. Just let me get it out.” He dismissed Clive’s dilemma, returning his attention to the open wound with renewed commitment.

  “He needs more fluids. He needs blood!” wailed Clive.

  “Let me do that,” intervened Maddie, who gestured towards the green re-breath bag. “I can do that while you see to the rest. I’ve seen how you do it” she urged, reaching towards the bag.

  “What can I do to help?” the timid voice of Danny joined in. At last emerging from his panic-stricken trance, he at last appeared to have recognised that his lack of participation was hardly contributing to the efforts being made to save the life of his father.

  “I need another pack of swabs, Danny. There are a few packs on the bottom of my trolley. Can you open one and tip them onto my tray the way I showed you. Mel saw his lips tighten as he drove himself reluctantly to become involved.

  “Roberts artery forceps.” Silas held out his hand expectantly as Mel scanned the row of implements.

  “Which one is it?”

  “That one, next to your clips. Quickly, I need it now.”

  Swiftly she selected a scissor-like instrument. It had the ability to crush, rather than cut, with a graduated ratchet at the base of the handles used to hold the clamp in the closed position. She pressed the handles firmly into his hand and watched as Silas attached the forceps to the splenic artery beneath the spleen.

  “Another!” He clamped again.

  “Scissors!” He proceeded to cut between the two forceps, severing the artery supplying the organ. Mel watched fascinated as next he clamped and cut the splenic vein, repeating the procedure and leaving all four forceps attached. Requesting again the scissors, he began cutting away at the pedicles holding the flaccid organ in place, finally lifting the spleen like a prize free of the body and placing it with satisfaction into the metal receiver, held in readiness by Mel.

  “Suction.”

  Still a light stream of blood gurgled its way up the tubing and into the second, almost full canister.

  Meeting his eyes across the operating table, Mel saw that the dark eyes had softened and more gently this time he asked for vicryl thread with which to tie off the clamped vessels before removing the forceps and returning them to Mel to replace on her trolley.

  Silas glanced again towards Clive, who was still absorbed in his own responsibilities. Maddie continued to bag the patient, frowning with concentration as she endeavoured to maintain a steady slow rhythm of respiration, as near as she could to a dozen per minute.

  “Clive,” he interrupted the anaesthetist. “I need to wash out the wound with saline. It’ll be cold. We’ve no means of warming it. That okay?”

  “Just get on with it and be as quick as you can. He’s really poorly,” he complained.

  It took several minutes to syringe and suck out the saline and few remaining small clots, after which Silas checked the severed vessels, examined the liver for lacerations and adjacent bowels. A silicone drain, its distal end embedded deep into the wound was held in position at skin level with silk sutures. This completed, he began the process of closing all the incised layers, finally suturing the skin and covering the neat line of the incision with an adhesive dressing.

  Mel felt elated. The operation was completed and Charlie had survived. Her role as the scrub nurse had gone better than she could possibly have hoped. As she replaced the bloody instruments into the tray and covered them with a green drape, she looked at each of the participants within the theatre. Silas dragged off the sterile drapes from Charlie and threw them onto the floor. After checking the viability of the wound drain, he stripped off his gloves with a flourish and discarded them in similar fashion. Clive, having regained control of the re-breath bag, continued to pump oxygen into the non-breathing recipient, anxiety still imprinted in his furrowed brow. Maddie, standing at his side, rolled her head round on her shoulders, relieving the tension in her upper body from maintaining a fixed position for over half an hour. She seemed more relaxed and in no hurry to regain her former position next to Dennis, still guarding the outer door. Danny passed from Silas to Mel, untying the gown tapes, a suppressed grin advertising the relief he obviously felt.

  Mel discarded her protective attire, abandoned her instrument trolley and anxiously approached Clive who, still working as though oblivious to the fact that the surgical procedure had been concluded, ran his fingers over the boxes of drugs piled on a small tray beside the anaesthetic machine. Post anaesthetic recovery was at least Mel’s expertise but as she studied the unconscious patient before her, her heart began to sink. Charlie was still making no respiratory effort, despite the administration of drugs to reverse the muscle relaxants given earlier. He was still dependent upon the manual supply of oxygen. A blue tinge of cyanosis on his earlobes betrayed poor oxygenation and his blood pressure, although improved, had been written by Clive on the side of the pillow as still only eighty over forty.

  “Clive?” she asked quietly.

  “He needs blood. He’s been slowly bleeding internally for too long. I can’t do the impossible.”

  “I got us some colloid fluids and plasma expanders in one of the yellow bags,” she recalled the selection of solutions stolen the previous night.

  “I’ve used them already,” he replied miserably. “All we have left are some dextrose saline and saline bags. About six litres, I think.”

  “Then we’ll have to manage with what we have,” said Mel decisively. “Let’s raise his legs for a start.” Gathering up the drapes and gowns that had been discarded on the floor, she proceeded to pack them together into a tight bundle and wedged them under Charlie’s heels. Dissatisfied with the result she looked around for something else with which to increase the height. The theatre offered nothing suitable. “May I look in the stockroom?” she directed her question to Maddie, who nodded, but moved back to her original post by the outer door.

  A few minutes later, Mel re-emerged carrying a stout square cardboard box. Placing it beneath the pile of green drapes, she managed, with Danny’s help, to raise Charlie’s legs further, thus improving the blood pressure to his vital organs. Another litre of dextrose saline chased earlier fluids into his veins. Mel relieved Clive of the bagging. Freed of the task, he chose to pace the floor, grinding his fists together, waiting for evidence that Charlie’s blood pressure would rise. Mel paused occasionally from compressing the bag and studied the flexible green plastic balloon. At the third respite, she at last detected the faint fluctuations which showed the early signs of spontaneous breathing. Muscle tone and nerve reflexes slowly improved as Charlie gradually emerged from unconsciousness. His blood pressure too, charted an acceptable one hundred over sixty. Clive nodded, a tight-lipped smile creeping across his face.

  “Right then, I’ve done my bit.” Silas confront
ed Maddie and Dennis at the door. “I need a shower and something to eat.” He spoke with the directness of one not accustomed to a refusal.

  “We’ll have to take turns at sitting here with Charlie,” Clive spoke to no-one in particular. “I’ll take the first turn. You go and take a break, Mel.”

  Mel looked towards Silas, who threw her a piercing look of ‘I told you so’ across the room before turning back to face the door.

  “No, I’ll take the first stint.” Mel spoke firmly. “Recovery is my job. You both go and have something to eat and a rest. I’ll be fine. Any problems and I’ll send for you.” Mel wished she was as confident as she sounded. As the doctors left her alone, she turned to look at the pale and weak patient left in her charge.

  Their make-shift theatre now resembled a battle-field, proof in its aftermath of the drama played out during the past hour. Blood splashes and footprints stained the floor, discarded gowns and gloves kicked unceremoniously to the side of the room and a collection of empty drug boxes and wrappings strewn on the floor where they had fallen. The abandoned trolley, covered by one of the green drapes which had been thrown over the soiled instruments, now stood beside the sink.

  They had done it. Yes, thought Mel with satisfaction, I think we all did incredibly well. We actually carried out a life-saving operation against all the odds. And despite Silas’s misgivings, I even managed to carry out my role as a scrub nurse without any major disasters.

  At that moment, the awful truth dawned. They had all been so absorbed by the enormity of the surgery performed that all three of them had probably missed the best opportunity they would likely get to escape from the clutches of this evil gang.

  20

  An uncomfortable silence enveloped the operating theatre. Mel slowly walked in a circle round the operating table on which Charlie lay prostate, observing the patient from every angle. The bandages securing his limbs were still in place and yet he appeared precarious, stretched out like a crucifix, positioned as he was on the makeshift table arrangement. It seemed strange that he was just as much a prisoner as she. With eyes closed, his grey form lay perfectly still, like a corpse. Mel placed a hand gently onto his diaphragm to better judge his respiratory effort. His breathing was so faint it was hardly discernable. For the third time in ten minutes, she felt his weak, erratic pulse. His blood pressure remained low and she observed no significant movement from him as she inflated the cuff and squeezed his upper arm.

  Despite the presence of Dennis by the door, Mel felt suddenly very alone and uneasy. Why had she let both the doctors leave like that? Her impulsive gesture to escape Silas’s monstrous innuendo and fearing perhaps a hurtful criticism of her competence as a scrub nurse had now placed her in a perilous situation. Charlie was very, very sick. He could die, now, in front of her. Would they hold her responsible if he did? Even Clive and Silas would blame her for the failure after their successful, stoic efforts. It had been she who had been so persuasive to go along with the operation in order to buy time, but now they were no nearer escape than two days earlier.

  With a deep breath, Mel tried to banish the rising panic in her chest. She had to get on with the task in hand. Concentrate. In the hope that their freedom could depend upon the recovery of this man, then she’d do her utmost to see that he made it. Reaching for the gauge on the cylinder, she increased the flow of oxygen to his facemask. Again she took his blood pressure. Eighty seven over forty. Not good. Releasing the control of the intravenous giving set, she increased the speed of the fluid passing into his veins. She checked the wound drain. About thirty millilitres of blood sat in the plastic container. Not bad.

  “Charlie. Charlie, can you hear me?” she called clearly and loudly, shaking his shoulder gently as she spoke. There was no response. He was maintaining his own airway, but remained unconscious. His skin felt cold and dry, his peripheral circulation slow to return to his fingertips when she pressed them. He had been nearly two hours lying on the firm flat surface of the table and his risk of pressure sores was increasing with every hour that passed. Despite the warmth of the room, Charlie was hypothermic. The quilted cover, which had accompanied him on his journey, lay discarded in the corner of the room on the floor. Retrieving it, she doubled it over and covered her patient, leaving his arms stretched out and exposed. With her mind made up, Mel moved to the foot of the table and lifted Charlie’s left leg up and placed its weight onto her shoulder. With both hands free, she massaged the calf muscles to stimulate his circulation. His leg was a dead weight. Unable to sustain the load for more than a minute or two, she changed position and repeated the massage to his right side.

  Mel stared at Charlie’s expressionless face. She watched the shallow rise and fall of his chest. At his wrist she placed two of her fingers onto his radial pulse. Irregular thready waves, barely palpable, resisted her attempts to count the number in a minute by fading and returning, so that she restarted the count several times before finally arriving at a figure of 115 beats. His blood pressure rose slightly to eighty-nine over forty-eight. He was still maintaining his own airway. Were his respiration becoming deeper or was it just her imagination? Still he did not wake. Again she checked the drain. Fifty millilitres now but not an excessive loss. The wound looked clean and dry; no seepage through the dressing. One by one Mel again massaged the circulation in his calves. Back to the blood pressure. Another slight improvement.

  “Charlie, wake up,” she called. “Please wake up, Charlie.” She said it louder this time. He remained oblivious to her presence.

  Startled by the sound of a movement behind her, Mel turned her head swiftly towards the far external door. Absorbed with the care of her patient, she had temporarily forgotten the presence of the guard. Dennis and Danny exchanged places. As the door was re-locked, Danny now stared back at her, fidgeting awkwardly, his right hand toying with the handle of a pistol. He looked embarrassed and ill-at-ease, the heavy firearm clumsy in his grasp. Mel opened her mouth to speak, but changed her mind. She was surprised that he had been chosen to remain behind alone with her, wondering whether he would really be prepared to shoot her if he had to. For an instant the temptation to rush at him in the hope of making her escape flashed into her mind, but just as quickly it fled. One shot, she knew, would bring him assistance. Grimly she turned back towards her patient.

  Danny saw the desolation in her face as she looked away. “The operation went okay, didn’t it?”

  Mel didn’t answer.

  “I messed up. I know I did,” he continued lamely. “You did well, though. He’ll be alright now, won’t he?” he searched for reassurance. When again she didn’t answer, he persisted, “You really want him to pull through, don’t you?”

  “Yes, though I don’t suppose he deserves to,” she replied bitterly.

  “You can’t choose who your father is,” he said falteringly.

  “And would you kill for him?”

  Danny paused. “Yes. Yes, I would. He’s not really a bad bloke. He’s good at what he does. He’s one of the best,” he boasted with growing confidence.

  “And what’s that - brain surgery?” she snapped back. “No! Don’t tell me. I don’t want to know.”

  “He’s the best explosives expert there is,” Danny ignored her request, unable to resist the opportunity to defend his father. “He earned a pittance training in a quarry, working out in all weathers, freezing cold. Now he’s worth a fortune. People ask for him from all over the world. Everybody needs him to help fight their cause. We supply the bombs and weapons to help them.”

  “Stop it!” yelled Mel. “I told you I don’t want to know. I just want to get out of here and go home.” She turned away, anger and frustration again bringing her close to tears.

  He returned to meddling with the firearm, consuming its power with satisfaction.

  Charlie’s emergence from unconsciousness was slow but progressive. Gradually frown lines c
rept across his flaccid facial muscles and he squinted up at the plain white ceiling, temporarily confused by the stark brightness and unfamiliar surroundings.

  “So, you’re back with us again, Charlie. You’ve had your operation and you’re just waking up.” Mel spoke mechanically and without emotion. “Take a deep breath for me, Charlie.”

  The tell-tale blue hue of cyanosis still tinged his earlobes and the circulation, when again she pinched the tip of one of his fingers, was slow to return from white to natural pink. Yet again she increased the flow of oxygen.

  Charlie winced with pain as he attempted to breathe deeply, glistening droplets of perspiration creeping onto his pale skin. “You trying to torture me?” he growled between clenched teeth. “Give me something for the pain.”

  “Give him something!” demanded Danny immediately, taking a step forward from the door. He was torn between his desire to be at his father’s side and his orders to stay on guard.

  Mel searched through the collection of small drug boxes carelessly piled into the base of the toolbox. Finding the one labelled ‘Morphine 10mg/ml’ she extracted one glass ampoule and snapped off the top. Normal protocol to only administer drugs prescribed by a doctor was as inappropriate as it was unnecessary, she decided, when being threatened by a gun. The entire operation had been carried out without documentation. She would give it without a fuss. With a syringe, she withdrew the contents of the file and, under the scrutiny of the patient’s son, slowly began to administer the clear liquid through the cannula in Charlie’s wrist and directly into the vein. As the powerful drug took its effect, Charlie succumbed once more to sleep, each inspiration of breath now deeper and less frequent. Mel watched him closely, aware that once again he could stop breathing altogether.

  Mel, at last, sat on the stool beside the head of her patient waiting for signs of improvement. Exhaustion swept like a wave over her hunched frame. It was hours since she had eaten and she longed for a home-cooked meal and ached to lie down on a warm soft bed. But she had to stay focussed. This could be, perhaps, her only opportunity to acquire some implement or weapon, which might come in useful later. Leaning against the head of the table, she considered the assorted instruments and equipment abandoned on the sterile trolley. What could she take, given the chance, which she could hide away on her person? She only had two thin square pockets in the upper garment of her blue scrubs. She mustn’t get caught.