Major Surgery

by Lola Keeley

  “Look,” Cassie interrupts before she can receive her institutional scolding. “I’m a trauma surgeon and I’ve pulled bomb fragments out of more people than you’ve had hot dinners, so instead of twenty questions, why don’t you give me something to sign that gives me temporary privileges?”

  “Well, our insurers—”

  “I’ve just interviewed for a job here, so believe me when I say I’m qualified. And the man they’re covering in blue sheets over there will likely die by the time you find someone else. Which do you think makes a bigger financial splash?”

  “This is highly irregular,” the woman answers with what can only be called a harrumph. “As Surgical Manager—”

  “Oh, you must be Jean.” Cassie sticks a hand out, though she’d rather be sticking it under a tap and getting scrubbed in. “I was sorry to hear I hadn’t snagged you for part of my interview panel. Major Cassie Taylor.”

  They shake hands, and Jean looks pleased to be recognised. The managers always are, especially when they’re non-practitioners.

  “There is a form for extenuating circumstances,” Jean says, rifling through her stack of papers. “And since we’re technically on emergency standing, what with the winter overload…”

  She drones on as Cassie snatches the proffered form and signs it without looking. Nodding along to Jean’s explanation, she backs up into the scrub room and taps the pedal to turn the tap on. From her vantage point she can see the anaesthesiologist arrive and take his seat, surgical cap untied and at least one night of no sleep in his weary expression. Fantastic.

  The team turns out to be solid, though. As soon as Cassie steps out in her too-tight scrubs, her gown is slipped on. While one curvy, middle-aged scrub nurse ties the loops down her back at regular intervals, another slight young man is snapping a brand-new pair of latex gloves into place over the sleeves. Mask in place, Cassie steps up to the table and watches her patient settle under the full strength of the anaesthetic.

  “For those of you who don’t know me,” she begins, reaching for the tray of instruments and selecting a ten-blade. “And I suspect that’s everyone here. I’m Major… That is, Ms Cassie Taylor. I came in today to interview for the Head of Trauma, no doubt competing with some people that you all like and respect. That said, all that matters right now is the life in our collective hands, are we agreed?”

  Nods on every side, some more tentative than others.

  “I’m going to work very quickly,” she tells them, her hands doing exactly that as she opens the abdomen just far enough. “And there’s no time for laparoscopy, I’m afraid. Every minute we delay, more of this spleen is compromised. Not only could this man lose his life, but even if we save him, delay means a life of being immunocompromised for no bloody good reason.”

  A layer of subcutaneous fat—not much; the cyclist is clearly in good shape—gives under Cassie’s knife as she continues to make quick deft cuts until her splenetic ground zero is fully revealed. The team move to retract and pack the open incision, absorbing blood even as suction starts up.

  “Who’s my, uh…helper?” she asks, at a loss for the correct terminology. A man opposite her, the one applying suction with great care, raises his free hand.

  “Well, I suppose I’m your registrar,” he replies. “Don’t have any F2s in yet; they’re at some training meeting or other this morning. It’s why there were no scheduled surgeries for another hour.”

  “Really? You can’t operate without your grunts? I’m assuming that’s what an F2 is?” Cassie asks, raising an eyebrow.

  “Well, we have F1s and F2s—they’re foundation-year doctors. You know, juniors, House Officers? They do the grunt work—holding things, standing for hours. It’s important for their learning to start with the dull, repetitive tasks and—”

  “Thanks for the explanation. But surely you must still remember how? Besides, you’ve done a great job already with holding the suction.”

  “No, of course, but—”

  “Between us and these very competent nurses, I’d say we can handle a little spleen, surely?”

  “Absolutely, Major.”

  “Really, ‘Ms’ will do fine,” she replies. “Going to have to get used to civilian life sometime. Now, hand me that retractor, because this one isn’t going to get the job done.”

  It’s easy work in the end; she’s more than used to impact injuries. Nobody questions her decisions, simply hands her what she asks for almost quickly enough.

  Only when it comes to closing does her registrar clear his throat behind the white surgical mask.

  “Usually I do that for the consultant,” he explains, almost apologetic.

  “Oh, right.” Cassie is used to racing through each procedure, start to finish. She doesn’t generally have a fleet of waiting juniors. On the best days every pair of hands is usually occupied with CPR and halting bleeding. This is going to take some getting used to.

  Assuming she even gets the job, which is looking far less likely after her spree of rule-breaking. She must still be a little demob happy, missing the structure to bounce against.

  Scrubbing out doesn’t take much time in comparison, throwing everything disposable in the bin and seeking out the nearby surgical locker room to change from scrubs back into her interview suit.

  Which, in a fantastic development for an already challenging day, has blood on the jacket and what appears to be bike oil smeared on one thigh. Her blouse hasn’t fared much better, but she pulls it all together as best she can.

  Cassie has never been one of those women who looks effortlessly put together, outside of uniform which makes it easy. She washes her hands one more time, using damp fingers to try and tame her hair again. Blonde wisps are escaping in too many directions, just like every other time she’s tried to fix it herself.

  Buttoning her jacket, she’s just about to leave when the locker room door swings open.

  Of course, it’s the woman from earlier. She doesn’t have a huge stack of files this time, but she does have that inscrutable “in charge” vibe that Cassie more readily associates with a general.

  “Well, if it isn’t the gung-ho army medic. How’s your patient, Major?”

  Is it a plus that she actually remembers the rank? Paying attention for hints of an accent, Cassie hears only that sort of BBC Home Counties polish so beloved of those in a certain social class. Cassie doesn’t fancy her chances in a war of words with this one, so she nods towards the operating theatre door instead.

  “Yes, I came that way and a very competent registrar is closing,” the woman continues in the face of Cassie’s silence. “I can assume that means I’m not putting a plus one on the mortality rates for this quarter?”

  A bureaucrat. Of course. Makes perfect sense, since they’re always the first to get squeamish at the prospect of someone actually taking action.

  “He survived. And kept what I’d estimate to be forty percent of his spleen. Enough to spare him a life of drug regimens and avoidable infections.”

  “Yes, well. I wouldn’t make a point of raiding the admission wards for stitching practice. We do actually have processes here. Ones that keep patients alive and people employed.”

  Jean, bless her and her bustling, comes barging in at that very moment.

  “Major Taylor, that was a wonderful job. We were expecting the theatre to be booked out another half hour at least, but I see they’re already clearing out. Ms Mallick,” she adds in acknowledgment.

  “Just lending a hand,” Cassie replies, trying to skirt around both women to get to the door. “It seemed like your other general surgeons were all busy.”

  Jean gives a disapproving glance at the Mallick woman, confirming another suspicion.

  “Ms Mallick here doesn’t operate on Mondays unless it’s emergent. It’s not on the schedule.”

  “Well, I don’t think our patient scheduled his
bike being clipped by the number twenty-seven bus either, but I understood this was a hospital, not a spa.”

  “I actually have an entire department to run,” Mallick cuts in. “Time in surgery is something that does have to be scheduled. I thought you would have known that, being up for Head of Trauma and all.”

  “That might be how things run in… Sorry, what’s your department called again? Minor Injuries Unit?”

  Well, that one lands. Mallick absolutely bristles at the condescension, dark eyes flashing under the stale fluorescent lights.

  “The AMU is the first point of admissions for everyone who comes through A&E. I don’t suppose you glanced at an organisational chart?”

  “The way I understand it, non-emergent cases from A&E go to you. The real cases go straight to Trauma, and more often than not straight to theatre.”

  Jean steps in as voices and tempers rise in tandem. Shame. Cassie could do with a good barney to let some of the day’s steeped tension out of her muscles. “Well, we all play a vital role,” Jean says. “I’m sure if you do end up in Trauma—”

  Mallick snorts.

  Cassie isn’t going to give her the satisfaction. “I’m sure I’ve ruled myself out with prioritising the patient this morning, but it was very nice just to be considered.”

  “Yes, well, you’ll be hearing from Mr Travers one way or another,” Jean replies. “Do you need a hand getting back to the car park, or…?”

  “I can find my way, thanks.” Cassie is done with chatty. She lets Jean leave, in case she does want to walk-and-talk her out of there. It’s more of a surprise when Mallick doesn’t go, too.

  With a steadying breath, Cassie makes her way towards the locker room door. She’s stopped by an unexpected hand on her forearm. Getting this close to Mallick wasn’t intentional, but now she is, Cassie can’t ignore the tantalising notes of perfume, something floral and summery despite the drizzling autumn grey outside.

  “Don’t feel too bad about the job.”

  “Oh?” Cassie bites back a more sarcastic reply.

  “We have a terribly strong internal candidate. I trained him myself, so he’s practically hand-picked. Just in case you were holding out hope.”

  “I’m a big girl; I think I can handle their decision, Ms Mallick.”

  “Very well.”

  Mallick releases her grip, and Cassie almost stumbles with a sudden burst of momentum. That’s quite enough hospital politics for one day. For a supposed fresh start, this place is making her long for Basra.

  “Well,” Cassie says, fresh out of witty retorts. “Good-bye, then.” At least she doesn’t default to “nice to meet you”, since it so clearly wasn’t.

  She strides out into the corridor before waiting for a response, if there is one, and focuses on getting the hell out of there.

  Chapter 3

  Going to check on the interloper is a prime example of Veronica’s worst instincts, the nosiness and impetuous decision-making that she’s spent years trying to train out of herself.

  And yet she does it anyway.

  Worse, she lets the kamikaze commando have the last word, which would surprise just about everyone in this building that Veronica has gone toe-to-toe with.

  Bustling out of the surgical locker room, she heads straight for the solace of her office. It’s one of the larger ones in this wing, two small offices knocked into one quite by accident and never put right. Aside from her desk, a master of bland Scandinavian whiteness that’s ergonomically sound in five different ways, there’s not room for much else since the meeting table and chairs dominate half the space. She’s done what she can to liven it up with some Klimt prints and a few well-stocked bookcases. Her last attempt at cultivating a green thumb has been mercy-killed by the cleaners, so no plants clutter the surfaces.

  The laptop she left to boot up before her morning meeting has finally blinked into life. Sunday is always a strictly no work day, the one attempt at disconnecting in her otherwise screen-filled life. Unfortunately that means every Monday morning the thing takes longer to revive than the average drowning victim. There’s a requisition form in for a new computer. It might be granted sometime before all their brains are uploaded to Skynet and robots are doing the surgeries.

  The bad mood has settled behind Veronica’s eyebrows like an incipient headache, and she knows frowning isn’t going to chase it away. The brief meetings with this new doctor, this intruder trying to steal Peter’s place and Veronica’s plan away, keep replaying on a mental loop. Each time, Veronica thinks of a wittier or sharper remark she might have made, frustrating her afresh with every round.

  She’s saved from her own obsessing by a rap of knuckles on her firmly closed office door. Lea, barely five foot nothing in her royal blue nurse’s tunic. It’s only three years since Lea moved to London from Manila, passing the rigorous nursing conversion exams with flying colours. Her glossy black hair is braided tightly, and unlike a lot of staff with a twelve-hour day ahead, she’s made the effort to apply lipstick and mascara. Warpaint, she calls it.

  Veronica is glad to see her at the best of times, but especially so when Lea has two travel mugs of coffee in her hands.

  “It’s like you read my mind,” Veronica says. “I was too busy snooping over in theatre to swing by the cafeteria.”

  “Cafeteria?” Lea scoffs. “I’m not that cruel, not on a Monday. I took the scenic route to the Greek place.”

  “You’re brave, fording the stream on Praed Street at this time of day.” Veronica takes a first sip, the milky coffee still hot enough to sting lips and tongue just a little. “Sometimes I think why fight it? I should just pick a vein and have you start an IV for me.”

  “You can take a number.” Lea sets her charts down but doesn’t take the other free chair. She glances back towards the corridor, as though on the lookout for spies. “Were you checking on your army doctor?”

  “She’s hardly mine. I just had the misfortune to try and stop her opening abdomens in the waiting room.”

  “But they let her operate? Only I heard that Jean marched down there to put a stop to the whole thing, finds the woman already scrubbed in and ready to operate. Signed a bunch of forms with a pen between her teeth, just to stay sterile.”

  Veronica wonders where the impenetrable NHS bureaucracy is at moments like this. She can’t order the wrong kind of pens without it being an insurance problem, a budget issue, and a political shit-storm all at once. But now they’re offering a walk-in operating theatre to any passing surgeon.

  “So you can what? Just waltz in and cut, as long as you know your way around the tools?” Veronica asks Lea. “Sounds more like a hairdresser than a hospital.”

  Lea shrugs as though she’s seen worse. “How was the surgical meeting? People are still chafing at cancelling everything but emergency surgery. The backlog’s getting harder to handle.”

  “Electives have been cancelled because we’re overstretched,” Veronica reminds her. “And we can’t operate on people if we don’t have anywhere to put them afterwards.”

  “I know this.” Lea’s reminder is gentle. “But there’s a lot of unused space. You don’t get off the ward much, but we all see it.”

  “Well, I’ve made my suggestions.” Veronica has finally gotten access to her email, and amongst a hundred needless circulars there’s the promised missive from Wesley Travers. She takes great delight in not clicking on it, knowing he’ll be on his way the moment he sees the read receipt.

  Lea smiles at someone in the corridor before taking a swig of her coffee. “Mr Wickham,” she says, stepping out of his way. “I should get going.”

  Peter comes in to take his habitual spot in the visitor chair, long legs stretched out in front of him as he drops his briefcase to the floor with more theatricality than usual.

  “Sorry to bother you before,” Veronica says, and he’s one of the few subord
inates to ever get an apology from her. “I thought I was going to have to rely on your muscle, and you know how I hate to do that.”

  “Well, gives me an excuse to keep up the tennis.” They both know he spends more time on the golf course lately, and the nineteenth hole at that. “Did your blonde spitfire get arrested in the end? It looked pretty close to assault from where I was standing.”

  “No, in their infinite wisdom, management waivered her into surgery. I assume someone, somewhere has checked her credentials. Don’t worry, though, I told her she doesn’t stand a chance of the job while you’re in the frame.”

  “I don’t know about that.” He scrubs a large hand over his face, ruffling his neat hair and making a scratching sound across his designer stubble. “I’ve had enemas more pleasant than that round of questioning.”

  “Vivid, thank you. Still, I insist on buying the first bottle of bubbly when you’re appointed.”

  “Now, come along, Veronica. No use putting the cart before the horse.” He leans forward, flicking idly at the files on her desk.

  “I trained you myself, Peter. There’s no better endorsement, remember?”

  “Did Edie get off to work all right?”

  He’s changing the subject. Uh-oh. Veronica hides a grimace at the thought of him saying something stupid to blow the whole interview. Unfortunately, it wouldn’t be without precedent. “She did. We’re having lunch later in the week, if you want to tag along.”

  “And interrupt you both talking about me?” Peter says, with a lazy grin. “Unlikely, boss.”

  “Not for long,” Veronica wonders again at whether he’s blown his big chance, with a little less confidence this time. “We’ll officially be peers when you get this.”