Major Surgery

by Lola Keeley

  “Because the ranks are different, innit?” Daniel sneaks a glance, but Veronica won’t give him the satisfaction of wincing. “Like, when I’m flying bombers in a couple of years, I’ll be going for Squadron Leader, not Major.”

  “A couple of years?” Cassie sounds sceptical. “You must be cramming a lot in, with a degree, and officer training and all.”

  “Okay, a few,” Daniel corrects with a sigh. “Oh! You can be my referee, right? When I do my forms.”

  “Danny, please. Let Cassie finish her lunch, and don’t be so presumptuous. She doesn’t even know you, let alone the fact that this phase of yours will be over in six months, just like dinosaurs and supporting Arsenal.”

  “To be fair, everyone should get over supporting them,” Cassie teases. There’s that Liverpool bleeding through again.

  Veronica doesn’t have the slightest bit of interest in sport, though she’ll sometimes put the Radio Five cricket commentary on while she works on a weekend, a rare bit of nostalgia.

  “So what is it you’re really here for?” Veronica doesn’t mean to sound so harsh, but there’s a long day still ahead of her. Having to cut out early to order a takeaway and listen to fibs about how much homework has been done wasn’t on the agenda. If she was really annoyed, though, she’d cook for him. “Cash, food, combination of the two?”

  “Feeling the love there, Mum. I came by the ward, but Lea said I just missed you. Figured you’d be here.”

  “Danny… I have to get back. Are you coming to mine tonight? Because you’ll have to wait for me a little bit, unless you’ve got your key.”

  How did he get so grown up, shuttling between parents on his own? Hopping buses and Tubes like any other streetwise city kid, his free travel card burning a hole in his pocket at the best of times. It was only a year ago they decided he needed his own key for both houses, their nagging parental guilt overwhelmed by the need to know he could always get inside, to safety, should the unthinkable come to pass.

  “Nah, I’m back at Mum’s. You’re safe.”

  Cassie chokes on something—the last of her lamb, presumably.

  “But I ran out of stuff to read again,” he continues.

  “London still has libraries, last I checked. I appreciate they might not for much longer with this government, but still…”

  “Mum…”

  “I’m giving you ten pounds, and I will check what you bring home with you, so don’t even think about fried chicken and loitering, or whatever it is this week.”

  He swipes the crisp note from her hand barely a second after it leaves her purse, circling the table to plant a sarcastic kiss on her cheek. “Thanks, Mum. See ya.”

  They both watch him go, and Cassie pushes her cleared plate aside.

  “Nice kid. I didn’t know they read anymore,” Cassie says when the silence stretches out too long.

  Their table is cleared by Eleni, who takes one look at Veronica and doesn’t ask if she’ll be sticking around for seconds. Since her purse is out, Veronica puts down more than enough to cover them both, which only sends Cassie scrambling to pay her way.

  “It’s on me,” Veronica insists, rubbing at her temples once she puts everything back in her handbag. There’s the threat of another stress headache, and that’s the last thing she needs with the afternoon she has ahead. “Did we ever get to the problem with your paperwork?”

  She stands to leave, which isn’t entirely fair of her. It’s not really inviting Cassie to unload her issues now.

  “You know what?” Cassie stands, too. “It’s best if I go as far as I can on my own. No point dropping it all in your lap.”

  “Well, if you’re quite sure—”

  “And what your boy said about the references… I mean, come the time, if it helps…”

  Veronica snaps before she realises it’s happening. “Daniel won’t be joining the military, thank you very much.”

  “You say that like—”

  “I really must be getting back. Now you know where the good coffee is, so enjoy that.”

  Veronica doesn’t wait for the rest of the polite protest, booking it out of there as fast as her heels will take her. She must look like one of those uptight waddling people who do marathons without actually running.

  She’s not going to think for one more second about why she might be so flustered. There’s work to be done.

  Chapter 8

  “Do you need another pair of hands, Ms Taylor?” Pauline asks as Cassie and her team greet the arriving gurney from A&E.

  The Trauma Team page went off seven minutes ago, and it’s felt like a bloody lifetime waiting for their patient to arrive. It’s time Cassie’s traitorous brain fills with fleeting thoughts of Veronica Mallick and her rudeness. In the face of Cassie offering a sincere favour—to help Daniel pursue a military career—it had been thrown back in her face like she’d said something offensive. Even though Cassie has given the damned woman every opportunity for a quick word, possibly an apology, Veronica has sailed on by. The only upside from that whole personal conversation has been a new reliable source for Cassie’s caffeine habit.

  Finally the patient is brought in, and the Trauma team quickly add to the strapping and supports the paramedics have used to immobilise their fall victim. There’s some discrepancy on where exactly their man fell from, with competing reports saying he went right off Waterloo Bridge into the Thames, but it seems more likely he went over one of the concrete stair landings on the South Bank, given that he’s almost bone dry.

  “Do we have ID?” Cassie barks at whichever nurse is fumbling with clothing for a wallet. Then she sees the glint around his neck. Just when she’d almost gotten out of the habit of checking there first. “Never mind! We’ve got dog tags.”

  Cassie grips the table with one hand and touches the battered steel on a chain with the other. The patient is intubated, clothes being cut from him, but they’re definitely civvies. The metal is warm from being between his skin and the light sweater, and that first contact is enough.

  She closes her eyes.

  Not now.

  Sound fades out, the shouts garbled and distant enough that they might be talking in Arabic. The world reduces to the heartbeat beneath her hand, and she only knows they’re all still in motion because she stumbles over her own feet.

  Then a hand on her arm. Pauline, concerned now. “Ms Taylor?”

  “We’ll need an orthopod standing by.” Cassie grasps at the visible problems first, and broken bones are not the priority unless they’re poking anything valuable. Any spinal involvement is mostly neutralised, and they won’t get to investigate that until any bleeds or threats to breathing are neutralised. “Neuro and cardio—put them on a warning, but it’s too many cooks right now.” As the shirt comes off, a badly distended abdomen shows where most of the damage is done. “General. Get a general surgeon into theatre with me, now.”

  The short, stocky paramedic to her left chimes in then. “Definite abdominal bleed, we had time to do the portable ultrasound.”

  “Thanks, um…”

  “Alan,” he supplies. “Heard we had ourselves a GI Jane working here now. Think he’ll make it?”

  “That depends on the next thirty minutes,” Cassie explains. “Check back with the desk and they’ll give you updates. Or so they tell me.”

  “Then let me get the hell out of your way,” Alan finishes, stepping aside as they get the trolley rolling. The dash to emergency theatre is mercifully short, and they move the patient as gingerly as possible.

  “We need at least five units of A-pos,” Cassie barks, pulling the chain of the dog tags free and handing them to a gloved nurse before ducking into the scrub room. “Service number is on there, get it looked up for medical history.”

  She doesn’t need to relay the other details: the surname and gender identifier are self-explanatory and little he
lp for operating. Hopefully the last bit of information on there won’t be necessary, because the RC for Roman Catholic suggests they’ll need last rites if it comes to that.

  But it won’t. Cassie’s pulled patients back from much worse than this, and with a lot less to work with.

  The on-call anaesthetist is already at work, and the intubation switches from the manual bag to ventilator. Cassie runs the brush hard over her skin, the antibacterial soap stinging in its pleasant way. Impatient though she is, she gives it the full three-minute scrub, before jogging out to the waiting gown and a double-gloving that the nurses bundle her into with consummate care. They’re good; this is a good team.

  The spare surgeon won’t be long and, regardless, Cassie is going to have to get in there and stop the bleeding one way or another. She steps up, and the scrub nurses look at her for guidance on which part of the patient to cover and which to expose to the scalpel’s blade.

  “Just top and tail for now,” she instructs, and the blue sheets are adjusted accordingly, leaving a surgical field from nipple to hip. Of course he’s fit; Cassie clocks the six pack and defined obliques. A glance at his passive face above the neck brace, the buzz-cut ginger hair. The sheet is unfolded further, taking him out of view. Not a private, she has the distinct impression. Sergeant feels a better fit for him somehow. Sergeant Baros it will be for now, until the service number brings back the rest of his details.

  A couple of F2s arrive, ready for the holding and catching duty they’re always stuck with. The blood is delivered, and the first pouch hung in readiness. Cassie holds out her hand, and the scalpel is perfectly placed within a second.

  She could get used to this kind of efficiency. The speakers have the hiss and low crackle of being turned on without sound playing through them, but eventually the strains of classical music start to seep through.

  “Who’s playing that?” she asks.

  The anaesthetist pops up sheepishly from her stool. “I don’t think we’ve met,” she says in a hurry. “Dr Hamann. The techs gave us Bluetooth access, since most surgeons like some background noise?”

  “Well, this one does.” Cassie has to keep her eyes on where she’s cutting. “But something with a bit of life? This is what I put on when I can’t sleep.”

  “Sure, got a request? I’ve got everything.”

  “What’s that song…” Cassie feels the twitch in her hands to drum it out. “The air tonight?”

  There’s a sudden, awkward silence before Dr Hamann replies. “You mean, like, Phil Collins?”

  “Maybe?”

  “O-kay.”

  There’s a snicker from the F2s, so Cassie shoots them a glare that usually makes subordinates a bit jelly-like in the knee region. It works, too.

  Moments later, the familiar song is coming through the speakers and Cassie is through the subcutaneous fat and ready to check organs for damage. Of course, even the first experimental prod has an unpleasant sloshing of blood, something that doesn’t bode well for how much has been lost already.

  Cassie looks at the monitors. Heart rate has stabilised with the anaesthetic, but nothing’s in a particularly promising range. She calls for suction, and it’s ominous how quietly it works. No air and blood to make it noisy, just blood to suck up and lots of it. Damn.

  “I was summoned?”

  Of fucking course. Who else would the on-call general surgeon be on a Friday afternoon, more than two weeks since they last spoke directly?

  “Ms Mallick, I’m going to need you in here.” Cassie manages to summon some professionalism in the face of wanting to ask for just about anyone else. The damage is considerable, but at first glance it can be salvaged. It means working quickly—she’s already reaching for the cauteriser.

  Making space on the opposite side, Veronica is quick to plunge her freshly gloved hands into the fray. That alone is shocking. Cassie expected to have to explain or argue for a course of action, but it seems jumping in for a collapsed airway last time out was no fluke. The queen of paperwork is the real deal when it comes to surgery.

  “Bloody hell,” she says, meeting Cassie’s eye over their surgical masks. “Spleen, liver, and I don’t like the look of this either. You zap, I’ll stitch?”

  “We’ve hung some blood—”

  “Can someone get the salvage machine up and running, please? It should be already.” Veronica manages to order people around without entirely taking over. “It cleans the existing blood and makes it ready for re-transfusion. We’ll need fewer bags of blood.”

  “Oh.” Cassie has learned a lot about the advances while she’s been working mostly on portable kit, but that’s a nice upgrade. “Well, isn’t it nice to have new toys?”

  They work instinctively, the blood flow slowing with each minor save they make. Once or twice their hands bump, the nature of the beast in something as limited as an abdominal cavity. They direct and redirect mostly through murmurs and nods, working around, over and under each other until the suction nozzle finally starts to encounter air and not just a pool of blood.

  It takes a considerable shift at the coalface, but by the time Cassie is ready to hand off to the paged neurosurgeon and orthopaedic surgeons, she’s buzzing as though she’ll never be tired again.

  Scrubbing out, she can’t keep still at the sinks, lightly bouncing from one foot to the other like she’s in a very small boxing ring. It earns her a quizzical glance from Mallick.

  “You were good. In there.” Cassie fumbles the compliment, but she means it.

  “Wrote me off as a pen pusher, even after last time, didn’t you?” Veronica says. “I did tell you, I love surgery when I get the time for it. You’ve got incredibly quick hands.”

  An innocuous comment, professional appraisal from a colleague. And yet Cassie’s cheeks are burning a little. She wishes she still had the paper mask to hide behind, but has to settle for turning away while untying her scrub cap. The safety she felt on presuming Veronica straight was obliterated over Greek food, talking about the son’s other mother. Now there’s the possibility that saying just the right thing—or in Cassie’s case usually the wrong thing—could be construed as flirting, or showing an interest. That is far more than Cassie’s surgery-hyped brain can process.

  “Never really had time to be slow, I suppose.”

  “He’s one of your lot, I heard?”

  Cassie tenses. Their last conversation about all things military hadn’t exactly gone swimmingly. She nods, not trusting herself to say more yet.

  “Well, they’ll have his information by now. No doubt a family will come rushing to his side. Strong lad like that, he might even walk out of here.” Veronica leads the way back through to the locker room, looking less than polished for once with her formal skirt and comfortable running shoes for surgery.

  Cassie doesn’t need to change, confident her scrubs were well protected by the gown. For the sake of something to do with her hands, she trades out her own running shoes for the lighter pair in her locker.

  Pauline bustles in then, smiling at each of them.

  “We found your boy. Reached out to his unit, but apparently he doesn’t have much by way of family. They’ll send someone over tomorrow, assuming he makes it through.” She hands a folder over to Cassie, the start of his patient file.

  Cassie opens it greedily, needing detail to chase away the impending sense of dread. Steven. Steven Baros, rank of sergeant. She’d been right. Thirty-three years old. No spouse, no children. Parents deceased and no mention of siblings. A copy of his army medical records sits tucked in behind the biographical data, paper still with a trace of warmth from the printer.

  He’d seen active duty, then, and picked up a couple of bullet wounds for his trouble. There are some scratched notes about shrapnel with abbreviations everywhere that will mean little to civilians. Cassie files each detail away as a check to make later, before handing the p
aperwork back.

  “We got the bleeding under control, so the others have to do their part now,” Veronica explains for both of them.

  “He’s in the best hands,” Pauline agrees, before taking her leave.

  Cassie spends a long time on her second shoelace, almost forgetting how to tie a knot in the first place. In the thick of it all, the familiar role of treating a fallen solider had been routine, almost welcome in its familiarity. Now she has the queasy feeling of two worlds colliding, of the army still reaching out to her despite her decision to walk away. Especially since this isn’t even the nearest hospital. There must have been some hidden forces at work on this one.

  “Is all this okay?” Veronica asks, sitting on the bench next to Cassie and slipping her heels back on. The black pencil skirt comes with a crisp white blouse, and it seems somehow miraculous that it can escape surgery without even a drop of blood.

  Part of Cassie wants to have blood on her hands now, all the better to smear that pristine surface with. “You don’t look like you’re struggling with the horrors of war or anything, but I think we both know appearances are usually deceiving on that front. Just thought I’d check.”

  “No, I’m just grand.” Cassie doesn’t want sympathy from this woman, not when it’s so close to pity. Her hand goes to the chain around her throat, the same chain that holds two identity discs of its own, just like Steven’s. “I promise if I become a gibbering wreck and start playing Ride of the Valkyries too loud, you’ll be the very first to know.”

  “Right. Well.”

  “Yes,” Cassie agrees to nothing in particular. “How’s Danny? Onto a new phase yet?”

  Veronica frowns. “Alas, no. Seems meeting a real-life army medic has only spurred him on. My ex is thrilled with me, I can’t tell you how much.”

  “So sorry,” Cassie says, grinning.

  “What about that paperwork of yours? Did you ever figure it out?”

  “Fine, I think. It’s all these codes for things that take up the time. I know where the duodenum is, not what an AFSR2001 stands for.”