Man on Edge

by Humphrey Hawksley

  They needed a fully-equipped and controlled operating room.

  ‘OR now,’ she said.

  ‘Room Four,’ said a nurse.

  The porters moved the gurney. Reynolds eyed Carrie quizzically. She second-guessed his thoughts. He was shadowing her. She had a duty to explain. ‘There’s a risk he may bleed out on the way to the OR. But his injuries are too complicated. If we stay here, he dies.’

  Reynolds might not have agreed but it was Carrie’s call and she liked the way he accepted it. He walked on the other side of the gurney to her. OR Four was a short distance down the corridor. Nurses, medics, technicians were waiting. Reynolds pushed open an adjoining door to the preparation room where she stripped off her coat jacket to scrub up.

  ‘Jenkins is in Two. Sanchez is on his way,’ said Reynolds.

  ‘Your prognosis?’ she asked.

  ‘A carotid tear that is partially but not completely closed by the presence of the rod.’ He gowned up.

  ‘Agreed.’

  The door opened from the operating room. A thin, late-middle-aged doctor was about to speak to Reynolds, then, seeing Carrie, asked: ‘Who the hell are you?’

  ‘Carrie Walker. From King’s County, Brooklyn.’

  The doctor pulled down his mask. ‘Greg Thatcher, anesthesiologist.’ He glanced at Reynolds. ‘No Dr Perkins?’

  ‘Fifteen minutes, max.’

  ‘Fifteen minutes, our patient will be dead,’ said Carrie.

  ‘Perkins messaged that we need a CT angiogram for the neck and chest,’ said Thatcher. ‘He wants to know the damage before intervening.’

  ‘He could bleed out,’ said Carrie. ‘We control the bleeding first.’

  ‘Perkins insists,’ said Thatcher.

  ‘Perkins is wrong. I am here. He is not.’ She finished fixing her gown.

  Quiet fell among the three of them. Carrie had some idea how seniority would work. It must be Thatcher, but he wasn’t a surgeon. Reynolds was inexperienced. He could do basic emergency room but not this. Or her, but she was an unknown. These were intelligent people. They needed a few seconds to make up their minds. Part of the reason she wanted this job was to break her loathing of red tape and big institutions, to learn how they worked, see if she could fit. Right now, she knew that as soon as her patient was wheeled away for a CT angiogram or anyone picked up a phone to get instructions, treatment would be dangerously delayed. CT angiogram would achieve legal protection for the hospital. Everyone in the operating theater would be covered for insurance. The young messenger could die.

  From the expressions on Reynold’s and Thatcher’s faces, she realized the same thought might be running through their minds. ‘You done this before?’ Thatcher asked.

  ‘Iraq, Afghanistan, Brooklyn.’

  Thatcher nodded. Reynolds checked Carrie’s gown. They pulled their masks over their faces and went in.å

  EIGHT

  Blue pastel light dimly lit the edges of the theater. Two circular lamps illuminated Carrie’s patient, who was now under general anesthetic, a safety strap across his thighs, ankles, and chest and his wrists secured to the operating table’s side boards. His right eyelid was gashed, hanging like cloth. Skin peeled from his forehead was stapled down to stop excessive bleeding. His blond hair was ripped along the right side of the skull. That was just what she could see. Invisible and silent, blood could be leaking into his abdomen or chest in a way to end his life at any moment.

  Carrie sanitized the entry point of the bicycle spoke and made the incision exactly where the spoke had entered the neck. She cut a five centimeter line, pulled back the skin, and secured it with a clamp to stem bleeding. She used forceps to draw back muscle and tissue and saw immediately the damage caused by the path of the spoke. Most dangerous was a partial tear to the carotid’s outer wall. The artery had two branches. The external one carried blood to the face and scalp. The internal one fed the front part of the brain. She needed to make safe the wound before withdrawing the spoke.

  ‘Vascular Prolene suture,’ she said. A nurse was ready with it. One millimeter wrong, a few seconds too slow, and the patient would die. Breathing steady, hand firm, Carrie passed a tapered needle through the outer layer of the carotid artery. She made a pass either side of where the spoke protruded, creating a figure of eight, leaving the ends loose to be tightened once the spoke was out. She created a second layer of stitches to reinforce the first.

  ‘Now,’ she said to Reynolds, who slowly drew out the spoke. Normally carotids would spray powerfully. With Carrie’s cordon of protection, blood pumped out, but not with unexpected force. She sealed the loose ends of the stitches, knotting both sets several times to keep blood inside the artery. She stepped back, took a breath, then moved in again to look behind the windpipe to ensure there was no injury to the laryngeal nerve that could affect the voice and to the esophagus, the muscular tube that runs from the throat to the stomach.

  ‘Prognosis?’ she asked Reynolds, moving aside so he could see.

  ‘Clear,’ he said.

  ‘Agreed. Let’s wrap it.’

  ‘Blood pressure seventy-six over forty-two,’ said a nurse.

  ‘We have a cardiac output problem,’ said Carrie. Blood pressure is controlled from the heart, not the throat. The electro-cardiogram showed critically weak low-voltage pulses around the heart.

  ‘Tension pneumothorax,’ she said, looking at Reynolds.

  ‘And pericardial tamponade,’ he said.

  ‘First, tension pneumothorax.’

  ‘Agreed.’

  The low blood pressure was caused by a build-up of fluid and blood in the narrow cavity between the heart muscle and the pericardium, its outer covering. There was every chance that air was trapped around one of the lungs. Trauma surgery rule was ABC, Airway, Breathing, Circulation. The tracheotomy had dealt with the airways. In the next few minutes, Carrie had to carry out two more procedures, lungs and heart. The lung procedure should take less than ninety seconds.

  Carrie made an incision just above the rib. She separated the muscles and tissue, inserted a tube, and there was a hiss of escaping trapped air. A nurse sealed it in. Carrie moved on to deal with the heart and blood pressure. The door opened, and a surgeon, scrubbed and gowned, with Andrew Perkins on his name badge, walked in from the changing room.

  ‘Tracheotomy? Cycle accident? Is that right?’ Perkins was beside Carrie. Behind his mask, he looked mid-forties, dark hair. Confident. Or arrogant. Or both. He spoke as if this were his operating room.

  ‘About to do a pericardial window,’ said Carrie.

  Perkins’ eyes scanned for her name badge which she didn’t have. ‘Do I know you? Are you cardiac?’

  ‘General trauma, sir. We have to—’

  Perkins cut her off to speak to Thatcher. ‘Greg, what’s going on here?’

  Thatcher was unfazed. ‘Ride with it, Andy. We’re on the clock.’

  ‘We can’t just ride with anything, and you know it,’ countered Perkins.

  A nurse walking toward Carrie with a steel tray of surgical implements stopped mid-step. The operating room quietened. Perkins read instruments, examined charts, looked back at Carrie. ‘You’re a shadow. Not authorized for this.’

  ‘I’m qualified.’ Carrie recognized Perkins as a stickler for protocol, a general-trauma surgeon, but uncomfortable with high-risk-taking. ‘Unless you want to do it?’ she challenged.

  Perkins ignored the question. ‘The patient has multiple injuries. If the pericardial window is a success, but another procedure fails, we will all be held responsible, together with the hospital because you are not authorized.’

  ‘Meaning the patient dies.’

  ‘I can’t permit you.’

  Carrie was unfamiliar with a situation of having too many doctors. She was used to working with a shortage, just her, no nurse, a tent, no refrigeration, no sanitation, guns pointed at her. She said to Perkins, ‘You stay and shut up, or you leave now.’ She caught Reynold’s eye and gave him a gritty l
ook, making clear he had to decide whether he was with her or against her.

  Perkins hesitated, his confidence fading. If he stayed, he would have to take charge and risked being implicated. He turned and left. Thatcher adjusted the anesthetic. Reynolds ushered forward the nurse with the steel tray. Carrie cut where the breastbone met the abdominal muscles. She worked through until she could make an incision in the membrane that enveloped the heart to bring out the blood that was crushing it. Moments later, she was finished. The heartbeat strengthened. Blood pressure increased.

  ‘Good work,’ said Reynolds quietly. Thatcher tilted his head in acknowledgment. Carrie opened the door of the changing room. Perkins was sitting on a bench, leaning forward scrolling down his phone. ‘All yours, Dr Perkins,’ she said. ‘Once he’s stabilized, you can do the CT angiogram and he has a broken—’

  ‘I’ll make my own assessment,’ said Perkins, washing his hands. ‘And you’ll be hearing about this.’

  Carrie had her hand on the door. ‘Yeah, and if you try to screw with one of my patients again, you’ll be hearing about it, too.’

  Perkins pushed past her into the operating theater. Alone in the changing room, Carrie let her adrenalin subside. That was the dumbest of the dumb thing to say. How in hell’s name could she know what power Perkins yielded? She had given him her in-the-field treatment; don’t mess with me, not with this patient, not now. Which worked well in difficult places because of Carrie’s height and her powerful face. She had sharp blue eyes with defined contours that ran through her high forehead and cheek bones. Her jaw was narrow and prominent, often giving a false impression that she knew exactly what she wanted and what she was doing. With medicine, yes. Most other things, she didn’t score that well.

  She checked her phone, ran through messages, and saw the one-liner from Rake. Heading to D.C. Coffee? Typically, he didn’t say when or why he was coming and, right now, she didn’t have the mental bandwidth for Rake Ozenna. He had taken enough of her space over the years. She needed to keep her mind on the patient, the hospital, and her stupid threat to Andrew Perkins.

  She took off her disposable surgery cap and loosened her light blonde hair, letting it fall long just above her shoulders. Since splitting from Rake, Carrie hadn’t worked out how she wanted her hair. She had tried it short, bobbed it, streaked it, grown it down her back, and had it styled just below the ears with a low curving arch exposing the back of her neck. When she and Rake first met, he had been a carnal, unfiltered lover, alive with instinct and lust. Carrie couldn’t get enough. Then, she taught him nuance, guided him to kiss her slowly where nerve ends all over different parts of her body gave her thrums of pleasure. Rake learned quickly. ‘Like hunting,’ he had told her, ‘slow love needs the patience of the wilds.’

  She changed into her blue denim jacket and wrote a note for Reynolds to give her a call, let her know the patient’s condition. Carrying her woolen coat, she headed out into the busyness of the hospital corridor, arriving late at the lecture hall for her familiarization course. She wore an apologetic expression which turned the trainer’s face from reprimanding to amicable acceptance. She slid quietly onto a bench at the back of the hall.

  Outside the hospital entrance on New Hampshire, in the early evening winter darkness, Carrie buttoned the collar of her coat and drew her scarf around her neck. Her patient was in intensive care recovery and stable. A successful day, except for a complaint from Dr Andrew Perkins. Carrie pulled her black leather gloves from her coat pocket, then changed her mind about putting them on. Her apartment was less than ten minutes away, although she wasn’t in the mood for it. There’d be a bar on the way. Over the years, she had walked alone into more bars than she could remember. Preferred it, in many ways.

  ‘Dr Walker, you did a great job. Want to get a drink somewhere?’

  NINE

  Carrie turned to see Peter Reynolds wearing a slight smile, half assured, half tentative. She stalled her reply: ‘Is he still stable? Out of danger?’

  ‘So far so good and don’t worry about Perkins. You have the support of the OR team.’ Out of his surgery gown, Reynolds wore a beige trench coat and jeans and exuded confidence.

  ‘Thanks. I’m glad you were there.’

  ‘So—’ Reynolds kept up the smile. ‘You got time for that drink?’

  ‘Sure, if you know a place.’ Carrie was unfamiliar with Washington etiquette, but she had no problem of medical professionals relaxing together after surgery.

  ‘The Hive rooftop. I think you’ll love it. It’s only—’

  Before he finished, a cyclist in a high-visibility yellow jacket pulled up next to her, skidding to a halt, the tire briefly losing grip on the packed snow. ‘Dr Carrie Walker?’

  Carrie nodded. The cyclist reached into a large bag strapped around his shoulders, drawing out not a package, but a phone, its screen on. He pressed the keypad and held it out to her. He stayed astride the saddle, one foot on the pedal and the other on the sidewalk. He leaned toward Carrie, a few feet away. She needed to take a step to get the phone. She didn’t move. The cyclist put it on open speaker.

  The caller’s voice was gravelly, heavily accented. ‘Carrie. Carrie. That you?’ There was static on the line.

  Carrie listened, tried to work out who it was. The cyclist kept his hand stretched out, palm flat, phone screen lit. His gaze stayed on Carrie. His face wasn’t threatening. It was an open street. He was just a messenger. Carrie took the phone. The cyclist straightened up. She turned off the speaker and put it to her ear. ‘This is Carrie.’

  ‘I am your uncle. Your mother’s brother. Uncle Artyom.’

  Her Uncle Art lived in Russia. Last time she heard from him was ten years ago, no, fifteen at least. ‘Hi, Uncle Art. What’s up?’ Her tone was upbeat and calm as if they spoke all the time. It didn’t reflect that a bicycle messenger had tracked her down and waited until she finished work.

  ‘I have something, Carrie.’ His reply was in Russian, which Carrie spoke as a kid at home, an urgent edge to his voice. ‘Tell them, please.’

  ‘Tell who?’ Carrie switched to Russian. ‘Tell who what?’

  ‘I saw you on television. Two years ago. That island.’

  Carrie had been famous for a few days after she and Rake became caught up in a Russian attempt against Rake’s Alaskan home island of Little Diomede right on the border. They had been engaged to be married, and Rake had been brave enough to take Carrie to meet his island community. Neither had yet worked out why those few days had impacted so badly on their relationship. Carrie wasn’t convinced of the identity of the speaker. ‘Tell me something about myself or my mom that no one else would know,’ she said.

  ‘You gave your first medical injection in India when you were a kid because there was no one else to do it. Your mother showed you how and you administered morphine to a gunshot victim.’

  She had told Rake. No one else. Only her mom, dad, and sister knew that.

  ‘Are you OK, Uncle Art?’

  ‘I’m fine. Thank you, Carrie.’

  Then why not call Mom at home?

  ‘Tell them I have it,’ he said. ‘Ask: How do I get it to them?’

  ‘I don’t understand.’

  ‘Call me, Carrie. Please. Only this phone.’ The line turned to static, then quiet.

  Reynolds yelled: ‘Hey. You. Come back.’ Carrie looked up to see the messenger gone, pedaling north into the traffic around Washington Circle.

  ‘What the hell was all that, Dr Walker?’

  ‘I don’t know.’ Carrie checked the phone’s incoming calls, only one, dialing code, 7 for Russia, 8152 for the city and region; not Moscow or St Petersburg; Carrie didn’t know further than that. A full seven-digit number.

  ‘What language was that you were speaking?’

  Carrie put the phone in her pocket and pulled out her gloves. ‘Let’s rain check that drink? Next time. On me. Owe you one. The Hive. Great suggestion. I hear it’s really good. They have roof heaters.’ She spoke in a r
apid flow, too fast for Reynolds to object. Confused, he stepped aside for her to walk off, which she did briskly, aware of the ice.

  Carrie headed in the direction of her apartment, less than a mile from the hospital, an eighth-floor studio on Virginia Avenue, opposite the famous Watergate building. But she didn’t go there. She circled round the neighborhood, letting the cold stimulate her thoughts.

  Only Artyom Semenov, her uncle, would have known her morphine story. Carrie was a child of the torn-down Berlin Wall. Her parents had met on a Soviet naval base in Estonia on the Baltic Sea, her father an Estonian doctor, her mother a Russian nurse. Her Uncle Art worked there as a naval engineer. They were all Soviet citizens, even Carrie briefly. When the Soviet Union collapsed, tensions flared between Russians and Estonians. Her parents got out with jobs in a hospital in Calcutta, India. One afternoon, her mother took Carrie along when a train had been blown off the track by insurgents. Patients needed morphine. Carrie learned to administer it. Uncle Art knew the story.

  So, Uncle Art had hired a bicycle messenger with a throwaway phone and his cell number punched in. He had asked her to tell ‘them’ he had ‘it’ and how did he get ‘it’ to them. To Carrie, there were three elements. First, someone in the US was expecting her uncle to deliver something. Second, the agreed method of delivery had collapsed. Third, he told her to relay his message. But to whom? Not her mother or he would have said. He knew she was in Washington, DC, and where she worked. But if he meant Carrie was to get involved with the US government, she had no idea where to start. She wouldn’t trust any of them with a broom to sweep the streets.