By the time I made it back to the hospital on Saturday afternoon I was not in a good mood. Time spent with my mother was always likely to ruffle my feathers even if they had been perfectly smooth to start with, and I’d already had a busy morning full of the usual frustrations and no time to write anything up. It wasn’t that I had any thrilling plans for the rest of the weekend, but I sometimes resented using up all my time on paperwork. On the other hand, it didn’t do to let it pile up. I knew people who let it slide, but I like to have a clean slate and a sharp focus.
I had found my mother, as usual, in the communal sitting room of the warden-assisted apartments where she lived, surrounded by a gaggle of her cronies, holding court. I suspect she was bored much of the time, because her wits had not deserted her, and they were as acid as ever.
“Rachel, darling, how lovely!” she carolled as I entered the room. She liked to make out my visit was a surprise, when we both knew I was required to turn up once a month, on the dot, and heaven help me if I didn’t. The cronies all fluttered and twittered as I bent over her chair and pecked her cheek.
“Hello, Mother. How are you?”
“As well as can be expected,” she sighed. I should have been used to her theatrical ways, but they never failed to irritate. Her followers were all she had now of the adoring public of more than two decades ago, but even though her circle was restricted she made the most of it. Of course the other residents were of a similar age, and those that weren’t senile could remember how she had been at the height of her celebrity: beautiful, elegant, perfectly groomed, and who could forget that voice! They just don’t make them like Frances Chester any more. And a good thing too, thought her sour only daughter.
“Why, Rachel!” she trilled that afternoon. “Why the beetling brows?” She leaned forward, as if to whisper in my ear, but her voice lowered not a jot. “You know, dear, you really ought to have your eyebrows seen to. They really are – well, so bushy and black!”
I’d learned to ignore her little jibes, and the accompanying smothered giggles of her entourage, but I could feel my blood pressure rise a notch nevertheless. I smiled – oh, so false! – and said loudly, “Any chance of a cup of coffee, do you suppose?”
One of the nicer old ladies, Dorothy someone, jumped up. “Of course, Rachel. I’ll make you some. I expect you’ve had a hard morning at the hospital, haven’t you?”
“Do sit down, Dorothy,” my mother snapped. “It’s hardly the time for tea yet, let alone coffee.” Dorothy subsided into her armchair looking quite stricken, and my mother leaned over and patted her hand, all twinkly smiles and powder-puff charm. “Perhaps a little later, all right, dear?”
So it went on, for a long, stretched-out hour and a quarter, the chat dominated by my mother’s reminiscences of her sparkling career, and the other old ladies sighing as they recollected the elegant and glamorous figure she had once been. Finally she announced that it was indeed time for tea, and grudgingly allowed me to have coffee instead, muttering at my barbarity. We sat in silence and sipped out of flowery china cups. Sometimes, though not today, a man joined us, a tweedy octogenarian who called my mother “Dear lady!” in unctuous tones and played up outrageously to her need for adulation. Once he seemed to glance at me and I swear I saw him wink. Good for you, Basil, I thought.
If it wasn’t such a monumental waste of time I might have found it funny, this ridiculous little charade of my mother’s. But I’d had many grim years of her, and funny it was not. My watery coffee drunk, I made my “goodbyes” and “see-you-next-times” and escaped. The air outside smelled deliciously fresh.
By the time I parked back at the hospital a brisk wind was blowing round the building. I paused as I locked the car, seeing myself reflected in the driver’s window, and was not encouraged by the shadowy vision of a dishevelled individual with a surly expression: perhaps, I had to concede, not the ideal image of the competent surgeon to present to an anxious patient and parent on a first meeting. I took the lift to the fourth floor where I shared a tiny office with Sefton Chalmers, a colleague as flowery and vain as his name implied, but a respectable craftsman nonetheless. I had little to say to Sef at any time but as it happened he was off sick with conjunctivitis and I had the cubbyhole to myself. An immaculate white coat was hanging on a coat hanger on the door, and I purloined it: Sef wouldn’t be needing it, and if it was a bit large round the middle it was at least a cover for my workaday jeans. I rarely bothered with this traditional disguise but somehow, today, I felt it might be needed – to foster confidence, if nothing else (whose, I didn’t ask). I found a lanyard with my face and name on it in a drawer, and smoothed down my unruly hair. I sometimes tell myself I will have it all cut short one day, but something holds me back, despite the inconvenience of having thick wiry hair that refuses to behave predictably. I heaved a sigh. Would I do? That’s a question I can never answer, apart from when masked and gowned in theatre. Am I up to expectations? No idea.
Shaking off this unproductive self-doubt (probably the result of seeing my mother, who was uncannily able to undermine me) I took the lift back down to the ward where Craig Rawlins awaited his operation, and was buzzed in by a nurse yawning over a file at the desk inside the door. She directed me to the bay where his bed was.
The curtains were partly drawn across, but there was a gap and I could see that this was not for any medical intervention but just for privacy. I tapped politely on the metal strut of the curtain and cleared my throat before I entered.
Eve Rawlins was sitting on a hard chair beside the bed, at an angle to me, holding her son’s hand as it lay unresisting on the white sheet. She turned her head as I approached, and it took all my years of medical training not to flinch when I saw her face. Malcolm had not prepared me for the large, vivid, port wine stain that spread, bumpy and deep red, from her hairline over her brow and her right cheek, bisecting her chin and splashing down across her jaw before it came to an untidy halt. I smiled, trying to mask my shudder, and I thought, Why on earth haven’t you had that seen to? It seemed such a burden to carry.
“Ms Rawlins? Rachel Keyte.”
I stretched out my hand, and she shook it as briefly as she could. Looking past that facial disfigurement, I saw a tall, thin woman, perhaps a few years older than me, sitting very upright. She had long, thick, surprisingly lustrous brown hair, tied back in a ponytail, and straight, regular features. But even if her appearance had been more arresting it would have been overshadowed by the birthmark. I looked away from her to the boy in the bed, and saw no resemblance to his mother. His smallness was due in large part to his illness. He was thin, apart from his enlarged chest, and very pale. His hair was black and stuck up all round his head, and his eyes had a slant to them: slight, but noticeable.
“Hi, Craig. I’m Rachel, your surgeon.” He raised his free hand in a languid wave, and smiled faintly. “You heard about Mr Harries’ accident, I guess.”
When he spoke, his gruffness came as a surprise. He may have been the size of an average ten-year-old, but he was almost thirteen and his voice was changing. “Yeah. Fell off his bike, didn’t he?”
“Mm. Almost under a lorry. But he’s OK. Just sorry he can’t do your operation, that’s all.”
Craig shrugged. Perhaps who held the knife didn’t mean much to him. His mother clearly thought otherwise, and she cut in sharply, “Mr Harries said you had experience of this type of surgery?” Her voice was somehow both shrill and flat. I suspected the shrillness owed itself to a high degree of anxiety; the hand that wasn’t clutching her son’s was clenched tightly in her lap.
I spoke as gently as I could, though I felt little empathy with this woman. “Yes, I’ve performed many successful coronary bypass operations, though usually on older patients.” She nodded. “Mr Harries will have taken you through the procedure, I imagine.” She nodded again, pursing her lips. I battled on. “Has he made you aware of the risks and possible complications? I don’t foresee any, but no operation is without risk.”
“Yes. But he said it was absolutely necessary.”
“Well, I agree with him. The sooner, the better.” I turned back to Craig, who was watching me with those clear dark eyes. “Do you have any questions you want to ask me, Craig?”
He shook his head. I looked at his mother, my eyebrows raised enquiringly. “Is there anything…?”
She cut me off. “No. I just want to get this over with.” Her voice was low, tense, almost grating.
“All right, so I’ll see you both on Monday. Till then, just rest, OK?” As I pushed aside the curtain to leave, I turned back to Eve Rawlins. It seemed that something else needed to be said. “I’ll do my best for him, Ms Rawlins,” I said very quietly. “As I do for all my patients.”
She stared at me for a long moment; then she nodded briefly, unsmiling, and I left them.
I was unlocking my car when my phone rang. It took a while for me to register my ringtone, buried as it was in the junk-heap I called my handbag, which I kept promising myself I would sort out. There were always more important things to do, and as it was I never seemed to keep up with my reading. Just as I found it the ringing stopped. I thumbed the appropriate key and saw that the caller was my friend Beth Walters. I said the Harries were my only friends at the hospital, because now it was true: Beth was my scrub nurse till she got pregnant (unplanned, I’d guess, but I don’t really know). Now Beth was waiting for the birth, and living with her Ugandan boyfriend Jimmy, whose surname I could never remember how to spell. He was an anaesthetist, but he was not around the hospital that much, because like me a few years ago he was working on a PhD.
Beth had left a message. “Hi Rach, just thought I’d see if you were still alive. Want to come to dinner Sunday night?”
I called her number, and she answered straight away. “Hi, Beth, thanks for the invite. I’d love to, but I’ve got an op to do first thing Monday so I’ll need an early night.”
“I thought you didn’t operate on Mondays,” Beth said.
“I don’t normally. This is one I’m doing for Malcolm.” I explained the circumstances.
“Another time, then, OK?” Beth said. “But don’t leave it too long, or I’ll be much too busy.”
“Can’t think why,” I said, smiling.
“Yeah, right – I can change a nappy one-handed while proof-reading Jimmy’s latest pages and knocking up a four-course meal at the same time.”
“Piece of cake, love.”
“Ha!” Beth said. “I’d like to see you do it.”
“Of course I could – I’m a surgeon.”
“What you are is an idiot,” Beth said with a fond smile.
“Probably. See you soon.”
“Yep, hope the operation goes well.”
I spent the rest of the weekend doing my laundry, going for a run when it wasn’t raining, and reading some research papers I’d downloaded from the internet. I got takeaway food and didn’t see anyone, which suited me fine.
Monday morning started as it had for the past week – cold, dreary, with patches of fog. Craig Rawlins’ surgery was scheduled for 8:30, and at 7:30 I met up with the other members of the team. These were Malcolm’s people: there hadn’t been time to reschedule and anyway they knew the case and were therefore the best people to work with me. For various reasons Malcolm had decided to do the operation the traditional way, with the chest open and the heart stopped, so as well as the theatre nurse and the anaesthetist – a tall, gangly man I’d worked with on occasion – there was also the perfusionist, a garrulous Irishman I didn’t much like but who, I knew, was good at what he did and trusted by Malcolm. Once we’d established that we’d got the right patient for the right procedure, and talked over some of the details, we were ready to begin.
Then came the part of every operation which, but for the fact that I am highly alert, has an almost hypnotic quality for me – perhaps because I have done it so many times before, following an exact sequence of actions. I have always preferred not to talk during the process, because silence is what takes me into the zone of total focus. Wearing a mask, hat and scrubs, with headlight and magnifying loupes in place, I chose gloves from the rack, size seven and a half; I peeled the packet open and placed the gloves beside my sterile gown on the trolley. At the long stainless-steel communal basin I turned the taps on with my elbows, waiting for the water to get to a comfortable temperature as I opened a new pack containing a nailbrush which I doused with antiseptic. For ten minutes or more I scrubbed: hands, nails, arms up to the elbows, brushing, rinsing, repeating; then, holding my clasped hands up, I dried them thoroughly on a paper towel, touching nothing else. My surgical gown, made of paper, was folded so that I needed to touch only the inside. I thrust in my arms and wriggled it onto the rest of my body, sleeves covering my hands, and waited for someone to fasten the ties at my back. With my hands still hidden in the sleeves of the gown, I put on the gloves, making sure each finger fitted with immaculate smoothness, and folded each glove over the cuffs of the gown.
I was ready. The team congregated around the operating table. Once again, for the last time, we checked who the patient was and what we were going to do. I looked down briefly at Craig’s inert anaesthetized body, then I drew a line down his bony white chest, marking my intended incision.
After that it went as it always did, and on this occasion there were no scares, no unexpected hitches: it was like a well-rehearsed and perfectly executed dance. The patient’s chest was painted and draped, the tubes of the heart-lung machine secured. Now I set to work with scalpel, diathermy, oscillating saw, stopping any small bleeds as I went. Then the retractor, the action that always seemed most invasive. The chest was open. I gently set aside the thymus and cranked the retractor a little more, exposing the pericardium. We were almost there. If anything my level of concentration rose. I was unaware of my colleagues, assuming they were doing their part efficiently as I focused only on my own delicate actions. Craig was just a skinny kid, and I was more used to burlier patients; I made a conscious effort to slow down. I incised the pericardium vertically, and stitched the edges away. There was the heart – that miraculous organ which has dominated my working life, practically my every thought, for almost twenty years. For a brief moment I remembered the first time I laid my gloved hand on a beating heart. I have never forgotten it, and it can still send a shiver through my whole body.
Four hours later it was all over. Following Malcolm’s plan I bypassed all Craig’s coronary arteries, replacing the damaged sections with a nice leg vein, and made the neatest of tiny stitches to attach the ends. There were still many things to do, much to check, before we could go into reverse, closing the wound layer by layer. But finally it was done. The team wheeled Craig away, and I was able to strip off the gloves and gown and flex my shoulders and wrists. Now it was someone else’s job to look after him as he recovered from the necessary trauma we had inflicted on his fragile body.
“Nice one, Rachel,” said the anaesthetist (I remembered his name – James), “as always. Malcolm will be pleased.”
I nodded. “Thanks, everyone,” I said to the team. “Good work.”
Feet up in the coffee lounge, I rang Malcolm. He answered the phone after the first ring; obviously he had been on tenterhooks all morning. “You can relax for a while,” I said. “Textbook operation. Now I’m going home.”
I heard him heave a huge sigh. “Thank you, Rachel. Before you go, have a word with Eve, will you? She’ll need to know from you that it went well.”
“If I must. Yeah, OK.” Privately I thought the nurses could tell her, but I went along with Malcolm’s way of doing things, this once.
I found Eve Rawlins sitting in the side room next to the bay where Craig was being monitored, prior to taking him back to the ward. She was as upright as ever, her hands clasped in her lap, her face pale and expressionless but for a tiny telltale tic at the corner of her eye.
“Ms Rawlins?” She turned her head towards me. For a moment, seeing her face, I fel
t a pang of sympathy with this rather unprepossessing woman. The birthmark seemed to show up more raw and fierce in the white light of the room. “It’s over, and he’s as well as can be expected,” I said. “The operation went smoothly. I have hopes of a good recovery.”
I heard her swallow, and with some difficulty she said “Thank you” very faintly and immediately turned away from me. I waited for a moment before I left the room. Odd woman, I thought.
That was Monday. On Tuesday I called in on Craig to see how he was doing. I didn’t much like the look of him, but he’d had major surgery the day before – it wasn’t unusual, and I relied on the ICU team to let me know if anything developed. On Thursday I was on call, and I’d just gone up to my office to file some paperwork. I was thinking about going for a run; then I looked out of the window and saw it had started to rain. I don’t like running in the rain: too slippery. I didn’t want to have an accident that would stop me from working, certainly not while Malcolm was out of action. At that point my pager bleeped.
I rang the ICU straight away. A senior nurse I knew quite well, Julia Williams, answered. “Rachel, we may have a problem with Craig Rawlins,” she said with admirable calm. “He’d been restless, complaining of chest pain, and there was some sign of infection in the incision site – nothing to worry about, but something to keep an eye on, I’m sure you’d agree. But then his condition suddenly, I mean very suddenly, worsened. Just this afternoon, within the last hour or less. Rachel, I’ve seen this before – I think it’s mediastinitis. You’re going to have to open him up again. Or someone must.” She sighed. “Poor lamb.”
I rarely swear, but I did then, and immediately apologized. “Look, Julia, I need to check the exact procedure, but I’m in my office in front of a computer now, so that shouldn’t take long. I’ll be with you as soon as I humanly can. Meanwhile can you get someone to organize a free theatre and the necessary people? Ideally the same team I had on Monday, but anyone who’s free and sober.”
The Healing Knife Page 2
