“Yes, of course.”
I’d been booting up my computer while I was speaking. I typed in mediastinitis and scanned the page. As I thought, it was a case of sternal reopening and debridement – clearing out the necrotic and infected tissue. Speed was essential, because an infection of this kind dramatically increased the chances of patient death. The question that remained now was just how I would approach the reopening. The best practice seemed to be to leave the wound open after I’d dealt with the infection, just in case yet more surgery might be needed subsequently. I shut down the computer and went to the door, but then a thought struck me. I decided to ring Malcolm – partly for a valued second opinion, but also to cover my own back in these days of “let’s find someone to blame” litigation. I rang his mobile, and he answered after a few rings. There was raucous noise in the background; it sounded as if he might be enjoying a pint at his local.
“Malcolm, be prepared for this – I need your thoughts, and I need them fast.” I told him briefly what Julia Williams suspected, and I heard him groan. Perhaps heartlessly I ploughed on, running before him what I was planning to do. “I’m going up to ICU now,” I said. “As soon as a theatre’s free I’ll re-operate. Are you in agreement with what I’ve outlined?”
He sounded almost dazed, and I remembered that he too was not in good shape. But it was Craig that needed our best, and quickest, efforts now.
“Yes, yes,” he said. “That’s absolutely spot-on. Keep the chest open until you see adequate granulation tissue. Then use muscle-flap closure. That’s what I’d do. Did it once, patient survived, but it was a while ago. Mediastinitis isn’t something you see every day.”
“No,” I said, hearing the grimness in my own voice. “Seems young Rawlins is determined to be as unusual as possible. I’m going now, Malcolm. Thanks for your input.”
“Yes, OK. Keep me posted.”
Consulting the internet and speaking to Malcolm had taken little more than fifteen minutes – twenty at most. Now I power-walked down the corridor and rode two floors down in the lift: perhaps another ten minutes. At most it had been half an hour since I’d spoken to Julia Williams. But when I got to the ICU swing doors and was admitted, she stood in my way, her expression anguished.
“Rachel, I’m so sorry, but we’re too late.”
I felt my eyes widen. “What?”
She spoke with her usual calm, but there was a huskiness to her voice. “Truly, I’ve never seen sepsis race away so fast. We did everything we should, and more. But then Craig started to moan, complaining of chest pain. He said, ‘I can’t breathe.’ It was difficult to hear him – like he was choking.” She cleared her throat, swallowing down tears.
“Renal failure?”
She nodded. “I think so. He had a seizure, Rachel – quite horrible. And then it was over. Nothing we could do. It all happened so incredibly quickly.”
That was when I swore again. Not loudly, but vehemently. “Sorry.”
She patted my arm. “No, it’s OK. We’re all devastated, of course.”
“Does his mother know?”
“Yes. Someone’s with her. She’s in the relatives’ room – she wouldn’t go home. Been here all day, every day. I told her you were on your way – that was before he died, of course. I’ll go and see her now. Will you come with me?”
I made a face. “If I must. Not my favourite job.”
“It’s no one’s favourite job, is it?” Julia said. “But you get used to it, working here.”
“Yes. We do our best. I certainly did, all the team did, for Craig. But patients die.” I shook my head. Death is everywhere.
She nodded. “Let’s get it over with. However bad we feel, it’s always worse for the family.”
I followed her to the relatives’ room, a short walk up the corridor. Inside, a nurse was sitting beside Eve Rawlins, her arm round the older woman’s shoulders. The nurse looked up and wordlessly shook her head. Eve’s head was bowed, her hands, as usual, clenched.
“Ms Rawlins – Eve,” Julia said softly. “Ms Keyte is here. I told you she was on her way, ready to do another operation. I explained that, didn’t I?”
I stepped forward into the room. “Ms Rawlins, I’m so very sorry. We did our best. Sometimes things happen that are simply out of our control –” I stopped suddenly, because then Eve raised her head. I took in her eyes, red-rimmed with fatigue, staring, her hair greasy with neglect, scraped back from her forehead, the angry birthmark that dominated her face; but what forced me back, stumbling, through the open door, was the guttural sound that came from her throat, like a snarling dog, and the baring of her teeth, and the way she threw off the young nurse’s arm as she half-rose from her seat. Julia saw it too, and stretched a protective arm across me.
“Go, Rachel. Obviously she’s not herself.”
I pushed open the door. “I’ll tell Mr Harries,” I mumbled. Then the door banged closed behind me, and I stood in the corridor, puzzled and shaken. A mother had lost her son. But her face had been almost demonic, her fury unmistakable. And I was the culprit.
***
Life returned to normal – normal for me, which is probably not normal for most people – and I forgot about Craig Rawlins. If that makes me seem heartless, I probably am. Of course no surgeon likes losing a patient, but it happens. By the time they get to us many patients are very ill and we’re their last hope.
Everyone involved in Craig’s case convened for a meeting and all the angles were thrashed out: what we could have done better, what we should learn from the whole experience. We weren’t hopeful that the post-mortem would cast much light. A couple of weeks later I sat again in Malcolm’s study, listening to Bridget downstairs as she practised scales – she was taking singing lessons – and Malcolm leaned back in his chair, nursing his plastered arm. “All it’ll tell us,” I said, “is that Craig died of mediastinitis – a massive bacterial invasion that his compromised body couldn’t withstand. It’ll mention staphylococcus aureus and staphylococcus epidermidis. What it can’t tell us is how those little devils got into his system.”
Malcolm looked down at his desk where papers were scattered. “It says here,” he said, tapping the uppermost sheet, pushing his glasses further up his nose, “‘… the origin of infection following open heart operations is not known in most patients.’ And the fact is, even if it seems like a cop-out, the likeliest source of infection is the patient’s own skin flora. The thing that surprises me, though…” He paused.
“What?”
“Well, how quickly it took hold. Just hours. But they must have been monitoring him constantly in ICU.”
“Of course they were. But symptoms aren’t always clear-cut. Full-on florid sepsis can be a galloper, and it can be very difficult to control. We know that. It’s what we all dread, isn’t it? But even when the PM is released there’ll be no blame attached. There can’t be.”
Malcolm sighed heavily. “Try telling Eve Rawlins that.”
“What? You’ve seen her?”
“Mm.” He looked up at me. “Don’t forget I had a lot to do with both her and Craig, over the years, not just pre-op. I felt, feel, a certain responsibility. She’s a mess, obviously. Angry, grieving, bitter, just a bit wild. I don’t know, possibly quite a repressed personality, and maybe all the more explosive for that.” He hesitated. “I tried to assure her that Craig’s death was not down to an individual, or a group, or the hospital. It was a tragic event, but these things happen: our knowledge isn’t complete, our systems aren’t perfect, however hard we try. But she wasn’t buying it.”
I sucked in my breath. “Is she going for medical negligence? I can’t see she’d have a case.”
Malcolm shook his head. “No. By the time I left she was quite calm – cold, even. She said, ‘I can’t afford to sue. I’m not well-off; I can’t risk incurring costs I won’t be able to pay. But there are other ways. One way or another someone will feel my pain.’ You should have seen her face – completely expressionle
ss – especially with that awful birthmark of hers. I’ve never felt I could get anywhere near her. She’s such a strange woman, but I feel very sorry for her all the same. She has nothing now. I just hope she gets some support from her church and they can convince her that her anger is destroying her.”
“Oh,” I said. “She’s a churchgoer, is she? More brimstone than meek-and-mild, it seems.”
Malcolm frowned. “Whatever your private opinions, it’s better not to voice them. I hope she finds some comfort in her beliefs.”
“Yes. Sorry, that was flippant.”
Malcolm took off his glasses and rubbed his eyes. “Look, Rachel, once the PM comes through they’ll release the body and they can hold the funeral. I can’t drive at the moment, what with this arm, but I’d like to go – represent the hospital, at least. Bridget will be at work, of course. Would you consider driving me, maybe even go to the funeral with me?”
I felt my eyebrows shoot up. “Me? Are you serious?”
“It would give a positive message – that we’re not heartless butchers but human beings with feelings, a conscience, whatever you like to call it.”
“Well,” I said dubiously, “I can’t see what good it would do, but if you think so… if it doesn’t interfere with something more important, like someone needing surgery.”
“Understood. Maybe,” Malcolm said thoughtfully, “maybe by then she’ll have calmed down a bit. Had a chance to think it through.”
As it happened it was less than a fortnight later that Malcolm rang me with details of the funeral. “St Joseph’s, Thursday, eleven o’clock.”
Thursday was my day off, a fact well known to Malcolm. I had no excuse. “All right.”
“I’ll buy you lunch afterwards.”
“Better.” I thought for a moment. “St Joseph’s – isn’t that a Catholic church? Is Eve Rawlins Catholic?”
“No, high Anglican. All the things you might associate with a Catholic church, but within the Church of England fold.”
“Right. I’ll pick you up at ten thirty, then.”
I liked to give the impression of being, if not exactly an atheist, uninterested and dismissive of things spiritual. I had a reputation for pragmatism, for extreme self-belief, for impatience with sentiment. I read somewhere, probably in some old heart surgeon’s autobiography, “Cardiac surgery is not for the faint-hearted.” It may have been the same guy who claimed that surgeons tend to be psychopathic – something to do with having too little sleep, becoming immune to stress, and the loss of empathy that goes with it. Many of them do, it’s true, take self-confidence to an extraordinary level. Malcolm bucks the trend: he’s a good surgeon and a good guy. But I’m pretty sure most people think I’m one of the psychos: clever, but nasty. I let them think it. But it isn’t true – at least not entirely.
I had to believe in myself, because nobody else did, during those long years of studying and training. My mother certainly didn’t – the day I voiced my aim to be a heart surgeon, aged not quite fifteen, she laughed uproariously, as if it was the best joke she’d heard in years. Then, trying to specialize, to gain experience, I came up against that hoary old cliché – male prejudice – not to say sexual harassment and breathtakingly outrageous behaviour. Some bad things were said, and done: like the operation I undertook under supervision when the supervisor was an old goat of a professor, eminent and respected, who stood behind me and rubbed up against me, sighing, for the whole time I was cutting and stitching, determined to make me slip. What I wanted to do was stick my scalpel where it would hurt him most; but I didn’t. I knew the only person to suffer the consequences would be me. My revenge then was completing a textbook bit of surgery, and continuing to work and study till I was the best in my field. I just needed to succeed. And that’s what I did, and what I’m still doing. That old professor may be senile, or dead; I won’t be weeping. Whatever; they can’t come out with any claptrap about female cardiac surgeons when I’m around. Leaving out the unforeseen, I’m headed for a consultancy before I’m forty. Who cares what any of them – my mother, my superiors and colleagues, past and present – think? I’ve got no time for most of them, and they know it.
The day before Craig Rawlins’ funeral I rooted around in my wardrobe and found a black skirt and jacket I’d used for innumerable interviews. I hung them on a hanger hoping the creases would drop out overnight.
I picked Malcolm up on time. He came out of the house swathed in a vast black overcoat, with his plastered arm clutched to his chest and one arm of the coat hanging limply.
“You look almost Napoleonic,” I said as he squeezed into my car. “Just need the tricorn.”
“Hm,” he grunted. He slammed the car door shut and shuddered. “Horrible month for a funeral, February. More depressing than ever.”
“Not much of a month for anything,” I said as I swung out onto the main road.
“You still running?”
“When I can. But only if it’s not too wet or icy. We don’t need another surgeon with a broken bone.” I glanced at him. “It can’t be too long, can it, before they take your plaster off?”
“About ten days, probably.”
As we left the bypass we came up against a long tailback of traffic. Malcolm groaned, peering out of the window. “Now what? We’ll be late.”
“Some idiot going too fast, I guess. Maybe skidded off the road. It’s a bit of a blackspot.” I turned off the engine. “Who told you when the funeral was going to be, anyway? Not Ms Rawlins herself, I imagine.”
“No. It was her priest, Father Vincent. I’ve met him a couple of times. He seems to be the only person who knew the Rawlinses well, apart from a couple of women who used to be Eve’s lodgers. I asked to be informed.”
I cleared my throat. “Malcolm, if you don’t mind me asking a personal question – are you a Christian?”
He pulled a face. “Funny you should ask that,” he muttered. “To be honest with you, I’ve never quite made up my mind. I’m an eternal oscillator, really. Sometimes I swing towards belief, then I get cold feet and retreat. Bridget is – but you know that. Sometimes she enquires after my spiritual health, but mostly she keeps a diplomatic silence.” He squirmed in his seat. My little car was restrictive for a bulky man in an even bulkier overcoat. “What about you, Rachel? I imagine you are, at the very least, a sceptic.”
I smiled. “It’s hard to say, really. My mother was, and is, quite scornful and dismissive, though she enjoys the colourful aspects, the pomp and show. But my dad was a staunch believer and he encouraged his children to follow on. Martin – my brother – abandoned any faith he might have had, but I hadn’t, not quite, despite everything. Maybe because it was something my dad valued so much – who knows? I don’t practise; I barely even think about it. It’s well and truly on the back burner. But I think it’s probably quite a deep part of me. Maybe one day I’ll have the space in my life to revive it.”
Malcolm was looking at me with raised eyebrows. “Well, you do surprise me.” He thought for a moment. “It’s odd, though. Something Bridget said a while back makes me think she might have suspected… Bridget’s a bit uncanny that way. And you can never tell what’s really going on in someone else’s mind.”
I was curious. “What did she say?”
But Malcolm was looking out of the window again. “Hold on, Rachel. I think there’s movement ahead. Brake lights. They must have cleared whatever it was.”
A few moments later the cars ahead of me started to move off. I restarted the engine and followed at a distance. As we came off the bypass and took the exit into the city centre we saw the problem: a jackknifed lorry, now on the hard shoulder surrounded by an ambulance, police cars, and breakdown vehicles.
I dropped Malcolm off outside the church and managed to find a parking space up a nearby cul-de-sac. An icy wind, spitting rain, whisked round my barely covered ankles as I ran up the church steps. I opened the tall wooden door as quietly as I could, and located Malcolm in a back pew. He beck
oned me over and I slid in beside him. A few heads had turned as I entered; now everyone was looking forward again. I saw a sea of black: suits, coats, hats, armbands. The church itself was high and wide, a modern building of red brick, with tall plain windows. Around the altar there was more ornamentation, and on each side paintings whose rococo style jarred with the plainness of the rest: I noted a few bleeding hearts and punctured saints.
Before the altar, in the middle of the nave, the coffin rested on a wooden trestle. It was white with gilt handles, and seemed pitifully small. Facing the congregation, between coffin and altar, a tall, balding priest was speaking; his voice was soft, and from where I was standing I could hear almost nothing of what he said. It was no loss. All I wanted was to escape unnoticed, and soon. Malcolm frowned at me, and I realized I’d been restlessly shuffling my feet.
There followed, interminably, singing, prayers, an address. Then I realized that there was also to be a communion service – this was going to be a long job. The church was full, and everyone shuffled forward when their turn came. I stayed in my seat, head down. Finally the priest raised his arms in benediction and the organ pealed forth. I touched Malcolm’s elbow and waved my hand, discreetly, towards the exit. He shook his head. I felt a sinking in my stomach as the black-coated pall-bearers marched down the nave, hoisted the coffin onto their brawny shoulders, swung it round, and paced slowly back towards the doors, their gloved hands respectfully folded. Directly behind them came Eve Rawlins. Her bowed head was covered with a square of black material. Two women accompanied her, one on each side, holding her by the elbows, both of them weeping. The congregation fell into line behind them and filed out. I felt terribly exposed; the last thing I wanted was for Eve to look up and see me.
She did not look up. Then it was our turn to follow the procession out.
Malcolm stopped me before the door, his face sombre. “I should speak to her, however briefly.”
The Healing Knife Page 3
