“There’s no such thing as putting in too many hours in my job,” I told him. “What we do tomorrow potentially means life or death for the patient. I’m going to spend the evening studying, and then go to bed early. I need to be fresh first thing tomorrow. Not tonight, sunshine.” He rang off, grumpily muttering.
I’d only assisted at myxoma surgery on two occasions, some years before. I trawled all the internet sites I knew, read, and took notes. Finally, around ten o’clock that evening, I stretched and walked around a bit, flexing my muscles, made myself a cup of coffee, and thought about the patient: a forty-one-year-old woman, overweight but otherwise in reasonable health until the accidental discovery of a left atrial myxoma three years before, when she had visited her GP with chest pain and incidences of fainting. Transoesophageal Echocardiography had provided a definitive diagnosis, and she had the myxoma excised without unnecessary delay. Myxomas, while benign, were potentially lethal, because of the possibility of their preventing normal blood flow, and because of their fragility. If a fragment broke off it could wind up in your brain or your eye – anywhere, really – and kill you.
Unfortunately for our patient, that first surgery failed to remove every bit of the tumour, and it had recurred close to the original site, so now we at Brant had the job of opening her up again. Peter had been at pains to remind us that re-operation was often trickier, and this patient’s health had declined. “I didn’t do this surgery, and it wasn’t done at this hospital,” he said. “Mrs Gooch has moved house in the last year. She’s in a more vulnerable condition than she was: that’s our challenge. This time we have to be sure we get all of it.”
“Is the mitral valve affected?” I asked.
“Not as far as we know. But if we get in there and find it is in fact regurgitating, we’ll have to do a repair at the same time.”
I fell silent for a moment, thinking, and was aware that Peter and the others were listening, not saying a word. More and more I got the distinct impression of being tested. “It might be as well to take a look at the valve even if it appears to be normal,” I said.
“Go on.”
“I read somewhere in the historic literature that a myxoma was successfully excised, but when the valve leaflets were prised open, another, tiny tumour was found there. It would have been impossible to detect with the technology available at the time, but even with what we have now it wouldn’t be easy to see.”
Peter nodded. “Good point. This time we have to get it right.”
Soon afterwards he closed the meeting and people left, leaving just him and me in the room. “How do you feel about leading this surgery, Rachel? Obviously, I’ll be on hand, but the decisions will be yours.”
I nodded. “I welcome the challenge, and I feel confident,” I said. “It’ll be good to have someone of your experience there, of course, in case of the unforeseen.”
“So – anything else you need to bring up?”
“Not to do with this particular operation,” I said. “But I’m sure you’re aware of what’s going on elsewhere, in America and China and other places, with minimally invasive techniques. Atrial myxomas have been removed with robotic assistance on numerous occasions.”
He sighed. “Just not here at Brant – not yet. And I doubt that it’ll be common practice while I’m still working. It’s a different story for you, though.” He looked at me keenly. “Is it something you’re particularly interested in?”
I nodded. “I would very much like to do the specialist training. Surgery for all kinds of cardiac conditions will one day be done this way, don’t you think? With less pain and quicker recovery times.” In some ways I was finding that as far as innovation was concerned, contrary to expectations, Brant was a bit of a backwater.
“I’m sure you’re right.” He put a casual arm round my shoulder. “But for now, it’ll be crack open the chest as usual.” He dropped his arm and tapped his chin thoughtfully. “Rachel, I wonder…” I waited, and he turned to look at me. “I get the impression, and please correct me if I’m talking nonsense here, that you’re not the sort of surgeon who’s in a hurry to get to the pub with your friends after a ten-hour op.”
I smiled. “You’re quite right. I’m more likely to slip away, ditch the scrubs, and walk the long way home.”
“I thought so.”
“I hope it doesn’t come over as unfriendly, or even arrogant,” I said – not that I really cared what most people thought of me. “I just prefer to unwind on my own.”
“Fair enough. If you have a few minutes, there’s something I’d like to show you.”
I nodded.
“Come with me.” He led me out of the room and turned right down a long corridor. At the end a door led to a sharp bend to the right. He pushed through a set of swing doors, revealing a staircase that clearly belonged to a different era. “As you know,” he said, “much of this hospital was rebuilt in the last decade. Huge portions of it were actually pulled down. But some parts of the old Victorian building – parts that weren’t required for strictly medical purposes – were retained, especially as it was felt by some that they were of architectural interest.” He was leading us down a rather dilapidated staircase, and he looked back at me and smiled. “I hope you’re taking note of the route! Nearly there.”
Another set of doors took us into a deserted corridor, and at the end of it Peter pushed open a heavy wooden door on our left. “We’re at the far end of the hospital here,” he said. “Only a few people know about this place – I think it was used for some administrative purpose way back when.” He showed me into the room. It was long but quite narrow, with a huge table in the middle, and at one end a window that stretched from floor to ceiling, with elegant cream-coloured curtains. I walked up to the window and looked out. We were on the ground floor now, and the window gave onto a flower bed planted with roses – well pruned and not yet flowering – a few feet below. Beyond the rose bed was a wide paved path, and people were walking in both directions, some in white coats, some carrying armfuls of files, others simply chatting in groups.
“This end is very near some of the university buildings and research units,” Peter said as he came up behind me. “At this time of day there are a few students about, as you can see.”
“Do you come here often?” I asked.
He smiled. “Once in a while. I’m not a pub-goer either. And –” he waved a hand towards a table which stood against the right-hand wall – “as you see, coffee-making facilities are always available. If you wanted to, this is a nice place to make yourself a drink, and you’ll most likely have it all to yourself. Feel free to come here whenever you like.”
“Thank you. It’s kind of you to share your hideaway.”
“Anything to help,” he said. “Getting pitched in to work somewhere different, especially when it was not your choice, isn’t always easy.”
“You’ve already helped me enormously,” I said, “you and Angela. I’m really grateful.” Oddly, I meant it.
At my old hospital I was known for being a fast cutter – bold and decisive, but never hasty or careless. From the reading I had done through the years I’d come to the conclusion that a dithering uncertain surgeon is a danger to his or her helpless patients. Preparation is vital, and so is a speedy gathering of information once the chest is open and the heart exposed. As it turned out, Mrs Gooch’s operation was straightforward. The myxoma was what we thought (and hoped) it would be, not a myxosarcoma, malignant and perilous; and where I expected it to be, having studied the most recent scans – adjacent to the fossa ovalis, a favourite spot. Once I had checked that there were no unforeseen complicating issues I excised the golfball-sized lump of jelly without hesitation and dropped it in a dish for the pathologist. I heard a barely suppressed gasp from someone round the table and looked up over my mask, fixing the culprit with a hard, challenging stare. Then I focused once more on my patient, carefully removing a circle of tissue round the spot where the tumour had been connected to the atr
ial wall. Once this was done I slowed my pace a little, checking meticulously for any sign of small myxomas or breakaway fragments. Satisfied, I left the clean-up and closure to others.
The surgery had gone well, I thought. I peeled off mask and gown and gloves as Peter joined me in the room adjacent to the theatre. “Excellent work, Rachel,” he said, and shook my hand. “Most impressive.”
“Thank you.”
“What’s on your agenda now?” He stripped off his own gloves and dropped them in the bin.
“Oh, I think a gentle stroll across the fields and home,” I said. “It’s a beautiful afternoon, but it’s April and everything could change tomorrow. I’ll drop by ICU in the morning and see how Mrs Gooch is doing.”
“Yes, that would be good. It’s my day off tomorrow, so I’ll happily leave that to you.”
As I crossed the meadow, the sun warming my bare head, I heard my phone bleep. I paused, found a handy bench, sat, and opened the text. “Amelia Maria,” I read, “born this morning, 3.5 kg. Baby perfect, Beth recovering, photo to follow. All well at yours, Jimmy x.” Smiling, I sent a reply. “Congratulations, look forward to photo, love to Beth x.” They wouldn’t have expected anything more gushing. I didn’t envy them, but I was pleased that my friends had their baby safe and sound.
I pulled myself to my feet and walked on. As I approached the river I heard someone yelling from behind. “Rachel! Wait!” I turned and saw a skinny figure loping towards me, a black and white bullet streaking along in front. Jasper caught up, flushed and panting, and Dulcie frolicked all round me as if we had been unbearably parted for weeks.
“Hello, Jasper. Hello, Dulcie.” I bent and stroked the dog’s gleaming coat.
“I gave her a good brushing this morning,” Jasper said. “Doesn’t she look shiny?”
“Sure does.”
“Can we walk with you?”
“OK. I’m heading for home.”
“Yeah, me too. We’ve just been for a really long walk, and even Dulcie needs a rest. Not for long, though. She’d be up for ten walks a day if they were on offer.” He smiled. “Have you been operating?”
“Yep. A re-operation, as it happens. Left atrial myxoma. Nice and uncomplicated.”
Jasper nodded slowly, his face serious. “You have a lot of responsibility in your job, I think. As does my dad.”
“Any idea what you want to do for a living, Jasper? Something in medicine, maybe?”
“I don’t know yet. It’s a lot of effort, isn’t it? You need to be super-dedicated.”
“I suppose you do.” I thought of the years of work and study, the long hours, the many discouragements, the necessary sacrifices. It was almost twenty years since I’d left school. Two decades of keeping on top of everything. Had it been worth it? Without a doubt.
Jasper broke into my thoughts. “Rachel, can I run with you on Thursday if you’re going?”
“I guess so. Yes, OK, I’ll be at your back gate at seven. That’s morning. Do teenagers recognize morning?”
Jasper grinned. “Not if they can help it. But I am not typical.”
“See you at seven, then. If you’re not there I won’t wait, OK?”
“Done.”
We crossed the river and went our separate ways, and Jasper turned and waved as he rounded a corner and the trees hid him from view. I wondered again, fleetingly, if this was OK. Why would a sixteen-year-old lad, even one that was considered atypical by himself and others, want to hang out with someone like me? Perhaps, as Angela had said, he was lonely. But although I had little interest in other people’s opinions of me, I didn’t want anyone making unsavoury assumptions about my friendship with Jasper. Perhaps I would sound out Angela. Discreetly.
***
I could hear myself screaming. The sound filled my head, jangled in my ears, blotting out all other sounds. And yet – was I perhaps dreaming? Was this some illusion? Were my lips not tightly shut? Where was this screaming coming from, if not from me? It was as if a peal of bells was being rung inside my skull, relentless and wild. Among all this noise I saw him, my father, through the terrified eyes of a child not yet fifteen. He lay flat in his bed, silent and still. For months he had been propped on several pillows: it was the only way he could breathe, and even then his chest crackled with every breath. I stretched out a tentative hand and touched his inert hand. His blue-grey skin was cold and moist. Did I begin to understand? The bedroom door opened, and I saw my mother. Her face showed anger, and her mouth was moving, but I heard nothing but the screaming, on and on, unbearably harsh.
“Rachel! Rachel, wake up!” I felt myself gently shaken.
I began to see light through screwed up eyes, and felt hands behind my back raising me up and organizing pillows behind me. My lips were shut tight, but I could hear myself moan: the thin, anguished sound of an implacable grief.
“Wake up, Rachel. Open your eyes.” The voice was soft, urgent but kind. I allowed my eyes to open a little, and I saw a fuzzy image: a pair of light brown eyes, a blue uniform. My lips peeled back from my teeth as I sucked in breath; my throat felt dry and cracked. The owner of the eyes seemed to understand: a moment later a beaker was held against my mouth and cool water slid down my throat. I choked a little and then drank greedily.
“Steady!” A cloth wiped my mouth. I dared to open my eyes wide, and saw the nurse I recognized.
“I’m still here,” I heard myself croak.
I saw her smile. “Still here, yes. You were dreaming. Moaning and crying. I had a job to wake you. I think you were dreaming about your father. You were calling out, ‘Daddy!’ Do you remember?”
Before I could answer I heard the door open, and she turned towards the sound. “Oh, Mr Wells. Rachel’s awake. Been having a bit of a nightmare, I think.”
He came to stand on the other side of the bed. “Hello, Rachel.” He had a deep voice, but he spoke quietly. I didn’t feel threatened; instead my tight shoulder muscles began to relax as I sank back against the pillows, and I felt helpless tears dribble down my cheeks.
“Do you feel able to talk to me now?” he said. I nodded. “All right, that’s good. I don’t want you to be frightened, but we need to know what you can remember. If you can tell me, maybe you can talk to the policeman as well. Think of it as a dry run.”
“OK.” My voice felt dry and hoarse. The nurse offered the beaker of water, and I drank again. She put the beaker down on the bedside table and left the room.
Michael drew up a chair and sat next to me. “All right, Rachel. Tell me what you can remember.”
The tears welled hot from my eyes. I remembered everything.
***
Jasper was sitting on his garden gate, swinging his feet, when I rounded the corner. Dulcie raced up to greet me and Jasper jumped lightly down.
“You’re early,” I said, surprised.
He jogged up and down on the spot. “I didn’t want you to go without me. So, are we ready?”
“You’re very keen,” I commented as we started off side by side. Dulcie ran ahead and dived into the bushes at the side of the path.
“I’ve been up for a while,” Jasper said. “My curtains aren’t very thick. The sunshine comes in and I’m wide awake!”
I smiled. “All right, let’s run.” I glanced around. “Where’s your crazy dog?”
“Don’t worry; she’ll catch up. Dulcie knows her way around here, and everybody knows her anyway. She’s probably off looking for rabbits.” He grinned. “Or something dead.”
I pulled a face and put on a spurt. Jasper kept up easily, arms and legs pumping in rhythm, and a few minutes later Dulcie reappeared, racing round us in circles till we almost tripped over her.
“Dulcie, calm down and give us some room!” Jasper said.
“You know what, Jasper?” I said. “That dog of yours could do with proper training. She’s very bright, but it’s going to waste.’
“I know,” Jasper agreed. “I’ve tried, but I’m not really here long enough for it t
o work. And Dad’s so busy. It’s a shame. We love her, but she’s a bit of a headache sometimes.”
Forty minutes later I called a halt by a wooden bench. “Time for a breather – I’m in a sweat. That sun’s warm for April.” I flopped down, breathing hard.
Jasper too was flushed and panting. “Did you bring any water?”
“’Fraid not.” I glanced at my watch. “Ten minutes, OK? Then I thought we’d cross the river by that little bridge and head over the meadow to the next one, cross back and turn for home. Suit you?”
“Fine.” He leaned against the back of the seat, lifted his face to the sun, and closed his eyes.
“I hear you have a place in France,” I said. Now that we weren’t running I thought I should probably make conversation, and he seemed a nice enough kid, after all. “Do you get down there a lot?”
He opened his eyes and shook his head. “Not really. I go for a few weeks, maybe a month, in the summer every year. My dad goes down more, though. When he can.”
“What’s it like?”
Jasper shrugged. “It’s just outside a little town – or maybe a big village; I don’t know. Called Roqueville. We have one neighbour, then there are some fields before the town starts. So we’re a bit of a way out, but you can still walk in if you want, to buy bread or whatever.”
“Is there much to do there for someone your age?”
“No, not much at all,” he said. “But I told you I’m not typical!” He smiled. “I like it. And it’s a chance to hang out with my dad. If I come down here, like now in the school holidays, he’s usually working. And most of the time I’m in London. I miss him.”
“So what do you get up to for a whole month?”
Jasper thought. “Well, we see friends. Dad’s friends, mainly, but they’re mine too. Our neighbours are nice – Monsieur and Madame Boutin – he’s a retired policeman and he has a huge moustache. Bit of a cliché, isn’t it, but he’s proud of it. We do a fair bit of swimming – there’s a good pool in the nearest big town. I read, fool around with Dulcie, go for walks. Dad does the garden… sometimes we invite people over for a barbecue. It’s just part of my life, I suppose. We’ve been going there since I was four.”
The Healing Knife Page 10
