Silent Song

by Lucilla Andrews

  I couldn’t face my own company in my flat. I went back to the hospital, looked in the public canteen as there was just a chance Trevor might have come down for a meal. He hadn’t, and there were no other faces I knew. I went on to our own canteen. Shirley was off from five. Often when we had the same free week-ends we sat over tea on Fridays whilst the canteen emptied around us. It did not close till eight, but by this time the medic students and staff going away had vanished for the week-end and the others were working.

  Only a few people, mostly in pairs were scattered among the sea of red-topped tables. Shirley and Paul were at a far table by a window and didn’t see me in the doorway. I was about to leave when I saw George’s back. He was alone at a table in the L-shaped alcove beyond the counter working on notes and as oblivious to his surroundings as to the untouched cup of tea at his elbow.

  He didn’t hear me walk up to him. He was drawing a diagrammatic heart on the back of a blank case-history sheet.

  ‘That tea looks stone cold, George. Like another cup? Or would you rather be left to your notes?’

  He didn’t look up, at once. He pushed the drawing into the notes and stood up first. His face was taut, older. ‘You’ve heard?’

  ‘What?’

  ‘Sit down. I’ll get some tea. Without, isn’t it?’

  ‘Yes.’ I sat down fast and looked across at Paul. He looked nearly as tense as George and for once Shirley was listening whilst he talked.

  George was back with two teas. ‘I’ve just noticed you’re not in uniform. Been out?’

  ‘Yes. George, what’s happened? Marlene?’

  ‘No. She’s all right.’ He had to take his own time, so I kept quiet. ‘Roseburn was parking his car a couple of hours ago when another lammed into him. Not much damage. Shattered the driving window onto his lap. He put up his right hand to save his face and got two inches jammed in the palm. Out and stitched up, but he can’t use that hand tomorrow.’

  ‘Oh, God, no! Postponed, of course. Those poor kids!’ Then I saw his expression. ‘Not?’

  He said very quietly, ‘No. He talked to L.B., then Trevor. I was there. He told Trevor he’d postpone it if that was what he and Marlene wanted, but ‒ er ‒ in his opinion that wasn’t necessary and though he can’t operate, he’d stand by to advise.’

  ‘Roseburn said that? He wants you to lead? George, you must be good!’ He shook his head. ‘What did Trevor say?’

  ‘ “If you says that’s all right, guv’, that’s all right then isn’t it?” Anne. It isn’t. I’m not in Roseburn’s class. Nowhere near.’

  ‘He wouldn’t let you lead his beloved team if he didn’t think you damned near. He’s seen you lead before. Mister God Almighty Farler, remember?’

  ‘I’d forgotten I told you that.’

  ‘Have you done this specific op before?’

  ‘Once.’

  ‘Leading?’

  ‘Yes.’

  It had to be asked, ‘How’d it go?’

  He tucked down the upturned corners of his mouth. ‘All right as I was bloody lucky.’

  I said, ‘I know luck comes into it, but I know ‒ and you know ‒ it takes more than bloody luck to make the empty heart fill up again. More than luck to cut out the rotten valve with the good valve fractions of an inch away.’ He was silent.

  ‘Was this the one Roseburn saw you do?’

  ‘Yes.’

  ‘Then I’m not surprised he’s making history by handing you the buck. What one’s done once, one can always do again. And you must’ve done dozens of single valves?’ He nodded. ‘Marlene know? What does she say?’

  ‘Same as Trevor.’

  ‘So you’re lumbered?’ I smiled faintly. ‘Poor old George. This would scare the daylights out of any surgeon I know apart from Roseburn, but as he’s got his shirt on you ‒ and he wouldn’t let you lay the tip of the knife on her if he hadn’t ‒ if it were my heart I’d let you have a go at it.’ I drank some tea. ‘Talking of going, to be honest. Would you rather I now left you to sweat it out alone? Or do you want to talk?’

  He stared at me absently and again took his time.

  ‘Listen.’

  I told him about my walk, the near-mutiny, the written offer that hadn’t yet arrived, Nigel and his kids, the Italian villa a fellow director was lending Miss Jordan when she left Martha’s. I doubted he heard more than one word in three or took any in, but gradually he grew less tense. I had seen this happen on roughly similar occasions with Joe, Andy, and other senior registrars but never Dave or Hamish, since neither when we worked together had then been sufficiently senior to be handed the buck.

  The canteen emptied before we left. He walked with me to the yard. ‘Someone ‒ forget who ‒ said you’re observing for the C.U.’

  ‘Yes. Sister can’t make it.’

  He looked at his feet. ‘Anne, I’m not just scared, I’m bloody terrified. She’s been so convinced Roseburn could save her, though that wasn’t what convinced him, it didn’t do any harm. But I’m not ‒’ he had to stop as his transceiver was buzzing. He hauled it out mechanically and switched on. ‘Farler?’

  The porter’s tinny voice was clear. ‘Mr Roseburn wishes to see Mr Farler in his office now. Do you receive me?’

  ‘Yes.’ He repeated the message. ‘Farler, out.’ He put the machine back in his top pocket. ‘I must go. Thanks, Anne ‒ thanks.’

  I didn’t know what to say, there was no time for working on it, and it wasn’t the moment for a facile ‘best of British’. So I went on instinct, not intelligence. ‘Adios, Mr Farler.’

  His eyes smiled. He didn’t say anything. He went back into the Wing and for a few moments I stayed in the yard watching the open door.

  Chapter Eleven

  The tiered gallery was nearly full when Shirley and I arrived and within minutes only the reserved seats in the front row remained empty. There were more student nurses, medic and post-grad students present than was usual for a Saturday, and in the aisle seats many more white coats. A post-grad directly behind us in the second row said there had been a queue of students in the outside corridor before the door to the gallery stairs was unlocked at eight-thirty.

  ‘What do they think this is?’ queried Shirley tartly. ‘Last night of the Proms?’

  He thought she was joking and laughed. ‘Wimbledon when a non-seed makes the mens’ singles finals would be more apt, Nurse.’ He bent closer and lowered his voice as three pundit-type middle-aged men were shown to seats at the other end of the front row by one of the Heart-Lung sisters. ‘I thought the away club would send over talent scouts.’

  ‘Benedict’s pundits?’

  ‘One physician and two surgeons.’ He named them. ‘Top brass, indeedy! For George Farler’s sake I hope he’s up to this limelight.’

  ‘And for Marlene Eccles’s.’

  ‘Who?’

  ‘The patient. Ours,’ I added icily, ‘up to Monday. We’re Coronary Care.’

  ‘Oh.’ He had the decency to look rather ashamed. ‘Sorry.’

  He sat back and we faced the toughened glass wall that sealed the gallery from the theatre below.

  ‘Ghouls,’ I muttered.

  ‘Sods!’ Shirley looked sideways without turning her head. ‘Bring on the gladiators! Ooh, look, Mummy, there’s one poor lion that hasn’t got a Christian! Nothing like the scent of blood to fill the house! Couldn’t you throw up?’

  ‘Easily, but one’s got to be fair.’ I blinked at the nearest television screen as some unseen technician below adjusted the picture. The gallery had four screens, two set high and at angles on either side of the glass wall, the two in the aisle three rows behind us directly faced the top back benches. ‘This one could be one for the textbooks.’

  ‘Plus making Martha’s history. Paul said last night being the first outsider to lead here could make or break George Farler. Bloody unfair ‒’

  ‘It is, but it’s how things work. This limelight’s the kind medic students dream of and experienced surgeons dr
ead worse than gas gangrene.’ We stood up as L.B. and Joe joined us. Shirley moved up one as Joe was on until one and wanted an aisle seat.

  L.B. sat on my right. He was off for the week-end and in tweeds. ‘Unfortunate about Mr Roseburn’s hand, but a great relief to all that no postponement was considered necessary. Or perhaps not all.’ He smiled not unkindly. ‘I had a word with Mr Farler before he vanished through the showers. A very anxious man, I’m thankful to say. Nothing worries me more at this stage than a surgeon who sees no cause for anxiety when, in my opinion, he has every cause.’ He exchanged bows with the Benedict’s men, then leant forward on the broad wooden shelf running the length of the glass wall. I mouthed at Joe, ‘What do you think?’ He shrugged and held up crossed fingers.

  The theatre was the largest in Martha’s, as it had to accommodate the massive machines and huge staff needed for major cardiac surgery. Each machine had its own medical and technical team; each team wore caps, gowns, and masks of a different colour. The operating team wore the dark green used in all our theatres; the three machine teams, dark blue, magenta, white. Beneath their gowns, with one minor variation, all wore the same. The men had white cotton T-shirts, the women cotton coolie shifts, then both sexes cotton trousers, socks, overboots and nothing else. In some of our theatres after going through the showers, women if they wished could wear their own bras. Not in that theatre.

  The Heart-Lung showers were set across the changing-rooms instead of, as more usually, tucked away in an annex. The theatre staff left their clothes in locked lockers on one side of the showers, and after showering stepped out onto the far side to dry and dress in the sterilized under-gown clothes. From there they moved on into a communal anteroom, and added the sponge-bag caps, masks and boots. The ante-room’s electronic doors opened into the scrubbing-up alcove. After scrubbing their hands and arms for Mr Roseburn’s insisted ten minutes under running water, they put on sterile gowns and gloves and moved into the theatre proper. From the showers to the theatre, any return was both forbidden and impossible as all the doors only opened one way. Each chamber had an emergency fire exit, but even a casual touch on the exit handles set off a loud alarm.

  From the theatre the only way out was through the main exit. If, for any reason, anyone had to leave the theatre once in, he or she could only return by again going through the showers and full routine. Before anyone was let in in the first place, throat swabs were taken and cleared. L.B. told us Mr Roseburn’s cut had been swabbed, cleared and specially sealed in the Path Lab early this morning. ‘He’ll be wearing two gloves on that hand, but, of course, he won’t touch anything.’

  In comparison with the size of the theatre, the table under the seven-spotlight lamp looked smaller than usual. When Marlene was wheeled in by a consultant anaesthetist, Dick Francis and three other resident anaesthetists, she looked a limp unconscious doll under the transparent mask and sterile sheet. Two of the R.A.s fitted a white linen screen across her shoulders. She wore a white turban and her closed, childish face on the television screens suddenly silenced the murmur of conversation as effectively as the curtain rising in that other kind of theatre.

  As the teams moved into position with the smoothness and precision of well-trained dancers, it could have been the slow-motion opening of a modern ballet. There was enough colour and light, and the great white and black machines with their tube-tentacles stood out sharply against the shadowless and shineless dark green walls, and made a startlingly right backdrop. Some of the blue, magenta, and white figures were stationary, others inter-wove with each other around the edges of the growing dark green centre-piece.

  Sister Heart-Lung behind one trolley. Sister Yates her deputy, behind another. Close by each sister, a staff nurse, theatre technician, and senior medic student. The four assistant surgeons, all senior registrars, had junior registrars as reserves. George had a senior registrar. Mr Roseburn had introduced the reserve team system to Martha’s and refused to operate or allow operations in his theatre unless it was complete. ‘Any man under those lights for hours,’ he said, ‘can faint. Fair enough. But no patient of mine in a cardiac operation is waiting fifteen minutes until someone else is clean enough to replace him.’

  Mr Roseburn had come in last with George, as etiquette and a deeply engrained Martha’s theatre tradition (and superstition) ordained. Only Mr Roseburn looked up at the gallery. ‘Good morning, ladies and gentlemen. Dr Lincoln Browne, are you getting me clearly? Sets working well?’

  The gallery inter-com worked both ways but during operations was only set to receive. L.B. sat forward to nod back.

  The gallery faced the machines and the table, lengthwise. The television cameras and technicians were invisible beneath the gallery overhang. George turned his back to us to look the machines over, then with the four assistant surgeons he moved closer to the table. Simultaneously, the reserves stepped a little back and all, in an almost identical gesture, unclasped their raised, gloved hands. Looking down at that moment it was like looking down whilst some great green tropical flower slowly opened. A flower with long and constantly increasing tentacles, as slowly they began connecting Marlene to the machines.

  The light rose and fell in the cathode ray tubes registering her heart-beat, the blood-pressure in her arteries and veins, the amount of oxygen in her blood. One by one, the men sitting watching the dials and lights, read out the checks in impersonal, casual voices. Mr Roseburn sat on a high stool at the foot of the table under one of the microphones. As always he described rather than lectured, and occasionally in the early stages, made a mild joke. The gallery smiled perfunctorily. Marlene’s face kept reappearing on our screens. The operating team paid no attention if they heard him, which was unlikely.

  L.B. murmured to me, ‘It is extraordinary how difficult television and transparent masks make it to forget the human being under the sterile towels.’

  George’s right arm again went out behind him. Sister Heart-Lung put a clamp into his unseen hand. Neither then, nor at any time, did he or the other surgeons have to ask for what they wanted. The sisters worked in silence and always one step ahead.

  ‘With the rib-clamps in place,’ said Mr Roseburn, ‘we’ll see this girl’s heart.’

  It wasn’t the first human heart I had seen bared. Perhaps as I knew Marlene so well and she was so young, it upset me so much more. I had to look away from the pulsating red mass and dry my hand on my skirts before I could go on with my notes. George knew her as well. I hoped to God he didn’t remember.

  The full transfer to the heart-lung machine took the usual very long time. Then, George’s voice, ‘Checks, please.’ And after every operative had replied, ‘Right. Total by-pass.’

  When operating Mr Roseburn never talked at this stage and he kept silent. The machine was keeping Marlene alive and the absolute concentration below turned the green flower into a many-handed human machine controlled by one brain. George, I thought incredulously. George Farler. A man I met in Spain.

  On the screens he was fitting a knife on to his forefinger. Then his hand, knife and finger were in Marlene’s heart. I had to sit back. Shirley glanced at me then silently took my pen and pad and went on with the notes.

  The cameras enlarged the new valves to water-lilies floating on a still pond. Through the glass wall, tiny snowflakes in solution in the small dish now at the front of Sister Heart-Lung’s trolley.

  ‘Shouldn’t be a porter,’ he said, ‘should be the Snow Queen.’

  I was rather peeved. I felt I had shared quite enough with him without that.

  Sister Heart-Lung arranged the row of needle-holders gripping the delicate curved needles trailing long black threads. On the screens, scythes trailing ropes too heavy for a man to lift unaided.

  ‘Could they have got up from here?’

  ‘Easily, if he’s not alone and has a bit of rope.’

  I didn’t know I had shivered till Shirley touched my arm. ‘You all right?’ she mouthed.

  ‘Fine, thanks.’ I mo
uthed back.

  ‘But I‘ve got my oasts to keep me warm.’

  The cameras altered focus. The long black threads lay outstretched waiting to be tied. George used his hands for the double slip knots and reverse loops and the first assistant clipped off the unwanted ends. It looked so easy.

  L.B. sat back, folded his arms. ‘Just one more little problem to clear up.’

  George had kept an eye on the theatre clock. Now he looked at it more often. Time was the greater enemy. The gallery was as silent as the theatre and in silence the gentle, rhythmical ssshush-ssshush of the heart-lung machine came over the microphones as human breathing.

  Joe had been coming and going. He was back when George put in the last stitch to close the repaired heart.

  The first assistant stiffened, his hands upraised as if someone had pulled a gun on him. George’s hands stayed poised above the wound. The whole ballet froze to a tableau and the gallery sat forward for the interminable moment before the empty heart began to swell. Then, at first tremulously, then steadily, the rhythm was visible as the lights flicking out the regular beat on the machine. The gallery breathed out and sat back.

  Just under two hours later and nearly seven from the start, it was over. For a few seconds after the table emptied, the surgeons stayed where they had stepped back and stared at the blank space. Our screens went dead, and just before the inter-com was switched off, we heard George’s mechanical ‘Thank you very much, everybody.’ His voice was old. Very slowly he peeled off his gloves, threw them in the nearest sink, hitched forward a stool with one foot and sat with his shoulders sagging and hands hanging limply at his sides. He looked up at the gallery for the first time since he had come in, but not as if he saw it. All the rest of the team found something to sit or lean on. Mr Roseburn did a kind of polka amongst them and said something they acknowledged with exhausted nods. The whole operating team, sisters included, were under thirty-four. At that moment there wasn’t one member who couldn’t easily have been double that.

  Sister Cardiac fed me tea, digestive biscuits and ward brandy and made a memo to thank Shirley on Monday for her half of the notes. ‘Don’t be absurd, Anne. No need to apologize. You’re a nurse not a machine and we all have our off-moments and particularly when subconsciously aware we can afford ’em. You’d have managed if Shirley Carter hadn’t been there. Go home, put your feet up, then have a good meal. Nothing to touch relief for making one feel one’s guts have dropped out.’