"Probably. Just so long as you fall away from the table. I'm leaving in half an hour."
They had passed through the Valley, Bentley driving and feeling a strange tension he had not experienced before, when Merrie spoke in a crisply assured tone; he had heard that before, during his first conscious meeting with her, after she had sutured his injured thigh.
"You might find Doctor Warren a little odd, at first," Merrie said.
"In what way?"
"He can't abide fools. Apart from that, he's naturally brusque."
"So what's new?" Bentley smiled, thinking of Sainsbury.
"He also tends to talk rather a lot while he's working. In explanation, I mean."
"Well, naturally, for you, seeing you're assisting him for the first time."
"For you, too."
"Come again?"
"He's quite brilliant. Don't misunderstand me, but he likes an audience. Normally it's professional, of course, but this morning it's you. So please try and appear interested."
"That," Bentley said, feeling a shiver inside, "you need have no worries about."
"Good. And Peter?"
"Yes, my sweet?"
"Please don't faint."
"That," said Bentley, "I do not need. Obviously your knowledge of psychology is zero. As a cheerer-upper you'd make a bloody good bosun's mate!"
"And another thing. Watch your language."
"Aye aye, sir."
"About the fainting bit," she went on casually. "I told him you had the Victoria Cross, so keeling over wouldn't look so good, would it?"
"No," he said, a bit weakly, and wished he hadn't eaten all that breakfast. Already it seemed to have ideas about getting out.
"I'd like to go into the hospital," Merrie said, "not past it."
"Hell!" Bentley braked hard and swung into the staff parking area.
From then on he was in a whirl of novel activity; but ordered and designed, he noted, as on a busy bridge. A bald-headed, friendly young fellow-he learned later this was the anaesthetist-helped him into a long-sleeved white gown and canvas boots that completely covered his shoes, then gave him a mask and showed him how to tie it, with the top strings running over his ears like reins. Finally, the cap, also tied behind.
"There we are, chum. By the way, I'm Frank Drummond. Call me Bulldog and I'll clobber you, big as you are."
"Peter Bentley. I'll watch it."
"You're Doctor Prescott's friend, right?" Doctor? But they'd hardly call her Mister. "That's right."
"First time in an operating theatre?"
"Conscious, yes."
"Hmmm. Two words of advice. On no account, absolutely on no account, touch anything, not a bloody thing. It's not all sterile in there, but you won't know the difference. Right?"
"Right. Where do I stand?"
"We'll come to that. Now the second thing. If you feel like fainting, for God's sake don't... What's the matter?"
"Nothing."
"I can see your eyes, remember."
"Oh. Well, then, Merrie's been on to me already about that pleasant little possibility."
"Who the hell's Merrie?"
"Doctor Prescott. Meredith, actually."
"Hmmm. Sorry, chum, but the Old Man's been on to me about it, too, so you'll just have to hear it again. If you feel faint-cold sweat, tight band around the forehead-for God's sake don't topple..."
"Seasickness," Bentley said, "symptoms of."
"Hmmm. Okay, then. But don't topple towards the table. In fact, get outside at the first sign. In fact, I'll be watching for it. The forehead turns white, even under that leathery tan. But you'll be all right. Seen a bit of action, eh?"
"A bit."
"Hmmm." Drummond stepped outside the dressing-room and looked through a large glass window, almost a wall. "They've got her all setup. Let's go."
Bentley shuffled down the passage, feeling awkward in the boots. Then, copying Drummond's movements, his wide shoulders had pushed open the swing doors and the brilliantly lit theatre shone before him and his mind became a tautly receptive mesh of awareness.
"This is Captain Bentley, sir," he heard Merrie saying, and he dragged his eyes away from the mounded mass of drapes on the table.
"Good morning, Mister Warren," he said, the mask crinkling with his smile, just in time remembering not to put his hand out.
"Captain." The voice was brusque, as expected, but Bentley was surprised to see, looking at him from a gnome-like face, that Warren's eyes were almost sleepy. "Glad to have you aboard." Now the eyes woke up, twinkling. "All right, so I watch naval films."
"American," Bentley said.
"Is that so? Well, well. However..." The subject of naval terminology was closed. "Drummond's given you instructions?"
"Yes, sir." Bentley had no hesitation about the title, even though in his own field he was as senior as Warren in his. He offered it as a mark of respect. Warren looked pleased. He said:
"I understand you have the Victoria Cross?"
Bentley saw the heads turn, and Drummond look up quickly from his anaesthetic machine. But Bentley's forehead was bare, and Warren saw what happened there. So did Merrie.
"Didn't mean to embarrass you, Captain," Warren said. "We don't meet V.C. winners every day, that's all." Bentley regretted his reaction, but before he could speak Warren turned to the head of the table. "What are we using, Drummond?"
"Cyclopropane."
"Good. We'll keep her as light as possible. I've had one suffocating baby from a uterus full of meconium. One's enough."
"That makes two of us, sir," Drummond said. "I'll watch it."
Warren nodded. "I won't need Trendelenburg," he said, "I like to keep `em horizontal. The other way," he said to Bentley, "the table is elevated about forty-five degrees, with the patient's abdominal organs pushed up towards the chest by gravity. Not for me, this morning."
"No," said Bentley, and flicked a glance across the table at Merrie, seeing her mask crinkle in answer. But only slightly; Merrie's eyes were intent, and fixed now on the master.
Warren walked round Drummond, careful to keep his hands clear, to where the theatre sister waited with gown and mask and gloves. She was scrubbed-up and dressed, little more than her eyes showing. Bentley heard her saying:
"Remember, Nurse, I want those packs shaken out before they're counted. Last night two were hung up stuck together. That won't happen again."
Bentley felt at home. But then, he reflected, you expected that sort of discipline in a place like this. His eyes went to Warren. The surgeon slipped his arms into the gown's sleeves; deftly the sister knotted its tapes behind his neck and back. The rest of the operating team were busy. No one was paying attention to the familiar routine in Warren's corner. Now his gloves were on; to Bentley, it seemed with one swift thrust for each. Nothing sleepy about those hands. He flipped the ends of the gloves up over the sleeves of his gown, where they gripped the fabric like elastic bands. Then Warren held out his right hand. Startling Bentley, both because it broke the quiet and he recognised it, came Merrie's voice: "Another glove, sir?"
"The second glove, for the right hand." Warren glanced at Merrie. "Haven't seen it before? You'll get the point later." The glove went on easily over the smooth rubber of the first. "Doctor Prescott will be assisting, as no doubt you know," Warren spoke generally. "I'll describe as I go. If anything bothers you, don't hesitate to ask. The same applies to you, Captain." He chuckled, a dry rustling sound. "Within reason, of course. Now please stand up there beside Drummond. Careful does it. Imagine you're in a cordite room with a lighted match."
The chuckle came again, and cut off sharply. "Sister Lennon?" The theatre sister turned. "The patient's been catheterized?"
"Yes, sir."
Warren gave the reason for his question. "I want the catheter withdrawn on the table just before I start the operation."
"Not... left in?" Merrie asked, making sure she had heard correctly.
"No. I believe a bladder gradually filling towards the end and
after the operation provides a small amount of pressure, just enough to stop the oozing spots you sometimes get after separating the bladder during the exposure of the low uterine segment."
"Yes, sir," Merrie nodded.
She was right about the explanation bit, Bentley thought, but it's damned interesting. Obviously Warren had his own technique, carefully thought out and precisely practised.
Bentley tensed. Warren was walking to the table. Mrs. Nelson's abdominal area had been liberally swabbed with red-coloured antiseptic. No other part of her body was visible. Warren stood on
her right side and glanced at the anaesthetist.
"Ready, Drummond?"
"Ready to start, sir."
Warren held out his right hand, palm uppermost, and Sister Lennon laid the scalpel gently in it. His eyes flicked to Bentley.
"See that, Captain? These knives are damned sharp. We'll let the film nurse slap `em into a surgeon's hands."
"Yes."
Bentley could say no more. His eyes, all their eyes, were on the knife and its downward movement.
Warren rested the razored joint on the red skin, and cut. He cut with a swift, steady firmness. The skin opened out like a miniature ploughed furrow behind the blade, an incision six inches long from umbilicus to symphysis.
"Human skin can be scratched. Human skin, incised deeply like this, is remarkably tough."
Bentley knew the comments were for him, without Drummond's surreptitious nudge.
"Yes," he said, "I noticed."
Then he was noticing Merrie. Her hands began swabbing at the seeping redness and her forceps, looking to Bentley like toothed scissors, picked up and squeezed off the bleeding points. But mainly he noted the assured deftness with which she worked. This, like Sister Lennon's discipline, was to be expected; he was impressed just the same, and a proprietary sense of pride moved in him.
Warren glanced up at Merrie, opposite him across the table.
"You'll notice I've incised half an inch to the left of the midline. If I have to extend upwards I won't have to cut the ligamentum teres running from the umbilicus to the liver. Damaging any tissue or cutting unnecessary structures-that's bad surgery, Prescott."
"Yes, sir."
Bentley was pleased at the use of her surname; somehow it wiped out any inferior implications of her sex and made her simply one of the operating team.
Merrie's hands drew back clear and the scalpel cut an inch-long incision in the rectus sheath, the thin membrane covering the long straight abdominal muscles. Through the slit the reddish muscle
showed. Warren said:
"Muscle, Captain; that's what you know as steak. Blunt-pointed..."
Before he could get further Merrie had placed in his hand the pair of closed, curved scissors. Warren made no comment on her prescience or knowledge of operative technique. He pushed the scissors down beneath the sheath, thus separating it from the underlying muscle.
"How are you feeling?" Drummond asked lowly.
Bentley nodded. "I'm too interested to faint. I think."
"You'll make it. The first cut's always the worst. I've seen nurses keel..."
"I'm working on the sheath well down on to the symphysis," Warren said brusquely, though not glancing at Drummond. "It's the unyielding sheath which limits your exposure, and in a pelvic operation like this you want every bit of room you can manage low down in the wound."
"Yes, sir," said Merrie.
The two pairs of hands worked on, one incising and scissoring, the other at their complementary work of swabbing and retracting the wound edges and tying off bleeders.
Fascinated, Bentley was reminded of a pair of experts splicing wire together. Merrie was impressed too, though for a different reason. She realised that she was watching as neat and economical surgical work as she had ever seen.
Warren called for the special retractor and Merrie contracted her thoughts to the job in hand. The uterus was now exposed.
"There you are, Captain." Bentley leaned forward, careful to touch nothing. "The uterus, or womb. In some places it's more than an inch thick with powerful contractual muscles. Now, of course, they're receiving no messages from the brain, thanks to Drummond."
Bentley just stared. The uterus showed in the wound as a smooth, rounded, board-hard organ, extended to its limit by the precious life it couched. He never felt less like fainting in his life; there was no room in his mind for anything except fascinated wonder.
Warren placed the retractor across the bottom of the wound; this was large, and allowed the whole width of Warren's gently feeling hand entry into it. Quite a big hand with thick fingers; so much for the popular conception of a surgeon's slender fingers, Bentley thought.
From beneath the gleaming edge of the retractor holding the wound open a small segment of an organ peeped. Warren's forefinger pointed at it.
"Danger, Prescott. Pregnant tissues are very vascular, they tear easily. I'm going to roll that bit of bladder back down out of the way, with a small sponge over my finger. If the bare finger should slip with a pushing movement, then we could have more blood on our hands than we want. Retractor, please."
Merrie lifted it a little and Warren's protected finger very carefully rolled the peeping segment back.
That was the bladder... Up till now-and this was partly the reason why he felt no faintness-Bentley had been looking at things totally alien to his knowledge, exposed between the anonymity of covering drapes. Umbilicus, symphysis, rectus sheath... these meant nothing, less familiar to him than the most complicated parts of Wind Rode's machinery. But that was a bladder, and bladders he knew about, and with an abrupt shock of awareness it struck his consciousness that this was a human body hidden under these sterile drapes, a woman. A living woman.
He looked at the red-edged violation of her abdomen and involuntarily he whispered to Drummond:
"My God, what if she wakes up?"
Drummond's mask moved with his smile. "I was waiting for that. You took longer than usual to ask. No, chum, she won't wake up. Even if she looked like coming round, we'd have plenty of warning." "Sorry," Bentley said, feeling a bit foolish.
"Don't be. I'd be lost in one of your gun turrets. Each to his own. Look here. Now comes the important part."
"Critical part, Drummond, I would say," Warren said.
"Yes, sir."
Drummond agreed so quickly that Bentley got the impression he had used his less-vehement adjective deliberately. Then he forgot analysis, for Warren had the scalpel in his hand, with the uterus waiting distended beneath its gleaming point. No medical knowledge was needed to understand what would happen shortly. Bentley felt
his scalp tighten, but instead of cutting, Warren spoke to Drummond.
"Ergometrine, please, 0.5 milligrams intravenously."
"Right." Drummond picked up a hypodermic needle, already filled.
"The purpose of this drug," Warren said, his hand still poised, "is to constrict veins and reduce bleeding. Our object is to confine tissue damage and blood loss to the smallest possible degree."
That was layman's language. "I see," Bentley responded. He looked at Merrie, but from her intentness of attitude he might have been in New Guinea.
The drug went in. Warren got a pulse and blood-pressure reading from Drummond, and then, satisfied, he lowered the scalpel.
The cut, in contrast to the gaping, retractor-held wound, was almost tiny. Warren held the knife vertically, pressing down with it until he was through the muscle, and then the inside membrane. Through that small hole liquor began to flow. Bentley wasn't the only one affected. Above her mask Merrie's eyes narrowed a little, not in alarm, but interest and attention. This liquor was the amniotic fluid, a clear watery substance which surrounded the baby and cushioned it from outside shock. They were getting very close.
Warren dropped the scalpel and into his hand Sister Lennon placed the curved scissors. With his left hand he carefully drew the uterus upwards. He said to Merrie:
"As I cut-
the retractor to one side a little, then the other." Merrie nodded understanding. The theatre was very quiet.
The jaws of the scissors went into the tiny cut. Warren's fingers moved, and the sharp steel cut a curved wound upwards. This was the entry-the intrusion of medical science and years of skill and training, the final and vital entry into the very couch of life. The uterus, the natural and jealously protective sac, was now violated. For thirty-six weeks Mrs. Nelson had borne and nurtured her baby, but now the child was bereft of protection; it was viable, alive, but its continued life depended utterly on the skill and experience in the fingers of Doctor Warren.
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