by Manda Scott
The first time I met her in person was at Nina and Matt’s engagement party when the vet school’s new super-star resident had just walked off the plane from the States and was busy telling the world how much better they did things in Madison, Wisconsin, where everything was smarter, shinier, bigger, brighter and more expensive and where the veterinary technology made everything in Scotland look like it had oozed from the primordial swamp.
For a newcomer expecting to spend three years in a foreign country, she seemed hellbent on unmaking friends, and by half an hour into the bash, no one was going to step out of their way to disappoint her. By halfway through the evening, she had one corner of the buffet table all to herself and when she ordered a taxi back to the vet school long before the party ended, there wasn’t a single volunteer offering to show her the way to the residents’ quarters.
For the last two and a half years, I have listened to weekly bulletins of Steff and her impact on the vet school hierarchy, which was not unlike the effect of rubbing carborundum paper briskly across an endless series of matchheads. In due course of time, when all the fires died down, the world was divided into two groups of people: those who thought she should be forcibly placed on the next plane back to Chicago and those who believed that she was one of the best things to happen to the clinical department in years. Fortunately for Dr Foster, Nina was of the latter group and Nina was the boss which meant that the lass got to stay. I don’t imagine she’s had a particularly easy time of it, however.
I found her in the horse ward down at the foot of the hill beyond the operating theatres and the small animal unit.
The place was oddly quiet. I’ve been into the vet school clinic three times as a client of Nina’s since she first came to see me for therapy. It’s not exactly orthodox and it made for an odd reversing of roles but, on the other hand, we didn’t have many alternatives. She’s the senior surgeon—at times, the only surgeon—at the clinic. I own a farm with upwards of twenty horses, an uncountable number of free-range cats and a dog. Simple law of averages says that at least one of them will need specialist attention every once in a while. In basic terms, there were only two other things we could have done: she could have changed therapists, or I could have sent Sandy in with the animals. Neither of us wanted to do that and so we settled on the principle that, on my territory, she was my client, while on her territory, I was hers.
It has worked so far. In the first year, I brought Midnight in with a surgical colic that kept her in the horse ward for two weeks. Three years after that, I brought a cat that had complex surgery for a femoral fracture and then, two months later, he went for a sprint in the orchard and managed to break the implant. It took almost six months for that one to heal and I was on first-name terms with everyone from the nurses through the canteen staff to the security guards by the time he was finally discharged.
In all that time, I have never seen either of the wards without at least a couple of long-stay patients to keep the yard staff and the nurses happy on their triple time. Even at Christmas they had a goat with a fractured metacarpus and a couple of chronic diabetics taking up room just in case anyone thought they might otherwise go home early. This time, I walked into a building that wasn’t just devoid of life, it was swept out and scrubbed clean. From the calf pens by the doors to the big stallion boxes at the far end, there wasn’t a single wisp of straw. Not one solitary flake of wood. Nothing. I was walking through a ghost ward, denuded even of ghosts.
I found Steff in the end, by following the smell. Like Nina’s overalls but with the toxic bite of the disinfectant rather stronger than was healthy. She was in a foaling box down at the far end of the barn that had ‘ICU’ etched on a copper plaque on the door. A handwritten note stuck to the wall with zinc oxide tape warned: ‘ISOLATION—TREAT AS INFECTIOUS’ and below it a rack of overboots and a tray of milky white disinfectant offered ostensible protection against whatever nasties lurked inside.
There were three of them inside the box: two humans and a horse. Steff sat, fast asleep, propped up against the wall beneath the manger; a spiked blonde replica of Nina down to the smell and the blood on her overalls. The student—only a student would wear a white coat in a box with a diarrhoeic horse—was, quite simply, comatose and could easily have been dead for all the movement he made. Which meant that when I pulled on the overshoes and swished my feet around in the foul phenol of the disinfectant, it was only the horse who was awake enough to take any notice.
He was a nice horse. A big, raw-boned chestnut with a white snip to his nose and the scars of old saddle sores lined up along his back. He lay calmly in the straw, with his legs curled under him in the way a dog would lie beside a fire. Even like that, he took up most of the box, his head near the door, his tail in the far corner opposite the hay rack. Sixteen hands, easily. Possibly more. He raised his head slightly as I looked in over the half-door and, even with a stomach tube blocking one nostril, he still managed a small, deflated huff of greeting.
There is a rule of thumb in the ICU that says the likelihood of coming out of the ward alive is inversely proportional to the number of drip sets, wires and tubes attaching the patient to the machines. In human medicine, the cut-off number is five. Below that and you’re probably OK. Above it and you’re in deep water. On the line is evens. I have no idea if the same applies to horses but if it does, this one was way over the odds. Four separate drip lines flooded different kinds of fluids into catheters in both jugulars and the tangled wires of a multi-lead ECG lay draped across him like a damp cobweb sending erratic signals to a bank of monitors high up on the wall. Other probes in his rectum and clipped to his nostrils fed temperature, respiratory rate and arterial oxygen tension in to the other boxes of tricks. The whole bank of monitor screens pulsed with livid streaks of electric light; greens and ambers and a cold, unpassioned blue. A stomach tube emerged from his left nostril, ran up the front of his face and was taped in place across the poll of his head collar with more of the ubiquitous zinc oxide tape. Suddenly, and very horribly, he looked not at all unlike Nina on the first day I met her.
I hope to God she doesn’t know.
It seemed important, then, to know his name. His case notes were leant up against the wall near the door. I slid back the bolt and let myself into the box. He huffed again as I crouched down by his head.
‘Hey, son. What’s up?’
He didn’t say much but he blinked a couple of times to show that he knew I was there and the anxious wrinkles deepened in the hollows above his upper eyelids. I moved back to pick up the case notes and the look in his eyes as he watched me walk past was anything but peaceful. Nina was right. He wanted death and he wanted it very badly. If I was her, I doubt if I would have held off with the gun.
The case notes carried his basic details in computer type: ‘Branding Iron’, property of one Mrs Campbell of Stewarton. An eleven-year-old thoroughbred gelding, exracehorse, ex-eventer, ex-show jumper with a future as a hunter if the surgeon could fix his larynx. The surgeon, had, by all accounts, fixed his larynx. Details of the surgery were recorded in a rounded longhand in the pages that followed and the line of a neat, new scar, four inches long, ran along the side of his throat still with the nylon sutures holding it shut. As Nina said, he should have been home enjoying the springtime. Except that there were liquid faeces running out from under his tail and the blood oozing out round the stomach tube was darker than anything I’ve ever seen in any living thing, human or otherwise.
There was movement in the straw across the box and a voice said: ‘Kellen?’
A Chicago accent, with just a touch of Glaswegian. I looked up. Steff hadn’t moved but her eyes were open and she was doing her best to focus in my direction. ‘What the hell are you doing here?’
Twice in one day. It’s so nice to feel welcome.
‘Guess,’ I said.
She sat up and started to run her hand through her hair then realised she still had her rectal gloves on and thought better of it. ‘You’ve
seen the boss?’ she asked.
‘I just suggested she took a month or so in bed. You don’t look any better. What’s going on?’
‘Pass.’ She smiled the same kind of hard-pushed, baring-of-teeth as her boss and shook her head. The hoops in her ears flickered in the green and amber glow from the monitors. ‘The devil has come to stay in the large animal ward and we can’t persuade him to move on.’
‘And the horse?’
She shrugged. An expressive all-encompassing shrug that spanned the entire contents of the box. ‘The horse is dying. He’s been dying since he hit the floor on Tuesday night. He’s only alive now because Nina doesn’t want to let him go.’
That’s not quite the way I heard it.
‘Is she getting overinvolved with the patients?’
The silver stud at her nose flickered as she smiled. ‘Nina’s always overinvolved with the patients. You know that … This time I would say she was obsessed.’ She stood up and stripped off her gloves, tying them absently in a series of intricate knots. ‘And—this time—she’s not the only one.’
‘You?’
She pursed her lips ruefully. ‘Me, the yard staff, the students—except Dominic,’ she nodded in the direction of the barely moving white coat on the floor, ‘who hasn’t noticed that there’s a crisis on—the anaesthetists, the secretaries, the librarian, the guy who comes in every other afternoon to refill the coffee machine … We’re all “overinvolved”.’ Her gaze ran round the monitors on the wall and she winced slightly at the news they carried. ‘I’d get out while the going’s good if I was you, Dr Stewart. Unless you want to be the next one on the bandwagon.’
Too late for that. I was on the bandwagon from the night the first one died. The night Nina Crawford turned up after hours and stood in the doorway to my consulting room asking for an emergency consultation. That was over six months ago.
A monitor warning alarm bleeped suddenly at the other side of the room. Like an electric alarm clock but with an undulating rhythm carefully selected to drive you mad if you don’t do something serious in the space of ten seconds. Steff reached over and jabbed a finger at the cancel button.
‘Stupid effing machine.’ She swears like her boss. Semi-controlled bad language as if the rest of us might be offended by the real thing. She fiddled at the back of the monitor for a second and the amber blip threading its way across the screen settled back into the double notch of an arterial pressure trace. She watched it for a screen or two, pressed a couple of buttons and swore again, more seriously.
‘Something wrong?’
‘Brainless bloody thing thinks his pressure’s falling.’
‘Do you believe it?’
‘Might do.’ She shrugged. ‘He lost a bit of blood when we tubed him.’ She knelt down by the horse, ran her fingers along his back, pinched his skin, looked in his eyes. All the kind of things I would have done if I’d had a machine telling me lies about a patient. They do that all the time, machines; tell lies. It’s part of the programming. Stops the clinicians from becoming complacent.
I watched one of the four drip bags run its last few mls of fluid into a giving set. The final drop hovered, shivering, in the plastic column far above eye level.
‘You could do with some more fluids up.’
I said it carefully. Not everyone appreciates other folk intruding on their cases.
Steff is not, apparently, as touchy as her reputation suggests. She looked up at the bag, nodded once and then looked down at her sleeping student. She smiled again, a broad smile this time, more real and laced with late-night acid. The silver in her nose flashed brightly.
‘Time for sleeping beauty here to do something useful.’
He looked too peaceful to disturb for something that trivial.
‘Leave him be. It’ll take longer to wake him up than it will to get the stuff. I’ll do it.’
She looked at me sideways. ‘You sure?’
I nodded. It’s a long time since I did anything clinical. It was fun once. Before the politics overtook the medicine.
‘OK,’ she said, ‘if you’re sure …’ She checked her watch. ‘We may as well do his eight o’clock treatment while we’re at it.’ She lifted the clipboard from the hook on the wall and ran her thumb down the treatment page. ‘There are five-litre bags of Hartmann’s in the cupboard behind the door in the drug store. Stick one of them in the microwave and get it up to blood heat. I’ll get everything else.’
Five-litre bags are huge and they take a good five minutes, even on full power, to come anywhere near body temperature. Most of the other drugs had gone in by the time it was ready. I carried the bag back to the box and knelt by the horse, hugging the bulk of it to my chest like an oversized hot-water bottle while Steff unhooked the old drip, flushed the catheter and reconnected the giving set with the kind of practised rhythm that said she could have done it in her sleep if I hadn’t been there. She has an odd kind of grace for someone so tall. A careful economy of movement. A reining-in of power as if the world is made of eggshells and she has broken them once too often.
She finished connecting up the drips and knelt by the horse, weaving the new piece of plastic tubing into his mane. He bent his neck and nuzzled at her pocket, carefully because he had a stomach tube taped to his nose and however stoic you are, it still hurts like hell if you move a nasal tube. She played with him for a moment, scratching the itch at the back of his ears where the sweat dried under the headcollar and then she started clearing the debris.
I looked at the growing pile of discarded empties. It costs me somewhere near a weekend’s takings to have Ruaridh Innes come out and spend half a night putting a single drip into one of the horses. More than that if he has to pile in more than fluids. Even more if he uses drugs that aren’t on the daily-use list. Penicillin and bute come cheap. Everything else costs more than the bank manager wants me to imagine. I looked at the empty vials of third-generation cephalosporins and the part-used bottles of non-steroidals and the half-litre bottles of intralipid and tried to imagine the possible cost. More than I could ever afford for a horse.
‘Is Mrs Campbell paying for all this?’ I asked.
She snorted, like the horse but with less energy. ‘You’re kidding? “Mrs Campbell” wasn’t even paying for the surgery. That’s Maureen. Mo. Was Maureen Flanagan till she married one of the guys from final year. You’ll have met her here, somewhere along the line; she’s been around for years.’
I remembered. A dark, slim-built lass with an Irish sense of humour and her countryman’s way with horses. ‘The head nurse?’
‘Right.’ She crouched down with a sharps box and began to strip needles from syringes. ‘So she knows what we’re up against, as much as anyone does. She’s been in charge of this end of the clean-up programme. She brought in laddie-boy here for us to run through to make sure theatre was clean. Kind of an act of faith to show the boss we all believed in her … “I hereby lay before you my first born and most beloved on the altar of Almighty Surgery.” Because we knew, we all knew, that there couldn’t be any infection left. Not a single effing microbe in the whole of the godforsaken large animal hospital …’
She stopped, reining in the irony and the anger in much the same way she reined in everything else, and stood up to check the pressure monitor. It blipped peaceably to itself. A nice, regular, healthy rhythm, aesthetically synchronised with the other blips ranged along the wall. All of them whispered peace. None of them said it was going to last. She sat down in the straw by the horse, resting her back against his shoulder and reached up to scratch the spot behind his ears. He leant back against her, angling his head against the push of her fingers. The yellowing light from the single strip in the ceiling merged with the fluorescent greens and ambers from the monitors to turn her hair the same shade of green-white gold as the hay in the rack. Her face caught in a patchwork of shadows, turned harlequin-smooth, washed free of the need for sleep. An ageless doll in the age of technology.
She pre
ssed the heels of her hands into her eyes and shivered once, violently, the way a horse shakes off flies. ‘I guess this is the good news,’ she said. ‘If it was anyone but Mo we’d have the lawyers camping outside the box by now.’
‘So where is she now?’ I asked. ‘Maureen?’
‘Home with the kids. We sent her off on Wednesday when it really got rough. Didn’t seem much point in her staying to watch the execution.’
‘Is she the reason you’re holding off with the gun?’
‘Partly … No …’ She stopped to think, curling a strand of straw round her fingers. ‘… We’re holding off because the boss thinks that if we can get him through the acute phase with fluids and intravenous feeding then we might bring him out in one piece.’ She bit on her bottom lip and turned to look at the horse. The horse turned his head to stare at the wall. The anxious wrinkles over his eyes deepened.
‘And you? What do you think?’
‘Me?’ There was a long pause. She found a sweet spot on the horse’s neck and scratched round and round in a circle. ‘I’m not paid to think. I’m just paid to get on with the treatments.’
Very likely.
‘And off the record …?’
‘Off the record? We’re fucked, Kellen. We’ve done everything there is to do and we still haven’t beaten it. There’s nowhere left to go.’
‘They’re dying. The horses are dying. They’re in theatre, most of them. On the table. Draped up, anaesthetised. Just like the real thing. I lift the blade and start to cut and Steff’s there, or Mo or one of the students, swabbing the blood away from the wound edges, passing me the scissors, or the retractors or the arthroscope. Everything’s so totally normal. I don’t notice at first that the bleeding doesn’t stop. Not until I’m deep down into the wound and the abdomen’s filling with blood and the suction jars keep overflowing and then suddenly it’s not Mo or Steff on the other side, it’s Matt and he’s telling me that the horse is dying, showing me the monitors with all the lines going haywire. The giving sets are pouring in blood but never fast enough to stop it flooding out of the hole that I’ve made. Then the horse wakes up and turns round and starts to scream at me that it’s all my fault. It always ends with the horses screaming and it’s always my fault. I make the wound and I don’t stop it bleeding. I do everything there is to do and they don’t get better. There’s nothing left to do.
