by Manda Scott
4
Each of us has our own nightmare. This is mine.
It is cold and it is dark and it is wet. Very wet. The world is awash with water. Rain soaks steadily through jeans and fleece and trainers. Arcing jets of it bounce off beech leaves on to the small, unprotected patches of skin at my ankles and wrists. The smell of it rising from the sodden turf almost covers the other smells of sweat and rancid faeces. The crash of the river spinning down over the shallows at the side of the field hushes all other noises to nothing. If I look anywhere away from the limmering pool of torchlight, all I can see is the sheen of the rain and the odd splash of foam from the burn.
If, instead, I choose to look down into the torchlight, there is a small, dun pony mare, stretched out on her side in the grass with her head heavy on my knees, her eyes dull with drugs and her twitching feet periodically smashing grass into mud.
If I look a fraction beyond that, there is a man; a short, compact man, lying face down in the dirt with his shirt off, his free hand clenched tight in a fistful of grass by way of an anchor and his face locked hard in concentration.
As I watch, he slithers backwards and kneels up, peeling the plastic rectal glove from his arm. The skin beneath is laced with a network of livid, red creases from the pressure. At least it’s clean, the arm. The rest of him is not clean. If he had kept his shirt on, it would be wrecked. Because he didn’t, his chest is awash with the mud and the blood and clinging fragments of grass, his right cheek the same. The torchlight makes comet trails of the smears on his glasses. He takes them off to wipe them clean and I can see his eyes even if he can’t quite focus on mine. They are brown and wide, and they struggle with something hard that goes beyond the lateness of the hour. They don’t tell me anything I don’t already know. I did what I could of a full clinical exam before the man ever arrived. Horses aren’t that different to people. And it doesn’t take a medic to spot a bad foaling from across the field.
The mare snores, in the way that a whale snores on surfacing and her feet smash the turf near his hand. Ruaridh Innes edges backwards and feels around in his case for the bottle of dope that will slow her back into sleep. He nods at me to tip the torchlight to her jugular, then slips the needle in the vein with the smooth practice of the addict. Blood swirls black in the body of the syringe and he shoots the load home.
I run my hand forward along the line of her jaw. The mare snores again and twists her head round to look at me. The whites of her eyes glisten oddly in the torchlight and her nostrils flare red. Her pulse hammers under my fingers and then calms as the drug takes hold. Her eyes glaze and fix on another reality, away from the cold and the rain and the pain in her guts. All I can smell now is the metallic bite of her sweat. It smells of death.
Ruaridh dumps his drugs in the box and reaches for the blood tube leaning up against the lid. He squints at it in the torchlight and reads it as a teller reads the dregs of the tea. What he sees doesn’t make him any happier but he still doesn’t look as if he’s about to break into speech. He’s not one for unnecessary rhetoric, our Ruaridh.
‘And?’ I ask. ‘What’s happening inside?’
He shrugs. ‘Not a lot,’ he says. ‘A lot less than there ought to be.’
‘Is it a breech?’
‘One of them is.’
One. One? Dear God. ‘She’s got twins?’
‘I’d say so. I can feel three joints and all of them are knees so either you have one foal with three front legs or else you have two foals.’ There is a pause while he fits his glasses back on. The smears are now pleasingly concentric. He tightens his lips and runs his cleaner hand across what is left of the hair on his head.
‘That’s not the worst of it,’ he says. ‘She’s ruptured, Kellen. There’s a whacking great tear in her uterus where one of them’s put a foot through. She needs surgery and she needs it now. If she stays as she is, they’ll all three be dead before morning and it’ll not be a pretty way to go.’
That’s what I like about Ruaridh. He saves his sentiment for small children and pocket pets. Adults are granted the dignity of adults.
He waits while the news sinks home, rummaging in his box for a towel and his shirt as if either are likely to be dry.
‘Edinburgh’s the closest,’ he says. ‘But that’s two hours away. Three if we drive at a sensible speed. Plus whatever it takes to get her into the box. I wouldn’t like to say she’d live that far. There aren’t too many other options.’
‘Are there any?’
‘I’ve got the gun in the car,’ he says. ‘We can give her a clean ending at least.’
No. Not yet. I owe her more than that.
‘What’s wrong with Garscube?’ I ask. ‘We took Midnight and she did fine. It’s ten minutes down the road. Less if you put your foot down.’
I exaggerate; it’s half an hour, even on a good day. But that’s not the point.
‘No deal.’ He reaches back into the box and loads another dose of happy juice into a clean syringe. ‘They’ve had a bunch of infected horses die after surgery. They’ve closed all the theatres while they get their act together and clean the place up. You won’t get a horse in there for love nor money.’
Oh, I think I might.
I reach in my back pocket, pull out the mobile phone and begin to key through the directory for the right number. ‘It’s worth a try, though, wouldn’t you say?’
The mare sighs as the pain pushes through the barrier of the drug. The man takes off his glasses and bites his lip. The full syringe balances in the palm of one hand and this time his attention is on me. This close, even without his glasses, his focus is sharper.
‘The gun would be kinder, Kellen.’
Maybe. But this is Rain. Who is my friend. And I have the key that unlocks the doors to theatre.
Magpies. And their secrets.
I spend my life working in other people’s night-mares. It seemed perfectly reasonable, just this once, to ask someone else to work in mine.
I have no good memories of theatre. If asked, I would have said I had no memories of theatre at all although I would have been lying, and wilfully so.
There was a time, in early studenthood when I believed, like all the rest, that the healing blade was the only way forward in modern medicine. I grew out of that one long before we were ever allowed to set foot in the hallowed spaces of the scrub room, and when I was finally old enough to experience the sacred art at first hand, the cloud of it cast a shadow well into my adult life.
They don’t like students in theatre, not in human theatres, anyway. They’re not overkeen on junior clinicians either, particularly not the ones who have already thrown in their hand with the physicians. I spent six months as a junior surgical intern in the general surgery unit of the Western Infirmary and my memories are, without exception, of being in the wrong place at the wrong time, locked in a circle of sterile space with a consultant surgeon whose prowess in the dissection of living house officers ran way ahead of his world-wide fame in hepatic and renal transplant techniques.
I don’t know, I never have known, the order of vessels leaving the vena cava from the diaphragm downwards. I have no memory, if I ever knew it at all, of the course of the pancreatic duct or the precise location of its opening into the proximal duodenum. I don’t even remember the number of lobes in the liver although I believe that I did remember it at the time. All of these I can forget. And I can forget that I forgot them. I could probably, if I had to, watch an entire kidney transplant on video and tell myself I had never taken part in the real thing.
Being inside theatre though, is different. In theatre, there are triggers more powerful than sight and sound. In theatre, there is the smell and smell is the arch-traitor. The one sense you can’t obliterate. The oldest. The earliest. The first to be formed and the last to leave. Ontogeny repeats phylogeny. The blind and deaf predecessors to the dinosaurs hunted their way up the evolutionary tree by smell. Everything else grew in as added luxuries. And so the olfactory lob
es reside in the paleocortex, the oldest and earliest portions of the brain. Long before there are wrinkles in the hemispheres, the olfactory bulb is there, picking up the scents of the uterine fluid. Which means that smell survives when all the other senses have succumbed to the lure of the dream. In sleep, in unconsciousness, under general anaesthesia, it’s the smell that sinks in and lingers. People will remember what they smelt long after they remember what they heard and they remember a frighteningly large amount of what they hear while they’re under anaesthesia. Wise anaesthetists play music to their sleeping patients. Some of them have been known to play prerecorded messages of healing and thereby speed up the recovery rates of their cases in the post-surgical period. The rest let their subjects hear the consultant’s description of their internal pathology to the gathered throng and then wonder why they don’t recover as well as expected afterwards.
For those of us who passed through theatre without the balm of unconsciousness, the clatter of a scalpel blade on a steel tray or the wheeze of a ventilator or the whistle of the oxygen alarm on an anaesthetic machine can trigger sudden twinges of primal fear. A sense of dry-mouthed anxiety without any real understanding of its source. But it is the smell alone that has the power to open the floodgates to memory, to take the twisting spirals of the nightmare and twist them tighter still.
Except, of course, I didn’t know this until it was too late.
Until the horse, who was my horse, lay on her back, unconscious, on the operating table with no music playing in her ears.
Until the surgeon, who was my friend and my client and who should, if the world were sane, have been in bed sleeping the sleep of the blessed, was gloved and gowned and ready to cut; glowing with the kind of radiant luminescence that one sees only in the truly driven.
Until the nurse, whose horse was dying in the barn, had laid out the trolley with an array of instruments that could just as easily have been there for a liver transplant.
Until the resident, who was taller than I remembered, even with the surgical cap flattening the spikes of her hair, had spread the spirit on the shaved patch of skin and laid out the drapes in the precise, retentive rectangle that defines the surgical field.
Until the surgeon, anonymous now behind surgical mask and tight-tied paper cap, called for a blade and a swab and ran her thumb along the line of the incision and turned to the anaesthetist, who is also a surgeon and who was once her lover and asked, in time-honoured fashion: ‘OK to cut?’ and received a short, preoccupied nod in reply.
Only then was it obvious that this was not the right place for me to be.
And by then it was a long, long way too late.
There was blood on the wall.
A thin, punctate, crimson line arced across the sterile white of the tiles. The hot, metallic smell of it filled the room, masking, just in that moment, the rest: the surgical spirit, the volatile anaesthetic, the hibitane. Then they were through the skin and into the abdominal cavity and the smell of that covered everything else. A warm, enveloping, new-hay smell spiked with silage and with something else sharper but still not unpleasant. I wasn’t expecting that. In all the shifting timeframes of the night-mare, I was not expecting the abdomen to smell so relatively unputrid. Human abdomens do not smell of new hay and fermented grasses. They smell of old sewage and rancid gall and the reek of it clings in your hair for hours after the last suture has been tied and the patient is back in the recovery ward. Or the mortuary.
I had braced myself for that smell, promised myself that I was not going to be sick. The unexpectedness of what came in its stead did odd things to my sense of reality.
‘Clip.’
‘Clip.’
‘Get that bleeder.’
‘Got it.’
The blood stopped. Cut off at the height of its arc. A final full stop in red. I hadn’t realised I was using it as an index of life. She could have died then and I would never have known.
Except the ECG carried on. And the arterial pressure wave. And the myriad other electronic miracles that monitored the life of my horse.
There were more lines here connecting the living mare to the machines than there had been in the ICU box where the technology was monitoring the slow progression to death.
I would rather not to think about that.
If I keep my eyes on the screens, I could believe myself a decade younger, locked back in the hellhole of surgery.
If I look instead at the vastness of the ventilator, or the diameter of the endotracheal tube, or the sheer size of the patient under the drapes, the extraordinary warping of scale will send me screaming over the edge. I am Alice and I have eaten in the company of the White Rabbit and the world has lost all sense of perspective.
Alternatively, it is half two in the morning and it’s a long, long time since I last worked straight through the night. Nothing is supposed to make sense at a time like this.
‘Scissors.’
‘Scissors.’
‘Retractors.’
‘Which ones?’
‘Whatever you’ve got. I don’t care. Just get her opened wide so I can see what’s going on in here.’
Real surgeons don’t talk like that. Real surgeons give precise orders in clipped monosyllables and expect them to be carried out without comment.
But this is Nina and the assistant on the other side of the drapes is Steff and I would trust either one of them with my life.
‘Hold that.’
‘Good … get the uterus up where we can see it … there’s the tear …’
‘Shit … she’s bled some …’
‘Leave it. She’ll be fine. We’ll get the kids out first … Blade.’
‘Blade.’
‘Scissors.’
‘Scissors … I’ve got the hock …’
‘Good. Lift him up … Oh. No. Not a him. It’s a her. Kellen, you’ve got a filly. A dun filly. Magic. Image of her mum. That’s it … lift her up. OK, guys, first one’s on her way out. Get going with the suction.’
And suddenly I am not alone in my space on the white-tiled floor. There is a lank-legged foal; a glowing, moon-gold dun with a dark mane and tail and a long dark eelstripe down her back and a faint spray of white-on-pink between her nostrils; an exact replica of her dam, sopping wet and coated from nostrils to tail with the slimed membranes of her failed birth. She is inert, unbreathing. Her heart thumps visibly through the barred cage of her ribs. I put my hand over it, to be sure, and feel the first attempt at a breath. It fails. The membranes are tight around her nose and mouth; all she can do is snore.
But Maureen is there with the suction catheter, sliding it deep, down each nostril, slurping noisily at the thick fluid in her airways, clearing a path for the breath. She passes me a wad of drapes, as if I am part of this team and, because it is expected of me and because I have been at enough foalings by now, I rub briskly in fast lung-thumping spirals, drying her off, scraping away the membranes from her eyes and her ears and her skin, rubbing dried whorls into the damp buckskin of her coat. She has to breathe. If she doesn’t breathe, she will never live. I stop for a moment to look. Her tongue protrudes from the side of her mouth; a dark, ugly purple. Her eyes are closed but when I touch them, there is a movement; a crinkling of the damp skin of her eyelid, a withdrawing, a gasp of pretended breath. Maureen is at her head now, kneeling, with her mouth to the foal’s nose, blowing in lungfuls of air. The filly twitches her head, knocking it free. She doesn’t want someone else breathing for her like that.
And then Matt is there. Matt, who should be concentrating on his anaesthetic, is there with a tracheal tube and an oxygen cylinder and together they run the tube up along her nose and into her larynx and then they squeeze the bag and push the oxygen into her lungs. To persuade her to breathe, to bring her into the land of the living.
An eye opens. A dark, lucid pool of night-time.
She looks at me and I am lost.
Every foal born is the most wonderful being that ever lived. This is
the one to die for.
‘Check her pulse.’ Matt. To me.
I slide my hand round under her hind leg and feel for the femoral pulse. It’s there. Regular. Weak, but regular.
‘Got it?’ He doesn’t look at me, he’s too busy trying to persuade my foal to breathe.
‘Yes.’
‘Good. Tell me if it stops … Mo, get the Dopram … Nina, how’s the mare?’
‘She’s fine. Second foal’s on the way … It’s a red colt, Kells. God, he’s gorgeous. You’ve got non-identical twins. This is the one that was jammed in the pelvis. Heart’s still going strong. All you have to do is get him breathing. Matt, we’re starting on the uterus. You can hit the mare with the oxytocin any time you like.’
And suddenly I am alone with the filly. Matt is drawing up drugs for the mare. My mare. And Maureen is waiting for the colt, weighed down like a midwife with a fresh set of drapes. ‘It’s OK, Kellen. I’ll get this one. The girl’s yours. Keep ventilating. Tell Matt if you run into trouble.’
The colt appeared; a bright, shining chestnut with shock-white socks on three of his legs and a spectacular, perfect new moon set between his eyes. I watched them lower him on to the bed of green cotton drapes, watched Maureen clear the mucus from his nose, watched the colt, with a prayer to gods I had forgotten existed, take a single strong breath and shake his head. Saw him kicking to live. A fighter born, that one. One to stare death in the eyes and dare him to move.
And then I turned back to the filly and saw her change.
There’s an odd space, halfway between living and dying and she was there. When I turned away, I was pushing breath into a foal with light in her eyes. When I turned back, the shine was already turning dull.
