Night Mares

by Manda Scott

  I let go of the oxygen bag and felt for her pulse.

  Nothing.

  I don’t believe this.

  I felt for her heart.

  Still nothing.

  I touched her eye. Right on the eyeball. Nothing at all.

  ‘Matt! She’s gone.’

  He was injecting something into the drip bag running into the mare. He turned and looked, not at me but at the clock on the wall above my head. ‘OK, we’ve got an arrest. Keep ventilating … Mo, can you leave the colt?’

  She didn’t look up. ‘Not if you want him to live.’

  ‘Fine.’ He dropped his syringe on the edge of the table and dragged a red plastic box from the shelf on the anaesthetic machine. ‘Can you do cardiac compressions?’

  ‘I don’t know.’

  ‘OK, I’ll do it.’ He knelt by the foal and leant over it, pushing his weight on her chest. The classic cardiopulmonary arrest protocol. A burst of short, sharp shoves, pause to feel the pulse, then back to the heart.

  Three times he went through it. Push the heart. Ten compressions. Check the pulse. Nothing. Back to the heart. Push and push and push and the room didn’t reek any more of surgical spirit and volatile anaesthetics. The air buzzed with the musk of male sweat and the salt-in-honey smell of placental fluid.

  On the third try, we got Maureen. ‘Colt’s breathing fine. What do you need?’

  ‘Adrenaline. And keep your finger on the facial artery. Tell me if you get a pulse.’

  ‘OK … Nothing so far.’

  The last time I saw anyone draw up a vial of adrena-line one-handed was in the ICU at the Western. It’s not a skill most of us need to learn. I watched Maureen snap the top off a succession of vials and draw up 5 cc of adrenaline left-handed with her free hand on the artery as if she did it on a daily basis.

  ‘Still nothing. There’s no pulse … wait a bit … you got one there … Nope … Gone again … OK, Adrenaline’s ready.’

  ‘Go for it.’

  They did go for it.

  Half a dozen times they went for it. They pulled the ECG from the mare and clipped it on to the fine buckskin of the foal’s chest to check that she wasn’t fibrillating and when all the machine could give them was a single, flat line, still they went for it again.

  I knelt on the wet tiles of the floor, squeezing my oxygen bag as if it was my life that depended on it and watched her eye grow more dull, saw the skin around her lids begin to slacken and begged all of the gods that looked over the colt to turn their gaze back to the filly.

  They didn’t.

  Or they did and she still chose not to live.

  We had been going for fifteen minutes, apparently, when Matt called the time of death. I believe him, because he was the one who had the sense to look at the clock when it started. But it didn’t feel like that. It felt like eternity. Or a fraction of a heartbeat.

  I sat, numb, on the floor while Maureen closed my filly’s eyes and pulled a half-dry drape across her head.

  The colt whinnied from the far side of the room. A call to a mother who lay asleep on an operating table with two surgeons tying sutures in her uterus. Or a call to a sister, lately gone. Or simply a demand for food. There was milk ready, in a bowl on the side. Steff milked the mare out before they put her under. The kind of thing you do as routine when your patients start dying unexpectedly.

  Maureen brought me the bowl and a calf-bottle, together. ‘He’s hungry, the wee lamb. D’you want to feed him?’

  ‘No.’ I stood up, feeling the thin cotton of the scrub suit cling wetly to my legs. ‘Can you do it? I think I need some fresh air.’

  ‘Are you sure?’ She looked doubtful, as if a therapist ought to know better than to run from the site of death and defeat.

  ‘I’m sure.’

  I changed in the staff changing room (female), a small shoebox of a room that smelled of old rubber and wet clothes. Most of the wet clothes were mine. The ones I was wearing and the ones I had left hanging on the peg by the door. The only difference was that the scrub suit I had on was warmer.

  A set of shelves along one wall held spare sets of dry scrubs. Short-sleeved tops on the left. Trousers on the right. Green for the surgeons. Navy blue for the nurses. One of each if you’re cold and wet and neither a surgeon nor a nurse. I wrapped my rain-sodden fleece round my shoulders in honour of the rain and went outside to find someone to talk to who knew nothing of foals.

  If you believe Schrödinger’s theorem, the cat in the box is not dead until the observer opens the lid to check. If the same applies to horses then it is possible that, had I not decided to go for a walk in the ward, Branding Iron might have lived for an hour or two longer. It doesn’t seem very likely. If theoretical physicists spent more of their time in hospital wards and less of it in the laboratory, they would know that people die all the time with no one in attendance. Horses are not so very different. And, in any case, he was dying long before I got there.

  I heard the shattering crack of a shod hoof striking wood as I slid in through the side door of the horse ward. In the time it took me to sprint the full length of the barn, he hit the walls three more times. If it had been the box door it would never have held. As it was, the oak planking of the partition between his box and the next held long and ragged scores that stretched from eye height down to the floor and the monitor nearest the manger hung over the edge of the rack with its screen imploded and a crescent-shaped dent in the steel of the case.

  The horse lay on his side; rigid, neck stretched out, nostrils flared, feet flailing, running, racing, fleeing. Anything, but not lying still with the pain. His eyes showed white along the entirety of their rims. His lips snarled back over gums the colour of dead fish. Blood ran from both nostrils. Not the bright jet of a good, honest nose-bleed, just a thin, steady stream of dark liquid washing his life down the drain. In those first few moments, the smell of horse-sweat and blood obliterated the stench from the rest of the box.

  He shuddered, once, as I watched and the frantic paddling slowed suddenly, as if the race was won. Only his breathing didn’t slow. His lips rolled tighter. His nostrils widened. He drew in one single, sucking, ear-tearing breath. The indrawn air-hunger of a drowning man magnified and multiplied. His body shook with the effort of it. And the next one. And the one after that. Each one followed the last by a longer and longer interval in a pattern that cut grooves somewhere near my kidneys. Agonal gasping. The final goodbye. The closing motor reflexes of that last section of brain to die. It happens in people too, sometimes, and you draw the curtains and move the visitors out of the ward and do anything you possibly can to make sure that the relatives aren’t there to see it.

  If anything, I’d say it’s worse in horses.

  I opened the box door and went in then, laying a hand on his neck. Not because there was anything left I could do, but because I was there and I didn’t want him to die alone. I knelt at his side, feeling the warm bulk of his body shudder against my knees, closed my hand over eyes that no longer knew the difference between night and day, talked irrelevant horse-talk into ears already deaf and stroked again and again down sweat-sodden withers, feeling skin that had lost all sense of touch. And I wept. Silent, unsqueezed tears. Not for him particularly, but for the night and the nightmares and everything ahead that I could feel in my guts but couldn’t see.

  I stayed there a long time when it was over. I could have gone back inside but walking back into a sterile surgical suite from the death-mire of a toxic horse is not one of life’s brighter moves. Steff showered twice, washed her hair with hibitane and changed all her clothes before they let her near the scrub room and still she double-gloved. Besides, Maureen was still in the theatre and I may be a therapist but I have yet to find a good way of looking someone in the eye and telling them that their best friend is dead. So I knelt against the great bulk of his body, feeling it slowly cool against my knees and I thought of the filly foal lying dead in the theatre and the mare lying fast asleep on the table and
I did my best not to remember the one, single unspoken rule of medicine: the rule of three.

  Three. Death comes in threes. It’s the last thing they don’t tell you in lectures and the first thing you learn when you start on the wards. People can die one at a time, with a decent interval between and you don’t need to start counting. But when the shit hits the fan, when everything is falling apart, when the world is turning itself upside down, then you know that death’s on a roll and that he always takes them three at a time.

  ‘Kellen? Are you all right?’

  It was Steff, leaning over me. Steff with her hair wet with sweat and the rain and flattened to her scalp by the surgical cap. Steff, wide awake and dressed for the weather in a clean set of overalls and someone else’s body-warmer that cut in under her armpits and barely covered her kidneys. Steff, clearly unhappy.

  Three.

  I tried to stand, faster than I should have done and ended up half sitting on the dead body of the horse with my head spinning and my mouth full of bile.

  ‘The mare?’ I asked and she managed to smile. A smile free of jewellery so that the small, punctate hole at the side of her nostril stretched briefly to oval.

  ‘She’s fine. They’re both fine,’ she said. And then: ‘I thought he’d crushed you.’

  ‘Sorry.’ I stood up straight, feeling my joints crack. The horse was still warm but his back, when I put my hand to it, was hard, like the wood of the walls. ‘I just … thought he needed company.’

  ‘I guess he did.’ Her eyes roamed the box. Broken drip sets hung from the ceiling. Fractured ECG lines lay knotted in the far corner. The dead monitor still tipped at a dangerous angle over the edge of the rack. The horse took up most of the box. In death, he looked bigger than he had in life. Seventeen hands. Maybe more.

  ‘How in heaven’s name are we going to get him out of the door?’ I asked.

  ‘There’s a winch on the back of the flat-bed.’ She wasn’t looking at me. She was looking at the chunks of timber missing from the far wall as if they were the last letter from a departed lover. She chewed her lower lip, painfully hard. ‘Mo’s gone home,’ she said. ‘At least she won’t be here when the boss decides to do a post-mortem.’

  ‘At half four in the morning?’ I asked. ‘Is that likely?’

  ‘In the frame of mind she’s in tonight? I’d have said it was guaranteed.’ She turned with that tight-reined, samurai grace and dipped her boots, one at a time, in the disinfectant at the door. ‘After all,’ she said, ‘she’s the one who’s had some sleep.’

  5

  Dawn came at ten to five that morning. I know, I sat on the threshold of the post-mortem room and watched it happen. Saw the burned edge of the sun knife its way up over the edge of the Parasitology block, saw the mist rise slowly off the river, heard the mutter of a tractor and the random calls of ewes to lambs and lambs to ewes as the morning feeding started in the fields beyond the bridge; heard, somewhere close by, the whicker of mare to foal and a brief, high-pitched answer.

  My mare. Her foal. Both of them alive.

  The sound carried past me, in through the open door, to where Branding Iron hung suspended in the centre of the room. A half-inch steel chain attached to a two-tonne electric hoist held his right hock somewhere up near the ceiling. His nose and both forefeet dangled a foot off the floor. A long, linear cut from pelvis to sternum opened him up, showing the empty cave of his abdominal cavity. All that had been inside lay in white plastic tubs underneath: liver and kidneys in one, guts and spleen in the other. A fire hose played gently over the surface of his intestines, running rivers of red water into the drain in the floor.

  Nina stood in front of him, her knife in one hand, a waterproof writing pad in the other, reading unspoken pathological truths from the patterns on the surface of his diaphragm.

  The foal whinnied again, demanding attention.

  Nina looked past the horse to where I was sitting in the doorway. ‘You can shower in the changing rooms next to the small animal ward if you want to go and see them, you know,’ she said. ‘Just don’t go straight from here. Your foal’s got no immune system yet. I don’t think we should take any chances on contagion from this one.’

  ‘I know. I’m not in any hurry. I’ll give them a few more hours to settle.’

  ‘So then go home, Kellen. You’re as bad as Steff. I can do this on my own. Really. I don’t need a chaperone for a basic post-mortem.’

  ‘I know. I heard.’ I heard Matt and Steff both try to argue to the contrary and heard them both fail. She’s very single-minded when she’s had some sleep. And a surgical success.

  I watched the heron fly in to its stand under the alders. The wind, warm now and coming from the south, shivered through the trailing leaves. A bank of solid cloud gathered just above the dawn line promising rain later. It always rains in April in Glasgow. But the dawns are usually bright. It makes up for a lot.

  ‘I’ll go home in a bit,’ I said. ‘I’m just building up courage for the lorry.’ Under normal circumstances, I’m quite fond of my lorry. She’s a challenge. Defective power steering and the acceleration of a slug. Just at that particular moment, I didn’t need any extra challenges.

  ‘Well then, go outside.’ Nina slid the knife into the belt loop of her rubber apron and crossed the room towards me. ‘Kellen, if you go any whiter, you’ll vanish into the walls. Go outside, get some fresh air, get a coffee and go home.’

  ‘Not yet.’ The angled steel of the doorframe dug into my spine as I stood upright. ‘I’ve never seen the insides of a horse before. I might not get another chance.’

  She looked at me carefully. Her brows are much darker than her hair, almost black. Her eyes were level and clear. No nightmares in sight. Just the familiar quirked smile. And more understanding than I would have expected.

  ‘There wasn’t anything you could have done, Kellen,’ she said.

  ‘I could have called you.’

  ‘He was infected. I wouldn’t have come.’

  ‘Somebody would have done.’

  ‘The only one who was free was Mo.’ She tipped her head to one side. ‘I don’t think she needed to be there.’

  ‘No.’ You do anything you possibly can to make sure that the relatives aren’t there to see it. ‘No. She didn’t need to be there.’

  Nina hefted her knife again, considering. ‘If you want to drive home,’ she said, ‘I’ll lend you my car.’

  ‘I don’t want to go home.’ Not yet. I don’t want to have to explain to Sandy Logan that we lost the filly he spent the last eleven months planning for. A few hours more and he’ll be out with the horses. Then I can simply go home and go to bed.

  ‘If you say so.’ She held out the writing pad. ‘In that case why don’t you put on an apron and come and help scribe. If you really want a close-up view of horse guts, you won’t get a better chance than this.’

  The post-mortem room is white-tiled and sterile, not unlike theatre. Unlike the theatre, it smells of formalin and glutaraldehyde and death which, oddly, made it easier to handle. I have no hidden memories of autopsies past and, in any case, there are no similarities at all between the delicate art of a human forensic dissection and its veterinary equivalent except possibly the endless rows of specimen jars and the pathological need to label every tissue sample in tedious, repetitive detail.

  Veterinary pathology is educated butchery, pure and simple. One step up from the Middle Ages when the kill was paunched before they slung it between two ponies and carried it home. The only difference between then and now is the technology available for the paunching. They still use a knife to open into the abdomen and free up the intestines like they always did but now they have a circular bone saw to slice through the sternum.

  I stood well out of the way while Nina Crawford, a surgeon who lectures students annually on the necessity of careful tissue handling, power-cut a line down the breastbone and then angled inwards across the left side of the rib cage. Fragments of bone dust and liquefied
particles of intercostal muscle sprayed finely out over a radius of about four feet. When she had finished, a neat rectangle of thoracic wall toppled out into the tub at her feet.

  She discarded the power tools in favour of the knife, reached her hand in through the gap in the chest wall and drew an organ up to the surface. ‘OK, this is what we’re after.’ She made a long, linear cut the way one would open a melon and peered closely at the results. ‘Heart. Left ventricle: congested. Petechiation on both surfaces.’

  I wrote to her dictation. When I looked up, she was holding out an offering on the point of her knife. I caught the small cube of tissue in a jar, flooded it with formalin and wrote the label. ‘That doesn’t sound too healthy.’

  ‘It’s not. It’s classic, non-specific endotoxaemia, just like all the rest.’ She handed me a syringe full of blood, the needle bent over near the hub to form a temporary seal. ‘That’s from the right ventricle. Keep half for culture, half for routine bloods. Unless this is some wild freak of nature, the path lab will come back with a diagnosis of peracute cardiac arrest with circulating endotoxins and then the cretins in Microbiology will run every test they’ve got and tell me there are no pathogenic microorganisms.’

  ‘You mean there is no E. coli?’

  ‘No. I mean our micro crew have two neurones to share between them and they don’t synapse often. It’s there. No question. I have horses dying of endotoxic shock. And the endotoxins all type for a pathogenic E. coli. We just can’t find it. We can’t find anything that kills it, either.’ She stuck her knife into the thorax and left it standing there. ‘Bastards.’

  I wouldn’t want to be a microbiologist if the cultures came up negative on Monday morning.

  Bacteriology was never my strong point. The bits I remembered were not entirely comforting. ‘Nina …?’

  ‘Mmm?’ She had turned back to the open thorax.

  ‘This is beginning to sound unpleasantly like the veterinary equivalent of MRSA.’

  ‘Not far off.’ She nodded, distantly. ‘Except this one’s specific to the surgery department. To me.’