The surgeons’ gowns seemed clamped to their shoulders, and their masks tight against their bent faces. They were directly under the shadeless light. The house-surgeon, Tom Ross, being the most junior, felt the heat the most. His forehead was purple. Joe and his registrar, George Ellis, were too accustomed to working in that temperature to notice it.
Bachelor again changed the saline bowls, one at a time. She balanced the fresh, hotter bowl on the open palm of one hand, removed the old bowl on the palm of the other, sliding one out, one in, without touching the bowl-stand or the sides or lips of the bowls. She was an efficient and neat-handed ‘dirty’, and never forgot to keep one eye on the instrument nurse while going about her job as liaison between the sterile-gowned and gloved operating team the ‒ to them ‒ untouchable world of sterilizers, tap-handles, cylinder knobs, electric switches, hypodermic trays, drugs, telephones, and anything else that might be required.
Joe worked swiftly, surely, his neat gloved hands moving as if they had an independent existence of their own. He never talked much while operating, but whether he talked or not his hands worked on.
The registrar followed his moves, clipping off each cut blood vessel, ligaturing each in turn, then unclipping the artery forceps. Tom Ross held various instruments in the necessary position, sponged the wound occasionally, or adjusted the angle of the sucker, but was more often required to stand holding, watching, and learning. There was a maxim in Barny’s that applied to the medical and nursing staff alike: first you watched, then you assisted while being yourself watched, then you taught others.
When each instrument was done with for the moment I removed it from the operating table, rinsed it in hot saline, replaced it in its recognized position on my trolley. The order of my trolley, another Barny’s rule, was upside down in relation to myself, and facing the surgeons. And since the official order of the various types of instrument never changed, the surgeons always knew exactly where to find what they needed if, for some unlooked-for reason, the instrument nurse was not free to hand this over.
In all our theatres it was a much cherished tradition that none of our surgeons ever had to name the precise instrument. When we were trained as instrument nurses we were trained to follow the operation as closely as the surgeons, and so anticipate their wants. This was never easy at first or when working with a strange surgeon, but experience made it perfectly possible, and resulted in the theatre serenity being undisturbed by grunted demands for instruments. And not only the theatre serenity; all Barny’s junior surgeons soon learned that the one sure way to make one of their own instrument nurses bristle with indignation for an entire list was to demand ‘Clamps … retractor … needle-holder’ ‒ and so on.
I had worked so often with Joe that I knew instinctively when his hand was going to stretch out my way, what he wanted, what he was going to do next, whether he was satisfied or anxious, without a word passing between us. When a patient worried him he had a mannerism of tilting his head slightly to the right as if listening for a sound no one else could hear. Our retiring Sister Theatre once asked, ‘Are you listening for a heart without a stethoscope, Mr de Winter?’
On that occasion he had just shaken his head and worked on. The patient had suddenly collapsed ten minutes later. Later still Joe had told me he had been as suddenly convinced something was going to go very wrong. ‘Some people smell danger. I sort of hear it.’
Now his hand stretched my way again. I set in it the first of the two final arterial clamps he was going to need.
‘Thanks, Nurse.’ His fingers closed over the clamp. ‘All well your end, Mark?’
‘Taking it like a text-book.’
‘Good.’ He worked on in silence for a few minutes. Then he put down the scalpel. ‘No wonder this poor chap had such a rough time.’ He glanced up, beckoned the dressers closer. ‘Take a look at these adhesions and those old scars. This is what an appendix looks like when it turns acute after years of being chronic.’
A dresser asked, ‘Why did he let it go on so long, sir?’
‘He had had attacks of pain before and got away with them. The body has very tough defences. And most people have strong feelings about operations and surgeons. They don’t want anything to do with either. I don’t blame ’em.’
The dressers were amused. ‘Surely there’s nothing very much to having an appendix out?’ suggested another.
Joe asked, ‘You ever had an abdominal operation?’
‘No.’
‘Presumably at some time in your life you’ve cut some portion of your anatomy? Superficially? With a penknife? Climbing over a gate?’
‘Lord, yes, sir!’
‘Did it hurt?’
‘A bit.’
‘Then how much more do you suppose all the cutting through delicate tissue and muscle I have just had to do hurts? A wound,’ Joe added thoughtfully, ‘doesn’t cease to hurt because it’s surgically inflicted. We can and do see our patients here through the worst of the pain. We can’t keep them drugged. The aching and general discomfort that follows most operations ‒ and certainly all abdominal ones ‒ is worth putting up with in the long run, but by no means insignificant. It’s not something any surgeon can dismiss as a triviality, unless he’s content to forget he ever qualified in medicine, and settles for just being an efficient technician with a knife.’
Teaching the boys was as much a part of his job as operating. He went on explaining and demonstrating as he stitched. He was dealing with the final layer of muscle and explaining why he had used the specific drain he had, when his hands and voice paused together. He tilted his head to the right and ignored the question on the elasticity of scar-tissue from one of the dressers.
Mark looked up, recognized that mannerism as I had done. ‘Trouble?’
Joe said, ‘Not this end. All gone like that text-book you mentioned. How about your end?’
‘Heart’s fine. A nice steady lubb-dupp.’ Mark’s fingers throughout the operation had been on our patient’s right temporal artery. He checked the many recording instruments on the anaesthetic machine again, as he had been doing constantly, then momentarily raised a corner of the anaesthetic mask. ‘Colour’s fine. Why?’
Joe shrugged, went back to his stitching. He still seemed to be straining to catch an unheard sound.
Our dressers, though senior, were new to the G.S.U. Theatre that week. They looked at the clock and then at each other expressively. The registrar noticed, frowned them to immobility. They waited until his attention returned to the patient and then exchanged some more resigned glances amongst themselves.
‘Hold it! Just one moment there!’ Mark’s voice a minute or so later was soft yet urgent. ‘Something’s cooking with this pulse.’
The surgeons froze to statues. The dressers’ four heads jerked towards Mark as if they were puppets and he had tugged their strings. Bachelor came quickly to my elbow. I nodded at the emergency hypodermic setting on a tray on a near-by shelf. We might not need it. If we did it would be in a hurry.
Mark was altering the various knobs on his machine fast. There was a little green rubber bag attached to the anaesthetic mask. It had been rhythmically inflating and deflating ever since the man was wheeled in from the anaesthetic-room. It had lost its regularity. It was moving more slowly. Then it fluttered. Then it stopped.
Until Mark’s ‘Hold it!’ the work had been progressing at its usual orderly pace. Then all but Mark were still. When that bag stopped the theatre atmosphere was electric and the tempo speeded up like an over-fast film.
Mark had the anaesthetic mask off, the small anaesthetic tube out of the patient’s mouth, and a long intratracheal tube in, in a matter of seconds. Joe swiftly seized a bundle of large abdominal gauze packs from my trolley, dipped them in the hottest bowl of saline, wrung them out, laid them over the still uncompleted wound. Bachelor had brought me the hypodermic tray with the dish lids removed. I fitted together a large syringe and long needle. Joe took this from me as Mark pulled off his steth
oscope.
‘Sorry,’ grunted Mark. ‘He’s gone. Probably a coronary.’
‘Probably.’ Joe glanced at the clock. ‘We’ve got about two and a half of those three minutes left.’ He looked at the label on the rubber-capped phial Bachelor had swabbed and was holding up for him. ‘Right.’ He plunged in the needle, drew up the fluid. ‘Let’s hope this has some effect.’
It was an accepted medical law in our hospital that three minutes from the moment a patient’s heart stopped was the maximum time we had in which to get the circulation going again safely, if it could be got going. An injection into the heart muscle might be enough. I had known it be; I had known the reverse.
Joe put down the syringe. ‘No. I’ll have to massage.’ He took the scalpel from the dish I was offering him, and opened the chest wall between the lower left ribs with a long, careful incision from right to left to avoid cutting the main arteries ‒ even though for the moment there was no bleeding, as the circulation had stopped. He dropped the scalpel back in the dish, then eased in his whole right hand between the ribs. ‘This man’s ribs are like a vice,’ he muttered. ‘That’s better ‒ I’m there. Watch out for those bleeding-points, George. All hell’s let loose if one gets it going again. Now ‒ let’s see.’
He had cut carefully. Even so, a fast-increasing scarlet stain soaked his gown sleeve, chest, and the sterile towels covering the patient. George Ellis worked as fast with his many artery forceps, with the houseman sponging and responging for him.
Mark said, ‘I can just get his pulse at the neck.’
‘Good.’ Joe’s forehead was tight with effort. ‘I’m afraid that’s me. His heart hasn’t taken over yet. It’s early. We’ll just have to keep on.’ He looked at the registrar’s work. ‘Good. You’re getting it under control. You keep on with that. Tom ‒ you keep that site at blood-heat.’
Sandra wheeled forward the dressing-trolley and a second double saline bowl stand she had set for that purpose. I said, ‘You’ll find everything just behind you, Mr Ross,’ and took the large, steaming kidney dish Bachelor was holding between two pairs of long-handled bowl forceps. ‘The rib-retractors are ready, Mr de Winter.’
‘Fine. Thanks. Shove ’em in, George. How’s his pulse now, Mark?’
‘It could be worse. Heart doing anything?’
‘Not yet.’
The rib-retractors were self-retaining. Once they were in position the registrar offered to take over. Joe said he could carry on pro tem. ‘Now his ribs are off my wrist my own circulation’s getting back to my hand. This may be a long job. We can start up shifts later.’
He went on massaging for another half-hour, then George Ellis took over, then Joe again, then George Ellis, then again Joe.
Cardiac massage for any length of time is always a physically exhausting feat. Of the two men now, George Ellis clearly felt the strain more. Bachelor was kept busy mopping his damp forehead with the special hand-towel reserved for that purpose.
The shifts were cut down to fifteen minutes each. It was around three hours from the moment of failure when Mark asked, ‘Are you going to get anywhere?’
‘God knows,’ retorted Joe wearily.
George Ellis noticed the time. ‘You’ve done overtime. My turn now.’
‘I’m all right for a spot longer. Got my second ‒ or is it third? ‒ wind.’ There was silence for a few minutes. Then, ‘By God! The bloody thing’s stirring! Come on, you bastard,’ muttered Joe, ‘come on, you lazy lump of good muscle ‒ do your stuff! You know the form. You’ve been pumping for forty-eight years ‒ pump, damn you, pump! That’s it!’ He sighed deeply. ‘That’s it, chum. You can do it all by yourself. Just keep it up. Just keep it up.’ He mopped his forehead with the sleeve of his free arm. ‘Don’t worry about the towel, Nurse. I’ll have to change anyway before we go on.’
His sigh had been echoed round the theatre. The tension of the last three hours vanished. Mark pushed his cap back a little with one thumb; the dressers mopped their own foreheads with their gown sleeves; Bachelor’s eyes were like stars; Sandra and I smiled at each other over our masks. No one said another word.
When it was all over Mark went up to Henry Carter with the patient, the porters, and the attendant ward nurse. I pushed my trolley towards one of the sinks. Joe walked slowly towards his, peeling off his gloves.
A dresser broke the silence. ‘Obviously if you hadn’t applied cardiac massage that case would have died, sir?’
He was very young, so he used textbook words. He would learn later that they were a hallmark of the young and inexperienced. He would also learn there was a time for not asking questions.
Joe untied the top strings of his second gown, removed it, and dropped it on the surgeons’ table before answering. ‘That wasn’t a case, Hall. That was a man. Yes. He would have died. Five kids would have lost a father. And a young woman up in our Mat Unit would have had to face bringing them up on her own and an immediate future in a strange country.’
The dresser was persistent. ‘But does one ‒ I mean ‒ should one think of people as people when one has them on the table? Doesn’t it disturb one’s concentration if one allows oneself to become emotionally involved?’
George Ellis was trying to catch the boy’s eye to tell him to be quiet. Teaching during a case was one thing. Few surgeons could bear chatting at the end of an exhausting operation until they had had time to get to their own room, have a cup of tea, perhaps a cigarette, and slowly relax.
Joe was no exception to this. The strain was clearly telling on him now. He looked even more tired than he had done earlier. He pulled off his cap, added it to his mask and gown on the table, pushed a hand through his hair. ‘In my experience there is no way of forgetting the human angle. It does not disturb my concentration.’ He glanced as if involuntarily at me. ‘It just hurts like hell. Well. That’s that.’ His tone was final. ‘Thank you very much, everybody. I hope we don’t have to trouble you again to-night. Good night.’ He walked out of the theatre without looking back. The thick doors swung soundlessly shut behind him.
George Ellis took off his long rubber apron. ‘Hey ‒ boy!’ He turned on the dresser. ‘You don’t know how lucky you are to have an S.S.O. who’s a patient man. But if you persist in asking ruddy tiresome questions at the end of ops any ideas you may have about specializing in surgery can go out of the window. Any other surgeon in this hospital would have taken you apart just now! And don’t think,’ he added sternly, ‘that because Mr de Winter dealt with you gently there is no limit to his patience. Watch it in future! And when in doubt, belt up!’ He stormed out after Joe.
It was half-past eleven before I took the theatre keys along to Night Sister. She told me Matron was waiting to see me in her flat.
Matron offered me cocoa in a fluted cup, shortbread, and the job of Sister Theatre for a certain six months. I accepted.
‘I am most grateful to you, Nurse Lindsay. This will give me time to find a suitable substitute should Miss Davis not be fit to return. Such an unfortunate and most distressing accident! We must hope for the best. I knew you would understand my position, and realize,’ she went on sincerely, ‘how much I regret having to ask you to postpone your marriage like this. But I cannot pretend you could combine the post with marriage. That might be possible in a smaller, less busy hospital. Not at St Barnabas’s.’
That was true. I did not dare comment on it. I told her why I was so late, and then we went on to discuss the theatre work in detail. Before I left she gave me a new Sister’s belt. ‘You must be measured for your new uniform in the morning. Sleep well, my dear. You look tired.’
I was tired. Too tired to risk thinking. I fell asleep directly I got into bed. The theatre haunted my dreams. All night long, men with masked faces, rows and rows of instruments, and a creeping, growing scarlet stain no one was able to control floated through my sleeping mind.
Sister Theatre came to say good-bye to me when I was dressing early next morning. There had been no time last ni
ght. ‘You mustn’t let this unexpected promotion frighten you,’ she said, after we had talked over Miss Davis’s accident. ‘You are perfectly capable for the job. As for Brown, you’ll just have to be firm with yourself as well as her.’ She watched me buckle on the new belt that automatically raised me to the rank and title of Sister. ‘You won’t have realized this yet, but from this moment you are in a new world. You are on the other side of the tallest fence in any hospital. It’ll be a little lonely at times. No more sitting gossiping with the other staff nurses in the dining-room or canteen. No long natters behind the linen-room door when Sister isn’t looking.’ She smiled. ‘And don’t forget to look behind those doors now. It’ll be expected of you.’
‘Sister, I don’t feel anything like a Sister.’
‘It takes some time before one does. When you get into dark blue you will keep getting a shock when you see your reflection unexpectedly. Shattered me.’
‘Sister! I didn’t think anything could do that.’
‘Indeed, many things still can. I’ve just learned to hide my feelings even when not wearing a mask. We all have to learn that as we turn senior.’
I thought of Joe last night. ‘Yes.’
She stood up. ‘I must let you get over to breakfast, my dear. One last and very minor tip. That new junior’s a nice child, but she’s got a memory like a sieve ‒ particularly about microphones. She’s always leaving them on. She did tidy the gallery last night?’ I nodded. ‘I thought so. The intercom was still switched on when I was up there having a final look round.’
That removed any doubts about Sandra overhearing Mark’s nonsense about my being the only girl he had ever loved. I could not worry about that. The only person I was worried about was Joe.
I said, ‘Sister, I hate saying good-bye.’
‘Me too. I’m going to take your young man’s advice. I’m sure he’s right that when one has to leave a person or place one loves the only thing to do is get away fast before one has had time to be missed.’
The New Sister Theatre Page 3
