Kingsley's Touch

by John Collee

  'Something the matter, darling?'

  'No.'

  They danced a Gay Cordons together but Kingsley talked hardly at all. He was lost again, abstracted. Over his shoulder she could see Richard Short dancing with Rhona. Short had found the side-to-side position ideally suited to continuing his train of suggestion in her pearled ear. Rhona was laughing with untypical abandon.

  'Take your partners for a Strip the Willow.'

  Kingsley steered Sheila towards the tables. William, the porter, intercepted them.

  'Hello, Mr Kingsley. You've not seen Mr Cranley have you?'

  'No, is something the matter?'

  'He just said he was coming.'

  'Have you tried the Rob Roy? He drinks there.'

  Richard had returned Rhona to a table on the opposite side of the hall. The gynaecology registrar found them there and asked Rhona to partner him. She declined.

  'I’m very flattered,' said Short.

  She laid her head on his shoulder. 'Don't be, I'm just too pissed to stand.'

  Richard Short looked down at her. The fat cheek of a breast was nudging out from her dress. Short eased it back in. Rhona was tearing a length of streamer and humming a faraway tune to herself.

  'What about lying?' he said.

  Rhona pursed her lips. A tiny smile began at the centre of her mouth and blossomed across her face. It was the first time he had heard her laugh like this – a soft, frothy laugh – unstoppered champagne. She dabbed her eyes and touched her cheek. 'You never give up do you?'

  'Only in the face of insurmountable odds.'

  'I'm surmounted,' she said, dropping the streamer.

  'You will be.'

  Richard Short helped her to her feet then followed her round the dance floor, steadying her from behind with one hand on her bottom.

  No one noticed them leave. McReady was stripping the willow with gusto, thundering down the rows of dancers like a strong wind in a campsite. Even Kingsley was absorbed by the spectacle.

  Beyond the great wooden doors, the hospital corridors were incandescent with muted strip lighting – all quiet but for the hum of the generators, the soft tapping of Rhona's heels and the distant whoops and bellows of the dance. Richard Short's hand rested on her waist as they walked down the empty corridors. She nibbled his neck as he searched for the key. Inside his darkened office a light from outside the blinds striated the walls and furniture.

  Rhona crossed to the window, steadying herself on the filing cabinet as she passed. 'Where's that light coming from?'

  'The mortuary,' Short told her. 'It's just across the close there. New pathologist,' he explained; 'works all night sometimes.'

  Rhona prised open a chink in the Venetian blind and looked out to the snow-covered mortuary beyond. 'Dr Dhangi,' she said. 'Poor old Dr Dhangi. Shall we go across and ask him to the party?'

  'I don't think he'd come.'

  Richard Short's hand travelled up the inside of her thigh. 'What do you think he's doing?' she asked.

  'Who?'

  'Dr Dhangi.'

  'I don't know,' said Short. 'Maybe he's going for the Nobel Prize.'

  'Aaah . . . yes . . . ,' she arched her back, 'and what are you going for Dr Short?'

  'Dick of the year,' he told her.

  'You're giving me goose-pimples.'

  Rhona closed the blinds. In the sudden darkness she slipped from Short's grasp with the deft agility of a sleep-walker.

  'Rhona?'

  A laugh, then his desk light snapped on behind the silhouette of her stooping form. Rhona straightened and reached for the clasp behind her neck.

  'Here,' Short volunteered, 'I'll help you with that.'

  'That's not helping.'

  She guided his hands away from her breasts and round to the zip at her neck, then brushed the straps from her shoulders. The thin black dress slipped to her ankles. Rhona stepped out of it then turned and allowed him to rummage through her hair as she unbuttoned his shirt. Short's breathing deepened as her taut skin burned against his. 'You're perfect,' he murmured.

  'Come on, Richard, you see naked women every day.' Richard Short disengaged himself from his underpants.

  'You affect me differently.'

  'So I see'.

  With his hands on her waist he drew her forwards again to press against his own precariously unsupported member. 'Rhona,' he whispered, 'Rhona, Rhona…’

  'Door,' she replied.

  'What?'

  'Lock the door.'

  With some difficulty Short cleared his fuddled brain. 'You think of all the details, don't you?'

  'Yes,' she said. 'I'm the perfect secretary.'

  Her legs linked behind him as he carried her to the door, turned the key and returned to his desk. His free hand swept the stationery from its leather top. Paper clips and memoranda rained on the floor. Short moved the anglepoise onto his chair then lowered Rhona gently down in its place. Her arms tightened round him and drew him on top of her.

  The casualty officer reached belligerently for another casualty card. He resented being dragged away from the party to deal with this kind of dross. He knew that with ten o'clock approaching and two patients already to be seen, the rest of the evening was written off. His first patient was a sailor with a crushed finger. In the next cubicle there was a hysterical little boy with a cut on his forehead. At a distance the cut looked as though it needed suturing and the patient looked as though he would probably put up a good fight. He had just closed the screens behind him and was about to engage the sailor in conversation when there was a rattling of the casualty doors and the sudden babble of voices. A wide-eyed nurse came through the curtains.

  'Assault. Looks terrible. You'd better come straight away.'

  The casualty officer followed her out, instantly recharged. Everyone got a big buzz out of major trauma. The figure on the trolley was surrounded by people; one nurse was cutting his shirt off, one taking his pulse and blood pressure. Two policemen fell back as he approached. The casualty officer looked down. The familiar face stared back at him, a grey mask.

  'Shit, that's Cranley.'

  His hand went to the old man's wrist: nothing. He felt for the femoral. A thready pulse was still palpable in the groin. 'What happened to his trousers?'

  'He was found like this.'

  'What's the story?'

  'Some porter found him round by the back gate. He must have been duffed over on the way to the party.'

  A nurse was bundling Cranley's shirt and black jacket into the laundry bag. A crushed carnation fell from the button hole.

  Cranley's lips were parted and his eyes stared upwards at the neon lights. His chest was hardly moving.

  'What's his blood pressure?'

  'Unrecordable.'

  'OK. Let's get an IVI. Saline to start, then Haemaccel.'

  The casualty officer studied Cranley's naked form. There was a big bruise on the temple but no skull fracture palpable. The pupils were equal and still reacting. Something had happened other than the head injury to account for his present state. One of the nurses had plugged in an airway and now began to squeeze in oxygen. The chest moved symmetrically. With his stethoscope the casualty officer could hear both lungs inflating. No obvious fractures in the limbs. He pressed on the belly – hard as a billiard table. No bowel sounds.

  'Where's that IV set, we'll need a CVP line as well. Put some jelly on those ECG leads. Someone call the anaesthetist and the surgical reg.' The casualty officer gave up looking for a vein in Cranley's arm and began stuffing the needle into his external jugular. Maybe the head injury was incidental. There were no bruises on the abdomen but its extreme rigidity suggested that he had perforated something.

  'Somebody alert theatre,' he added, relishing his brief moment of dictatorship. The evening hadn't been a total washout after all.

  The hall pulsed with disco music. The dancing had increased in vitality and the conversation in volume. Inhibitions, like the paper cups, had been weakened by wine and finally d
iscarded. A student nurse appeared in the doorway. She cast around the sea of coloured lights with the fractured, darting movements of a hunted fox. By chance she spotted Jennings in the centre of the dance floor. Starting forwards she ran into Kingsley.

  'I'm sorry,' he said. 'Can I help you?'

  The nurse reddened and straightened her cap.

  'I’m looking for Mr Jennings,' she said. 'Mr Cranley's had an accident. He's in casualty.'

  Kingsley dropped Sheila's arm.

  'What kind of accident?'

  'An assault,' she said. But Kingsley was already running down the corridor towards casualty.

  He burst into the resuscitation room. A young anaesthetist was already established at Cranley's head and was feeding a central line under the clavicle. Cranley was in a bad way. His skin had already taken on the glossy pallor of death. Sweat pricked from Kingsley' s own brow.

  'What happened?'

  'Query assault.' The casualty officer slipped happily into a punchy, telegraphic synopsis, 'Comatose since arrival. Blood pressure unrecordable. Bruise on right temple, no neuro signs. Abdominally . . .'

  Kingsley's hand was already there. 'His abdomen's like a board.'

  'Yup. They found him half naked.'

  'Have you done a rectal?'

  'Very lax sphincter. Some brown liquid.'

  Kingsley tapped with a finger over the liver and spleen. Cranley's abdomen was taut as a drum. 'Let's get a peritoneal tap.'

  He tore off his jacket and made for the sink. These were Macbeth's, not Pilate's hands. As he washed he shouted to the nurses behind him, exorcizing the guilt and fear with a series of curt orders. He returned from the sink dripping Hibiscrub. He yanked on a pair of gloves. Someone handed him a paper gown. He crumpled it and threw it on the floor.

  They handed him a beaker and Kingsley painted the abdomen. Cranley's chest movements were barely perceptible, splinted by the solid abdomen.

  'Cross match?'

  'Done.'

  'OK, rustle up a technician and get hold of all the O negative blood we have in the fridge.'

  The nurse handed him a syringe of local anaesthetic but Kingsley flung it away. He threw a couple of drapes over the abdomen and picked a scalpel off the trolley. One quick stab produced a hole in the skin just below the umbilicus. He picked up the long sterile catheter and threaded it into Cranley's abdominal cavity. The fluid that drained back was a deep crimson.

  Kingsley swore.

  The doors flapped open as Jennings stormed into casualty, pulling his white coat over one shoulder. A strip of tinsel hung from his hair.

  'What's happened?'

  'It's Cranley. His peritoneal fluid is this colour – major intraabdominal bleed. We're going to theatre.'

  The anaesthetist tapped the ECG.

  'Have you seen this?'

  A green line oscillated across the screen – the feeble, frantic tracing of Cranley's failing heart.

  'I doubt he'd survive an operation.'

  'We're taking him to theatre.'

  The anaesthetist opened his mouth to remonstrate. Kingsley cut him off.

  'Where the hell's Short? Someone get hold of Short. Tell him we need a consultant anaesthetist in theatre.'

  He clapped his hands. Cranley, moribund, gazed at the ceiling, already beyond any reasonable chance of survival, but Kingsley was clipping back the swing doors.

  'Come on,' he yelled. 'Let's move.'

  Cranley's trolley clattered out of casualty, chipping flakes from the plaster walls. The anaesthetist, hurrying backwards, continued to inflate Cranley's lungs with oxygen. Two intravenous drips now forced fluid into his flagging circulation. The nurse at the far side kept a wary finger on his femoral pulse. The crashing, rattling trolley echoed down the corridors. Rubber doors parted in front of them and flapped behind.

  The anaesthetist had only just transferred him to the theatre ventilator when Kingsley emerged from the changing room, gown tags flapping behind him like the reins of a riderless horse. Cranley's face and neck were already obscured by a spaghetti of tubing. By the time Jennings and the houseman arrived in theatre, Kingsley had already painted and draped the abdomen and was waiting for the anaesthetist to finish setting up. At intervals he shot hunted glances at Cranley's fingers and toes which were now a dusky blue. Sister rolled up with the instrument trolley. She began checking the swabs aloud – a slow countdown. Kingsley grabbed a scalpel. He looked to the anaesthetist, now pumping up two infusion compressors.

  'OK to cut?' he said. 'Cutting now.'

  His knife ran the length of Cranley's abdomen. He ignored the small bleeders which sprung from the wound and sliced again and again, down through fat, through red muscle, to the white ligamentous band in the centre of the abdominal wall. As he pierced the abdominal cavity dark blood began to well to the surface.

  'Scissors . . . Suction on.'

  Kingsley snipped up to the chest and down to the pubis. As he did so the blood covered his hands. 'Get in there, Steve.'

  Jennings was up to his elbow in the wound, groping with one hand for the aorta. Kingsley hauled Cranley's guts out towards him, over the green drapes. Blood flooded over the edge of the table, drenching his own gown and trousers.

  'You got it, Steve?'

  'Yup.'

  Jennings put all his weight on his one hand, flattening the aorta against the vertebral column, impeding the flow of blood below the diaphragm. Kingsley stuffed another sucker into Cranley's gaping abdomen. The field began to clear.

  'Retractor, self-retaining.'

  He looked to the anaesthetist, sunken-eyed.

  'Have we got a blood pressure?'

  'Just. It's come up to sixty since Steve compressed the aorta.' Kingsley sweated. There was still hope, there was still just hope. He looked down at the suction jars. Two litres of Cranley's blood in the first beaker and the second filling fast. Someone was mopping the floor round his feet. The anaesthetist was pushing in O negative as fast as it would go.

  'Who would want to beat up an old guy like Cranley?'

  'Where's Short?' said Kingsley.

  'He's not at the party.'

  'You managing to hold that, Steve?'

  Jennings grunted. Kingsley put his hand in the wound and explored the surface of the spleen: no obvious tears. He moved to the liver: nothing obvious there either.

  'Release the pressure a bit – I might see a bleeding point.' Jennings eased off. Immediately the abdomen began to refill with blood.

  'No! Press down again!' It was pouring out from somewhere. He sniffed his hand. It smelt foul.

  'There's faeces in here,' said Jennings.

  'You don't bleed like this from a bowel perforation. Let's have a look at the coeliac plexus.'

  Kingsley flipped the bloody coils of intestine over to Jennings's side of the abdomen. Bowel content dripped onto his hands.

  'Jesus Christ,' said Kingsley.

  Behind his mask his mouth and tongue grew thick, his lips dry and tacky. Sweat stung into his eyes. He began to pull the loops of small intestines through one hand. The jejunum terminated in a ragged, contused free end. Above his mask Jennings's eyes widened.

  'How the hell did he do that?'

  'Just clamp that, Steve. Clamp it!'

  Kingsley was already groping deep in the gutter of the abdomen to the right of Cranley's vertebral column. He was up to his elbows leaning low over Cranley's bowels, gagging in the festering stench. His fingers found the caecum. Half of it was missing.

  'He's lost his entire ileum.'

  With mounting horror Kingsley rummaged through the abdominal contents.

  'How does a man lose several feet of bowel?'

  'Can't feel an aortic pulse,' said Jennings suddenly.

  'VF,' said the anaesthetist.

  Kingsley looked up. The ECG tracing had deteriorated to a jagged, irregular scrawl. The anaesthetist was drawing up a syringe of lignocaine. He shot it through the central line and turned to the screen again.

  'No
change. Do we want to shock him?'

  'He's a hospital employee,' said Jennings. 'I think it's worth a . . .'

  'Don't bother,' said Kingsley quietly. 'I’ve found the source of the bleeding. He's ripped his inferior mesenteric artery off the aorta. I can put two fingers through the hole. Even if we brought him round, I can't perform an aortic graft in a contaminated abdomen.'

  As he spoke the activity in the old man's heart petered out. The bursts of electrical activity became less frequent. Then smaller, then nothing. The bright green dot traversed the viewer. A flat horizon.

  Jennings took his hand out of the wound.

  'I don't understand. What happened to the missing bowel?' Kingsley lifted the flaccid legs and forced three fingers into Cranley's rectum. They met little resistance.

  'He's . . . someone's pushed a hand into his anus, punctured the rectal wall, grabbed a loop of bowel. Then pulled.'

  He let the legs flop back on the table. Kingsley studied his handiwork.

  The theatre was stunned into silence. Just a drip, drip of blood on the floor. Sister excused herself.

  'Aw hell, that's sick, that's really . . .'

  'I’ll phone the police,' said Steve Jennings.

  Kingsley turned away, slowly peeling the gloves off his sleeves. He caught his reflection in the glass of the scrub room, a tall, masked figure, soaked in blood. He held up his hands, murderer's hands. The expressionless, transparent figure floated in the glass. Kingsley stared through it.

  'He was a nice guy,' the anaesthetist was saying. 'Just a nice old guy. Who would do a thing like that?'

  The used swabs dripped slowly from the counting rack. Kingsley wrenched off his mask. Then he made for the door.

  Chapter 22

  The party was over. In the semi-darkness tattered streamers still hung from the balcony like primordial creepers. Three junior doctors were supporting each other – an unsteady tripod – in front of the drinks table, singing 'When my baby walks down the street'.

  They stopped when Kingsley entered the hall. His theatre clogs rattled over the red tiles. One of the doctors turned and greeted him. Kingsley made no reply. He was still sick with the horror of Cranley's death. There was no surgery for that kind of injury.