Prognosis So Done

by Andrews, Amy

‘Don’t be obtuse,’ Siobhan rebuffed him good-naturedly in her gorgeous accent. ‘How many times in these situations do

  you get to see such a positive side to life? We see too much death and dying. It’s nice to see new life for a change. How many C-sections have you done with MedSurg?’

  ‘Counting this one? One.’

  ‘Precisely. We need to celebrate life. Don’t you think so, Harry?’

  ‘Yes,’ she said, her chin rising as she looked him square in the face, ‘we do.’

  ‘Well, great, we’ll all drink too much champagne on the flight home tomorrow. Naming the child isn’t necessary. For a

  start it’ll have its own name and secondly we’ll never see her again. What’s the point?’

  ‘The point?’ asked Harriet, as another cramping pain gnawed

  at her side. ‘The point is that names are important. I know

  you surgeons have difficulty remembering that, but they’re what humanise us. It’s how we’re identified. And each one tells a story about the person and the origin of their birth.’

  Harriet shoved her hands on her hips. ‘Take your name, for example. Your Australian mother wanted a French name to remind you of your heritage but your French dad wanted you to fit in so he wanted an English name. They compromised, christening you with the French version of William but settling on calling you Gill for short. Your grandfather is the only one who calls you by your proper name.’

  Drying her hands, Harriet continued. ‘A name’s not just what someone calls you to get your attention. It says so much about your family and your history. That’s important. And so was this birth, and I think Siobhan is right. When we talk about this night in years to come, we’ll be able to talk about the baby by name. It’ll make it that much more special.’

  Gill and Siobhan stared at her wordlessly for a few moments. ‘Yep,’ said Siobhan, ‘what she said.’

  ‘Are you OK?’ Gill asked.

  Harriet frowned at him. She’d been so deep in concentration she hadn’t realised she’d had her hand on her hip and was absently massaging her abdomen.

  ‘Fine,’ she dismissed briskly, dropping her hand.

  Gill frowned but let it drop as he glanced at Siobhan. ‘OK, let’s name the baby. Any suggestions?’

  ‘Kat,’ said Katya as she joined the conversation, and everyone laughed.

  ‘What about Caesar, after the way she was bought into the

  world?’ said Siobhan.

  ‘Too masculine,’ said Gill.

  Harriet blinked in surprise. For someone who was reluctant

  to get involved, he was opinionated. ‘Gillian,’ she said. It was perfect. ‘After Gill, the doctor who brought her into the world.’

  ‘Oh, yes.’ Siobhan clapped her hands together. ‘That’s perfect Harry.’

  ‘Gillian...Gillian,’ said Katya, rolling it around her tongue a couple of times before nodding her agreement.

  ‘No, no.’ Gill held up his hands. ‘It was a team effort.’

  ‘Yes,’ Harriet insisted. ‘Yours was the first face she ever saw. You’re connected. Whether you like it or not.’

  And Harriet couldn’t think of a better memory to take away from her last day.

  CHAPTER FIFTEEN - 2100 HOURS

  ‘Burr holes for probable extradural haematoma,’ said Gill,

  putting down the phone. ‘It’s on its way over.’

  The chatter about the newly named baby died down. It had been exciting for everyone after a decade of dealing in trauma and hatred and death, to be a part of life, to celebrate the beginning of life for a change. But they still had work to do.

  Harriet went out to the room behind the theatre and put a tray of neuro instruments into the clunky old steriliser. The organisation operated on a shoe string budget and, as such made do with many things that wouldn’t be tolerated in a modern hospital setting.

  The steriliser being a classic example.

  It used steam and heat to disinfect surgical instruments with two shelves for instrument trays. Pop them in, shut the door, turn the wheel to seal the unit, turn it on and a few minutes at maximum heat and pressure and, bingo! Sterile instruments.

  It wasn’t the most up-to-date equipment but it did the job.

  The important thing to remember was to release the pressure

  valve and not to open the heavy door until the pressure had

  come back down to zero. Her student nurse days had been filled

  with horror stories about nurses who had been killed by heavy

  pressurised doors blowing out and hitting them square in the

  chest.

  Between that and watching the graphic film Hospitals Don’t

  Burn Down that all students had to watch, Harriet had seen

  hazards around every corner. As long as she lived she’d never

  forget the scene where the nurse opened the linen chute on the

  top floor and the fire, which had started in the bowels of the

  hospital, tunnelled up the chute, killing her instantly.

  Harriet shuddered, thinking about it now as she shut off

  the pressure valve. She supposed it had achieved its aim — fire

  awareness. She’d always been really vigilant for potential fire sources. She’d even received an award at their end-of-training dinner for the nurse most likely to single-handedly evacuate an entire hospital in the case of fire.

  She had laughed and graciously accepted the beat-up old

  trophy someone had found at the dump of a fireman carrying a person in his arms. But deep down she’d hoped that her mettle would never be tested.

  Even at home in their Bondi unit she had insisted that they have a fire extinguisher, smoke detectors in every room and a fire blanket in the kitchen. Gill had always teased her, calling her his very own fire warden.

  He’d even bought her a fireman’s hat for Christmas one year, although, as she’d found out, it had had little to do with fire and everything to do with wanting her to wear it to bed and indulge in a little role playing. That hadn’t worked for her but on him...now, that had definitely worked!

  Harriet blinked as she realised where her thoughts were heading and roused herself from the past. She removed the tray from the steriliser, using a long-handled, angled instrument

  designed exactly for the job, and took care not to contaminate

  any of the instruments. Placing the tray down on a sterile towel she had laid out, she waited a couple of minutes for the steam to evaporate and for the instruments to cool off.

  And for her to cool off.

  She didn’t want to walk into the theatre and have to look at Gill when a vivid memory of him in a fireman’s hat and nothing else had her all a fluster — despite the pain in her side. They’d had so many good times, laughed so much. She knew it would be so easy to go to him and tear up the divorce papers and be with him and love him for the rest of her life.

  But something would always be missing. Gillian had brought it glaringly to the fore again. Just because he looked magnificent in a fireman’s hat drawling ma’am at her, wasn’t a good enough reason to sacrifice her wants and needs. She knew she could keep Gill happy but she also knew he couldn’t do the same for her.

  ‘Here she is,’ said Siobhan to Katya, as Harriet schooled

  her features into neutrality and entered the theatre.

  ‘Sorry,’ Harriet apologised.

  ‘Is OK,’ said Katya gently.

  Bless you, thought Harriet. Katya had obviously known that she’d needed some time to herself and, once again, Harriet realised how much she was going to miss these people.

  The patient was already in the theatre and had been

  intubated by Kelly for decreased level of consciousness. Helmut was looking after his airway and hyperventilating him with mechanical breaths from a bag attached to his tube.

  Hyperventilation was an important part of head-injury

  management. The theory was that carbon dioxide, a known pot
ent

  cerebral vasodilator, was blown off, thus preventing excess

  cerebral blood flow and keeping intra-cranial pressure down.

  Gill and Joan were looking at the patient’s X-ray on the viewing box, a fracture of his left temporal bone evident.

  ‘So we’re not sure if he has an extradural?’ asked

  Harriet, joining them.

  ‘Can’t be sure without a CT scan,’ said Gill. Unfortunately, resources did not stretch to a CT scanner. ‘All we can go on is the clinical picture. Kelly said he’d been complaining of a headache and weakness in his right arm and leg after sustaining a blow to the head with a rifle butt. They did a skull X-ray and found the fracture then he rapidly lost consciousness and blew his left pupil so she tubed him.’

  Harriet nodded, looking at their patient. Sounded like a typical cranial bleed picture. So they were going to have to drill a hole in his head and hope they could find the blood clot and evacuate it. If not, the patient’s problems were probably a lot more severe and, as Gill had said, without a CT, impossible to know for sure.

  ‘He looks so young,’ said Harriet, still not yet numbed to the fact that teenagers fought wars.

  Joan nodded. ‘Yeah. It’s so bloody senseless, isn’t it?’

  Gill scrubbed, taking his time to be thorough, despite the

  urgency. The last thing this young man needed was for him to introduce a pathogen directly into his brain. He just hoped, as he concentrated on his scrub, that he located the blood with his first burr hole. He was more than aware that the patient might not have an extradural at all - although his gut was positive.

  They were essentially embarking on a fishing expedition inside someone’s head and once he started he’d have to make several attempts to either find it or satisfy himself that there was nothing to be found.

  Gill had done many of these procedures over the years and

  was more than conscious that the object was to decompress the head and then get the patient out to specialised help. Drill a hole, evacuate the blood, stitch him up and fly him out.

  Not drill as many holes as he could and fluff around till he found something.

  The other possibility was that he’d find a subdural haematoma. Gill sincerely hoped not. It wasn’t that he couldn’t handle it, it was just a little longer, a little more complicated, a little more potentially serious for the patient.

  ‘Mannitol’s finished,’ said Helmut to Gill, as Gill entered the theatre with wet arms held up in front of him.

  Good. That should deal with any cerebral oedema caused by the pressure of the blood clot on the surrounding tissues.

  Now, to find it...

  Harriet and Helmut positioned the patient on the table as

  Gill gowned and gloved. They propped a doughnut headrest

  beneath the head and a sandbag beneath his left shoulder to help keep his head averted to the right. Helmut shaved half the patient’s head and Gill noted the boggy swelling above the temple and a slight graze where the assault had occurred.

  ‘Remind me to never let you cut my hair,’ murmured Harriet,

  and Helmut winked at her.

  ‘Ready, Joan?’ asked Gill.

  ‘Yep, all good my end.’

  Gill prepped the shaved area with Betadine and Harriet, who was circulating nurse this time, hit the play button on the CD player. The sultry tones of Ella Fitzgerald filled the theatre as Gill made his incision.

  It was about three centimetres long over the swollen fracture site, no lower than the cheekbone to avoid cutting the facial nerve, and one finger’s breadth in front of the tragus of the ear. He quickly separated the temporalis muscle and incised the periosteum, inserting a self-retaining retractor and cauterising a couple of bleeding blood vessels.

  The white of the skull bone glistened at him and he asked Katya for the drill which she passed over. Drill made it sound fancy when, in actuality it was a manual device, which looked almost exactly like a standard hand-operated wood drill.

  Nothing fancy and pneumatic out here which was fine because these ones still did the job. Slowly, Gill cranked the handle round and round to make a hole through the bone, careful not to use too much pressure and accidentally plunge through into the brain.

  He felt an irregular wobbling and pulled back, knowing that

  he had perforated through the temporal bone. The hole was too small to tell if there was any extradural blood.

  ‘Conical burr, please.’ Gill used it to enlarge the hole to and then yes! ‘There she blows,’ he said, as the haematoma became evident.

  Finding the bleed straight away was a relief and he relaxed a little. He hadn’t wanted to drill any more holes but wouldn’t have been able to avoid it had the first one been negative.

  ‘Ronguer, please.’

  Gill used the heavy bone-cutting scissors to nibble away a little extra bone and expose more of the haematoma. Katya passed him a syringe and he gently washed out the rather large blood clot and cauterised the bleeding point.

  ‘OK, let’s get this kid out of here,’ said Gill as he prepared to close.

  Harriet who’d been watching attentively, blinked as a rush of faintness washed over her and a wave of nausea tried to outdo the continuing niggly cyst pain for her attention.

  ‘Pupils are equal and reacting,’ said Joan, flashing a

  penlight in her patient’s eyes. ‘Well done, Guillaume. Good

  save. I’ve started him on a broad-spectrum antibiotic.’

  Harriet vaguely heard Gill thank Joan as she excused herself and hurried to the change rooms, shutting herself in a cubicle and pulling the lid down on the toilet. She sunk onto it with wobbly legs, swallowing down the acrid taste of vomit.

  A tear slid out from behind her closed lids as she held her side. God...she felt awful, the night stretching ahead of her like a long dark highway when all Harriet wanted to do was take a painkiller and go to bed for a week.

  Bloody ovary! Between this one and her non-existent other one, she’d had enough of her female bits and pieces.

  With the nausea settling, Harriet took a couple of deep breaths, pulled off some toilet paper, blew her nose and wiped her eyes.

  Only eight hours to go.

  CHAPTER SIXTEEN - 2200 HOURS

  Actually, Harriet felt better after her quick trip to the loo. The pain was still there but with the nausea gone, her teeth brushed and a quick splash of water on her face, she was considerably revived. She’d only been gone ten minutes

  so she doubted she’d been missed.

  ‘Here you are,’ said Gill, rounding the corner and virtually running straight into her, his hands slipping onto her elbows to prevent a collision.

  ‘Here I am,’ she said, injecting a note of cheer into her

  voice as she slipped out of his hold and kept going.

  ‘Wait.’ He put a staying hand on her shoulder. ‘How are you feeling? Are you OK? You look a little pale. I looked for you but you’d gone.’

  Harriet shrugged off his hand, refusing to look into his beautiful grey eyes. She had a night of surgery to get through and if she admitted feeling unwell he would demand she withdraw. And although the thought of it sounded quite inviting right now, she couldn’t let the team down.

  It was their last day. She’d already had two days out at the beginning of their rotation due to her gastro illness and they’d had to operate one person down. They were on the homeward stretch — she would cope with the pain and when it was all over she could skive off.

  ‘Harriet,’ he said. ‘It’s bad, isn’t it?’

  She sighed, still refusing to look at him. If she did that

  right at this moment, when she was feeling so vulnerable, she

  was going to cry again. ‘It’s fine,’ she dismissed.

  He turned her around and lifted her chin so she had no choice but to look at him. ‘Talk to me,’ he implored, softly.

  She sighed again. ‘It’s sore.’

  ‘Worse than when you ha
d it drained that time?’

  ‘No.’

  Harriet shook her head, remembering that vividly. Gill had taken her to the emergency department of the nearest London

  hospital, doubled up with pain. They’d done an ultrasound and found the large ovarian cyst, and a gynaecologist had done an

  ultrasonic-guided needle aspiration sucking off forty mils

  of fluid.

  The instant pain relief had been wonderful but short-lived as he’d decided to check out the state of her other ovary and had had to deliver the news about her unusual anatomy. It had been a double whammy on a particularly awful day.

  Gill had been great, so wonderful and sympathetic for a

  while, but as the full implications had dawned on Harriet and her biological clock had roared to life, that’s when the

  arguments had begun.

  ‘Absolutely not,’ she assured. ‘It’s just a constant ache, more annoying than anything.’ She decided not to tell him about the nausea. ‘I’ll take a couple of more painkillers. That really knocked it on the head last time.’

  She turned to go again but he stopped her short with his next statement.

  ‘I really am sorry, you know. About the tube, about the whole...baby thing. I swear to you, Harry, if I wanted a baby, I would want one with you.’

  Harriet could see the genuine sentiment written all over his gorgeous face. ‘I know, Gill. I know.’

  What was the point in leaving things bitter and twisted? She knew he meant it. She knew he was genuinely sorry about the way things had turned out between them.

  Turning away she headed back to help clean up, her side aching with each footfall and her heart aching for what they could have been.

  ‘You OK?’ Katya asked, as Harriet entered the theatre, followed closely by Gill. ‘You look pale.’

  Harriet rolled her eyes and forced a smile onto her face. ‘Looks like I’m going to need to top up my tan when I get home.’

  The phone rang and Harriet answered pleased for the distraction. It was Kelly. ‘How did the burr holes go?’

  ‘Large extradural. He’s in HDU awaiting evac.’

  ‘I’ve got a chopper landing in approximately thirty