Prognosis So Done

by Andrews, Amy

  The first thing Gill had to do was decide on the level of

  amputation. Most surgeons incised about fifteen centimetres above the knee joint but each case was individual and traumatic amputation often required a higher amputation level to allow for viable skin and muscle coverage of the bone.

  Gill made his incision about twenty centimetres, estimating there would be enough healthy skin to cover the stump. The tourniquet provided a perfectly bloodless field, enabling Gill to do his job without having to diathermy any bleeding points.

  He was aware only of the leg and Harriet beside him. She wasn’t humming as she usually did, but Gill couldn’t think of a better person to be in the zone with. She passed the instruments smoothly, the pain obviously not affecting her ability to assist him and he drew comfort from that.

  Harriet made a supreme effort to concentrate on the operation. Gill was proceeding through the muscle layers, dividing the nerves as he went so the cut ends would retract below the end of the remaining bone. This was important to

  help with the phantom limb pains suffered by most amputees.

  She did a quick mental check that everything Gill would need or ask for after this stage was on the tray and within easy reach. Orthopaedic sets were just a big boy’s tool set, the instruments not dissimilar to a standard toolbox — saws, chisels, hammers, screws, drills and nails.

  Sure, they had more sophisticated names but looked almost exactly the same. Harriet found the bone crunching and sheer force required in a lot of orthopaedic ops unsettling. It was kind of brutal and she guessed you just had to have the Y chromosome to get it.

  The pain had become hot and stabbing now and Harriet shut her eyes briefly. She opened them again, forcing herself to tune it out and concentrate on what Gill was doing. There was a long way to go yet, and she would not let him down.

  The clock ticked by as he worked, to relative silence in the theatre, apart from Ella’s singing and Joan and Helmut’s occasional condition updates. Harriet reflected how the in-theatre dynamics were different to their out-of-theatre dynamics.

  Their team chatted and joked a lot outside the operating theatre. They were close and revelled in banter. But on the job it very much depended on the type of surgery and the pressure Gill was feeling. If he was relaxed and chatty then everyone followed suit. If he was quiet then they all knew and respected his skill enough to let him work in peace without distraction.

  The clock was just about to tick over to the next hour when Gill said, ‘Release the tourniquet please, Helmut.’

  The tourniquet deflated slowly and Harriet watched the operative site pink up as blood flowed back to the tissues. A couple of little vessels oozed and Gill achieved hemostasis with quickly, not bothering with the tourniquet.

  Harriet picked up the Gigli saw for the next stage of the

  operation — cutting the femur. An intense, stabbing pain kicked

  her hard in the side with breathtaking ferocity and, startled, the saw slid from Harriet’s fingers, dropping with a loud metallic clatter to the floor.

  An instrument dropping in theatre pealed as loudly as a church bell. Everyone started and stopped what they were doing.

  ‘Harry!’ Gill frowned. ‘Are you OK?’

  ‘Of...course,’ she said weakly, swallowing a wave of nausea as she clutched the operating table for support. ‘Sorry, it slipped.’

  His eyes searched hers. ‘You’ve never dropped an instrument in my theatre - ever.’

  ‘Surely I’m allowed one slip-up in seven years, aren’t I?’ She forced a jovial tone into her voice as she fought to get her breath back from the suddenness of the fierce pain.

  ‘Siobhan, I’m sorry, can you sterilise the saw again?’ Harriet asked.

  Siobhan picked it off the floor at her feet and took it

  outside to run it through the three-minute sterilisation process.

  ‘Are you sure you’re OK?’ asked Gill. ‘Do you want Katya to scrub in?’

  ‘I’m fine,’ Harriet dismissed as the pain settled again to more of a throb.

  She’d never not seen an op through to the end, and she wasn’t about to start on her last day!

  CHAPTER NINETEEN - 0100 HOURS

  While they waited on the saw, Helmut told some jokes. He very good at jokes with just the right sense of drama to deliver the punch line well. He also had an endless supply and was exactly what they needed right at that moment.

  Harriet laughed weakly with everyone else at a one-armed

  surgeon joke, blinking hard to clear a wave of dizziness that

  threatened to unbalance her. She opened her eyes and was pleased to see the furniture that had been swimming in front of her eyes was firmly back on the floor.

  Siobhan returned with the newly sterilised instrument, placing it on Harriet’s trolley. Harriet passed it to Gill, without dropping it, and the procedure got back on track. She glanced at the clock on the wall as she shifted from foot to

  foot in her rubber theatre clogs, trying to work out a stance

  where the pain was more tolerable.

  Thirty minutes, she thought. Tops. All she had to do was last till the end of this procedure and then she would retire unwell, more casualties or not. She didn’t like letting the

  team down but this pain was only intensifying, and just getting through this op was going to be hard enough.

  She just wanted to get off her feet, take some more painkillers and curl up in bed for a while. Although she might ask Joan if she could run the hand-held ultrasound over her abdo first just to confirm it was a cyst. Harriet was beginning to become a little concerned by the ferocity of the pain.

  What if it wasn’t a cyst? What if she was brewing a hot appendix?

  That’d be a pretty horrid way to end a very eventful last day. She hadn’t been looking forward to the end of her rotation here — too many permanent goodbyes to be said, too much

  history coming to an end — but now it couldn’t come fast enough.

  Gill started to saw through the femur and Harriet shuddered as she suppressed another rush of nausea. The sawing noise wasn’t much different from sawing through wood but knowing it was human bone lent a certain gruesome quality to the procedure.

  After some furtive position changes, Harriet worked out a stance that helped with the pain mostly by leaning into the operating table for support. It was still there but the intensity was less and until the operation was over it was going to have to do.

  Next came the bone-shortening stage of the operation which Harriet knew Gill always took great care with because if he got the length wrong, it could set the patient’s recovery back. And if he didn’t smooth the end of the bone properly, uneven prominences could be damaging to surrounding tissue, cause pressure and irritation and even make it too painful to wear a prosthesis.

  She knew he had to get the basics right now so it didn’t complicate any further surgical procedures. But Harriet was about ready to scream by the time Gill was satisfied that the muscle and skin would adequately cover the bone and that the bone was smooth enough and everything was good for the next lot of surgeons.

  She blinked as a bead of sweat ran into her eye and gripped the table as a surge of dizziness made her sway a little. She could feel the threatening nausea and didn’t know how much longer she could stand here.

  God...something was very wrong.

  The pain in the last ten minutes had kicked up another notch. It felt like someone had stuck a hot, sharp knife into

  her side and was twisting it back and forth.

  This was now much worse than the time she’d had her cyst aspirated. Was it much bigger this time or had it ruptured? Or was it something else? She’d never had appendicitis and if it was that, had it ruptured? The knife twisted again and Harriet

  suppressed the moan that sprang to her lips.

  ‘Harry? Did you hear me?’

  Harriet blinked, shaking the fog out of her brain, and the two Gills she could see merged into one.
<
br />   ‘Dressing. We’re done here.’

  Harriet almost cheered as, with shaking hands, she passed him a non-adhesive dressing to place on the open wound. Lifting the leg so he could wrap a bandage around it took a supreme effort. Her arms felt like they couldn’t support a leaf, let alone half a limb, but she gritted her teeth, biting down on the sob that almost escaped.

  ‘Higher,’ said Gill, trying to wrap the last of the bandage

  down the thigh to anchor it a little.

  Harriet heard his voice from far away as a ringing in her

  ears grew so loud it was like being in the middle of a million crickets. Her arms shook uncontrollably and her vision blackened from the edges inwards until all she could see were two pinpoints of light and then not even that before she lapsed into unconsciousness.

  Gill realised what was happening just in time, dropping the

  almost bandaged leg with a thump and twisting to catch Harriet

  before she banged her head. Luckily he didn’t need to be sterile anymore because they both ended up on the floor.

  ‘Harry! Harry!’ Gill shook her, ripping her hat and mask off, alarmed at her rag-doll limpness. She moaned and her eyes fluttered open briefly and a cool surge of relief washed through him like a tidal wave.

  ‘What’s wrong?’ demanded Katya. Everyone had gathered

  around and were squatting next to Gill, their amputee patient

  temporarily forgotten. Their look of alarm and concern mirrored his.

  ‘She fainted,’ Gill said, a sick feeling of worry like a lump of cold porridge in his belly as he lay her head gently against the floor and called her name.

  She came around again slowly, moaning and drawing her legs up until she lay a foetal position, her arms folded around her abdomen.

  ‘Harry? What’s happening?’ he asked gently but she just moaned again and Gill’s alarm spiked further. ‘Joan, can you reverse the anaesthetic on our one-legged friend and get him out to Megan so we can put Harry up on the table?’

  The team sprang into action. Joan injected the reversal agent and they shifted the groggy amputee onto a trolley. Helmut wheeling him out to Megan while Siobhan and Katya cleared the table and wiped it quickly down.

  Helmut returned and he and Gill lifted Harriet off

  the floor and placed her on the table.

  ‘Harriet,’ Gill said, giving her shoulder a gentle shake. ‘Talk to me. What’s happening? Is it your belly?’

  Her pallor was terrible as he reached for the blood-pressure cuff attached to the anaesthetic monitor, wrapped it around her arm and pushed the button. Her skin felt cool and clammy and Gill tried to stay calm.

  Tried to be the doctor she needed him to be right now.

  Joan clipped a tourniquet on Harriet’s other arm and flicked at the crook of her elbow looking for a vein to insert an IV.

  ‘The pain...it’s been getting worse and worse.’ Tears ran down her cheeks.

  ‘Why didn’t you say something?’ he chided gently.

  ‘I thought it was just a cyst but...I don’t know, Gill. This is different. I think maybe it’s ruptured or I have appendicitis.’

  ‘Where does it hurt?’ he asked.

  ‘Same place, but it’s never been this bad. Not even that time in London.’

  “Can you lie on your back so I can have a feel?” he asked.

  She unfurled but it was obviously uncomfortable as Gill lifted her scrub top to expose her abdomen and pushed down gently with his fingertips in the right lower quadrant, using the prominent jut of her hipbone as leverage.

  Harriet cried out and clutched his sleeve.

  ‘I’ll get the hand-held,’ said Katya.

  The blood-pressure reading pinged onto the screen. Eighty-five systolic and her heart rate was one hundred and twenty.

  Crap. That was not good.

  Katya arrived back and handed the portable ultrasound

  machine to Gill. He flicked it on, applied some gel and ran

  the transducer over the suspect area. Harriet groaned and

  tried to push the transducer away, guarding the tender area.

  Katya clucked and soothed in Russian and took Harriet’s hand so Gill could complete the procedure.

  He located the ovary and it looked normal. It wasn’t her

  appendix either but there was an alarming amount of free fluid and he flicked a quick, worried glance at Joan. Looking further, Gill thought he could see an irregularity in her remaining Fallopian tube and felt his heart sink.

  A problem tube, extreme pain, hypotension, tachycardia and a lot of free fluid added up to only one thing.

  He took a deep breath to calm his racing heart, which was

  thudding so loudly it could have been mistaken for a helicopter landing outside. ‘Harry, could it be possible that you’re pregnant?’ He switched off the machine and passed it back to Katya.

  ‘W-what?’ She shook her head like she couldn’t quite compute what he’d said. ‘What do you mean?’

  ‘I mean I think you have an ectopic pregnancy that’s ruptured your Fallopian tube.’

  She stared at him her fevered brow scrunched. ‘Pregnant? But ...how? I’m sub fertile and on the Pill.’

  Yeah, Gill knew all that but there was no doubt in his mind what this was. ‘I need to operate. You need a laparotomy.’

  ‘What? No.’ She placed her hand protectively over her

  abdomen. ‘No.’

  And she burst into tears.

  CHAPTER TWENTY - 0200 HOURS

  Harriet sobbed as everyone talked around her.

  ‘Let’s go, people.’ Gill’s authoritative tone was calm but urgent. ‘There’s a lot of blood. Joan, let’s get another line and rapidly infuse some O into her. Are you right to do the anaesthetic?’

  ‘Of course.’ Joan’s voice now. ‘What about you? You shouldn’t be operating on Harry. I can get Ben.’

  ‘No.’ Gill again. ‘He’s in the middle of his own amputation.’

  ‘You can swap.’

  Joan’s voice was firm. But... ‘We don’t have time.’ Gill was emphatic. ‘I’m it. I’m doing it.’

  All that swirled above her as the miserable implications dawned on Harriet. She’d been pregnant and now she wasn’t. And there was no time to ponder the details or grieve over a baby she had never known about because she was bleeding. A lot. And she knew ectopic pregnancy rupture was the highest cause of maternal death in the first trimester of pregnancy.

  So, she could die.

  And, if she survived? Then she’d probably never be able to conceive naturally again. It just wasn’t fair.

  She clutched Gill’s arm to get his attention as he barked orders. ‘Promise me you’ll try and save the tube, Gill. Promise me. Don’t take away any chance I have of having a baby.’

  He shut his eyes looking as bad, if not worse as he had earlier after the call about his grandfather. ‘Harry, I love you and I will try but right now I have to be a surgeon first and a husband second.’

  Harriet knew that. She did. But. ‘Just try,’ she begged, her face screwing up as she choked on a sob. ‘Please, Gill. Please.’

  ‘I’ll try,’ he said tersely. ‘I have to go and scrub now.’ And he walked away.

  The next few minutes passed in a blur as Helmut placed a mask on her face and connected her up to the monitor. She couldn’t stop crying. Even among the hustle and bustle all around her and amidst some of her dearest friends, she felt

  totally alone.

  ‘I’m going to put you to sleep now, Harry,’ said Joan gently.

  Harriet blinked as Joan’s blurry face appeared above her. ‘No, wait, Joan,’ said Harriet, pulling her mask off, desperate to garner more support. ‘Swear to me you’ll remind Gill of his promise.’

  ‘Harry...’ Joan was obviously torn between her medical training and Harriet’s tearful plea.

  ‘I will keep him to it,’ said Katya, her head appearing in

  view now. The fierceness in her eye
s was about the only thing Harriet could see thanks to the mask Katya was wearing.

  ‘Thank you, Katya,’ whispered Harriet, more hot tears pouring from her eyes.

  She wanted to link hands to touch her friend and convey her gratitude, but even in this warm and fuzzy state she knew Katya was standing with her gloved hands clasped together and in close to her body which meant she was already scrubbed and sterile and therefore untouchable.

  ‘It’s time,’ said Joan gently, replacing the mask Harriet had removed.

  Harriet nodded and swallowed another lump of emotion rising in her chest that threatened to overwhelm her. She pulled the

  mask off again. She knew that things were touch and go with her and that she might not pull through. She didn’t want to leave without these people knowing how much they meant.

  ‘I love you guys,’ she said in a voice she had to force to be loud, a single tear squeezing out from the corner of an eye. She didn’t have the energy for grand speeches but at least she’d said what she’d needed to.

  Everyone paused for a moment at Harriet’s words. Gill’s step faltered as he entered the theatre. Joan stopped mid-check of the laryngoscope. Helmut looked up from preparing drugs and Siobhan and Katya stopped their count. Every one of them knew what was on the line.

  Harriet’s life was hanging in the balance.

  Gill recovered first. ‘Let’s go, people,’ he barked tersely.

  The team resumed their duties. Joan injected the milky anaesthetic agent into Harriet’s IV and Gill watched, relieved, as her eyes drifted shut and the muscle relaxant smoothed the lines of anguish on her face. He looked away while Harriet was intubated. It was a procedure he’d seen a thousand times, a

  necessary requirement for surgery, but he just couldn’t bear

  to watch.

  Siobhan cut Harriet’s scrubs away, preserving as much of

  her modesty as possible, and Gill prepped her abdo with Betadine then quickly draped her body. He couldn’t stand to see her lying there so exposed.