Prognosis So Done

by Andrews, Amy

  Harriet was comfortable with her nudity, sure, but this wasn’t a beach. It was a cold operating theatre in a strange country and these weren’t random strangers, they were her friends and colleagues.

  When he looked back at Joan she had completed the intubation and Gill swallowed hard as she taped Harriet’s not quite closed eyes shut. The large plastic tube protruding from Harriet’s mouth and tied to her beautiful face looked so brutal.

  She didn’t look like Harriet, his wife, his lover. Harriet, who he had made love to only that morning. Harriet, who had thrust the divorce papers at him. She looked pale and thin and small and... ill. An edge of desperation rose in him, a moment of panic at all the possible adverse outcomes.

  He thought back to all the complicated operations he had

  performed over the last ten years. This was so simple in comparison, a lot simpler than the amputation he’d just performed, but the stakes had never been higher.

  Trying to mentally prepare himself for what he was about to

  do, he understood why surgeons weren’t allowed to operate on relatives. The crush of emotions crowding his head and filling his chest made concentration impossible.

  And what if he failed?

  What if he couldn’t stop the bleeding and she bled out?

  What if he couldn’t do what she’d asked him to do? What if he couldn’t save her tube?

  Suddenly he wished Benedetto was doing the operation instead. That Harriet’s life and fertility weren’t his sole

  responsibility. He wished he could just pace up and down the corridor outside and be free to worry and think the worst.

  He couldn’t think the worst now.

  He had to do his best, his very best, and that was all he could think about. He was it. It was his responsibility.

  ‘Go, Gill,’ said Joan.

  He didn’t need to be told twice. ‘Scalpel,’ he said, holding out his hand.

  He took a deep steadying breath and made a midline vertical incision from below her umbilicus straight down to her pubic bone. He thought about the scar it would make and wondered if that would prevent her from nude sun-baking.

  His hand shook slightly as he made a smaller vertical incision in the fascia and then lengthened the fascial incision, using scissors. He could see the rectus muscle and used the scissors to separate it.

  Below was the shiny peritoneal lining and he used his gloved fingers to make a small opening in it near the umbilicus and then used the scissors to lengthen the incision. The object was to be able to view the entire uterus but all he could see was blood.

  So much blood.

  Oh, Jesus. His pulse pounded through his ears and neck and belly. Don’t die, Harry. Please, don’t die.

  ‘Suction,’ he said, knowing that he sounded panicky but he couldn’t see a goddam thing and he needed to clear it so he could clamp the arteries and stop the bleeding.

  He tried to control his panic as the continuous welling of blood slurped down the suction tubing and spat into the bottle, filling one and half filling the next. And he tried not to think the worst as he manually removed the clots and tissue too large to go down the sucker.

  Tried to divorce himself from the grisly facts and failed. The fact that her blood loss was frightening and the tissue he was touching was the remains of a tiny, tiny embryo.

  His embryo. His baby. And he could do nothing to save this life. Nothing.

  Suddenly he had flashes back to Nimuk’s mother. Her abject

  misery as she had handed Nimuk over, knowing he was dying and knowing there was nothing she could do about it. He remembered her powerless, felt it acutely right now as he delved inside his wife’s body and tried to save her life.

  ‘What’s her pressure?’ he demanded.

  ‘Holding at eighty. She’s had two lots of colloid and just

  finishing her second bag of O.’

  He had to stop the bleeding. ‘Bladder retractor.’

  Katya handed him the instrument and he placed it, anchoring it on the pubic bone. She also handed him a self-retaining abdominal retractor and he placed that, giving him a good view. He inserted moist towels to absorb the remaining blood and pack off the bowel and omentum from the operative field.

  He located the Fallopian tube and his heart sank. “Fuck,” he said quietly, behind his mask as he placed two clamps on the destroyed Fallopian tube between the uterus and where the ectopic had erupted, instantly stemming the haemorrhage.

  In a theatre where the atmosphere was so tense that no one even dared breathe, the quiet expletive was loud.

  ‘What?’ asked Katya, crowding him to get a closer look.

  She repeated his expletive in her mother tongue and stepped away. Glancing at her, Gill could see that Katya also knew he had no hope of repairing the tube. He doubted whether the most

  skilled gynae microsurgeon could have done anything with it.

  He had promised Harriet he’d try, but there was no way anything could be done.

  The clock ticked loudly in the silent room. Everyone waited

  for Gill’s next move. After a minute Joan said gently, ‘We know you’d repair it if you could, Gill. There’s not a surgeon in this world that could save that tube.’

  ‘It’s her only one,’ he said, raising anguished eyes to Joan. ‘She wants a baby. I promised her.’

  ‘No,’ said Katya, opening Gill’s hand and slapping a scalpel into it. ‘You promised her you’d try, and I promised her to keep you to it. And if I thought there was any chance, I would. But there’s nothing you can do. Cut it, Gill, and get on with the op.’

  He’d never felt more out of depth in his life. It wasn’t

  something he was used to feeling in an operating theatre. Here

  he was in control. Always. He looked at Joan.

  ‘Katya is right. She’s lost a lot of blood, Gill. Don’t

  prolong the stress to Harriet’s system. There are other ways to get pregnant.’

  Gill nodded, knowing they were right but hating himself for what he was about to do. This was why there was a rule about operating on relations. He was the one who was going to have to face the music for what he was about to do.

  And she was going to hate him for it.

  He hesitated briefly before slicing through the tubal

  pedicle between the two clamps he’d applied earlier. And that

  was it. There was no going back now.

  It was done.

  Pushing all thoughts of Harriet’s reaction aside, he got on with the job - there was still more work to do. He ligated the artery and then ligated the end of the pedicle. Before he could remove the tube completely, he had to divide part of the broad ligament that attached along the length of the tube which he did until the tube was finally free.

  Katya held out a kidney dish and Gill discarded the twisted

  flesh. It looked alien, so removed from its actual function and too damaged to do it anyway.

  ‘Keep it,’ he said to Katya. Maybe Harriet would need proof, justification as to why he hadn’t tried to salvage it. Maybe for her grief process she’d need to see it with her own eyes.

  She looked at him for a long moment. ‘Da.’ She nodded and indicated to Siobhan to get her a specimen container.

  ‘Pressure rising. One hundred systolic,’ Helmut said.

  An enormous weight lifted from Gill’s shoulders, the cramp in his neck and the tension along his jaw, dissipated. They had done it. He had controlled the bleeding and Joan had replaced Harriet’s blood loss and stabilised her blood pressure.

  As he sutured Harriet back together, Gill’s mind began to

  wander and he forced himself to push the thoughts away and

  concentrate. He would have time later to think about how close

  he’d come to losing her, about all the blood and how he’d taken from her the one thing she’d asked him not to.

  And that Harriet had been pregnant with his child. A child that he hadn’t even known he’d wanted. U
ntil tonight.

  CHAPTER TWENTY-ONE - 0300 HOURS

  ‘No, I can’t take it, Kelly. My rotation here finishes in

  three hours and I want to be there when Harriet wakes up. How

  far is Ben off finishing?’

  ‘Approximately thirty minutes.’

  ‘How stable is the patient?’

  ‘OK, for now,’ she confirmed. ‘The X-ray shows the knife still in situ, but it appears to have missed anything major and it’s been well padded and supported so it can’t move around.’

  ‘Sedate him,’ suggested Gill. ‘He should be fine as long as the knife remains stabilised. What else is there?’

  ‘That’s it for now. We’ve had mainly medical and minor surgical cases from this skirmish. How’s Harry?’

  ‘Still sleeping.’

  ‘I’ll be over to see her when I can. Are you OK?’

  ‘No. Not really. It’s been a hell of a last day.’

  And that, thought Gill, was an understatement. Divorce papers, his grandfather’s poor health, a helicopter shot out of the sky, Nimuk, seven hours of operating and Harriet.

  ‘New team is scheduled to land at 6 a.m.’ she said. ‘Not long now.’

  Three hours away. It stretched ahead of Gill as he replaced the phone in Megan’s HDU/recovery area. He’d rather evacuate Harriet now, but he knew she was stable and their scheduled flight wasn’t really that far off. And he knew she wouldn’t want to take the place of a critical patient who needed it more.

  He wandered back over to the bed where Harriet lay, sleeping off the effects of the anaesthetic. The background battle noises outside that had been going all night had ceased and it was very quiet in the darkened area. All he could hear was the sound of

  monitors and the squeaking of shoes somewhere down the corridor.

  She looked fragile, like she’d had the stuffing knocked out of her - still and pale despite the third bag of blood currently dripping into her IV. It was the sheets, he’d decided. The white, white sheets weren’t helping with her pallor.

  He held her hand, careful not to bump the bed or her stomach, and thought back to their wedding day. She’d worn white that day and had glowed with vitality during the ceremony on that secluded Fijian beach in front of immediate family and a few close friends.

  If he thought hard enough, he could almost hear the gentle

  lap of the waves against the shore as she had walked the short frangipani-strewn distance between the guests. And he could almost smell the heady fragrance of the sweet flowers.

  Harriet had worn an exquisite white sarong lightly embroidered with unusual milky pink and grey mother-of-pearl beads. She had been planning on wearing a bright sarong to match his bright hibiscus print silk shirt, but had seen the beautiful

  garment in the resort shop and hadn’t been able to resist it.

  And what a bride she had made.

  She had been stunningly gorgeous. With white frangipani blossoms in her loose, long brown hair and a white frangipani bouquet, she had looked beyond beautiful. She had looked tanned and healthy and glowing and he hadn’t been able to wrap his head around the fact that she was actually marrying him.

  Harriet stirred and mumbled a little, and Gill smoothed her

  wedding band with his thumb as the memories faded. She’d woken only briefly after Joan had extubated her. She had asked for him then had mumbled and made no sense. She no doubt felt as wretched as she looked, and sleep was the best tonic immediately post-op so he didn’t disturb her.

  He was overwhelmed though by the urge to crawl in beside her and cradle her against his body. She looked eerily lifeless, despite the steady blip, blip, blip of her heart rate on the monitor beside her, and he yearned for the reassurance that only feeling the thud of her heart against his would give him.

  Gill’s ragged breath stuttered into the quiet air and he began to tremble as he set free the thoughts and feelings he hadn’t allowed himself during the operation. It was only now, after the surgery and being relieved from his duties and watching the even rise and fall of his wife’s chest, that the enormity of everything loomed.

  Harriet had been pregnant. With his baby. At least, he

  assumed so. She’d told him earlier that there had been no one else and he had believed her. Which meant the baby was his.

  His baby.

  The words reverberated through every cell of his body and

  his hand trembled as the fact sank in. He waited for the usual

  feelings of rejection and denial but none came. The idea didn’t seem so antithetical to him now.

  He remembered the moment during the operation when he’d had his hands inside her and he was panicking because her warm, sticky blood had been everywhere, but despite all that, there’d been this yearning for his child.

  Gill screwed his eyes shut as a shaft of pain stabbed into his heart. Was this the yearning she had felt for the last couple of years? And why had it taken the death of his child and the near death of his wife to realise how strong these emotions could be?

  The ache was too much and he forced himself to concentrate on the how’s and whys. The timing fitted with an ectopic pregnancy. Not that he’d been up on her cycle, but if she’d conceived almost immediately it would have put her in the right gestational bracket for a tubal pregnancy.

  He knew she was on the Pill to help with the cyst situation and he’d seen her take it on more than one occasion on this rotation. But there had been those couple of days when she’d been ill at the beginning that could have interfered with the absorption of the contraceptive, leaving her unprotected.

  She could even have gone on to have a normal period under the influence of the Pill, despite being pregnant, which would explain her obvious confusion when he had told her the news.

  So he didn’t believe that she’d known and had been keeping it from him, or that she had deliberately got pregnant either. Her vehement rejection of Katya’s suggestion supported this and Gill felt sure that Harriet would have told Katya about the baby if she had known.

  They did confide in each other and Katya had given her the perfect opening after all.

  No, she had been walking around for weeks with a time bomb

  in her belly, completely oblivious. His child had lodged in

  her only Fallopian tube, instead of moving down to the roomy

  comfort of the uterus, and when it could no longer grow within

  the narrow confines it had met an inevitable end and had almost taken Harriet with him.

  Him? Gill stroked her hand and wondered about the sex of the baby despite the ridiculousness of it. A boy or a girl — it hardly mattered now. Would the child have been like him, tall and lean, or like Harriet, toned and tanned? His laugh or her hip mole? His French-ness or her gypsy-ness?

  These were questions he’d never have an answer to now. Questions he’d never even cared about or pondered before. But he was now. He’d been a father ever so briefly - many would consider not at all - but the loss he felt was surprisingly heavy.

  He looked at Harriet’s pale pink lips and wondered if she’d ever forgive him for what he’d had to do. His paternal instinct had only just kicked in but her maternal instinct had been active for two years now. Her reduced fertility had caused her a lot of grief and he could only begin to imagine how devastated she was going to be.

  ‘I love you, Harry. I’m sorry,’ he whispered, and gently stroked his thumb in a butterfly caress across her mouth. She stirred a little, murmuring something in her sleep, and he quickly withdrew his hand.

  He knew she would wake up eventually but he was relieved to see her sleeping so heavily. She’d been through so much that she needed it — her body stretched to its limits of pain and

  blood loss.

  But also, while she slept, it delayed the inevitable. He was going to have to tell her the bad news and he couldn’t bear to witness her distress when he told her that not only was there no longer a baby but her ability to have another had been
severely compromised.

  He felt a hand on his shoulder and looked up to see Katya

  standing there. ‘Did you know?’ he asked her quietly.

  Katya shook her head solemnly. ‘I don’t think she even knew.’

  He nodded, pleased to have confirmed what he’d already surmised. Katya pulled up a chair on the opposite side of the bed and they watched in silence for a few minutes.

  ‘Don’t beat yourself up,’ said Katya. ‘You did what anyone would have done.’

  Gill’s gaze didn’t leave the rise and fall of Harriet’s chest. ‘But I’m not just anyone, am I?’ he asked.

  ‘There is more than one way to have a baby, no? She still has an ovary. She still has eggs. IVF will help. And if not, you can adopt. Or foster.’

  ‘I know,’ said Gill, turning anguished eyes on the Russian nurse. ‘But she’s still going to be devastated.’

  ‘Da. She has lost something very important to her. But as I said, Guillaume, there are other ways and don’t forget, you are important to her, too. I suspect as long as you’re the father, she’ll be OK.’

  Gill felt the weight of the shrewd gaze - too shrewd for one so young. Him, a father. Something that had horrified him a mere few hours ago suddenly appealed immensely.

  The pain of losing the little life they had made together seemed to have kicked started his fatherly instincts. And it had been like rousing a sleeping lion — they had well and truly tripped into overdrive as the desire to see Harriet holding their child almost crushed him.

  CHAPTER TWENTY-TWO - 0400 HOURS

  Harriet roused slowly, coming out of the layers of fog

  gradually. Her tongue felt furry and disgusting, her breath tasted bitter. The room was blurry and it took a few moments for it to come into focus. She couldn’t remember where she was, although it was vaguely familiar.

  It certainly wasn’t her bedroom in Bondi. She couldn’t hear the familiar beat of waves against the shore but Gill was there. She looked down, his head warm against her arm, his eyes shut and she took a moment just to stare at his face, something she’d done often while he’d slept. Although his features didn’t seem quite as relaxed as usual.