LITMIR.BIZ

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OR—Theatre One, which sounded odd to her ears—was a place in which she was used to possessing undisputed control. She loved this environment, and the way everything was geared towards a single focus. One patient, one operation and six people who knew exactly what they were doing.

      The scrub sinks were different—old-fashioned porcelain, with long levers on the faucets which you flicked on and off with a quick touch. She was used to stainless steel, and foot pedals. Theatre One had washable vinyl walls and the hard, antistatic floors which she knew only too well. They were murder on backs and legs after you’d been standing there for more than a couple of hours.

      Candace was the last to scrub, and everything was ready to go now that she had arrived. She briefly greeted the other staff and the patient. Mrs Allenby looked a little nervous, of course. Years ago, Candace had had to fight the instinct to give her patients a reassuring pat, but now it was second nature to keep her gloved hands back.

      There was music playing on a black compact disc player set up on a shelf. Something classical. Beethoven, Candace recognised. Not that it made any difference.

      ‘Could we have that off, please?’ she said.

      The scout nurse, whose name badge was hidden beneath a green surgical gown, immediately went across and pressed a button on the player, bringing silence.

      ‘Would you like something else, Dr Fletcher?’ she offered. Her name was Pat, Candace found out a little later.

      ‘No, thanks,’ she answered, calm and polite. ‘I can’t operate with music.’

      She registered one or two slightly surprised looks above pale green disposable masks, but didn’t take the time to explain. This was her space now. All surgeons had their quirks, and she wasn’t going to apologise for hers, now or later. She never swore or threw things or yelled at the nurses; she didn’t practise her golf swing to warm up her hands; she was consistent in her preference of cat-gut length and instrument size.

      But she liked silence. It helped her sense of focus. No music. A minimum of chatter. No jokes or ribbing. Absolutely no disparaging comments about the patient.

      ‘OK, we’re looking good at this end,’ Steve said a few minutes later.

      ‘Thanks, Dr Colton.’

      Her gaze tangled with his as he looked briefly away from his monitors, and she could tell he was still thinking about the ‘no music’ thing. Maybe he’d chosen the Beethoven himself. Well, he could listen to Beethoven at home.

      ‘All right, are we ready for the gas?’ she asked, and began the operation.

      She’d done it hundreds of times, probably.

      Several litres of carbon dioxide were injected into the abdomen to provide a space to work in between the outer layers of tissue and the internal organs. A tiny incision allowed the passage of a laparoscope with an equally tiny camera on the end of it, manipulated by the assistant surgeon, Peter Moody. What the camera saw was then screened like a video, allowing Candace to guide her instruments. The lumpy, disorientating appearance of the human abdominal cavity on the screen was a familiar sight to her now.

      This patient’s symptoms suggested the need for a cholangiogram, which would confirm or rule out the presence of stones in the bile duct. In this case, the X-ray-type scan showed that, yes, there were three small stones present. Candace decided to remove them immediately, rather than bring Mrs Allenby back for a second procedure at a later date.

      The monitors indicated that she was handling the anaesthesia well. Candace had no trouble in removing the stones successfully.

      ‘If I know Mrs Allenby, she’ll want to see those later,’ Steve said.

      ‘She’s your patient?’ Candace asked.

      ‘Since I started here four years ago. And she’s got a very enquiring mind, haven’t you Mrs A.?’ Under anaesthesia, Mrs Allenby’s conscious mind was almost certain to be unaware, but there was strong evidence that many patients could retain a memory of what happened during surgery. ‘She wanted to know last week—’ Steve began.

      ‘Could we save it until later?’ Candace cut in.

      ‘Sure.’ He gave a brief nod and a shrug.

      Again, there was a moment of tension and adjustment amongst the other staff. Candace ignored it and kept going. She used tiny metal clips to close off the bile duct at the base of the gall bladder, as well as the vessel which provided its blood supply. Next, she used a cautery to detach the gall bladder from the liver, once again working through tiny incisions.

      She brought the organ to the incision in Mrs Allenby’s navel and emptied its contents through a drain. The gall bladder was limp now, and slid easily through the incision. She checked the area for bleeding and satisfied herself that all was looking good, then the patient’s abdomen was drained of gas, the incisions were covered in small bandages, Steve reversed the anaesthesia and the operation was over.

      Easy to describe, but it had still taken over two hours, and there was more work yet to be done. The two nurses chanted in chorus as they counted up instruments, sponges and gauze to make sure nothing was missing. Forceps and retractors clattered into metal bowls. Surgical drapes were bundled into linen bins. Mrs Allenby was wheeled, still unconscious, into the recovery annexe where two more nurses would monitor her breathing, consciousness, behaviour, blood pressure and pain as she emerged from anaesthesia.

      The two hernia operations which came next were simpler and shorter. Both were of the type known as a direct inguinal hernia, which resulted from a weakness in the muscles in the groin area. A short incision just above the crease between thigh and abdomen on each patient allowed Candace to slip the bulging sac of internal tissue back into the abdominal cavity.

      The first patient’s abdominal wall had quite a large area of weakness, and Candace asked for a sheet of synthetic mesh to strengthen it. The second patient, several years younger, needed only a series of sutures in the abdominal tissue itself. Each incision was closed with sutures, and both patients would rest on the reclining chairs in the day-surgery room after their first hour or two of close monitoring in the recovery annexe.

      She would check on them as soon as she had showered, Candace decided. You never came out of surgery feeling clean.

      The shower beckoned strongly as she pulled off her gloves and mask just outside the door of Theatre One. Behind her, Steve and the other staff were preparing for a Caesarean, and Candace crossed paths with Linda Gardner. The obstetrician was about to squeeze in a lunch-break while Theatre One was tidied and replenished with equipment, ready for her to take over.

      ‘Quiet in here today,’ Linda commented.

      ‘They’ll probably appreciate a request for rock and roll, I expect,’ Candace answered.

      ‘So you’re the culprit? You like reverent silence?’

      ‘Reverence isn’t a requirement,’ she returned quickly. ‘Silence is.’

      ‘No one gave you a hard time?’ Linda asked with a curious smile.

      ‘In surgery, I don’t give anyone the opportunity.’ She softened the statement with a smile in return, then went and answered the clamouring of her aching back with a long, hot shower.

      She emerged in a skirt, blouse and white coat twenty minutes later to find Theatre Two up and running and ready for her.

      ‘All the symptoms of appendicitis, admitted through Emergency,’ on-call theatre sister Lynn Baxter explained.

      ‘Give me five minutes,’ Candace said.

      ‘And turn off the music?’

      ‘Word travels fast around here. Thanks very much, yes.’

      As usual, she didn’t go on at length. Didn’t admit either that the unexpected extension of her list today was almost as unwelcome as the discovery that the last leg of a long flight home would be indefinitely delayed. She considered it her responsibility to each patient and

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