A Surgical Affair (2 page)

CHAPTER TWO

“
We
’ll
see Mrs. Phillips first, Sister!” shouted Mr. Cole, as soon as he was through the door of Charity Ward.

So began Diana’s first round of her ward.

Mr. Lawrence Cole quickly led the way, rattling the keys and money in his pocket, which meant he was in a hurry to get on. Sister Baker followed close behind. When Diana had met her the previous day she knew immediately that they would get on well together. Anybody could see that she was efficient and kind, but Diana was glad of her maturity and sense of humor. Mark sauntered along after Sister, with Diana, feeling rather nervous, at the end of the line.

They visited 32 beds; 32 women. Young, old; too fat, too thin; beautiful, plain. Some were dying, some waited for an operation, others were recovering from one. Symptoms were discussed, examinations made, treatment reviewed, progress assessed.

“It’s no good. We’ll have to take Mrs. Phillips to the theater again and close that opening,” declared Mr. Cole, lighting his pipe. “What do you say, Royston?”

They had all returned to Sister’s office for coffee.

Mark looked worried. “I guess there’s nothing else for it. The thing’s just not healing.”

“It’s my feeling that the hole on the outside connects up with another one in the gut, probably made by one of the instruments during the operation.” Seeing Mark frown, Mr. Cole added hastily, “Might happen to anyone.”

He went on, “I’d better do this repair myself. I’d like to see if my hunch is right.”

Mark grunted. “I was thinking—my newly acquired degree. Those magic letters F.R.C.S., they didn’t teach me how to avoid this sort of thing. Back in Sydney we used to think they meant a lot; now I’m not so sure. As I get older, I’m coming to the conclusion that a really first-rate surgeon is made in the wards and the theater.”

Mr. Cole nodded knowingly at his registrar. “And that’s after he gets his Fellowship, not before.”

“Perhaps you’re right, sir.”

Diana stood silently sipping her coffee, absorbing every word, savoring every minute. This was a new experience. She was with the surgeons now, a part of their discussions, hearing their decisions; no longer a mere student, treated as a necessary evil by everyone in the hospital.

“See you both in the theater this afternoon,” said Mr. Cole as he left the office in a haze of tobacco smoke.

“Get four bottles of blood ready, Dr. Field,” Mark said sternly. He might have said “please,” she thought. “Organize the anesthetist. We’ll do Mrs. Phillips at the beginning of the afternoon’s list—and tell the theater.”

Diana hurriedly left the office, followed by Sister, who was saying, “Mr. Cole will want Mrs. Phillips to have a cut-down for the drip in her arm. He’s very keen on this before operating.” Diana felt herself go cold. A cut-down! She’d never done one in her life. The house surgeons always used to do them. Then she remembered that she was the house surgeon now. A feeling of panic swept over her. Had Sister noticed anything wrong?

“Thank you for telling me that, Sister,” she murmured, and walked quickly out of the ward.

On the way to the pathology lab she tried to think of all the things to be done before the afternoon’s list—collect the blood, tell the anesthetist, phone the theater, put up Mrs. Phillip’s drip ... and two new patients being admitted to the ward before lunch!

Diana imagined Mr. Cole saying to Mark Royston, “How are you finding our new house surgeon?” To which the reply would probably be, “I reckon she’ll be all right, when she knows her way around.”

But at that moment Diana found herself completely lost and arrived at the dispensary by mistake. “I’ll never find my way around here,” she thought, for the second time.

At last, half an hour later, breathless but with all the jobs done, she arrived back in Charity Ward. She had decided that there was only one thing to do about the cut-down—admit to her registrar that she had never actually done one herself. If he flew into a rage, surely that was better than Mr. Cole flying into one during the operation?

Sister Baker came out of the ward kitchen and smiled at Diana. It was almost as if she guessed something was wrong. Perhaps she had helped so many house surgeons on their first day. “Everything all right, Dr. Field?”

“I was just wondering where I could find Dr. Royston.”

“At this moment he’s sitting in my office, reading my newspaper.” Diana hesitated. “He doesn’t mind being disturbed there,” Sister went on. “In fact, of all Mr. Cole’s registrars, he’s the one I’ve worked best with. He’s so easy to talk to; doesn’t mind what I ask him to help me about, or when I ask him.”

Then, as she walked away Sister added, almost as an afterthought, “A clever surgeon, too. All his patients do well.” Diana felt better already. She opened the door of Sister’s office quietly. Mark Royston was settled in the armchair, his long legs stretched out in front of him. He was gazing thoughtfully at a photograph in the newspaper of three beauty queens.

“I’m sorry to disturb you, but Sister says Mrs. Phillips must have a cut-down made, before her operation. I’ve never done one.” Diana wondered whether to add, “Dr. Royston.” But he seemed so young, almost her own age.

He did not look up from the newspaper.

“Don’t worry. I’ll do it in the anesthetic room, before we start.”

“Thank you very much,” she said gratefully. Then, almost to herself, “I thought you would be annoyed.”

He looked up and noticed her long hair, trim figure and slender legs. She wished she didn’t have to wear a shapeless white coat over her dress.

Smiling, a penetrating genuine smile, his brown eyes gazed keenly at her. “Watch carefully when I’m up there. It’s very simple. I’ll cut open a vein, sew a cannula into it. The blood drips in from the bottle through some rubber tubing. You can do it yourself another time.”

“Yes, I will.” She sighed with relief. “I’ve always been afraid my registrar would turn out to be an ogre, and never help me or explain anything.”

Mark laughed. “Watch out! Perhaps I’m in a particularly good mood today, Diana.”

Then Sister Baker hurried into the room.

“Now, you two, I need the office for my nurses.” She was examining the box of chocolates on the windowsill; a smile broke out on her face. "Dr. Royston, have you been at these again? In the one month you’ve been at this hospital, you must have eaten most of the chocolates in this office.”

Mark stood up and placed a hand gently on Sister’s shoulder. “It’s my only vice,” he told her, with mock seriousness.

“Well, I know you don’t smoke, but I’m not sure about any of the others. Anyway
,
I’ll let you off today, as it’s my birthday.” They were laughing, when the nurses arrived to hear the morning report. Diana suddenly realized that Sister Baker and Mark Royston would be good friends to have.

In the operating theater, Sister Mary Jay, only 27 and one of the youngest and prettiest Sisters at the hospital, was arranging, in meticulous order on her trolley, every instrument that might be required during the coming operation.

“This shouldn’t take long, once I’ve mobilized the gut.” Mr. Cole roared above the running of the water, as he scrubbed up.

Bill Evans, one of the resident anesthetists, whom Diana had met at lunch the previous day, wheeled in Mrs. Phillips on a trolley. She was unconscious now, so with one hand he squeezed a rubber bag, rhythmically sending gas into her lungs. The porters lifted her onto the operating table.

Mark and Diana, already in their green gowns and rubber gloves, painted her abdomen with antiseptic solution and covered the rest of her body with sterile towels.

At last Mr. Cole strode up to the table and stood beside Sister Jay. A short stubby hand was held out. A scalpel, glistening under the overhead lamp, was put into it.

“All right, Evans?”

“Right, sir.”

Mr. Cole made an oval-shaped incision. Blood seeped out and trickled down, to be soaked up by the towels.

It was two o’clock in the afternoon.

Diana was standing opposite Mr. Cole, squeezed between Mark and the anesthetic machine, unable to move. The rubber tube, taking blood into Mrs. Phillips’ arm, dangled at her side. Out of the corner of her eye she could see the slow, relentless drip-drip inside the glass tubing.

Evans leaned forward and hissed at her under his mask, “If you touch that tubing, you’ll make your gown unsterile!” She looked at him anxiously. “And don’t lean on the patient’s chest,” he added sharply.

Diana knew she would be standing in that one spot for the next hour, maybe longer. Her cap and mask felt too tight, the gown was tied firmly around her waist with tape, and her rubber boots were already hot and sticky. The gloves, drawn over her sleeves, make it impossible for air to reach the arms.

“Keep swabbing, man! Keep swabbing!” yelled Mr. Cole, as blood poured from the wound. “Give him more swabs!”

Sister Jay immediately put a pile of white gauze squares beside Mark.

“Dr. Field, are you taking part in this operation or not?” Mr. Cole demanded, raising his bushy eyebrows at her.

“Yes, sir. I’d like to do something—sir,” Diana murmured nervously.

“Retract that muscle, then.”

Mark gave her a retracting instrument that was shaped like a miniature garden fork.

“Don’t tear it to bits. Just hold it gently, so I can see what I’m cutting,” Mr. Cole told her.

In case she should loosen her grip of the retractor, Diana stood motionless. By now, a single thought was going around in her head.
You must not faint
... You must not faint
... You must not faint...

She felt the perspiration dripping from under her arms and badly wanted to scratch her left cheek. The heat from the overhanging light seemed to be increasing. She could feel Mark’s elbow pressing into her side.

He stood with one leg straight, the other one bent at the knee. Occasionally, about every quarter of an hour, he would straighten the bent leg, and bend the other one. He had probably been doing this for years. It kept the circulation going. Diana decided to try it. She was tall, like Mark. It might help her not to faint.

“There’s the hole in the gut. Only the size of a pin’s head. Heaven knows how I managed to make that,” Mark said, frowning.

“We’ll never know,” Mr. Cole sighed. “I’ll sew it up, and then we’ll get out of here. How is she, Evans?”

“Not too bad. But I’m glad you’re nearly through.”

Mark took the retractor out of Diana’s hand, without looking up.

“You can relax a bit now,” he told her softly, under his mask.

As Mr. Cole neatly stitched up the hole, Mark caught hold of the loose thread each time and pulled it through.

Diana was thinking, “This is a neat piece of work. Mr. Cole’s a good surgeon
... Mark wanted to do this repair. Mrs. Phillips is his pigeon. Still, it’s the consultant’s privilege to choose his own cases
... Mr. Cole was a bit sarcastic to me, but he was quite right. Some house surgeons just stand and gaze in admiration, instead of helping.”

“You close up, Royston, I have to get away,” Mr. Cole said just as he started sewing together the thick, fatty layers under the skin. “My eldest son is captain of the rugger team this term. I’ve promised to go down and watch one of his matches. I’m late already.”

He dropped the needle-holder and strode off to the changing room.

Mark walked around to the other side of the ta
b
le, he stretched out and took an instrument from Sister’s trolley.

“If you ask me, I can hand you what you need, Dr. Royston,” she told him sharply.

“My fault, Sister. I apologize.” Mark handed Diana another retractor; this time it looked like a garden hoe. “Follow me along. Hold the skin out of my way, as I stitch. If this isn’t done properly, Mrs. Phillips will burst her stitches. We’ll be bringing her back here a third time.”

Diana felt more free to move now, as she had the whole of one side of the table to herself. He was closing up the wound, and she had not fainted. She was proud. But her back and neck were aching, so she shrugged her shoulders and moved her head from side to side.

“Watch it,” Mark said under his mask, so softly that she could hardly hear. “You’ll get used to looking down all the time. We all ache at first. Right. Skin sutures, please, Sister.”

“He works very neatly,” thought Diana. “Slower than Mr. Cole, but more calmly. I’m glad he speaks quietly in the theater, too. Somehow it seems wrong to shout in here.”

The operation was over. The towels were removed, Sister Baker came up from the ward to collect Mrs. Phillips, and the instruments were put into the sterilizer.

“Time for tea,” declared Bill Evans, in his strong Welsh accent. Diana thought he certainly looked as if he enjoyed his food.

As they took off their gowns, Mark warned her, “Watch that guy Evans. He eats all the sandwiches before the surgeons have their gloves off.”

She collected the file containing Mrs. Phillips’ case notes from the table outside the theater
.
Perched on a stool in the office, while Mark and Evans were trying to decide whether they were eating fish or sardine paste, Diana wrote a detailed account of every stage in the operation. Then she poured them all a cup of tea.

“Remember the diagram?” Mark asked her, pushing his green cap back on his head. “Most important. Then anybody who reads your notes in 50 years’ time will be able to see at a glance what we did.”

She wondered if he was joking and looked at Evans anxiously. But he was starting at the fruit cake and didn’t seem to have heard.

“Here, give me the notes.” Mark took her pen. With clear lightning strokes he drew three simple diagrams, labelled them neatly and handed back the papers. It had taken two minutes.

Diana gazed at the drawings in amazement. “It’s the whole operation—brought to life!” she exclaimed in admiration.

He smiled at her and propped his legs up on the desk. “Better get scrubbed up for the next case, Diana. Then you can paint up the patient and put the towels on. Three more, aren’t there?”

“Mmm,” she replied, between gulps of tea, “but all fairly short ones.”

They began again, scrubbing hands and arms and putting on clean gowns before each case. With Mr. Cole away, the atmosphere in the theater was less strained. The nurses became more relaxed. Diana realized that she was finding it all extremely interesting and exciting.

Two hernia operations followed. Neatly and systematically the weak place in the groin was found and repaired, “like darning a sock,” as Mark said. Diana noticed that, if the thread or catgut were to break, he would mutter angrily under his mask but never blame the nurse.

Finally, Mark took out a thick, swollen, useless varicose vein, which, like a blue snake, had twisted and curled its way up from the foot to the thigh.

Ten to six, and the end of the day’s list. Mark threw his cap across the theater and kicked off his bloodstained rubber boots. Then he sauntered into the changing room.

Diana watched a junior nurse picking up the cap and boots. Sister Jay explained. “We let him do that, if it makes him feel better. All surgeons have to release their nervous energy somehow. Don’t you agree, Dr. Field? Some do it by shouting, others by dropping sterile instruments onto the floor. That’s just Dr. Royston’s way. Quite harmless, really!”

Diana started collecting together the notes of all the patients. They could hear Mark having a shower, whistling,
Who wants to be a millionaire?

A nurse came into the theater and knocked loudly on the changing-room door.

“Telephone for you, Dr. Royston!” she shouted. “A personal call on the outside line!”

“Thanks, Nurse!” he yelled. “Tell her I’ll call back!”

As Diana walked out of the theater she couldn’t help wondering if it was Mark’s wife. Or perhaps he wasn’t married? Perhaps it was a girl friend?

It was only when she arrived back at her room that Diana realized how tired she was. But it was a satisfying kind of tiredness, as if she had climbed to the top of a mountain and found a wonderful view waiting for her. She didn’t want to rest.

As Diana left her room after a wash and change, Mark Royston appeared in the doorway opposite.

She greeted him, smiling. “Hello! So it’s your records I heard last night.”

“Sorry. Were they too loud?” They were walking along the corridor.

“Oh no! I liked them. Quite a mixture you have.”

“I picked up over 100 of them, at bargain sales in New York. What sort do you prefer? Jazz, straight or in between?”

She thought for a moment. “I like classical and light music, but no jazz.”

He looked amazed. “But jazz is great! I used to go to the Hollywood Bowl whenever I could. All the world’s top jazz artists performed there. It was terrific! One thing about the States that I miss.”

“Perhaps I haven’t really tried to understand it,” she admitted, as they went downstairs. “It just seems to be a lot of noise, with no tune.”

“You have to be in the right mood for it. I’ll play you my Louis Armstrong records some time,” he told her as they walked into the common room.

Diana decided that she lik
e
d Mark and was glad to be working with him. He was so enthusiastic about everything; he made operating seem fun, not a dull, routine job.

She picked up a glossy magazine and flicked through it. It was relaxing to gaze at the colored photographs of models in luxurious clothes, to escape from reality for a moment.

Suddenly Mark’s voice came from the other end of the room, asking the switchboard girl for an outside number, “Chelsea 8644.” The room was quiet. Tony Spring was lying on the sofa fast asleep; another doctor was absorbed in a crossword puzzle.

“Hello, dear. I was taking a shower.” Although he spoke softly, Diana could hear every word Mark was saying as clearly as if he had been sitting next to her.

“Why can’t I call you ‘dear’?” he laughed. “It’s a term of friendship.”

Diana felt guilty about overhearing this conversation, but she told herself that if Mark had wanted privacy there were two phone
booths in the corridor that could be used for outside calls. Obviously he preferred sitting in an armchair to standing up, so why should she leave the room for him?

“What have you been doing with yourself? Modeled any mink bikinis lately? I saw you in
Vogue,
in a kind of Cossack hat.”

“So she’s a photographic model,” thought Diana, “like the ones in this magazine. Must be very beautiful. An apartment in Chelsea, too. Probably uses a black cigarette holder and has a French poodle called Alphonse.”

“We’re very busy right now, Denise.”

Denise! Diana nearly laughed out loud. It seemed such a perfect name for a model. It probably wasn’t her real name. She had probably been born something very ordinary like Jean or Joyce. Her life must be very exciting—fashion shows, trips abroad, society parties. Diana thought that her favorite word would be “hectic.”

“On Wednesday I’m playing squash with Alec Neal, and—he took you out to dinner, did he? My best friend! Let’s hope it was only because I was working.”

Diana decided that if Mark was really fond of Denise he would want to telephone her in private.