Kate Hardy - His Honourable Surgeon

Mrs Foster shook her head. ‘No, nothing like that.’

‘Does he have any allergies—penicillin or anything like that?’

‘No. He’s always been so healthy.’

Even so, Vicky needed to ask the last question. ‘Is he taking any medication?’

‘No. What’s wrong with him?’

‘I’ll know more when I see the results of his scan, but I think he’s got a subdural haematoma. That’s a blood clot between the tissue of his brain and the membrane called the dura mater, which goes between his brain and his skull. It sometimes happens after someone bangs their head hard—the bridging veins between the brain and the membrane stretch and tear, a bit of blood leaks out and forms a clot.’

Mrs Foster’s face turned a shade paler. ‘Does that mean you’ll have to operate?’

‘I won’t know until I see the scan,’ Vicky answered honestly. ‘Sometimes we can treat it without operating—just by careful monitoring—because smaller ones tend to go away on their own, but sometimes we need to operate before it puts too much pressure on the brain.’

‘Oh, my baby,’ Mrs Foster whispered.

‘Is there anyone we can call for you?’

‘M-my husband’s on his way.’

‘Good. If you want me to run through anything with you again, or you’ve got any questions, just let me know. That’s what I’m here for.’

Mr Foster had arrived by the time Declan had had his scan. Vicky reviewed the files and pointed out one area to Hugh. ‘I’m really not happy about this. I’m going to have to take him to Theatre.’ She went back in to see Declan and his parents.

‘Was the scan all right?’ Mr Foster asked.

‘I’m afraid not,’ Vicky said gently. ‘It showed me there’s a clot forming between Declan’s brain and the membrane covering it. It’s pressing down on the brain and causing pressure, which makes the brain swell and not enough oxygen gets to it—that’s why Declan’s finding it a bit difficult to see and why he’s sounding a bit confused. The good news is that I can operate—he’ll have a general anaesthetic, and I’ll cut a tiny lid into his skull so I can get the clot out. He’ll need to be in here for about a week so we can keep an eye on him, but he should be fine.’

‘Is he going to die?’ Mrs Foster mouthed, turning her face away so Declan wouldn’t see the question.

‘There are risks, yes, but it’s much safer to do the operation than to leave it,’ Vicky said quietly. ‘He’ll have a headache afterwards, but he won’t be in any real pain.’

‘I’ll kill them,’ Mr Foster said between gritted teeth. ‘I’ll kill them for what they’ve done to our Declan. Just leave me on my own with them with a cricket bat.’

‘Neil, no,’ Mrs Foster said. ‘You can’t do that. That makes you as bad as they are.’

‘Well, they’re not going to get away with it,’ Mr Foster declared.

‘There are things you can do,’ Vicky said quietly. ‘But, right now, let’s concentrate on getting Declan sorted.’

While Declan was being prepped for Theatre, Vicky rang up to the ward. ‘I’m going to be in Theatre Five.’ And this was the bit she’d been dreading and looking forward to at the same time. ‘Could you page Mr Lewis?’ It didn’t really matter whether she led or assisted: this was where she’d see what he was made of, and whether he was better with patients than he was with the staff. Or, at least, than he was with her.

She’d just scrubbed up when he came into the room. ‘What have we got?’

‘Craniotomy, to remove a subdural haematoma. The files are there, if you want to take a look.’

Jake reviewed the files swiftly. ‘Good call. Have you done a craniotomy before?’

She nodded. ‘I’d use a linear incision rather than the standard reverse question-mark incision in this case. We’ve pinpointed exactly where the haematoma is—and a linear incision will mean we spend less time controlling bleeding and it reduces surgery time.’

Jake’s dark, dark eyes appraised her—and she thought she saw the glimmering of respect. But luckily she was prepared for his next comment. ‘Good call. I’ll lead, you assist.’

She’d told herself it didn’t matter: but it did. ‘How about I lead,’ she said, ‘and if you don’t like the way I do it, you can take over?’

He finished scrubbing up before he answered her. ‘All right. But you talk me through exactly what you’re doing and why.’

Her mouth tightened behind her mask. ‘Like a junior?’

‘Like any other senior registrar on their first operation with a new consultant. It’s a quick way of getting to know how we both work.’

Fair enough. He was still a bit abrupt for her liking, but maybe he’d discovered that she was the daughter of a baron and thought she was just playing at being a doctor. This was her chance to prove to him that she was serious—and she wasn’t going to blow that chance.

As part of the preparation, Declan’s head had been completely shaved. Instead of making him look like a thug, the haircut made him look like a defenceless little boy. Which was exactly what he was.

But there was no room for sentiment or emotion here in Theatre. Vicky had a job to do. And she was going to do it well.

‘This is where I’m going to cut,’ she said, indicating the area on Declan’s head.

‘OK,’ Jake said.

Deftly, she cut through the layers of skin, muscle and membrane at the site. ‘Burr-holes next,’ she said, drilling a series of tiny holes. ‘The bone’s not too thick at this point, so I don’t need to drill them very, very close together.’

She talked him through the rest of the operation—using a Gigli’s saw, passed between the burr-holes using a malleable saw guide, then lifting the lid of bone back on a hinge of muscle so she could open the dura mater to reveal the inner membranes. ‘Here’s the clot. Suction and irrigation,’ she said, working carefully to remove the clot. ‘Here’s the ruptured blood vessel. I’m going to clip it here.’

When she’d finished and was sure the blood vessel had stopped leaking, she gently replaced the bone, ready to sew the membranes, muscles and skin back into position.

‘Want me to close?’ Jake asked.

It wasn’t really a question. He’d assessed her; now it was time for her to see how he worked. She nodded and stood back.

He was good. Fast, thorough and very deft. She’d never seen such neat stitching—and said so.

‘Thank you.’ He inclined his head slightly at the compliment, but didn’t allow anything to detract from his focus.

That, Vicky thought, was impressive. She had a feeling she was going to enjoy working with Jake Lewis. A like mind, focused on his job. He really didn’t care what people thought about him—the patient came first. Refreshing.

When they’d finished, he walked back to the ward with her. ‘Do you want me to talk to his parents?’

She shook her head. ‘I’ll do it. They know me from the emergency department, and it’s better that they have continuity of care as far as possible.’

‘I agree. You know where I am if you need me.’

Meaning that he trusted her. Quite why that should make her feel enveloped in a warm glow, she had no idea. She already knew she did her job properly, so it shouldn’t matter what he thought.

She went into the relatives’ room, where the Fosters were waiting anxiously. ‘I’m pleased to say the operation was a success. Declan should be coming round in a few minutes and you’ll be able to see him straight away. We’ll need to keep him flat for the next day or two so his brain can settle down again, and gradually we’ll raise the head of the bed. We’ll be assessing him very, very frequently and he’ll have more CT scans over the next few days, so we can keep an eye on how he is and pick up on any little niggles before they turn into problems.’ She decided not to mention the fact that the CT scan would pick up extra fluid; it was perfectly routine, but would sound scary to the Fosters and they were already upset enough.