Stephen Westaby - The Knife’s Edge

It was not an easy conversation. Richard Kerr was the chief. He had seen it all, done it all, and was destined to be President of the British Association of Neurosurgeons. I asked him to decompress Steve’s brain by removing the top of his skull. A craniectomy is like taking off the top of a boiled egg, except the bone is kept in a fridge and put back again should the patient survive. Richard was a man of few words. Before he even spoke, I knew he believed it to be a lost cause. I pleaded the family’s case for them. Richard said that even if he survived, he would never be a GP again, indeed he might not even wake again. The delay in re-perfusing the stroke with the surgery had already destroyed his chance of survival. But that was now history. We couldn’t turn the clock back.

So I played my last card. Steve was an old friend, I said, and I had spent all night and lots of money trying to save him. Richard groaned and went back through the scans.

‘OK, you win. He has nothing to lose, but it has to be quick. I’ll put off my next case.’

Within thirty minutes Steve was on a neurosurgery operating table at the far end of the hospital. I pushed the bed there myself.

2 pm. Steve’s scalp was peeled back and the bone saw removed the top of his cranium, revealing a tense, swollen brain without pulsation. We were watching a dying brain. Richard inserted an intracranial pressure monitor into the pulp and closed the scalp skin loosely over the top. Then we took him back to cardiac intensive care, whose expertise he needed most.

Hilary and her children were still napping on a single bed and an armchair in their room. Consumed by my own misery and her husband’s impending doom, I tentatively knocked on the door. Hilary read my gaunt expression and realised that this was not a social call.

‘He’s dead, isn’t he?’

I hesitated to say no, since Steve’s chances of survival were negligible. I just told her the truth. That he had a dilated pupil and the brain scan looked bad, that I’d immediately persuaded the finest neurosurgeon in the country to help, but we were both doubtful that Steve could recover now. It was a waiting game. More of our medical school friends arrived, hoping for better news. I heard that old chestnut – ‘If anyone can save him, Westaby can.’ But he couldn’t. Great dissection repair, pity about the outcome. Soon afterwards, the second pupil dilated. Neither reacted to light. Despite the decompression, his brain was not going to recover. Hilary and the children had lost him.

Unbeknown to me, both Hilary and her eldest son had congenital polycystic kidneys, and the lad was teetering on the edge of needing renal dialysis. With remarkable composure, she asked whether he could be given his father’s functioning kidney. An organ from his dad would provide the best possible chance of immune compatibility – same blood group, same genes, no rejection. For a brief moment I thought I could generate something positive out of this disaster. At the same time as the intensive care doctors carried out tests for brain stem death, I called the director of the transplant service.

What I learned was barely believable. While Steve was conscious he could have voluntarily donated a kidney to his son. Now that he was functionally dead, the family could request that he become an organ donor. But now the body blow. Whatever was still transplantable must go to the national donor pool. Those were the rules. The transplant authorities would not allow Steve’s kidney to be used for his son, nor given to Hilary, who was close to needing a transplant herself. That was the law, so the Oxford transplant team couldn’t get involved. I was dumbstruck, then apoplectic about it. Fucking bureaucracy.

Steve’s ventilator was switched off at lunchtime. He died peacefully, surrounded by his family, with many of my medical school year grieving in the hospital corridors. I was alone in my office when his proud heart fibrillated, when the metallic click of his prosthetic valve finally came to a stop. Twelve hours earlier I had watched it beating vigorously and I had been confident that I’d saved him. Now it was forever still. All his organs died with him, except the corneas from his eyes. Despite my protestations, the transplant authorities had their way.

When Sue went home she left a note on my desk – ‘The medical director wants to see you.’

‘One day,’ I said to myself, and drove home with Gemma’s present still tucked away in the passenger seat.

Next day I was back in the car park by 6.10 am, another three cases on the operating list, beginning with a newborn infant whose right ventricle was missing. The car park lies between the graveyard and the mortuary at the back of the hospital. I always attended the autopsies of my own patients, so the morticians knew me well enough. This morning was a social call. I wanted to let Steve know that we had done our best for him. He was cold, pale and peaceful now. It was the only time I’d known him to be speechless. Had he still been able to talk, he would have said, ‘You bastard. You were meant to get me out of this mess!’ My instinct was to remove the drips and drains left in his lifeless body, but I was not allowed to. Those who die soon after surgery are the coroner’s property, and the pathologists must satisfy themselves as to the cause of death. Not difficult in this case, but it was an autopsy I wouldn’t be returning to watch. So I said my goodbyes to a great character.

There were many sad moments in my professional career, but this one stayed with me. Steve had devoted his life to the NHS but was caught up in the pass the parcel lottery that was out-of-hours surgery for aortic dissection. Eventually a decree was issued by the Society for Cardiothoracic Surgery that each regional centre must take responsibility for patients in their area. Special aortic dissection rotas were established in London and specific experienced surgeons designated to operate on the cases. That brought the mortality rate down. After UK Transplant prevented us taking a kidney for Steve’s son, the issue of organ donation was not discussed further. A healthy liver and two lungs could have gone in to the pool, had that single functioning kidney been used in Oxford.

Later that year Steve’s son Tom received a kidney donated by his wife. Steve’s daughter Kate was given one of her husband’s kidneys in 2015. Hilary was fortunate enough to meet a new partner and received one of his kidneys in 2011. They are all well.

Текст предоставлен ООО «ЛитРес».

Прочитайте эту книгу целиком, купив полную легальную версию на ЛитРес.

Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro, со счета мобильного телефона, с платежного терминала, в салоне МТС или Связной, через PayPal, WebMoney, Яндекс.Деньги, QIWI Кошелек, бонусными картами или другим удобным Вам способом.