MELANIE MILBURNE - A Date with Her Valentine Doc

Theatre was tense but, then, Stuart McTaggart always operated that way. He wasn’t one of those surgeons who chatted about what he did on the weekend or how well his kids were doing at Cambridge or Oxford—yadda-yadda-yadda. He didn’t have classical music playing, like a couple of the other surgeons on staff did. He insisted on absolute silence, apart from when he had something to say. I’d had to learn early on to button my lips while in Theatre with him. He was gruff to the point of surly and he barked out orders like a drill sergeant. Some of the junior theatre staff found him terrifying. Some of the more senior staff hated working with him.

Funnily enough, I didn’t find him too hard to handle. I understood the pressure he was under. Patients were more demanding of good outcomes than in the past, or at least they had better access to legal representation and were more aware of their rights. The litigious climate meant a lot of clinicians at the pointy end of medicine were under far greater pressure and scrutiny than ever before. That could be a good and a bad thing depending on the circumstances. It was part of why I wanted to pursue my research. Reducing the stress of the hospital experience was a win-win for everyone. Apart perhaps from the greedy lawyers, of course, but don’t get me started.

Stuart McTaggart was operating on a twenty-seven-year-old man with a very vascular and awkwardly placed benign brain tumour. Jason Ryder was a recently married man with a baby on the way. He was a keen sportsman, playing semi-professional golf. He had collapsed whilst playing in a tournament and been admitted to St Iggy’s via A and E. All was going well until he developed a bleed. Alex Kingston, the surgical registrar, was the first to cop the flak from Stuart.

‘Suck the blood out of the way, Kingston!’ he said. ‘I can’t diathermy bleeders if they’re underwater!’

Next in line was Leanne Griffiths, the scrub nurse.

‘Be aware of what’s happening in the operation, Sister Griffiths. I can’t wait around while you call for more swabs. They should be open, on the table, ready when I need them. Which is now!’

Then it was my turn. Woot. Woot.

‘What blood pressure have you got this patient running at, Dr Clark? He looks hypertensive to me and that’s not assisting with this blood loss!’

And on it went. Everyone was to blame except Stuart. But, then, really, no one was to blame—it was just the nature of the tumour and the stress of trying to remove it with minimal damage to the normal brain. The human body was not always predictable. Things didn’t always work out. They weren’t working out now. The only way to eventually stop the haemorrhage was to ligate a couple of largish vessels, causing irreparable damage to a large part of what had been a normal brain.

The person I’d anaesthetised wasn’t going to be the person who woke up … if he woke up. I hated even thinking those words. I always focussed on the positive. It gave great comfort to loved ones if they could hold onto hope for as long as possible.

I went down to ICU with the patient, keeping an eye on the monitor as we went. I was trying not to be influenced by the air of doom and gloom that had blown up in Theatre. I had seen patients much worse than Jason recover. It was a setback, certainly, but with time and patience and careful monitoring he had a chance, maybe even better than expected, given his level of fitness.

Once Jason was settled on the ventilator I went out to the family waiting in the relatives’ room. His wife, Megan, was about six months pregnant and stood with Jason’s parents as soon as I came in. ‘How is he?’ she said, holding her hand over her belly as if to protect her baby from hearing bad news.

‘The operation was very difficult, Megan,’ I said in a gentle but calm tone. ‘The tumour had a lot of blood running through it. Mr McTaggart was able to get it out, but not without bleeding, and there is likely a bit of damage to some of the surrounding brain. It’s impossible to tell at this stage how he’s going to be. There’s no choice but to wait and see what effect the tumour and the operative trauma has had. But it’s important to keep positive and try not to feel too overwhelmed at this stage. Everything that can be done is being done to bring about the best possible recovery for Jason.’

There was a sound behind me and I turned to see Matt Bishop come in. ‘I’m sorry to keep you waiting,’ he said, briefly shaking hands with Jason’s parents and then Megan. ‘I’m Matt Bishop, the head of ICU.’

Jason’s father Ken swallowed thickly. ‘What’s happening to our boy?’

‘He’s being ventilated and kept in an induced coma,’ Matt said. ‘During surgery there was a major bleed from the tumour bed. Mr McTaggart was able to stop the bleed, but it’s possible normal brain may have been damaged in the process. When the brain swelling has decreased, we’ll gradually reduce the sedation, and see what effect the surgery has had. But I should warn you that surgery to a vascular tumour like this, and the bleeding that goes with trying to remove it, can cause a lot of damage. I’m sorry but there’s a possibility he won’t wake up.’

Jason’s mother put a shaky hand against her throat. ‘You mean he could … die?’

Matt’s expression was grave. ‘A bleed like the one Jason suffered can damage vital areas of the brain. In the morning we’ll repeat the CT scan and try to assess what physical damage has occurred. We might be able to predict from that how he might recover. In the end, though, we just have to wait, try to wean him off sedation and see if he wakes up.’

The word lingered in the air like a toxic fume.

If , not when he wakes up.

I watched as the hope on Jason’s mother’s face collapsed, aging her a decade. I saw the devastation spread over Megan’s, distorting her young and pretty features into a mask of horror. Jason’s father’s face went completely still and ashen. All their hopes and dreams for their son had been cut down with one two-letter word.

Matt answered a few more questions but it was obvious to me that the poor family weren’t taking much in. They were still trying to get their heads around the fact the son and husband they had kissed that morning on his way to the operating theatre might not come back to them.

My heart ached for them. I know as a doctor you’re supposed to keep a clinical distance. And I do most of the time. But now and again a patient comes along who touches you. Jason was such a normal, nice type of guy. He was exactly the same age as me. His family were loving and supportive, the sort of family who loved each other unconditionally. I thought of the baby in Megan’s womb who might never get to know his or her father. I thought of the implications for Megan, trapped in a marriage to a man who might be permanently disabled, unable to talk, to eat or drink unassisted. Then there were the bathing and toileting issues—the whole heartbreaking scenario of taking care of someone who could no longer do anything for themselves. Her young life would be utterly destroyed along with his.

Once Matt left I took the family to my relaxation room where my aromatherapy infuser was releasing lavender and tangerine, which had a calming effect and was shown to be beneficial in helping with anxiety and depression. I sat with them for a few minutes, handing them tissues scented with clary sage, another stress reliever, and listened as they talked about Jason. They told me about his childhood and some funny anecdotes about him as a teenager, and of his passion for golf and how hard he worked at his game. How they had mortgaged their house and forgone holidays for years in order to sponsor his career because they believed so unreservedly in his talent.