Lilian Darcy - The Surgeon's Love-Child

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 to the rest of the surgical team never to talk about how she felt.

No complaints, no explanations. Her aching back and feet were private—her problem. So were hunger, thirst and an itchy nose or a throbbing head.

And as for the inner turmoil she’d felt during each agonising step between her discovery of Todd’s affair and their outwardly businesslike divorce…She had said nothing about it at all until the final papers had been signed and their marital assets divided. Then she had simply made an announcement in the doctors’ change-room at the end of a Friday list with a three-day weekend coming up. She had asked those present to pass the word around.

Most of her colleagues had been stunned, she knew, but they had three days to get used to the idea and to recognise the signals she was sending out. They knew her professional style by this time. Comments had been sympathetic and heartfelt, but mercifully brief…

Theatre Two was the exact twin of Theatre One, with all equipment and supplies set out in exactly the same way. This patient, a thirty-five-year-old woman with an uncomplicated medical history, had been given a pre-med through her drip and was already drowsy and relaxed, her considerable pain masked by the medication.

The appendix was notorious for sending out mixed signals, so Candace kept her mind open as she prepared to make the incision. You could open someone up and find nothing at all, even when a patient’s white cell count was up and all his or her symptoms slotted into place. Or you could find—

‘Good grief!’ she said.

She’d spotted it before anyone else. There was a tumour wrapped around the appendix, turning this operation from a routine excision into a complex feat of surgical technique.

‘It’s huge,’ muttered on-call assistant surgeon Mark Daley.

‘But still potentially benign,’ Candace said. ‘We’ll take it out straight away to send to Pathology, then explore a bit to see if there’s any obvious spread to other organs.’

She excised both appendix and tumour, then looked at the ovaries, which were the most likely sites for a primary tumour in a woman of this age. Fortunately, they looked healthy and normal. Neither was there any evidence of metastasis to the liver.

‘We’re looking pretty hopeful on this one,’ she concluded, and there was a sense of relief all round.

It was after three by the time Candace emerged from Theatre, and her stomach was aching sharply with hunger. She took another brief shower, grabbed a packet of potato chips from the vending machine in the emergency department, gulped some coffee and went straight in to check on the recovery of her day patients.

Mrs Allenby had eaten a sandwich and drunk some juice and tea, voided her bladder and shown a return of bowel sounds. She could manage a strong cough, her lungs were clear and she’d walked up and down the corridor a couple of times to assist her circulation.

‘But my shoulder is hurting,’ she said.

‘Your right shoulder?’