Comeback (11 page)

“Watch the screen,” Ken said. “This is the colon, now distended by gas. The equine colon’s not held in place by connecting tissue like in humans, it just zigzags free. Half of all cases of twisted gut are colon trouble.” He pulled out at least another yard of the enormous tube and gave it to Scott to support in a green cloth while he felt around in the cavity it had come from.

“The mare’s less than a month from foaling,” he said. “It’s a good-sized foal.” He was silent for a moment or two, then said unemotionally, “If she collapses and I can’t save her, I’ll deliver the foal here and now by cesarean section. It might have a chance. It’s got a good strong heartbeat”

Scott glanced at him quickly and away, knowing, I thought, a good deal more than I did about the risks of such a procedure.

From time to time, as the drip bag emptied, Scott replaced it with a full one from the two-way cupboard, asking me to fetch it for him and to throw the empty one away.

“Screen?” Ken asked me after each change.

“Same,” I said.

He nodded, intent, slowly feeling his way round the internal organs, his eyes in his fingertips.

“Ah,” he said finally. “Here we are. God, what a twist” He brought some part I couldn’t see up into his own vision but still just inside the mare and made an instantaneous decision to cut out the tangled obstruction altogether.

“Eyes on the screen
all the time,”
he instructed me sharply.

I obeyed him, seeing his actions only in peripheral vision.

Supplied with instruments by Scott, he worked steadily, attaching clamps, clipping, removing tissue, swabbing, stitching, making occasional noises in his throat but otherwise not talking. Time passed. Eventually he took two clamps off and watched the results unwaveringly.

“Monitor?”

“Steady.”

He murmured to himself and finally looked up. “All right. The obstruction’s excised and the gut repaired. No leaks.” He seemed to be fighting down hope he couldn’t help. “Ready to close up.”

I glanced at the great length of huge intestine looped over Scott’s arm and couldn’t see how on earth they were going to stuff it all back into the body cavity.

As if reading my mind Ken said, “We’ll empty the colon.” Scott nodded. Ken asked me to fetch an open trash can that stood against one wall and to position it near him beside the table. Next he wanted me to slot a tray into the table, rather like tray tables in airplanes. A colon tray, he said.

He nodded his thanks. “You’re a nonsterile area,” he said almost cheerfully. “Go back to the screen, will you?”

He straightened the colon until part of it was on the tray and over the trash can, then swiftly made a slit, and he and Scott began systematically to squeeze out all of the contents.

This time it did smell, but only like a stable yard, quite fresh and normal. For some reason I found myself wanting to laugh: the process was so incredibly prosaic and the can so incredibly full.

“Monitor,” Ken said severely.

“Steady.”

Scott washed the now empty, flabby and lighter tubing with fluid, and Ken, in a fresh gown and gloves, stitched up the slit he’d made in it; then, carefully folding it into zigzags, he returned the large gut to its rightful position inside. He did a quick, half-audible checklist on the abdomen, almost like a pilot coming in to land and, still with deftness and care, fastened the incision together in three layers, first the linea alba with strong separately knotted stitches, then the subcutaneous tissue with a long single thread, finally closing the skin with a row of small steel staples, three to an inch. Even the stapler came separately packed, sterile and throwaway, made mostly of white plastic, handy and light.

After the briefest of pauses, when he’d finished, Ken pulled his mask down and gave me a look of shaky triumph.

“She’s made it so far,” he said. “Scott, gas off.”

Scott, who had put a lid on his odorous trash can and rolled it away, had also been round to the ventilator to turn off the halothane.

“Blood pressure?” Ken asked.

“No change,” I said.

“Ventilator off,” Scott said. “Disconnect the catheter?”

Ken nodded. “She’s got a strong heart. Write down the time,” he said to me, and I looked at my watch and added the time to my notes.

“Ninety-one minutes from incision to finish,” I said.

Ken smiled with the professional satisfaction of star work well done, the doubts and shakes in abeyance. He light-heartedly peeled off the green sterile cloths from the mare’s round body and threw them into a trash can.

He and Scott unclipped the mare’s legs from the bed-posts. Then the hoist, with Scott supporting her head, lifted her up off the table. In reverse order she rolled along the rails and through the sliding door into the padded room, where Ken brought over an extra panel of padding and placed it on the floor. The hoist lowered the mare onto that until she lay on her side comfortably, her legs relaxing into their normal position.

Scott removed the padded cuffs from her legs and put a rope halter on her head, leading the rope through a ring on top of the half-wall so that someone standing behind the wall could partly control her movements and stop her staggering about too much.

“She’ll take twenty minutes or so to wake up slowly,” Ken said. “Maybe in half an hour she’ll be on her feet, but she’ll be woozy for a good while. We’ll leave her here for an hour after she’s standing, then put her in the stable.”

“And is that it?” I asked, vaguely surprised.

“Well, no. We’ll leave in the stomach tube to make sure nothing’s coming back up the wrong way, like it was before—reflux, it’s called—and because we can’t give her anything to eat or drink for at least twelve hours, we’ll continue with the intravenous drip. Also we’ll continue with antibiotics and a painkiller-sedative and we’ll monitor her heart rate, and tonight if everything’s OK we’ll take out the stomach tube and try her with a handful of hay.”

Hay, after all that, seemed like bathos.

“How long will you keep her here?” I asked.

“Probably a week. It knocks them over a bit, you know, a major op like that.”

He spoke with earnest dedication, a doctor who cared. I followed him back into the operating room and through to the vestibule, where he stripped off all the disposable garments and threw them into yet another bin. Scott and I did the same, Ken walking back immediately to take a continuing look at his patient.

“He won’t leave her,” Scott said. “He always wants to see them wake up. How about that coffee?”

He strode off towards the office to return with the Thermoses and all three of us drank the contents, watching the mare until movement began to come back, first into her head and neck, then into her forelegs, until with a sudden heave she was sitting sideways, her forelegs bearing the weight of her neck and head, the hind legs still lying on the padding.

“Good,” Ken said. “Great. Let’s get behind the wall now.” He suited the action to the word and took hold of the steadying rope.

The mare rested in the same position for another ten minutes, and then, as if impelled by instinct, staggered onto all four feet and tottered a step or two, weaved a bit at the end of the rope and looked as if she might fall, but stayed upright. I supposed she might have been feeling sore, disoriented and in her own way puzzled, but she was clearly free of the terrible pain of the colic.

Ken said, “Thanks,” to me and rubbed his eyes. “You gave me confidence, don’t know why.”

He handed Scott the rope and left him watching the mare, jerking his head for me to follow him back into the operating room.

“I want to look at something,” he said. “Do you mind if I show you?”

“Of course not.”

He went over to the table where the dishes still lay with the spent syringes in them: not three dishes now, but four. The fourth contained a large unidentifiable bit of convoluted bloody tissue with flapping ends of wide tube protruding, the whole thing pretty disgusting to my eyes.

“That’s what I took out of the mare,” Ken said.

“That?
It’s huge.”

“Mm.”

I stared at it. “What is it?”

“A twisted bit of intestine, but there’s something odd about it. Wait while I get some gloves, and I’ll find out.”

He went and returned with clean gloves, and then with strong movements of fingers and a spatula he slightly loosened the fearsome knot in which one loop of intestine had tightened round another like a noose, throttling the passage of food altogether. Incredibly, there seemed to be a thread wound in among the tissue: pale, strong thread like nylon.

Frowning, Ken spread some of the cut edges apart to look at the contents, astonishment stiffening in his face.

“Just look at this,” he said disbelievingly, and I peered through his hands into the gap he was holding open and saw, with an astonishment beyond his own, a three-inch-diameter semicircular needle, the strong sort used for stitching carpet.

He spread open another few inches and we could both see that the needle was threaded with the nylon. The needle, passing round and round in the intestine, had effectively stitched it into the knot.

“We have this happen from time to time with cats and dogs,” Ken said. “They swallow sewing needles that have fallen to the floor and literally stitch themselves together. I’ve never known it in a horse. No needles carelessly dropped in their vicinity, I suppose.” He looked at it, fascinated. “I don’t think I’ll take it out, it’s more interesting in situ.” He paused, thinking deeply. “It’s a real curiosity and I’ll organize photos of it for our records and maybe veterinary magazines, but to do that I need to keep this in good condition, and bugger it, the fridge was in the other building, in the path lab there. The lab was by the rear door. We didn’t go to the expense of another lab in the hospital. I mean, there was no point.”

I nodded. I said, “What if you take it home?”

“I’m not going home. After I’ve set up the mare’s drip I’ll catch quick naps on the bed in the X-ray room. I do that sometimes. And I’ll watch the monitor until Belinda arrives.”

“What monitor?” I asked.

“I hope to God it still works,” he said. “It’s connected to a monitor in the main building as well.” He saw I was going to ask the question again, and answered it. “There’s a closed-circuit television camera in the intensive-care box, the nearest stall this end, with a monitor in the office here and another at the main reception desk. Well, there used to be. It’s so we can check on the patient all the time without forever going out there.”

I looked at the cause of the mare’s troubles.

“I could put that in the fridge at Thetford Cottage,” I said briefly, “if we labeled it conspicuously not to be touched.”

“Christ.” His pale face crinkled with amusement. “All right, why not.”

He carefully wrapped the piece of gut, and in the office tied on a luggage label with a cogent message to deter curiosity in future parents-in-law.

The television circuit, when he pressed switches without much hope, proved in fact to be working, though there was nothing at present on the screen but night and a section of barred window in the empty stall.

“If only tomorrow was that simple,” he said.

I SLEPT AT Thetford Cottage for four hours as if drugged and was awakened by a gentle persistent tapping on the bedroom door. Rousing reluctantly, I squinted at my watch and managed a hoarse croak, “Yes?”

Vicky opened the door with apology and said Ken had phoned to ask if I would go down to the hospital.

“Not another emergency, for God’s sake.” I sat up, pushed my fingers through my hair and looked back with awe at the night gone by.

“It’s some sort of meeting,” she said. “I didn’t want to wake you but he said you wouldn’t mind.”

She had taken off the ear-shield and had washed her hair, which was again white and fluffy, and she looked altogether more like Vicky Larch, singer.

“Are you feeling better?” I asked, though it was obvious.

“Much,” she said, “though still not right, and Greg’s the same. It’s going to take us days. And I don’t like this house, which is ungrateful of me.”

“It’s unfriendly,” I agreed. “A personality clash.”

“And boring. Did you put that ‘don’t touch on any account’ parcel in the fridge?”

“Yes,” I said, remembering. “It’s some horse innards.” I explained about the burnt lab and Ken’s need for them to be stored.

“Ugh,” she said.

She went away and I tottered into some clothes, jet-lagged myself if the truth were told. The face in the bathroom mirror, even when newly shaven, had tired, brownish-green eyes below the usual dark hair and eyebrows. Teeth freshly brushed felt big behind stiff facial muscles. I pulled a face at my familiar real self and practiced a diplomatic expression to take to the meeting.

Diplomatic expression? Air of benign interest with give-away-nothing eyes. Habit-forming, after a while.