Scalpel (2 page)

'Dr Morgan slipped out about half an hour ago. He said he could be contacted on his mobile phone. Do you want me to ring him?'

For the first time in almost fifteen years of midwifery June Morrison noticed her hands trembling. 'No, just give me the number, I'll contact him myself.' She scribbled the number on a pad as it was read out. 'Pat, just one more thing, who's on duty for emergencies?'

A rustle of paper came over the other end of the line. 'Dr Dean Lynch.'

She stared into the receiver for a whole minute before hanging up. Her mouth was dry and she could feel her heart pounding. 'Shit, shit, shit,' she muttered as she dialled.

Somewhere up in the satellite she could hear the digits clicking as the numbers were fed in. Then a mechanical voice interrupted, 'Your call is being diverted, please wait… Your call is being diverted, please wait.' There was a short pause, then a ringing tone.

Unexpectedly, a woman's voice answered. 'Hello?'

For a moment Morrison was confused and could hardly put two words together. Finally she burst out, 'Is Dr Tom Morgan there?' She could sense the phone being passed and then the familiar voice.

'Dr Morgan here.'

You bastard, Morgan, she almost screamed. You frigging bastard! But that would all have to come later. He shouldn't have been out of the hospital, and certainly not in the company of the woman whose voice was definitely not that of Mrs Tom Morgan.

Her voice was ice cold with controlled rage. 'Dr Morgan, this is Sister Morrison. I suggest you get back here immediately. We're in trouble with Sandra O'Brien. She may need an urgent section.'

She hung up before he could reply, imagining the panic
at the other end. She picked up the internal phone again and punched in three digits.

'Can I speak to Sister Mullan please? Tell her it's urgent. This is June Morrison in ward three.'

At the other end the phone was laid down and she could hear Mullan's name being called. Then came a shouted reply and the patter of feet hurrying across tiled flooring. The phone was snatched up.

'June? Hi, it's Breda here, what's up?'

'Breda, get a theatre ready for me as soon as you can and warn the duty anaesthetist he may be needed.' There was an urgency to her voice that came across clearly. 'Ring Paddy Holland down in paediatrics and put him on protective notice. Tell him we may have an urgent section for foetal distress.'

'Right.' Breda Mullan had known Morrison long enough to realise she didn't issue such orders lightly. She also knew by the tone of voice that something big was brewing. 'It's as good as done.'

'Just one more thing, Breda. It's the O'Brien girl we're dealing with.'

Morrison just heard the 'Oh my God!' before she replaced the receiver. She looked out the office window onto the streets below and the crawling traffic. It was raining. Umbrellas were being blown inside out in the wind and people were huddling in doorways, newspapers and bags over their heads for shelter. One word kept repeating itself in her mind and she mentally shook herself, as if trying to dislodge it.

Nightmare.

Nightmare, nightmare, nightmare. That's the way this was turning out. A nightmare.

Tom Morgan out whoring with his mistress leaving her with Dean Lynch as back-up. Dean Lynch, the one person in the world she knew would cause trouble if she had to call on him. She prayed she wouldn't need to.

2

10.58 am

Outpatients' Department, East Wing

Dr Dean Lynch, consultant obstetrician and gynaecologist, wouldn't exactly stand out in a crowd. Physically short at five foot five inches he at least had enough body weight to save him from looking totally insignificant. His once black hair was now mainly grey and combed severely from front hairline into a duck's tail at the back, accentuating his high forehead and pencil-thin eyebrows. His clothing was quiet to the point of being dull, which in turn matched his manner most of the time. The only noticeable physical feature in Dr Dean Lynch was his eyes. They unsettled those who worked with him, seeming to pierce their very souls. Few held his gaze for long.

He sat at his desk fiddling with paperclips, surveying the scene before him. Outside in a large waiting room sat rows of patients. To his right, about ten feet away at another desk, sat Dr Ali Sharif, his Egyptian registrar, while to his left and slightly closer at another desk, was Dr Donald Armstrong, his house officer. Behind them were three examination cubicles, separated from one another by curtains only. Dean Lynch dealt with most new patients, Dr Sharif with follow-up surgical and minor procedure cases while the house officer acted as general dogsbody, taking blood, filling in laboratory forms and waiting for a call from Lynch when anything of interest came in. Not that Lynch called him often. House officer to Dr Dean Lynch was one of the least sought after positions in the hospital. He
examined every patient himself, always without a nurse in attendance despite hospital guidelines advising otherwise, and wrote up all his own lab tests and X-ray requests. He was meticulous in his note taking and almost obsessive in his selection of surgical material. Dr Sharif had long since abandoned attempts to be included in the major surgical cases on Lynch's theatre list. When Dean Lynch held his outpatients' clinic everyone knew better than to disturb him. He presided over these clinics like an overseer in a sweat shop, relishing the human misery that came his way, delighting in the female flesh. He passed all minor problems over to his registrar, concentrating only on the major conditions that might require operative intervention.

Dean Lynch was considered more than anything else a surgeon.

The nursing staff felt he had no bedside manner whatsoever, showing neither interest nor sympathy in the emotional feelings of his patients. June Morrison had once privately commented that the only time she felt Lynch looked happy was when operating. 'I'll swear he just loves to see his patients unconscious,' she'd confided to her colleague Breda Mullan. Morrison always cautioned the other girls who had to work with him. 'Never get on the wrong side of Dr Lynch,' she'd warned. 'Keep him happy, even if you have to frigging well go out of your way and it sticks in your craw. And whatever you do, don't upset him during an operation.' That was her way of protecting the staff in East Wing and at the same time keeping the theatre and maternity work moving smoothly. Despite Lynch's reputation no one could find fault with his work. He was reliable and punctual, careful and controlled. Unexciting and unpleasant, yes, but not unreliable.

'You can show the first patients in,' Lynch ordered without as much as acknowledging the nurse standing at his side. Massaging his throat, he scanned a referral letter from a local doctor and placed it on the edge of his desk. 'That one
can go to Dr Sharif.' He picked up the next letter and read it quickly. 'Give him that one too.'

Dr Sharif looked at the nurse and they exchanged knowing glances.

Finally Lynch found one that interested him. 'I'll take this woman, thank you Nurse. Show her into my cubicle and ask her to undress.' He turned to his house officer. 'Donald, there are some reports from yesterday's theatre list in pathology. Would you mind popping down and getting them before we go up to the wards?'

Don Armstrong almost leapt from his seat, disappearing down the corridor past the hospital library, towards the laboratories. Anything was better than the endurance test of Dean Lynch's outpatient clinic.

'Right Nurse,' said Lynch, finally looking up, a thin smile breaking his usually dour expression. 'Let's begin then, shall we?' He slipped his right hand inside his trouser pocket and felt for the penicillin tablets he had placed there earlier. As soon as the nurse had her back to him he popped two into his mouth and swallowed them whole. His throat had been feeling raw for some days now and he had finally forged a prescription in a nonexistent patient's name for some antibiotics. Strangely they were not working as quickly as he had expected.

3

11.17 am

Ward Three, North Wing

June Morrison returned to Sandra O'Brien and, without even looking at her, did an immediate print out of the foetal heart rate. It had dropped a little again, not dangerously so, but down certainly from a healthy one hundred and thirty beats per minute. She pressed the CTG scan printer and inspected the graph closely for further signs of distress.

'Everything okay?' she asked Nurse Roche, one of the best girls ever to train under her care.

'Yes Sister.' But something in the nurse's eyes warned Morrison that everything was very far from okay. 'Mrs O'Brien's observations are perfect, blood pressure one twenty over seventy, heart rate eighty-four and regular, urine clear and no sign of protein. She's getting regular contractions, three minutely and strong, lots of backache but no liquor draining yet.'

Morrison flicked her eyes very deliberately downwards at a CTG print out she held tightly in her left hand, all the time keeping her back to the pregnant woman who was listening closely to every word. Nurse Roche's expression betrayed alarm.

Morrison turned to Sandra. She couldn't even force a reassuring smile.

'Sandra, I'm going to examine you again to see how far you've progressed. Dr Morgan will be here soon and I want to be able to give him an up-to-date assessment.'

At the mention of Tom Morgan's name Sandra O' Brien
looked relieved and relaxed back in the bed. She ran her hands over her stomach again. 'Come on Gordon,' she muttered. 'Let's get a move on.'

Nurse Roche adjusted the pillows behind her. 'Is that what you're going to call the baby?'

Sandra looked up, trying to suppress the pain on her face as another contraction built up. 'Yeah. As soon as the ultrasound scan showed a boy, Harry insisted on calling him Gordon. That was the name of his little boy who died in the accident.'

June Morrison washed her hands thoroughly at the sink before slipping on a pair of sterile surgical gloves. She dipped her first two fingers into a tub of antiseptic examination cream on the bedside locker then gently lifted the white maternity smock that loosely covered Sandra O'Brien's stomach and upper legs.

'Just a gentle feel inside,' she murmured as her fingers entered the young woman's body.

Sandra drew in a deep breath. Nurse Roche took one of her hands and held it tight. 'Squeeze me if you feel any discomfort. It'll all be over in a moment.'

June Morrison's trained fingers explored the cervix, noting how much further it had dilated since the last examination, two hours earlier. It was thinning perfectly and she could feel the distinct soft, bulging sensation of forewaters pressing against her tips. The hard surface of the baby's head bounced slightly as she pressed upwards.

'Cervix eight centimetres dilated, forewaters bulging,' she reported. Nurse Roche recorded this in the labour progress chart. 'Pass me the Kocher forceps.'

Roche placed the chart on the rail at the foot of the bed and turned to open a sterile tray resting on a stainless steel trolley nearby. She picked up a long sealed slim packet, peeled it open and, without touching, dropped an instrument into Morrison's free hand.

Sandra O'Brien started deep breathing exercises, pressing her head back fully against the pillows. She gripped hard onto the bars of the bedhead behind her.

'You won't feel a thing here, Sandra,' Morrison reassured her as she gently slipped the forceps inside with her free hand. 'I'm just going to break the baby's waters.'

Nurse Roche took hold of one of Sandra's hands. 'Grip tightly,' she whispered into her right ear.

Then it happened again.

Sandra's pregnant stomach suddenly began to heave and ripple violently. The baby's threshing limbs punched out, clearly visible as her abdomen seemed to stretch to breaking point. For one, two, maybe three minutes, the heavily pregnant abdomen seethed and buckled with a frenzied activity. June Morrison stared at the foetal monitor screen as the heart rate initially rose slightly to one hundred and forty beats per minute and then steadily and inexorably began a slow decline. Nurse Roche looked on in horror.

'What's happening? For God's sake, what's happening?' Sandra O'Brien started screaming.

Just as Morrison was about to withdraw her examining fingers, Sandra O'Brien's forewaters broke.

'Oh, my God!' screamed Sandra. 'What's going on? For Christ's sake tell me what's going on?'

The heavily stained liquor poured out from inside the young woman's body. Instead of a clear, free flowing issue this was dark green, thick with meconium, a sign of severe foetal distress.

Sandra O'Brien's baby was in imminent danger of dying before he was born.

'Foetal distress!' Morrison's years of experience took over. She reached across to a red alert button situated above the bedhead and pressed it three times in rapid succession. Nurse Roche also moved into automatic pilot, disengaging the brakes holding the castors on the bed wheels and swinging the bed around swiftly and with a remarkable degree of accuracy so that the end pointed towards the door. Ignoring totally O'Brien's frightened pleas for help, Morrison and Roche had the bed through the door frame and into the corridor within seconds.

They rushed along towards a lift which had already risen
to the third floor and opened, and would remain open until the release button inside was engaged. Dublin's Central Maternity Hospital prided itself on its emergency procedures. In recent years they had become automated, tested, and re-tested to the highest level of performance. Once the bed was fully inside the lift, Roche engaged the release mechanism, punched in the code for the theatre level on the North Wing and watched as the doors glided shut in front of them.

Sandra O'Brien stared at June Morrison, a look of terror on her face. 'Is my baby going to be all right?' she sobbed.

Morrison took one of her hands and squeezed it tightly. 'You're baby's going to be just fine, Sandra, it's just that he needs to part company with you sooner than we thought. You're going to need a Caesarean section.'

Sandra O'Brien pulled the sheet up to her lips and bit into it deeply. 'Poor Harry,' she sobbed. 'Poor, poor Harry. He wants this baby so much.'

As another contraction cut in, Sandra O'Brien suddenly pulled June Morrison closer, her nails cutting into the other woman's arm. 'Don't let my baby die,' she pleaded through the pain. 'Don't let my baby die.'

Morrison and Roche glanced at each other, but said nothing.

It was now 11.48 am.