Unknown (21 page)

She flicked quickly through the laboratory results from the other hospital, noting that morning's hadn't been included. Grabbing a needle and needle holder and a thick bundle of blood tubes, she went back to the room.

'Mrs Wesson, hello, I'm Dr Ryan.' She nodded thanks when Celia, her face worried, slipped adroitly out of her way. 'Are you in pain?'

'Not pain as such,' Mrs Wesson gasped weakly, holding her abdomen. 'It's just the diarrhoea. Where's John? The doctors said...that you were going to operate. Is that... now?'

'Your husband's on his way,' Celia said soothingly. 'He rang the ward on his mobile to say he's stuck in traffic just nearby. He won't be long. Merrin, have you spoken to Neil? Her pulse is one-twenty.'

'He's on his way.' Merrin couldn't find the vein in their patient's neck which indicated body fluid levels, and her mouth was very dry and sore-looking so Merrin opened up the bag of fluid which had been dripping slowly into a Venflon in the patient's left arm and let the fluid flow. 'We'll need another bag to follow,' she told Celia.

The charge nurse nodded. She put a thermometer into Mrs Wesson's mouth and then went for a blood-pressure cuff.

'Mrs Wesson, I'm just going to take some blood for testing.' Merrin clipped a tourniquet around the woman's upper arm, found a vein in the crook of her elbow, inserted the needle in its holder and filled each tube slowly. 'Have you been feeling worse today than the last few days?'

'BP ninety over sixty,' Celia said quietly. 'Temp thirty-eight point four.'

'I've been bad for days,' Mrs Wesson said weakly, once the thermometer was gone. 'I can't remember any more.'

'Cross-match six, Merrin. Thanks.' Neil, still in theatre gear, appeared in the door, his eyes narrowing on their new patient assessingly. 'Hello, Mrs Wesson. I'm Neil McAlister. Have you had a blood transfusion today?'

'Not today,' she said weakly. 'Most other days they've been giving me some, I think.'

Celia repeated her findings and Merrin added, 'I think she's dehydrated and there's swelling in her legs and back, suggesting her protein levels are low, but I haven't had a chance to examine her otherwise. X-rays are in the office. I'll get these down to the lab.'

'Urgently,' he said quietly. 'Get hold of Chris Jennings as soon as you get the results.'

When she came back from the lab he'd obviously just told their patient and her newly arrived husband that she needed surgery immediately. 'I'm going to have to take almost the whole large bowel,' he explained. 'Which means a bag to drain your bowel post-operatively.'

'Permanently?' Mrs Wesson asked.

'Once your system's recovered from this and your nutrition's better and if you decide that it's what you want, I'll operate again and staple together some of your small bowel to make what we call a pouch. That acts as a storage area and means you can be connected up again. It's not always a perfect solution but we can discuss the details later. Right now we have to get on and operate.'

'And if she doesn't want surgery now?' her husband demanded.

'There's no alternative,' Neil said flatly.

'What about medication?'

'Don't ask stupid questions, John.' Mrs Wesson lifted a pale hand to her husband's cheek. 'You heard the doctors this morning. The medication hasn't worked. There's no choice.'

As soon as she had the blood test results, Merrin ran down to Theatres to show Chris Jennings. The anaesthetist read through Mrs Wesson's results grimly but he acknowledged that there wasn't any alternative to operating immediately. 'How much blood have you got?'

'Prof said six. Blood bank say they should be through in another thirty minutes.'

'What's he doing with the rest of his list?'

'Cancelled.' On Neil's instructions Merrin had had to explain to both patients listed for routine surgery that afternoon that their operations would have to be delayed. Neither man had been happy, but fortunately both had understood that an emergency had to take precedence. 'He's doing them Thursday.'

'What about steroids?'

'She's been on hydrocortisone 250 milligrams q.d.s.,' she told him, meaning that dose four times daily. 'Plus one hundred milligrams a day rectally.' She understood why he'd asked. The fact that Mrs Wesson had been having steroid therapy for her ulcerative colitis meant that her body's stress-response mechanisms would have been switched off so she'd need extra steroid cover throughout the period of her surgery. It was the anaesthetist's job to administer the drugs.

She heard noise outside and opened the doors of the anaesthetic room. 'Here's Mrs Wesson now.'

She scrubbed. Lindsay took over the minor cases at the end of Douglas's list to free him up so he could assist Neil, and Merrin was second assistant.

She'd never seen any of them—not Neil, not Douglas, not even Chris Jennings—so tense, not while operating, but as soon as Neil opened the peritoneum and she saw Mrs Wesson's grossly swollen, fluid-drenched bowel she understood. The tissue was so fragile that the slightest wrong move from any of them could rupture it.

'Chris, this is bad,' Neil said quietly. 'I'm going to have to go gently. How's she doing at your end? How much time can you give me?'

'She's holding,' the anaesthetist answered tightly. 'Just. I'm sticking in another central line. Do what you have to do.'

Normally, in Merlin's experience, the sort of operation Neil wanted to do took less than an hour, but now just finding and clamping off each end where he wanted to divide the bowel took two.

'The splenic flexure's the most dangerous bit,' he explained quietly to Merrin as he gently packed off the inflamed, weeping area from the rest of the abdomen with carefully placed thick layers of moist gauze. 'If it's going to rupture as I take it out, it'll do it here.'

But when he finally lifted out the fragile tissue, still intact, the mood in the theatre soared immediately as they all relaxed.

The last bit of the procedure, sewing off the bottom end and forming an ileostomy with a loop of small bowel, went smoothly.

'They should have referred her here earlier,' Douglas said scathingly, the first person to break the silence with anything other than a surgical instruction or comment and speaking only once they were starting to sew up. 'We almost lost her. They were mad, keeping her there so long. Are you going to make a complaint?'

'It's always easy, judging these things in retrospect,' their consultant countered calmly, pulling the peritoneum and rest of the abdominal wall together with wide bites of alternating deep and superficial Vicryl stitches. 'She's all right now. They thought they were doing their best.'

'Doesn't sound like you, Neil.' The anaesthetist, busy spearing another unit of blood with the plastic prong of a giving set, sent him what looked to Merrin like an amused look. 'Growing mellow in your old age?'

'There's a frightening thought.' Neil didn't look up. 'Shirls, I need Prolene. Merrin, what's up with you this afternoon? This has to be the first time you've come to my theatre and not made a peep.'

'I'm submitting my enquiries in writing,' she told him, watching the fluid confidence of his fingers as he closed the skin. She had dozens of questions but she'd contained herself throughout the operation out of fear of disturbing his concentration. 'When will you do a pouch?'

'Within a couple of months. If she wants one. Not all our UC patients do. Some prefer the simplicity of an ileostomy bag.' He moved his hands away so that Douglas could swab the wound in preparation for the dressing. 'Room on the unit, Chris?'

'We'll take her for twenty-four hours at least,' the anaesthetist answered easily, and Merrin understood that meant Mrs Wesson would be going to Intensive Care from Theatres rather than back to Orange Ward.

She helped Douglas and the scrub nurse strip the guards and then she untied the registrar's gown while he did hers. They shed both onto the nurse's trolley. Douglas went off to check his bleeper at Reception to make sure there was nothing he needed to see urgently in Casualty but Merrin went to the tearoom to find Neil.

Neil
was alone, making coffee. Merrin pulled down her mask. 'I just wanted to tell you that that was the most amazing surgery I've ever seen,' she said warmly. 'Thank you for letting me assist. I'll never forget it. It was incredible. You were incredible. Douglas looked like he was going to faint when you clamped off that bottom end, but you didn't even flinch. It scares me to think how it would have gone with any other surgeon.'

'It's not an uncommon operation,' he said calmly, pouring water into a second mug. 'Any specialist surgeon could have done it. There's only real milk. Do you want that or will you take it black?'

'Black.' She only drank skim milk in her coffee because the full-cream stuff invariably left an oily taste in her mouth. 'You're too modest.' She took the cup he passed her with a murmur of thanks. 'You saved her life.'

'That's our job.'

They stood, their hips propped against the edge of the Formica bench, mugs in hand, but when she took a nervous mouthful of her coffee his hand came up and he brushed away a remnant of the dark liquid from the corner of her mouth. 'How's the study going?'

'Slowly.' Her mouth tingled from his touch. 'I'm only up to the limbs.' Thinking about sitting for the primary surgical exams, she'd made a start on revising the anatomy she'd studied as a medical student. 'My concentration doesn't seem to be as good as it used to be.'

'Working too hard?'

'No, not that.' She moistened her bottom lip. 'No, it's more that I find myself daydreaming a lot more than I've ever done before.'

'Daydreaming?' His thumb came up to her mouth again, only this time it brushed at the faint dampness her tongue had left behind. 'About what?'

'You,' she admitted, sure that he knew that. 'When I go to the library I mean to concentrate, but my mind keeps wandering. I can't stop myself imagining how it would feel if you come to find me and want to make love to me there. I imagine what I'll say, I imagine what you'll do, I imagine how it will feel, how you'll feel...everything. I know it's silly to fantasise like that but anatomy doesn't seem so exciting when I can think about you instead.'

His eyes had narrowed. 'You're crazy.'

'I know.' She loved the roughness of his voice because it told her he was aroused even though his face hid that from her. 'Nothing like this has ever happened to me before. I used to worry that I had the opposite problem. It used to be that when men kissed me I found my attention wandering away to my work.' She looked at his mouth, felt herself growing heavy and hot. 'My work used to seem much more exciting than sex.'

'You're utterly crazy.' But to her delight, when she'd thought him too strong in his resistance, he took her cup away from her and pushed it towards the other end of the bench close to his. 'Utterly, utterly crazy,' he continued heavily, taking her hands and tugging her close to him. 'I miss that. I miss you. Open your mouth.'

She obeyed thoughtlessly, matching his abrupt urgency with her own as he lifted her off her feet and against him, kissing him back passionately, lost in him, forgetting completely where they were—until sour words from Douglas reminded her.

'Do you mind?' the registrar grated. 'Some of us do have to eat in here.'

Merrin froze immediately, but Neil lifted his head with what felt to her like deliberate slowness. Ignoring the other man, he put her carefully away from him and retrieved their drinks. 'Want your coffee?'

'Yes, please.' Her mouth ached. She could barely speak. Her heart was pounding and if she hadn't had the bench to lean against she thought she might have fallen over. 'Thank you.-'

'Your hat's come off.' While she stared up at him, still bemused, he crouched and retrieved the paper hat she'd been wearing and put it back on her head. He collected her hair behind her into a bunch and twisted it beneath the elastic.

'How touching.' Douglas, she saw, was looking on cynically. 'How utterly sweet. I feel sick.'

Precisely, explicitly, still watching Merrin, Neil told the registrar exactly what he could do with himself, but although Merrin stiffened, shocked as much by his calm delivery of the instructions as by the language itself, Douglas seemed unmoved.

'This is a staffroom,' he observed defensively. 'I'm entitled to be here and that's anatomically impossible. Can't you keep your hands off the poor girl for five minutes?'

'It would seem not.' To Merrin's surprise, Neil's hand at her back urged her past the registrar towards the door. 'Where's your bleeper?'

'Theatre reception,' she explained huskily.

'Pick it up,' he ordered Douglas. 'Merrin's taking a break and you're covering for her.'

'Charming.' The registrar scowled at both of them. 'And are you keeping your own bleeper, boss, or do I also consider myself acting consultant for the duration of your little... frolic?'

'You don't,' Neil said tersely. 'I'm on my bleeper and my mobile. If there's an emergency you can call me.'

He prodded Merrin along to the changing rooms. 'Two minutes,' he told her firmly. 'I'll meet you outside.'

She was nervous. Her fingers fumbled with her clothing and it took longer than the two minutes to ready herself, but he greeted her impassively when she reached him, not obviously impatient.

'Where are we going?' she asked faintly. 'Your office?'

'I want to show you something,' he said with a quick shake of his head. 'Away from the hospital. A short drive, that's all.'

She hoped that meant he was taking her to his home but instead of turning right at the main hospital gates he went left then right. It was a short drive. Ten minutes, if that. 'Who lives here?' she asked, peering interestedly through the early evening darkness towards the house he'd parked beside. 'One of your patients?'

'No one at present.' He had a bundle of keys and he used one to open a set of French-style doors. She heard snapping sounds as he turned on lights. 'But I've been given an option on it. Do you like it?'

'Yes,' she said cautiously, looking around. Unfurnished, the large open living area they'd come into smelt musty, as if it had been deserted a long time. But it had promise. The floors were polished wood, which she loved, and the walls now covered with worn-looking paper would be redeemable with a few coats of cream paint. More importantly, it felt roomy and open and there was so much glass that during the day she knew that there'd be plenty of light.