Page 48 of Prognosis So Done

CHAPTER EIGHTEEN - 2400 HOURS

Twenty minutes laterthey were operating again. Harriet was

scrubbed in with Gill. She hadn’t really wanted to. The pain in her side was getting quite bad but at least with something to do she might be able to keep her mind off the constant throb.

And she had promised Katya.

It was going to be a long procedure, probably close to ninety minutes barring complications, and would require all her concentration to anticipate Gill’s requirements and keep the operation flowing smoothly. She loved that most about her job. The dynamics of an experienced surgeon and the assistant.

Watching people who had been operating together for a long time was like watching prima ballerinas dance Swan Lake or a

concert pianist playing classical music. Every move was choreographed perfectly. It was fluid and graceful. One hand meeting the other at just the exact moment to accept an instrument without any interruption to the flow of the proceedings.

It was a special skill built over years. It was...art.

The pain in her side was making it difficult for her to concentrate. She needed to get into the zone that Gill always entered the second he picked up a scalpel. Because if she didn’t stay one step ahead of him and he had to wait for something, it would pull him right out of his bubble. And that made him frown and even though he was too polite to say anything, she would know she had let him down and professionally she had never let him down.

Never.

Sure, in the beginning there had been an awkwardness to their technique, as there always was with a new partnership. It hadn’t been as smooth and the flow had been stilted. Rigid, mechanical even. But she had always managed to anticipate his

requirements and the flow soon followed.

Harriet took a deep breath, forcing herself to relax. If she could get outside her body and into her head then, just like Gill, nothing else but what the two of them were doing would exist.

Including the wretched pain!

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Gill heard Harriet’sindrawn breath, quite loud in their close confines. He turned to her and raised his eyebrows, still worried about her abdominal pain. He felt slightly reassured by her quick wink but he noted the fine sheen of sweat on her brow with concern. It wasn’t an uncommon sight, given the hot theatre lights directly above their heads, but it was unusual before the op had even got under way.

‘I’m good to go,’ said Joan.

‘Tourniquet on at 0010,’ said Helmut, noting it down on the anaesthetic sheet.

The leg’s major blood vessels had been crudely ligated in the field as a temporary measure to prevent the patient from exsanguinating through his open wound. It was Gill’s job to fix the mess and to do that he needed a bloodless field and haemostatic control of the leg.

A tourniquet was used for this purpose. It could be left on for a maximum of two hours but it was important that it be released a little about every ten minutes to reperfuse starved tissues and prevent ischaemia, possibly necrosis from tissue hypoxia.

The normal rule of thumb was ten minutes on, ten minutes off and it was Helmut’s job to control, monitor and document the

inflation and deflation of the tourniquet.

Gill looked down at the prepped, mangled right leg. It had been traumatically amputated just above the knee joint, necessitating a transfemoral or above-knee amputation. The flesh was shredded. The distal extremity of the femur had been completely blown to smithereens exposing the sharp splintered edges of the femoral shaft.

The missing part of the limb had apparently been completely blown to pieces by the explosion but, even if it had been rescued and been in good enough condition, there wasn’t the time and this theatre wasn’t the place for lengthy limb salvage operations requiring delicate microsurgery.

Gill examined the remains of the leg, thinking it looked like some gruesome prop dreamed up by a special effects department. War injuries necessitating amputation were very different to nice clean civilian jobs, the majority of which were performed electively for vascular problems.

In combat wounds the initial trauma usually involved a high-energy impact, completely shattering bone and severely damaging soft tissue. The nature of these wounds required a staged-management approach and were left open until the soft tissue had recovered and stabilised.

They were also exceedingly dirty and attempting to close the wound too early could result in failure and infection, requiring a higher level of amputation.

Gill’s immediate job was to get the bleeding under control and prepare the muscles, nerves and bone for closure at some future stage. And evacuate to the nearest specialist facility.

These centres were equipped to deal with traumatic war injuries. Through aggressive wound care and physio, they would optimise recovery of the injured tissues and eventually close the skin, fashioning a stump to which a prosthetic device could be fitted.

The first thing Gill had to do was decide on the level of

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