Page 47 of Prognosis So Done

wouldn’t have paid any heed to the tone of his voice.

‘You love her, don’t you?’ she demanded.

‘Of course.’

‘Then give her what she wants. That’s what you do when

you’re in love. You make the other person happy.’

‘She doesn’t want that, Katya. I offered this morning. She wants me to want a baby.’

‘Like I said. Stupid man.’ Katya flicked off the tap with her elbow and flapped her arms in and out to shake off the excess water. ‘What’s not to want?’

She disappeared quickly and Gill, who was stuck with a mental image of Harriet holding Gillian as he washed off his soapy arms, couldn’t answer her question.

He followed her into the theatre and noticed that Ella was already playing. Their patient was anaesthetised and Joan indicated she was ready. Gill gowned and gloved and moved to the table where he prepped the operative area, swabbing it generously with Betadine, streaks of the brown liquid running down the patient’s flanks.

Next he draped the abdomen, leaving the patient’s stomach exposed and, with a final nod from Joan, he accepted the scalpel from Katya and put knife to skin.

He made a classic incision about twenty centimetres long, over the spleen area, cauterising the bleeding points as he went. Entering the peritoneal cavity, he retracted the skin and muscle layers.

There was blood, a lot of blood.

He couldn’t see a thing. ‘Suction,’ he said to Katya, who put the sucker head into the pool of blood, half filling the litre suction bottle.

‘How’s he doing?’ he asked Joan, without taking his eyes off the operative site.

‘A little hypotensive still.’

‘There’s a hell of a lot of blood here. You may want to rapidly infuse some O-neg.’

Gill approached the spleen from the underside to fasten the splenic artery, fully expecting the dark purple, bean-shaped organ to fulfil the grade five criteria — totally screwed. There was too much blood to hope to salvage it and zero place in field

surgery to attempt it anyway.

This young man needed the haemorrhaging organ removed pronto so his blood loss could be stemmed. Luckily it was a bit like the appendix — not vital to life. Sure, it had important immune and storage functions, but other areas of the body could take over the spleen’s role if required.

Gill worked methodically to tie off the spleen’s blood supply and ligaments so the organ was no longer fixed to the peritoneum. He was aware all the time of the nearby pancreas and careful not to interfere with any of its blood supply.

He shut himself off to everybody and everything except the odd update from Joan and Ella Fitzgerald singing...He forgot about his grandfather and the divorce and Peter and Harriet and that this was their last day. All he could see was moist, bloody tissues, all he could feel were slippery, warm body parts and all he could smell was burning flesh as he zapped anything that bled.

And in thirty minutes he’d removed the spleen.

‘Good God, it looks like someone’s put it in a blender,’ said Helmut, as Gill held it up for everyone to see.

Plonking it in the kidney dish Katya held out for him, he removed the sponges he had packed into the abdomen to soak up some of the blood while Harriet and Katya did the count. He realised then he was back from the zone he’d been in. He was conscious of things again, noises and activity beyond his immediate space.

He took the opportunity, now that the patient’s bleeding

was under control and his observations had stabilised, to do a

quick exploration of nearby organs. The pancreas, diaphragm and stomach were all examined and found to be intact. Gill explored a little further, checking also on the nearby kidneys.

Satisfied that everything looked good, Gill lavaged the abdomen and closed the muscle and skin layers. The phone rang as Gill was pulling the drapes off the patient and Harriet, who was nearest, answered. He saw her nod a couple of times before putting the phone down.

‘Above-knee amputation. Incendiary device,’ said Harriet.

‘Bring it on,’ he said.

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