the pinion’s in place, holding Gretel’s head in position, so let’s start.’
To someone who’d not met her before, Hayley’s voice would have sounded confident, but Tom detected her massive stress levels in the tiny alto quavers. She’d explained the scan to him earlier and he could picture it all very clearly in his mind. ‘Due to the position of the mass, you’re making a lateral incision and then performing a suboccipital craniotomy.’
‘Removing a bone flap to relieve the pressure,’ Hayley muttered as if it was a mantra. ‘That’s the easy part.’
It is. ‘One step at a time and we’ll get through this.’ But he too was talking out loud to reassure himself as much as everyone else. So much could go wrong in so many unpredictable ways and he couldn’t see a damn thing.
He’d always operated with music playing, but not soothing classical. His OR would vibrate with hard rock and, during extremely tense moments, heavy metal. Hayley was operating in silence so he sat listening to the whoosh of the respirator and the hiss of the suction, which only ramped up his agitation. He started to hum.
‘Tom, I’ve turned the skin flap and I can see bone.’
‘Now you use the high-speed drill and make three small burr holes into the skull.’
The shrill shriek of the drill against bone always made medical and nursing students jump the first time they heard it. Tom had always teased and laughed at their reaction, but he didn’t laugh today. Instead, his fingers clenched against nothing, wishing they were holding the drill, wishing he was able to do the job, not just for himself but for the patient. For Hayley.
The shriek died away. ‘Done.’ Hayley swallowed. ‘What’s next?’
He visualised the silver instruments all laid out in neat rows on the green sterile sheet. ‘Use the Midas Rex drill to create the bone flap.’
‘Oh, my, it’s like a can opener.’ Hayley gave a tight laugh and a few moments later said, ‘The bone flap’s removed and I can see the dura.’
Like an illustrated textbook, Tom’s mind beamed the image Hayley was looking at. ‘Excellent. Now you need the grooved director. It’s your atraumtic guide. Using the scalpel, cut the dura over the groove and this protects the brain tissue underneath.’
‘Too easy.’
But the everyday slang expression was laden with her anxieties. He moved to reassure her. ‘You’re doing fine, Hayley. David, how’s our patient?’
‘She’s holding her own at the moment, but I’ll be happier when Hayley’s stopped the bleeding.’
‘You’re not alone there.’ Tom counted to ten because he didn’t want to rush Hayley, but he also needed to keep her within a particular time frame. ‘Can you see brain tissue, Hayley?’
‘I’ve found the clot.’ Her relief filled the theatre.
‘Theo, position the microscope.’
The rustle of plastic-covered equipment being wheeled into place was the only sound and Tom hated not being able to see what was going on. ‘Hurry up, Theo.’
‘It’s in position now, Tom,’ Theo said.
‘Good. Hayley, have you found the bleeding?’
‘Give me a minute, I’m still looking.’
Her normally mellow voice rose as her semblance of calm shredded at the edges. Tom wished he could take over, relieve her of this unwanted task that was stretching her and forcing her to go places she’d never been before. But he was powerless to help so he did the next best thing. ‘Theo, suction the clot and keep the field clear. She needs to be able to see.’
‘On it, Tom,’ the nurse replied.
For a moment all he could hear was the gurgle of suction and he couldn’t stop his foot from tapping on the floor.
‘Okay.’ Hayley’s breath came out in a rush. ‘I see it.’
Thank you. ‘Stop the bleeding with the bipolar forceps.’
‘What if that doesn’t work?’
Don’t panic on me now, Hayley. He infused his voice with a calm he didn’t feel. This surgery was something he’d perfected over years of training. Hayley was being thrown in feet first. ‘We’ve got the option of clipping, but try the electrical coagulation first because it will probably work.’
Please let it work. The sooner she stopped the bleeding, the better it was for their patient.
He held his breath while Hayley worked, but he could only guess at what was going on because, apart from a few muttered words, she was silent. He’d always grunted, yelled, talked and even sung his way through surgery. Her silence was unnerving.
‘Suction, Theo,’ Hayley snapped.
‘Her intracranial pressure’s still rising.’ David sounded seriously worried.
‘Has it worked?’ Tom hoped like hell it had.
‘Pray that it has,’ Hayley said. ‘This is the moment of truth, team.’
No one said a word. Only the buzz and whirr of the machines dared to make a sound as time slowed down, stretching out interminably and reaching into infinity.
‘Yes!’ Hayley’s woot of relief bounced around him. ‘Field is clear. Bleeding’s stopped. Clot’s evacuated. We did it. Thank goodness I’m sitting down or my legs would collapse.’
‘Great job. You’ve done well.’ Tom grinned, wanting to high-five her. She’d held her nerve in a tight corner and now step one was complete. He immediately focused. ‘Don’t get too excited. You’ve stopped the bleeding, but we’ve still got the problem of the pressure. With a mass that size you’re going to have to excise a part of it so the brain can get some relief and relax. This takes the risk of her brain herniating down to zero. We also need a biopsy for pathology so we can hand over to Lewis Renwick, who’ll operate to remove the rest of the tumour in a day or so.’
‘You make it all sound so simple.’
‘It’s just brain surgery.’
Like a pressure valve being released, everyone laughed. Despite the life-threatening emergency, the fraught conditions and the fact he couldn’t operate, something inside Tom relaxed. Something that hadn’t relaxed in a very, very long time.
Hayley felt utterly shattered as she walked toward ICU. Even though it had only been three and a half hours since she’d operated on Gretel, it felt like years ago. Having used up every ounce of her concentration whilst operating on her neurological patient, she’d expected to be able to fall in a quivering heap the moment the surgery was over. Instead, just as Tom and David had left the OR to escort Gretel to ICU, she’d been called back down to Emergency for another consultation. Half an hour later she’d been scrubbed again and busy resecting an ischaemic bowel. It hadn’t been an easy operation either.
Now pink streaks of dawn clung to the clouds and
