things I knew instinctively. Had the stake damaged the heart or aorta she would have bled out at the scene. Traumatised small arteries will go into spasm, clot and stop the bleeding themselves as long as injudicious clear fluid infusion doesn’t raise the blood pressure and blow the clots off. So I surmised that most of the bleeding must be coming from the veins, which do not constrict. I asked the nurses for some scissors to remove her clothing, now stiff with dried blood. It was like cutting through cardboard and opening a window on the grim reality of her situation.
Her pleading brown eyes remained firmly fixated on the stake. I could make out the jagged ends of ribs protruding through macerated fat and pale, bruised skin. The post had entered directly below her right breast, marginally to the right of the midline, and emerged from her body higher up in her back, suggesting that she had slid feet first after tumbling from her motorcycle. My three-dimensional anatomical knowledge left me in no doubt which structures had been damaged. The post must have taken out her diaphragm and liver, the lower lobe of her right lung and probably the largest vein in the body, the inferior vena cava. The lung wasn’t a problem. But if her liver was pulped and the veins torn off the cava, I knew that we couldn’t fix her. Scrutiny of the post protruding from her back confirmed my fears – there were fragments of both liver and lung on the wooden shards. Everyone knows what liver looks like from the butcher’s, while youthful lung is pink and spongy. I recognised both, and it made me sad.
In just seconds on a Saturday morning she had gone from vivacious carefree student to dying swan transfixed like a vampire. With every agonising breath, blood slopped from the wound edges. Whatever the way forward, I had to talk to her. I edged around the trolley and knelt by her head to distract her as the emergency doctors painfully probed with needles to locate an empty vein. With blood and froth dripping from her mouth, she was finding it difficult to breathe, let alone speak. We needed to put her to sleep right there in the ambulance, then get a tube into her windpipe – a seemingly impossible task in that awkward position. By now I was pretty sure that whatever we did she would die. If not soon, it would be in days or weeks as a result of infection and organ failure in the intensive care unit. So whatever else we attempted to do for her, we had to be kind. Do as little as possible to add to her pain.
Staring directly into her eyes I asked her name. I was simply trying to inject a semblance of humanity into the proceedings and relieve the brutality of it all. Stuttering between breaths, she told me she was a law student, like my own daughter Gemma, which added to my discomfort. I took her icy cold fingers in my right hand and rested my left hand on her hair, hoping to obscure that stake from her gaze.
With tears streaming down her cheeks she murmured, ‘I’m going to die, aren’t I?’
At that point I ceased being the surgeon because I knew she was right. For her last agonising moments on earth I could only comfort her. So I would be her substitute dad for that time. I held her head and told her what she wanted to hear. That we would put her to sleep now and when she awoke everything would be back in its place. The stake would be gone. The pain and fear would be gone. Her shoulders dropped and she felt less tense.
The gadget clipped onto her index finger showed very low oxygen saturation, so we had to move her to give the anaesthetist his chance with the endotracheal tube. Only then could we begin a token effort at resuscitation. I extended my hand to feel her belly, which was distended and tense. As we explained the need to move her, I could sense her consciousness fading.
She whispered, ‘Can you tell mum and dad that I love them, and I’m sorry? They never did want me to have that bike.’
Then she coughed up a plug of blood clot. As she rolled backwards the stake shifted, grating audibly against her shattered ribs. Her eyes rolled towards heaven and she slipped away. Whatever blood she had left in her circulation was pouring out over me. But I didn’t mind. It was a privilege to be there with her. The junior doctors from the resuscitation room stirred, intending to begin cardiac massage. Without hesitation I told them to back off. What the fuck did they expect to achieve?
The back of the ambulance fell silent with the horror of it all. I would have loved to have dragged that hideous fence post out of her chest – that had to be left to the pathologists. I couldn’t bring myself to watch her autopsy, but it confirmed that her diaphragm had been torn away and her pulped liver avulsed from the inferior vena cava.
That balmy summer’s evening I went walking through the bluebell woods of Bladon Heath with Monty, my jet black flat-coated retriever. While he chased rabbits, I sat on a fallen tree carpeted in moss and wondered if there was a God. Where was he on those fraught occasions when I needed some divine intervention? Where was he today when that poor girl tried to avoid hurting a deer and was killed by her kindness? I visualised her devastated parents sitting with a cold corpse in the mortuary, holding their daughter as I’d done in the ambulance, beseeching God to turn the clock back.
There was no point trying to be logical about religion. I knew that high-ranking Oxford – and indeed Cambridge – academics scoffed at the deity concept. Both Richard Dawkins and Stephen Hawking had that gold-plated atheistic confidence in their own abilities, spurning outside help. I guess I was the same. But I would still sneak into the back of a college auditorium and listen to debates on the subject. Some disputed God’s existence because of all the evil and misery in the world, and while I could identify with that, I had contrary and privileged insight through the odd patient who actually claimed to have reached the Pearly Gates before we clawed them back.
These vivid out-of-body experiences were rare but occasionally compelling. One spiritual lady described floating calmly on the ceiling as she watched me pumping her heart with my fist through an open chest. Forty minutes into this internal cardiac massage my thumb tore through into her right ventricle – she clearly recalled my words: ‘Oh shit, we’ve had it now.’ Fortunately, the perfusionists arrived with the circulatory support system I needed to keep her alive, and I succeeded in repairing the hole.
She uncannily related her memory of the events a number of weeks later in the clinic. Having been party to her own resuscitation attempts from above, she had floated through the clouds to meet with St Peter. This journey amid peace and tranquillity contrasted sharply with our gruesome efforts back down on the ground. But having arrived in heaven she was told she had to return to earth and wait her turn again – a ridiculously close-run thing between me and Grim Reaper. Perhaps God changed as he got older. Maybe he started out with the best of intentions but became cynical and less caring with time. Just like the NHS.
It was only after retiring from surgery that I began to reflect on my role in dispatching so many to that great hospital in the sky. One tranquil spot on the heath still holds a great deal of significance for me. It is a haunted place, a gap in the woodland that overlooks both Blenheim Palace, where my hero Winston Churchill was born, and St Martin’s Church, Bladon, where he is buried. A few yards from this clearing a jet plane that had just taken off from Oxford Airport crashed and exploded.
My son Mark was working for exams in his bedroom and watched the whole spectacle unfold. Heroically, he was the first to reach the drama in the field but could do nothing amid the conflagration. He watched the cockpit burn and cremate the occupants. Obviously at seventeen he had a different constitution to his lobotomised father, so the dismal spectacle disturbed him as it might any normal person. After dropping a single grade in biology he was dumped by his chosen university. I was very bitter about that. I still am.
One day when we reached this sacred ground, Monty spotted a stag silhouetted against the evening sky a hundred or so yards up the ride. A shaft of evening sunlight shone through the trees to illuminate a clump of fading bluebells, their heads dipping at the end of their season. Was that majestic stag in fact God looking down on me, surrounded by the spirits I had set free during my career, the ghosts of operations past?
In truth, I had always been a loner. I was still a restless insomniac who would wake in the early hours and write,
