fix it internally because of the risk of infection with the soft tissue injuries, so we’ll put screws into all the various fragments, pull them out into line with a little judicious twiddling, and fasten the whole lot onto a rod outside his leg and let it get on with it.
‘Hopefully the old one’ll heal this time, and the new one’s got two chances. I’m not so worried about the fibula; I want to sort the tibia out once and for all.’
He flicked off the light, returned the plates to the envelope and gestured towards the door. ‘Shall we go? They’re all prepped up and ready for us.’
Watching him operate was a joy. He was careful, precise and meticulous, and Frankie realised with a surge of humility how much she had to learn. Oh, she knew the theory—she’d studied it endlessly—but it was nothing compared to watching the real thing.
And he made it look so easy! Fixing the femur with an intramedullary nail driven down inside the bone had always sounded fairly brutal. In his hands it became a skilled procedure, using imaging techniques to see the nail slowly descending through the femur until it reached the fracture, then the ends aligned so that the nail continued on down the second section.
Finally they were fixed in place with screws through the bone into the nail, and so the bone was held, unable to rotate or slip, with the ends in perfect alignment, and all without disturbing the break in the neck of the femur.
He checked on the image intensifier to ensure that all was as he wanted it, then closed the wound on the thigh and at the top of the femur and straightened up with a sigh.
‘Thank you, everyone,’ he murmured, and turned to Frankie, peeling off his gloves and dropping the mask down off his face. ‘How about a cup of coffee while they prepare the operating room for the next onslaught?’
‘Sounds good.’
She followed him out, accepted the cup and listened as he talked to the anaesthetist, Peter Graham. From the conversation she gathered that this was far from the first operation they had performed in the last few hours, and there were at least two more ahead—the man with the fractured lower leg and another new admission from A and E.
Robert Ryder turned to her. ‘I don’t suppose you’d like to pop down there and have a look at the plates, would you, and report back? Perhaps bring the plates back here and we can study them together.’
‘Sure.’ She put down her untouched coffee and stood up. ‘Um—where is A and E?’
Peter grinned. ‘Out the door, turn left, down the corridor to the end and turn left again. You can’t miss it.’
She followed his directions and found herself in the busy bustle of a typical accident and emergency department. She found the desk in the middle, collared a staff nurse and introduced herself.
‘Oh, you’ve come about the cyclist. He’s in here—it’s a nasty mess.’
She opened the curtain to reveal a young man on a trolley, the cot sides up and a drip running in. He was lying motionless, his face pale and clammy, and he looked very shocked.
The staff nurse eased off the thick gauze pad covering the wound on the outside of his left foot, and Frankie’s mouth tightened slightly. It was very badly mangled, bent in at an unnatural angle and with extensive soft tissue injuries. There was a great deal of grit and tarmac ground into the exposed bones, and she winced.
‘Not nice, is it?’ the staff nurse agreed. ‘His X-rays are here.’
Frankie studied them thoughtfully. The bones were nearly all intact, amazingly, but one or two were broken through the ends and would need fixing. The main damage, she could see, was to the soft tissues.
‘Do you know what happened?’ she asked the nurse.
‘He was knocked off his bike and dragged along the ground for a few yards by a car. Luckily for him he had a helmet and leather jacket and gloves on, or he’d be a lot worse off. His little finger’s broken as well, by the way—just a minor fracture. We’ve put a garter strapping on to support it. We’ve done chest X-rays but there didn’t seem to be anything on them. He’s complaining of pain in the left shoulder, though.’
‘May I see?’ she asked, and, studying the plate, she ran her finger lightly along the left collar-bone to the outer end. ‘The clavicle’s partially dislocated,’ she said quietly. ‘Must have happened as he landed on that shoulder. We’ll have to support that for a while as well. OK, thanks—can I take the plates up to Theatre to show Mr Ryder?’
‘Sure. What do you want to do with the patient?’
She turned back to the foot and studied it again. The soft tissue injuries were nasty, infection was likely and the toes were looking discoloured. ‘I’m inclined to think he’ll want this one next. Is the consent form signed?’
‘Yes—his wife’s here. Do you want to talk to her?’
She shook her head. ‘Not until I’ve spoken to Mr Ryder. I think I’ll ring him and ask him to come down.’
She contacted him on the phone, explained the situation and then had to defend her suggestion that he go in next.
‘The soft tissues look awful. I think the circulation could be compromised,’ she told him.
‘The other man’s soft tissues look awful.’
‘Is the circulation affected?’
She heard him sigh. ‘Apparently not. So you want me to come down?’
‘I think you should.’
The phone clicked and she replaced it thoughtfully. Was he cross with her? Perhaps she should have just tacked the man on the end of the list, but she wasn’t even officially working and the last thing she wanted to do was blow her chances at this job by fouling up in the first few hours!
She needn’t have worried. He came down, took one look at the foot and nodded.
‘Let’s do him next,’ he agreed, and Frankie’s fragile ego heaved an enormous sigh of relief. The relief quickly turned to horror, however, when he told her that if she liked jigsaws so much she could do this one.
‘Me?’ she squeaked.
He rolled his eyes above the mask. ‘Sure, you. Why not? Don’t worry, I’ll tell you blow by blow what I want you to do.’
And so she did her first orthopaedic jigsaw, carefully reinstating the circulation by reconnecting the damaged blood vessels as well as possible. When the foot turned pink again she could have wept with delight.
Ryder, however, kept her feet firmly on the ground and her optimism in the dirt—literally.
‘Right,’ he said, ‘now you can set about picking all those bits of tarmac out of the bone-ends and cleaning up the field before closing the skin.’
It took ages, with both of them working although the area was quite small, and finally it was cleaned up to his satisfaction.
‘Right, we need to screw back that small chip of bone with its ligament attached and we’re done,’ he told her. ‘We won’t close it because of the
