Monday 5 April 2010

A Breath of Fresh Air



Seeing him on the day of the operation, I finally knew.  The night before, on my assessment ward-round, I hadn’t been convinced. Both of us had changed a lot, but when I saw him on the operating table, I knew it was Murdo.

I’d seen his name in the local newspaper once or twice in the intervening thirty years, so I knew he was a major drug-dealer, but the demeanour of the prison officers in close attendance at his bedside indicated that he’d been put away this time for offences involving children.

It had been Murdo who made my life a misery throughout my school years, Murdo who’d framed me for a village-girl’s pregnancy, Murdo who had ruined my musical career the very year I’d been accepted for the Conservatoire, by dropping a cement block on my right arm.  With intent.  Not that the court took much notice of what he’d done to my prospects, instead taking the line that he was a poor misunderstood boy from an unfortunate background.

I greeted my new patient civilly, as the prison-officers stepped back a little, though warily and not too far.  Wearing gloves – you can’t be too careful with the prison population these days – I put a big plastic cannula in a vein and began trickling in my anaesthetic induction agents, as ever conscious of my stiff elbow inhibiting free and easy movement.

Murdo watched me, a slightly unsettled expression eventually appearing on his ugly fat face.  As the drugs began to take effect, suddenly his pupils dilated with dawning fear, and he began to say, “I know you, you’re…” but the words tailed off and he started to breathe stertorously in deep anaesthetic sleep.

I was pretty sharp in those days, and I could get a pneumonectomy case ready in twenty minutes, establish safe and stable anaesthesia, with a double lumen tube in the airway, cardiograph, arterial and central lines in the right places, urinary catheter, temperature sensors, neuromuscular transmission monitor, heating blanket, everything ticketty-boo.

Not that Mr Crawford Smythe, the surgeon, appreciated anything other than his own skills and massive ego.  He was a complete boor, not only that but liable to blame others for his own mistakes.  A couple of times, he had so impressed the sheriff conducting a fatal accident enquiry with the veracity of his story, along the lines that “the patient died through the fault of that fool of an anaesthetist of mine”, that I’d been lucky to get away with some shreds of my reputation and my General Medical Council registration intact.

So it was, “Where the hell have you been all morning?” as I wheeled the unconscious and beautifully-prepared Murdo through from the induction room and parked him under the operating lights.  Paying no attention, I connected up my anaesthetic machine, which I’d previously checked in every particular, turned on the gases and volatile agents, and connected my various monitors.  All was well, blood pressure not too high, not too low, heart rate not too fast, not too slow.  My IV infusion and syringe-pumps were nicely adjusted so as to produce predictable levels of unconsciousness and deep analgesia.  And Mr. Crawford Smythe was raring to go.  “Adjust the lights, for God’s sake,” he snarled in my direction.  The theatre sister, no friend of mine either, glared at me maliciously.

For once, I obeyed meekly.  An unusual thought was crossing my mind, for it had occurred to me that the anaesthetic machine I’d been allocated this morning was a slightly older version than usual – perhaps it had been missed out in the recent upgrading exercise – and there was a little orange-painted cylinder attached to the back-rail.

Medical gases are very carefully identified by colour-coding on the cylinders, and to make mistakes even less likely, connections are pin-indexed so, for example, oxygen and nitrous oxide can never be mistaken one for the other.  You would be surprised to learn how many people had to die before simple design aspects like these were finalised.  Even the floors in operating theatres have a precisely specified electrical conductance to minimise the risk of fires and explosions.

Cyclopropane is a gas with a very simple molecule, whose physical characteristics are responsible for its extreme potency as an anaesthetic agent.  There is a slight problem, though:  it's very highly explosive, especially when mixed with oxygen.

Having cleaned and draped the patient’s skin, Mr. Crawford Smythe was cutting, swabbing the blood and tying off bleeding arteries as he dissected his way through Murdo’s chest wall.  Within a few seconds he would come to the pleural cavity surrounding the lungs, and then as usual he would use a diathermy machine, adjusted to give a powerful flesh-cutting spark from the business end, to cut his way into lung-tissue towards the tobacco-smoke induced malignant tumour which had been the cause of Murdo’s recent illness.

Glancing at the blood-loss measurements chalked on the swab-board, I saw that the surgical procedure was on track, and at that moment what had been a passing thought suddenly hardened into a definite intention.

The rotameter bobbin rose gracefully as I adjusted the orange cylinder’s knurled steel valve, conscious as never before of my hatefully stiff elbow.  Cyclopropane was now joining the patient’s gas stream, and would very shortly be delivered to Murdo’s lungs by the ventilator.   I could feel my hatred for Murdo rising too, but there was little time to spare as I took my student nurse assistant by the arm and we sauntered rapidly out of the operating theatre, through the induction room without pausing, and round the corner.

Nearing the coffee room, we were blown over by an enormous explosion.  The entire surgical suite became pitch black in an instant, and before losing consciousness I realised my elbow was broken again.

A year later I finally got back to work.  We have a nice new operating suite now, of which I’m the Director, and people still haven’t forgotten how I saved a young nurse’s life by my quick thinking;  she’s certainly never ceased being grateful, anyhow.  The new elbow-joint is amazing, and my piano teacher says I have tremendous talent.  I’m so fond of people who can be positive – like a breath of fresh air, don’t you think?

Copyright © Donnie Ross 2010

3 comments:

  1. Love it, love it. More please. (And thank God you're no longer practising. Unless ...)

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  2. Hehe...ace story Donnie... :D

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  3. Thank you Bill & DarknessDesired, your encouragement is much appreciated!

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