St Matthew's Passion - By Sam Archer Page 0,9
helped him out of his overalls and exposed his abdomen, then began to probe with flat hands. She pressed down gently and released, but Barry didn’t react. No rebound tenderness, then.
‘Where’s the pain?’ Melissa asked. ‘Still in your shoulder?’
‘Yeah,’ he groaned. ‘The left one. Getting worse.’
‘BP’s ninety-seven over fifty-two, Ms Havers,’ said Deborah.
That was low, and coupled with the rapid pulse the finding was ominous. Melissa said, ‘Barry, does the shoulder pain get worse when you breathe in?’
He inhaled, then gasped. ‘Oh yeah.’
Kehr’s sign. Pain in the left shoulder, aggravated by inhaling. It indicated blood in the abdominal cavity, most likely from a damaged spleen. A life-threatening injury.
‘Deborah’, said Melissa, ‘could you please bring the CT scanner over here?’
While she was waiting for the CT films to process, Melissa kept close watch over the injured man. He’d started to report pain in his abdomen, and this time when she palpated it there was a sharp moan of pain. She set up an intravenous drip but when his blood pressure failed to rise satisfactorily she asked Deborah for a central venous line kit. With practised skill Melissa inserted a large-bore cannula into the internal jugular vein in the side of Barry’s neck. It allowed a high volume of fluid to be infused rapidly into his system to counteract the blood loss that was occurring somewhere within his abdominal cavity.
Deborah handed her the CT films. Melissa clipped them into the backlit screen mounted on the wall. There it was: an extensive fluid collection in the right upper quadrant. The spleen was hard to see accurately, but looked far from intact.
At her shoulder Deborah said, ‘I’ll call Mr Finmore-Gage out of theatre.’
‘There’s no time,’ said Melissa. ‘That’s a stage five injury. A shattered spleen. He needs it out, and urgently.’
Deborah gazed into her eyes, as if gauging whether Melissa understood the implication of what she’d said. Melissa nodded silently: yes. I know.
Over her shoulder, already on the move, Deborah called: ‘I’ll alert theatre.’
Heart hammering in her throat at the realisation of what she was going to have to do, Melissa spoke rapidly to the injured man, explaining the procedure, trying to keep a tone of calmness in her voice. He took the proffered pen and consent form from her and signed, and she assured him that his wife would be notified immediately.
On the way to theatre, as a nurse and a porter steered the trolley deftly through the corridors with Melissa at its head, Deborah appeared beside her. ‘Theatre’s ready,’ she murmured. ‘There are complications with Mr Finmore-Gage’s case and he’s tied up there, so he says you’ll have to do this one. I’ve arranged an assistant for you and an anaesthetist.’
In the scrub room, her hands sheathed in sterile latex gloves and a nurse tying her surgical gown behind her back, Melissa stared at her reflection in the mirror over the basin. Her eyes were calm, her mouth set. To all appearances she was relaxed, confident, the very model of a cool and collected surgeon. Inside, she was terrified. She was about to perform a laparotomy and splenectomy on her own for the first time ever. The patient’s life depended on her.
The nurse put on Melissa’s face mask for her, leaving only her eyes exposed. Melissa used her back to push open the door and stepped into the theatre, where amongst the beep of the monitoring equipment and the clatter of the instrument trolley as it was moved into place, her patient lay supine on the operating table, draped in green apart from his exposed abdomen, yellow in the harsh light from above.
The next hour would linger in Melissa’s memory as one of the most intense of her life, in which her senses – sight, smell, hearing – were heightened to an almost animal level. She made the incision in the upper abdomen at the midline and opened the abdominal wall. As she’d predicted, and as the scan had confirmed, the cavity was filled with blood. In short order, while the junior doctor assisting her held the retractors to keep the cavity exposed, Melissa used suction to visualise the internal organs, detached the anchoring ligaments of the spleen, clamped off and cauterised the vessels connecting the organ to the vascular system, and lifted the spleen free. It was a wreck, fragmented beyond salvage. After that the process was straightforward: examine the rest of the organs including the pancreas for damage, clear out all remaining fluid from the cavity, check for bleeding vessels,