Dr John Watson knocks and enters patient room number 11 in the Neurosurgical Ward of King's College Hospital. He stops in front of the only bed in the room. Next to it stands a woman in her sixties, supposedly the Mrs Holborn whose chart John is holding. She seems to be frantically packing her things, assisted by a younger woman. Probably her daughter.
"Good afternoon," John says. "Am I in the right room? It seems as though you're leaving, Mrs...?"
"Holborn," The woman says, turning, "Anne Holborn."
"I wasn't aware you were being discharged," John says, slightly confounded.
"I'm not being discharged, I'm going home."
John glances at the chart, frowning. "I have you scheduled for an operation tomorrow. I was not aware it had been cancelled?" John inquires and adds, "I'm John Watson, I've been assigned as your anaesthetist for tomorrow. I'm here to discuss some issues."
The woman continues to pack, looking quite upset. He younger companion crosses her arms and regards John with an angry look. "We're not staying here a minute more. Honestly, I wish they'd told us sooner that the surgery would be useless."
John puts the chart down on a nearby table. "Look, Mrs Holborn and -?"
"Lucy Holborn. I'm her eldest."
"Could you please sit down, Mrs Holborn? It's obvious there's something going on that I wasn't made aware of. Could you please explain why you seem to have decided to withdraw consent?"
The older woman stops rummaging around her floral-patterned suitcase and slumps down onto the hospital bed. Her jaw is shaking as she is holding back tears. "It was that surgeon, he was just here, he told us that even with the surgery, I'm going to d-" She begins sobbing inconsolably.
The daughter leans down and puts an arm across her shoulders. "Mom, please. It's okay."
John grabs a chair and pulls it closer to the bed. He sits down and leans his palms on his knees.
The daughter passes Mrs Holborn a paper tissue from a nearby trolley.
"You talked to the surgeon. What did he say exactly?" John asks.
This time it's Lucy Holborn who speaks. "He said that he is certain he can get the tumour out but with this type and grade it'll just grow back later and-," she glances at her mother and inhales nervously, "Be fatal."
John checks the name of the neurosurgeon on the chart. A Dr Holmes. He's not familiar with the name.
Mrs Holborn has a grade three astrocytoma. It can't really be cured, but there's always a chance of a long remission.
"If I'm going to die anyway I'm not getting the surgery. I want to go home to my family," Mrs Holborn says slowly, sniffling.
John smiles in what he hopes is a reassuring manner. "While it's true that most patients will succumb in the long run, we can usually give them many great years with current treatments. Decades, even."
"Well he should have told us that, then!" Lucy Holborn says accusingly and leans on a wall next to the bed. Mrs Holborn has stopped sobbing but is still looking crestfallen.
"Look, sometimes surgeons are so focused on an upcoming operation that they can be a bit distracted. It's a good thing, really - it means that they're extremely focused. Unfortunately they can sometimes appear a little brusque," John says in an attempt to soften the tension.
"But that doesn't explain why he'd have to be so bloody cruel about it all!" Lucy says accusingly. "He didn't seem to care about Mom at all!"
John purses his lips. "I'm so very sorry to see you this upset. Maybe I could walk you through the surgery so you could have an idea what to expect. Then you can decide together what you want to do. Does that sound okay?"
Mrs Holborn looks out of the window and then at her daughter, who shrugs. "Couldn't hurt, I guess," Lucy Holborn says.
Mrs Holborn turns on the bed to face John.
He explains the usual course of the surgery and the post-operative care as meticulously as he can without emphasizing any potential risks in an unsettling manner.
When he has finished his explanation, he answers the many questions the two women have. Mrs Holborn decides to have the surgery after all.
It's half-past four in the afternoon when John finally excuses himself from the company of Mrs Holborn and her daughter. The daughter had thanked John for giving them a bit of hope after "that horrible man" had tried to completely take it away from them.
John wanders into the anaesthetists' lounge. It's been a month since he's last seen his colleagues due to a long-overdue holiday. He mostly spent it at his parents' house in Birmingham, apart from a short trip to Kent to see his sister.
The first person to greet him when he walks into the lounge and heads straight for the coffee machine is his ex, Dr Natalie Temple. They'd broken up a little before John's holiday. They'd been together for two years before the smoldering disagreements finally escalated into full-on war. Nat was smart but a little too much of a free spirit for John's tastes. They'd even tried an open relationship on her initiative. Even though John did have a reputation of being quite the ladies' man, his moral compass somehow never allowed him to seek other bed companions during their relationship. Natalie hadn't had such qualms. It wasn't the only reason for the downfall of their affair, but a large part of it.
It seemed that their explosive break-up was the best thing that could've happened because somehow they'd ended up as good friends again.
Their combined salaries had been enough to get them a very nice rental in Soho. Now that John was on his own, all he could afford was an abysmal little bedsit in Shoreditch. Maybe he ought to find himself a flatmate or something to get a bit more space for his stuff and a shorter commute to the hospital.
"Johnny!" Natalie calls out from where she's stretched out on a worn couch, "How was Kent?"
"Harry's drowning herself in a bottle again. Clara's moved out and they're getting a divorce."
"Which one came first, the booze or the divorce?" Nat asks. John had told her about his sister's tumultuous life when they'd still been together.
"Fuck if I know," John says and sips his coffee. He sits down onto the adjoining couch. The lounge is empty except for a cleaner mopping the floor. "Everyone else still busy?"
"Nah. I let the registrars home early since I'm on call and there isn't much on. Why are you still here? I thought you only had that laminectomy today, which ended ages ago. Just released the patient from obs back to the ward."
"Anything happen while I was away?" John asks, idly flipping through an old issue of the British Journal of Anesthesia.
"Not much. Oh, they finally filled that neurosurg fellowship position. Turns out there was this guy they were looking to headhunt the minute he got his consultancy, that's why the job has been unfilled for such a long time."
"Anyone we know?"
"I've heard of it but never met him before he got hired. Dr Sherlock Holmes? He invented that new anti-siphon valve a couple of years back that was all the rage in the conference circles. Did his training at The National, apparently."
The National Hospital for Neurology and Neurosurgery is the country's premier unit in the field. John himself had applied for a registrar position there years back and got turned down even though he had quite a decent CV.
"Weren't they sorry to let him go, if he's that good?" John asks.
Natalie leans back on the sofa, dangling her clog on her big toe. Eventually she loses control of it and it flops onto the floor, revealing a yellow sock with a smiley face on it. She mostly anaesthetizes patients for the pediatric surgery unit, and has made a habit of wearing funny socks and hats that she can use as a distraction while cannulating her tiny, needle-hating patients.
"That's the thing. He's supposedly really, really good with a scalpel, but I'm facebook friends with some of the gassers at the National and they all seemed to really hate his guts."
"What's he like, then?"
Natalie looks amused. "Well, as long as you don't talk to him and he doesn't talk to you, everything's just peachy."
End of chapter 1
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Author's notes:
Welcome to the fascinating world of neurosurgery. In "The Road of Bones" I aimed for medical accuracy wherever I could, whereas in this story the goal was to have some adorable tropey fun with the AU concept. I have thus tweaked and twisted many medical facts for storytelling purposes. This is not a medical textbook. I'm using the names of existing British neurosurgical units in this story, but I know next to nothing about them. I have no idea what the quality ranking would be, or if there even is such data available.
Do correct me, British colleagues, if I'm wrong in any of these explanations. Also, I am NOT a specialized neuroanaesthetist, although I do handle neurosurgical cases on occasion. I'm more of a generalist gasman. Gasperson. Gaswoman?
Concerning preoperative visits: Practices vary between hospitals, medical specialties and countries but as a general principle the surgeon and the anaesthetist try to meet up with the patients and their accompanying family members prior to major surgery. They explain what's going to happen before and during the operation, and what sorts of plans have been made for the patient's care immediately after the surgery. If they haven't done so before, the surgeon will also explain potential risks and complications of the operation. The same usually applies for anaesthesia, if the surgery requires significant procedures such a cannulating major blood vessels.
A lot of minor operations are done on an ambulatory/day surgery basis, which means that the patients sleep at home before the day of the operation. In those cases it's difficult and mostly unnecessary to arrange a preop visit.
Astrocytomas are a common type of brain tumours. Grade 1 is quite benign and easiest to cure, Grade 4 is the worst and almost invariably fatal.
A registrar is a doctor who has graduated from medical school and who is well on his/her way in specializing in a certain field. When a registrar finishes his/her training, he/she will become a fully fledged consultant.
A laminectomy is a common type of back operation. As Mayo Clinic explains it, "Laminectomy is surgery that creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves."
Obs = observation. I'm not British nor do I work in the UK so I have no idea what doctors usually call this (patients being observed in a specialized, monitored post-anesthesia care area).
OR = Operating room. Also called an operating theatre for historical reasons. They used to sell actual tickets.
Fellowship = After a doctor has reached consultancy, ie is a fully licensed specialist in a certain medical field, they can seek additional training in a subspecialty by doing a fellowship, which I think usually lasts a couple of years. I'm using the term here quite loosely.
"New antisiphon valve" = Anti-siphon-type shunt devices are used to regulate the flow of cerebrospinal fluid in patients whose own regulatory mechanism are failing.
Clogs = Many doctors wear clog-like shoes for work in the ORs. They're handy because they cover your toes and therefore prevent all sorts of biological fluids and materials seeping into your socks (which is icky, I can tell you). (My current clogs are black, in case you were wondering.)
Pediatric = refers to something having to do with children
Gasser, gas man = colloquial for anaesthetist