Author's Note: In one scene, I have incorporated some medical slang used in UK hospitals from Dr. Fox's article on that subject. "GROLIIES" stands for "Guardian reader of limited intelligence in ethnic skirt". "Handbag positive" refers to an older woman often found in her hospital bed still clutching her handbag. A "derma-holiday" is a transfer to a dermatology rotation, perceived by doctors-in-training as a less strenuous rotation.
Losing It
Chapter 2 – Blood Relations
There was nothing about that rainy Wednesday morning to indicate it would be different from any other. In his Kensington flat, Martin awoke automatically at 4:28, two minutes before his alarm was due to ring. He rose promptly, without lingering, and did a few brisk calisthenics in his pyjamas to get the blood moving. He checked his pulse to make sure he had gotten the appropriate benefit before heading to the lavatory. He performed his morning ablutions with the same scrupulousness he would use later in the day when scrubbing up to perform surgery. There was precision and economy in all of his motions, as though these tasks were performed by rote in exactly the same way, day after day.
After dressing carefully in the suit, shirt and tie he had selected the previous night, he made the bed, shut the window, and tidied the room before heading to his sleek modern kitchen. With implements laid out like sterilized surgical tools, he efficiently boiled his egg, brewed his coffee, made his toast, and peeled his orange. He made a brief detour to the front door of the flat for the post and the newspaper before sitting down at his spotless, glass-topped table to eat his breakfast.
By quarter to six, the dishes were in the dishwasher and the table cleaned of any crumbs. He booted up his laptop to ascertain whether there had been any changes to this morning's schedule. There was only one change – an overnight admission in A&E had been put on his schedule for endovascular carotid stenting. Satisfied that the day was well in hand, he took a moment to scan the sole personal e-mail in his box and was pleased to see his friend, Chris Parsons, was coming up to London for a conference in a couple of weeks. He shot him a quick reply that he would be glad to meet for dinner after the Saturday session.
After shutting down the laptop, he donned his fawn trench coat and left the flat for the hospital. He pulled his dark blue Jaguar into his assigned spot in the consultant's car park at half six exactly.
By seven fifteen he was making his rounds in the company of a gaggle of registrars, house officers and medical students to check his pre-operative cases. He looked impressive in his white coat, under which you could just see his smart blue shirt and subtle striped tie. His shoes and his cuff-links gleamed. He stopped at each bed, perused the patient's notes, and gave a brief review of the relevant procedures for the benefit of subjects and students alike. He answered each patient's questions, and those of their assorted family members and miscellaneous hangers-on, with as much patience as he could muster. Being Martin, that was not really much patience at all.
Last on his list was a Mrs. Marion Clark, 62, a waitress of Jamaican extraction, who was scheduled to have an artery in her lower leg repaired to increase blood flow to her foot. The decreased circulating was aggravating a severe diabetic foot ulcer and it was hoped this procedure would be sufficiently successful to prevent ischemia and the amputation of her lower leg. She was on the schedule for one p.m., assuming his morning went smoothly.
As he came on the ward, a timid-looking brunette nurse approached him warily.
"Mr. Ellingham? Are you here for Mrs. Clark?"
"Yes – the list says bed 3, correct?"
"That's right. But before you see her, I wanted to let you know that she is extremely anxious about this procedure. Is there anything you can do to reassure her?"
"Nothing for her to be too anxious about. This is a routine procedure. I'm sure you've told her she has nothing to worry about."
"Well, we've been over the details of the procedure with her of course, and with her family, but I think she might be more confident hearing it from you."
"Right, then, I will keep that in mind." With that Martin strode down the row to bed 3. As he did, he ran through the diagnosis and surgical plan briefly with his disciples. He overheard one, a brash, newly-minted registrar called Hugh Percy, snigger to one of the students. "Now that's a GROLIIES if I ever saw one. And handbag positive to boot."
Martin had never liked Percy or his cavalier attitude towards surgery. Self-assurance was a necessary skill for a surgeon, but Percy's cockiness was the sort that leads to mistakes - mistakes a surgeon cannot afford to make. He needed to be brought down a peg, and Martin saw this as the opportunity.
"I beg your pardon, Mr. Percy. Would you care to repeat that for the benefit of the group?"
The younger man did not back down. "Just giving the newbie a lay of the land." He was almost preening. Martin gave him a look of disgust.
"You have just insulted the age, gender, intelligence, politics and ethnicity of our patient without ever having met her. That sort of behavior may be tolerated down in the A&E department. I, however, am a surgeon. By your presence here, I trust that it is your ambition to become one as well. I expect you to treat my patients, our patients, with the dignity and respect they deserve. And Percy, if I ever hear you use that kind of language about a patient in my presence, you will be on a permanent derma-holiday. Have I made myself clear?"
Percy reddened. Not embarrassed but angry. Martin ignored him and proceeded to Mrs. Clark's bedside. As he approached, Martin noticed there was an older man, graying at the temples, wearing an old but well-pressed suit, holding Mrs. Clark's left hand. Martin made a mental note – husband. On the other side of the bed was a woman he judged to be in her late fifties, wearing an orange jumper, holding the patient's right hand. Sister, most likely, Martin mused, too old to be a daughter. A strapping younger man, perhaps in his mid-thirties, leaned against the wall near the head of the bed and had a hand on Mrs. Clark's shoulder. He wore jeans and trainers and a grey hoodie. Without the tear stains on his cheeks, he would have looked menacing. Son, Martin mused.
He immediately took the notes from the end of the bed to check her vitals and make sure that his pre-operative orders had been followed. When he looked up, he saw Mrs. Clark looking at him fearfully. "Mrs. Clark. I'm Mr. Ellingham, your surgeon. We'll be repairing the artery in your lower left leg today." She nodded but said nothing. Martin lifted the blanket and began to examine the foot. He could see the importance of improving circulation immediately – the only other alternative would be amputation and that would be a whole different story for this patient. The students gathered around him as he examined the leg. He showed them the foot ulcer and drew a circle on the patient's leg with his finger to indicate where they would be working later in the day. Mrs. Clark was quivering.
"Have you any questions then, about your operation?" he asked her.
"Doctor, can ya, I mean, do y'think ya can, save m'foot with this?" she asks, anxiously.
"Well there are no guarantees in medicine, but the procedure we're performing today is the standard tool to improve circulation in cases like these. It should greatly increase the blood flow to your foot and that should have a positive impact on the ulcer."
"But, Doctor, they tole her that the next option is cuttin' the foot an' ankle off altogether. D'ya think ya'll need to do that? Are ya thinkin' ya'll be doin' that today then?" asked the older man – the husband. The woman beside the patient, the putative sister, sobbed at this point and clutched Mrs. Clark's hand between both of hers.
"No decision about amputation will be made today. We will need to wait a few days or even a week and see the effect the increase in blood flow has and track the progress in healing the ulcer. If an amputation is required, I would not be the consulting surgeon as that procedure lies outside my subspecialty. But I see no reason to expect that we won't have a positive outcome from the surgery today."
"Beggin' y'r pardon, mon, but what does that mean, exactly? Is she keepin' her foot or not?" said the son, angrily. "It's m'mum y'r talkin' 'bout, mon. Tell us y'r not cuttin' off 'er foot."
Martin sighed. "No, I am not cutting off her foot. No one is cutting off her foot today. It is too soon to tell if that will become necessary later. For now, she will come to my operating theatre this afternoon and I and my team will do our best to improve the circulation in her lower limb so that amputation is not necessary." Martin looked next at the clock on the wall behind the nurses' station and saw that it was eight twenty-five. He was anxious to move on.
"Anything else you'd like to know, then?" he said, turning to go as he said it.
"Just one thing," said the sister, in tones more clipped that that of her nephew. Martin turned back, slowly, facing her. He nodded to her to indicate he was listening. "You're the one going to do this operation, right? The lady I clean for, she says you are the best one; the one that fixes all the posh people. When I told her you was the one Marion was having for a surgeon, she told me don't worry then, he's the best one."
"Yes, I am her surgeon. I'll be performing her operation." Martin was uncomfortable with the praise, even now unused to it.
The sister nodded. "We'll be countin' on you, then," she said, looking straight at Martin, as if to memorize his face.
Martin nodded again, and then turned to go, gesturing to his entourage to follow along as he headed to the hallway. He paused at the nurses' station to leave a note for Mrs. Clark's anesthesiologist about the anxiety he had observed. As he did, he saw one of his students, Ms. Singh he thought her name was, put a hand on Mrs. Clark's bed and say something too softly for him to overhear. The husband and the sister nodded and he thought he saw a glimmer of a smile on Mrs. Clark's face. Ms. Singh walked past him without meeting his eye on her way to the lifts. Martin's last sight before he walked off the ward to follow her was Mrs. Clark being hugged by her son.