"Don't take this the wrong way, Martin, but I still wish you were doing my surgery." Parsons gazed at me through the rails of his hospital bed. Without the benefit glasses or contacts, I wondered how clearly he saw my face.
I knew the statement was meant as a compliment and that Parsons was merely assuring me that I remained his preferred surgeon. Still, it hurt more than it should have. "Leahy is excellent," I replied.
"I know. You wouldn't have recommended him otherwise, right?" Parsons gave me a weak smile.
"Right."
I sat at Parsons' bedside in one of the uncomfortable visitor chairs, his wife Emily next to me. Their son, having already given pre-surgery well wishes to his father, was in the waiting room with Louisa.
So much had happened in the past two weeks. I'd had to perform the emergency hernia repair on Louisa's mother. There'd been no other option and, as Aunt Ruth had predicted, I could successfully operate when I needed to, in a crisis situation. It had been important to prove that to the village, to Louisa, and most importantly, to myself. It didn't change my situation - I still wasn't prepared to operate on Parsons - but my success with Eleanor had restored at least some of my confidence.
Not long after, Louisa's mother had left Portwenn, that nutcase Mrs. Tishell had turned psychotic and kidnapped James Henry, and I'd told Louisa that I loved her. We were still coming to terms with our relationship but I was happier than I'd been . . . maybe forever. Just as I hadn't shared the news of our breakup with Parsons, I also hadn't told him about the events of the past days. There'd be plenty of time for that once he was through the surgery.
It was hard for me not to view Parsons with a clinical eye. He seemed a bit pale, although the thin white hospital gown and overhead neon lights didn't do much for anyone's complexion. A quick glance at the bedside heart monitor confirmed what I'd suspected – mild tachycardia. The pre-op sedative would take care of that.
Like most patients awaiting imminent surgery, Parsons was doing his best to remain brave in the face of obvious apprehension. He'd been chatty with the hospital staff, all of whom clearly knew and liked him, and had joked with his family about the skimpiness of the hospital gown and how the mandated fasting was a great start to a diet. I saw the act for what it was because I'd seen it so many times before.
Emily was bearing up surprisingly well. She'd been upbeat when Dan was in the room and remained positive as nurses went about their preparations. She was a strong woman, I decided, not unlike Louisa.
Parsons was scheduled to go into theatre in less than an hour. Leahy had come by a few minutes ago to go over the procedure as well as the potential risks of surgery. The list of what could go wrong was long and ominous. Even though most of those complications were unlikely with a healthy patient in the hands of a skilled surgeon, I could see Emily flinch a bit as she listened to the recitation. Nonetheless, I had to admit that Leahy projected an aura of confidence and assurance that seemed to calm both the patient and his wife.
After Leahy had finished, I'd had a quick word with him in the corridor. He'd agreed that this was a routine procedure and, given Parsons' overall health, the prognosis was excellent.
"Don't worry, Martin," he'd said upon taking his leave. "I know he's special. I'll take good care of him."
Shortly thereafter, pre-op activities began to pick up. A registrar came in to insert the arterial line, which would be used to monitor blood pressure during surgery. The procedure was usually performed after the patient was in theatre, but Parsons had insisted it be done before he went in. When the registrar asked Emily to wait outside during the insertion, I also started to take my leave.
"Mart?" Parsons' voice called me back. "I'd like you to stay."
He crooked his finger at me and I moved closer to the bed. "Make sure they do things right," Parsons said in a soft voice. "But please don't say anything to piss them off," he finished with a wink.
The young anesthetist covered Parsons' lower left arm with surgical drape and laid out her instruments. "Small stick," she said.
Not exactly, I thought; arterial punctures could be somewhat painful. As she inserted the catheter, Parsons flinched – more than he should have, I noted automatically. A glance at the site of the insertion showed far too much blood pooling on the surface of his skin. She'd obviously missed the artery.
"Blast," the registrar said, shaking her head in frustration. "Sorry, Dr. Parsons."
"It's all right," Parsons replied though gritted teeth.
"No it's not," I said, forcing myself not to look away even though the contrast of the crimson blood on Parsons' pale arm was turning my stomach. I took several deep breaths to sublimate my queasiness. "Insertion of an arterial line is a simple procedure. If you can't do it properly, find someone who can."
"Martin," Parsons cautioned me.
"Christopher," I mimicked in the same tone.
The registrar gave me a nasty look and I rather wished I were the surgical consultant on the case so that I could give her a proper dressing down.
Thankfully for Parsons, and probably for me as well, her second attempt at inserting the line was successful. Almost immediately, a nurse came in to add antibiotics to the IV line and insert a Foley catheter. There would be no general anesthesia; Leahy had informed me he would go with a local, which is what I would have chosen.
It was strange watching all of the pre-op activities, most of which I hadn't seen since my days as a senior house officer. Like Leahy was doing now, I'd always waited patiently in theatre, assuming everything would be done properly so that a fully-prepped patient was laid out on the table, ready for me to exercise my surgical skill. I didn't stop to consider all that needed to happen and the effects of the activity on the patient and his relatives.
Emily had come back into the room just as the nurse was administering the sedative, which meant that Parsons would shortly become incoherent from the effects of the drug.
I stood out of the way as he and Emily spoke to each other in hushed tones, her hand grasping his. She kissed him lightly on the cheek and lips and I heard each of them say, "I love you" more than once. When they'd finished, she stepped away from the bed, sucking in a few deep breaths. Outwardly, she seemed at peace, but I could read the tension in the lines of her face and in the way her hands balled into tight fists.
Parsons turned toward me, his eyes trying hard to focus. "Mart, thank you for everything."
"I haven't done anything." In fact, I was standing at his bedrail when by all rights I should be the one in the operating theatre. Even though I'd come to terms with the current state of my professional status, the moment starkly reminded me of the cruel hand fate had dealt.
"Yes, you have. Someday I hope you'll realize just how much." Once again he waved me toward him. "Come here."
I took a step toward the head of the bed.
"Closer."
I leaned in until my head was only inches from his mouth.
"If anything happens," he whispered, "take care of Emily and Dan."
"There'll be no need. It's a routine—"
"I know. A routine procedure."
"Chris, you'll be fine."
"But, if I'm not—"
"Yes, I'll take care of your family."
Whether it was my reassurances or the sedative finally kicking in, Parsons' eyes slowly closed.
Medical Glossary
Arterial line – basically an IV placed into an artery rather than a vein. In this case, it's used to measure blood pressure during surgery.
Foley catheter – used to drain urine
Heparin – a blood thinner
Senior house officer – a junior doctor; the UK equivalent of a US junior resident
Note: In the US, vascular surgeons typcially use general anesthesia for carotid endarterectomy. However, based on my research, in the UK, local anesthesia is preferred.