The operation started well. Karl, the consultant, was friendly, which was never a given. After the briefing he put on an excellent playlist of seventies tracks. The energy in the theater was good.
As first assistant I stood across from the table from him, helping with retraction and the diathermy. For a while, all was calm and I had a clear view as Karl began to tunnel carefully under the neck of the pancreas. The cancer had already spread since the patient’s scan three weeks earlier, increasing quite substantially the risk of injury to the portal vein.
“Oof,” Karl said as he pushed on. “Can you see what a mess this is? How everything’s got stuck together as the tumor’s grown?”
I could see. I would not want to be working next to a delicate portal vein in among all that mess. Avoiding a bleed seemed near impossible.
Sure enough, the cavity began to fill with blood minutes later. Karl sighed. “OK. Carrie, please start packing.”
The scrub nurse handed me swabs—one after another after another, but my careful pressure was no match for the insidious flow from underneath the pancreas.
To my left, the anesthetist warned that the patient’s pressure was dropping.
Soon after, the heart monitor alarmed. People began to talk over each other. Karl put out an urgent call for one of his colleagues; he was going to need to split the pancreas to get at the damaged blood vessel. The blood kept pouring from the portal vein, on and on, faster than I or anyone else could have packed it. The anesthetist put out a major hemorrhage call. The theater door was unlocked as help arrived.
We all react differently to emergencies, Yanika had once told me.Those who fare best are those who go into a mental underpass. Let the traffic roar above your head. Just keep on walking to the end of the tunnel. Do nothing else except that.
I made myself feel my feet on my metal box. Hands calm and precise in spite of my elevated heart rate. I listened only to what Karl was asking me to do and nothing else.
A senior consultant arrived at speed and scrubbed in. Karl briefed him; the nurses gowned him up. In the background the music continued to play. It was “Wild World” by Cat Stevens, the bass smooth and muscular, the tune buoyant. I waited for someone to ask for it to be turned off but they were all too busy to notice.
As Stevens sang about getting by with only a smile, the monitors alarmed and the anesthetist started squeezing blood and vasopressin. The senior consultant arrived at the table, scalpel in hand, and began incising without so much as a moment’s pause.
Minutes later, the pancreas had been divided at the neck and Karl did a formal resection of the injured portal vein. I suctioned blood and cut sutures. I had learned this script years ago and I remained steady, consciously holding myself in the safe rhythm of my training.
As soon as the vein was repaired, the anesthetist took over. The operation would now be on hold until the patient was stable.
After we’d descrubbed the two consultants sat down and started chatting about the senior consultant’s son. He’d told his dad he didn’t want to do A-levels and wanted instead to “chill for a while,” doing ski seasons “or whatever.”
“Not necessarily a bad move,” Karl grinned, as if they were just two friends in a cafe, having a catch-up. “Would you really want him to end up in a career like this?”
“Fuck, no!”
The Velvet Underground was playing now, yet nobody thought to turn it down. The anesthetist and her registrar were working hard on the patient, who was beginning to stabilize. Their medical student, watching intently, crossed and uncrossed her legs, but I knew she wouldn’t go to the loo. I never did when I was a student.
“Ain’t No Mountain High Enough” started playing, and I couldn’t take it anymore. I went over to the speaker and turned it off.
Not quite able to ignore what was happening in front of me, I stood watching for a while longer while the consultants chatted about summer plans and the “insufferable” manager who kept overfilling their surgical lists. The patient’s blood pressure was increasing. A greater calm began to take root, and I felt my own heart rate decrease.
Eventually I forced myself over to my laptop to clear some emails.
Johan had messaged a little over half an hour ago.
You’d better have meant it about the scuba lesson because I’ve booked you in. Meet me outside Marshall Street Baths at 7:45. I’m looking forward to it. Carrie Cole in a wet suit is something I badly need to see.
I smiled, then laughed, then felt sick. In spite of everything that had happened over the past hour, it was this email that opened a space of fear in my body—this disquieting promise of water closing over my head like a coffin lid in a few hours, my body reliant on a tank.
—
He was outside the baths when I arrived, leaning against the wall. He watched me walk toward him. I had rarely seen him outside the context of the hospital or his flat and I felt skittish and uncertain suddenly—a girl on a first date. He was almost unbearably handsome, and he looked as if he could read every thought in my head.
Time to overcome that ridiculous fear of submersion, I’d told myself earlier. Outgrow these limiting beliefs! How naive, the idea that I or anyone else could just switch off fear as if it were a light.
“Good evening,” he said as I arrived in front of him. “And just a reminder that, as your teacher, I’m unable to kiss you.”
I paused momentarily, then kissed him on the mouth.
This, I now remembered, was why I’d decided to do this stupid lesson in the first place. I might not believe in my own ability to outgrow fear, but I believed completely in Johan.
