Nurse In The Outback

CHAPTER FOUR

THE EARLY morning sun was already fierce on Kate’s bare head as she made her way from the apartment to the hospital block. Her fatigue had been genuine and, despite the rather troubled encounters with Tessa and Grant, she had experienced a deep and dreamless sleep. As she travelled up in the lift, her heart quickened with anticipation. She was determined to forget and enjoy her first day at work.

The suite was empty, save for the two night nurses, who were busily clearing up after an early emergency appendicectomy.

Kate preferred a leisurely start in the mornings, and a quick glance at her watch told her that she had over half an hour before ‘knife to skin’. First she went into the female changing room, where a short search produced a package of laundry labelled ‘Nurse Carpenter’. This contained fourteen plain white dresses and matching cotton kerchiefs. She was soon in uniform, and her hair, having disobeyed all the laws of gravity, now lay concealed beneath the cotton scarf. She slipped on the ubiquitous white clogs and left the changing room.

Thus garbed, it was difficult to differentiate Kate Carpenter from any other theatre nurse. A keen eye might notice that she had somehow contrived to make the white dress appear more fashionable and attractive than it actually was, since it clung so softly to her slender curves. Surgeons often joke that a theatre nurse is only recognisable by ‘ankles and eyes’, and indeed, many a theatre marriage had begun by eyes meeting across an operating table.

Kate made her way to the common room where a pot of coffee percolated merrily. The two night nurses were just pouring themselves cups, and one of them smiled and gestured to Kate to help herself. They departed in the direction of the Sister’s office, presumably to hand over to Tessa when she arrived.

Kate sipped the strong black coffee appreciatively, and scanned the notice board to see what the morning’s list was. There were two theatres at Dampland Hospital, and Kate was assigned to the smaller Theatre Two as scrub nurse. The surgeon was a Dr. Manners and the anaesthetist a Dr. Lillywhite.

She noted that Theatre One had been given over to Dr. Kershaw, with Sister Hetherington scrubbing for him.

Kate assumed that Dr. Manners was the senior house officer, as he had a fairly basic list of surgical operations. There were two large lipomas to be removed, one stripping of varicose veins and a cystoscopy all of which Kate felt that she could have scrubbed for in her sleep. Still, it was over four months since she had been in theatres and it was just possible that she might have become rusty.

Dr. Kershaw’s list was the grander and more delicate list of a senior surgeon, where the potential for complications was that much greater. His list began with two thyroidectomies, and Kate felt a wave of envy. She had twice had the honour of working with John Garvie-Fozard, surgical consultant at St. Jude’s, and one of England’s leading authorities on this intricate operation.

The over-activity of the thyroid gland which most often caused it’s partial or total removal presented great hazards to the surgeon. It’s close proximity to the trachea in the neck raised the threat of airway obstruction, and the rich supply of blood vessels to the area, meant that the risk of severe haemorrhage was never far away.

If, to perform this operation, the surgeon needed both speed and precision, then the scrub nurse certainly needed to match those qualities.

One of Kate’s proudest moments had been at the end of a particularly tricky morning’s list, when Mr. Garvie-Fozard had pulled off his gloves and turned to her.

‘Very well done indeed, Nurse,’ he said. ‘I see I must be grateful you weren’t motivated to be a surgeon, or no doubt my position would be in jeopardy!’ The old man’s eyes had twinkled at her, and in two sentences he had vanquished his reputation as Fierce Fozard for ever.

The opening and shutting of the lift doors, together with called greetings, indicated that more of the day staff were beginning to arrive, and Kate walked into Theatre Two to prepare her instruments.

The anaesthetic nurse had not yet arrived, neither had Kate’s runner. The runner was usually a student nurse who was required to run and fetch any different instruments or sutures which Kate might suddenly need during the operation, as the scrub nurse always stays sterile and must not move away from the clean field of the operating table.

Kate quickly wiped down all the surfaces in the theatre with a solution of disinfectant and water, then place an unopened dressing pack on the trolley.

At that moment a nurse burst through the swing doors and beamed anxiously at Kate. She was a big strapping girl and, try as she might, hadn’t been able to hide her orange hair beneath the theatre cap.

‘I’m sorry if I’m late, Staff,’ she said, in a broad Irish accent.

‘You’re not—I’m early,’ explained Kate, smiling. ‘What’s your name, Nurse?’

‘It’s Carmel O’Connor, Staff. It’s mouthful, I know, true enough!’ She burst into an infectious laugh, ‘I trained in England though.’ She mentioned the name of a large hospital on the outskirts of London, which Kate had heard of. ‘We all heard you trained at St. Jude’s.’ The Irish girl spoke with a trace of awe in her voice, and Kate was just about to reply when Sister Hetherington swept in.

‘Get cracking, O’Connor,’ she ordered perfunctorily and the big Irish girl immediately scuttled off.

Tessa Hetherington’s gaze took in the whole scene, from the gleaming surfaces to the unopened pack.

‘Well done, Staff,’ she said grudgingly. ‘Nice to see you’ve used a bit of initiative. To be honest, I get irritated with trained staff who expect to be spoon fed.’

‘Thank you, Sister,’ replied Kate demurely. The Australian girl looked strained and tired, she thought, noting dark shadows and a pallor lying beneath the tan. Probably dancing the night away in the arms of her surgeon.

‘And now I must go and prepare my theatre for Dr. Kershaw.’

Her tone could hardly have been more possessive, mused Kate as she waited for Tessa to dismiss her.

‘There are two things which you ought to know, Nurse Carpenter. The first is that I insist on the utmost formality in my theatres. I do not allow first-name terms during operations. Even Dr. Kershaw and myself adhere to that rule.’ She paused to allow a small smile to play on her lips. ‘The other is quite straightforward—you’ll find all the individual surgeons’ likes and dislikes printed in a red book. There are copies in each of the anaesthetic rooms and there’s also one in my office. All right, Staff, you can get on now.’

She nodded and disappeared through the swing doors. As if by clockwork, Carmel O’Connor’s face appeared round the door of the anaesthetic room.

‘Sure, and it’s like Romeo and Juliet here,’ she quipped, widening her eyes expressively. ‘What’s your glove size, please, Staff?’

‘Six and a half, thank you,’ replied Kate, managing with difficulty to hold back a smile. She suspected that Sister Hetherington was not popular with the junior staff, certainly Nurse O’Connnor didn’t seem to hold her in any particular esteem. Kate realised, however, that even if she might privately agree with Carmel’s opinion, it would never do to demonstrate her disloyalty to her senior. So she declined any comment on Sister’s love life and set off into the scrub room.

As she carefully soaped her hands and arms up to the elbow with antiseptic solution, and scrubbed her hands and nails for the obligatory two and half minutes, she called to the junior.

‘Please check whether Dr. Manners has any extra requirements for his lipoma removals. Also I’d like to know his glove size, and which sutures he prefers.’

‘The answer is no, eight and catgut!’ said a voice behind her, Kate turned to find a pair of earnest eyes peering at her from behind wire-trim spectacles. The small surgeon grinned at her.

‘Hi. I’m John Manners, but you’ll forgive me if I don’t shake hands,’ he laughed.

‘Hello, Dr. Manners. Kate Carpenter—I’m scrubbing for your morning list, and mostly probably your afternoon one too, and no, I’ll be jolly angry if you put any of your nasty germs near my nice clean hands!’ Kate began to dry them carefully on a sterile towel brought in by Nurse O’Connor.

‘I must just have a word with the gas-man,’ explained John Manners. ‘I look forward to seeing you in theatre.’

Carmel helped Kate on with a sterile green gown and tied the tapes up for her. Kate was now ready to prepare her pack, putting all the instruments in order, counting and checking them and holding sterile gallipots for her runner to pour skin cleaning solutions into.

Meanwhile, the patient was being transported by trolley from the ward to the anaesthetic room, and while the anaesthetic nurse established that the correct patient was about to have the correct operation, the anaesthetist or ‘gas-man’ was checking the cylinders of gas in both rooms.

The anaesthetised patient was wheeled in, accompanied by the anaesthetist and his nurse, and carefully lifted by two theatre porters on to the narrow table.

Kate surrounded his nude abdomen with sterile towels and motioned to Carmel to point the strong light at the operation site, which John Manners had marked on the patient’s skin in indelible ink the previous day.

The gowned and masked surgeon stepped forward and generously washed the abdomen with the large wad of soaked cotton wool which Kate handed to him. This done, he held up his right hand, and she firmly slapped into it the scalpel she had ready. The initial incision was made—knife to skin—John Manners glanced up at the anaesthetist, who nodded, and the operation progressed.

This was the part of the job which Kate loved the most. To a great extent the skills of a scrub nurse can be taught, but Kate had the extra qualities of anticipation and speed. During her theatre course she had purloined various surgical text books, reading up on basic procedures and familiarising herself with the normal sequence of steps in an operation.

She watched John Manners’ hands closely and he soon found that he was able to hold his hand out for an instrument and she would put the right one there, without having to be asked.

She judged Dr. Manners to be a competent surgeon—he worked steadily and neatly. Kate knew that the real test of a surgeon came, not during the routine operations, which ran normally and which he would have performed many times over, but during a surgical emergency when he would be required to use his initiative to make major decisions. A wrong decision could prove potentially fatal, and so the onus on the surgeon to predict correctly was enormous. Instinct might prompt him to play safe, but the irony lay in the fact that all the truly great surgeons took risks.

However, there was no sign of any crisis as the list proceded smoothly. The two lipoma removals were followed by the varicose veins, which proved slightly more difficult to strip than John Manners had expected.

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